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

When you hear Hormone Replacement Therapy, a medical treatment used to manage symptoms of menopause or gender transition by replacing declining or absent hormones. Also known as hormone therapy, it can bring relief from hot flashes, night sweats, and mood swings—but it’s not without serious trade-offs. Many people assume HRT is a simple fix, but the real story is more complex. The risks aren’t the same for everyone. A 55-year-old woman with no history of blood clots faces different dangers than a 45-year-old with a family history of breast cancer or a transgender man on long-term testosterone. These aren’t just numbers on a chart—they’re real, measurable dangers that show up years later.

Estrogen therapy, a common form of HRT that replaces estrogen levels dropped after menopause, is linked to a higher chance of blood clots and stroke, especially in the first year. The risk goes up if you smoke, are overweight, or have high blood pressure. For women with a uterus, adding progestin, a synthetic hormone used to protect the uterine lining from estrogen’s effects can lower endometrial cancer risk—but it may raise breast cancer risk slightly. And while testosterone therapy, used for gender-affirming care or low testosterone in men can improve energy and mood, it can also raise red blood cell counts, strain the heart, and worsen sleep apnea. These aren’t side effects you’ll feel tomorrow. They’re slow-burn consequences that show up after years of use.

The biggest mistake? Thinking HRT is one-size-fits-all. Some people use it for just a few years to get through menopause. Others stay on it for decades. The longer you’re on it, the more the risks pile up. That’s why your doctor should check your personal history—not just your symptoms. If you’ve had a blood clot, a history of breast cancer, or liver disease, HRT might not be safe for you. Even if you’re healthy now, your body changes. What was low risk at 50 might be dangerous at 65.

What you’ll find below isn’t a list of scare tactics. It’s a collection of real, practical guides from people who’ve walked this path. You’ll read about how to spot early warning signs of HRT complications, how to talk to your doctor about alternatives like low-dose vaginal estrogen, and why some people choose herbal options or lifestyle changes instead. There’s no single right answer—but there are smart ways to protect yourself while still getting relief.