Your First Hormone Reports

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Alban Dalton
5 years ago
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1 This lecture is intended as an introduction to the growing discipline of salivary testing and bio-identical hormone balancing. Any doses and therapies suggested are examples that apply to the sample cases presented. The care of each individual patient will vary and not all patients are candidates for bio-identical hormone therapy. Your First Hormone Reports Laura Neville, ND Staff Physician Labrix LLC

2 Case 1: Sally 31 y.o. female Premenopausal, cycles are somewhat irregular, vary from days Primary presenting complaints are: Difficulty sleeping Severe PMS / breast tenderness / dysmenorrhea Fatigue

3 Sally s Report

4 3/27/17 Sally s Symptoms

20-30 mg* Days 15-28 * Dosage amount is for women <

9 Sally s Treatment Considerations Cycling herbal tinctures 30mg progesterone topically qd days mg* Days * Dosage amount is for women < 150 lbs; for women > 150 lbs dose is doubled (40-60 mg)

10 Example Rx 31 y.o. premenopausal female 137 lbs Interested in conception

12 Sally s Treatment Plan 30mg progesterone topically qd days Cycling herbal tinctures DHEA 5mg q am

14 Sally s Treatment Plan 30mg progesterone topically qd days Cycling herbal tinctures DHEA 5mg q am Adrenal support product that includes B vits and adaptogens am & noon Phosphorylated serine 100mg at bedtime

15 Case 2: Amber 56 y.o. female 6 years post-hysterectomy Has been on progesterone supplementation (30 mg topically qd) for 6 months Still having quite a few residual symptoms including: Sugar craving Fatigue Hot flashes Forgetfulness Vaginal dryness

16 Amber s Report

17 Amber s Symptoms 10/27/ /05/14 4/13/17

18 4/13/ /05/14

20 Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid 1 mg daily Consider vaginal estriol Sig: 1 mg qhs X 1-2 weeks, then 1-4X/week prn

22 Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Increase progesterone to 50mg topically qd

24 Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Increase progesterone to 50mg topically q Vitamin D iu/day Low glycemic index diet, 30 min exercise 4 times/week

26 Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Increase progesterone to 50mg topically q Vitamin D iu/day Low glycemic index diet, 30 min exercise 4 times/week No DHEA at this point due to elevated T

27 Example Rx 56 y.o. postmenopausal female 162 lbs, daily hot flashes

28 Example Rx Sublingual 56 y.o. postmenopausal female 162 lbs, daily hot flashes

30 Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Continue 30mg progesterone topically qd Vitamin D iu/day Low glycemic index diet, 30 min exercise 4 times/week Adrenal support product that includes B vits and adaptogens am and noon Hydrocortisone 10mg in am, 5mg at noon

31 Case 3: David 46 y.o. male PTC Primary presenting complaints are: Decreased erections Decreased libido Fatigue Foggy brain

32 David s Report

33 David s Symptoms

37 David s Treatment Plan 10mg progesterone, 10mg testosterone, 50mg chrysin/ml Sig: 1 ml topically qd 5-10 mg daily mg Daily

38 Example Rx 46 y.o. male 237 lbs

39 Example Rx-Concentrated 46 y.o. male 237 lbs

41 David s Treatment Plan 10mg progesterone, 10mg testosterone, 50mg chrysin/ml Sig: 1 ml topically qd DHEA 10mg po q am

43 David s Treatment Plan DHEA 10mg po q am 10mg progesterone, 10mg testosterone, 50mg chrysin/ml Sig: 1 ml topically qd Adrenal support product that includes B vits and adaptogens am and noon

44 Dosing in percentages 10 mg/ml = 1% cream or gel Script can be written in % although not necessary 100 mg/per ml of cream = 10% cream 50 mg/per ml of cream = 5% cream 25 mg/per ml of cream = 2.5% cream 10 mg/per ml of cream = 1% cream

45 Example Rx As a % 62 y.o. male 190 lbs

OTC Hormone Creams Kajarin (www.kajarin.com) Product Contains Dosage 4 Balance Progesterone Each pump delivers ½ ml that includes 29.8 mg prog.

47 OTC Hormone Creams Kajarin ( Product Contains Dosage 4 Balance Progesterone Each pump delivers ½ ml that includes 29.8 mg prog. 4 Balance Plus Biest (4:1) Progesterone 4 Male Progesterone Chrysin Each pump delivers ½ ml that includes 1 mg Biest and 32 mg prog. Each pump delivers ½ ml that includes 12.1 mg prog and 30.3 mg chrysin 4 Comfort Estriol Each pump delivers ½ ml that includes 1.4 mg E3 Route of Administration Topical Topical Topical Vaginal *Each bottle contains pumps Kajarin (503) wwww.kajarin.com customerservice@kajarin.com

48 OTC Hormone Creams Bezwecken (800) Progonal Progesterone 20 mg per ¼ tsp Topical OstaDerm Estriol 20 mg Pg and Topical Progesterone 1 mg estriol per ¼ tsp OstaDerm-V Estriol 20 mg Pg and Topical applied to Progesterone 1 mg Biest per ¼ tsp vulva (formulated without alcohol) Sarati (800) Product Contains Dosage Route of Administration NPC Progesterone ¼ tsp = 20 mg Pg Topical EMP- Essential Estriol ¼ tsp = 0.6 mg estriol and 6 mg Pg Vaginal Moisture Plus Progesterone EST- Essential Support Treatment DHEA- for women and D-35 for men NPG- Nature's Precise Gel for Men Biest (9:1) Progesterone Plant estrogens DHEA Progesterone Pregnenolone Chrysin 1/4 tsp = 20 mg Pg, 0.1 mg E2, 0.9 mg E3. ¼ tsp = 20 mg Pg, 10 mg DHEA, 3 mg Chrysin and 0.6 mg of Pregnenolone Topical Topical Progesterone ¼ tsp = 12 mg Pg Topical

49 Monitoring BHRT Laboratory and clinical follow up is essential! Baseline testing 2-3 month interval lab and clinical follow up until hormones balanced Yearly follow up thereafter (sooner should symptoms return)

50 Dispensing a kit Go over collection guidelines with the patient Remind them of dates to collect (to catch luteal surge) Remind them of proper dosage intervals Samples must be frozen for at least 4 hours and shipped as soon as possible

51 A common comment If a patient is supplementing with a hormone and testing reveals an elevated level (assuming correct dosage interval was followed), you will see this comment: XXXX level is consistent with slow liver clearance. We use this language to illustrate the point that hormone is coming into the body faster than it can be metabolized. We do not necessarily mean that the liver is compromised. This is basically code for overdose.

Take Home Pearls Review and factor dosage interval into interpretation Helpful to look at symptoms on the back of the requisition form Interpretation

52 Take Home Pearls Review and factor dosage interval into interpretation Helpful to look at symptoms on the back of the requisition form Interpretation notes will help to guide treatment, along with specific treatment plans on website Can always call to consult with a staff physician no appointment necessary!

2016. All Rights Reserved. 1

2016. All Rights Reserved. 1 Pamela W. Smith, M.D., MPH, MS Copyright 2016 The suggested dosages are for educational purposes only. They are suggestions for patients with normal renal and hepatic function. They are based upon my research