Ep. 258 The Basics of “How To” for HRT Management: Effective and Safe Prescribing with Dr. Rachel Rubin

Sep 2, 2025

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When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women.
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SYNPOSIS
Dr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health.
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TIMESTAMPS
00:00 - Introduction
03:41 - Challenges in Menopause Medicine
07:21 - Misconceptions and Risks of HRT
15:35 - Understanding Bioidentical Hormones
18:48 - WHI Studies and Their Impact
23:21 - Practical Guide to Prescribing HRT
33:47 - Understanding Estrogen Levels and Risks
36:04 - Debating Gels vs. Patches
37:51 - Concerns with Compounded Products and Pellets
38:50 - Patient Education and Meeting Them Where They Are
42:12 - Progesterone Benefits and Sensitivities
46:38 - Testosterone Therapy for Women
51:36 - The Importance of Lab Tests
55:39 - DHEA and Vaginal Health
57:14 - Advocacy for Accurate Hormone Therapy Information
01:00:05 - Conclusion and Final Thoughts
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RESOURCES
The Peter Attia Drive episode with Dr. Rachel Rubin:
https://peterattiamd.com/rachelrubin/
FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women:
https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4m
Dr. Rachel Rubin’s Hormone Therapy for Early Adopters Course:
https://rachelrubinmd.thinkific.com/courses/MHTCME