Empowering Midlife Wellness with Dr. Susan

Dr. Susan Hardwick-Smith

Meet Dr. Susan, a renowned Board-Certified Gynecologist and Certified Menopause Practitioner through the Menopause Society (former NAMS), focused on hormone optimization, sexual wellness, and longevity. She's the pioneering force behind the Complete Midlife Wellness Center in Houston, TX, and the best-selling author of "Sexually Woke." Tune into her engaging podcast, "Empowering Midlife Wellness," for insightful conversations. Boasting numerous accolades, including the Texas Super Doctor award and being consistently rated among Houston's top gynecologists, Dr. Susan combines her medical expertise with her passion as an ICF-certified life and leadership coach. Outside the clinic, she's a fitness enthusiast, marathon runner, Ironman triathlete, and mother of three young adults. Join her YouTube channel for empowering wellness strategies designed for midlife and beyond. Content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your health care provider with any questions you have regarding a medical or mental health condition, and before undertaking any diet, dietary supplement, exercise, or other health program.

  1. Jun 25

    Vagina-Maxxing: Science or Social Media Nonsense?

    The internet is buzzing about a new trend called "vagina-maxxing"—the idea that women should optimize their vaginal microbiome to achieve the "perfect" vaginal health profile. But how much of this trend is actually supported by science? In this video, I break down what we currently know about the vaginal microbiome, why certain Lactobacillus species are associated with vaginal health, and whether genetic testing, probiotics, supplements, and various vaginal wellness products truly deliver on their promises. We'll discuss: What "vagina-maxxing" actually means The role of the vaginal microbiome in women's health Why Lactobacillus crispatus gets so much attention The different vaginal community state types (CSTs) What the research says about vaginal probiotics The difference between evidence-based treatments and marketing claims Whether you really need microbiome testing Vaginal wellness treatments including the O-Shot®, PRP, Emsella®, vaginal laser therapies, labiaplasty, and vaginoplasty When these treatments may be appropriate—and when they may not What women should focus on instead of chasing the "perfect" vaginal microbiome The truth is that vaginal health is far more complex than a single test result or social media trend. While the vaginal microbiome is an important part of women's health, there is no such thing as a perfect vagina, and many of the claims circulating online deserve a closer look. If you are experiencing vaginal dryness, recurrent infections, discomfort, sexual concerns, pelvic floor symptoms, or simply have questions about your vaginal health, there are evidence-based options available. The right approach depends on your symptoms, goals, and stage of life. As always, my goal is to help you separate science from hype so you can make informed decisions about your health. If you'd like personalized guidance, we'd be happy to help. Schedule a consultation with our team at Complete Midlife Wellness Center to discuss your concerns and explore the options that may be right for you. https://completemidlifewellnesscenter.com RESOURCES:Live Vaginal Laser Therapy & O-Shot Procedurehttps://youtu.be/_ZZYgWAgUYI Urinary Incontinence? Here are your optionshttps://youtu.be/BvN2-Z3SIdQ Labiaplasty 101https://youtu.be/jRAsEXTPU9A Amazon - VagiBiomhttp://bit.ly/4oTuzHX Amazon - Genetic testinghttps://a.co/d/03BqtsZS ARTICLES:Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosishttps://www.nejm.org/doi/full/10.1056/NEJMoa1915254 Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trialhttps://pubmed.ncbi.nlm.nih.gov/41855531/

    24 min

  2. Jun 19

    Progesterone Levels Explained: What Every Woman Should Know

    Progesterone is one of the most important reproductive hormones in a woman's body, yet there is often confusion about what progesterone levels actually mean and whether they should be measured. In this video, I explain what progesterone is, how it is produced, how levels change throughout a woman's reproductive life, and why interpreting a progesterone blood test is often more complex than many people realize. We'll discuss The role of progesterone in the menstrual cycle and reproductive health How progesterone levels change from the reproductive years through perimenopause and menopause The normal rise and fall of progesterone during a menstrual cycle Why progesterone levels can vary dramatically from day to day in perimenopause Common signs and symptoms associated with declining or fluctuating progesterone When progesterone testing may provide useful information—and when it may not Why symptoms and clinical context are often more informative than a single laboratory value One of the most important concepts to understand is that progesterone is not a static hormone. Its levels change throughout the cycle and can fluctuate significantly during perimenopause, making a single blood test difficult to interpret in many situations. My goal is to help you better understand the physiology of progesterone so you can make more informed decisions about your health and have more productive conversations with your healthcare provider. Interested in booking an appointment? Click here: https://completemidlifewellnesscenter.com

    13 min

  3. Jun 12

    Hormone Therapy Timing: When to Start, When to Stop, and Is It Ever Too Late?

    Now that we understand much more about the potential health benefits of menopausal hormone therapy, I want to tackle one of the questions I hear most often: when should you start hormone therapy, when should you stop it, and is there ever a point when it's too late to begin? We know that starting estradiol close to menopause can help support healthy blood vessels and may reduce the risk of cardiovascular disease and other age-related conditions. But what if you weren't offered hormones when you first entered menopause and are now 10 or more years beyond it? In this video, I discuss what the research actually shows about starting estrogen later in life, who may benefit, who may not, and why some of the perceived risks have often been overstated or misunderstood. I'll also take a closer look at the Women's Health Initiative study that changed the course of hormone therapy conversations more than 20 years ago. We'll discuss what the study found, the limitations that were recognized over time, the lessons we learned from it, and why its conclusions do not apply equally to all women. I'll also discuss the ELITE trial and what it taught us about the timing of hormone therapy, including findings that suggest estrogen may help preserve vascular health when started closer to menopause. I'll explain what the researchers discovered, how these findings have influenced our understanding of hormone therapy today, and what they may mean for women who are considering treatment now or wondering whether they missed their opportunity to benefit from it. Whether you're considering hormone therapy for the first time, wondering if you should continue taking it, or questioning whether you've missed your opportunity to benefit from it, I'll walk you through what we know today. By the end of this video, you'll have a clearer understanding of the evidence behind starting, stopping, and starting hormone therapy later in life—and the questions you should be asking when making these decisions for yourself. If you'd like personalized guidance, you can schedule an appointment with me or one of our Menopause Society Certified Practitioners. We offer in-person care in Houston and Cypress, Texas, as well as virtual appointments for patients throughout Texas, California, and New Mexico. https://completemidlifewellnesscenter.comhttps://completemidlifewellnesscenter.com/on-hormone- consultations/info/https://completemidlifewellnesscenter.com/virtual-medical-care/

    19 min
  4. Do I Still Need a Pap Smear? Brand-New ACOG Cervical Cancer Screening Guidelines Just Released

    Jun 3

    Do I Still Need a Pap Smear? Brand-New ACOG Cervical Cancer Screening Guidelines Just Released

    New cervical cancer screening recommendations have just been released and many women haven't heard about them yet. These brand-new ACOG guidelines are among the most important updates we've seen in years, and they may change how often you need screening, which tests are recommended, and when screening can safely stop. In this video, I'm breaking down these newly released recommendations and explaining what they mean for you. We'll talk about the differences between Pap tests and HPV tests, how often screening is recommended at different ages, and why the guidelines have evolved as our understanding of cervical cancer prevention continues to improve. My goal is to help you understand the science behind the guidelines so you can make informed decisions about your health with confidence. One important takeaway: even if you don't need a Pap smear every year, that doesn't mean you should skip your annual wellness visit. Cervical cancer screening is just one part of preventive care, and a comprehensive wellness exam should address many other aspects of your health as you move through midlife and beyond. Learn more about our Annual Wellness Experience:completemidlifewellnesscenter.com/annual-wellness/ Interested in booking an annual wellness appointment?completemidlifewellnesscenter.com We offer in-person care in Houston and Cypress, Texas, as well as virtual medical care for patients throughout Texas, California, and New Mexico. As always, this information is intended for educational purposes and should not replace personalized medical advice from your healthcare provider. For more evidence-based information about women's health, menopause, hormone therapy, longevity, and thriving in midlife, be sure to subscribe to the channel. RESOURCES:New ACOG Cervical Cancer Screening Guidelinesdrive.google.com/file/d/1IMPnlA7b…view?usp=sharing Detailed recommendations and information on exceptions (such as previous hysterectomies or high-risk history) can be viewed directly on the ACOG Cervical Cancer Screening page. www.acog.org/womens-health/info…l-cancer-screeningWe'll talk about the differences between Pap tests and HPV tests, how often screening is recommended at different ages, and why the guidelines have evolved as our understanding of cervical cancer prevention continues to improve.My goal is to help you understand the science behind the guidelines so you can make informed decisions about your health with confidence.RESOURCES:New ACOG Cervical Cancer Screening Guidelineshttps://drive.google.com/file/d/1IMPnlA7blnGD2GsC-MHrj2OCfWAI3WSO/view?usp=sharing Detailed recommendations and information on exceptions (such as previous hysterectomies or high-risk history) can be viewed directly on the ACOG Cervical Cancer Screening page.https://www.acog.org/womens-health/infographics/cervical-cancer-screening

    21 min
  5. Testosterone for performance enhancement? Yes, please!

    May 13

    Testosterone for performance enhancement? Yes, please!

    It’s time to move beyond the fear-based conversation around testosterone and start discussing the science. Testosterone is not simply a “male hormone.” It plays a critical role in women’s physiology — influencing muscle mass, endurance, motivation, cognition, mood, metabolic health, sexual function, recovery, and overall vitality. In this video, I explore: • The evidence behind testosterone and physical performance • Significant improvements in muscle mass and time to exhaustion (running) • Why free testosterone matters more than total testosterone alone • SHBG, albumin binding, and equilibrium dialysis • Genetic differences in androgen receptor sensitivity (CAG repeats) • Why there is no single “optimal” testosterone number for every woman • The importance of individualized dosing and monitoring • Long-term safety data, including transgender testosterone research More than 95% of testosterone is bound to SHBG and albumin. Hormonal physiology is nuanced, individualized, and far more complex than many outdated narratives suggest. The reality is this: When properly prescribed, dosed, and monitored, testosterone therapy is remarkably safe. Referenced studies include: • British Journal of Sports Medicine (May 2020) Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study https://drive.google.com/file/d/1z8dvTerB0fnXRhYZ8Y2dwivRHgZKvu_6/view?usp=sharing • Louise Newson pilot study on cognition and mood Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study https://drive.google.com/file/d/1TxdsaiYIzKtsTmSD5NLBazeUeC250Bya/view?usp=sharing • Long-term transgender testosterone safety data Trans men can achieve adequate muscular development through low-dose testosterone therapy: A long-term study on body composition changeshttps://drive.google.com/file/d/1aoDrxl7rMUoHLEIgXI8KAM38pg9W6vhf/view?usp=sharing Bone Safety During the First Ten Years of Gender-Af rming Hormonal Treatment in Transwomen andTransmenhttps://drive.google.com/file/d/1D47vmWxnWr9I_DBMOGcfzakZ8dGNQUMF/view?usp=sharing The efficacy, safety, and outcomes of testosterone useamong transgender men patients: A review of the literaturehttps://drive.google.com/file/d/1M11Qvii1geSYaIr141iedD75IAKV-PAX/view?usp=sharing 💻 Interested in booking an appointment? Click here: https://completemidlifewellnesscenter.com Virtual medical care available in Texas, California, and New Mexico.

    22 min
  6. How to host a women's circle | Empowering Midlife Wellness with Dr. Susan

    May 6

    How to host a women's circle | Empowering Midlife Wellness with Dr. Susan

    In this conversation, I explore how women’s gatherings can become spaces for connection, reflection, honesty, and transformation. I created this video to gently encourage more women — wherever they are — to host these kinds of gatherings within their own homes, friendships, and communities. We need spaces where women can come together more intentionally, especially during seasons of transition, uncertainty, growth, and midlife change. Throughout this video, I walk through almost everything you need to thoughtfully host a meaningful women’s gathering — from inviting people, setting the tone, and arranging the space, to guiding conversation, creating emotional safety, and allowing deeper discussions to unfold naturally and authentically. I also share a few of the questions I personally love using during gatherings and conversations. https://drive.google.com/file/d/1nw_61gkBateSIULdD_Lpgr-S00_WTYjL/view?usp=sharing

    28 min
  7. Perimenopause: The Missing Diagnosis

    Apr 22

    Perimenopause: The Missing Diagnosis

    Perimenopause is one of the most misunderstood phases in a woman’s life—and too often, it’s missed entirely. Every day, I see women who have been told they’re “too young,” that their labs are “normal,” or that what they’re experiencing is simply stress or something psychological. And yet, they know something is changing. Perimenopause is not a steady decline. It’s a phase of hormonal unpredictability—where estrogen can fluctuate significantly, progesterone declines, and testosterone gradually shifts. These changes can drive a wide range of symptoms that may seem unrelated, but are deeply connected. Yet many women find their symptoms are addressed in isolation—often without a comprehensive view of their hormonal landscape. I believe we can do better. This is where the concept of midlife baseline screening becomes essential. By measuring hormones thoughtfully and at the right time, we can move from assumption to clarity—and from generalized care to a more precise, individualized approach. In this video, I walk through: – Why perimenopause is often overlooked – What is actually happening hormonally – The limitations of symptom-only care – The role of baseline screening – How to find a provider trained in perimenopause and menopause care My goal is simple: to help you better understand your body, and to ensure you are met with the level of care and expertise you deserve. If you’re navigating perimenopause, you are not alone—and there are answers. 💻 Interested in booking an appointment? Click here: https://completemidlifewellnesscenter.com We offer care across three convenient locations—in the vibrant Houston Museum District, the heart of Tanglewood/Piney Point, and in Cypress, serving Northwest Houston. For those who prefer remote access, we provide secure virtual medical care across Texas, California, and New Mexico. Coaching programs in perimenopause and menopause are available nationwide and globally. Our services are thoughtfully designed by women who understand your journey and delivered by menopause-certified professionals.

    23 min
  8. Testosterone for Women: When Dosing Is Right, You Have Options

    Apr 15

    Testosterone for Women: When Dosing Is Right, You Have Options

    Testosterone is often misunderstood in women—and too often reduced to oversimplified or fear-based messaging. The reality is this: testosterone can be a safe and effective therapy for women—particularly for Hypoactive Sexual Desire Disorder (HSDD) and other symptoms of low testosterone—when it is dosed appropriately. And that’s the key. When dosing is right—meaning carefully adjusted for female physiology and monitored over time—women are not limited to a single option. They can choose the delivery method that fits their body and their life. In this video, I walk you through: 🌿 What testosterone actually does in the female body 🌿 Common symptoms of low testosterone 🌿 When therapy may be appropriate 🌿 The difference between FDA-approved testosterone products for men and the formulations commonly used in women 🌿 How dosing is approached in women (low, individualized, and not one-size-fits-all) 🌿 The pros and cons of different delivery methods, including gels, injections, and pellets We also touch on emerging clinical experience and ongoing research exploring pellet dosing in women, including work in collaboration with Baylor College of Medicine. Early observations suggest that, when dosing is appropriate, stable levels and low rates of side effects are achievable—and in some cases may compare favorably to the variability seen with topical therapies. This is not about one method being “right” and another being “wrong.” It’s about understanding that dose—not delivery—is what determines safety and outcomes. Testosterone is an important hormone in women. It affects libido, mood, energy, muscle, bone, and overall quality of life. We need more research. We need better education. And we need to move toward collaborative, patient-centered care—where women are informed, supported, and able to choose what works best for them. As always, hormone therapy should be individualized and guided by a qualified clinician. A must-watch video: Should Women Use Male Testosterone Products? | Real-Life Demo with Dr. Susan https://youtu.be/nQlrkWpZOAE Interested in booking an appointment? Click here: https://completemidlifewellnesscenter.com 💻 We offer virtual medical care in Texas, California, and New Mexico.

    29 min
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About

Meet Dr. Susan, a renowned Board-Certified Gynecologist and Certified Menopause Practitioner through the Menopause Society (former NAMS), focused on hormone optimization, sexual wellness, and longevity. She's the pioneering force behind the Complete Midlife Wellness Center in Houston, TX, and the best-selling author of "Sexually Woke." Tune into her engaging podcast, "Empowering Midlife Wellness," for insightful conversations. Boasting numerous accolades, including the Texas Super Doctor award and being consistently rated among Houston's top gynecologists, Dr. Susan combines her medical expertise with her passion as an ICF-certified life and leadership coach. Outside the clinic, she's a fitness enthusiast, marathon runner, Ironman triathlete, and mother of three young adults. Join her YouTube channel for empowering wellness strategies designed for midlife and beyond. Content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your health care provider with any questions you have regarding a medical or mental health condition, and before undertaking any diet, dietary supplement, exercise, or other health program.

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