Hurdity, when I mention clinicians and researchers I’m not referring to self-styled HRT ‘experts’ without medical degrees writing columns in Cosmopolitan etc.
I’m referring, among others, and because I have direct experience of some of them, to medics like Nick Panay and colleagues at Chelsea & Westminster. While the BMS refuse to acknowledge that T does anything other than improve sexual function, Panay et al. unequivocally say (to patients and in public interventions) that it affects cognitive function, musculoskeletal health and mood. Less often mentioned, but established in two studies, is T’s breast protective action. Not to mention the protective role of other androgens such as Dhea, Dht, Dhea-s.
It is irrational, I would even say preposterous, for them to maintain that the depletion of a major sex hormone would affect just one function, when men and women have sex hormone receptors throughout so many of the body’s systems.
I agree with you that evidence-based findings are in principle the way to go, but looking into the machinations of medical research, one soon realises that it is a highly flawed system.
Most studies are small, and/or limited and unbalanced in some way and in the last 10 years or so many findings even of larger studies in medicine and science have been called into question because of the ‘Replication Crisis’ - ie. the virtual impossibility of reproducing the same results of a study in repeated investigations, thereby undermining the robustness of the original results.
At the same time, an enormous and well-funded study such as the WHI one in America that wiped HRT off the menu for years, was a complete travesty.
Even Randomised Control Trials, the so-called gold standard of medical testing, have many pitfalls. And what study doesn’t end with that old chestnut “more research is needed to establish X, Y, Z”…
All this to say that ‘evidence-based’ research is an extremely imperfect enterprise.
More generally, I also find that an organization – the BMS - that claims that “most menopause care is ably provided by primary care teams” diminishes its credibility, given that virtually every day on this forum there is a ‘read it and weep’ post about seriously subpar GP menopause ‘support’ and on here we’re only a tiny fraction of affected women.