How do doctors decide on the best hormone treatment option?

In most cases this is a matter of personal preference based on experience. I sometimes feel that it is a little like a conductor arranging his orchestra. On occasion, the requirements may be obvious. For example, a pianist is needed for a piano concerto. One instrument may be quite inappropriate ? bagpipes may be wonderful at Edinburgh Castle but out of place in an orchestra. If one part of the orchestra, such as the percussion, plays louder, the other sections will sound relatively quiet even if individually they make no changes. So it is with hormone therapy. There are more hormones in the body than there are instruments in a symphony orchestra. When introducing one hormone treatment, there will inevitably be a knock-on effect on the others. Frequently, the treatment may involve more than one additional hormone; the combined oral contraceptive pill has oestrogen and progestogen. Several hormones must be given in se quence for in vitro fertilisation, (Figure 10.3). Finally, one expert will prefer an arrangement by one conductor to that of another. This is a matter of personal preference. So it will be with hormone treatment one patient may feel happier on one pill than another but that choice may not suit everyone.

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