Thyroid UK
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HRT when hypothyroid

I would like to start HRT due to concerns about the possibility of developing osteoporosis in the future. However, I am feeling the best I have done for many years and have just taken a full time contract after having to work part time for a couple of years because of fatigue. This will also be the first time seeing a new doctor (my old doctor who was reasonably knowledgeable has just retired).

I am very nervous about taking anything that will have a negative effect on my thyroid. Does anyone have any links to articles or some advice on the way forward?

5 Replies


A transdermal HRT patch is unlikely to affect Levothyroxine absorption. If you take oral HRT take it at least 4 hours away from Levothyroxine and it should be fine.



As you previously suffered from heavy bleeding and have fibroids, I would say it is imperative to have private comprehensive sex hormone testing before medicating HRT. HRT is helpful in preventing osteoporosis but so is optimal thyroid hormone and you may find you don't need further sex hormones but a more balanced thyroid.

If you medicate HRT the thing to watch for is a protein called thyroid binding globulin (TBG). Ask your GP to test it as the oestrogen in HRT can cause the liver to produce high levels which can bind the thyroid hormone, decreasing the amount that can be assimilated into and utilized by the cells.

This will lead to a low level of active thyroid hormone and all of the negative side effects of hypothyroidism. Many people require a levothyroxine dose increase when medicating HRT.

Beware that it take many many months after starting Levothyroxine for the body to recover after long term undiagnosed hypothyroidism.

Also for many, thyroid hormone replacement will only work well with optimal iron and nutrients. Adopting a g/f diet may help reduce elevated thyroid antibodies that can impair good thyroid hormone synthesis.

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Thank you for the replies. I have very recently adopted a gluten free diet, I am taking steps to improve my gut health and also take vitamin D. I will look into sex hormone testing. The whole thing seems to be incredibly complex - I am so grateful this board exists.

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I take HRT, & use a brand called Angelique, that was recommended by my friend's sister who is a gynaecologist. It's supposedly the safest on the market.

It reduces the effect of my THs if I take it too close, & also seems to work less well close to D3, so I make try to take them at least 6 hours apart.

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I am not an expert by any means, however, I have to take thyroid meds for hypothyroidism, and also, since I was "castrated" about 20 years ago, I also take sublingual bio-identical hormones. From all I have researched, bhrt helps thyroid, and thyroid meds help sex hormones. The more one is "off" then the other may be more "off" as well. Myself, since I need help in both areas, I would not forgo getting supplementation for the other. Check into it. In my idea, it just may be the extra boost you might need to make things so much better.

Good luck!


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