I recall my endo saying at one time that we might allow her to be a bit more than normal as long as the other levels were okay. That is, trying to keep him in normal range might require a larger dose when he could get by with a smaller one. Of course if the 17-OHP and the testosterone were up, then med change would be needed. Like the previous poster said....I hear over and over....It is the Big picture you have to look at and a balancing act. Her previous history may make the endo think this is a trend of an upswing for her, but not necesarily for each CAH child.