HORMONE MAKEOVER

GUIDEBOOK

HOW TO OVERCOME HORMONE IMBALANCE WITH

BIOIDENTICAL HORMONES + SUPPLEMENTS

BY: DONNA WHITE

 TABLE OF CONTENTS
4 FOREWORD
5 INTRODUCTION

9 A MAKEOVER FOR YOUR HORMONES?

How Do You Know If You Need A Hormone Makeover?
10 Who Do Hormone Problems Affect?
When Do Hormone Symptoms Start?
What Causes Hormone Problem?
10 WHAT ARE BIOIDENTICAL HORMONES?
11 What Are The Benefits of Bioidentical Hormones?
Are Bioidentical Hormones Safe?
13 THE HORMONE MAKEOVER PROCESS
How Do You Test Hormones?
14 Which Hormones Should You Test?
15 BIOIDENTICAL HORMONE PRESCRIPTIONS
16 What is a Compounding Pharmacy?
How Much Do Bioidentical Hormones Cost?
Does Insurance Cover BHRT?
16 USING HORMONES
17 Progesterone
20 Estrogen
23 Testosterone
25 DHEA
28 CORTISOL IMBALANCES
29 Managing Cortisol Imbalance
31 THYROID HORMONE IMBALANCE
32 Thyroid Treatment
33 INSULIN RESISTANCE
What Causes Insulin Resistance?
34 Addressing Insulin Resistance
35 SUPPLEMENTAL SUPPORT FOR HORMONE IMBALANCE
36 When To Expect Results for BHRT

37 RESOURCES
Copyright © 2013 by Hormone Makeover LLC First Printing 2013
The Hormone Makeover Guidebook, How to Overcome Hormone Imbalance with
Bioidentical Hormones and Supplements
by Donna White
Printed in the United States of America
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Warning: This book is designed to provide information in regard to the subject
matter covered. The author and publisher do not intend that information in this
book substitute for personalized medical advice from a licensed medical doctor. The
information in this book is only intended as general information and should not be
used in any way to diagnose, treat, cure or prevent any disease. It is sold with the
understanding that the publisher and author are not liable for the misconception or
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 FOREWORD
Each of us has a unique hormonal makeup, and our
bodies have different needs for different hormones
at different times of our lives. Figuring out which
hormones are out of balance and correcting the
problem can be a confusing process for women
and their doctors!

In this e-book, Donna White explains how different

hormones affect virtually all of the important
functions in the body, and she provides information
to help you understand how hormonal imbalances
may be contributing to your symptoms.

Not all hormone therapies are the same - the difference between synthetic and bioidentical
hormones is discussed to equip you with the knowledge you need to make well-informed
decisions you can feel confident about.

Donna White has been helping women to balance their hormones for over a decade,
and I am privileged to have the opportunity to work with her. She is an excellent teacher
– helping patients to understand their complex hormonal puzzle, and training many
healthcare professionals over the years.

Please use the information provided to guide your discussion with your healthcare provider.
Balanced hormones may be just what you need to feel like yourself again!

Deborah Matthew, MD
Advanced Fellow in Anti-Aging and Functional Medicine
Diplomate, American Board of Anti-Aging and Regenerative Medicine
Diplomate, American Board of Integrative and Holistic Medicine
Founder and Medical Director of Signature Wellness Center for Optimal Health
www.signaturewellness.org

4
INTRODUCTION
Hello my name is Donna White and I am a
recovering PMS patient.
Just to be clear, PMS stands for Pretty Mean Sister. Yes, that was
me, nearly 20 years ago, when once a month I became an irritable,
grouchy, short-tempered woman with heavy periods, accompanied
by premenstrual headaches and acne. It was affecting my life, my
work, and my relationships.

I needed help but I did not want to take medications or synthetic

hormones. Synthetic hormones are made of chemicals or are animal
derived. Therefore they are different from the hormones our body
is supposed to make which often leads to side effects. I wanted
to fix whatever was causing my symptom so I did not have them
any more. I knew my issues were hormone related and achieving
hormone balance was the solution. By testing my hormones I found
out that I was low in progesterone and made too much testosterone.
I also learned that using natural, biologically identical progesterone
(the same progesterone our body makes) has a 90% success rate in
treating PMS with no side effects. I researched the supplements that
help address PMS and the foods that make it worse.

I implemented these key elements and rapidly overcame the PMS. Armed with the right
information and treatment plan, you can do the same thing.

However, as I moved through my thirties and forties, the stressors in my life mounted and new
symptoms arose despite the fact that I followed a very healthy diet and exercised. I am sure many
of you can relate to dealing with a lot of stress day after day. The severity of the stress in my life
affected my adrenal gland health, resulting in adrenal hormone imbalances. With PMS managed, I
then faced fatigue, feeling wired but tired, pain, and I could not get a good night’s sleep because
I woke up several times each night. To make matters worse, a slight thyroid hormone deficiency
caused me to feel even more tired, always cold, and my hair was thinning. I soon realized that
all of my hormones needed care and they all affect each other. Once again, hormone testing,
nutritional supplements, and bioidentical hormones alleviated my symptoms.

Now I have gone through menopause, I watch my hormone levels and keep them managed.

This gives me great peace of mind knowing these same strategies are also protecting my long-term
health. After turning 50 a few years ago, I am concerned about aging - everything from wrinkles to
bone loss and Alzheimer’s. I have four children and I do not want them to take care of me. I want
to help them with their children and enjoy my life to the fullest. I know I can’t stop the birthdays
from coming but I can do a lot to slow down the effects of aging and prevent diseases associated
with aging by making sure my hormones do not drop too low. So can you. You don’t have to get
all wrinkled, feel tired, hunched over and forgetful. You can look and feel good at 50, 60, 70, 80 and
even 90. Let me help.

5
 Do You Need a Hormone Makeover Too?

If you can relate to my story maybe you need a Hormone Makeover too. To put it simply, a
Hormone Makeover identifies hormones that are too high, too low, or out-of-balance with
each other then correcting those with a customized treatment plan consisting of bioidentical
hormones, supplements, nutrition, and lifestyle changes to correct the underlying hormone
imbalances. Let me help.

How To Get Your Hormone Makeover

Step 1 – Review The Symptoms

I have written this guidebook to help you walk through the process of a Hormone Makeover.
First, I invite you to look at the symptoms of hormone imbalance on the next page. If you
have many of the symptoms in these lists, you most likely have some type of hormone
imbalance and you will need to work with a medical provider trained in Bioidentical Hormone
Replacement Therapy.

Step 2 – Read This Guidebook Before Seeing You Medical Provider

Hormones and the current treatment options can be confusing. Before you even see your
medical provider for the first appointment read through this guidebook. It will answer most
of the common questions about hormones. I want to help you learn more so you can make
informed choices. As you learn about hormones, the better equipped you will be to help
your provider help you.

Step 3 - Work With Your Medical Provider

Your medical provider will examine you, review your health history, your symptoms, and
your health concerns and goals in detail. Specialty testing to verify hormone imbalances
will be ordered. Armed with your personal medical information and lab results your
medical provider can develop the appropriate customized treatment plan with bioidentical
hormones, supplements, and nutrition to correct the underlying hormone imbalances.

Step 4 – Implement Your Hormone Makeover Treatment Plan

Once you have the results of your lab work and your customized treatment plan, read
through this guidebook again to refer back to sections that apply specifically to you. For
example, if your progesterone is low, review the symptoms of low progesterone, using
progesterone, and the symptoms of excess progesterone. The information in this guidebook
will be even more relevant once you know your lab results and have your plan.

Take advantage of other helpful resources on my web site:

www.hormonemakeover.com.

You can also read my in-depth book, “The Hormone Makeover – 7 Steps to Transform
Your Life With BioIdentical Hormones”.

6
Step 5 – Ongoing Care for Your Hormone Makeover
You will need ongoing care and monitoring to make sure you are getting the results you
want and need. This includes periodic office visits with your medical provider and repeat
testing. You should see this as a way to be good to yourself and protect your long-term
health.

Let me conclude with this last thought.

I realize that the symptoms of hormone imbalance (as listed in detail on the next
page) are common, but they are not normal. You do not have to be resigned
to just deal with them! Nor do you have to chalk symptoms up to just getting
older. You don’t have to get all wrinkled, feel tired, hunched over and forgetful.
You can look and feel good at 50, 60, 70, 80 and even 90.

You deserve to look and feel good. Believe me, I know what it is like to have
hormone imbalance and I know what it is like to have balanced hormones.
Balanced hormones make my life so much better. Balanced hormones can
greatly improve the quality of your life too.

Get yourself a hormone makeover. I will walk you through the process.

Let’s go!

7
DO YOU NEED A HORMONE MAKEOVER?
Because hormones affect every cell in your body, it’s not surprising that hormone excesses, deficiencies or
imbalances can produce some very unpleasant, debilitating and even dangerous symptoms. For example,
hormones affect your cardiovascular system, central nervous system, blood sugar levels, bone density, weight and
skin. Hormones also affect brain function and mood, so hormone imbalances can impair mental sharpness, ability
to focus, and short-term memory, causing you to feel as if your brain is in a fog. At the same time, mood swings,
irritability, depression, and anxiety may increase, thus creating a dreadful combination! Needless to say, this perfect
storm of ‘out of control’ hormones can be pretty rough on your career, relationships, and all other areas of your
life. The following questions can help you decide if you might need a hormone makeover…

SYMPTOMS OF HORMONE IMBALANCE...

Progesterone Estrogen Testosterone Thyroid Cortisol
Deficiency Deficiency Deficiency Deficiency Deficiency
Physical symptoms or Physical symptoms or Physical symptoms or Fatigue/exhaustion Fatigue
related conditions: related conditions: related conditions: Cold hands and feet Allergies
Weight gain Hot Flashes/Night Aches and pains Weight gain Stress
Low body temp sweats Thinning skin Memory lapse Irritability
Headaches Poor memory Loss of muscle tone High cholesterol Heart palpitations
Hypothyroidism Insulin resistance Fatigue Low blood pressure Sugar cravings
Heart disease Bone loss Heart palpitations Decreased sweating Chemical sensitivity
Hair loss Hair loss Insomnia Hair loss Cold body
Fluid retention Dry skin /eyes/ Bone loss Aches/pain temperature
Allergies/Sinusitis wrinkles Hot flashes Heart palpitations Arthritis
Bone loss Insomnia-wake up Poor memory Bone loss Aches/pain
Sleep disturbances frequently Weight gain Infertility

Gynecological Headaches Elevated cholesterol Slow pulse Excess Cortisol

Heart disease Constipation
symptoms or related Heart palpitations
Sleep disturbances
Depression
conditions: Poor concentration
Gynecological Tired but wired
Lack of focus Low body
Breast pain/cysts symptoms or related temperature feeling
Increased
Breast cancer conditions: Inability to loose Low libido
cholesterol
PMS Vaginal dryness weight Cravings
Increased blood
Fibroids Incontinence Puffy eyes Stressed feeling
pressure
Heavy cycles/clots Loss of pubic hair Poor concentration Irritability
Heart disease
Irregular cycles Impaired sexual Dry skin Bone loss
Endometriosis Gynecological function Loss of muscle
Brittle nails
Cramps symptoms or related mass
conditions: Emotional symptoms Low libido
Miscarriage Thinning skin
Lighter/no cycles
or related conditions: Sleep disturbances
Water retention Hoarseness Symptoms of low
Irregular or missed Loss of libido
Hot flashes/Night thyroid, estrogen,
Depression
sweats cycles Insulin/glucose testosterone, or
Vaginal dryness Lack of motivation
Emotional symptoms progesterone
Urinary tract Fatigue after meals
or related conditions: Excess Testosterone
Breast cancer
infections Weak, skaky, brain Headaches
Anxiety
Incontinence Acne/oily skin fog, headaches Heart palpitations
Depression
Facial hair when missing a Cardiovascular
Irritability Emotional symptoms meal
Thinning scalp hair disease
Tendency to be or related conditions: Poor concentration
Excess body hair Insomnia
stressed easily
Depression Mid-cycle pain High blood
Low libido
Anxiety Pain in nipples pressure,
Carb cravings triglycerides, or
Excess Estrogen Ovarian cysts
Low libido Hypoglycemia cholesterol
same symptoms Teary/Weepy Insulin resistance Weight gain,
as progesterone Aggression abdominal obesity
deficiency Irritability Sugar cravings
8
A MAKEOVER FOR YOUR HORMONES?
Makeovers are the hallmark of the baby boomers – from our bodies to our homes, our
careers, and everything in-between, it seems. Something needs a makeover when it no
longer looks like it used to or does not function properly - when it needs to be restored or
renovated. That is precisely what happens when it comes to women’s hormones. They do
not always function properly, triggering symptoms. These symptoms may include monthly
Premenstrual Syndrome, better known as PMS, perimenopausal symptoms occurring in
the years before menopause, or full-fledged menopause symptoms. Hormone imbalance
certainly is not limited to reproductive hormone imbalances. Many women also have stress
hormone imbalances, thyroid hormone insufficiency or blood sugar fluctuations. Problems
with any of these hormones can lead to some very significant symptoms, suggesting a
hormone makeover might be just what the doctor should order.

WHAT IS A HORMONE MAKEOVER?

A hormone makeover addresses and corrects hormones that are too low or too high by
testing your hormones and then using the indicated bioidentical hormones, supplements,
and proper nutrition. The goal is to balance hormones, thereby eliminating symptoms and
preventing diseases associated with excess or deficient levels of hormones.

To experience a hormone makeover women must work with a physician trained in

bioidentical hormones and its application called Bioidentical Hormone Replacement
Therapy or BHRT for short. A BHRT physician will evaluate your hormones and prescribe a
personalized treatment plan that addresses your specific imbalances. BHRT typically consists
of prescriptions for bioidentical hormones and supplements, as indicated by your lab results
and your specific symptoms, that will correct the underlying hormone imbalances. Your
doctor will monitor your progress to make sure you are on appropriate therapy and your
symptoms have resolved.

HOW DO YOU KNOW IF YOU NEED A HORMONE MAKEOVER?

Here are a few questions that may help you determine your own need for a hormone
makeover, Have you gained weight, especially around the abdomen or hips? Are you having
hot flashes or night sweats? Have your menstrual cycles becomes irregular or recently
stopped? What about hormonal headaches or migraines? How about your skin - has it
become very dry or too oily? Has your doctor told you that you have lost bone mass? Are
you having trouble remembering what you went to the pantry for or even close friends’
names? Do you have brain fog? Perhaps you have lost interest in physical intimacy or maybe
you are having trouble sleeping. In addition to these physical and intellectual symptoms,
have you experienced unexplainable depression or weepiness? Have you felt more anxious,
easily stressed or irritable? Have you had a hysterectomy and found that you have not been
the same since? If you answer “yes” to any of these, be assured, you do not have to live with
these symptoms. Perhaps you need a hormone makeover, in order to regain the quality of
life you had before the onset of these symptoms.

9
 WHO DO HORMONE PROBLEMS AFFECT?
All women are prime candidates for hormone imbalance. If you are experiencing some of
the previously mentioned symptoms, you are not alone. In fact, there are an estimated 40
million women in the United States in menopause. Additionally, 80% to 90% of all women
report PMS symptoms.

WHEN DO HORMONE SYMPTOMS START?

As women approach their thirties, hormones begin to decline, thus triggering symptoms
associated with the menstrual cycle. These same early imbalances can cause weight gain,
headaches, lack of sex drive, or depression, just to list a few. Unfortunately, it does not get
any better as women move into their forties and fifties when new symptoms can add to their
dilemma such as hot flashes, night sweats, vaginal dryness, foggy thinking, or insomnia.
Left unattended, some types of hormone imbalances can result in bone loss, breast cysts,
uterine fibroids, and increased risk of cardiovascular disease.

WHAT CAUSES HORMONE PROBLEMS?

Hormone imbalance stems from several different factors that commonly affect women,
including:

• Age related decline of estrogen, progesterone or testosterone

• Stress triggered changes in adrenal hormones, DHEA and cortisol
• Significant weight gain or loss
• Nutritional deficiencies and poor diet
• Failure to ovulate or ovarian dysfunction
• Other glandular dysfunctions such as thyroid or blood sugar problems
• Non-bioidentical hormones – HRT or any type of synthetic hormones including birth
control pills
• Xenoestrogens- hormone like synthetic chemicals in the environment or food supply

WHAT ARE BIOIDENTICAL HORMONES?

Bioidentical hormones are derived from plants and are converted into chemical structures
that precisely match the human hormones manufactured by the body. The plant derived
bioidentical hormones function exactly the same as the hormones the body makes and
in fact, the body recognizes them as if they were actually produced by the ovaries. To be
clear, there is no difference between the hormones the ovaries make and the bioidentical
hormones used in BHRT. BHRT has a long history of safe and successful use, specifically in
Europe where they have been used for over 65 years.

10
WHAT IS HRT AND SYNTHETIC HORMONES?
HRT stands for Hormone Replacement Therapy, which does not usually consist of hormones
biologically identical to those our bodies produce. Instead, HRT is comprised of synthetic
and/or animal-derived hormones. I refer to them as non-bioidentical. Since non-bioidentical
hormones differ in molecular structure from those the human body produces, they do not
function exactly like endogenous human hormones. Nor do our bodies process them the
same way. These non-bioidentical hormones are similar enough to mimic some of the
activities of the human hormones they are replacing but only in a clumsy way. While they
perform some of the vital functions of endogenous hormones, they can cause problems
that human-produced hormones do not. We know these problems are side effects, which
vary depending on the type of non-bioidentical hormone.

WHAT CAN BIOIDENTICAL HORMONES DO FOR YOU?

Bioidentical hormones - estrogen, progesterone, or testosterone have demonstrated many
benefits such as:

• Decreases menstrual bleeding and spotting

• Increases metabolism
• Protects against cancer, especially breast cancer
• Helps prevent hardening of the arteries and heart disease
• Improves brain function
• Reduces water retention
• Reduces irritability and anxiety
• Helps reduce hormonal headaches/migraines
• Reduces carbohydrate cravings
• Helps restore normal sleep patterns
• Regulates the menstrual cycle
• Reduces vaginal dryness
• Slows bone loss
• Protects the heart
• Slows aging
• Uplifts mood
• Lowers LDL/raises HDL
• Adds moisture to the skin
• Enables brain function

Note: These results are not demonstrated by synthetic hormones in HRT.

ARE BIOIDENTICAL HORMONES SAFE?

Women and their physicians should be concerned and informed about the safety of any
treatment. This is especially true when it comes to hormones. We all know that synthetic
or traditional HRT has been clearly proven to have significant side effects. Not only has
research demonstrated bioidentical hormones to be effective for symptoms, published
studies also show their safety.

11
 In fact, Dr. Kent Holtorf published an article in the January 2009 issue of Postgraduate
Medicine. He cited 196 research studies and commented, “Physiological data and clinical
outcomes demonstrate that bioidentical hormones are associated with lower risks,
including the risk of breast cancer, cardiovascular disease, and are more efficacious than
their synthetic and animal derived counterparts. Until evidence is found to the contrary,
bioidentical hormones remain the preferred method of hormone replacement therapy.”

While this is my opinion based on my understanding of the current medical research and the
opinions of medical experts that prescribe bioidentical hormones, there may be potential
side effects or risks associated with their use. Larger scale studies will help shed more light
on this. Hormones are powerful substances, whether our body makes them or we take
by prescription. There are health risks and side effects associated with any hormone in
excess or at deficient levels. For example, if your body makes too much insulin or thyroid
hormone or if you take too much of one of these hormones by prescription, this can lead
to serious problems. It is up to your medical doctor to decide if there are potential risks
or side effects that may pertain to you associated with taking hormones whether they be
over-the-counter or compounded prescriptions. The point is there may be risks associated
with any type of hormone therapy and by all means make sure that you work with a licensed
medical doctor that can properly evaluate and treat you and explain any potential risks as
they pertain to you.

To comply with legal recommendations, I will paste the FDA’s comments on BHRT below.
<http://www.fda.gov/ohrms/dockets/dockets/05p0411/BHRTletter.html>

“The potential public health risks from compounded BHRT drugs are significant.
Compounded BHRT drugs have not been demonstrated to be safe and effective. Many of
these compounded BHRT drugs are labeled and advertised as having benefits that have
been definitively disproved or for which there is no evidence. Furthermore, there are no
scientific data to support the contention that compounded BHRT drugs carry fewer risks
for women than FDA-approved prescription hormone therapy drugs. Claims that are false
or misleading can have significant health consequences for women.”

For an interesting rebuttal and debate on these comments see the resources section of my
web site. www.hormonemakeover.com

If you or your physician would like to review more published medical studies on bioidentical
hormones and Bioidentical Hormone Replacement Therapy (BHRT), please refer to the
extensive bibliography in the book, “The Hormone Makeover – 7 Steps to Transform Your
Life With Bioidentical Hormones”.

12
THE HORMONE MAKEOVER PROCESS
You will start by making an appointment with a physician that offers BHRT. At the initial visit
your BHRT physician will conduct a thorough physical exam and evaluation of your medical
history, health, and symptoms as they relate to hormone imbalance. He or she will order
hormone testing. This should include saliva testing or dried urine and blood work. You can
expect your results to be back in 2 weeks if you don’t have periods. Some tests have to be
performed on a specific day of your menstrual cycle if you still have periods. If you do have
periods, your doctor will help you determine when to take your test and when to expect
your results. You should expect to have another office visit with your doctor once your lab
tests are back.

At your second visit you should expect your doctor to review your lab work with you. This is
a very interesting visit because hormone testing explains the cause of your symptoms. You
will also receive your treatment plan designed to correct the imbalances detected by the
labs and to address your specific symptoms. A hormone makeover treatment consists of any
indicated prescriptions for bioidentical hormones, supplements or dietary changes required
to balance hormones, complete instructions on how to take hormones or supplements,
and follow-up care instructions.

After you start on BHRT you will need follow-up care. You should plan to repeat your
hormone testing in about 3 months and then see your physician again. By repeating your lab
work or reviewing your progress, you and your physician can determine if your treatment
plan is appropriate for you or needs some adjusting. It may take a couple of adjustments
to get your hormones balanced; it takes some patience, but you’ll find it is well worth it.
Paying careful attention to changes in your symptoms, taking good notes about them, and
conveying that information to your BHRT practitioner can speed the process and improve
the results. Once your hormones are balanced, you will need to be evaluated once or twice
a year. You may find that your treatment protocol needs to be adjusted after periods of
stress, significant weight gain or loss, or as endogenous hormone levels shift such as during
perimenopause. If you notice that your symptoms are not under control you may need to
change your treatment plan.

WHAT IF YOU CANNOT FIND A DOCTOR?

Go to my website for resources to help you locate the nearest physician to you that has
experience in BHRT. If your physician wants to start prescribing BHRT, I have training
resources on my web site. www.hormonemakeover.com

HOW DO YOU TEST HORMONES?

To determine the underlying hormone imbalances causing your symptoms, it is essential to
test your hormones. A comprehensive analysis of all hormones requires blood testing along
with dried urine or saliva testing. Blood testing is used to assess thyroid hormone levels
and their function while saliva or dried urine testing measures reproductive hormones and
adrenal hormones.
13
 WHICH HORMONES SHOULD YOU TEST?
Your doctor will find these blood tests particularly helpful to your hormone makeover.
Hormones that should be measured through blood tests:

• Thyroid Stimulating Hormone

• Free T4
• Free T3
• Reverse T3
• Thyroid Peroxidase (TPO)
• Vitamin D (25-hydroxy)

Hormones that should be measured through saliva or dried urine tests:

• Estradiol (Testing Estriol and Estrone is also helpful.)

• Progesterone
• Testosterone
• DHEA
• Morning Cortisol
• Noon Cortisol
• Evening Cortisol
• Night Cortisol

Optional blood work your doctor may order:

• Complete Blood Count - a broad screening test to determine general health status
• Complete Metabolic Panel – to measure your sugar (glucose) level, electrolyte and fluid
balance, kidney function, and liver function
• Fasting Insulin and Hemoglobin A1c – to assess insulin resistance
• Serum Iron - measures how much iron is in your blood
• Advanced Cardiovascular Risk Factors such as: C Reactive Protein, Homocysteine, Lipid
Profile
• Ferritin

Optional urine tests your doctor may order:

• Bone Turnover – to evaluate if your body is breaking down your bones faster than normal
and to monitor treatment of osteoporosis
• Estrogen Metabolism – to see how estrogens are metabolized by your body

14
BIOIDENTICAL HORMONE PRESCRIPTIONS
Most bioidentical hormone prescriptions are prepared at compounding pharmacies.
Prescriptions may include one or more hormones compounded in the specific dose
you need by a compounding pharmacy. Some prescriptions may come from traditional
pharmacies such as an estradiol (estrogen) patch.

Hormones commonly prescribed are:

• Progesterone
• Biest – a combination of Estriol and Estradiol, both are estrogens
• Estriol
• Estradiol
• Testosterone
• DHEA

Bioidentical hormone prescriptions come in different dosing forms. These include:

• Transdermal creams or gels applied to the skin

• Patches (estradiol only) applied to the skin
• Pellets inserted just under the skin in the buttocks
• Vaginal cream or suppositories
• Oral (capsules) - progesterone and DHEA only, never use oral estradiol or testosterone
• Troches (lozenges)
• Sublingual drops (under the tongue)
Your doctor will help you determine which dosing form is preferable in your treatment.

15
 WHAT IS A COMPOUNDING PHARMACY?
Compounding pharmacies create formulations of hormones and other medicines
customized for each patient according to doctors’ specifications, thus permitting the
doctor to adjust the dose to fit each patient’s needs. Unfortunately, some opponents to
BHRT want you to think that compounded hormones are not safe or that compounded
hormones may not be reliable. Compounding pharmacies are regulated by each state’s
pharmacy board and by the Pharmaceutical Compounding Accreditation Board. The
hormones they use are regulated by the U.S. Pharmacopoeia and the Code of Federal
Regulations, which requires purity testing. The prescriptions filled at compounding
pharmacies are not FDA regulated or FDA approved but do contain FDA approved
hormones.

The benefit of compounded medications is that your doctor can prescribe bioidentical
hormones in individualized dosages and combinations with delivery systems that are
not commercially available. Compounded prescriptions can also specify the creation of
hypoallergenic creams and gels without the use of excipients and chemical preservatives.

HOW MUCH DO BIOIDENTICAL HORMONES COST?

Of course, costs do vary. To give you a general idea, hormone creams, for example, which
are very commonly prescribed, average from $45 - $75 a month. Costs vary depending
on how many hormones are compounded into the cream. There may be benefit to having
separate prescriptions in some instances. For example, you may need or want to use
estrogen and progesterone on your face to prevent and reduce wrinkles. If you also need
testosterone, you will not want to use that on your face.

DOES INSURANCE COVER BHRT?

Some physicians that offer BHRT do take insurance for office visits, some do not. Practices
that do not take insurance often provide a fee statement that you can submit to your
insurance company for reimbursement. Do not rule out working with a cash-only practice.
There is great value to working with these physicians because they are able to spend more
time with their patients.

WHAT HORMONES DO AND HOW TO USE THEM

The following sections will help you understand more about what each hormone does in the
body, the symptoms of each hormone deficiency, and how to use prescription hormones.

16
PROGESTERONE
SYMPTOMS AND CONDITIONS ASSOCIATED WITH
PROGESTERONE DEFICIENCY:
Progesterone has 300 jobs in the body and over 9000 genetic mechanisms. This explains
why it is so imperative to have a normal level. The ovaries make approximately 4 to 28
milligrams of progesterone during ovulation, which tends to occur sporadically by the mid-
thirties. This means that typically progesterone is the first hormone that begins to decline
leading to many symptoms. Women without ovaries and women on the pill or hormones
that block ovulation are more than likely progesterone deficient.

GENERAL PHYSICAL EMOTIONAL SYMPTOMS OR

SYMPTOMS OR RELATED RELATED CONDITIONS:
CONDITIONS:
• Depression
• Weight gain • Anxiety
• Fluid retention • Irritability
• Low body temperature • Mood swings
• Hypothyroidism (under-activity of the • Tendency to be stressed easily
thyroid gland)
• Headaches – especially before periods
• Pain and inflammation
• Allergies/sinusitis
• Insomnia or sleep disturbances
• Hair loss
• Bone loss

GYNECOLOGICAL SYMPTOMS
OR RELATED CONDITIONS:
• PMS
• Cramps
• Breast pain/benign cysts
• Heavy periods
• Irregular cycles (periods too close
together)
• Spotting before period or break-
through bleeding
• Fibroids
• Endometriosis
• Infertility
• Miscarriage

17
 ACTIONS AND EFFECTS OF PROGESTERONE
GESTATION: CENTRAL NERVOUS SYSTEM:
• Enables egg implantation • Improves brain structure/function/
• Protects against miscarriage memory
• Facilitates fetal brain development • Reduces irritability/anxiety
• Protects brain and nervous system
EFFECTS ON ESTROGEN AND • Promotes normal sleep patterns
REPRODUCTIVE FUNCTIONS:
ANTI-MINERALOCORTICOID:
• Decreases and normalizes menstrual
bleeding • Acts as a potassium sparing diuretic
• Permits action of estrogen
• Normalizes clearance of estrogen
and protects from excessive estrogen SKELETAL:
stimulation
• Inhibits Fibrocystic Breast Disease • Stimulates osteoblast production for
• May inhibit growth of fibroids new bone growth
• Counters symptoms of Estrogen
Dominance: Breast tenderness, fluid MISCELLANEOUS:
retention, headaches, irritability, etc.
• Increases endurance during exercise
SKIN: • Increases metabolic rate
• Prevents and reduces PMS
• Inhibits aging of skin by increasing • May increase libido
production of collagen and elastin • Enables growth/development/repair of
tissue
CARDIOVASCULAR • Has anti-inflammatory properties
• Decreases hot flashes
PROTECTION:
• Protects against hardening of the BREAST PROTECTION:
arteries
• Has no negative affect on lipid profile • Stops breast cell multiplication and
• Has no negative affect on blood prevents breast cancer, breast cysts,
pressure and breast tenderness
• Does not raise C-reactive protein
EFFECTS ON OTHER
HORMONES/GLANDS:
• Facilitates thyroid hormone utilization
• Opposes stress hormone cortisol
• Balances or opposes estrogen

18
USING PROGESTERONE
If your progesterone is low and your doctor writes a prescription for progesterone it may
be in the form of a cream or an oral capsule. Your prescription may have other hormones in
it as well. Your treatment plan should indicate when and how you are to use progesterone.
Directions will also be on the label.

In general you use progesterone once daily for 3 weeks according to the menstrual cycle
starting on day 5 and stopping on day 26. (To determine the day of your cycle always count
day one as the first day of blood flow.) Non-cycling women typically use progesterone
once daily on days 1-26 of the calendar month. Depending on your symptoms or response
to progesterone, your doctor may have you use progesterone twice daily or use it until day
28 of your cycle.

Progesterone cream may be applied to the arms, legs, behind the knees, on the breast,
abdomen, face or vaginally. Alternate the place you apply the cream from day-to-day.

Common dosing ranges for progesterone cream are 20mg-100mg. Most physicians will
allow you to use progesterone cream in the morning or at night. It is best to keep it in your
bathroom or somewhere convenient. Do not use any hormone cream in such as way as to
expose children or your partner.

Common doses of oral progesterone range from 50mg -300mg. Oral progesterone is taken
at bedtime.

SYMPTOMS OF EXCESS PROGESTERONE

Women never over produce progesterone. However, symptoms may arise if you take
too much progesterone. These may include: drowsiness, slight dizziness, increased
water retention or heaviness in extremities and depressed feeling. Rarely do women
have side effects to using progesterone but a small percentage of women are sensitive
and require very small doses. Call your doctor if you feel that you are experiencing any
of these symptoms or notice any unfavorable changes since starting progesterone.

19
 ESTROGEN
Estrogen has an estimated four hundred crucial functions in the body. The ovaries make
60% of our estrogen while the other 40% comes from other sources, including the adrenal
glands. The body converts androgens such as DHEA and testosterone made by the adrenals
or ovaries into estrogen. Women make approximately 0.01 to 0.03 mg of estradiol, one of
the three primary estrogens. Estradiol is the strongest estrogen and is the most abundant
estrogen produced premenopausally. Estrone is the main estrogen made after menopause.
Both estradiol and estrone are stimulatory estrogens especially to the breast and uterine
tissue. Therefore, they need to be used in small amounts and monitored properly. Estriol
is not considered to be stimulatory and believed to be protective against hormone-related
cancers. (Estriol references may be found in the bibliography of “The Hormone Makeover”
e-book.)

GENERAL PHYSICAL GYNECOLOGICAL SYMPTOMS

SYMPTOMS OR RELATED OR RELATED CONDITIONS:
CONDITIONS:
• Lighter/non-existent periods
• Hot flashes/night sweats • Vaginal dryness
• Headaches or migraines • Urinary tract infections
• Inflammation • Incontinence
• Insomnia or sleep disturbances
• Poor memory/concentration or EMOTIONAL SYMPTOMS OR
forgetfulness RELATED CONDITIONS:
• Hair loss
• Dry skin/eyes/hair
• Depression or depressed / low mood
• Thinning /aging skin and wrinkles
• Weepiness
• Bone loss
• Anxiety
• Insulin resistance
• Carbohydrate cravings
• Increased cholesterol
• Low libido
• Poor carbohydrate metabolism/weight
gain
• Heart palpitations
• Oily skin /acne
• Insulin resistance

20
ACTIONS AND EFFECTS OF ESTROGEN
REPRODUCTIVE SYSTEM: EFFECTS ON UROGENITAL
SYSTEM:
• Creates the blood lining in the uterus
and regulates menstrual cycles • Increases thickness of walls of the
vagina
CARDIOVASCULAR • Reduces vaginal dryness and painful
PROTECTION: intercourse
• Decreases frequency of urinary tract
• Prevents heart disease by lowering infections
LDL (bad) cholesterol, increasing • Decreases frequent urination
HDL (good) cholesterol, lowering
triglycerides
• Decreases other risk factors: EFFECTS ON SKELETAL
homocysteine, lipoprotein (a) SYSTEM:
• Manages blood pressure
• Slows bone loss and assists in calcium
EFFECTS ON CENTRAL utilization
NERVOUS SYSTEM:
• Prevents memory disorders
• Increases neurotransmitters that
improve mood, alertness, focus and
attention
• Acts as an anti-depressant

EFFECTS ON GLUCOSE/
INSULIN:
• Improves carbohydrate metabolism
and keeps insulin in check, helping to
manage weight

EFFECTS ON SKIN HEALTH:

• Increases water/moisture content of skin
• Increases collagen, elastin, and
hyaluronic acid formation preventing
wrinkles
• Thickens skin
• Maintains oral health by preventing gum
disease
• Maintains eye health by preventing
cataracts and macular degeneration
21
 USING ESTROGEN
If your estrogen is low and your doctor writes a prescription for estrogen it may be in the form of
a cream. You may be given a prescription for an estrogen patch if your hot flashes are severe, you
tend to have migraines, or if you are being switched from HRT to BHRT. You should never take
estrogen orally due to increased risk of stroke, blood clots, and potential negative effects on the
liver. Your prescription may have other hormones in it as well. You will be taking progesterone
in addition to estrogen since estrogen should never be taken without it. This is because estrogen
stimulates hormone sensitive tissue such as the breasts and uterus. Progesterone is necessary
to moderate the stimulatory properties of estrogen. This also applies to women that have had
a hysterectomy. Even without a uterus you still need the many other essential and protective
properties of progesterone and for your overall hormone balance.

When prescribing bioidentical estrogen cream, most physicians order BIEST. This means that
there are two estrogens in your cream: estriol and estradiol.

Your treatment plan should indicate when and how you are to use estrogen. Directions will also
be on the prescription label. Estrogen cream is typically used once daily for 3 weeks according
to the menstrual cycle starting on day 5 and stopping on day 26. (To determine the day of your
cycle always count day one as the first day of blood flow.) Non-cycling women typically use
estrogen once daily on days 1-26 of the calendar month. Depending on your symptoms or
response to estrogen, your doctor may have you use it twice daily or during different times of
your cycle.

BIEST cream may be applied to the arms, legs, behind the knees, abdomen, face or vaginally.
Do not use hormone creams containing estrogen of any type on the breast tissue. Alternate
the place you apply the cream from day-to-day. Most physicians will allow you to use estrogen
cream in the morning or at night. It is best to keep it in your bathroom or somewhere convenient.

Do not use any hormone cream in such a way as to expose children or your partner.
Common doses of Biest: 0.25mg-1.0 milligrams per milliliter.

SYMPTOMS OF EXCESS ESTROGEN

Starting estrogen should alleviate symptoms of estrogen deficiency without causing
symptoms of excessive estrogen. After starting estrogen, if you experience any of these
symptoms call your doctor for a reduced dose or further instructions: fluid retention, breast
tenderness or pain, headaches, heavy periods, or vaginal bleeding if you are postmenopausal.

Starting BHRT should not cause women that no longer have menstrual cycles to start having
periods again. If you experience this you need to be evaluated by a gynecologist.

22
TESTOSTERONE
Even though testosterone is thought of as a male hormone, women do make and need
a normal amount of testosterone for good health. The ovaries make around 0.3 mg of
testosterone daily, which is about 60% of the total testosterone. The rest comes from DHEA
contribution, which is made by the adrenal glands.

SYMPTOMS AND CONDITIONS ASSOCIATED WITH

TESTOSTERONE DEFICIENCY:

GENERAL PHYSICAL EMOTIONAL SYMPTOMS OR

SYMPTOMS OR RELATED RELATED CONDITIONS:
CONDITIONS:
• Depression
• Hot flashes/night sweats • Lack of motivation
• Aches and pains • Low self-esteem
• Fatigue • Hypersensitive
• Insomnia • Anxiety
• Poor memory
• Thinning skin
• Loss of muscle tone
• Bone loss
• Heart palpitations

GYNECOLOGICAL SYMPTOMS
OR RELATED CONDITIONS:
• Loss or thinning of pubic hair
• Vaginal dryness
• Incontinence
• Loss of libido
• Impaired sexual function or female
sexual arousal disorder

23
 ACTIONS AND EFFECTS OF TESTOSTERONE
EFFECTS ON THE SKELETAL EFFECTS ON
SYSTEM: CARDIOVASCULAR SYSTEM:
• Increases bone mineral density • Lowers cholesterol
• Reduces fractures • Prevents Heart Disease

EFFECTS ON THE MUSCULAR EFFECTS ON SKIN:

SYSTEM:
• Thickens skin
• Increases muscle bulk and tone • Increases oil production in the skin
• Maintains lean body mass, strength and • Increases hair growth
stamina
EFFECTS ON GLUCOSE:
EFFECTS ON THE BRAIN: • Improves insulin sensitivity
• Increases libido
• Increases sense of well being
• Improves mood
• Increases energy
• Improves memory
• Supports self esteem

USING TESTOSTERONE
If your testosterone is low and your doctor writes a prescription for testosterone it will be
in the form of a cream. You should never take testosterone orally since it can have negative
effects on the liver. For convenience, testosterone may be added to any other hormone
cream that is prescribed for you or it may be used separately.

Your treatment plan should indicate when and how you are to use testosterone. Directions
will also be on the prescription label. If your testosterone is combined with progesterone
and/or estrogen cream, your directions will be to use it once daily for 3 weeks according
to the menstrual cycle - starting on day 5 and stopping on day 26. (To determine the day
of your cycle always count day one as the first day of blood flow.) Non-cycling women
typically use hormone cream once daily on days 1-26 of the calendar month.

24
If your testosterone prescription contains only testosterone or is combined with DHEA,
your doctor may have you take this on a daily basis.

Testosterone cream may be applied to the arms, legs, behind the knees, abdomen, or
vaginally. Alternate the place you apply the cream from day-to-day. Do not use hormone
creams containing testosterone to the breast tissue or on the face. Testosterone cream
may be prescribed for application to the clitoral area or inner labia. In this instance you do
not need to alternate application site. Do not use any hormone cream in such as way as to
expose children or your partner.

Common doses of testosterone: 0.1 – 1.0 milligrams per milliliter.

SIDE EFFECTS OF EXCESS TESTOSTERONE

Starting testosterone should alleviate symptoms of testosterone deficiency without causing
symptoms of excessive testosterone. After starting testosterone if you experience any of
these symptoms call your doctor for a reduced dose or further instructions: oily skin or hair,
acne, increased facial hair, or increased body odor.

DHEA
Made by the adrenal glands, DHEA is the most abundant steroid hormone in the human
body. DHEA is a precursor of (or contributes to the formation of) other hormones. About
40% of our estrogen and testosterone are made from the conversion of DHEA. Therefore,
a deficiency in DHEA can trigger shortages of these hormones. DHEA levels decline with
age, dropping from its highest level in the second decade of life to about 50% of youthful
levels by the time we reach the age of fifty. In our sixties, we typically produce only about
20% of what we did in our youth. Longterm, chronic stress can also reduce the adrenals’
production of DHEA.

DHEA DEFICIENCY IS ASSOCIATED WITH THESE PROBLEMS:

• Immune dysfunction • Rheumatoid Arthritis
• Greater risk for certain cancers • Chronic back, neck, and shoulder pain
• Heart disease in men • Osteoporosis
• Excess body fat • Neurodegenerative diseases
• Type 2 diabetic complications • Cognitive decline
• Chronic Inflammatory Disease • Depression

25
 Many symptoms of DHEA deficiency can also result from other
problems, making diagnosis difficult. But here are common
symptoms of DHEA deficiency:
• Feeling stressed • Poor abdominal muscle support
• Intolerance of loud noises • Impaired immunity
• Moodiness • Dry eyes and skin
• Memory loss • Loss of pubic hair
• Constant fatigue • Low sex drive
• Lack of stamina

ACTIONS AND EFFECTS OF DHEA

PROTECTS THE HAS ANTIBACTERIAL/ANTIVIRAL
CARDIOVASCULAR SYSTEM BY: PROPERTIES/IMMUNE
PROPERTIES WHICH IMPROVE
• Strengthening the heart muscle IMMUNE FUNCTION BY:
• Preventing blood clots
• Protecting against atherosclerosis • Supporting immune system
• Lowering cholesterol • Helping decrease allergic reactions
• Reducing amount of atherosclerotic • Possibly protecting against activation of
plaque (in animal studies) HIV
• Possibly fighting, in conjunction with
PROTECTS THE BRAIN AND melatonin, retroviral infection and anthrax
CENTRAL NERVOUS SYSTEM toxin
BY: • Protecting against bacterial sepsis
• Developing mature immune cells and
• Protecting against age-related enhancing antibody production
deterioration of mental function
• Promoting brain function
• Protecting the brain from damage due ADDITIONAL PROPERTIES OF
to stroke DHEA:
• Reducing risk of Alzheimer’s
• Protecting brain from excess cortisol, • Decreases formation of fatty deposits
which may prevent dementia • Increases bone growth
• Reducing inflammation • Promotes weight loss
• Helping reduce lupus symptoms • Increases sense of well-being
• Helps repair and maintain tissues
• Diminishes allergic reactions

26
USING DHEA
If your DHEA is low, for your convenience your doctor may order it to be compounded
with other hormones in a cream, in combination with testosterone, or by itself. Some
physicians recommend oral DHEA.

Your treatment plan should indicate when and how you are to use DHEA. Directions
will also be on the prescription label. If your DHEA is combined with progesterone and/
or estrogen cream your directions will be to use it once daily for 3 weeks according to
the menstrual cycle - starting on day 5 and stopping on day 26. (To determine the day
of your cycle always count day one as the first day of blood flow.) Non-cycling women
typically use hormone cream once daily days 1-26 of the calendar month.

If your DHEA prescription contains only testosterone or is combined with DHEA your
doctor may have you take this on a daily basis.

DHEA may be applied to the arms, legs, behind the knees, abdomen, or vaginally.
Alternate the place you apply the cream from day-to-day. Do not use hormone creams
containing DHEA to the breast tissue or on the face. DHEA cream may be prescribed for
vaginal application. In this instance you do not need to alternate application site. Do not
use any hormone cream in such as way as to expose children or your partner.

Common doses of DHEA cream: 2.0 – 10.0 milligrams per milliliter.

Common doses of DHEA pills: 5.0 – 25.0 milligrams daily.

SIDE EFFECTS OF EXCESS DHEA

Starting DHEA should alleviate symptoms of deficiency without causing symptoms of
excessive DHEA. After starting DHEA, if you experience any of these symptoms call your
doctor for a reduced dose or further instructions: oily skin or hair, acne, increased facial hair,
or increased body odor.

27
 CORTISOL IMBALANCES
Cortisol, an important hormone made in the adrenal glands, is involved in proper
glucose metabolism, regulation of blood pressure, insulin release for blood sugar level
maintenance, immune function, and inflammatory response. It has been termed “the
stress hormone” because it’s also secreted in higher levels during the body’s “fight or
flight” response to stress and is responsible for several stress-related changes in the
body. Cortisol plays a role in the metabolism of fats, proteins, and carbohydrates. When
you sleep at night, cortisol prevents glucose from dropping too low.

Just as with the other hormones, both excessive levels and deficiencies result in symptoms
and health problems. Chronic stress initially raises your cortisol level. If stressors last
long enough, cortisol levels may then begin to fluctuate between normal to high or low,
or eventually become deficient throughout the day. We think of stress as being caused
by our life circumstances and events, and it often is, but physical stressors like illnesses,
injuries, viruses, bacteria, and exposure to certain chemicals all stress our bodies too.
Chronic pain and inflammation and even hormone imbalances can stress our bodies
and affect cortisol levels. Some medications can increase cortisol as well. Unfortunately,
eating high-glycemic foods like white flour and white sugar raises cortisol too.

Your cortisol level does not remain constant. Instead, cortisol production follows a daily
rhythm. It should be at its lowest level between midnight and 2:00 a.m., when it slowly
starts to rise to help us wake up and prepare for another day. It normally drops rapidly
between 8:00 and 11:00 a.m. and then continues to decline gradually throughout the
rest of the day. Due to the change in cortisol through the day it is important to test
cortisol with saliva testing 4 times during the day: upon awakening, noon, evening and
before bed.

SYMPTOMS OR CONDITIONS RELATED TO ELEVATED CORTISOL:

• Insomnia/sleep disturbances • Thinning skin
• Headaches • Loss of muscle mass
• “Tired but wired” feeling • Bone loss
• Stressed feeling • Heart palpitations
• Irritability • Cardiovascular disease
• Low libido • Breast cancer
• Depression
• Food cravings
• Low serotonin (causes depression and
carbohydrate cravings)
• Hormone resistance (meaning that
the body is unable to properly use
any or all of these hormones: thyroid,
insulin, estrogen, testosterone, and
progesterone - causing symptoms of
deficiencies of these hormones)
28
SYMPTOMS OF CORTISOL DEFICIENCY:
• Severe fatigue • Sugar cravings
• Allergies • Chemical sensitivities
• Stressed feelings • Low body temperature or any low-
• Irritability thyroid symptoms
• Aches/pains such as muscle and joint • Hypoglycemic symptoms when missing
pain a meal or eating sugar: irritability,
• Heart palpitations shakiness, headache, and foggy thinking

MANAGING CORTISOL IMBALANCE

If your cortisol level is abnormal, your doctor will most likely recommend 1-2 supplements
to support the health of your adrenal glands and to address the symptoms of cortisol
imbalance. You may only need to use adrenal supporting supplements for a short period
of time. However, some people with significant stressors use them indefinitely. Your
treatment plan will tell you how and when to take the supplements.

CORTISOL MANAGEMENT SUPPLEMENTS

Addressing cortisol imbalance is critical for treating symptoms and achieving overall
hormone balance. This typically involves use of one or more supplements for a short
period of time. However, some people with significant stressors use them indefinitely.
These include plant adaptogens, adrenal glandulars, and cortisol reduction or fortifying
supplements.

PLANT ADAPTOGENS
The primary benefit of plant adaptogens is the ability to restore healthy, balanced adrenal
gland function. They are indicated for all types of cortisol imbalance whether it is too high,
too low or fluctuates between high and low.

ADAPTOGENIC HERBS ARE USED TO:

• Normalize release of cortisol from the adrenal glands
• Support symptoms of fatigue
• Enhance endurance
• Support normal mental and emotionally well-being
• Increase the body’s ability to resist and recover from stress
• Can support mental performance and physical working capacity

29
 PHOSPHATIDYL SERINE
Phosphatidyl serine is used to decrease high cortisol levels. It may be taken at times of the
day when your saliva test shows elevated cortisol levels. Many people have elevated cortisol
at night, which will cause them to be unable to go to sleep or repeatedly wake up through
the night. Phosphatidyl serine is especially helpful to improve sleep. Research has also
found phosphatidylserine to have protective effects on brain function and memory.

GLANDULAR EXTRACTS
Many physicians recommend glandular extracts for patients with low cortisol and/
or significant fatigue. The action of adrenal glandular supplements is to support, fortify,
and restore normal adrenal function. They are not replacement hormones but provide
constituents for adrenal repair. As the cells of the adrenals recover, they can begin to
produce normal levels of adrenal hormones once again.

NATURAL CORTISOL
Some people are so exhausted and have such low cortisol levels they need to
temporarily take very low doses of natural cortisol medication, hydrocortisone, (another
name for cortisol). This is marketed under the brand name Cortef or compounded by
compounding pharmacists. Taken in small doses it can imitate the natural secretion of
cortisol, giving the adrenal glands a rest so they can recover and start producing their
own cortisol again.

30
THYROID HORMONE IMBALANCE
Hypothyroidism often surfaces during perimenopause. Hypothyroidism is the condition in
which the thyroid gland does not produce enough of the thyroid hormones. Subclinical
hypothyroidism, also called mild thyroid failure, is diagnosed when thyroid hormone levels
are within normal reference laboratory range but thyroid stimulating hormone (TSH) levels
are mildly elevated.

Additionally, some women have thyroid hormone blood work that is “normal” but their
results may be close to the upper end or lower end of what the lab says is normal. Moreover,
some women have many of the symptoms of hypothyroidism with perfectly normal lab
results. In these two scenarios, symptoms may improve with treatment, such as a trial
of medication, a supplement that supports thyroid function, or correcting other hormone
imbalances that affect thyroid hormone function.

Hyperthyroidism is a condition in which the thyroid gland overproduces thyroid hormones.

This is less common and not addressed in this guidebook. It is most often treated by an
endocrinologist.

Optimal function of the thyroid is vital to health in many critical ways. The thyroid gland
regulates the body’s metabolism, thereby controlling the rate of function of every cell and
gland in the body, including growth and repair. It also controls calcium balance throughout
the body. The thyroid gland uses iodine to produce and secrete iodine containing hormones
called thyroxine (T4) and triiodothyronine (T3). Thyroid hormones in conjunction with the
hormone calcitonin, promotes the formation of bone. The T4 and T3 hormones stimulate
every tissue in the body to produce proteins and increase the amount of oxygen used by cells.

Since thyroid hormones influence and interact with the adrenal and sex hormones, it is
important to evaluate and correct any underlying thyroid problems to achieve overall
hormone balance and to feel your best.

SYMPTOMS OF HYPOTHYROIDISM
Symptoms may include:

• Weight gain • Decreased sweating

• Difficulty losing weight • Depression, mild to severe
• Exhaustion • Memory loss
• Lack of energy • Fuzzy thinking
• Excessive sleeping • Difficulty following conversation or train
• Sleep disturbances of thought
• Low body temperature • Slowness or slurring of speech
• Intolerance of cold • Slowed reflexes
• Cold hands and feet • Brittle nails or hair

31
 SYMPTOMS OF HYPOTHYROIDISM
• Anemia • Elevated LDL (the “bad” cholesterol)
• Hair loss • Irregular periods
• Thinning or loss of sides of eyebrows • PMS
• Itchy scalp • Diminished sex drive
• Dry skin • Infertility
• Thinning skin • Miscarriage
• Persistent cold sores, boils, or pimples • Headaches
• Orange-colored soles and palms • Allergies (sudden appearance or
• Joint and muscle pain worsening)
• Carpal tunnel syndrome • Hoarseness
• Tingling sensation in wrists and hands • Puffiness in face and extremities
that mimics carpal tunnel syndrome • Constipation
• Low blood pressure • Calcium metabolism difficulties resulting
• Slow pulse in leg cramps or bone loss
• Heart palpitations • Insulin resistance
• Blood clotting problems
• Bruising

THYROID HORMONE TESTING

Thyroid hormones are tested through blood work. A comprehensive thyroid evaluation
should include thorough testing. Your doctor may order labs for Thyroid Stimulating
Hormone (TSH), Free T3 (triiodothyronine), and Free T4 (thyroxine). Other thyroid tests may
include Reverse T3, Total T4, and Thyroid Peroxidase.

Even if you are already taking thyroid hormone medication you may be asked to repeat
blood work. This is to make sure that the dose you are taking has your levels in optimal
ranges and that all of the important labs have been done.

OPTIMAL THYROID HORMONE LEVELS

TEST Optimal Range
TSH 0.2 to 2.0
Free T4 1.0 to 2.0 or middle to upper end of range
Free T3 3.0 to 4.5
Reverse T3 11 to 32 - lower end of the range

THYROID TREATMENT
If you have symptoms and non-optimal labs your physician may decide to prescribe thyroid
nutritional supplements. If so, you will need to repeat the blood work to make sure your
dose is correct in 4 to 12 weeks.
32
COMMON BRANDS AND STARTING DOSES
Dessicated thyroid USP: Armour, Naturethroid, Westhroid, or Compounded Thyroid
starting with 15-30mg.
T4 Only: Synthroid or Levoxyl starting with 25 mcg.

INSULIN RESISTANCE
Carbohydrates are broken down into glucose, so when you eat too many of certain types of
carbohydrates, like simple carbohydrates or high glycemic carbohydrates, the level of glucose
in your blood increases dramatically, causing the pancreas to release a large amount of
insulin to lower it. This surge often lowers blood sugar too much, causing fatigue, irritability,
depression, mood swings, memory problems, confusion, and carbohydrate cravings.

Long-term overproduction of insulin, along with other risk factors (such as those listed
below) can lead to insulin resistance, which means that cells become less sensitive to
insulin. This insensitivity forces your body to produce yet more insulin to deal with glucose.
Unfortunately, high insulin levels cause the body to store fat, which is why insulin is often
called the fat storage hormone.

Since insulin is a major hormone, it is critical in managing the minor hormones such as
estrogen, testosterone, and progesterone. But the minor hormones affect insulin in turn. A
decline or imbalance in the sex hormones in women can cause them to become increasingly
intolerant of carbohydrates; therefore, the cells become less sensitive to insulin. This leads
to weight gain and increased risk of other health problems.

THE CAUSES OF INSULIN RESISTANCE

Several factors can lead to insulin resistance which include:

• Genetic predisposition • Elevated cortisol

• Diet (high carbohydrate, high glycemic, • Oral contraceptives
with excess simple carbohydrates) • Synthetic progesterone
• Obesity • Hormone Replacement Therapy (Non-
• Sedentary lifestyle Bioidentical)
• Smoking • Hypothyroidism
• Stress • Estrogen deficiency
• Elevated estrogen levels from
overproduction or from excessive Estrogen
Replacement Therapy

33
 SYMPTOMS AND EFFECTS OF INSULIN RESISTANCE
Symptoms of insulin resistance and long term effects may include:

• Fatigue (especially after meals) • Increased risk of breast cancer,

• Poor mental concentration endometrial cancer, and other cancers
• Weight gain • Increased risk of cardiovascular
• Abdominal (apple-shaped) obesity problems
• Edema • Accelerates aging and premature death
• Intense craving for sweets (especially • Increased risk of alzheimer’s disease
after meals) • Increased risk of diabetes
• Excess testosterone and/or DHEA

OPTIMAL INSULIN AND GLUCOSE LEVELS

Glucose: 80-90 ng/dL (fasting level)
Fasting Insulin: 5- 10 IU /ml or below
HBG A1C or Glycated Hemoglobin: 5.4 or less
(This is another optional test for insulin resistance, which is a marker for average blood
glucose levels over the previous months.)

Insulin Resistance Calculations:

• (Fasting Insulin X Fasting Glucose) ÷ by 405. Results > 1.8 may = insulin resistance
• Triglycerides ÷ HDL. Optimal 1-1.5. >2.0 = insulin resistance

ADDRESSING INSULIN RESISTANCE

It is very important to have normal glucose and insulin levels for many aspects of health and
long-term disease prevention. Doing so can promote fat loss, increase energy, enhance
mental clarity, slow aging, lower blood pressure, improve cholesterol, and is essential for
overall hormone balance.

DIET AND EXERCISE

Improve your diet by eating low-glycemic foods which promotes a slower, sustained release
of glucose and insulin, and increasing your fiber intake. Non-starchy vegetables generally
have low glycemic index levels. Proteins and good fats are also good choices for blood
sugar and insulin control because they contain no carbohydrates; therefore, they register
zero on the glycemic index.

Exercise is highly effective at preventing insulin resistance and helping to improve insulin
sensitivity.

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DIETARY SUPPLEMENTS TO IMPROVE INSULIN SENSITIVITY
A variety of supplements and herbs are very effective to reduce insulin resistance. Some
of these are: thiamin, biotin, chromium, alpha-lipoic acid, N-acetyl-cysteine, Gymnema
sylvestre, fish oil, Coenzyme Q10, L-carnitine, fiber, and magnesium. Your BHRT physician
may recommend a supplement consisting of some of these key supplements in your
treatment plan.

MEDICATION FOR INSULIN RESISTANCE

Physicians often put their patients with elevated glucose or elevated hemoglobin A1c levels
on medication when necessary. Metformin is a medication that reduces insulin resistance,
reduces the release of glucose from the liver, stimulates the clearance of glucose, and
reduces the absorption of glucose in the small intestine after a meal. This and other similar
medications are generally well tolerated.

SUPPLEMENTAL SUPPORT FOR HORMONE BALANCE

Optimal amounts of key nutrients are absolutely critical for hormone balance. They are
required for synthesis and healthy metabolism (clearance) of hormones. Specific nutrients
that help balance hormones and the conditions associated with hormone imbalance such
as PMS, perimenopause, bone loss, and aging include: antioxidants, B-vitamins, fish oil,
calcium, magnesium and probiotics.

Just as critical as the nutrients themselves, is the quality of the supplements. Cheaper, inferior
supplements just do not work and may do more harm than good. Supplements should be
pharmaceutical grade, which have superior bioavailability and potency. Pharmaceutical grade
supplement manufacturers follow the same strict production guidelines as pharmaceutical
companies.

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 WHEN TO EXPECT RESULTS
Typically once you start your BHRT treatment plan you can expect to start noticing some
results within the first month. By the time you repeat your testing in 3 months and then
see your doctor for any necessary adjustment, you should be very close to having your
hormones in balance. Should any new symptoms arise, you should contact your physician’s
office. If you feel as though you are not making progress, you should discuss this with your
physician. Hormones always do what they are supposed to do in the body. There are times
when some women are slow to make progress in symptom improvement. This can be
due to other health related factors which need to be addressed through different types of
tests and treatment modalities, such as performed by a physician specializing in Functional
Medicine, Environmental Medicine, Naturopathic Medicine, Acupuncture, etc.

Women who have experienced hormone makeovers repeatedly report, “I feel like me again”,
“I can’t believe the difference”, “You have given me my life back”, “My husband thanks you”,
and “I feel like I did when I was in my twenties.”

NOTE

The educational content I have included does not guarantee that you will experience
the results suggested or the results you may anticipate. Not all women respond to these
approaches. Ultimately, it is up to your physician to treat your symptoms and appropriately
address your health care goals.

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 MORE RESOURCES
For more information about hormones I invite you to read my
book, The Hormone Makeover-7 Steps to Transform Your Life With
Bioidentical Hormones. On my web site, you will find articles on
specific topics such as, “Hormones and Weight Gain”, The Effect
of Hormones on Wrinkles” as well as a variety of topics under the,
“Frequently Asked Questions”.

www.h o rmonemakeover.com

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 ABOUT THE AUTHOR: DONNA WHITE
Donna White has over 20 years of experience in the field of
Bioidentical Hormone Replacement Therapy helping women
and medical providers.

HRT PRACTICE CONSULTANT AND CLINICAL PATIENT EDUCATOR

Working as a Bioidentical HRT Practice Consultant training 50+ practices and personally
building 4 practices, Donna understands what it takes to make implementing Bioidentical
HRT practical and successful. As a Bioidentical HRT Clinical Patient Educator, Donna
understands the challenging symptoms patients with hormone imbalance present. She
has worked directly with patients in premier anti-aging and wellness medical practices
since 2001 personally helping thousands of women and men get their hormones back in
balance.

SPEAKER, AUTHOR, AND MEDIA PERSONALITY

As a professional speaker and author, Donna is gifted at communicating complex

science and protocols in easy to apply strategies for both lay people and medical
providers. She has spoken on BHRT for medical conferences, women’s groups,
women’s conferences, and business and professional groups across the US and Canada.
Donna also shares her message of hope and help for hormones in magazine articles,
blog posts, and on radio and television programs. She is the author of the book, “The
Hormone Makeover – 7 Steps to Transform Your Life with Bioidentical Hormones”.

AVERAGE WOMAN

Donna understands what it is like to deal with hormone problems. She first started
studying hormones over 20 years ago due to her own severe case of PMS. Through out
her 30’s and 40’s she had to manage excessive stress hormone imbalance and thyroid
problems. Now in her 50’s, having successfully navigated menopause, her passion is to
make sure women realize that they truly do not have to live with symptoms or problems
related to hormone imbalance. Donna’s message helps women to understand the impact
THE HORMONE MAKEOVER GUIDEBOOK
How to Overcome Hormone Imbalance with
Bioidentical Hormones and Supplements

The Hormone Makeover Guidebook is the ideal resource to guide you

through the process of working with your doctor to get your hormones
back in balance. Hormones and the current treatment options can
be confusing. Learning more helps you make informed choices. This
guidebook addresses the most common questions about hormones and
is designed to be a reference as you work through the process of your own
hormone makeover. As you learn about hormones, the more equipped
you will be to help your doctor help you and monitor your progress.

Symptoms of hormone imbalance are common, but they are not normal.
You do not have to be resigned to just deal with them. Nor do you have
to chalk symptoms up to just getting older. You deserve to look and
feel good. Balanced hormones make life so much better. Get yourself a
hormone makeover. The Hormone Makeover Guidebook will show you
how step-by-step.