Hormone therapy (HT) is often discussed as a solution for managing the symptoms of menopause—hot flashes, night sweats, mood swings—but it’s so much more than that. Emerging research shows that HT is also a powerful tool for anti-aging and long-term health, particularly in slowing down biological aging and reducing the risk of chronic diseases like cardiovascular disease (CVD) and cancer.

However, as we look closer at the data, it becomes clear that this conversation isn’t just about hormones. It’s also about access to care, medical racism, and the inequities in our healthcare system that leave certain women behind. Let’s break down the science of HT, what the latest research reveals, and why the way we think about hormone therapy, especially for marginalized women, needs to change.

 

The JAMA Study: What You Need to Know

In 2024, a major study published in JAMA analyzed data from 117,763 postmenopausal women to understand how HT impacts biological aging. The study used phenotypic age, a calculation based on a range of biomarkers (like inflammation and immune function), to compare a woman’s biological age with her actual chronological age. The results were clear: women using HT had younger biological ages than those who didn’t.

Here are the key takeaways:

  • HT users showed an average of 0.17 fewer years of biological aging compared to non-users.
  • Women who started HT at age 55 or older had an even greater benefit, showing 0.32 fewer years of biological aging than their actual age.
  • HT use was linked to a 12.7% lower risk of all-cause mortality, particularly from cardiovascular disease.
  • HT users also saw about a 5% reduction in major cancers, with better cancer survival rates and lower chances of recurrence for those who returned to HT after treatment.

Clearly, HT isn’t just about symptom management. It’s about longevity and anti-aging.

 

Timing and Duration: Is There Really a Limit?

One of the more surprising conclusions from the study was that using HT for more than 7.4 years might be associated with increased biological aging. But when we take a step back and look at the bigger picture of hormone health, this conclusion seems flawed. Here’s why:

  1. Self-Reported Data Issues: The study relied on participants’ self-reported data regarding when they started and stopped HT. This opens the door to inaccuracies, as people often misremember dates or durations, which could skew the study’s findings.
  2. Lack of Clarity on HT Types and Routes: The study didn’t clarify which types of hormones were used (e.g., estrogen alone or estrogen-progesterone) or how they were administered (e.g., orally, transdermally). This is critical because different forms of HT can have very different effects on health outcomes, and without this clarity, it’s hard to draw firm conclusions.
  3. Contradictory Evidence on Long-Term Use: Other studies, such as the Million Women Study and extensive research on breast cancer, show that long-term HT use is linked to lower cancer rates, better survival rates, and even reduced recurrence of cancer. These studies clearly support the idea that staying on HT longer could offer more protection against aging-related diseases.
  4. Hormone Deficiency and Aging: When we’re in our 20s and 30s, our hormones are at their peak, and we see lower rates of chronic diseases like cardiovascular issues and cancer. Our tissues are younger, heal faster, and regenerate better. As hormones decline with age, diseases become more common, and tissues age and lose the ability to regenerate effectively. Given this, it doesn’t make sense that longer HT use—which helps maintain hormone balance—would lead to negative outcomes. In fact, keeping hormones balanced longer should logically help tissues stay healthier and younger for longer.

So, while the JAMA study suggested a limit of 7.4 years, the broader body of research indicates that long-term HT use can actually provide significant health benefits. This is why it’s important to interpret the study’s findings with caution.

 

Medical Racism and Social Justice: Who Gets Left Behind?

Beyond the data, this study brings to light a much deeper issue: the role of medical racism and social injustice in healthcare access. The study showed that women from lower socioeconomic backgrounds (SES)—who often come from marginalized racial and ethnic communities—benefited the most from HT. These women had more pronounced reductions in biological aging when they used HT compared to women from higher SES backgrounds.

However, these same women are the least likely to have access to HT. Here’s why this matters:

 

Systemic Barriers to Care

Women from lower-income backgrounds and marginalized communities face multiple barriers to healthcare:

  • Implicit bias from healthcare providers often leads to women of color being dismissed or not offered treatments like HT, even when they report severe menopausal symptoms.
  • Financial barriers mean that many low-income women can’t afford HT or don’t have access to healthcare providers who offer it.
  • Geographic and systemic inequalities in healthcare access further marginalize these women, keeping them from receiving treatments that could significantly improve their health and longevity.

This isn’t just a healthcare issue—it’s a social justice issue. The women who stand to benefit the most from HT are the ones being denied access because of structural inequalities embedded in the medical system.

 

Medical Racism in Menopause Care

Women of color, particularly Black and Hispanic women, are more likely to experience worse menopause symptoms but are less likely to be offered or informed about HT. This neglect is part of a broader pattern of medical racism that impacts everything from maternal care to chronic disease management.

The JAMA study indirectly highlighted this inequality by showing that women from lower SES backgrounds saw the greatest benefits from HT in terms of reduced biological aging and mortality. But without addressing the systemic barriers preventing these women from accessing care, this research simply becomes another statistic in a long line of health disparities.

 

The Call to Action: Healthcare for All Women

This study underscores the urgent need to fight for health equity. We can’t talk about hormone therapy and anti-aging without addressing the fact that many women, particularly women of color and those from low-income communities, are being left behind.

What can we do?

  • Push for policies that make hormone therapy accessible and affordable for all women, regardless of their socioeconomic background.
  • Address implicit bias in healthcare by ensuring that women of color receive the same level of care and treatment options as their white counterparts.
  • Raise awareness about the benefits of HT, especially for women who may not even know that these options exist due to systemic barriers in healthcare access.

Hormone therapy is a powerful tool for promoting healthy aging, reducing mortality, and improving quality of life for postmenopausal women. But for it to be truly effective, everyone must have access to it.

 

The Bottom Line: Hormone Therapy for Longevity

Hormone therapy isn’t just about relieving menopause symptoms. It’s about slowing biological aging, reducing chronic disease risk, and enhancing longevity. For women in marginalized communities, HT could be a key part of closing the gap in health disparities. But without equitable access to care, those who need it most will continue to miss out on its life-changing benefits.

As we move forward, we need to rethink how we offer and provide HT, ensuring that it’s not just available to the privileged few, but to every woman who can benefit from it. After all, aging well is something that should be within reach for everyone.