The HRT University® Podcast

You have a patient who is doing everything right on paper. Hormones optimized, sleep handled, xenoestrogen exposure coming down. And still the weight will not move, the thyroid numbers look off, and the inflammation lingers. In this episode Nico Misleh, MSN, FNP-C, makes the case that the missing variable is often sitting in the patient’s diet: seed oils, and the polyunsaturated fatty acids, or PU...

A century ago the average girl reached her first period at 16 or 17. Today it is closer to 12, and breast development is turning up routinely at 6, 7, even 8 years old. Genetics do not move that fast. Something in the environment is switching the reproductive axis on years ahead of schedule, and in this episode Nico Misleh, MSN, FNP-C, makes the case that the driver is xenoestrogens, and that it l...

You have seen this patient. Her estrogen reads optimal. You have checked it two or three times. And she is still bloated, still constipated, still dealing with breast tenderness, heavy bleeding, and the irritability that shows up like clockwork before her period. The labs say one thing. The woman in front of you says another. In this episode, Nico Misleh, MSN, FNP-C breaks down the estrobolome: th...

Polycystic ovary syndrome is no longer called polycystic ovary syndrome. A landmark consensus study in The Lancet, built on 22,000 clinicians and patients across 11 years of global consultation, has renamed the condition polyendocrine metabolic ovarian syndrome, or PMOS. The cysts were never the story. The metabolism was. The hormones were. The gut was. In our 100th episode, Nico Misleh, MSN, FNP-...

You hired a logo designer, picked your brand colors, maybe even named your clinic something clever. And now you are ready to hand the whole thing to an ad agency and watch the patients roll in. Except that is not how it works. Not even close. In this episode, Nico Misleh, MSN, FNP-C walks through how to market a medical practice from scratch, and why spending money on agencies before you have done...

This week I'm switching from clinical to business. I want to talk about the stuff nobody told me when I was building my own clinic. Apollo Health Optimization is three years in now, and it's been the best decision of my life, professionally and personally. Most providers approach building a cash-pay HRT clinic backwards. They start with the brand, the marketing, the website, and treat the...

A 16-year-old walks into your office with acne and walks out with a birth control script. So does the 28-year-old with heavy periods, the 35-year-old with PMS, and the 42-year-old with migraines. Same prescription for almost every female symptom that touches the cycle. Most of us write it without thinking, and most of us were trained to. In this episode, Nico Misleh, MSN, FNP-C makes the case that...

Think about how many of your patients walk in with the same story. Low mood. Zero motivation. Brain fog that will not lift. They feel like a different version of themselves, and nothing they have tried has brought them back. You run a standard panel. Everything comes back normal. And the next step in the algorithm is an SSRI. But here is the question nobody seems to be asking: did anyone check the...

Your patient started thyroid medication. She is feeling better than she has in months. And then you open her follow-up labs and her Free T3 barely moved. This is the moment where most providers either overcorrect or lose confidence. They increase the dose beyond what is needed, switch to a less effective medication, or start questioning whether the treatment is working at all. None of those are th...

The Alzheimer’s conversation in HRT has been almost entirely about estrogen for 20 years. A 2025 Nature study says that framing is only half the picture. The real driver is the ratio of estradiol to progesterone during perimenopause, and what happens to the brain when that ratio stays unbalanced for years. In this episode, Nico Misleh, MSN, FNP-C walks through the full metabolic cascade the study...

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...

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 compoun...

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. Th...

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...

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, includin...

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...

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 hormon...

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 pra...

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,...

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 advocate...

In this episode, Nico Misleh explores the significance of progesterone, often overlooked in discussions about hormones. He emphasizes the importance of understanding the relationship between progesterone and estrogen, the misconceptions surrounding hormonal terminology, and the clinical implications of these misunderstandings. Misleh advocates for a more comprehensive approach to hormone replaceme...

In this episode, Nico delves into the principles of functional medicine, contrasting it with traditional allopathic medicine. He emphasizes the importance of a systems approach, curiosity, and the need for healthcare providers to ask deeper questions about patient health. Misleh encourages practitioners to start integrating functional medicine into their practice and highlights the significance of...

In this episode, Nico Misleh shares why being willing to admit you are wrong is essential for growth in hormone replacement therapy and patient care. He reflects on early beliefs around male progesterone, how mentor influence and cognitive bias shape clinical decisions, and why evolving with new evidence leads to better outcomes for patients. This conversation explores humility in medicine, the im...

In this episode, Nico Misleh breaks down the growing crisis of endocrine disrupting chemicals (EDCs) and their impact on hormonal health. From environmental toxins to modern medical blind spots, Nico explains why hormone replacement therapy should be viewed as a proactive solution—not a last resort—in today’s increasingly toxic world. Ready to build a brand and practice that is as unique as you ar...

In this episode, Nico breaks down how healthcare providers can approach pricing conversations with confidence and clarity. From reframing cost discussions to understanding patient value, this episode explores why pricing isn’t sales — it’s part of patient care Ready to build a brand and practice that is as unique as you are? Learn the clinical and business systems to create a thriving hormone opti...