Hormone prescriptions are never one-size-fits-all. This comprehensive guide merges HEALOR® clinical experience with the BHRT Dosing Chart —now including hormone pellet dosing protocols—to give you a streamlined, evidence-based reference for PMS, perimenopause, surgical menopause, and natural post-menopause.
Clinical Reminder
Achieving endocrine homeostasis can take 3–6 months. Re-evaluate labs and symptoms every 8–12 weeks and titrate conservatively.
1. Premenstrual Syndrome (PMS) BHRT Dosing
| Formulation | HEALOR Range | Other Ranges | Timing |
|---|---|---|---|
| Micronized Progesterone (oral) | 25–200 mg | 25–400 mg | Days 14–25 |
| Progesterone (topical) | 5–25 mg | 5–50 mg | Days 14–25 |
2. Perimenopause BHRT Dosing
When insomnia dominates
Micronized Progesterone (oral)
- 25–200 mg qHS, Days 12–24
- Male patients respond well to progesterone of 20 mg or higher.
Persistent vasomotor or mood symptoms
Add Bi-Est 50:50 (Estriol:Estradiol)
- Start 0.25 mg daily; Data supports 0.1–1.5 mg topical/sublingual or 0.3–2.5 mg oral
- Maintain progesterone schedule above
Topical option
- Progesterone 10–25 mg topical, Days 12–24 (Can be up to 50 mg)
- Low-dose “bridge” (1–5 mg) Days 1–11 to reduce spotting
- If needed, Bi-Est 0.25 mg once–twice daily
3. BHRT Dosing Natural Post-Menopause
| Hormone | HEALOR Range | Other Ranges | Frequency |
|---|---|---|---|
| Bi-Est 80:20 or 50:50 | 0.25 mg 1–2× daily | 0.2–2 mg topical/sl | Continuous or 3–5 d break |
| Progesterone | 5–25 mg topical or 25–200 mg oral | 10–50 mg topical/sl or 25–400 mg oral | Match estrogen cycle |
| Testosterone (topical) | 0.25–2 mg daily | 0.25–4 mg topical/sl | Morning Preferred |
| DHEA | 0.25–2.5 mg topical/sl or 25–50 mg oral DHEA is a pro hormone and can convert Androgens or Estrogens | 0.25–2.5 mg topical/sl or 5–25 mg oral | Morning Preferred. |
4. Surgical (Induced) Menopause BHRT Dosing Chart
| Component | HEALOR Start Point | Other Ranges | Comments |
|---|---|---|---|
| Bi-Est 30:70 | 1 mg cream 1–2× daily | 2 mg topical/BID | Estradiol-dominant blend |
| Progesterone SR (oral) | 100–200 mg qHS | up to 400 mg | Daily if insomnia; otherwise Days 1–25 |
| Testosterone Cream | 1 mg/mL daily | up 4 mg topical | Evaluate q8–12 wks |
| DHEA SR (oral) | 5–10 mg daily | 25-50 mg | Morning dosing preferred |
5. Hormone Pellet Therapy – Dosing Guidelines
Pellets offer steady-state hormone delivery over 3–6 months. They are particularly useful for patients who have difficulty with adherence to daily dosing or who need sustained symptom control.
Female Pellet Dosing
- Estradiol pellets: 6–25 mg (common range 8–10 mg), adjust based on symptoms and labs
- Testosterone pellets: 50–150 mg (common range 75–100 mg)
- Progesterone pellets: Not routinely used; oral or transdermal route preferred for endometrial protection
Male Pellet Dosing
- Testosterone pellets: 800–1,600 mg total (inserted as multiple pellets)
- Typical: 4–8 pellets × 200 mg each
- Duration: 4–6 months depending on metabolism
- Estradiol pellets: Not used in men unless for specific clinical indications
- DHEA pellets: Rarely used; oral preferred
Pellet Insertion Protocol
- Interval: Re-implant every 3–6 months
- Site: Subcutaneous, upper gluteal or hip region
- Monitoring: Hormone panel at 4–6 weeks post-insertion, then mid-cycle before next insertion
Safety & Considerations
- Infection risk is low (<1%) when performed under sterile technique
- Avoid in uncontrolled polycythemia (men) or hormone-sensitive cancers without oncology clearance
- Dose adjustments are based on serum hormone peaks at 4–6 weeks and symptom duration
6. High-Risk or “Cancer Watch” Patients
Favor estriol-dominant therapy to minimize proliferative risk:
| Hormone | Range | Frequency |
|---|---|---|
| Estriol (E3) | 0.5–2 mg topical/sl | QD or BID |
| Progesterone | 20–80 mg topical/sl or 25–400 mg oral | BID split dosing |
Monitoring & Safety Checklist
- Baseline labs: CBC, CMP, estradiol, estriol, progesterone, free & total testosterone, DHEA-S, SHBG, TSH, FT4, lipid panel, HbA1c, Vitamin D
- Follow-up: Hormone panel + symptom review q8–12 weeks until stable; q6 months thereafter
- Imaging: DEXA q2 yrs; mammogram & pelvic ultrasound per guidelines
- Pellet-specific: Monitor hemoglobin/hematocrit in men; watch for prolonged supraphysiologic levels in women
Key Takeaways
- Start low, go slow, even with pellets—overshooting can mean months of supraphysiologic exposure.
- Pellets excel for adherence but require careful patient selection and monitoring.
- Use a multimodal approach—oral, topical, and pellet options—tailored to individual needs.
If you want, I can now create a visual pellet dosing chart that matches the style of your earlier BHRT image so this blog has a consistent visual theme. That would make it even more clinician-friendly.
Raj P. Singh, MD – Founder & Medical Director, HEALOR® | Hormone & Longevity Medicine
DISCLAIMER:
The information shared in this blog is for educational and informational purposes only and is not intended as a substitute for professional medical evaluation, diagnosis, or treatment.
