Balancing HRT Perceptions with Research

Welcome to Storyful Rx, a monthly dispatch delivering the latest developments and trends emerging in the pharma and healthcare industries that reveal how people are approaching health and medicine today. ? Subscribe here ? By Storyful Intelligence Lead Strategist Ria Knapp .

What's Happening:?The global hormone replacement therapy (HRT) market—valued at $22 billion—has faced shortages amid increasing demand in recent years. Nearly half of postmenopausal women in the U.S. use some form of HRT, while England’s HRT prescriptions have doubled since 2020. This growth comes as new research has debunked safety concerns. Medical review boards are now citing HRT as a first-line menopause treatment and major pharmaceutical companies—including Bayer, Novo Nordisk, Eli Lilly, Merck, and Pfizer—are expanding into more global markets.?

Why It Matters: As interest in HRT rises for menopause and gender-affirming care, so too do questions and misconceptions about who it is for, what it treats, and whether it is safe. Monitoring social media conversation and political trends can help HRT makers shape public narratives, broaden audience reach, and anticipate how policy changes may impact distribution and demand.

Storyful Intelligence analyzed the 17.1k most-engaged mentions of HRT across social media, from January 21, 2024 - January 21, 2025. Read on for insights into the evolving discourse.

Knowledge Gaps Across HRT Audiences

Above: Analysis of the 17.1k most-engaged posts on HRT from X, Reddit, and digital media?from January 21, 2024 - January 21, 2025.?

Storyful analysis found that HRT drove more than 183k mentions across digital and social media in the past year. More than half of those discussions involved either menopause (25.1%) or gender transition care (25.2%).?

• High Awareness: Popular subreddits like r/menopause (123k members) and r/asktransgender (344k members) drove more than 25% of Reddit’s HRT mentions. Menopause-related discourse spotlighted the conflicting advice women face when managing symptoms, ranging from pelvic floor physiotherapists (1.6k upvotes, 684 comments) promoting the safety of vaginal estrogen to accounts of gynecologists calling HRT dangerous (1.5k upvotes, 586 comments). Conversations around gender-affirming HRT also reflected mixed opinions, with some downplaying risks (1.8k upvotes, 126 comments) and others seeking advice to distinguish real risks from rumors (951 upvotes, 229 comments).
• Low Awareness: While HRT is a treatment for various hormone-related conditions, social media discussions rarely mentioned (3.5% of posts) its use for hypothyroidism, growth hormone deficiency, hypogonadism, osteoporosis prevention, and post-operative care after ovary or testicle removal. A thread on starting growth hormones saw just seven upvotes and 17 comments, while male hypogonadism accounted for only 0.1% of HRT mentions in the past year.

The Storyful Take: Despite high engagement on menopause and gender-affirming HRT, medical consensus is lacking when it comes to usage, safety, and side effects. There is also little public awareness of HRT’s role in treating other hormone-related conditions. To dispel misconceptions and expand audience reach, drug makers could develop targeted campaigns that highlight more HRT applications and work with medical experts to promote evidence-based HRT benefits.

Broader HRT Discourse Overshadows Specific Medications

Above: Breakdown of the 3.5k most-engaged mentions of HRT Complements and Alternatives across X, Reddit, and digital media from January 21, 2024 - January 21, 2025.

While HRT encompasses a range of medications, social and media discussions focused more on personal experiences, emerging research, and hormones themselves rather than specific drug names.

• Debunking Misconceptions: Following new research disproving past concerns, several high-traction media posts and public figures including Oprah (74k likes) worked to clarify current findings (369 likes, 225 shares). Medical advice posts (32.4k views) on menopause emphasized individual factors—such as age, family history, and treatment duration—in mitigating known risks. Social conversations on HRT research (6.8% of mentions) had the highest positive sentiment (57% as compared to a 41% positivity baseline across all HRT discussions).?
• Focus on Hormone Types Over Drug Names: While 3.5% of discourse mentioned HRT delivery methods (patches, gels, implants, and pills), only 1.8% referenced specific medications like Pfizer’s Premarin and Merck’s Finasteride. Instead, discourse centered on the hormones themselves—estrogen (6.4% of posts), testosterone (4.7%), and progesterone (2.6%).?
• HRT Complements and Alternatives: Conversations about other approaches to hormone balance and deficiencies accounted for 15% of HRT-related conversations. The majority (66%) centered on talk therapy, with many suggesting therapy alone (86 upvotes) isn’t enough to mitigate menopause symptoms. While many framed diet and lifestyle changes as complementary to HRT (1.5k likes), others promoted treatments, like supplements, as alternatives (193 likes, 150 comments). Topics included “seed cycling,” mindfulness practices, and medicinal herbs like ashwagandha.

The Storyful Take: While media outlets are debunking HRT myths and expanding public understanding of treatment options, social discussions show little focus on specific drug names, concentrating more on hormone types and alternative approaches instead. HRT makers have an opportunity to contribute to conversations around HRT research, but also to socialize drug names behind emergent efficacy and safety studies.

Political Shifts Fuel HRT Access Concerns

Above: Volume-over-time analysis of the 17.1k most-engaged posts on HRT from X, Reddit, and digital media from January 21, 2024 - January 21, 2025.

The lead-up to the U.S. presidential election, election results, and speculation around Project 2025 fueled spikes in HRT-related discussions across social platforms. Many questioned how a Trump presidency might impact HRT access (302 upvotes, 127 comments).

• Federal Speculation: HRT mentions spiked in November 2024, shortly after President Trump’s victory, surpassing 3k mentions. While fears of federal funding cuts primarily appeared in gender-affirming care discussions, menopause-related HRT users also expressed concerns about losing treatment access (1.5k upvotes, 478 comments).?
• State-Level Bans: Local policy changes also sparked social media discussion. Indiana’s February 2024 ban on gender-affirming care (1.3k upvotes, 205 comments) and Kansas lawmakers’ narrow May 2024 vote to uphold Gov. Laura Kelly’s veto of a ban on gender-affirming care for transgender youth (14k likes) illustrate how state policies remain volatile for everyone.
• HRT User Reactions: Policy shifts impacting HRT access have driven some users to ration supplies or seek alternative sources. One thread (2k upvotes, 148 comments) described “DIY” HRT as the only option for many transgender people without local access. Another r/trans discussion addressed splitting HRT pills to extend supply amid concerns about executive bans (1.6k upvotes, 247 comments). Meanwhile, users on r/menopause discussed stockpiling hormones (346 upvotes, 240 comments), despite no confirmed changes to women’s health HRT access.?

The Storyful Take: Federal and state policies are fueling concern and uncertainty in the HRT market. As users respond to potential restrictions, many are finding ways to secure HRT independently. With HRT-related policies in flux, HRT makers can step up to support patients by creating tools and advice around navigating access changes.

What’s Next

While HRT use is becoming more normalized, uncertainty around the treatment will continue to impact the market. For HRT makers navigating this landscape, Storyful recommends:

• Expand Audience Awareness: Offer HRT education campaigns beyond menopause and gender-affirming care. Discuss other HRT-related conditions and monitor social discourse to track audience reach and emerging concerns.
• Address Knowledge Gaps and Public Perception: Leverage thought leadership and digital media to counter misconceptions. Partner with medical societies, influencers, and digital platforms to amplify science-backed information about specific HRT drugs and highlight success stories, clinical advancements, and safety updates.
• Mitigate Political Uncertainty: Monitor policy developments and advocate for regulations that align with the medical community's standards and latest research. Where regulation allows, establish direct-to-consumer communication channels to address fears about access.?

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