2016. All Rights Reserved. 1

Size: px

Start display at page:

Chastity Stanley
5 years ago
Views:

2 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 and my personal and professional experiences after reviewing 20,000 saliva tests. They are not intended as a substitute for a personalized approach to each patient but are designed instead to be a guideline. PCCA and Pamela W. Smith, M.D., MPH, MS are not responsible for any adverse effects or consequences resulting from the use of any of these suggestions or preparations in this seminar. This seminar is protected by Federal United States Copyright laws and International Copyright laws. No portion of this seminar can be copied or disseminated in any form without the express permission of Pamela W. Smith, M.D. Any dissemination of this seminar or contents of this seminar without express permission from Pamela W. Smith, M.D. will result in a $10,000 fine All Rights Reserved. 1

5 Ranges are for transdermally applied estrogens Estradiol: pg/ml with the optimal range being pg/ml Estriol: pg/ml Always prescribe biest cream (E2 + E3). Do not prescribe triest (E1 + E2 + E3). Biest is estradiol and estriol compounded together. To determine the percentages of biest cream between the amount of estradiol and estriol: go according to saliva results. For example if the lab shows that the estradiol level is 1.0 pg/l and the estriol level is 5 pg/ml the prescribe 90% E3 and 10% E2. For example if the lab shows that estradiol level is 0.5 pg/l and the estriol level is 2 pg/l then prescribe 50%E2/50%E3. When you write the prescription: whether E2 or E3 is stated first is related to whether there is more E2 or more E3 by percentage in the biest cream. When changing the dose of biest: small changes at a time are helpful. Sometimes you may keep the amount of biest the same but change the dose by changing the ratio of E2 to E3. Biest cream 1.0 mg 50%E2/50%E3 is 0.5 mg of estradiol mg of estriol. Usually do not change the ratio and the amount of biest both at the same time: change one or the other All Rights Reserved. 4

6 When you change dosages of biest usually change by increments of 0.25 mg cream. When changing the ratio of E2 to E3 usually change by increments of 5%. Lowest dose of biest cream: 0.10 mg 80%E3/20%E2. Upper limit of biest dose is 3 mg 80%E3/20%E2. Progesterone orally prescribed pg/ml Progesterone prescribed as transdermal cream, troche, or vaginally (vaginal as hormone replacement and not for vaginal dryness) 200-3,000 pg/ml All Rights Reserved. 5

7 Oral progesterone When you change doses change by mg increments Lowest dose: 50 mg E4M Highest dose: 300 mg E4M in cycling women days Highest dose: 200 mg E4M in menopausal women Transdermal progesterone When you change dosages change by 5 mg increments Highest dose: 40 mg cream in cycling women days Lowest dose: 5 mg cream in cycling women days Highest dose: 35 mg cream in menopausal women Lowest dose: 5 mg cream in menopausal women All Rights Reserved. 6

8 Testosterone pg/ml (age dependent) When you change doses of testosterone cream change in 0.25 mg increments. Lowest dose of testosterone: 0.25 mg cream Highest dose of testosterone: 4.0 mg cream All Rights Reserved. 7

10 Morning ng/ml Noon ng/ml Evening ng/ml Night ng/ml 78-year-old patient who presents for a follow-up visit. FH: Mother and father were very healthy and lived into their 90s. Medications: biest cream 0.25 mg, progesterone 90 mg E4M, DHEA 5 mg E4M. SH: housewife and is very active in her church. PH: unremarkable except for bilateral cataract surgery. ROS: unremarkable. P/E: normal. Patient appears younger than stated age All Rights Reserved. 9

Breast tenderness Too much estrogen Too much progesterone Decrease the dose of either the estrogen or

Hot flashes Not enough estrogen Estrogen receptors are sensitized If the patient calls you after 60 days and

12 Breast tenderness Too much estrogen Too much progesterone Decrease the dose of either the estrogen or progesterone. Do not change both at the same time or you will not know which hormone caused the problem. Hot flashes Not enough estrogen Estrogen receptors are sensitized If the patient calls you after 60 days and states that their hot flashes had gone away and are now back again this usually means that the dose of biest is too large. The estrogen receptor sites have become saturated and will not hold onto more hormone so the patient gets hot flashes: lower the dose of biest and the hot flashes will resolve. Adrenal dysfunction All Rights Reserved. 11

13 No sexual interest Low testosterone Low estrogen Adrenal dysfunction Low or high DHEA Hypothyroidism Local treatment for females scream cream Mason, D., Orgasmic Dysfunction in Women, International Journal of Pharmaceutical Compounding, 2002; 6(4): Formulation contains: Aminophyllin 30 mg/ml Ergoloid mesylate 0.5 mg/ml Isosorbide dinitrate 3.72 mg/ml L-arginine 60 mg/ml Pentoxifyline 50 mg/ml Directions Apply 1 ml to the clitoris one hour prior to intercourse. The formulation basically is a vasodilator and works to increase blood flow. Vaginal dryness Have compounded: Estriol 1-2 mg inserted vaginally as a cream or suppository (have the patient which form they prefer) DAW the base: Use 50% VersaBase and 50% MucoLox and you will get a better result Directions Nightly for two weeks, Monday and Thursday for two weeks then PRN All Rights Reserved. 12

14 Always start low and go slow. This way it is easier to make adjustments in dosing of natural hormones when the patient comes in for a revisit. With compounded medications you can optimize and personalize the patient s care. Also see handout for saliva reference ranges All Rights Reserved. 13

15 Saliva Reference Ranges Disclaimer: Supplement type and dosage are for provider information and are not recommendations for treatment. Reference ranges are observed ranges based on collected laboratory data. For more information, please contact ZRT Laboratory. Saliva Test Reference Ranges for WOMEN Reference Ranges for MEN Estradiol (E2) Premenopausal - Luteal pg/ml Premenopausal - Follicular Postmenopausal Estrogen Replacement Synthetic HRT, Contraceptive Estrone (E1) Postmenopausal pg/ml Premenopausal - Luteal Estriol (E3) Postmenopausal <1.9 <1.7 pg/ml Premenopausal - Luteal <3.0 Topical Estriol/Biest/Triest Oral Estriol/Biest/Triest Progesterone (Pg) Premenopausal - Luteal pg/ml Premenopausal - Follicular Topical Progesterone (5-10 mg) Postmenopausal Oral Progesterone ( mg) Topical, Troche, Vaginal. Pg ( mg) Synthetic Progestins (HRT, Contraceptive) Testosterone (T) Age Dependent Age Dependent pg/ml (5-50 mg topical hr) DHEA-S (DS) Age Dependent 2-23 Age Dependent 2-23 ng/ml Cortisol (C) Morning Morning ng/ml Noon Noon Evening Evening Night Night All Rights Reserved.

Your First Hormone Reports

Your First Hormone Reports 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