#435 Hormone Doc Amy Killen Reveals the TRUTH About TRT and HRT Safety

Amy Killen (0:00)

You know, people were so scared of estrogen, they weren't replacing it, but we know from multiple studies that if you give women estrogen early in menopause, so before 10 years, then there is a 40% reduced risk of cardiovascular disease. And heart disease is the number one killer of men and women. And we can reduce your risk by 40%. And we know from studies that the testosterone serum level does not mean that you feel a certain way. Like you could have a high testosterone serum level and you could still feel bad.

Siim Land (0:29)

Amy, welcome back to the show.

Amy Killen (0:31)

Thank you. It's so good to see you again.

Siim Land (0:33)

Yeah. And it's been a while. And I'm very always interested in like some of the different kind of longevity therapeutics and like interventions that you're doing at your clinic and your work. But for this episode, I was thinking of focusing mostly on the hormone side. So HRT, hormone replacement therapy for women, and TRT as well, so disaster on replacement therapy. There's a lot of like misconceptions about TRT and HRT, thinking that it's harmful for your health. But I guess we can cover all those topics and refute some of the misconceptions.

Amy Killen (1:10)

Yes, I would love that.

Siim Land (1:12)

Yeah. So what do you think then is replacing hormones as you get older with these therapies? Is it like, you know, net positive or what does the evidence say from the studies?

Amy Killen (1:27)

Yes. I mean, I think that outside of a healthy lifestyle, replacing these hormones in men and women are the best things that you can do for your health if you want to live longer and live better. We have a lot of other things in the longevity space that are being looked at, but we have so much data behind testosterone, estrogen, progesterone therapy, and there's a lot of misconceptions and myths out there, but these hormones overall are very net positive.

Siim Land (1:55)

Gotcha. Yeah, I often hear that, obviously, that there's the connotation that steroids, the bodybuilders use in larger quantities, and much larger quantities than TRT, then they obviously have negative effects on your health and shorten your lifespan. A lot of bodybuilders die young because of abusing those drugs, so maybe people have a negative association because of that reason.

Amy Killen (2:19)

Yeah, I think that's part of it. Certainly, in men, the high-dose testosterone, as well as all the other non-testosterone, androgen steroids that are out there, the synthetic steroids, those can be damaging. They can really affect your lipids especially. They can affect your liver. They can do all kinds of things. And oftentimes, people are using them without a doctor's oversight, and so that's always a problem, too, of just kind of messing with your body and not checking things along the way. So, I think that's one of the problems with men. And then in women, we have still the sort of misunderstanding of the Women's Health Initiative, which was a 2002 study that kind of came out and scared women about hormone therapy, and we still have not gotten over that study.

Siim Land (3:04)

What was it like? What did they find in that study, and why were people so scared?

Amy Killen (3:08)

So, initially, this is a study, this is a randomized, controlled trial, where they gave, there was three arms, they gave one arm the estrogen, which is synthetic estrogen, they gave one arm estrogen and progesterone, and then the other arm was a placebo, and they were going to be at eight-year study. They stopped the study just after five years because they were concerned about increased risk of breast cancer, heart attack, strokes, dementia, and blood clots. And so, there are all these headlines that went out that said, these hormones are causing all these horrible things, and 88% of women who were taking hormones at that time got off of them because of the study. But they were, in the last 20 years, we've gone back and we've analyzed that study in detail. And what we've learned is several things. First of all, the estrogen did not cause breast cancer. And in fact, the women who took the estrogen by itself without the progestin, the synthetic progestin, which is not a great drug, the estrogen-only arm had a 29% reduced risk of actually getting breast cancer. And the women who started hormones early in menopause within the first 10 years had reduced heart disease. And they had reduced, like all of these things were not actually true if you adjusted the study to be the right patients in the right age group and the right drugs.