WorldLink Medical

Hormone Q&A: An Evidence-Based Web Conference

On leap year day, we launched our first online Q&A session and received an outstanding response. It provided a wealth of knowledge and HRT guidelines for physicians and practitioners who are newbies, and for those who have been practicing it for years. This web conference was presented by Neal Rouzier, M.D.

The following questions were answered during the web conference:

    • Would you please walk us through your bleeding algorithm for female patients on estrogen, progesterone, and testosterone therapy. i.e. from increasing progesterone dosage to referring out for embolization, ablation etc.


    • Will the FSH in a post-menopausal woman who is on adequate E2 replacement revert to follicular levels, or are the feedback receptors desensitized so it stays elevated?


    • What is the best way to follow a male’s testosterone level if he is maintained on a compounded transdermal cream?


    • When should we stop treating symptomatic postmenopausal females or symptomatic post-hysterectomy females with estrogen and estradiol?


    • Are there any post-menopausal or post-hysterectomy females who should not receive progesterone?


    • Should progesterone also be used on a peri-menopausal basis or for younger females with PMS symptoms?


    • When is the optimal time for testosterone to be rechecked in men who inject every 2 weeks?


    • What is your opinion on using Bhcg as an aid to weight loss?


    • What is the ideal route of testosterone supplementation?


    • What is your opinion and experience with sublingual testosterone drops?


    • What is your current opinion regarding the relationship between optimal thyroid hormone replacement and the risk for osteoporosis? If free T4 and free T3 are optimal, Is there a TSH blood level that you would consider too low?


    • Do you think it is important to include pregnenolone in a balanced approach to promote healthy aging?


    • What is the cut off point for elevated h&h in patients that are being treated with testosterone?


    • What is your current treatment for hairloss in females when all your hormone adjusted levels are normal?


    • What is the best way to test for testosterone level and adjust the dose?


    • Can we replace the thyroid hormones only with T3 slow release?


    • What guidelines do you use when providing BHRT to women with a family history of breast cancer?


    • What clinical significance has elevated DHEA levels after oral supplementation has started with low dose (50-75mg day orally)?


    • What are some situations in which prolonged-release micronized progesterone is better than the regular-release micronized progesterone?


    • Use of testosterone after prostate cancer- how long do you wait?


    • Thyroid question: What do you think of patients that need increasing doses of thyroid meds?


    • Do you think there is evidence that we should prescribe T4 & T3 in a particular ratio?


    • Testosterone Cream vs IM : What are your considerations? (assuming patient has no preference and transfer is not an issue)


    • Is it possible to achieve the same levels of free and total testosterone using cream? Is there a significant difference in monthly cost to the patient?


    • Stage 4 sleep: At what age do men and women start losing it? What are typical subjective complaints and changes in lab values? How and when do you treat?


    • Starting BHRT on post-menopausal woman who starts vaginal bleeding. What steps should be taken and how do we introduce the estrogen, progesterone and testosterone (order and dosages) to prevent the bleeding?


    • Patient has a “breakout” (acne) on progesterone, how do we treat it so that we can get to therapeutic blood levels?


    • Since progesterone is only produced by the corpus luteum in the luteal phase of the cycle wouldn’t it seem contradictory to administer during the proliferative phase and likely interfere with the ovulation mechanism?


    • Recommended hormonal therapy for breast cancer patients on Anastrazole? Can they have some progesterone and testosterone back in a transdermal cream or even some estrol?


    • Patient with TSH 10, free T3 3.7, free T4 1.35?


    • Post-menopausal bleed, sometimes it is not transitory. Now what?


    • Premenopausal women are starting to come to me wanting to start bioidentical progesterone and testosterone. I am concerned with the ones who chose to keep their IUD with progestin. Can they still receive progesterone and testosterone, their levels are low but they want to keep their IUD’s? Some of these women want to use bioidentical progesterone, I have not found a study to support this use?


    • Oral or transdermal estrogen: which is better & why?


    • What is your take on 17 keto DHEA?


    • Is it possible to increase estradiol levels using a cream to protective levels for bone and heart?


    • Indication for prolactin?


    • I am watching men on testosterone and the estradiol is getting quite high….can you review the issues there.


    • In women who already on estrogen, can you treat with progesterone only for extended periods of time?


    • I am finding that often Armour thyroid is not optimizing both T4 and T3 simultaneously, and I am thus reverting to liothyronine and levothyroxine. What has been your experience? Is it preferable to have thyroid compounded?


    • How to increase testosterone without supplementing or when supplementing is not enough?


    • Hair loss for women: their thyroid has already been treated.


    • How to handle irregular bleeding in perimenopause. Short cycles, long cycles, no cycles?


    • For male patients on trans-dermal testosterone replacement is high/increasing estradiol levels an indicator for increased risk of prostate cancer?


    • I have come across some BHRT practitoners including Progesterone and aromatase inhibitors to the transdermal testosterone formulation. What is your comment on this?


    • Is corionic gonadotrophin used in a man and when?


    • I get the impression that IM testosterone was good for muscle development, but peaked and dropped out too soon. Is it advisable to use IM testosterone twice weekly and use the creams in the off days to maintain levels? (Of course, appropriate monitoring of blood levels would be employed.) Would this not give the best of both worlds?


    • After 3 months of testosterone replacement (compounded transdermal), free and total blood levels have fallen off. Is this due to lack of absorption in some patients What would you recommend in the future, injections or pellets?


    • Do “normal” FSH and LH levels in a woman on HRT mean that the HRT is adequate?


    • Should a woman with normal premenopausal levels be cycling?


    • With the changing healthcare environment, cost of overhead, and retirement looming, I would like to continue to provide hormones through an internet-based practice. What would be some concerns that need to be addressed to do this safely and legally?


    • Is there a commercial DHEA supplement that you like? or melatonin? Any good branded products?


    • Testosterone supplementation, either injectable or cream, causes significant rise in HCT. What is best resolution and/or replacement?


    • Please discuss preference and reasons for choosing armour thyroid or synthroid or other forms of compounded thyroid.


    • Oral, topical, or pellet form estrogen replacement. Which is the best form to use and in what case. There is argument about them being safer than oral. What guidelines do you suggest?


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Comment (1)

  • Hiedi Ybarro Reply

    Several investigations are being carried out to well investigate the effectiveness of natural supplements over low Testosterone levels. Another natural products which is said to improve T levels is from Ayuveda. Ayuveda is an native Indian medical science and it is a highly regarded domain.

    April 2, 2013 at 1:14 pm

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