HRT Guide: TRT, Female HRT & Thyroid Optimization

What Is Hormone Replacement Therapy?

Hormone replacement therapy (HRT) involves supplementing or replacing hormones that the body no longer produces in adequate amounts. As we age, hormone levels naturally decline — testosterone, estrogen, progesterone, thyroid hormones, and growth hormone all decrease, leading to a wide range of symptoms that affect quality of life.

Testosterone Replacement Therapy (TRT)

TRT is the most common form of HRT for men, typically indicated when total testosterone falls below 300 ng/dL with symptoms. Common forms include testosterone cypionate and enanthate (injectable), testosterone cream, and pellet implants. TRT is typically combined with ancillary medications to manage estrogen conversion and maintain fertility.

• ✓Symptoms of low testosterone: fatigue, low libido, brain fog, muscle loss, mood changes, poor sleep
• ✓Common protocols: Testosterone Cypionate 100-200mg/week via injection
• ✓Ancillaries: HCG for testicular function, anastrozole for estrogen management
• ✓Required labs: Total/Free Testosterone, Estradiol, SHBG, PSA, CBC, Lipids
• ✓Regular monitoring every 6-12 weeks initially, then quarterly

Female Hormone Optimization

Female HRT addresses the hormonal changes of perimenopause and menopause. Bioidentical hormone therapy using estradiol, progesterone, and sometimes low-dose testosterone can significantly improve symptoms. The approach depends on whether a woman is perimenopausal, menopausal, or post-menopausal.

• ✓Key hormones: Estradiol (patches or cream), Progesterone (oral or cream), Testosterone (microdose cream)
• ✓Symptom relief: hot flashes, mood swings, vaginal dryness, sleep disruption, cognitive changes
• ✓Required labs: Estradiol, Progesterone, FSH, LH, Total/Free Testosterone, DHEA-S, Thyroid panel
• ✓Bone density protection with long-term estrogen therapy

Thyroid Optimization

Thyroid dysfunction is one of the most common and underdiagnosed hormonal issues. Standard TSH testing often misses subclinical thyroid issues. A functional medicine approach includes testing TSH, Free T3, Free T4, Reverse T3, and thyroid antibodies (TPO, TG) to get a complete picture.

• ✓Optimal TSH range: 0.5-2.0 mIU/L (vs conventional 0.5-4.5)
• ✓Free T3 is the active hormone — should be in the upper third of the range
• ✓Reverse T3 elevation can indicate stress-related thyroid dysfunction
• ✓Common medications: Levothyroxine (T4), Liothyronine (T3), Natural Desiccated Thyroid (NDT)
• ✓Nutrient support: Selenium, Zinc, Iodine, Iron, Vitamin D

Working With a Provider

HRT should always be prescribed and monitored by a qualified provider. Finding a provider who specializes in hormone optimization — rather than just checking if levels are "in range" — is critical. Functional and integrative medicine practitioners often take a more comprehensive approach to hormone health.