“Why doesn’t HRT stop the weight gain?” A woman asked me that on my masterclass last week, and she’s on HRT herself. I’m 50. I take estradiol and progesterone, most recently, I’ve added testosterone. I am the opposite of anti-HRT, and I’m still going to tell you it will not do this job on its own. Estrogen is protective for insulin sensitivity. Putting it back can make that easier to hold onto. What it can’t do is undo the years your body spent being asked to produce insulin all day long. Insulin climbs long before your A1C moves, and a prescription doesn’t reach that. HRT replaces what’s gone. It does not rebuild what’s broken. Those are two different jobs. So estrogen lands on a body that’s still spiking insulin all day, still under-slept, still digesting half of what it eats. You feel a lift for a few weeks. Then the same symptoms come back and you chase the dose, or you decide HRT failed you. It didn’t. It never had the terrain. A hormone only ever works as well as the terrain...