Hormone Therapy Explained: What Experts Want You to Know

Aging is an inevitable part of life, but how we experience it has changed dramatically thanks to advances in medical science. While many people accept fatigue, weight gain, brain fog, and decreased libido as unavoidable consequences of getting older, hormone replacement therapy (HRT) is emerging as a way to help counteract these age-related changes. Whether you're navigating menopause, dealing with declining testosterone levels, or simply looking for ways to optimize your health, HRT offers a science-backed solution that could significantly enhance your quality of life. But what exactly is HRT, and is it right for you? Let’s dive into what the experts have to say.

If hot flashes, night sweats, and other symptoms of menopause or Low T are making you miserable, hormone replacement therapy (HRT) may help. Here, Dr. Benjamin Hilliker is one of a few physicians internationally with specialty-specific training in General Surgery, Obstetrics & Gynecology, and Emergency Medicine to answer common questions about hormone therapy.

The Reality of Aging: How Hormonal Decline Affects Health and Well-Being

According to the most recent data, roughly half the US population is 40 or older. According to the U.S. Census Bureau, the number of people over 40 has been steadily increasing due to increased life expectancy and the aging of the Baby Boomer generation, born between 1946 and 1964. Despite advances in modern medicine and anti-aging technologies, this aging population is subject to the inevitable declines in cognitive, physical, and sexual function.

For many, these changes can manifest as chronic fatigue, weight gain, sleep disturbance, brain fog, mood swings, and decreased libido, despite our attempts to control as many of life’s inputs as possible. I.e., ensuring adequate sleep, eating a nutrient-rich diet, maintaining good oral hydration, taking the right supplements, or working out several times a week - we all succumb to the inevitable age-based decline.

What is Hormone Replacement Therapy?

Hormone Replacement Therapy (HRT)—also known as Menopausal Hormone Therapy (MHT) for women or Testosterone Replacement Therapy (TRT) for men—is recommended on a personalized, case-by-case basis. It’s typically used when hormone levels drop due to life stages like menopause, perimenopause, or andropause (the gradual decline of testosterone in men). However, it can also help support the natural changes accompanying aging, even in otherwise healthy individuals.

Hormones are essential for regulating virtually every system in your body. They help maintain balance in functions such as:

• Metabolism and energy levels

• Heart rate and blood pressure

• Blood sugar control

• Sex drive and reproductive function

• Mood regulation and emotional well-being

• Thyroid function for energy and metabolism

• Hunger cues and feelings of fullness

• Bone density and bone strength

• Muscle growth, strength, and maintenance

• Skin health and tissue repair

• Memory, focus, and cognitive function

Why Would I Need HRT?

One of the largest contributing factors to this decline is decreasing hormone levels. For men, levels of testosterone decline at a rate of 1-3% annually starting at the age of 30. For women, the average age of menopause in the US is 52.5 years, and estrogen levels can plummet by 80-90% during this transition. The exact annual rate of decline is not linear, but most of the significant reduction occurs within a few years of menopause. What makes this transition particularly troublesome is that women lose a majority of their estrogen over a few years as they transition through menopause. 

On average, men’s testosterone levels are roughly half of the peak levels seen in their late teens and early twenties, and once they reach age 50. In contrast, women’s levels decline to half of their peak levels at a later age but then precipitously decline during menopause. Hormone replacement therapy (HRT) emerged in the 1930s as a medical treatment used to supplement or replace hormones that the body no longer produces in sufficient quantities. 

One of the most widely used forms of HRT, Premarin, was made from conjugated equine estrogens derived from the urine of pregnant (Pre-) mares (-marin). Premarin became the most commonly prescribed form of estrogen replacement therapy for menopausal women throughout much of the 20th century. HRT gained widespread popularity until the early 2000s, when studies like the Women's Health Initiative (WHI) raised concerns about potential risks associated with long-term use, leading to a decline in its use.

Early studies (such as the WHI) that linked HRT with an increased risk of cancer, heart attack, and stroke had several methodological flaws and limitations, which have since been re-evaluated. Some key issues with the early studies included the age and health of study participants, the use of synthetic or animal-derived hormones as opposed to bioidentical hormones, the length of follow-up, and the lack of individualized therapies.

Later re-analyses of the WHI data and other studies have shown that for many women, the benefits (such as relief from menopausal symptoms and protection against bone loss) may outweigh the risks. In men, earlier studies that showed a possible link between cardiovascular risk (e.g., heart attack, and stroke) and testosterone therapy have been largely discredited. Most recent studies have demonstrated a strong beneficial relationship between normal testosterone levels and cardiovascular health.

Updated research provides a more nuanced view highlighting the importance of personalized treatment. Currently, an estimated 6 million people in the U.S. are on some form of HRT. For many, HRT has proven to be the fountain of youth, leading to longer, more vibrant lives. Multiple preparations for HRT exist, and consultation with a trusted physician or medical professional is essential to ensure maximal benefits are derived.

Related Reading: Learn how hormone replacement therapy improves weight loss.

When Do You Need Hormone Replacement Therapy?

Hormone replacement therapy (HRT) can benefit both men and women by restoring hormone levels that naturally decline with age or due to certain health conditions. While the specific hormones and symptoms differ, the ultimate goal remains the same: to rebalance your body’s hormones and improve your overall well-being.

For Women:

Women typically seek HRT when estrogen and progesterone levels decline during perimenopause or menopause. It can also be prescribed for health conditions like hypothyroidism or after surgical procedures such as a hysterectomy or oophorectomy (surgical menopause).

Symptoms that HRT can alleviate in women include:

• Hot flashes

• Night sweats

• Mood swings

• Vaginal dryness

• Painful intercourse

• Urinary incontinence

• Insomnia

• Memory problems

• Loss of sex drive

• Depression and anxiety

HRT helps restore hormonal balance, reducing symptoms and preventing complications linked to low estrogen, such as osteoporosis, cardiovascular disease, metabolic disorders, and potentially lowering the risk of Alzheimer’s dementia, especially for women with a family history of the condition.

Women who experience early menopause (before age 45) or premature menopause (before age 40) often require long-term hormone replacement to protect their long-term health.

 For Men:

In men, testosterone levels gradually decline with age, usually starting around the age of 30. This natural reduction can be accelerated by health issues affecting hormone production, such as pituitary gland disorders, chronic stress, sleep disturbances, or metabolic dysfunction.

Symptoms of low testosterone that HRT can help address include:

• Reduced sex drive

• Erectile dysfunction

• Muscle loss and weakness

• Weight gain

• Loss of body and facial hair

• Fatigue and insomnia

• Memory issues

• Depression, anxiety, and trouble concentrating

Testosterone replacement therapy (TRT) helps restore hormonal balance, improve energy levels, increase muscle mass, enhance mood, and boost libido, leading to a better overall quality of life.

What to Expect During HRT Treatments

When starting hormone replacement therapy (HRT), your provider will review your medical history, conduct a physical exam, and run blood tests to check your hormone levels.

If you're a good candidate, they may prescribe bioidentical hormone replacement therapy (BHRT), which uses hormones that closely match those naturally produced by your body. This approach tends to cause fewer side effects and allows for more personalized dosing. BHRT can be delivered in various forms, including topical treatments (patches, gels, creams), oral medications (capsules, tablets, or troches), or injections.

Your prescription can be filled at a compounding pharmacy for a customized solution or through a traditional pharmacy if using insurance. Your provider will monitor your hormone levels regularly throughout your treatment and adjust your dosage to ensure the best results.

Get HRT Near You in Newport, RI

As research continues to evolve, hormone replacement therapy remains a powerful tool for those looking to manage the effects of aging and hormonal imbalances. While early studies raised concerns, modern research has provided a clearer understanding of its benefits, especially when treatment is personalized and carefully monitored. 

If you’re experiencing symptoms that may be linked to declining hormone levels, contact the leading HRT provider in Newport. FirmMD and Dr. Ben are proud to provide this personalized hormone therapy program to our incredible clients living in Newport and the surrounding areas of Providence, including Warwick, Narragansett, North Kingstown, Bristol, Aquidneck Island, and Prudence Island. Call us at (401) 324-5356 to schedule a consultation and learn if this hormone treatment is right for your body, health, and current concerns. By taking a proactive approach to your health, you can maintain vitality, improve well-being, and continue living on your terms.