Is estrogen really the villain it's been made out to be? In this Quick Hits episode, Dr. Lindsey Berkson, a hormone scholar and functional medicine thought leader, takes on the most persistent myths about estrogen hormone replacement therapy. She covers the breast cancer fear, the overlooked protective roles of progesterone and testosterone, and why individualized dosing matters so much for women in perimenopause and menopause.
Few hormones have been misunderstood as badly as estrogen. For more than two decades, many women have been told that estrogen hormone replacement therapy causes breast cancer, that it's dangerous by default, and that toughing out menopause is the safer choice. Much of that fear still shapes the conversations women have with their doctors today.
In this Quick Hits episode, I'm revisiting one of my favorite conversations with Dr. Devaki Lindsey Berkson, a thought leader in functional medicine with a focus on hormones, nutrition, digestion, and intimacy. Dr. Berkson served as a distinguished hormone scholar at an estrogen think tank at Tulane University, a role she was given after writing one of the first breakthrough books on endocrine disruption. She has spent years studying how estrogen actually behaves in the body, including in women who have survived breast cancer.
We get into why estrogen isn't simply a cancer-causing hormone, why progesterone and testosterone deserve far more credit than they get, and why a one-size-fits-all approach to hormone dosing can backfire. If you've felt scared off HRT, or confused by conflicting information online, this is a conversation worth hearing.
The relationship between estrogen HRT and breast cancer is more complicated than "estrogen causes cancer." In this episode, Dr. Berkson explains that estrogen alone is not responsible for driving cancer growth, and that current research suggests estrogen may have protective effects in some contexts. Risk can vary depending on the type of hormone, the dose, how it's delivered, whether progestogens are used, and a woman's personal and family history. Any woman weighing HRT should review her individual risk profile with a qualified clinician.
Progesterone and testosterone support hormone balance and are often overlooked in conversations focused on estrogen. Dr. Berkson describes both as having protective roles. For women taking estrogen who still have a uterus, progesterone is typically used to protect the uterine lining. Testosterone, while often associated with men, is also an important hormone for women and may influence energy, libido, and muscle.
Yes, in some women, higher doses of progesterone can cause unwanted effects. In the episode, Dr. Berkson explains that high-dose oral progesterone can lead to issues like depression and breast tissue inflammation. This doesn't mean progesterone is harmful for everyone. It means dose and delivery method matter, and any changes to your prescription should be made with your clinician.
Women respond differently to the same hormone dose because of differences in receptors, metabolism, symptoms, and health history. A standard dose that works well for one woman may be too much or too little for another. Dr. Berkson explains that a one-size-fits-all approach can potentially be harmful, which is why ongoing monitoring of both symptoms and lab testing is so important.
It may be possible in some cases, but it should only be considered in close collaboration with an oncologist. Dr. Berkson discusses innovative uses of estrogen therapy that she believes may benefit certain breast cancer patients, and she covers the topic in her eBook for survivors. Because each cancer and treatment history is different, this is never a decision to make without your oncology team.
Estrogen appears to support healthy metabolism, and Dr. Berkson discusses how it may help reduce the risk of type 2 diabetes. As estrogen declines during perimenopause and menopause, many women notice changes in weight, blood sugar, and energy. These shifts are one reason midlife metabolic health deserves attention alongside symptom relief.
Yes. Dr. Berkson emphasizes that nutrition and lifestyle interact with hormones and influence overall health. Diet, digestion, and daily habits can affect how hormones are metabolized and how well they work. HRT tends to work best as part of a broader approach rather than as a standalone fix.
About Dr. Lindsey Berkson
Dr. Devaki Lindsey Berkson is a thought leader in functional medicine with an emphasis on hormones, nutrition, digestion, and intimacy. She was a distinguished hormone scholar at an estrogen think tank at Tulane University, a role that followed her authorship of one of the first breakthrough books on endocrine disruption. She is known for her in-depth work on estrogen, and she offers an eBook on hormones for breast cancer survivors at DrLindseyBerkson.com
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