Useful BHRT Information for Practitioners

Bio-Identical Natural Hormone Replacement Therapy

Natural Hormone nomenclature:
E1 Estrone (estr one )
E2 Estradiol (estra di ol )
E3 Estriol (es tri ol )
P or P4 Progesterone
T Testosterone

Bi-Est Estriol plus Estradiol
Tri-Est Estriol Plus Estradiol Plus Estrone
Bi-Est is usually 80% E3 and 20% E2 but can be 70/30 or 60/40 or 50/50. Tri-Est has always been 80% E3, 10% E2, and 10% E1 (also written as 8:1:1)

Any strength can be ordered. The following are suggested ranges:
Oral or Topical:
E3 1 to 5mg per day
E2 0.3 to 2mg per day
P4 25 to 400mg per day
T 0.5 to 4mg per day (female)
25 to 50mg per day (male)

Sublingual:
E3 0.5 to 3mg per day
E2 0.15 to 1mg per day
P4 10 to 200mg per day
T 0.25 to 2mg per day (female)
5 to 20mg per day (male)

Compounding pharmacies use micronized E2 so it is usually prescribed in somewhat lower strengths than if ordered from pharmaceutical manufactured stock.

In addition to using micronized estrogens, progesterone and testosterone, Acology chooses to dissolve these hormones in oil before putting into capsules or compounding into creams or S.L. drops. Hormones are soluble in vegetable oils but not in water. Pre-dissolving in oil helps insure absorption. We use olive oil, safflower oil and medium chain triglycerides for this purpose. Our oils are preserved with Vitamin E. There is also a theory that hormones dissolved in oil are partially absorbed into the lymphatic system to help beat first pass liver metabolism.

Suggested Conversion Guide
(Every patient is different- these are just suggested starting points)
following suggestions are for daily dosing- they may be halved for BID if desired

If patient is on: Premarin .625mg or Estrace 0.5mg or Estraderm 0.05mg or Estinyl 0.02mg or Ogen 1.25mg
Try Bi-Est 80/20 at 2.5mg per day oral or topical or Bi-est 80/20 at 1.25mg per day for sublingual

If patient in on Prempro:
Try Bi-Est 80/20 at 5mg plus Progesterone 50 to 200mg per day (oral or topical) or Bi-Est 80/20 at 2.5mg plus Progesterone 25 to 100mg per day for sublingual

If patient is on Estratest:
Try Bi-Est 80/20 at 2.5mg plus Testosterone 2.5mg per day (oral or topical) or Bi-Est 80/20 at 1.25 plus Testosterone 1mg per day for sublingual

Since Progesterone (NOT MEDROXYPROGESTERONE) helps to redeposit new bone, slow conversion of estrogens to catachol estrogens in breast tissue(cancer), balance natural estrogenic side effects (breast tenderness, fluid retention etc), helps patients sleep, decreases headaches and bruising etc etc. it is recommended in addition to Bi-Est for all NHRT candidates.

Consider topical low dose Estriol intravaginal dosing for patients with dryness, chronic vaginal yeast, chronic UTI, vaginal breakdown. 0.5mg at bedtime for 14 days then just 2 or 3 times a week for maintenance.
Consider Testosterone not only for libido but for bone density, muscle strength and sense of well being. (male and female).

Consider SSRI antidepressants as possible cause of libido problems.

Consider natural hormones for patients with depression that are on Premarin. Also consider triiodothyronine as a possible treatment (with or without levothyroxin).

Consider possible low hormone levels as a result of anti-cholesterol medications. Cholesterol is the basis for all hormone production.

Consider increasing bone density with natural estrogens (to slow re-absorption) PLUS progesterone (and testosterone) to speed deposition of new bone.

Natural Hormone Replacement Therapy has gained so much acceptance and respect that there are a lot of companies trying to get a piece of it. Herbs and Premarin are natural. However, they are not Bio-Identical. That is why you will see more references to the terminology Bio-Identical Natural Hormone Replacement Therapy (BNHRT).