Precision Hormone Therapy

Emily Clarke

Welcome back to Hormone Dosing Protocol, everyone. I’m Emily Clarke, and I’m joined by Dr. Richard Nkwenti. Today, we’re diving into the world of precision hormone therapy—why the old “one-size-fits-all” approach just doesn’t cut it anymore. Richard, I have to say, when I first started reading about this, I was shocked at how outdated some of the standard hormone dosing methods still are.

RICHARD NKWENTI

Absolutely, Emily. It’s a bit like trying to tune a piano with a hammer instead of a tuning fork. The traditional protocols—using generic lab ranges and fixed doses—miss the mark for so many people. Hormones are these incredibly nuanced messengers, and the body’s needs are, well, unique for each person. The old way just doesn’t respect that complexity.

Emily Clarke

Right, and it’s not just about symptom relief, is it? I mean, the book we’re referencing makes it clear: hormones like estradiol, progesterone, and testosterone are involved in, what, over 400 bodily systems? That’s wild. So, if you’re just guessing at a dose, you’re potentially missing out on benefits for bone, brain, metabolism—all sorts.

RICHARD NKWENTI

Exactly. And the real game-changer is the use of advanced diagnostics—blood and saliva tests that actually measure free hormone levels, not just the total. That’s the active stuff, the part that’s actually doing the work in your cells. I remember back at the days when I started compounding, I had this patient—let’s call her “M”—who’d been on a standard hormone patch for years. She still had brain fog, fatigue, the works. Her labs looked “normal” by old standards, but when we checked her free estradiol and progesterone, they were way below what she needed. Once we tailored her regimen based on those numbers, her symptoms turned around in weeks. It was, honestly, one of those moments that stuck with me.

Emily Clarke

That’s such a powerful example. And it really highlights how the “normal” lab ranges aren’t always optimal, right? I always think of it like, just because something’s in the “normal” range doesn’t mean it’s the best for you. Like, I might be “normal” at running, but I’m not winning any races! So, with these more precise tests, you can actually see what’s bioavailable and adjust accordingly.

RICHARD NKWENTI

Exactly, and that's the heart of personalized, data-driven bioidentical hormone replacement therapy—BHRT. It's not about chasing numbers on a lab report, but about restoring the body's natural balance and rhythm, and that means regular, detailed assessments that go way beyond basic hormone panels. The old protocols just don't keep up with the current science or the real needs of patients. We're talking about looking at free hormone levels, not just total levels, checking hormone metabolites to see how your body is actually processing these hormones, and understanding the ratios between estrogen, progesterone, testosterone, DHEA, and pregnenolone. It's also about timing—testing at the right points in a woman's cycle, or understanding how a man's testosterone fluctuates throughout the day. Then there's the delivery method—creams, pellets, injections—what works for one person might not work for another based on their genetics, lifestyle, and how their body absorbs and metabolizes hormones. The goal isn't to give everyone the same cookie-cutter protocol, but to create a truly individualized approach that works with your unique biochemistry and life circumstances.

Emily Clarke

And it’s not just about numbers, either. It’s about how people feel, right? I mean, you can have a “normal” lab but still feel rubbish. That’s where the iterative dose adjustments come in—using both the data and the patient’s feedback to get it right. It’s a much more dynamic, responsive approach.

RICHARD NKWENTI

Absolutely. It’s a partnership, really. The patient’s story, their symptoms, and the lab data all work together. And when you get it right, you’re not just treating hot flashes or insomnia—you’re supporting bone health, cognitive function, metabolism, the whole system. That’s the promise of precision hormone therapy.

Emily Clarke

It’s honestly a bit mind-blowing how much of a difference that shift can make. And I think it’s so important for people to know they don’t have to settle for “good enough” when it comes to their health. There’s a better way, and it’s rooted in science and personalization.

Emily Clarke

So, let’s talk about how these hormones actually get into the body. I was fascinated to learn that sublingual dosing—putting hormones under the tongue—can be a total game-changer compared to pills or creams. Richard, can you break down why that is?

RICHARD NKWENTI

Sure thing. The science is pretty elegant, actually. When you take hormones sublingually, they’re absorbed directly into the bloodstream through the oral mucosa. That means you skip the digestive tract and, crucially, the liver’s first-pass metabolism. With oral pills, a lot of the hormone gets broken down before it even has a chance to work. With creams, absorption can be all over the place—depends on skin thickness, hydration, even the weather sometimes. Sublingual dosing gives you faster, more predictable absorption and more stable blood levels.

Emily Clarke

That makes so much sense. I mean, in astrophysics, we’re always looking for the most efficient way to get a signal from point A to point B. This is kind of the same, isn’t it? Direct route, less interference. Actually, it reminds me of some of the rapid drug delivery systems they’ve developed for astronauts—when you need a medication to work fast and reliably, you can’t have it getting lost in the shuffle. Sublingual is like the express lane.

RICHARD NKWENTI

That's a great analogy, Emily. And the clinical results back it up. Patients who switch to sublingual dosing often report their symptoms—hot flashes, mood swings, brain fog—improving much faster and staying under control more consistently. I've seen it time and again. There's also less risk of side effects because you can use a lower dose to get the same effect, thanks to the higher bioavailability. Here's the key thing practitioners need to understand: when testing progesterone levels, we're actually measuring metabolites rather than the actual progesterone level, and these tests weren't designed for sublingual therapy. So when analyzing results, you have to focus on how the patient feels, not just the numbers, because those numbers can be incredibly misleading. You'll often see lower lab values with sublingual administration but dramatically better clinical results. Meanwhile, oral dosing might show higher numbers on paper, but the patient doesn't feel nearly as good because so much of that hormone is being destroyed in the digestive process. It's a perfect example of why we can't just treat lab values—we have to treat the whole person and listen to what their body is telling us.

Emily Clarke

And it’s not just theory, right? There are real-world examples. I read about a woman who’d been struggling with creams for ages—her hormone levels were all over the place, and she still felt awful. She switched to sublingual, and suddenly her labs stabilized, and she felt like herself again. It’s not magic, it’s just better science.

RICHARD NKWENTI

Exactly. And it’s not just about symptom relief, either. Stable hormone levels mean better long-term protection for things like bone density and cardiovascular health. Plus, it’s easier for patients to stick with—no messy creams, no complicated routines. Just a drop or lozenge under the tongue. It’s simple, but the impact is huge.

Emily Clarke

I love that. And I think it's empowering, too. When people understand why a certain method works better, they're more likely to stick with it and be proactive about their health. It's not just "take this and hope for the best"—it's "here's why this works, and here's how we'll know it's working for you." That's exactly the approach we take with personalized hormone therapy. Education and individualization go hand in hand. When patients understand the science behind their treatment, they become true partners in their health journey, not just passive recipients of medication. They know what to look for, what questions to ask, and how to communicate what they're experiencing. For listeners who are ready to take control of their hormone health with this kind of personalized, science-based approach, I'd encourage you to visit Pharmaprodia at www.pharmaprodia.com. They specialize in customized bioidentical hormone restoration that focuses on how you feel, not just what the numbers say. It's about getting your life back, not just getting your labs back.