Which endocrine medication is not recommended systemically due to carcinogenic potential and lack of cardioprotective effect, though vaginal estrogens may be safe?

• A. Desiccated thyroid
• B. Estrogens with or without progestin
• C. Growth hormone
• D. Megestrol

Answer: (B)

Systemic estrogen therapy in older adults is avoided because it does not provide cardioprotective benefits and increases risks of cancer and thromboembolic events. The Beers Criteria flag its systemic use as not recommended in the elderly. In contrast, vaginal estrogens deliver very little estrogen systemically, so they have a much lower risk profile and may be considered safe for local genitourinary symptoms when used at the lowest effective dose. This distinction between systemic and local delivery is why the statement points to estrogen therapy as the one not recommended systemically, with vaginal estrogen being the safer local option.