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Background: Hormone replacement therapy (HRT) for post-menopausal women is associated with increased incidence of ischemic stroke risk. Effects of HRT on stroke related deficits and functional outcomes in acute ischemic stroke (AIS) are uncertain. We retrospectively examined female consult data for HRT use and National Institutes of Health Stroke Score (NIHSS) at baseline and recovery for 2015 and 2016 in a large stroke telemedicine program.Hypothesis: The age of women on HRT will affect stroke severity and outcomes.Methods: We analyzed consult data from two consecutive years for women HRT use, age, and baseline and 24 hour NIHSS’s. We included all treated with IV Activase.Results: In two years 235 women received Activase therapy. Women without HRT use numbered 208 and 27 women listed HRT use. All 235 consults regardless of HRT use had significantly improved 24 h NIHSS vs. baseline (7.5 +/- 0.5 vs. 11.2 +/- 0.5, p<0.0001). Women on HRT had significantly improved 24 h NIHSS vs. baseline, (4.9 +/- 1.6 vs. 8.4 +/- 1.2, p=0.0084). Composite NIHSS’s at 24 h for ‘No HRT’ was not different from ‘Yes HRT’ (7.8 +/- 0.6 vs. 4.9 +/- 1.6, p=0.084) when groups included all women regardless of age. The baseline NIHSS’s when divided into specific age ranges showed decreased values when on HRT from 50s through 70s (figure A) p=0.028. Women placed in decade age ranges showed that 24 h NIHSS’s (40-80 years) with HRT use were lower vs. women >80 years (figure B). p=0.084.Conclusion: While controversy persists on the use, route and dosage of HRT for risks of ischemic stroke, positive HRT benefits could include moderation of AIS deficits and improved outcomes in women <80 years of age. Further study is needed.