NATURAL human-identical HORMONES. Dosage Directions. HRT (Hormone Replacement Therapy) The importance of hormonal balance!

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1 NATURAL human-identical HORMONES Dosage Directions for HRT (Hormone Replacement Therapy) Universally valid empirical data and bibliographic references For each patient an individual dosage needs to be carefully established! The importance of hormonal balance! A hormonal imbalance can lead to frequent problems such as premenstrual syndrome (PMS), menopause problems, infertility, miscarriages, osteoporosis, breast cancer, heart diseases, fibrosis, endometriosis, menstrual problems/dysmenorrhea, moodiness or cysts of the ovaries. It is the purpose of HRT to bring a disturbed hormone balance back to normal, i.e. all hormonal deficiencies should be balanced. The level of each single hormone should be brought back to physiological juvenile hormone levels. Hormone replacement prevents an ongoing process of hormone deficiency. A real endocrine insufficiency causes irreversible damages. Thus HRT offers protection against health problems during the different stages of life, increases the quality of life, and may even lead to an extended life span. All hormones need to be tested before giving HRT. This is the key to the success of the therapy. Hormones have synergistic effects; balanced hormone levels mean among other things that individual hormone dosages may be reduced. Throughout the entire life span, Hormone Replacement Therapy should only be given after regular hormone checks; possible necessary changes are required in a different hormone situation. Individual Hormone Replacement Therapy An individual HRT should be carried out only when observing the following criteria: Improvement of nutrition and digestion Improvement of living habits and care for healthy environment Complete physical check-up with lab tests Adjustment of patient to optimal juvenile hormone levels Query patient with regard to subjective symptoms Watch for disappearance of hormone deficiency symptoms Watch for symptoms of hormone surplus (to be avoided under all circumstances) 1

2 Average Daily Dosage in case of MRT (multiple replacement therapy) Human Growth Hormone 0,05 0,75 IE (Injection in upper thigh or pelvis) Thyroid hormone (= Armour 1,5 grain (1,5 3 grain) = µg T4 + 13,5-27µg Thyroid) T3) or 100µg T4 + 20µg T3 (=Novothyral) Melatonin 1,25mg (0,5-10mg) encapsulated in oil Progesterone mg encapsulated in oil, oral intake before going to bed Or 4-16mg transdermal in the morning and before going to bed Hydrocortisone (only when patients 15mg (-30mg) encapsulated in oil, in the morning show a real deficiency) 10mg (-20mg) encapsulated in oil, at noon 5 mg (-10 mg) encapsulated in oil, in the late afternoon 2-3 x higher dose in case of stress or in case of a flu that lasts longer than 1-3 days (max. 7 days) DHEA Women: 5-20mg encapsulated in oil / daily orally (alternative in postmenopause: 25mg Proviron or 8-14mg testosterone transdermal as liposomal cream) Men: 20-45mg encapsulated in oil / daily orally Alpha-Fluorohydrocortisone 100µg / daily Testosterone (men) 0,5 3g liposomal cream (50mg /g = 5%) Or mg Mesterolone Or mg Testosteroneundecanoate Or mg injection every days Estradiol (women) 1,5-5g liposomal cream or liposomal gel (0,6mg/g = 0,06%) Symptoms of women in case of spontaneous onset of menopause. (DW. Stucker, Clinical Symptoms of estrogen deficiency in Estrogen Deficiency: causes & consequences, 1996, Ed. RW Staw, The Parthenon Publishing Group, New York, USA) NATURAL ESTROGENES micronized Nomenclature: 1. Estron is normally referred to as E1 2. Estradiol is normally referrd to as E2 3. Estriol is normally referred to as E3 2

3 Actions compared: Estradiol is the most potent form of Estrogen with strongest action; it is the primary estrogen produced in the ovaries. Estron has only a poor action because of its low binding affinity. The importance of Estron is due to the fact that it functions as a metabolite and precursor of Estradiol. The conversion of Estradiol takes place in the stomach and in the liver. Estriol is a weak Estrogen that is synthesized from Estron. Its weak action is due to the short half-live period of Estriol. Although Estriol seems to be the weakest Estrogen it appears to have the strongest effect on vagina, uterus and the bladder. Due to this fact the following indications apply: - Dryness of vagina - Prolapse of the uterus - Lack of muscle tonus in bladder In this case it is best to use an Estriol vaginal cream or gel (non-alcoholic) with 0,6mg Estriol per g = 0,06%. Dosage: For one week every night before going to bed apply directly in the vagina 1 g, later 1 3 times per week. Action compared 0,05 E2 patch = 1 mg E2 orally = mg conjugated Esstrogen = 2.5 mg Triest Compared action of Presomen: Presomen Estradiol (E2) micronized Tri-Estrogen micronized 0,3 mg 0,5 mg 0,625 mg 1,0 mg 2,5 mg 0,9 mg 1,5 mg 1,25 mg 2,0 mg 5,0 mg Triest (Triple Estrogen) E1, E2, E3 micronized Triest = Estrose (E1) 10% - Estradiol (E2) 10% - Estriol (E3) 80% Dosage: previous experience has shown that 4 times the quantity of conjugated Estrogen is necessary Encapsulated in oil 1,25 2,5 mg Triest 2 x daily 3

4 Cream 1,25 2,5 mg Triest 2 x daily e.g. 0,25%: 1 g = 2,5 mg Liposomal Gel 2,5 5,0 mg Triest 1 x daily e.g.0,5%: 1 g = 5,0 mg Northrup, Dr. Christine 1994, Women s Bodies, Women s Wisdom, New York: Bantam Books, page 475 Gaby, Dr. Alan 1994, Preventing and Reversing Osteoporosis, Rocklin: Prima, page 136 Jonathan Wright MD recommends the following dosage: Triest = Estrone (E1) 10% - Estradiol (E2) 10% - Estriol (E3) 80% Dr. Wright has successfully treated more than 200 women with this dosage which comes closest to the natural hormone profile of women. Biest (Bi-Estrogen) E2, E3 without E1 (Estron) micronized Biest = Estradiol (E2) 20% (E3) 80% Dosage: same as Triest (in combination with e.g. 100 mg Progesterone capsules 2 x daily) Estriol E3 micronized Dosage: Encapsulated in oil (orally) mg Estriol 2 x daily Liposomal cream 1 3 % 1 g daily Vaginal gel (non-alcoholic) 0,06 % 1 g daily According to Dr. Gaby 2 4 mg Estriol correspond to 0,6 1,25 mg conjugated Estrogen Gaby, Dr, Alan 1994, Preventing and Reversing Osteoporosis, Rocklin: Prima, page 132 Vaginal cream (0,05%) 0,5 mg/g Estriol 1 g cream daily before going to bed for a period of 1-2 weeks Later 1-2 times per week Northrup, Dr. Christine 1994, Women s Bodies, Women s Wisdom, New York: Bantam Books, page 450 Raz, Rauland Stamm, Walter 1993, A Controlled Trial of Intravaginal Estriol in Postmenopausal Women with Recurrent Urinary Tract Infections, N Engl. J. of Med., 329 (11); pages Estradiol E2 Dosage: encapsulated in oil (orally) 1 mg Estradiol 1 x daily (0,35 0,5 mg 2 x daily) Lippincott 1990, Drug Facts and Comparisons, St. Louis: Facts and Comparisons Division (Estrogen Section), Hargrove J. et al Menopausal Hormone Replacement Therapy with Continuous Daily Oral micronized Estradiol and Progesterone. OB/GYN 73(4): pages Liposomal gel 1,5 3 mg/g (0,15-0,3%) 1-2 g liposomal cream 1-2 x per day 4

5 Whitehead MI, Townsend PT, Kitchin Y., et al. Plasma steroid and protein hormone profiles in postmenopausal women following topical administration of estradiol 17ß. In: Mauvais-Jarvis P., et al., eds. Percutaneous Absorption of Steroids. New York, Academic Press, 1980:231. Dosage: a normal initial dosage would be 0,5mg Estradiol 2 x daily a) The estrogen that is suspended in oil may be administered in a capsule either as a single substance or together with 100 mg natural progesterone. b) Women who have not substituted hormones for several years should start with a dosage of 0,25mg Estradiol/50mg Progesterone 2 x daily. This dosage may be increased slowly until the symptoms disappear or until the breast starts to become sensitive. c) When using Estrogen (10% Estradiol, 10% Estron and 80% Estriol) the standard dosage would be E2 0,25mg, E1 0,25 mg, E3 2 mg with 100mg Progesterone 2 x daily either separately or together in one capsule) 5

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7 Estrogenes for men: This is an interesting aspect. However, so far only a few studies are known which do not yet justify the use of estrogens. NATURAL PROGESTERONE Progesterone levels decline long before Estrogen levels decline. Precursor effects of Progesterone which is synthesized from corticosteroids in the adrenal glands, may also be low, especially in the case of a stressful menopause. A low level of Progesterone increases insulin resistance and lowers thyroid function. Optimal bioavailability is achieved when taken orally. A prerequisite are the quality of Progesterone and a professional production of the capsules; only then it is possible to achieve hormone levels that can be accurately measured, controlled and predicted. There are only two exceptions when progesterone should not be taken orally: 1. In case of malabsorption. 2. In case of systemic Candida infections. After oral intake of Progesterone joint troubles or nausea can appear within 48 to 72 hours. Should these troubles appear without established Candida infection, this may indicate such an infection. Yeast does feed on hormones; yeast especially lowers Progesterone levels (Dr. Constantini, University Heidelberg). Alternative: administer progesterone as cream. Dosage: encapsulated in oil (orally) 100 mg Progesterone 2 x daily Hargrove J. et al Menopausal Hormone Replacement Therapy with Continuous Daily Oral Micronized Estradiol and Progesterone. OB/GYN 73(4): pages mg Progesterone daily for a period of 12 days Northrup, Dr., Christine 1994, women s Bodies, Women s Wisdom. New York: Bantam Books, page 475 in combination with Estradiol (E2) or conjugated Estrogenes 100 mg Progesterone 1 x 2 x daily 7

8 in combination with Triest or Estriol mg Progesterone 2 x daily Liposomal cream/gel 1 x per day the entire daily dose of capsules Liposomal cream/gel 3% - 5% - 10% Progesterone suppositories: 100 mg 200 mg Progesterone protects the skin: According to recent researches, Progesterone inhibits a violent activity of biochemical modulators, thus preventing breakdown of body tissue which results in an increased aging of the skin. 1. P M S Progesterone would be the medication of choice. However, a prerequisite would be that all other hormone systems have been checked and work together in harmony. Symptoms: a) moodiness b) water retention c) fibromes and cysts grow larger when stress levels increase d) short menstrual cycles Therapy: Start use of Progesterone at the time of ovulation - some women can feel their ovulation - often discharge of mucus - body temperature rises (temperature should be taken before getting up in the morning, if possible, always at the same time) Progesterone needs to be taken until all symptoms have disappeared, if necessary, also during the entire menstrual period. Should the symptoms disappear at the beginning of the menstrual period, then the use of Progesterone may also be terminated. Dosage: 100 mg Progesterone encapsulated in oil 4 x to 8 x daily The average daily dosage consists of 400mg: 100 mg each in the morning, at noon, in the evening and before going to bed. Without hesitance, the dosage may be increased to 800mg per day. A singular dose of 200mg may lead to fatigue; therefore it is recommended to take several doses of 100mg spread over the day; before going to bed a dose of 200mg may be used without problems. 2. Infertility 8

9 A low level of Progesterone and thyroid problems are main causes for infertility. It is suspected that up to 40% of the population suffer of hypothyroidism. Pollution, malnutrition and a high amount of stress may be the reason for a reduced production of Progesterone. A disorder of the luteal phase leads to a decreased amount of Progesterone in the second half of the menstrual cycle. In the case of cycles without ovulation there is no need of Progesterone. Dosage: mg daily - Begin of intake at the time of ovulation - A dose of 400mg per day should result in blood levels of approx. 25ng/ml. If necessary, a dose of up to 800mg per day may be taken without hesitance. 3. Menstrual Cycle: Ideal case: Take daily dosage of Estradiol early in the morning until the 15 th day of month Take daily dosage of Progesterone in the evening until the 25 th day of month A combination of hormones is preferred for reasons of compliance; half dosage of each should be taken morning and night. For purposes of an increased build-up of mucus in the uterus during the pause of the menstrual cycle, 1/3 of the dose of Estrogen may be used. Should no ovulation be desired, Estradiol and Progesterone are used up to the 25 th day of the menstrual cycle. A combination of Progesterone and E3 is recommended after hysterectomy. NATURAL TESTOSTERONE Testosterone for Women Dosage: encapsulated in oil (orally) mg per day (in 2 dosages) Liposomal gel 1 5 % mg per day (in 2 dosages) Northrup, Dr. Crhistine 1994, Women s Bodies, Women s Wisdom, New York: Bantam Books, page 450 Encapsulated in oil (orally) Liposomal cream/gel 2 10 mg/day 2,5-20mg/day /e.g. 0,25%-2%: 1g = 2,5 resp. 20mg) How to combine: E2 0,15%, Prog. 5%, Test. 0,125% Apply 2 times daily to soft parts of the skin 9

10 Testosterone in case of loss of libido: Testosterone gel thick (non-alcoholic) 2 5% Apply one little grain to the clitoris once a day. Testosterone in facial creams: 2 5 mg/g 1 x daily 0,2 0,5% = 1 g daily dosage Note: Testosterone is converted in the body to Estrogen! Testosterone for Men Dosage: Encapsulated in oil (orally) Liposomal cream/gel 5% mg 2 4 x daily mg/day (e.g. 3%-10%: 1 g= 30 or 100mg) NATURAL DHEA (Dehydroepiandrosterone) Prophylaxis should begin at onset of climacterium. Average dosage is between 10 and 50 mg per day when taken orally. It would be advisable to start with lower dosages and increase them slowly as needed. Average Dosage: Men: encapsulated in oil (orally) mg/day taken in the morning Liposomal cream/gel mg/day 2%-10% (1g cream/gel = 20 mg resp. 100 mg) Women: Encapsulated in oil (orally) mg/day taken in the morning Liposomal cream/gel 5-30mg/day taken in the morning 0,5%, 3%-6% (1g cream/gel = 5mg or 30mg or 60 mg) Literature: - A Look At A Newly Proclaimed Antidote To Aging and Age Related Health Problems, Lauri Lee - HRT-Workshop: Quality of Life & Longevity, Brussels, 9/1998, Dr. Thierry Hertoghe - Dehydroepiandrosteron Biological Effects and Clinical Significance, 1996, Dr. Alan Gaby - The DHEA Breakthrough, Stephen Cherniske - The Superhormone Promise: Natur s Antidote To Aging, Dr. William Regelson and C. Colman 10

11 - DHEA: a Practical Guide, Dr. Ray Sahelian - Stopping The Clock, Dr. Elmer Cranton and William Fryer - Ten Weeks To A Younger You, Dr. Ronald Klatz - DHEA: The Fountain of Youth Discovered?, Alana Pascal Written by: Peter Cornelius (Pharmacist) Copyright 2/

Female Sexual Hormones Indications and Therapy

Female Sexual Hormones Indications and Therapy In puberty, a woman has about 400,000 ovules, at the age of 40-44 years about 17,000 only. On average, each grown-up woman (still having ovulation) loses