💊 Is Hormone Therapy “Cheating”?
This is a question I get every so often that always makes me think, “Is it?” Spoiler: I don’t think it is, but I understand where the question is coming from, especially when it comes to age group competition.
Age categories exist in sports like running, triathlon, Hyrox, etc., to make competition fairer and more motivating across different life stages. Though training, nutrition, and recovery knowledge are keeping folks highly competitive longer, most of us hit our cardiorespiratory and musculoskeletal peaks somewhere in our 20s to 30s, and, after 40, start experiencing some level of decline.
The underlying assumption baked into the question “is hormone therapy cheating” is that perimenopause and menopause factor into that decline, and, if that’s the case, hormone therapy taps the brakes and keeps you ahead of the curve.
You can make a case for that on paper, but to call it “cheating” is a stretch. If you look at the research broadly (and to be clear there isn’t much on performance specifically), hormone therapy doesn’t stop aging or turn back the clock, but some research suggests it can slow the rate of decline in certain areas. It can also make training feel more sustainable by improving sleep, overall well being, and recovery.
Here’s what research shows, recognizing that research blends formulations, doses, routes, populations, and training protocols, so drawing universal conclusions is always challenging.
❤️ For aerobic capacity: Some older observational research finds that estrogen therapy is linked to increased exercise capacity. But a more recent review article concludes that hormone therapy isn’t required for exercise‑induced gains in vascular function and fitness, and results are mixed on whether adding menopause hormone therapy (MHT) to training boosts exercise capacity in
postmenopausal women. Some studies show MHT plus exercise improves vascular measures, but others find it doesn’t change cardiorespiratory fitness.
💪 For muscle and strength: Some research, like this older randomized controlled trial, have found that women using hormone therapy experienced greater improvements in muscle performance, mass, and composition after a year long training program than those training on a placebo. Similarly, papers like this one make a case for hormone therapy being able to offset age-related loss of muscle
mass and function. Research like this suggests that estrogen therapy can also increase muscle mass in response to training. But then you have meta-analyses like this showing no real benefit of hormone therapy with muscle mass. The research on connective tissues is somewhat mixed. Obviously, if hormone therapy helps with overall muscle and joint pain, that’s a plus. And it’s well-known
that it helps prevent osteoporosis.
😵💫 Symptoms: Obviously if you have raging hot flashes and night sweats, can’t sleep, or think straight and hormone therapy has made you feel human again, that’s going to help your training and performance.
Is any of that “cheating”? It may give some women advantages in their age group relative to women not on hormone therapy, but we’d need those studies to say for sure. Importantly, governing bodies don’t think so. No current sport‑governing body treats standard clinically prescribed hormone therapy for menopause as doping; instead, they regulate exogenous anabolic steroids and testosterone more tightly.
Which brings us to testosterone. Menopause hormone therapy is still technically considered estrogen and/or progesterone. Testosterone is rapidly growing in popularity to the point where some women assume it’s part of the MHT mix. It’s not, and it is a banned substance in most sports and therapeutic use exemptions (TUEs) are not easy to come by. Whether or not physiological doses of testosterone should be banned for menopausal women? That’ll be a newsletter for another day.
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