Fear-mongering about hormone therapy isn’t good science. For the right woman with nasty menopausal symptoms and the right man with low testosterone, hormone therapy can mean the difference between living life to its fullest and dragging through the day (and night). So when we saw the latest scary warnings, we wanted you to know the whole story.
A downside for women: A recent Wake Forest University analysis found that women taking estrogen or estrogen plus progesterone had a higher risk for ovarian cancer. While 13 of every 1,000 women in the general population develop ovarian cancer, HT added about one additional case for every 1,000 women who used it for five years. Risk fell after stopping, but fell more slowly for those who’d stayed on HT the longest.
Our view: We take this seriously, and you should, too. Because ovarian cancer is difficult to detect, it’s often discovered in more advanced stages. As a result, just 44 percent of women survive five years or longer. If you have risk factors such as a personal history of breast cancer, a family history of ovarian cancer or even a family history of breast or colorectal cancer (which could signal a family cancer syndrome worth discussing with your doctor) or if you simply worry about your risk for this cancer, HT is not for you.
If you’re not at higher risk and if menopausal symptoms are making your life miserable, we think you should discuss HT with your doctor. We recommend that women use bioidentical estrogen plus micronized progesterone, which is encapsulated to protect it from damaging digestive acids. (You don’t need progesterone if you’ve had a hysterectomy.) Use HT for the shortest time possible. And remember — it’s safest when taken within 10 years of your last menstrual period, or before age 60.
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Two days before you begin, start taking two low-dose aspirins (a total of 162 mg) daily, with a glass of warm water before and after. Aspirin lowers your risk for clots and several types of cancer, including ovarian cancer. (A recent National Institutes of Health-sponsored study suggests that it might lower risk as much as 20 percent.) The warm water reduces your risk of digestive-system bleeding. If you can’t tolerate aspirin, ask your doctor what else you can take to reduce clot risk. It’s that important.
A downside for men: A recent U.S. Food and Drug Administration announcement cautioned men about extra risk for heart attacks and strokes when using testosterone supplements. This new alert came after researchers, who completed a yearlong “T” study in 788 older men last fall spoke with the FDA about label warnings.
Our view: That connection is controversial. A recent review in Mayo Clinic Proceedings found flaws in studies linking cardiovascular trouble to testosterone and found no extra risk for men. One author told USA Today: The FDA’s warning is “bad news for men. It will make it even more difficult for men suffering from true testosterone deficiency.”
For guys with truly low T levels, extra testosterone can boost energy, fire up a flagging libido and slow down runaway muscle and bone loss. All men’s testosterone levels fall about 1 percent per year after age 30. After age 70, about 30 percent of guys may have clinically low levels (below 300 ng), yet many will have no symptoms. But if you’re tired, losing your sex drive or are sporting a beer belly where that six-pack used to be, talk with your doc about the big picture and about a T prescription. Consider medication side effects, health conditions like high blood pressure and diabetes, and don’t forget that a sofa-and-snacks lifestyle can contribute to low T.
If your tests show that your testosterone is truly low, T may be for you. We’ve seen it give guys an undeniable emotional and physical lift. Just be sure to reduce your heart, blood vessel and cancer risk with the same aspirin strategy we recommend for women.
Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into “The Dr. Oz Show” or visit sharecare.com.