The Controversial Hormone Cycling Method That’s Dividing Doctors (And Why It Matters) with Dr. Salome Masghati

06 May The Controversial Hormone Cycling Method That’s Dividing Doctors (And Why It Matters) with Dr. Salome Masghati

Posted at 04:45h in Midlife Conversations, Midlife Health, Midlife Hormones by
Learn everything about hormone replacement therapy from a medical expert. Discover bioidentical vs synthetic hormones, optimal levels, and how to become your own health detective for midlife hormonal health. Hormone replacement therapy doesn’t have to be confusing. Yet every woman I speak with seems to have a different story—different advice from doctors, conflicting research, and overwhelming choices. Today, I’m sharing insights from Dr. Salome Masghati that will transform you from an overwhelmed patient into your own health detective.

Understanding Bioidentical vs Synthetic Hormones

The difference between bioidentical and synthetic hormones isn’t just marketing speak—it’s about how your body processes these molecules. Dr. Masghati explains that bioidentical hormones have a molecular structure identical to what your body produces naturally. Synthetic versions, like those in birth control pills, can disrupt your endocrine system. Key differences:
  • Bioidentical hormones are derived from yams and closely match your natural hormones
  • Synthetic versions like Premarin (derived from horse urine) contain metabolites your body wasn’t designed to process
  • Birth control pills can suppress your own hormone production, increasing clotting factors and inflammatory markers

Decoding Hormone Levels: What’s “Normal” vs Optimal

Most doctors test for “normal” ranges, but Dr. Masghati emphasizes there’s a huge difference between average and optimal levels for midlife women.  Estradiol Levels:
  • Average postmenopausal: Below 35 pg/mL
  • Minimum for bone protection: 60-80 pg/mL
  • Optimal for brain health: 100+ pg/mL
  • Some women need 200+ pg/mL for symptom relief
Testosterone Insights:
  • Total testosterone in healthy 25-year-olds: 55-65 ng/dL at peak
  • Free testosterone should be around 1.5-5 ng/dL
  • The key isn’t just total numbers—SHBG levels matter significantly
DHEA Sulfate:
  • Optimal range: 150-200 µg/dL
  • Below 100: May indicate adrenal fatigue
  • Above 250: Could signal insulin resistance

Becoming Your Own Health Detective

The health detective approach means understanding how your hormones interact like pieces of a puzzle. Estrogen builds testosterone receptors, so low estrogen means testosterone won’t work effectively, no matter the dose. Your FSH should drop below 20 when estrogen is properly optimized. And thyroid function affects hormone metabolism, which is why you need to test free T3 and T4, not just TSH. Dr. Masghati particularly emphasizes watching your SHBG levels. When SHBG climbs above 100, it binds testosterone so tightly that you won’t feel the benefits, regardless of your total testosterone numbers. This is why some women feel awful despite “optimal” lab values—they’re looking at the wrong markers.

Hormone Delivery Methods: What Works Best

Oral hormones might seem convenient, but Dr. Masghati strongly prefers transdermal options that bypass liver metabolism. Patches, creams, gels, and injections deliver hormones directly to your bloodstream without increasing clotting factors, elevating inflammation markers, or raising SHBG that binds your testosterone. Even oral progesterone has its quirks. While it converts to allopregnenolone (nature’s Xanax) for sleep benefits, about 80% gets metabolized this way, potentially leaving less for uterine protection. Some practitioners are now exploring transdermal progesterone as an alternative, though it requires careful monitoring since it doesn’t show up well in blood tests.

Advanced Strategy: Rhythmic Physiologic Dosing

This cutting-edge approach mimics your natural cycle even after menopause. Instead of giving the same dose every day, hormones vary throughout the month—estrogen never drops below 80 pg/mL but peaks higher to stimulate growth factors, while progesterone cycles in the second half of the “month.” This rhythm helps reset receptors and may offer superior protection for bones, brain, and cardiovascular health. Dr. Masghati explains this approach builds on the Wiley protocol but with modifications: more estrogen on day 12 and slightly less progestin in the luteal phase. The theory? By cycling hormones, you get the renewal of cells that happens naturally in premenopausal women—in breast tissue, bones, and throughout the body.

The Methylation Connection

For women with COMT gene variations that affect estrogen metabolism, Dr. Masghati offers practical solutions. High stress, excessive coffee, and elevated cortisol all compete with estrogen for methylation pathways. Supporting liver detoxification with NAC and glutathione, managing stress levels, and sometimes adding melatonin for sleep can help these women tolerate higher estrogen levels without issues.

When to Optimize Your Protocol

Your body gives clear signals when hormone replacement needs adjustment. Persistent sleep disruption despite progesterone, unexplained mood changes, low libido despite testosterone therapy, continued hot flashes, or high FSH levels despite estrogen therapy all indicate it’s time for optimization. Remember that optimal testosterone-to-estrogen ratios matter for metabolic health. High testosterone with low estrogen creates a PCOS-like state, potentially causing insulin resistance and lipid changes. This is why women on pellets or high-dose testosterone injections sometimes feel worse despite “great” testosterone numbers.

Practical Health Detective Tools

Testing comprehensively gives you the full picture. Beyond basic hormone panels, look at complete thyroid function, DHEA sulfate, and calculate your free testosterone using online formulas rather than relying solely on lab values. Monitor for metabolic impact—insulin resistance affects how your body processes hormones, and proper gut function ensures you metabolize estrogen effectively. Supporting hormone detoxification doesn’t require expensive supplements. Focus on broccoli sprouts for liver phase 2 support rather than DIM, which can actually lower overall estrogen levels. Address gut dysbiosis that affects the estrobolome (gut bacteria that metabolize estrogen), and ensure daily bowel movements to eliminate toxins properly.

Your Path to Hormonal Optimization

The journey to optimal hormone replacement is highly individual. Start by:
  1. Getting comprehensive testing (not just standard panels)
  2. Understanding the difference between average and optimal levels
  3. Finding a provider who treats you as an individual
  4. Considering delivery methods that bypass the liver
  5. Learning to interpret your body’s signals
Optimal lab values for handy reference:  Estradiol Levels:
  • Average postmenopausal: Below 35 pg/mL
  • Minimum for bone protection: 60-80 pg/mL
  • Optimal for brain health: 100+ pg/mL
  • Some women need 200+ pg/mL for symptom relief
Testosterone:
  • Total testosterone in healthy 25-year-olds: 55-65 ng/dL at peak
  • Free testosterone should be around 1.5-5 ng/dL
  • The key isn’t just total numbers—SHBG levels matter significantly
DHEA Sulfate:
  • Optimal range: 150-200 µg/dL
  • Below 100: May indicate adrenal fatigue
  • Above 250: Could signal insulin resistance
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.  
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Natalie Jill

Natalie Jill is a leading Fat Loss Expert and high-performance coach. She helps you change the conversation around age, potential, pain and possibility. She does this through a SIMPLE and FUN unique method that you can find in her best-selling books, top-rated podcasts, interactive programs and coaching sessions. As a 50-year-old female, she KNOWS the struggles and pain that can come with aging! She takes the guesswork away and help you kill the F.A.T. (False Assumed Truths) holding you back from achieving your goals. To know more about Natalie Jill, you can visit her Facebook Profile, Tiktok, and Instagram.