Content warning: This story includes references to suicidal ideation. Lisa Schrenk didn’t know it yet, but her life was about to change. She was trudging down a dirt trail in Virginia’s Blue Ridge Mountains last August, her boots scuffing the rocky path, her shoulders heavy in a way that had nothing to do with her pack. The climb had been hard—she and her hiking group had started out late the night before, scrambling up Old Rag Mountain in the dark with headlamps cutting through the black. They had reached the summit in time to watch the sun rise over the mountains, and afterward, the women had taken pictures to mark the moment. In one photo, Schrenk gazes out over the horizon, her long dark hair pulled back in a ponytail, her face calm and composed. The image is deceptively triumphant. In reality, she was contemplating suicide. She had been for a while. A longtime IT specialist for the federal government, she had spent months quietly getting her affairs in order: setting aside belongings for friends and family, organizing her financial paperwork, clearing out her office as if she wouldn’t be coming back. To the outside world, she was a woman on a mountain at sunrise, strong and capable. To herself, she was someone who had already begun the slow, heartbreaking work of saying goodbye. What she didn’t know—couldn’t know—was that the answer to her despair was waiting for her on the way down. The descent would be uneventful in all the obvious ways. The sun climbed higher, the trail grew crowded, and the ordinary chatter of the women filled the air. Schrenk walked among them, present but not present, going through the motions of a person who has learned how to function while falling apart. She had been to doctors. She had been told she had treatment-resistant depression, a label that felt less like a diagnosis and more like a door slamming shut. She had tried to explain that her mind and body seemed to be singing from different songbooks, that something deeper felt broken. But no one seemed to hear her. So she kept walking, expecting nothing.
Her hallelujah moment—though she didn’t know it at the time—began not at the summit but on the descent, when Schrenk overheard a conversation between two hikers about hormone therapy. One of the women was describing how she had suffered from intense anger, anxiety, and exhaustion for years, until she started a course of hormones typically offered to people in menopause. Now, she said, she was thriving. Schrenk felt her chest tighten. Could this be the answer to her problems, too? “I was like, oh my God,” she later remembered. It was as if the woman had lifted a page from Schrenk’s own private diary. The anger that flared out of nowhere. The anxiety that churned in her stomach day and night. The exhaustion that followed her even after a full night’s sleep. She had been naming these things as depression, and depression was real. But what if depression was only the surface, the visible part of an iceberg that was actually hormonal? Schrenk had already suspected as much. In her early forties, she was potentially approaching or was already deep inside perimenopause, the long transitional period when the ovaries gradually stop making reproductive hormones and estrogen levels can fluctuate wildly. But when she asked her primary care physician about hormone therapy, the doctor dismissed the idea. After all, Schrenk was already taking one of the most common treatments for perimenopause symptoms: an oral contraceptive containing synthetic versions of progesterone and estrogen. Why would she need more hormones? Schrenk tried to explain that the pill wasn’t working for her, that it felt like treating a wildfire with a garden hose. She went to two different gynecologists, hoping for a different answer. “Automatic no,” she says. One of them switched her to a different brand of birth control. It made no difference. The depression deepened, and the mountain became the only quiet place she knew.
After the hike, Schrenk did what so many people do when the conventional medical system lets them down: she went looking for another way. She searched online for “HRT-friendly doctors near me”—a phrase that already told the story. She wasn’t necessarily looking for a miracle; she was looking for someone who would at least hear the question without flinching. She found Midi, a telehealth startup focused on women’s midlife care, and signed up for a video consultation. It was the beginning of a different kind of medicine. During that first appointment, Schrenk broke down. “I cried through my first appointment, sobbing with snot and tears falling from my face,” she says. The nurse practitioner did not seem put off. Instead, she listened. She didn’t treat Schrenk as a difficult patient or a woman looking for a quick fix. She understood that switching from a contraceptive dose of synthetic hormones to a lower, bioidentical version of the same molecules could change the way the body responded. She also understood that delivery mattered—that a patch or a gel might be processed differently than a pill, and that the way progesterone is given can influence whether it makes a person feel sedated, depressed, or unchanged. It was a level of nuance and flexibility that Schrenk had never encountered in a medical office. For the first time in years, she felt like someone was on her side. The nurse practitioner agreed to switch her from the birth control pill to hormone therapy, and they began a process that was less like a prescription and more like a partnership. Over the next five months, they met regularly, adjusting dosages and methods, fine-tuning the medications to minimize side effects and find the combination that felt right. It was painstaking, patient work. But it was also a form of respect. “I finally felt heard,” Schrenk says. And being heard, she learned, could be the first step toward being healed.
Today, Lisa Schrenk is not quite the same person who climbed Old Rag Mountain with a plan to die. The most obvious change, she says, is that “I’m no longer planning my own funeral.” It is a stunning sentence to say out loud, and Schrenk knows it. She doesn’t take the words lightly. She still remembers what it was like to sort through her belongings, to organize her finances, to clean out her office for people who would have been devastated to know what she was doing. But that part of her life is over. The turnaround came gradually, as her body adjusted to the hormones and her mind began to follow. She describes it as a radical improvement in her mental health—not because the hormones were a magic spell, but because they corrected a deficiency that had been masquerading as a psychological illness. These days, she spends time with her beloved dog, going for long walks and ordinary errands that once felt like chores. She goes hiking again, not as a desperate attempt to feel something, but because she genuinely wants to be outside. She notices the small things again: the smell of rain, the sound of birds, the simple comfort of being alive. She even finds herself feeling happy when she’s stuck in traffic in Washington, DC, which is almost a form of proof that something fundamental has changed. “I’m noticeably happier even when I’m stuck in traffic,” she says, laughing. That sentence may sound trivial, but for someone who had been preparing to leave the world, it is everything. The patches and pills did not erase every bad day. They did not make life perfect. But they gave Schrenk a foundation on which she could rebuild the rest of herself. She stopped planning her own funeral and started planning the next hike.
Schrenk’s personal breakthrough came at a moment when the broader world was also changing its mind about hormone therapy. For years, the treatment had been treated as a menace, ever since a huge 2002 study known as the Women’s Health Initiative seemed to show that hormone replacement therapy raised the risk of breast cancer and heart disease. Headlines blared warnings, and millions of women stopped taking hormones. Many doctors, afraid of being sued and trained on the new orthodoxy, simply stopped prescribing them. The pendulum swung so far that a generation of perimenopausal and menopausal people were told that hot flashes, night sweats, insomnia, and mood swings were just something they had to endure. The problem was that the study had serious limitations. It focused largely on older women, often many years past menopause, and it used specific formulations and doses that did not reflect the way hormone therapy was typically used for younger, perimenopausal women. When researchers reanalyzed the data, the risks turned out to be far smaller than the public had been told, and for many women the benefits were enormous. But by then, the damage was done. It took more than a decade for the medical community to begin correcting course. By the end of the Biden administration, the attitude had flipped. Medical professionals, mainstream feminists, and even the Make America Healthy Again movement—groups that rarely agree on anything relating to women’s health—all seemed to agree that the blanket rejection of hormone therapy had been a disaster. Potentially millions of people were suffering through symptoms that could be effectively treated. Newer language, more inclusive and less paternalistic, began to circulate: talk of people with ovaries, of midlife hormonal health, of patients as partners rather than passive recipients of care. The revolution didn’t happen in one dramatic moment. It happened in small ways, in clinics and conversations and online searches like the one Lisa Schrenk made while sitting at home, trying not to lose hope.
Lisa Schrenk’s story is, at bottom, a human story rather than a medical one. It is about the moment you finally feel seen. It is about the difference between a doctor who listens and a doctor who simply prescribes. It is also about how easy it is to mistake a physical problem for a personal failure. Schrenk was told she had treatment-resistant depression, and she believed it. She began to believe that nothing could save her, that she was somehow broken beyond repair. The truth was more complicated and, in some ways, more hopeful. Her depression was real, but its roots ran through a hormonal system in turmoil. When the hormones were addressed, the despair began to lift. Her story carries a warning and a promise. The warning is that symptoms speak in many languages, and sometimes the words they use sound like sadness, anger, or exhaustion. The promise is that those symptoms can be deciphered, and that there is no shame in asking for help, even when the first doctor, or the second, says no. Schrenk almost didn’t hear the hiker who changed her life. She was lost in her own dark thoughts, walking down a mountain she hadn’t expected to descend. But she heard the words, and she followed them. She found a doctor who listened, and a treatment that worked. In the months since, she has not transformed into a different person; she has simply returned to herself. She is the woman who loves her dog, who hikes for pleasure, who can sit in traffic on a sunny afternoon and smile without knowing exactly why. She still has a body, which means she still has hormones, which means life will still have its stormy moments. But she is no longer making plans to leave the world. She is making plans for the next trail, the next sunrise, the next ordinary beautiful day. The mountain that once witnessed her quiet despair has become the place where she heard a few passing words that helped bring her back to life. She didn’t know it yet, standing on that summit, but she was not at the end of her story. She was at the beginning.
