I have given many lectures about anti-aging. Invariably, as I have come to expect, a woman raised her hand: “But I want to be natural, I don’t want to take hormones!” The natural thing to do at menopause is die, I told her. Without modern sanitation, vaccines, good nutrition, antibiotics and surgery in previous centuries, women died at about age 50 or younger. We are living longer than ever, but those added years may be in a very debilitated state without hormones. Of course, there are women who do not suffer hot flashes, bone loss, or vaginal dryness. I have seen women in their mid -50s with normal estradiol levels. I counseled them against hormone replacement therapy—but they are not the norm.

The only medication powerful enough to change one’s gender? Hormones! Why any doctor would consider prescribing hormones for men or women without precisely being guided by blood levels is shocking. I told them that many doctors, however, did exactly that, prescribe estradiol by feeling, asking patients to describe symptoms and prescribing estradiol based on symptom control. A doctor would never ask a diabetic, are you still thirsty? urinating excessively? losing weight? Maybe you need a little bit more insulin. Of course not, blood level would be drawn and the medication prescribed precisely.

Based on my observation of thousands of patients over more than 10 years devoted to hormone replacement therapy, lack of testosterone and progesterone also have severe consequences. But what about the side effects: blood clots, cancer, disorders of the liver and even cataracts have been linked to hormone replacement, whether synthetic or bio-identical. Studies are on-going. A complete discussion on the risks and side effects of hormone replacement therapy and information related to benefit/risk ratio for each individual must be discussed in detail.

Why bio-identical hormones—because you want to thrive and grow until you die…not dwindle.