Hormone replacement therapy

What if all my other hormones are low too, besides estrogen?

Q: I’m 51, and my hormone panel showed that my hormone levels are very low — but it’s not just estrogen, it’s ALL of them, including some I didn’t even know I had! But my doctor says all I really need is estrogen and progesterone pills. Since my testosterone and DHEA levels are low, don’t I need them, too?

A: Testosterone and DHEA can be difficult to obtain from a conventional doctor, so you may want to wait on these and get the natural estrogen and progesterone first. We do not usually recommend synthetic testosterone (methyltestosterone) because it is taken orally, and is not natural or bioidentical. In fact, the brand name synthetic Estratest has been taken off the market, though generic forms are apparently still available for “off-label” use.

If really needed for libido, energy, or muscle tone, there are bioidentical testosterone products that can be considered for women. The female testosterone patch is still being studied, and seems held up by the FDA for various reasons. Testim gel is FDA-approved for men only, but again, sometimes prescribed “off-label” for women. Only a pea- or dime-sized amount is suggested, applied daily to the skin of the thigh, pubis, or clitoris area.

Alternatively, bioidentical testosterone can be obtained by prescription from a compounding pharmacy, in the form of a topical cream or gel. You will need to see a practitioner versed in compounding bioidentical hormones to obtain a prescription. I suggest only 1–4 mg applied daily for women, starting at the lower dose and slowly increasing it. (To read more about testosterone, see our articles on low libido and rekindling desire.)

Likewise, to address your low DHEA levels, we suggest you seek out a practitioner familiar with compounded hormones, as most conventional practitioners do not subscribe to its benefits as a form of hormone replacement, and have no experience with it. You can obtain a list of practitioners from the Natural Woman Institute or the Women’s International Pharmacy (please note we have no direct knowledge of individuals listed there). We also have a number of articles on improving adrenal health naturally, as well as a Personal Program that specifically addresses adrenal imbalance.

Return to:

• FAQ’s on bioidentical hormones and other forms of HRT
• An intro to HRT and alternatives

Related to this article:

References & further reading for FAQ’s about HRT

 

Original Publication Date: 03/02/2009
Last Modified: 02/16/2010
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician