A small percentage of menopausal women who start on bioidentical hormones experience little to no relief of their menopausal symptoms despite using higher than average doses of estrogen (BIEST). A common mistake made by practitioners is to continually increase their estrogen dose above physiological doses in an attempt to overcome their symptoms which can be potentially dangerous. The preferred path is to arrange a 24hr urine test measuring all three estrogens. The results usually reveal high levels of the three estrogens in the urine. This then indicates that the patient is hyper excreting the hormones which means the liver is metabolising the hormones very rapidly and excreting them out of the body before they can exert any therapeutic benefit. Long term estrogen use, especially if using Premarin, can stimulate estrogen hyper excretion. It is also possible that exposure to environmental estrogens may do the same.
I first came across an article by Dr Jonathan Wright1 (a well respected pioneer of Biodentical Hormone Therapy) on this subject when researching a solution to this issue I was seeing in a few of our patients. After doing some library research, in the late 1990s Dr Wright found that 300-600 micrograms of cobalt chloride almost always corrects this situation, although it happened very gradually over 3 to 6 months.2 According to one group of researchers, cobalt reduces the total number of estrogen-metabolizing enzymes, called cytochromes,3 so that less estrogen is excreted and thus more is retained in the body where it can function. With more estrogen retained by the body, symptoms of low estrogen decreased and ultimately disappeared.
Other hormones such as testosterone and cortisol may also be hyper excreted and treated the same way with cobalt chloride however it is less common with these hormones. I have only seen it occur in a handful of men on Testosterone therapy over the years.
Although the results vary somewhat between different studies the average dietary daily cobalt intake (without supplementation) is around 160 – 580mcg. Cobalt is considered safe at dietary doses however mega doses at 20 to 30mg a day can cause thyroid hyperplasia, myxedema and congestive heart failure. Therefore supplementing dietary range cobalt doses is considered safe and well below the toxic doses. The usual recommended dose for hyper excretion is 500mcg daily. Symptomatic relief may not start for 2 to 3 weeks and be completely corrected in 2 to 6 months. When symptom relief is accompanied by normalization of laboratory values, cobalt can usually be stopped. Resumption of cobalt supplementation to control both symptoms and lab confirmation of recurring hormone hyper excretion is rarely necessary.
1 PHYSIOLOGIC-DOSE COBALT REVERSES ESTROGEN HYPEREXCRETION and BIO-IDENTICAL ESTROGEN REPLACEMENT FAILURE By Jonathan V. Wright, M.D.
2 “Bio-identical steroid hormone replacement: selected observations from 23 years of clinical and laboratory practice,” Ann NY Acad Sci 2005; 1,057: 506-524
3 Maines MD, Kappas A. “Metals as regulators of heme metabolism,” Science 1977; 198: 1,215-1,221