Many clinics — including conventional healthcare and those that promote themselves as “med spas” — offer hormone replacement therapy (HRT) for women.

HRT, when part of a thoughtful treatment plan, can be a safe option for alleviating symptoms of perimenopause and menopause, as well as optimizing health. Having robust and balanced hormones slows the aging process and can help reduce the risk and slow the progression of chronic diseases associated with aging.

Unfortunately, the HRT often being offered by both traditional healthcare practices and med spas is typically a one-size-fits-all solution that overlooks other factors that may be causing or contributing to your health conditions or symptoms.

Graphic for hormone replacement therapy

Worse, typical HRT offerings overlook the fact that the body needs to be able to metabolize hormones effectively in order to maintain optimal hormonal balance. If the body is already struggling to metabolize its endogenous (internally produced) hormones, adding exogenous (pharmaceutical) hormones can do more harm than good.

In my healthcare practice, I take a more holistic approach to hormone replacement therapy — one that accounts for each patient’s diet, lifestyle, body composition, and overall health and that not only supplements hormone production but also supports hormone metabolism.

What we offer in my clinic is unique because we take a holistic approach to your health and the use of hormone replacement therapy as part of your doctor-supervised treatment plan.

Recognizing the Benefits of Hormone Replacement Therapy

If you’re a woman around the age of 50, your ovaries are gradually producing less and less estrogen, resulting in a hormonal imbalance. You may start to experience hot flashes, anxiety, depression, mood swings, fatigue, brain fog, dry skin, wrinkles, brittle hair, reduced sex drive, vaginal dryness, tender breasts, weight gain, and poor sleep.

Hormone replacement therapy can boost levels of estrogen and progesterone and, when part of a thoughtful plan of care, establish and maintain healthy hormonal balance. HRT is beneficial to the brain, heart, bones, muscles, digestion, metabolism, and circulation, and it can slow many of the signs of aging.

Within weeks to months of starting HRT, most women can expect to experience the following benefits:

  • Improved sleep quality
  • Healthier skin, hair, and nails
  • Increased energy and mental focus
  • Enhanced sex drive
  • Elimination of hot flashes and vaginal dryness
  • Reduced anxiety or depression
  • Enhanced mood
  • Weight loss

Effective hormone replacement therapy is less about increasing levels of estrogen and progesterone and more about establishing and maintaining a healthy hormonal balance.

Addressing Hormone Metabolism

Hormones need to be metabolized. And that’s whether they are endogenous or exogenous, whether natural or synthetic, and whether they are bio-identical (derived to appear identical to the endogenous hormones) or not (think birth control pills and many conventional hormone therapies). Effective metabolization means that once they are used in the body, they must be processed by the liver and broken down for excretion and elimination or recycled.

Here are two examples:

  • Testosterone is converted to estrogen by the action of aromatase (an enzyme) in certain tissues — the ovaries, blood vessels, and brain — and is thought to be an important source of estrogens in postmenopausal women.
  • Estrogens are eliminated from the body by metabolic conversion, mostly in liver and breast tissue, to metabolites that are excreted in the urine and/or feces. Numerous estrogen metabolites, some of which are inflammatory and cause oxidative stress, must be processed and excreted. All women, regardless of whether they are on hormone replacement therapy, must be able to metabolize estrogen effectively.

As these two examples illustrate, hormone levels and hormone production are only half of the equation. Hormone metabolism is the other half. However, many HRT providers often ignore or overlook how effectively individual patients metabolize their hormones.

Factors That Impact Hormone Metabolism

Numerous factors can impact estrogen metabolism, including the following four:

  • Genetics
  • Diet/lifestyle
  • Estrogen dominance
  • Xenoestrogens


Some women have genetic tendencies to metabolize estrogen that travel down more dangerous pathways. Genetic factors may be evident in a family history and can be confirmed or ruled out using genetic testing or via a urine test for evaluating estrogen metabolites. At a very basic level, metabolites come in three forms:

  • 2OH
  • 4OH
  • 16OH

4OH is often referred to as the “bad” estrogen. Research associates 4OH with an increased risk for cancer. Supplementing with diindolylmethane and glutathione can help to reduce oxidative stress caused by dangerous metabolites such as 4OH. Many women enter menopause with deficiencies in antioxidants or elevated levels of inflammation stemming from a chronic condition.


Diet and lifestyle play key roles in estrogen metabolism, which is one reason I stress the importance of taking a holistic approach to hormone replacement therapy. That entails combining the therapy with a healthy diet and exercise, along with the removal of toxic products from the diet and from any sources that come in contact with the skin.

Case in point: Eating refined oils or trans fats blocks key enzyme pathways associated with hormone metabolism. Weight gain in the form of increased fat cells can also contribute to hormonal imbalances by increasing the body’s ability to store estrogens. Metabolizing this elevated estrogen increases the potential for producing dangerous byproducts. In contrast, healthy fats, including olive oil, avocado oil, and a balance of Omega 6 and 3 fatty acids, contribute to healthier metabolism.

Metabolic pathways require enzymes to work. These enzymes often fuel reactions that are inherently oxidative in nature, meaning they produce inflammation or what is termed “free radical damage.”

Antioxidants such as glutathione, along with vitamins and minerals, are needed to support metabolic pathways. The fact that hormone metabolism is oxidative begs the question of whether supplementation with antioxidants such as glutathione and Vitamin C should be routine with patients taking birth control pills or receiving HRT.

While no specific study answers this question with certainty, logic would lead most people to conclude that antioxidants would be helpful, and my clinical experience supports that conclusion.

When we add glutathione to our HRT protocols, we see tremendous improvements in our patients’ symptoms and reductions in inflammation markers previously present in their lab tests. This is not a double-blind, placebo-controlled study, but it is strong clinical evidence. In addition, the positive benefits of glutathione are well delineated in the medical literature for everything from fighting infection to protecting the liver.

Glutathione and Vitamin C are both powerful antioxidants to which most people should pay more attention. Vitamin C is quickly depleted in sepsis (systemic bacterial, viral, or fungal infections), which we witnessed at the height of the COVID-19 pandemic. Glutathione is also depleted when we are exposed to toxins in our environment and personal care products (which include a variety of chemicals that require metabolism in the liver) and when we metabolize hormones.

Vitamin C levels can be increased by consuming foods that are high in Vitamin C and by taking a quality Vitamin C supplement. Glutathione doesn’t generally survive the digestive tract, but several supplements can be used to increase glutathione levels. including N-acetyl cysteine (NAC). Glutathione can also be increased by breathing nebulized glutathione or via glutathione intravenous (IV) therapy. Certain foods, including broccoli, cauliflower, Brussels sprouts, and cabbage, can also be helpful.

Estrogen Dominance

During perimenopause or in the beginning of menopause, progesterone levels decline sharply. As progesterone declines, estrogens can dominate, leading to an imbalance. It is this imbalance that often leads to a barrage of symptoms including, hot flashes, restless sleep, and irritability. Progesterone decreases the target organ’s response to estrogen by decreasing the number of receptors the organ has for estrogen. In this way, progesterone protects breast tissue.


Xenoestrogens are a subset of chemical compounds that disrupt the endocrine system — the body’s chemical (hormone) messaging system. In the human body, xenoestrogens function like estrogens. They are found in a variety of everyday items, including skin care products, cosmetics, plastics, building materials, pesticides, and foods and food additives. When they enter the body, they increase the total amount of estrogen, resulting in estrogen dominance.

You probably cannot totally avoid xenoestrogens, but you can reduce your exposure to them by eating lower on the food chain, opting for organic foods, using natural health and beauty products, and avoiding plastics.

Holistic Hormone Therapy

If you are considering HRT, I encourage you to find a healthcare provider who takes a holistic approach to restoring and maintaining hormone levels — a doctor who understands and accounts for all the major contributing factors, including chronic illness, genetics, diet, lifestyle, hormone metabolism, and exposure to xenoestrogens.

Here are some of the key elements of holistic hormone replacement therapy:

  • The doctor must understand your lifestyle habits, diet, stress levels, history with chronic illness, family health history, and vitamin and antioxidant levels.
  • The doctor must monitor symptoms and labs closely, starting with a 30–60-day follow-up once therapy is initiated, then periodic follow-ups to ensure symptoms and lab results are improving.
  • You may need to start with a diet protocol or lifestyle intervention that helps to manage chronic conditions including weight gain, digestive issues (which can impact hormone metabolism), and inflammation.
  • In concert with hormone replacement therapy, specific supplements should be used to support hormone metabolism. Supplements may include diindolylmethane (DIM), B vitamins, glutathione (or N-acetyl cysteine), selenium, and fiber. Supplementation must be tailored to your needs.

Benefits of a Holistic Approach to Hormone Replacement Therapy

Using hormones and ignoring metabolism puts women at unnecessary risk and minimizes treatment effectiveness. Using a holistic approach, doctor and patient work together to optimize total body health and function. Proper digestion, nutrition, brain function, immune function, and a healthy circulatory system are all just as important as hormone balance, and all systems of the body influence one another. The holistic approach takes all the body’s systems into account, down to the cellular level, to tailor a unique treatment plan that includes hormone replacement therapy. This is quite different from a one-size-fits-all approach to treating symptoms with hormones — an approach that falls short of addressing the whole picture.

For example, suppose a woman in perimenopause is experiencing a problem with constipation. She’s having a bowel movement only about three times a week, which indicates that her metabolism has slowed. Recall that estrogens are secreted in the urine and bowels. Adding hormones could improve her motility (the movement of food and waste through her digestive tract). However, the opposite could happen — adding hormones when metabolism is slow could lead to excess metabolic byproducts thereby increasing the risk for harmful side effects.

In a traditional medical setting, this potential downside is largely ignored. As a result, upon experiencing the negative side effects of HRT, the patient either stops taking the hormones and forgoes the benefits, or she proceeds taking them, thus suffering the side effects. A more holistic approach would be to address the sluggish digestive system first and then proceed with HRT.

Another example would be a patient who is experiencing anxiety and restless sleep. This could be a result of hypoglycemia, skipping meals, or stress. Adding hormones to support sleep may work temporarily, but after a few short months, the sleep issues return. The doctor increases the hormone prescription and now the patient starts to have challenges metabolizing the increased dose, leading to side effects.

In a holistic setting, sleep might be addressed with a combination of the right diet, along with ashwagandha to support resilience and the body’s stress response. With the sleep issues off the table, the patient could experience all the benefits of HRT.

A holistic approach to hormone replacement therapy is all about whole health — using HRT — not as a cure-all —but as a useful component of a comprehensive and personalized treatment plan.

– – – – – – – –

About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.

author avatar
Dr. Matt