Bioidentical HRT

[Jaymatheson]

Any idea what the monthly cost is for BHRT in Thailand and where to buy?  Is it available at larger pharmacies or do you typically have to order/purchase through a hospital?

 

Thank you

[Sheryl]

To clariy, do you mean estrogen and progesterone for postmenopausal women or do you mean testosterone for men? 

[Jaymatheson]

11 hours ago, Sheryl said:

To clariy, do you mean estrogen and progesterone for postmenopausal women or do you mean testosterone for men? 

Hi Sheryl.  BHRT for women.  

[Sheryl]

These hormones do nto require a prescription, and can be bought at a pharmacy, but availability varies by type.

 

1. Estrogen (estradiol)

Easily found. Most common brand being Oestrogel, made by Besins (French pharma company) any large pharmacy will have it.  It is an alcohol based gel, easy to apply and easy to titrate dosage. Personally I find that much less than the amount indicated on the applicator suffices, and one tube lasts me many months. 

 

2.  Progesterone:

much harder to find, especially in the (preferred) transdermal form. You can get oral forms, brand names GynProgesterone and Utrogestan. the latter also made by French firm Besins and micronized for better absorption, I'm not sure about the first.  Besins also makes a dermal progesterone gel called Progestogel bit it is offmarket in Thailand; it is what I use and I get it in Cambodia. Lacking that, Utrogestan is your best bet.

 

3. Vaginal estradiol/estriol (using systemic estrogen alone usually not enough for vaginal dryness). Several preparations, all rather expensive and can be hard to find:

Femiest (Medisafe has this - but note dose is low, only 10 mcg  so would likely need to use every other day after initial period of daily for 2 weeks)

Ovestin  (Very hard to find in Thailand but great preparation, I get it from Cambodia)

Gynoflor (also contains lactobacillus)

[Jaymatheson]

Many thanks, Sheryl.  I know very little on the subject and trying to help someone who knows even less.

 

She's already on meds for hyperthyroidism and will test her hormone levels soon.  They were tested a few years ago and were low.

 

I assume the best way is to bring the hormone results to a doctor and ask them what to take?  Or can you get away with sorting it out yourself?

[Sheryl]

On 6/22/2025 at 2:28 PM, Jaymatheson said:

Many thanks, Sheryl.  I know very little on the subject and trying to help someone who knows even less.

 

She's already on meds for hyperthyroidism and will test her hormone levels soon.  They were tested a few years ago and were low.

 

I assume the best way is to bring the hormone results to a doctor and ask them what to take?  Or can you get away with sorting it out yourself?

 

HRT:

Beyond possibly the initial determination that she is in menopause (if then...this is usually decided based on age and absence of menstruation), there are no blood tests involved. It is worth getting initial doctor consultation to ensure no contraindications to HRT (mainly through review of medical and family history).  If there is not, then the HRT regimen  is titrated to the lowest estrogen dose that produce symptomatic relief. The progesterone dose is pretty much fixed though there are alternatives in terms of duration e.g. continuous estrogen plus progesterone versus cyclic progesterone.

 

Given the apparent lack of knowledge,  this woman  would be best advised to get doctor advice throughout. If she is Thai this can be done at no cost.  Thai doctor will likely prescribe synthetic progestin and perhaps also synthetic estrogen, she can tell the doctor she only wants bioidentical and ask specifically about Oestrogel plus Utrogestan,

 

Hyperthyroidism is a very serious condition and should be closely managed by an endocrinologist. Though your statement that thyroid levels were "low"  a few years ago raises some doubt as to whether she is hyper or hypothyroid.

[Jaymatheson]

Many thanks.

 

The low test results were regarding hormone levels.  She's regularly going to a govt hospital for the thyroid issue .... although i doubt it's an endocrinologist.  

 

She's planning to find both Oestrogel and Utrogestan.

[Jaymatheson]

Hi again Sheryl.  Friend is post-menopause but is concerned that taking Oestrogel & Utrogestan will start her periods again .... as a doctor told her.  I don't think that's the case.  From what i've read she might experience some spotting etc. while her body adjusts but she won't experience extreme changes.  Correct?

[Sheryl]

21 minutes ago, Jaymatheson said:

Hi again Sheryl.  Friend is post-menopause but is concerned that taking Oestrogel & Utrogestan will start her periods again .... as a doctor told her.  I don't think that's the case.  From what i've read she might experience some spotting etc. while her body adjusts but she won't experience extreme changes.  Correct?

It doesn't usually have this effect.

 

With the Oestrogel, should use the smallest amount that controls symptoms. This will usually be less than full applicator. That also helps to prevent much buildup of the endometrium. 

 

There are several different schedules that can be used:

 

Continuous (Oestrigel + utrogestan) every day, all the time

 

Oestrogel every day, adding Utrogestan for just last 10-14 days of the month

 

Oestrogel for 25 days of the month, adding Utrogestan for the last 10-15 days

 

Of these approaches the last one is most likely to produce some spotting but even that, in only some women.  The first is probably least likely to cause any bleeding but will also be more costly (the Utrogestan is not cheap!). 

 

So if she is troubled by spotting with one regimen can modify it.

 

All that said, no need to take systemic HRT at all unless she is significantly bothered by symptoms such as hot flashes and mood swings. 

 

Vaginal estrogen, on the other hand,   pretty much all women need. 

[Jaymatheson]

You're a superstar.

 

Thank you. 

 

I'll pass the message on.