How Old Is Too Old For HRT?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝I think you guys do a great job. Wondering if I can suggest a topic? Older women who were not offered hormone replacement therepy because of a long term study that was misread. Now, we need science to tell us if we are too old to benefit from begininng to take HRT. Not sure how old your readers are on average but it would be a great topic for older woman. Thanks❞
Thank you for the kind words, and the topic suggestion!
About the menopause and older age thereafter
We’ve talked a bit before about the menopause, for example:
What You Should Have Been Told About The Menopause Beforehand
And we’ve even discussed the unfortunate social phenomenon of post-menopausal women thinking “well, that’s over and done with now, time to forget about that”, because spoiler, it will never be over and done with—your body is always changing every day, and will continue to do so until you no longer have a body to change.
This means, therefore, that since changes are going to happen no matter what, the onus is on us to make the changes as positive (rather than negative) as possible:
Menopause, & When Not To Let Your Guard Down
About cancer risk
It sounds like you know this one, but for any who were unaware: indeed, there was an incredibly overblown and misrepresented study, and even that was about older forms of HRT (being conjugated equine estrogens, instead of bioidentical estradiol):
As for those who have previously had breast cancer or similar, there is also:
The Hormone Therapy That Reduces Breast Cancer Risk & More
Is it too late?
Fortunately, there is a quick and easy test to know whether you are too old to benefit:
First, find your pulse, by touching the first two fingers of one hand, against the wrist of the other. If you’re unfamiliar with where to find the pulse at the wrist, here’s a quick explainer.
Or if you prefer a video:
Click Here If The Embedded Video Doesn’t Load Automatically!
Did you find it?
Good; in that case, it’s not too late!
Scientists have tackled this question, looking at women of various ages, and finding that when comparing age groups taking HRT, disease risk changes do not generally vary much by age i.e., someone at 80 gets the same relative benefit from HRT as someone at 50, with no extra risks from the HRT. For example, if taking HRT at 50 reduces a risk by n% compared to an otherwise similar 50-year-old not on HRT, then doing so at 80 reduces the same risk by approximately the same percentage, compared to an otherwise similar 80-year-old not on HRT.
There are a couple of exceptions, such as in the case of already having advanced atherosclerotic lesions (in which specific case HRT could increase inflammation; not something it usually does), or in the case of using conjugated equine estrogens instead of modern bioidentical estradiol (as we talked about before).
Thus, for the most part, HRT is considered safe and effective regardless of age:
How old is too old for hormone therapy?
👆 that’s from 2015 though, so how about a new study, from 2024?
❝Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%).❞
❝Among senior Medicare women, the implications of menopausal hormone therapy use beyond age 65 years vary by types, routes, and strengths. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with E2 rather than conjugated estrogen.❞
Read in full: Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses
As for more immediately-enjoyable benefits (improved mood, healthier skin, better sexual function, etc), yes, those also are benefits that people enjoy at least into their eighth decade:
See: Use of hormone therapy in Swedish women aged 80 years or older
What about…
Statistically speaking, most people who take HRT have a great time with it and consider it life-changing in a good way. However, nothing is perfect; sometimes going on HRT can have a shaky start, and for those people, there may be some things that need addressing. So for that, check out:
HRT Side Effects & Troubleshooting
And also, while estrogen monotherapy is very common, it is absolutely worthwhile to consider also taking progesterone alongside it:
Progesterone Menopausal HRT: When, Why, And How To Benefit
Enjoy!
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Kiwi vs Grapefruit – Which is Healthier?
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Our Verdict
When comparing kiwi to grapefruit, we picked the kiwi.
Why?
In terms of macros, kiwi has nearly 2x the protein, slightly more carbs, and 2x the fiber; both fruits are low glycemic index foods, however.
When it comes to vitamins, kiwi has more of vitamins B3, B6, B7, B9, C, E, K, and choline, while grapefruit has more of vitamins A, B1, B2, and B5. An easy win for kiwi.
In the category of minerals, kiwi is higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while grapefruit is not higher in any minerals. So, no surprises for guessing which wins this category.
One thing that grapefruit is a rich source of: furanocoumarin, which can inhibit cytochrome P-450 3A4 isoenzyme and P-glycoptrotein transporters in the intestine and liver—slowing down their drug metabolism capabilities, thus effectively increasing the bioavailability of many drugs manifold.
This may sound superficially like a good thing (improving bioavailability of things we want), but in practice it means that in the case of many drugs, if you take them with (or near in time to) grapefruit or grapefruit juice, then congratulations, you just took an overdose. This happens with a lot of meds for blood pressure, cholesterol (including statins), calcium channel-blockers, anti-depressants, benzo-family drugs, beta-blockers, and more. Oh, and Viagra, too. Which latter might sound funny, but remember, Viagra’s mechanism of action is blood pressure modulation, and that is not something you want to mess around with unduly. So, do check with your pharmacist to know if you’re on any meds that would be affected by grapefruit or grapefruit juice!
All in all, adding up the categories makes for an overwhelming total win for kiwis.
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer ← kiwi is top of the list!
Take care!
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How to Change – by Katy Milkman
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Sometimes it seems that we know everything we should be doing… We have systems and goals and principles, we know about the importance of habits, and we do our best to live them. Yet, somehow, life has other plans for us and things don’t quite come together they way they did in our genius masterplan.
So, what happened? And more importantly, what are we supposed to do about this? Katy Milkman has answers, right from the start.
Sometimes, it can be as simple as when we try to implement a change. It’s not that there’s a “wrong time” for a good change, so much that there are times that are much more likely to succeed than others… and those times can be identified and used.
Sometimes we’re falling prey to vices—which she explains how to overcome—such as:
- Impulsivity
- Procrastination
- Forgetfulness
- Laziness
We also learn some counterintuitive truths about what can boost or sabotage our confidence along the way!
Milkman writes in a compelling, almost narrative style, that makes for very easy reading. The key ideas, built up to by little (ostensibly true) stories and then revealed, become both clear and memorable. Most importantly, applicable.
Bottom line: this is a great troubleshooting guide for when you know how everything should be working, but somehow, it just doesn’t—and you’d like to fix that.
Click here to check out “How To Change” on Amazon, and get those changes rolling!
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The Kitchen Doctor
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Dr. Rupy Aujla: The Kitchen Doctor
This is Dr. Rupy Aujla, and he’s a medical doctor. He didn’t set out to become a “health influencer”.
But then, a significant heart condition changed his life. Having a stronger motivation to learn more about nutritional medicine, he did a deep dive into the scientific literature, because that’s what you do when your life is on the line, especially if you’re a doctor!
Using what he learned, he was able to reverse his condition using a food and lifestyle approach. Now, he devotes himself to sharing what he learned—and what he continues to learn as he goes along.
One important thing he learned because of what happened to him, was that he hadn’t been paying enough attention to what his body was trying to tell him.
He wants us to know about interoception—which isn’t a Chris Nolan movie. Rather, interoception is the sense of what is going on inside one’s own body.
The counterpart of this is exteroception: our ability to perceive the outside world by means of our various senses.
Interoception is still using the senses, but is sensing internal body sensations. Effectively, the brain interprets and integrates what happens in our organs.
When interoception goes wrong, researchers found, it can lead to a greater likelihood of mental health problems. Having an anxiety disorder, depression, mood disorder, or an eating disorder often comes with difficulties in sensing what is going on inside the body.
Improving our awareness of body cues
Those same researchers suggested therapies and strategies aimed at improving awareness of mind-body connections. For example, mindfulness-based stress reduction, yoga, meditation and movement-based treatments. They could improve awareness of body cues by attending to sensations of breathing, cognitions and other body states.
But where Dr. Aujla puts his focus is “the heart of the home”, the kitchen.
The pleasure of food
❝Eating is not simply ingesting a mixture of nutrients. Otherwise, we would all be eating astronaut food. But food is not only a tool for health. It’s also an important pleasure in life, allowing us to connect to others, the present moment and nature.❞
Dr. Rupy Aujla
Dr. Aujla wants to help shift any idea of a separation between health and pleasure, because he believes in food as a positive route to well-being, joy and health. For him, it starts with self-awareness and acceptance of the sensory pleasures of eating and nourishing our bodies, instead of focusing externally on avoiding perceived temptations.
Most importantly:
We can use the pleasure of food as an ally to healthy eating.
Instead of spending our time and energy fighting the urge to eat unhealthy things that may present a “quick fix” to some cravings but aren’t what our body actually wants, needs, Dr. Aujla advises us to pay just a little more attention, to make sure the body’s real needs are met.
His top tips for such are:
- Create an enjoyable relaxing eating environment
To help cultivate positive emotions around food and signal to the nervous system a shift to food-processing time. Try setting the table with nothing else on it beyond what’s relevant to the dinner, putting away distractions, using your favorite plates, tablecloth, etc.
- Take 3 deep abdominal breaths before eating
To help you relax and ground yourself in the present moment, which in turn is to prepare your digestive system to receive and digest food.
- Pay attention to the way you sit
Take some time to sit comfortably with your feet grounded on the floor, not slouching, to give your stomach space to digest the food.
- Appreciate what it took to bring this food to your plate
Who was involved in the growing process and production, the weather and soil it took to grow the food, and where in the world it came from.
- Enjoy the sensations
When you’re cooking, serving, and eating your food, be attentive to color, texture, aroma and even sound. Taste the individual ingredients and seasonings along the way, when safe and convenient to do so.
- Journal
If you like journaling, you can try adding a mindful eating section to that. Ask questions such as: “how did I feel before, during, and after the meal?”
In closing…
Remember that this is a process, not only on an individual level but as a society too.
Oftentimes it’s hard to eat healthily… We can be given to wonder even “what is healthy, after all?”, and we can be limited by what is available, what is affordable, and what we have time to prepare.
But if we make a conscious commitment to make the best choices we reasonably can as we go along, then small changes can soon add up.
Interested in what kind of recipes Dr. Aujla goes for?
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Beyond “Make Your Bed”—life lessons from experience
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Beyond “Make Your Bed”—life lessons from experience
This is Admiral William H. McRaven, a former United States Navy four-star admiral who served as the ninth commander of the United States Special Operations Command.
So, for those of us whose day-to-day lives don’t involve coordinating military operations, what does he have to offer?
Quick note: 10almonds’ mission statement is “to make health and productivity crazy simple”.
We tend to focus on the health side of this, and in the category of productivity, it’s often what most benefits our mental health.
We’re writing less for career-driven technopreneurs in the 25–35 age bracket and more for people with a more holistic view of productivity and “a good life well-lived”.
So today’s main feature is more in that vein!
Start each day with an accomplishment
McRaven famously gave a speech (and wrote a book) that began with the advice, “make your bed”. The idea here doesn’t have to be literal (if you’ll pardon the pun). Indeed, if you’re partnered, then depending on schedules and habits, it could be you can’t (sensibly) make your bed first thing because your partner is still in it. But! What you can do is start the day with an accomplishment—however small. A short exercise routine is a great example!
Success in life requires teamwork
We’re none of us an island (except in the bathtub). The point is… Nobody can do everything alone. Self-sufficiency is an illusion. You can make your own coffee, but could you have made the coffee machine, or even the cup? How about, grown the coffee? Transported it? So don’t be afraid to reach out for (and acknowledge!) help from others. Teamwork really does make the dream work.
It’s what’s inside that counts
It’s a common trap to fall into, getting caught up the outside appearance of success, rather than what actually matters the most. We need to remember this when it comes to our own choices, as well as assessing what others might bring to the table!
A setback is only permanent if you let it be
No, a positive attitude won’t reverse a lifelong degenerative illness, for example. But what we can do, is take life as comes, and press on with the reality, rather than getting caught up in the “should be”.
Use failure to your advantage
Learn. That’s all. Learn, and improve.
Be daring in life
To borrow from another military force, the SAS has the motto “Who dares, wins”. Caution has it place, but if we’ve made reasonable preparations*, sometimes being bold is the best (or only!) way forward.
*Meanwhile the Parachute Regiment, from which come 80% of all SAS soldiers, has the motto “Utrinque paratus”, “prepared on all sides”.
Keep courage close
This is about not backing down when we know what’s right and we know what we need to do. Life can be scary! But if we don’t overcome our fears, they can become self-realizing.
Writer’s note: a good example of this is an advice I sometimes gave during my much more exciting (military) life of some decades ago, and it pertains to getting into a knife-fight (top advice for civilians: don’t).
But, if you’re in one, you need to not be afraid of getting cut.
Because if you’re not afraid of getting cut, you will probably get cut.
But if you are afraid of getting cut, you will definitely get cut.
Hopefully your life doesn’t involve knives outside of the kitchen (mine doesn’t, these days, and I like it), but the lesson applies to other things too.
Sometimes the only way out is through.
Be your best at your worst
Sometimes life is really, really hard. But if we allow those moments to drive us forwards, they’re also a place we can find more strength than we ever knew we had.
Keep on swimming
It’s said that the majority in life is about showing up—and often it is. But you have to keep showing up, day after day. So make what you’re doing sustainable for you, and keep on keeping on.
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Death by Sitting – by Carolyne Thompson
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You may be wondering: is this a lot of words to say “sit down less”?
And the answer is: there’s a lot more in here than that. Of course, yes, “sit down less” is an important take-away, but there’s a lot about the specific problems caused by sitting in chairs, the health risks are that are increased and how, and the early warning signs to watch out for.
After these chapters of woe, most of the book is given over to solutions; about taking standing and walking breaks, tying movement to productivity, why exercise alone is not enough to offset the damage of sitting, relearning ergonomic posture in the context of mitigating the harm, psychological shifts to break the habit of sitting, redefining social norms around sitting and socializing, rewiring one’s body and retraining better movements as well as postures to always immediately move out of if one finds oneself in, and much much more.
The style is light and easy to read, while still including scientific research as appropriate along with practical, actionable advice.
Bottom line: if you’d like to do better for your body than slowly killing it for however many hours a day, then this book has a wealth of advice far beyond the obvious (but important!) “sit less”.
Don’t Forget…
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Does Ginseng Increase Testosterone Levels?
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❓ Q&A With 10almonds Subscribers!
Q: You talked about spearmint as reducing testosterone levels, what about ginseng for increasing them?
A: Hormones are complicated and often it’s not a simple matter of higher or lower levels! It can also be a matter of…
- how your body converts one thing into another
- how your body responds (or not) to something according to how the relevant hormone’s receptors are doing
- …and whether there’s anything else blocking those receptors.
All this to say: spearmint categorically is an anti-androgen, but the mechanism of action remains uncertain.
Panax ginseng, meanwhile, is one of the most well-established mysteries in herbal medicine.
Paradoxically, it seems to improve both male and female hormonal regulation, despite being more commonly associated with the former.
- It doesn’t necessarily increase or decrease testosterone or estrogen levels (but it can, even if indirectly)
- It does improve sexual function
- …and alleviates symptoms associated with conditions as varied as:
- Late-onset hypogonadism (common for men during the andropause)
- Benign prostate hyperplasia (again common for men during the andropause)
- …and also counteracts unwanted side-effects of finasteride. Finasteride is often taken by men as a hair loss remedy or, less often but critically, in the case of an enlarged prostate.
But it also…
- Alleviates symptoms of PCOS (polycystic ovary syndrome, which effects around 20% of women)
- May even be an effective treatment for PCOS (rat model only so far)
- It also may improve female reproductive fertility more generally (the studies are down to fruit flies now though)
Bottom line: Panax ginseng is popularly taken to improve natural hormone function, a task at which it appears to excel.
Scientists are still working out exactly how it does the many things it appears to do.
Progress has been made, and it clearly is science rather than witchcraft, but there are still far more unanswered questions than resolved ones!
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