27 Jan Part Two: Why You Need Estrogen Even If You’re “Estrogen Dominant” with Dr. Betty Murray
Here’s something most women don’t realize: you can have estrogen dominance even when your estrogen is technically low. You can feel testosterone deficiency even when your levels look adequate on paper. And the difference between understanding this and not could mean the difference between finally feeling like yourself again or spending years chasing solutions that actually make things worse.
I’ve watched too many midlife women get dismissed by doctors who look at lab results and say everything’s fine, while those same women are lying awake at night, battling constant fatigue, and feeling like their bodies have completely betrayed them. The frustration is real, and it’s not in your head.
That’s exactly why I brought Dr. Betty Murray back for a second conversation. In our first discussion, we covered the basics of hormone pathways and detoxification. But today, we’re going deeper into the nuances that most practitioners either don’t understand or won’t take the time to explain. Dr. Murray has spent decades helping women decode their hormone health, and she’s not afraid to challenge the conventional wisdom that’s leaving so many of us stuck.
This conversation is for every woman who’s been told her hormones are “fine” while feeling anything but fine. It’s for the woman who started testosterone therapy and suddenly lost half the hair on her head. It’s for the woman navigating conflicting advice about estrogen, progesterone, and whether cycling hormones even matters.
Let’s cut through the confusion and get to what actually works.
The Three Stages of Hormone Chaos: What’s Actually Happening in Your Body
Understanding where you are in the menopause transition changes everything about how you should approach hormone therapy. Dr. Murray breaks this down into three distinct stages, and recognizing which one you’re in is critical.
Early Perimenopause: When Progesterone Takes the First Hit
In your late 30s to early 40s, progesterone typically starts declining first. This happens because you’re not ovulating consistently anymore. When that follicle doesn’t collapse after releasing an egg, it doesn’t produce progesterone the way it should. The result? Heavier periods, fibroids, more painful cramping, worse PMS, sleep disruptions, and increased irritability.
Here’s what makes this confusing: your estrogen might still be relatively normal during this phase, but without adequate progesterone to balance it, you become estrogen dominant simply by the relationship between the two hormones. It’s not that your estrogen is necessarily high in absolute terms – it’s just high relative to your progesterone.
Mid-Perimenopause: The Bungee Cord Years
This is when things get truly unpredictable. Progesterone has already declined significantly, but now estrogen starts doing what Dr. Murray calls “the bungee cord” – jumping wildly up and down. One day it might spike to 600, the next week it drops to 40. This erratic pattern creates a constellation of symptoms: hot flashes, night sweats, heart palpitations, mood swings, anxiety, depression, joint pain, and brain fog.
This is also why single hormone tests during this phase are almost useless. That snapshot of your levels on one particular day may not reflect what’s happening across the entire month. You could test at 350 one week and 40 the next, making it nearly impossible to know if replacement is needed based on a single lab draw.
Post-Menopause: The Flatline That Changes Everything
Once you’re truly in menopause, both estrogen and progesterone have flatlined. If you haven’t replaced them, you’re now experiencing the full impact of hormone deficiency. This is when the protective effects of estrogen for your brain, heart, and bones become critically important. Many women who were told they were “estrogen dominant” in perimenopause suddenly realize they actually needed estrogen all along – they just needed progesterone to balance it.
Estrogen Dominance vs. Estrogen Deficiency: The Truth Your Doctor Probably Doesn’t Understand
This is where things get really interesting, and where most conventional practitioners get it completely wrong.
You can be estrogen dominant in multiple ways: you might be making too much estrogen, not clearing it efficiently through detox pathways, or simply have too little progesterone to balance whatever estrogen you do have. The symptoms can look remarkably similar across all these scenarios: weight gain around the midsection, sleep issues, mood problems, and inflammation.
But here’s the critical distinction: if you’re post-menopausal and your estrogen has flatlined, aggressively lowering your estrogen levels because you think you’re “dominant” is actually making things worse. You’re depriving your brain, heart, and bones of the protection they desperately need.
Dr. Murray explains that estrogen dominance in the classic sense – where you’re making too much estrogen – is different from simply having more estrogen than progesterone or testosterone. The former requires different intervention than the latter. And if you’re five years into menopause and someone tells you to lower your estrogen because you’re “dominant,” you need to understand they’re likely confusing relative relationships with absolute values.
Many women in this situation are prescribed DIM, calcium-d-glucarate, or broccoli sprouts to help clear estrogen. While these supplements can be beneficial when used appropriately, if you’re already low in estrogen and you lower it further, you’ll experience worse weight gain, hair loss, night sweats, and hot flashes – plus you lose the protective benefits for your brain, heart, and bones.
The environmental factor adds another layer of complexity. We’re constantly exposed to xenoestrogens – chemicals in plastics, pesticides, herbicides, cleaning products, and personal care items that mimic estrogen in the body. These sit in your estrogen receptors but don’t provide any of the protective benefits that real estradiol does. Without adequate bioidentical estrogen occupying those receptors, these harmful imposters take over.
Dr. Murray shares a stunning statistic: the average age of breast cancer diagnosis in the United States is 62 years old – that’s 10 to 12 years after menopause. Most of those women don’t have hormones. When hormone therapy prescriptions dropped after 2002, breast cancer diagnoses actually went up. So what’s sitting in those estrogen receptors when you don’t have protective estrogen? Plastics, herbicides, phthalates, fragrances, and chemicals from cleaning supplies and body care products.
The Soy Controversy: Phytoestrogens vs. Xenoestrogens
The confusion around plant-based estrogens versus chemical estrogen mimickers is profound, and it’s worth clearing up.
Phytoestrogens are weak estrogen-like compounds found in plants – primarily soy isoflavones and flax lignans. These have been studied fairly extensively and show mild estrogenic effects that can help with hot flashes and night sweats. Some research even suggests they may be protective against certain cancers. They’re significantly weaker than your body’s own estradiol, so they can’t replace hormone therapy for protecting your brain, heart, and bones, but they can provide symptom relief for women who choose not to do traditional HRT.
The soy controversy has multiple origins. In the 1990s, the US had a massive surplus of GMO soy that other countries wouldn’t accept. Suddenly, soy appeared in everything – soy milk, soy protein powder, soy ice cream. The problem wasn’t necessarily soy itself, but the extreme overconsumption combined with genetic modification. Additionally, when the Women’s Health Initiative scared everyone away from estrogen in 2002, the backlash extended to anything estrogen-like, including soy.
Research on soy infant formula does suggest potential developmental concerns when it’s the only food source for babies whose hormones and reproductive systems are still developing. Studies show relationships between early estrogenic effects and issues like early menstruation in girls and potential testosterone impacts in boys. But moderate consumption of non-GMO, organic soy as part of a varied diet appears safe for adults.
Xenoestrogens are entirely different. These are synthetic chemicals that have an estrogen-like chemical structure but don’t provide any of the beneficial effects of real estrogen. Dr. Murray uses a perfect analogy: think of estradiol as a key with five notches that fits perfectly into a lock and turns easily. Xenoestrogens are like a key with only three notches – it can jam into the lock partway, but it doesn’t turn properly and doesn’t unlock the door. Even worse, it blocks the real key from getting in.
Progesterone: The Misunderstood Hormone That Changes Everything
Progesterone gets far less attention than estrogen or testosterone, but Dr. Murray argues it’s one of the most critical hormones for midlife women.
Progesterone production happens when your ovary creates a follicle that swells – Dr. Murray compares it to a sunflower with seeds ready to pop. When one seed blows open and the egg shoots out like a “batwing fighter” down the fallopian tube, that collapsing follicle produces progesterone. This is why you have to ovulate to get adequate progesterone. In your late 30s and early 40s, when ovulation becomes inconsistent, progesterone production drops.
Progesterone is incredibly active in the brain. It turns on the receptor for GABA, your body’s natural calming neurotransmitter – essentially your natural Xanax. This is why adequate progesterone helps you stay asleep, keeps you calm, and helps regulate your core body temperature at night to prevent night sweats.
For women still cycling in perimenopause, progesterone is typically dosed from day 14 through day 28 of the cycle – mimicking the natural luteal phase. But here’s where Dr. Murray diverges from some practitioners: she doesn’t believe cycling is necessary or even beneficial for most women once they’re fully menopausal.
The argument for cycling is that it mimics natural hormone patterns. The argument against it – which Dr. Murray strongly supports – is that it complicates adherence, can cause breakthrough bleeding that’s difficult to distinguish from pathological bleeding, and we simply don’t have clinical trial data showing cycling is superior to continuous use.
Her perspective is refreshingly practical: she won’t ask patients to do things she wouldn’t or couldn’t do herself. She started cycling progesterone in her late 30s, but when she couldn’t sleep during the off-weeks, she switched to continuous use and has stayed with it ever since. If she forgets it for just one day, her sleep immediately suffers.
The concern some practitioners raise is that continuous progesterone might cause uterine buildup. But Dr. Murray points out that progesterone’s job is actually to inhibit the uterine lining. Doctors give high doses of progesterone continuously to women with heavy bleeding or endometriosis specifically to shut down the lining. When women use progesterone consistently, ultrasounds show very thin uterine linings – the opposite of what cycling proponents fear.
Important Progesterone Nuances:
There’s a difference between instant release (IR) and sustained release (SR) progesterone. If you’re taking progesterone and it helps you fall asleep but you can’t wake up in the morning, you likely need instant release instead of sustained release. IR comes on sooner and is out of your system halfway through the night.
Also, if you get progesterone through insurance at regular pharmacies, it often contains food coloring and peanut oil. If you’re sensitive, compounded progesterone will feel completely different.
The Testosterone Truth: Why More Is Definitely Not Better
If there’s one area where the wellness industry has gone completely off the rails, it’s testosterone dosing for women. Dr. Murray doesn’t mince words here: the explosion of high-dose testosterone therapy for women is concerning, and we’re likely to see consequences down the road.
Here’s what you need to know: research shows that most women benefit from relatively low doses of testosterone – typically between 5 and 10 milligrams. The physiological range for a healthy woman’s total testosterone is generally between 40 and 80, with some women thriving slightly lower or higher depending on their individual receptor sensitivity.
But the longevity and biohacking movement has pushed doses far beyond this. Women are ending up with testosterone levels of 150, 250, 380, or even 450 – levels that would be considered low for a man, but are astronomically high for a woman. The short-term effects might feel good: increased libido, better muscle building, more motivation. But the potential long-term consequences include excessive hair loss on the head, chin hair growth, clitoral enlargement, and potentially increased cancer risk.
Dr. Murray shares a personal example: when she tried a testosterone troche that absorbed through the mouth, her levels shot to 450. Her immediate reaction? She became, in her words, predatory – demanding her husband come to the bedroom immediately, even at breakfast time. He got scared. That’s what testosterone at near-male levels does to a woman’s brain and body.
To put this in perspective: a very low testosterone level for a man is around 250, and most reference ranges go up to 950 or even 1100. If a woman feels predatory at 250, imagine what teenage boys experience at 950.
The other problem with super-high testosterone is what your body does to compensate. When testosterone gets too high, your body increases sex hormone binding globulin (SHBG) to transport it, which also binds estrogen. You start converting more testosterone into estrogen through aromatization. This can overwhelm liver detoxification pathways and create the very estrogen dominance problems you were trying to avoid.
Understanding Free vs. Total Testosterone
Most labs measure total testosterone and calculate free testosterone. Total is everything in your blood sample. Free is what’s actually available to your cells – what got “out of the taxi cab,” as Dr. Murray explains.
You can have a total testosterone of 55, which looks decent, but if your free testosterone is only 0.1, almost nothing is actually usable. It’s all stuck bound to transport proteins. This is why saliva and urine testing can be more valuable – they measure what’s actually active in your body, not just what’s floating around bound and unavailable.
For optimal health, Dr. Murray recommends a free testosterone between 2.5 and 5, without symptoms. Even if your total testosterone is 170 or 200, your free should not be 40 or anywhere near that high – that would be problematic.
A Real-World Example:
Natalie shares her own hormone journey as an illustration. She was on a 0.1 estrogen patch, small testosterone injections, and 200mg progesterone. She thought everything was fine until she developed fibroids and a thick uterine stripe. Her testosterone total was 175 (high for menopause), but her free was less than 1. Her SHBG was extremely high.
The theory: her testosterone was aromatizing to estrogen, creating estrogen dominance. She wasn’t getting any usable testosterone because her free was too low. This dominance created the thick uterine lining and fibroids.
She went to the opposite extreme – completely stopped testosterone. Her most recent test showed zero testosterone, both free and total. Zero. Which explained why she had no motivation for a month. After restarting at a very low microdose, she felt like a new woman after just one day.
This is a prime example of why we can’t just look at numbers. The relationship between hormones, how you metabolize them, and how your body responds matters more than any single lab value.
Delivery Methods: Why How You Take Hormones Matters as Much as What You Take
The method you use to deliver hormones into your body significantly impacts both efficacy and safety.
Estrogen and Testosterone: Keep Them Topical
Both estrogen and testosterone should generally be applied to the skin – as patches, creams, or oils. When you take these hormones orally, they go directly to your liver through first-pass metabolism, which can stress liver detoxification pathways and increase certain risk factors.
Topical application allows hormones to enter your bloodstream through the skin, do their job throughout your body, and then only a small amount passes through the liver for eventual elimination. This is the safer, more physiological route.
Dr. Murray’s practice uses organic bioidentical hormones in jojoba oil because absorption tends to be excellent and there are no additional chemical bases or endocrine disruptors to worry about. However, not all creams or oils are created equal. If you try one compounded product and it doesn’t work, don’t give up – try a different pharmacy or base formula. The same is true for patches, which are bioidentical but contain adhesives that some women react to.
Progesterone: Oral or Vaginal Work Best
Progesterone is the exception to the topical rule. Because it metabolizes so rapidly, oral or vaginal administration tends to work better. When taken orally, progesterone metabolizes into byproducts that contribute to its calming, sleep-promoting effects in the brain. Some women find it too sedating, in which case vaginal administration provides the uterine protection without the strong brain effects.
Topical progesterone creams don’t have strong clinical data supporting their ability to adequately protect the uterine lining, which is critical for women taking estrogen who still have a uterus.
What to Avoid Completely
Never use synthetic progestins like medroxyprogesterone (Provera) or conjugated equine estrogen like Premarin. These are not bioidentical to what your body makes, and they come with significantly different risk profiles. Stick with bioidentical hormones that match your body’s natural chemistry.
Troches (which dissolve in the mouth) are different from oral – they absorb through the mucous membranes rather than being swallowed. Some absorption will be swallowed, but most goes directly into the bloodstream. Dr. Murray generally doesn’t recommend swallowing estrogen or testosterone.
The GLP-1 Controversy: When Weight Loss Drugs Become Dangerous
The explosion of GLP-1 and GIP medications like semaglutide and tirzepatide has completely changed the weight loss landscape, and Dr. Murray has strong thoughts about their appropriate use.
These incretin hormones – small peptide messengers your body naturally produces – work primarily by modulating hypothalamic control. They affect hunger, satiety, brain mechanisms, and cravings. At the high doses used for rapid weight loss, they eliminate hunger almost entirely and slow gastric emptying significantly, which is why users often experience nausea and digestive issues.
But here’s what most people don’t know: at much lower, more physiological doses, these medications have anti-inflammatory and anti-aging effects without the severe side effects. The problem is that pharmaceutical companies dosed them as high as possible to achieve maximum weight loss as quickly as possible. That’s not how your body naturally produces these hormones.
Dr. Murray’s concerns are primarily about inappropriate use: giving high doses to people who don’t need significant weight loss (like someone trying to drop 5 pounds for a college reunion), failing to provide adequate nutritional counseling, allowing patients to essentially starve themselves, and creating a generation of people with loose skin, muscle wasting, bone loss, and eating disorders.
She’s already seeing Instagram ads for skin tightening devices specifically marketed for GLP/GIP facial fat loss and body loose skin from rapid weight loss. The eating disorder culture emerging around these medications is deeply concerning – videos on TikTok showing people asking “what do you do when your friend comes over for dinner but you’re on a GLP?” with the answer being essentially not to eat.
The medication itself isn’t the problem – it’s the complete lack of proper medical oversight and education. Dr. Murray has been a critic of the misuse for years, not because of the drug mechanism (we’ve been using these drugs for diabetes for a long time), but because practitioners and telemedicine companies are abusing people by not counseling them on proper nutrition, protein intake, and exercise.
People are getting these online through telemedicine companies that don’t do video visits, don’t provide counseling, just send a prescription. Users lie about their weight and health history to get access.
When used appropriately, at lower doses, with proper nutrition and resistance training to maintain muscle mass, these medications can be valuable tools – particularly for obesity, insulin resistance, autoimmune conditions, and potentially reducing coronary artery disease. But the current trend toward extreme weight loss at any cost mirrors the starvation diet culture that has damaged Gen X women’s bone density.
Peptides: The Longevity Industry’s Favorite New Toy
Peptides are small molecule hormones that your body naturally produces – insulin was the first one we ever synthesized. Now there are hundreds available, from tissue regeneration compounds to collagen stimulators to hair growth promoters and even melanin-increasing peptides for tanning.
The reason peptides have exploded in the longevity market is that they naturally exist in the body, so they can’t be patented. This means compounding pharmacies can manufacture them. We have peptides for tissue regeneration, collagen production, gut health (like BPC-157 and KPV), and numerous other functions.
Dr. Murray’s main caution: peptides should be cycled and managed by knowledgeable practitioners, not self-administered based on internet research. Because peptides are signaling molecules that come and go in pulses naturally, constantly supplementing them can shut down your body’s ability to produce them naturally. Even peptides like BPC should ideally be rotated, though there are some indications for using them at specific doses for longer periods.
The other critical point: no amount of peptides will compensate for poor diet, inadequate sleep, chronic stress, or sedentary lifestyle. They’re optimization tools for people who already have the foundations in place, not magical solutions for people looking to bypass the basics. If you’re not doing the diet, lifestyle, and exercise work, you’re wasting your money. Peptides won’t march you back 30 years while you’re eating at Chick-fil-A.
To see real benefit from longevity peptides, you have to commit – not for a month, but as an ongoing practice.
The Bottom Line: Physiological Doses, Not Supraphysiological Experiments
Dr. Murray’s overarching philosophy is simple: replace what’s deficient at doses that match what your body would naturally produce during your healthiest years, then support your body’s ability to use and eliminate those hormones properly.
Throughout human history until industrialization, we never had access to supraphysiological doses of anything. You couldn’t juice massive amounts of spinach in 500 AD. You couldn’t extract concentrated hormones. Our bodies evolved to function optimally within specific ranges.
The modern tendency – particularly in American health culture – is to assume that if something is good, more must be better. But with hormones, this simply isn’t true. More growth hormone led to increased cancer rates because it stimulates insulin resistance and IGF-1, which promotes cancer cell growth. More testosterone for women causes hair loss, voice changes, and unknown long-term risks. More estrogen without adequate progesterone creates uterine hyperplasia.
Your body is remarkably intelligent. When you support it upstream, gently allowing it to function at physiological levels rather than forcing it with extreme doses, it generally self-corrects. The goal isn’t to override your body’s wisdom with massive doses of hormones and supplements. It’s to support your body’s natural functioning by replacing what’s truly deficient and optimizing what you can control.
The more you can go upstream and gently support where the deficiency is at a physiological dose, the more the body is going to operate as designed.
The path forward isn’t about becoming your own doctor or following the loudest voice in the wellness space. It’s about finding practitioners who understand these nuances, getting proper testing that looks at the full picture rather than single snapshots, and making informed decisions based on your unique body’s needs.
Your hormones aren’t something to fear or fight against. They’re powerful tools for optimizing your health in midlife and beyond – when used correctly, at appropriate doses, with proper monitoring and support.
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
