About

Ksenia Malarkey, ND

She/her


Naturopathic Physician

Dr. Malarkey is a licensed naturopathic doctor in the state of WA with a deep commitment to whole-person healing. A graduate of Bastyr University, she completed a two-year residency at the AIMS Institute, where she continues to practice now. She also offers virtual consultations for both in-state and out-of-state patients at a reduced rate, making her care more accessible. Dr. Malarkey’s clinical focus includes integrative oncology, chronic illness, hormone health, including biHRT, autoimmune disease, digestive health, and mental wellness. She is a trained provider of Ketamine-Assisted Psychotherapy and offers this at AIMS Institute.

Originally from St. Petersburg, Russia, Dr. Malarkey learned about health through the lens of environments from a young age. Summers were spent foraging mushrooms, berries, and herbs under the guidance of her grandmother. Those teachings laid the foundation for Dr. Malarkey’s belief in the importance of holistic care and “vis medicatrix naturae” (the healing power of nature).

In her practice, Dr. Malarkey blends this grounding in traditional wisdom with evidence-based medicine, creating thoughtful, individualized treatment plans designed for lasting transformation. Her approach is holistic, addressing not only physical health, but also the emotional, cultural, and spiritual dimensions of healing.

Outside the clinic, she finds joy in movement, nature, and building community.

Specialty Testing Offered:

– Liquid biopsy

– Genetics

– Mold and environmental toxins

– Allergies & sensitivities

– Autoimmune panels

– Hormone testing

– Gastrointestinal health panels

– Nutritional & metabolic assessments

What's New?

Bioidentical Hormone Replacement Therapy (BiHRT) and Cancer

You’ve probably heard that hormone replacement therapy (HRT) is dangerous, increases breast cancer risk, and should only be used short-term. That reputation stems from the 2002 Women’s Health Initiative (WHI), which reported an increased risk of breast cancer in users of combined estrogen–progestin therapy. However, in the two decades since, follow-up studies and expert reviews have clarified that the original conclusions were overly broad—especially for younger women and those using estrogen-only therapy.

Current evidence shows that when HRT is individualized—considering hormone type, timing, and delivery method—it does not significantly increase breast cancer risk. In fact, when initiated within 10 years of menopause, HRT offers protective benefits for bone density, cardiovascular function, and cognitive health.

1. Type and Duration Influence Risk

- Estrogen-Only Therapy (ET) in women without a uterus is associated with neutral or even reduced breast cancer risk.
- Combined Estrogen–Progestin Therapy increases breast cancer risk by approximately 7–8% for each year of use. However, short-term use (fewer than five years) results in only a slight increase in risk, which often returns to baseline after discontinuation.
- Estrogen + Micronized (Bioidentical) Progesterone carries a lower breast cancer risk than estrogen combined with synthetic progestins.

Key Findings:

- A meta-analysis of ~86,000 women across three cohort studies found that ET combined with micronized progesterone was associated with a 33% lower risk of breast cancer compared to ET plus synthetic progestins (RR 0.67; 95% CI 0.55–0.81) (Smith et al. 2021).
- The E3N cohort in the UK found no increased risk with ET + micronized progesterone (OR 0.99), but a 28% increased risk with synthetic progestins (OR 1.28) (Dupont et al. 2019).
- French E3N-EPIC data similarly confirmed a neutral risk with micronized progesterone (RR 0.9) and a 40% higher risk with synthetic progestins (RR 1.4) (Martin et al. 2018).
- A 2024 review in Annals of Oncology further affirmed the lower risk associated with micronized progesterone (Kim et al. 2024).
- A 2016 meta-analysis concluded that bioidentical progesterone is significantly safer than synthetic progestins in terms of breast cancer risk (Asi et al. 2016).

2. Localized (Vaginal) Estrogen

For women experiencing genitourinary symptoms such as dryness or painful intercourse, vaginal estrogen therapy is considered extremely safe—even in breast cancer survivors.

Recent Evidence:

- A 2024 meta-analysis of eight studies (~24,000 women) found no increase in recurrence (OR 0.48) or mortality (OR 0.60) among breast cancer survivors using vaginal estrogen (Jones and Lin 2024).
- TriNetX registry data (2009–2022) confirmed a neutral risk of recurrence.
- A 2025 ASCO presentation reported that among 18,620 survivors using vaginal estrogen cream, breast cancer mortality dropped by 47%, and all-cause mortality by 44%, even in hormone-sensitive cases (Reuters Health 2025).

3. Localized (Topical) Progesterone

A common question is whether topical progesterone is systemically absorbed. The answer is yes—despite low serum levels, evidence from tissue and alternative blood tests shows significant absorption and biological activity (Burry et al. 1999; Du et al. 2013).

4. HRT and Gynecologic Cancer Risk

Emerging data provide reassurance for gynecologic cancer survivors considering HRT.

Key Updates:

- A June 2024 ASCO update analyzing WHI data reported that estrogen-only therapy may modestly increase ovarian cancer incidence and mortality.
Combined estrogen–progestin therapy did not increase ovarian cancer risk and may lower endometrial cancer risk (Perez et al. 2024).
- A 2025 review in Current Treatment Options in Oncology found no significant recurrence risk with HRT in early-stage endometrial cancer survivors, though data remain limited for advanced or high-grade cases (Nguyen et al. 2025).
- A 2023 review of PubMed-indexed studies concluded that HRT is not contraindicated for most gynecologic cancer survivors, with the exception of low-grade serous ovarian cancer or high-grade uterine malignancies (Khan et al. 2023).
- A 2024 meta-analysis found no increased recurrence among early-stage endometrial cancer survivors using HRT (Lopez et al. 2024).


How Are Hormones Tracked?

1. Blood Testing (Serum)

The most common and conventional method for hormone analysis.

Best for:
- Baseline hormone levels (estradiol, progesterone, testosterone, DHEA-S, FSH, LH)
- Monitoring HRT dosing (especially injections or oral therapies)

Examples:
- Estradiol (E2) – to assess menopausal status or HRT response
- Progesterone – to confirm ovulation (mid-luteal phase)
- FSH/LH – for evaluating ovarian reserve or menopause

Accuracy:
- High precision and reproducibility
- Measures both bound and free (total) circulating hormone levels
- Limited in detecting tissue-level or diurnal fluctuations

Limitations:
- May not reflect bioavailable or intracellular hormones
- Results highly sensitive to timing of the draw

2. Urine Testing (24-Hour, Dried Urine & At-Home Devices)

Provides a broader picture of hormone metabolism and patterns.

Best for:
- Evaluating hormone metabolites (e.g., estrogen detox pathways)
- Tracking cortisol rhythm and adrenal function
- At-home ovulation confirmation and fertility monitoring

Clinical Examples:

DUTCH Complete by Precision Analytical (Dried Urine):
- Measures estradiol, estrone, estriol + estrogen metabolites (2-OH, 4-OH, 16-OH)
- Progesterone metabolites (α- and β-pregnanediol)
- Diurnal cortisol and cortisone
- Androgens, DHEA, melatonin, and oxidative stress markers

At-Home Devices:

MIRA Analyzer:
- Measures LH, E3G (estrone-3-glucuronide), PdG (progesterone metabolite)
- Tracks ovulation, fertile windows, and trends via app
- Optional FSH test wands available

Inito Fertility Monitor:
- Measures LH, E3G, PdG on a single urine strip
- Smartphone-connected device with predictive algorithm for ovulation

Accuracy:
- DUTCH: Clinically validated, high accuracy for metabolites
- MIRA & Inito: FDA-registered, ~99% accurate for LH surge; PdG correlates well with serum progesterone

Limitations:
- DUTCH: Requires practitioner interpretation and tends to be costly 
- MIRA/Inito: Designed for fertility tracking, not comprehensive diagnostics
- These tests are sensitive to hydration, timing, and user consistency

3. Saliva Testing

A non-invasive method that measures free (unbound) hormone levels.

Best for:
- Diurnal cortisol rhythm tracking
- Monitoring topical/transdermal bioidentical hormone therapy
- Functional medicine protocols

Examples:
- Four-point cortisol tests (morning, noon, evening, bedtime)
- Estradiol and progesterone monitoring in bioidentical protocols

Accuracy:
- Reflects active hormone fractions (unbound)
- More accurate than serum for topical hormone delivery
- Well-validated for cortisol and melatonin; less so for sex steroids

Limitations:
- Affected by eating, drinking, oral health
- Less accepted in mainstream medicine
- Inconsistent for estrogen and testosterone

Final Takeaways

- Misinterpretations of WHI findings led to excessive caution with HRT, especially in younger women.
- Micronized progesterone is consistently associated with lower breast cancer risk than synthetic progestins.
- Vaginal estrogen is not only safe but may reduce mortality in breast cancer survivors.
HRT appears broadly safe in gynecologic cancer survivors, particularly in early-stage disease, when personalized appropriately.
- Hormone monitoring should be individualized based on delivery method, symptoms, and goals—considering blood, urine, and saliva modalities.


Click here to view all references. 

Bioidentical Hormone Replacement Therapy (BiHRT) and Why I Should Care?

A FOREWORD

Patients and providers alike have been misled for over twenty years about the risks and benefits of hormone replacement therapy (HRT). Most providers and medical organizations are still not using BiHRT/HRT correctly and are depriving patients of safe and effective treatment options. No other currently available option, aside from lifestyle changes, can enhance your quality of life and decrease your risk of dying as effectively as BiHRT/HRT.

WHAT IS BIOIDENTICAL HORMONE REPLACEMENT THERAPY (BIHRT) AND HOW IS IT DIFFERENT FROM CONVENTIONAL HORMONE REPLACEMENT THERAPY (HRT)?

Bioidentical hormones are “compounds that have exactly the same chemical and molecular structure as hormones produced in the human body.” These typically come from plants and are modified in a lab. The term is used to describe preparations containing either progesterone or one or more of three estrogens—estradiol (the predominant estrogen in premenopausal women), estrone, and estriol (the main estrogen produced during pregnancy). These can be compounded, or a small portion is available pharmaceutically. They are often referred to as “bioidentical,” “body identical,” or “natural” and tend to be safer and better tolerated.

– An example of a conventional hormone is Premarin, which is synthesized from the urine of pregnant mares and contains a mix of estrogens (some unique to horses), steroids, and various other substances. Progestins such as medroxyprogesterone acetate and norethindrone acetate are also examples of synthetic hormones. These are not the exact structure of human hormones and can come from natural and unnatural sources. These are termed “synthetic” and are less safe, less effective but are FDA-approved and more widely covered by insurance.

WHAT ARE THE BENEFITS OF BIHRT AND/OR HRT?

Estradiol:

– E2 has been shown to have protective factors against heart disease, stroke (1, 2), osteoporosis (3), Alzheimer’s disease (4), memory disorders (5), vaginal atrophy, urinary incontinence, UTIs, macular degeneration (6), cataracts (7), and breast and colon cancer (8, 9).

– It is commonly used to treat menopausal hot flashes and mood disorders.

Progesterone:

– Bioidentical progesterone is important for menopausal, perimenopausal, premenopausal, pregnant, and postpartum women.

– It has been shown to reduce bloating, headache, cyclical migraines, PMS, perimenopause and menopause symptoms, bleeding, fibroids, breast soreness, insomnia, anxiety, infertility, and miscarriages.

– It moderates many side effects of excess estrogen. Progesterone is synergistic with estrogen’s effect on bone and lipids; it is antagonistic to estrogen in the breast and uterus.

Testosterone:

– When done correctly, testosterone can improve well-being, energy, strength, endurance, body composition, bone density, and sexual function.

– It has bene shown to lower cholesterol and improve all lipid parameters, thus decreasing the risk of cardiovascular disease (10).

– Additionally, testosterone can lower insulin resistance, lower incidence of syndrome X, and improve metabolism.

WHAT ARE THE SIDE EFFECTS OF BIHRT AND/OR HRT?

Estrogen:

– Synthetic estrogens, including Premarin (conjugated equine estrogen) and the estrogens in birth control, increase clot risk (though the risk is small). Estradiol does not (especially if given transdermally).

– Estradiol can cause breast tenderness, abnormal or breakthrough bleeding, and fluid retention from too much estrogen or increased sensitivity. These issues are typically mediated by lowering the dose and balancing with adequate progesterone.

Progesterone:

– Provera (medroxyprogesterone acetate, MPA) increases inflammation and is the reason the WHI told women that “hormones cause cancer.” Progesterone does not. It has anti-breast cancer activity (similar to testosterone).

– Progesterone can cause drowsiness, so it is suggested to be taken before bed.

Testosterone:

– In women, testosterone can most commonly cause abnormal hair growth and acne. This can be managed with medications, dosage adjustment, or discontinuing therapy altogether. Another concern is clitoromegaly, a condition where the clitoris becomes enlarged. This condition is benign but not preventable. Lowering or discontinuing THT may reverse clitoromegaly, but not in everyone.

Water Retention:

– With testosterone, this may occur due to aromatization into estrogen (mostly only in men), which increases thirst and sodium absorption. Testosterone also stimulates muscle growth, which can cause water retention, typically improving within a few months.

– Estrogen interacts with the brain to elicit thirst and the renin-angiotensin-aldosterone pathway to increase sodium absorption in the kidneys.

– Bioidentical progesterone typically improves water retention associated with unopposed estrogen or estrogen therapy by blocking the mineralocorticoid receptors, limiting how much salt and water are reabsorbed by the kidney. Synthetic progestins do not.

DOES TESTOSTERONE REPLACEMENT THERAPY INCREASE THE RISK OF HEART ATTACKS?

– No. This misconception came from a study published in 2014 that concluded older men and younger men with pre-existing diagnosed heart disease had an increased rate of heart attacks. However, there was no control group, and the researchers “selected men who filled a first prescription… [and] did not have data on how much of the prescribed medication was consumed” (11).

– In fact, several studies found that TRT reduces the risk of heart attack, stroke, and all-cause mortality rates by as much as 50% (12). Additionally, TRT can reduce insulin resistance, reduce visceral fat, improve lipids, reduce blood pressure, and reduce inflammation (13, 14).

Click here to view all references. 

30 Years of Integrative Oncology: A Look at How Far We've Come

This year marks the 30th anniversary of integrative oncology in North America—a field that blends conventional cancer treatments with evidence-informed complementary therapies. Back in 1991, the U.S. Congress took a bold step by launching the Office of Alternative Medicine to explore non-traditional approaches to healthcare, especially for cancer. Since then, the field has grown tremendously, with researchers and naturopathic doctors alike contributing to its evolution.

So, what have we actually achieved over the last three decades?

- IV Vitamin C (Ascorbate) has shown promising results in supporting chemotherapy for some cancers.
- Hyperthermia therapies—both whole-body and targeted—are being used to help treat solid tumors like brain cancer.
- Immunotherapies, especially those targeting the PDL-1 pathway, are showing outstanding results in select cancer patients.
- Tumor DNA sequencing has opened the door to highly personalized, targeted treatments.
- Understanding glucose metabolism in cancer has led to therapeutic strategies like intermittent fasting and the use of metformin.
- Medical cannabis is now widely accepted for managing treatment side effects and is being studied for its potential to slow tumor growth.
- Mind-body medicine—including therapies like meditation and yoga—is now a recognized part of many cancer care plans.
- Psychedelic-assisted therapy is emerging as a powerful tool for easing the emotional and spiritual burdens that come with a cancer diagnosis.
- Psychoneuroendocrinoimmunology (PNEI)—a field that studies how our psychological and biological systems interact—has helped redefine how we understand and treat cancer from a truly holistic angle.
- Spiritual well-being is now considered an essential aspect of healing and can even be measured with tools developed by the NIH.


The journey hasn’t been perfect, and there’s still work to be done. But looking back, it’s clear that integrative oncology has grown from a fringe idea into a respected and valuable component of modern cancer care.

Click here to view the publication.

Can Three Common Medications Help Fight Cancer? 

A small study from the AIMS Institute in Seattle looked at whether a combination of three medications—artesunate, high-dose vitamin C, and doxycycline—could help fight cancer in two patients. These drugs were given through an IV (intravenously), and the results are encouraging.

What Are These Medications?

Artesunate: Originally used to treat malaria, it comes from the sweet wormwood plant. Recent research shows it may also help fight cancer by stopping tumor growth and making cancer cells more sensitive to chemotherapy.
Doxycycline: A common antibiotic that has shown potential in stopping cancer stem cells from growing.
High-dose Vitamin C (Ascorbate): Large doses of vitamin C given through an IV may damage cancer cells and help patients feel better during chemotherapy.

How Was the Study Done?

The doctors followed two women with ovarian cancer. They tracked how many cancer cells and cancer-related DNA fragments were in their blood before and after this triple IV therapy.

What Did They Find?

In both cases, the number of circulating tumor cells and tumor DNA dropped after treatment. This suggests the therapy might be shrinking tumors or slowing down the disease. The treatment also appeared to be safe and well-tolerated.

Why Is This Important?

Blood tests that look at tumor DNA are a newer and less invasive way to track how well cancer treatments are working. These early results hint that this triple IV therapy could be a useful tool, especially for patients who aren’t responding well to standard treatments.

What’s Next?

This was a small, early study with only two patients. More research is needed to confirm how well this therapy works. Still, it offers hope that combining these three medications might one day become part of integrative cancer care.