07/15/2025
How does Hormone therapy work?
Here in our little corner, in the name of transparency, here is how:
Hormone Therapy Protocol for Women: Estradiol, Progesterone, and Testosterone
Purpose:
To provide evidence-based, individualized hormone therapy using estradiol, progesterone, and testosterone to alleviate symptoms of hormone deficiency and improve quality of life in women.
Initial Assessment and Indications
Menopausal or perimenopausal symptoms: hot flashes, night sweats, mood swings, insomnia
Low libido, fatigue, poor concentration
Vaginal dryness, urinary symptoms
Osteopenia/osteoporosis
Surgically induced or premature menopause
Sexual dysfunction (testosterone)
1.2 Contraindications
History of breast or endometrial cancer (unless cleared by a specialist)
Active or recent thromboembolic disease
Undiagnosed vaginal bleeding
Active liver disease
Pregnancy
2. Baseline Workup
2.1 History
Full menstrual, reproductive, and surgical history
Cardiovascular risk, cancer history, bone health, libido/sexual function
Medication and supplement use
2.2 Physical Exam
Vitals (BP, weight, BMI)
2.3 Baseline Labs
Minimum panel:
Estradiol (E2)
Progesterone
Total and free Testosterone
DHEA-S
FSH, LH
CBC, CMP, lipid panel
TSH, free T3, free T4
HbA1c or fasting glucose
Vitamin D and more
3. Hormone Therapy Regimens
3.1 Estradiol
Purpose: Alleviate vasomotor, genitourinary, cognitive, and mood symptoms
Preferred forms:
Transdermal patch: 0.025โ0.05 mg twice weekly
Transdermal gel: 0.5โ1 mg/day
Oral estradiol: 0.5โ1 mg/day
3.2 Progesterone
Purpose: Endometrial protection (if uterus intact), sleep support, mood stabilization
Preferred form:
Micronized progesterone (bioidentical): 100โ200 mg orally at bedtime
Alternatives:
Vaginal progesterone (if GI intolerance)
IUD (e.g., Mirena) for progestin delivery
3.3 Testosterone
Purpose: Treat low libido, fatigue, poor muscle mass, and cognitive issues
Common forms and doses (female dosing):
Transdermal cream/gel (compounded): 0.25โ0.5 mg/day
Intramuscular (less common): 2โ4 mg IM every 2โ4 weeks
Commercial male-dose products must be compounded for women
4.0 Follow-Up Schedule
3 months: Symptom review, side effects, labs (estradiol, progesterone, testosterone, SHBG)
6โ12 months: Lipids, liver function, CBC, continued symptom and risk assessment
Annually: Mammogram, pelvic exam, bone density (if needed), comprehensive review
4.1 Adjustments
Estradiol: Increase dose if hot flashes persist; decrease if breast tenderness or fluid retention
Progesterone: Adjust based on uterine bleeding, mood, and sleep
Testosterone: Adjust if no symptom improvement or signs of excess (acne, hair growth, voice changes)
5. Duration of Therapy
Use the lowest effective dose for the shortest necessary duration, but duration can be individualized based on age, symptom severity, and patient preference
Women with premature menopause or POI should continue HT at least until the average age of menopause (~51)
6. Patient Counseling and Consent
Discuss risks (e.g., breast cancer, VTE, endometrial hyperplasia) vs benefits
We explain the role of each hormone clearly
Encourage lifestyle support: diet, exercise, stress management, smoking cessation
Follow-up evaluations and response to therapy
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