How long should you be on hormone replacement therapy?

There is no universal recommendation for how long someone should be on hormone replacement therapy (HRT). The appropriate duration of HRT is highly individualized and depends on several factors:

Key factors determining duration of HRT:

Reason for starting HRT: The underlying condition necessitating HRT guides expected duration. For example:
- Menopausal symptoms: Most guidelines suggest HRT for 4-5 years for relieving menopausal symptoms. HRT may be continued beyond this timeframe based on patient preference and risk/benefit assessment.
- Gender transition: HRT is often lifelong to maintain affirmed gender traits for transgender individuals.
- Hypogonadism: HRT treats hormone deficiency so is often lifelong for conditions causing permanent gonadal failure.
Patient age and time since menopause or gonadal failure
Risk factor profile: Personal and family medical history impact risks from prolonged HRT.
Response to therapy: Benefits and side effects experienced affect duration decisions.
Patient preferences and goals: Quality of life improvements and goal achievement shape interest in continuing/discontinuing.

General duration recommendations

Below are general starting points for expected HRT duration in common scenarios:

Menopausal HRT

<50 years at start: At least until average age of menopause at ~51 years. Evaluate continuing beyond natural menopause age.
50-59 years at start: 4-5 years.
60 years at start: More caution due to higher risks. Generally limit to a few years based on benefits evaluation.

At any age, evaluate ongoing need/risk/benefit profile yearly with provider.

Gender Affirming HRT

Goal is hormone levels matching affirmed gender. This typically necessitates lifelong therapy, barring major contraindications.

Hypogonadism / Hypoestrogenism

Usually lifelong if irreversible primary gonadal failure cause (e.g. premature ovarian insufficiency, castration).
Duration guided by reversible cause (e.g. steroids, stress, weight loss).

Key times to re-evaluate HRT duration

Yearly: Assess current symptoms, bone density, and cardiovascular / breast cancer risk factors.
1-5 years: Recheck need for short-term HRT like menopause.
Age 50-59: Consider lower dose or discontinuation of combined estrogen-progestin.
Age 60-69: Risk may outweigh benefit for combined HRT. Evaluate continuing.
Age 70 : Combined HRT not recommended. Evaluate continuing estrogen alone.
Persisting abnormal uterine bleeding: Prompt evaluation needed.
New onset concerning symptoms: Evaluate for possible side effects.

Discuss goals, risks and benefits at least yearly with your provider. Shared decision making allows tailoring duration to your health profile and preferences. Stay engaged in monitoring for optimal personalized hormone therapy.