Ep.165 My Menopause Wake-Up Call: The Story Behind My HRT Journey

Hormone replacement therapy (HRT) shouldn't be shrouded in outdated fears and misinformation. When I finally started HRT at 57, I realized I'd spent years unnecessarily suffering through sleepless nights, hot flashes, and night sweats—chalked up to “normal aging”—when effective treatments already existed.

My journey began after a hysterectomy, when a nurse practitioner discovered my testosterone level was critically low (11 ng/dl, with a normal range of 13–87). That led to my first experience with vaginal estrogen and topical testosterone. But over time, I learned I needed a more comprehensive approach—including systemic estrogen and progesterone—to truly feel like myself again.

This episode also breaks down the recent FDA meeting that addressed two major barriers to women’s hormone health:

1. The outdated black box warning on vaginal estrogen
2. The ongoing lack of FDA-approved testosterone options for women

These regulatory hurdles continue to block access to treatments that dramatically improve quality of life for midlife women.

Whether you're working with your OB-GYN or exploring options through platforms like MyAlloy, MidiHealth, HerMD, or Parlor Games—support exists. But you must advocate for yourself. No woman should suffer in silence or settle for a life that feels like a shadow of her former self.

Share this episode with someone who thinks they’re “just getting older” and doesn’t realize how good they could actually feel.

Some Online Women's Health Resources:

Allara Health, Midi Health, Alloy Women’s Health, Evernow, Winona, HerMD, Femgevity, Maven Clinic

This episode is not intended to be medical advice. I'm sharing my personal journey with hormone replacement therapy in hopes of starting a conversation and helping other women feel less alone. I realize HRT is not the right fit for everyone.

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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling run-down. Faster Way, a transformative six-week group program, set me on the path to sustainable change.
https://www.fasterwaycoach.com/?aid=MicheleFolan

Have questions about Faster Way? Please email me at:
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Sign up for Michele's weekly newsletter for more health and fitness tips and insights. https://michelefolanfasterway.myflodesk.com/i6i44jw4fq

RIMAN skincare finally gave me real, visible results—restoring my glow, firmness, and confidence in my skin at 61. RIMAN Korea's #1 Skincare Line - https://michelefolan.riman.com

*Transcripts are done with AI and may not be perfectly accurate.

**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Episode Transcript

Michele Folan (00:00):
Before we dive in , I want to make one thing clear
.
This episode is not intended tobe medical advice.
I'm sharing my personal journeywith hormone replacement
therapy in hopes of starting aconversation and helping other
women feel less alone.
I realize HRT is not the rightfit for everyone and not all
women are candidates.
My goal is to normalize theidea that we don't have to

(00:23):
suffer in silence just becausemenopause is a part of life.
Always talk to a qualifiedhealth care provider about your
specific needs and options.
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(01:05):
chaos.
Ready to finally make a changethat sticks?
Email me through the link inthe show notes or DM me on
social media.
I look forward to hearing fromyou.
Health, wellness, fitness andeverything in between.
We're removing the taboo fromwhat really matters in midlife.

(01:28):
I'm your host, Michelle Folan,and this is Asking for a Friend.
Welcome to the show.
Thanks for listening every week.
I really appreciate all of you.
I'm incredibly grateful.
The show's still in the top 2%globally and your support and
sharing has not gone unnoticed,so thank you so much for that.

(01:52):
It's been a long time since Ihave recorded a solo show and
with some of the recent stuffgoing on here with the big FDA
meeting last week around hormonereplacement therapy, all the
questions that I get from peopleI coach and also just through

(02:13):
Instagram, people always want toknow what HRT I'm taking and I
thought you know what.
This would be a great topic fora podcast and I actually did a
reel this week about the HRTthat I take.
So if you had a chance, checkthat one out.
But I thought it might be goodfor you all to hear a little bit

(02:34):
about my journey.
My journey with hormonereplacement therapy may not be
too unlike yours.
Be too unlike yours, but Ihadn't been on anything up until
the time I was 57.
Probably needed to be Now.
You know in hindsight, we didn'tknow anything about
perimenopause.

(02:54):
No one talked about it.
But the sleepless nights, thehot flashes, the night sweats.
I had all of that and justchalked it up to aging, did not
know that there was relief rightthere.
But again, even if I had askedmy doctor about it at that point

(03:16):
, would that have been somethingshe would have prescribed for
me?
I don't even know.
But what happened was I washaving some weird abdominal pain
and we decided to do anultrasound.
Good news was that it wasn'tcancer or anything like that.
They were fibroids, and theywere relatively large.

(03:36):
And the doctor said you know,I'm not really comfortable doing
this surgery unless we can getthose things to shrink a little
bit.
So she put me on a course ofLupron.
Now Lupron is a drug that wasdeveloped for men with prostate
cancer to shut off thetestosterone that feeds the

(04:00):
prostate cancer.
And it shuts down all yourhormones, because the thought
was that my hormones werefeeding the fibroids, which was
making them large.
So if we cut that off, maybe wecould get them to shrink a
little bit.
Well, not only did it kind ofmess up my hormones like a lot,
I was pretty uncomfortableduring that time because I

(04:22):
really didn't feel like myself.
But it didn't work, and so Iended up having to have the
surgery anyway.
But the doctor that I wasseeing at the time was not
comfortable doing the surgerybecause of the size of the
fibroids, and so she sent me toan oncology surgeon.

(04:44):
So it was a gynecologiconcologist who was very capable
to do this with minimallyinvasive, I should say.
So we did that, I would say.
In terms of recovery, I wassuper lucky.
Basically, I was back at workin a week, felt pretty good,

(05:07):
actually, went.
I had the surgery on a Mondayand went carpet shopping with my
sister on a Friday.
So just know that keepingyourself somewhat fit is always
a good thing before you havesurgery, because it does make
recovery so much easier.
But okay, that's neither herenor there.
I was going for these follow-upappointments with the office

(05:31):
that did my surgery and I wasseeing a nurse practitioner and
she said hey, look, we've testedyour hormones.
You really need to be on someHRT.
I said well, what do yousuggest?
She said, well, I think we'regoing to do vaginal estrogen
because your vaginal tissues arelooking kind of sad and we're
also going to put you ontestosterone and because she's
like, you know how's your libido?

(05:52):
And I was like, what libido?
Because you guys had me onLupron for three months.
That just shut off all mytestosterone.
So my testosterone was at an 11.
So, in perspective, for a womanat my age at that time so
between 55 and 60, your typicaltestosterone level would be 13

(06:13):
to maybe 87, on the very highend, for men of the same age be
like 218 to over 800.
So I was at 11.
I was really really low.
I said, well, how high are youwanting to get my testosterone
if we do this?
She said, well, if we candouble it, we're doing well.
I was like, all right, okay,I'm game.
So we did a topicaltestosterone which was

(06:37):
compounded and we did vaginalestrogen.
Now I did not know at the timethat vaginal estrogen was not
absorbed systemically, so I wasnot getting estrogen to benefit
my bones and some of the othernuisance side effects of
menopause.
And they did not put me onprogesterone because typically

(07:00):
they would not give youprogesterone if you didn't have
a uterus.
So I had hysterectomy.
So they took everything, tookthe ovaries too.
And so here I am thinking, okay, I'm getting pretty good care,
love this practice, they'rewonderful.
But I was missing a veryimportant piece and that was
systemic estrogen and also someprogesterone.

(07:24):
Systemic estrogen and also someprogesterone.
I went to a different GYNbecause I wasn't happy with the
person that I was seeing beforeand I went to her MD here in
Cincinnati and it's Somi Javaid.
She's pretty well known, Ithink, on Instagram, but she now
does her practice throughonline, so it's very convenient

(07:48):
for me now.
But they put me on oralestrogen, which I had asked for
based on one of my podcastguests, and put me on
progesterone because of some ofthose vasomotor symptoms that I
had with the hot flashes and thenight sweats, motor symptoms
that I had with the hot flashesand the night sweats.
Now the thought was, because Ididn't have a uterus, that I

(08:12):
didn't need the progesterone,but I still have breasts and so
there's some thinking out therenow that you may want to be on
progesterone, because theprogesterone kind of keeps the
estrogen in check.
So I am on all four now, so I'mon vaginal estrogen, am on all
four now, so I'm on vaginalestrogen, I'm on topical
testosterone progesterone andalso now I just switched to the
patch, so I'm on the estrogenpatch and this is not really

(08:35):
trial and error.
I think what I tried prettymuch worked right out the gate.
We haven't had to make any realadjustments or anything.
So I just wish I would haveknown sooner that I needed to be
on a systemic estrogen, becauseI have osteoporosis and you're

(08:55):
not going to get those benefitsfrom just using vaginal estrogen
.
And there's also thecardiovascular, too, that you
have to consider as well withusing a systemic estrogen.
We're going to take a quickbreak and when we come back I
want to talk about the FDAmeeting on hormone replacement
therapy.
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(09:19):
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(10:04):
isn't too much to ask.
Alrighty, we are back.
I want to talk a little bitabout the FDA meeting that took
place a little earlier in July.
The reason this meeting wascalled, and there were so many
advocates and amazingresearchers and doctors that

(10:26):
were so incredibly passionateabout being there for this
meeting was to take that darnblack box warning off of the
vaginal estrogen.
So remember, vaginal estrogenis not absorbed systemically,
but there's still a black boxwarning for cancer on the
product right, and this not onlyscares off women but it scares

(10:47):
off the healthcare communityfrom using it because of the
supposed liability with usingthis.
So the Women's HealthInitiative was a 20-year study
and that data came back, I thinkin 2002.
And they were reporting cancerin women, increased risk of

(11:09):
cancer in women, and keep inmind that the estrogen that was
used was the conjugated estrogenthat you know comes from
pregnant mare urine, and so itwas Premarin and PremPro, and
there were these older women inthe study and it skewed the
study.
Well, even the people thatwrote the study have retracted

(11:30):
all of those warnings aroundincreased cancer risk and
cardiovascular risk in womenbecause they've gone back and
reanalyzed the data.
Super important, but the reasonwhy vaginal estrogen needs to be
readily available for all womenis its impact, and we're going

(11:50):
to talk about that a little bitmore here.
But we can't keep women frombeing able to use it because
it's so, so incredibly effectivein so many places in women as
we age right.
The other thing that wasbrought up at the meeting was
the fact that there is not anFDA-approved form of topical

(12:13):
testosterone for women.
Now, testosterone's been usedfor, I think, 70 years or so in
men, and there's plenty ofoptions for men, but there isn't
a women's dose.
We have to go to a compoundingpharmacy to use it or we have to
use the men's version and usejust a tiny little bit of it,

(12:35):
because we don't want to begrowing chin hairs and have all
that testosterone.
We don't need that much.
I think it's revisiting women'shormone care due to overwhelming
demand and persistentinformation or misinformation, I
should say.
And really, if you think aboutwhat really triggered this

(12:56):
attention, it's just increasedadvocacy, midlife women getting
louder and emerging science, andyou know we just had to address
the lack of innovation inwomen's HRT despite decades and
decades of need.
But if you want to learn more,you can go to YouTube and go to
the FDA's channel and you cantype it in FDA, vaginal estrogen

(13:22):
panel or whatever.
Just you can Google it andlisten to it.
It's about two hours.
I listened to probably 75% ofit and there's a ton of
information in there and it'llmake you feel really good about
what you're doing in terms ofyour own hormone replacement
therapy.
So I want to break it down alittle bit.
I want to talk a little bitabout each of these individual.

(13:43):
Talk a little bit about each ofthese individual products, why
they're used, where they're used, and just to provide a little
more clarity around this.
I'm going to start with vaginalestrogen, because that's
probably my favorite.
So it's local estrogen.
Think of it as face cream.
It's like a really high qualityface cream for your vaginal

(14:05):
area, but also the vulva I cannever say this word, vulva area.
So that's the outside right.
So it targets genitourinarysyndrome of menopause, so they
call it GSM, which is vaginaldryness.
It can mean painful sex,recurrent UTIs and also, don't

(14:25):
forget, your pelvic floor health.
So you think of that urgencythat we get.
You know the urinary urgencythat we get in midlife.
Some of that can just be from,you know, just poor quality
tissues in there.
So this goes way beyond thewhole painful sex thing.
It's really about your vaginalhealth.
Here's the sex thing.

(14:47):
It's really about your vaginalhealth.
Here's the other thing.
With UTIs, it can get a littlescary when older women get a UTI
, because we may be asymptomatic, which means we don't have the
symptoms like we did when wewere younger, which would be the
itching, the pain, the burning.
And so sometimes, when olderwomen are having these weird

(15:07):
acute onset of dementia,sometimes it's just a bad UTI
gone rogue and the problem isyou can go septic and
unfortunately some women diefrom UTIs when they're older.
You think about women thatdon't have a voice.
Maybe they've got a littledementia anyway they're in a

(15:28):
nursing home.
Scary, scary stuff.
And if we're good about usingour vaginal estrogen and I'm
telling you it's such a smallamount I use like a half a gram,
so I think that's 0.5 is whatI'm using twice a week and I
take the extra and just kind ofsmear that around the outside.
It is a absolute game changer.

(15:51):
It's a very low dose, it actslocally, it's not systemic and,
like we said, that FDA boxwarning is outdated.
It was fueled by the Women'sHealth Initiative.
Fear that and it needs to go.
And I would say probably mostdoctors could prescribe this now

(16:14):
for women who have had breastcancer or some kind of cancer.
Again, if you are one of thosewomen.
Make sure you're having theconversation and you're going to
hear me say that probably fourmore times.
But if you're not getting evenentertained with the
conversation of using vaginalestrogen, you need to find a

(16:35):
doctor who will at least talk toyou about it.
Now there's other formsavailable too.
Besides the creams, there'srings and there's also tablets.
I use the cream.
I like it, I will say in fulltransparency.
I sometimes use it on my facebecause some of the
dermatologists on my podcasthave said that's okay, so I

(16:57):
listen to them.
But anyway, yeah, it's safe, sorelax.
The other thing that I thinkthen would be the dovetail onto
this would be systemic estrogen,so that would be an oral or a
patch.
Common forms are estradiol, butthere's also again, there's

(17:19):
still the conjugated equineestrogens, which is premarin or
prempro, which would be thecombination of estrogen and
progesterone.
Now the oral version has totake a first pass at the liver
and there is some data out therethat would say that that would
impact clotting and maybetriglycerides.

(17:40):
So I think now most doctorsprefer to use the transdermal
estrogen patch or even a gel.
I think there's a spray outthere too.
Correct me if I'm wrong, butthat seems to be the more
preferred avenue to go, justbecause the oral estrogen has to
be metabolized in the liverfirst and you may have a more

(18:02):
variable amount of how muchyou're getting.
Both are good for bone health Idon't think there's really any
question there but obviously thetransdermal, so the one that's
absorbed in the skin, is goingto bypass the liver.
So there would be maybe lowerrisk of clots and a more stable
delivery system with fewerspikes in the amount that you're

(18:27):
getting.
And the real benefits ofsystemic estrogen would be sleep
, brain fog, mood, I would say,bone density and cardiovascular
support.
There is some data out therethat would suggest too that it
can improve skin and also yourhair quality.
And think of it if you are,you're getting that skin laxity,

(18:51):
you're losing hydration.
I mean all of that's connectedto menopause.
You know when our estrogendrops, you know we start to age
and our skin is no different andour hair?
I have my DEXA scan coming uphere at the end of July.
Actually, when this podcasthits, I have it that week.

(19:12):
I am really, really curious tosee how my bone density has
improved or not improved fromtaking the estrogen.
Now I will say too, I've beenlifting weights.
I've improved my diet.
I'm eating more protein, I'mtaking vitamin K2 and vitamin D

(19:34):
and all the stuff that I'msupposed to be doing, so we'll
see how that goes.
Now I'm going to talk aboutprogesterone, and what's
interesting is, if you aretaking estrogen, they do
typically put you onprogesterone.
And what's interesting is, ifyou are taking estrogen, they do
typically put you onprogesterone.
And they say that if you have auterus, it's needed to protect

(19:54):
against endometrial hyperplasia.
The oral micronizedprogesterone, which is
bioidentical, is probably bettertolerated and it can support
sleep and mood.
I don't want to discount themood piece, because I think the
sleep and the mood are probablytied together in some way, but
just the kind of feeling ofwell-being that you get when

(20:17):
you're on progesterone and somewomen are on estrogen and
progesterone despite havinghysterectomy, like me, for
additional benefits.
If someone tells you you don'tneed to be on progesterone if
you've had a hysterectomy, Iwould say let's do our homework
on that one, because I havedefinitely benefited from being

(20:39):
on progesterone even though I donot have a uterus.
All right, I want testosteroneto be an honest conversation
here.
I was put on testosterone, likeI said, after my hysterectomy
and I was on it for a coupleyears and then for some reason I
went off, and I'm not sure whyI did, because that was a big,

(21:00):
big mistake.
Testosterone is one of thosethings that you don't realize.
You miss it until it's gone.
And I will say my libido wentfrom pretty good to non-existent
without the testosterone.
But I don't want to make thisall about libido.

(21:22):
I think there is this generalenergy and mood that is enhanced
when you are on testosterone.
I think my brain works betterwhen I'm on testosterone.
I'm quicker, sharper, and Idon't want to discount the
muscle mass.
Muscle mass is super importantthis phase of life and I think

(21:46):
it has really helped me withsome of my recent gains with
muscle.
There's a lot of factors there,but I think the testosterone
has really, really helped.
But I want to go back to thelibido piece.
I know many women and coupleshave just chalked up their sex

(22:07):
life as to.
You know it was in the pastnon-existent and that's fine.
If you are in a relationshipwhere you and your partner agree
that your sex life is not apriority and that you have moved
on to a different phase of yourrelationship, I respect that.

(22:27):
But if you have a low desirepartner and a partner who has a
sex drive and you two aren'tmeshing, I see that as potential
problem.
So for me this is my personalopinion and I'm going to get a
little personal here and God ifmy daughters are listening,

(22:48):
they're just going to die.
But I think sexual intimacy isvery, very important to a
relationship and it's just thatdeeper connection that you get
beyond the friendship and theday-to-day that you have with
your partner.
So I made the decision to goback on the testosterone because
I think it's that important.

(23:10):
But I didn't realize how muchthe testosterone was helping me
until I went off of it.
So I probably do to get myblood work done.
I don't know where my numbersare right now, but I'm
suspecting they're probablydecent and I don't need any kind
of tweak or change to thetestosterone that I'm using.
But I am using a compoundedversion that is made at a

(23:33):
compounding pharmacy near whereI live and I won't stop taking
it.
Unless some health issue arises, I will continue to take the
testosterone Again.
This is a choice.
I don't judge anyone.
If this is not something thatyou're interested in having in
your life, that is totally fine.

(23:54):
But for me it was important andstill is important, and if
you're a woman out there who isstruggling because you don't
feel like yourself and I'm notjust talking in the bedroom, you
just don't feel like your oldself talk to your doctor about
testosterone.
Unfortunately, there's not anFDA approved version for women

(24:14):
in the US, so so it is usedoff-label.
Now Australia does have afemale-specific testosterone
cream I think it's calledAndrofem or something like that
but it's not available here.
But, like I said, thecompounding pharmacies do fill
the gap, but you know, it doesadd cost and access issues.
For some women it's not coveredby insurance and it may not be

(24:37):
as easy to get for some women insome areas that may not have
access to that.
I almost forgot to mention thereare bone benefits with
testosterone.
It does support bone density,especially in combination with
estrogen, and the way it works,I believe, is like testosterone
helps stimulate osteoblastactivity and that's the bone

(25:00):
building cells, and it'sparticularly helpful in women
who are estrogen deficient andat risk for osteoporosis and
osteopenia.
So I already mentioned themuscle piece, but I think there
is just one more reason why youknow testosterone therapy is
important in midlife, and thenwe should probably talk about

(25:24):
pellets Now, the testosteronepellets.
I don't see them being used asoften as they were, say, maybe
three, four years ago.
What they are?
Tiny little pellets.
They're inserted under the skin, kind of typically you know the
back of the hip area, andusually you know, maybe every

(25:45):
three to six months, and they'redesigned to slowly release
hormone over time.
The problem is that they'redifficult to dose because once
you put them in there's noturning back.
So once they're inserted youcan't adjust the dose.
So if it's too much you'restuck and you got to ride it out
.

(26:06):
Symptoms of overdose oftestosterone are things like
acne, hair growth, irritabilityI guess some women could even
have voice changes and there'salso clitoral enlargement.
I just kind of think that thereare better options out there.
I think pellets are kind ofexpensive.

(26:26):
They're not going to be coveredby insurance.
The transdermal testosterone, Ithink, is just a better, safer
alternative than just usingthose pellets.
But I think the FDA silence ontestosterone for women is
unacceptable and it has shown aconsistent systemic neglect of

(26:50):
women's sexual health andvitality and this bullshit's got
to stop.
I really hope that last week'smeeting with the FDA and these
amazing, amazing researchers andhealthcare providers will move
the needle in getting women theproducts that they need and

(27:12):
deserve.
The rate of women that have toleave the workforce because of
their menopause symptoms is muchhigher than you think, and some
of us are just kind of wingingit right.
We just, oh, this is justgetting older, you know.
Oh, this is everybody goesthrough this.

(27:33):
Well, for some women it's worse.
They have it way worse, and weneed to start paying attention
to that.
This is about quality of life.
It's not about vanity, anuntreated hormone deficiency.
It affects relationships, work,sleep and your long-term health

(27:54):
.
Many women still think you knowthat they just need to tough it
out, or they fear HRT based ontotally outdated studies, and I
think we need to startempowering women to ask better
questions and demand someevidence-based care.
But you have to make thatdecision for yourself how

(28:15):
important it is to you to havethat conversation.
So here's my encouragement foryou.
I want you to talk to yourprovider or find one that will
listen.
I had a chat with a client theother day.
She's like well, I really likemy doctor.
He's helped me through somerough times.
I said well, if he's notlistening to you about your
hormone replacement therapyneeds.

(28:36):
It's time for you to findanother healthcare provider.
You know I liked my GYN before.
She was a nice person, but shewasn't doing it for me.
She wasn't giving me what Ineeded.
Be strong, come in with yourdata, have a list of questions
and don't be afraid to walk.
One other thing there are someamazing online platforms out

(29:01):
there that have licensed doctorson staff who can walk you
through this.
And just a few and these areoff the top of my head, so I
apologize, I'm going to miss afew MyAlloy MidiHealth Winona I
think it's my Winona onInstagram Parlor Games, and

(29:24):
those are not prescription items, but they're really high
quality.
And then HerMD, who is mydoctor.
She sees patients onlinethrough limited states like Ohio
, indiana, kentucky, tennesseeand New Jersey.
I believe there is help outthere.
You just got to seek it out.
The last thing I want is foranyone to sit here and suffer in

(29:44):
silence when that is just notnecessary.
Do me a favor share thisepisode with a friend who thinks
she's just getting older andthat there's no hope for her to
feel better or to feel likeherself again.
I really appreciate it.
I should also mention that Ihave done quite a few episodes
on hormone health and menopause.

(30:04):
So go back and listen to someof those episodes.
It might help you understandsome of your symptoms and how
you can best address this withyour own health care provider
and, on that note, I'm not adoctor or healthcare provider,
but I certainly hope this hasgiven you some encouragement to
have these conversations withyour own healthcare provider and

(30:27):
hopefully you'll get theanswers that you need.
Thanks for listening.
We'll see you next week.
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