Your Options for Safe and Effective Hormone Replacement Therapy

The Current GYN Protocol For HRT is to prescribe estrogen and progesterone only, and these usually as oral tablets which until recently were the only formulations available. The average gynecologist has to worry about liability if he/she prescribes testosterone which is not yet approved for use in women without an irrefutable corroborating test result.

This regimen will only help you marginally. In order for HRT to be effective, you should be replacing all three of the sex hormones, including; a low dose of testosterone. It is also advisable to use topical formulations.

Let's look at ALL your OPTIONS by hormone group. Some of these products are available by prescription from your doctor; others do not require a prescription and can be purchased over-the-counter or from on-line pharmacies.

There are a great many available estrogen replacement products that you can get by prescription from your gynecologist that are covered by most insurance policies. Do not accept oral forms of this hormone as these are very unlikely to alleviate your symptoms. Insist on parenteral formulations.

That said, the choices are many:

1) Patches - Applied to the belly or buttocks, these adhesive patches deliver estrogen through the skin, can be worn while showering or swimming, and need to be changed only twice a week or every couple days, depending on the package directions. They come in a variety of strengths according to your individual needs.


2) Creams and Gels - These can be made up by a compounding pharmacy on prescription, and commercially packaged versions are also available from your doctor. (Still others are sold without need of a prescription by internet pharmacies.) These creams are intended to be applied to the external genital area or inserted vaginally with an applicator.


3) Rings - A new form of estrogen delivery is the intervaginal ring, worn in similar fashion to a diaphram, continuously for an extended period (30-90 days specified in manufacturer's directions), then replaced.


4) Pellets - Another means of estrogen replacement is by subdermal pellets. These time release pellets are injected beneath the skin every 3 to 4 months.

More information about this method of HRT can be found here:

5) Nasal Spray - There is at least one such product available, although probably only available by purchase through internet pharmacies.

6) Oral Pills inserted vaginally - If you must pay for HRT out of pocket because you are not insured, this is the most cost-effective means of obtaining safe and effective estrogen replacement. Generic estrogen tablets cost a fraction of the price of patches, creams and rings. However you will want to cut those tablets in halves or quarters depending on their strength and your needs, because bioavailability through mucus membrane tissue is high. A 2mg tablet would be best cut into 4 doses of .5mg each.


SAFETY NOTE: None of these topical estrogen products should be applied to the breast area. Estrogen will not cause breast cancer, but in the event that you should develop breast cancer cells, estrogen applied to the breast will feed the cancer and make it grow faster. This is precisely why topical estrogen products are safer, because unlike oral estrogen pills, they do not make that first pass through your entire body via your digestive system. Instead topical estrogen is applied directly to those areas where it is needed.

The so called "male hormone". However this hormone is present in both sexes, although in differing quantities, and when the supply runs low our health takes a major hit. This hormone keeps our hearts and other vital organs healthy, maintains bone density and muscle strength, controls brain activity, and performs a host of other critical functions. This hormone is so important, in fact, that I have devoted an entire web page to testosterone.

Unfortunately testosterone is caught in the crossfire of the DEA and their ill-conceived mandate to remove controlled substances from the public sector.

This is the reason behind the FDA's refusal to approve the "Intrinsa" testosterone patch for women. Approval of this product and those in line for approval behind it would have revolutionized women's health care. As it stands no testosterone product is approved by the FDA for women (despite the fact that NO serious adverse health effects have ever been shown to result from low dose testosterone replacement in menopausal women).

These facts have made physicians extremely reluctant to prescribe any product containing even a trace amount of this "anabolic steroid". You will undoubtedly be required to take a blood hormone level test before your doctor will prescribe testosterone. If you are lucky and the lab test shows low enough levels, he/she can write a prescription for:

Testosterone Gel or Cream
A compounding pharmacy will mix this per your gynecologist's order. This is applied the same way as estrogen topical gel/cream.

See above (under Estrogen Products). Most hormone pellet therapy includes both estrogen and Testosterone. This therapy is not FDA approved and the insertion technique requires that the administering doctor have some skill.

Estratest and theThe Black Hole of Legality.
Although this combination estrogen/testosterone product for women is an oral medication, I know women who swear by it, and, after all, any testosterone replacement therapy is better than no TRT. The deal is that gynecologists have the green light to prescribe this non-FDA-approved medication for women who have not shown substantial improvement on "traditional" estrogen or estrogen/progesterone combination HRT. Here is the full story.

DHEA, An Inexpensive Legal Alternative to Testosterone
For those who wish to pursue alternate channels,
I would caution that purchasing any type of testosterone product from an internet pharmacy is putting yourself at risk. After all, you don't want these guys after you!

There is a non-prescription alternative to testosterone on the shelves of drugstores and vitamin shops. DHEA (dehydroepiandrosterone) is a viable substitute for testosterone. Like testosterone it is an androgen, and my experience is that both work equally well. However, like testosterone and other hormones, DHEA should not be taken by mouth. DHEA has only 3% bioavailability when swallowed but 33% when used transdermally and still higher absorption through vaginal tissue. A 5mg capsule per day inserted vaginally should perform as well as any of the testosterone products listed above.

It is said that DHEA can convert into estrogen as well as testosterone, but based on my experience I believe it has a propensity to remain androgenic. However I also suspect that in a menopausal woman taking no supplemental estrogen, DHEA might fill the need. My strong suspicion is that DHEA could be a complete HRT program all by itself, but this has yet to be proven.

I listed this hormone last because of the uncertainty that surrounds it. Progesterone is the least understood of the sex hormones.
Some facts are known, for instance that progesterone's major role is to maintain pregnancy. (When a woman ovulates, her progesterone levels rise. If she becomes pregnant the levels continue to rise, but if conception does not occur the levels fall off and the uterine lining is shed.)

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