WOMEN'S HORMONE REPLACEMENT THERAPY TRAINING
Women's HRT training built on physiology, not protocols
Why women's hormone therapy is more complex than most training prepares you for
Female hormone physiology is not a single-variable system. Estrogen, progesterone, testosterone, thyroid, cortisol, and insulin all interact. When one shifts, the others respond. When several shift at once (as they do in perimenopause, postpartum, PCOS, and endometriosis) the clinical picture becomes something that protocols alone cannot navigate.
A Common Presentation
A woman in her early 40s presents with worsening anxiety, disrupted sleep, and weight gain concentrated around her midsection. Her labs are “normal.” Her TSH is 3.8. Her progesterone was never checked. She has been on an SSRI for two years with minimal improvement.
This presentation is not unusual. It is one of the most common patterns in early perimenopause, and it is routinely missed because most providers were never trained to connect these systems.
Women’s HRT education needs to cover how estrogen and progesterone function as opposing regulatory forces, how thyroid insufficiency compounds hormonal imbalance, how environmental estrogen exposure shifts the baseline, and how the gut, liver, and adrenals all participate in the hormonal picture.
Perimenopause & Menopause
Perimenopause and menopause HRT training: what providers need to understand
Perimenopause is not a switch. It is a transition that can begin in the late 30s and last a decade, producing symptoms that overlap with thyroid dysfunction, mood disorders, metabolic syndrome, and adrenal insufficiency. Menopause marks a defined hormonal state, but the clinical complexity does not end there.
Providers trained in women’s HRT need to understand:
The physiology of the perimenopause transition
How progesterone declines first, how estrogen fluctuates before it falls, why symptoms often peak years before a woman is technically “menopausal,” and why labs during this window are frequently misleading.
Estradiol and progesterone prescribing across the transition
Not a single protocol. Dosing strategies that account for where a woman is in the transition, whether she is cycling or not, and how her metabolic and thyroid status influence hormone metabolism.
Testosterone in perimenopausal and menopausal women
Testosterone is not optional in women’s HRT. Indications, dosing, monitoring, and how it fits alongside estrogen and progesterone in the broader hormonal picture.
Risk management based on physiology, not fear
How to think about breast health, cardiovascular risk, and clotting in the context of bioidentical hormone therapy. Clinical decision making rooted in mechanism rather than headlines.
The HRTU Master Course covers all of this in Module 03 (Female HRT Across the Lifespan, 19 lessons) and extends into advanced presentations in Module 04.
Women's HRT Curriculum
What comprehensive women's HRT training should cover
The HRTU Master Course addresses female hormone therapy across two dedicated modules, plus the supporting systems (thyroid, metabolic, adjunct) that determine whether treatment actually works.
03
19 Lessons · 4+ Hours
Female HRT Across the Lifespan
Foundational female module. Physiology and prescribing from reproductive years through perimenopause through postmenopause.
Menstrual Cycle Physiology
Progesterone as Neurosteroid
Estradiol Management
Female Testosterone
Birth Control Considerations
Menstrual cycle physiology and lab interpretation
Foundational female module. Physiology and prescribing from reproductive years through perimenopause through postmenopause.
Progesterone: far more than endometrial protection
Progesterone as a neurosteroid that converts to allopregnanolone and modulates GABA receptors. Deficiency patterns, dosing strategies, and side effect management.
Estradiol production, administration, and risk management
How estradiol supports cognition, bone density, mitochondrial function, mood, and libido. Dosing philosophy based on physiology rather than fear.
Female testosterone integration
Indications, dosing, monitoring, and how testosterone fits alongside estrogen and progesterone.
04
28 Lessons · 6+ Hours
Advanced Female Hormone Therapy
The complex conditions most providers refer out. Twenty-eight lessons going further than any comparable program.
PCOS
Endometriosis
PMDD
Postpartum
Fertility
Libido
Breast Health
GLP-1 Microdosing
Hair Loss
PCOS: 5 lessons on diagnosis, labs, myths, and treatment
Reframed as a metabolic disease involving insulin resistance, estrogen dominance, and ovulatory dysfunction. Fasting insulin interpretation (not just glucose or A1c), SHBG and androgen panels, and a full treatment stack: progesterone, thyroid support, LDN, myoinositol, GLP-1 microdosing, and when to use spironolactone.
Endometriosis and adenomyosis: 4 lessons
Conventional treatment has a 50% recurrence rate in 5 years. The course teaches endometriosis as a systemic disorder driven by LPS, gut dysbiosis, and peritoneal inflammation. Treatment through progesterone, thyroid support, and LDN targets the root cause, not just symptom suppression.
PMDD: pro-metabolic treatment
PMDD reflects the body's failure to adapt to hormonal shifts due to stressors, estrogen excess, and inflammation. Progesterone (200-400mg) often works as well as brexanolone by restoring allopregnanolone, the neurosteroid that modulates GABA. Includes thyroid and calcium protocols.
Postpartum depression, anxiety, and OCD
Progesterone is safe in breastfeeding, supports brain development, and does not affect lactation. The course covers starting progesterone before labor for patients with a history of PPD, thyroid screening for TPO antibodies, and the role of testosterone, oxytocin, and melatonin in postpartum recovery.
Fertility, libido, and sexual health (HSDD)
Fertility addressed as a direct application of the hormonal framework. Libido treated as a clinical priority with specific tools: PT-141 microdosing, oxytocin protocols, topical testosterone and estradiol, PDE5 inhibitors, PRP, and pulse wave therapy. Comprehensive enough to build a sexual health practice.
Breast health and HRT safety
Evidence-based risk assessment: bioidentical progesterone shows no increased breast cancer risk. Testosterone interacts with androgen receptors to inhibit cancer growth. The course covers when to continue HRT after breast cancer, shared decision-making frameworks, and why the risk of CVD, fractures, and dementia often outweighs breast cancer risk.
GLP-1 microdosing and hormonal hair loss
GLP-1 agonist microdosing protocols for PCOS and metabolic support. Hormonal hair loss addressed through its upstream drivers: low progesterone, thyroid, iron, zinc, and high cortisol. Includes compounded hair serum formulations.
Supporting modules that complete the picture
The Metabolic Foundation
Every clinical concept in the course traces back to energy metabolism. Oxidative phosphorylation, mitochondrial function, and the metabolic disruptors that push cells toward dysfunction. Without this lens, hormone prescribing is guesswork. With it, you understand why a patient is not responding.
Thyroid Optimization
Thyroid function interacts directly with sex hormones and metabolism. TSH, free T3, free T4, reverse T3, thyroid antibody interpretation, subclinical versus overt hypothyroidism, and when to include T3. If thyroid is not addressed, women’s HRT optimization is incomplete.
Adjunct Hormones
DHEA, pregnenolone, oxytocin, melatonin. The tools that complete the hormonal picture when the core hormones are not enough on their own.
Advanced Conditions
PCOS, endometriosis, and PMDD: what women's HRT training should address
These are among the most common and most mismanaged conditions in female endocrinology. Most HRT training programs either skip them entirely or cover them in a single lecture. The HRTU Advanced Female module dedicates 28 lessons to these presentations because they require the same depth of clinical reasoning as any other complex medical condition.
PCOS training for providers
Most PCOS education reduces the condition to an androgen problem. The course reframes it as a metabolic disease: insulin resistance lowers SHBG and stimulates ovarian androgen production. Fasting insulin (not glucose or A1c) is the most sensitive marker. Treatment includes progesterone, thyroid optimization, myoinositol, LDN, and GLP-1 microdosing.
PMDD and progesterone metabolism
PMDD is not a psychiatric disorder. It reflects the body's failure to convert progesterone to allopregnanolone, the neurosteroid that modulates GABA receptors. Progesterone (200-400mg) often works as well as brexanolone. The course teaches a pro-metabolic treatment model with thyroid and calcium support.
Endometriosis clinical framework
Conventional treatment (birth control, GnRH antagonists, surgery) has a 50% recurrence rate in 5 years. The course teaches endometriosis through the endotoxin pathway: LPS and gut dysbiosis drive peritoneal inflammation and lesion growth. Treatment targets the root cause with progesterone, thyroid support, and LDN.
Postpartum hormonal disorders
SSRIs are first-line but may impact offspring neurodevelopment. Progesterone is safe in breastfeeding, does not affect lactation, and can be started before labor in patients with a history of PPD. The course also covers postpartum OCD (linked to low progesterone and oxytocin) and thyroid screening for TPO antibodies.
Physiology First
Why physiology-first women's HRT
education matters
Protocol-based programs teach what to prescribe. They work until the patient does not respond the way the protocol predicted.
Physiology-first training builds a framework for clinical reasoning. When you understand how estrogen and progesterone behave at the cellular level, how thyroid and insulin interact with sex hormones, you can reason through novel presentations instead of freezing when the case gets complicated.
That is the difference between training that gives you confidence for a month and training that changes how you practice.
The course is built on a metabolic foundation that connects every hormone to cellular energy production and mitochondrial function.
The HRTU Master Course integrates six modules into a single curriculum because that is how the physiology actually works. Female-specific content (Modules 03 and 04) represents the largest portion of the course (47 lessons, 10+ hours), but every other module makes the women's content more effective.
Who It's For
Women's HRT certification
and training: which
providers benefit
The HRTU Master Course is built for licensed providers who prescribe: nurse practitioners, physicians (MDs and DOs), and physician assistants.
Providers newer to women's HRT
The HRTU Master Course is built for licensed providers who prescribe: nurse practitioners, physicians (MDs and DOs), and physician assistants.
Providers with some HRT experience
Many students arrive after completing another program and still feeling uncertain. That is not a failure. It is a signal that protocol-based training left gaps. HRTU fills them by teaching the reasoning underneath the protocols.
Experienced HRT providers
The Advanced Female module covers PCOS, endometriosis, PMDD, postpartum, and complex metabolic presentations that most programs do not touch. Designed for clinicians who want to move from competent to expert.
Nurse practitioners adding women's HRT
NPs who add women’s HRT can build meaningful, independent patient relationships. In most U.S. states, NPs with full practice authority can prescribe both compounded and FDA-approved bioidentical hormones.
This course is jointly accredited through Pinnacle Conference, LLC (ACCME, ACPE, and ANCC).
Accreditation
Jointly accredited through Pinnacle Conference, LLC (ACCME, ACPE, and ANCC). 30 CE hours, including 12 hours of pharmacology. Meets credentialing standards for nurse practitioners, physicians, and physician assistants.
Integrated Curriculum
Why comprehensive women's HRT training includes thyroid, metabolic, and adjunct hormones
Hormones do not operate in isolation, and neither should the training. Estrogen, progesterone, and testosterone interact with thyroid, cortisol, and insulin at the metabolic level. Strip any of those out and you are treating hormones as isolated variables, which is the exact problem most providers are trying to solve.
The female-specific content is substantial: Module 03 (19 lessons) and Module 04 (28 lessons) together represent the largest portion of the course. You are not getting less women’s training because it is part of a larger program. You are getting more, because every other module makes the women’s content more useful.
Estrogen, progesterone, testosterone. Hormones are one interconnected system.
Go Deeper
The Master Course
Six modules. Thirty CEs. Jointly accredited. The physiological framework that holds when the guidelines do not.
Beyond the Course
Continuing support
after the Master Course
The Master Course builds the foundation. For providers who want ongoing
support, HRTU offers additional tools and community, available separately.
Pearl
An AI clinical thinking partner built on the same framework Nico teaches. Available as a separate subscription for course graduates.
Clinical community
A space where providers work through real cases together and share clinical reasoning. Membership is separate from the course.
Continued learning
Advanced content, live case discussions, and evolving research integration. Available to providers who want to go deeper after completing the course.
What the Course Actually Teaches
Clinical questions
this training answers
These are the kinds of questions providers bring to the Master Course. If you have been asking them, the course was built for you.
Why do my patients' labs look "normal" when they clearly are not?
Most providers never check progesterone, and when they do, they draw it on the wrong cycle day. The course teaches when to draw labs (day 21 for premenopause, any day AM for peri/post), what optimal ranges actually look like (progesterone above 10-12 ng/mL in the luteal phase, fasting insulin under 7), and why “normal” reference ranges routinely miss the clinical story.
My patient's TSH is 2.5 and she is still exhausted. Now what?
TSH is not a reliable symptom indicator. Free T3 is more clinically meaningful, and optimal TSH is under 1.0, not “under 4.5.” The thyroid module covers why suboptimal TSH drives inflammation and catabolism, when to add T3 to desiccated thyroid, how to interpret TPO antibodies, and why thyroid must be addressed before women’s HRT optimization can work.
Is progesterone just for endometrial protection?
That is the most common misconception in women’s HRT. Progesterone is a neurosteroid that converts to allopregnanolone and modulates GABA receptors. It supports brain function, myelination, bone density, cardiovascular health, and mitochondrial function. The course covers deficiency patterns, dosing across premenopause through postmenopause, and why increasing progesterone (not lowering estrogen) is the first move for breakthrough bleeding.
What do I actually prescribe for PCOS beyond birth control?
Birth control masks symptoms without addressing root causes and can accelerate ovarian aging. The Advanced Female module teaches a full treatment stack built on metabolic physiology: progesterone, thyroid optimization, myoinositol, LDN, and GLP-1 microdosing. Five lessons cover diagnosis, labs, myths, and treatment.
Is bioidentical HRT safe for patients with a history of breast cancer?
The course covers the evidence: bioidentical progesterone shows no increased recurrence risk, and testosterone interacts with androgen receptors to inhibit cancer growth. Four lessons address risk assessment through physiology, shared decision-making frameworks, and when to consider resuming HRT after remission.
When do I add DHEA or pregnenolone to a female patient's protocol?
The adjunct module covers the hormones that complete the picture when estrogen, progesterone, and testosterone are not enough. DHEA supports immune health and cognition (optimal 200-300 ng/dL in women). Pregnenolone is the precursor to all steroid hormones with anti-stress and anti-inflammatory properties. The course teaches when each is indicated, dosing by age, and how they fit alongside the core hormones.
FAQ
Women's HRT training:
frequently asked questions
Who should take a women's HRT training course?
The adjunct module covers the hormones that complete the picture when estrogen, progesterone, and testosterone are not enough. DHEA supports immune health and cognition (optimal 200-300 ng/dL in women). Pregnenolone is the precursor to all steroid hormones with anti-stress and anti-inflammatory properties. The course teaches when each is indicated, dosing by age, and how they fit alongside the core hormones.
What does the HRTU Female module cover?
Module 03 (Female HRT Across the Lifespan) includes 19 lessons: menstrual cycle physiology, progesterone physiology and dosing, estradiol administration strategies, female testosterone integration, hormonal birth control considerations, and clinical decision-making frameworks. Built on the metabolic foundation taught in Module 01.
What is the difference between the Female and Advanced Female modules?
Module 03 covers foundational hormone physiology, lab interpretation, prescribing, and clinical decision making. Module 04 (28 lessons) goes deeper: PCOS, endometriosis, PMDD, postpartum disorders, fertility, libido, breast health, GLP-1 microdosing, and hormonal hair loss.
Can nurse practitioners prescribe HRT for women?
Does the course cover perimenopause and menopause specifically?
Yes. Module 03 covers the full female lifespan, including the perimenopause transition, menopausal hormone therapy, and postmenopausal management. The course teaches how progesterone declines first, how estrogen fluctuates before it falls, and why symptoms peak years before a woman is technically menopausal.
Is there a standalone women's HRT course at HRTU?
The women’s content is part of the integrated Master Course because that is how the physiology works. Estrogen, progesterone, and testosterone interact with thyroid, cortisol, and insulin. The female-specific modules (03 and 04) represent the largest portion of the course: 47 lessons, 10+ hours.
Does the course cover PCOS, endometriosis, and PMDD?
Yes. The Advanced Female module (Module 04) dedicates detailed lessons to each. PCOS is taught through metabolic physiology, endometriosis through the endotoxin pathway, and PMDD through progesterone metabolism and allopregnanolone production.
How is HRTU different from other women's HRT training programs?
Most programs teach protocols. HRTU teaches the physiology and clinical reasoning underneath the protocols. The course is built on a metabolic foundation, covers male and female HRT plus thyroid and adjuncts in one integrated curriculum, is jointly accredited with 30 CE hours including 12 pharmacology, and includes options to upgrade for post-course support.
How long does the Master Course take to complete?
The course is fully online and self-paced. 30 hours of CE content across six modules. Most students complete it over several weeks alongside their clinical schedule.
Learn more about the Master Course
See the full curriculum, accreditation details, tuition, and what other providers are saying.
Or start with Nico’s daily email or the HRT University Podcast.