Andrew and all,  I think the courtesy here should go to the CAH child and the person managing the doses daily (in this case its me, the mother).  I have tried to be couteous to this doctor by letting him know we are concerned that she is on such a high dose of medication and that now at age 9 she is so heavy at almsot 90 lbs and has such a hard time with the teasing thats starting at school not to mention the long term affects.  I am under the assumption that although she will have some backlash from long term steriod use that the less now the better later???  I think the thing to point out to you all is that this is not our first endo.  Unfortunately we have dealt with many an endo over these 9 years.  My hubby is a techy and we have been in CA, VA and now TX so we have met our share.  I am a bit disappointed to say the least in the endo profession.  I am not so sure they all are interested in getting this condition under one certain protocal and nor do I believe they place much value on her as a "case study" in which to learn by.  There may be a few out there who do but I have to say of the 10 I have met.... I’d give it to 2.   So I dont really care much what my endo is thinking and I am not much worried about his being "conservative" on her dosing style.  Were doing what we believe to be the best for her and he can agree or not.  Our insurance tells me to use him and I will for appts and emergencies.  We dont have to be best friends.  He obviously hasnt researched the best or alternative ways to treat my daughter and thats just the wrong answer!