(Peri)menopause

It sounds like checking hormone levels is a good plan but I don’t know how you do that when it’s unknown if my cycle will continue or actually have stopped.
You can contact Dr. Taguchi for a video consult for the appropriate test for you. She ordered a Expanded Cycling Female Hormone Panel by lab DiagnosTechs for us. I see that DiagnosTechs also has a Expanded Perimenopause Hormone Panel. If you want, I can send you Dr. Taguchi's contact information by private message.

Expanded Perimenopause Hormone Panel
2 saliva samples sent for comparison – Estrone, Estradiol, Estriol, Progesterone, Testosterone, DHEA & DHEA-S
Plus Follicle stimulating hormone, Luteinizing Hormone
Expanded Cycling Female Hormone Panel
Mapping of menstrual cycle with 11 samples measuring Estradiol, Progesterone, DHEA & DHEA-S (cycle average), Testosterone (cycle average)
Plus Follicle stimulating hormone (x7), Luteinizing Hormone (x7)
 
I was just reading that the herb Blue Vervain is apparently very helpful for hot flashes during menopause:


Blue Vervain has become one of my staple relaxant remedies over the years and is the perfect remedy for some common patterns in our overworked and burned-out culture. You can use Blue Vervain for a full spectrum approach to alleviating tension, whether that be psychological or a stiff neck. This herb acts as the conduit between your nervous and musculoskeletal systems, so you feel a sense of relief not only in the mind but in the body as well.


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Blue Vervain (Verbena hastata)

Blue Vervain has a long traditional usage in European herbal medicine and was considered a sacred plant to the druids. This plant has some very unique psycho-spiritual indications that aid in planetary and elemental imbalances culminating in the body and mind. It is one of the very best relaxant remedies available in the Western Materia Medica, and as you will learn, this property translates to nearly every aspect of the way it works in your body and mind.

Common name: Blue Vervain

Latin name: Verbena hastata

Family: Verbenaceae

Tastes: Bitter, Acrid

Affinities: Nervous, musculoskeletal, and female anatomical reproductive systems, febrile mechanism, liver, neck region

Actions: Nervine sedative, antispasmodic, bitter tonic, relaxant diaphoretic, emmenagogue

Energetics: Relaxant, cooling, drying

Taste​

Blue Vervain tastes bitter. Now when I say bitter, I mean so bitter it can induce nausea in large quantities. For this reason, you would not want to brew an infusion with it as it would be extremely difficult to drink. Like many bitter plants, Blue Vervain sends a shiver down your spine, alluding to its grounding effects on the vital force. This downward bearing action corresponds to many of Blue Vervain’s medicinal properties.

The second taste associated with Blue Vervain is acrid. Although I like to think of this flavor as the combination of bitter and sour, Matthew Wood succinctly describes it as “the sensation of bile in your throat.” If you’re unfamiliar with this flavor, think of other acrid plants like Lobelia (Lobelia inflata), Kava-Kava (Piper methysticum), and Valerian (Valeriana officinalis). This taste indicates that the medicinal plant is antispasmodic. This action calms excess physiological tension, ultimately leading to affinities in the nervous and musculoskeletal systems.

Affinities​

Blue vervain acts as a mediator between the nervous and musculoskeletal systems. By decreasing excess psychological tension, Blue Vervain softens musculoskeletal tension, which is often exacerbated by stress and anxiety. The opposite is true as well, for when we are physically more relaxed, our mind tends to calm down as well.

Blue Vervain has a unique affinity for the back of the neck and “the shoulders and up.” This makes it a valuable remedy for stiff shoulders, TMJ, and a sore neck. Blue Vervain relaxes tension in the liver, making it specific for headaches. More specifically, it works well for tension headaches that start in the back of the neck and radiate to your forehead. This plant is a valuable remedy for people with tension headaches since it supports the liver and the head, thereby addressing the root cause of the headache while alleviating painful symptoms. Illustrating another affinity for the head, Blue Vervain was traditionally used for epileptic seizures that started at the nape of the neck and moved downward. Nowadays, you would want to seek professional care in the case of a seizure, but the historical usage of Blue Vervain is consistent in its application for matters of the head.

With its relaxant quality, Blue Vervain is an excellent herb for the female anatomical reproductive system and is used for many menstrual-related complaints, such as amenorrhea, cramping, and anxiety. This herb can alleviate physical and psychological tension associated with the preceding and first few days of menses. Although this application is less common, you can use Blue Vervain for spasms and pain in the urinary system in the case of kidney stones and similar conditions.

Because of its relaxant properties, Blue Vervain is a valuable remedy for the febrile system. This “system” describes the body’s process of circulating the blood to the periphery and opening the pores to induce a sweat during a fever. As mentioned before, Blue Vervain affects the liver because of its bitterness. However, it also impacts the gallbladder and entire digestive system by stimulating gastric secretions and bile for the healthy assimilation of fats and oils while encouraging elimination as well.

Actions​

In my opinion, the root of Blue Vervain’s medicinal virtue is as a nervine sedative. Herbs in this group differ from nervine hypnotics in that you can comfortably use them throughout the day without feeling tired. In fact, Blue Vervain can support you at school or work by regulating your nervous system and helping you feel calm enough to sit and focus for long periods. Just as it relaxes tension in the mind, Blue Vervain eases constriction and tightness in the musculature. As an antispasmodic, Blue Vervain relaxes the smooth muscles, which surround the organs, and skeletal muscles, which comprise most of the musculature in the body.

It’s quite common that plants with sedative properties for the nervous system will also relax the musculature. This is because muscle fibers are innervated by the nerves, so when the nervous system excessively “fires” the muscles tend to tense and cramp. Relax the nerves and you tend to relax the muscles as well.

Another way Blue Vervain’s relaxant effects translate to its medicinal properties is through its relaxant diaphoretic action. Diaphoretics are herbs you would use during a fever. There are two different types of diaphoretics; stimulant and relaxant. Stimulant diaphoretic herbs are typically hot, spicy, and pungent and work by directing the blood flow to the skin surface to relieve internal heat. You would typically use these in the beginning stages of a fever or when someone is pale and feeling cold. Relaxant herbs, on the other hand, are used when someone is feverish, hot, and tense. However, they cannot produce a sweat because the pores and capillary beds are contracted. People who need relaxant diaphoretics experience pain, can’t sleep, and may thrash around in irritability as the psychological and physical tension couple. This depiction is the perfect illustration for when you would want to use Blue Vervain. With its relaxant diaphoretic properties, it relaxes the pores of the skin and capillary beds beneath the skin so that the circulation can rise to the surface and produce a sweat, thereby relieving the internal heat of a fever. Blue Vervain is a specific for fevers that will not break and is the choice herb when other diaphoretics don’t work.

As mentioned earlier, Blue Vervain is a strong bitter herb. Because of this, it improves digestion through increasing gastric secretions and bile, thereby enhancing the assimilation of fats and oils and encouraging elimination. By supporting the liver in its detoxification process, Blue Vervain prevents a “hot liver” pattern from developing and prevents tension headaches from occurring at the very core. Blue Vervain’s bitter tonic action also lends it an emmenagogue property that can facilitate healthy menstruation and alleviate menopausal symptoms. Blue Vervain is a specific remedy for hot flashes and is one of the best remedies you can use to relieve them. If we consider all of these actions combined, it makes sense it would be supportive for hot flashes, for it cools down a hot liver, relaxes the pores and capillary beds, and calms psychological tension.

Energetics​

Blue Vervain is relaxant, cooling, and drying. You can see Blue Vervain’s relaxant property in virtually every aspect of its medicinal actions – from its ability to ease tense muscles to calming an irritable mind. Since it is bitter in taste and action, this lends it a particularly cooling effect energetically. Finally, because the bitterness of Blue Vervain increases secretions which ultimately leave the body, it has a net drying effect. Although Blue Vervain is deemed a drying plant in the Western model, the Chinese model states that Blue Vervain protects the fluids when “the yin is not holding down the yang.” This pattern describes a scenario where the internal heat is raging out of control because there are insufficient fluids, or moisture, to contain it.

In the Ayurvedic model, Blue Vervain is a specific remedy for vata since this dosha is prone to tension in the body and mind. If you look at Blue Vervain, you might notice that the plant looks tense! This thin and spindly plant has narrow flower heads that point to the top. Altogether, a very vata-looking plant. Blue Vervain’s relaxant and antispasmodic properties help balance vata. However, the cooling and drying nature can aggravate this constitution over time. For this reason, it may be best to pair Blue Vervain with a warming or moistening plant to balance these energetics if you intend on administering this herb for a prolonged period.

Blue Vervain is very helpful for pitta dosha as well since this constitution tends to run hot and can burn themselves out. The bitterness of the plant helps to cool their excited systems down while its relaxant property soothes an agitated mind. Blue Vervain is a specific remedy for when the fire and wind elements combine to create a negative feedback loop or when “there is a fire beneath the wind.” This can look like nervousness and anxiety leading to a high drive, burnout, and exhaustion.

From the physiomedicalist perspective, Blue Vervain balances the wind/tension tissue state. This pattern can be boiled down to two words: elevated vata. When there is wind/tension, there is psychological and mental tension combined with cramping and pain. Through Blue Vervain’s relaxant effects, it balances this tissue state and leads to greater balance.

Blue Vervain (Verbena hastata)

Psychological and Emotional Aspects​

Although herbalists make flower essences using all sorts of herbs these days, Blue Vervain was one of the original Bach flower essence remedies. This herb has a specific indication for people with mental excess, who get stuck in their head, think too much, and are extremely driven. Despite feeling burned out and exhausted, the Blue Vervain archetype keeps pushing forward. In the words of Matthew Wood, “Blue Vervain is for the avid list maker.” This person always has their to-do list and is adding yet another item to it. They tend to be really hard on themselves, and because they have such high ideals, they end up being hard on others since they expect to live up to the nearly impossible standards they set for themselves. This pattern commonly leads to conflict in relationships. “Rest” is an unspoken word, and the burnout they feel leads to psychological and physical tension with patterns of nervousness, anxiety, and exhaustion.

I like to think of the Blue Vervain person as someone with an excess of wind and fire. Their minds are running a million miles a second with all the stuff they have to do, all of which is striving towards some lofty goal or accomplishment. They don’t take care of themselves and might push themselves past their limits… perhaps fueled by an excess of caffeine, which surely doesn’t help their situation. That excess of wind fuels the fire, and the fire whirls the winds, and a vicious cycle begins until they just completely burn themselves out. In this way, it is the perfect remedy for the overworked and burned-out.

Blue Vervain (Verbena hastata)

Alchemical Correspondences​

Astrologically, I place Blue Vervain under the domain of Venus. You can view this correspondence with its dainty and graceful morphology, relaxant effects on the wind/tension tissue state, affinity for the female anatomical reproductive system, and overall softening influence on the mind and body. https://www.evolutionaryherbalism.c...n-Verbena-hastata-flower-leaf-Landscape-1.jpg

Venus is known as “the great relaxant” in medical astrology. When you have an excess of Venus in your chart or constitution, your tissues may be overly lax and leak fluids, tending towards the damp/relaxation tissue state. Alternatively, your muscles may be tight and contracted if you have a Venus deficiency. With its antispasmodic actions, Blue Vervain works as a sympathetic venusian remedy to ease tension in the body and mind. https://www.evolutionaryherbalism.c...n-Verbena-hastata-flower-leaf-Landscape-1.jpg

Since the Blue Vervain archetype is so rigid, they can struggle quite a bit in their relationships since they tend to project unrealistic ideals onto the people in their lives. Additionally, they can have difficulty accepting people for how they are instead of how they want them to be. Since Blue Vervain is ruled by Venus, the planet of relationships, it can introduce a sense of ease and relaxation into the way you relate to others. https://www.evolutionaryherbalism.c...n-Verbena-hastata-flower-leaf-Landscape-1.jpg

Lastly, Blue Vervain is a specific remedy for the female anatomical reproductive system and supports menstrual and menopausal complaints. In a way, you can see that Blue Vervain is a Venusian remedy that balances an excess Mars. This is exemplified with its cooling and relaxant effects on fevers, psychological irritation, hot flashes, and the ability to mellow out fiery and driven dispositions prone to exhaustion. https://www.evolutionaryherbalism.c...n-Verbena-hastata-flower-leaf-Landscape-1.jpg

Blue Vervain is distinctly ruled by the Air Element – something you can observe through its morphology, herbal actions, energetics, and tissue state affinity. Morphologically, Blue Vervain is tall, skinny, and spindly. The upward movement of this plant indicates its psychological application for mental excesses, such as too much thinking, rumination, and mental stress.

Blue Vervain is a nervine sedative with a clear effect on the mental and psychospiritual faculties. An interesting doctrine of signatures that allude to this property is Blue Vervain’s purple flowers, which are associated with the top of the head, crown chakra, brain, mind, and general higher centers. You can also see its correlations to the Air Element through its ability to modulate excess Wind (or vata) in the body and mind through its relaxant and antispasmodic effects, as well as its affinity for the nervous system.

Blue Vervain (Verbena hastata)

Growing Blue Vervain​

Blue Vervain is in the Verbenaceae family and is native to North America. This medicinal herb grows well in cool climates and can be found in parts of the United States and Canada. Verbena officinalis is natural to Europe and has a longstanding history there as well. Blue Vervain has a thin square stem and flowers that gather into a narrow cone-like shape at the top. This plant is beautiful, hardy, and easy to grow- making it the perfect medicinal herb to add to your garden.

You can grow Blue Vervain from root cuttings or seeds. If you prefer to use the root, you should wait until the fall to cut the plant back and divide the roots for future propagation. If you would rather grow Blue Vervain from seeds, you should grow them in the early spring so that they can receive a cold stratification. This helps “wake” the seeds up and prime them for healthy growth later in the season. Because Blue Vervain self-seeds, you will likely find flowers popping up around your garden the following year.

The medicinal parts of Blue Vervain are the aerial leaves and flowers. To prepare a plant medicine using Blue Vervain, simply pick off the leaves and flowers and proceed with your preparation.


Preparation​

Because Blue Vervain tastes so bitter, you are best off preparing it into a tincture to increase client compliance. You can tincture Blue Vervain fresh or dry. However, if you prefer to dry the plant, ensure it does not get too hot, or the medicinal compounds will degrade and lose their potency. For this reason alone, I prefer to tincture Blue Vervain fresh.

To prepare a fresh Blue Vervain tincture, use 60% alcohol. To tincture it dry, use 40-50% alcohol. Because it is a nauseant bitter, it can upset the stomach in large doses. While not toxic, it can lead to mild gastric upset. If this occurs, simply lower the dosage. Blue Vervain is an emmenagogue herb, and thus is contraindicated during pregnancy.

From its tall and rigid stance in the garden to its acrid taste and antispasmodic actions, Blue Vervain provides you with lots of signals that it is helpful for a particular pattern: tension.

Whether you struggle with mental rumination, a tense and frozen neck, or the inability to slow down and rest, Blue Vervain teaches you that you do not have to work until your tank is empty. Rather, it is with a full cup that you are able to experience the daily joy and peace life has to offer, all while reaching your goals.
 
Any woman who suddenly started having recalcitrant acute pain at around the critical age, from seemingly out of nowhere, whether so-called arthrosis pain or any body part tendinitis, will definitely appreciate the following testimonial/talk:
After watching the video I called my GP and asked them whether they could test my testosterone, progesterone and estradiol plus a slew of other things like cortisol and minerals. The GP (I am in Holland) was knowledgeable and aware of the developments in the US in regards to testosterone supplementation for women, but explained that supplementation is still a bit tricky for women, but he is willing to give it a go and see where it will lead me after a trial period of a few months. So, that's great.

He did say that it was best to test testosterone mid-morning? I will report back with more details if anything interesting crops up. Thank you so much for posting this video, Gaby!

Fatigue and lack of motivation is really a biggie for me ATM, which could be related to a lack of testosterone. Also, my skin is super dry. Since I stopped eating butter these aches and pains have lessened considerably and I now only drink coffee after eating and that also makes a difference OSIT.
 
I've been having night sweats and hot flushes for a couple of years now....I've tried a few things in the hope to alieviate these, like black cohosh, which really didn't ease anything. About 2 months ago, my neighbour gave me a bunch of lavender, which I dried and sewed into a linen pouch to put into one of my clothes drawers. Having forgotten to put it in the drawer, it was left on my bedside table. That night, I had the best, uninterrupted nights sleep I'd had for a few years, so I put the pouch in my pillowcase..and then the next night and so on, no waking multiple times with night sweats! I thought I'd experiment, so I changed the bedcovers and removed the lavender...2 nights of waking up hot and sweaty...then I put it back...slept right through! Its been a game change for me...I use lavender essential oil and put a few drops on my shirt for when I work...no hot flushes!!
 
After watching the video I called my GP and asked them whether they could test my testosterone, progesterone and estradiol plus a slew of other things like cortisol and minerals. The GP (I am in Holland) was knowledgeable and aware of the developments in the US in regards to testosterone supplementation for women, but explained that supplementation is still a bit tricky for women, but he is willing to give it a go and see where it will lead me after a trial period of a few months. So, that's great.

He did say that it was best to test testosterone mid-morning? I will report back with more details if anything interesting crops up. Thank you so much for posting this video, Gaby!

Fatigue and lack of motivation is really a biggie for me ATM, which could be related to a lack of testosterone. Also, my skin is super dry. Since I stopped eating butter these aches and pains have lessened considerably and I now only drink coffee after eating and that also makes a difference OSIT.
Skin care tip for very dry skin: Try castor oil and then a tallow cream over it- helped me go from very dry to best skin ever!
 
I've been having night sweats and hot flushes for a couple of years now....I've tried a few things in the hope to alieviate these, like black cohosh, which really didn't ease anything. About 2 months ago, my neighbour gave me a bunch of lavender, which I dried and sewed into a linen pouch to put into one of my clothes drawers. Having forgotten to put it in the drawer, it was left on my bedside table. That night, I had the best, uninterrupted nights sleep I'd had for a few years, so I put the pouch in my pillowcase..and then the next night and so on, no waking multiple times with night sweats! I thought I'd experiment, so I changed the bedcovers and removed the lavender...2 nights of waking up hot and sweaty...then I put it back...slept right through! Its been a game change for me...I use lavender essential oil and put a few drops on my shirt for when I work...no hot flushes!!

Thank you for that! I'm definitely going to give it a try.
 
He did say that it was best to test testosterone mid-morning? I will report back with more details if anything interesting crops up.

Good to hear your doctor is open to it. Once you have your panel, you may know what you can experiment with. It's hard to find the exact combo... As for taking testosterone, I take it upon waking up, but I know others take it in the evening with good effects too.
 
Has anyone been able to source testosterone online? I am not in peri (yet) but I would like to optimize my hormones before then. I can find everything else but finding a backdoor source for that has been difficult. I know I wouldn't get anywhere if I asked my doctor for it since I am not menopausal so I need to find another route.
 
So, my results are back and my testosterone is low, 0,7 (that's all they said). Progesteron 1.2 and Estradiol 43.3. So, the GP has now prescribed Tostran, a testosterone 2% gel. So, I will have to experiment and wait and see. I have been applying Progesterone cream off and on, but so far I haven't been able to find any data as to what are normal hormone levels for postmenopausal women.
 
Is this bioidentical testosterone?
If I understood the pharmacist correctly, it is. The structure of the molecule is identical to the hormones which the body produces, but it's not like the progesterone cream I use which is made from wild yam. Tostran is synthetic. But they still call it bio-identical.

Bio-identical hormones (the article is in Dutch) have obtained a central role in guidelines as stated by Dutch Menopausal Society and this guideline has been adopted by the Dutch society for GPs.

The pharmacist told me that more and more Dutch men are prescribed testosterone, but she hadn't heard of women getting it. So, I promised her I would keep her posted, as she was interested in the outcome.
 
I've been having night sweats and hot flushes for a couple of years now....I've tried a few things in the hope to alieviate these, like black cohosh, which really didn't ease anything. About 2 months ago, my neighbour gave me a bunch of lavender, which I dried and sewed into a linen pouch to put into one of my clothes drawers. Having forgotten to put it in the drawer, it was left on my bedside table. That night, I had the best, uninterrupted nights sleep I'd had for a few years, so I put the pouch in my pillowcase..and then the next night and so on, no waking multiple times with night sweats! I thought I'd experiment, so I changed the bedcovers and removed the lavender...2 nights of waking up hot and sweaty...then I put it back...slept right through! Its been a game change for me...I use lavender essential oil and put a few drops on my shirt for when I work...no hot flushes!!
Will have my wife try this and might get some for the pillow myself.
 
In case it's of any use to someone I thought I'd share an experience I had over the past two years. Around 2.5 years ago I had some sort of a hormonal mishap that started with my period lasting three weeks. It was followed by sudden weight gain - which was very unusual for me as I was always the person who could eat pretty much anything in whatever amounts I wanted and I'd remain very skinny. The weight stopped at a certain point and I could eat whatever I wanted again but it wouldn't go down.

Then late last year I started to experience worsening of certain symptoms I'd had for a while and my weight started to go up again - and this time it wouldn't stop at a certain point. I approached my gynaecologist and he said it was most likely perimenopause and suggested tests. But then early this year I had a conversation with a friend of mine that I thought was unrelated to the peri issue and he said to me he was almost certain I had a pretty bad sugar addiction going on.

I gave it a bit of thought and concluded he was most likely right - I did eat lots of sugary snacks and use lots of sugar in my drinks. I decided to not just limit sugar but cut out all processed sugar completely cold turkey. What followed was pretty rough two weeks where I experienced ridiculous sugar cravings, nausea, headaches, irritability, sleeplessness and a whole bunch of other symptoms. But then it got much better and the cravings lessened to a very manageable point.

But the interesting thing is that within a month or so my alleged perimenopause disappeared completely. My periods became regular again (well, ish, they were never 100% regular), and my weight started to go down. I was back to my pre 2022 weight by May this year and I only cut out sugar in January. We're not talking about lots of weight, some 8kg in total, but I'm not a very big person so it was noticeable.

This makes me wonder just how bad sugar is for hormones if cutting it out removed perimenopause symptoms so quickly. And I also wonder if it cutting it out could alleviate symptoms of menopause too. I remember seeing testimonials of women who are on the carnivore diet who said that they don't really experience particularly bad symptoms. I also found studies that show that high fat and animal protein diets help delay natural onset of menopause. Some examples:

Dietary patterns and age at natural menopause: Evidence from the UK Women's Cohort Study - PubMed



I can't really do the carnivore diet, it made me feel absolutely awful when I tried, but a low carb diet clearly seems to be the way to go for me. Today my diet does involve some snacks, but that's only small amounts as a treat. If I crave something sweet I have fruit. Interestingly enough I never particularly liked fruit and only ate it very rarely, maybe once every couple of months or so and in very small amounts. But once I but out processed sugar I started to crave it. And my perimenopause symptoms disappeared when I was eating fruit, starchy vegetables, or gluten free bread, so in my case the issue was processed sugar specifically.

I also tightened my intermittent fasting window and it is now only 6 hours to make sure I benefit from temporary ketosis pretty much daily. I do have cheat days if I'm in a social situation and I don't experience recurrence of the previous symptoms. And intermittent fasting helps with menopause symptoms too:


I also do a form of calorie cycling, i.e., I have my carbs only on certain days and I have less fat on those days. On my high fat days I only have low GI carbs and protein. I found evidence that calorie shifting works better for weight loss than calorie restriction but I mostly do it because apparently mixing saturated fat with high GI sugars increases sugar spikes. So keeping fat and sugar separate makes sense.
 
I got inspired by @Gwenllian to go test my estradiol, progesterone and testosterone levels as well. I am postmenopausal, and for over 2 years now I have had these on and off heart palpitations, a huge spike of osteoarthritis, and problems sleeping. I had a number of things checked, was very worried initially about that racing heart, but everything was good. I did have high blood pressure whenever a white coated person takes it, but my GP thought nothing of it. Phew. So it probably is hormonal. My levels came back as:

Estradiol: 20.8 pg/ml
Progesterone: 0.45 ng/ml
Testosterone: 27.3 ng/dl

I have been applying Progesterone cream off and on, but so far I haven't been able to find any data as to what are normal hormone levels for postmenopausal women.

To get an idea of the values of a postmenopausal woman, I listened to the webinar by Dr. Tyna Moore as linked in this thread (in which she mentions the work of Dr. Rebecca Glaser). She doesn't get into the optimal values specifically, so I asked Grok (so, FWIW) what the optimal levels for postmenopausal women are based on their work. According to Grok:

Dr. Tyna Moore, a naturopathic physician and chiropractor specializing in metabolic and regenerative health, emphasizes hormone replacement therapy (HRT) as a key tool for managing menopause symptoms, particularly through bioidentical hormones. Her work, including podcasts and courses on menopause optimization, advocates for personalized dosing to achieve symptom relief (e.g., low energy, mood changes, and libido issues) while supporting metabolic health, bone density, and muscle maintenance. She highlights the importance of testosterone in women for vitality but does not specify rigid numerical ranges, focusing instead on individualized therapy guided by symptoms and lab monitoring to avoid over-supplementation.Dr. Rebecca Glaser, a retired breast surgeon and hormone researcher at Wright State University, has conducted extensive studies on subcutaneous testosterone implants for women, including postmenopausal and breast cancer survivors. Her research, published in journals like Maturitas and Menopause, demonstrates that physiologic (natural-like) testosterone levels via implants relieve menopausal symptoms (e.g., fatigue, hot flashes, joint pain) without increasing breast cancer risk and may even offer protective effects. She stresses that therapy should target levels mimicking premenopausal ranges, monitored via serum tests, with estradiol controlled if needed (e.g., via aromatase inhibitors). Like Dr. Moore, Dr. Glaser prioritizes clinical response over strict numbers, but her pharmacokinetic studies provide concrete therapeutic ranges.
Both experts align on using bioidentical hormones, starting low, and adjusting based on symptoms, side effects (e.g., acne or hair growth from excess testosterone), and periodic blood tests (e.g., every 3-6 months). They caution against synthetic hormones and emphasize lifestyle factors like strength training (a focus of Dr. Moore's) to enhance hormone efficacy. Below is a summary of optimal levels based on their work, cross-referenced with supporting evidence from their publications and related guidelines (e.g., International Menopause Society consensus, which they reference). Note: These are therapeutic targets for HRT; natural postmenopausal levels are lower. Units are standardized (serum blood tests); consult a provider for personal testing.

[th]Hormone[/th]
[th]Natural Postmenopausal Range (No HRT)[/th]
[th]Optimal Therapeutic Range on HRT (Per Dr. Moore & Dr. Glaser)[/th]
[th]Rationale & Key Insights from Experts[/th]
[td]Testosterone (Total Serum)[/td]
[td]7–40 ng/dL (0.24–1.39 nmol/L)[/td]
[td]30–100 ng/dL (1.04–3.47 nmol/L); aim for mid-to-upper premenopausal physiologic range (e.g., 40–70 ng/dL for symptom relief)[/td]
[td]- Dr. Glaser's studies (e.g., 2013 pharmacokinetic trial in Maturitas) show 100 mg subcutaneous implants achieve peak levels of 50–150 ng/dL (average 80 ng/dL) in postmenopausal women, restoring energy, libido, and mood without virilization. Levels >150 ng/dL risk side effects like hirsutism. - Dr. Moore recommends testosterone gel/cream (starting 5–10 mg/day) to reach 20–70 ng/dL, emphasizing its role in muscle preservation and metabolic resilience during menopause. Both advise free testosterone (1–6 pg/mL) as a better marker of bioactivity. - Supported by Global Consensus (endorsed by both experts): Physiologic dosing improves hypoactive sexual desire disorder (HSDD) and vasomotor symptoms without cardiovascular risks at these levels.[/td]
[td]Progesterone (Serum)[/td]
[td]<0.5 ng/mL (1.59 nmol/L)[/td]
[td]0.5–5 ng/mL (1.59–15.9 nmol/L); for continuous HRT, target 1–3 ng/mL with micronized oral/vaginal forms[/td]
[td]- Dr. Moore advocates bioidentical progesterone (e.g., 100–200 mg/day micronized) to balance estradiol, prevent endometrial hyperplasia, and support sleep/anxiety relief in menopause. She notes low levels exacerbate insomnia and mood swings. - Dr. Glaser's work focuses less on progesterone but supports its use (e.g., 100 mg/day) with estrogen in non-hysterectomized women to protect the uterus; her studies show no added breast cancer risk at these doses when combined with testosterone. - Evidence from their referenced trials (e.g., WHI follow-ups): 100 mg/day achieves protective levels without suppressing testosterone benefits. Monitor via symptoms; salivary tests can complement serum.[/td]
[td]Estradiol (Serum, E2)[/td]
[td]<30 pg/mL (<110 pmol/L)[/td]
[td]40–100 pg/mL (147–367 pmol/L); avoid >150 pg/mL to minimize risks like breast tenderness[/td]
[td]- Dr. Glaser's research (e.g., 2021 review in Androgens: Clinical Research and Therapeutics) uses testosterone implants that naturally aromatize to estradiol, targeting 20–80 pg/mL for symptom relief; adds anastrozole if >100 pg/mL to prevent excess in breast cancer patients. - Dr. Moore promotes transdermal estradiol patches (0.025–0.1 mg/day) to reach 50–100 pg/mL, improving hot flashes, bone health, and cognition while pairing with progesterone. She warns low levels (<30 pg/mL) worsen vaginal dryness and osteoporosis. - Consensus from their sources (e.g., Menopause journal): These levels mimic early follicular phase, reducing cardiovascular/bone risks without elevating cancer odds. Transdermal preferred over oral to avoid liver strain.[/td]
Key Considerations from Their Work

  • Individualization: Both doctors stress symptom-driven dosing over lab numbers alone. Dr. Moore integrates strength training to naturally boost testosterone sensitivity, while Dr. Glaser's 15-year cohort (2,000+ women) shows no increased breast cancer incidence at these levels—in fact, a reduced rate (0.083% vs. expected 1.67%).
  • Monitoring & Safety: Test hormones mid-cycle (e.g., day 21) or trough/peak for implants. Side effects (e.g., high testosterone: acne; high estradiol: bloating) are rare at optimal doses. No long-term risks for heart, liver, or cancer in their studies when estradiol is controlled.
  • Delivery Methods: Dr. Glaser favors pellets (every 3–6 months) for steady release; Dr. Moore prefers creams/gels/patches for adjustability. Combine with lifestyle (protein-rich diet, resistance exercise) for best outcomes.
  • Limitations: Their focus is therapeutic HRT; natural levels vary by age/health. Always consult a menopause specialist—self-treatment risks imbalance.
BTW, besides progesterone and testosterone supplementation, my GP also prescribed calcifideol and trace elements. Someone else suggested drinking only distilled water to combat arthritis, which so far really works!
 
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