The Real Issue with HRT and Heart Attacks - Hormone Therapy Center of America

The Real Issue with HRT and Heart Attacks

Believing that HRT can cause heart attacks is rampant throughout the medical and layperson community. Myths and rumors abound around this problem.


But, is it true?


And if it’s not true, why do so many doctors and people believe HRT causes heart attacks?


How the HRT Causes Heart Attacks Myth Started



Two groups of studies started the myths and the controversy of whether HRT causes heart attacks or not. Let’s take a look at both of them.


The Body Builder Study


Some years ago, when bodybuilding was at its peak, many of these patients took steroids, mainly testosterone and other androgen steroids, to increase their muscle mass. It worked and worked very well.


However, it came with some pretty significant side effects. Primarily, it caused heart attacks and damage to the heart muscle.


Since the first studies came out regarding testosterone hormone replacement, many people associated the studies that showed bodybuilders have a significantly higher chance of having a heart attack when using testosterone supplements to ordinary people with hypogonadism using HRT to improve their levels. Unfortunately, there is no real correlation.


While a direct association between testosterone and heart disease has never been fully established, the link is suspected. According to the Harvard Medical School, the general assumption is that men develop more heart disease earlier than women; therefore, testosterone could be the primary hormone to blame. Additionally, athletes, bodybuilders, and those who want to increase muscle mass abused testosterone supplements and other androgenic steroids. They developed significantly higher risks of high blood pressure, heart attack, and stroke.


A few studies show that higher than normal levels of testosterone within the body harm the heart muscle. However, there are no studies that show that normal amounts of testosterone, whether produced naturally by the body or through supplementation, show any physiological harm to the body.


The difference comes from the levels of testosterone when starting the supplementation. In bodybuilders, they already had an average to high level of testosterone in their system. Then, they added more.


In women, there’s another study that portrays another complicated relationship between hormone replacement therapy and heart attacks. According to the Estrogen-Progestin Replacement study that was published in the Journal of the American Medical Association in the late 1990s, more than 2,700 women with existing coronary heart disease were tested to determine if estrogen plus progestin would prevent a second heart attack.


During the first year, the study showed that the woman had a 50% increase in heart attacks and strokes. But, in the second and subsequent years, they had significantly fewer heart disease symptoms and fewer heart attacks and strokes. Additional studies from the National Institute of Health showed early the HRT significantly decrease the risk of breast cancer, heart attacks, stroke, and blood clots in a study that looked at estrogen and progesterone. (In 2004, the NIH stopped estrogen-only research that showed a significant increase in blood clots and strokes but did not reduce the chance of a heart attack.)


One of the biggest problems with these studies is that they looked at the synthetic hormone replacements rather than natural levels or bioidentical hormones. We’ll be taking a look at the bioidentical hormone angle a little bit below.


Because these studies were so prominent and showed such significant problems, the media sensationalized the headlines. It was portrayed to the ordinary person that hormone replacement therapy causes more problems than it solves, increases heart attacks, and should not be taken by people.


 But, what the media portrays and what becomes myth and legend is not always the truth.


The Real Science Behind Heart Attacks and HR


A significant portion of the studies focused on other hormone delivery methods, such as oral supplementation, injections, creams, and gels. Bioidentical pellet therapy has often not been included in these studies as it was not as prevalent at the time.


Fortunately, many of the newer studies, even though they are smaller, show that there are reductions in blood pressure, arterial buildup, stress, and other factors related to heart disease, such as cholesterol and liver problems.


Anxiety & Stress


Stress is a risk factor for heart attacks, and controlling stress helps reduce the chances of a heart attack. Fortunately, using appropriate hormone replacement therapy can help reduce the stress and anxiety a person feels. Although certain studies indicate that HRT reduces the risk of depression and anxiety, surprisingly, the synthetic hormone progestin does not. This suggests that bioidentical hormone replacement therapy is more beneficial to reducing stress and anxiety, which can in-turn help reduce heart attack risk.


Even in the long term, such as this five-year study, HRT helps reduce the hormone cortisol. The long-term effect on anxiety and stress is diminished as cortisol is modulated within the body.


The Psychiatric Times reports, “[H]igh sex hormone levels (and resulting increases in brain plasticity) during stress or trauma may facilitate over-consolidation of these experiences, thereby increasing the propensity to develop anxiety disorders. Conversely, once anxious symptoms have developed, high sex hormones may be beneficial during CBT by facilitating the formation of new safety memories and more adaptive means of coping.”


Blood Pressure & Cholesterol


High blood pressure and cholesterol levels do have some impact on heart attack risk, the degree to which they impact has been debated in the past couple of years. Most doctors do agree that elevated blood pressure and cholesterol levels place a person at a higher risk of developing issues with the heart that can lead to a heart attack.


Fortunately, hormone replacement therapy is moderately effective at reducing blood pressure and cholesterol levels. In postmenopausal women, the effect of HRT on blood pressure increases, helping to keep arterial blood pressure lower the longer a woman takes HRT.


Weight Gain


Excess weight and obesity are risk factors for a heart attack because of their association with increased anxiety, depression, adrenal fatigue, increased blood pressure, increased cholesterol levels, lower antioxidant levels, and other risk factors for heart disease. One of the specific measures is the C-reactive protein, as it is identified with inflammation within the body. By the level of the obesity for a person, the higher levels of C-reactive protein, thus, a more elevated risk of a heart attack.


Fortunately, other studies, more extensive and better studies, have shown this is not the case. HRT does not increase the risk of coronary artery disease or heart attack. These studies show that weight and obesity have a more significant impact. Other studies show that physically active postmenopausal women who take HRT and maintain a healthy weight do not have an elevated C-reactive protein. Furthermore, even in women who have a little bit of excess weight, healthy supplements with healthy oils, such as fish oils, negate any increase in the C-reactive protein.


What we can conclude is that women concerned about a heart attack risk would be best to maintain a healthy weight, use proper supplements, and use HRT to help mitigate the risk of heart disease and heart attack.


How Bioidentical Hormones Eliminate Heart Attack Risk


You may have noticed that many of the studies utilized bioidentical hormones rather than synthetic versions. While synthetic hormones are more prevalent and mass-marketed, they are not identical to what the body uses and tend to cause other types of problems.


One of the most prominent examples of the difference between synthetic hormones and bioidentical hormones come from estrogen and progestin. Synthetic versions of these hormones are tied to significant increases in the risk of breast cancer and other problems. However, when doctors prescribed bioidentical hormones for the same issues in a similar group of women, they found no risk of breast cancer. Long term studies show that bioidentical hormones may indicate a decrease in the risk of cancer.


Some of the risks also come down to the delivery method. Oral supplements have been known to cause liver problems. Injectable and patch therapy tends to create uneven muscle growth and the risk of skin cancer at the application sites. Creams and gel are notorious for underdosing in many women and men (link to underdosing article). Any product that has to be taken daily, such as oral supplementation and creams and gels, have consistency problems. Injections have similar patient compliance problems, although it is more prominent in men than women.


On the other hand, bioidentical pellet therapy presents fewer risks and provides a more consistent delivery of hormones. When dosed appropriately, bioidentical pellets release the exact doses of hormones the patient needs over three to six months. Pellet therapy can be customized to each patient, getting a better balance of hormones. And as each pellet is placed under the skin, patient compliance is almost at a 100% level.


 Pellet therapy also has a far better consistency of use, which we cover in this article here (add link).



The most significant thing to remember about your patient is that they can do considerable research on different forms of hormone replacement therapy. They come to you with questions and predetermined ideas of what they want and don’t want. Many may be convinced that HRT causes heart attacks without proper justification or will look into some of the additional studies that show the opposite.


This article helps show that the proper application of bioidentical hormones, mainly through pellet therapy, provides consistency, reliability, and safer overall treatment. If you would like to talk to one of our representatives, they can share additional studies and send you information on how to get started with either bioidentical hormones or pellet therapy.