A Reader Asks: Is 73 Too Late?

Written by: Meredith Paci | Functional Health Coach

A reader sent this through the Ask Fortify form a couple of weeks ago:

"My friend is 73. She seems to be in the same place I was when I first met with you. She thinks she is too old for the kind of treatment I am getting. Is she? My tribe of women are in their late 60s and early 70s and seem to believe it is too late. I think they are wrong. Am I?"

My short answer: you are right!  Age by itself does not close the door on strength training or hormone therapy.

Age is one part of the conversation, and it is rarely the part that decides where a woman starts. Her timeline (for example, how long she has gone without hormonal support), her training history, how she moves today, and her overall health shape that far more. Two 73 year old women who have never lifted a weight can start in completely different places.

Below I go through strength training and hormone therapy, what the research shows for women in their 60s and 70s, and where it still has gaps.

Strength training: no age cutoff

Muscle and bone both respond to load, meaning the weight or force a muscle works against. When you ask a muscle to handle more than it is used to, the body builds more muscle tissue. The strain on bone signals the cells that build bone to lay down more of it. This keeps working at 65, 75, and beyond. In one small 1990 study, frail nursing home residents with an average age of 90 more than doubled their strength in eight weeks of training.

My own client roster runs from about age 20 to 70. Among the women in their 60s, I have clients who out lift many women in their 30s.

One trial I came across while researching this piece is worth knowing about. LIFTMOR (2018) took 101 postmenopausal women with low bone density, average age 65, and randomly assigned them to either supervised heavy lifting or a light home exercise program for eight months. The lifting group trained twice a week for 30 minutes, doing 5 sets of 5 reps at more than 85 percent of their one rep max (close to the heaviest weight they could lift a single time).

Bone density, measured with a DEXA scan, is how much mineral is packed into your bone. The lifting group gained bone density at the spine and held steady at the hip, while the light exercise group lost bone at both. The lifting group also improved on every function test, with one minor injury reported. Two limits: the women were screened and closely supervised, and they were younger on average than 73.

For years, older women and women with low bone density (hell women at any age) were steered toward light weights out of fear of injury. LIFTMOR was designed because that approach had not shown much effect on bone. Bone and muscle adapt to the load you give them, so the weight has to be heavy enough to challenge you.

My opinion: something can be, with context, better than nothing when you are starting out, and when life is incredibly full. There is a place for days where you show up and check the box. I believe in that, and this past year I have leaned on it more often than I would like. That will only carry you so far. Three or five pound weights, a routine with no plan behind it, or a routine that only happens when it fits around everything else will not give your body a reason to build strength and bone. With strength training, you get out what you put in, and what you put in has to increase or change over time. That is called progressive overload.

Hormone therapy: no age cutoff

Hormone therapy replaces hormones the ovaries make less steadily during perimenopause and stop making in menopause: estrogen, progesterone, and testosterone. Systemic therapy reaches the whole body and comes as pills, patches, gels, creams, and injections. Vaginal therapy works locally, with very little reaching the bloodstream.

When people ask whether a woman is too old for hormones, two questions usually get blended together.

1. Can a woman stay on hormone therapy past 65? Yes. The Menopause Society's 2022 position statement says hormone therapy does not need to be stopped routinely at 60 or 65. There is no age at which a woman is cut off.

A 2024 study of Medicare records from 10 million women over 65 found that women who stayed on estrogen alone had about a 19 percent lower rate of death from any cause than women who never used it or stopped, along with lower rates of several cancers and heart attack. Results looked best with low doses, with routes other than pills, and with estradiol. This was an observational study. It shows what happened to women who stayed on therapy and cannot prove the hormones caused those results, since those women may also have had better health or better access to care.

2. Can a woman start hormone therapy beyond 65 (ie: at 73) ? Yes. In November 2025 the FDA removed the boxed warning about heart disease, breast cancer, and dementia from hormone therapy labels. The label still recommends starting systemic therapy before 60 or within 10 years of menopause, because most of the reassuring data come from younger women. Why? because a woman has then had LESS time without. 

Smaller trials in women who started later are encouraging on markers. In the ELITE trial (2016), oral estradiol started 10 or more years after menopause neither slowed nor sped up plaque buildup in the neck arteries compared with placebo...that is positive especially with all the "fear" regarding hormone therapy, estradiol and specifically oral estradiol. In a 2003 trial of women over 65, a low dose of oral estradiol raised bone density at the hip and spine over three years.. What is missing: no large trial has followed women who start in their 70s and counted heart attacks, strokes, fractures, or dementia.

Testosterone. Testosterone declines with age in women too, and I believe it belongs in this conversation. In the US, no testosterone product is FDA approved for women. That does not mean "can't have it" nor "can't prescribe it". Many people get that confused. Because of this it is prescribed "off label" or compounded.

Just a note here to reduce the fear around "off-label": Off-label prescribing is more common than it sounds. If you have ever been prescribed spironolactone for hormonal acne, metformin for PCOS, trazodone for sleep, or gabapentin for nerve pain or hot flashes, you were prescribed a medication off label. Each one is FDA approved for something else: spironolactone for blood pressure and heart failure, metformin for type 2 diabetes, trazodone for depression, and gabapentin for seizures and nerve pain after shingles. Providers commonly prescribe all four for these other uses.

Going back to testosterone: A 2019 global consensus statement from the major menopause and endocrine societies found strong evidence for using testosterone for low sexual desire that causes distress in postmenopausal women. That said, respectfully, testosterone is important for way more than sexual desire. 

Where my opinion comes in. I believe age alone should never be the reason a woman is told no. For a woman who has gone many years without hormonal support, I may lean toward patches, creams, or oral options, depending on the woman. No single form suits everyone; a patch, for example, can be a poor fit for an athlete who sweats heavily. The form and dose are a decision for her and her prescribing provider, based on her own history.

In my client work, I have seen bone density, strength and muscle mass, blood sugar, lipids, and thyroid markers improve after women start hormone therapy. It tends to be a domino effect. These clients had also built the rest of their health habits: lifting regularly with progressive overload, eating well with attention to micronutrients, and treating a drink as the exception. So I cannot credit the hormones alone.

A word on vaginal and urinary health

I have written on this before and will continue to do so. For now, one point. As estrogen falls, vaginal and urinary tissue thins, which leads to dryness, painful sex, and repeat urinary tract infections (UTIs). In older women, a UTI can spread to the kidneys and bloodstream, a serious condition called urosepsis. Vaginal estrogen is the guideline recommendation for postmenopausal women with recurrent UTIs, and it can be used at any age. Vaginal DHEA is another option. This covers comfort and pleasure as well as infection risk, and a woman in her 70s deserves both addressed. Fun fact, women in their 20's on birth control are listening to the perimenopause and menopause education because they are also asking for vaginal support! Ladies on birth control.... just saying. 

Where I land

Well supported:

• Strength training that progressively challenges you builds strength and function at every age that has been studied, into the 90s.
• In postmenopausal women with low bone density, supervised heavy lifting improved bone density compared with light exercise, without the injuries people feared.
• Hormone therapy has no routine stopping age.
• Vaginal estrogen (cream and/or insert) is recommended for women and can be used at any age.

Still open:

• Whether starting systemic hormone therapy in the 70s "lowers" rates of heart attack, stroke, fracture, or dementia. The current evidence is bone density, artery markers, and observational records.

My opinion: your friends are not too old. If you told me they were in their 80s or 90s, I would still say they are not too old for some form of support and at the very least a freakin' conversation. They may need a different starting point than you did, and so might a neighbor who is younger than you or the same age. 

Where your friends can start

None of this applies the same way to every woman, so treat these as starting points to bring to a provider and a coach.

• A DEXA scan to see where her bone density stands.
• A women's health exam that includes a breast, vaginal and vulvar exam.
• Blood work, including:
  • ApoB, a count of the particles that can carry cholesterol into artery walls.
  • Lp(a), a cholesterol carrying particle set largely by genetics. One measurement is usually enough.
  • CBC, CMP, FULL thyroid panel, Iron Panel, Lipid Panel, a1c, fasted insulin, hs-crp, ESR, LH, FSH, ovarian hormones, etc...

One question that fits any of these appointments: "Given my history, what would you consider for me, and is my age the reason you are ruling anything out?" If age is the only reason given for a no, it is reasonable to get a second opinion from a provider trained in menopause care.

Have a question?

This piece started with a reader question. If you have one, send it through the Ask Fortify anonymous form [linked here]. If you or someone you love wants to map out a starting point, a 1:1 strategy session is where we do that [inquire here].

Disclaimer: I am not a licensed medical provider. This  is for education only and is not medical advice. Talk with a qualified provider before starting, stopping, or changing any medication or hormone therapy.