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
Case 1: Sally 31 y.o. female Premenopausal, cycles are somewhat irregular, vary from 28-45 days Primary presenting complaints are: Difficulty sleeping Severe PMS / breast tenderness / dysmenorrhea Fatigue
Sally s Report
3/27/17 Sally s Symptoms
Sally s Treatment Considerations Cycling herbal tinctures 30mg progesterone topically qd days 15-28 20-30 mg* Days 15-28 * Dosage amount is for women < 150 lbs; for women > 150 lbs dose is doubled (40-60 mg)
Example Rx 31 y.o. premenopausal female 137 lbs Interested in conception
Sally s Treatment Plan 30mg progesterone topically qd days 15-28 Cycling herbal tinctures DHEA 5mg q am
Sally s Treatment Plan 30mg progesterone topically qd days 15-28 Cycling herbal tinctures DHEA 5mg q am Adrenal support product that includes B vits and adaptogens am & noon Phosphorylated serine 100mg at bedtime
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
Amber s Report
Amber s Symptoms 10/27/2011 07/05/14 4/13/17
4/13/2017 07/05/14
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
Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Increase progesterone to 50mg topically qd
Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Increase progesterone to 50mg topically q Vitamin D3 5000 iu/day Low glycemic index diet, 30 min exercise 4 times/week
Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Increase progesterone to 50mg topically q Vitamin D3 5000 iu/day Low glycemic index diet, 30 min exercise 4 times/week No DHEA at this point due to elevated T
Example Rx 56 y.o. postmenopausal female 162 lbs, daily hot flashes
Example Rx Sublingual 56 y.o. postmenopausal female 162 lbs, daily hot flashes
Amber s Treatment Plan Addition of 1mg biest (4:1 ratio) Sig: ½mg topically bid Continue 30mg progesterone topically qd Vitamin D3 5000 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
Case 3: David 46 y.o. male PTC Primary presenting complaints are: Decreased erections Decreased libido Fatigue Foggy brain
David s Report
David s Symptoms
David s Treatment Plan 10mg progesterone, 10mg testosterone, 50mg chrysin/ml Sig: 1 ml topically qd 5-10 mg daily 10-20 mg Daily
Example Rx 46 y.o. male 237 lbs
Example Rx-Concentrated 46 y.o. male 237 lbs
David s Treatment Plan 10mg progesterone, 10mg testosterone, 50mg chrysin/ml Sig: 1 ml topically qd DHEA 10mg po q am
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
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
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. 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 60-70 pumps Kajarin (503) 482-9162 wwww.kajarin.com customerservice@kajarin.com
OTC Hormone Creams Bezwecken (800) 743-2256 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) 900-0701 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
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)
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
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 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!