I started hormones when I was 46 years old. I was healthy. I exercised. My weight was fairly normal. My bloodwork was excellent. Two or three times a year I was an absolute lunatic — I didn't understand myself, I felt deeply emotional in a way that wasn't me, and I had what I can only describe as profound sadness during those times, when normally I never felt low mood at all.
I did the hormone assessment more out of curiosity than desperation. The only things I thought might be improvable were those difficult episodes a few times a year, and the fact that it had become increasingly more difficult to reach orgasm as I got older. I wasn't really expecting them to find anything significantly wrong.
When the results came back, my estrogen and progesterone were well balanced. My bloodwork was excellent. The only thing that showed up was very, very low testosterone — and this is the part that shocks most women.
Women have testosterone too. And it matters enormously.
Most women do not know they have testosterone. Most men certainly do not know their wife has testosterone. Women produce a very small fraction of what men produce — but that fraction is responsible for sexual desire, ability to reach orgasm, energy levels, and the ability to build and maintain muscle mass.
My testosterone, when it should have been at least 30, measured at five. Less than 30 is considered normal for my age — but "normal for your age" and "optimal for your wellbeing" are two completely different things. This is one of the most important distinctions we make at this clinic.
The normal range is not the optimized range. As we age, what is considered "normal" quietly shifts downward. At a certain age your normal range for testosterone as a woman goes from less than 60 to less than 30 — not because your body functions better at that level, but because that is what most women measure at that age. We are not interested in normal. We are interested in optimal.
What testosterone does for women.
What progesterone does — and why it matters.
Progesterone is the most underappreciated hormone in menopause care. Most conversations focus on estrogen — but progesterone is what many women notice most dramatically when it is added.
Progesterone helps with anxiety — even in women who did not consider themselves anxious before. It supports sleep quality in ways that sleeping medications do not. It calms the nervous system. It balances estrogen. Many women describe going from feeling like they were barely holding it together to feeling genuinely like themselves again within weeks of starting progesterone.
It does not work the same for everyone. But for many women, it is life-changing — and it is frequently the last hormone to be offered by conventional practitioners who are focused primarily on estrogen for hot flashes.
Why perimenopause starts years before menopause.
Menopause is defined as 12 consecutive months without a period. But the hormonal changes that produce every symptom you associate with menopause — hot flashes, sleep disruption, mood changes, weight gain, sexual changes, vaginal dryness, joint pain, brain fog — begin in perimenopause, which can start 10 years before your last period.
Most family practitioners do not ask prompting questions about perimenopause. You have to really complain about symptoms to get treated, and even then you are unlikely to be offered compounded testosterone. You will be offered estrogen when your hot flashes are severe enough, and sometimes progesterone to go with it. But the full hormonal picture — testosterone, thyroid, cortisol, comprehensive metabolic assessment — is rarely part of the conversation.
We do not wait for you to be suffering. We look at the full picture before symptoms become overwhelming. The women who come to us in early perimenopause, when changes are subtle, have the best outcomes. They drift into menopause gradually, supported, rather than crashing into it unprotected.
What menopause does to your body — and your relationship.
Biology does not care about your marriage. When menopause arrives, the biological imperative to reproduce is over. Estrogen drops. Testosterone drops. Vaginal tissue begins to thin. Natural lubrication decreases. Pain during intercourse — which women rarely discuss and are often embarrassed to report — becomes more and more common.
It does not happen overnight. It happens slowly, a little at a time, until one day you look back and wonder where the woman went who enjoyed intimacy. Who wanted it. For whom it felt good. This is not who you are — this is what hormonal deficiency does to your body.
The consequences extend far beyond the bedroom. Men whose wives have gone through unsupported menopause — who have become sexually unavailable, often through no fault of their own — find themselves in a profound mismatch if they have taken care of their own health. A man with optimized testosterone and treated erectile function, facing a woman in hormonal freefall, may not stay. Not because he does not love her, but because the gap has become insurmountable.
This is a correctible thing. Not a permanent state. We see couples regularly. We help both partners. We have watched relationships transform when both people feel good, feel desired, and can be intimate again.
Now I am 50. Here is what changed.
I am now having more frequent urinary tract infections. Sex is not quite painful yet, but it can be uncomfortable at times. My estrogen levels are dropping, so I have had to start using a vaginal estrogen cream. This is exactly what women do not understand about menopause — it is not a moment, it is a progression. As I get closer to it, things need to be adjusted. I am supported through it rather than suffering through it.
I share this because I think it matters. Not because I want your sympathy, but because if you recognize yourself in my story — the two or three times a year that did not feel like you, the slowly changing energy, the orgasms that take longer and feel less — I want you to know that there is a reason for every one of those things. And most of them are addressable.
What our program actually looks like.
Every patient starts with a comprehensive hormone panel — estradiol, progesterone, testosterone, thyroid, cortisol, and a complete metabolic picture. We look at where you are, not just whether you fall within the reference range. We look at whether you are optimized.
Our Nurse Practitioner Jennifer Kowalyk has full prescribing authority and brings a nuanced, unhurried approach to hormone management. Appointments are 50 minutes — not 10. Virtual, from anywhere in Ontario. We reassess every three months because hormones are not static, especially as you move through perimenopause. What worked six months ago may need adjustment today.
In-clinic patients also have access to O-Shot PRP, GAINSwave® GAINSwave® focused shockwave therapy for arousal and lubrication, and EMSELLA for pelvic floor health — treatments that directly address the tissue-level changes that hormones alone cannot fully reverse.