Julia Ordway on the consequence of hormone supplementation in a postmenopausal woman

The legacy of the 2002 Women’s Health Initiative (WHI) study continues to shape the landscape of menopause management. According to Julia Ordway, a third-year medical student at Tulane University School of Medicine and speaker at the 2026 ISSWSH meeting, the dissemination to the media of the erroneous report… has led to a reluctance of providers to prescribe HRT and thus a failure to meet their patients' needs,” according to the ISSWSH abstract.

This gap has allowed alternative clinics to thrive by promoting unregulated, compounded hormone treatments that often lack FDA oversight.

The danger of unregulated pellets

Ordway presented a case study of a postmenopausal woman who sought care at an anti-aging clinic for 4 years, receiving 16 testosterone pellets. Upon presentation to a traditional clinical setting, the patient exhibited severe bloating, weight gain, and mood instability. Laboratory analysis revealed serum testosterone levels exceeding 200 times the upper limit of the normal female physiologic range.

“These compounded hormones are often marketed as safer, but they don't have to go through the same regulatory process,” Ordway explained. She noted that while FDA-approved products must include safety labels, compounded alternatives do not, which creates a false sense of security.

“The pellets are also tricky because once [they’re] in, you can't exactly take [them] out,” she added.

Navigating withdrawal and recovery

The patient’s recovery underscored the severity of hormonal mismanagement. After discontinuing the pellets to restore physiologic levels, the woman experienced profound withdrawal symptoms, including heightened mood instability and loss of libido. Because the patient originally sought treatment for genuine menopausal distress, HRT had to be slowly reintroduced. The abstract noted that the patient did not return to a "sense of normalcy" regarding her physical and mental health for 2 years.

“You really shouldn't be going through testosterone withdrawal if you're staying within this normal level,” Ordway said, emphasizing that the goal of HRT is to return hormones to pre-menopausal physiologic ranges rather than supraphysiologic levels.

Clinical recommendations

Ordway advocated for stricter adherence to established guidelines, such as those provided by ISSWSH. She emphasized that while testosterone is a "wonderful way" to achieve relief, it requires careful monitoring of serum levels and symptoms.

"This case demonstrates the importance of using consistent FDA approved products with appropriate dosing, so women can safely achieve the relief they deserve," the study concluded.

Reference:

Ordway J. A Consequence of Excessive Hormone Supplementation in a Postmenopausal Woman. Poster. Presented at: ISSWSH. February 12-15, 2026. Long Beach, California.