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.👉 What Is Bioidentical Hormone Replacement Therapy Used For?
https://healor.kinsta.cloud/what-is-bioidentical-hormone-replacement-therapy-used-for/
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
- How to Know If You Need BHRT
👉 How to Know If You Need BHRT
https://healor.kinsta.cloud/how-to-know-if-you-need-bhrt/
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
👉 Testosterone Pellet Therapy for Men: Everything You Need to Know
https://healor.kinsta.cloud/testosterone-pellet-therapy-for-men/
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
👉 The Benefits of Bioidentical Hormone Replacement Therapy
https://healor.kinsta.cloud/the-benefits-of-bioidentical-hormone-replacement-therapy/
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
👉 How Are Bioidentical Hormones Given to Men and Women?
https://healor.kinsta.cloud/how-are-bioidentical-hormones-given-to-men-and-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.
Raj P. Singh, MD – Founder & Medical Director, HEALOR® | Hormone & Longevity Medicine
👉 Our Team
https://healor.kinsta.cloud/our-team/
👉 Contact Us
https://healor.kinsta.cloud/contact/
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.
-
What is BHRT dosing and why does it vary between individuals?
BHRT dosing involves tailoring hormone doses (like estrogen, progesterone, or testosterone) based on lab results, symptoms, and treatment goals. Each person metabolizes hormones differently, so personalized dosing helps optimize outcomes.
-
How often should BHRT dosing be reassessed?
Clinicians typically re-evaluate hormone levels and symptoms every 8–12 weeks during BHRT to adjust doses safely and effectively.
-
Are pellet dosing protocols included in BHRT dosing guides?
Yes — pellet therapy dosing (e.g., testosterone or estradiol pellets) is part of many BHRT dosing protocols and useful for sustained hormone levels over months.
-
Does BHRT dosing differ between men and women?
Yes — men and women have different hormonal baselines and clinical goals, so doses of testosterone, estrogen, or progesterone are adjusted accordingly in BHRT.
-
What symptoms are monitored when adjusting BHRT doses?
Providers watch for improvements in energy, mood, sleep, libido, and unwanted side effects like breast tenderness or irritability to help fine-tune dosing.
