Ground Truths
Jennifer Gunter & Eric Topol - Discuss Women’s Health and Recent Changes by FDA for MHT
28 Nov 2025
A couple of weeks ago, the FDA Commissioner published a WSJ oped “The FDA Liberates Women’s Hormone Replacement Therapy” (←gift link) and, with other FDA colleagues, a JAMA essay entitled “Updated Labeling for Menopausal Hormone Therapy” (open-access). That change, and the data cited, led to a series of articles in the days that followed, such as at STAT News “FDA reverses decades-old warning on hormone therapy products for menopause. Agency says the treatments o!fer heart, brain, and bone health benefits” and at the Washington Post “The FDA finally corrects its error on menopause hormone therapy. Women have been needlessly scared away from effective treatments.” If you read through these links, you’ll be confused. Does MHT have proven cognitive benefits? What about a study from 1991 that showed ~50% reduction of fatal heart events with MHT? Or the 35% decreased risk of Alzheimer’s disease? Or the breast cancer increased risk attributed to medroxyprogesterone acetate?I turned to my go-to gynecologist truth teller, Dr. Jen Gunter, to get her review of the evidence. This is a complex topic, with old data from the 2002 Women’s Heath Initiative (WHI), new reports since, population level analysis, changes in preparations of MHT including local delivery, and much more.Here is our conversation which isn’t just about MHT but includes “Big Wellness” marketing direct to middle aged women, the new FDA approved drug for hot flashes, the $14 million cut of the NIH’s Office of Women’s Health , marked increase in philanthropic support of women’s health research, the Surgeon General nominee, ovarian failure, and a lightning round on proven benefits of MHT.Here’s a brief clip on her views of the women’s health “wellness” predatorsWe also discussed the reasons for Dr. Gunter’s planned move next year back to Canada after practicing gynecology for 3 decades in the United States. I referred to a recent GT I wrote about the WHI and the potential favorable impact of MHT on the immune system, as suggested by new data on organ clocks. That finding, which has been replicated, may be linked to healthy aging, extending healthspan.****************************Thanks to the 190,000 Ground Truths subscribers from every US state and 210 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile.If you found this interesting PLEASE share it!Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support 47 summer interns in 2025! We aim to accept even more of the several thousand who will apply for summer 2026.Thank you Debbie Weil, Cynthia Brumfield, Sara Garcia, Harshi Peiris, Ph.D., Liane Moccia, and many others for tuning into my live video with Dr. Jen Gunter! Join me for my next live video in the app. Get full access to Ground Truths at erictopol.substack.com/subscribe
Full Episode
So let me introduce the person who I have just a real pleasure, privilege to interview today. I have a conversation with Dr. Jen Gunter. She is a gynecologist, OB-GYN in Kaiser, Northern California. And she's been in the US for a few decades. She has two New York Times bestselling books. That's a big accomplishment on top of her career. She has a blog. Vagenda, which is phenomenal on Substance.
And she's out there as one of the great truth tellers in medicine, in particular, and this topic. She's been my go-to source for years. So welcome, Jen.
Thank you. Thank you so much for having me.
Oh, this is really a delight. And so I thought we'd start because just two weeks ago was a big day in the world of MHT. Uh, and this was when there was a wall street journal editorial by Marty McCary, the FDA commissioner, and also simultaneously a JAMA paper, um,
And so I just was gonna start by reading, obviously it was a big deal to have the black box from 2003 taken away, but there were a couple of statements I wanted to get your reaction to. The first was in the liberation editorial that Marty wrote. He said, in my professional opinion,
The demonization of hormone replacement therapy for perimenopausal women and the undercreation of its health benefits ranks among the greatest mistakes of modern medicine. And then the other one in JAMA, which is kind of in the same category,
With the exception of antibiotics and vaccines, there may be no medication in the modern world that can improve the health outcomes of older women on a population level more than hormone therapy. What did you think about that?
Well, I would say that Marty McCary is an incredible cherry picker and really displays a lack of breadth of knowledge of women's health care in general, or I would say even like health care in general. Because, you know, if the data were that clear, if it was that thing, you know...
Why do all the professional societies who have people who do the research and who have combed through everything and disclosed their biases, why do they have different conclusions? And so I think that, yeah, I mean, that was just propaganda.
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