The best age to start hormone replacement therapy (HRT) is a complex question that depends on several factors. There is no universal "right" age, as each person's situation is unique. However, there are some key considerations when determining the optimal timing for beginning HRT:
Medical necessity - HRT may be medically necessary for some people to treat symptoms related to low hormone levels that are significantly impacting quality of life. In these cases, HRT may be recommended regardless of age if the benefits outweigh the risks.
Age - The benefits and risks associated with HRT can vary depending on age. Some key age considerations include:
- For transgender youth, hormone therapy may be used to suppress puberty and induce desired secondary sex characteristics. This treatment is controversial but often considered in adolescents.
- For transgender adults, starting HRT earlier allows more time for desired physical changes to develop before the body ages. However, emotional readiness and social support should also be considered. Many guidelines recommend waiting until at least age 18.
- For menopausal women, starting HRT around the time of menopause may have more benefits for relieving symptoms. But risks may be greater if started more than 10 years after menopause.
Duration of treatment - How long HRT needs to be taken depends on the reasons for treatment. Longer duration of therapy comes with increased health risks. The minimum effective dose and treatment duration should be considered.
Individual factors - The best timing for an individual depends on factors like:
- Ongoing health conditions
- Risk factors for diseases like heart disease and cancer
- Family history
- Lifestyle factors
- Emotional readiness
- Social support system
Weighing benefits vs risks - The benefits of beginning HRT at a younger age may include greater physical feminization for transgender women, relief of disruptive menopausal symptoms for cisgender women, and other effects. However, starting HRT earlier in life also may increase long-term health risks. Each person must weigh short-term life enhancement against potentially elevated risks to health from longer exposure.
In summary, while some general guidelines exist, there is no universal best age for everyone to begin HRT. This complex decision depends greatly on each person's unique medical situation, goals, risks, lifestyle and resources. Careful consideration with a knowledgeable medical provider is warranted to determine appropriate timing of HRT for each individual.
