Part 2: Starting treatment for menopause - Progesterone, a human hormone

Recently, a doctor said to me, "We should put progesterone in the drinking water, then the world would be a better place." This doctor knew what he was talking about. For those that take it, the difference between before and after replacement is remarkable. This doctor knows firsthand the important functions of progesterone, not just on the uterus but the whole body.

This doctor prescribes progesterone to both women and men. He prescribes progesterone to men and women because progesterone has the same function whether in a man's or a woman's body. Progesterone is a hormone that is made by the gonads, ovaries for women and testes for men, and the adrenal glands of both women and men. Progesterone is a precursor to testosterone. This means that in the metabolic pathway to make testosterone, progesterone has to be made first.

Yet, all too often women and men are denied treatment with progesterone. For women the reason typically given is that without a uterus, there is no need for progesterone. For men the reason typically given is that progesterone is a female hormone and not needed for a man. From a physiologic point of view this makes no sense.

To associate progesterone with benefits to the uterus only is to ignore the important functions that progesterone has throughout the body. Research on progesterone and its health benefits has been going on for decades. Why progesterone is generally limited to women with a uterus and typically not offered to men is baffling.

Here are some interesting and important facts about progesterone:

1) The levels of progesterone in men and women are nearly identical during the first two weeks of a woman's monthly cycle. It is only during the second two weeks that women have more progesterone.

2) Progesterone helps to elevate and maintain mood. Progesterone is often referred to as the 'feel good' hormone.

3) Progesterone is a key component in maintaining cognitive function.

4) Progesterone is a key component in maintaining sleep.

5) Progesterone helps to reduce inflammation.

6) Progesterone helps to keep blood vessels flexible.

Clearly, progesterone is a human hormone and important to the health of men and women.

Treatment for hypogonadism starts with restoring levels of gonadal hormones to normal levels. Normal levels of progesterone for women (first 2 weeks of the cycle) and men are about 1000 pg/ml. A good starting dose to achieve this level is 3-5 mg of transdermal compounded progesterone cream. For women who want to mimic the menstrual cycle, the smaller 3-5 mg daily dose can be used for two weeks and a higher dose of 30-60 mg daily can be used for two weeks. Prometrium, the only physiologic (bio-identical) progesterone pill has dosages too high for men. If a woman wants to take Prometrium, a suggested regimen is 100 mg nightly for three weeks, then stop taking it for a week. An alternate regimen for women is 200 mg nightly for two weeks then stop taking it for two weeks. For women on gonadal replacement, you may or may not menstruate. You may only have a light period or not have a period for many months, then a very light one.

Remember that treatment of hypogonadism for women and men means including all of the gonadal hormones, testosterone, progesterone, estradiol and more. All of the gonadal hormones work together to maintain our health, not just one or two.

So now you see that progesterone is a human hormone that is important to the health and well-being of our bodies, with or without a uterus!

Next time I will write about estrogen and the importance of including it in the treatment of hypogonadism, for women and men.