There Is No Absolute Age Cutoff for Hormone Therapy
A timely Substack essay challenging outdated age-based limits for HRT and advocating for a personalized approach to hormone health.
It's time to debunk the myth that hormone therapy is only for younger women.
Older women, especially those beyond the so-called 'ideal' window, can still
benefit from treatment. Let's shift the focus from age prohibition to the
potential benefits of hormone therapy.
It's time to stop pretending that there's some magical age where hormone
therapy (HT) suddenly becomes too dangerous to consider. The science doesn't
support that fear-based messaging, and in fact, it tells a very different story.
For decades, women who were more than 10 years past menopause were told they were
'too late' for hormones (this usually means estrogen, implying that progesterone
and testosterone don’t matter). You are too old. Past the window. Told that hormone
therapy was 'only for young menopausal women' and 'not safe after age 60.' But let's
be clear: those warnings were based on broad, outdated interpretations of the WHI
study - a study that used oral conjugated equine estrogens and synthetic progestins
(no longer the gold standard) in women who were already decades into menopause,
many with underlying conditions. As the years went on in that study, the 'risks'
didn't hold up - most strikingly, the risk of stroke.
The actual truth? It tells a different story. A safer, more nuanced one.
Especially when discussing transdermal estradiol, the other hormones, and
individualized care.
What to read next
An evidence-based article outlining how estrogen decline contributes to joint pain, muscle loss, and osteoporosis in menopause.
An illuminating NeurologyLive interview where Dr. Mosconi explains how menopause affects brain function and the importance of targeting midlife for Alzheimer’s prevention.
Hormones regulate so many of the systems in your body. At times, it seems unclear exactly what each of them accomplishes, or why certain levels of particular hormones are floating around. This conversation comes up, especially around perimenopause, and even post-menopause, when specific hormone therapies can be utilized as treatments for bothersome menopause-related symptoms like hot flashes, low energy, and low libido. Estrogen is the most common hormone used in hormone replacement therapy, also known as menopausal replacement therapy, but what about testosterone? Yes, we’re talking about that hormone, the one that’s typically known as the “male” hormone. That’s right — testosterone is found in women’s bodies (at one-tenth of the amount in men’s bodies, but still) and any people born as female. Ovaries make testosterone and technically produce it at even higher levels than estrogen. And during menopause, when the ovaries slow down in their functioning, estrogen levels lower, as do testosterone levels in the body. Just like estrogen, testosterone can be safely used as a hormone replacement therapy during menopause. Still, not many people know that, because it’s not well-studied or officially FDA-approved for women. Keep on reading for everything you didn’t know about testosterone in women, testosterone replacement therapy, and how to know if it could be the right treatment for you.