Hormone Replacement Therapy and Stroke

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A stroke can occur at any time – suddenly – with no advanced warning. Strokes are the third leading cause of death in females – especially in older age as compared with males. The prospect of experiencing a stroke is indeed scary as it is a major contributor to disability. In this report, we look at the latest research on the use of hormone replacement therapy and stroke risk. We will examine the most common types of HRT – estrogen, progesterone, progestin, testosterone, and human growth hormone.

Hormone Replacement Therapy and Stroke

Is There a Correlation Between HRT and Stroke?

In some instances, the relationship is well-defined. For other hormones, more research is necessary before a clear answer can be given. What we do know is this – the body is designed with a balanced need for hormones. When any particular hormone is out of balance, it can increase certain health risks. That is why doctors specializing in the field of hormone replacement therapy use great care when determining who can benefit from HRT, and how much growth hormone for men or women to prescribe.

Understanding the relationship between hormones and stroke is essential because many people who experience ischemic stroke tend to have reduced hormone levels that can impair memory and cognitive functions, decrease energy, and cause other significant health problems

Does Hormone Replacement Therapy Increase the Risk of Stroke?

In our first look at hormone replacement therapy and stroke, we find that the use of testosterone and human growth hormone does not increase the risk of a stroke in men. There is no reported concern over HGH use and increased stroke risk in males or females.

However, one study does show that higher testosterone to estradiol ratio in postmenopausal women may increase the risk of stroke and heart failure. Higher total serum testosterone levels were associated with an increase in risk for cardiovascular disease (CVD) while increased estradiol levels lowered risk factors. Again, these issues were limited to one study – much more research is necessary. Testosterone has also been found beneficial for many women and can increase estrogen levels due to testosterone conversion to estradiol.

Studies are also conflicting in their findings. A report published in 2017 shows that the timing of hormone therapy in women may also alter the stroke risk. Data from 5 population-based Swedish studies showed that HRT administered early in menopause onset did not increase stroke risk. However, initiating hormone therapy later – 5 years after menopause onset – did increase stroke risk for either synthetic estrogen alone or in combination with synthetic progesterone. 

The Women’s Health Initiative (WHI) examined HRT and stroke risk using synthetic estrogen along with estrogen and progestin therapies. The trial ended early after only five years due to increased risk factors for breast cancer, stroke, coronary events, and pulmonary emboli. Also, as part of the WHI, women who used Estratest (testosterone and synthetic estrogen combined) had a higher risk of stroke. There were no assessments done on women using only bioidentical testosterone.

In another study out of Denmark, oral HRT increased stroke risk, but vaginal and transdermal estrogens decreased the risk.

When it comes to bioidentical progesterone hormone replacement therapy and risk of stroke, progesterone treatment appears to have no bearing on stroke risk. It is considered a safe form of hormone replacement therapy.

For the percentage of women on HRT, 2019 will likely offer many other studies. New research out of Finland shows that women taking HRT longer than ten years have a 9 to 17 percent increased risk of Alzheimer’s disease. Again – conflicting reports say that HRT improves brain function, and many factors were left out of that study. We cannot stress enough the importance of speaking with a hormone specialist to assess your risks vs. benefits when it comes to any type of hormone replacement therapy. 

Can Hormone Replacement Therapy Decrease the Risk of a Stroke?

A significant question about HRT centers around prevention. Is there a connection between the use of hormone replacement therapy and stroke risk decline?

When it comes to preventing or decreasing the risk of stroke and HRT use, again, it depends on the hormone in question.

Testosterone:

A review of seven studies of testosterone replacement therapy (TRT) in men turned up the following results:

  • Two studies demonstrated a significant decrease in ischemic stroke risk associated with TRT use
  • The remaining studies did not report any associations between stroke and TRT

When it comes to hormone replacement therapy and stroke, testosterone may provide protective benefits against stroke and myocardial infarction (heart attacks).

Progesterone:

Based on considerable research, it seems that not only does natural, bioidentical progesterone doesn’t increase the risk of a stroke, but it may also decrease the incidence.

Estrogen:

Based on research from numerous studies, estrogen use is not indicated for the prevention of strokes in women.

Human Growth Hormone:

HGH may offer preventative measures for reducing the risk of stroke. Human growth hormone provides many neuroprotective benefits for the brain. More research is warranted in this area.

Katherine Donnelly

    Katherine Donnelly

    A qualified doctor, Jane G. is someone who wears many hats, working also as a health writer, author, researcher, and media medic. She is a master communicator who is passionate about putting convoluted health information into words that make the information widely accessible. Her primary interests are child and adolescent health, women’s well-being, beauty, and nutrition.

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