Webinar Recording: Physiologic Dosing of Females & Laboratory Findings
Presented by Paul Savage, MD, FAARM, ABAARM
Listen to/watch the recording below and download the slides by clicking here!
- Physiologic dosing of female hormones with regards to menopause/perimenopause.
- Correcting misinformation about laboratory testing in regards to treatment modality.
- Definitions of evidence-based clinical algorithms for female BHT.
- Q&A (below the video)
Webinar Recorded: February 22, 2016
QUESTION: Which testing is most accurate for females and males if they are not on hormones?
ANSWER: They are all the most accurate, but it’s all a matter of reference. It doesn’t matter what you’re measuring, all that matters is that the measurement is reproducible. The key is understanding how hormones change with the month, day and time. In our offices, we always have patients prepare themselves for testing the same way each time: Fasting for 10 hours with water only and taking all meds and supplements the night before, but nothing the morning of. Then, they do their blood test within two hours of waking. We always have them do the first tube of saliva or collect urine within one hour of getting up. Then they can take the rest of their hormones during the rest of the day. We know where they are NOT on hormones, and now we want to know where the patient is ON hormones.
QUESTION: If you are giving a biest 50/50, would you give 1 mg biest to give the .5 mg estradiol?
ANSWER: Yes, that is correct! If you’re trying to get the total amount of estradiol .5 and you want it to be in a 1:1 mixture, then you would add .5 of estriol, when makes your total biest 1 mg.
QUESTION: Do you suggest giving a hormone holiday, especially for progesterone, such as one day weekly?
ANSWER: From 20 years of clinical experience, it makes a lot of sense to give hormone holidays. Especially if we are trying to give a woman her period, a hormone holiday is required, because it’s that drop-off of progesterone (and to some degree the estrogen) that brings on the period. More importantly, the philosophy of Integrative Medicine and the philosophy of health is a cyclic nature; things are always changing from day-to-day, hour-to-hour, month-to-month. The cells need that variability in order to maintain a proper receptor balance. Giving a hormone holiday allows the cells to “miss” the hormone and up-regulate receptors. It also gives the body a chance to detoxify a little bit more.
It comes back to the truth that if you give someone a holiday from hormones and they feel no symptoms, they have probably been overdosed for some time. Conversely, if you’re giving them the right amount of hormones and they go a couple days off and then start to feel the lack of them, then you probably have them at the right dose (if they were asymptomatic beforehand).
I see a lot of advantages of giving hormone holidays. What’s the right method? If you’re looking to give someone a hormone holiday, it’s for days in a row and now just one day a week. I can’t say that’s not useful, but what we typically do in our office is have women take it for four weeks and then take a couple of days off towards the end of the month and then restart it again (unless we’re cycling them). In which case, there is a certain amount for the first two weeks, a certain amount for the next two weeks, then a couple days off.
QUESTION: Do you ever treat women with testosterone and iodoral to allow for conversion of T to E2, in other words, give no exogenous E2?
ANSWER: A lack of iodine does inhibit women from converting testosterone to estradiol. But, it’s much more than that. There are many things that affect the aromatase inhibitor and decrease its ability to work. Not enough zinc, too much stress, too much insulin or inflammation, not enough vitamin D; there are a lot of things that slow the conversion of testosterone to estradiol. Plus genetically there are SNPs with aromatase that some women are fast converters and some are not converters at all.
After 20 years’ of experience, I find it really interesting that you can give some women estradiol and they don’t do well. It’s not that they need to detox, yet that may be the case—that they need to get their detoxification pathways open—but some women just don’t do well on estradiol, even after detox pathways are cleared up.
So the answer is yes, I have treated someone with testosterone and iodoral, but I don’t do it to assist the conversion of testosterone to estradiol. I have never looked at it in that way, but lack of iodine would inhibit that conversion. So in other words, give no exogenous E2, and the answer is that there are a number of women that I only give testosterone, and that’s all they get, and they do fantastic with it. We could check their estrogen levels and they respond wonderfully. Their FSH and LH comes down, and more importantly, they feel great. But when you start to give them the estrogen, they don’t do well.
QUESTION: As a follow-up to the hormone holiday question, how long should they do hormones then take a break? Three weeks on and one week off, or a couple days off?
ANSWER: Typically, if we’re not cycling a woman, we do four weeks on and a couple of days holiday at the end of the month. Some women don’t do well with a break, and sometimes those women need more hormones during those four weeks so they can manage that break more often. Other women feel better when they’re not taking the hormones. In that case, dial it down. It’s really not a set number, and clients will need to help figure it out. Very commonly, we will give a woman various topical creams, suggesting a certain number of clicks per dose, and encourage her to figure out what works best for her in relating the symptoms that progesterone will resolve, including estrogen dominance. Once she feels better and finds balance, we retest her to see where the levels are. Some ladies who take a couple days off don’t feel good doing so. In that case, we don’t have them continue taking days off. Otherwise, if we could get them to take 3-4 days off, it’s arbitrary number that isn’t based on literature, but it’s essentially what we try to accomplish.
QUESTION: How would you modify the dose for vaginal application?
ANSWER: The dose is the same as topical and there is no modification. We just let women dose to their effects.
QUESTION: How long after starting hormones do you retest?
ANSWER: A lot of it has to do with how soon a woman becomes more comfortable and has less symptoms. With that said, we usually try to get women to retest about six weeks into the treatment. Now, they may not stabilize completely at that time, but for the 20% that struggle, we need that testing to get them back in the office for an assessment. It’s usually within the first couple of weeks that women struggle, but we like to check numbers and answer questions about nutrition, detoxification, etc., at six weeks.
About the Presenter:
Paul Savage, MD, FAARM, ABAARM, founded Power2Practice in 2011 and currently serves as the Chairman of the Board as well as the Chief Medical Officer. He graduated from the University of Michigan Medical School in Emergency Medicine and later earned his board certification in Integrative Medicine at George Washington University. He is currently enrolled in the Fellowship for Stem Cell Therapy through A4M and the University of South Florida.
Since 2004, he has practiced Integrative Medicine exclusively and is considered by many as one of the world’s foremost authorities in the area of Integrative Metabolic Medicine (IMM), including bioidentical hormone therapy.
Dr. Savage is the President of Chicago Integrative Care, his practice in Chicago. He continues to lecture worldwide and frequently provides expert insights on integrative medicine to major news media.
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