Is My Estrogen Dose High Enough? | PYHP 156

In this episode, we dive into the important topic of HRT (Hormone Replacement Therapy) dosing. Our discussion is inspired by a question from Leah, a 56-year-old listener who is healthy, fit, and navigating menopause. Leah has been experiencing significant anxiety and wonders if her current estrogen dose might be too low. 

What You’ll Learn in This Episode 

• The difference between static vs. rhythmic HRT dosing and how they impact symptoms. 
• Various HRT applications, including estradiol patches, transdermal/transvaginal creams, and oral HRT options. 
• Key hormones involved in HRT: estradiol, estriol, testosterone, progesterone, and cortisol. 
• Why anxiety is a common and often overlooked symptom of menopause—and how HRT can help. 

Let’s Read Leah’s Question: 

"Hello there! After 6 months of deep diving I found your site! I feel like no one here in Vancouver has a full hold on how to treat me. Your information has been so invaluable, but now I’m worried I’m not being cared for properly. 

I’m 56, fit, work out regularly at moderate intensity with muscle training, normal weight, healthy my entire life-no menopause issues till March. 

I was a week away from a big gig and suddenly got this weird, crippling anxiety. It started with a massive hot flash upon waking one morning, then this feeling like I had just missed being in a car accident … like a fright- for no reason. It was bad enough the first week that I didn’t want to drive. It settled to about 30% and so was able to function. But it recurs at this level now and it’s been 8 months. Its the most uncomfortable feeling, and little things bring it on, like getting ready to go out and always first thing when I wake up. 

I started with an obgyne who put me on .05 estradot patch with 100 mg progesterone. Hot flashes went away but nothing else. Went up to .075, no change. Also started on 2 mg testosterone ordered perivaginally. 

Then I went to see a naturopath. Did a DUTCH. Test, my hormone levels looked as if I wasn’t taking anything! Also adrenals were fatigued and low cortisol.Basically everything really low but progesterone ok. 

My naturopath put me on 50:50 bi-est 2.0 mg vaginally applied. Progesterone 40 mg transdermal and staying on the oral progesterone. No change after 3 weeks.

I feel like I need more hormones. My naturopath says she never gives more than 3 mg testosterone because it can raise cholesterol but all the research shows 5 mg starting dose? 

I also asked her about vaginal application of biest and systemic concerns and she said because it was 50:50 the estriol would help regulate the estradiol. 

After listening to all your podcasts and reading your case studies, I’m feeling like there’s so much contradicting info and I don’t want to apply it vaginally. I feel like my dose is too low, did I mention in addition to this weird anxiety, I’m also getting little hot flashes again? 

I want to enjoy my life and feel like me again. This ins...