General Medicine & Hormonal Health · Bioidentical Hormone Replacement
Safe Hormone Replacement (Guided by Science, Not Sales.)
Are you wondering if hormone imbalances are causing your symptoms? I’m here to help. I have years of experience prescribing safe hormonal therapies to women who are struggling with symptoms.
Lately, I’m seeing a large number of women who have been hurt by irresponsible doctors, hormone clinics and med spas who are more interested in pushing sales than reading the science to see what is best for you.
In my practice, I take a middle ground between conventional doctors who think that synthetic hormones are a good idea and the hormone crowd who thinks every symptom can be fixed by increasing your hormone dose. Read on to learn more about my approach to hormonal replacement.
Joseph Mather MD, MPH
Board-Certified Family Medicine
- ✓Evidence-based approach to menopausal & hormonal health in women
- ✓World class medicine — works with patients across the globe
- ✓Helped patients avoid unproven, high-dose pellet therapy they didn't need
- ✓Educator and mentor offering CME education for physicians
Functional Medicine Expert — Treats the Cause of Disease
Board-Certified American Board of Family Medicine
Tulane School of Medicine & Tulane University School of Public Health
Watch: Are Testosterone Pellets Safe?
Hormone clinics and med spas are exploding in number, and more women are being hurt. In this lecture, I walk through real patient cases, review the published research behind the largest pellet manufacturer in the country, explain what a true bioidentical testosterone level actually looks like, and lay out a safer way to deliver testosterone to the women who need it.
Ready for a hormone plan based on evidence, not marketing?
Does this sound like you?
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You’ve been offered a testosterone pellet for fatigue, low libido, or “hormone imbalance”
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Your hormone provider bumps your dose every time you don’t feel better
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You have acne, unwanted hair growth, or mood changes since starting hormone therapy
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Your testosterone level has tested over 100 and no one can explain why
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You were treated by a med spa or hormone clinic instead of a physician who took a full history
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You’re menopausal and want real relief — without the guesswork
What Is A Real Bioidentical Testosterone Level?
Across a woman’s life, testosterone generally runs between 10 and 40 ng/dL. Even in pregnancy — when the body needs extra anabolic support for a developing fetus — testosterone rises to a maximum of about 85 ng/dL. That’s the outer edge of what’s normal for a woman, at any point in her life.
Routine testosterone pellets don’t come close to that range. In real patient cases, levels after a pellet have measured in the hundreds, and in one documented case of psychosis, over 1,100 ng/dL. Clinically, many women feel their best with levels up to roughly 100 — but that’s clinical experience, not proof, and there is no good justification for pushing a woman’s total testosterone above 100.
How my medical office is different
Three ways I’ve built this practice differently than a typical doctor’s office — or a typical functional medicine office.
01
Time to listen, think, and research
I run an independent private practice, free of hospital and insurance demands, so that I have the time to listen, think, and research your case properly.
I take a lot of pride in the fact that I am one of the few doctors who has been able to build my knowledge and skills day after day to make sure you get the best care possible.
My goal is for you to leave my office thinking:
“That was the best doctor’s visit I ever had.”
02
Treating the cause — without overdoing it
I treat the cause of your symptoms with natural and conventional medicine. But unlike other functional medicine offices, I don’t require thousands of dollars of labs or ask you to take hundreds of pills to get better. My goal is to get you well as quickly as possible — with the fewest supplements, the broadest diet that keeps you healthy, and a treatment plan that’s practical and down to earth.
03
Functional medicine you can afford
Paying out of pocket for medical care can be daunting. Because I want to help as many patients as possible, I’ve done all that I can to make care affordable:
- ✓I charge less than other experts in the field, despite getting better outcomes for my patients
- ✓I never profit from any testing I recommend
- ✓30% off supplements from Moss Nutrition
- ✓Discounted wholesale cash lab pricing through Clinical Pathology Labs for New Orleans patients
- ✓No subscriptions or memberships — ever
My approach to hormone replacement
The same evidence-based standard I hold conventional medicine to — applied equally to functional and integrative medicine’s own overuse of hormones.
1
Rule out other causes first
Fatigue, low libido, and “feeling off” during perimenopause and menopause are often driven by gut health, sleep, thyroid, and lifestyle factors. I look at the whole picture before assuming hormones are the answer.
2
Manage menopausal symptoms with the best-supported tools first
In my experience, most menopausal symptoms are well managed with a low-dose estrogen patch, oral progesterone, and lifestyle and GI work — without ever needing testosterone.
3
Avoid pellets, and be cautious with med spas and hormone-only clinics
Pellets deliver long-term hormone release at the cost of supraphysiologic peaks that can last for months. Clinics built around volume hormone therapy are, in my experience, where patients are hurt the most.
My Preferred Approach: Estradiol Patch & Oral Progesterone
For most menopausal women, I reach for a transdermal estradiol patch combined with oral micronized progesterone long before I would ever consider testosterone — and the research on route of administration is a big part of why.
Oral estrogen
- Passes through the liver first, which increases production of clotting factors
- Associated with a meaningfully higher risk of venous blood clots in case-control research
- One-size dosing is harder to fine-tune to an individual patient
Transdermal estradiol patch (my preference)
- Delivered through the skin, bypassing first-pass liver metabolism
- Was not associated with an increased clotting risk in the same research, unlike the oral route
- Combined with oral micronized progesterone, which also was not linked to increased clotting risk
What the research shows
A large French case-control study of postmenopausal women (the ESTHER study) found that oral estrogen was associated with a meaningfully increased risk of blood clots, while transdermal estrogen was not. The same study found that micronized progesterone — the form I typically prescribe — was not associated with increased clotting risk, unlike certain synthetic progestin derivatives.
This is a major reason I favor an estradiol patch paired with oral micronized progesterone: it lets me give real relief from hot flashes, night sweats, sleep disruption, and vaginal dryness while minimizing the cardiovascular downsides that oral hormone regimens can carry.
The Good News About Hormone Replacement
None of this means hormone therapy is bad — quite the opposite. Dosed and delivered correctly, it can meaningfully improve a woman’s quality of life through menopause.
The breast cancer fears were overstated
The 2002 Women’s Health Initiative headlines linking hormone therapy to breast cancer alarmed a generation of women and doctors. But a detailed 2009 physician review of the published WHI data found that the reported breast cancer increase never reached statistical significance, and that the relative risk associated with HRT was smaller than the risk linked to eating fish, grapefruit, or working the night shift. The same review found that estrogen-alone therapy showed no increased breast cancer risk at all.
Relief of menopausal symptoms is real, and it's fast
For women with genuine hot flashes, night sweats, and sleep disruption, hormone therapy remains the most effective treatment available, and most women feel meaningful relief within days of starting it. Quality of life during menopause matters, and it’s reasonable to treat it.
The right route of delivery lowers the risk further
Transdermal estradiol, paired with oral micronized progesterone, has not been linked to the increased clotting risk seen with oral estrogen and certain synthetic progestins in large case-control research. Choosing the right delivery method — not avoiding hormone therapy altogether — is often the real answer.
The science behind this approach
A few of the published studies and society statements behind this approach.
More Lectures & Resources
More from my YouTube channel, plus patient stories and interviews.
Patient Success, Interviews, Lectures & More
What patients say
I’ve helped many women get real relief from menopausal symptoms — without being pushed into hormone doses they didn’t need. Read more patient stories and reviews on the testimonials page.
What a visit costs
I run an independent, cash-pay practice — no insurance billing, no pressure to fit your visit into a 10-minute slot. You can request reimbursement from your insurer using a superbill I provide after each visit.
INITIAL VISIT
$700
45 MINUTES
Focused on your history, current labs and medications, and a plan for what to test next.
EXTENDED INITIAL
$950
2 HOURS
Ideal if you’re traveling to establish care, have a complex history, or want more time to go deep.
FOLLOW-UP
$350
45 MINUTES
Most patients follow up every 4 weeks as we work through each part of the plan.
Not sure if I'm a fit?
Book a free 15-minute discovery call to ask questions before you commit to a visit.
Hormone replacement questions, answered
Do you think testosterone is never appropriate for women?
No. There may be select cases where it's justified. But I've prescribed it fewer than six times in my career, because most menopausal symptoms respond well to a low-dose estrogen patch, oral progesterone, and lifestyle and GI work — without ever needing testosterone.
Why won't you prescribe testosterone pellets?
Pellets deliver a large dose all at once, producing testosterone peaks far above what's bioidentical for a woman, followed by a slow taper that can take months to fully leave the body. That pattern is linked to real complications, and it isn't something I can safely reverse once it's placed.
My testosterone is over 100. Is that a problem?
It can be. There's no good justification for a woman's total testosterone to be pushed above roughly 100, and definitely not above the 85 seen at the peak of pregnancy. If your level is higher than that, it's worth asking your provider why.
Is estrogen therapy safe?
For most healthy menopausal women, yes — and the route matters. Research suggests transdermal estrogen carries a lower clotting risk than oral estrogen, which is a major reason I typically prescribe a patch rather than a pill.
What about the Women's Health Initiative and breast cancer risk?
Those headlines caused a lot of unnecessary fear. A closer look at the published WHI data shows the breast cancer signal never reached statistical significance, and estrogen-only therapy showed no increased risk at all. Concerns about HRT are worth discussing with your doctor, but they shouldn't keep you from real symptom relief.
Do you accept insurance?
I don't bill insurance directly, but I provide a superbill after each visit that you can submit for out-of-network reimbursement. Working this way gives me the time and freedom to treat you as an individual, not a diagnosis code.
Let’s Get Started
A doctor who cares about science
Working as an independent physician gives me time to study and keep learning new ways to help my patients. I’m proud to have contributed to our understanding of the gut–thyroid axis in a paper published in 2022.
I graduated from Tulane University School of Medicine and School of Public Health in 2011 and completed my Family Practice training in 2014. I treat many conditions, with particular expertise in GI health and mold and heavy-metal toxicity. When I’m not with patients, you’ll find me playing with my three kids, exercising, meditating, or playing the drums.
