Peter Attia· MD
So I think this is a really important question in the sense of what is the risk of taking hormone therapy in that patient and what is the risk of not taking hormone therapy in that patient. And so I think it's super interesting because we love talking about the risks of medication but we don't spend a lot of time talking about the risks of not taking medication. So if we think about that woman as she gets older um she certainly will have the microbiome and genital and urinary changes of not having hormones. So as a urologist this is the actually one of the things that one of the couple things that will kill her right as the you lose hormones in the genitals which are very hormone sensitive the bladder is very hormone sensitive you change the microbiome you increase you decrease the acidity of the tissue the bad bacteria grow your risk of urinary tract infections increase drastically. So she may get recurrent urinary tract infections or pelvic pain. she may develop osteoporosis, right? Which we know more people die of hip fractures about the same die of hip fractures as die of breast cancer. So the risk of not taking hormone therapy when you get a hip fracture as all of your listeners know you're you're going back to the life that you lived is very challenging, right? Or you die. Um, and so there's also the risk of we know dementia and Alzheimer's much higher in women and we can argue the data and I don't think we actually have good data about you know whether hormones are you know when to start them and and if they're actually protective and how they're protective but we also know that heart disease is the number one killer of women and we know that things get worse as you get older.