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The Truth About HRT and Lipedema

Alexey Markelov of AM Plastic Surgery

11,042 views

In this video, I break down the peer-reviewed science on whether Hormone Replacement Therapy (HRT) causes Lipedema fat to grow during menopause. We explore the 2025 clinical data explaining the estrogen receptor imbalance inside Lipedema tissue and how the diseased fat produces its own localized estrogen to drive chronic inflammation. I provide a direct clinical guide on safely protecting your metabolic health without worsening your symptoms, detailing why transdermal estradiol and hormone pellets are vastly superior to oral estrogen pills for minimizing blood clot risks. You will learn the critical timing for starting HRT, precise application protocols to avoid stimulating leg fat, and why utilizing a specific progesterone like drospirenone is essential to counteract fluid retention and block further fat expansion.

Hello, I’m Dr. Markelov, expert lipedema surgeon, Lipedema specialist, and double board certified plastic surgeon specializing in lipedema.

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0:00 Will HRT make lipedema worse
0:24 Estrogen milestones in lipedema
0:36 2025 study on estrogen receptors
1:12 How lipedema fat makes estrogen
1:41 HRT risks for clotting and legs
2:09 Why avoiding HRT can backfire
2:42 Best HRT routes for lipedema
3:18 Where to apply estrogen safely
3:44 When to start HRT for lipedema
4:16 Best progesterone choice explained
4:39 Using HRT to stabilize lipedema

20 Comments

@monicabarboza1011 2 months ago

After my full hysterectomy and going straight into surgical menopause I started HRT patch. My lipidemia continued to worsen over a year. I was doing everything from eating healthy strength training cardio and it was only getting worse! I started red light therapy on my lower body, vibration plate daily, incline walking with a vest and finally saw improvement but adding Retatrutide lowest dose for 4 weeks now has been the game changer!!! It has diminished tremendously!!! GLP/GIP reduce inflammation inside the cell which decrease the fat lobule. Everything I am doing is working synergistically and I have seen major improvement!! I might even get to wear shorts this summer!

@Dahnoie 2 months ago

All the best science concerning HRT using only bioidentical hormones has shown no health concerns, but many, many benefits. Too many doctors are still way out of date or completing missing any hormone replacement info and training.

@mperez2730 2 months ago

Post menopausal 7 yrs and started estradiol patch on belly and oral progesterone 6 weeks ago. So far so good. My heart palpitations have greatly decreased, my legs are the same not better but not worse. My sleep is great, I feel calm and grateful for HRT. I also follow a low inflammatory diet and practice prolong fasting 3 times a week. Thank you for your informative videos ❤

@user-zy7uj1bu7q 2 months ago (edited)

I am so thankful for your content!

@travelwithzarab 1 month ago

Bless you. Thank you so much for all this valuable information. I've been in tears tonight from looking at my legs. I have strength trained for years. Eat healthy and I'm not over weight. My upper body, i can see muscle definition but my lower body just makes me so depressed as its lumpy on my legs and the fat doesn't leave..but coming here, watching your videos gives me strength in some way, a bit of hope that things might get better.

@jemmagardner8618 2 months ago

People with lipedema have estrogen sensitivity. I've been learning about this condition for over a year and I'm just a young lady. I'm still learning and finding new things about this condition.

@Thrivelipoedema 2 months ago

This is such great information! Thank you. I’m 41 & just had the coil (progesterone) & I spent years prior in pain worried what effect it would have on my legs (I’ve never been able to have anything estrogen related ) 4 months of the mirena & It’s been ok for my Lipoedema, if anything I’m less swollen and a kg down of inflammation, still have pain & get my massages & compression. This information is so helpful for so many 🙌

@rochellemunrobrown2916 2 months ago

Interesting. I have not heard of that type of progesterone.

@rowenaroche2850 3 weeks ago

Excellent video

@happy_bubble7 10 days ago

I didnt have this until I had to have 18 years of HRT to supposedly treat PCOS and endometriosis.... which it never actually treated because I had cancer all over my system.

@villiehaizlip7626 2 months ago (edited)

Never used birth control or HRT. I guess it was a good thing. Now need to see a vascular Dr. Still trying to get diagnosed. Thank for your posts.

@eagleschic4926 2 months ago

Wow. Thank you.

@lizahipolito4422 2 days ago

I started HRT over a year ago after being post menopausal for 8-9 years. I did the estrogen patch with the progesterone pill. At first I felt great. But over that year my lipedema got worse and I gained 20 lbs while still using a GLP1 med! I am now off of HRT but miss some of the positive benefits. I have lost 5 of the 20 lbs I gained but it’s coming off very slowly. I wish I had never been put on HRT!😢

@warmfuzzyfeeling 2 months ago

Thank you, this has answered some questions I have had for a while. I went through menopause at 46 and gained around 25kg having been slim all my life despite the lipedema. I started HRT 18 months later and my weight stabilised. However, I wish I had started HRT a lot earlier as I feel it would have prevented a lot of the health issues I have had since. I have been worried about using estrogen gel on lipedema tissue but I'm not sure where else I can put it, as I have it on arms, legs, and possibly stomach too. I also have a mirena coil as I don't tolerate progesterone in other forms, and I'm not sure if there is any benefit to my lipedema from that.

@amieh5829 4 weeks ago

Started ht premenopause. I have lipedema with normal bmi. My lipedema did not get worse with ht and improved many things including reversing my osteopenia scores due to previous medications for JIA. Some doctors have said it is bad for all women with lipedema. I call bs because are women being cured when menopause happens? What other things are getting worse? I am a woman and have always had hormones and will die with my hormones. Ht may not be for everyone, but menopause is more than hot flashes. The benefits, risks etc need to be made individually. Glp1 and GIP seem to help me as well. Between my JIA and lipedema, it reduces my inflammation greatly. I am not taking it to lose weight, but many women in menopause or with lipedema could use it for weight loss as well. Last note. I am vegan for 20 years and eat pretty healthy…I am not going to do keto or carnivore, and I won’t live in compression 24/7 for the rest of my life either. I think everyone needs to assess the data and consider their own individual bodies and goals. I support women who with informed consent develop their treatment with the right doctors. What I am doing may not be for everyone, but wanted to share since it is working for me.

@scullyxenacat9657 2 months ago

Wow, do you do phone consults for Australians? I’ve got lipedema, sick euthyroid, dysautonomia/paradoxical vasovagal syndrome, and am now getting heart pain from the BP crashes during exercise, all my doctors are struggling to help me!

@SodikaAbdullah 2 months ago

I have a primary ovarian cyst and am 17 years old and have an ovarian cyst and rest assured to a doctor and give me medicine to regulate hormones and balance P.S. means I eat is a quail's nest of sugar and eggs and on days I am fat is a buckle of sugar without dates and depends on frike or potatoes I am thin from above so the doctor says I have uterine lining I am weak and I must have 15 percent fat and as much as possible, the doctor says you are asthmatic adjust my day of eating to be available naturally by the morning and I am stuffed I am deprived I am sensitive I am flustered possible your lordship continues to depend on your lordship's word I am needy experience limit and am I deprived of the length of my life I have a primary ovarian cyst

@LoveofLearning-j1k 2 months ago

Hello. Thank you for your great videos. I am using estradiol 0.5 estrogen vaginally and 150 mg progesterone in pill form. Also, testosterone 0.75 Is this ok?

@pattiiman989 2 months ago

Thank you!

@herakleiaandreadis1808 2 months ago

I am so grateful for your advice 🙏🏻
About the progesterone though you have not mentioned the micronized natural progesterone like Utrogestan. How does affect lipedema compared with progestins?