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Health topic hub · Clinically reviewed

Hormone therapies, from menopause to cancer care, contraception to bone health.

A whole family of medicines that replace, block or modulate hormones. This hub explains where each fits, who prescribes it and the risks worth talking through.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, MHRA, BMS, EAU, NICE breast and prostate cancer guidance, and specialist society standards.

  • 03

    Current for 2026

    Reflects modern UK guidance on HRT, endocrine oncology, GAHT, GLP-1 therapies and bone-active agents.

Key facts

Hormone therapies at a glance.

The essentials, in plain English, what these medicines do, where they fit, and how UK teams prescribe them.

  • What it is

    A broad family of medicines that replace, block, mimic or modulate hormones to treat disease or restore normal physiology.

  • Common uses

    Menopause, hypogonadism, breast and prostate cancer, contraception, gender-affirming care, thyroid disease, diabetes and bone health.

  • Delivery routes

    Tablets, transdermal patches and gels, intramuscular injections, subcutaneous implants, intrauterine systems and infusions.

  • Principles

    Lowest effective dose, clearest indication, shared decision, individualised risk-benefit and planned review.

  • Key risks

    VTE, breast cancer, cardiovascular events, mood change, bone loss and metabolic effects vary by therapy and route.

  • Who prescribes

    GPs, gynaecologists, endocrinologists, oncologists, urologists and gender specialists work as an MDT depending on indication.

Why this guide matters

One family of medicines, many indications.

From HRT and contraception to endocrine cancer therapy, GAHT and GLP-1 metabolic care, the principles are the same. Three ideas shape the rest of this page.

  • Clear indication first

    Symptoms alone are not enough. A named diagnosis, baseline bloods and a considered plan protect against under and over-treatment.

  • Route often changes the risk

    Transdermal versus oral oestrogen, agonist versus antagonist, injection versus tablet. The route can move the risk profile as much as the molecule.

  • Every course deserves a review

    A written review schedule, an exit plan and a route back if things change. Hormonal medicine is a conversation, not a prescription.

How a hormone therapy is chosen

From first question to a settled plan.

The steps a UK GP or specialist will follow before, during and after prescribing so you know what to expect and why.

  1. 01

    Assessing

    Confirm the indication

    A clear diagnosis first, symptoms alone are not enough. Menopause, hypogonadism, cancer, hypothyroidism or bone loss each has its own criteria.

  2. 02

    Assessing

    Baseline history and risk

    Personal and family history of VTE, breast cancer, cardiovascular disease, migraine with aura, mood and metabolic factors shape the choice.

  3. 03

    Assessing

    Targeted investigations

    Hormone panels, tumour biology, DEXA, lipids, glucose or thyroid function depending on the therapy under consideration.

  4. 04

    Choosing

    Shared decision conversation

    Benefits, risks, alternatives and what doing nothing looks like. A written summary and time to reflect where possible.

  5. 05

    Choosing

    Route and regimen

    Oral versus transdermal, cyclical versus continuous, agonist versus antagonist. Route often changes the risk profile.

  6. 06

    Reviewing

    Start and safety-net

    Clear instructions on what to expect, what to report early and how to reach the team out of hours.

  7. 07

    Reviewing

    Structured review

    A first review at three months and at least annually thereafter, with bloods, symptoms and risk reassessment.

Typical pathway: first question to settled plan in a few weeks, sooner in cancer and endocrine emergencies.

Therapy families

The main families at a glance.

Eight overlapping groups, each with its own indications, monitoring and MDT. Details, doses and combinations are on the pages linked below.

  • Menopausal HRT

    Oestrogen plus a progestogen if the uterus is present, with testosterone considered for persistent low sexual desire.

  • Testosterone replacement

    For confirmed hypogonadism in men, delivered by gel, injection or long-acting implant with monitoring.

  • Endocrine breast cancer therapy

    Tamoxifen, aromatase inhibitors, GnRH agonists, fulvestrant and CDK4/6 inhibitors used across the disease course.

  • Prostate cancer hormone therapy

    GnRH agonists and antagonists, AR-targeted agents and abiraterone control androgen-driven disease.

  • Contraceptive hormones

    Combined pill, progestogen-only options, implants, injections, LNG-IUS and emergency contraception.

  • Gender-affirming hormones (GAHT)

    Feminising or masculinising regimens prescribed by specialist commissioned gender identity services in the UK.

  • Thyroid and steroid replacement

    Levothyroxine, liothyronine, hydrocortisone and prednisolone replace deficient hormones or dampen inflammation.

  • Metabolic and bone-active agents

    Insulin, GLP-1 and dual GIP/GLP-1 agonists, denosumab, teriparatide and romosozumab modulate downstream hormone effects.

Therapies

How each family is used in the UK.

A quick tour across HRT, endocrine cancer therapy, contraception, GAHT, thyroid and steroid replacement, growth hormone, fertility hormones, diabetes and bone-active agents.

  • HRT for menopause

    Oestrogen plus progestogen where a uterus is present, tibolone as an alternative, testosterone for HSDD and local vaginal oestrogen for genitourinary symptoms.

  • Testosterone replacement

    Testosterone gel, intramuscular esters or long-acting implants for symptomatic biochemically confirmed hypogonadism, with haematocrit and PSA monitoring.

  • Breast cancer endocrine therapy

    Tamoxifen, aromatase inhibitors (anastrozole, letrozole, exemestane), GnRH agonists for ovarian suppression, fulvestrant and CDK4/6 inhibitors in advanced disease.

  • Prostate cancer hormone therapy

    GnRH agonists (leuprolide, goserelin, triptorelin), antagonists (degarelix, relugolix), AR-targeted agents (enzalutamide, apalutamide, darolutamide) and abiraterone.

  • Contraceptive options

    Combined oral pill, progestogen-only pill, implant, injection, LNG-IUS (Mirena) and emergency contraception, matched to age, comorbidity and preference.

  • Gender-affirming hormones

    Feminising oestradiol with antiandrogen or masculinising testosterone, prescribed by specialist commissioned gender identity services in the UK.

  • Thyroid and corticosteroids

    Levothyroxine (with liothyronine in selected cases) for hypothyroidism, hydrocortisone for adrenal insufficiency and prednisolone for inflammatory disease.

  • Growth hormone replacement

    Somatropin for confirmed adult or paediatric growth hormone deficiency, initiated and monitored by specialist endocrinology.

  • Fertility hormones

    Clomifene, letrozole and gonadotrophins for ovulation induction, delivered through a fertility service with cycle monitoring.

  • Diabetes and weight-loss hormones

    Insulin for type 1 and advanced type 2 diabetes, plus GLP-1 and dual GIP/GLP-1 agonists for type 2 diabetes and obesity where criteria are met.

  • Osteoporosis bone-active agents

    Denosumab, teriparatide and romosozumab for high fracture risk where oral bisphosphonates are unsuitable or insufficient.

  • Shared decision and review

    Every hormone therapy needs a documented review schedule, an exit plan and a route back if symptoms return or risks change.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Menopause: identification and management (NG23).

  • British Menopause Society. Consensus statements on HRT, testosterone and transdermal therapy.

  • NICE. Early and locally advanced breast cancer (NG101) and advanced breast cancer (CG81).

  • NICE. Prostate cancer: diagnosis and management (NG131).

  • MHRA. HRT and breast cancer risk, VTE risk with combined hormonal contraception, and yellow-card guidance.

  • FSRH. UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).

  • NHS England. Service specifications for adult and young persons gender dysphoria services.

  • Society for Endocrinology. UK guidance on adrenal insufficiency, hypogonadism and adult growth hormone deficiency.

  • British Thyroid Association. Guidance on levothyroxine and liothyronine prescribing.

  • NICE. Osteoporosis (NG issued through TAs on denosumab, teriparatide and romosozumab).

Red flags

When to seek urgent help.

Most hormone therapies are safe. These are the situations that need same-day review, a two-week-wait referral or an emergency call.

  • New or worsening breast lump

    Any new lump, nipple change or bloody discharge in someone on HRT or endocrine therapy needs urgent breast clinic review.

  • Suspected venous thromboembolism

    Unilateral leg swelling, calf pain, chest pain or breathlessness needs same-day assessment. Oral oestrogen carries higher VTE risk than transdermal.

  • Chest pain or focal neurology

    Suspected myocardial infarction or stroke warrants a 999 call. Migraine with aura is a contraindication to combined hormonal contraception.

  • Adrenal crisis on steroids

    Vomiting, hypotension or drowsiness in someone on hydrocortisone needs emergency parenteral steroid and hospital admission.

  • Severe hypoglycaemia on insulin

    Confusion, seizures or loss of consciousness needs urgent glucose and safety review of the insulin regimen.

  • Suspected pregnancy on teratogens

    Isotretinoin, tamoxifen, aromatase inhibitors and CDK4/6 inhibitors are teratogenic. Any suspected exposure needs specialist input.

  • Low mood or suicidal thoughts

    Hormonal changes can affect mood. New or worsening depression or suicidal thoughts need urgent GP or crisis support.

  • Unusual vaginal bleeding on HRT

    Bleeding beyond the first few months of a continuous combined regimen, or any postmenopausal bleeding, needs a two-week-wait gynaecology referral.

  • Rapid PSA or symptom change on ADT

    A rising PSA, new bone pain or urinary symptoms on prostate cancer hormone therapy warrants urgent oncology review.

Living with it

A long conversation, not a single prescription.

Four habits make the biggest difference across every hormone therapy, from HRT and contraception to endocrine oncology and GAHT.

A quiet reminder

Individualisation beats a one-size-fits-all script.

What works for one person, at one stage of life, is not the answer for everyone. Reviews exist for a reason.

  1. 01 Purpose

    Know why you take it

    Understanding the indication makes it easier to weigh benefits against risks and stay with the plan when doubts appear.

  2. 02 Routine

    Build it into your day

    A patch on a Monday, a tablet with breakfast, an injection every twelve weeks. Small anchors keep long courses on track.

  3. 03 Review

    Never assume it is forever

    Every hormone therapy deserves at least an annual review. Doses, routes and even the indication can change over time.

  4. 04 Signals

    Learn your red flags

    Know the two or three symptoms that should trigger a call, and the fastest route back to your team.

Frequently asked

Everything we get asked about hormone therapies.

Quick answers on HRT, endocrine cancer therapy, GAHT and GLP-1 medicines.

  • What counts as a hormone therapy?

    Any medicine that replaces, blocks, mimics or modulates a hormone signal. That includes HRT, testosterone, endocrine therapy for breast and prostate cancer, contraceptives, gender-affirming hormones, thyroid hormone, steroids, growth hormone, fertility hormones, insulin and newer GLP-1 based therapies for diabetes and obesity.

  • Is HRT safe?

    For most healthy women under 60 or within ten years of menopause, HRT offers meaningful symptom benefit with acceptable risk. Transdermal oestrogen has a lower VTE risk than oral. Micronised progesterone and dydrogesterone have a lower breast cancer signal than older progestogens. The right regimen depends on your history and preferences.

  • How is prostate cancer hormone therapy different from menopause HRT?

    They work in opposite directions. Menopause HRT replaces oestrogen and progestogen. Prostate cancer hormone therapy lowers testosterone to slow androgen-driven cancer growth, using GnRH agonists, GnRH antagonists, AR-targeted agents like enzalutamide, apalutamide and darolutamide, or abiraterone.

  • What monitoring does endocrine breast cancer therapy need?

    Regular clinical review, bone density on aromatase inhibitors, endometrial vigilance on tamoxifen, and lipid, glucose and cardiac checks on CDK4/6 inhibitors. Your oncology team will personalise the schedule to the drug and the stage.

  • How is gender-affirming hormone therapy accessed in the UK?

    Through NHS specialist commissioned gender identity services, historically including the Tavistock and now delivered through a network of NHS regional adult and young person clinics. Private services follow the same clinical standards and communicate with the GP for shared care.

  • Do GLP-1 medicines count as hormone therapy?

    Yes. GLP-1 agonists like semaglutide and dual GIP/GLP-1 agonists like tirzepatide mimic gut hormones to improve glycaemic control and support weight loss. They belong within a wider hormonal and metabolic strategy, prescribed against agreed criteria with structured review.

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