You’re Not Crazy. It’s Your Hormones. | Dr. Heather Hirsch

Summary

Superwomen with Rebecca Minkoff

Episode: You’re Not Crazy. It’s Your Hormones. | Dr. Heather Hirsch

Date: June 4, 2026
Guest: Dr. Heather Hirsch, Menopause & Women’s Hormone Health Specialist
Host: Rebecca Minkoff

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Episode Overview

In this deeply informative and candid episode, Rebecca Minkoff sits down with Dr. Heather Hirsch to demystify the wild, often frustrating world of perimenopause, menopause, and hormone health for women. The conversation tackles the medical system's shortcomings, the confusion women feel navigating symptoms and protocols, and practical, empowering steps toward better health and advocacy. Dr. Hirsch shares her philosophy of personalized care, the importance of self-trust, and new frontiers in education and AI in women's health.

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Key Topics & Insights

1. The Medical System and Women’s Health

Starting at [03:30]

• Medical Training Bias: Dr. Hirsch explains the problem: “The biggest problem is that we were taught that these sex hormones do sex things. But in fact, the place where they have the biggest impact is probably the brain.” ([03:30])
• Male Model as Default: She reveals how medical training centers the male body, making female health seem like an afterthought:

  “When we're in medical school, we learn the male body as sort of the foundation and then we have us fucked up... they should be doing it the other way around.” ([04:07])

• Effect: This results in misdiagnosis, gaslighting, and providers failing to acknowledge real, complex symptoms.

2. Trusting Women’s Intuition & Symptom Tracking

[06:18]

• Dr. Hirsch encourages women to trust their intuition and track symptoms:

  “Journaling and tracking is the very first thing I think all women can do to start to lean into really following that intuition.” ([08:16])

• Tracking provides tangible evidence, helps spot patterns, and makes conversations with clinicians far more productive.

3. Frustration With One-Size-Fits-All Solutions

[08:40]

• Rebecca and Dr. Hirsch critique the “protocolization” of care:

  “One of the ways you can kind of tell which doctor should you listen to versus... those just offering up a one size fits all... that's something you want to avoid.” ([09:39])

• Women are often desperate for solutions, making them vulnerable to practitioners who skip necessary diagnostic steps.

4. Dr. Hirsch’s Personal Journey & Motivation

[10:27]

• Inspired by her father (an OB/GYN), Dr. Hirsch wanted to talk to and help women—but saw a gap where neither internists nor gynecologists truly “owned” perimenopause.
• Her “aha moment” came during her fellowship at Cleveland Clinic, where she saw how transformative hormone therapy could be.

  “It wasn't until they came back and they were like, you saved my life... that I thought, like, there's something here that I'm missing.” ([13:22])

5. Perimenopause: When and Why It Hits Hard

[14:03]

• Rebecca highlights the cruel timing of perimenopause: often when women feel most confident, it hits.

  “It seems like this is happening to women when they're at their height... just, I've got this, and then this happens and you're like, oh, fuck... we've just gone down the ladder.” ([14:03])

• Dr. Hirsch: Public dialogue helps normalize and educate, lessening isolation and stigma.
• Common Misconception: Sex hormones are about “sex”–but their main effects are in the brain, affecting mood, cognition, motivation, sleep, and more. ([15:37])

6. Overinflated Symptom Lists—Fact or Fad?

[17:37]

• With memes claiming hundreds of perimenopause symptoms, Rebecca worries this trivializes the reality:

  “If anything is wrong with you at all, any day of the week, it's perimenopause... it's weakening the fight for real care.” ([17:38])

• Dr. Hirsch agrees:

  “There's usually not one thing causing all of these symptoms... It's a mixture... There is a major stressor in your life, and that impacts just how you sleep and how you function.” ([17:58])

• She emphasizes embracing aging and discernment, and not blaming everything on hormones.

7. Hormone Therapy & The ‘Hormone Stacking’ Philosophy

[20:14]

• Dr. Hirsch introduces “hormone stacking”—introducing one intervention at a time and adjusting iteratively for best effect.

  “Do one thing at a time and get that hormone right... then add the next.” ([21:13])

• She avoids overwhelming the body or muddying results by prescribing too much at once.
• Hormone therapies can be systemic (whole body) or local (e.g., vaginal estrogen), with different uses.

8. Time & Individualization in Care

[23:16]

• Both discuss patience—results can take months to materialize:

  “It takes time... I was not prepared for five months.” – Rebecca ([23:24]) “The magic is in that relationship and then that change you make... my patients react so differently.” – Dr. Hirsch ([24:10])

• Adjustments often needed as “tectonic plates” of hormones shift.

9. Supplements, Peptides, and the Pitfalls of Over-Stacking

[25:53]

• Rebecca noticed her libido improved when she stopped supplements.
• Dr. Hirsch explains:

  “A lot of these supplements are metabolized in the liver... that can actually cause your sex hormone binding globulin to go up, making your testosterone... less effective, therefore lowering your libido.” ([27:50])

• The advice: bring the same “stacking” method to supplements and peptides as to hormones—add one at a time, see what’s working, and be prepared to peel things back.

10. The Challenge of Scaling Personalized Care

[30:07]

• Dr. Hirsch discusses teaching clinicians her philosophy rather than rigid protocols, believing this multiplies her impact:

  “If I can teach one clinician, they're probably going to touch a couple thousand patients... that's how I can hopefully get this to go farther than just, like, one practice.” ([31:27])

• She has also been developing AI models to support wider access to individualized advice, especially for cost-effective solutions. ([32:13])

11. Advice for Women Feeling Lost

[33:21]

• Step 1: Acceptance—feeling “not like yourself” is common and normal.
• Step 2: Journaling & symptom tracking—start noticing patterns.
• Step 3: Prioritize—what ONE thing, if fixed, would have the biggest domino effect for you?

  “If I had a magic wand... and could fix one thing, what would it be?” ([34:10])

• Step 4: Empower yourself—read, follow practitioners who share your philosophy, seek supportive clinicians, and practice shared decision making.

12. Vision for Society: Leadership & Workplace Support

[37:08]

• If perimenopause were treated as a leadership/workplace issue:

  “I think a lot about how far women have come in terms of lactation rates, rooms. And I think what's the lactation room for perimenopause?... It might be access to care or 1-2 days off a month to get care.” ([37:18])

• Proper support would decrease missed work, lost productivity, and even improve family and relationship outcomes.

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Memorable Quotes

• Dr. Heather Hirsch:

  • “Journaling and tracking is the very first thing I think all women can do to start to lean into really following that intuition.” ([08:16])
  • “You cannot protocolize it. You just can't.” ([25:14])
  • “That volatility is extraordinarily noted to the brain. And that's why it feels like everything shifts—because it keeps shifting.” ([26:22])
  • “Every year is a joy to be smarter and wiser and, you know, have more friends and have deeper connections.” ([18:34])
  • “This feeling of not feeling like myself is very common. The first is just acceptance.” ([33:21])
  • “There's so much that can be done to help support you and you're going to get there.” ([41:08])

• Rebecca Minkoff:

  • “It seems like this is happening to women when they're at their height... and then this happens and you're like, oh, fuck... we've just gone down the ladder.” ([14:03])
  • “If perimenopause was treated as a leadership issue and not just a private health issue, what would that look like to you?” ([37:08])
  • “No woman is a cut and paste.” ([29:35])

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Key Timestamps

• 03:30 – Dr. Hirsch intro: Medical system bias, male body as default
• 06:18 – Importance of trusting yourself, journaling, and tracking
• 09:19 – Dangers of “protocolized” hormone therapy
• 13:11 – Dr. Hirsch’s career origin story & motivation
• 15:37 – Why hormones don’t just affect “sex things”—brain impact emphasized
• 17:37 – Cultural confusion: memes, symptom overload, skepticism
• 20:14 – Hormone stacking: slow, careful individualization
• 25:53 – Difficulties with supplements and unexpected impacts
• 30:07 – Scaling impact: teaching clinicians & developing AI
• 33:21 – Advice to women feeling lost: acceptance, tracking, empowerment
• 37:08 – Perimenopause as a workplace/leadership issue
• 41:08 – Final encouragement: “There is hope... you're going to get there.”

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Resources & Where to Find Dr. Heather Hirsch

• Book: The Perimenopause Survival Guide (Part two is “choose your own adventure” style, focusing on pragmatism and empowerment) ([36:32])
• Podcast: Health by Heather Hirsch ([40:03])
• Practice: Dr. Hirsch runs Join the Collaborative, a telemedicine practice with a growing number of clinicians ([40:08])

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Final Takeaway

Perimenopause and menopause are complex, deeply individual experiences—there’s no “one size fits all.” By embracing tracking, intuition, and empowered decision-making, women can reclaim agency over their health. Dr. Hirsch’s philosophy: focus on actionable steps, educate yourself, demand personalized care, and, above all, know that there is hope and meaningful support available.

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Transcript

[Rebecca Minkoff]

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[Rebecca Minkoff]

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[Dr. Heather Hirsch]

The biggest problem is that we were taught that these sex hormones do sex things. But in fact, the place where they have the biggest impact is probably the brain. What women don't know about their bodies is.

[Rebecca Minkoff]

Hey everyone. Welcome back to Superwomen. Today's guest is Dr. Heather Hirsch. And you guessed it, we are talking about my favorite subject, perimenopause. She has been helping women for for almost a decade, specifically on hormone support, perimenopause, menopause. There's hope for you. There's hope for all of us. But not only is she empowering you, she's empowering practitioners everywhere so they can affect thousands of women so that we all start to get the help we need. Take a listen.

[Dr. Heather Hirsch]

When we're in medical school, we learn the male body as sort of the foundation and then we have have us fucked up. Yeah, right. When really they should be doing it the other way around.

[Rebecca Minkoff]

How do you get women to trust themselves to listen to their intuition for

[Dr. Heather Hirsch]

us to listen to our intu? Intuition is where a lot of women feel the gaslighting. They'll say, but I feel this way. And the clinician will say, but your labs don't look like this. But the problem is, is that it's not always that simple. And that is like One of the ways you can kind of tell which doctor should you listen to versus which ones maybe are just offering up a one size fits all or a more protocolized type of medicine that is something you want to avoid. We're definitely at a point where women are desperate to feel better, and so it's really hard to know if it's placebo or if they really need it.

[Rebecca Minkoff]

I'm Rebecca Minkoff, and this is Superwomen. Each week, inspiring women are interviewed to uncover the unexpected journeys, the challenges, and the unwavering spirit that makes them powerful. Get ready to be motivated by stories

of resilience and discover the keys to

unlocking your own potential. Welcome. I'm so excited to talk to you today.

[Dr. Heather Hirsch]

I am thrilled to talk today, too. This is such a fun opportunity to talk about all things entrepreneurial. Ship women's health.

[Rebecca Minkoff]

So most episodes are like the woman's story, what she needed to be to become a superwoman. But while I have an expert here, I want to go deep on all things women's hormones and health, just because it's the Wild West. And even with an expert such as yourself, I go, well, do I listen to her or her or her or her? And you get overwhelmed.

[Dr. Heather Hirsch]

So.

[Rebecca Minkoff]

So anyways, I'm really glad you're here today. And so I wanted to start off with, most women haven't heard of perimenopause, and that is a subject I want to go deep on today. And women are too busy or they're too stressed or it's just anxiety or whatever. But in your work, how do you get women to trust themselves to listen to their intuition?

[Dr. Heather Hirsch]

That is a good one to start off with. Now, I know we're not going to get through all 15, because the idea to trust your intuition really goes against so much of what women are up against when it comes to their health. There's so much to unpack here, but it really starts with the basics. When we're in medical school, we learn the male body as sort of the foundation, and then we have fucked up. Yeah, right. Then we kind of have a gynecologic rotation, and we kind of try to superimpose women's health on top of a male body when really they should be doing it the other way around. Because women are so, so much. You know, there's just more complicated. There's so much going on. And so if you actually were teaching medical school with the female body and then you took off the complicated parts, that's the male body, like, that should be how they do it. And so because we're really in a situation where clinicians and healthcare professionals have been taught to think about a male body, as women, we get put into all these boxes and they've been doing that to us as patients because I'm a patient myself in real life for so long that for us to listen to our intuition is where a lot of women feel the gaslight. They'll say, but I feel this way. And then the clinician will say, but your labs don't look like this. Right. And then it's so easy to talk up everything to stress. You're obviously not sleeping, you're obviously stressed. But again, that's because clinicians were taught the male body. And so if it doesn't fit, they don't know what else to do with it. Right. All right. So then the question, how do we learn to lean into our intuition? I always say it's helpful to start journaling and tracking symptoms, because when you come to a clinician armed with like, this is what's been happening to me, I can start to see some cyclic behaviors, patterns, then it can really help just sparse out this whole idea that it must just be stress. Because if you can see, here's when it gets worse, here's when it gets better. This is what's happening to my bleeding, my mood, my sleep, my libido, all of the. Yup. Anything else you want to include of there? Yeah. That really can then help to put the bigger picture together. And then it can take out this biases of like, well, this sounds so complicated because you come armed with facts. So journaling and tracking is the very first thing I think all women can do to start to lean into really following that intuition. So that would be my go to.

[Rebecca Minkoff]

And I think, like, at least for me, I keep. Because I've been on my perimenopausal journey for two years now. Like, I literally met a woman on Saturday. She was telling me she was struggling with her husband. I was like, get your hormones checked first. And I described some symptoms. And I said, now here's a doctor that you don't want to stick with. If you arrive and they want to slap an estrogen patch on you and not check the cycle date and not test your testosterone and progesterone. Run. And she literally had a doctor's appointment two days ago. She texted me, she said, they said I should go on estrogen. They didn't bother testing my blood. And they said my symptoms sound like I just need more estrogen. I was like, run.

[Dr. Heather Hirsch]

Yeah. And so that's kind of the protocolization of healthcare. One of the reasons I think this is happening in perimenopause and menopause is because the topic has exploded.

[Rebecca Minkoff]

Yeah.

[Dr. Heather Hirsch]

Which is good on one hand because I remember a day when you couldn't even get an estrogen patch. But the problem is, is that it's not always that simple.

[Rebecca Minkoff]

There's not ones I don't know.

[Dr. Heather Hirsch]

So many nuances. Exactly. So she could have been low in progesterone, testosterone, estrogen. It depends on her health goals. It depends on what symptoms bother her the most, where are those levels, where is she in her cycle? It depends on so many things. And that is like one of the ways you can kind of tell which doctor should you listen to versus which ones maybe are just offering up a one size fits or a more protocolized type of medicine. Like this is how we do it. We do this and then we do this and then we do this.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

That is something you want to avoid though, again, where to find this unicorn of a clinician is sometimes like the, the, the hardest part.

[Rebecca Minkoff]

I'm always at a loss. I was recommending one person, then they're like, she won't see patients anymore. She's too bugged. And I was like, well, now I got, now I have you, so now I'm going to.

[Dr. Heather Hirsch]

You got it.

[Rebecca Minkoff]

So let's go backwards. What made you interested in this topic? Because I read somewhere and I don't know if it's true that like you get eight hours of like men perimenopause in eight years of medical school.

[Dr. Heather Hirsch]

Yeah.

[Rebecca Minkoff]

So what made you say, let's focus on this?

[Dr. Heather Hirsch]

So it was almost an accident. So when I was in medical school, I always wanted to go into women's health. My father was an obstetrician and I just loved him. He was one of the best people. So positive. Everywhere we went as a little kid, people would come up to him because this is when, you know, there weren't big hospitals. He must have retired in the 80s, so his peak was like in the, you know, 60s and 70s. So he wasn't practicing after I was born. But everywhere we went, he was like the gynecologist in town. Everyone knew him, which must have been awkward for my grandmother. But hey, that's what happened. And so I thought, well, the only way to take care of women is to deliver babies. So I ended up doing an ob GYN year. But I realized that my favorite thing was just talking to patients. I loved talking, and that's hard to do when all of a sudden you have to run to a C section or stay up all night. And then the next day you feel pretty grogg. So I decided to transition into internal medicine.

[Rebecca Minkoff]

What does that cover? Internal medicine?

[Dr. Heather Hirsch]

That is sort of your general practitioner or your primary care doctor. Okay, Yep. So your primary care doctor who does things like blood pressure, cholesterol, you know, checks your labs once a year and does all your preventative tests. This is more like internal medicine. It gets more complicated because these doctors then could go into different specialties. You could go to cardiology from here, gastroenterology, oncology, rheumatology. So that's the fundamental before you become one of those specialists.

[Rebecca Minkoff]

Okay.

[Dr. Heather Hirsch]

So everyone knew me as the former OB GYN girl. So they would run up to me and like, oh, Heather, Heather, Heather, I have a very difficult case. Okay, I have a pregnant lady. Can she take Allegra? And I was like, oh, my goodness, yes. Or they would say, can you do a pap smear? Yes, I can do a Pap smear. I just saw you put an A line in somebody in the icu, but yes, I can help you do a Pap smear. So I then realized there was this, like, gray area in between internists who could handle chronic disease and complicated medication lists, and my gynecology colleagues who could do major surgeries and stay up all night and make big decisions, but didn't have as much training in, like, chronic care management. So anyways, by chance, I ended up doing a fellowship at Cleveland Clinic. And this is 2014. I said, oh, this is my chance. I love contraception and postpartum. But my mentor, Dr. Thacker, was just doing perimenopause and menopause. So in 2014, that is now 11 years ago, I guess, maybe 12.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

People would come from all over the country and they would say, something is so mysteriously wrong with me. Nobody knows what it is. Nobody knows how to help me. And it was just perimenopause or menopause.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

And everything I learned about menopausal hormone therapy at my seemingly top notch residencies was actually not evidence based. So this was the first time I saw someone prescribing MHT or menopausal hormone therapy, like, day in and day out. And I thought to myself, well, this is interesting. And it wasn't until they came back and they were like, you saved my life. You saved my life. You saved my life, that I thought, like, there's something here that I'm missing.

[Rebecca Minkoff]

Yeah.

[Dr. Heather Hirsch]

And so it just became this beautiful place for me to really say, that's where I want to take my career. This is where women are really suffering and no one's giving a shit right now. And so that's what I dedicated my career to for the last 12 plus years.

[Rebecca Minkoff]

Well, thank God, because it seems like this is happening to women when they've, like, they're at their height of, like, confidence of raising children. They're like, through the baby phase. Most of us, they're at. At the top of their, like, just, I've got this, and then this happens and you're like, oh, fuck. Like, it's chutes and ladders and we've just gone down the ladder, you know, And I've talked Openly. Like, in 2014, I was a year postpartum, but, like, the thought of my husband touching me was, like, disgusting. And I knew it wasn't him because he hadn't changed. And I knew it wasn't our marriage because he's a great guy. And I was like, what is wrong? And it wasn't until I got my test back that I was like, oh, that's what's wrong. And so I just know that women are having this happen when it's like, feels like the cruelest time. And do you have words of how you can become more aware of this and steps to maybe prevent ever falling into the abyss?

[Dr. Heather Hirsch]

Yeah. Well, talking about it is, like, one big thing. So having a lot of public figures, whether it's celebrities or politicians or any type of public figure, really talking about a subject that really now, in 2026, doesn't even seem as taboo, but it still is. We're talking about aging and we're talking about our bodies and changes. And so it's really opening up the dialogue. There's so many people to start to kind of think to themselves in, like, the quiet corners of their bed at 1:00am like, oh, could this be what it is? And common things happen commonly. And so anyone with ovaries is going to experience a decline in their ovarian function.

[Rebecca Minkoff]

Right?

[Dr. Heather Hirsch]

And then it's about educating. So what else are these sex hormones doing? Like, the biggest, you know, problem is that we were taught that these sex hormones do sex things. They, you know, cause us to get pregnant and breastfeed. But in fact, the place where they have the biggest impact is probably the brain. Like, the least sexiest of all organs. Although for all of my neurologists, the brain's very sexy. Right. But, you know, it really impacts our executive functioning, our mood, what we're motivated to do even hot flashes stem from the hypothalamus, a part of the brain. And so the next steps about, you know, we've got talking, opening the dialogue and then learning more, having people, you know, kind of share stories, journaling and tracking, which I already talked about, and then about getting down to the facts, finding someone who can actually help you in a way that feels aligned, where you're going forward, not backwards, where you don't feel like you're getting taken advantage of. Because also now this has kind of become, like, a big industry, too. Right? And so.

[Rebecca Minkoff]

And women are so desperate that they'll just be like, yeah, give me all the supplements, give me all the shot, whatever it is.

[LinkedIn Representative]

You're just.

[Dr. Heather Hirsch]

Yes. Women spend so much money, probably on the wrong things. I mean, tons of money on the wrong things. And so then it's kind of about finding a place for women to go and actually get the right care.

[Rebecca Minkoff]

Hey, everyone. Sorry for the quick pause. I want to share something really exciting. Superwoman has a brand new YouTube channel. It's still under construction, but big things are coming in 2026. You'll find past episodes, new episodes, and some bonus content I cannot wait for you to see. Just search SuperWoman Media on YouTube and hit subscribe so you don't miss a thing. Okay, back to the pod. There's a lot of memes online, but it's like, frozen shoulder, nasal, whatever, Anxiety, blah. Hair falling out, low libido. Like, there's like 600 symptoms. And part of me, even though I'm a deep believer in symptoms, is like, okay, this is going too far.

[Dr. Heather Hirsch]

Yeah.

[Rebecca Minkoff]

And now it's like, if anything is wrong with you at all, any day of the week, it's perimenopause. Right, Exactly. And I also think that is weakening the fight for real care, because people are just like, oh, she's another one of those that saw the meme on Instagram.

[Dr. Heather Hirsch]

Yeah.

[Rebecca Minkoff]

So what would you say to women who are like, yes, that's me, that's me, that's me. But, like, we can't have a hundred things going wrong with us, otherwise this species would not survive.

[Dr. Heather Hirsch]

Yeah, I. I agree. In fact, my original motto was, you know, Dr. Hirsch, a no BS approach to menopause. That was like my tagline when I first left Brigham and Women's Hospital and started on my own. And so that's been a couple of years now, but this is now coming back around to, like, oh, my gosh, now we're just kind of blaming everything on one thing. And so it is kind of about reeling it back a little bit to make it actually not so overwhelming. Right. And also not like this one thing's gonna fix this, this list of 200 things that are bothering you. Right. So I think that it's important to just say that there's usually not one thing causing all of these symptoms. It is a mixture of. Like we talked about, you're at the peak of your career often, and you're at the peak of your life, even just if you think about it linearly. Right. And you're thinking about houses and spouses, pets, pets, you know, kids, retirement in laws. All these things are happening. So there is a major stressor in your life, and that impacts just how you sleep and how you're. How you function. Yes, your hormones are declining, and that's a stressor as well. But at the same time, you know, you can. Women can be developing rheumatologic conditions that are unrelated to hormones, maybe, maybe sort of related. You can always. I can always probably make an argument for it. But separate, there is two. Just the natural process of aging. And that's okay. You know, sometimes we'll have like a knee that really hurts or, you know, a little bit of wrinkles. And, you know, this idea of anti aging or that we shouldn't age, that's kind of silly. I think that actually every year is a joy to be smarter and wiser and, you know, have more friends and have deeper connections. So I think pulling it back a little bit and sort of having some discernment, when you kind of see these memes, that all of this could be related to one thing. There's just no way that's humanly possible. Correct.

[Rebecca Minkoff]

I'm glad you said that because I was like, this is getting insane now. Everyone's just blaming everything on this. There's, I feel like an incredible circle of women, whether it's Dr. Marie Claire or Amy Shaw yourself. Where do you guys on the Venn diagram agree? Because I all feel like you have things that. That all make sense. And then where do you sort of say, this is where I differ?

[Dr. Heather Hirsch]

Yeah, well, you know, to be totally honest, I'm not actually sure exactly where we might differ. So it may be more helpful to hear how I do things that I think are indivi, like, unique to me, that I've kind of cultivated along the way. So one of the methods that I kind of teach and talk about a lot is this thing called hormone stacking. And it's something that I learned, actually, over the years of Treating patients. So what it really means, and it's simple, dullest form, is do one thing at a time, right? And there's a lot of hormones. So a lot of women are also on GLP1s. And these are hormones. Or maybe they have hypothyroidism or they're on peptides. Exactly. Other peptides, other peptides. Besides for GLP1 or GIP, they may be on Synthroid or NP Thyroid or a thyroid medication. And then when you think about hormone therapy, that's sometimes a systemic estrogen, a local estrogen progesterone, systemically, if you have your uterus, and sometimes testosterone. So that's four more right there.

[Rebecca Minkoff]

So when, when you say systemically, that means what's your body's already making?

[Dr. Heather Hirsch]

So, great question. Systemic hormone therapy versus local hormone therapy is really just the difference between vaginal estrogens.

[Rebecca Minkoff]

Okay.

[Dr. Heather Hirsch]

And then your estrogen, progesterone and testosterone that are going to go through your whole body. Got it. So the local vaginal estrogens, like estrogen cream or the suppositories, even though they're not in the same way competing for all of the proteins that bind these hormones and move them all around, they're still doing something, even if it's little. So it's like another sort of layer almost. So for me, one thing I think is unique is that for the last 12 years, since my fellowship training, this is all I've been doing. No delivering babies. Most of my career has been sitting with women and just like this, although without the microphones and without the cameras and really listening to them, and then very much taking a stepwise, individualized approach. And this hormone stacking idea is do one thing at a time and get that hormone right. So that's get the dose right, the route, whether it's oral or it's on your skin, get the formulation. So whether that's bioidentical or that's more of a lab based medication, whatever it might be, get that one right first, then add the next. And that is really, really helpful because for the first three years when I was prescribing hormone therapy, I wanted my patients to walk away with everything. In the first visit, I wanted them to be like, okay, I got this. So I'm gonna do my estrogen and then I'm gonna dab my testosterone and then use the vaginal estrogen twice a week. And then they would come back and they'd be like, well, you know, it's overwhelming. The body's going through so many changes. I Just gave them four different hormones, and they're like, and this is going well, but my pinky hurts. And I'm like, which one's causing the pinky to hurt? So that's kind of when I learned through experience, do one thing at a time.

[Rebecca Minkoff]

And may I add, it takes time. Like, I didn't feel the results from the hormones for five months.

[Dr. Heather Hirsch]

Yep, it can take a while.

[Rebecca Minkoff]

And. And my trainer, ironically, he said a girl at the gym was also doing it. She's like, oh, it takes. It can take a while. Like, get ready.

[Dr. Heather Hirsch]

Uhhuh.

[Rebecca Minkoff]

And I was like, I was not prepared for five months. And then it felt like when you get. I don't know if this happens to you, but when you get Novocaine and you feel the medicine travel through your whole body, that, like, old feeling. Yes. And then I was like, that's what it felt like when the hormones kicked in. I could just, like, feel it. Yeah.

[Dr. Heather Hirsch]

It can take absolutely. It can take time. And again, when you try to protocolize that, like, okay, we're going to give you an estrogen patch for me, what if your biggest symptom was anxiety? Sometimes I think about progesterone, and then I want to try that. And then we want to make sure, do we have the right dose? Did that cause any bleeding? And we want to get that right, then add the next thing. So I think that hormone stacking approach is something that I really taught myself. After years of giving everything to my patient upfront, I really actually was doing a disservice by trying to, like, speed up the whole process. And along the same lines, what I think is the most important part of doing this is not so much what should you do first and how to get started. It's actually very easy to get started. It's actually the magic is in that, that, that relationship, and then that changes that you make based on one patient's individual experience with that medication. So my patients react so differently. I could prescribe the same thing to 20 different people and they would have 20 different responses. And so what's most important, and I think what I like to do differently than. Than most is, like, really think through that. Use a lot of shared decision making with my patients. So I really have my patients tap into their intuition. Do you think this dose feels too high? Do you think it too low? And if they're like, I don't know which one, Great, I'll take over then. But it's really a lot of shared decision making. You cannot protocolize it. You just can't that was the very first thing.

[Rebecca Minkoff]

We sat down and we said, no, you can't. And I think also I call, like, tectonic plates, because the minute I get in a groove, I feel like something new shift. I'm like, oh, now I gotta go experiment again. And that is so frustrating. Like, my mom gave me. She has progesterone pills. I do the cream. Yep. So she's like, take the pills. You're gonna sleep like a baby. It's like triple the dose. And I did sleep like a baby, but I had more anxiety than I knew what to do with. And I. It took me, like, two weeks. Like, oh, it's the pills. Even though my sleep was, like, incredible, and I was like, okay, pull back. So I feel like, yeah, the plates are also shifting. So it's not just like, you get your protocol, and you're like, I'm good for the rest of my life. You're like, I'm good for three to six months.

[Dr. Heather Hirsch]

Yep.

[Rebecca Minkoff]

After I've waited five months for it to kick in. And I am going against everything I believe here. I was so sick of taking all the supplements that I take. I take morning supplements at night. And then I think I got Covid a couple weeks ago, and I, like, like, didn't want anything. And I noticed. This is weird. My libido went up.

[Dr. Heather Hirsch]

Uhhuh.

[Rebecca Minkoff]

When I stopped taking all these supplements for my perimenopause. And I was like, now what?

[Dr. Heather Hirsch]

I can totally explain that to you.

[Rebecca Minkoff]

Okay, good. Because I was like, wait, I've been taking all this stuff to, like, help.

[Dr. Heather Hirsch]

Yes. Yes. Okay. So, you know, okay, the light at the end of the tunnel. What was the light for some women, I feel like when perimenopause is so difficult, the body really doesn't like that volatility in hormones. And once we're kind of past that, that season and even into menopause, it gets better. So much easier. And for some women, I find the opposite. Perimenopausal was like a breeze. They didn't even think about it. And then one or two years into not having their period anymore is when the symptoms really start to pile on. So I feel like if one. If one of those cousins is bad, the other is good. So I. I feel like that this is going to kind of sort itself out. That volatility is extraordinarily no to the brain. And that's why it feels like everything shifts because it keeps shifting. And the other point here is really interesting. So it's about the supplements and the supplements is difficult because it is a booming industry. But at the same time, we're definitely at a point where women, as we talked about, are desperate to feel better. And so it's really hard to know if that's what's making them feel better, if it's placebo or if they really need it.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

And so it's. It's really hard to tell. This is why supplements really are best with a clinician.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

It's so easy to just go online and order things at night.

[Rebecca Minkoff]

I have them with a clinician, but I guess they're not a hormone expert.

[Dr. Heather Hirsch]

So it's like, yeah, well, it's also kind of like supplement stacking. Remember I talked about, I'm going to

[Rebecca Minkoff]

supplement, like, I'm going to add them in slowly and see if it does anything slowly.

[Dr. Heather Hirsch]

But a lot of these supplements are metabolized in the liver and when they're metabolized in the liver, that can actually cause your sex hormone binding globulin to go up. And that makes your testosterone that you do have less effective, therefore lowering your libido.

[Rebecca Minkoff]

Wow.

[Dr. Heather Hirsch]

Yeah. So you should supplement stack. I think stacking is something we should like incorporate everywhere, right?

[Rebecca Minkoff]

Yeah. I mean, same with peptides. I do like 10 different peptides and I'm like, I don't know which one is working. I'm just taking them. All right?

[Dr. Heather Hirsch]

Exactly. And so there is a process called like sometimes we'll just do exactly this, we'll just peel them all off again. And sometimes there is a good reason to do that. It's either when my patients say, I don't know if this is even doing anything for me, or I'm like, curious, am I better? Can I come off of these now? And so we'll kind of either wean off of that them. Sometimes it's like a cold turkey because my patients will come on, you know, they'll come on one month, they'll be like, I did something bad. I'm like, you cannot do anything bad. Trust me. And they're like, I stopped everything. I'm like, that's fine.

[Rebecca Minkoff]

Right?

[Dr. Heather Hirsch]

That your body wanted a reset. Right. So I use a lot of shared decision making. Listen to my patients and then wherever they are, meet them where they are. So if they're like, I just, I couldn't take it anymore. I've been. Okay, like, all right, how long have you been off everything? Like a good two date, two fake. Okay, okay, Two weeks. I'm like, okay, great, let's start from there and let's Figure out why did you pull off? So there was some symptom that was bothering you, there was something in your intuition that said this wasn't right.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

And then how do you feel now? Sometimes they feel so much better and then sometimes we just coast like that. Right. Typically, if it's perimenopause, which again, it will happen to everyone. So common things are common. Like something will stir back up again, that trickle will happen and then we'll slowly start over again and then we'll stack if we didn't do it in the first place. Or sometimes it's. It's nice to just restock.

[Rebecca Minkoff]

This industry is interesting because on the one hand, women are desperate and they're going to spend a lot of money, but you can't protocolize anything because each woman is different. So I feel like it'll never get the funding that it deserves because of those, like, it'll just be like one size fits all. Take all the supplements, do all the peptides, do all the hormones, here's a patch, whatever. And then on the flip side, it's like, well, we. You're not a cut and paste. No woman is a cut and paste. So how do you help, help so many women when you have to sit down for an hour and talk to them and you can't scale that?

[Dr. Heather Hirsch]

Really one of the ways I've tried to solve this is by teaching other clinicians. And that's actually been the biggest opportunity, like since I left academic medicine that I didn't know I was going to have. So a lot of my journey through medicine, especially the six years I was in large academic institutions, was trying to explain to the higher ups of the hospital why perimenopause and menopause wasn't like a cute little clinic. It was actually really important both to keep patients once they already had their babies. You know, women are the drivers of health care, so where the mom goes. And also that it also means as, as patients come into the hospital, they will need more touch points with other clinicians. So it's about meeting with the endocrinologist, the neurologist, whoever it might be. It also lowers the cost of healthcare if we treat women accordingly in perimenopause and menopause. But how do you get to a place where you. You don't protocolize it? So it's been a really interesting journey. Since I left academic medicine. I started teaching this course how to prescribe and manage hormone therapy. And I teach this. I almost teach, like, listen to your patients learn how to hormone Stack and I really teach my clinicians not so much a protocol, but more of, like, a philosophy. So what's safe? You know, what do we do with information that we don't know? How do we think outside the box, but keep our patients safe?

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

And then, you know, we go over. Over so many different case scenarios, because then every month we kind of get together, and in going over all these different cases, hopefully I've given them enough, you know, of this confidence to sort of start to think, like, how to treat patients in a philosophical way, like how to follow the philosophy, but not exactly the protocol. So training clinicians is an incredible thing because while I love helping, you know, women learn this, and that's a lot of what I do is teaching. So even with my patients, I'm teaching them all day. But if I can teach one clinician, here's, she is going to probably touch a couple thousand patients in their lifetime. So that's how I can hopefully get this to go farther than just, like, one practice. You know, I'm also working on utilizing AI.

[Rebecca Minkoff]

That was my next question is, do you think AI is good at this?

[Dr. Heather Hirsch]

Yes.

[Rebecca Minkoff]

Well, so even though it was built by men.

[Dr. Heather Hirsch]

Right. So not yet, but I'm hoping to change this. So for the last three years, I've kind of been secretly working on another project which is taking all of this intellectual property and trying to train a model so that it can help not so much, well, clinicians and patients, but in a way so that how could patients get expert care but not, you know, have to pay so far out of pocket, because that's not accessible for everybody. So the answer would be maybe using artificial intelligence. So I've been mucking around, if you will, with, like, how can I get an AI, Dr. Hirsch, to understand the nuances of prescribing and stacking or for patients in that way.

[Rebecca Minkoff]

That's really exciting because, again, financially, everyone probably has access to a computer at this point or a phone, but not necessarily you. So what would you say to someone listening who's like, I've totally lost myself, and where do they start? And if they can't come to New York and see you, how do they take that first step?

[Dr. Heather Hirsch]

What I would say is, first of all, that feeling is really normal, and it's okay to just acknowledge that feeling that you feel. Feel completely unlike yourself. Whether you have so much brain fog and you feel like, the places where you're the most confident, you don't feel anymore. You look in the mirror and you literally don't recognize the same person. So you don't look the same, you don't sound the same. The things that used to excite you don't excite you anymore. Actually, that is. That's more common than anything. This feeling of not feeling like myself is. Is very common. So the first is just acceptance. The second, though, is I love my journal and tracking because it's like, like, so easy, but so actionable. Okay. The very first thing is to start to think about what really bothers you the most. And I always used to say to my patients, like, if I had a magic wand behind this chair and I could, like, fix one thing, what would it be? And the point of that is just tend to say, you know what? I think if I slept better, then I wouldn't be so moody and I'd have less brain fog. And then I'd get up, and I used to get up and go to the gym and make my own food. And one thing can sometimes be like a major domino effect. And you have to just kind of start by looking at yourself symptoms. It's kind of like you can't know where you want to go until you know where you are now. So sometimes, just like anything, if you're in debt and you want to get out of debt, if you're, you know, wanting to run a race but you haven't gotten off the couch, you have to figure out where you want to go, but where are you now? So that's the whole journaling and tracking and then thinking about what are the biggest symptoms that I kind of want help with. And then it's about being a little bit proactive. So there's so many great books. There's great places to start. I always say, use your discernment, and there are lots of clinicians, but find the one that you resonate with. If somebody either just has the right attitude for you or has a philosophy that you like or you gravitate towards, do that, because there's. There are options. And start with one of their books, or maybe they have something on socials or videos and dig in there. Because once you start learning about the topic, you feel more empowered. Then that last piece is, find the right clinician to help you. And we are in this scenario right now where very often, outside of the specialists, a lot of women find that they do do. Basically, they get their Ph.D. like, you know, within a few weeks. Then they go to see their clinician, and they know more than their clinician.

[Rebecca Minkoff]

And their clinician is like, you don't know what you're talking about, I went to medical school.

[Dr. Heather Hirsch]

Yeah.

[Rebecca Minkoff]

So you're gonna listen to me.

[Dr. Heather Hirsch]

That is that frustrating tension that's probably gonna exist for a little bit more. And again, I'm working on that and really educating clinicians, that's part of my mission. I really wanna, you know, treat the patients, but also train the clinicians. But, you know, the more, you know, sometimes, sometimes if you do find the right clinician where you can kind of say, look, you know, I do think this is the right thing for me, or can we talk about using? I always say, bring up the shared decision making, bring up the quality of life to your clinician, and hopefully they can just start getting you on the path somewhere. Because somewhere is honestly sometimes even better than, you know, not being treated at all. And then again, top of mind for me is always, you know, safety as well. So I just want to make sure that my patients are using discernment with what they're using and they feel confident about it and where it comes from, from.

[Rebecca Minkoff]

And also your book, which came out in October.

[Dr. Heather Hirsch]

Yeah.

[Rebecca Minkoff]

Is also a great place to start.

[Dr. Heather Hirsch]

My book, the Perimenopause Survival Guide, is I love. What I love about it is the way I've written it is kind of part two is like a choose your own adventure. And I think this is exactly what I was saying before. If you can find one thing that if you fix that, things will start to get better, that's kind of what I call the big win. If you can get a win, it doesn't mean every everything's perfect, but then you feel a little bit better, so you can tackle all the nuances. So that's kind of the way I wrote the Perimenopause Survival Guide. And it's perfect for anyone who is still having periods or ovulating and going through this frustrating time.

[Rebecca Minkoff]

Oh, my God, it's so frustrating. If perimenopause was treated as a leadership issue and not just a private health issue, what would that look like to you?

What would the world look like?

[Dr. Heather Hirsch]

I think a lot about how far women have come in terms of lactation rates, rooms. And I think what's the lactation room for? Perimenopause.

[Rebecca Minkoff]

Yes.

[Dr. Heather Hirsch]

Right.

[Rebecca Minkoff]

The rage room.

[Dr. Heather Hirsch]

Exactly. I think about what is this? And you know what? I think it might be access to care or one to two days off a month to get care.

[LinkedIn Representative]

Right.

[Dr. Heather Hirsch]

Because that's what basically when we're breastfeeding, if, you know, I used to. Oh, my gosh. I pumped everywhere. I had three kids, so I Pumped an office with guys. Then I had the ones where you can still walk around and, you know, whatever. But if you think about how much time it took a month, if you put all that time together, it's probably about a half of a day or a day. So women deserve to get care, and that takes time. And so I don't necessarily think that women need colder offices. That might help, but that's not at all. That's just scratching the surface. I think the lactation room for perimenopause is, if benefits are tied into work, like have this be a benefit and not just a colder office office or less starchy uniforms, that's great. But women need a half a day off, one day off, two days off a month to see their clinicians and start the right care. Because just like you said, it takes time. It takes time to find the right clinician, to get your labs drawn, to get them analyzed and to start on treatment. That I think is going to be the new lactation room. There was a big study actually done in 2015 that we're losing tons of money on our female employees. But it's not their fault, you know, and it's not just the loss of productivity. It's the loss of work because they're going to see so many different clinicians. But the more we know and we start to, instead of thinking about this as like eight different problems but just one, the faster they'll get to where they need to be to be healthier. Women love to contribute. They love their jobs. Oftentimes they love feeling their passion. That feeling of brain fog is actually what affects quality of life the most for women.

[Rebecca Minkoff]

Right.

[Dr. Heather Hirsch]

So if we can get right to the source, we can help the economy, we can help families, we can help

[Rebecca Minkoff]

so many things when, like perimeter divorce rates will plumish. I think Mindy Pelt said that if we could just get women on hormones, like, probably wouldn't be 50%.

[Dr. Heather Hirsch]

So if we kind of have. If perimenopause is now sort of, we're trying to find the new lactation room for it. You know, I think in order to capitalize on the incredible careers that women have already built, their families that they've spent so long, you know, curating and, and, and really putting all this thoughtfulness into, you know, helping to treat women at that time is going to make all of these things better, which we will all benefit from as a society. Right? Even relationships.

[Rebecca Minkoff]

Totally. I agree with you on the relation. It's such a big piece of it. It's wild to me. So for those listening, where can they start? They can buy your book. Where I'm assuming it's available everywhere books are sold.

[Dr. Heather Hirsch]

Yeah. Yeah.

[Rebecca Minkoff]

They can listen to you on your podcast. What's the, what's it called?

[Dr. Heather Hirsch]

Yes, my podcast is called Health by Heather Hirsch.

[Rebecca Minkoff]

Okay. They can maybe come see you.

[Dr. Heather Hirsch]

Yes. And actually I have a medicine practice and about 11 clinicians who work with me and that's the collaborative. So the website is. Join the Collaborative.

[Rebecca Minkoff]

Love that. Thank God. Because I hate sending people to someone who turns them down.

[Dr. Heather Hirsch]

Yep.

[Rebecca Minkoff]

No. And what would your last piece of advice for a hot, sweaty, low libido, angry, anxious, losing hair listener? Need to hear from you today.

[Dr. Heather Hirsch]

I think that there is hope. There's a lot of hope for, for you. A decade ago, we've come so far from then where you had to go to the mistake on the lake, which was Cleveland, and beg for menopausal hormone therapy and then just be looked at like it was kryptonite. We've come so far. And the good news is, is that in finding, you know, the right treatment or even being along the journey, you're going to learn so much about your body and you are going to get to feeling better. So that is the great news. We have FDA approved treatment. We've got lots of different options. We've got things that fit everybody. So, you know, that would be my last thing is this positivity of there is so much that can be done to help support you and you're going to get there.

[Rebecca Minkoff]

I love it. Thank you, Dr. Heather Hirsch, for coming on today.

[Dr. Heather Hirsch]

Thank you for having me.

[Rebecca Minkoff]

Thanks so much for watching today's episode.

Before you head out, I want to

invite you to my brand new YouTube

channel for all things super women.

It's a fresh space I'm building out for 2026, packed with past episodes, future episodes, and some special new content we're cooking up. Just search SuperWoman Media on YouTube and subscribe so you're there for everything coming next. I'll see you over there. Thanks for listening to today's episode. If you've enjoyed it, take a second to rate and review the show.

Wherever you're tuning in, it really helps

others find the podcast. You can follow me on Instagram, Rebecca Minkoff and at @RMSuperWoman. Or for a slice into my personal life at BeckyMetall. And don't forget to check out my

[Dr. Heather Hirsch]

book, Fearless the New Rules for Unlocking

[Rebecca Minkoff]

Creativity, Courage and Success. See you next week.