Progress Your Health Podcast

Maria’s Question:  Hello, I’ve been reading the articles on BHRT, and I have questions. Does the body or will the body develop tolerance to hormones? Whether progesterone, testosterone or estrogens, will I eventually have to increase my dose to get the same effect, progesterone for sleep, estrogen for hot flashes, testosterone for energy and libido… Thank you very much. Short Answer:  There are many factors that go into a BHRT dosage for a patient. This includes age, gender, lifestyle, stress level, and severity of symptoms. Typically, when we work with a patient, their BHRT dosage will increase over time. A patient does not necessarily develop a tolerance to bioidentical hormones; however, a lower starting dosage may not be effective to manage symptoms and a slight increase may be needed. PYHP 083 Full Transcript:  Download PYHP 083 Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the progression podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson.  Dr. Maki: So, we’re going t

Staci’s Question:  Hello, Dr. D, I was on Biest, 80:20 ratio. One mg/mL. I take one click, which is a quarter gram per day. I have been taking that for two and a half months to come about sleep disturbances, low libido, and hot flushes. I also take 100 mg of progesterone capsules at night. After the two and a half months, my breasts were so dense, tender and sore that I had to stop, to get some of the estrogen out of my body. I still get my period intermittently, so I don’t think I’m quite finished going through menopause yet. Should I lower my Biest dose or take it every other day? The hormones do alleviate my symptoms. It’s just that, eventually, it seems to be too strong. Short Answer:  For a woman, it is a tough situation to be experiencing hot flashes, but still be mensturating at the same time. When a woman is still mensturating, she is not an ideal canidate for bioidentical estrogen. The fact that a woman is have a cycle means that she is still producing enough of her own estrogen, so taking an exogeno

Heidi’s Question:  Hi, I’m a 48 year old female who has struggled with PCOS my whole life. I’ve taken 200 milligrams of oral progesterone for several years now. I also take 45 milligrams of Armour Thyroid, and my TSH is 3.87, and my free T3 is 3.22. I’ve had symptoms of: hair loss, dry eyes, vaginal dryness, very low sex drive, and irritability. I just had a saliva test done which revealed very low estradiol levels, and low DHEA along with borderline low testosterone. The practitioner I have, put me on sublingual drops with a dosage of 80/20 ratio of biased being– which is interesting, .8 milligrams of an 80/20 bias, .8 milligrams of testosterone, 25 milligrams of oral DHEA and kept me on my 200 milligrams of oral progesterone. My question is, is this a safe way to administer my Biest and testosterone? Do you agree with the dosing amounts? Any advice would be appreciated. Thank you for your time, Heidi. Short Answer:  We do not like the idea of taking Biest and testosterone orally. Taking BHRT in a sublingual

Sarah’s Question:  Thank you for writing your post weighing the differences between creams and oral capsules. What dosing would be typical for a premenopausal woman with PCOS and amenorrhea (1-2 menstrual cycles per year) who is seeking to regulate cycles? Short Answer:  We often prescribe between 50 mg and 200 mg of bioidentical, sustained-release progesterone for women with a variety of hormone-related symptoms. For PCOS, a good dose would be 75 mg of progesterone. It is common for many women with PCOS to have irregular cycles, so the progesterone can help to restore a consistent monthly cycle. Depending on the symptom profile, the dose may need to increase over time, but 75 mg is a good starting point. Some other podcasts related to PCOS: PYHP 063 – What Type of PCOS Do I Have – Classic  PYHP 064 – What Type of PCOS Do I Have – Common PYHP 065 – What Type of PCOS Do I Have – Concealed PYHP 066 – Do I Have Adrenal Fatigue or PCOS?  PYHP 080 Full Transcript:  Download PYHP 080 Transcript:  Dr.

Elizabeth’s Question:  I just got my lab results back and they are: TSH, Thyroid-stimulating hormone, is 1.33, Free T4 is 1.64, Free T3 is 2.9, thyroid peroxidase antibodies, that’s for the Hashimoto’s, is 16. My doctor said my Free T4 was a little high so she suggested cutting my levothyroxine, which is a T4 only medication, 50 micrograms in half, which would be 25 micrograms and to come back in a couple of months for labs. Do you think my Free T3 levels are low? I’ve been having terrible issues with my muscles and heart palpitations. –Elizabeth. Short Answer:  Lowering her dosage is a common reaction, but is not the right one. In this case, we would most likely switch the medication to a compounded, sustained-release combination of T4 and T3. As for the heart palpitations, it is probably not related to her medication because the dose is only 50 mcg. Women in perimenopause and going into menopause will commonly experience heart palpitations and be related to adrenal dysfunction and declining estrogen levels.

Lisa’s Question:  I have a free T4 of 1.5, a TSH at 3.09 and I have a free T3 of 2.7. Do these seem like they are within parameters? My ENT says everything is fine with my numbers, and my vitamin D is 26.5. Short Answer:  This is a good example of a high normal TSH level (3.09), which does raise some concerns. Any time we see a TSH above 2.0 to 2.5, it gets our attention. A high normal TSH level, along with clinical symptoms helpt to determine the best course of action for the patient. We like to see a low normal TSH level and a high normal Free T3 level, preferably greater than 3.2. PYHP 078 Full Transcript:  Download PYHP 078 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson. Dr. Maki: So how are you doing this morning? Dr. Davidson: I’m doing great. How are you doing? Dr. Maki: Pretty good. Pretty good. 2020 is moving along. Dr. Davidson: It sure is. Dr. Maki: A little bit of a hiccup earl

Danette’s Question:  Can you determine if I should be considered for hypothyroidism? I have five of the listed symptoms, but my labs fall into “normal ranges” from my lab. Free T4 is 1.1, free T3 is 3.0. TSH, thyroid-stimulating hormone, is .82. Short Answer:  Many people could be considered to have Subclinical Hypothyroidism. This is when thyroid labs are all within the normal range, but several symptoms are present. In Danette’s case, her labs actually look fairly decent. Her TSH is below 1.0 and her Free T3 is 3.0, but she has many hypothyroid related symptoms. She does not have hypothyroidism, but could easily be in the subclinical category. However, many of the symptoms listed below can be attributed to many other issues including PMS, Perimenopause, Menopause and adrenal dysfunction. Symptoms of Hypothyroidism: (not a comprehensive list) fatigue weight gain or slow metabolism dry skin constipation low mood heavy periods heavy irregular periods brain fog, hair loss. PYHP 077 Full Transcript:  Download

Angie’s Questions:  Hi, I’m going to start Biest compounded at 80/20 ratio; 80% estriol, 20% estradiol, 2.5 milligrams once a day, and 100 milligrams compounded slow-release progesterone pill. My doctor and I decided on this amount because I read from a well-known hormone doctor that anything less will not help the heart, the brain, and the bones. Question. Will the cream travel through my body enough to help with those or should it be in a pill form, which I would rather not do since I’m already going to be taking a progesterone pill. I heard that the progesterone pill is a must if you have a uterus, I am in my late 50s and I started menopause later. Short Answer:  Biest is a very common form of Bioidentical Hormone Replacement Therapy (BHRT). This is often prescribed as a transdermal cream. Biest contains two different forms of estrogen, which is estradiol and estriol. A common starting ratio of Biest is 80/20, which means 80% of estriol and 20% estradiol. A typically starting Biest dose for us is usually 3

Lisa's Question:  I have recently started taking 50mg of progesterone and bi est cream 50.50 it's been 3 weeks. Experiencing hot flash at night and seeing very little improvement in my sleep. Does it really matter where we apply the bi est cream, I was told inner highs, I feel I absorb it better in the inner arm, Also could the dosage be too low, I cannot tolerate more than 50mg of progesterone. These are compounded in pharmacy. Short Answer:  We recommend that our patients apply their cream to the inner thigh. In some situations, the back of the knee is fine, but most often the inner thigh is the best place. We do not recommend applying the cream to the upper arm or forearm, as this can skew blood testing results. PYHP 075 Full Transcript: Download PYHP 075 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson Dr. Maki: So I’m not sure if you can tell or not, but we actually have some

Carrie’s Question:  I really liked this article about capsules versus creams. So, it was about progesterone, so bioidentical capsules or progesterone capsules versus progesterone cream. “I do have a question. I recently started 100 milligrams generic progesterone called Generic Prometrium and have had horrible side effects after almost three weeks of taking 100-milligram Prometrium pill each night. My anxiety has increased, terrible headaches the next day, very teary, exhausted the next day. Extreme brain fog like scary forgetfulness. Is it possible something could be with the fillers or the brand or maybe too high of a dose too soon? I’m being treated for very low progesterone in order to help my mood. Which sounds really sad because her mood sounds even worse on the Prometrium but anyway, My mid-luteal phase of my cycle, my levels were .9, which is very low. And should I ask for a different brand or compound capsules? Thank you. Short Answer:  We don’t consider Prometrium and Bioidentical Progesterone the s

Michelle’s Questions: I am 52 years old going through menopause since 48. I had a hysterectomy at age of 36 and kept my ovaries for the hormones. My ovaries are nonfunctional now. I was on Premarin, but when I sought out a specialist for hormone therapy, I was prescribed: Estradiol 0.5 Estriol one milligram, which is technically Bios. It’s the combination of estriol and Estradiol. Estradiol was 0.5 milligrams, Estriol is one milligram. And I am also taking a hundred milligrams of Progesterone. I take this at night. I’ve had a weight gain of 40 lbs and suffer from anxiety at night since starting menopause. I was prescribed Propranolol, which is technically a blood pressure medication, but it does help with reducing anxiety. But she has prescribed the propranolol for this and it seems to take the edge off. I have poor sleep as well, where I used to sleep very well. What am I missing? Am I on the right track? I feel deconditioned fatigue and brain fog to mention a few. I feel poorly when I used to be a happy,

In this episode, we discuss the immune system and give you specifics to help you during the cold and flu season. Most of us are very busy and don’t really have time to get sick. Below are some simple ideas to help you boost immune function and hopefully protect you during the cold and flu season. What Supplements Support Immune Function?   Vitamin D: for immune support, we recommend taking 2,000 to 10,000 IU depending on your exact situation. To boost immune function, you could take 5,000 IU’s daily for 1 to 2 weeks and then reduce down to 2,000 IU daily for maintenance. Note: before you starting taking Vitamin D, you should have your level tested. Vitamin A: for immune support, we recommend taking 25,000 to 100,000 IU depending on your exact situation. To boost immune function, you could take 100,000 IU for 1 week, then reduce down to 75,000 IU for 1 week, reduce again down to 50,000 IU for 1 week and then maintain at 25,000 IU daily. Note: 100,000 IU daily is considered a high dose, so don’t take this amoun

The holiday season is upon again, which is a great time of year to spend with family and friends. However, it can be a stressful time of year as well. Not to mention, it is also the cold and flu season. Most of us are too busy and don’t have time to get sick, but that is part of the problem. We push ourselves too hard. Sleep is often never enough, so we open ourselves to illness. In this episode of the podcast, we discuss the connection between stress, your adrenals, and immune function. Over the years, we have seen it many times with our patients. They are very busy with work, family and just life in general. If an unexpected stressor comes along, they don’t have enough reserves to keep them well. Inevitably, they are laid up in bed with a cold or the flu.   PYHP 071 Full Transcript:  Download PYHP 071 Transcript Dr. Maki: Hi everyone. Thank you for joining us for another episode of Progress Your Health Podcast. I’m Dr. Maki– Dr. Davidson: –and I’m Dr. Davidson. Dr. Maki: So have you noticed the weather’s ch

In this episode of the Progress Your Health Podcast, we continue explaining the three main types of Adrenal Fatigue/Dysfunction that we see often. Here is a quick recap:  Vampire (episode 68): High cortisol at night and low cortisol in the morning. Hard to fall asleep and very difficult to wake in the morning. Weight gain and evening carb and sugar cravings. Feel much better in the evening and will refer to themselves as a night person.' Ghost (episode 69): Cortisol is very low in the afternoon and early evening. This is why they fall asleep so easily, but there is a lot of difficulty staying asleep through the night. The Ghost is broken up into two subtypes: the Ghoul and the Poltergeist. Ghoul: The cortisol is low in the afternoon and evening. They fall asleep so easily. But come 2 am the cortisol rises for hours. The cortisol will drop a touch, so they fall back asleep after two hours. But it remains elevated until noontime where the cortisol will dive, along with their energy. Poltergeist: The cor

In this episode of the Progress Your Health Podcast, we continue talking about the main types of Adrenal Fatigue that we see. We are certainly not trying to minimize Adrenal Dysfunction but to make it more interesting and easy to understand, we call these main types: Vampire (episode: 68) Ghost (this episode 69) Zombie (episode 70 – next episode) Adrenal Fatigue or Adrenal Dysfunction (which is what we like to call it) is a real condition that affects millions of people in our country. And the effects can seriously impact a person's health and quality of life. We have seen different types of Adrenal Dysfunction. These three main types are important to know because a person with a Vampire type of Adrenal Fatigue will have a completely different treatment plan than someone that is a Zombie type.   In this episode, we are to talk about the Ghost type of Adrenal Dysfunction. There are actually two subtypes of the Ghost. We call them, the Ghoul and the Poltergeist.   But first, just to jog your memory. In t

In our last episode, we talked about Adrenal Fatigue / Adrenal Dysfunction and how to test for it. In the next three episodes, we are going to focus on three main types of Adrenal Dysfunction that we see. Three main types of Adrenal Fatigue: The Vampire The Ghost The Zombie Adrenal Fatigue is quite real and can seriously impact someone's life. We are not trying to make light of the effect that Adrenal Dysfunction can have. But we find by putting some easily remembered descriptions; this medical condition will resonate with people. And it will be more easily understood.   Symptoms of the Vampire: Cannot wake up in the morning: these are the people that press the snooze button a lot. Often Vampires will have several alarms to help them get up in the morning  They might not be drinking your blood, but will drink a lot of caffeine to get going in the morning. Even with copious amounts of coffee but are still tired.   Morning and daytime brain fog Weight gain  Sugar and carbohydrate cravings mainly in the

In our last episode we talked about the differences between PCOS and Adrenal Dysfunction, which is often called Adrenal Fatigue.  Adrenal Fatigue or Adrenal Dysfunction is not a ICD10 diagnosis. There is an actual ICD10 billable code called: unspecified adrenocortical insufficiency (E27.40).  But there is controversy in using this code for patients. It is technically meant for conditions where the adrenal glands do not produce enough steroid hormones such as cortisol and aldosterone.  You might be saying, but this sounds exactly like Adrenal Fatigue/Dysfunction! Most people with Adrenal Dysfunction have normal labs, so their doctor cannot code for Adrenocortical Insufficiency (E27.4).  And because their labs and testing look normal people are told they are fine and dismissed. In this episode, we are going to talk about the testing for Adrenal Dysfunction.  There are some testing that can show Adrenal Dysfunction such as saliva and urine testing.  But most conventional docs are mainly familiar with blood t

In our last series of episodes, we talked about polycystic ovarian syndrome (PCOS). We have categorized PCOS into three types: Classic Common Concealed Classic has the majority of all the symptomatology that pertains to PCOS. Common has some but not all of the symptoms of PCOS.  Concealed PCOS is often missed. What we have found is that the Concealed type of PCOS has a lot of properties and similarities with adrenal fatigue. In this episode, we are going to talk about the similarities between PCOS, and especially the Concealed type and Adrenal Fatigue. We are also going to explain the differences between PCOS and Adrenal Fatigue.  Let’s differentiate between Concealed PCOS, Adrenal Fatigue: Concealed PCOS: As mentioned, the Concealed type of PCOS is not often picked up on. It is often mistaken for Adrenal Fatigue/Dysfunction. These are the women that have been to many doctors looking for answers. Their symptoms seem to develop or get worse when they hit their late 30's to early '40s. Because at

In this episode, we are going to continue talking about the Types of PCOS that we have seen. As we have said, (repetitively) PCOS is not a one size fits all. There are some women that have most of the symptoms to just a few. We have three types that we have seen in treating patients since 2004. It is important to have this distinction when it comes to health goals and treatment plans. Doctors that routinely treat PCOS will tell you there are different types. They might have their types that they have seen. But in our experience, these are three types that we have seen most regularly. The three types of PCOS  Classic Common Concealed Concealed: This type of PCOS is never picked up on. These are the women that have gone to many doctors looking for answers. This is because they have just a small few of the symptoms but not enough to point to PCOS. But they do have a hormone imbalance, and when you break it down, it is a type of PCOS. It seems to get worse when a Concealed Type hits perimenopause or late 30&apo

In this episode, we continue talking about PCOS. As mentioned in the previous episode, we have seen three main types of PCOS. PCOS is more of a spectrum of symptoms. Some women have most of the symptoms of PCOS and others just a few. The varying degree of hormonal imbalances will help mold the three types of PCOS that we have seen. Many doctors that treat PCOS all can agree that there are different types of PCOS.  The three types that we have found with PCOS are: Classic Common  Concealed In this episode, we are going to talk about the Common-Type of PCOS. In the previous episode, we spoke about the Classic type. And in the next episode, we will go over the Concealed Type.   The reason that we want to differentiate the Types of PCOS is because, in each type, there are different health goals, health consequences, and multiple treatment plans.  Common PCOS: This is the most common type of PCOS seen. The Common-types should be diagnosed fairly easily. But because they do not fall into the Classic presentat