In recent years, hormone replacement therapy (HRT) has made headlines, praised by some for its effectiveness in improving menopause symptoms and feared by others for its rumored increased risk for certain health conditions. The confusion surrounding HRT even extends to its name — many clinicians suggest “hormone therapy” as a more accurate alternative (but for simplicity, we’ll stick to “HRT” here). These conflicting viewpoints have ultimately caused confusion among the general public, leaving many to question the safety and benefits of HRT.
What is HRT?
Designed to supplement falling levels of hormones like estrogen, HRT is a common treatment used to alleviate symptoms for individuals going through age-related hormonal changes like menopause or low testosterone (low T). In fact, HRT was the most prescribed treatment for menopause for decades in the U.S. because of its ability to relieve a range of symptoms that may disrupt everyday life, like hot flashes, night sweats, and genital dryness.
However, the use of HRT in the U.S. drastically declined after a 2002 study that indicated certain women may be at an increased risk for health conditions like heart disease, stroke, and breast cancer. These findings, however, were later reported to be taken out of context without proper evaluation of the methods and analysis of the data, leading to widespread misinterpretation of the data and the risks associated with HRT.
Due to a myriad of factors including misinformation perpetuated by inaccurate media sources and flashy celebrity endorsements for hormonal supplements, many people find it difficult to separate fact from fiction when it comes to HRT. So we’re debunking some of the biggest myths surrounding this treatment and shedding light on the facts.
The most common HRT myths debunked
Myth #1: HRT can delay menopause.
Age-related hormonal changes like menopause are inevitable, but for many, treatment options like HRT can make the menopause experience more bearable. Menopause symptoms like hot flashes, genital dryness, and mood swings can be disruptive in a person’s life. For some, these symptoms can be debilitating. In a survey of 1,000 women experiencing perimenopause (i.e. the period leading up to menopause) or menopause, 59% of respondents reported that the physical symptoms are the most challenging part of the experience. And among this population, hot flashes were the most common symptom. Research has shown that HRT is the most effective treatment for mild and severe hot flashes for those younger than 60 years old or who have started HRT within 10 years of menopause. While HRT does not delay or prevent menopause, it can relieve uncomfortable symptoms and restore a sense of normalcy in a person’s life.
Myth #2: HRT is only used to relieve menopause symptoms.
HRT is a term often associated with menopause; however, HRT can be used to restore other hormones like testosterone. When replacing testosterone levels in people with testes, this treatment is more specifically called testosterone replacement therapy (TRT). While lesser known than menopause, people with testes can experience declining levels of hormones, too. This decline in testosterone is part of the aging process, but some individuals’ testosterone levels may drop to a point so low that it negatively affects their health and/or quality of life. TRT has become an increasingly popular treatment to relieve low T symptoms like fatigue, irritability, low sex drive, and more.
In addition to relieving menopause and low T symptoms, HRT in general can have added benefits in osteoporosis, relieving some cancer symptoms, or as a part of gender-affirming care.
Myth #3: There’s only one type of HRT.
There are many assumptions about what HRT really is and how it’s delivered. Some associate HRT with a daily pill, while others expect to wear a patch or have weekly injections. These aren’t wrong — in fact, there are a number of different types and ways that HRT can be delivered.
Based on factors such as symptoms, age, and health history, a healthcare provider will work closely with an individual to determine the best treatment option for them. For example, if a healthy, 53-year-old individual with a uterus is considering HRT to manage their hot flashes, a healthcare provider may prescribe a medication with a combination of progestin and estrogen. Progestin combined with estrogen can help reduce the risk of uterine cancer. In comparison, an estrogen-only medication can cause the uterus lining to thicken, increasing the risk for uterine cancer. An estrogen-only medication may be appropriate for individuals who don’t have a uterus.
In addition to the different types of hormones used in HRT, the treatment can also be administered in a variety of ways including pills, patches, injections, and implants. How HRT is administered depends on many factors, including personal preference, treatment availability, cost, local regulations, and a provider’s overall clinical assessment.
Myth #4: Over-the-counter testosterone boosters and testosterone replacement therapy are the same.
Despite growing popularity and celebrity endorsements, over-the-counter testosterone supplements found in sports clinics and vitamin stores are not the same as TRT. In fact, there’s limited data to indicate that these types of testosterone-boosting supplements are effective in improving low T symptoms.
The truth is that TRT is not as simple as taking daily vitamins. TRT requires proper clinical assessment and ongoing monitoring. Before starting TRT, a provider will conduct screenings and exams to determine if it’s the best treatment option for the patient. For example, a healthcare provider may discuss alternatives to traditional TRT for individuals who are interested in growing their families through intercourse, as taking testosterone supplements can impact sperm production. After treatment has started, continuous follow-ups, including blood work, become a routine part of TRT to monitor improvements in symptoms.
Myth #5: HRT has been proven to cause heart disease in individuals going through menopause.
This myth stems from data from the Women’s Health Initiative (WHI) study published in 2002. The majority of participants in this study were over 60 years old — a decade past menopause — and received a combination hormone therapy of a single type of estrogen and progestin. Among this study’s population of women over 60 taking a specific form of HRT, researchers found that these women were at an increased risk for heart disease.
In a follow-up analysis of the WHI study, it was revealed that healthy women who start HRT before 59 or within 10 years of menopause actually have a decreased risk of heart disease compared to those who don’t take HRT. This myth highlights the nuances of HRT and how it can be a helpful treatment for some, and not for others.
The bottom line: Like any type of medication and treatment, HRT has its risks and benefits. In order to make an informed decision about what will work best for you, it’s important to discuss your symptoms and health history with your healthcare provider so you can confidently and comfortably navigate these hormonal changes.
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