Hormone replacement therapy, also known as HRT, typically refers to the process of supplementing low levels of estrogen or testosterone. This is done for a wide variety of reasons. However, the majority of hormone replacement is for women in the early stages of menopause.
Current estimates show around 44% of women who will use estrogen replacement will begin within the first year of menopause. The intent is to help delay potential negative symptoms associated with the natural loss of estrogen. Women whose estrogen levels drop due to surgical intervention also have higher rates of estrogen replacement. Around 74% of women who’ve had their ovaries removed will go on hormone replacement therapy. In total about half of women who’ve undergone natural menopause report using hormone replacement therapy.
Benefits and Risks
These numbers paint a clear picture. Women undergoing a sudden drop in estrogen have a high chance of using hormone replacement therapy. With that in mind, what benefits do women receive from estrogen replacement? Estrogen typically helps relieve most of the overt symptoms of menopause. This includes insomnia, vaginal dryness and hot flashes. However, these symptoms are only one small part of a much larger picture.
At one point people simply assumed that estrogen replacement would have a positive effect on the cardiovascular system. Estrogen increases HDL cholesterol and decreases LDL cholesterol. Basically, this means that it increases levels of the good cholesterol while decreasing levels of the bad. It also dilates blood vessels which can increase overall blood flow and circulation. It was widely believed that this was the main reason why women typically developed heart disease a full decade later than men.
However, long term studies involving supplementation with either estrogen or a combination of estrogen and progestin showed this isn’t the case. In fact, heart issues have been seen to increase as hormone replacement therapy progresses. More studies need to be performed to get a clear picture. But the role of estrogen as a cardiovascular protective agent seems to have been disproven. In fact, in some instances there’s suggestions that it might actually increase risk of heart issues.
This isn’t to say that estrogen replacement doesn’t have benefits. Early evidence suggests that HRT might decrease risk of Alzheimer’s disease. Estrogen does still improve circulation even if it isn’t acting as a protective agent against heart attacks. Additionally hormone replacement therapy has been proven to protect against both osteoporosis and fractures. Finally, estrogen replacement has also been shown to protect against symptoms of menopause.
All of this leads to a difficult answer in regards to hormone replacement therapy’s benefits. It’s very clearly beneficial for a number of conditions. But at the same time it carries some risk factors. And in particular hormone replacement therapy seems to carry risks for women predisposed to heart issues.
Should Women Use HRT?
There’s no clear yes or no answer to whether any individual woman should use hormone replacement therapy. Instead it’s best to consider it a matter of individual biology and medical need. As such it needs to be discussed with a doctor in order to form a potential HRT plan which will fully meet one’s needs.
Hormone replacement therapy for men is a more clear cut issue. For the most part men shouldn’t need to replace testosterone levels which are falling due to the natural aging process. However, a number of factors can result in abnormally low levels of testosterone.
Abnormally low levels of testosterone are linked to a number of serious symptoms. These can include increased body fat, loss of muscle mass, lethargy and a lowered sex drive. Supplementary testosterone has been shown to help all of these symptoms in men suffering from abnormally low levels. Testosterone supplementation isn’t without side effects of its own. These can include gynecomastia, oily skin, added risk of heart attacks, testicular shrinkage and lowered sperm count.
Men considering testosterone replacement should approach it in a similar way to women considering estrogen replacement. It’s not a subject that one can instantly say will be beneficial or detrimental to any given individual without additional observation. However, this is even more true for men than women due to lower testosterone levels being less predictable. Most men won’t even be fully aware of their low testosterone levels without first being tested. It’s only at that point where the discussion can proceed to whether or not HRT is called for.