Learn how to Use Lowest Effective Dosage of BHRT

Use Lowest Effective Dosage by Joseph J Collins, RN, ND 

BHRT is one of those situations where “too much of a good thing can be dangerous”. A good rule to follow for women is to have your hormones tested after on BHRT for at least a month. In women taking estrogen, progesterone or testosterone, the target range for either salivary hormone or blood hormone tests should be in the middle levels of the follicular phase reference range that a healthy 30 woman would have. That is the reference range for the first half of the monthly cycle. These levels represent the “physiological baseline” – the levels before the hormone elevations seen in ovulation and before the hormone elevations seen in the luteal phase (and premenstrual). For men taking testosterone, aim for the middle levels of a healthy 30 year old. Thyroid hormones should be at least in the middle of reference range, and may need to be at the high end of normal in some cases. Dosages that are above the natural range may appeal to those of us who are hoping that they may have anti-aging properties. However, there is no real evidence that massive dosages have any benefit. Likewise, there is no evidence that it is safe to give women higher dosages for part of a month, so that they will have monthly bleeding long after menopause has occurred. In truth, longer a woman menstruates the higher the risk of cancer. If women were created to only have menses for a certain number of years, then we should recognize that fact, and provide BHRT in a safe effective dosage. 

The predilection of holding on to a “more is better” philosophy overlooks one simple truth: hormones can be overdosed. We saw a lot of the “no-side effects at any dose” hype hit its’ peak in the 90s when over the counter progesterone cream became all the rage. The “progesterone parties” of that era (error) encouraged unbridled use – because progesterone would fix anything – and “had no side effects”. 

Now we know that these robust dosages of progesterone can increase urinary incontinence, can suppress libido, cause insulin resistance, is a feedant (increases eating behavior), and - contrary to popular mythology – high dosages of progesterone can increase risk of breast cancer. This is discussed (with references) on pages page 55 through 80 of Discover Your Menopause Type. Unfortunately, I found some sellers of progesterone creams to be quite indignant when I talked about the problems of too much progesterone. They were apparently more concerned about their, marketing of progesterone, than about the health of their customers. However, I want to make it clear that I do recommend progesterone when it is indicated – which is often - but not always. I always recommend much lower dosages, and I recommend that it be as a prescription filled by a compounding pharmacist. 

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