Hormonal Health Ask Me Archives

I am 41, perimenopausal. I have regular, yet heavy periods. I have insulin resistance, which I treat with low-carb and exercise; therefore, I am no longer overweight. I am still having worsening of hirsutism and hair loss (itchy, oily scalp, graying and breakage). My nails have developed longitudinal lines. My TSH is 2.0 on saliva test. Progesterone cream was prescribed, but it only increased my insulin resistance, or at least my oily, loss of hair. My estradiol is high, but estrone and estriol are low. Giving me a luteal phase 0.18L for 24-hr urine level of estrogens total. My testosterone is normal-high and so is cortisol, DHEA low. I took Kenalog shot for allergies back in 1992 and I believe the side effect of ballooning out/water retention over entire body, set off the high cortisol that I can’t seem to lower—even though I quit my job 4-yrs ago and now go quite happily to college part-time. I am no longer stressed, in other words. Doctors suggest Estrofem (17-estradiol) tablets at .50, and estriol cream at 2mg, plus progesterone cream last week before period only. Any suggestions?

Your doctor is trying to re-balance your hormones. When your testosterone is high, you can get the symptoms you mention. Estrogen has some testosterone balancing effect. You may wish to talk to your doctor about tri-est if estrogen is needed. Tri-est is the natural form and low in E2 while the drug is pure E2 which is not as natural. You need to normalise your cortisol level and the cortisol to DHEA ratio. Too high a ratio (high cortisol and low DHEA) indicates a catabolic state and a catabolic state can be associated with estrogen dominance (with heavy period, for example), insulin resistance, and excessive testosterone. Once your adrenals are balanced (normalization of cortisol and DHEA), it is likely that the rest of your symptoms will be reduced. The bottom line – don’t just adjust the female hormones without paying attention to the adrenals which may likely be the root cause. Read my adrenal fatigue article here and you will know what I mean:
Adrenal Fatigue
While your TSH is considered normal by conventional standards, I would caution you to look at other hypothyroid symptoms as any number 2 or higher is an alert. Get your doctor to do a free T3 and a Free T4 for more info. Read more here:
I have given you quite a bit to read. It is imperative that you understand that in women, the thyroid-ovarian-adrenal axis is highly interrelated, and imbalance of this axis may be the root cause of your problem. You need to consider all three as a syndrome and not try to put a band-aid one at a time which will invariably fail.

I am a 32-year old female and was tested in November and had a low TSH and low T3. After one month of being on Armour thyroid (gradually working up to 45 mg) my T3 was in the high normal range and my TSH was suppressed further (.03) My doctor lowered my Armour to 30 mg. He also tested my pregnenalone which was in the mid-range of normal. I guess he ruled out adrenal fatigue because of the normal pregnenalone. 
I also had RAST testing and was a 6 for eggs and dairy and 3’s for wheat and beef. I know there can be a connection between food allergies and adrenal fatigue. What exactly is it? Does adrenal fatigue cause allergies? I checked in with my doctor last week still complaining of severe mood swings, hair loss, and fatigue. He ran another thyroid panel to discover a TSH of .018, a T3 total of 89 and a T4 total of 9.4 and 1.35 free T4.I am waiting to hear from my doctor about these results. What, in your opinion is going on? Why is my TSH level becoming more suppressed, but yet my T3 level is still relatively low? What treatment or further testing would you recommend?

As you are being supplemented on armour thyroid, your TSH will drop. I don’t have your free T3 and its reference range. Total T 3 is of little value. The best way to diagnose adrenal fatigue is by cortisol level and DHEA, not pregnenolone in my view. I am unable to offer you much advice as the key pieces of information are missing. Sometimes there is a lag. TSH will return to normal (under 2.0) while T3 gradually goes up. Sometimes if you have adrenal fatigue, that in itself may lead to estrogen dominance, and excessive estrogen blocks the conversion from T4 to T3. You can see therefore that the situation can get more complicated as a estrogen progesterone workup may be needed in addition to what you already have done. In the female, the dysfunction of thyroid-adrenal-ovarian axis is very common. It is very difficult to isolate one of the 3, and the conventional myopic attempt to treat them individually will normally fail. Perhaps you should discuss with your doctor more on a complete workup on thyroid (TSH, Free T3, Free T4) adrenal (cortsiol and DHEA-S), and ovarian (estrogen, progeterone) axis. Salivary test is preferred as they measure accurately the free hormone available to the cells. Once you have the entire test, then it is easier to decipher what is the underlay cause of your problem.

I am a UK resident and have been receiving treatment for my thyroid for two years after I had sub-acute thyroiditis in May 2001. My GP started me on Levothyroxine in October 2001 and gradually increased the dose to 150 mcg by Aug 2002. At this point I asked to see a consultant because I was still having problems, including extreme fatigue, loss of memory, depression, and irregular periods. The worst of it was the fatigue after exercise – I used to be fit, cycling 6 miles to and from work, long walks at the weekend, gardening etc, but found I could no longer do any of these activities. The consultant immediately reduced the dose of thyroxine to 100mcg and suggested that the fatigue was due to post-viral fatigue syndrome. Reducing the dose of thyroxine normalised my T4 and T3 levels, but I was still feeling ill. I suggested to the consultant that more tests should be done to rule out other causes before the problem could be attributed to post-viral fatigue, so he ordered a short synacthen test. The results were normal. After the test, I had a short period of about three weeks when I felt really good, could do a lot more exercise without feeling tired and really began to think I was on the road to recovery, but this didn’t last. Having read your web-page on adrenal fatigue and other pages like  Dr Rind, I realised that the synacthen test is not really appropriate for my symptoms. Could you tell me if the test might even have been responsible for the turnaround in my symptoms i.e. could the chemicals in the test have kick-started my adrenal glands? Do you know of a doctor in the UK who might be a bit more up to date on adrenal fatigue testing?

The most important physiological effects of ACTH involve the adrenal cortex and include the maintenance of adrenal weight and the control of adrenal corticosteroid synthesis and release. In its absence, adrenal blood flow is diminished, adrenal atrophy invariably ensues and cortisol secretion is markedly reduced. In addition to controlling corticosteroid secretion, ACTH also increases the synthesis and release of the other adrenal steroids, namely aldosterone and the adrenal androgens. It also has some degree of melanotropic activity and lipolytic effect. Thus the application of the test you received actually gives a little boost to your adrenals. While the test comes back “normal” because it is designed to diagnose adrenal failure or late stage adrenal fatigue, you are not quite there yet, so to say. If you are in the early stages of adrenal fatigue, then the test you have taken will come back "normal" but you are still suffering. To accurately measure your adrenal status, get your doctor to do salivary cortisol and DHEA levels as the best indicator of your adrenal health.

My name is Heather Hayden, age 28, and I have recently read your article about the side effects of using hormonal cream. The one that was prescribed for me is Pro-gest and I used it, rubbing about a dime size dosage on my ovarian area for about a month during June 2002. I was being treated for a hormonal imbalance and suffering from acne. During the time I was applying the Pro-gest, I also began doing exercises, mainly stomach crunches.
I stopped using the product because my abdomen swelled and bloated, it felt like I was retaining large amounts of excess water and it was very painful. I have experienced since using the Pro-gest, symptoms/side effects of synthetic progesterone usage: hair loss, depression, rashes, severe forms of acne, irregularities of menstrual cycle, migraines, severe edema ( all over especially in the areas of the abdomen, hands, legs, feet, face…), excessive facial hair growth….I went to a specialist, an endocrinologist who ran extensive blood work on me and concluded that I am allergic/sensitive to my bodies own free testosterone, extremely low levels of protein, iron, HDL cholesterol. The tests revealed that I am retaining excessive amounts of fluid but couldn’t determine exactly why. My doctor prescribed Spironolactone 50mg each day, to reduce and alleviate the water retention as well as desensitize the androgen with in my system. I have taken the medication for about 1 1/2 months but have stopped taking it due to the side effects I was experiencing (extreme headaches, nausea, excessive menstruation, slowed heart rate, dehydration, physical fatigue). My next appointment with my doctor is at the end of this month and he wants to start me on Accutane for the acne. However, this course of treatment does not address the bizarre water retention I am still experiencing or the painful stomach/abdominal bloat. I am very frustrated as this has been going on for so long and I feel I am no closer to understanding what has happened or what is continuing to happen to my body. I found your comments very interesting in regard to the side effects of using hormonal creams, such as I did. Could this perhaps be the cause and reason for my problems and discomfort? If so, what do I do to clear this problem and the effects out of my system?

You basically had a surgical induced menopause. Whether you need hormone replacement depends on whether you have any symptoms or not. Don’t forget that while your ovaries are gone, your fat cells are still making some estrogen, so it is not as if you have zero estrogen in your body. Many people pass through menopause without any problem. Due to your young age, it will be good to establish certain baseline on your hormonal profile by saliva testing, including estradiol, progesteron, and testosterone to start. Don’t forget that you do put out testosterone as well from your ovaries, and male hormones such as testosterone are important as well to achieve overall hormonal balance. From the test and symptoms, you will be able to evaluate whether you need natural hormone replacement or not. Replacement comes in the form of estrogen (in a variety of forms), natural progesterone cream, and testosterone cream. You may need one or all of the above, depending on your needs. Take only as needed based on symptoms.
Generally speaking, start with Natural Progesterone Cream (not synthetic) delivering 15-20 mg a day for day 1-25 of each month. If your symptoms go away, then you do not need to consider estrogen replacement. If your symptoms persist (30% of the people) , then your doctor can choose to add small dose (key is small dose) of estradiol (ie. .25 mg) orally from day 1-25 of each month. Some doctors choose to use Premarin, but have it in low dose. You can also request your doctor for natural estrogen (tri-est) or estriol only vaginal cream to use in combination with the progesterone. On the testosterone side, small amount of cream can be used effectively toincrease libido or vaginal dryness as needed. There is no "standard" protocol when it comes to individualized treatment. Find a good doctor near you who is knowledge. I find many who are being "overtreated". Balance is the key – take what is needed, and preferably naturally. That is the safest route in my opinion.

I had a myomectomy but the fibroids have returned. They are small now, but I would very much like to control them with diet. I have been reading very confusing and conflicting information about fibroids and the consumption of soy and soy products. I would be very grateful if you could clear this up for me? I would not like to miss out on what some say is an extremely important food for women dealing with fibroids, but I do not want to be eating a food that acts like estrogen. Please advise me, should I be eating or avoiding soy?

Soy has been heavily promoted as a good source of phyto-estrogen. Millions of dollars on advertising and industry support studies are all over the press. Your recurrence obviously mean that there is still underlying hormonal imbalance, most like estrogen dominance.
The use of soy products to competitively inhibit estrogen is under intense research. There are conflicting reports, and some recent ones are more negative than positive. I personally think that a small amount of isoflavone will not hurt, but the key is not to depend on phytosestrogen pathway until more is known and avoid heavy dose. Eating lots of cruciferous vegetables will definitely help, but I would not suggest anyone take heavy amount of soy, especially not tofu (miso is ok as it is fermented). Extracts and soy supplements should be done carefully under the supervision of a physician. What is important is to counteract the effect of estrogen with natural progesterone.
Here is an article you may wish to study more: Progesterone, Fibroids
Until you rebalance your hormones, fibroids are likely to return.

I am prone to get cysts in my body. Recently, I discovered 4 in my body. One under each armpit, one in my left breast, and one on my labia. They hurt to the touch and are sensitive. My doctor has always told me to take Vitamin E. Could you please let me know the foods to eat and those not to eat. And anything that I could do to decrease these.

Your cysts condition may be due to an imbalance in estrogen/progesterone level in your body, in which estrogen is much higher than progesterone.
A plant based whole unprocessed food diet is recommended. At least 30 grams of fibers should be consumed a day. Avoid high glycemic foods such as refined sugar. Avoid alcohol or drugs that can damage the liver which will lead to an increase in estrogen due to the lack of estrogen breakdown. Caffeine intake from all sources was linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking, and alcohol and cholesterol intake. Studies have shown that women who consumed at least 500 milligrams of caffeine daily, the equivalent of four or five cups of coffee, had nearly 70% more estrogen during the early follicular phase than women consuming no more than 100 mg of caffeine daily, or less than one cup of coffee.
A decrease intake in hormone laced meat and poultries is recommended also. Increase your legumes, fermented soy products, and natural nuts.
Elevated estrogen level can be neutralized by reduction of estrogen exposure through a proper wholesome fresh whole food diet, especially a diet rich in crucifrous vegetables such as broccoli, cauliflower, cabbage, kale, bok choi, and brussels sprouts. Take at least 3-5 servings of these important vegetables a week.
You should also consider natural progesterone which you can read up more at: Progesterone

I have just had a hysterectomy one week ago. I am 35. No children. The original surgery was scheduled for removal of very large ovarian endometriomas, and the possibility of removal of ovaries if needed. When the doctor opened me up he said he knew immediately it was bad. He said the endo was everywhere and he had to dig out the ovaries and uterus. The fallopian tubes were severely damaged. He said he didn’t want to try to remove the appendix for fear of infection.
I have not started a hormone replacement therapy yet. He wants to wait at least 6 weeks if I can stand it that long. Is that okay?
Will the endo that is still in there go away over time?
Can it come back once I’m on estrogen?
How does the doctor know how much estrogen to give?
Will there be other hormones to take?

At the age of 35, you are sure going through a lot. From natural medicine perspective, your problem may have a strong link to hormonal imbalance systematically. Your physician’s approach of hormonal balance but in a conservative stance is to be applauded. Since each person is different,and general rules do not apply, the process to your healing will be a journey that no one has gone before. With an experience physician, he or she will be the best person to guide you through with some roller coster ride along the way. That is to be expected. We wish all patients are textbook cases but the reality is that few are fortunate enough to belong to that class.
Hormone replacement therapy is a very tricky subject. Generally speaking, the trend is not so much estrogen replacement therapy but estrogen and progesterone together to achieve a good balance. The issue becomes even more complicated when the experts starts debating whether the hormones should be natural or synthetic etc.
If you are not medically trained, it is almost impossible for the general public to get enough knowledge over a short time to be able to understand the mechanics. Choosing the right doctor is your best bet, and then follow his advice. Along the way, ask lots of questions, and in a matter of a few months to a year, provided that you have done your homework and asked enough questions, you will know what to do.
I am writing this long email to you not to evade your question but more to guide you towards a direction of learning that you will need to embark upon for your problem which will be with you for the rest of your life.
When your hormonal balance is achieved by balancing estrogen and progesterone, then the likelihood of recurrence is lessened (but no guarantee because 30% of your problem may be genetically linked).
To get started, you may wish to start getting some generally knowledge by reading my special article on progesterone

Does taking natural isoflavones (PROMENSIL-(NOVOGEN) pills cause the raising of the calcium level in the blood? All I can say is that these pills have a good effect on my body, because they lower the hot flashes much more effectively, than the Estrogen I used to take a long time ago.  My endocrinologist also asked me to pass the PARATHORMONE (PTH) blood test, which came out normal. In Your opinion, why did my other tests of CALCIUM IONISED show a high level of Calcium in the blood, (2.79%)?

First of all, promensil is just isoflavone extracts. Isoflavone is a phytoestrogen that acts like weak estrogen and therefore can relieve your hot flashes. With regards to the calcium level in the blood, note that the serum calcium represent the bound and unbound form – in other words, everything that is floating around and varies with time easily. Any element level taken from the serum is not a true reflection of the level. To really truly know your real calcium level, you need to consider getting a red pack cell study of calcium and other minerals. This test will measure the amount of calcium inside the cell, where it counts. Red pack cell studies are quite expensive and not normally done, for your information. If your Parathyroid function is normal and you are symptomatic but still concerned with your calcium level, talk to a knowledgeable doctor on red pack cell studies.

Malic acid is not a nutrient I associate with women’s health, skin, hair or nails. As a matter of fact, I had to look it up! Do you have any articles on your web site on malic acid? I do use a lot of MSM, which has proven to be very helpful. Is Alpha lupaline available as a separate supplement or is it best used in symphony with other ingredients?

Alpha lupaline is not a supplement but an ingredient. It is a strong antioxidant. Malic acid is a little known secret very good for fibromalygia generally, but when used in right configuration and in combination with magnesium, is very good for skin and women in general, esp in hormonal balance.

Is it effective to restore elasticity and firmness if applying very little topical triestrogen cream on the face on every other day? Would Estiol cream also with the same effect as triestrogen?
Would estriol and progesterone cream cause weight gain because these 2 hormones are the main hormones during pregnancy?

Elasticity and firmness has to do with collagen structure. Estrogen does not have significant collagen rebuilding effect. You need vitamin C, lysine, proline, ascobyl palmitate to build collagen, or topical secretagogue that can stimulate collagen production.
Triestrogen cream and estriol are very different compounds. Tri-estrogen, as its name imply, is a combination of three types of estrogen: E1 (estrone), E2 (estradiol), and E3 (estriol). It can be synethetic or natural, and the ratio is very different in each. Synethetic kind is commonly available as a drug called Premarin. Natural kind needs to be compounded by a special pharmacy.
During pregnancy, your progesterone is kept high to maintain proper function. The weight gain is from the pregnancy and not so much from the progesterone. In fact, progesterone has the opposite effect from estrogen which causes water retention

I am a 53 year old menopausal (15months since last period) woman with several uterine fibroids, the largest of which is in the fundus part of the uterus. I had been advised to have surgery but was hoping that the fibroids would shrink on their own. I was also considering uterine artery embolization. Do you think the natural progesterone cream and chaste berry supplement would be effective in shrinking the fibroids? I also occasionally get PMS symptoms (bloating, abdominal cramping) and feel as if I am about to have some menstrual flow but nothing happens. Is this normal for menopausal women? You should also know that I have had a history of PCOS, anovulatory periods, infertility all of which, I believe (thanks to the Internet) was precipitated by Insulin Resistance. I sense that although I am in menopause, my estrogen level is still quite high due to my diet and the excessive fat in the abdominal area, which I’m told makes estrogen. As you have probably guessed, I have syndrome X and have begun to experience male pattern baldness hair loss. Does natural progesterone cream function as an anti andrrogenic? Can natural progesterone cream be used in conjunction with spironolactone without negative side effects? And last but not least, do you have any colleague in the New York city area (OB/GYN or Endocrinologist) that share your view regarding estrogen dominance that you can refer me to? I have mentioned this concept and Dr. Lee’s research and every Gyn i have ever been treated by seem to dismiss it. Please forgive the length and no doubt complexity of my inquiry and thank you so much for providing this opportunity to get some fresh and innovative input.

Your plight is quite typical and not complicated at all. I see it all the time. In fact, it’s the norm. The progression of what you mention – pms, pcos, fibroid represent the same underlying hormonal imbalance that has going on for years in most cases. You fit into Dr Lee’s classical picture of estrogen dominance. I cannot diagnose or treat disease over the internet, but for general information only, Natural progesterone as an alternative modality is very effective for those with estrogen dominance syndrome. You can read more about my personal feeling on this matter at: Firboids
Reducing estrogen load is important. Reducing weight will help, reducing meat intake will help, increasing cruciferous vegetables will help, taking phtoestrogens will help, together with fish oil, multivitamins etc all will contribute to a more hormonally balanced body. Everyone’s reaction is different. But being food-based, there is not much downside. To modulate hormones takes a complete program of nutritional balance both in terms of supplements and lifestyle factors which I am sure you are aware of. There is no one single magic modality, including natural progesterone.
Unfortunately, I don’t know of anyone in New York area to refer you to. I would recommend the following as basic nutritional supplement you should be on regardless of whether you are on natural progesterone or not: Womansoda.

James Howard, in 1997, suggests that people with high testosterone use up DHEA faster and die sooner. Has that theory been debunked? I am on the testosterone patch, for a 3 month trial, before measuring PSA and testosterone levels. Am I shortening my life doing this? Am I using up DHEA faster and should I supplement with DHEA capsules?

I am not aware of the testosterone and DHEA pathway you mention. It does not make a lot of sense to me up front, as DHEA is the precursor to testosterone and actually helps, unless there is way too much testosterone on board leading to a negative feedback system to reduce output and thus DHEA production is shut down, so to say. In reality, when you are on testosterone patch, your doctor would be checking your testosterone level regularly to make sure it is within therapeutic range. Your doctor would also be checking your dhea-sulfate level in the blood to ascertain it is also in the therapeutic range, so the risk of what you mention is quite remote, if I may say. Your blood level will tell you what is needed and how much.

I have Type AB blood and I also have hypothyroidism. Take 0.075 mg. Levoxyl. I heard that sea kelp is good and wanted to take it but read that if an individual has hypothyroidism, they should not take kelp. What is your opinion?

Sea kelp (and other seaweed) is a source of iodine and it also is a nutrient that highly alkalinize your blood. For those who are not on medicine, this is a good substitute. Talk to your doctor about natural thyroid replacement as an alternative. See article: Hypothyroidism

I had a first attack of breast cancer in 1983; I had my breast removed and also underwent radiation treatment. After 14 years I had a reoccurance of breast cancer in the same breast, I underwent surgery for the second time and also had radiation and chemotherapy for the first time. After chemotherapy was over I have been having anticancer tablets 2 per day, the doctor has advised me to take these tablets for a period of 5 years. What are the chances of me getting a third attack of cancer, though in my first treatment due to the negligence of the doctor I did not undergo chemotherapy and oral cancer drugs?

Looking at your history, you have had your fair share of pain and suffering fighting cancer. Congratulations on winning the battle so far.
Your history of recurrent breast cancer is very common. Most people think that after resection and radiotherapy, their cancer is gone. Breast cancer is a generalized disease manifested with local symptom and not a local disease that is "cured" after resection. Breast cancer is basically a symptom of underlying hormonal imbalance. Breast tissue, together with cervical, uterus, and ovarian tissues, is all hormonal sensitive tissue. While it is possible that your recurrence could be simply coincidental, my experience with many breast cancer patients is that until you get rid of the underlying hormonal imbalance, you are always at risk. The degree of risk varies from 0 to very high, depending on your body and its reaction, your genetic make-up, and environmental. Generally speaking, the majority of the time is due to estrogen overload. As such, preventive measures include nutrients, lifestyle, and other things you need to do to reduce estrogen dominance. Please read my take on this and memorise it. The article is on progesterone, but the underlying problem is estrogen dominance most of the time, and progesterone (natural form only) is a way to reduce estrogen load in your body. In order to start protecting your body against estrogen insult, read: Progesterone
It takes me an hour or more to fully understand a person’s history in minute detail down to the diet, the family history, medication, environment factors etc. This is obviously not possible over the internet. If you have more questions after you read the article, let me know. But I think that is the first step. As usual, always follow up regularly with your oncologist and keep him abreast of what you are doing all the way.

I am pregnant 6 months now, a couple of months ago my tsh was 0.15 ft3 3,02 ft4 1,43 and also my (sorry I don’t know what it’s called in english but I will explain) in my throat some gland I think has gotten a bit thicker. However, I don’t have those little lumps. I had a blood test this month: my tsh 0.28 ft3 2.79 ft4 0.98 and the gland in my throat has gotten a bit bigger but not much. I saw a doctor and he said I don’t have a problem – I want treatment yet I have another check up in 2 months. However, I might have problems giving birth in two months. Can you please tell me if my metabolic system works fine now? I have the risk of having gaining weight or losing weight.
Please also explain what hyperthyroidsm and hypothyriodism mean – what’s the difference?
Also I would like to say I have gained 8-9 kg and I’m only 6 months pregnant – is it normal or has it got anything to do with thyroid problem? I don’t eat too much, I eat normally and healthily.
Before I was pregnant I was 55 kg (height 1,75) I was very steady with my weight. Please tell me if I have a problem or what produces the problem?
Sorry I would also like to mention that my throat feels funning – when I swallow my saliva feels really thick. Please answer my questions because I’m really worried.

Your lab value looks normal on face value, but obviously it bothers you due to other symptoms with your throat which I am unable to really put a good handle on over the internet. I think you need to get through with your pregnancy first under the care of your doctor, as that is the key. After delivery, your body will stablize down. At that time, you can proceed to continue work up if the problems are still bothering you. Right now, it is hard to know what is really going on from my end. I am sure your OB doctor has a good handle on this once he examines you thoroughly. You can also ask to see an endocrinoloigist for second opinion.
Some people gain more weight than others during pregnancy as they tend to retain more water. General terms do not work when it comes to each person as each is unique. For your height and weight and as you say, you are healthy – so you should be fine.
You should continue to exercise moderately and make sure you take prenatal vitamins with the approval of your doctor. That is important. By the way, there is a lot of talk now on vaccination causing autism etc so you may want to start doing some research on this if you are focused on natural medicine and optimum health as this is an issue you have to decide on in the course of time.

I hope you can help answer this question for me. My saliva hormone assay tests recently have shown that my progesterone levels are ultra high, as are my estradiol and testosterone levels. My progesterone levels have been this way for years now and I have even quit using the ProGest cream to get the test levels down. I have gone off for four or five months but they are still high. I have my saliva tests done every six months. My cortisol levels were in the normal range BUT my DHEA levels were almost nothing. I know that the imbalance between those two is not good and that even though the cortisol is in the normal range, I still have a problem with cortisol dominance, thus giving me the effects of the cortisol, which I know what they are and I can see that I am experiencing those effects. As DHEA is a precursor for estrogen and testosterone, what are the chances that the DHEA will precurse into those already high level hormones when I use the DHEA to balance that and the cortisol? Or, does the DHEA only cascade into those other hormones when its own levels are sufficient? Also, I am using transdermal DHEA. Knowing what I know about hormone application and my health, it is the only way I will apply hormones. If the container says that each 1/2 t contains 25mgs of DHEA, wouldn’t I have have to really tone down the dosage because transdermal application is normally about 1/10th the amount needed for oral? My thought is that the manufacturer doesn’t know about the proper conversion otherwise they would not make a transdermal application so high. Do you know what I am saying? I would really like to hear your "take" on all of this.
I await your response with great expectation and respect.

It took me some readings to fully absorb and understand your plight and your question, and as it is, the picture you have painted is complicated. My response is as follows and I hope you dont mind my bluntness. Rather than answering point by point, I will give you my overall take as you requested which is more important.
If your progesteron level is very high and stays high, it is very unusual. You have to find out why, and you may want to try taking a blood sample and compare it with saliva. If your proegesterone level is still high despite going on progesterone cream, it may be that some progesterone that is fat or protein bound and now is releasing. Your age might also have some bearing. Blood test is more stable as you can get free progesterone and not simply total progesterone which contain the bound and unbound form.
Cortisol level needs to be measured in am and pm to properly gauge and account for the circadium rhythm. DHEA can be measured by blood and supplemented easily to increase your DHEA level. That is the most accurate.
As far as hormonal supplementation of DHEA leading to other hormones, there is a negative feedback loop so generally speaking, you will not get excessive hormones if the loop is working properly.
As far as testing is concerned, Saliva testing is not a mainstay of medicine. We generally do blood testing which, though late, is more stable. The pro-saliva testing camp is very strong on this, and many naturally oriented doctors do use saliva testing, but those with technical pathology background tend to use blood still.
You know a lot about the variety of pathways, but I think in your very special case which is not text book in presentation, you really need to see a knowledagable naturally oriented physician specializing in hormones and get a consistent and complete blood work (and saliva if you wish).When the data is in place, then the advice will make more sense.
I think my reply will elicit more questions which unfortunately I cannot attend to in a general email form. I hope you understand.