Functional medicine and HRT keep getting framed as rival philosophies. That framing is wrong, and patients are the ones paying for it. In this episode, Nico Misleh, MSN, FNP-C walks through why hormones are foundational, why lifestyle alone has a ceiling, and how to sequence HRT and functional medicine for real clinical outcomes.

He tells the story of a 35-year-old patient who did everything right, was offered an antidepressant by her primary care, ended up on a shopping bag of supplements through a functional provider, and only turned the corner once progesterone and testosterone were restored. Then he flips the argument and names the HRT-only mistake clinics make when they prescribe hormones without terrain work.

Learn more about the Master Course: https://bit.ly/4twBb0D

HRT University is a physiology-first clinical education program for licensed providers. Jointly accredited with 30 CEs.

There is a group of providers who oppose compounded HRT medications on principle. Their argument sounds evidence-based. Standardization. Regulation. Studies. It holds up until you look at what they are actually prescribing.

In this episode, Nico Misleh, MSN FNP-C, walks through two clinical examples that expose the internal contradiction: the Androgel problem, in which providers who oppose compounding are instructing female patients to eyeball a fraction of a men's testosterone gel; and the progesterone problem, in which the FDA-only framework leaves patients with no option except a pharmacologically distinct synthetic progestin when commercial dose ranges fall short.

The episode also goes into the regulatory reality of 503A and 503B compounding pharmacies, the neurosteroid pharmacology that makes progesterone and synthetic progestins non-interchangeable, and what individualized prescribing actually requires when a patient does not fit the commercial options.

The compounding debate does not have to stay murky. This is the clinical argument.

HRT University is a physiology-first clinical education program for licensed providers. Jointly accredited through Pinnacle Conference LLC (ACCME, ACPE, ANCC) for 30 CEUs.

Learn more about HRT University:https://bit.ly/4twBb0D

HRTU Newsletter:https://nicomislenp.kit.com/8050eeea5f

Join the HRT University Facebook Group:https://www.facebook.com/groups/1179376819949373/

Thinking about starting your own healthcare practice but unsure where to begin?In this episode of the HRT University podcast, Nico Misleh speaks with Nurse Practitioner Katie Edge about her journey toward opening her own independent practice. From working in emergency medicine to pursuing autonomy in patient care, Katie shares the real-world challenges and lessons she’s learning along the way.They discuss the importance of patient advocacy, navigating state regulations, finding collaborating physicians, and doing the necessary research to build a practice the right way from the start.If you are a nurse practitioner, physician assistant, or healthcare provider considering independence, this episode offers practical insight into what it actually takes to build your own practice.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:-

Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)-

Join HRT University: https://bit.ly/4twBb0D

Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

Are peptides actually safe, or are concerns being driven by misunderstanding and incomplete data?In this episode of the HRT University podcast, Nico Misleh explores one of the most common concerns in hormone therapy today: peptide safety. With changing regulations and limited human data on some newer peptides, many providers and patients are asking important questions about risk, safety, and long-term use.Nico walks through the historical lessons from hormone therapy that still impact medicine today, including the long-standing myths surrounding testosterone and prostate cancer, as well as the widespread fear that followed the Women’s Health Initiative (WHI) study. These examples highlight why understanding mechanisms matters more than blindly accepting conclusions from flawed or incomplete research.If you work in hormone therapy or are considering peptide-based treatments, this episode will help you better understand how to evaluate safety and think critically about emerging therapies.In This Episode, You'll Learn:Why many peptides have long-standing safety recordsHow flawed studies shaped hormone therapy historyWhat the testosterone and prostate cancer myth teaches usWhy the WHI study changed hormone therapy for decadesThe importance of understanding mechanisms of actionHow clinicians can evaluate new therapies responsiblyFor practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University:https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

Why do patients leave a practice even when the care is good?In this episode of the HRT University podcast, Nico Misleh breaks down one of the biggest challenges for healthcare providers, patient attrition. Many practices focus heavily on acquiring new patients but overlook the systems needed to keep them engaged long term.Nico explains the three primary reasons patients leave a program, including perceived lack of value, lack of engagement, and major life changes. He also shares practical strategies providers can implement to strengthen relationships, improve communication, and create a patient experience that keeps people committed to their care.If you run a private practice, membership clinic, or hormone therapy program, this episode will help you understand how to reduce attrition and build long term patient relationships.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University: https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

Is oral progesterone harmful to brain health?Recently, claims have circulated suggesting that progesterone may contribute to cognitive decline or act similarly to benzodiazepines because of its metabolite allopregnanolone. In this episode, Nico Misleh breaks down the science behind these claims and explains why much of the concern comes from misinterpreted research.This conversation explores the role of progesterone in hormone replacement therapy, the difference between animal studies and human evidence, and why understanding hormone physiology is essential for both providers and patients.If you are navigating hormone therapy or want a clearer understanding of progesterone’s role in cognitive health, this episode offers an evidence-based perspective on one of the most misunderstood hormones in medicine.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University:https:https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

Most people think of serotonin as a mood hormone. But what if it also plays a role in bone loss?In this episode, Nico Misleh explores emerging research linking elevated serotonin levels to increased osteoporosis risk in post-menopausal women. He breaks down a recent study examining serotonin markers and bone mineral density, and explains why this connection could reshape how we think about hormone balance and long-term bone health.If you are navigating menopause, managing osteoporosis risk, or interested in the deeper hormonal drivers of bone density, this conversation provides important insight into an often overlooked factor in women’s health.Chapters00:00 Introduction to Serotonin and HRT01:26 Understanding the Study on Serotonin and Osteoporosis04:44 The Impact of Serotonin on Bone Health09:27 Serotonin: The Misunderstood Hormone12:48 The Role of Hormones in Bone Density18:07 Chronic Stress and Its Effects on Bone Health20:32 Prevention and Understanding Osteoporosis25:18 The Importance of Continuous Learning in HRTFor practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University: https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

Thinking about leaving your employed position and starting an independent practice? One of the biggest concerns for medical professionals is health insurance.In this episode, Nico Misleh sits down with Kevin and Joy Kincaid of Kincaid Solutions to discuss what really happens to your health coverage when you go independent. They break down common fears, explain the options available to private practice providers, and share how personalized guidance and transparency can make the transition far less overwhelming.If you are considering private practice, entrepreneurship, or stepping away from employer-sponsored benefits, this conversation will help you understand what is realistic, what is exaggerated, and how to move forward with confidence.

For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University: https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

In this episode, Nico Misleh discusses the critical role of thyroid in hormone replacement therapy (HRT), emphasizing that thyroid should not be viewed as an adjunct but as a foundational component. He critiques the conventional approach of using T4 monotherapy for hypothyroidism, highlighting the limitations of TSH as a diagnostic marker. Misleh advocates for combination therapy using T3 and T4, supported by recent studies showing its effectiveness in reducing risks of dementia and mortality. He encourages healthcare providers to adopt a pro-metabolic lens and to empower patients by moving away from outdated practices.Chapters00:00 The Importance of Thyroid in Hormone Replacement Therapy02:50 Monotherapy vs Combination Therapy for Hypothyroidism06:11 Understanding TSH and Its Limitations08:57 The Risks of T4 Monotherapy11:57 The Case for Combination Therapy14:47 Pro-Metabolic Lens on Thyroid Function18:10 The Role of T3 in Metabolism20:58 Empowering Patients and Providers24:03 Creating a New Standard in Thyroid TreatmentFor practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University: https:https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

In this episode of the HRT University podcast, Nico Misleh discusses the complexities and misconceptions surrounding hormone replacement therapy (HRT), particularly for women over 60 or 10 years post-menopause. He emphasizes the importance of bioidentical hormones, the risks associated with synthetic hormones, and the necessity of early initiation of HRT for better health outcomes. Misleh advocates for patient empowerment through informed decision-making and shared understanding of the risks and benefits of HRT.Chapters00:00 Introduction to HRT University Podcast01:38 Understanding Hormone Replacement Therapy Risks06:45 Bioidentical Hormones vs. Synthetic Hormones12:15 The Importance of Early HRT Initiation14:09 Empowering Patients with HRT KnowledgeFor practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠(yes, it's daily... and yes, people stay subscribed)- Join HRT University: https://bit.ly/4twBb0D- Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr