Hormone Replacement Dangers

Men and women may seek hormone replacement therapy for many reasons, but there are serious risks.

Hormone Replacement Therapy

HRT, or hormone replacement therapy, refers to a medical prescription of hormones to patients who cannot naturally produce the right amount. The general categories of patients receiving HRT are transgender or intersex patients, men receiving androgen replacement, and post-menopausal women. After menopause, women may have less estrogen and progesterone. This can also occur after a hysterectomy. Sometimes testosterone is added to the HRT plan. For men, androgens may be introduced to counter hypogonadism, aging, or testicular dysfunction due to cancer or disease. There are some positive outcomes of hormone therapy. Estrogen may boost working memory, and it can improve sexual functioning.¹ Menopause causes symptoms such as vaginal dryness and hot flashes, as well as an increased risk of osteoporosis. HRT may be prescribed to protect against these issues.² There are a few types of HRT for women. Systemic hormone therapy (gel, cream, pill, patch, or spray) is estrogen. There are also low-dose vaginal estrogen forms (ring, tablet, or cream) that minimize absorption. Unlike the systemic products, the low-dose vaginal products do not help with night sweats, hot flashes, or osteoporosis; however, they do treat urinary and vaginal symptoms. Typically, women going through natural menopause receive estrogen and progesterone, while post-hysterectomy patients (uterus removed) would only receive estrogen, due to the fact that estrogen alone can increase the risk of uterine cancer. The patients most likely to need HRT are those who have lost bone mass, who have severe symptoms of menopause, or who have gone through premature menopause (before 40) or premature ovarian insufficiency (lost ovarian function before 40). The risks of early menopause (or ovary removal) include coronary heart disease, osteoporosis, dementia, sexual concerns, anxiety, depression, and Parkinson’s-like symptoms. Early menopause, however, lowers the risks of ovarian and breast cancers.³ For men, low testosterone can result from chemotherapy, injury, too much iron, inflammatory diseases, certain medications, cirrhosis, kidney failure, stress, obesity, and alcoholism. Without enough testosterone, there can be sexual dysfunction, depression, cholesterol changes, osteoporosis, anemia, and a decrease in muscle mass. Testosterone replacement forms include injections, skin or mouth patches, gels, tablets, implants, and sticks (like a deodorant).⁴

Risks of HRT

Hormone replacement therapy can have some positive effects, but there are risks. Progestin can cause hearing problems in women, due to negative effects on the ear and central nervous system. HRT can increase cardiovascular issues in women. Over time, hormone replacement therapy can lose its effectiveness.⁵ Besides heart disease, HRT in women can increase the risk of stroke and breast cancer.⁶ Blood clots may also occur. Hormone therapy used to be routinely prescribed for post-menopausal women.⁷ Now, it is being reconsidered, and prescriptions may be issued for a shorter period of time. Lifestyle, age, and health are all factors in choosing HRT.⁸ While testosterone replacement can help mood and improve erectile dysfunction (ED), there are risks for men, too. Some men don’t respond at all, or they only have mild improvement in symptoms.⁹Low testosterone (low T) treatments can increase cardiovascular problems, and there is mixed evidence about risks such as prostate cancer. Dietary changes, exercises, therapy, and working on relationship and life stressors may also improve testosterone levels.¹⁰ Testosterone replacement therapy (TRT) has other side effects, such as acne, breast enlargement, sleep apnea, and possibly stroke. Any woman or child coming into skin contact with the gel could develop hair growth or premature puberty. Risks and benefits of TRT must be weighed.¹¹ Natural options and lifestyle changes may be beneficial alternatives to HRT and TRT.