I do not know Dr New or had any dealings with her, and I think the work/research she has done in CAH is tremendous, however I also think thoughts, as doctors are learning more, are changing.  It is only recently that they discovered the potency of dex to hydro is 80:1, hence the reason dex was not used by paeds due to the side effects. Dex has the longest half life - therefore only needed once a day, pred has a longer half life than hydro and is needed x2 a day.  It is a known fact that hydro has the shortest half life, if it lasts in the body say 6 hours, (in most people), then taking 3 times a day makes sense.  Some people with CAH still do make a little of their own cortisol, so perhaps this is why they can do well on X2 hydro dosing because it suits them. I believe the biggest problem with x3 dosing a day is compliance - it is easy to forget that lunchtime dose. When dosing x3 - the total daily dose is same but given in smaller doses, which must mean less side effects?  I wonder how many patients have actually had 24 hour cortisol and 17 OHP profiles done (blood tests 2 hours) to trace exactly what these levels are and so that their meds can be fine tuned?