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Patients ask whether hormones will help them live longer. The honest answer is: it depends what you measure and when you start. Population studies conflict because populations differ. Healthy user bias, age at initiation, and endpoint selection dominate outcomes. I focus on healthy aging: function, strength, cognition, libido, sleep, metabolic resilience. Those matter to patients now. We should resist anti-aging marketing and equally resist therapeutic nihilism. The evidence supports thoughtful use in appropriate candidates with ongoing reassessment. Longevity messaging without monitoring is reckless. Hormone medicine with realistic goals is preventive care.