Getting treatment started for hypogonadism in women and men of all ages

So you’re ready to treat your hypogonadism. Let’s get started!

The very first thing you’ll want to do is get with a doctor who understands endocrinology. It doesn’t have to be an endocrinologist, in fact, it probably won’t be. While the treatment of hypogonadism of all ages should be treated by an endocrinologist it usually doesn’t happen. You say to a doctor of endocrinology that you want to treat your hypogonadism and you will likely get a blank stare. Just move on. The field of endocrinology is a huge disappointment on many levels, from their silence on the lack of science guiding clinical trials to their widespread medical negligence of the healthcare needs of the millions of women and men suffering from hypogonadism.

In our experience the best doctor to partner with is an internist or family doctor. It is very important that you are on the same page from day 1. Agree on as many points as possible.

  1. You have a multiple hormone deficiency illness
  2. You need to measure hormone levels after replacement
  3. You may need to adjust hormone dosages to achieve normal, adult hormone levels

The next thing you need to do is find out what stage of hypogonadism you have. You have 4 gonadal hormones which are produced by the ovaries or testicles, just in differing amounts.

Stages 1 or 2 of hypogonadism is when 1 or 2 of the gonadal hormones dip below normal levels.

Typically, starting about age 30, the first hormones to dip for women are testosterone and progesterone. It is easy to start with testosterone to help maintain menstrual cycles and proper maturation of eggs. If menstrual cycles become irregular then a small amount of progesterone can be added.

Here are some suggestions to get started:

  • For women: 0.5 – 1.0 testosterone cream nightly
    • Testosterone levels: about 40-80 ng/dl
      10 mg – 20 mg progesterone cream nightly for the first half of menstrual cycle.
    • Progesterone levels: about 1000 pg/ml during first half of cycle

Starting around age 30 the first hormone to dip for men is progesterone. Over time lower than normal levels of progesterone will allow estradiol to edge up. When this happens the prostate begins to enlarge. To prevent this from happening consider starting on a low dose of progesterone.

  • For men: 3-10 mg progesterone cream nightly
    • Progesterone levels: about 1000 pg/ml
      (yes, it is the same as a the first two weeks of a menstrual cycle)

Stage 3 of hypogonadism is when 3 or more gonadal hormones dip below normal levels.

Starting around age 45 for women, as the ovaries begin to run out of eggs and smaller and smaller amounts of hormones are produced, stage 3 or advanced hypogonadism sets in. Treatment can start with testosterone, progesterone and DHEA. Estradiol is the usually the last gonadal hormone to dip to low levels.

A sample regimen could be:

  • Testosterone:
    • 1-6 mg testosterone cream nightly
    • Testosterone levels: about 40-80 ng/dl
  • Progesterone:
    • 20-30 mg progesterone cream for two weeks, 200-300mg oral progesterone pills at bedtime
    • Progesterone levels: about 1000 pg/ml
  • DHEA:
    • 5 – 10 mg dhea every morning or at bedtime
    • DHEAS levels: between 200-275 mcg/dl
  • When estradiol levels begin to dip significantly:
    • 0.1 mg estradiol patch or 1-3 mg estradiol cream
    • Estradiol levels: between 100 – 175 pg/ml

For men, by age 55 – 60 several of the gonadal hormones dip below normal levels. Expect progesterone to be too low, DHEA too low, testosterone low, and estradiol too high. Treatment with progesterone, testosterone and DHEA is generally effective and reducing estradiol levels to normal and reversing the advanced hypogonadism.

A sample regimen could be:

  • Progesterone:
    • 5-15 mg progesterone cream nightly
    • Progesterone levels: about 1000 pg/ml
  • DHEA:
    • 10-15 mg DHEA every morning or at bedtime
    • DHEAS levels: between 250 – 350 mcg/dl
  • Testosterone:
    • 25-50 mg testosterone cream nightly
    • Testosterone levels: about 450 – 850 ng/dl

It is important to work with a doctor who is interested in helping you. It will take time to find the right regimen for you. Other hormonal issues that should be addressed are thyroid and adrenal hormone levels. Again, an endocrinologist should be the one helping you out but the politics of our times prevents this. It is what it is and you have to work with what you have.

It is very important to be patient and to start at low doses. Measure your levels every 4-6 weeks and increase slowly. You are the best judge as to what level you feel good at.

If you have any questions please email us at treatment_suggestions@diamondrf.org

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