@tamsenfadal's menopause hormone routine, fact-checked
Quick answer
Fadal is using a standard transdermal estradiol patch at 0.075 mg/day with oral progesterone, a regimen consistent with combined menopausal hormone therapy guidelines for women with an intact uterus. She has added off-label testosterone for libido, a common but unregulated practice in the US given the absence of an FDA-approved testosterone product for women. Her dose titration and 90-day adjustment timeline are clinically plausible and suggest she is working with a provider, though compounded progesterone introduces formulation variability that warrants monitoring.
Our take · Written by FormBlends editorial team · Reviewed by FormBlends Medical Team· This is not a transcript. It is our independent review of the video above.
What did @tamsenfadal actually say?
Tamsen Fadal described her current menopausal hormone therapy stack: an estradiol patch at 0.075 mg/day changed twice weekly, oral progesterone (including a compounded dose to hit an in-between amount), and testosterone she started recently. She said estrogen plus progesterone improved her sleep, brain fog, and focus. She credited testosterone with a noticeable change in libido and possibly muscle mass, though she acknowledged she was also working out more. She was transparent that she is not a doctor and that these are her personal results.
She also mentioned it took roughly 90 days to feel the effect of her dose increase from 0.050 to 0.075, and she noted that the two hormones, estrogen and progesterone, "have to go together." That last point is clinically significant and worth examining closely.
Does the science back this up?
Mostly yes, with some nuance. The estrogen-progesterone pairing claim is the strongest thing she said. The progesterone-for-focus and sleep claims are real but often overstated online. The testosterone-libido connection is well-supported; the muscle mass claim is less settled for women at typical HRT doses.
On estrogen and progesterone together: if you have a uterus and you are taking systemic estrogen, you need progestogen to protect the endometrium from hyperplasia. This is not optional. The PEPI trial (Writing Group for the PEPI Trial, 1995, JAMA) established this clearly. Fadal is right that these two go together, at least for women with an intact uterus.
On progesterone and sleep: oral micronized progesterone does have sedative properties via GABA-A receptor activity, and small randomized trials support improved sleep quality (Schüssler et al., 2008, Maturitas). On brain fog: the evidence is suggestive but not definitive. The SWAN study and follow-on cognitive work suggest estrogen timing matters more than the hormone alone (Greendale et al., 2009, Neurology). Testosterone and libido in women: there is reasonable trial evidence here, including the APHRODITE trial (Davis et al., 2008, NEJM), showing improved sexual function with low-dose testosterone in postmenopausal women.
What did they get wrong (or right)?
She got the core framework right and avoided several common mistakes. She did not claim hormones reverse aging, she did not recommend doses to her audience, and she was clear this is her personal experience. Those are green flags. One thing that needs flagging: she describes her compounded progesterone as simply a dose adjustment to hit "in between two amounts." That framing is fine, but viewers should understand compounded drugs are not FDA-approved and are not equivalent to brand-name oral micronized progesterone like Prometrium. Compounded formulations vary in absorption and quality depending on the pharmacy.
The muscle mass comment is the weakest claim she made. She essentially walked it back herself, noting she was also working out more. That is honest, but worth being explicit about: the evidence for testosterone improving muscle mass in women at physiologic replacement doses is thin. Studies like Huang et al. (2006, JCEM) show modest effects in older women, but effect sizes are small and the data at doses used in menopausal HRT are not robust.
Her 90-day timeline for feeling the full effect of a patch dose increase is realistic and actually more accurate than most social media content, which tends to promise results in two to four weeks.
What should you actually know?
A few things matter here that the video does not cover, not because Fadal did anything wrong, but because 60-second TikToks cannot carry this much nuance.
- Transdermal estradiol carries a lower venous thromboembolism risk than oral estrogen. That distinction matters and is supported by multiple observational studies, including Canonico et al. (2007, Circulation).
- Testosterone is not FDA-approved for women in the United States. That does not make it inappropriate, but it means every prescription is off-label and monitoring standards vary widely between providers.
- The "timing hypothesis" for hormone therapy suggests that starting estrogen close to menopause onset may have different cognitive and cardiovascular effects than starting it years later. The KEEPS trial (Harman et al., 2014, Annals of Internal Medicine) is relevant here.
- Compounded hormones are not interchangeable with FDA-approved versions. Absorption, potency, and sterility vary.
- "Feeling different" is real data, but it is not a substitute for regular bloodwork and follow-up with a provider who can monitor levels and endometrial health.
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Cardiovascular Safety of Testosterone-Replacement Therapy
TRAVERSE trial anchor for cardiovascular-safety discussions in appropriately diagnosed men.
PubMed
Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline
Guideline anchor for diagnosis, monitoring, contraindications, and appropriate TRT framing.
PubMed
Understanding weight gain at menopause
Background source for body-composition and weight-change discussions around menopause.
PubMed
Management of obesity in menopause
Current source for menopause-specific obesity management framing.
PubMed
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Fadal is using a standard transdermal estradiol patch at 0.
FormBlends verdict
Fadal is using a standard transdermal estradiol patch at 0.075 mg/day with oral progesterone, a regimen consistent with combined menopausal hormone therapy guidelines for women with an intact uterus. She has added off-label testosterone for libido, a common but unregulated practice in the US given the absence of an FDA-approved testosterone product for women. Her dose titration and 90-day adjustment timeline are clinically plausible and suggest she is working with a provider, though compounded progesterone introduces formulation variability that warrants monitoring.
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What it helps with
- Fadal is using a standard transdermal estradiol patch at 0.075 mg/day with oral progesterone, a regimen consistent with combined menopausal hormone therapy guidelines for women with an intact uterus. She has added off-label testosterone for libido, a common but unregulated practice in the US given the absence of an FDA-approved testosterone product for women. Her dose titration and 90-day adjustment timeline are clinically plausible and suggest she is working with a provider, though compounded progesterone introduces formulation variability that warrants monitoring.
- Transdermal estradiol carries lower clotting risk than oral estrogen, per Canonico et al. (2007, Circulation), making patch-based therapy a clinically reasonable choice.
- Women with a uterus taking systemic estrogen require concurrent progestogen. This is not optional and is supported by the 1995 PEPI trial in JAMA.
What it may miss
- It may not cover eligibility, contraindications, medication interactions, lab history, or dose escalation.
- Compound access, legal status, and product quality still need a separate safety check.
- Social video captions rarely show the full evidence base behind a claim.
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Start provider reviewWhat You'll Learn
- Transdermal estradiol carries lower clotting risk than oral estrogen, per Canonico et al. (2007, Circulation), making patch-based therapy a clinically reasonable choice.
- Women with a uterus taking systemic estrogen require concurrent progestogen. This is not optional and is supported by the 1995 PEPI trial in JAMA.
- Testosterone is not FDA-approved for women in the US. Every prescription is off-label, and dosing and monitoring standards vary significantly between providers.
- Compounded progesterone is not equivalent to FDA-approved oral micronized progesterone. Potency and absorption can differ depending on the compounding pharmacy.
- The APHRODITE trial (Davis et al., 2008, NEJM) supports testosterone for sexual function in postmenopausal women, but muscle mass benefits at physiologic doses remain poorly documented.
- The 'timing hypothesis' suggests hormone therapy started early in menopause may have different cardiovascular and cognitive outcomes than therapy started late, per the KEEPS trial (Harman et al., 2014, Annals of Internal Medicine).
- Self-reported symptom improvement is meaningful but is not a substitute for regular monitoring of hormone levels and endometrial health through a qualified provider.
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About the Creator
Tamsen Fadal · TikTok creator
86.8K views on this video
Replying to @sherridee865 here’s a breakdown of my current hormone routine in menopause #menopause #hormonetherapy #estrogen #progesterone #testosterone
Sources & references
- [1]Greendale et al., 2009
- [2]Davis et al., 2008
- [3]Huang et al. (2006)
- [4]Canonico et al. (2007)
- [5]Harman et al., 2014
Citations extracted from our medical team's review. Click any citation to search PubMed.
Read More on This Topic
Our written guides go deeper with dosing details, comparison tables, and medical-team reviewed protocols.
Not medical advice. This video was made by Tamsen Fadal, not by FormBlends. Our write-up above is an editorial review, not a medical recommendation. Talk to your doctor before making any decisions about medications or treatments.