The Mayo Clinic Proceedings study (Faubion et al., 2026) is an observational analysis of a large U.S. health database tracking filled prescriptions (≥180 days/year) among women 40+, revealing MHT use falling from 4.4% (2007) to 1.7% (2023), with just 3.5% uptake in the 50-59 peak-benefit group. This observational design lacks randomization and relies on claims data, limiting causal inference on barriers but highlighting persistent trends across racial groups (higher in white women). It builds on the landmark Women's Health Initiative RCT (2002, n>16,000), whose initial harm signals were later nuanced by reanalyses showing net benefits for women under 60, yet triggered regulatory caution that lingers. A 2023 meta-analysis in JAMA (n>100,000 across cohorts) confirms low-dose transdermal options reduce cardiovascular and breast cancer signals versus oral, yet underuse persists. These patterns tie to broader mistrust: post-WHI media amplification, sparse menopause training in residency programs, and regulatory emphasis on rare risks over quality-of-life gains, disproportionately leaving Black and Hispanic women undertreated. Untreated vasomotor symptoms correlate with sleep disruption, mood disorders, and workplace absenteeism, amplifying economic costs. Closing gaps requires targeted clinician education and updated guidelines prioritizing individualized risk assessment over blanket caution.