Is Hormone Therapy Safe? What Women and Men Should Know

By Barbara W. Turpin, DNP, APRN, FNP-BC

It's the first question most of my patients ask, and it's the right one. The honest answer depends on who you are, why you're considering it, your health history, and how you manage it. Here's what the evidence says.

For women

For many healthy women under 60, or within 10 years of menopause, who have bothersome symptoms and no reason to avoid it, the benefits generally outweigh the risks. Hormone therapy is still the most effective treatment for hot flashes and night sweats, and it often helps sleep too. That's the position of the major menopause and women's health organizations. It's also a big shift from the fear a lot of women still carry from headlines 20 years ago.

Safe doesn't mean risk-free. Risk depends on the medication, the dose, how you take it, whether you need progesterone, how long you're on it, and your own history. Patches, gels, and sprays, along with lower doses, carry a lower risk of blood clots and stroke than pills.

I usually don't recommend hormone therapy for women with unexplained vaginal bleeding, active liver disease, a history of breast cancer or another estrogen-sensitive cancer, blood clots, stroke, heart attack, coronary heart disease, or an inherited clotting disorder.

For men

Testosterone therapy can be appropriate for men who truly have low testosterone. That means symptoms like low libido, fatigue, or muscle loss, plus low levels confirmed on more than one morning blood test. Symptoms alone aren't enough.

The 2023 TRAVERSE trial studied men with low testosterone who already had heart disease or were at high risk for it. Testosterone gel didn't increase heart attacks or strokes compared with placebo. That was reassuring. But the testosterone group did have higher rates of irregular heart rhythm (atrial fibrillation), blood clots in the lungs, and kidney injury.

Testosterone can also raise your red blood cell count, called erythrocytosis, which adds to clot risk if nobody's watching. It can worsen sleep apnea. And it lowers sperm production, so if you want children in the future, talk with me before starting.

I usually don't start testosterone in men with known or suspected prostate or breast cancer, a high red blood cell count, untreated severe sleep apnea, a recent heart attack or stroke, a clotting disorder, or plans to father children soon.

What makes it safe: how it's managed

For men and women alike, safety depends less on the hormone and more on how carefully it's prescribed and followed. So treatment starts with a careful evaluation, not a one-size-fits-all prescription. I review your symptoms, history, medications, and labs. If hormone therapy is a good fit, I choose the type and dose that suit you, then recheck your labs and symptoms along the way. If it isn't the right fit, I'll tell you, and we'll find what will work.

I spent nearly nine years in the ICU before family practice. I take this part seriously.

If you've been wondering whether hormone therapy could help you feel like yourself again, book a visit and let's talk it through.

This article is for general information and isn't a substitute for individual medical advice.