Estradiol (HRT — oral/transdermal/vaginal)
Hormones · Estrogen replacement
Tier B+
What this is
WHI 2002 prematurely tarnished HRT — subsequent reanalyses, KEEPS, and ELITE demonstrate the 'timing hypothesis' (benefit when started within 10 years of menopause). 2022 NAMS Position Statement strongly affirms benefit:risk for symptomatic women. Transdermal strongly preferred over oral in biohacker/longevity practice. For women who can't or won't take HRT, NK3/NK1 receptor antagonists (fezolinetant, elinzanetant) are now non-hormonal alternatives specifically for vasomotor symptoms — see separate entries.
Mechanism
Primary mammalian estrogen; binds ERα/ERβ; modulates thousands of genes; transdermal route bypasses first-pass hepatic metabolism and avoids VTE/stroke elevation seen with oral estrogens
Dose & route
Transdermal: 0.025-0.1 mg/day patch or gel; oral: 0.5-2 mg/day; vaginal: 10-25 mcg tablet 2x/wk
Citations
- https://pubmed.ncbi.nlm.nih.gov/36125259/
- https://pubmed.ncbi.nlm.nih.gov/27500523/
- https://pubmed.ncbi.nlm.nih.gov/28085824/
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This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.