Is HRT right for you? Key considerations and benefits

Hormone replacement therapy (HRT) is a medical treatment designed to restore optimal hormone levels in people whose body’s hormone production has decreased. HRT’s purpose? Relieving the often life-altering symptoms of this deficiency and helping people feel like themselves again.

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HRT can restore hormone levels to an appropriate range in women and men as well as eliminate — or greatly reduce — symptoms associated with low hormone levels. In women, the main hormones at play are estrogen, progesterone, and testosterone. In men, testosterone is the key player, said Dr. Andrea Caamano, head of medical at The HRT Club. Also, just recently in a big shift, the FDA removed warnings on menopause HRT products.

Who is a candidate for HRT?

According to Caamano, women who are within 10 years of menopause and experiencing symptoms like hot flashes, night sweats, brain fog, fatigue, mood swings, or low libido are often good candidates. The goal is to ease symptoms while protecting heart and bone health.

Men with symptoms of low testosterone — low libido, fatigue, or depression — should also ask their doctors for an evaluation. The goal of HRT for men is to restore testosterone levels to a healthy range, which can improve energy, mood, and sex drive.

Key differences between HRT for women and men

The primary difference between HRT therapies lies in the hormones themselves, said Caamano. For women, HRT typically involves a combination of estrogen, progesterone, and sometimes testosterone. For men, the main hormone it replaces is testosterone.

Both genders on HRT require regular monitoring, including routine blood tests to check organ function and red blood cell levels. Yearly physicals are important, with a focus on cardiovascular health and blood pressure. Women also need to get regular mammograms and gynecological exams. Men should monitor their prostate health through PSA levels and prostate exams.

Women tend to use HRT for a shorter period to manage menopause symptoms, while men often remain on testosterone replacement therapy longer to maintain their levels.

How is HRT administered?

You have many choices on how to take HRT, and the right one for you depends on your specific needs, health profile, and what your insurance covers. Caamano offered these options:

• Oral: You can take HRT in pill or capsule form. While convenient, oral hormones pass through the liver, which can lead to a slightly higher risk of blood clots and gallbladder issues. This delivery method can also reduce a dose’s consistency as your body processes it.
• Transdermal: Patches, gels, and creams allow your skin to absorb the HRT directly. This method bypasses your liver, which can lower certain risks. However, you’ll need to be careful to avoid transferring the medication to others via skin contact.
• Injection and pellets: It’s common to administer testosterone and estrogen via injection, although they can cause some discomfort at the injection site. Pellets are tiny implants placed under your skin by your healthcare provider. These release a steady dose of hormones over several months, so you don’t have to remember to take a daily dose or change your patch regularly. The biggest drawback to pellets is that it’s difficult to adjust the dose once they’re in place.
• Vaginal: For localized symptoms like vaginal dryness or painful sex, vaginal creams, rings, and inserts deliver estrogen directly to the affected area. Although this treatment is a great way to relieve those specific symptoms, it doesn’t address other perimenopause issues, like hot flashes or night sweats.

What hormones are used in HRT?

The main hormones used in HRT are estrogen, progesterone, and testosterone. “They’re often bio-identical, meaning they’re chemically identical to the hormones your body naturally produces,” said Dr. Jobby John, CEO and founder of Nimbus Healthcare.

Estrogen

This key hormone influences many biological processes. During perimenopause and menopause, it relieves symptoms like hot flashes, night sweats, vaginal dryness, and mood swings. Estrogen also helps restore sleep and has a protective effect on the heart and bones. The most common type of estrogen prescribed is estradiol, which is the most potent form your body makes.

Progesterone

This hormone is critical for women who still have a uterus. “It’s used in conjunction with estrogen because it protects the uterine lining, preventing the increased risk of uterine cancer that can occur with unopposed estrogen therapy,” said Caamano. Progesterone also has a calming effect, helping with anxiety and improving sleep.

Testosterone

Though often considered a “male” hormone, women also produce testosterone in small amounts. In microdoses, testosterone can be beneficial for combating fatigue, increasing energy, and boosting libido. It also contributes to muscle mass and an overall sense of well-being, said Caamano.

What questions should you ask your doctor if you’re prescribed HRT?

Before beginning HRT, have a clear, open conversation with your doctor. To confirm you’re a good candidate and get the best results, Caamano recommends asking the following questions:

• Am I a good candidate for HRT? Discuss your complete medical history, your family medical history, and current symptoms so your doctor can assess your personal risk factors and determine if HRT is the right choice.
• Which type of HRT is best for me? Ask about HRT’s different forms. Discuss the pros and cons of each, including potential side effects, and decide together on a plan that fits your lifestyle.
• What are the expected benefits and risks? Your doctor should explain what symptoms you can expect to improve and what potential side effects or risks to be aware of.
• How will we monitor my progress? Ask about the follow-up plan, including how often you’ll need blood tests or other check-ups. These tests ensure your hormone levels stay in the optimal range and confirm that the therapy is working as intended.
• What should I do if I experience side effects? Have a clear plan for how to handle any unexpected side effects. Knowing whom to call and what steps to take should provide you with peace of mind.

HRT isn’t a one-size-fits-all solution, but for many, it’s an effective way to manage the challenging (and unwelcome) symptoms of hormone changes we experience as we age. By understanding how HRT works, available options, and what to discuss with your doctor, you can take control of your health.