Hormone Replacement Therapy (HRT) is having a moment.
As women live longer, work harder, delay childbirth, and demand better quality of life in midlife, interest in hormone support has exploded. Once whispered about behind closed doors, HRT is now openly discussed in boardrooms, podcasts, and primary care offices. Recent studies have helped rehabilitate its reputation, showing meaningful benefits for symptom relief, bone health, cognitive support, and cardiovascular protection when used appropriately and individualized.
For many women navigating perimenopause and menopause, HRT can feel like a lifeline.
But beneath the growing enthusiasm are three major controversies that most patients don’t hear about before they start—and each one can deeply influence your decision on making the right choice.
Controversy #1: Denial for Testing
One of the most frustrating experiences women report when exploring HRT is being told: “There’s no need for testing.”
Insurance-driven care often limits hormone testing to basic panels—or your doctor may deny hormone testing altogether. This creates a major disruption to understanding why you feel off, creates a strain on your relationship with your clinician, or worse, being prescribed and staying on a dosage that is not right for you.
What’s rarely discussed is that hormones behave differently depending on how and where they’re measured:
Blood tests show circulating hormone levels at a single point in time ( least accurate and the most prescribed)
Saliva tests reflect free, bioavailable hormones at the cellular level.
Urine tests reveal hormone metabolites and how the body is processing and clearing hormones over a 24-hour period.
Depending on insurance coverage to pay for testing and relying on only blood (one testing method) can miss the root cause of symptoms like insomnia, anxiety, brain fog, weight gain, or persistent fatigue. Women are then subject to gaslighting, ignored —or worse, told they don’t “qualify” for care.
Controversy #2: Drug Shortages in the Wake of Sudden Demand
The rapid rise in HRT prescriptions—alongside GLP-1 medications and testosterone therapies—has created an unexpected problem: shortages.
You may finally decide to start HRT, only to face:
Backordered estrogen patches
Inconsistent pharmacy availability
Forced switches between delivery methods
Interruptions in therapy that destabilize symptoms
For someone already dealing with hot flashes, mood changes, sleep disruption, or joint pain, these disruptions aren’t minor inconveniences—they’re destabilizing.
Controversy #3: Hidden Chemical Irritants in Commercial HRT Products
Not all HRT is created equal.
Many over-the-counter creams and even some commercial prescriptions contain preservatives, fragrances, penetration enhancers, and stabilizers that can trigger skin reactions, headaches, hormone fluctuations, or systemic inflammation—especially in women who are already sensitive or dealing with autoimmune, gut, or cortisol issues.
Ironically, women seeking relief can end up feeling worse, assuming HRT “isn’t for them,” when the real issue is the delivery system—not the hormones themselves.
Where Our Practice Is Different—and Why It Matters
At our practice, we approach HRT as support, not a crutch.
Here’s how we address each of these controversies head-on:
1. Comprehensive Hormone Testing—Without Shortcuts
We believe it’s critical to test- and being prescribed HRT without monitoring is just bad medicine!
We evaluate hormones using blood, urine, and saliva, because each method tells a different and essential part of the story. This allows us to personalize treatment, track progress accurately, and validate what patients are feeling—not dismiss it. Choosing the right test to capture your symptoms is critical for prescribing hormones safely.
2. Strategic Pharmacy Partnerships
We work closely with trusted compounding pharmacies to ensure access, continuity, and flexibility—even during nationwide shortages. This allows us to adjust formulations and delivery methods without interrupting care.
3. Hypoallergenic, Clean Formulations
An of course, our compounded options are designed to minimize irritants and unnecessary additives. For sensitive patients, this can make the difference between success and failure on HRT.
And the Most Critical Point:
We do not rely solely on hormones to “do the heavy lifting.” Our health programs address the root cause of sleep, stress physiology, cortisol patterns, gut health, nutrient depletion, metabolic health, and inflammation—because hormones don’t exist in isolation.
HRT can be life-changing—but only when it’s thoughtfully tested, carefully sourced, and properly supported.
If you’re navigating perimenopause or menopause and wondering whether HRT is right for you, the real question isn’t “Should I take hormones?”
It’s “Do I have the right team to help me use them safely?”
If you’re ready for a more personalized approach to navigating this transition, we are here to help you make informed, confident decisions—without guesswork, shortcuts, or unnecessary setbacks.
If you have more questions about how to support your hormones, we’d love to hear from you. Schedule a consultation with our team of experts at Potentia MedSpa in Lafayette, California, or call us at 510 230 2282. We are the only Functional Aesthetics Medspa in the San Francisco Bay Area, offering a combination of medical expertise, innovative technology in skin care, and holistic support for midlife hormone changes.
XO
Dr. Vera