Hormone Replacement Therapy


Aging leads to hormonal changes causing symptoms such as hot flashes and sleep disturbances, with women facing perimenopause and men experiencing andropause. Hormone Replacement Therapy (HRT) provides relief by using either bioidentical or synthetic hormones, each with distinct origins and structures. Hormones like progesterone, estrogen, and testosterone play essential roles in managing various symptoms.

How Men & Women Are Affected by Hormone Decreases

Both men and women are affected by decreasing amounts of reproductive hormones, each with it’s likely symptoms.

Learn about each of thetypes and then how hormone replacement therapy (HRT) can help.

Women: Perimenopause and Menopause

As we age, our organs produce decreasing amounts of reproductive hormones. As this change occurs, it can wreak havoc on our bodies and cause a wide range of unpleasant symptoms. These changes can begin as early as your mid 30’s.

The most known symptom is hot flashes, but many women complain of:

  • Chronic fatigue
  • Depression
  • Anxiety
  • Mood swings
  • Weight gain
  • Loss of muscle mass
  • Sleep disturbances
  • Loss of sexual desire
  • Vaginal dryness
  • and painful intercourse

These symptoms can vary in severity and decrease one’s quality of life.

Men: Andropause

Similar to what happens to women in menopause, men also have hormonal changes later in life. Andropause ls defined as a syndrome associated with a decrease in sexual satisfaction or a decline in a feeling of general well-being with low levels of testosterone in an older man[3].

Male symptoms can be described as:

  • Nervousness
  • Reduced potency
  • Decreased libido
  • Irritability
  • Fatigue
  • Depression
  • Memory problems
  • Sleep disturbances
  • and hot flashes

What is Hormone Replacement Therapy?

Hormone replacement therapy ls when bloidentical or synthetic hormones are taken orally, topically, injected or implanted to reduce the symptoms of menopause/perimenopause/andropause.

These medications come in many forms, and your provider will choose which is appropriate for your specific hormone profile and constellation of symptoms.

Most common hormone replacements are estrogen, progesterone, testosterone, and desiccated thyroid hormone.

BHRT vs. Synthetic

“Bioidentical” hormones are defined as substances that have the same chemical and molecular structure as hormones that are produced in the human body.

These substances are made from a treated yam and are produced at local compounding pharmacies. Some patients may benefit from nonstandard doses of hormones that are available in compounded preparations, but there is currently no scientific support for an advantage of these compounds over commercially produced synthetics.

Pharmaceutical companies research drugs that they can patent.

Bioidentical structures are not able to be patented, therefore they are not researched in the same way as their commercial counterparts.

“Synthetic” hormones are synthesized from urine from a pregnant mare. These are not the same molecular structure as hormones that are produced in your body. Molecular side chains are added to a bloldentical substance to make a synthetic product that can be patented by a manufacturer.

These substances are researched, marketed, and sold in standard dose formulas. These medications are FDA approved for the treatment of select symptoms associated with menopause/andropause.

Risks of Hormone Replacement Therapy

All hormone replacement therapy comes with risk. These risks are usually small, and depend on the type of HRT you take, how long you take it and your own health history.

Overall, the increased absolute risks associated with HRT are rare (<10/10,000/year) and Include risk for blood clots and gallbladder disease [1]. Additionally, there is a rare risk for stroke and breast cancer and if estrogen is inadequately opposed (if patient is only supplementing estrogen and she has a uterus), an increased risk of endometrial overgrowth and cancer may occur [1].

Most importantly, know that you do not need to live with unpleasant symptoms of menopause/andropause. Your provider can help safely manage risks and get back to living life to the fullest.

Contraindications for HRT

Unfortunately, for some men and women HRT is too risky.

Contraindications for HRT include unexplained vaginal bleeding, liver disease, prior estrogen sensitive cancers (breast/endometrial/ovarian), prior heart disease, stroke, heart attack, prior blood clots, or personal history of a clotting disorder [1].

Benefits of Progesterone

During a woman’s reproductive years, progesterone prepares the uterine lining to hold a fertilized egg and help it grow. Aside from reproduction, it regulates multiple hormonal tasks within the body.

As the levels of progesterone decline, multiple symptoms can occur, such as: headaches, sleep disorders, decreased bone density, hot flashes, mood changes (specifically an increase in anxiety and depressive symptoms) and brain fog. Unfortunately, women are often prescribed antidepressant medications for menopausal symptoms, which is only masking the underlying cause.

With proper progesterone supplementation, there can be improvement in sleep onset and maintenance, hot flashes, brain fog, anxiety and depressive symptoms.

Benefits of Estrogen

There are three naturally occurring estrogens that have hormonal activity in the female body: estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the strongest and most prevalent (2). Another estrogen called estetrol (E4) is produced only during pregnancy [2]. Estrogen is the most known female hormone, and women have estrogen receptors all over their bodies.

Estrogen replacement is mostly used for relief of hot flashes, night sweats, and vaginal symptoms (dryness, painful intercourse). Estrogen can be used as a monotherapy in a women who have had a hysterectomy, however, if a woman has a uterus progesterone must be added to protect from uterine lining overgrowth.

Benefits of Testosterone

While testosterone is primarily seen as a “male” hormone, it is Important for females as well. Testosterone helps to increase energy levels, muscle mass protection and growth, painful intercourse (dryness) and low libido.

In men, testosterone helps restore a sense of virility, increase libido, energy levels and muscle mass. Testosterone can be given in injections and creams and doses are titrated as needed until individual goals are reached.

Contact us to schedule your appointment today. 

Lake Howell Health Center

Our physicians are board certified Doctors of Osteopathic Medicine. They focus on the prevention, diagnosis and treatment of human illness and injury. They selectively utilize all accepted medical modalities to maintain and restore good health. In addition, our doctors have training in manipulative therapy, a helpful treatment for many musculoskeletal disorders.

Last modified: October 9, 2023

View 3 Sources
  1. The 2022 hormone therapy position statement of the North American Menopause (2022). Menopause, 29(7), 767-794. https://dol.org/10.1097/gme.0000000000002028

  2. Huether SE, Mccance KL (2019). Understanding Pathophysiology. Elsevier Health p. 767. ISBN 978-0-32-367281-8. Estrogen is a generic term for any of three similar hormones derived from cholesterol: estradiol, estrone, and estriol.

  3. Indian J Endocrinol Metab. 2013 Dec; 17(Suppl 3): S621-S629. doi: 4103/2230-8210.123552