How Personalized Medicine Is Changing My Menopause Practice

After three painstaking days of learning what feels like every study in the world about hormones—how they work, how to test them, and how to replace them— (thank you, Dr. Pam Smith at the University of South Florida Morsani College of Medicine!), I am ready to up my hormone game in ways I could not have previously imagined.

I’m now switching to primarily salivary hormone testing for most patients (with a few exceptions). Saliva testing shows what’s really happening with your active, free hormones throughout the day—especially cortisol, estrogen, progesterone, testosterone, and DHEA. It’s a much more complete picture than a single blood draw.All of these are hormones that really matter in even more ways than I ever realized—it’s incredible what the studies show!

Most hormone tests can be done right at home, which makes tracking your progress easy and convenient. My goal is to soon have lab capabilities at the clinic as well, offering both in-office and at-home options for individualized testing and follow-up.

I’ll also be prescribing compounded estradiol:estriol (often called Biest) instead of standard estrogen patches for most women. The cost is similar (and sometimes better), and this estriol–estradiol combination supports both breast health and bone health. Estriol appears to balance the effects of estradiol on breast tissue, while both forms of estrogen help preserve bone density and overall vitality.

My compounding pharmacist at Pure Scripts is amazing, and one reason I’m moving toward compounded formulations is the inconsistency of generic patch dosages—even when prescribing the same amount of estradiol, the daily dose can vary from brand to brand and even from month to month. With compounded Biest, I expect my patients will experience more consistent estradiol and estriol dosing, along with greater symptom stability and predictable results.

I truly feel the breast health benefits of Biest far outweigh the small inconvenience of daily application. And as a bonus, compounded estrogen, progesterone, and testosterone can all be made and applied together, so you’re not managing multiple creams.

I’ll be using progesterone regularly for women without a uterus, too. I always tell my patients progesterone deserves way more credit than just “protecting the uterus from estrogen”—and now I have even more evidence to back that up. Progesterone and estrogen work best together to protect breast tissue and keep hormones balanced. And now that we have more safety data, transdermal progesterone feels like a great, effective option, especially for women who don’t tolerate oral forms.

I feel especially strongly about my patients with a history of hormone-positive breast cancers using Biest and being on bioidentical progesterone (whether compounded or in capsule form) for the protective benefits these hormones provide to breast tissue.

I’ll also be taking a much deeper look at thyroid health—because honestly, if we don’t get the thyroid right, nothing else goes right. The thyroid drives energy, metabolism, mood, and how other hormones function. I’ll be checking full panels (free T3, free T4, reverse T3, and antibodies when needed) instead of relying on TSH alone.

You’ll also see me testing pregnenolone more often. These two hormones—DHEA and pregnenolone—support energy, resilience, memory, and metabolism, and they connect directly to how estrogen and progesterone perform.

This course also eased my mind about using hormones in women over 65. With informed consent and the right individualized approach, age alone should never be a barrier to treatment. Estrogen, in particular, has well-documented benefits for the heart, brain, and overall vitality—even later in life when prescribed thoughtfully.

I’ve also gained better strategies for balancing cortisol, supporting insulin sensitivity, and choosing high-quality supplements that actually make a difference. Moving forward, I’ll be adjusting dosing not just based on symptoms but also on lab data, creating a more precise, evidence-informed approach for every individual.

The real goal, though, is to get everything balanced—and to always keep in mind the whole picture. Hormones, thyroid, adrenals, gut, stress, sleep, and lifestyle all work together. When we understand and treat the body as an interconnected system, everything starts to make more sense—and people truly start to feel better.

I intend to continue learning and improving the safety and quality of care I provide, and from time to time, that means change. My hope is that my patients always see these updates for what they are—my commitment to doing what’s best for them.

Bottom line: hormones aren’t just for symptom relief. They’re central to how we age, how we think, how we feel, and how we thrive. This training gave me an even greater appreciation for the beautiful complexity of the body—and for the privilege of helping women (and occasionally their partners!) navigate it with confidence and compassion.

At Dragonfly Menopause Care

Every patient’s story is unique, and personalized hormone care lets me tailor treatment to what your body truly needs. At Dragonfly Menopause Care, I work independently—combining science, experience, and one-on-one partnership to help you feel like yourself again… maybe even better.

And yes—if I’m already caring for your spouse or significant other, I’ll be welcoming a few men into my practice as well. Hormones affect everyone, and balance benefits the whole relationship.