Hormone restoration, titrated to you
Why the dose that works for someone else is rarely the dose that works for you.
Hormone therapy works when the dose fits the person. That means testing before you start, adjusting on how you feel and what your labs say, and accepting that the first dose is a starting point rather than an answer.
Two women the same age with the same symptoms can need doses that differ by a factor of three. That is not imprecision, it is biology, and it is the entire reason this has to be titrated.
How much you make, how fast you clear it, what your receptors do with it, and what else is going on all vary. A protocol that starts everyone in the same place will be wrong for most of them.
Why one dose does not fit
A pellet mill can only really offer one thing, so it offers that. Insert, wait months, repeat. If the dose was too high there is no taking it back, and if it was too low you wait.
That model exists because it is efficient, not because it is precise. What it removes is the ability to adjust, which is the part that actually makes hormone therapy work.
“The first dose is a hypothesis. What makes this work is being willing to change it.
The first dose is a hypothesis. What makes this work is being willing to change it.
What we test before starting
Before anything is prescribed, we want these in front of us:
The starting point, timed to your cycle if you still have one.
Relevant for women at small doses, and often the piece that returns energy and libido.
Tells us where you are in the transition, which changes what we expect from treatment.
Stress hormones compete for the same raw material. Ignoring them stalls the plan.
Thyroid and sex hormones affect each other constantly. Both get read together.
Safety first. Family history and clotting risk shape both the route and the dose.
Read together, these give us a starting point rather than a guess.
The pellet problem
Estrogen alone is only half the conversation. Unopposed estrogen is a real problem, so progesterone comes with it for anyone with a uterus, and it does useful work on sleep and anxiety besides.
Testosterone belongs in this conversation for women too, at doses far smaller than most people assume, and it is often the piece that returns energy and libido. Where the whole picture needs mapping, the urine hormone panel gives us the fullest view.
Titration is the actual treatment
Then it is a conversation over months rather than a prescription. We start conservatively, wait six weeks, retest, and adjust against both the numbers and how you actually feel.
Feeling well at a lower dose beats a textbook number every time. The labs keep us safe and honest, and your experience decides whether we have arrived.
What changes when we work this way
Done this way, most people land somewhere they did not expect, and they stay there comfortably rather than riding a cycle of highs and crashes between appointments.
We monitor at ninety days indefinitely, because bodies keep changing and a dose that was right two years ago may not be right now.
Where to start
Bring any hormone labs you have, a list of what you have tried, and what specifically you want back. Sleep, energy, libido, and clarity respond on different timelines and it helps to know which one matters most to you.
Then we sit down for half an hour, look at where you are, and decide whether we are testing first or starting low and watching closely.
Where this connects
Dr. Nina reads the full panel, connects it to how you actually feel, and builds the plan from there. She sees patients in Atlanta and virtually worldwide.
More about Dr. Nina →Learn & Answers holds the short ones, answered in a sentence or two by Dr. Nina and the team.
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