HRT - How do I know it's working for me, not against me?

This is coming up a lot in conversations I’m having. To be clear, I work from a Functional perspective and therefore educate from that point too. I’d always advise you to do your own research but if you are looking for a deeper level of understanding with hormone health, gut health, or health optimisation, that’s where Empowered Her Health sits…

There is a level of confusion around Hormone Replacement Therapy and wider health that I’m seeing more and more in clinic. Women are being asked to make decisions with incomplete information. (This also goes for GLP1s).

Most of the women I see are eating well, exercising consistently, taking supplements, and often starting or considering HRT. Despite doing everything “right”, they are still experiencing mood instability, bloating and fluid retention, weight that won’t shift, fatigue, and disrupted sleep

From a clinical perspective, this is where surface level intervention stops being enough. What I consistently see in practice are unresolved systemic issues such as:

• Altered steroid hormone metabolism (not just levels, but how hormones are being processed)

• Impaired phase I and phase II detoxification pathways

• Dysregulated Hypothalamic–Pituitary–Adrenal Axis affecting cortisol rhythm and downstream hormone signalling

• Gut dysfunction influencing oestrogen recirculation via the estrobolome

• Genetic polymorphisms impacting methylation and clearance pathways

HRT can be supportive. In many cases, it’s appropriate. However, without understanding the context in which it’s being introduced, it can feel like another layer added to an already dysregulated system. This is why testing becomes clinically relevant.

I work with multiple functional tests, but an example of the most common tests I review are:

• DUTCH Test allows us to assess hormone production, metabolism, and diurnal cortisol patterns

• GI-MAP provides insight into microbial balance, inflammation, and markers influencing hormone clearance

• Genetic testing helps us understand predispositions that influence detoxification, methylation, and overall resilience

The conversation around women’s health needs to move beyond “Are your hormones high or low?”, to “What is your body actually doing with them?”

I’ve expanded my clinical testing packages to reflect this with a structured 3-session framework and the option to integrate multiple functional testing where appropriate.

An initial Advice Call is recommended to ensure the right testing is selected and interpreted in context.