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When Hormone Replacement Therapy May Be Good

When Hormone Replacement Therapy May Be Good

Fear-mongering about hormone replacement therapy isn’t good science. For the right woman with nasty menopausal symptoms and the right man with low testosterone, hormone replacement therapy (HRT) can mean the difference between living life to its fullest and dragging through the day (and night). So when we saw the latest scary warnings, we wanted you to know the whole story.

A downside for women: A Wake Forest University analysis found that women taking estrogen or estrogen plus progesterone had a higher risk for ovarian cancer. While 13 of every 1,000 women in the general population develop ovarian cancer, HRT added about 1 additional case for every 1,000 women who used it for five years. Risk fell after stopping, but fell more slowly for those who’d stayed on HRT the longest. 

Our view: We take this seriously and you should, too. Because ovarian cancer is difficult to detect, it’s often discovered in more advanced stages. As a result, just 44% of women survive five years or longer. If you have risk factors, such as a personal history of breast cancer, a family history of ovarian cancer, or even a family history of breast or colorectal cancer (which could signal a family cancer syndrome worth discussing with your doctor) or simply worry about your risk for this cancer, HT is not for you.

If you’re not at higher risk and if menopausal symptoms are making your life miserable, we think you should discuss HRT with your doctor. We recommend that women use bioidentical estrogen plus micronized progesterone, which is encapsulated to protect it from damaging digestive acids. (You don’t need progesterone if you’ve had a hysterectomy). Use HT for the shortest time possible. And remember, it’s safest when taken within 10 years of your last menstrual period, or before age 60.

Two days before you begin, start taking two low-dose aspirins (a total of 162mg) daily, with a glass of warm water before and after. Aspirin lowers your risk for clots and several types of cancer including ovarian cancer. (A recent National Institutes of Health-sponsored study suggests it may lower risk as much as 20%.) The warm water reduces your risk for digestive-system bleeding. If you can’t tolerate aspirin, ask your doctor what else you can take to reduce clot risk. It’s that important.

A downside for men: A US Food and Drug Administration announcement cautioned men about extra risk for heart attacks and strokes when using testosterone supplements. This alert came after researchers, who completed a year long “T” study in 788 older men, spoke with the FDA about label warnings.

Our view: That connection is controversial. A review in Mayo Clinic Proceedings found flaws in studies linking cardiovascular trouble to testosterone and found no extra risk for men. One author told USA Today: The FDA's warning is "bad news for men. It will make it even more difficult for men suffering from true testosterone deficiency."

For guys with truly low-T levels, extra testosterone can boost energy, fire up a flagging libido and slow down run-away muscle and bone loss. All men’s testosterone levels fall about 1% per year after age 30. After age 70, about 30% of guys may have clinically low levels (below 300ng), yet many will have no symptoms. But if you’re losing your sex drive or are having ED, talk with your doc about the big picture and about a T prescription. Consider medication side effects, health conditions like high blood pressure and diabetes, and don’t forget that a sofa-and-snacks lifestyle can contribute to low T.

If your tests show that your testosterone is truly low, T may be for you. We’ve seen it give guys an undeniable emotional and physical lift. Just be sure to reduce your heart, blood vessel and cancer risk with the same aspirin strategy we recommend for women.

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