Hormone therapy questions, answered plainly

HRT (hormone replacement therapy) and MHT (menopausal hormone therapy) are two names for the same treatment: estrogen, usually with a progestogen, for menopause symptoms. Bioidentical means the hormone has the same structure as the one your body makes. FDA-approved estradiol and micronized progesterone are bioidentical, so bioidentical does not have to mean compounded.

For most healthy women under 60 or within 10 years of menopause who have bothersome symptoms, The Menopause Society finds that benefits outweigh risks. In November 2025 the FDA began removing boxed warnings about heart disease, breast cancer and dementia from menopausal hormone therapy. Updated labels were approved for the first products in February 2026, with more in October 2026. The warning about endometrial cancer with estrogen used alone remains. Your own history still decides what is right for you.

All relieve hot flashes. Patches, gels and sprays deliver estradiol through the skin and bypass the liver, and observational studies link them to a lower risk of blood clots and stroke than tablets. They are often preferred for women with migraine, high triglycerides, obesity or higher clot risk. Tablets are convenient and well studied. Vaginal products treat local symptoms only.

If you have a uterus and take whole-body estrogen, yes. Estrogen alone thickens the uterine lining and raises the risk of endometrial cancer, and a progestogen prevents that. Women who have had a hysterectomy do not need it. Low-dose vaginal estrogen does not require it either.

There is no fixed time limit. The Menopause Society advises against stopping automatically at 65 and recommends reviewing dose, route and goals with your clinician every year, since risks rise gradually with age.

It depends on the regimen. In the Women’s Health Initiative, oral conjugated estrogens with a synthetic progestin added fewer than one extra breast cancer case per 1,000 women per year. Estrogen alone, in women without a uterus, was associated with lower breast cancer incidence over long-term follow-up. Women with a history of breast cancer should not use whole-body hormone therapy without specialist advice.

It can clear brain fog indirectly by controlling night sweats and restoring sleep, but it is not recommended to prevent dementia. It does not cause weight gain and may limit the shift of fat to the abdomen, but it is not a weight-loss or muscle-building treatment. Strength training and protein protect muscle.

Testosterone has evidence for one use in women: low sexual desire that causes distress after menopause. There is no FDA-approved product for women in the US, so it is prescribed off-label, either as a small fraction of a male gel or as a compounded cream, with blood levels kept in the female range. The FDA held a public workshop on testosterone for women in September 2026.

Diagnosis needs both symptoms, such as low desire, fewer morning erections and fatigue, and two low total testosterone levels drawn early in the morning on different days. The American Urological Association uses a level below 300 ng/dL. A single afternoon test, or a test during illness, is not reliable.

In the TRAVERSE trial of 5,246 men with low testosterone and heart disease or high risk, testosterone did not increase heart attack, stroke or cardiovascular death compared with placebo. Atrial fibrillation, kidney injury and blood clots in the lung were more frequent. In 2025 the FDA removed the boxed cardiovascular warning and added a warning about increased blood pressure to all testosterone products.

All can restore normal levels. Gels give steady levels but can transfer to others by skin contact. Injections cost least but cause peaks and troughs and raise red blood cell counts more. Capsules are taken twice a day with food. Pellets last three to six months but cannot be adjusted once placed. The best choice is the one you will use consistently and can monitor.

Yes. Testosterone by any route signals the brain to stop stimulating the testes, and sperm counts can fall to zero. Recovery after stopping usually takes months and is not guaranteed. Men who want children should discuss alternatives such as clomiphene or hCG before starting.

Current evidence does not show that it does. In TRAVERSE, carefully screened men on testosterone had no more high-grade prostate cancer than men on placebo. PSA is still checked before and during treatment, and testosterone is not started in men with untreated prostate cancer.

In men with confirmed deficiency, desire and mood often improve within three to six weeks, body composition over three to four months, and bone density over a year or more. Trials have not shown better memory or a longer life.

Levothyroxine is the standard because the body converts it to active T3 as needed, and most trials find no added benefit from T3. Some people who stay symptomatic with a normal TSH may try adding liothyronine under close monitoring. Desiccated thyroid, such as Armour Thyroid, has never been FDA-approved, and its regulatory status has been under review since 2025.

Yes. Fatigue, weight change, low mood, poor sleep, hair thinning and low libido occur in all three. A TSH blood test is simple and is usually checked before symptoms are attributed to sex hormones.

The symptoms are real, but adrenal fatigue is not a recognized diagnosis. A systematic review of 58 studies found no consistent evidence that stress exhausts the adrenal glands. True adrenal insufficiency is a different, serious condition diagnosed with a morning blood cortisol and a stimulation test. Persistent fatigue deserves a workup for thyroid disease, anemia, sleep apnea, depression and diabetes.

For most people, no. A two-year randomized trial in older adults found that oral DHEA did not improve muscle, physical performance or quality of life. Vaginal DHEA (prasterone) is FDA-approved for painful sex after menopause, and oral DHEA may be tried in women with adrenal insufficiency. Over-the-counter DHEA is not checked by the FDA for content.

Only when symptoms or signs point to a cortisol disorder, such as unexplained weight loss with low blood pressure, or easy bruising with muscle weakness. The right tests are specific: a morning blood cortisol for deficiency, and late-night saliva, 24-hour urine or a dexamethasone test for excess. Four-point saliva panels sold for adrenal fatigue are not validated.

No evidence shows that they are. The active ingredients are the same molecules. The difference is oversight: FDA-approved products are tested for how much hormone they deliver and carry full safety labeling, while compounded preparations are not reviewed by the FDA. The National Academies and ACOG both recommend approved products when one exists.

When you are allergic to an ingredient in the approved product, when you need a dose or form that is not sold, such as testosterone at female doses, or during a shortage. Ask whether the pharmacy is accredited or a registered 503B outsourcing facility and how each batch is tested.

One testosterone pellet, Testopel, is FDA-approved for men. Estradiol and testosterone pellets marketed to women are compounded and not FDA-approved. Pellets cannot be removed or adjusted after insertion, and a study in women found higher hormone levels and more side effects than with approved therapy.

No. Saliva and dried-urine hormone panels are not validated for diagnosing menopause or low testosterone or for adjusting doses. Menopause after 45 is diagnosed from symptoms and cycle history. Testosterone deficiency and thyroid disease are diagnosed with standard blood tests.

Most FDA-approved generics, including estradiol patches and tablets, progesterone capsules, testosterone injections and levothyroxine, are covered by most plans. Compounded preparations and pellets are usually paid out of pocket.