“ Learning is 50% learning something new and 50 % unlearning something old”
– In a Pit with a Lion on a Snowy Day – Mark Batterson
Early this summer I attended the Functional Medicine and Advanced HRT Symposium in Nashville. These intensive review sessions allow me to return home with new information, knowledge, and ideas that will help me to better serve my patients and practitioners. During this seminar, several experts in the field emphasized physiologic dosing of hormones with the adage “Start low, go slow”. They stressed that excessive doses may provide clinical relief of symptoms initially. Then, symptoms return in a couple months because excessive hormones mimic the symptoms of hormone deficiency. This phenomenon is the result of down-regulation of hormone receptors.
They also highlighted the fact symptoms classically attributed to sex hormones (estrogen, progesterone and testosterone) can be caused and/or aggravated by other endocrine hormone imbalances or nutritional deficiencies. Diet, exercise, sleep patterns, thyroid levels, cortisol levels and insulin resistance can all contribute to those symptoms. Addressing those issues and concerns may have more effect on symptoms than supplementing or changing sex hormone dosages.
The take away message is “more is NOT better”. The goal is to find the lowest dosage that controls symptoms. Proper dosing can take several months to alleviate the symptoms. Understanding that symptomatic relief may take up to 60 days to achieve when a dosage is changed or initiated is definitely one of the basic principles in hormone replacement. I have always considered my dosage recommendations to be conservative but these experts made me realize I have some unlearning to do.