Testosterone therapy for menopause: what the evidence actually shows

What did @dr.regina_nd actually say?

Dr. Ann Marie Regina, a naturopathic doctor specializing in menopausal health, laid out 10 interventions she says she would recommend before prescribing hormone replacement therapy. Her list spans diet (Mediterranean), exercise with resistance training, vitamin D at 2500 IU daily, thyroid testing, cardiovascular workup, creatine monohydrate, omega-3s, sage for hot flashes, iron testing, and standard preventive screenings. She was careful to say she does support HRT, calling it "the gold standard for some symptoms in menopause," but argued that lifestyle and diagnostic groundwork has to come first. That framing is reasonable. The list itself, though, is a mix of well-supported recommendations, a couple of overstated claims, and one dose figure that deserves scrutiny.

Does the science back this up?

Mostly, yes, with some important caveats. The Mediterranean diet recommendation is well-grounded. A 2020 review in Maturitas (Barrea et al.) found associations between Mediterranean diet adherence and reduced menopausal symptom severity, including mood and cardiovascular markers. The exercise recommendation aligns with current public health guidance, and resistance training for bone density in postmenopausal women is strongly supported by data from the Cochrane reviews on exercise and osteoporosis. Vitamin D for bone health has solid backing, though the 2500 IU figure she quotes as a "public health recommended dose" is specific to Ontario health guidance and not a universal standard. Creatine monohydrate is one of the more interesting additions. A 2021 review in Nutrients (Smith-Ryan et al.) found emerging evidence for creatine supporting lean mass and potentially mood in women, though most studies are still in early stages. Sage for hot flashes has some supporting trial data (Bommer et al., 2011, Advances in Therapy), though effect sizes are modest. Omega-3s for cardiovascular and anti-inflammatory effects have decent evidence behind them at one to two grams EPA daily.

What did they get wrong (or right)?

The thyroid point is genuinely useful clinical advice. Hypothyroidism and perimenopause share overlapping symptoms including fatigue, mood changes, and weight gain, and missing a thyroid condition while starting HRT is a real diagnostic error that happens. Credit where it is due. The cardiovascular workup recommendation is also sound. Transdermal estrogen is generally considered safer than oral for women with certain cardiovascular risk profiles, so knowing that risk profile before prescribing makes clinical sense. Where the video gets shakier is the 2500 IU vitamin D claim. Health Canada recommends 600 IU daily for adults up to age 70, with a tolerable upper limit of 4000 IU. Some clinicians do recommend higher doses in practice, particularly in northern climates, but presenting 2500 IU as the "public health recommended dose" is not accurate as a universal statement. It may reflect Ontario-specific clinical guidance, but the framing could mislead viewers in other regions. The sage claim is backed by some evidence but four to eight weeks for hot flash relief is optimistic based on the available trial data, which showed variable results.

What should you actually know?

The overall framework here, test before you treat, address lifestyle before adding pharmaceuticals, is legitimate medicine. No serious clinician would argue with getting thyroid panels and cardiovascular markers before starting HRT. The problem with videos like this is that 843,000 viewers will walk away with different takeaways. Some will use this as a checklist to delay HRT they actually need. Others will hear "creatine" and start supplementing without any clinical context. A few things worth knowing clearly: HRT remains the most effective treatment for moderate to severe vasomotor symptoms (hot flashes and night sweats) according to the 2022 Menopause Society guidelines. Lifestyle interventions are additive, not a substitute for indicated hormone therapy. Naturopathic doctors are licensed in some Canadian provinces but are not equivalent to medical doctors in terms of prescribing authority for HRT. If you are experiencing significant menopausal symptoms, see a licensed provider who can review your full medical history before making any prescription decisions.