risks of hormone replacement therapy

Reducing the Risks of Hormone Replacement Therapy (HRT): Do Bioidentical Hormones Help?

by Charlotte

If you’ve ever seen a commercial for a drug on the television, you know that many medications carry a host of potential risks and side effects. At times, the seemingly endless list of possible outcomes can even make some therapies seem worse than the conditions they treat. On the flip side, you’ve probably also taken medications without ever experiencing any side effects at all. So how concerned should you be regarding the risks of hormone replacement therapy?

Hormone replacement therapy (HRT), like all therapies, inevitably carries risks. Although HRT is generally safe and well-tolerated by both men and women, some risks associated with HRT can be severe, causing many patients to wonder whether hormonal therapy is right for them. Upon closer inspection, however, many of the risks that are linked to HRT are confined to patients with pre-existing conditions, those of advanced age, and members of certain ethnicities. As such, it’s important to learn whether you are in one of these patient populations before you decide whether to pursue HRT treatment. Additionally, you may be able to reduce the risks of conventional HRT by choosing bioidentical alternatives.

The Risks of HRT for Andropause and Low Testosterone Levels

HRT can be transformative in the lives of men experiencing andropause or other types of low testosterone. However, HRT for men—specifically, testosterone therapy—can have some risks, such as hair loss. Overwhelmingly, these risks are minor and not life-threatening. It’s important to acknowledge, however, that even side effects like hair loss can have a significant impact on confidence and self-esteem. If you’re concerned about the risks while undergoing HRT for andropause or low testosterone levels, taking a closer look at the research can help you make an informed decision.

In general, the most serious risks commonly believed to be associated with HRT for andropause relate to the impact of hormone therapy on the heart. Many of the men taking HRT for andropause are old enough that they are at an elevated risk of having a non-fatal heart attack and are hesitant to take on any additional cardiovascular risk. Currently, however, there is no strong evidence that HRT taken by healthy men causes heart attack. In fact, there is some evidence that it may even reduce cardiac events. Men with pre-existing heart conditions, however, should discuss any concerns regarding HRT and their cardiovascular health with their health practitioner and may be advised against this form of treatment.

Historically, HRT for andropause or low testosterone levels has been thought to be linked to prostate issues and contraindicated for men with prostate cancer. Indeed, in a meta-analysis of 38 years of data, men taking HRT for andropause were significantly more likely to detect prostate events than men who were not taking HRT. But they were not more likely to develop prostate cancer. As such, increased detection of prostate events may indicate that men taking HRT experience a greater burden of anxiety regarding the functioning of the prostate rather than an increased risk of actually experiencing serious prostate conditions. However, while studies have overwhelmingly found no association between testosterone therapy and prostate cancer, the data has not been unanimous, and some experts remain wary of using HRT in men with a history of prostate cancer. If you currently have or have had prostate cancer, you may wish to discuss the current evidence more deeply with your practitioner before proceeding with HRT.

The Risks of HRT For Menopause

For many women, undergoing HRT for menopause allows them to recapture a physical and emotional sense of well-being as they enter a new phase of life. But there are risks associated with hormonal therapies for women, including:

  • Breast cancer
  • Endometrial cancer
  • Dementia
  • Acne
  • Fluid retention

Some of these risks are associated only with certain hormones or hormone combinations. For example, evidence suggests the risk of endometrial cancer only increases when estrogen is taken alone, and the added risk disappears when estrogen is combined with progestin. Furthermore, effects such as acne and fluid retention may be resolved by other forms of medical treatment or lifestyle changes.

Of these risks, dementia is often one of the most concerning for women. Researchers have consistently found higher rates of dementia in women who take HRT for menopause in comparison to women who don’t take HRT—but only when women start HRT long after the onset of menopause. For women who start HRT shortly after the onset of menopause, the risk appears to be the same as in the no-HRT population, and some studies suggest that estrogen therapy initiated around the time of menopause may actually reduce the risk of dementia. In other words, if you are going to start HRT for your menopause symptoms, you should only worry about the added risk of dementia if you have been in menopause for more than three years. Additionally, researchers have found that HRT may reduce dementia risk in women who have elevated testosterone levels, as women with balanced estrogen, progesterone, and testosterone appear to be less likely to develop dementia.

The link to other risks is far from conclusive. In particular, breast cancer is one of the most hotly debated potential risks of hormone replacement therapy for menopause, and researchers have not yet been able to come to a consensus. One study documented the risk of developing breast cancer as being 49% higher in certain populations of women taking estrogen-progestin therapy than in the same populations of women who were not taking HRT Nonetheless, the same study goes on to say that for other populations of women, undergoing HRT for menopause actually decreases the risk of developing breast cancer by up to 9%. Race, body mass, and density of breast tissue all appear to play a role in determining a woman’s risk of developing breast cancer while undergoing HRT, with overweight women, black women, and women with less dense breast tissue generally experiencing a lower risk. If you fall into one of the higher risk populations, like underweight women with dense breasts, you should be aware of the potential for increased breast cancer risk. Meanwhile, the impact of estrogen-only therapy on breast cancer is less well-understood, with some data suggesting an increased risk of breast cancer with long-term use and other data suggesting a decrease in breast cancer risk.

Bioidentical Hormone Therapy May Be Less Risky

The risks of HRT may be enough to discourage many people from pursuing treatment. However, many patients find that the benefits of HRT far outweigh the risks, and many of the risks of hormone replacement therapy are manageable provided that you are in good health. Additionally, these risks can potentially be mitigated by using bioidentical hormones rather than traditionally formulated hormone therapy. This is due to the fact that bioidentical hormones may be easier for the body to handle owing to their superior chemical properties; while traditional hormones are very similar to human hormones, bioidenticals are structurally indistinguishable from human hormones.

Thus far, few high-quality clinical studies have examined the difference in risk between bioidentical and conventional form of HRT. However, the studies that do exist have had promising results. For example, a 2009 review found that the risk of cardiovascular disease was 9-10% lower in women undergoing HRT for menopause when they took bioidentical hormones as opposed to conventional hormones. Additionally, women who took bioidentical hormones were 9% less likely to develop breast cancer. While there has not yet been any investigation into reducing the risks of hormone replacement therapy for andropause by using bioidentical hormones, studies are currently underway. If the results in women taking bioidentical hormones are any indication, men may also expose themselves to fewer risks by taking bioidentical hormones rather than conventional therapies.

Getting Expert Guidance

The decision of whether or not to use HRT and which type of HRT to use is highly personal. But you don’t have to make it on your own. If you’re considering starting HRT and are concerned about the risks, seeking out an expert who will guide you through the pros and cons of HRT for your individual situation is essential. Connecting with a practitioner who specializes in HRT, such as those affiliated with BodyLogicMD, will help you get more accurate, up-to-date information to help you decide whether HRT is right for you. Together, you can discuss your treatment goals and develop a comprehensive plan to help you achieve them, safely and comfortably.

If you are ready to start HRT with the expert guidance of a practitioner who specializes in bioidentical hormone therapy and integrative medicine, a BodyLogicMD practitioner can offer the tailored care you are looking for. Our network is comprised of top medical professionals who are specially certified to address hormonal health concerns using customized treatment plans designed to fit your needs and your lifestyle. To begin your journey toward optimal wellness, contact a local practitioner within the BodyLogicMD network to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz today.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure, or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.