597: Expert insights on hormone replacement therapy for women
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Welcome to our fourth episode of the MBG Compilation podcast series. Every Thursday in May, we're dropping a special compilation episode focused on some of our most popular topics like brain health, strength training, VO2 max, and more. In each show, you'll hear expert insights pulled together from some of our listeners' favorite conversations, giving you a quick, powerful look into the topics that matter most for your health and longevity. We're excited to hear what you think of them. Now let's get to it.

Hormone replacement therapy has long been a topic of confusion, controversy, and conflicting advice, but the science is evolving and so is the conversation. In this episode, we're bringing together expert insights from Maddy Dechtwald, Dr. Mari McCary, Dr. Amy Killen, and Dr. Jessica Shepard to help you cut through the noise and understand what HRT is really about.

out. You'll hear how outdated research shaped public fear, why hormones play a bigger role in longevity than most people realize, and how to make a more personalized, proactive approach to your health, whether you're navigating menopause or simply planning ahead. From estrogen to testosterone, this episode covers the key facts, the common myths, and the powerful potential of hormone therapy.

First up, we're hearing from Maddy Deichwald, author, longevity expert, and co-founder of AgeWave, who's been digging into the intersection of aging, gender, and health for decades. She unpacks one of the most pivotal moments in the history of hormone therapy, a widely publicized study that dramatically, and as we now know, inaccurately, changed the way HRT was viewed. Here's Maddy explaining what went wrong and why it's time to rethink the narrative.

So there's a lot of misinformation still, even though the conversation is beginning to open up. And I love the fact that the conversation about hormones, particularly menopause, it's really opening up. But there was a study that was done late 1990s, early 2000s, the Women's Health Initiative that came out. It was a big study that

but it was also a flawed study. And it was flawed in a variety of ways. One is the people who took part in the study were all women who never took hormone replacement over the age of 65. It was 60 or 65. I'm not sure which one it was. So they were new to hormone replacement and didn't start until they were well either 60

into or through menopause. And that is a no-no. That is not something that one wants to do. Second, they used synthetic hormones. In fact, they used hormones that were derived from pregnant horses' urine. Now, if that doesn't sound gross all by itself, I don't know what is. But the study was halted because it showed that

but in very small numbers, correlation with heart disease. But they stopped the study. Gynecologists, many well-meaning gynecologists who went to school back then still use that study as their go-to for saying, no, you don't want to do hormone replacement. When in fact,

It was a very flawed study. Now today, menopause specialists and physicians and scientists and researchers who have really dug deep down into the changes that took place as we go through perimenopause and menopause, they all believe that taking some kind of hormone replacement is a very good idea for women.

Dr. Marnie McCary is the commissioner of the U.S. Food and Drug Administration, a Johns Hopkins surgeon, public health expert, and best-selling author known for exposing some of medicine's biggest missteps. He unpacks why HRT may be one of the most powerful and overlooked tools for women's long-term health.

From protecting the brain and heart to boosting bone strength and easing symptoms, the benefits are hard to ignore. He also weighs in on testosterone therapy for men and why, while promising, it needs a more cautious, expert-guided approach.

And another one, very topical right now. And I do think consensus has turned on this one, maybe in our space, which is a little bit more health forward, hormone replacement therapy. Oh, big time. This is probably...

one of the biggest screw-ups in modern medicine, and it's tragic. So hormone replacement therapy for postmenopausal women, that is starting estrogen or estrogen plus progesterone at the time of menopause or within 10 years of the onset of menopause, is amazing. Women live three and a half years longer. The estrogen replaces your body's natural estrogen or estrogen progesterone hormones.

The rate of heart attacks goes down by almost 50% because the estrogen produces a nitric oxide, and that helps keep the blood vessels dilated and soft. The rate of cognitive decline goes down by 50% to 60%. In one study, the risk of Alzheimer's goes down by 35%.

And if a woman falls or is in a car accident, they're far less likely to break a bone. Their bones are much stronger. And so they have less hip fractures and other complications. And on top of all those long-term health benefits, it can alleviate most of the symptoms or many of the symptoms of menopause. There's probably never been a medical intervention that has improved the health outcomes of a population more than

than hormone replacement therapy in postmenopausal women, arguably with the exception of antibiotics. But tragically, women have been denied this therapy because of a dogma from an announcement 22 years ago by an NIH scientist

claiming that it caused breast cancer when in that study, the data never showed a statistically significant increase in the risk of breast cancer, one of the greatest misrepresentations of data in the modern era. And because the media ran with it and because that scientist did not release his data at the time of the announcement, tragically,

80% of doctors today roughly still believe that it causes breast cancer and refuse to prescribe it. So 50 million women in the last 20 years have been denied this incredible health benefit. And on the flip side, for us men, middle-aged men like myself,

TRT, what are your thoughts on testosterone replacement therapy? So hormone replacement therapy for women has been studied far more than testosterone replacement for men. But in the little research we have on testosterone replacement for men, there appear to be some parallels. Testosterone levels go down typically when a man's in their 50s or so. And there was a dogma that it causes that taking exogenous or prescribed testosterone

causes prostate cancer that's been debunked, just as the hormone replacement therapy in women causing breast cancer has been debunked, or at least I explain how that's not true in the book. And so there are benefits, and doctors have described testosterone replacement for men

helping with sleep and energy levels and help with their workouts and losing weight. So there are candidates for testosterone replacement in men. It's just less well-established. And you really want to do this with an endocrinologist or a doctor who understands the pluses and minuses. And sometimes you need to take other medications to prevent

what we call feminization features of the body. So it's not something you should get at a gym or pill mill. It's something you should get with a good doctor.

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Dr. Amy Killen is a regenerative medicine physician who specializes in longevity, hormone optimization, and sexual health. Her work focuses on helping people stay vibrant and resilient as they age. She makes a compelling case for why hormone health isn't just about symptom relief, it's a core pillar of longevity. She also breaks down when to start thinking about HRT, what symptoms might signal hormone shifts, and how to approach testing and treatment with your doctor.

We also touched on hormone health, you know, for men, TRT, for women, HRT. And can we spend some time talking about hormone health and the 180 I think we've done there and this realization that hormone health is longevity? Yes. I say, I think outside of a healthy lifestyle that optimizing hormones for women with HRT is essential.

probably the best thing that you can do to improve long-term health and longevity. I think it is better than almost anything else that we have out there outside of lifestyle optimization. At what age should I start thinking about HRT? What are some of the labs I should begin to do to look at to begin to have a conversation with my medical provider about undertaking this?

You know, it's really in perimenopause that we start really thinking about estrogen and progesterone, testosterone. And that can be anywhere in the kind of five to 10 years before menopause. Menopause onset average age is 50, but some women go into menopause at 45. So you may be having these symptoms starting at like 35 or 40 for perimenopause. And that is, you know, the symptoms are usually things like weight gain or you're not sleeping very well or you're irritable or anxious or you're having headaches before your periods or things like this that just change.

changes in those hormones initially because of loss of progesterone. And so when those symptoms start anywhere from like 35 to 50, it could be perimenopause, we start thinking about checking hormones. Usually I just do blood tests. I think blood tests are still the gold standard for checking hormones. I don't think that the urine tests are nearly as good.

And so we do blood tests. The estrogen, progesterone don't really, they go up and down so much during the month that they're not all that helpful. But when we pair that with symptoms and perimenopause, we can start deciding if you need therapy. And then certainly as you get into menopause, even if you didn't have symptoms, I tend to recommend considering hormone therapy and menopause.

Dr. Jessica Shepard is a board-certified OBGYN and women's health expert who's passionate about making hormone therapy conversations more accessible and empowering for women. Dr. Shepard offers a crash course on the different types of hormone therapy, pharmaceutical, bioidentical, and compounded, and explains what those terms really mean and when you're sitting across from your doctor what to ask. She delivers a powerful reminder, you are the CEO of your own health.

You say in your practice use all forms of HRT. This is, we're going to go a level deeper. Pharmaceutical, bioidentical, and compounded bioidentical hormones. Can you spend some time educating our audience so they can be empowered to have a conversation? When we think of just how drugs were made from back in the 20s or the early 1900s, it was done through compounding. That's when your pharmacist would take whatever medication and put it together and

And that's how we started compounding and that's how we got our medications. And in the 40s is really where we started to see more of the expansion of pharmaceuticals, right? So making the drug that's going to help your blood pressure decrease or, you know, insulin to help with diabetes. But we still do today have both forms of providing medications, whether that's through compounding or through pharmaceuticals.

When we look at HRT specifically, we again have those both ways of doing that. So I always like to put them in those two categories first so people have a true understanding of what's presented to them so they understand that's usually where we're starting. Something that's compounded being made from a pharmacist and those that are made synthetically from a pharmaceutical company. Now the difference is when we think of hormones, they can be bioidentical.

But you can have bioidentical pharmaceutical made medications and bioidentical compounded HRT. So that's usually where I hear a little bit of the difference is because people believe if it's bioidentical, it can only be compounded. But pharmaceuticals do make bioidenticals. Now, taking it even a step further is bioidentical.

Pharmaceutical HRT is FDA approved, meaning it's gone through the oversight of what is considered FDA approved. Compounding is a little bit different because it does have regulation in how it's manufactured. It's just not like made on the corner in someone's apartment. It goes through a very rigorous regulations through 503B pharmacies and regulations, but it's just not FDA approved.

And so let's say that's happening and a woman listening goes to her medical provider and asks for HRT. The medical provider says no, other than leave the medical provider and go see you if they can or someone else. How does one make the case to their doctor? Or in your view, is it just impossible once you have a doctor who's just not open to this treatment? I would say at that point, that's when you've kind of reached this junction of

I'm not going to necessarily get the pathway that I feel would be best for me at this point. And that's when I do, you know, empower women to say, you know, you're the CEO of your health. And if the partner in this business of your health is not necessarily tuned in all the way,

then you might need to find another partner. And that may mean finding another health care provider, which for some is so hard because it's such like an intimate relationship you have usually with your doctor that you feel a lot of people feel like they're breaking up. But at the end of the day, we've said this earlier, even in our conversation is your health and your well-span and longevity are much more important.

If there's one takeaway from this deep dive, it's this. HRT isn't just about easing symptoms, it's about supporting long-term health from cognitive function to bone strength to heart health. As you've heard from our experts, we're in the middle of a much-needed shift in how we think about hormones and aging. Whether you're in perimenopause, menopause, or just starting to notice changes, it's worth having the conversation with a provider who truly understands this space.