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HowtotakeyourbioidenticalhormonesHow to Take Your Bioidentical Hormones
Depending on the hormone, some can be taken by mouth on an empty stomach, some can be injected, some can be taken as trans-dermal (through the skin) creams, or sublingual (under the tongue) drops or “troches” – little compounded tablet-like pills that dissolve under your tongue, or between your cheek and gum. If you are getting a blood draw to check hormone levels, make sure that you are taking each hormone being tested that day, do not rub the hormone cream on your arms that day, and wait 4-6 hours after taking it before having the blood drawn. If the dose has recently changed, wait at least 3-4 days before checking the blood level to get to a steady state. For thyroid, we may want a mid-cycle blood level, or a trough level 12 hours after your last There are two basic surfaces on the human body that can absorb transdermal hormones – skin and
mucosa. Mucosa absorbs hormones better than skin, but most thinner-skinned areas work well. It
is important to rotate sites when rubbing hormones on the skin, to avoid what is called “dermal absorption fatigue” - meaning it may absorb well from that location for awhile, but then not as well over time. Hormone creams can be rubbed on the inner and outer arms (upper and lower), the backs of the hands (if you are not going to wash your hands for at least 4 hours!), the top of the foot, the inner thigh, neck, abdomen, even face. Just spread out the cream and gently rib it in until the area is slightly dry to the touch. Wait a few minutes before putting clothes on over the As for mucosa, women have the inside of the external labia, the vaginal opening and vaginal canal. Men and women both can use the anal opening for hormone creams, since it absorbs well there. For troches or sublingual drops, under the tongue or between the cheek and gum is another mucosal surface that can absorb hormones well, but it is important to try not to swallow them. For mucosal application, the hormones are generally compounded into a smaller amount of cream, so It is always important to take oral hormones on an empty stomach, which means one hour
before, or two-three hours after a meal. However, two hormones can be taken at the same time, such as Thyroid and Cortisol in the morning. The classic oral hormones are natural Thyroid – such as Armour or Naturethroid which
contain both T3 and T4 (the two naturally occurring thyroid hormones), as opposed to Synthroid, Levothroid, or L-Thyroxin which only contain T4. T3 is a short-acting hormone, which is why it is better to dose natural thyroid twice or even three times per day. I recommend keeping your bottle of natural thyroid by your bedside, so that you can take it when you first get up, and again before bed. Alternatively, the second dose can be taken an hour before dinner if you have trouble DHEA can be swallowed at night (to help calm over-active adrenals at night) or in the
morning, and can be compounded into a cream as well. Cortisol, brand name Cortef (generic Hydrocortisone) can be taken orally as a small
white tablet. It is also relatively short-acting, so can be dosed approximately every 4-6 hours during the day, but not later than 3-4 pm or it may cause insomnia. Pregnenolone can be taken by mouth in the morning.
Estrogens should not be taken by mouth since this causes a pro-inflammatory state
which can pre-dispose to blood clots and other problems. It is best to deliver bioidentical estrogens through a transdermal cream or sublingual drops. Some doctors have compounded bioidentical Estradiol into a capsule for oral delivery, but I do not recommend this. Bioidentical Estradiol is available from the pharmaceutical industry as a patch (they couldn’t patent the hormone itself, but did patent the patch delivery system), but the dose is not as adjustable as the cream, and it does not contain any of the breast-protective Estriol that most bioidentical doctors add in a combination called Biest – meaning two kinds of estrogen – Estradiol plus Estriol. Estrogen should not be rubbed on the breasts, but Progesterone can go there.
Bioidentical oral Progesterone is available from the pharmaceutical industry as a pink ball-
shaped pill called Prometrium, but the Progesterone is suspended in Peanut Oil, which again can cause some allergic or inflammatory problems, and is also not adjustable beyond its 100 mg dose. It can be taken at night orally for those who need help with sleep, since it is more sedating this way. Progesterone is also used as a compounded cream, or sub-lingual liquid. Progesterone can be taken all month in women who feel better this way, who don’t want to have periods, who have an increased risk of cancer, or who have cyclic migraines or severe anxiety or mood swings. But when women are premenopausal, they only have a little bit of Progesterone the first two weeks of their cycle, and more on the second two weeks of their cycle. Integrative medicine doctors generally try to mimic nature as closely as possible, so I prefer to have women cycle the Progesterone on and off if they can. A low dose of Progesterone cream or capsule at night for men Testosterone for men can be taken as a twice-daily compounded cream or gel, or it can be given
as a shot. Advantages of the cream is that it gives a very even blood level with little highs and lows, it is not a needle, and can easily be done at home. It is somewhat easier to travel with. But men have to remember to do it twice a day, and not all men absorb the cream well through the skin. Men have to be careful not to accidentally rub some off onto others that they may touch, and they can’t overly sweat, swim or shower within four hours of application. Men should not rub Testosterone on the scrotum. Most rub it on the arm or shoulder, but some rub it on the anal The advantage of taking Testosterone as a shot is that you only have to remember it once or twice a week, there are no concerns about touching or sweating or showering it off, or lack of absorption through the skin. The shots can be given every two weeks, but it is best to use lower doses and to do it weekly or even twice weekly to get a more even blood level. But some experience mild mood swings as the Testosterone blood levels go more drastically up and down with the shots, and travel with the bottle and needles may be an issue. Also it is a larger needle to inject it into the muscle which some men find uncomfortable. After some training, men can inject themselves in their thigh, or have a partner inject them in the hip. Testosterone for women is generally given as either a small sub-lingual troche or liquid drops in
the morning, or as a transdermal cream, given only in the morning. The reason for this is that Testosterone at night can be too activating for some women and may keep them awake. Women should not regularly rub Testosterone on the clitoris, because it may cause irreversible clitoral
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