We've been told to think about testosterone mostly through sex drive, but I take us into a much bigger story in this episode.

I'm opening the door to a bigger conversation that almost never gets the attention it deserves: testosterone and women's heart health after menopause.

When this hormone drops, the effects may reach far beyond the bedroom and into the strength of the body itself.

I'll explain why the heart, blood vessels, muscle, energy, and longevity may all be tied to a hormone that women were never told to take seriously.

In this episode you'll learn…

• The limited research on testosterone therapy and female cardiovascular health.

• Why testosterone receptors exist throughout female heart and vascular tissue.

• What estrogen loss after menopause means for cardiovascular structure.

• The role of androgen receptors in cardiac and vascular function.

• How hormone dose and duration influence receptor signaling effects.

• Why heart muscle composition makes muscle health clinically relevant.

• The link between skeletal muscle mass and cardiovascular outcomes.

• How muscle weakness predicts increased heart attack and stroke risk.

• What grip strength reveals about longevity and mortality risk.

• The importance of body composition beyond total body weight.

• How testosterone supports muscle fiber production and repair.

• The decline of testosterone production before and after menopause.

• The indirect cardiovascular benefits of improved muscle strength.

• How hormone balance influences motivation for physical activity.

• The interaction between testosterone signaling and receptor availability.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

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In this episode, we push past the cholesterol conversation and dig into why calcium scoring may change the way we look at heart risk.

I take us inside two cases that make one thing clear: a simple number on a test never tells the whole story.

We get into the details of plaque, hormones, stress, sleep, food, movement, menopause, estrogen loss, and the fight patients may face just to get testing approved. I challenge the default path toward statins and open a bigger conversation about what women over 50 should know before decisions are made about their hearts.

In this episode you'll learn…

• How calcium scoring reveals plaque without measuring blood calcium levels.

• What separates calcified plaque from soft plaque in heart vessels.

• The low score case that still preceded a heart attack.

• The high score case without a heart attack despite worsening numbers.

• Why lifestyle context changes the interpretation of any calcium score result.

• The reason women rarely receive calcium score recommendations before statins.

• How insurance delays can block calcium score scheduling for months.

• The cash price option when insurance refuses calcium score coverage.

• Why mammogram screening receives attention while heart screening receives less.

• How calcium results could redirect prevention conversations after menopause.

• What statin decisions should include before lifelong therapy begins.

• How estrogen loss changes cholesterol, blood pressure, and inflammation.

• Why menopause can accelerate plaque formation inside blood vessels.

• The limits around judging every estrogen therapy option, according to a WHI study.

• How hormone therapy enters the conversation around root causes.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

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Today we're continuing our discussion about heart health and cardiovascular surveillance, and we're specifically focusing on what's true about cholesterol and what to monitor as a woman ages.

When it comes to cholesterol, we're often made to believe "the lower the better", but this is not always true. Cholesterol plays an important role in the body, and the truth is more complicated.

In this episode, you'll learn the truth about cholesterol and the risk factors that really matter for your heart health.

In this episode you'll learn…

• A reminder about cholesterol that women need to hear.

• What should be considered if you're taking cholesterol-lowering medications.

• The various roles cholesterol plays in your body (and what happens without it).

• What big pharma is mandated to do, along with what they avoid doing.

• How doctors treat the threat of cardiovascular events and what we need to do better.

• The factors that actually matter when assessing your risk for cardiovascular issues.

• The importance of uncovering the cause of inflammation in connection with heart health.

• How to find out your Framingham Risk Score and why it matters.

• How your age impacts your risk for a cardiovascular event.

• The difference between your chronological age and your biological age.

• How the loss of estrogen in women during menopause contributes to heart disease.

• What you can do to slow your biological aging (and it's supported in the research).

Hard Coronary Heart Disease (10-year risk): https://www.framinghamheartstudy.org/fhs-risk-functions/hard-coronary-heart-disease-10-year-risk/

Framingham Risk Score for Hard Coronary Heart Disease: https://www.mdcalc.com/calc/38/framingham-risk-score-hard-coronary-heart-disease#when-to-use

CVD Risk Estimator Plus: https://tools.acc.org/CVD-Risk-Estimator-Plus/#!/calculate/estimate/

Biological Age Calculator: https://triangledisc.com/biological-age-calculator/

Aging backwards: How to measure, slow, or reverse your biological age: https://www.functionhealth.com/article/how-to-measure-or-reverse-your-biological-age

Hormone Therapy and Biological Aging in Postmenopausal Women: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822953

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

https://www.instagram.com/herabeautyandwellness/

https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/

Recently, I've been speaking about how estrogen and FSH levels are valuable indicators for a woman's cardiovascular health. While not all medical professionals are well-versed in this, it's a topic that needs to be discussed.

So, what should you look for when your doctor is monitoring your cholesterol, especially during menopause?

In this episode, we're shedding light on the role cholesterol, inflammation, and plaque play in developing heart disease.

In this episode you'll learn…

• Why talking about cholesterol is so important for women, especially during menopause.

• What modern medicine tends to focus on for heart health, and what's been missing.

• Why smaller, more dense LDL particles are more harmful than larger ones.

• What your bad cholesterol is made up of and the risks it increases.

• Inflammation trackers you'll want your doctor to pay attention to.

• How low cholesterol can impact heart health, especially when combined with risk factors.

• Signs you have moderate to severe inflammation and what it indicates.

• What oxidized LDL, which can be measured on a regular blood test, tells you.

• How the formation of plaque leads to heart disease and what you can do about it.

• What foam cells are and the role they play in setting the stage for heart issues.

• What happens when plaque grows too large and how this leads to a serious event.

• The truth about cholesterol that your health professionals aren't telling you.

• How doctors usually address heart disease and what we should do instead.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

https://www.instagram.com/herabeautyandwellness/

https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/

Estrogen plays many significant roles in a woman's body, but on this episode of HOW MD, we're talking about why estrogen is so important for heart health.

In 2002, women and doctors were told estrogen therapy would increase the risk of a cardiovascular event. But the truth is much more complicated, and when taken correctly, estrogen can be more beneficial despite its potential—and often minimal—risks.

In this episode you'll learn…

• Why women started fearing estrogen therapy, and what has changed since.

• Why the truth about estrogen is more complicated than one simple study.

• Which types of estrogen are easiest on your liver and heart.

• Why knowing about cardiovascular health risk factors for women is so important.

• What the biggest risk factor for heart disease is (and what you can do about it).

• What FSH is and how it's impacted by low estrogen during menopause.

• What happens with your FSH levels over time and the symptoms that can arise.

• Why getting treatment to control symptoms isn't good enough—and what to do instead.

• How hot flashes impact your health in the short term and in the long run.

• How physicians who understand hormone therapy can help you deal with fluctuations.

• Why untreated hot flashes are bad for your heart.

• Why addressing hot flashes can be even more important than a pap smear.

• The lifestyle choices that influence your risk of heart disease.

• What typically happens to your cholesterol during menopause and beyond.

• The truths you haven't heard about hormone therapy that you need to know.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

https://www.instagram.com/herabeautyandwellness/

https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/

When I started this podcast, I focused largely on overall wellness and even beauty.

After looking back on the last three years of my journey, I came to realize it was time for a change.

I'm shifting to focus specifically on optimizing hormones for women in menopause and beyond. From now on, I'll be providing hormone tips and strategies you can bring to your medical provider to help you feel your best!

In this episode you'll learn…

• How my passion and focus has shifted with time.

• The services I actually provide in my practices and what it highlights for me.

• How menopause actually opens a new chapter for women.

• What the real safety concerns around hormone therapy actually are.

• The areas of medical care that call for specialties that don't yet exist.

• How demand for estrogen has changed over time and where it stands today.

• Why all women have the basic human right to be educated about hormone therapy.

• Why very few doctors offer hormone optimization (hormone therapy isn't the same).

• Why I'm changing the name of this podcast from Wow MD to How MD.

• Why some women feel stuck on their hormone journey and how this podcast can help.

• How I vow to serve you on this podcast moving forward.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

https://www.instagram.com/herabeautyandwellness/

https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/

In this episode we're concluding our conversation about breast cancer screening. This part discusses the importance of breast exams and what an ideal breast surveillance process could look like (versus how it looks today for most women).

Many women today are bypassing a breast exam by believing that a mammogram is sufficient. Here's the truth: 10% of breast cancers are not picked up by a mammogram. You should have a breast exam performed at the doctor's office annually. You can also perform your own regular breast exams at home.

Regardless of whether or not you need a pap smear, you will still always need an annual breast exam. Breast cancer risk increases as you get older, so during menopause and beyond is not the time to put off testing. While a pap test can identify potential risks very early, the mammogram does not screen for pre-cancer changes.

A mammogram picks up breast cancer early on—hopefully early enough to save your life. Introducing new testing that could identify harmful cell growth early on in breast tissue will allow time for the woman to create a plan of action with her health care provider. We should also be screening for inflammatory markers, hormone imbalance markers, and more so we can identify risks as early as possible.

Not using hormone therapy isn't a guaranteed protection against breast cancer. It may also not decrease your risk. Hormones are not to blame for increasing breast cancer risk. In fact, the picture is so much bigger than that. We have to take a look at our lives as a whole to really identify what actually increases breast cancer incidence.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

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https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/

We're moving on to part 3 of our conversation about breast cancer screening in this episode. Previously, we've covered breast health surveillance in general. Today, we're going to dive into breast cancer screening when a woman is on hormone therapy, as this therapy often brings up concerns for breast cancer risk.

So, is there an association between hormone therapy and breast cancer? Although hormone therapy doesn't cause breast cancer, this kind of therapy can act as a catalyst for existing cancerous tissues—if they're already growing, estrogen-sensitive cancers can respond. Generally, the outcome is that your already present cancer may grow more quickly or become apparent faster.

That said, hormone therapy isn't the cause of the cancer. Some women experience extremely difficult issues going through menopause—so much so it creates an actual medical need to be on hormone therapy. Women who are on hormone therapy during menopause should consider increasing their surveillance.

Ultimately, the responsibility will fall on you to figure out what caused your cancer in the first place. You'll have to investigate and address the environmental factors, lifestyle factors, and more that could have contributed to it so you can avoid recurrence. The decisions you've made in years prior, like birth control use, for example, can have a significant impact on your risk of breast cancer.

Generally, the further away from menopause you progress, your risk of cancer is going to go up no matter what. But will a lower dose of hormone therapy reduce the risk of associated cancer growth? While this is an option, remember that all hormones should be balanced and optimized to protect your health, as ultimately this will provide you with the most resilience.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

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https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/

In today's episode we're continuing our conversation about breast cancer surveillance, focusing on the risks of getting a regular mammogram. Last week, we discussed the cumulative risk of radiation damage that women are subjected to over decades of annual mammogram screenings. Mammograms also have shortcomings: they don't detect pre-cancer changes.

Many women aren't aware of the unintended harm a regular mammogram can cause. One of those issues is overdiagnosis. This doesn't refer to a false-positive diagnosis, but rather when a mammogram finds a cancer that grows slowly or not at all (which requires no treatment).

However, mammograms can't firmly identify these types, so all cancer is treated the same. This means some women enter aggressive treatment when it isn't actually necessary, especially if they are older in age and may not recover well from the treatment they've been recommended.

These false-positives can also lead to psychological harm. After the detection of an abnormal finding on a mammogram, women are often sent for additional screening tests (such as a diagnostic breast ultrasound). If this process continues, a woman may also be sent for a biopsy. However, this diagnostic process can take some time—months or even years—and may hurt her mental and emotional wellbeing.

93% of the additional testing required after an abnormal screening mammogram will yield normal, reassuring findings. The chance of false-positives also increases over time. This isn't about dissuading women from getting screened, but it does highlight the importance of exploring screening options.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

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Today we're beginning our conversation about breast cancer screening when on hormone therapy. There are biological markers and overall wellness indicators that need to be assessed every time a woman has an annual checkup when on hormone replacement therapy. Regardless of what therapies she is taking, every woman should have their breast wellbeing monitored, especially as she ages.

Is an annual mammogram done over decades actually safe? Some medical experts say that the benefits of identifying cancer early outweighs the risk of yearly exposure to radiation. But the reality is that radiation exposure is cumulative, so you can achieve the maximum threshold for tolerance sooner than you'd think.

On top of this, breast sensitivity is heightened when the breast cells are younger, so the risk is higher the younger you are. Aside from mammography, we now have other techniques for breast cancer detection. These advancements, like ultrasounds and thermography, should also be considered for use.

Thermography offers great benefits and can do so much more than identify cancer when it's present. This technology is also able to recognize abnormalities that could lead to cancer later on. When abnormal findings come up on mammograms, there is very little information to go on in terms of what should happen next.

Early intervention is of the utmost importance when screening for breast cancer, but the question remains: what kind of screening methods are available for women? Mammograms are uncomfortable, and it would be much better for women to explore alternative options than to forgo any regular breast health monitoring at all.

Connect with Dr. Cernaianu

https://www.herabeautyandwellness.com/

https://www.instagram.com/herabeautyandwellness/

https://www.facebook.com/people/Hera-Healthcare-Mirela-Cernaianu-MD/100063462643162/