These guidelines are provided based upon 26+ years of combined
experience balancing women and men's sex hormones.
INTRODUCTION: We have found the dosages, intervals and applications to be excellent starting points once a need for supplementation has been established clinically and through laboratory validation.
Please note that these are starting dosages, which need to be monitored through laboratory and clinical follow-up. We routinely test saliva for baseline hormone levels prior to initiating supplementation with repeat laboratory testing and clinical follow-up at 2 months intervals until hormones are balanced; then yearly thereafter.
PROGESTERONE
Pre-menopause interested in conception: USP Progesterone 20-30mg in a trans-dermal base (e.g. Vanpen) applied day 15 thru 28 of the menstrual cycle. Rotate application daily to the "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: P4 25mg/ml, #30, Sig: ½ml bid or 1ml qd (day 15 thru 20). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Pre-menopause NOT interested in conception: USP Progesterone 20-30mg in a trans-dermal base (e.g. Vanpen) applied day 7 thru 28 of the menstrual cycle. In other words, this means apply on days not menstruating. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. An example script: P4 25mg/ml, #30, Sig: ½ml bid or 1ml qd(day 7 thru 28). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Post-menopause: USP Progesterone 20-30mg in a trans-dermal base(e.g. Vanpen) applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and 1 week off. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: P4 25mg/ml, #30, Sig: ½ ml bid or qd or alternatively: Sig: ½ ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Andropause (Men): USP Progesterone 5 to 10 mg in a trans-dermal base (e.g. Vanpen) applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example script: P4 10mg/ml, #30, Sig: ½ml qd.You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
BI-ESTROGEN (BIEST)
Pre-menopause interested in conception: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a trans-dermal base (e.g. Vanpen) applied day 1 thru 13 of the menstrual cycle. Rotate application daily to the "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: Biest 1mg (E3:E2;4:1)/ml, #30, Sig: ½ml bid or 1ml qd (day 1 thru 13). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Pre-menopause NOT interested in conception: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a trans-dermal base (e.g. Vanpen) applied day 1 thru 25 of the menstrual cycle. Rotate application daily to the "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: Biest 1mg (E3:E2;4:1)/ml, #30, Sig: ½ml bid or 1ml qd (day 1 thru 25). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Post-menopause: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a trans-dermal base (e.g. Vanpen) applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and weeks off. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Biest 1mg (E3:E2;4:1), #30, Sig: ½ml bid or 1ml gd or alternatively: Sig: ½ml bid or 1ml gd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
TESTOSTERONE
Women: USP testosterone: 0.5 to 1.5mg in a trans-dermal base (e.g. Vanpen) applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and weeks off. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Testosterone 0.5mg/ml, #30, Sig: ½ml bid or 1ml qd or alternatively: Sig: ½ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Men: USP testosterone: 10 mg in a trans-dermal base (e.g. Vanpen)applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Testosterone 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Note: It is important to monitor PSA and CBC levels during the treatment interval.
DHEA
Women: USP DHEA: 10mg in a trans-dermal base (e.g. Vanpen) applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: DHEA 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Note: DHEA supplementation will often raise testosterone levels (conversion in the adrenal glands), which may alleviate the need for testosterone supplementation.
Men: USP DHEA: 10 mg in a trans-dermal base (e.g. Vanpen) applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: DHEA 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Note: DHEA supplementation in males will NOT raise testosterone levels.
COMBINATION FORMULAS
All bio-identical hormones can be combined effectively into a single trans-dermal cream. Though while finding the correct balance, it may be advantageous to prescribe the hormones individually. Conversely, once combined into a single cream the absorption characteristics of each hormone may change slightly. Providers tend to be split evenly on which approach is best--as are we. You will have to find the approach that best suits you and your patients. The following combination examples have been found by each of us to effectively correct hormone imbalances:
Post-menopause: Biest 1mg (E3:E2;4:1), P4 25mg, DHEA 10mg, testosterone 0.5mg, #30, Sig: ½ml bid or 1ml qd or alternatively:Sig: ½ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Men: P4 5mg, testosterone 10mg, DHEA 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Copyright 2008 Labrix Clinical Services, Inc.
experience balancing women and men's sex hormones.
INTRODUCTION: We have found the dosages, intervals and applications to be excellent starting points once a need for supplementation has been established clinically and through laboratory validation.
Please note that these are starting dosages, which need to be monitored through laboratory and clinical follow-up. We routinely test saliva for baseline hormone levels prior to initiating supplementation with repeat laboratory testing and clinical follow-up at 2 months intervals until hormones are balanced; then yearly thereafter.
PROGESTERONE
Pre-menopause interested in conception: USP Progesterone 20-30mg in a trans-dermal base (e.g. Vanpen) applied day 15 thru 28 of the menstrual cycle. Rotate application daily to the "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: P4 25mg/ml, #30, Sig: ½ml bid or 1ml qd (day 15 thru 20). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Pre-menopause NOT interested in conception: USP Progesterone 20-30mg in a trans-dermal base (e.g. Vanpen) applied day 7 thru 28 of the menstrual cycle. In other words, this means apply on days not menstruating. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. An example script: P4 25mg/ml, #30, Sig: ½ml bid or 1ml qd(day 7 thru 28). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Post-menopause: USP Progesterone 20-30mg in a trans-dermal base(e.g. Vanpen) applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and 1 week off. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: P4 25mg/ml, #30, Sig: ½ ml bid or qd or alternatively: Sig: ½ ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Andropause (Men): USP Progesterone 5 to 10 mg in a trans-dermal base (e.g. Vanpen) applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example script: P4 10mg/ml, #30, Sig: ½ml qd.You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
BI-ESTROGEN (BIEST)
Pre-menopause interested in conception: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a trans-dermal base (e.g. Vanpen) applied day 1 thru 13 of the menstrual cycle. Rotate application daily to the "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: Biest 1mg (E3:E2;4:1)/ml, #30, Sig: ½ml bid or 1ml qd (day 1 thru 13). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Pre-menopause NOT interested in conception: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a trans-dermal base (e.g. Vanpen) applied day 1 thru 25 of the menstrual cycle. Rotate application daily to the "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: Biest 1mg (E3:E2;4:1)/ml, #30, Sig: ½ml bid or 1ml qd (day 1 thru 25). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Post-menopause: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a trans-dermal base (e.g. Vanpen) applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and weeks off. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Biest 1mg (E3:E2;4:1), #30, Sig: ½ml bid or 1ml gd or alternatively: Sig: ½ml bid or 1ml gd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
TESTOSTERONE
Women: USP testosterone: 0.5 to 1.5mg in a trans-dermal base (e.g. Vanpen) applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and weeks off. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Testosterone 0.5mg/ml, #30, Sig: ½ml bid or 1ml qd or alternatively: Sig: ½ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Men: USP testosterone: 10 mg in a trans-dermal base (e.g. Vanpen)applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Testosterone 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Note: It is important to monitor PSA and CBC levels during the treatment interval.
DHEA
Women: USP DHEA: 10mg in a trans-dermal base (e.g. Vanpen) applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: DHEA 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Note: DHEA supplementation will often raise testosterone levels (conversion in the adrenal glands), which may alleviate the need for testosterone supplementation.
Men: USP DHEA: 10 mg in a trans-dermal base (e.g. Vanpen) applied daily. Rotate application daily to a "thin" region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: DHEA 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Note: DHEA supplementation in males will NOT raise testosterone levels.
COMBINATION FORMULAS
All bio-identical hormones can be combined effectively into a single trans-dermal cream. Though while finding the correct balance, it may be advantageous to prescribe the hormones individually. Conversely, once combined into a single cream the absorption characteristics of each hormone may change slightly. Providers tend to be split evenly on which approach is best--as are we. You will have to find the approach that best suits you and your patients. The following combination examples have been found by each of us to effectively correct hormone imbalances:
Post-menopause: Biest 1mg (E3:E2;4:1), P4 25mg, DHEA 10mg, testosterone 0.5mg, #30, Sig: ½ml bid or 1ml qd or alternatively:Sig: ½ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Men: P4 5mg, testosterone 10mg, DHEA 10mg/ml, #30, Sig: ½ml bid or 1ml qd. You may want to give 2 refills, which will take the patient up to the 2 month retest interval.
Copyright 2008 Labrix Clinical Services, Inc.
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