BHRT - part 2

Sunday August 14, 2011 comments

I stated that hormone testing is the first and most critical part of a successful Bio Identical Hormone Therapy regimen.  I, first, need to clarify that only you and your doctor can determine if BHRT, or conventional hormone therapy for that matter, would be appropriate.  Some people have pre-existing conditions e.g.- breast of prostate cancer, etc.  This may preclude you from replacement therapy, at least in the short term.  However, if hormone replacement is deemed to be beneficial after consultation with your doctor, then BHRT is the logical choice.

So how do you know which hormone(s) you need and at what dose?  There are a variety of testing modalities that can be used.  The two most common are serum blood testing and saliva testing.  The most traditional and best known among providers is serum blood testing. 

The amount of hormone in your blood has well established ranges.  These normal ranges hold up well when they are measuring a hormone level that is being naturally produced by the body and not supplemented.  Serum blood testing is fine for testing someone who is not supplementing with hormones and is being tested for "baseline" levels.  Baseline levels are the concentration of the hormone(s) when they are being produced by your body.

Saliva testing is another type of hormone level test.  Instead of looking at hormone levels in the blood, we are looking at concentrations of hormone outside of the blood in the saliva gland.  This level better mirrors the levels of hormones found in other glands and organs that produce hormone related symptoms including the brain.  Saliva hormone levels correlate well to clinical symptoms.

Discrepancies between saliva and serum blood test results begin to occur when you are testing patients who are supplementing with hormones, especially topically applied creams and gels.  An example of this would help highlight the dilemma.  Young men produce approximately 5-10 mg of testosterone daily.  A typical commercially available pharmaceutical product recommends 25-100 mg of testosterone be applied as a gel.  Why is this testosterone level 5-10 times more than when a young man produces it naturally?  The pharmaceutical company says that this is what it takes to produce the same blood level that a young man has, while producing 5-10 mg's daily, naturally.  Why is there such a large discrepancy?  A saliva test on the other hand shows 5-10 times higher levels than it would be at baseline.  Which testing modality should you use?  While the controversy roars, I personally would rather start low and go slow when it comes to hormone dosing.

Please feel free to comment or ask questions.  We will be glad to address every one that we receive. 


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