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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS coronary artery disease, stroke and pulmonary embolism xi . One of the most common endocrine disorders that leads to anovulation and subsequent estrogen dominance is polycystic ovarian syndrome (PCOS), a metabolic disorder where the ovaries and adrenal glands produce excessive androgens due to stimulation from insulin xii . Though there can be a genetic predisposition to this condition, it is often exacerbated by a diet that is high in simple carbohydrates and low in fiber that leads to increased insulin resistance. The insulin stimulates testosterone production in the ovaries and DHEA production from the adrenal glands. The androgens are converted into estrogens, primarily estrone, in the periphery and feed back to the hypothalamus and pituitary, which interferes with LH and FHS levels that stimulate ovulation. With no ovulation, there is no corpus luteum produced and therefore little progesterone, leading to estrogen dominance. While the crux of treating this condition often requires significant diet and lifestyle changes, supporting the body with progesterone to balance excess estrogen can help significantly. Regardless of a woman’s age, proper analysis of endogenous hormone levels and correction of any imbalance will reduce risk of proliferative diseases, such as breast and endometrial cancer as well as treat a myriad of common symptoms. When creating a treatment plan, the dosage as well as route of administration of hormones is important. Progesterone has a large first pass effect, meaning that a significant majority of the hormone is metabolized by the liver immediately after being absorbed through the gastrointestinal tract xiii . Because of this, the preferred method of delivery is in a transdermal (topical) cream or gel applied to an area of the body with very little subcutaneous fat. In this medium, the hormone is absorbed directly into the capillary beds and delivered to tissues and bypasses the immediate first pass through the liver xiv . Estrogen supplementation is also best when done in a topical cream, due to the fact that oral estrogens reduce the liver’s production of growth hormone xv . 164 Though there is much variability in the dosages recommended to patients, a general rule of thumb is to use the lowest amount needed for therapeutic effect xvi . The following guidelines are provided based upon 35 years of clinical experience in balancing women’s hormones. The dosages, intervals and applications listed below have been determined to be excellent starting points once a need for supplementation has been established clinically and through laboratory validation. Please note that these are starting dosages, which need to be monitored through laboratory and clinical follow up. Routinely check saliva for baseline hormone levels prior to initiating supplementation with repeat laboratory testing and clinical follow up at 2 month intervals until hormones are balanced; then yearly thereafter. Progesterone: Pre-menopause interested in conception: USP Progesterone 20-30mg in a transdermal base applied day 15 through 28 of the menstrual cycle. Rotate application daily to the ‚thin‛ region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: P4 25mg/ml, #14, Sig: ½ml bid or 1ml qd (day 15 through 28). You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Pre-menopause NOT interested in conception: USP Progesterone 20-30mg in a transdermal base (applied day 7 through 28 of the menstrual cycle. In other words, apply on days not menstruating. Rotate application daily to a ‚thin‛ region of the body: inner wrist, behind knees, upper inner arm or upper chest. An example script: P4 25mg/ml, #21, Sig: ½ml bid or 1ml qd (day 7 through 28). You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Post-menopause: USP Progesterone 20- 30mg in a transdermal base applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and 1 week off. Rotate application daily to a ‚thin‛ region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS scripts: P4 25mg/ml, #30, Sig: ½ ml bid or qd or alternatively: Sig: ½ ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval Bi-Estrogen (Biest) Pre-menopause interested in conception: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a transdermal base applied day 1 through 12 of the menstrual cycle. Rotate application daily to the ‚thin‛ region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: Biest 1mg (E3:E2;4:1)/ml, #13, Sig: ½ml bid or 1ml qd (day 1 through 12). You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Pre-menopause NOT interested in conception: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a transdermal base applied day 1 through 25 of the menstrual cycle. Rotate application daily to the ‚thin‛ region of the body: inner wrist, behind knees, upper inner arm or upper chest. Dose may be given qd or split into bid application as preferred by provider and patient. An example script: Biest 1mg (E3:E2;4:1)/ml, #26, Sig: ½ml bid or 1ml qd (day 1 through 25). You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Post-menopause: USP Estriol(E3) and estradiol(E2) combination: 1mg (E3:E2;4:1) in a transdermal base applied daily. Some providers prefer to cycle dosage, e.g., 3 weeks on and 1 week off. Rotate application daily to a ‚thin‛ region of the body: inner wrist, behind knees, upper inner arm or upper chest. Example scripts: Biest 1mg (E3:E2;4:1), #30, Sig: ½ml bid or 1ml qd or alternatively: Sig: ½ml bid or 1ml qd (3 wks on, 1wk off). You may want to give 2 refills, which will take the patient up to the 2 month retest interval. Men: 165 Hormone balancing isn’t just important for women. Men experience a significant shift in their hormones as they age and these changes can have some very profound effects on their health. Declining testosterone levels are commonly seen in men beginning in the fourth decade of life. xvii Suboptimal or low testosterone levels in males are often associated with symptoms of aging and are referred to as andropause or male menopause. This is the equivalent of menopause in women when ovarian production of estrogens and progesterone begins to decline. Testosterone is an important anabolic hormone in men, meaning it plays important roles in maintaining both physical and mental health. It increases energy, prevents fatigue, helps maintain normal sex drive, increases strength of all structural tissues such as skin/bone/muscles, including the heart, and prevents depression and mental fatigue. Testosterone deficiency is often associated with symptoms, such as night sweats, insulin resistance, erectile dysfunction, low sex drive, decreased mental and physical ability, lower ambition, loss of muscle mass and weight gain in the waist xviii . The primary cause of this increase in girth is visceral fat, not excessive subcutaneous fat (fat under the skin). The visceral fat cells are the most insulin resistant cells in the human body xix . They have excess hormone binding receptors for cortisol and androgens and decreased receptors for insulin (resistance to insulin). As a person ages, hormone levels change in favor of insulin resistance. The cortisol and insulin levels rise, while progesterone, growth hormone and testosterone decline. The visceral fat cell with its increased receptors, blood supply and innervation begins to collect more fat in the form of triglycerides. A vicious cycle is initiated, which if not interrupted with natural hormone balancing, will lead to abdominal obesity, diabetes and high cholesterol levels. This phenomenon is known as metabolic syndrome. Stress management, exercise, proper nutrition, dietary supplements (particularly adequate zinc and selenium), and androgen replacement therapy 2012
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