As each of us approaches either Menopause for women or Andropause for men, we have to decide if we will replace those depleted hormones or not.  As with most choices in life, it is more complicated than it might first appear.  While medical professionals are a great source of information about the subject, it is too important a decision to defer the answer to someone else. We need to do some research ourselves.

So, why would a person choose to replace hormones?  For most people, the primary reasons to seek hormone replacement are physical symptoms which happen as a result of missing hormones.  For women, these symptoms include hot flashes, night sweats, mood swings, brain fog and an overall decrease in health, while for men fatigue, loss of or decreased libido, loss of muscle mass, and also decrease in health occur when they lose too much testosterone with aging. The benefit of a better quality of life by reducing or eliminating these sometimes debilitating issues is enough to make men and women who suffer more than average at this time of life at least consider it. For people with no big risk factors this decision is fairly easy, but for those with risk factors, it is more complicated.

For women, the biggest concern is an increased risk of breast cancer. Women who have a family history of breast cancer are at greater risk than others. Other women have had previous blood clots or some other issue which hormones, in general, might affect negatively. Other writings have explored this in detail, but we have to separate the risk for conventional HRT from Bio-Identical HRT. For BHRT, we are doing several things which reduce the risks compared to conventional; using the right ratio of the right hormones including human progesterone, using topical or pellet forms instead of oral use (this primarily matters for estrogens), and using lower dosages contribute to reduced risk, but it is important to note that we haven’t identified how much less risk at this point.

In addition to the relief of physical symptoms, there are several documented long-term benefits from hormone replacement. In women, reduced risk of Alzheimer’s, colon cancer, and osteoporosis are important.

Who should NOT pursue hormone replacement?  At this time for women who have a personal history of estrogen positive breast cancer almost all practitioners would recommend against HRT.  Other women with a strong family history of breast cancer need to explore all the pros and cons, but there is no absolute reason not to consider a rational approach.  It might be that the family history is strong enough to not use the stronger estrogen, estradiol and instead use just the estriol form. This form has not been shown to increase the risk of breast cancer and can be used to reduce physical symptoms.  History of blood clots also deserves extra consideration before starting HRT.

For men, historically we had thought that replacing testosterone was a risk factor for prostate cancer. Recent studies have shown that there is no added risk of developing it, but at this time, we would not recommend testosterone for a man who actually has or has been treated for prostate cancer.

In short, whether we replace hormones or not is an individual choice, and each of us should consider all the reasons for both choices when making this important decision.