Practitioners and patients working together to apply Hormone Health Guidelines and achieve optimal function of hormones.

Applying Hormone Health Guidelines by Joseph J. Collins, RN, ND
Practitioners and patients can work together to help the patient achieve optimal hormone health, no matter what hormone problem(s) the patient is struggling with. The Hormone Health Guidelines provide insight into how lifestyle, diet, detoxification, omega-3 oils, probiotics, phytotherapy, hormone precursors and bioidentical hormone replacement therapy can be properly used to restore optimal hormone health.

Though the concepts in the Hormone Health Guidelines appear to be presented in a linear, sequential format, they can be applied in clusters during office consultations with a healthcare practitioner. Follow up consultations and evaluations are important to evaluate response to recommendations and fine-tune the program for each patient.

Achieving Optimal Hormone Health
These follow-up evaluations are best performed in visits that are 3 – 4 weeks apart. They must be at least 3 weeks apart to ensure that there has been adequate time for physiological response to therapy. If follow-up visits need to be delayed, the delay should be no longer than 4 to 5 weeks at the most – this will ensure that a response to recommendations is evaluated soon enough to make required adjustments. In my experience, people get discouraged if they are told to “give it more time” and have to struggle with their problems for a month or more.
Three (3) weeks is enough time to evaluate how the patient is responding, and determine if there are areas that are resisting improvement – so those areas can be addressed. Examples of areas that may need to be addressed further include inflammation, sleep or bowel functions that do not improve after starting the Foundations of Hormone Health and Hormone Specific Formulations™. Inflammation, sleep deprivation and constipation can each interfere with achieving hormone health. These specific examples may need extra attention so the measures to improve hormone health can continue.
It is important to note that inflammation, sleep deprivation and constipation will often improve once a patient starts on the supplements recommended for the Foundations of Hormone Health, and the Hormone Specific Formulations chosen for their specific needs.

Scheduling Guidelines:
The following guidelines are an example of how to monitor patient response, and adjust as needed so that patient can experience relief from the symptoms of poor hormone health. This schedule has to be customized based on patient need. Those patients that present with other significant problems, or severe symptoms, may need to be seen more frequently.

First Consultation Visit
1) Evaluate baseline symptoms. Use questionnaires and clinical notes to quantity the number, intensity and frequency of symptoms. This information on baseline symptoms will be used to evaluate patients’ response to recommendations.

2) Make sure patient is following Foundations of Hormone Health guidelines, which include:

a) Hormone Healthy Lifestyle & Diet
b) Complete Multiple Vitamin & Mineral:
c) Essential Fatty Acids
d) Probiotics

3) Start appropriate Hormone Specific Formulations based on whether or not patient is already following adequate Foundations of Hormone Health guidelines:

a) If patient has been following Foundations of Hormone Health guidelines, then start Hormone Specific Formulations right away.
b) If patient has not been following Foundations of Hormone Health guidelines, then instruct patient to start Hormone Specific Formulations one week after starting to follow those guidelines. This will give the body some time to restore baseline nutrition, so it will respond appropriately to the Hormone Specific Formulations.

4) Make additional recommendations as appropriate. 

5) Reinforce lifestyle recommendations (sleep, exercise, relaxation) as well as healthy diet recommendations.

6) Schedule follow-up evaluation visit to be after patient has been on Hormone Specific Formulations for at least 3 to 4 weeks.

Second and Subsequent Consultation Visits
1) Evaluate if the patient was able to follow recommendations for Foundations of Hormone Health and Hormone Specific Formulations, and what may have interfered with their ability to follow recommendations.

2) Evaluate response to recommendations. Use questionnaires and clinical notes to quantity the number, intensity and frequency of symptoms. Compare this information to baseline symptoms and discuss relative changes with patients.

3) Ask patient to give their overall impression as to how much better that feel, such as 40% better, 50% better, or 70% better.

4) At this point discuss with the patient the two options

A) Stay on course with current recommendations. Look for continued improvement on next visit, and see if there needs to be an adjustment on the next visit.
B) Adjust recommendations as indicated. This may mean increasing omega-3 oils to overcome persistent inflammation, or increasing probiotics to improve bowel function, or temporarily increasing a Hormone Specific Formulations based on the Customized Dosing Guidelines.

5) Make additional recommendations as appropriate.

6) Reinforce lifestyle recommendations (sleep, exercise, relaxation) as well as healthy diet recommendations.

7) Schedule next follow-up evaluation visit for 3 to 4 weeks.

When to Consider Hormone Precursors
Before considering the use of precursors such as pregnenolone, DHEA and 7-KETO-DHEA ensure that the patient has consistently adhered to recommendations to the Foundations of Hormone Health and proper use of Hormone Specific Formulations as outlined in the Hormone Health Guidelines. If hormone precursors are going to be used, please see the guidelines for Proper Use of Hormone Precursors.

When to Consider Bioidentical Hormone Replacement Therapy
In some patients, Bio-identical Hormone Replacement Therapy (BHRT) may be required. Bioidentical hormones, such as testosterone, estrogen, progesterone cortisol or thyroid hormone replacement are a healthier choice than non-bioidentical hormones, and they work well in patients that have made other healthy choices.
The patient may require testosterone, estrogen, progesterone, cortisol or thyroid hormone replacement because their body is unable to reacquire the ability to make hormones, even after the patient has made healthy lifestyle, diet, nutritional support and essential fatty acids choices, the appropriate Hormone Specific Formulations, and appropriate dosages or hormone precursors. This may be because of surgical removal of endocrine tissue, such as when an oophorectomy is performed during a hysterectomy in women. Or, the inability to make hormones may be because the tissue was destroyed by disease, such as autoimmune thyroid disease.
Before considering prescription Bioidentical Hormone Replacement Therapy (BHRT) it is best that the patient maintains healthy lifestyle, diet, nutritional support and essential fatty acids choices, and uses the appropriate Hormone Specific Formulations, and appropriate dosages of DHEA, pregnenolone and/or 7-Keto-DHEA.
I have seen a number of cases where patients have been taking BHRT, but did not have healthy lifestyle choices. In each of these cases, the patients did not experience the beneficial results of BHRT.
For years I have taught patients and healthcare practitioners this simple truth:
If you give BHRT to a patient who is sleep deprived, toxic and constipated, has nutritional imbalances and is jacked up on caffeine, then all you have is a sleep deprived, toxic and constipated, nutritionally imbalanced, and jacked up patient on BHRT.

Next: Integrative Hormone Health Specialist™.

This article is part of the Educational Module on Hormone Health.