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2.5K to 15K🎙 ~2x weekly·93 episodes·Last published 3d ago - Monthly Reach
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On the show
Recent episodes
Early Puberty and Xenoestrogens: What It Means for Your HRT Patients
Jun 22, 2026
Unknown duration
The Estrobolome: How Your Patient's Gut Is Recycling Estrogen
Jun 15, 2026
Unknown duration
PCOS Is Now PMOS, What the Rename Means
Jun 8, 2026
Unknown duration
How to Market a Medical Practice: Email, Social Media, and Storytelling
Jun 1, 2026
Unknown duration
The Cash-Pay HRT Practice: What Actually Works
May 27, 2026
Unknown duration
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| Date | Episode | Description | Length | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 6/22/26 |  Early Puberty and Xenoestrogens: What It Means for Your HRT Patients | 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 lands directly in your exam room.Xenoestrogens are estrogens from outside the body: the parabens, phthalates, pesticides, plastics, fragrances, and even some essential oils that bind estrogen receptors closely enough that the receptor cannot reliably tell them apart from the real thing. Exposure begins in utero and never fully stops, so it is both continuous and cumulative. Nico connects that early and prolonged estrogen signaling to the patients now arriving in HRT clinics in their 20s and 30s with pronounced estrogen dominance and progesterone deficiency, at times more severe than the perimenopausal patients down the hall.He reframes age of menarche and environmental exposure history as clinical variables that belong on the intake form, explains why some patients fail to respond to progesterone because of receptor competition rather than a dosing problem, and walks through the exposure-reduction conversation that lets the hormones you prescribe actually win at the receptor. This is the lifespan view of the Big Five: the same xenoestrogen load that pulled puberty early keeps shaping estrogen dominance, PCOS, and endometriosis in adults.Hosted by Nico Misleh, MSN, FNP-C, founder of HRT University. The HRT University Podcast is provider-facing hormone education grounded in physiology and mechanism. For the full clinical framework, including the xenoestrogen section in Module 1, explore the HRT University Master Course, jointly accredited through Pinnacle Conference LLC (ACCME, ACPE, ANCC): https://bit.ly/4twBb0DNewsletter: https://nicomislenp.kit.com/8050eeea5fProvider community: https://www.facebook.com/groups/1179376819949373/ | — | ||||||
| 6/15/26 |  The Estrobolome: How Your Patient's Gut Is Recycling Estrogen | 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: the collection of gut bacteria and bacterial genes that decide whether estrogen leaves the body or gets sent back into circulation. The liver does its job. It conjugates estrogen and packages it for excretion through bile and stool. Then beta-glucuronidase, produced by a disrupted microbiome, cleaves that package open and frees the estrogen to reabsorb through the gut wall and travel back to the liver. This is enterohepatic recirculation, and it is a problem of accumulation. It builds quietly for years, then surfaces as estrogen dominance, PCOS, PMDD, fibroids, and elevated breast cancer risk.Nico connects the mechanism to what you can actually do. Why industrialized guts carry higher beta-glucuronidase capacity. Why a menopausal woman can run higher circulating estrogen than expected with no progesterone to counterbalance it. Why a patient who reacts to a low dose of estrogen may have a gut problem, not a dosing problem. Then he walks through the targeted interventions he reaches for first: the raw carrot, coffee and gut motility, glycine and taurine for phase two liver detoxification, and the role of progesterone and thyroid in clearing estrogen instead of recycling it.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 the Master Course: https://bit.ly/4twBb0D HRTU Newsletter: https://nicomislenp.kit.com/8050eeea5f Join the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/ | — | ||||||
| 6/8/26 |  PCOS Is Now PMOS, What the Rename Means | 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-C breaks down what the rename actually means. Why the old name pointed providers toward the wrong organ and the wrong mechanism. Why so many women with every sign of the condition were told they did not have it because their ovaries looked clear. And why the framework HRT University has taught from the start, relative estrogen dominance layered on sluggish detoxification, gut-driven estrogen recycling, compromised thyroid, and a metabolic engine forced into glycolysis, is the same physiology the new name finally reflects.If you have been treating PCOS the way you were taught and something never sat right, this episode is the reframe. The name changed. The mechanism did not.The HRT University Master Course is jointly accredited through Pinnacle Conference, LLC (ACCME, ACPE, ANCC). Earn 30 CE hours, including 12 hours of pharmacology.Master Course: https://bit.ly/4twBb0D Nico's weekly clinical email: https://nicomislehnp.kit.com/8050eeea5fProvider community: https://www.facebook.com/groups/1179376819949373/ | — | ||||||
| 6/1/26 |  How to Market a Medical Practice: Email, Social Media, and Storytelling | 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 the foundational work is one of the fastest ways to burn cash as a new practice owner. He talks about the daily email practice that shaped his own voice over eighteen months, the Facebook group strategy that builds community without feeling like a sales pitch, and why your social media content is probably talking to your colleagues instead of your patients.He also breaks down the esthetics example that keeps showing up in provider marketing: the Moxi 3000 announcement that impresses other clinicians and confuses every cold lead who reads it. Then he flips it into a story-driven version that actually speaks to the patient sitting on the other side of the screen.If you have been wondering why your content is not converting or why your marketing feels like it is missing something, this episode lays out the organic playbook that comes before the ad spend.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/4twBb0DHRTU Newsletter: https://nicomislenp.kit.com/8050eeea5fFacebook Group: https://www.facebook.com/groups/1179376819949373/ | — | ||||||
| 5/27/26 |  The Cash-Pay HRT Practice: What Actually Works | 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 clinical work as something they'll catch up on once patients are flowing in. The clinical foundation is not a prerequisite for the business. It IS the business.In this episode I walk through the mug analogy, the surgeon analogy, why patients can feel the difference between real clinical mastery and the performance of it, and why my friend Ashley got 200 patients in her first year doing almost no traditional marketing. I get into the donut-shop comparison for why word of mouth runs medicine, the brick-and-mortar to virtual transition I made at Apollo, why geography is now irrelevant for a cash-pay HRT clinic, and the predatory equipment sales and marketing agencies you should not be writing checks to in year one. I close with the four-step sequence I'd follow if I were starting today: clinical mastery, then reps with patients, then a practice model that emerges from the clinical work, then the brand on top of all of it.If you're a provider weighing the move out of insurance, or you've already made it and the practice isn't building the way you thought it would, this one is for you.00:00 Switching from clinical to business, the stuff nobody told me01:32 Apollo three years in, the best decision of my life02:14 The Field of Dreams approach and why providers get it backwards04:08 The clinical foundation IS the business05:10 The mug analogy06:46 Built on clinical depth, no traditional marketing07:11 The surgeon analogy, why patients can feel confidence08:30 My friend Ashley and 200 patients in year one08:57 What happens when you fake it for too long09:41 My NP school primary care rotation11:54 Studying hormones obsessively, building the framework12:33 Hormones as a symphony, not separate parts14:26 Word of mouth in medicine vs. the donut shop16:40 Patients call it Nico's Place18:59 The brick-and-mortar to virtual transition20:31 Geography is irrelevant, patients fly in from everywhere22:53 Predatory laser and ultrasound reps23:56 Step one of the sequence: clinical foundation, for real25:01 Step two: actually treat patients, competency builds confidence27:10 Step three: let the practice model emerge from the clinical work29:04 Step four: build the brand last, the whiteboard story31:20 Mastery, practice model, marketing, in that orderThe HRT University(R) Master Course is jointly accredited through Pinnacle Conference LLC (ACCME, ACPE, ANCC) for 30 CE hours including 12 hours of pharmacology. Course: https://bit.ly/4twBb0D. Newsletter: https://nicomislenp.kit.com/8050eeea5f. Community: https://www.facebook.com/groups/1179376819949373/.About the host. Nico Misleh, MSN, FNP-C, is a nurse practitioner, the founder of HRT University, and the owner of Apollo Health Optimization. | — | ||||||
| 5/18/26 |  Birth Control is Not Treatment: What Providers Should Use instead | 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 birth control isn't medicine for any of those things. It's medicine for pregnancy prevention. For everything else we use it for, it's suppression, and it costs the patient the diagnostic information you needed to actually treat what's wrong. He walks through what hormonal contraception is doing to the HPO axis, why synthetic progestins aren't the same compound as bioidentical progesterone, and what a real PCOS (now renamed PMOS) workup looks like when the pill isn't the first move. He's also honest about the cognitive dissonance providers run into when they realize the prescription they've written thousands of times might not have been the right call, and reframes that moment as the start of better practice, not a verdict on what came before.The HRT University Master Course is jointly accredited through Pinnacle Conference LLC (ACCME, ACPE, ANCC) and offers 30 CE credits across six modules, including the Female and Advanced Female sections that cover hormonal contraception, bioidentical progesterone, and PMOS in clinical depth.Explore the Master Course: https://bit.ly/4twBb0DJoin the Free Newsletter: https://nicomislenp.kit.com/8050eeea5fFacebook Community: https://www.facebook.com/groups/1179376819949373/Website: https://hrtuniversity.comFollow HRT University on Instagram: @hrtuniversityStandard Links | — | ||||||
| 5/11/26 |  96. Hormones and Depression: Why SSRIs Are Not the Full Answer | 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 their hormones?In this episode, Nico Misleh, MSN, FNP-C challenges the framework that has dominated depression treatment for three decades, the idea that depression is a disease caused by low serotonin. He walks through Dr. Joanna Moncrieff's 2022 umbrella review that found no consistent evidence linking serotonin levels to depression, and then builds the clinical case for why testosterone, progesterone, estradiol, and thyroid should be among the first things you evaluate in a depressed patient, not the last. Testosterone drives dopaminergic function, motivation, and cognitive clarity. Progesterone converts to allopregnanolone, a neurosteroid that modulates GABA receptors, the same calming pathway that benzodiazepines act on, without the dramatically ill effects. Estradiol upregulates serotonin receptors and modulates dopamine in the prefrontal cortex. When these hormones are deficient, the clinical presentation looks exactly like major depressive disorder. And putting that patient on an SSRI without checking any of them is the equivalent of treating chest pain with tablets without ever running an EKG.The HRT University Master Course is jointly accredited through Pinnacle Conference LLC (ACCME, ACPE, ANCC) and offers 30 CE credits across six modules covering metabolic foundations, male HRT, female HRT, advanced female endocrinology, thyroid optimization, and adjunct hormones.Explore the Master Course: https://bit.ly/4twBb0DJoin the Free Newsletter: https://nicomislenp.kit.com/8050eeea5fFacebook Community: https://www.facebook.com/groups/1179376819949373/Website: https://hrtuniversity.comFollow HRT University on Instagram: @hrtuniversity | — | ||||||
| 5/4/26 |  95: Thyroid Labs: Why a Low Free T3 After Treatment Does Not Mean Failure | 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 the right call. The problem is not the medication. It is a misunderstanding of what the lab is actually showing you.In this episode, Nico Misleh, MSN, FNP-C walks through the clinical distinction between peak and trough Free T3, explains why a seemingly unchanged number on follow-up labs can actually reflect meaningful improvement, and breaks down the pharmacokinetics that make this one of the most common thyroid management mistakes in clinical practice. If you have ever second-guessed yourself after seeing a low Free T3 on a patient who is clearly doing better, this episode will change how you read those labs.The HRT University Master Course is jointly accredited through Pinnacle Conference LLC (ACCME, ACPE, ANCC) and offers 30 CE credits across six modules, including a dedicated Thyroid Optimization module that covers lab interpretation, medication selection, and dosing strategy in depth. LinksExplore the Master Course: https://bit.ly/4twBb0DJoin the Free Newsletter: https://nicomislenp.kit.com/8050eeea5fFacebook Community: https://www.facebook.com/groups/1179376819949373/Website: https://hrtuniversity.comFollow HRT University on Instagram: @hrtuniversity | — | ||||||
| 4/27/26 |  94. Progesterone and Alzheimer’s: The Ratio That Changes Everything | 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 identifies: estrogen receptor alpha destabilization, ERR alpha dysfunction, mitochondrial energy failure, glutamate excitotoxicity, and the on-ramp to neurodegeneration. He explains why unopposed estradiol can actually worsen the neuronal environment, why synthetic progestins like MPA do not deliver the same neuroprotection as bioidentical progesterone, and why perimenopause, not postmenopause, is the window that matters most.If you prescribe HRT or are reconsidering whether to, this is the clearest mechanistic argument for treating progesterone as foundational rather than optional.Link to the Study: pubmed.ncbi.nlm.nih.gov/41274899/ HRT University is a jointly accredited, physiology-first clinical education program for licensed providers. Learn more about the Master Course.HRTU Newsletter: https://nicomislenp.kit.com/8050eeea5fJoin the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/ | — | ||||||
| 4/20/26 |  93. HRT vs Functional Medicine: Hormones Are the Foundation | 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/4twBb0DHRT University is a physiology-first clinical education program for licensed providers. Jointly accredited with 30 CEs. | — | ||||||
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| 4/14/26 |  92. Compounded HRT: Why the Anti-Compounding Argument Fails | 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/4twBb0DHRTU Newsletter:https://nicomislenp.kit.com/8050eeea5fJoin the HRT University Facebook Group:https://www.facebook.com/groups/1179376819949373/ | — | ||||||
| 3/30/26 |  91. Starting a Healthcare Practice from Scratch | 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/4twBb0DJoin the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr | — | ||||||
| 3/23/26 |  90. Are Peptides Safe? | 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 | — | ||||||
| 3/16/26 |  89. Why Patients Leave Your Practice and How to Keep Them Long-Term | 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 | — | ||||||
| 3/9/26 |  88. Progesterone and Brain Health: Debunking the Cognitive Decline Myth | HRT University® | 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 | — | ||||||
| 3/2/26 |  87. Serotonin and Osteoporosis Risk in Post-Menopausal Women: What the Research Shows | HRT University® | 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 | — | ||||||
| 2/23/26 |  86 Health Insurance for Independent Medical Providers | HRT University® | 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 | — | ||||||
| 2/16/26 |  85. Thyroid Combination Therapy and Better Hormone Care | 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 | — | ||||||
| 2/11/26 |  84. Age Limits for HRT | 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 | — | ||||||
| 2/9/26 |  83. Progesterone and Hormone Balance: What Is Often Overlooked in Hormone Therapy | HRT University® | 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 replacement therapy (HRT), highlighting the benefits of bioidentical progesterone over synthetic progestins. He calls for a movement to reclaim the narrative around hormonal health, ensuring that both practitioners and patients are educated about the true nature and benefits of hormones.Chapters00:00 Introduction to Progesterone01:30 The Importance of Progesterone02:59 Understanding Hormonal Relationships05:56 Estrogen vs. Progesterone Dynamics09:20 Progesterone's Role in Metabolism11:43 Misunderstandings in Hormonal Terminology15:15 The Distinction Between Progesterone and Progestins19:50 The Clinical Implications of Hormonal Confusion23:57 The Broader Impact of Progesterone29:09 Progesterone Beyond Reproductive Health32:34 The Misconception of Progesterone Necessity35:44 The Dangers of Progestins39:39 Reclaiming Hormone Replacement Therapy43:37 The Future of Hormonal HealthFor 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 | — | ||||||
| 2/2/26 |  82 Functional Medicine and Better Hormone Care: A Root-Cause Approach | HRT University® | 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 mentorship and community in this journey. He also discusses the intersection of hormone replacement therapy (HRT) and functional medicine, advocating for a holistic view of patient care.Chapters00:00 Introduction to Functional Medicine02:47 The Shift from Allopathic to Functional Medicine06:13 Understanding the Systems Approach in Functional Medicine08:51 Curiosity and the Importance of Asking Why11:47 Practical Steps to Start Practicing Functional Medicine15:05 Integrating Hormone Replacement Therapy with Functional Medicine17:55 The Role of Curiosity in Medicine20:53 The Importance of Mentorship and Community24:05 Exploring the Complexity of Human Biology27:07 Conclusion and Call to ActionReady to build a brand and practice that is as unique as you are? Learn the clinical and business systems to create a thriving hormone optimization practice with The HRT Master Course. This program offers 30 ANCC-accredited credit hours and gives you the expert guidance you need to succeed. Start your journey at: https://hrtuniversity.com/hrtcourse/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://hrtuniversity.com/- Join the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr | — | ||||||
| 1/26/26 |  81. Growth, Humility, and Better Patient Care in Hormone Therapy | 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 importance of real-world clinical experience, and how providers can build trust by staying open to learning and improvement.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 optimization practice with The HRT Master Course. This program offers 30 ANCC-accredited credit hours and gives you the expert guidance you need to succeed. Start your journey at: https://hrtuniversity.com/hrtcourse/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://hrtuniversity.com/- Join the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr | — | ||||||
| 1/21/26 |  80. Unmasking Endocrine Disruption: The Hidden Crisis of Environmental Toxins and Hormone Health | 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 are? Learn the clinical and business systems to create a thriving hormone optimization practice with The HRT Master Course. This program offers 30 ANCC-accredited credit hours and gives you the expert guidance you need to succeed. Start your journey at: https://hrtuniversity.com/hrtcourse/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://hrtuniversity.com/- Join the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr | — | ||||||
| 1/19/26 |  79. How to Talk About Pricing Without Killing Trust | 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 careReady to build a brand and practice that is as unique as you are? Learn the clinical and business systems to create a thriving hormone optimization practice with The HRT Master Course. This program offers 30 ANCC-accredited credit hours and gives you the expert guidance you need to succeed. Start your journey at: https://hrtuniversity.com/hrtcourse/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://hrtuniversity.com/- Join the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr | — | ||||||
| 1/14/26 |  78. Why DPC Practices Should Add Functional Medicine & HRT | In this episode, Nico Misleh discusses the benefits of Direct Primary Care (DPC) and the integration of Functional Medicine and Hormone Replacement Therapy (HRT) into practice. He emphasizes the importance of providing personalized care that goes beyond conventional methods, addressing the needs of patients seeking wellness rather than just treatment. The conversation highlights the potential for DPC providers to stand out by offering innovative solutions and the necessity of continuous education in Functional Medicine. Nico shares real-world applications and success stories, encouraging providers to embrace these practices for better patient outcomes and satisfaction.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 optimization practice with The HRT Master Course. This program offers 30 ANCC-accredited credit hours and gives you the expert guidance you need to succeed. Start your journey at: https://hrtuniversity.com/hrtcourse/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://hrtuniversity.com/- Join the HRT University Facebook Group: https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr | — | ||||||
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