Hello, many thanks. One question, I read from Dr Mercola that he agrees with progesterone bioidentical as the needed hormone for menopause women, but he says cream stops working after a few months, so he recommends transmucosal. What do you think?
Hi Pepe, great question, and a somewhat complicated one. I agree with Dr. Mercola that transmucosal delivery is useful and possibly also optimal for progesterone. As for generally choosing transdermal delivery of hormones for patients, I would make the following points:
1. Progesterone IS, too a degree, transformed to several downstream hormones, including allopregnanolone. (see https://www.mdpi.com/2218-273X/13/4/652 for a schematic of this biochemical pathway) This transformation actually has several downstream benefits. Allopregnanolone itself has many beneficial roles, especially in neurogenesis and maintenance of cognitive function. It requires two different enzymes to achieve this, so the level of conversion will vary from person to person.
2. I have used transdermal delivery of progesterone for my patients for more than 30 years, with thousands of patients followed over time with testing (using salivary, blood or urinary metabolites) to verify adequate tissue levels. I have found that as a rule they do not drop over time, although the amount of progesterone used to achieve optimal levels will vary among individuals (with multiple variables including body mass, correct topical use and application, and likely the phenotypic expression and activity of the two enzymes in question.)
3. After the adequacy of delivery requirement, next on my list is practicality and cost of use. We can place all of the desired HRT components (estriol, estradiol, progesterone, testostosterone and if desired, adrenal building blocks of pregnanolone and DHEA) in a single, once daily topical compounded prescription. I've found that when I raise the "number of things I ask a patient to do, " the likelihood of consistent compliance drops drastically. I do have some patients, probably those having a degree of OCD, who use multiple daily therapies consistantly, but they are in a distinct minority. I find that if we use a topical and also a transmucosal for progesterone, we double the compounding cost and reduce the consistency of use. I have found that putting everything in one topical for once daily use has been the best combination for systemic delivery, cost and compliance.
To conclude, if one is a) willing to do two forms (topical and transmucosal) of HRT delivery daily and b) you find a prescriber that will manage this for you, you may have the best of both worlds.
As always, we need to find the version that works best for each individual. This takes time and effort from both the patient and the prescriber, which is why, I believe, it is not done as often as it should be.
Hello, many thanks. One question, I read from Dr Mercola that he agrees with progesterone bioidentical as the needed hormone for menopause women, but he says cream stops working after a few months, so he recommends transmucosal. What do you think?
Hi Pepe, great question, and a somewhat complicated one. I agree with Dr. Mercola that transmucosal delivery is useful and possibly also optimal for progesterone. As for generally choosing transdermal delivery of hormones for patients, I would make the following points:
1. Progesterone IS, too a degree, transformed to several downstream hormones, including allopregnanolone. (see https://www.mdpi.com/2218-273X/13/4/652 for a schematic of this biochemical pathway) This transformation actually has several downstream benefits. Allopregnanolone itself has many beneficial roles, especially in neurogenesis and maintenance of cognitive function. It requires two different enzymes to achieve this, so the level of conversion will vary from person to person.
2. I have used transdermal delivery of progesterone for my patients for more than 30 years, with thousands of patients followed over time with testing (using salivary, blood or urinary metabolites) to verify adequate tissue levels. I have found that as a rule they do not drop over time, although the amount of progesterone used to achieve optimal levels will vary among individuals (with multiple variables including body mass, correct topical use and application, and likely the phenotypic expression and activity of the two enzymes in question.)
3. After the adequacy of delivery requirement, next on my list is practicality and cost of use. We can place all of the desired HRT components (estriol, estradiol, progesterone, testostosterone and if desired, adrenal building blocks of pregnanolone and DHEA) in a single, once daily topical compounded prescription. I've found that when I raise the "number of things I ask a patient to do, " the likelihood of consistent compliance drops drastically. I do have some patients, probably those having a degree of OCD, who use multiple daily therapies consistantly, but they are in a distinct minority. I find that if we use a topical and also a transmucosal for progesterone, we double the compounding cost and reduce the consistency of use. I have found that putting everything in one topical for once daily use has been the best combination for systemic delivery, cost and compliance.
To conclude, if one is a) willing to do two forms (topical and transmucosal) of HRT delivery daily and b) you find a prescriber that will manage this for you, you may have the best of both worlds.
As always, we need to find the version that works best for each individual. This takes time and effort from both the patient and the prescriber, which is why, I believe, it is not done as often as it should be.