Abstract
Bioidentical hormone replacement therapy (BHRT) may indirectly support mobility and flexibility when hormone changes contribute to joint stiffness, bone loss, muscle weakness, poor sleep, or reduced activity. Estrogen therapy can help protect bone density and may modestly reduce joint pain in some postmenopausal women. Testosterone replacement may improve muscle strength in appropriately diagnosed men with low testosterone. However, hormone therapy is not a direct treatment for tight muscles, restricted joints, or poor flexibility. Exercise, stretching, strength training, rehabilitation, and appropriate musculoskeletal care remain important.
At Injury Medical Clinic PA in El Paso, Texas, an integrative approach can bring hormone and medical oversight together with chiropractic care, functional medicine, rehabilitation, and personal injury services. The goal is to address both the biological factors that may influence movement and the mechanical factors that affect how the body moves.
Can Bioidentical Hormone Therapy Help Mobility and Flexibility?
The short answer is possibly, but mostly indirectly.
Mobility describes how well a joint and the surrounding muscles can move through a useful range of motion. Flexibility usually describes how easily muscles and soft tissues can lengthen. Both depend on many factors, including:
Joint health
Muscle strength
Connective tissue health
Pain levels
Bone health
Balance and coordination
Physical activity
Previous injuries
Sleep and recovery
Age-related changes
Hormones can influence several of these areas. During menopause, estrogen levels fall. Aging men may also experience lower testosterone levels. These changes can occur along with joint aches, changes in bone density, loss of muscle strength, and changes in body composition.
Hormone therapy may help address some of these underlying concerns, but it does not replace movement training or rehabilitation.
Why Hormones Can Affect the Way the Body Moves
Estrogen receptors are found in many tissues throughout the body. Estrogen plays roles in bone maintenance, connective tissue biology, and other processes that may affect musculoskeletal health.
During the menopause transition, some women report more joint pain, stiffness, or difficulty staying active. Current research also describes musculoskeletal changes associated with menopause, including joint discomfort, declining bone density, and changes in muscle health (Wright et al., 2024).
A large Women's Health Initiative randomized trial found that estrogen-alone therapy produced a modest but sustained reduction in joint pain compared with placebo in postmenopausal women (Chlebowski et al., 2013). Importantly, the improvement was modest, and hormone therapy should not be viewed as a stand-alone treatment for joint pain.
A more recent menopause review similarly notes that hormone therapy may reduce joint pain for some women but should not be prescribed simply as a joint-pain medication (Maven Clinic, 2026).
BHRT, Joint Stiffness, and Daily Movement
When joints hurt, people naturally move less. Less movement can then contribute to:
Muscle tightness
Reduced range of motion
Weakness
Poor balance
Lower exercise tolerance
Greater stiffness after sitting or sleeping
If medically appropriate hormone therapy reduces menopausal symptoms or joint discomfort, a person may find it easier to walk, exercise, stretch, and participate in rehabilitation.
This is one reason BHRT may indirectly improve mobility.
Patient education from Mobility Bone & Joint Institute also describes the importance of maintaining joint health after menopause, while movement programs such as Essentrics emphasize combining flexibility with strength, control, and connective-tissue movement (Essentrics, 2025; Mobility Bone & Joint Institute, 2025).
Some BHRT clinics also report improved joint comfort among appropriately selected patients, although these clinic reports should not be considered equivalent to randomized clinical research (BodyLogicMD, 2025; Renew Health & Wellness, 2021).
What About Cartilage and Inflammation?
Hormones can influence inflammatory pathways and connective tissues, but it is important not to overstate the evidence.
Some BHRT resources describe possible benefits for inflammation, cartilage health, and tissue repair. However, BHRT has not been established as a treatment that regenerates damaged cartilage. Osteoarthritis, cartilage injuries, ligament injuries, and tendon problems may require their own evaluation and treatment plan.
If joint pain improves after hormone treatment, a person may become more active. That increased movement can help maintain joint function, muscle conditioning, and range of motion.
This is different from saying that BHRT directly repairs a damaged joint.
Bone Density Is an Important Part of Long-Term Mobility
One of the strongest connections between menopausal hormone therapy and physical function involves bone health.
The Menopause Society states that systemic hormone therapy can help protect bones, and its position statement recognizes hormone therapy as effective for preventing bone loss and fractures in appropriately selected women (The North American Menopause Society, 2022).
Women's Health Initiative research also found that estrogen plus progestin increased bone mineral density and reduced fracture risk in postmenopausal women (Cauley et al., 2003).
Strong bones do not automatically make a person more flexible. However, maintaining bone health can help preserve:
Independence
Walking ability
Exercise participation
Confidence with movement
Resistance-training ability
Long-term physical activity
These factors become increasingly important with age.
Can Hormone Therapy Improve Muscle Strength?
The answer depends on the person and hormone involved.
For postmenopausal women, hormone therapy has not consistently been shown to preserve muscle mass. A systematic review and meta-analysis involving more than 4,000 participants did not find a significant overall improvement in lean body mass with menopausal hormone therapy (Javed et al., 2019).
That means resistance training, adequate protein, proper nutrition, and regular physical activity remain essential.
For men with medically confirmed testosterone deficiency, testosterone replacement may have a more direct effect on muscle. A 2023 systematic review found that testosterone replacement improved muscle strength in older men with relatively low testosterone levels, although treatment should be based on a proper medical diagnosis rather than age alone (Lee et al., 2023).
More muscle strength may make activities such as getting out of a chair, climbing stairs, exercising, and maintaining balance easier.
Again, strength and flexibility are not the same thing.
Flexibility Still Requires Movement
No hormone medication can replace regular movement.
Improving flexibility normally requires a combination of:
Gentle stretching
Full-range joint movement
Strength training
Balance exercises
Walking or other aerobic activity
Progressive rehabilitation when needed
Adequate recovery and sleep
Exercise therapy is well supported for improving physical function in people with common musculoskeletal problems (Hayden et al., 2021).
This explains why the best results may come from viewing hormone treatment as one possible part of a larger mobility plan, rather than the entire solution.
How Integrative Chiropractic Care Fits Into the Plan
Chiropractic care does not directly replace estrogen, progesterone, or testosterone, and chiropractic treatment should not be described as correcting hormone deficiency.
Its role is different.
Integrative chiropractic care can focus on the mechanical side of movement. Depending on the patient's condition, care may include:
Evaluation of spinal and joint mobility
Posture and movement assessment
Chiropractic manipulation or mobilization when appropriate
Soft-tissue treatment
Corrective exercise
Strength and stability training
Mobility exercises
Rehabilitation
Education about safe activity
Evidence suggests that manipulation and mobilization can reduce pain and improve function for some people with chronic low-back pain, although results vary by condition and patient (Coulter et al., 2018).
Dr. Alexander Jimenez's published clinical material similarly emphasizes combining musculoskeletal assessment, mobility work, functional medicine, nutrition, exercise, and rehabilitation rather than treating one symptom in isolation (Jimenez, 2026a, 2026b).
In practical terms, hormone management may address a biological barrier to movement, while chiropractic and rehabilitation may address a mechanical barrier to movement.
A Multidisciplinary Model in El Paso, Texas
At Injury Medical Clinic PA in El Paso, Texas, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, works within a multidisciplinary model involving chiropractic care, functional medicine, rehabilitation, wellness care, and personal injury services. His published clinical observations focus on looking at the whole patient rather than treating an isolated painful joint or laboratory number.
Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician with more than four decades of medical experience, works with Dr. Jimenez as medical director and collaborative physician. Public provider information identifies her Texas medical license as J2933 and NPI as 1164426748.
This MD-DC collaborative structure allows medical and musculoskeletal concerns to be considered together.
Dr. Cardenas's internal medicine role can provide medical direction and oversight when patients require evaluation of hormone-related symptoms, medications, health risks, laboratory findings, or other medical concerns. Dr. Jimenez's role can focus on chiropractic assessment, movement mechanics, musculoskeletal care, rehabilitation, and functional strategies.
Together, the broader clinical model may incorporate:
Medical oversight
Chiropractic care
Functional medicine
Hormone-health evaluation
Nutrition and lifestyle strategies
Personal injury care
Musculoskeletal rehabilitation
Mobility and strength training
Referral to other specialists when appropriate
Clinic materials describe this type of coordinated approach as a way to connect medical management with functional and musculoskeletal rehabilitation (Jimenez, 2026c).
BHRT Is Not Right for Everyone
Hormone therapy requires individualized medical decision-making.
The term bioidentical does not automatically mean safer. FDA-approved estradiol and micronized progesterone are chemically identical to hormones made by the human body, but custom-compounded hormone preparations have not been proven safer or more effective than approved hormone therapies.
Mayo Clinic specifically notes that products marketed as “bioidentical” or “natural” are not automatically safer than traditional hormone therapy (Mayo Clinic, 2024).
The Menopause Society likewise recommends individualized decision-making because the benefits and risks of systemic hormone therapy depend on factors such as:
Age
Time since menopause
Medical history
Personal and family history
Type and dose of hormone
Route of administration
Treatment duration
Systemic estrogen may carry risks, including blood clots and, depending on the treatment plan and duration, changes in breast cancer risk. Discuss these issues with a qualified medical professional before treatment begins.
The Bottom Line: BHRT May Support Movement, but Movement Still Matters
Bioidentical hormone therapy may help some people feel and move better when a true hormone-related problem contributes to joint discomfort, bone loss, weakness, poor sleep, fatigue, or reduced activity.
The greatest potential benefit is indirect.
BHRT may help create a better physical environment for movement, while exercise, rehabilitation, strength training, stretching, and appropriate chiropractic care help the body actually develop better movement.
A complete strategy may therefore look like this:
Hormone evaluation + medical oversight + joint and spinal care + strength training + mobility work + nutrition + recovery.
For patients dealing with aging, menopause, hormone changes, previous injuries, or chronic stiffness, addressing both biology and biomechanics may provide a more complete path toward maintaining mobility, independence, and quality of life.
References
BodyLogicMD. (2025, April 10). How BHRT supports joint health and reduces chronic pain.
Cauley, J. A., Robbins, J., Chen, Z., et al. (2003). Effects of estrogen plus progestin on risk of fracture and bone mineral density: The Women's Health Initiative randomized trial. JAMA, 290(13), 1729–1738.
Chlebowski, R. T., Cirillo, D. J., Eaton, C. B., et al. (2013). Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial. Menopause, 20(6), 600–608.
Coulter, I. D., Crawford, C., Hurwitz, E. L., et al. (2018). Manipulation and mobilization for treating chronic low back pain: A systematic review and meta-analysis. The Spine Journal, 18(5), 866–879.
Essentrics. (2025). Mobility for menopause.
Javed, A. A., Mayhew, A. J., Shea, A. K., & Raina, P. (2019). Association between hormone therapy and muscle mass in postmenopausal women: A systematic review and meta-analysis. JAMA Network Open, 2(8), e1910154.
Jimenez, A. (2026a). A clinical approach to hormone optimization & metabolic health.
Jimenez, A. (2026b). Patient wellness and health with bioidentical hormones.
Jimenez, A. (2026c). Physician-led integrative chiropractic care in El Paso.
Lee, T. W., et al. (2023). Effects of testosterone replacement therapy on muscle strength in older men.
Maven Clinic. (2026, July 14). HRT and joint pain in menopause: What the evidence says.
Mayo Clinic. (2024, October 3). Bioidentical hormones: Are they safer?.
Mobility Bone & Joint Institute. (2025, March 12). A guide to joint health after menopause.
The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794.
The Menopause Society. (2026). Hormone therapy.
Wright, V. J., et al. (2024). The musculoskeletal syndrome of menopause.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
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Blessings
Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-State Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
New York APRN License #: N25929, Verified: APRN-N25929*
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
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Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
