Stepfamily Network Group

In 2026, BHRT is no longer guided by a single blood draw. Clinicians utilize Comprehensive Metabolite Mapping (often via dried urine testing) to see not only the hormone levels but also how the body processes them.

This "functional" view allows doctors to ensure that estrogen is being metabolized down the 2-OH pathway (the "protective" pathway) rather than the 4-OH pathway, which can be associated with DNA damage. If an imbalance is found, clinicians can adjust the BHRT protocol with specific micronutrients to "steer" the metabolism toward safer, more effective outcomes.