Dosing Hormone Replacement – Fast and Slow Metabolizers

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Hormone replacement dosage can be significantly different from person to person. Even if they are the same gender, age, and size.

It is a Little-known fact that each person has his or her own individual metabolism that breaks down food, drugs, vitamins, and toxins such as alcohol and poisons down.  When it comes to metabolism one size does not fit all! Metabolism determines the dose of hormones a patient needs and how often they need their hormone pellets. This is our subject for this week’s Healthcast. 

My medical practice, BioBalance Health is centered on the replacement of bio-identical hormone pellets.  The dosage of these pellets is the trickiest part of prescribing pellets and one of the reasons more doctors don’t use them to replace hormones after andropause and menopause.

Hormone pellets for women last between 3 and 6 months before they need to be redosed.  We arrange the timing of the insertion of pellets so that the old pellets are still dissolving when the next pellets are replaced so there is no big fluctuation in blood levels before and after the new pellets are inserted. 

My specialized medical pellet training taught me the hormone pellet dose for the average size woman or man, for the average metabolism, and average level of physical activity.  So we learn the dose for a 170 lb male who takes no other medications, drinks minimal alcohol, and exercises no more than 3 times a week for an hour each.  I don’t know about you but I rarely meet this average patient.

In reality the hormonal dosage depends on many variables that are different for each individual.  These variables depend on the following:  how much hormone a person needs daily, genetically how sensitive that person is to estradiol and testosterone (the receptor sites on the cells); how quickly the fat dissolves the hormone pellets; how long the hormones spend circulating in the active form in the body; how fast the liver breaks the hormones down; and the speed of break-down through the liver.

One of the most important facts that help me and any other doctor decide on dosage is how much medication you need when prescribed.  An example, if do you need 2 rounds of antibiotics to get rid of an infection, or double the amount of sleep medicine to go to sleep?  If this is typical for you, it means you have a fast metabolism and need more hormone dose, not less, or you need pellets more often.  On the other hand, if you take ½ a narcotic and it knocks you out or one pain pill makes you silly or knock you out then you are in general a slow metabolizer, and would need less hormone dose to last 4-6 months.

The metabolic factor that is the part of the dosage equation that is the hardest to factor in to decide on a starting dose of pellets.  You as the patient can help me decide on an accurate dose by correctly listing medications, supplements, habits like smoking, accurate count on your alcoholic intake and exercise, because history is all there is to determine how much hormone you will need over 4-6 months.

In the end, I use all of these pieces of information to determine a starting dose, however I don’t always get it right, so I have to use blood work and symptoms to adjust the dose at 3-4 months after pellet insertion.  The more I prescribe pellets the better I do at initial dosage for my patients.   After deciding on an effective dosage, maintenance is a breeze and much more stable a dose for our patients.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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