Interview with Dr Susan Ward: The Truth About Hormone Replacement Therapy

Dr. Susan Ward (Left) , Shannon Chabaid (Right)

Shannon Chabaud (SC):  Dr Susan Ward, thank you so much for joining me today. Let’s dive straight in — there’s still a lot of confusion around HRT. Why is it so important to personalise hormone therapy rather than take a one-size-fits-all approach?

Dr Susan Ward (SW):  Absolutely, Shannon. Hormones are powerful chemical messengers, and how we metabolise and respond to them can vary greatly from person to person. Factors like age, stress levels, genetics, detoxification pathways, liver function, and lifestyle habits all play a role. That’s why HRT should be guided by both symptom relief and functional testing — not just static doses or generalised protocols.

SC: Some people think estrogen is the main hormone to focus on in HRT — but that’s a common misconception, right?

SW: Absolutely. Estrogen is just one piece of the hormonal symphony — and for women who still have a uterus, we must balance estrogen with progesterone to protect against endometrial cancer. There are different types of estrogen — estradiol, estrone, and estriol — and how each is processed in the body matters. Some women convert estrogen down more inflammatory pathways, which can lead to symptoms like anxiety, breast tenderness, or stubborn weight gain. So we don’t just look at blood levels — we assess how estrogen is metabolised and cleared by the liver.

SC: And that’s where the DUTCH test comes in?

SW: Yes. The DUTCH (Dried Urine Test for Comprehensive Hormones) is an incredible tool. It shows levels of estrogen, progesterone, testosterone, DHEA, cortisol, melatonin — and most importantly, how your body processes and detoxifies them. It gives us insight into liver methylation, oxidative stress, adrenal function — all of which guide how we tailor HRT. But we always start with a thorough medical history, including modifiable lifestyle factors like stress, sleep, diet, and environmental exposures. The testing is layered on top of that foundation to create truly personalised care.

SC: We often forget about testosterone, DHEA, and pregnenolone in women. Can you explain why they matter?

SW: Absolutely. These androgens and precursors are vital for brain function, libido, bone density, and energy.

• Testosterone supports muscle mass, confidence, drive, and libido.

• DHEA is a precursor to both testosterone and estrogen and supports the adrenals.

• Pregnenolone is known as the “mother hormone” — it supports memory, mood, and resilience.

Even low doses — especially in microdosed, liposomal, or transdermal forms — can be powerful. For example, microdosing DHEA can reduce anxiety, support mood stability, and gently nourish the system without overstimulation.

SC: So if a woman is struggling with low mood, fatigue, anxiety, poor sleep… how would you approach testing?

SW: I would begin with either a DUTCH Complete or DUTCH Plus or similar saliva hormone panel, depending on her symptoms. Both give us real-time data, unlike standard blood tests that only show static levels. If cortisol is dysregulated, if estrogen isn’t clearing properly, or if DHEA is tanked, we can intervene early — sometimes even before a woman qualifies for HRT by conventional standards.

SC: So it's about listening to the body, but also using testing as a guide?

SW: Exactly. We use symptom tracking and testing in tandem. No lab can tell you how you feel, but it can reveal why you feel that way — and what to do about it.

SC: I love that. Thank you, Dr Ward — this really sheds light on the depth of what we do at Thrive Medical and why we don’t just “prescribe and forget.” It’s personalised, it’s scientific, and it’s evolving with each woman.

SW: Thank you, Shannon. It’s such a privilege to support women in reclaiming their energy, confidence, and clarity — especially in midlife and beyond.