AI Summary
5 min readThe Zone of Chaos
Casey Stumpf, a nurse practitioner with a specialty certification in menopause, estimates there are roughly 4,100 providers in the United States with her credential, serving 75 million women who are in perimenopause, menopause, or postmenopause. The math does not work. That gap between need and available care is the central problem she spends her days trying to solve, and it is the reason the response to her first appearance on this podcast was overwhelming: women who had been told they were "fine" by four or five previous providers finally heard someone describe what was actually happening to them.
The Patch Shortage and What It Reveals
The most immediate crisis in women's hormone therapy right now is a shortage of estrogen patches. Before the Women's Health Initiative study published results in 2002, about 25 percent of women used hormone therapy. That study—which Stumpf says was later discredited—claimed estrogen caused breast cancer and heart disease, and prescriptions plummeted to about 5 percent. In July 2024, the FDA acknowledged the therapy could be lifesaving, and by November, the black box warning was removed. Prescriptions doubled almost overnight.
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What you'll learn
- 1 (00:20) **Opening Hangover & The Estrogen Patch Shortage** - Casey arrives slightly hungover, then dives into the nationwide shortage of estrogen patches.
- 2 (09:16) **The Patch Shortage Workarounds & The Oral Estrogen Trap** - Casey outlines the alternatives to patches and explains a critical hormone interaction.
- 3 (13:12) **Military Testosterone Screening: The Headline vs. The Reality** - Casey and Andy discuss the Pentagon’s new policy to screen service members for low testosterone.
- 4 (18:07) **The Overwhelming Response & The Provider Math Problem** - Casey reflects on the massive listener response to her first appearance and the scale of the unmet need.
- 5 (24:33) **HRT After Breast Cancer: When "No" Is Not the Answer** - Casey addresses a listener question about hormone therapy after a non-hormone-reactive breast cancer diagnosis.
- 6 (29:09) **The Best HRT Regimen for Perimenopause & The Lab Testing Trap** - Casey explains the ideal hormone protocol and why standard lab tests often fail perimenopausal women.
- 7 (35:00) **Testosterone for Women: Dosing, Formulations & The FDA Gap** - Casey details how to use testosterone in women and the barriers they face.
+ Full timestamped outline available in the app
Show Notes
Casey Stumpf is a nurse practitioner and my sister. Years in emergency medicine and hospice, a stretch inside military medicine at Camp Pendleton, and now her own practice in Montana treating hormones full time — perimenopause, menopause, testosterone for men and women. She is one of roughly 4,100 providers in the country holding the MSCP certification. There are 75 million American women in some phase of menopause. The math does not work.
She is back to answer listener questions and to explain why estrogen patches are disappearing. The FDA says there is no shortage. Pharmacists say otherwise. Best estimate on a fix is two to three years.
She lays out what the 2002 Women's Health Initiative did to an entire generation of women, and why the black box warning finally came off. Testosterone for women, prescribed off-label because no FDA-approved formulation exists. GLP-1s and what they pull out of you besides fat. Hormone therapy after breast cancer. Vaginal estrogen, UTIs, and hip fractures. The suicide risk in perimenopause that standard screening misses.
Contact Casey Here: https://theradiantwelltality.com/
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