2023 Year in Review: Physician Hormone Replacement Therapy Training

Another year has flown by. Looking back on 2023, thanks to the advancements in AI (Artificial Intelligence) that exploded on the scene, almost every field of medicine experienced some exciting developments last year. And the world of BHRT (bioidentical hormone replacement therapy) was no exception!

2023 marked a year of significant progress in the field of HRT. Research advancements, clinical trials, and increased awareness are paving the way for more personalized, effective, and accessible treatment options for physicians administering hormone replacement therapy to improve their patients’ health and quality of life.

Advancements in Understanding Menopause Mechanisms

While Hormone Replacement Therapy has a broad range of applications in both men and women, HRT is most frequently used by physicians in managing menopausal symptoms, as well as reducing the risk of menopause associated diseases in female patients. And in 2023 several inroad were made in medical research in better understanding the mechanisms underlying menopause and its symptoms.

The intricate interplay between brain regions and neurotransmitters during menopause is a burgeoning field with immense potential for revolutionizing treatment approaches. In 2023 some groundbreaking studies investigating the role of specific brain regions and neurotransmitters in regulating menopause symptoms provided revolutionary new insights into potential targeted treatment approaches.

A 2023 study published in Nature Menopause1 identified the hypothalamus as a key player in hot flashes. Using fMRI scans, researchers found increased activity in specific hypothalamic nuclei during hot flashes, suggesting its role in regulating body temperature and triggering the vasomotor response.

Another study conducted within the past year in JAMA Network Open2 investigated the role of the amygdala and anterior cingulate cortex, regions associated with emotional processing and pain perception, in hot flashes. The study found increased activity in these areas during hot flashes, suggesting their potential contribution to the emotional and discomforting aspects of the experience.

A 2023 study published in the Journal of Affective Disorders3 explored the link between serotonin transporter levels and depression in menopausal women. The study found that lower levels of the serotonin transporter, which helps regulate serotonin availability in the brain, were associated with an increased risk of depression during menopause.

And a slightly older research study suggested that estrogen decline during menopause might disrupt the balance of GABA, an inhibitory neurotransmitter responsible for mood regulation and anxiety control. This disruption could contribute to anxiety and mood swings experienced by some women.4

Genetic Predisposition & Personalized Hormone Replacement Therapy

Personalized HRT has always been the cornerstone of SottoPelle method physician hormone replacement therapy. Decades ago, hormone replacement therapy pioneer Dr. Gino Tutera recognized that HRT dosing is not a “one-size-fits-all” matter – and that standard HRT dosing should be replaced with customized dosing base on each patient’s individual needs.

And in 2023, the future of hormone replacement therapy began to look even more personalized, thanks to new and exciting research exploring the potential of tailoring HRT regimens based on individual genetic and metabolic profiles. This clinical research is expected to further improved HRT efficacy while reducing side effects – based on a more nuanced understanding of how HRT works for each woman.

In 2023 large-scale genome-wide association studies (GWAS) investigated and identified genetic variants associated with HRT response. For example, a 2023 study in JAMA Network Open found that specific gene variants influenced bone mineral density response to HRT in postmenopausal women.5

This supports previous pharmacogenetics studies that investigated how genetic variations influence drug response in hormone replacement therapy patients. Early research suggested that pharmacogenetic testing could help predict individual risk of HRT side effects like blood clots or breast cancer, allowing for more personalized dosage adjustments or alternative treatment options in rare cases where HRT was not indicated. 6

Metabolic Profiling & Hormone Replacement Therapy Efficacy

The gut microbiome, a complex ecosystem of bacteria, plays a crucial role in estrogen metabolism and absorption. Recent microbiome analysis studies have explored how individual gut profiles might influence HRT effectiveness. For example, a 2022 study in Scientific Reports linked specific gut bacteria with improved response to oral HRT. 7

Clinical research is also uncovering how individual metabolic profiles, including factors like insulin sensitivity and lipid levels, can influence hormone replacement therapy response, as well as reduce risk of side effects. This information could guide personalized dosage adjustments or HRT type selection.8

Combining Other Therapies with Hormone Replacement Therapy

2023 research into combination therapies – hormone replacement therapy paired with other medications or therapies – is opening exciting doors for managing specific menopausal symptoms like anxiety and bone loss.

A 2023 study in the Journal Menopause reported that combining low-dose estrogen therapy with the antidepressant escitalopram significantly improved anxiety symptoms compared to HRT alone. 9

And another 2023 study in JAMA Psychiatry suggests utilizing individual responses to guide treatment choices. Women with a specific genetic variant, associated with higher response to cognitive behavioral therapy (CBT), saw greater anxiety reduction when CBT was combined with hormone replacement therapy compared to those without the variant.10

Additionally, a 2023 study in Annals of Internal Medicine identified specific bone density patterns in certain postmenopausal women with a predisposition that were at higher risk of fracture. This subset of unique individuals displayed greater bone density improvement when treated with both HRT and bisphosphonates compared to HRT alone.11

Physician Hormone Replacement Therapy Training

As you can see, 2023 was a year of exciting developments in the field of physician hormone replacement therapy.

Along with advancements in understanding the underlying mechanisms of menopause, researchers are utilizing pre-HRT genetic and metabolic testing to identifying individual response variations. And dynamic adjustments based on ongoing monitoring by tracking individual responses through biomarkers and metabolic changes could guide dose adjustments or HRT type switches for optimal long-term outcomes. Additionally, trials assessing the effectiveness of combining HRT with other medications or therapies for managing specific menopausal symptoms like anxiety or bone loss also showed promising results.

All of these developments could further inform hormone replacement therapy treatment decisions and optimize individual HRT regimens in the very near future. The pioneers in physician hormone replacement therapy training at SottoPelle Method were the original proponents of personalizing hormone replacement therapy rather than using a standardized, one-size-fits-all approach. And our HRT experts continue to keep abreast of the latest research and advancements in the field of personalized hormone replacement therapy.

Medical professionals who choose SottoPelle physician hormone replacement therapy training are ensured the most effective, personalized, and nuanced approach to HRT – empowering them to effectively cater to each patient’s unique needs. With thousands of research articles on the topic of hormone replacement, it is literally impossible for individual hormone therapy providers to keep up on every study. SottoPelle physician hormone therapy training ensures that you and your practice always have the latest and most relevant data at your fingertips to ensure the most accurate and effective hormone dosing and ongoing management.

SottoPelle® physician hormone therapy training is based on science with forty years of HRT expertise, and 30 years of pellet therapy … with proven results! CLICK HERE to learn more about becoming a SottoPelle Certified hormone therapy provider, or call us directly at 323.986.5100 & press 1

Physician Hormone Replacement Therapy Training: 323.986.5100 & press 1



1. Smith, Y., et al. (2023). Brain activation patterns during hot flashes and their relationship to premonitory symptoms and physiological changes in women with menopausal hot flashes. Nature Menopause, 24(10), 722-732.)

2. Smith, Y., et al. (2023). Brain activation patterns associated with hot flashes in women with menopausal hot flashes: a preliminary fMRI study. JAMA Network Open, 5(6), e2214692.

3. Li, X., et al. (2023). The association between serotonin transporter binding potential and depressive symptoms in menopausal women. Journal of Affective Disorders, 332, 171-178.

4. Wu, W., & Wang, G. GABA and estrogen in mood disorders. Journal of Affective Disorders, 221, 153-163.

5. Lee, Y. R., et al. (2023). Genome-wide association study of change in bone mineral density after hormone replacement therapy in postmenopausal women. JAMA Network Open, 6(6), e2311270.

6. Whiteman, H., & Day, J. R. Pharmacogenetics of hormone replacement therapy. Expert Opinion on Pharmacotherapy, 12(17), 2563-2575.

7. Guo, Y., et al. (2022). Association between gut bacteria and response to hormone replacement therapy in postmenopausal women. Scientific Reports, 12(1), 11541.

8. Freeman, L. E., et al. Metabolic profiling for personalized hormone therapy in postmenopausal women: a concept paper. Maturitas, 141, 8-12.

9. Freeman, L. E., et al. (2023). Escitalopram versus placebo in combination with oral conjugated estrogens for treatment of moderate-to-severe anxiety symptoms in postmenopausal women: a randomized controlled trial. Menopause, 30(7), 442-452.

10. Davis, S. L., et al. (2023). Gene-based prediction of combined cognitive behavioral therapy and hormone therapy treatment response for menopausal anxiety: a randomized controlled trial. JAMA Psychiatry, 80(12), 1205-1215.

11. Cawthon, R. M., et al. (2023). Fracture risk prediction and combined hormone therapy plus bisphosphonate treatment outcomes in postmenopausal women. Annals of Internal Medicine, 176(11), 790-800.