The Tamsen Show

Episode Title: 7 Leading Doctors Reveal The Truth About Hormone Therapy
Host: Tamsen Fadal
Date: November 26, 2025

Episode Overview

This episode delivers an in-depth, myth-busting exploration of hormone therapy for women, especially around perimenopause, menopause, and midlife health. Emmy-winning journalist and host Tamsen Fadal convenes a diverse panel of renowned doctors—including OB/GYNs, a cardiologist, a neuroscientist, an endocrinologist, and an orthopedic surgeon—to answer the most pressing and confusing questions about hormone therapy (HT/MHT/HRT). The experts clarify what hormone therapy really is, its safety profile, impacts on different aspects of women’s health (brain, heart, bones, body composition), and debunk lasting fears rooted in misunderstood research. With practical advice, lived experiences, and scientific evidence, the episode aims to empower women to make informed health decisions without stigma or unnecessary fear.

Key Discussion Points and Insights

1. What Is Hormone Therapy? (04:12 – 06:53)

• Dr. Sharon Malone (OB/GYN) explains that “hormone replacement therapy,” “menopausal hormone therapy,” and “hormone therapy” are different labels for giving back lower doses of hormones (estrogen, and if needed, progestin) that the body stops making at menopause.
• HT is prescribed to address classical menopause symptoms: hot flashes, night sweats, mood swings, brain fog, sleep disruption, and more.
• She points out a major misconception: “Women are afraid of menopausal hormone therapy who've been on birth control pills for 20 years. And I just look at them and I’m like, girl, you’ve been on estrogen and progestin since you were 25...and you're going to be taking far less of it in menopause.” (Dr. Sharon Malone, 06:19)
• The MHT dose is often a third or quarter of what’s found in birth control pills.

2. The 2002 Women's Health Initiative Study and the Roots of Fear (07:46 – 16:12)

• Tamsen shares her initial fears: “My mom had breast cancer and somewhere along the line, I absorbed this idea that hormones were dangerous... Estrogen equals breast cancer. That was all I knew.” (Tamsen, 00:54)
• Dr. Malone recounts the release of the 2002 Women's Health Initiative (WHI) study, which fundamentally altered public and medical opinion, conflating HRT with increased breast cancer risk and overshadowing other risks like heart disease.
• The WHI’s significant flaws:
  • Designed as a prevention study for heart disease, but included women with an average age of 63—far older than typical HT patients.
  • Results for older women were erroneously applied to younger women.
  • Only one medication, at one dose, was studied—ignoring nuance around drugs, dosing, timing.
  • “The increase in the risk of breast cancer did not reach the level of statistical significance that you could even call that a positive finding.” (Dr. Sharon Malone, 15:30)
• Fallout was dramatic: HT use plummeted from 38% of eligible women to under 6%, and that level has persisted.
• The misconception that estrogen is synonymous with breast cancer risk persists, even though cardiovascular disease remains the leading cause of death for women.

Notable Quote:
“It cemented this idea that doctors had been doing something really to the detriment of women’s health...And women abandoned hormone therapy in droves.”
– Dr. Sharon Malone, 10:36

3. Impacts of Menopause and Hormone Therapy on the Brain (18:10 – 20:26)

• Dr. Lisa Moscone (Neuroscientist, Weill Cornell) summarizes robust findings that starting estrogen within 10 years of menopause is linked to a significant reduction in Alzheimer’s risk—32% in women without a uterus (estrogen-only), and a lesser, trending-reduction (23%) for women with a uterus (estrogen-plus-progestin).
• “For women who are using only estrogens and they take it at the right time... there is a significant risk reduction for Alzheimer's disease.” (Dr. Lisa Moscone, 19:02)
• The so-called ‘window of opportunity’—the decade after menopause—is critical; starting HT later appears neutral, rather than beneficial, for dementia prevention.

4. Heart Health and Hormone Therapy (22:02 – 24:46)

• Dr. Jane Morgan (Cardiologist) discusses:
  • The evidence is evolving, but HT started near menopause may halt progression of heart disease; it likely does not reverse existing plaque, but could help prevent worsening.
  • New thinking suggests the '60/10 Year Rule' (no HT if past age 60 or 10 years post-menopause) shouldn't be absolute. Instead, consideration should be individualized, weighing medical history and health status.
  • “All 60-year-olds are not equal. All people who are 10 years post-menopause are not equal. And so the answer is, maybe have the conversation, but it’s no longer no.” (Dr. Jane Morgan, 24:25)

Memorable Moment:
Tamsen relates an anecdote: “Who here is afraid of heart disease? One or two hands went up. Then he asked, who is afraid of breast cancer? Every single hand in the room shot up...Heart disease is the number one killer of women. I want you to remember that.”
(Tamsen, 24:46)

5. Bone Health, Longevity, and Hormone Therapy (25:48 – 29:45)

• Dr. Vonda Wright (Orthopedic Surgeon, Longevity Expert):
  • Estrogen is critical for bone health. “The data are so clear that estrogen can be used to prevent osteoporosis and bone death in women. It’s FDA approved for that. And yet it's never talked about.” (Dr. Vonda Wright, 26:39)
  • 70% of all hip fractures occur in women; after a hip fracture, risk of death and institutionalization skyrockets.
  • Bone loss is preventable and begins early; “I beseech people to build better bone while we still have hormones on board.”
  • Peak bone mass is reached by age 30. Early bone screening and awareness are vital.

6. Visceral Fat, Body Composition, and Hormone Therapy (29:45 – 31:09)

• Dr. Rocio Salis Whelan (Endocrinologist, Obesity Medicine):
  • Estrogen decline in perimenopause increases visceral fat and reduces muscle mass.
  • “Hormone replacement therapy will help rechange body composition. We never promote estrogen as a weight loss hormone, but it will help change, recompensate your body again.” (Dr. Rocio Salis Whelan, 30:43)
  • HT aims to reduce visceral fat and preserve muscle, improving metabolic health even though it’s not a weight loss tool per se.

7. Testosterone and Women’s Health (31:51 – 35:02)

• Dr. Kelly Casperson (Urologist, Sexual Health Expert):
  • Testosterone is not just a “male” hormone; it is actually the dominant sex hormone in women and essential for numerous body functions, including libido and brain health.
  • “Testosterone is actually women’s dominant sex hormone. It is wrong when people say estrogen is our main hormone. Our main hormone is testosterone.” (Dr. Kelly Casperson, 33:12)
  • All sex/steroid hormones are made from cholesterol—progesterone leads to testosterone, which leads to estrogen.
  • Many clinicians and patients are unaware of the close interplay of these hormones.

8. Who Can and Cannot Take Hormone Therapy? (38:09 – 43:20)

• Dr. Sharon Malone reviews FDA-approved indications and true contraindications:
  • Indications: Vasomotor symptoms, genitourinary syndrome of menopause, osteoporosis prevention, and early/premature menopause.
  • Absolute contraindications: Personal history of breast or estrogen-dependent cancer, personal history of heart attack or stroke, liver disease (for oral formulations), undiagnosed vaginal bleeding, and personal history of blood clots.
  • Many commonly cited reasons for denying HT (e.g., family history of breast cancer, treated hypertension, migraines) are not valid per current evidence.
  • Delivery method matters: Transdermal estrogen has lower clot risk than oral.
  • Mortality is not increased for women on HT, even in WHI; estrogen-only users had decreased incidence and mortality from breast cancer.
  • “For the women who took estrogen only in the Women’s Health Initiative… not only had a 23% decrease in the incidence of breast cancer, but they had a 40% decrease in the risk of dying if they took estrogen than if they did not.” (Dr. Sharon Malone, 43:07)

9. Vaginal Estrogen: A Neglected Solution (43:20 – 45:50)

• Dr. Corrine Min (OB/GYN, Menopause Specialist, Breast Cancer Survivor):
  • Low-dose vaginal estrogens (or DHEA) are highly effective for local symptoms (dryness, painful sex, UTIs), are well-tolerated, and are not significantly systemically absorbed.
  • New AUI guidelines confirm safety for most women, including estrogen receptor–positive breast cancer survivors.
  • Lubricants and moisturizers help, but do not treat the underlying tissue changes—only hormones can do that.
  • “Even breast cancer survivors, even ER-positive breast cancer survivors, women who are on estrogen blockers or lowering estrogen, can safely use vaginal hormones. And it's really important.” (Dr. Corrine Min, 44:24)

Notable Quotes & Memorable Moments

• Tamsen Fadal (00:54):
  “Estrogen equals breast cancer. That was all I knew. But when my own symptoms hit and I started digging for real answers, I realized I didn’t actually know what hormone therapy was. I only knew the fear. And once I learned that most of that fear came from one misunderstood study in 2002...everything changed.”

• Dr. Sharon Malone (10:36):
  “It cemented this idea that doctors had been doing something really to the detriment of women’s health...And women abandoned hormone therapy in droves.”

• Dr. Lisa Moscone (19:02, 19:54):
  “These women have on average 32% reduced risk of Alzheimer’s disease and dementia in old age relative to those who don’t take hormones... For the other type of formulation...there’s still a 23% reduction in Alzheimer’s risk...However, a trend level...”

• Dr. Jane Morgan (24:25):
  “All 60-year-olds are not equal. All people who are 10 years post-menopause are not equal. And so the answer is, maybe have the conversation, but it’s no longer no.”

• Dr. Vonda Wright (28:35):
  “I repeatedly beseech people to build better bone while we still have hormones on board. Because the number one way to get control of bone health is to have estrogen on board.”

• Dr. Kelly Casperson (33:12):
  “Testosterone is actually women’s dominant sex hormone. It is wrong when people say estrogen is our main hormone. Our main hormone is testosterone.”

• Dr. Corrine Min (44:24):
  “Even breast cancer survivors, even ER-positive breast cancer survivors, women who are on estrogen blockers or lowering estrogen, can safely use vaginal hormones. And it’s really important.”

Timestamps for Important Segments

• What is hormone therapy? – 04:12 – 06:53
• The 2002 WHI Study and Fear of Estrogen – 07:46 – 16:12
• Menopause, Hormones, and the Brain (Alzheimer’s) – 18:10 – 20:26
• Heart Disease, the “Window” for Therapy – 22:02 – 24:46
• Bone Loss and Estrogen – 25:48 – 29:45
• Belly Fat, Body Composition, and HT – 29:45 – 31:09
• Testosterone’s Role in Women – 31:51 – 35:02
• Eligibility and Safety for Hormone Therapy – 38:09 – 43:20
• Vaginal Estrogen for Local Symptoms – 43:20 – 45:50

Final Thoughts & Resources

• Tamsen emphasizes: "You do not have to suffer. You do not have to wait until your symptoms are unbearable. There is no medal for powering through." (Tamsen, 02:40)
• The episode directs listeners to practical tools like the Menopause Map (symptoms, options, doctor questions) and Tamsen’s new book, How to Menopause, for a comprehensive resource.
• All references, time codes, and resources mentioned are linked in the show notes for easy navigation.

Summary Tone and Takeaway

The tone is conversational, candid, myth-busting, and supportive—matching Tamsen’s mission of women’s health empowerment. Each expert breaks down complex, emotionally charged topics into actionable insights, aiming to replace fear with facts and guide women in reclaiming their midlife health. Women are encouraged to ask questions, seek individualized care, and challenge outdated medical dogma.

“You’re not supposed to navigate this stage by yourself. We can break down the things that no one ever taught us.”
— Tamsen Fadal (46:18)

For more details, chapter breakdowns, and links to referenced guides and experts, see the show notes.