Are you drowning in conflicting information about hormone replacement therapy while your body feels like it’s betraying you every single day? You’re not alone in this confusion, and frankly, I’ve contributed to some of it myself by having so many different perspectives on my podcast. What I love about today’s conversation is that it cuts through the noise with a strategic, middle-of-the-road approach that’s grounded in actual science, not fear-mongering or wishful thinking.
As someone who’s walked this journey myself and witnessed thousands of women navigate these same choppy waters, I know how frustrating it can be when every expert seems to have a different opinion. That’s exactly why I was so excited to sit down with Dr. Betty Murray, a PhD in integrative and functional nutrition who brings both the research credentials and personal experience that’s often missing from these conversations. She’s not just studying this stuff in a lab – she’s lived it, worked with tens of thousands of women over 20 years, and built her expertise on both solid science and real-world results. Now, she’s here to share her knowledge and tips with you.
Why THIS Midlife Hormone Conversation Matters
Every time I release an episode on hormones, my inbox explodes with questions. The confusion is real, and the stakes feel high. Women are asking: Do hormones cause cancer? How much is too much? What’s the difference between bioidentical and synthetic? How do we know if they’re helping or hurting us? What type should we be using? The questions keep coming because we’ve been fed incomplete information for decades.
What makes Dr. Murray’s perspective so valuable is her unique background. She started in sales and marketing, got swept up in the tech boom of the 90s, then discovered her true calling when her own health challenges led her to functional medicine. Her journey from corporate executive to health detective mirrors what so many of us experience: that moment when conventional medicine fails us and we have to become our own advocates.
Dr. Murray’s transformation into a hormone expert wasn’t planned. In her mid-30s, she made what seemed like a simple decision to get her tubes tied to avoid staying on birth control. Within six months, her hair started falling out, she lost the outer parts of her eyebrows, and gained 35 pounds rapidly. Despite being connected to the functional medicine community, everyone kept telling her it was her adrenals or thyroid or work stress from opening her clinic.
The reality was much more complex. The tubal procedure had altered blood supply to her ovaries, essentially throwing her into early perimenopause. This began a ten-year journey through her forties that she describes as “hell” – a journey that ultimately led her back to school for a PhD focused specifically on women’s hormone metabolism and gut health interactions where she found the answers she (and everyone else) had been missing.
This personal “midlife” experience gives her insights that male practitioners simply cannot have. As she puts it, she knows about erectile dysfunction from a scientific standpoint, but she’d never presume to tell men how to manage it because she hasn’t lived it. The same should apply to menopause and hormone replacement, yet we see male practitioners dismissing women’s experiences all the time.
Breaking Down Estrogen Dominance: It’s Not What You Think
One of the biggest misconceptions women have about hormones is what “estrogen dominance” actually means. Most people think it means you have too much estrogen, but that’s not accurate. Estrogen dominance is actually about the relationship between your estrogen and progesterone levels – you can be estrogen dominant even with very low estrogen if your progesterone is even lower.
This distinction matters enormously because many women are told they’re “estrogen dominant” and need to clear estrogen from their bodies, even when their estrogen levels are already dangerously low. Dr. Murray sees this frequently with women whose estrogen levels are barely detectable, yet they’re still being told to take supplements to reduce estrogen further.
Understanding this concept is crucial because during perimenopause and menopause, progesterone typically drops first and fastest. When we’re not ovulating regularly, we’re not producing adequate progesterone, creating that dominance pattern even as overall hormone production declines.
The Cancer Conversation: Separating Fear from Facts
Let’s address the elephant in the room: the cancer concerns that keep so many women from considering hormone replacement therapy. The fear stems primarily from the Women’s Health Initiative study, but that study was fundamentally flawed from the beginning.
The Women’s Health Initiative wasn’t designed to study cancer risk. It was designed to look at cardiovascular death risk. The researchers excluded healthy women because they wouldn’t die from cardiovascular disease quickly enough for a relatively short study. Instead, they chose women who already had cardiovascular disease, high blood pressure, diabetes, obesity, and other health problems.
When they found increased stroke risk in the group taking synthetic hormones (Premarin plus synthetic progestin), they appropriately stopped the study. But then they went digging through the data for other findings (something that skews statistical validity). They found that breast cancer risk went from 4 in 1000 women to 5 in 1000 women, which wasn’t statistically significant. But they presented this as a 25% increase, and the media ran with that number.
Here’s what’s really interesting: the women in that same study who took Premarin alone actually had a 23% reduced risk of breast cancer compared to the control group. But that finding was largely ignored.
The Game-Changing Medicare Study
A Medicare study examining 10 million women over 65 from 2006 to 2023 is the most important study for understanding hormone replacement therapy’s real risks and benefits. This massive retrospective study looked at all causes of death and separated women into three groups: those who never used hormones, those who used them briefly, and those who stayed on them long-term.
The results were stunning. Across every category: heart attack, stroke, osteoporosis, falls, infections, all causes of death, women who stayed on hormones consistently outperformed and outlived women who didn’t use them. Breast cancer risk went down 16%, lung cancer decreased 13%, colon cancer risk dropped significantly, and dementia risk decreased by 34%.
Most importantly, this study included women using what we consider standard care today: bioidentical hormones applied topically rather than synthetic hormones taken orally. The finding was so significant that topical estrogen showed zero increased risk for stroke, blood clots, or cardiovascular disease – zero!
Therapeutic Hormone Dosing vs. Excessive Protocols
One area where Dr. Murray takes a distinctly different approach from some practitioners is dosing. While some protocols attempt to mimic the cycling hormones of a 30-year-old woman, she advocates for therapeutic dosing that provides protection without excessive levels.
When you were cycling in your 20s, your estrogen could spike as high as 500 during ovulation, then drop to 250-400 in the luteal phase. But research shows that therapeutic levels (the amounts needed to protect your brain, bones, and cardiovascular system) only require getting estrogen levels to about 50-80 on a blood draw.
This is roughly 10% of what you made at ovulation and less than 25% of your average cycling levels. Yet this modest amount can eliminate hot flashes and night sweats while providing significant protection against dementia, osteoporosis, and cardiovascular disease.
The challenge with protocols that attempt to mimic youthful cycling is that they ignore a crucial factor: your body’s ability to process and eliminate hormones is also aging. Your liver’s detoxification capacity isn’t improving just because you’re taking hormones, and you’re carrying a much higher toxic load than you did at 25.
The Testosterone Factor: More Isn’t Always Better
Testosterone replacement in women has become increasingly popular, but Dr. Murray cautions against the “more is better” mentality that’s often promoted, particularly in the pellet industry. She traces much of this over-prescribing to the competitive nature of pellet companies and their male-dominated origins.
Women naturally produce three to four times more testosterone than estrogen, but we use different measurements on lab tests, so the numbers look different. The problem arises when practitioners dose testosterone to levels that make women feel like “low-level men” – highly motivated, increased libido, ready to “kick ass and take names.”
While this might feel amazing initially, it comes with significant side effects: hair loss, unwanted hair growth, irreversible clitoral enlargement, and voice changes. Dr. Murray advocates for replacing testosterone to physiological levels appropriate for women, not attempting to recreate male-pattern benefits.
Testing: Blood, Urine, or Saliva?
The testing conversation often creates confusion because different practitioners swear by different methods. Dr. Murray uses a tiered approach that makes practical sense.
Blood testing serves as “quick and dirty” baseline information. Most research on hormone replacement has been done using blood levels, so we have good reference ranges. Blood tests can quickly identify if levels are dramatically high or low and provide a starting point for dosing.
Urinary hormone metabolite testing (like the Dutch test) provides the closest thing we have to understanding how hormones are being used and eliminated by your body. These tests show not just how much hormone is free and active, but also how well your liver is processing and detoxifying hormones through various pathways.
However, these urine tests have significant limitations. They’re not accurate when hormone levels are extremely low (like in post-menopausal women before starting replacement), and they don’t capture all the detoxification pathways. Dr. Murray recommends using them strategically (after achieving therapeutic blood levels and symptom resolution) to ensure optimal processing and elimination.
The Detoxification Piece: Why It Matters
One aspect that’s often overlooked in hormone replacement discussions is how well your body eliminates hormones once they’ve done their job. This is where Dr. Murray’s research expertise really shines – she’s done extensive work on an enzyme called beta-glucuronidase and its role in hormone metabolism.
Your body packages hormones for elimination through the liver, but if certain pathways aren’t working efficiently, hormones can get “unpacked” and recirculated rather than eliminated. This is where targeted nutritional support becomes important – not before starting hormones, but after achieving appropriate levels and symptom relief.
The order matters enormously. First, address gut health, hydration, and basic nutrition. Then optimize hormone levels. Finally, add specific supplements to support hormone metabolism pathways. Trying to “detox” hormones when you’re already deficient is counterproductive and can make symptoms worse.
Finding the Right Practitioner
Perhaps the most challenging aspect of hormone replacement therapy is finding knowledgeable practitioners. Dr. Murray points out that less than 20% of gynecologists have any training in menopause management – not even an hour. Gynecology is a surgical specialty, not a hormone specialty.
Endocrinologists, who should be hormone specialists, typically focus on managing diabetics and thyroid disorders rather than sex hormone replacement. The reality is that practitioners who understand hormone replacement have sought additional education outside their primary training.
This creates a customer service issue. Medicine is both a community service and customer service business, and if your doctor is dismissive, gaslighting, or rude about your hormone concerns, Dr. Murray’s advice is simple: fire them. Find someone who will listen, evaluate your individual situation, and work with you rather than against you.
The Virtual Solution
Recognizing the shortage of knowledgeable practitioners, Dr. Murray created the Minerva Project, a telemedicine platform that brings her clinic’s 20-year framework to women nationwide. The platform provides access to licensed providers trained in bioidentical hormone replacement, individualized dosing, and ongoing monitoring.
What sets this approach apart is the comprehensive evaluation that includes not just sex hormones, but thyroid function, metabolic markers, and eventually peptide therapies. The team understands that hormones work as a symphony; when one section is completely flat-lining, the others try to compensate, often unsuccessfully.
Looking Forward: The Future of Women’s Health
Dr. Murray’s ultimate vision extends beyond individual hormone replacement. She’s working to build a technology platform that will collect data from hundreds of thousands of women to identify patterns and predict optimal treatments based on symptoms and biomarkers.
This data-driven approach could revolutionize women’s healthcare by providing personalized recommendations rather than one-size-fits-all protocols. Instead of the current guessing game, women could receive targeted advice based on comprehensive data from others with similar presentations.
Key Takeaways for Your Journey
If you’re considering hormone replacement therapy, here are the essential points to remember:
Education is your responsibility. Don’t rely on a single source or opinion. Listen to multiple perspectives, but trust your own intuition about what resonates with your situation and values.
Symptom dismissal is unacceptable. If any healthcare provider makes you feel dismissed, gaslighted, or unheard, find someone else. Your symptoms are real, valid, and deserve proper evaluation.
Start with the basics. Optimize gut health, nutrition, hydration, and sleep before adding complex supplement protocols. Hormone replacement works best when your foundation is solid.
Less can be more. Therapeutic dosing that eliminates symptoms and provides long-term protection is preferable to excessive dosing that attempts to recreate your 25-year-old hormone levels.
Testing has its place. Use blood work to establish baseline levels and monitor dosing. Consider metabolite testing after achieving stable therapeutic levels to optimize processing and elimination.
Individual response varies. What works perfectly for your best friend might not work for you. Pay attention to your body’s signals and work with practitioners who understand bio-individuality.
The goal isn’t to turn back the clock or recreate your younger self. It’s to optimize your current biology for the healthiest, most vibrant version of yourself at this stage of life. With the right information, the right practitioner, and the right approach, hormone replacement therapy can be a powerful tool for thriving through midlife and beyond.
Experience the Future of Hormone Health for Women with MENRVA HERE
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
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