Redemption For Women's Hormone Replacement Therapy

Welcome to another edition of the Doctor's Note, where we talk about what's on our minds when it comes to your health.

This week I'm shining a spotlight on a topic that has not only shaped my career but the lives of countless women: the safety and necessity of women's hormone replacement therapy (HRT). For the past 18 years, hormone therapy has been a cornerstone of my practice, and yet I still see hesitation and confusion driven by fear, outdated studies, and a clear lack of education in the medical community. Recently, I watched an eye-opening discussion featuring Dr. Marty Makary—our new FDA commissioner, Johns Hopkins professor, and a fierce patient advocate—who articulated what I've long witnessed: the misinformation around women’s hormones needs to end. With such a respected voice leading the charge, I felt it was time to do another deep dive into the facts versus fiction around hormone therapy for women.

In the episode we covered how and why decades-old misconceptions have kept women suffering unnecessarily, and how the mountains of scientific evidence actually show the protective benefits of bioidentical hormones, not the risks. Those infamous risks of HRT—breast cancer, blood clots, heart disease—don’t apply to properly prescribed bioidentical hormones. In fact, these therapies can offer women not just relief from menopausal symptoms, but real long-term protection against some of the most serious health threats women face as they age. The episode unpacks why education has lagged for both doctors and patients, underscores the importance of starting hormone therapy at the right time, and calls on everyone to re-examine the evidence. If you're a woman approaching or in menopause, or you care about someone who is, this is a must-listen.

PODCAST NOTES 

• Bioidentical Hormone Replacement Therapy (BHRT) is both safe and necessary for the vast majority of women experiencing menopause, especially when initiated within ten years of the onset. The therapy addresses more than just hot flashes and night sweats—it impacts metabolic health, cognitive function, bone strength, and overall quality of life, making it one of the most powerful preventive tools we have for women as they age.

• Much of the lingering fear surrounding HRT comes from misinterpretation of the 2003 Women’s Health Initiative (WHI) study, which suggested increased risks for breast cancer, blood clots, and heart disease. Subsequent analysis and more modern studies have shown that these risks were overstated or simply not present with bioidentical formulations, meaning many women and doctors have been operating under misleading information for decades.

• Dr. Marty Makary, an authority in medicine and now the FDA commissioner, is advocating for the removal of the black box warnings from women's hormone therapies. These warnings have contributed to a culture of fear and hesitancy but do not reflect the best and newest scientific evidence, especially regarding bioidentical estrogen and progesterone.

• Bioidentical HRT is not just safe—it is highly protective. Women who start hormone therapy at the appropriate time can reduce their risk of fatal heart attacks by up to 50%. In some cases, these benefits even outweigh those achieved by taking statin medications for heart disease prevention, completely flipping the script on what patients have been told.

• Cognitive decline and Alzheimer’s risk are dramatically reduced with HRT—by as much as 64% and 35% respectively, according to recent studies. Despite the billions spent on new Alzheimer’s medications, these preventive benefits from HRT are under-discussed in both the medical field and public health conversations.

• Because many doctors are not taught about bioidentical hormones in medical school or residency—and pharmaceutical companies have little incentive to educate physicians about non-patented, bioidentical options—patients often receive incomplete or incorrect counseling. In reality, there is a significant and clinically meaningful difference between, for example, micronized progesterone and older synthetic progestins that are rarely explained to patients.

• The missed opportunity for improved health is staggering: over the past 22 years, as many as 50 million women have likely been denied access to effective hormone therapy, often being given antidepressants instead for menopausal symptoms. This substitution does nothing to address the underlying hormone deficiency and leaves many women feeling unheard and untreated.

• Empowering women to make informed choices means seeking out clinicians who are knowledgeable about bioidentical hormone therapy and up-to-date with the literature. Early intervention—preferably within ten years of menopause—is key, but it requires a shift in thinking among both providers and patients, moving away from fear and toward fact-based, individualized care.

Let this be a wake-up call. The science is there, the benefits are clear, and women deserve better than outdated warnings and reflexive prescriptions of antidepressants. If you’re struggling with menopause symptoms or simply want to explore your health options as you age, I urge you to reach out to a healthcare provider who truly understands the nuances of bioidentical hormones. 

Don’t let myths dictate your well-being. Share this information with your friends, advocate for yourself, and let's work together to rewrite the narrative around women’s hormone health. Your future self will thank you!

Stay educated. Stay healthy. 

Till next week.