If there’s one topic that sparks confusion, fear, and endless questions in my office, it’s hormone replacement therapy or HRT.
Patients often tell me, “I’ve heard hormones are dangerous,” or “Doesn’t HRT cause cancer?” or “I thought I was too old to even ask about it.” Many have also quietly suffered for years, assuming that night sweats, brain fog, or painful intimacy are just things they have to live with.
I understand why. The conversation around HRT has been full of mixed messages for decades, and women have paid the price. Millions were told hormones weren’t safe, leaving them to endure symptoms that could have been eased, and in many cases, prevented.
“The conversation around HRT has been full of mixed messages for decades, and women have paid the price.”
Here’s what I want women to know: In 2025, hormone replacement therapy looks very different than it did twenty years ago. It’s not something to fear, but it’s also not a silver bullet.
The truth is, HRT isn’t for everyone. But when it’s used thoughtfully, safely, and as part of a larger plan for whole-body health, it can be one of the most powerful tools we have to help women feel like themselves again.
What hormone replacement therapy actually is
At its simplest, HRT is a treatment that restores declining hormones like estrogen, progesterone, and testosterone. These hormones are essential not only for reproduction, but also for bone density, brain health, cardiovascular function, metabolism, and sexual health.
“HRT is a treatment that restores declining hormones like estrogen, progesterone, and testosterone.”
When hormone levels decline, whether from perimenopause, menopause, medical treatment, or other causes, women can experience a host of symptoms: hot flashes, night sweats, disrupted sleep, low libido, brain fog, mood swings, and more. HRT helps replenish these hormones and bring the body back into balance.
Why HRT got such a bad rap
Back in the early 2000s, the Women’s Health Initiative (WHI) study made headlines suggesting HRT was unsafe. What wasn’t clear at the time was that the study was deeply flawed in its design and reporting. But the damage was done: Fear spread, and millions of women were abruptly taken off hormones or never offered them in the first place.
“The damage was done: Fear spread, and millions of women were abruptly taken off hormones or never offered them in the first place.”
For more than two decades, women suffered — and many are still suffering. They were told to just “tough it out” through hot flashes, brain fog, painful sex, poor sleep, mood swings, and accelerated bone loss. I still meet women in my office who tell me, “I was a victim of misinformation about hormones.” And they’re right.
The good news is that we now have decades of follow-up research that paints a very different picture. Today we have bioidentical hormone formulations, safer delivery methods that include patches and creams, and more individualized prescribing practices.
When HRT is used properly, it can be far safer and more effective than it was ever given credit for.
What HRT can actually do
Hormone therapy is not about turning back the clock or chasing youth. It’s about restoring balance to systems in your body that struggle without estrogen, progesterone, or testosterone.
When used appropriately, HRT can:
- Reduce or eliminate hot flashes and night sweats
- Improve sleep and stabilize mood
- Restore vaginal tissue health and ease painful intimacy
- Protect bone density and lower osteoporosis risk
- Support brain health and possibly reduce long-term dementia risk (when started at the right time)
- Support cardiovascular health and lower risk of heart disease in certain women
And this list is just the beginning. Hormones influence nearly every system in the body, which is why restoring balance can feel so transformative.
Timing matters. The benefits of HRT are strongest when started closer to the onset of menopause, not 10 or 15 years later. That’s why education and awareness are so critical — so women can make informed choices at the right time in their lives.
The myths that still linger
Even with new evidence, myths persist. Here are a few I hear most often:
Myth #1: You have to stop HRT at 60.
Truth: There is no hard cutoff age. The decision should be individualized based on symptoms, history, and goals, in conversation with your doctor.
Myth #2: HRT causes breast cancer.
Truth: The risk is nuanced, varies by type of therapy, and can often be managed with proper screening & support. In some cases, HRT may even be protective. And even for breast cancer survivors, local treatments like vaginal estrogen can safely support tissue health without raising systemic risk — something too many women are still denied.
Myth #3: HRT causes heart disease.
Truth: Estradiol can actually support cardiovascular health in women. Again, timing and type matter.
Myth #4: HRT causes dementia.
Truth: Estrogen has neuroprotective effects, and HRT may reduce dementia risk when started in the right window.
Myth #5: HRT causes weight gain.
Truth: In fact, it may help counteract the metabolic changes of menopause.
Why it’s not a magic fix
Hormones are powerful, but they’re not the whole story. If your sleep, nutrition, movement, and stress are completely out of balance, HRT isn’t going to fix everything.
Think of hormones as part of the toolkit, not the entire toolbox. In functional medicine, we look at the whole person — your gut health, metabolism, nervous system, and environment — and consider how those factors affect your hormones.
“Think of hormones as part of the toolkit, not the entire toolbox.”
One often-overlooked piece is hormone metabolism. Estrogen and other hormones are broken down and cleared through the gut, liver, and kidneys. If your detox pathways are sluggish or your gut bacteria are out of balance, hormones can recirculate in unhealthy ways. In my practice, I often use additional testing to understand how a woman’s body is metabolizing hormones. That insight guides how we support her with nutrition, targeted supplementation, gut health strategies, and lifestyle shifts like regular movement, sweating, and stress care.
And yes, there are times when HRT isn’t the right choice. Certain cancers, clotting risks, or other conditions may make hormone therapy unsafe. But even then, conversations about options like local vaginal estrogen or non-hormonal strategies are critical. Too many women are left suffering unnecessarily because no one brought it up.
“Too many women are left suffering unnecessarily because no one brought it up.“
In my medical practice at Love.Life, I never begin with HRT as the first step. We start with the whole person: Health history, labs, lifestyle, nutrition, stress, movement, recovery, and emotional well-being. If HRT makes sense, it’s layered in as one part of a larger plan that might also include herbs, nutrients, circadian rhythm support, gut healing, recovery modalities, and ongoing monitoring.
If there’s one thing that I want people to understand it’s this: Hormones deserve respect, context, and nuance.
What women need to know now
Too many women still say, “I wish someone had told me sooner.” That’s why this conversation matters.
HRT isn’t right for everyone, but it should always be part of the discussion. With thoughtful prescribing and a whole-person approach, it can be life-changing for women in perimenopause, menopause, and beyond.
“HRT isn’t right for everyone, but it should always be part of the discussion.”
As a functional medicine doctor and a breast cancer survivor, I see HRT not as a shortcut or cure-all, but as one tool in a much bigger toolkit. Paired with lifestyle foundations like sleep, nutrition, stress care, movement, and community, it can help women not just get through midlife, but truly thrive in it.
The bottom line is this: Ask questions, stay curious, and don’t let outdated information keep you from exploring your options. You deserve to know what’s possible.
Dr. Jaclyn Tolentino is a Board-Certified Family Physician and the Lead Functional Medicine Physician at Love.Life. Specializing in women’s health and hormone optimization, she has been featured in Vogue, The Wall Street Journal, and Women’s Health. As a functional practitioner and a breast cancer survivor, Dr. Tolentino is dedicated to uncovering the root causes of health challenges, employing a holistic, whole-person approach to empower lasting wellbeing. Follow her on Instagram here for more insights.
The post A Functional Medicine Doctor Explains Hormone Replacement Therapy — And Why It’s So Misunderstood appeared first on The Good Trade.
