A therapeutic objective in endocrinology aimed at minimizing the periods of lowest hormone concentration, or troughs, which can occur between doses in standard replacement regimens or due to dysfunctional pulsatile secretion. Eliminating these troughs ensures a more stable, physiological concentration of active hormones, preventing symptoms associated with temporary deficiency and promoting consistent receptor saturation. This is particularly relevant for maintaining stable mood, energy, and metabolic function.
Origin
The concept stems from pharmacokinetic studies of hormone delivery systems, recognizing that large fluctuations in serum hormone levels can lead to supraphysiological peaks and sub-physiological troughs. Modern approaches in hormonal health prioritize mimicking the natural, stable kinetics of the endocrine system.
Mechanism
Strategies for trough elimination typically involve utilizing delivery methods that provide a continuous, sustained release, such as transdermal patches, gels, or pellet implants, or by increasing the frequency of oral or injectable administration. By maintaining hormone levels within a narrow, physiological range, this mechanism ensures consistent gene transcription and cellular signaling, avoiding the deleterious effects of intermittent receptor under-stimulation.
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