Most physicians treating recurrent UTIs in women are missing half the picture. Estrogen gets some attention. Testosterone almost never does. And yet the female urethra is rich in androgen receptors, depends on testosterone for its resilience and thickness, and becomes significantly more vulnerable to bacterial colonization when those levels decline. This is not experimental medicine. This is physiology that has simply never made it into the standard of care.

Most women have been taught to think of hormones in simplistic categories: natural versus synthetic, safe versus unsafe, good versus bad. But the reality is far more nuanced. In this article, I break down what “bioidentical” hormones actually mean, why so-called natural estrogen was historically made from pregnant mare urine, and why progesterone and progestins are not interchangeable. Because women deserve more honest, evidence-informed conversations about menopause and hormone therapy.