Why Physiologic HRT Over Static Dosing
Many hormone protocols involve “static doses” where blood tests are used to estimate hormone levels, and patients are then prescribed a fixed amount of estradiol and/or progesterone to be taken or applied daily. However, this approach does not align with the natural way hormones are produced in the body or how they appropriately activate genes. It overlooks the complex interplay between estrogen and progesterone, leading to suboptimal physical, mental, and behavioral outcomes.
Physiologic hormone replacement therapy (HRT), on the contrary, achieves a proper balance of estrogen and progesterone by ensuring that they are present in the correct quantities, at the appropriate times, and with an overlap of suitable hormones. This meticulous adjustment of the genetic signal is intended to enable the body to optimize its organ systems, including the cardiovascular system, bone metabolism, and reproductive system, among others.
For more information, please go to our The 28-Day Cycle and Health page.
Why does Physiologic HRT use Estradiol vs Biest?
The primary estrogen produced by the human ovaries is estradiol, while estriol is a non-reversible metabolite of estradiol that is predominantly produced by the fetal liver during pregnancy. In non-pregnant women, estriol is generated in very small quantities as a byproduct of estradiol metabolism, and it does not function as effectively. Additionally, combining estriol with estradiol dampens its effects and disrupts the proper genetic signaling necessary for optimal health.
Do women mind getting their periods again?
Throughout history, and even today, there has been a lack of cultural acceptance of a woman’s menstrual cycle. This societal norm, perpetuated by birth control pill marketed by pharmaceutical companies, portrays menstruation as unwanted and unnecessary. However, a closer study of the release patterns of estradiol and progesterone during a menstrual cycle reveals that a monthly period can serve as a barometer for overall body functioning. Having a uterus, being on hormones, and experiencing menstruation can indicate optimal cardiovascular health, bone health, brain health, and more. While some women may be hesitant about returning to having periods while on Physiologic Hormone Restoration, the benefits in terms of overall health make it a worthwhile trade-off for most.
Are the Physiologic HRT hormone doses too high?
Women in their mid-teens through their 30s, just prior to perimenopause, typically produce an average of 250 pg/ml, but potentially up to 800 pg/ml, of estradiol on day 12 of their menstrual cycle. These levels, though seemingly high, are physiologically necessary for establishing progesterone receptors for the luteal phase of the cycle.
Many practitioners typically target estradiol levels of approximately 70 ng/ml when using low-dose hormone replacement therapy (HRT) to address menopausal symptoms. However, such levels may only be sufficient to alleviate symptoms and may not provide the necessary gene signaling for optimal health. Additionally, administering estrogen and progesterone, even in the form of bioidentical compounds, in static low-dose regimens is not physiologically reflective of the natural hormonal patterns in healthy, fertile women.
The hormone levels in Physiologic Hormone Replacement Therapy (HRT) are not high; they are designed to mimic the same levels that women naturally produce during their reproductive years.
Is it safe to give estradiol unopposed for 2 weeks out of the month?
In Physiologic Hormone Restoration, progesterone is used for only two weeks of the month, mimicking the natural progesterone production pattern during a normal menstrual cycle. This approach is supported by a study of women on hormone replacement therapy (HRT), which demonstrated that cyclical use of progesterone with estrogen provides greater cardiovascular protection compared to continuous use of estrogen and progesterone. This is further supported by the current standard of care recommended by the European Medicines Agency and the US Endocrine Society, advocating for cyclic use of progesterone throughout the month in women. (read the article here).
What about the risk of breast cancer on Physiologic HRT?
Dr. Julie Taguchi, an oncologist in Santa Barbara who specializes in breast cancer, has conducted observational studies in her own practice on the use of physiologic dosing of estradiol and progesterone in patients with cancer. Her findings suggest that women experience a better quality of life without a significant increase in recurrence or new breast cancers when using physiologic hormone replacement. However, long-term data with large patient populations is currently unavailable, which has led some physicians to be cautious due to the lack of comprehensive data. Nevertheless, ongoing clinical research is underway in this field. (read about our IRB-approved clinical study here.)
How does Physiologic HRT address estrogen dominance?
Estrogen dominance is a non-traditional HRT term used to describe the ratio of estrogen in reference to progesterone, or the excess amount of xenoestrogens that may be prevalent in women’s bodies today due to environmental toxins. In perimenopause, women may have higher levels of estradiol compared to progesterone, or in menopause, women may have higher estrone levels compared to a non-existent progesterone level.
To combat this estrogen-progesterone “imbalance”, many HRT practitioners provide patients progesterone solo-therapy, and maybe just a little bit of estrogen, with the reasoning that they have too much estrogen. Estrogen dominant or not, women in perimenopause and in menopause are still estrogen deficient and need estrogen replacement therapy. The goal of Physiologic HRT is to replete this estrogen deficiency and restore the balance between estadiol and progesterone to where they keep women healthiest.
The Mission of WHN is to expand the Standard of Care by promoting, advocating, and advancing women’s wellbeing and longevity through clinical research and education about the benefits of Physiologic Restoration™ to reduce the symptoms of hormone imbalance, chronic disease and degenerative decline.
WHN is a registered 501(c)3 not-for-profit corporation