Benefits and Risks of Hormone Replacement Therapy

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Hormone replacement therapy is a medicinal route that can be followed by men or women in order to relieve themselves of various side effects experienced due to reduced levels of reproductive hormones. These therapies are typically used to relieve women from menopausal symptoms and men from symptoms experienced due to low testosterone levels. Although hormone replacement therapy seems like the go-to, it is advised that careful considerations be taken into place before starting with this therapy as it holds great benefits but also poses a risk to the individual’s health.


Female Hormone Replacement Therapy

Hormone replacement therapy for females consists of 2 types. The first is oestrogen-alone therapy which is indicated for women who have had a complete hysterectomy. The second is a combination therapy of oestrogen and progesterone and it is indicated for women who still have their uterus intact. The therapies are available in various formulations including tablets, patches, creams and sprays. Both of these options have beneficial elements for a woman’s health but also contain a few risks.


Benefits of RCT for Women

Oestrogen therapy will typically alleviate menopausal symptoms such as hot flashes and vaginal dryness. Oestrogen also have other health benefits such as maintaining bone density and preventing osteoporosis. Oestrogen has an effect on both osteoclasts and osteoblasts. Osteklasts are known to break down bone and decrease bone density, whereas osteoblasts are known to form new bone tissue and repair damage to bones. Oestrogen results in improving the activity of osteoblasts and inhibiting the effect of osteoclasts reading to greater bone density and the prevention of osteoporosis.

The benefit of combined hormone replacement therapy is that it can be used in females who still have their uterus and who still experience menstrual bleeding. The combination of the progesterone decreases the possible effects that oestrogen might have. Another benefit of hormone replacement therapy is that when it is started within 10 years since menopause started, the benefits outweigh the risks.


What are the Risks of RCT for Women

Oestrogen-only therapy might have some side effects such as breast tenderness, but this is dose-related and will subside later or when an adjustment is made to the dose. One risk that oestrogen therapy may include is a higher risk for a stroke, especially for women older than 60. This is especially related to oral oestrogen, however, transdermal formulations have a lower risk of the development of blood clots and can then be suggested as an alternative. Hormone replacement therapy also increases the risk of thromboembolism as well as pulmonary embolism, especially in women who have a history of embolisms or who are smokers.

The oestrogen-progesterone combination therapy also increases the risk of both thromboembolism as well as pulmonary embolism. It also increases the risk of developing breast cancer. It also increases the risk of higher LDL levels leading to an increase in a lipid profile.


Male Hormone Replacement Therapy

Hormone replacement therapy for males is usually referred to as testosterone replacement therapy (TRT). It usually consists of exogenous testosterone to be administered due to low testosterone levels caused by older age or due to a medical condition that led to a male being diagnosed with hypogonadism. Testosterone is available in various formulations including injections, patches, transdermal implants, gels or tablets. Depending on the individual’s needs and symptoms, the prescriber will determine which formulation would work best for the patient and will include patient adherence.


Benefits of RCT for Men

Exogenous testosterone is mainly used in males of an older age. This is done to alleviate them from severe effects that they might be experiencing which is affecting their quality of life. Some symptoms that can be alleviated include sexual dysfunction, low libido, low energy levels and mood disruptions. Young males diagnosed with hypogonadism, can where indicated, receive TRT. This will typically boost their testosterone levels, improve sperm production, improve sperm function and increase reproductive health. 


What are the Risks of RCT for Men?

Men who still want to have children should be extremely cautious when considering TRT as it can result in the biological inhibition of testosterone production, leading to low sperm counts and low sperm function, affecting fertility. In men diagnosed with hypogonadism, there are other treatment options that are safer and that can be considered.

Older men who do not want to have children should be aware of the possible risks that TRT hold. It can increase the risk of an embolism by increasing the amount of red blood cells, especially in men who have a history thereof. TRT can also worsen sleep apnea in patients who are diagnosed with it. It can also stimulate a benign growth of the prostate resulting in benign prostate hyperplasia. Some studies suggest that it might increase the risk of developing prostate cancer, while other studies seem to differ. When deciding if one wants to be on TRT,  it is best to discuss it with a general practitioner, urologist or endocrinologist to ensure one is aware of the risks and benefits the therapy holds.

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