HRT Risks: What You Need to Know Before Starting Hormone Therapy

When you’re struggling with hot flashes, sleep loss, or mood swings from menopause, Hormone Replacement Therapy, a treatment that replaces declining estrogen or testosterone levels to relieve menopausal symptoms. Also known as hormone therapy, it can bring back a sense of normalcy — but it’s not without serious trade-offs. Many people assume HRT is a safe, go-to fix, but the truth is more complicated. Studies show that for some, the benefits outweigh the risks; for others, the dangers are too high to ignore.

The biggest estrogen therapy, a form of HRT that uses synthetic or bioidentical estrogen to treat menopause symptoms risks include blood clots, stroke, and breast cancer. These aren’t rare side effects — they’re well-documented in large-scale trials like the Women’s Health Initiative. If you’re over 60, have a history of clots, or carry a BRCA mutation, even low-dose estrogen can be dangerous. testosterone therapy, used in men for low T and sometimes in women for low libido or energy carries its own risks: liver strain, sleep apnea, and increased red blood cell counts that can thicken your blood. And if you’re using compounded hormones — often marketed as "natural" — you’re stepping outside of regulated safety standards. No FDA oversight means no guarantee of dose accuracy or purity.

It’s not just about the hormones themselves. Your existing health conditions change everything. If you have high blood pressure, liver disease, or a history of migraines with aura, HRT can make things worse. Even if you’re healthy now, your body’s response to hormones shifts over time. That’s why doctors now recommend the lowest dose for the shortest time possible. And it’s why skipping regular checkups while on HRT is a bad idea — you need ongoing monitoring for breast changes, liver function, and clotting markers.

Below, you’ll find real-world advice from people who’ve walked this path. You’ll learn how to spot early warning signs of HRT complications, how comorbidities like diabetes or heart disease affect your risk profile, and why some people end up switching to non-hormonal options after a bad reaction. These aren’t theoretical concerns — they’re lived experiences that can help you make smarter, safer choices.