Using natural hormones to treat estrogen, progesterone, and testosterone deficiency

Townsend Letter for Doctors and Patients, May, 2004 by Jacob Teitelbaum

or

Natural Non-Prescription Estrogen/Progesterone (from 800-743-2256);
____ Phyto B--8 pellets a day (=21/2 mg Triest   50 mg progesterone);
____ Osta B3--8 pellets a day (= 2mg Estradiol   50mg Progesterone) OR;
____ Osta Derm Cream 1/2 teaspoon a day (= 2mg Triest   66mg
Progesterone).

Natural Progesterone (Rx)--(Prometrium--available in most pharmacies)--
100 mg daily if over 48 years old OR 200 mg a day for the 16th to 25th
day of your cycle if under 48 years old. Take it at night. Available
without prescription from (800) 743-2256 as _____ Progerol Cream
(66mg/1/2 teaspoon) or _____ Progon B 12-1/2mg per pellet.

Low Testosterone--Not Only a Male Problem!

Low testosterone is a major problem in 70% of my male patients with CFIDS/FMS. After six to eight weeks, the effect of treatment is sometimes marked. It is important (again, in both men and women) to check the free, or unbound, blood testosterone level. This measures the active form of the hormone. A serum (or total) testosterone level measures only the inactive storage form of the hormone. Inactive (total) testosterone levels are often normal while the active (free) testosterone levels are low or barely normal in most male CFIDS/FMS patients. Low testosterone is associated with many problems, including fatigue, poor stamina, muscle wasting, and poor libido. Although testosterone levels are normally much lower in females, deficiencies in women cause these same problems. Testosterone is critical in females, as well as males, and I find low free testosterone levels in many female CFIDS/FMS patients as well.

Again, it is important to check the free (not just total) testosterone. Most laboratories can test free testosterone only if they also do the total testosterone--this is a normal procedure. Be sure that the normal ranges for the lab results are broken down by ten-year age groups (31 to 40 years old, 41 to 50 years old, and so on). It is meaningless to have a normal range that includes 80 year-olds if the patient is 28. If the result is below normal, or even in the lowest 25% of the normal range, I would consider a trial of testosterone therapy.

Treating Low Testosterone

For men, the standard dose is about 100 to 125 milligrams intramuscularly (by injection) every seven to ten days. It can also be given as 200 milligrams every two weeks, but this can result in peak levels right after the shot that are too high, and levels that go too low for a few days before the next shot. Adding testosterone patches on day nine to fourteen (when getting injections every fourteen days) can avoid the levels going too low. I feel that getting shots weekly is preferable, though. Unfortunately, the skin patches are not adequate for the job. I may begin with the cream or switch to testosterone cream (100 milligrams per gram in pluronic-lecithin-organogel (PLO gel) from a compounding pharmacy after a male patient has been on the shots for eight weeks so he can tell what the optimum effect is. Most men need 25 to 50 milligrams rubbed onto thin-skinned areas (for example, the inner upper arms from the elbow to two inches below the armpit) one to two times a day. The problem (for men) with taking tablets, instead of the shots or cream, is that oral testosterone goes to the liver first. The higher dose required by men (as opposed to women) can raise cholesterol levels. I'm beginning to suspect that avoiding other possible side effects by using the hormone cream twice daily (instead of getting high and low levels by taking the shot every week or two) is better. The cost can be markedly decreased by ordering the cream as 100 milligrams of testosterone per gram of cream. A new testosterone gel (Androgel, available in 25- and 50-milligram packets) may also work. Although much more expensive--approximately five dollars a packet--it may be cheaper if the patient's insurance covers prescriptions. A single daily dose of 50 mg of Androgel rubbed onto the arms or abdomen maintains blood levels for over 24 hours.