How testosterone and estrogen shape aging for both sexes

For decades, hormone replacement therapy (HRT) for women was a standard tool to ease the symptoms of menopause and preserve long-term health. That ended abruptly in the late 1990s when a media-fueled panic—sparked in part by Boston surgeon Dr. Susan Love—led to a full-scale retreat. Physicians, once confident in prescribing estrogen, were suddenly cowed into silence. “Top-down doctrine,” said Dr. Ryan Welter, “is just the worst. Everybody groupthinks and follows one direction.”

That direction hurt women. Badly.

Millions were denied care based on flawed studies and media hype. “Estrogen therapy would have probably been very helpful for millions of women—and they were all denied it,” Welter noted. “They’ve suffered from osteoporosis and sarcopenia because of it.”

Now, decades later, a quiet revolution is underway. Dr. Marty Makary, a surgeon and current FDA chief under the Trump administration, has begun to correct the record. He’s said publicly what many clinicians have whispered for years: the Women’s Health Initiative studies were deeply flawed. The risks were overstated. The benefits—stronger bones, sharper minds, longer lives—were buried beneath the noise.

“We realized that the original studies were flawed,” said Welter. “We really need better data.” But the clinical experience has been consistent: women on HRT live better—and often longer. I noted that “there was never a spike in mortality. And those who stayed on estrogen got mammograms, got Pap smears, and stayed healthier overall.”

What’s lost can’t be regained. But it can be stopped from repeating.

Today’s HRT is different. Bioidentical hormones. Micronized progesterone. Measured replacement. “You can do testosterone without estrogen—especially in women with a uterus,” Welter explained. Estrogen has to be balanced with progesterone to prevent uterine proliferation and cancer, but testosterone carries no such baggage. “Adult women typically have more testosterone than estrogen,” said Welter. “Most of the benefits for women on HRT come from testosterone, not estrogen.”

This challenges everything people thought they knew. “Testosterone doesn’t masculinize women—it restores femininity,” said Welter. “This is the 35-year-old woman who wanted to be with her husband—now, at 55, she doesn’t. It’s not about turning into a man. It’s bringing the woman back.”

And for men? The case is even more straightforward. Testosterone declines slowly, starting around age 30. “Every man should check testosterone at least once per decade,” said Welter. Most don’t—until the signs catch up: fatigue, muscle loss, brain fog, low libido.

“We’re not treating disease—we’re optimizing for life,” Welter said. “Hormone optimization is not about enhancement—it’s about prevention.” Stronger bones, preserved muscle mass, better cognitive function—these are not fringe benefits. They’re the difference between aging and eroding.

The fears of testosterone and prostate cancer? “Debunked,” said Welter. “They’re independent variables.”

Welter’s preferred method is bioidentical pellet therapy, designed to mimic the body’s own hormone release via cardiac output. “We aim to keep men and women functioning like their 35-year-old selves.” Not jacked. Not superhuman. Just steady, vital, and whole.

The greatest tragedy of the HRT collapse wasn’t the retreat itself—it was the silence that followed. For 25 years, an entire generation of women suffered through avoidable decline because the medical establishment panicked and the media cheered. “Clinical outcomes show massive lifestyle improvements—even if studies lag behind,” Welter said. “This is low-hanging longevity fruit.”

Now the fruit is ripe again. Those listening carefully can hear the pendulum swinging back—slowly, but finally—with Makary and others leading the charge to correct a generational mistake. Women need to be given back what nature (and timid physicians) took—slowly, quietly, and prematurely.

Join us at 5 pm ET weekdays on America Out Loud Talk Radio. Listen on iHeart Radio, our world-class media player, or our free apps on Apple, Android, or Alexa. Discover all the episodes on podcast networks, i.e., Apple Podcasts, Spotify, Pandora, TuneIn, Stitcher, and iHeart. You’ll find them the day after they air on talk radio, available on podcast. Extraordinary voices for extraordinary times.