Before the detail that follows: Transmucosal progesterone therapy requires a prescription and a clinician's supervision. What is described below is how it is used under that supervision. It is not a protocol to begin on your own, and progesterone is not a supplement you should self-dose — it is a hormone, and the right dose, the right timing, and whether it is appropriate at all depend on your own circumstances. If you are pregnant, trying to conceive, on hormonal contraception or being treated for a hormone-sensitive condition, this needs a doctor before anything else.
Before you consider using progesterone, it is important to understand that it is not a magic bullet, and that you get the most benefit by implementing a Bioenergetic diet approach that allows you to effectively burn glucose as your primary fuel without backing up electrons in your mitochondria that reduces your energy production. My book, “Your Guide to Cellular Health: Unlocking the Science of Longevity and Joy,” covers this process in great detail.
Once you have dialed in your diet, an effective strategy that can help counteract estrogen excess is to take transmucosal progesterone (i.e., applied to your gums, not oral or transdermal), which is a natural estrogen antagonist. Progesterone is one of only three hormones I believe many adults can benefit from. (The other two are DHEA and pregnenolone.)
I do not recommend transdermal progesterone, as your skin expresses high levels of 5-alpha reductase enzyme, which causes a significant portion of the progesterone you're taking to be irreversibly converted primarily into allopregnanolone and cannot be converted back into progesterone.
Please note that when progesterone is used transmucosally on your gums as I advise, the FDA believes that somehow converts it into a drug and prohibits any company from advising that on its label. This is why companies promote their progesterone products as “topical.”
However, please understand that it is perfectly legal for any physician to recommend an off-label indication for a drug to their patient. In this case, progesterone is a bioidentical hormone rather than a synthetic progestin, and the two have different safety profiles — the risks associated with progestins in the hormone therapy literature do not transfer straightforwardly to bioidentical progesterone. That is not the same as being risk-free at any dose. Progesterone is sedating, can affect mood, and interacts with other medications, and the dose belongs with the prescribing clinician rather than with the reader.
Dr. Ray Peat has done the seminal work in progesterone and probably was the world's greatest expert on progesterone. He wrote his Ph.D. on estrogen in 1982 and spent most of his professional career documenting the need to counteract the dangers of excess estrogen with low-LA diets and transmucosal progesterone supplementation.
He determined that most solvents do not dissolve progesterone well and discovered that vitamin E is the best solvent to optimally provide progesterone in your tissue. Vitamin E also protects you against damage from LA. You just need to be very careful about which vitamin E you use, as many supplemental vitamin E products are synthetic and do not provide the form your body uses.
It is imperative to avoid using any synthetic vitamin E (alpha tocopherol acetate — the acetate indicates that it's synthetic). Natural vitamin E will be labeled “d alpha tocopherol.” This is the pure D isomer, which is what your body can use.
There are also other vitamin E isomers, and you want the complete spectrum of tocopherols and tocotrienols, specifically the beta, gamma, and delta types, in the effective D isomer. Look for a label showing the full spectrum of tocopherols and tocotrienols in the D isomer form.
Doses in this range are typically taken in the evening, and the specific amount, the timing and the preparation are matters for the prescribing clinician to set.
If you are a menstruating woman, you should take the progesterone during the luteal phase or the last half of your cycle, which can be determined by starting 10 days after the first day of your period and stopping the progesterone when your period starts.
If you are a male or non-menstruating woman, you can take the progesterone every day for four to six months and then cycle off for one week. The best time of day to take progesterone is 30 to 60 minutes before bed as it has an anti-cortisol function and will increase GABA levels for a good night's sleep.
This is what I have been personally doing for over a year with very good results. I am a physician so do not have any problems doing this. If you aren't a physician, you should consult one before using this therapy, as transmucosal progesterone therapy requires a doctor's prescription.