HRT: Practical Guide to Hormone Replacement Therapy

If you're thinking about HRT, you want clear facts without the fluff. This page explains what HRT does, who might need it, the main types, and simple steps to start safely. No jargon, just practical advice you can use in a conversation with your doctor.

What HRT does and who it's for

HRT replaces hormones your body no longer makes enough of. For many people this means estrogen and sometimes progesterone during menopause. For transgender and nonbinary people, HRT can mean estrogen or testosterone to align body and identity. HRT can reduce hot flashes, night sweats, mood swings, vaginal dryness, and bone loss. It can also improve energy and sexual function for some users.

Types of HRT and how they work

Estrogen-only therapy uses estrogen to relieve menopausal symptoms but is only recommended if you do not have a uterus. Combined HRT adds progesterone to protect the uterine lining. Delivery methods include pills, patches, gels, creams, and injections. Patches and gels keep hormone levels steadier, while pills are easy and familiar. "Bioidentical" hormones mimic natural hormones; some are standard pharmaceuticals and some are custom-compounded, so discuss evidence and safety with your clinician.

Benefits and risks in plain terms

HRT can be very effective for symptom relief and can help prevent bone fractures. Risks include a higher chance of blood clots, stroke, and in some cases breast cancer, especially with long-term combined HRT started later in life. Risk varies by age, dose, personal health history, and type of HRT. If you smoke, have a history of blood clots, or uncontrolled high blood pressure, HRT may not be safe.

How to start and stay safe

Talk openly with your provider about your goals and health history. Get a baseline check: blood pressure, weight, and relevant blood tests. Start with the lowest effective dose and reassess symptoms and side effects after three months. If you're on estrogen and still have a uterus, add progesterone or a progestin. For trans care, follow protocols from reputable sources and get regular hormone level checks.

Monitoring and follow-up

Plan regular follow-ups: every three to six months at first, then yearly once stable. Watch for new symptoms like leg pain, sudden shortness of breath, or unusual breast changes and report them right away. Bone density, lipid profile, and liver tests may be monitored depending on your regimen.

Questions to ask your doctor

What are the benefits for me? Which HRT types fit my health history? What dose is best, and how long should I expect to use HRT? What side effects should I watch for? How often will we need to check bloodwork?

Real talk: HRT isn’t one-size-fits-all. It works well for many people and is unnecessary or risky for others. Use this guide to have a focused conversation with your clinician and make a plan that fits your life.

Also ask about lower-dose choices, patches, clinic programs, and whether your insurance will cover part or all of treatment costs today.