Case study

Case Study: How We Approached Knee Osteoarthritis in an Active 51-Year-Old

A regenerative protocol combining BHRT, IV stem cell therapy, and a targeted PRP + exosome knee injection.

Every outcome here is an individual result, not a typical or guaranteed one. Outcomes vary substantially between patients, which is why we lead with how each protocol was reasoned rather than a headline number. Whether any therapy is right for you is determined from your own labs and history at consultation.

Patient snapshot

A 51-year-old premenopausal woman, an avid pickleball player who swims with her grandchildren every summer, presented with progressive right-knee osteoarthritis. Her orthopedist had recommended surgery.

The struggle

Classic pickleball knee, progressive stiffness and pain that had cut her playing schedule in half. Her orthopedic workup confirmed moderate osteoarthritis; she was offered a cortisone injection and told to plan for surgery. Her hormonal picture was also in transition, with premenopausal sleep, mood, and temperature shifts compounding everything.

The protocol

The treatments

  • Comprehensive 45–60 minute consultation with Dr. Southern including physical assessment, review of prior knee imaging, and full labs (hormonal, inflammatory, metabolic)
  • HRT pellet insertion at week 1: testosterone drives tissue regeneration in women too, since cartilage, ligament, and tendon are all hormone-responsive
  • 1 IV stem cell infusion at week 3
  • 1 intra-articular injection to the right knee at week 5, combining PRP from her own blood with exosomes
The outcome

The transformation

  • Within 2 weeks of the pellet: sleep improved, mood stabilized, energy returned
  • At 6 weeks post-injection: morning stiffness eased, stairs no longer required favoring the good leg
  • At three months she reported she was back on the pickleball court.
  • By month six she had returned to competitive play, and reported recovery between matches had shortened considerably.
  • That summer she reported swimming with her grandchildren through the season.

Her recovery has been so complete that several of her pickleball friends have since become patients, in her words, "just to keep up with me."

Clinical commentary

Cartilage, ligament, and tendon tissue is hormone-responsive. When estradiol, progesterone, and testosterone drop below optimal, tissue repair capacity drops with them, and regenerative interventions administered into that terrain deliver a fraction of their potential response. Her hormonal picture wasn’t adjacent to her regenerative protocol; it was the terrain those interventions were working in.

Dr. Ashley SouthernDr. Ashley Southern, NMD

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