Hormones Out of Whack? What You Should Know About Hormone Therapy

Hot flashes, brain fog, mood swings, stubborn weight gain … many of us chalk these up to the unavoidable side effects of getting older. But what if they’re actually signs our bodies are missing something essential? And what if outdated stigma is keeping us from getting the support we need?

Hormone Replacement Therapy (HRT) is often whispered about, but it’s still shrouded in confusion. Some med spas even rebrand it as “hormone optimization” to make it more approachable. To cut through the noise, we turned to Melissa Rhodes, adult nurse practitioner and founder of Nashville’s Ona Skincare, who has spent decades as a nurse and is helping women navigate the complicated world of hormones.

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First things first. What exactly is Hormone Replacement Therapy (HRT)?

At its simplest, HRT means restoring hormones the body has stopped producing in the same amounts it used to — usually estrogen, progesterone, and testosterone. These are the building blocks of everything from mood stability to bone strength, and when they decline, women often feel it in dramatic ways.

But not all HRT is the same. “Bio-identical hormones, which are what we work with, are geared a little bit more to mimic exactly what our body makes, so the molecule looks identical,” Melissa explains. These differ from synthetic hormones, which were the standard for decades.

She points out that a major research effort in the early 2000s created a cultural setback. “The WHI study (Women’s Health Initiative) that came out years ago really put a damper on hormones being prescribed for women; so, they were scared of them, or their doctors wouldn’t prescribe them. The study was flawed … Now, there’s this whole generation of women who didn’t get hormone replacement. And now they have weak bones, dementia, and muscle loss.”

That outdated fear is now being replaced with new research — and a new movement toward safer, more effective bio-identical options.

Do hormones matter at every age or only during menopause?

Hormones aren’t just about hot flashes or night sweats. They influence nearly every part of the body. “We have hormone receptors throughout our entire body. There are estrogen receptors everywhere,” Melissa says. “Women have testosterone in their bodies, too.”

When hormone levels drop or fluctuate, which can happen as early as our mid-30s, the ripple effects are enormous. Testosterone, often dismissed as just a male hormone, plays an equally vital role in women’s health. Its decline, alongside estrogen and progesterone, can contribute to everything from osteoporosis and muscle weakness to anxiety, depression, and brain fog.

Melissa tells us, “Without testosterone, our muscle mass decreases, so we don’t have the strength and mobility to get around as well, which makes us more prone to falls. And then when you fall, you’re more prone to a fracture because your bones are weak.”

And the risks go beyond the physical. “Progesterone and testosterone are very mood stabilizing,” Melissa says. “So, a lot of anxiety and depression can start in perimenopause. Women might have big anxiety attacks that they’ve never had, and it’s because of those big fluctuations in hormones.”

Brain health is another overlooked element. “Dementia, they’re finding, is more common in women who have not done hormone replacement, or who go through menopause — either surgically or naturally — early on,” she adds.

For Melissa, these aren’t just clinical observations. She regularly hears similar stories from her patients, who say things like, “My skin’s changing, I have no sex drive, my relationship is suffering, all these things. And they’re really not getting anywhere.” That’s why, Melissa emphasizes, the balance between hormones is just as important as replacing them.

So, who should consider HRT?

While perimenopause and menopause are the obvious triggers, Melissa stresses that the conversation should start sooner. “We can start as early as 30 or 35 with changes in hormones, so I don’t ever think there’s a wrong time to get checked and see what’s going on with your body,” she tells us.

In fact, she wishes someone had encouraged her to test her own levels early on. “I would have loved it if somebody had told me at 30, ‘Hey, you feel good right now. Why don’t you get your levels checked and see where you live?'” she shares. “Because my normal may be different from your normal.”

Establishing a baseline while you feel healthy can help doctors detect shifts early and make adjustments before symptoms become disruptive.

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What does the process look like?

Getting started is more thorough than you might expect; Melissa begins with a discovery call, labs, and an in-depth consultation. “We usually work on a three- or six-month program with a patient, where we include everything they’re going to need so we can change the doses if we need to adjust as we figure out what’s going to work best,” she explains.

Unlike traditional medicine, this process is dynamic and nuanced. “We’re never going to just look at labs and say, ‘This is where the lab says you should be,'” says Melissa. “We’re looking at a tighter range of what we know people feel best at, and we’re going to tweak all of that until we see that the labs look good and you’re reporting that you feel good.”

From there, treatment options range from creams to patches to injections — and yes, even pellets, which are perfect for women on the go, as they are inserted under the skin and release hormones steadily for three months. “That’s how I get my hormones,” Melissa admits. “I travel. I don’t want to worry about packing them, that kind of thing.”

How is success measured?

Improvements aren’t judged on numbers alone. “Usually in a program, we’re seeing you at least once a month … to go over your symptoms, see how you’re feeling, and adjust things as needed,” Melissa says. Success is about women understanding their own bodies.

The ultimate goal is empowerment. “After three or six months, we want you to be an expert in what you feel so you can work with us and say, ‘I’m not sleeping well; maybe we need to adjust progesterone,'” she explains, “or ‘I’m not feeling like I have enough stamina or libido; maybe we need to look at testosterone.'”

It’s important to note that hormones are only one piece of the puzzle. “If your stress hormones are out of whack, it doesn’t matter how many hormones we give you, your body’s not utilizing them,” Melissa shares.

Hormones are powerful, but they’re not magic. Melissa is quick to point out that lifestyle habits can make or break progress. “At one point, I was working out six days a week, measuring my food, all the things, and was 20 pounds heavier than I wanted to be,” she says. Once she swapped high-intensity training for yoga and walking, the weight came off. “It’s just whatever’s working well for you at that stage in your life … and it changes.”

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Is HRT safe?

Perhaps the biggest barrier for women considering HRT is fear. Melissa doesn’t shy away from addressing it head-on. In fact, according to her, today’s science paints a very different picture than that outdated WHI study. “The studies that indicated any type of risk were all done with synthetic hormones,” she tells us. “There are multiple studies now showing that bio-identical hormones actually decrease the risk of cancer, Alzheimer’s, osteoporosis, and more.”

Some of the myths she encounters most often:

Myth: HRT causes cancer.

Myth: Only women can benefit.

Myth: If you’re not having hot flashes, you don’t need it.

Myth: You’re too old to start.

On the last one, Melissa is firm. “There’s a myth that if you’re over 60, or you’ve been in menopause for more than 10 years, you wouldn’t benefit … There’s so much prevention women can still do at 60 so their bones can still be strong when they’re in their 80s.”

What are the costs?

For many of us, the next question is, “How much does it cost?” While costs vary, patients can expect the initial consult and labs to be around $650. From there, treatment is highly individualized. “Some patients need really extensive gut testing and a little bit more on the toxin testing. And for some patients, it’s truly just optimizing hormones,” Melissa tells us. Because these are specialty labs, insurance often won’t cover them.

It’s an investment, yes. But it’s one that pays off in long-term health and quality of life.

Where do you start?

For those curious about HRT, Melissa says it all starts with that discovery call. “We want someone who’s invested and looking to make those lifestyle changes,” she says, “because it’s not a ‘one thing fixes the issue.'”

Hormones influence everything from mood to memory to muscle strength. For women in their 30s through their 60s and beyond, understanding HRT means looking beyond outdated fears and focusing on a tailored, whole-body approach. Or as Melissa puts it, “We want you to really understand what’s going on, not just depend on us to refill a prescription.”

Happy hormone balancing!

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