What HRT Can Help With

Hormone replacement therapy is most often used to treat symptoms associated with the menopausal transition, including:

  • Hot flashes and night sweats
  • Vaginal dryness and pain during intercourse
  • Low mood, irritability, and increased or new-onset anxiety
  • Sleep disruption
  • Skin dryness and adult acne
  • Weight gain associated with hormonal shifts

What the Evidence Actually Shows About Broader Health Benefits

The most important concept in current HRT research is the timing hypothesis: cardiovascular outcomes depend heavily on a woman's age and how many years have passed since menopause when she starts HRT.

Figure 3. Cardiovascular risk and benefit from HRT depend significantly on when treatment begins.
Figure 3. Cardiovascular risk and benefit from HRT depend significantly on when treatment begins.

A large 2024 meta-analysis of 33 randomized controlled trials (over 44,000 postmenopausal women) found that HRT did not significantly reduce all-cause mortality or major cardiovascular events overall, and was associated with an increased risk of both stroke and blood clots. At the same time, women who started HRT within about 10 years of menopause onset showed more favorable outcomes than those who started later.

In 2024–2025, the FDA updated estrogen product labeling to remove broad boxed warnings that had linked HRT to cardiovascular disease and cognitive decline across the board, since those warnings were based on early, non-age-stratified data. The updated guidance emphasizes individualized assessment based on a woman's age, time since menopause, and route of administration.

What TRT Can Help With

When testosterone deficiency is genuinely present, evidence supports improvement in:

  • Sexual function: improved libido and erectile function in men with confirmed low testosterone.
  • Body composition: increased muscle mass and reduced fat mass with appropriate treatment and exercise.
  • Bone density: testosterone plays a role in maintaining bone mineral density, which can help reduce osteoporosis risk over time.
  • Energy and mood: many men report improved energy, reduced brain fog, and better sleep quality — though these are more variable, subjective outcomes than the physical measures above.

HRT Risks & Side Effects

Most people tolerate HRT well, but possible side effects and risks include:

  • Headaches, nausea, and breast tenderness
  • Vaginal spotting or bleeding
  • Mood changes and leg cramps
  • A modestly increased risk of blood clots and stroke — this appears to vary by formulation, dose, and delivery method (transdermal routes generally carry a lower clotting risk than oral routes)
  • A breast cancer risk that varies based on the type of hormone used, duration of use, and individual risk factors

TRT Risks & Side Effects

  • Increased red blood cell count (polycythemia), which raises blood clot risk and requires monitoring
  • Worsening of existing prostate cancer (TRT is not started in men with known prostate or breast cancer)
  • Reduced sperm count and fertility
  • Acne, oily skin, and fluid retention
  • Sleep apnea can worsen in some patients
  • Mood changes, including increased irritability in some patients

How Each Therapy Is Administered

Figure 4. Hormones can be delivered through several different routes, each with different tradeoffs.
Figure 4. Hormones can be delivered through several different routes, each with different tradeoffs.

HRT Delivery Methods

  • Oral tablets: taken daily; processed through the liver first, which may affect clotting factors more than non-oral routes.
  • Transdermal patches: applied to the skin and replaced on a schedule; generally associated with a lower blood clot risk than oral estrogen.
  • Gels, sprays, and topical creams: applied to skin; similar transdermal advantages to patches.
  • Vaginal rings, creams, and suppositories: deliver hormone locally, often used specifically for vaginal dryness or pain with intercourse rather than systemic symptom relief.
  • Pellet implants: inserted under the skin for slow release over months; ACOG specifically recommends against pellet delivery for testosterone in women due to limited safety data.

TRT Delivery Methods

  • Injections: administered in a clinic or self-administered; levels can peak shortly after injection and decline before the next dose.
  • Gels and creams: applied daily; carry a real risk of transferring testosterone to others through skin contact — careful application and covering the area is important.
  • Patches: applied to skin, replaced daily or as directed.
  • Pellets: implanted under the skin, releasing testosterone over several months; cannot be easily adjusted or removed if side effects occur.
  • Oral tablets and lozenges: less commonly used than other methods, though available.

Why Delivery Method Is a Real Clinical Decision

The route a hormone takes into your body changes how it's processed and what risks it carries. Oral estrogen passes through the liver first, which can increase clotting-factor production more than transdermal options — part of why patches and gels are often preferred for women with higher baseline clotting risk. For TRT, injectable and implantable methods avoid the skin-transfer risk that comes with topical gels and creams.