Medical replacement of sex hormones—chiefly estradiol, progesterone, and testosterone—when deficiency causes symptoms or disease risk. Includes FDA-approved products and, in some clinics, compounded bioidenticals. Not a longevity drug and not the same as thyroid or peptide protocols.
Hormone Replacement Therapy (HRT) means using prescription sex hormones to treat a documented deficiency or a clear menopausal indication. In longevity clinics that usually means estradiol and progesterone around menopause, and testosterone for men (and sometimes women) with hypogonadism. Bioidentical describes molecular structure, not a free pass on risk. Thyroid hormone and peptides are separate topics.
What it includes
Menopausal hormone therapy (MHT): estradiol ± a progestogen if the uterus is present.
Testosterone replacement (TRT): for men who meet hypogonadism criteria; female testosterone is a different, usually off-label, low-dose use.
Routes: patch, gel, oral, injection, vaginal, pellet. Route changes clotting and convenience more than the brand name does.
Evidence and limits
The 2002 WHI trial (oral conjugated estrogen plus medroxyprogesterone in older women) raised coronary and breast-cancer alarms and emptied HRT clinics. Later analyses and guidelines (including NAMS 2022) support MHT for bothersome vasomotor symptoms in appropriately selected women, especially when started nearer to menopause, with transdermal estradiol and micronized progesterone often preferred. It is not indicated to prevent dementia or as generic anti-aging. Cancer history, unexplained bleeding, prior VTE, and active liver disease change the math. Compounded custom mixes are not automatically safer than FDA-approved estradiol and progesterone.
Bring prior labs, cancer screening dates, a medication list, and a fertility/pregnancy plan. Do not start HRT to treat fatigue before iron, thyroid, sleep, and mood are considered.
Patches and gels have no downtime. Injections may cause a day of site soreness. Pellet insertion needs wound care. Symptom change is often weeks, not hours.
Breast tenderness, bleeding, mood change, VTE (higher with some oral estrogens), stroke, gallbladder disease, erythrocytosis and infertility on testosterone, and the usual risks of an unmonitored supraphysiologic pellet. HRT does not cancel mammography or endometrial evaluation.
Rossouw J.E. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women (WHI) (JAMA, 2002).
https://doi.org/10.1001/jama.288.3.321The 2022 hormone therapy position statement of The North American Menopause Society (Menopause, 2022).
https://doi.org/10.1097/GME.0000000000002028Bhasin S. et al. Testosterone therapy in men with hypogonadism: Endocrine Society clinical practice guideline (J Clin Endocrinol Metab, 2018).
https://doi.org/10.1210/jc.2018-00229Lincoff A.M. et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE) (N Engl J Med, 2023).
https://doi.org/10.1056/NEJMoa2215025ACOG. Compounded bioidentical menopausal hormone therapy (Committee Opinion).
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/08/compounded-bioidentical-menopausal-hormone-therapy© 2026 Longevity Clinic Finder. All rights reserved.
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Frequency
Daily (patch/gel/oral), weekly to monthly (injections), or every 3–6 months (pellets), plus lab visits.
People with a guideline-supported indication after screening. Not a first-line treatment for normal-range labs and a longevity brochure.
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