Most health providers understand the value of establishing baseline hormone levels when creating an individualized treatment plan that includes bioidentical hormone replacement therapy.
Two important questions then arise:
- Once treatment is initiated, which hormones should be monitored and how often?
- What additional measures need to be taken to ensure that the proper therapeutic levels are measured? If you've had these questions then you aren't alone! Here are a few guidelines to ensure that your hormone levels are well monitored and their hormones remain at optimal levels.
While conventional recommendations regarding hormones are to use them for a short period of time to manage the acute symptoms of hormone changes, a comprehensive hormone balancing program is a long term proactive plan to maintain an optimal quality of life and prevent many degenerative conditions.
Many patients on a BHRT program will be on physiologic doses of hormones for years - often during and into their golden years. During this time frame endogenous production of hormone levels continue to decrease concurrent with the aging process. Lifestyle factors such as weight fluctuations, changes in activity level and various diet and disease states can also influence individuals' hormone levels.
Retesting salivary hormone levels is therefore imperative to ensure optimal levels are maintained over time. Monitoring hormones is necessary not only as a periodic "check-in" to ensure optimal levels, but also for any individual who develops new complaints while participating in a BHRT treatment plan and for incomplete resolution or worsening of initial symptoms.
For those individuals utilizing cortisol therapy as a component of their BHRT program, retesting at regular intervals is necessary to monitor the adrenal response to treatment and recovery. Whether a BHRT program is addressing cortisol levels, sex hormone levels (estradiol, progesterone, and testosterone) or prohormone levels (DHEA), regular retesting ensures proper dosage amounts are being used.
In general, an initial retesting should be done 2-3 months after a patient begins a new hormone regimen. If symptoms resolve in this time frame and salivary testing reveals optimal levels of the tested hormone(s), monitoring does not need to be performed for another 12 months unless symptoms of hormone imbalance develop in that time.
An exception to this initial 3 month guideline occurs when retesting cortisol levels in an individual with established (Phase 3) adrenal gland fatigue. In these individuals, initial cortisol retesting may be considered anywhere from 3-6 months after starting their treatment plan depending on clinical response and treatment.
It is important to understand the hormone cascade when determining which hormones should be retested. The levels of any hormone that is part of a treatment plan should be monitored, as well as downstream hormones as conversion from one hormone to another is not easily predicted. For example, the aromatase enzyme converts testosterone to estradiol and DHEA is a precursor to both testosterone and estradiol. For these reasons, when DHEA or testosterone are used in a treatment plan, it is important to also monitor estradiol levels.
When retesting, it's important to instruct the patient in proper dosage intervals based on the form of supplementation they are utilizing. This ensures the results gleaned from the test accurately reflect your therapeutic hormone levels.
Supplementation Form Dosage Interval
Sublingual 24-36 hours after last supplementation
Topical 12-24 hours after last application
Oral Continue supplementation as normal on day of collection
Injection Mid cycle collection of sample