Most women begin assembling their HRT "portfolio" with estrogen. As we said elsewhere, a woman in surgical menopause just isn't likely to be able to make enough for herself any more, and will need to take at least some. Some doctors feel that estrogen is all a woman without a uterus needs, and that is all that they are willing to prescribe.
That strategy has merit, in that we really can't tell what other hormones we may or may not need to supplement until our estrogen needs are fully met. It's important to remember in all of this that it's not about what hormones our ovaries used to make or what hormone we think we might like to take, but rather about the specific needs our bodies demonstrate.
For women who have endometriosis, however, estrogen alone may be a faulty strategy that can feed the remaining endo and allow it to regrow and perhaps even become cancerous.
Estrogens of various chemical configurations are available in human-identical and synthetic forms by prescription and alternative forms from a number of non-prescription sources.
Some women may choose to take progesterone to balance, or counter, some of the effects of the estrogen. Because of the risks progesterone and progestins pose, however, this should not be reached for just on a conceptual basis before tuning estrogen as finely as possible.
Because progesterone has many actions of its own that may be desirable—such as its ability to increase bone density—adding it to estrogen may confer additional benefits. And because progesterone can be readily converted to testosterone by the adrenal glands, adding progesterone to HRT can serve to support libido without incurring the risks of taking testosterone itself.
Progestagens (that's the collective term for agents-that-act-like-progesterone, which includes progesterone itself) are available in bioidentical and synthetic forms by prescription. There are no active alternative (herbals or foods) forms: the "wild yam" products and the chemical diosgenin that are sometimes sold labeled as progesterone cannot in fact be converted to usable progesterone by the body. Human identical progesterone is also sold without prescription in transdermal formulations.
Testosterone is available only by prescription, and in bioidentical or synthetic form.
Another agent that is sometimes added to HRT is the hormone precursor dehydroepiandrosterone, or DHEA. This naturally-occurring precursor can be converted by the adrenal glands into both estrogen and testosterone by the body, and thus the benefits attributed to it are those of estrogen and testosterone.
Because it is available over the counter and unregulated, it is popularly believed to be a simple and safe alternative to prescription HRT This is not necessarily the case, however. In some women, this conversion does not happen, and even when it does, the levels so obtained may not be safe, adequate, or consistent. Remember, testosterone in excess can be one of the most dangerous of hormones.
Many reputable practitioners recommend against supplementing with DHEA unless blood testing has demonstrated a primary DHEA deficiency and its use is closely monitored.
Over the counter DHEA supplements are notoriously unreliable, so if you do use DHEA, you should seriously consider a prescription source to be sure you're getting the real thing. It's also very important, since this hormone precursor supports adrenal activity, that you never stop taking one suddenly without supervision of a health care practitioner.