Friday Q&A: when to stop HRT; vaginal estrogen for UTIs; testosterone for men; & when to get a colonoscopy
TGIF!
ICYMI 👉
Today’s LIVE Q&A is about MANAGING MENTAL & PHYSICAL HEALTH IN TANDEM: a conversation with physician and bestselling author
. Join us HERE TODAY at 5/16 at 3 pm ET!Paid subscribers can submit their questions for me to answer live, right here!
In this week’s reader-submitted Q&A, we’re tackling these questions:
How long should I stay on HRT?
Does vaginal estrogen help prevent UTIs?
Should I consider testosterone therapy?
Do I need to get a colonoscopy?
📣 Send me your questions for future Q&As! Click here to write me. ✍️
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: WHEN TO STOP HRT
I recently started HRT for menopause symptoms and I feel much better. How long is it safe to stay on hormones—and how will I know when (or if) it’s time to stop?
- Jenny
Jenny,
I’m so glad you’re feeling better. Relief is not overrated—and I hear from women all the time that they feel like themselves again once they start HRT. The question of how long to stay on hormones is a good one—and the answer, like most things in medicine, is: it depends.
The old rule of thumb—“lowest dose for the shortest time”—was born out of early concerns about hormone therapy and breast cancer risk, especially after the Women's Health Initiative study in 2002. But we’ve since learned that for healthy women under 60 and within 10 years of menopause, the benefits of HRT often outweigh the risks, particularly when it comes to quality of life, sleep, bone health, mood, and even heart protection.
So how long can you stay on hormones? There’s no universal expiration date. For many women, continuing HRT beyond age 60 is safe, especially if symptoms persist and they’re doing well on treatment. Some of my patients taper off in their early 60s; others continue into their 70s with careful monitoring. It’s a conversation we revisit together each year.
What matters most is:
How you feel: If HRT is helping you sleep, think clearly, move comfortably, and feel more like yourself, that matters.
Your health profile: We keep tabs on things like blood pressure, breast health, and cardiovascular risk over time.
Your preferences: You get to decide what trade-offs make sense for your body and your life.
Stopping HRT doesn’t have to be abrupt or final—you can taper gradually, try a pause, and even restart if needed.
Menopause may be natural, but suffering through it isn’t a virtue. You have options. And it’s okay to keep choosing what helps you feel like yourself!
QUESTION #2: VAGINAL ESTROGEN FOR UTIS
I’ve had a few mild UTIs over the past year. My doctor mentioned vaginal estrogen as a preventive option. Is that really necessary if I’m not having constant infections?
- Megan
Megan, I get this question all the time—because who wants to add a medication if they’re not in constant discomfort? But here’s the thing: recurrent urinary tract infections (even if they’re mild or spaced apart) can be a hallmark of a bigger, often overlooked issue—genitourinary syndrome of menopause (GSM).
GSM is the new umbrella term for the changes that happen to the vulvovaginal and urinary tissues after estrogen levels decline. These changes can lead to symptoms like dryness, irritation, discomfort with sex, urinary urgency, and—you guessed it—more frequent UTIs. And they often show up slowly and subtly, so it’s easy to miss the connection.
The latest guidelines from the American Urological Association emphasize that vaginal estrogen is a first-line, evidence-based treatment for preventing UTIs in postmenopausal women—especially when infections are recurring or tied to GSM-related changes. Unlike systemic HRT, vaginal estrogen stays local and has minimal absorption, making it safe for most women, even long-term. It works by restoring the integrity of the vaginal and urethral tissues, helping your own body defend against infection.
So no, you don’t have to wait until infections are constant or severe to benefit. Many of my patients start vaginal estrogen proactively—and end up preventing that spiral of recurrent discomfort and antibiotics before it really takes hold.
In short: it’s not just about managing symptoms. It’s about protecting the tissues that protect you. And when it comes to aging gracefully and comfortably, prevention is powerful.
QUESTION #3: TESTOSTERONE SUPPLEMENTATION FOR MEN
I’m a 58-year-old overall healthy guy, but my doctor mentioned that my testosterone is “on the low end of normal.” I feel fine, just a little more tired. Should I be considering testosterone therapy—or is that overkill?
- Mark
Mark, this is a classic midlife crossroads—and I hear some version of it almost weekly. Testosterone levels naturally decline as men age, and “low normal” is, well, normal for a lot of guys in their 50s and beyond. The real question isn’t just what’s your number?—it’s how do you feel?
If your symptoms are mild or absent, testosterone therapy may not offer much benefit. But if feel depleted or depressed or if you are losing muscle mass, experience a low libido or difficulty getting an erection, it may be worth a supplementing with topical testosterone.
Testosterone replacement therapy (TRT) can help men with true hypogonadism—that is, low levels and significant symptoms. But starting TRT when you're simply “low-normal” carries trade-offs. It can suppress your body’s own testosterone production over time, and it may require ongoing monitoring for red blood cell counts, prostate health, and cardiovascular risk. It’s not a quick energy fix, as much as it is touted to be!
So, before jumping to medication, I often encourage my patients to consider other factors that may be contributing to low energy:
Are you sleeping well and enough?
Is your alcohol intake creeping up?
Are you getting regular exercise—especially resistance training?
Have your stress levels gone through the roof (hello, modern life)?
All of those can drag energy down and nudge testosterone down, too.
Bottom line: if you’re thriving, there’s no need to chase a “better” number. But if your symptoms shift—or if that fatigue becomes more than background noise—then it’s worth revisiting with your doctor. For now, keep focusing on the boring, powerful basics that support hormone health: sleep, movement, nutrition, and managing stress. Sometimes the best medicine is reminding yourself that feeling a little tired at 58 isn’t a failure—it’s being human.
QUESTION #4: WHEN TO GET A COLONSCOPY
My doctor wants me to get a colonoscopy now that I’m 50. I’ve put it off because I feel healthy and have no symptoms. Is it really necessary if there’s no family history?
- Mitch
Mitch,
I get it. No one is itching to schedule a colonoscopy—especially when you feel fine. But here's the thing: feeling fine is exactly when we should be screening.
Colon cancer is one of the most preventable cancers we have, if we catch it early. The reason we recommend colonoscopies starting at age 45 (and sooner if there’s a family history) isn’t because we expect you to have symptoms. It’s because polyps—the small growths that can turn into cancer over time—don’t usually cause symptoms at all. They just quietly grow. And if we find them early, we can remove them before they ever have a chance to cause harm.
It’s not just about family history, either. The majority of people who get colon cancer have no family history. That’s why population-wide screening matters.
I sometimes think of screening like brushing your teeth—you don’t wait for a cavity to start brushing. You do it to keep trouble from starting in the first place.
If you’re nervous about the prep, know that it's improved a lot in recent years. And there are other less-invasive screening tools like stool DNA tests (e.g. Cologuard), though colonoscopy remains the gold standard because it allows for diagnosis and treatment in the same procedure.
So yes, Mitch—it really is necessary, even when you're feeling great. That’s when you have the most power to prevent problems down the road. Consider this one uncomfortable day a gift to your future self!
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
ICYMI, check out my recent Q&As on:
I’ve been using estradiol cream for about 15 years. I started using it mainly to continue my sex life. I’m 65 now. I use lubricants but I honestly don’t know how women continue sex without it.
Thanks for the first question about how long to continue HRT. I’m getting the idea that there’s a faction of doctors who learned in medical school that you shouldn’t use it after a particular age, and that if you still have symptoms, you ought to use other, more expensive medications to treat them. Marty Makary explains in his book Blind Spots, that simply continuing HRT seems to solve the problems of the symptoms we have , plus lots of other things that could go wrong. My new, very young gynecologist seems to want me to stop HRT, but charitably suggested getting a second opinion, which luckily, I’ll be able to do before I see him again.