That fear traces back to one scary headline from a 2002 study — and bad news makes better news than good news, so the scary version is what stuck. What most people (and most doctors) don't know is that a follow-up finding three years later showed something almost nobody heard about: women given estrogen alone actually had less breast cancer than women given no hormones at all. On top of that, it takes an average of 17 years for new research to actually change how doctors practice. That's almost a generation. So the fear you're hearing is a reflection of outdated information, not current science.

Women make testosterone too, and it plays a real role in libido, drive, and confidence. Most of the women I work with do best with testosterone levels above what most labs even consider the normal reference range. As for the old fear that testosterone causes cancer, this is also a fear based on outdated information, not current science. Testosterone has actually been shown to be protective against several types of cancer in both men and women. We still need more testosterone options for women.

The official guidance suggests using the lowest doses for the shortest time needed to relieve symptoms. I don't agree with that. Estrogen keeps protecting your bones long after your hot flashes are gone, and I personally recommend — and plan for myself — staying on at least a small amount of estrogen for life, to avoid the devastating effects of a hip fracture down the road. That said, I'm not here to talk you into anything. My goal is to take away the fear so you can make the choice that's right for you.

Bioidentical means the hormone is the same form and structure as what your body used to make plenty of on its own. It matters most with progesterone: bioidentical progesterone does not raise your risk of breast cancer, while the synthetic progestins still used in a lot of standard prescriptions have been shown in multiple large studies to raise that risk. Same goes for estrogen — used through the skin (patch, gel, cream) rather than in pill form, to avoid the cardiovascular risks that come with oral estrogen. These are details that get lost when a doctor is prescribing from habit instead of current understanding.