Test results for sex hormones

[TheBrain]

As I mentioned in another thread, a recent pelvic ultrasound showed I have a thickened endometrium (10 mm), and I've been experiencing some post-menopausal bleeding (but not for the past several days). I have a hysteroscopy scheduled for Monday.

For bHRT, I'm using 1/2 of a .05 mg/day estradiol patch and taking 200 mg oral progesterone at bedtime. I also take 5 mg DHEA per day. Several weeks ago, I stopped taking compounded testosterone due to concerns that it might be converting to estrogen as a consequence of mold illness/CIRS. Plus, it didn't seem to be helping me in any obvious way.

Yesterday, I got my test results for my sex hormones (and my thyroid hormones, which are suboptimal, but I'm not reporting on that here).

3/9/18
Testosterone, Total 28 ng/dl (no reference range given)
Testosterone, Free 1.4 (reference range: .6-6.8 pg/ml)
Sex Hormone Binding Globulin 178 (reference range: 13-73 nmol/L)
Progesterone 24.3 ng/ml (Dr. Bredesen's optimal range: 1-20 ng/ml)
Estradiol 35 pg/ml (Dr. Bredesen's optimal range: 50-250 pg/ml)
Estrone 40 pg/ml (reference range for post-menopausal women: < or = 65 pg/ml)

Some observations/questions:

1. I believe my estradiol is too low, and my progesterone is too high.

2. Dr. Bredesen's optimal estradiol:progesterone ratio is 10:100. I'm thinking he's saying that with an estradiol of 35, my progesterone should be 350. However, I can't be interpreting this correctly. What am I missing?

3. My Sex Hormone Binding Globulin is quite high. But I think I might have the answer as to why, per a post by Tincup from June 2017. He wrote:

On the diet/longevity front. Gundry would like us to keep our IGF-1 between 50-75. I've not met that standard, with mine running between 110-120 (my wife keeps hers in the 70's), except on day 7 of a fast where mine was 64 and hers 48. That being said, 120 is still fairly low. A consequence is high sex binding globulin hormone. Hence my free testosterone is low. Gundry has me taking 50 mg/day of DHEA to help this. It has but it is still low, out of range.

On 9/19/16, my IGF-1 measured at 46 ng/mL. My endocrinologist at the time said it's because my insulin is so low. I'm a bit below Dr. Gundry's optimal range. I supplement with DHEA (5 mg per day, as noted above), but my DHEA is suboptimal. For women, Dr. Bredesen recommends 350-430 mcg/dl. When I take 5 mg DHEA per day, I’ll get into the 100s. When I stop taking it, I can drop as low as 25. I tried taking 15 mg DHEA at one point, but my testosterone went too high per my endocrinologist.

4. I'm confused as to why I would have a thickened endometrium with such a high progesterone level relative to my estradiol. But in September 2017, my estradiol (while on the .05 mg/day estradiol patch) shot up to 234.9 pg/ml. My progesterone was 3.8 ng/ml (while taking 200 mg oral progesterone per day). Maybe my endometrium thickened then (I did start bleeding a few days after I got these test results) and has stayed that way for all these months?

5. I gather that my estrone is fine, per the reference range given. I was wondering about this based on something Slacker wrote in a post a few weeks ago. She wrote:

My FMD implied that my elevated estrone level (the "bad" metabolite pathway) could be partially explained by CIRS, which apparently can affect hormone pathways. No explanation, no references, just her opinion/experience. Again, my understanding is the "bad" metabolites can contribute to risk for breast cancer.

6. For those of you with experience using bHRT, have you had difficulty stabilizing your estradiol, progesterone, and testosterone levels? Mine seem to be jumping around. I have yet to find dosages that yield similar results two testing times in a row.

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I welcome thoughts on any of this. I am in between bHRT doctors right now and will start seeing a new one sooner than I was planning to.

[Julie G]

1. I believe my estradiol is too low, and my progesterone is too high.

2. Dr. Bredesen's optimal estradiol:progesterone ratio is 10:100. I'm thinking he's saying that with an estradiol of 35, my progesterone should be 350. However, I can't be interpreting this correctly. What am I missing?

Just guessing, but a progesterone of 3.5 with an estrogen of 35? Makes more sense.

[TheBrain]

Thanks, Julie. That does make more sense.

[KatieS]

Great to have the scope since my endometrium was misinterpreted by one GYN as thickened, only to be a polyp excised during the scope. I had intermittent bleeding, now none.

Generally with only 0.025 estradiol patch, you only need 100mg Prometrium daily or 200mg for half the month. My Gyn thought I could safely go down to 100mg at least 21 days/month. Hopefully, after Monday, you'll have more answers.

[SusanJ]

Katie, like you I am on 0.025 estradiol and 100mg Prometrium (on 21 days / month).

Allyson, underlying inflammation can wreak havoc on your hormones, including DHEA, as can hypothyroidism. Perhaps it will stabilize more as you treat your CIRS and support your thyroid.

[TheBrain]

Great to have the scope since my endometrium was misinterpreted by one GYN as thickened, only to be a polyp excised during the scope. I had intermittent bleeding, now none.

Yes, it's good you had that scope! I like hearing about good endings.

Generally with only 0.025 estradiol patch, you only need 100mg Prometrium daily or 200mg for half the month. My Gyn thought I could safely go down to 100mg at least 21 days/month. Hopefully, after Monday, you'll have more answers.

Thanks for this information. Do you think it's possible that my estradiol would increase as a consequence of dropping my Prometrium to 100 mg? I'd like my estradiol to be higher, so I've been wondering if I should go back to the full patch (instead of half a patch).

[TheBrain]

Katie, like you I am on 0.025 estradiol and 100mg Prometrium (on 21 days / month).

Do you mind if I ask what your estradiol typically runs on these doses (though I know we're all unique)?

Allyson, underlying inflammation can wreak havoc on your hormones, including DHEA, as can hypothyroidism. Perhaps it will stabilize more as you treat your CIRS and support your thyroid.

Thanks, Susan. It does make sense that inflammation could be wreaking havoc on my hormones. Hopefully, treating the CIRS will stabilize my sex hormones and improve my thyroid function. My thyroid function is not a matter of tweaking meds. I've tried that with various doctors for years. I've also been thinking about Isabella Wentz's first recommended protocol for Hashimoto's, her liver protocol. It provides gentle liver detox/support. I have no idea if my liver is up for all this detoxing. I have my share of methylation SNPs and my Doctor's Data Methylation Profile from June 2016 showed abnormalities. I have no idea where I stand with that, as I haven't been retested.

[slacker]

Katie, like you I am on 0.025 estradiol and 100mg Prometrium (on 21 days / month).

Susan, please explain why you are cycling your hormones? Are you bleeding during the 7 days you don't take them?

[SusanJ]

Alysson, I run about 50 pg/mL for estradiol. I could only hit that by using the patch (vs compounded cream). And in reading Ben Lynch's new book, he makes a convincing argument to fix methylation last, so you might leave that on the later pile.

Slacker, I found I was having brain fog among other brain effects after 8 months on Prometrium, so I tried cycling the progesterone and the brain effects subsided. No bleeding after about a year of doing this, and my levels of both are fine. Hathaway mentioned cycling in her slides. (Slide 63)

[slacker]

Generally with only 0.025 estradiol patch, you only need 100mg Prometrium daily or 200mg for half the month. My Gyn thought I could safely go down to 100mg at least 21 days/month.

Thanks for this information. Do you think it's possible that my estradiol would increase as a consequence of dropping my Prometrium to 100 mg? I'd like my estradiol to be higher, so I've been wondering if I should go back to the full patch (instead of half a patch).

TheBrain, I may be misinterpreting your question about estradiol increasing as a consequence of dropping Prometrium to 100mg (but here goes anyway); your estradiol will not go up with less prometrium. Since you are on a lowish dose of estradiol, you may not need 200 mg of prometrium to balance estrogen dominance and protect your endometrium. However, if you increase your estradiol dose, you may need the 200 mg of prometrium.