Hormone Levels and Solutions

• Pamela W. Smith, M.D., MPH, MS is the author and holds the copyright for this information as of 2024.
• The activity has been planned to improve patient care, and is jointly accredited to provide continuing education credits.
• AKH Inc. designates a maximum of 24.0 AMA PRA Category 1 Credit(s) for this activity.
• There is no commercial support for this activity.
• A certificate of completion will be awarded based on attendance but requires an online evaluation.

Objectives

• The level of hormones a woman makes throughout her menstrual cycle will be reviewed.
• Male hormone levels on a daily basis will be explored.
• Understanding dosing for female hormones for PMS, PCOS, PMDD, peri-menopause, and menopause.
• Male hormone dosing will be examined.
• Solutions to common hormonal problems will be reviewed.

Disclosures

• AKH Inc. requires independence, balance, objectivity, scientific rigor, and integrity in all continuing education activities.
• Authors must disclose significant relationships with ineligible companies.
• Conflicts of interest are mitigated by AKH before accreditation.
• AKH planners and reviewers have no relevant financial relationships to disclose.

Women: Twenty-four-hour production rates of sex steroids (mg) during menstrual cycle.

• Progesterone production is 1.0 in the early follicular stage, 4.0 preovulatory, and 25.0 in the midluteal stage.
• 17-hydroxy-progesterone production is 0.5 in the early follicular stage, 4.0 preovulatory, and 4.0 in the midluteal stage.
• Dehydroepi-androsterone production is 7.0 across all stages.
• Androstenedione production is 2.6 in the early follicular stage, 4.7 preovulatory, and 3.4 in the midluteal stage.
• Testosterone production (mcg) is 144.0 in the early follicular stage, 171.0 preovulatory, and 126 in the midluteal stage.
• Estrone production (mcg) is 50.0 in the early follicular stage, 350.0 preovulatory, and 250.0 in the midluteal stage.
• Estradiol production (mcg) is 36.0 in the early follicular stage, 380.0 preovulatory, and 250.0 in the midluteal stage.

Bio-identical Estrogens

• In primary female human estrogens, Estriol (E3) accounts for 34%.
• Estradiol (E2) accounts for 6%.
• Estrone (E1) accounts for 54%.
• The relative "strength" between these includes E2 at 12x E1 and 80x E3 (on endometrial lining).

Conventional Synthetic Therapies

• Conjugated Equine Estrogen (CEE) is not Estrogen Replacement Therapy (ERT) and it's a synthetic drug that does not restore normal estrogen levels.
• CEE and Medroxyprogesterone are not Hormone Replacement Therapy (HRT): this synthetic drug products does not restore normal physiologic levels of endogenous hormones.

Topical Administration Permeability (Scheuplein Units-cm/hr)

• Aldosterone permeability is 3.0 x 10-6.
• Hydrocortisone permeability is 3.0 x 10-6.
• Estriol permeability is 4.0 x 10-5.
• Estradiol permeability is 3.0 x 10-4.
• Testosterone permeability is 4.0 x 10-4.
• Pregnenolone permeability is 1.5 x 10-3.
• Progesterone permeability is 1.5 x 10-3.
• Estrone permeability is 3.6 x 10-3.
• Permeability increases from Aldosterone to Estrone on this list.

Estradiol Route of Administration

• Transdermal estrogen replacement therapy is safer than oral administration.

Converting Administration Routes

• Dosage comparisons are difficult due to multiple influences on relative bio-availabilities.

• Approximate topical: S/L: oral ratio:

• Progesterone, estrogen, DHEA: topical 1: sublingual 2: oral 4-5

• Testosterone: top 1: s/l 2: oral 5-6

• Switching to topical dosing may require higher initial dosing.

• Estrogen: 5-10 days

• Progesterone and testosterone: 3 to 6 weeks

• Lab results may be confusing.

Vaginal Administration: Suggested Dosages in MG/ML

• Usual sig: apply 0.25 ml to vaginal labial mucosa in the AM 6 out of 7 days, so the daily dose is 1/4 of the amount per ml.
• Estriol: 1 to 2.5
• Estradiol: 0.8 to 2
• DHEA: 5 to 30
• Keto DHEA: 10 to 50
• Pregnenolone: 5 to 40
• Progesterone: 20 to 100
• Testosterone: 0.1 to 3

Dosing Guidelines for PMS/PMDD/PCOS

• Progesterone: Oral administration of E4M (SR) capsules.
• 50 mg to 300 mg daily.
• Dosed once daily at bedtime.
• Give cyclically days 14 through 25.
• Progesterone: Topical administration.
• 5 mg to 30 mg daily.
• Applied once daily in the am.
• Give cyclically days 14 through 25.

Dosing Guidelines for Peri-Menopause

• Oral administration E4M (SR) is recommended.
• Progesterone: 50 mg to 300 mg daily.
• Dose once a day at bedtime.
• Give cyclically days 14 through 25.
• Biest Cream for Menstrual Migraines:
• If Progesterone alone doesn’t control symptoms Biest cream 0.01 mg daily can be used, and continue Progesterone as above.

Dosing Guidelines for Post-Menopause

• Biest Cream: 0.25-2,0 mg (80%E3/20%E2) to 1.0 mg 50%E2/50%E3 to be applied in the am.
• Progesterone: 50 mg to 200 mg E4M (SR) one hour before bedtime.
• Testosterone: 0.25 to 2.0 mg cream to be applied in the am.
• DHEA: 2.5 mg to 50 mg E4M (SR) capsule in the am.

Hormonal Holiday: Method #1 when Patient Wants to Cycle

• Use biest cream daily with a little more, or less, for four days during what would mimic the luteal phase.
• Take progesterone days 14-25 (mock cycle).
• Use/take testosterone, DHEA, or pregnenolone every morning depending on what hormone the patient is deficient in.

Hormonal Holiday: Method #2 when Patient Does Not Want to Cycle

• Take all of the hormones Monday through Saturday and off (no hormones) on Sunday.

Hormonal Holiday: Method #3 when Patient Does Not Want to Cycle

• Take all the hormones to mimic days 1-25 and no hormones for four days.
• If the patient is balanced, she will not bleed.

Healthy Male Daily Hormone Production

• Cortisol: 20-30 mgs/day
• Testosterone: 5-6 mgs/day
• Androstenedione: 3 mgs/day
• DHT: 0.300 mgs/day
• Estrone: 0.066 mgs/day
• Estradiol: 0.045 mgs/day
• DHEAS: 50 mgs/day
• DHEA: 15 mgs/day

Male Dosing

• Testosterone: 5 mg to 50 mg transdermal
• DHEA: 5 mg E4M to 100 mg E4M
• Progesterone: 2 mg cream to 20 mg cream
• Pregnenolone: 10 mg to 100 mg E4M
• Chrysin: 2 mg to 25 mg cream
• Testosterone, progesterone, and chrysin can be mixed when needed into the same syringe or pump.

Solutions to Common Problems and Questions

• Problem #1: Breast tenderness can be due to too much estrogen or progesterone. Decrease the dose of either hormone, but make changes one at a time.
• Problem #2: Hot flashes can be due to not enough estrogen or sensitized estrogen receptors. Estrogen levels changing frequently can also be a factor. If hot flashes return after 60 days, the dose of biest may be too high. Adrenal dysfunction can also cause this issue.
• Problem #3: No sexual interest can be caused by low testosterone, low estrogen, adrenal dysfunction, low or high DHEA, or hypothyroidism. Local scream cream treatment may help.
• A scream cream formulation contains Aminophylline 30 mg/ml, Ergoloid mesylate 0.5 mg/ml, Isosorbide dinitrate 3.72 mg/ml, L-arginine 60 mg/ml and Pentoxifyline 50 mg/ml.
• Apply 1 ml of the cream to the clitoris one hour before intercourse as the formulation works to increase blood flow.
• Problem #4: Vaginal dryness can be combatted with compounded estriol 1-2 mg as a cream or suppository.
• Insert nightly for two weeks, then Monday and Thursday for two weeks, and then as needed (PRN).
• Problem #5: Exacerbation of acne can be handled by a gut health test, lowering testosterone levels, treating cortisol dysfunction, changing DHEA to keto DHEA, changing makeup and facial creams, and cleansing the face twice a day.