Questions About Hormones

I get a lot of questions from patients about hormones, especially as we get older.

“Is hormone replacement bad for women after menopause?”

“If it’s bad for women, what about testosterone replacement for men?”

“What age does perimenopause actually start?”

“Why does one person have terrible symptoms while someone else barely notices anything?”

These are good questions, because hormones don’t suddenly become unimportant once we reach a certain age.

For women, hormone changes can start during perimenopause, often in the 40s, although it can happen earlier. Estrogen and progesterone can fluctuate quite a bit during this time. Menopause is when you have gone 12 months without a period.

For men, the change is usually different. Testosterone tends to decline more gradually with age rather than dropping over a short period of time.

And that difference matters.

When hormones decline slowly, our bodies may have more time to adjust. Some people have very few symptoms.

Others notice fatigue, poor sleep, brain fog, mood changes, decreased libido, changes in body composition, loss of muscle, vaginal dryness, sexual dysfunction, hot flashes or night sweats.

An abrupt hormonal change can feel very different.

For example, a woman who has both ovaries surgically removed can experience a sudden drop in hormones instead of the gradual transition of natural menopause. Her symptoms may be much more intense. Certain medical treatments can cause similarly abrupt hormonal changes in both women and men.

This is also why I don’t believe hormone care should be based on a lab number alone.

I look at the patient’s symptoms, age, medical history, risk factors, hormone levels when appropriate, and, most importantly, how they actually feel.

Some people go through these changes and feel completely fine. They may not need treatment at all.

For others, the symptoms can significantly affect sleep, energy, relationships, sexual health, work, and overall quality of life.

Hormone replacement is not simply “good” or “bad.” The question is whether treatment is appropriate for that particular patient, and whether the potential benefits outweigh the risks.

That is the conversation I think we should be having.

— Dr. Lee

Sunny Health DPC