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Monitor Hormone Levels Before & After Starting BHRT
Dr. Joseph J Collins, RN, ND
they need increased dosage of hormones to get relief, some prescribers comply without keeping an eye on hormone levels. As a result, the patient may have levels that are too high. By following the Hormone Health Guidelines, including the Foundations of Hormone Health and the Hormone Specific Formulations, it is possible to achieve desired outcome with lower, safer, dosages of hormones.

Ideal Levels: In women, the follicular phase (first half of the cycle – right before ovulation) represents what her hormone levels are before the stimulation of ovulation and before the increased hormone levels of the luteal phase. This follicular phase therefore represents her “physiological baseline”. It shows us the basic physiological function of her ovaries and adrenal glands. The adrenal glands actually provide 60% of the progesterone during follicular phase. So, low follicular progesterone levels actually tell us quite a bit about adrenal health.  BHRT for perimenopause, menopause or postmenopause women should be aimed at same level of hormones that occur in the follicular phase (physiological baseline) of a 30 year old woman.
I men, aim for testosterone levels of a 30 year old male. In addition, when men are on BHRT (testosterone) it is very, very important that their estrogens (estrone & estradiol) also be monitored. As men age, they are more likely to convert testosterone to estrogens – especially if they are overweight or have any liver problems. Excessive testosterone can also result in increased conversion to estrogens. Too much testosterone in men can increase heart disease, diabetes and cancers.

Percentile Analysis: One of the best ways to interpret lab tests for both men and women is to evaluate where the lab values fall within the reference range, and then interpret those results in light of the patients’ symptoms. A patient may be just barely into the reference range – such as 10% into the range – which means that 90% of people within the range have higher hormone levels than that patient. Unfortunately, the patient at 10% and the patient at 75% are both interpreted as “normal”. The patient at 10% is more likely to have signs of low hormone function.
It is best to assess all lab values by percentile analysis – determine exactly where the levels lie within the reference range. Percentile analysis is quite easy. When given Patient Value (PV), Low Reference Range (LR) and High Reference Range (HR), the percentile is calculated by dividing (PV minus LR) by (HR minus LR), and them multiplying by 100.
The formula would look like this:
Percentile = ((PV-LR) / (HR-LR)) X 100

Percentile analysis is one of many analytical methods used in the Female Hormone Health Profile, a multiple sample assessment of estradiol, progesterone and testosterone.

Quartile Analysis: After the percentile analysis is determined, you can easily see which quartile a lab value falls into. In most cases, patients do better with sex hormones in the 3rd quartile – from 50% to 75%. In some cases, the 4th quartile may be desired for certain hormones – such as keeping testosterone in 4th quartile for patients with heart failure. Other cases may do better in the 1st quartile – such as keeping estradiol in the 1st quartile for women with history of epilepsy.
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For information on specific protocols, please go to: Protocols



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Bioidentical HRT
Proper monitoring of hormone levels is very important. The goal is to have hormones levels in a range that allows them to support healthy function of tissues – but not so high that they can cause risks. It’s important to know that the concern is not just cancer risks. Though there is that concern, we also need to talk about other risks. Some other risks of too many hormones have already been noted; too much progesterone can increase urinary incontinence, can suppress libido, cause insulin resistance, can increases eating behavior, and yes - can increase risk of breast cancer. Too much testosterone in women can increase risk of heart disease, diabetes and cancers. Too much testosterone in men can result in increased conversion of testosterone to estrogens.
Monitoring hormone levels before and after starting BHRT is the only way to really be sure that the therapy is safe and effective. Unfortunately if a patient insists that