This follow-up visit focused on reviewing hormone therapy, inflammation support, sleep, energy, libido, and overall treatment progress.

How You’re Feeling

Overall progress has been encouraging.

Improvements Reported

• More energy
• Better sleep
• Less joint pain and inflammation
• Hormones feeling more stable after correcting progesterone dosing

Although weather and allergies affected symptoms at times, the overall baseline appears improved.

Medication & Hormone Review

Progesterone (Oral)

200 mg nightly

Progesterone Cream (AM)

 Dose: 1 click (15 mg daily)

• No side effects reported

Important Goal

Progesterone is being used to help thin the uterine lining and reduce bleeding risk during hormone therapy.

Progress

• No bleeding for approximately 46 days
• Previous ultrasound and biopsy results were normal

Plan

• Continue current dose
• Monitor bleeding
• If bleeding becomes frequent, repeat ultrasound may be needed

Estrogen + Estriol

• Estradiol patch (0.0375)
• Estriol 3% cream (2x/week)

Progress

• Stable and effective
• No regression symptoms reported
• No longer needing daily use

Testosterone

Dose: 2 mg (1 click daily)

Progress

Stable with no concerns reported.

DHEA

• 10 mg daily

Continues as part of the hormone support plan.

LDN (Low Dose Naltrexone)

LDN is being used as part of inflammation, autoimmune, pain, sleep, and energy support.

Benefits You’re Seeing

• Reduced inflammation
• Reduced autoimmune activity
• Increased energy
• Better sleep quality
• Reduced pain

Even the rheumatologist was supportive of continuing treatment.

Dosing Plan

• Current dose: 3 mg
• Increase by 0.5 mg weekly
• Target dose: 4–4.5 mg

Notes

• Full effect may take up to 3 months at a stable dose

If side effects occur:

• Return to previously tolerated dose
• Stay there for approximately 4 weeks before retrying increase

Libido & Hormonal Balance

Progress

● With partner: 100% functioning 
● Spontaneous desire: lower
 This is very common and reflects different pathways:
● Physical response vs. dopamine-driven desire

Mucuna (Dopamine Support)

● May improve interest/thought initiation 
● Dose: 2 capsules daily (ideally empty stomach

Bone & Metabolic Health

Progress

• Bone density remains very good
• Strength training is ongoing

Focus

• Maintain muscle mass
• Support metabolic health
• Continue current supplements

 What’s Working

Positive trends reported during follow-up include:

• Hormones stabilizing
• Inflammation decreasing
• Energy and sleep improving
• Bleeding remaining controlled
• Vaginal tissue health improving

Overall progress appears positive and appropriately monitored.

Plan Going Forward

Continue

• Current hormones and supplements
• LDN titration to 4–4.5 mg
• Strength training

Add

Mucuna for dopamine and libido support

Monitor

• Any return of bleeding
• LDN side effects during titration

Next Appointment

Tuesday, August 11th at 12 PM.

Final Thoughts

This follow-up reflects thoughtful and gradual progress.

The overall treatment approach continues to focus on:

• individualized care
• careful monitoring
• hormone balance
• inflammation support
• sustainable long-term wellness.