Progress Your Health Podcast

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Latest Episodes:

Perimenopause and Thyroid | PYHP 143 Jun 27, 2024

In this episode, we return to a listener’s question regarding thyroid dosing in perimenopause. In our previous episode, we answered Tracy’s question about taking estrogen in perimenopause. Tracy also asked us an additional question about her thyroid doses. Tracy does not have a thyroid gland and has been noticing her dose is continually increasing as […]

Biest and Perimenopause | PYHP 142 Jun 27, 2024

In this episode, we discuss a listener’s question regarding perimenopause and estrogen hormone replacement. Tracy is concerned because she is still having a period but also has symptoms of low estrogen. She is not sure if she is a candidate for estrogen therapy since she is still cycling. Tracy’s Question: Hi- you’ve discussed in past […]

Menopause and Anxiety | PYHP 141 Jun 27, 2024

In this episode we discuss Jenell’s question she submitted on our website (Ask the Dr). Jennell has been having terrible anxiety since entering menopause and it is really affecting her quality of life. Jenell’s Question: Since starting menopause, I’ve had debilitating anxiety, especially bad in the morning. By evening, It practically goes away. I’m 54 […]

Can Menopause Cause Heart Palpitations? | PYHP 140 Jun 27, 2024

In this episode, we discuss a listener’s question. Amanda is 50 years old and starting to have menopausal hot flashes and weight gain. However, she is most concerned about the heart palpitations she is having. Amanda has had a cardiovascular workout and does not have heart disease. Most people might not be aware, but feeling […]

Does Progesterone Help You Sleep in Perimenopause? | PYHP 139 Jun 27, 2024

In this episode, we discuss a listener’s question about perimenopause. ‘Maggie’ is in her 40’s and experiencing severe insomnia with anxiety. She has tried supplements and different doses of progesterone with minimal results. She is having so many ups and downs with her insomnia, anxiety, and hormones. She is wondering how long this is going […]

How to Treat Premature Ovarian Failure? | PYHP 138 Jun 14, 2024

In this episode, we talk about Mary’s hormone concerns after ovarian failure. She is only 34, and in the last 7 years since her ovarian failure has tried many hormone replacement options, all without the success she was looking for. Let’s Read Mary’s Question: When I was 27 years old I was diagnosed with iatrogenic […]

Is Biest Better Than Estradiol Patch? | PYHP 137 Jun 14, 2024

In this episode, we answer a listener’s question about her HRT dosing. ‘Donna’ is 63 years old and has been on some type of hormone replacement therapy for the last 13 years. Hormone therapy is not ‘one size fits all.’ There are so many types of menopause hormone therapies that each treatment needs to be […]

Menopause and Heart Disease Risk | PYHP 136 May 03, 2024

In this episode, we discuss a question from Janice, a podcast listener’s question regarding the benefits of estrogen therapy for heart health. There is much evidence to show that estrogen has cardiovascular protective benefits. We wanted to discuss how estrogen benefits heart health and can help reduce the risk of cardiovascular disease. Janice’s Question: Are […]

Estrogen and Bone Density | PYHP 135 May 02, 2024

In this episode, we talk about the benefits of estrogen on bones. A listener’s question (Alison) inspired this episode. Alison asked if taking vaginal biest has the same heart and bone effects that other estrogens and estrogen therapies have. So, we wanted to expand on estrogen’s role in helping keep bones strong and healthy. In […]

Does Estradiol Cause Weight Gain in Perimenopause? | PYHP 134 Apr 04, 2024

In this episode, we talk about hormone treatments for perimenopause and menopause. There is a vast distinction between perimenopause and menopause when it comes to treatment options. We often see women who are being treated for menopause when they are genuinely not in menopause. Meet Linda: Linda is a listener who sent us a question […]

When to Apply Biest Cream | PYHP 133 Apr 04, 2024

Recently, Catherine posted a question on our website about Biest cream, and we knew this could interest our listeners. Biest is a combination of estriol and estradiol, one of the most common forms of estrogen therapy used in bio-identical hormone replacement. There are many doses, ratios, options, and methods of using Biest, so we thought […]

Perimenopause and Sex | PYHP 132 Mar 20, 2024

Welcome to the Progress Your Health Podcast! This is a podcast that helps you learn about balancing hormones, especially during perimenopause and menopause. We love hearing from our listeners. If you have a question, please visit our website and click Ask the Doctor a question. Let’s read Brigitte’s question! I have been listening and learning […]

Is Perimenopause the Same as Early Menopause? | PYHP 131 Mar 20, 2024

In this episode, we talk about the difference between perimenopause and menopause. Both Dr. Maki and I (Dr. Davidson) have worked with women in perimenopause and menopause since 2004 and sometimes get a bit myopic and technical when it comes to explaining the differences. The other day, a patient of Dr Maki’s asked the question, […]

Does Perimenopause Cause Irritability and Weight Gain? | PYHP 130 Mar 10, 2024

We recently got a great question from a listener and want to share it with you. This question is about a perimenopausal 51-year-old female. She is still menstruating and having confusion about her hormone testing and the hormone therapy that she is currently taking. She is experiencing some breast tenderness and irritability related to her […]

Can Progesterone Help with Sleep? | PYHP 129 Mar 10, 2024

in this episode, we answered a listener’s question. We love questions from listeners. If you have a question, please visit our website and click Ask the Doctor a question. Here is the listener’s question: I have been perimenopause for at least 4 years now I am 47 and after completing a Dutch test with a […]

Vaginitis vs Yeast Infection | PYHP 128 Oct 06, 2023

The dreaded, uncomfortable, annoying, burning, itchy, achy, irritating vaginal infection. Ladies, we have all been there. And for those unicorns that have never had a vaginal infection such as yeast or bacterial vaginosis, well, you are certainly one of the lucky ones. While a yeast infection or BV is not life-threatening, not fatal, and maybe […]

Can Progesterone Cause Anxiety? | PYHP 127 Oct 04, 2023

Can Progesterone Cause Anxiety? Often we get reader/listener questions about their own experience with hormones. We love that readers of our blogs and listeners of the podcast (TheProgressYourHealth Podcast) reach out for more information. If they have concerns and questions, that means many, many other people have the same concerns. A lot of questions we […]

When Is It Too Late To Start HRT? | PYHP 126 Sep 29, 2023

When is it too Late to Start HRT? Recently we received a great question/comment from a listener of our podcast (The Progress Your Health Podcast). I’ll call her ‘Jenny’ (because I never reveal any personal information for the sake of privacy). Jenny was wondering if she is too far into menopause to be able to […]

What Are Five of the Most Common Symptoms of Perimenopause? | PYHP 125 Sep 26, 2023

Perimenopause is the time in a woman’s life prior to entering menopause. Most people are familiar with menopause, which is when the ovaries stop producing hormones and women stop their periods. There are many options to deal with menopause (which is an entirely different podcast and blog). But perimenopause is a completely different animal compared […]

Can Estriol Cream Be Used For Vaginal Atrophy | PYHP 124 Aug 23, 2023

Discover how estriol can address post-menopausal vaginal & urinary concerns. Learn about its benefits for atrophy, leakage, & infections in this episode of Progress Your Health podcast.

Does Estrogen Cause Weight Gain? | PYHP 123 Dec 01, 2022

Download the diagram above, click here. Tracy’s Question: Episode 052 – What Biest Ratio is Best for Menopause? This is such helpful information. I have often wondered who 80:20 is good for and who 50:50 is good for. One thing I'm still confused by is the estrogen weight gain component. You said that estrogen (as well as menopause in general) could be the cause of her weight gain. I can relate. I was very thin my whole life, now 53 and about 30 lbs overweight. But you also said she might benefit from getting her estrogen balanced, and she was not using enough. If too low a dose made her gain weight, won't an increased dose cause more weight gain? I have heard other podcasts and read articles that in menopause, we gain weight because our estrogen falls. Estrogen seems to be blamed for weight gain, whether it's high or low. Can you help clarify? There's something I'm not understanding. Thank you! Tracy Short Answer: Often estrogen has been the scapegoat for weight gain. I'm sure you have heard too much causes weight gain. Too little can pack on the pounds. It can be pretty confusing. So which is it? Is too much estrogen causing my pants to become uncomfortably tight? Or is it too little estrogen that has given me the gut I never had? Well, it’s not that simple. Estrogen levels do have a hand in weight gain and weight loss. But it is not the only variable. It really is the combination of the balance of estrogen with other hormones in your body. To name a few main players, progesterone, insulin, and cortisol, as well as enzymes, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). Okay, I know that sounds vague and doesn't answer the question. Let's back up a bit and look at what women are saying about estrogen. As soon as menopause hits, women complain that they are instantly 15-30 lbs heavier. Not because of diet or lifestyle. It's like menopause adds an unwanted 15-30 lbs overnight. Then some women are on hormone replacement therapy, taking estrogen, and are horrified because the HRT caused them to gain 10 lbs in a month. So what is it? Did the lack of estrogen in menopause cause that 20 lb weight gain? Or did that hormone replacement estrogen create rolls that were never there? Well, actually, both are true. Before you throw out your jeans in favor of high-waisted yoga pants, let’s learn about the other players in weight gain. Progesterone will buffer estrogen. Estrogen does like to grow things'. That is why in puberty, you grow breasts and hips. Progesterone helps to balance some of the growth' that estrogen can cause. That is why in perimenopause, when the progesterone drops and the estrogen is running the show, the weight gain begins. That is also why when a woman starts estrogen therapy for menopause but not enough progesterone, there is weight gain. Cortiso

What Hormone Tests Should I Get? | PYHP 122 Nov 22, 2022

‘Doc, I really don't feel like myself. I think it's my hormones. Could it be my hormones? Can you test my hormones?' How many times have I heard new clients tell me this story? They go to see their GP, Gyno, or Internist, asking to have their hormones tested. Only to be told that there is no testing for hormones. Or that it's not necessary to test hormones. Only to leave feeling dismissed, with no answers to why they do not feel well. While I understand that your GP, Gynocologist, and Primary Care Physician are not the jack of all trades,’ there are many tests for hormones. There are blood tests, urinary testing, and even saliva testing. The more difficult part of hormone testing is the interpretation. The basic lab values assigned by the labs are very vast, and without experience and training, it can be quite difficult to determine if there is a hormone imbalance. If you are feeling like you have a hormone imbalance or having symptoms concerning your hormones, below is a list of common hormones to be tested and why. Because blood lab testing is so popular, I am going to stick to blood testing. Later we will have more labs and interpretations for urine and saliva. To start, blood testing is just a look at one moment in time with respect to your hormone levels. In a menstruating woman, her hormone levels are changing every day. But in a menopausal woman where the ovarian function has ceased, her hormone levels are going to be pretty level day to day. So in a female that is still having her period, I like to try and aim for getting the blood drawn around day 12 and/or day 21. In a 28-day cycle, the estrogen will surge around day 12, and the progesterone will surge on day 21. This can give us better insight into her levels of progesterone and estrogen. In a menopausal woman that has not had a period or has sporadic periods with common menopausal symptoms, I will have her draw her blood any time of the month. FSH and LH: FSH stands for follicle-stimulating hormone, and LH stands for luteinizing hormone. These are not actually hormones. They are stimulating hormones.' Meaning both the FSH and LH are released from the pituitary gland (in your brain) in response to estrogen and progesterone production. The FSH and LH work in what is called a negative feedback loop.’ Meaning if the levels of estrogen and progesterone are high, then the FSH and LH are low. In turn, if the estrogen and progesterone levels are low, then the FSH and LH are high. It is like when you want your husband to take out the garbage. If he doesn't, you might raise your voice until he does. It is the same with all stimulating hormones. If the ovarian production of hormones is low, as in menopause or perimenopause, the FSH and LH levels will look high. Estradiol and Progesterone: Always test estradiol to get specific results for estrogen levels. Estradiol is much more specific for estrogen levels than simple total estrogens. Ideally, in a menstruating woman having the blood test around day 21 will give you insight if that woman is ovulating. It will so give you insight if there is progesteron

Is Surgical Menopause Worse Than Natural Menopause? | PYHP 121 Nov 10, 2022

Michelle’s Question: Hi, thank you so much for sharing your knowledge with us! In March 2022 at 42 years old, I had a total hysterectomy with bilateral salpingo-oophorectomy because of stage 4 endometriosis, grapefruit-sized fibroids, ovarian cysts, and my left ovary adhered to my colon. I was immediately put on an estradiol patch. I was recovering and doing well until the beginning of June. Then I started having hot flashes, 24/7 anxiety, insomnia, and not feeling well every day. Since March, my dosage has gone from .25, .5, .75, and 1 mg. But I saw no improvement in my symptoms and have said this was the worse summer of my life. I am debilitated by it. After much research, I decided to try bio-identical creams that have estriol, estradiol, progesterone, pregnenolone, and DHEA. Even though I no longer have a uterus, I know that my body is used to having these hormones and am hoping they help me get through this surgical menopause and be able to function again. Is this a combo hormone protocol you've ever done for your patients? If so, should I apply estriol and estradiol in the morning, and progesterone, pregnenolone, and DHEA at night? Short Answer: Surgical menopause is much different from what you could call your typical menopause. Honestly, there is nothing typical about menopause. Some women breeze through menopause and others have symptoms so severe it can seriously affect their quality of life, not to mention the people around them. And I (Dr. Davidson) can say this honestly, being just shy of 50 and feeling the effects of menopause. But being that I am a hormone doctor, I have some advantages to easing my transition. This is why we do what we do, here at Progress Your Health Inc. We know that hormone imbalance can alter how you feel. From your energy to your sleep, to your libido (or lack of) and more. Hormones can even affect your actual overall health. Menopause is when the ovaries naturally start to decline and then cease producing hormones. Those hormones in particular are estrogen (estradiol) and progesterone. Menopause is a natural part of life. Those ovaries have worked well for a long time and are ready to retire, naturally so. Making that transi

Is Armour Thyroid Better Than Levothyroxine? | PYHP 120 Sep 22, 2022

Laura’s Questions: I am on 25 mcg of Levothyroxine for 6 yrs with hypo symptoms, every one! My endocrinologist just took a panel, and the results are the following: TSH 2.36 uUI/mL Reference Range = 0.45 to 4.5 uUI/mL Free T4 1.1 ng/dL Reference Range = 0.82 to 1.77 ng/dL Free T3 2.9 pg/mL Reference Range = 2.0 to 4.4 pg/mL Should we up my dose of Levothyroxine to 50 or should I just switch to Synthroid or Armour? Thanks! Short Answer: We typically don’t recommend or prescribe Levothyroxine or Synthroid for our patients. Both of these medications only contain the T4 hormone. This is referred to as T4 Monotherapy. These medications do a good job of lowering the TSH level but do not always help the patient feel better. We like to prescribe thyroid medication that contains both the T4 and T3 hormones. In our experience, our patients tend to feel much better on a combination medication, rather than on a T4-only medication. In our opinion, we feel that sustained-release compounded thyroid medication is the best option most of the time. This type of thyroid medication gives the doctor many dosing options, which is certainly good for the patient and their overall symptom profile. Because this medication is compounded, the T4 and T3 hormones can be changed independently of the other hormone. With a commercial prescription, there are only so many dosing options, and both hormones are affected when raising or lowering the dosage. Also, the sustained-released nature of the medication helps to reduce any unwanted side effects that are common with commercial instant-release thyroid medications. Related Podcast Episode: PYHP Episode 038 – Do You Have a Low Free T3 Level? Check out Dr. Davidson’s new book – The Perimenopause Plan Buy the book on Amazon. If you have questions about your thyroid or any other hormone related issue, feel free to contact us. The post Is Armour Thyroid Better Than Levothyroxine? | PYHP 120 appeared first on .

Why Am I Getting Acne In My 40s? | PYHP 119 Sep 16, 2022

Patient Question: Why am I getting acne in my 40s? Short Answer: Women’s hormones are always changing. From puberty to middle age, to when the ovaries cease producing hormones in menopause. When we hit our 40s, our progesterone starts to decline. And our estrogen levels drop slightly as well. But the androgens, which are testosterone and DHEA do not decline. That means that there is less progesterone and estrogen to buffer the effects of the androgens. Testosterone and DHEA are great, useful hormones for a female’s body. They help with muscle mass, motivation, ambition, libido, bone density, and stress management to name a few. But in our 40s when estrogen and progesterone start to decline that makes the androgens the ‘leaders of the hormonal pack.’ There is no buffer against the negative side effects of androgens. One being, acne. Women in their 40s are usually still getting a period and cycling. So that means that the breakouts and acne are worse anywhere from 7-14 days before their period. That is because women really only make progesterone in the last half of their cycle. Those days being days 14-28. Because of the decline of progesterone, acne can be quite prominent before a period. But because the estrogen may have declined a bit in our 40s, we are still apt to have breakouts all month long. Because acne in the 40s is from the unopposed androgens, the acne is mostly on the chin and jawline. Although the neck and back are also common in a lot of women in their 40s. And the breakouts are more cystic in nature. They are deep and hard to “pop” (which we all know we should never ever do, and yes, I can’t help it either). And cystic acne lasts for weeks. So when one cystic pimple is starting to heal, aggravatingly three more show up. It is very frustrating. In addition too unbalanced androgens, stress, and cortisol levels can exacerbate acne. Women in their 40s are busy. There are family commitments, work, home life, and trying to stay fit is certainly not as easy as it was in our 20 and 30s. Plus the drop in progesterone and estrogen lets the androgens (testosterone and DHEA) make us feel more easily ‘testy.’ The stress and unbalanced hormones cause cortisol levels to rise. Which unfortunately also makes the breakouts worse. We really like to use Acnutrol and Inflammatone to help with breakouts. Below are some other episodes where we discuss other issues related to Perimenopause.

When Should A Woman Take Progesterone? | PYHP 118 Aug 30, 2022

Listener’s Question: Hello, recently my Nurse Practitioner recommended that I should start taking progesterone because she mentioned that I was estrogen dominant. I don’t have any real symptoms, so just want to make sure if I even need to take the progesterone. Thanks. Short Answer: If you don’t have any direct symptoms, then progesterone would not be necessary. We prescribe progesterone to women of all ages, but usually, they have a symptom profile that justifies the prescription. It is not likely for a woman to be truly estrogen dominant without any noticeable symptoms (fibroids, endometriosis, heavy bleeding, etc). If a cycling woman does her blood work around day 12 of her cycle. The estradiol will be higher, and the progesterone level will typically be less than one (

Can Ovarian Failure Be Treated? | PYHP 117 Aug 17, 2022

Sarah's Question: Hi I was diagnosed with ovarian failure at the age of 36. Its been 4 years now, I have been to a few different clinics, trying to figure out what works best for myself. Right now I am using estrogen patches, which do seem to work well, and Prometrium. My main problem that I still face is lack of sleep. The estrogen patches help my mood and sleep some but I have tried a few different progesterone creams and pills, and have not found any improvement in sleep from it. I am wondering what is the brand name of the slow release progesterone you described. Thanks Short Answer: We almost always use bioidentical sustained-release progesterone from a compounding pharmacy. A typical dose we like to start with for sleep is 100 mg. The commercial form of progesterone available at big box pharmacies is Prometrium, which is an instant release. However, in a situation like Sarah’s being diagnosed with Ovarian Failure at 36, we would consider prescribing Rhythmic Dosing to restore her hormones to physiologic levels. This type of dosing protocol is intended to initiate a period in a menopausal woman that still has a uterus. If Sarah still has a uterus, she would also resume menstruating on a monthly basis. Estrogen is what makes a woman a woman. In many cases, the more estrogen a woman has, the better she will feel. The better she will sleep. For more information, below is another episode we did explaining the rationale and how Rhythmic Dosing works. Episode 91: How to Cycle Bioidentical Hormones? One of the best pharmacies we work with for Rhythmic Dosing is Harbor Compounding Pharmacy, located in Costa Mesa, CA. They are PCAB Certified and are currently licensed in 32 states. Feel free to contact us if you have more questions regarding Ovarian Failure or Rhythmic Dosing. The post Can Ovarian Failure Be Treated? | PYHP 117 appeared first on .

How Do I Stop Weight Gain During Perimenopause? | PYHP 116 Aug 05, 2022

Megan’s Question: This was great information. I have been 130lbs until I turned 48. Now up to 157. Weight gain all in my stomach, legs, arms, boobs and butt. I have still been working out intensely with weights and cardio and no weight loss . After listening to this is sounds like I should do […]

Why Do Breasts Grow During Perimenopause? | PYHP 115 Nov 22, 2021

Question: I am forty-six years old and a 34A. Now, I’m a 34BC. My breasts hurt at least two weeks out of the month. Swollen, heavy, painful, have to take ibuprofen. It’s annoying as hell and it’s changed how I view my body. Not to mention, my midsection has changed too. I never wanted large breasts. I know BC cup is not large, but it is to me. And now I need to wear two sports bras to run. And I like to run all the time. And I feel like I did when I was nursing. This totally stinks. Does it get better? Short Answer: During a woman’s 40’s, there are many hormonal changes that are happening, which lead to a wide variety of symptoms. Progesterone is declining, and estrogen is still being produced and stress levels can be all over the place. These changes can lead to many unwanted symptoms. Breast tenderness and an increase in cup size is generally related to too little progesterone and proportionally too much estrogen. There is not necessarily an increased amount of estrogen production, but really just a lack of progesterone that leads to many of the symptoms of Perimenopause. PYHP 115 Full Transcript; Download PYHP 115 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 we’re back, we’re back in the saddle do another podcast. Dr. Davidson: We sure are. Dr. Maki: It’s been a little while. We haven’t posted any for a little while. We apologize for that. But we’ve been very busy. We got a new puppy. Dr. Davidson: We did get a new puppy, a poodle puppy. Dr. Maki: Alright. So we’ve talked about Bob, our little co-pilot. He is having a little bit of a crisis. He’s kind of having a crisis with the new puppy. About one minute, it was really funny, we brought her into her first grooming sessions placed here in town called Bailey’s and she looked like a little bit of a shaggy mess. And then they just really didn’t do much because this is her first one. She’s only like four weeks old and she came back from the groomer with a nice blowout. She got her hair done. And Bob was all interested and her name is Vivi, Vivian, one of my relatives. Bob’s named after my dad, and Vivi, our new poodle is named after another relative. She was technically my great aunt, but more like my grandmother. So it’s Bob and Vivi. She came back from that groomer, a grooming session. And Bob was, he was very… he changed his

Which is Worse, Perimenopause or Menopause? | PYHP 114 Oct 05, 2021

Patient Question: A patient in her later 40’s, who is having a tough time with perimenopausal symptoms, recently asked me which is worse, perimenopause or menopause? Short Answer: After dealing with many patients over the years, it is clear that both Perimenopause and Menopause are difficult and the symptoms can have a significant impact on a women’s quality of life. However, there are better treatment options for menopause then for perimenopause. PYHP 114 Full Transcript: Download PYHP 114 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 this morning, we’re just going to kind of sort of a question, but this was not actually one that someone answered on the website or wrote to us. This is actually from a patient that I recently saw. She’s 46, which is kind of a- I’m sure you would agree, it’s kind of like a very common age for our new patients. She’s kind of miserable at the moment, has a lot going on, and just does not feel very good. And she actually asked me the question because she hears horror stories about menopause, but she’s feeling pretty rotten right now. So she asked the question, “Which is worse, perimenopause or menopause?” So I thought that was a very nice way for us to do an episode around that. Dr. Davidson: Exactly, because we see this all the time, you know, a lot of menopausal females, perimenopause. And sometimes, we kind of overlook a little bit of the differences between the two and how people feel because, you know, everyone’s different. Dr. Maki: Yeah. Now, honestly, this is the reason why we’re doing the podcast in the first place, because when it comes to some of these female hormone issues in general whether it’s PMS, PCOS, perimenopause, menopause, the conventional treatments and approaches are just not very good. Women are kind of left to their own devices. They’re not really given a lot of options. We’ve kind of figured that out over the years, right? There’s this big gap in the problems that women are experiencing. Before, it used to be just, “Well, that’s just aging and you just have to deal with it.” I don’t think that’s really acceptable, really, in the 21st century. Dr. Davidson: I think some people still hear that, you know, “It’s okay. That’s just getting older.” Dr. Maki: Well, yeah. That’s easy for the practitioner to say when they’re not the o

Can Progesterone Cause Dizziness? | PYHP 113 Sep 14, 2021

Kathy’s Question: I tried progesterone 100 mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed an estrogen patch. Short Question: It is certainly possible that progesterone can cause someone to feel dizzy. It is often prescribed to help with sleep issues and anxiety, but some women claim to feel dizzy or “weird” after taking it. In our experience, this is more common with Prometrium, which is an instant-release form of progesterone. Bioidentical, sustained-release progesterone can still cause some of the same side effects but is typically much better tolerated. Progesterone cream usually does not cause some of the same side effects but is not effective for insomnia or anxiety. There is some research to suggest that progesterone is a vasodilator. This effect could lower blood pressure, which could make someone feel dizzy after taking. PYHP 113 Full Transcript: Download PYHP 113 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson. Dr. Maki: So, again, we have another question. This one’s from Kathy. So, again, in the future, for those of you that are new to the podcast, hopefully we’re getting lots of new listeners all the time. If you are an avid listener, you like what we have to say, please give us a review on whatever platform. We are on all the major platforms. I still haven’t added our podcast yet, or I have had it added to an Audible or Amazon Music, but that’s on the list which I think is cool. But we’re on iTunes. We’re on Stitcher. We’re on Spotify. We’re on iHeartRadio. We’re on all those different podcast platforms. So, please give us a review. That’d be really nice. So, this question is from Kathy. Once you dive in and give it a whirl. Dr. Davidson: Sure. We always change everybody’s name. We always say that on every podcast too. And these questions come from podcast listeners, and also from our website, from our blogs too. Kathy doesn’t say on here whether she got this from the podcaster or from reading one of the articles or one of the blog’s. So, this is from “Kathy”. I tried progesterone 100mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed in estrogen patch. Dr. Maki: Yeah, so there’s a lot. This is a really simple question, which is nice. Right? It’s just a couple of questions and it’s fairly similar. We’ve done a bunch on progesterone. But this one adds a little bit of a different element with the progesterone patch or the estrogen patch. She doesn’t specify, but I would assume that if she’s getting the estrogen patch, that means she’s getting prometrium. We could probably make that as… Would that be a fair assumption to make? Dr. Davidson: Yes, like you said, this is a short question. It seems simple, but it I like it because we can really

Can 200 mg Prometrium Make You Tired? | PYHP 112 Sep 09, 2021

Danielle’s Question: So, Thank you for this article. I’m having side effects from taking 200 milligrams of oral progesterone. I take forever to wake up and feel really, really groggy. I read where you said that take it early and when I take it early and out in an hour, I can barely keep my eyes open and feel drunk or drugged. So, I usually take it in half an hour before bed. I sleep like a rock but have a hard time coming to the next day. I’m a lightweight when it comes to any medication and always thought that might be due to being clean and sober for 32 years, but I might be wrong. I’m probably just sensitive. So, should I try a hundred milligrams of oral progesterone or change it to a compound? Because currently, I am taking Prometrium. I really love the solid sleep, but it takes hours to wear off in the morning and it seems like I’m just so tired. But I do take thyroid medication and I do have low morning cortisol and take some adrenal glandular as well. So, thank you so much in advance. Short Answer: The commercially available form of progesterone is called Prometrium. It is an instant-release medication and comes in two doses of 100 mg and 200 mg. In our experience with patients, they tend to be strong for women and not well tolerated. It is not surprising that 200 mg is causing next-day fatigue. We typically prescribe 100 mg of bioidentical, sustained-release progesterone. Some women are still sensitive but is usually very well tolerated. PYHP 112 Full Transcript: Download PYHP 112 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 this morning we’re going to just kind of dive right in. Of course, as we always do we have a lot of listener questions. So, for the future or for those that are listening, if you’re new to the podcast you can always send us an e-mail at help@progressyourhealth.com, help@progressyourhealth.com. That is if you want to keep it somewhat private and discreet. We always change everybody’s name. So, there’s no question about who is sending in the question. You know, we do get sometimes some sensitive female issues. And I’m sure people wouldn’t want that to be kind of public knowledge. So, like I said, we do try to protect everybody’s privacy as much as possible and we love the questions because that means we know people are listening. And you know, it gives us kind of an unlimited amount of topics that we can discuss in the podcast. So, Dr. Davidson won’t you just kind of dive in and let’s go through Danielle’s question. Dr. Davidson: Sure. Sure. So this question is from Danielle, but just on a quick little side note is we love all the questions. So, if you have any concerns, please write into us. But at the same time if it’s maybe not exactly like a lot of the questions were doing or pertaining to. You can probably hear our little pup in the background. He always gets a little more, I don’t know. When we do the podcast he gets a little more rambunctious or something.

Does Progesterone Help With Perimenopause? | PYHP 111 Sep 05, 2021

Amanda’s Question: I’m 41. I have regular periods every 35 days. I have some anxiety, tiredness, stress, but I do work a lot. I don’t have trouble sleeping, but my doctor checked my serum progesterone level, and at day 21, it was .5. She said it was low. She had prescribed me oral 200 milligrams a day of compounded progesterone. I work at a job that requires 24-hour shifts twice a week. I’m trying to verse myself in information about this replacement therapy and if this is the right way for me to take progesterone therapy. She told me to just not take it on the days that I work, but I’m concerned with things that I read about replacement therapy and increased mood issues and anxiety. I don’t think I could deal with those any worse than I have than what I have. Can you please tell me if I’m on the right path as I’m scared to begin this therapy? Thanks, Amanda. Short Answer: When women enter their early to mid 40’s, they typically stop ovulating, but continue to have periods. This lack of ovulation usually causes a significant drop in progesterone levels and can lead to many unwanted symptoms of perimenopause. Taking oral, bioidentical, sustained-release progesterone is a simple, but effective way to help deal with many of the unwanted symptoms. We typically start a patient on 100 mg of sustained-release Progesterone and they can increase to 200 mg later if needed. Some women may even need to cycle the progesterone dose. For example, taking 100 mg (1 capsule) from Day 1 to Day 13 of the cycle and then increase to 200 mg (2 capsules), from Day 14 back to the period. PYHP 111 Full Transcript: Download PYHP 111 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress You Health podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson. Dr. Maki: We mentioned in the last couple of times on the podcast, you actually have a book coming out, The Perimenopause Plan. It should be out probably within the next, I would say, probably the next couple of weeks to the next month or so. Dr. Davidson: Depending on when we post this podcast. It’s all written. It’s just having a little bit of issue trying to make it look pretty- the design process. Dr. Maki: Yeah. It should be fun. We’re excited about. It’s going to be published in Amazon as an e-book. Perimenopause is something that we deal with all the time and it was definitely a- I know you like to write. You’ve always been the writer. That’s always been your forte for the most part so we’re definitely excited about that. We’ll keep you up to date on that. Now, diving in, we have again more questions. We just have lots and lots of them. So, hopefully, if everyone keeps sending us emails with their questions that I’m assuming that the questions that we’re answering, people are finding some value or enjoying the questions because we just keep getting more of those. So, hopefully, it’s not getting stale or we don’t want to be boring

Biest vs Estradiol Patch for Vaginal Dryness | PYHP 110 Sep 02, 2021

Tammy’s Question: Hi. Recently, I read your article about estriol. I’m currently using a Biest Progesterone Vaginal Cream, but it’s compounded, and it’s expensive. I could use an estradiol patch and Prometrium and this therapy could be much more affordable. Would I expect a big change in that? Short Answer: First off, we don’t recommend using Biest for vaginal use. We use Estriol only for vaginal use, especially if a woman still has a uterus to minimize any spotting or bleeding issues. Switching to an Estradiol Patch and Prometrium will not produce the same results, and could cause some unwanted side effects. Using Estriol is best for vaginal dryness and pain with intercourse. For more information: read the article about the difference between Biest vs Estradiol. PYHP 110 Full Transcript: Download PYHP 110 Transcript Dr. Maki: Hello, everyone. Thank you for joining us in another episode of the Progress Your Health Podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson. Dr. Maki: So we’re back in the swing of things. We’re just going to dive right back in. Now, this time, we have a question from Tammy. This is relatively pretty short, but you and I have actually had a couple of recent experiences with the estradiol patch. Let’s just dive right in, and why don’t you go ahead and read the question. Dr. Davidson: Like we’ve said in our other podcast, we want to say that we always change everybody’s names. We get lots of email questions from people, so we’re really trying to get to as many of them as we can. So we really love that you are sending in those questions, but know that we do change any personal information and all that jazz. Okay. So this one is from “Tammy”. Hi. Recently, I read your article about estriol. I’m currently using a Biest Progesterone Vaginal Cream, but it’s compounded, and it’s expensive. I could use an estradiol patch and prometrium and this therapy could be much more affordable. Would I expect a big change in that? Dr. Maki: Yeah, right. So her question, she’s using right now a compounded by Biest Progesterone Vaginal Cream which based on our last episode and we are not sure about the Biest Vaginal part. We’ll segue back into that a little bit just as a refresher. So her question is, can she switch completely the types of prescriptions to the estradiol patch, also called the Vivelle patch? Dr. Davidson: Or CombiPatch. There are a few different names. Now, they have the generic. So Vivelle was around, but now they have generic. So just estradiol patch. Dr. Maki: They are all still basically estradiol. It comes in a couple of different which seems like – and this is what we’re going to talk about – which seems like a relatively low dose .025, .05, .075, and then, of course, Prometrium. Prometrium is commercially available progesterone, instant release progesterone. That’s something key that we’ll get to in a second. So tell me your thoughts, Dr. Davidson. Dr. Davidson: Well, she’s using it as a vaginal cream and she’s using a Biest. We don̵

Does Estradiol Work for Vaginal Dryness? | PYHP 109 Aug 30, 2021

Kate’s Question: Hi, I’ve been doing extensive research and I came across your site. I don’t know if you’re still responding to email questions or not, but I thought I’d give it a try. I just completed my first year of no periods. Dryness, I have the beginning of atrophy, is really my only issue. But I was given 50/50 ratio Biest, one gram a day. I do that vaginally as an insertion for two weeks, and then I reduce it to two times a week after that. I don’t do any progesterone, but this is what my experience has been. After the first full week, I started bleeding. After the second week, it became heavier bleeding. So then they put me on it for a third week and I was supposed to drop down my Biest 50/50, but I continued bleeding. So, I do feel great. And now it’s week four, and the bleeding is starting to taper and I’m loving this but worried about the bleeding. So just wondering your about your thoughts. Thank you, Kate. Short Answer: With our patients, we don’t use Estradiol vagainlly in order to minimize any unwanted spotting or bleeding. We only use Estriol for vaginal use as it is a “weaker” hormone and less likely to cause any bleeding issues. PYHP 109 Full Transcript: Download PYHP 109 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 we have a lot of questions to do. We have, it seems like we just keep getting more and more and more. So we really apologize that we’re not able to keep up with is as many of them as they keep coming. I think it’s a good thing. Alright, we have an unlimited amount of content to talk about. We are gonna dive in. This is Kate’s question. We are changing everybody’s name just to keep it, you know, just to keep it you know. So no one’s, there’s no identifying information. So if you did submit a question, we might have answered it or we were probably going to answer it but the name might be different so you might have to actually pay extra attention to the podcast. So Dr. Davidson won’t you go ahead and we’ll just dive in. Dr. Davidson: All right, let’s dive in. So this question is from Kate. So, ‘Hi, I’ve been doing extensive research and I came across your site. I don’t know if you’re still responding to email questions or not, but I thought I’d give it a try,’ and this is why we do get a lot of email questions. We get a lot of, lot of questions on the website, but we want to do them for everybody to listen because it actually all this really applies to a lot of people. So, okay, just to continue with Kate here, ‘So I just completely…’ Dr. Maki: Oh sorry, that’s the copilot. Our co-host Bob is playing with his antlers, deer antlers. So sorry about that. Dr. Davidson: And he loves to talk and make lots of noise.

What Should Estradiol Level Be On BHRT? | PYHP 108 Aug 23, 2021

Anne’s Question: Since moving to the high desert, I have to use very large doses of Bio HRT or bioidentical hormone cream, and it is still not getting blood levels up to where my doctor would like. I tried switching to the patch and the level dropped to less than half. This is all giving me terrible symptoms and impacting my quality of life. I am worried the high doses are harming me somehow. Can I just rub some DMSO on the skin prior to applying the cream or will that help? Short Answer: This is somewhat of a complicated question to answer because it is based on the type of BHRT a woman is using. We do have different blood level targets for women using static dosing vs women who are using rhythmic dosing. When prescribing BHRT for a patient, we have some very general blood levels that we are trying to reach, but the woman’s subjective response is a much better indicator for dosing. How she feels is much more important than her blood level of Estradiol. In regards to DMSO, we don’t typically use or recommend this for women, but we do add DMSO to testosterone cream for men because they have more body hair. PYHP 108 Full Transcript: Download PYHP 108 Transcript Dr. Maki: Hello, everyone. Thanks for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: Of course, this is audio so nobody can see anything but you and I are getting ready and we were having a little problem with our boom mic stand. It was not sitting at the table. You are getting a little impatient with me and then you end up fixing it which was great. As we are just starting, our dog, Bob is at my feet right now and he is upside down, chewing on like a little bone. Dr. Davidson: It is so cute. It is so cute. Dr. Maki: I am trying to stay focused on doing the podcast and he is upside down with a little bone in his mouth. It is too cute. We are back into podcasting land. We have a ton of questions to get to. We are just going to do it. I think we kind of for a while we were kind of doing a few questions per episode. I think it is a little bit better, a little more focus by doing just one question per episode. It is also easier to figure out a title for it, that is more specific to what the question is about. This one is from Anne. So why not you go ahead and read the question. Dr. Davidson: Now he just got up and you shake it around. All right. This question is from Anne. Of course like we always say, we change everybody’s names and any kind of pertinent information just for privacy protection. We kind of renamed her Anne. From Anne. Since moving to the high desert, I have to use very large doses of Bio HRT or bioidentical hormone cream, and it is still not getting blood levels up to where my doctor would like. I tried switching to the patch and the level dropped to less than half. This is all giving me terrible symptoms and impacting my quality of life. I am worried the high doses are harming me somehow. Can I just rub some DMSO on the skin prior to applying the cream or will that help? Dr. Maki: Yeah. This comes up a lot, people are worried about absorption. DMSO is one of the rhythmic dosing protocols we use for men. We do add… The compounding pharmacy we use doe

Does Estrogen Cream Affect Male Partner? | PYHP 107 Aug 19, 2021

Carrie’s Question: I am currently taking, .25ml’s Biest which is 1.25mg, 70/30 ratio per gram. I apply it to the labia and vaginal area at night, every night. About how long do I have to wait for it to absorb before having intercourse? I am getting conflicting reports. My doctor says I do not have to wait at all, as it will not affect my husband but the pharmacist says, it will affect my husband and not have sex for several hours after application. Thank you. Short Answer: Carrie is taking a very low dose of Biest. However, she is applying the estrogen cream vaginally, so in theory, her partner could absorb some estrogen during intercourse, but Carrie’s applied dose is only about .30 mg. This small amount of Biest is barely enough to affect Carrie, let alone her husband. If the male partner is worried about the estrogen, simply skip applying the cream until after intercourse. If the Biest cream is being used to help with pain and discomfort during intercourse apply about an hour or so before activity. For vaginal use, we typically only recommend Estriol cream and not Biest, which has both Estradiol and Estriol. PYHP 107 Full Transcript: Download PYHP 107 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: Well again, we are trying to do our best to get back in the swing of things back in podcasting land. It actually feels pretty good. On the last podcast, we talked a little bit about the book that you have coming out. I would just mention it real fast up for perimenopause plans, going to be available on Amazon. We will keep you up to date when that comes out. If you have any questions, just in general. You can always send us an email at help@progressionhealth.com. We are going to do another question today again because we took some time off over the summer. We got a whole slew of questions for us to do, this one does come up quite often. Why do not we just dive into it? This question is from Carrie. Dr. Davidson: We always change everybody’s names and personal information just for privacy, but this is a really good question. We are going to break it up a little bit, give the general answer to it. And then I am going to get probably a little nitpicky on it because I like the math part. But, this is from Carrie. “I am currently taking, .25ml’s biased[?] which is 1.25mg, 70/30 ratio per gram. I apply it to the labia and vaginal area at night, every night. About how long do I have to wait for it to absorb before having intercourse? I am getting conflicting reports. My doctor says I do not have to wait at all, is it will not affect my husband but the pharmacist says, it will. And she capitalizes ‘WILL’, which will affect my husband and not have sex for several hours after application.” Thank you. She is wondering which way should she go? Dr. Maki: This one comes up a lot and I guarantee you that the husband is worried about the estrogen, right? Men are always worried about little estrogen, It is probably more of his concern, he is more of, what about that estrogen? He does not want to grow boobs or something. To be honest, every man is worried about that, but I do not think it is really that big of a deal. She might not want to apply it vaginally and hav

Is an Estrogen Patch Good to Use? | PYHP 106 Aug 18, 2021

Joy’s Question: Is the Vivelle patch good to use? My gyno prescribed it for hot flashes, vaginal burning, vaginal itching, and mood issues during ovulation before my period. I have not tried it yet, though. Short Answer: Some women do fine with the Vivelle patch. However, in our experience, many women do not tolerate the patch very well, or it does not provide full relief of menopausal symptoms. The key to this question is the fact that Joy was prescribed the patch, but is still having a regular period. We don’t agree with using the patch for women who are still menstruating. There are some better options that we discuss in this episode. PYHP 106 Full Transcript Download PYHP 106 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: Well, we are back. It has been a little bit of a hiatus. We had a really amazing summer, right? You know, summer is always a fun time. So we took a little bit of time off on the podcast, but now the weather has changed a little bit. We are into fall, the perfect time to kind of get back into the podcasting routine. Dr. Davidson: Definitely. Ready to hit the ground running. Although fall was really beautiful here with the leaves changing. So yeah, it is good. I am definitely ready to get back into the podcasting seat. Dr. Maki: For some reason, when it was really nice out and the sun was shining every day, it was really difficult to come and sit down and do a podcast. It was really challenging, but nonetheless, we kind of decided ahead of time that we were going to do that anyways. But now we have lots of questions that people have reached out to us with. So we have just a tremendous– [laughter] in some ways, we probably should not have taken that time off because now we have so much work to do, but this is good. These are legitimate questions that people are asking us, and we feel that without coming up with topics of our own, this makes it so relevant when people ask us question because we get to hear our listeners. We get to hear our readers for the blog post. We get to hear what problems they are actually dealing with. And I think that is really valuable because now we have a chance to sit down, kind of discuss them, give everybody our opinion. So that one person really is helping a lot of people because now we are giving our answer to that very specific question to lots and lots of people. Dr. Davidson: Exactly. When you write in or email us with your question, know that you are not alone. The question you have, trust me, we have heard it over and over and over again so it is really great to get it from a reader or listener’s perspective, and then when we can apply it to the masses, it helps everyone. Dr. Maki: Yeah, right. So we are going to dive in this question. Now, we are changing everybody’s name just to keep it so there is no question about identity or anything like that. So the name that we are going to give is not the actual name of the person, but nonetheless– Dr. Davidson: Just for protection, anything that looks like it would be something that– we would just change even if it is descriptions

Can BHRT Cause Weight Gain? | PYHP 105 Feb 17, 2021

Mary’s Question: I am 58 years old and lost my thyroid to cancer eight years ago. I am finding it impossible to lose weight and have thinning hair near my hairline and no eyebrows. I started Bi-est cream, 50/50 ratio, 2.5 milligrams; progesterone, a 175 milligrams; and testosterone, 1 mg. About a year ago, it was lower doses and then went up to those as recently my doctor had me using it twice a day, the cream, and then the progesterone, one pill at night, because my levels have shown that my progesterone is 7, estradiol less than 5, – that means it is not even in the bloodstream – free testosterone is 1.2, total testosterone is 6 . I am so afraid I am going to gain weight more or more hair loss from some of the things I have read. Please give me your opinion. I also take Tirosint and Cytomel for my thyroid. Do I have to worry about any medication interactions? Please help. Mary. Short Answer: Typically, bioidentical hormone replacement therapy (BHRT) is not going to cause consistent weight gain. When starting BHRT, there might be slight water retention, but should not lead to consistent weight gain over time. If weight gain continues once on BHRT, pay attention to insulin status and stress level. For more information on our approach, you can download our Keto Carb Cycling Program. PYHP 105 Full Transcript: Download PYHP 105 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of Progres Your Health Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So what are we going to do later today? Dr. Davidson: I do not know. Hopefully, get to go, maybe, for a hike or a long walk. Dr. Maki: Yeah. Weather is good. It is August in Western Washington. Beautiful. It does not get too hot here. You know, we still have some patience in the Southwest. When I am getting ready to talk to them I look at the weather app and I see those triple digits: hundred and five, hundred and nine, hundred and ten and I have to say, it makes me cringe a little bit. Dr. Davidson: I remember living in the Southwest and, August, I could not wait for August to be over with, like, come on, let us get to September. Let us get to the middle of September. And now I am like, I just want August to last forever. Please go slow go slow. [laughs] Dr. Maki: Yeah. It is amazing how much of a contrast in you and I in the summertime. So June, July, August– it seems like, in the Southwest, Labor Day is when everything starts to change. You can feel it. Like you wake up one of those mornings and it is like, “Oh, okay. Summer is just– Dr. Davidson: It is still pretty warm, but at least you are on the tail end. Dr. Maki: Yeah, but you can start to feel like it starts to, you know, you get rid of some of those hundred and ten degree days and it will be in the upper 90s, maybe a hundred, and then it starts to gradually trickle down. But I remember you and I used to

Where Do I Apply Testosterone Cream As A Woman? | PYHP 104 Jan 28, 2021

Monica’s Question: Hi, I have been prescribed testosterone cream and I have been advised to apply it to my inner thigh. I was wondering, in doing so, will this reverse the results of my laser hair removal on my bikini line? As per you stated that someone had a similar experience to this. Should I apply it there or should I apply in another area? Thank you. Short Answer: Applying testosterone cream to the mid-inner thigh should not affect the bikini line. However, the hair in the area of where the testosterone cream is applied will get darker. There is no real way to avoid the hair from darkening. Switching thighs can help, but it will probably still darken in both areas. PYHP 104 Full Transcript: Download PYHP 104 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So summer is moving along very quickly I cannot even believe it is almost the middle of August already. Dr. Davidson: I know summertime is so fun in Washington. Dr. Maki: We have got rain in the last couple of mornings which actually has been– We had quite a bit of rain in June at least it seemed like July was really nice and now the last couple mornings we had a really nice stretch with no rain at all. And now it was kind of nice actually with a little bit of drizzle in the morning. We have got this jungle in the back of our house. I know that you kind of went back there with little clippers and trying to– We have this little trail that leads up to another trail and you are back there a couple of days ago trying to clean up the trail. Dr. Davidson: Exactly. We have a beautiful trail up there and it is funny because I always laugh with my patients that summertime. It is almost, even though it is beautiful, it seems like it is harder to exercise and eat well because it is almost like you are just having too much summertime fun. Where the holidays, you can be a little bit more diligent because the holidays are one day but it seems like summertime fun. So we have been trying to rain it in and do some more exercise and eating a little cleaner

Can Estriol Cream Cause Constipation? | PYHP 103 Jan 21, 2021

Mary’s Question: Hi. I just started estriol cream a couple of weeks ago. I am fifty-three years old and have been told I have PCOS for the past twenty years with a history of absent periods, heavy facial hair growth, and moodiness, and PMS. I have managed my PCOS through diet change, supplementation, and exercise. And I am told I am quite healthy. I began taking the estriol cream for bladder urgency and frequency and for the mucous membrane support for vaginal dryness. Sex had become very painful. I am experiencing some really wonderful positive benefits from the estriol. And in some ways, I realize I have probably been short of this for many many years likely due to the malfunctioning of my ovaries with the PCOS. The skin over my shinbones that has always been flaky no matter how much I moisturize, now, is soft, smooth, and supple for the first time in many years. The skin on my elbows, knees, and heels is softening. And it seems to have helped my skin tremendously. Even my facial hair is coming in much lighter. It seems to be reducing my belly fat in some ways. It is kind of a miracle. And I wish I had known about this years ago. The possible deal-breaker here is that I have become so painfully constipated over the past few weeks. And the estriol cream is the only thing that has changed. I also take bioidentical progesterone in a troche form which I have been taking for about ten years without a problem. The estriol is the only thing that has changed. The only time I can remember being this consistently constipated over a long period of time was during my two pregnancies. Any thoughts? Short Answer: For constipation, the common advice is to drink more water and eat more fiber. However, for some, this does not work. It may seem strange to think that bioidentical hormones could impact digestion, but it is certainly possible for either progesterone or estrogen to cause someone to become constipated. We look at constipation as being a liver issue. Taking hormones can put a slightly extra burden on the detoxification capacity of the liver, which can slow down digestion. PYHP 103 Full Transcript: Download PYHP 103 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So how is your summer going? Dr. Davidson: My summer is going great, although it is already August. So I feel like it is almost over. Dr. Maki: Yes. 2020 has been such a roller coaster. But yes. Weather is good. We are surviving everything. Dr. Davidson: How is your summer going? Dr. Maki: Well, it is a rhetorical question, because I know exactly how your summer has been, because mine has been pretty much the same as yours. So I cannot complain. But you are right. It is going by way too fast. I cannot believe it is already August. But we still have a couple of months of nic

Can You Put Estriol Cream On Your Face? | PYHP 102 Jan 20, 2021

Allison’s Question: I have opened a hormone wellness practice and came across your blog. You mentioned the application of estrogen cream to the face, neck, and chest to improve skin health. From what I found, it appears that .3% Estriol and .01% Estradiol is typically used. Do you recommend a once-daily application? Can this same dose be applied to the inner and outer labia for improvement of external skin appearance as well as the vaginal entrance to improve vaginal dryness, etcetera? Thank you in advance for any feedback you can provide. Short Answer: We typically only use Estriol cream for the face and the vagina. For the face, we do recommend using estriol daily, usually as a nighttime moisturizer. As for vaginal use, we recommend daily use of estriol cream for the first 1 to 2 weeks depending on the severity of symptoms. After that, we suggest a frequency of 1 to 3 times per week. We don’t use estradiol for vaginal use. The dosage of estriol we typically use for both is is 4 mg/gram, but apply 1/2 gram with each application. PYHP 102 Full Transcript: Download PYHP 102 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So I got an email back this morning from the designer. The kind of the first draft of your book cover. It was in my inbox this morning. What do you think about that? Dr. Davidson: I think I am nervous as heck. Dr. Maki: It is good. There are two different versions. I like a couple of things about each one of them. I will show it to you a little bit later, but it just came in right before we sat down to do this. Got to change the color scheme a little bit but so far so good. Dr. Davidson: All right, and the book is on perimenopause. Dr. Maki: This is the middle of summer 2020 so hopefully this will be available on Amazon probably, I am hoping within the next month but there are some other things we want to do prior to that. Maybe by Labor Day, I am thinking and to be conservative and to give ourselves a little bit more time to make sure we have all the things that need to be working, working properly. But we will definitely keep everybody posted.

Can I Take Progesterone All Month? PYHP 101 Jan 12, 2021

Question: Hello. I am forty-five, perimenopausal diagnosed by blood work. I have my uterus and I am taking 200 milligrams of bioidentical progesterone each night orally by capsule. I do not take anything else for hormone balance other than evening primrose oil and some adrenal support. Neither of these is new to my regimen. What is new is the administration of the progesterone orally. Previously, I was using a progesterone cream, 40 milligrams per night. All nights of my cycle, no break. Doc suggested that I needed to be more cyclical with my administration and then I try oral progesterone instead. I am doing this. I go to sleep well but toss and turn a bit more than I used to, then wake up around four thirty-five and cannot sleep any longer. My body temperature seems to be all over the place. At some nights around that same time, I wake up hot, not really a hot flash per se but just hot, but the very next night, I can have on the same bedclothes, sheets, house temperature, et cetera, and will not get hot. She has me doing fourteen days, fourteen to twenty-eight, taking the oral progesterone. My trouble is the fourteen days I have to wait to take it, I have all the trouble sleeping and all the other symptoms while I am waiting for that fourteenth day to come so I can take my oral progesterone. My question, can I take it full-time during my cycle and never take a break or does that go against all medical wisdom and/or would be bad for my body not to have a break? Short Answer: Based on a woman’s physiology, it does make sense to only take progesterone during the second half of the month. Typically, progesterone is produced from ovulation to the period and usually peaks around day 21 of the cycle. However, many women feel better when they take oral progesterone all month long. Oral progesterone helps reduce irritability, reduces anxiousness, and can improve sleep. Because of this, we most often prescribe progesterone to be taken all month long. Sustained Release Oral Progesterone is usually very well tolerated, but sometimes it can change a woman’s cycle. Based on how the cycle changes will determine if the dosage needs to be cycled or not. For example, we might prescribe 50 mg for the first half of the month and then increase to 100 mg during the 2nd half of the month. Then we have our patients stop the progesterone during menstruation. PYHP 101 Full Transcript: Download PYHP 101 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Prog

What is a Common Biest Starting Dose? | PYHP 100 Aug 07, 2020

Alexis Question: Hi there, this forum is fabulous. Thank you. I am so confused with dosing. How much is one gram of Biet in mL – milliliters. So confusing. I use a one mL syringe. One mL is a lot of cream. It is an eighty-twenty ratio and I will split the dose. Reading that your recommended starting dose is three milligrams, how much exactly is that in cream in terms of milliliters or MLs? That cannot be three MLs, that would be three syringes. Sorry to be daft. I have tried to find the answer on Google but nothing is making sense to me. Maybe that is why I need bioidentical hormones. Anyway, Help. Thank you, Alexis. Short Answer: 1 gram is equal to 1 mL. A BHRT prescription can be written in either mg/gram or mg/mL. For example, when we call in prescriptions to a compounding pharmacy, let’s say the Biest prescription is 3 mg/gram with an 80/20 ratio. This is the same as 3 mg/mL with an 80/20 ratio. The instruction we give the patient is to apply 1/2 gram, twice per day. If the patient is using a Topi-Click device, 1/2 gram is equal to 2 clicks. We like to have the patient apply 1/2 gram because they have to apply much less cream to the skin. We always recommend women apply their Biest to the inner thigh. We don’t recommend applying Biest to the arms, forearms, wrists, abdomen, or vaginally. If the patient is having any vaginal dryness, then we will provide separate Estriol (E3) prescription that can be used vaginally. We don’t like to have patients apply Estradiol (E2) vaginally, especially if they still have a uterus. PYHP 100 Full Transcript: Download PYHP 100 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So it is the middle of summer, enjoying some beautiful weather. Dr. Davidson: Gorgeous. Dr. Maki: It is a little hard to get into the podcast room and actually sit down and record some of these. You know, summer gets a little distracting. But nonetheless, we are here. Actually, some questions came in recently that were really good. Good in the fact that they are the ones that come up a lot and we figured that these would be good to talk about. Dr. Davidson: It would be helpful to the listeners. Should we just go ahead and start reading the question? Dr. Maki: Yeah, let us dive into this. What is the name of the first one? Dr. Davidson: Yeah. We always change the names of the questions, you know, just to respect the privacy of our Progress Your Health community. So this one, we changed to Alexis. Dr. Maki: Why is it Andrea and then you said, Alexis? Dr. Davidson: I like the name, Alexis. But I like the name Andrea too, but I like Alexis. Dr. Maki: Yeah. Okay. Alright. This person, we will call her Alexis. Dr. Davidson: Alexis. So do you want me to read it? Dr. Maki: Go ahead. Dr. Davidson: So again, this is from Alexis. “Hi there, this forum is fabulous. Thank you.” Well, thank you right back. “I am so confused with dosing. How much is one gram of bias in ml- milliliters. So confusing. I use a one-ml

What Are Symptoms of Thyroid Problems in Females? | PYHP 099 Jul 30, 2020

Question: What are symptoms of thyroid problems in females? Short Answer: There is a wide variety of thyroid symptoms in women. Some of the more common are fatigue, weight gain, constipation, and dry skin. Based on our experience, we have noticed many other hypothyroid related symptoms as well. These symptoms include heavy periods, infertility, anxiety, low libido, hair loss and low mood. PYHP 099 Full Transcript: Download PYHP 099 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So it is officially a little bit past the beginning of summer in Washington, although looking out the window right now, it certainly does not look like summer. It is raining kind of heavy right now. Dr. Davidson: I would say even though it is supposed to be summer, it seems like spring has officially started because it is really beautiful with the little deer out and the flowers are blooming, and I think it will clear up a little bit later. Dr. Maki: Yes, you know that I sent you the picture you saw but for the listeners, I was sitting here, you were upstairs and I was looking out the window and I saw a female deer and then she just took a picture of it. You know, that is great. A deer walks through the yard all the time and then she moved and there is a little, literally like a little fawn, a little Bambi right next to her and kind of following along and she hit the little white spots on the side and there. Eating little weeds in the yard and they walked over to the little garden over there and ate some things out of the garden. Dr. Davidson: I was so happy to see that picture because I saw that little fawn a couple. I think a couple of weeks ago right after it was just born with its mom walking through the driveway and then I did not see them again and well, little baby still. Okay, so it is really neat to see him or her a little bit bigger with those little white spots on the bum. Dr. Maki: Yes, right. That was that was nice. You know, we do not see the deer hardly at all winter long and then it seems like June, I remember where we lived. Now we moved in here lack last year and June came literally like June first I will send, the deer came almost every day. We are having deer come through the yard and sure enough, here is June again. I do not know where they go. Dr. Davidson: Only because we do not cover up our garden beds. So we basically are growing a garden to feed deer. [laughing] Which is fine. Dr. Maki: That is okay. Dr. Davidson: They need to it. Dr. Maki: That is all right. Make sure the little one gets the gets a meal here and here and there. So on today’s episode, we are going to talk about thyroid. This is a question, this is actually a specific question from somebody

What Diet Is Best For Perimenopause? | PYHP 098 Jul 02, 2020

Question: What diet is best for Perimenopause? Short Answer: One of the most common complaints we get from women in perimenopause is unexplained weight gain. Their lifestyles have not changed in years, but all of a sudden, their weight keeps increasing. And if they try to lose the weight, their efforts fall short and often gain more weight in the process. An observation we see quite often is that many women are still tyring to “eat less and exercise more.” This might have worked when they were 25, but for women in their 40’s, this weight loss approach often seemed to backfire. Women in their 40’s typically have a good deal of stress already, so trying to exercise the weight off only adds to their stress. This makes the weight loss process very frustrating, if not seem impossible. Click the link to download our Keto Carb Cycling Program. PYHP 098 Full Transcript: Download PYHP 098 Transcript Dr. Maki: Everyone thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So on this one, we are just going to dive right in, and we of course have a lot to talk about. We cannot not talk about perimenopause or menopause without discussing diet and weight loss at least to some extent. Would you agree with that? Dr. Davidson: Absolutely when women, hit their 40s, they especially perimenopause and menopause. They always say it is like I put on 10, 12 pounds overnight like it, just where did it come from and they will point right to their stomach. I have had women, I love them dearly they will even grab their stomach and say, “I have never had a belly before where did this gut come from?” And things are different, of course, we all know obviously from when we are twenty, to when we are forty, to when we are sixty, we are always changing but it definitely comes from the change in hormones. Dr. Maki: Yes, right and believe me that is very complicated and you and I, we have been doing this a long time and we certainly do not have all the answers when it comes to diet and weight loss and especially perimenopausal weight loss or menopausal weight loss for that matter. But the purpose of this episode is to kind of just shed some light on some of the observations that we have noticed and in some ways what does not work for people, we do know some of those things. Everyone is still trying to follow the same advice eat less, exercise more all the time. They are just trying to basically starve themselves and exercise a bunch and that strategy right there and we will kind of dive into that, what that strategy looks like little bit more specifically but that strategy clearly does not work. And in some cases that actually make their situation worse, they actually gain more weight. They are exercising five, six days a week and their weight is going up. Dr. Davidson: Yes, you will see that I mean granted I was a child of the 80s. I remember the 80s and the 90s, if you were going to go on a diet, you

What Supplements Are Good For Perimenopause? | PYHP 097 Jun 26, 2020

Question: What supplements are good for Perimenopause? Short Answer: The conventional treatment options for Perimenopause are limited. Most often, women are offered birth control and other habit forming medications. None of those options are very effective in providing women relief of their symptoms. PYHP 097 Full Transcript: Download 097 Transcript Dr. Maki: Hello everybody. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So on this episode, we are going to continue our talk about perimenopause. We are going to talk about some of the supplementation that we use in helping people deal with some of the symptoms of perimenopausal. Dr. Davidson: Exactly. We have talked about perimenopause many times in other podcasts and blog posts as well. Like we always say, there is really not a lot of answers out there, especially conventionally. The last thing you want to do is take habit-forming or ineffective medications, but at the same time, we also want to have some help so we can kind of transition and feel good during this time of perimenopause. Dr. Maki: Yes, right. Now conventionally, like we talked about the past, really, the only options for this window, this demographic, this ten-year span, ten-plus years span for women. Dr. Davidson: Possibly. Dr. Maki: Yes, right. Let us say from forty to fifty, if we just kept it to that, but I think there is an overlap into the late thirties and even the early fifties. So we are looking at a really good solid decade. In some ways, a really highly productive time frame for women where they need to be on their game. They have lots of things, are juggling lots of different parts of their lives and we hear it all the time. Women get to this certain point and all of a sudden, their bodies just stop cooperating. They cannot sleep. They have anxiety. They are irritable. They are gaining weight. They have all these things that are happening that they have never really experienced at that point. They really do not know what is going on. They go to their gynecologist. They go to their primary care doctor and no one really has any answers to be able to help them. Dr. Davidson: Yes. Like you were saying, probably the most common medication is birth control pills, which the last thing you want to do is be in your forties taking birth control pills. So, that is kind of frowned upon. I mean antidepressants, a lot of doctors will offer perimenopausal females antidepressants. And they will say, “Well, I am not depressed. Sure, I do not feel well. I am irritable. I am not sleeping. I have a lot of brain fog. My short-term memory is not right.” They have a lot of these symptoms but it is not necessarily a disease. So, a lot of conventional practitioners do feel like their hands are tied. Even like anti-anxiety medications are extremely habit-forming. The last thing you want to do is put somebody on some kind of prescripti

Why Is Perimenopause So Awful? | PYHP 096 Jun 25, 2020

Question: Why Is Perimenopause so awful? Short Answer: We work with a good number of women in their 40’s and most of them do complain about how difficult Perimenopause is for them. As female hormones begin to decline, but stress levels are high it can cause a wide variety of symptoms. The most common perimenopausal symptoms are weight gain, irritability, and insomnia. PYHP 096 Full Transcript: Download PYHP 096 Transcript Dr. Davidson: Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Valerie Davidson and I am here joined with my co-host, Dr. Maki. Dr. Maki: Good morning. How are you today? Dr. Davidson: I am doing great. Thanks. Dr. Maki: We are experiencing a little bit of almost a torrential downpour this morning. Looking out the window, it is, unfortunately, raining a little bit too hard. Dr. Davidson: But it is not that cold. So June, June in Washington, Western Washington. What do you expect? Dr. Maki: Hopefully the sun will come out later this afternoon. So in this episode, I think that we are going to answer a question but it is not an actual specific question. We actually wrote a blog post a while ago. Why is perimenopause so horrible? So we are just kind of playing off that a little bit. That is a blog, this is going to be a podcast, obviously. Why is perimenopause so awful. The same idea, just a little bit of a different title. As of the last few years, I think, the perimenopausal demographic, women in their late thirties to early fifties is probably the majority of the people that we see on a regular basis. Dr. Davidson: I think you know with perimenopause, it is a little bit of an under-represented, I guess, demographic because it is, you know, it is not menopause but it is not your typical PMS. It is somewhere right in between. So a lot of times women sort of getting blown off and perimenopause is exactly what it sounds like before menopause. It can happen, you know as late as you are in your late thirties and it can last even you know, thirty or early fifties depending on how a female’s ovaries are performing, and when they decide to retire or work part-time or work full time. Dr. Maki: And their stress level. Dr. Davidson: And their stress level exactly but I always kind of you know, I do not want to make it so negative. You know, why is perimenopause so awful or so horrible. It is not a negative thing but a lot of women will say that to me like, “This is really awful, what do I do? I cannot stand it. Nobody else can stand to be around me.” But it really has to do with those hormone imbalances. So working on those hormones is completely different in perimenopause than it is with menopause. Dr. Maki: Yeah, right. Conventionally, in the medical community, no one is really equipped or prepared to deal with it. Given a woman in her late forties birth control to deal with her menstr

What Is Oxytocin Used For? | PYHP 095 Jun 19, 2020

Question: What is Oxytocin Used For? Short Answer: The hormone oxytocin is available by prescription from compounding pharmacies. The most common uses for oxytocin is to enhance female libido and mood. Also, research has shown that oxytocin may also be helpful in weight loss. More research is needed to better understand how oxytocin can be used as an effective therapy for obesity. PYHP 095 Full Transcript: Download PYHP 095 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So on this episode, again, we are going to introduce something that we have used quite a bit with our patients. We are going to talk about a hormone, actually, a hormone prescription called oxytocin. I know a lot of people have heard of that before, right? It is considered to be kind of the love hormone. But it can be used, it can be turned into a prescription and we use it quite often. Dr. Davidson: Yeah. I have actually used it a lot with patients. When it works, it works really well and the great part to it is there is not any necessarily, negative side effects to it. So if it works, awesome. If it does not, then okay, we are back to the drawing board. Those of you that have heard of oxytocin, they think of it as like the love hormone. But it is. You know what, it can help with female libido and that is probably a cup. Probably the two reasons that we use it or I use it is for working on female libido because we know that that can be a tough one. Because school rules are complicated. The other part that I use it for is just a sense of well-being. It does kind of help bring up that mood. We live in a stressful world. We live in a sympathetic, adrenal fight-or-flight world, whether it is watching the news, or driving your car, or getting to work on time, or working with family, things are stressful that I find that oxytocin can really push you over to the other side to help bring that joy back so you do not always feel so rushed and overwhelmed. Dr. Maki: Yeah, right. I would agree that those are the two main things that you and I use it for. We are not really big fans of antidepressant medication in general. We never use them. That is fine if people want to take them, but we are not necessarily going to prescribe those things. That is just not what we choose to focus on. Oxytocin is kind of our version of something like that. It has very good, as we are talking about one of our previous episodes, the cost-benefit ratio oxytocin, also has a very good cost-benefit ratio. It works great. You get some benefit from it. There have been a few where they just do not notice anything or the effect of it is not substantial enough for them to notice any subjective improvement. Again, it is very subjective. Libido, maybe not as subjective either, your libido increases or it does not. The mood can also be kind of an up-and-down roller-coaster. There are good days and bad days that it can also be a hard thing to gauge or quantify over time if it is actually helpful or not. But the ones that it does, I had a patient to talk to earlier this week.

What Is LDN Used For? | PYHP 094 Jun 18, 2020

Question: What is LDN Used For? Short Answer: There are many possible uses for Low Dose Naltrexone (LDN). The common use for LDN is autoimmune diseases but has also been used in many immune system-related conditions, including cancer. PYHP 094 Full Transcript: Download 094 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki Dr. Davidson: And I am Dr. Davidson. Dr. Maki: So today, we are going to do not really an actual question like we have been doing on some of the past episodes. But today, we are going to actually something that does come up quite often. So it is kind of a question. It is not coming from one person. But today we are going to talk about low dose Naltrexone or LDN. Dr. Davidson: Exactly. So LDN, low dose Naltrexone. We have actually used with our patients for a number of years, but we do get a lot of listeners, just people that run across our website, people from thyroid groups looking for low dose Naltrexone, because while it has been around for… Gosh. Naltrexone has been around like… Dr. Maki: Thirty years. Yeah, late 70s or early 80s. Dr. Davidson: Yeah, the 80s, you know, doing low dose Naltrexone has not been as, you know, as common wise. Maybe for about the last ten like we have been using it probably for about the last eight to ten years, but it is not very much wide-known. I guess you could say, conventionally, so people will go to their conventional doctor looking into it and then, you know, they then their doctor looks at him like you want to go on Naltrexone. Dr. Maki: Yeah, right. Yeah. It was originally developed for as the HIV and AIDS epidemic was starting to kind of show up in the early 80s. It was used as a medication to curb alcohol and drug addiction because it has certain effects on the brain. It is supposed to limit your cravings for those types of things, those kind of dangerous behaviors that becomes a little bit too habitual and you have an addiction. But actually, along that path over the early 80s, a doctor in New York – I think his name is Dr. Bukhari – noticed that his, and I am not even really sure how he discovered or how we figured out the low dose part, but notice that some of his patients were actually improved. Their immune system status was improving with HIV. Now, we do not necessarily hear as much about HIV or Aids anymore. It is still around but not nearly as stigmatizing as it was in the early 80s. In some ways, if you think back, even up until the 2000s, you know through the 80s and 90s, you know, HIV and AIDS was kind of, you know, everyone was very fearful of that kind of like they are now at the Coronavirus. A little bit similarities there as how fearful everybody was because we just did not know anything about it. But low dose Naltrexone, so using it for what it was intended for, FDA approval, that was in doses of let us say 50 to 300 milligrams. What we are talking about low dose Naltrexone if you look it up online and there is some couple of re

How to Lose Weight During Menopause? | PYHP 093 Jun 12, 2020

Linda’s Question: Hello, Dr. Maki. I hope you are well. I eat perfectly. I a small amount of organic food daily. No alcohol. No smoking. I bike forty miles a week. I am a 51-year-old postmenopausal woman at five foot eight. I am now 25 pounds overweight at 154 pounds. I cannot lose one pound. My TSH was 1.6 free T4, 1.1 free T3, 2.6 reverse T3, eleven had very low sex hormones. Hence, probably the postmenopausal part, recently began one milligram of biest troche daily and 50 mg capsule of progesterone at bedtime. My worst symptoms are water retention, bloating, and weight loss resistance. I also have aching joints and muscles. This hormone protocol does not seem to be working. I was thinking of switching to an Estradiol Patch. Short Answer: Most people trying to lose weight all use the same strategy. They eat less and exercise more. Over time, this approach does not work very well cause the body is forced to adapt to the significant drop in calories and increased exercise. This is especially true for women in perimenopause and menopause. For women to reach their weight loss goals, we encourage them to eat more and exercise less. Bioidentical Hormone Replacement Therapy (BHRT) can be helpful, but it is not as important as how much someone eats, how much they exercise, and how well they sleep. PYHP 093 Full Transcript: Download PYHP 093 Transcript Dr. Davidson: Hi everyone. This is Dr. Valorie Davidson. Thank you for joining us for another episode of the Progress Your Health Podcast. I am sitting here with my co-host and husband and partner in business. I do not know if that is a good thing or not but here we are with Dr. Maki. Dr. Maki: Good morning everyone. How are you doing today? Dr. Davidson: It is a very good thing to be married and to work with your husband and have our business together. I did not mean to say that inappropriately. It is a very good thing. Dr. Maki: Yes well, it was not very nice to say. I like that. Dr. Davidson: I am very sorry. Not only am I sitting here with Dr. Maki. We are also sitting here with our little Australian shepherd dog who is always our little shadow. Dr. Maki: Oh, yes. He is always there. Dr. Davidson: So if you hear a little click-click in the background. That is probably his paws on the wood floor or he is chewing on his little bony. Dr. Maki: Yes, right. He is always underfoot all the time. So this one we are going to do a question. This one is from Linda. Why don’t you go ahead and read the question? Dr. Davidson: Sure. Sure. Okay. So we are going to do a reader question. This is from a blog post that we wrote called “What is Biest?” and this is from Linda. “Hello, Dr. Maki. I hope you are well. I eat perfectly. I [inaudible] amount of organic food daily. No alcohol. No smoking. I bike forty miles a week. I am a fifty-one-year-old postmenop

Should I Take Thyroid Medicine Before Blood Test? | PYHP 092 Jun 04, 2020

Question: A question we get all the time from patients and podcast listeners is if they should take their thyroid medication before a blood test. Short Answer: There is not a simple answer to this question. It depends on the patient and their situation. For new patients, we typically want them to take their medication in the morning 3 to 6 hours before a blood test. This is especially true if we have made a recent medication change. If a patient skips their medication the morning of the blood test, it is harder to determine dosing adjustments. The longer someone has been on thyroid medication, the more likely we are to have them skip taking the medication the morning of a blood test. PYHP 092 Full Transcript: Download PYHP 092 Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. Dr. Davidson: And I am Dr. Davidson. Dr. Maki: How you doing this morning? Dr. Davidson: I am doing very well. How are you doing this morning? Dr. Maki: Well, the skies are blue. The birds are out. Looks like it is going to be another beautiful day. Dr. Davidson: I look forward to it. It is what, spring in Washington. And even though, it does, it is Washington State it does rain here. But at least the you know; everything is green, and we do get some beautiful days. Dr. Maki: Yes. We certainly do. Now, granting the summer, people that are not familiar in summertime, there were hardly rains at all. June, July, August, September, does not rain hardly much. It gets kind of dry. But certainly, the spring, the fall, the winter, it makes up for those months that it does not rain for sure. Okay. So, this one is a situation that comes up all the time, for existing patients, for new patients, for questions we get from listeners and readers, the timing of thyroid medication and blood testing. Some say to take it in the morning, some say to take it the day before, and skip it that morning. There is, like I said, there is, you know, there is a couple of opinions and how that is supposed to be done or what say you? Dr. Davidson: I would say both. Dr. Maki: Yes. So, you would say that both are right. Dr. Davidson: Yes. When somebody asks, should I take my thyroid the morning of the blood test, there are times when I say yes, and there are times when I say no. You know, it really depends on how we are going to monitor it now. We are very specific when we monitor thyroid levels. Specifically, we will do the thyroid stimulating hormone, the TSH, the free T4 in the free T3. You know, we want to, you know, those are kind of like my nitty-gritty. I mean, then you can do a reverse T3 and a few others but really, you know, the free T3 is super important. A lot of conventional doctors do not always test the fre

How To Cycle Bioidentical Hormones? | PYHP 091 Jun 03, 2020

Question: How to cycle bioidentical hormones? Short Answer: When it comes to BHRT dosing, the two main options is static dosing and rhythmic dosing. Static dosing is by far the most common, but depending on the patient’s symptoms and goals, rhythmic dosing might be a better option. We like to use rhythmic dosing with testosterone for men almost exclusively. We are not fans of injectable testosterone or hormone pellet implants. PYHP 091 Full Transcript: Download PYHP 091 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki. Dr. Davidson: I am Dr. Davidson. Dr. Maki: How are you doing this morning? Dr. Davidson: I am doing great. Spring is here in Washington. It is beautiful. The plants are growing, birds are singing. Dr. Maki: Yeah. We are getting a little bit of rain but a lot of it has been coming at night. In spite of the lockdown, we are still getting some really nice weather. We have been able to spend some time outside. The plants are growing, a lot of weeds. We have a bunch of, what are they, raspberry bushes or blackberry bushes. They are kind of going a little crazy. Dr. Davidon: They are blackberry bushes. Blackberry bushes grow like weeds here in Washington, which is fun in August because then you get to pick them and eat them, but I definitely have a lot of scratches on my legs from tramps and throw them. Dr. Maki: Oh my God, yeah. Then, we played with the dog outside. He likes to play with the tennis ball and then chuck it. We live on a kind of a busy road. They are out in front in our yard, and they kind of kind of create a really nice fence because he is very careful going around those bramble bushes or blackberry bushes. He tiptoes in them very carefully. He does not want to hurt his little paws. Dr. Maki: On today’s episode, we are going to talk about rhythmic dosing. The title of this one is How to Cycle Hormones but we are specifically going to talk about the difference between or the two options, the two main philosophies for hormone replacement: static dosing which is the more common type, and then rhythmic dosing which is in some ways maybe our favorite, or at least my favorite anyways in the right circumstance. It is not right for everybody but there are certain situations where, I think it is the right situation for men pretty much across the board, but we will kind of discuss some of those. Why do not we dive in? First, let us talk about the static dosing, kind of what that involves and entails, not every aspect of it but just an overview and then we will come back around and talk a little bit more about the rhythmic dosing. Dr. Davidson: Exactly. With bioidentical hormone replacement, static dosing has been kind of like the norm or probably what people think of when doing the hormone replacement but the rhythmic dosing has been around for a long time, and it is a completely d

Can You Take Progesterone With An IUD? | PYHP 090 May 22, 2020

Jennifer’s Question: Hi there! Thank you for this forum! My sister is using the Mirena. I would like to recommend she starts BHRT as she is 49 and has perimenopause symptoms. Is she able to take Prometrium and stay on the Mirena? Thank you in advance Short Answer: The Mirena IUD contains 52 mg of levonorgestrel, which is a synthetic form of progesterone. This is often recommended for women in their mid to late 40’s to control some of the symptoms of perimenopause. The IUD is fine for pregnancy prevention, but we don’t agree with women in perimenopause given birth control to control their symptoms. There are better BHRT options for managing perimenopause symptoms. However, depending on the woman and her symptoms, she could take progesterone with an IUD. We recommend bioidentical sustained-release progesterone, but not Prometrium. There are more dosing options with bioidentical progesterone and the sustained-release form seems to be better tolerated than the instant-release Prometrium. PYHP 090 Full Transcript: Download PYHP 090 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 good morning. How are you doing today? Dr. Davidson: I’m doing great. I’m doing fantastic. How are you doing? Dr. Maki: I’m doing fine. Dr. Maki: We have a question. This actually comes up quite often talking about different types of contraception. Although this one isn’t exactly about contraception. But we’re going to talk about the Merina. just a little bit. Anyways, why don’t you go ahead? This is from Jennifer which is pertaining to I believe her sister, which is kind of like an indirect sort of thing, but she wants to encourage her sister and to be HRT, but her sister wants to use the Mirena. Dr. Davidson: Which yeah, it sounds like she is using it. It says, so this is from Jennifer she says “thank you for this forum. Hi there.” You’re very welcome. We love it when we get compliments. So Jennifer says, “my sister is using the Merina, I would like to recommend she starts BHRT, bioidentical hormone replacement therapy as she is 49 years old and has perimenopause symptoms. Is she able to take Prometrium and stay on the Merina? Thank you in advance.” So this is actually a question or somewhat a little bit of a roundabout question that we get all the time because since you know the introduction of the IUD, which is from gazillion years ago with Cleopatra, but now they have hormonal IUDs as opposed to the copper IUDs, and they’ve been around for a long time. But a lot of people ask well, you know my hormones are awry, things are off, I’m in my 40s, I don’t want to take birth control pills when you’re in your 40s is an IUD

Does Progesterone Help You Sleep? | PYHP 089 May 21, 2020

Laura’s Question: Dear. Dr. Maki, I read your article about progesterone cream versus oral format. I have used the cream with some satisfaction but not one hundred percent happy. My sleep has been my main complaint for the last six to eight months. I’m 44 years old, still menstruating with a lot of menopausal symptoms. Recently, I found a doctor in the Netherlands who did blood tests on me. She put me on oral progesterone and transdermal testosterone. The testosterone seems a little too high, one percent, but overall helped me a lot. Four weeks into my treatment, the oral progesterone, on the other hand, is driving me crazy! So, shortly after I take it, I feel a bit sleepy and then around two AM, full wide awake. Today, I took it during the day and I still can’t fall asleep in the evening. It seems like I’m converting it into cortisol, the progesterone. Any thoughts about what to do? Thanks very much. Short Answer: The first question to ask is if the progesterone is sustained release or is it Prometrium. Sustained-release progesterone is often much more tolerated than Prometrium, which is instant-release. The next consideration of the progesterone is the dose. A typical dose for women in there mid ’40s is 100 mg. However, this could be too much for some. Reducing the dose down to 75 or even 50 mg might be helpful. PYHP 089 Full Transcript: Download PYHP 089 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: How you doing this morning? Dr. Davidson: I’m doing great! How are you doing on this beautiful, sunny, blue-sky day? Dr. Maki: It is. It was actually raining like crazy overnight in Washington. It’s pretty common this time of year but woke up and looks like it’s going to be a really nice day today. So, be nice to be outside, which will probably go outside a little bit later but yeah time to get a podcast done. So, why don’t we kind of dive into that? We have a question from Laura. Dr. Davidson: Yes, Laura. So Laura is a reader. So she had read one of our blog posts about progesterone cream versus the oral. So this is her question, “Dear. Dr. Maki, I read your article about progesterone cream versus oral format. I have used the cream with some satisfaction but not one hundred percent happy. My sleep has been my main complaint for the last six to eight months. I’m 44 years old, still menstruating with a lot of menopausal symptoms. Recently, I found a doctor in the Netherlands who did blood tests on me. She put me on oral progesterone and transdermal testosterone. The testosterone seems a little too high, one percent, but overall helped me a lot. Four weeks into my treatment, the oral progesterone, on the other hand, is driving me crazy! So, shortly after I take it, I feel a bit sleepy and then around two AM, full wide awak

Is Prometrium Safer Than Progesterone? | PYHP 088 May 15, 2020

Donna’s Question: Hello. I’m 62 years old with a uterus. Recently my nurse practitioner switched me from 6% progesterone cream to Prometrium capsules. The amount of cream I was using was 1/4 teaspoon two weeks out of the month. She also added in the Intrarosa vaginal inserts instead of the estradiol cream for vaginal discomfort. I do not have many symptoms other than occasional sleepless nights and occasional hot flashes. My question is are the Prometrium capsules safe? And is the cream safer than the capsules? Thank you, Donna. Short Answer: Both Prometrium and bioidentical progesterone are safe to take. However, many women do not seem to tolerate Prometrium very well. Prometrium is instant release, which seems to make it less tolerable for some women. In most cases, we prefer to us sustained-release progesterone, which is typically better tolerated by most women. This is important for women taking estrogen who still have a uterus. Estrogen causes the uterine lining to thicking and oral progesterone inhibits this thickening. Progesterone cream does not inhibit the growth of the uterine lining, which is why we prefer to prescribe oral progesterone for our patients. PYHP 088 Full Transcript: Download PYHP 088 Transcript Dr. Maki: Hello, everyone. Thank you for joining us for another episode of Progress Your Health podcast. I’m Dr. Maki. Dr. Davidson: I’m Dr. Davidson. Dr. Maki: How you doing this morning? Dr. Davidson: I’m doing great. Thank you. How are you? Dr. Maki: Pretty good. Pretty good. You were surprised by that question? Dr. Davidson: Yes, a little bit [laughter]. Dr. Maki: Why are you surprised? Dr. Davidson: Because we’ve been hanging out all morning. [chuckle] Now you’re asking me how I’m doing. Dr. Maki: Well, we had to start over on this podcast a couple of times, so that’s okay. That’s… Dr. Davidson: I felt like I had rocks in my mouth. So I’m like, “Just stop it. Let’s start it over.” So I think this one will be the one [chuckle]. Dr. Maki: Yes, yes. So this one is a question we have from Donna. So why don’t you go ahead and read it? Dr. Davidson: Oh, okay. So yes, this is a listener question from Donna, it says, “Hello. I’m 62 years old with a uterus. Recently my nurse practitioner switched me from 6% progesterone cream to Prometrium capsules. The amount of cream I was using was 1/4 teaspoon two weeks out of the month.” So it looks like they were trying to cycle the progesterone or cycle the hormones. “She also added in the INTRAROSA vaginal inserts instead of the estradiol cream for vaginal discomfort. I do not have many symptoms other than occasional sleepless nights and occasional hot flashes. My question is are t

How Much Estriol Cream Should I Use? | PYHP 087 May 14, 2020

Lilly’s Question: Dear Dr. Davidson, I’m writing to say how illuminating your article on Estriol was for me. Especially your metaphorical descriptions of the actions of the 3 types of estrogens. I have a question, if I may. I am 49-years-old, I just entered menopause and started taking Botanical Phytoestrogens to help with the once a day hot flash. It helped for a month and then the flashes increased to several times a day. I then took Estriol, 5 milligrams and it helped. But since then that flashes have again increased and I’m using even more Estriol, 2 pumps morning and night. It’s made me feel very, very good, calm and a great sense of well being. My question is, is this too much Estriol to be using? What is the safe upper limit for Estriol in cream form? If I take progesterone and cream form as well, with this dull the good effects of the Estriol? Thank you for the possibility of asking these questions. Very best wishes, Lily. Short Answer: Dosing for bioidentical hormones is dependent on the woman. It also depends on if she has her uterus or not. One of the rules of BHRT that we follow is that you never give a woman “unopposed” estrogen. This is especially true if she still has her uterus because estradiol and estriol will cause the uterine lining to grow. This is why progesterone is important because it helps to inhibit the growth of the uterine lining. For women that still have their uterus, we prefer to use bioidentical progesterone capsules, as opposed to progesterone cream. PYHP 087 Full Transcript: Download PYHP 087 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 just getting ready to start talking and my mic and my headphones practically fell off my head. How you doing this morning? Dr. Davidson: I’m doing great. Maybe you shouldn’t wear your Golden Knights hat. Dr. Maki: Yes, shoutout to everybody in Vegas. Dr. Davidson: We’d love The Golden Knights. Dr. Maki: Yes, it’s really ironic. We live there for so long never had any professional sports. And right when they got that team, the season was going to start. And we left pretty much like, right as the season started and they had like one of the, I don’t know if anybody out there is a hockey fan or not I’m from Minnesota. So of course, I’ve liked hockey since I was a little kid. But they had like this crazy season that no one’s ever had before, for an expansion team. Dr. Davidson: It was definitely inspirational. Dr. Maki: And it’s funny too, well have granted it’s kind of started off in tragedy with that whole shooting they had there in October. But there are people there, we have patients there. And none of them really care for sports all that much now. Everybody is into the Golden Knights, which is kind o

What Biest Dosage is Best for Menopause? | PYHP 086 May 01, 2020

Nathalie’s Question: Hello Dr Maki, I am 45 full menopause and currently on biest 80:20 (0.5 mg) and progesterone 200 since July 2018. I was also given testosterone injection at the time and by Oct 2018 I was losing hair so we stopped that and no longer take it. I have been gaining weight steadily and even though we try to increase my estrogen slowly, I get too many side effects (constipation, weight gain, horrible bloating, hair loss-diagnosed with androgenic alopecia). My Thyroid is in normal range. Is it possible that a biest 90:10 would be more beneficial for me? I do like having my brain again and dryness cured but hate the bloating and weight gain. When I stop hormones completely I feel better, my belly fat reduced no more bloating and wgt loss happens. I tried DIM but my weight just kept on increasing. Thanks! Short Answer: The Biest dose of 0.5 mg is very low. I would not think this low of a dose could cause any side effects. Issues could be with the 200 mg of Progesterone. Changing Biest ratio to 90:10 would not really help either because dose is slow low already. However, for sensitive women, using just estriol only is an option. PYHP 086 Full Transcript: Download PYHP 086 Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki. Dr. Davidson: I’m Dr. Davidson. Dr. Maki: Let’s dive right back in. We have another listener question to do. This one is from, actually, her name is Natalie. Dr. Davidson, this one’s fairly similar to what we did recently for Monica’s, we’ve kind of thought this would be appropriate. I want you to go ahead and read the question. Dr. Davidson: Sure, sure. So, this is from Natalie. Hello, Dr. Maki. I am 45 years old, full menopause, and currently on 80/20 ratio, biased 0.5 mg, and 200 mg of progesterone since July of 2018. At that time, I was given a testosterone injection. By October of 2018, I was losing hair, so we stopped that. I no longer take the testosterone injection. Since then, I have been gaining weight steadily, and even though we try to increase my estrogen slowly, I get too many side effects such as constipation, the weight gain, horrible bloating, hair loss, diagnosed as androgenic alopecia. My thyroid is in normal range. Is it possible that a different ratio of bias, like 90/10, would be more beneficial for me? I like having my brain in the dryness cured but hate the bloating and the weight gain from the estrogen. When I stop the hormones completely, I feel better. My belly fat goes away. I have no more bloating, and the weight loss happens. I did try DIM, but my weight just keep increasing. Thank you, Natalie. Dr. Maki: Yes, right. This is a challenging one, right. I can understand where she might be frustrated. Even her doctor might be frustrated. She’s on a very low dose, 80/20 at 0.5 mg. Maybe, she talks of bloating quite a few times in that question. I’m thinking maybe it might be more related to the progesterone than it actually is to the bias. What do you think? Dr. Davidson:

Can You Take BHRT During Perimenopause? | PYHP 085 Apr 30, 2020

Monica's Question: Hi, Thank you for providing such great information regarding BHRT, this has been a great resource and one of the best sites I have visited. My question is: I am currently going through peri-menopause; while back in July my hormones levels tanked and I started having terrible problems with hot flashes and night sweats, after about 3 mos in and no period blood test confirmed my levels are very low. I decided to go with BHRT cream and within a week I could tell a huge difference. I do have uterus and my cream included Bi-est (50-50) plus P Plus T 1.8 mg plus 200 mg plus 5mg/ml cream. On my second month in I started my period within another 10 days I started bleeding again for about 3 weeks straight. During this time I was given a 7 day supply of 10 mg oral progestin this didn't help slow down the heavy bleeding and returned to talk back to my doctor. I was told most likely I was not absorbing the progesterone. I explained my concerns of not really wanting to take the oral progesterone and was changed over to 100 mg progesterone capsule finally after about 7 more days this meds had stop the bleeding. While during this time frame of a few weeks of bleeding, I decided to get in with my regular gyno for an ultrasound although I had one in 2018 for a side pain in which everything was healthy and looked normal. I want to make sure I am getting on track and taking the oral progesterone with using the cream is the better safer option. It was also mentioned that I might consider pairing the Mirena insert with BHRT cream I am not really crazy about that idea. I always had a regular cycle with no issues and only took birth control for a short time frame in my early twenties. At age 47 I am hoping I am on the right track to have a well balance and using the least I can and feel confident in making good choices. Any suggestions or feedback is greatly appreciated. Short Answer: First off, for a woman new to BHRT, we don’t like to combine so many hormones into one cream. If issues arise and the dose needs to be modified, that inital cream can’t be used. Typically, we will not start a woman on a 50:50 ratio right away. We will start with an 80/20 ratio to see how she responds. We will usually wait on the testosterone for later, once the Biest dose is optimized. Finally, we will prescribe a bioidentical progesterone sustained release capsule, instead of using a cream. This is important if the woman still has her uterus. PYHP 085 Full Transcript: Download PYHP 085 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: How you doing this morning? Dr. Davidson: I’m doing great. How are you? Dr. Maki: Pretty good. Pretty good. The weather’s nice. We’re still in lockdown, but we’re getting a lot of podcasts done. Dr. Davidson: That’s certainly are. Dr. Maki: Good thing, we're going to do another question. We have a few to catch up on so this is very appropriate. This one is from Monica. Dr. Davidson once you go ahead and read the question. Dr. Davidson: Sure. I know we’re on this kind of trend answering questions, but we’ve

Is Insomnia Related to Hormones? | PYHP 084 Apr 23, 2020

Marisa’s Question: Dr. Davidson and Dr. Maki, I truly appreciate what you are doing to share your information with the public!! You are helping many people learn more about their body!! I wasn’t sure the best place to ask this question or where you may answer it, but I found your podcast after I have been digging into how to repair adrenals. I was elated once I found your Podcast #69 Adrenals affecting sleep. The Ghost, defined me to a tee and I wanted to learn more on how to get better from my symptoms you so clearly described. My main concern is that I wake up almost every night at 2:00 – 4:00 am and my neck is tight and my heart is beating a little heavier. If I focus on breathing, I can go back to bed shortly thereafter, but some nights it does take a little longer. I may wake up another time or 2 after that as well. Is this hormonal or adrenals? All my hormone levels are low, except for progesterone is healthy (169.) I have taken the ZRT test with almost normal cortisol levels. TSH is too high at 5.3, free T3 – 3.2, and free T4 – 1.2. I take Armour Thyroid at 60mg. Vit D is 60. I am 44 years old female. My blood sugar is typically in the 80’s on my morning reading when I check it on a glucometer. I eat mainly vegetables and focus on all food groups. I have been focused on adrenals for the past 2 months and have been sleeping at 930pm and sleep for about 8 hours. I do exercise every other day, but take it easy to not wipe myself out. Body weights and walking. Pharma Gaba/L’theanine has helped me get back to sleep, but not from waking up. I also take Ashwaghanda and practice meditation and breathing exercises. Again, any guidance on what to look at is appreciated. All the tips you mentioned for how to help on the podcast I have alr

Do BHRT Dosage Amounts Change Overtime? | PYHP 083 Apr 22, 2020

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 to kind of dive right in. This is another question. This one comes from Maria. Again, looks like she found us on a blog post on how does bioidentical progesterone help. So, Dr. Davidson want to read the question from Maria. Dr. Davidson: Sure, sure. So, I know we’ve been doing a lot of reader questions lately. Only because we’ve been getting a lot of questions in and I do think that they’re important, but know that we’re going to do a combination on what questions, topics, concerns. Dr. Maki: Yes, yes. Like I said, we have a kind of a backlog. And these are very specific type questions. And we know, which is why we’re doing them that these kind of answers to these questions are next to impossible to find on the internet, you can’t just type in a question that we get and be able to find that answer. You have to look and look and look and then when it comes to hormone replacement in general, there’s a million different opinions, right? There’s not just one way to do a bioidentical hormone replacement therapy. You talk to 10 doctors. You’re going to have 10 different opinions, which makes it even more confusing for the patient. Because, well, their doctor does one thing, we say another, another doctor says something else. How does the average person make any sense of any of that, okay? But we have our approach. We have what works for our patients. And a way to when problems arise like on the last episode, when something comes up, knowing how to, which is also an issue that comes up quite a bit. Sometimes doctors do a dose or do a prescription or do a treatment plan, but then something comes up that is not favorable, and they don’t know how to fix it. That’s also why we’re kind of doing this podcast as well, because we end up seeing a lot of those people because they got it, they went to see somebody else, and they just didn’t get the results they wanted and they end

What Are The Side Effects of Biest? | PYHP 082 Apr 15, 2020

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 exogenous source of estrogen can cause some unwanted side effects like breast tenderness or unwanted bleeding. In Staci’s case, taking progesterone alone might be enough to help aleviate some of her symptoms. Also, supplementing with iodine can help to reduce breast tenderness. PYHP 082 Full Transcript: Download PYHP 082 Transcript Dr. Maki: Everyone, thank you for joining of another episode of the progressional podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson. Dr. Maki: So we’re back at another episode. Again, if you hear weird noise in the background, we have our co-pilot Bob with us. He’s chewing on a beef cheek and he’s making quit of the noise so, let me apologize for that. Like I said, we used to try to redo this with all the background noise but, we just kind of gave up on it because he always has to be right in our feet where we are, and we are to keep from occupied, is to give him something to chew on so. Hopefully, it’s not too distracting but at the same time when we record these, we always listen to the recordings afterwards and you can hear it back there so hopefully it’s not too terrible. Dr. Davidson: And he likes to push that beef cheek up against the table desk here and it’s got this metal little prod on the bottom that he just likes to push up against it, so that’s why it’s making all that noise. Dr. Maki: Yes. He’s trying to get some leverage. It’s not as bad as it probably could be, I guess. But it is connected through the table and the microphones are attached to the table and of course, the frame of the table has to be metal. But anyways- Dr. Davidson: He could be barking. Dr. Maki: Anyways, hopefully, it’s not too annoying for you. He’ll probably change positions in a little bit and it’ll go away. So, on this one, we’re going to do another question. We have a kind of a backlog of questions, that come in via email and comments through the website. And it is all time consuming, to be abl

What is a Usual Dose of Bioidentical Hormones? | PYHP 081 Apr 14, 2020

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 form is ok because the intention is to avoid the digestive tract and liver. However, for Estrogen and Testosterone, we prefer to use a transdermal cream instead. Also, in this case, the dosing is too low. Her Biest needs to be gradually increased, but with caution in order to prevent any bleeding or spotting. PYHP 081 Full Transcript: Download PYHP 081 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: I’m Dr. Davidson. Dr. Maki: So, we’re going to dive right back in. We have another listener question. Actually, this is a reader question from a post on our website. What is bias? This is from Heidi. Dr. Davidson, why don’t you go ahead and give it a read. Dr. Davidson: Oh, sure. Sure. So, this is from Heidi. “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.” Dr. Maki: So, yes, there’s a lot to dissect there. This is– and I actually responded to her on the website. I asked her a question, is her progesterone, is it Prometrium or is it bioidentical progesterone? She came back to say that it was actually 200 milligrams of Prometrium. She had asked why we don’t– because in my response to h

What is a Good Progesterone Dose for PCOS? | PYHP 080 Apr 09, 2020

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. 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 we have another question. This one we’re going to talk about PCOS. But it’s a combination of PCOS and progesterone. This question is from Sarah. Dr. Davidson, why won’t you go ahead and read it? Dr. Davidson: Sure. Sure. So Sarah sent us an email about a blog post that we had written, talking about the difference between creams and oral capsules for bioidentical progesterone replacement. So Sarah’s asking or actually saying thank you. Thank you for writing your post weighing the differences between creams and oral capsules, that would be for the progesterone. What dosing would be typical for a pre-menopausal woman with PCOS and amenorrhea having one to two menstrual cycles per year who is seeking to regulate cycles? Dr. Maki: Okay, so this is a fairly common situation that we deal with on a regular basis, both with the progesterone, the capsule versus cream comes up a lot. Prometrium versus progesterone comes up a lot. I know we’ve talked about Prometrium on the past. Prometrium always comes in a capsule. That’s what you get from a big box pharmacy. That pos

What Should My T3 Free Level Be? | PYHP 079 Apr 07, 2020

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. PYHP 079 Full Transcript: Download PYHP 079 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: How are you doing today? Dr. Davidson: I’m doing great this morning. Thank you. It’s springtime, the birds are singing. The flowers are blooming, the weather’s finally getting to be about 50 degrees, which is good here, which is actually really, really good. Dr. Maki: Yes, we can’t complain. There’s been less rain, more sun, that’s always fun. The weather’s definitely picking up, now, it’s interesting here in Bellingham where we live. There’s not a lot of difference between– like winter it averaged, this, at least this winter anyway, which I thought was odd. It averaged 40 degrees almost the entire winter which is pretty nice. I’m originally from Minnesota, Wisconsin area and 40 degrees in the wintertime is there wouldn’t be any snow, there wouldn’t even be winter if it was 40 degrees all year. So, we got pretty lucky this winter. Dr. Davidson: And your sister, my sister-in-law, she still lives in Minnesota. When I send her the– you know, “how warm it is?” I’m like, “Oh, it’s cold. It’s 41.” And she’s like, “That’s t-shirt weather.” Dr. Maki: Yes, yes yes, she thinks worse, and living in Las Vegas, like we did for so long. We’re getting acclimated certainly to the northwest and I think we’ve transitioned pretty well, but she still thinks we’re wimps when it comes to the weather. I don’t consider that. I think that back there, I think the weather is just a little bit ridiculous. It’s not as bad as it used to be like, I remember being a kid, and it was in January, it was always below zero all the time. Just frigid temperature, it doesn’t seem like it gets that cold anymore like it used to.

What TSH Level Indicates Hypothyroidism? | PYHP 078 Apr 02, 2020

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 earlier in the year, but we survived. We’re all making it through. We’re going to continue answering some more questions. This one also is pertaining to thyroid, and this is from Lisa. So, Dr. Davidson, why don’t you to go ahead and read it from Lisa? Dr. Davidson: Sure. So, Lisa is a podcast listener, hence we’re doing the podcast, but she has a question based on episode 38 which seems like light years away. Dr. Maki: Yeah, it seems like it was so long ago. Dr. Davidson: That we did that episode 38. Episode 38 was, Do you have a low free T3 level? So, Lisa’s question is, 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. Dr. Maki: Yeah. Right. So, this is in some ways in contrast to Dinette that we talked about. In some ways, almost exactly, the opposite. So here her TSH is already on the high end of normal. 3.0, that’s a little bit of a red flag for us, right? When we talked about Dinette, her number was point– I don’t remember exactly what it was. It was 0.82 or something. So, way on the low end of normal. Now here, her number is on the complete high end of normal. Right away, that automatically puts up some red flags. Dr. Davidson: Why don’t you reiterate what TSH does and what does it mean when it’s high and when it’s low? Dr. Maki: Oh, well, why don’t you do that?

Do I Have Hypothyroidism? | PYHP 077 Apr 01, 2020

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 PYHP 077 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: I’m Dr. Davidson. Dr. Maki: So, Dr. Davidson, how are you doing this morning? Dr. Davidson: I am doing really good. I’m just actually looking at our little dog, Bob. His name is Bob, that we have. He’s what, 15 months old right now? 16 months old? Anyway, I just love to look at him. He’s laying at my feet with his head using, there’s on the desk here, there’s a metal rod and he likes to use that metal rod as his pillow. Dr. Maki: Yes, yes. So, if you’re wondering, my name is Robert, his name is Bob. My dad’s name was Bob. He always went by Bobby, didn’t go by Robert or Rob. So, he passed away in 2000. But when we got him, he went through a kind of a whole bunch of awful names. Then you just came up with Bob one day like, I think we should name him Bob. I’m like, alright, that’s good. That was my pick in the first place. But you went through a bunch of, I didn’t remember some of that. There are some weird ones. Dr. Davidson: I won’t tell you but he is a Bob and he’s very cute. Dr. Maki: We’ve talked about him in some other podcasts, but if you’re interested, he is half Australian Shepherd, a mini Australian shepherd. He’s quarter Border Collie and a quarter Blue Heeler. Needless to say, he’s smart as a whip and he has an unlimited amount of energy, almost to a frustrating point sometimes, but nonetheless, he’s fantastic. So, we’re gonna talk about some listener reader questions. This one is about thyroid, kind of questioning whether someone is hypothyroid or not. This one honestly is something that we get quite often, this is very, in some ways, a little bit of a controversial topic. We’ll get into why that is here in a second. This

What Does Biest Mean? | PYHP 076 Mar 31, 2020

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 mg, but it depends on the severity of menopausal symptoms. PYHP 076 Full Transcript: Download PYHP 076 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 we’re still stuck in quarantine coronavirus. 2020 is upon us still, I think we’re up here in Washington State. Everything’s closed except for banks and grocery stores, gas stations. Bars and restaurants are closed. Of course, hospitals are not, healthcare practices and medical clinics. But hopefully, this will resolve soon. Hopefully, by social distancing we’ll have some positive effects, and we’ll be able to get back to some normalcy fairly soon. In the meantime, we’re going to continue on with the podcast. It does seem a little weird, I’m talking about hormones when all this other stuff is going on but at the same time, we don’t want to focus on that too much. It is what it is. If we all do our part, I think it’ll kind of dissipate, and we’ll minimize some of the collateral damage as much as possible. Dr. Davidson: Yes, I completely agree. Instead of panic, just try to hope for the best, everybody’s going to be okay. Let’s try to stay home and not infect anybody else. Like Dr. Maki said, we’re in Washington, which there is a lot more cases of deaths here so people are being extra proactive, which I think it’s wonderful that we’re all trying to support the community. I think when this is done, we’ll come together and try to help everybody else that have been impacted financially from this too because that could be very devastating. Dr. Maki: Yes, completely. Let’s get back to hormones. The last one we talked about Lisa. So, again, some very typical questions. This one, we’re going to talk about Angie. In some ways, we’ve kind of paired these two together from last one to this one, just because it kind of reiterates some of the things that we talked about. Dr. Davidson, why don’t you go ahead and read Angie’s question.

Where Do You Apply Biest Cream? | PYHP 075 Mar 26, 2020

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 new podcasting equipment. We upgraded our microphones, we got this piece of podcasting equipment for all the tech geeks out there. It’s called a Road Caster Pro. It makes the whole process and the production of the actual podcast very, very simple and easy so far, it’s in pretty, I know you don’t really get too excited about any of that kind of stuff, but certainly, certainly I like all the gear and everything. Dr. Davidson: Well, I liked all the options and I certainly like the color two little buttons on it. They’re real pretty. Dr. Maki: Yeah, it looks very sophisticate looks almost like a mini version of a real radio studio. So hopefully this sounds, our voices sound good. And, I know our last one, the sound is okay. We still have a little bit of echo in the room. We’re in the middle of a Coronavirus quarantine. So we’ve kind of a stuck in the house a little bit. And we’ve been kind of planning this, kind of this new launch of our podcast, not really a lot is gonna change but really it was the upgrading the equipment and pretty exciting nonetheless. Dr. Davidson: And the cool new microphones. Dr. Maki: Yeah, yeah. Microphones are for those that are interested is the Road Pod mic, specifically designed for podcasting. Again, for those of you that are not into microphones, you probably don’t care. But these are considered dynamic microphones, so they, and they’re designed specifically for podcasting. And they’re meant to make your voice sound good without picking up all the extra sounds in the room. Our dog is at our feet and in the past he’s been chewing on a bone and sometimes that noise, it get picked up. You’re hearing a strange noise in the background but now this one is only supposed to pick up our voices and cut down some of the echo and, for example, in the summertime if the air conditioning comes on, our car drives by or something, the microphone isn’t gonna pick up all that extraneous noise, so. Dr. Davidson:

Is Prometrium and Progesterone the Same Thing? | PYHP 074 Mar 25, 2020

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 same thing. In our experience, many women do not seem to tolerate Prometrium very well. Prometrium is an instant release. We prefer to prescribe bioidentical sustained-release progesterone. PYHP 074 Full Transcript Download PYHP 074 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, like the last episode, we answered a question from Michelle. This one we kind of follow the same trend. Like I said due to the recent Google update, we have been getting a bunch of comments and questions. That means people are finding our website, which is great. This one, we’re going to answer a question from Carrie. She’s got some concerns or questions about progesterone. Dr. Davidson: We love reader and listener questions. So, it’s been kind of cool, we had a little bit of a dip for a while. But then all of a sudden, all these questions came flooding in in this last week. And they take time to answer and we really do want to get back to you when you have your questions. So, we thought it would be easier if we just did some podcasts on the questions because these questions apply to a lot of other ladies that are listening to this. So, I think it would be helpful. So, this question is from Carrie, Carrie’s comment is, “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.” Wh

What Is A Low Dose of Bioidentical Hormones? | PYHP 073 Mar 24, 2020

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, healthy person. Please help with recommendations. Would testosterone help? My levels were not terrible enough to prescribe. Answer: In this episode, we discuss a question we received from Michelle that was started on Premarin but then transitioned to 1.5 mg of Biest cream. Of course, we are not fans of Premarin and would never prescribe this for our patients. However, we do prescribe Biest all of the time. There is very little similarity between Premarin and Biest. When transitioning from a tablet form of estrogen like Premarin to a transdermal cream, the dosing of the Biest needs to be definitely increased. For most women, our starting Biest dose is typically 3 mg to 5 mg. Full Transcript PYHP 073 Download Transcription PYHP 073 Dr. Maki: Hello everyone. Thank you for joining us for another episode of the progression health podcast. I’m Dr. Maki. Dr. Davidson: And I’m Dr. Davidson. Dr. Maki: So just as a warning before we get jumping into the episode, we are in our home office recording this. Our dog is with us as well. He’s always with us. We can’t really go anywhere without him, but he’s laying on the floor with a bone. So, if you hear any strange noises or any banging around, he’s just either repositioning or trying to find another bone. We can’t really go anywhere without him. And he’s happy as long as we’re close by. Dr. Davidson: In some ways. He’s kind of our first dog, ’cause our other one was a poodle, which they always say once you have a poodle, all the other ones are just dogs. So, he was completely different from this one. He follows us everywhere so if you hear him chewing, he’s chewing on a bone. Thank goodness he doesn’t chew on other things. It’s just his bones. Dr. Maki: No shoes, no clothes, no furniture. Just bones. So, we’re good, we’re lucky about that. All right, so, now this episode and the next few, we know enough to

What Supplements Support Immune System? | PYHP 072 Dec 19, 2019

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 amount for too long. A couple of weeks is enough to boost immunity, but not long enough to cause any unwanted side effects. Larch Arabinogalactan: for immune support, we recommend taking the fiber found in Larch Arabinogalactan, which has been shown to prevent the common cold. To boost immune function, take 2 capsules daily for 1 to 2 weeks. After that, you can reduce to 1 capsule daily for maintenance. Probiotic (Ther Biotic Complete): for immune support, we recommend taking a probiotic, especially if antibiotics have been taken. Maintaining a healthy microbiome is very important to optimal immune function. Ther Biotic Complete is one of our favorite probiotics. It provides 25 billion organisms per capsule. You can take 1 to 2 capsules daily. Echinacea Hydrastis and Berberine: for immune support, we recommend taking Echinacea, Hydrastis, and Berberine. Echinacea has a long history of boosting immune function and Hydrastis (Goldenseal), which contains the constituent berberine have anti-microbial properties. EHB is one of our favorite products to boost immune function. Vitamin C & Zinc: for immune support, this contains vitamin A, vitamin C, vitamin E, selenium and zinc. We have been using this with patients for years as it provides several immune-supporting nutrients. Elderberry: most of the time, when people get sick, it is typically a virus of some sort. Sambucus or elderberry has a long history of boosting immune function against the common cold. PYHP 072 Full Transcript: Download PYHP 072 Full Transcript Dr. Maki: Hello everyone. Thank you for joining us for another episode of the

Can You Get Sick From Stress? | PYHP 071 Dec 03, 2019

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 changing a little bit? It’s getting a little cold. Dr. Davidson: Oh, absolutely. Dr. Maki: I think it was like in the 20’s these last couple of days in the morning. Dr. Davidson: Yeah. I think 30’s because it didn’t completely freeze but when it’s cold here, it usually means that the sun is out which is really pretty. Then with the fall leaves being orange and read, it’s actually been a really beautiful Fall here in Washington. Dr. Maki: Yeah, you and I went for a hike the other day, we have this called the inner urban trail right behind our house and when we went up to this hike that’s in Bellingham called Fragrance Lake which is a really popular hike. You are telling me about when you went down the trail and all the leaves were on the path and it looks like, kind of, like the yellow brick road from Wizard of Oz. Dr. Davidson: Yeah, there was a big– kind of like a windy time like a windy night and then the next day when it was really beautiful I went for a walk by myself on that inner ravine trail and nobody had been on there yet. No bikers, no walkers and it was just all these yellow leaves all over and just me that did it. I was like, “I feel like I’m on a brick trail.” Dr. Maki: Yeah, that’s great. Dr. Davidson: A yellow brick road. Dr. Maki: Yeah, yellow brick road. I’m originally from the Midwest Minnesota and there’s a scenic tour, scenic drive you go from Duluth, Minnesota up the, what they call North Shore which is the North Shore of Lake Superior and everyone takes this kind of– I won’t say everyone– but a lot of people take this annual trip to be able to see the change of the leaves and certainly, we never really got a sense of that in Las Vegas when we live

How Do Adrenals Get Exhausted? Zombie | PYHP 070 Oct 29, 2019

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 cortisol is low in the afternoon and evening (like the Ghoul). And come 2 am the cortisol rises. But the difference here is the cortisol will rise and fall all night long. That is why these people wake up numerous times in the night. Like the Ghoul, the Poltergeist will have good morning energy but will crash come afternoon. In this episode, we go on to explain the third type of Adrenal Dysfunction that we have encountered with our patients, the Zombie. The Zombie has low cortisol all day and night. It is not Addison's disease. But due to the lower levels of cortisol, the Zombie is tired all day and night. They have no trouble falling asleep. They are the people that will easily sleep 8 to 10 or more hours but not feel rested when they wake up. Zombies report that they could sleep all day long. They have a lot of physical fatigue and cannot exercise. If they tried to exercise, they are wiped out for the rest of the day. And it can take them days to recover after intense exercise. They do crave sugar and carbs. In some ways, it gives them a little short-lived energy to eat sugar, soda, or refined carbohydrates. Not only are they physically tired, but they are also mentally tired and comment that they have a lot of brain fog. It is hard to focus and finish a project, and Zombie's report that they have no short term memory. As we mentioned in the podcast, we wanted to give you some tools that can help. Some options that include nutrition, lifestyle, supplementation, and prescription medication that can help a Zombie type Adrenal Dysfunction. Before we answer this, we have to put out the disclaimer: All content found in this blog, including text, images, audio, video, or other formats were created for informational purposes only.

How Do Adrenals Affect Sleep? Ghost | PYHP 069 Oct 24, 2019

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 the last episode, we talked about the Vampire. The Vampire has very low cortisol levels in the morning and elevated levels at night. This causes a lot of morning tiredness, to the point that Vampires are chronically late to anything in the morning. Vampire types also feel more awake at night and cannot fall asleep. On the other hand, the Ghost type has a different dysfunctional secretion of cortisol from the adrenal glands than the Vampire. The Ghost will have very low levels of cortisol in the early afternoon that continues until the evening. So you will see the Ghost very tired in the afternoon and evening. These are the people that can fall asleep easily at 8-9 pm. But in the middle of the night, the cortisol levels will rise so they will wake up. It is common for Ghost types to fall asleep hard for four hours and then wake up like it is morning when it is only 2 am. There are two subtypes of the Ghost: Ghoul: They will fall asleep easily in the evening but will wake up after about 3-4 hours of sleep. The Ghouls will be awake easily for two hours straight. Ghouls might not be roaming halls, but they certainly are roaming their iPhones. Because they cannot fall back asleep. Then by the time they do fall back asleep, they need to wake up shortly thereafter. Poltergeist: Fall asleep very easy at night. After about 3-4 hours of deep sleep, they wake up. The difference here from the Ghoul is the Poltergeist can fall back asleep within minutes. But then less than an hour later they wake up again. Just lik

What Does Adrenal Fatigue Feel Like? – Vampire | PYHP 068 Oct 17, 2019

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 late afternoon and evening. They will say their diet is perfect during the first half of the day. But come later in the day and evening time, they cannot control the sugar cravings. Even if they are full from dinner, Vampires still find themselves snacking in the evening. Fatigue: mental and physical fatigue Cannot sleep at night. These are the people that will lie in bed for hours, unable to fall asleep. They were so tired in the morning but come evening, wide awake. Feels more awake in the evening. This type of commonly seen Adrenal Fatigue will get all their chores done in the evening. More energy at night, especially mental energy. This is when they are getting projects, emails done. The adrenal glands secrete cortisol in a diurnal curve. In a perfect world, you will see the cortisol being highest in the morning and will slowly decline, being lowest at night. With the Vampires, you will see what is called a reverse diurnal curve.' With very low cortisol levels in the morning, it makes it very difficult to wake up in the morning. The cortisol can continue to stay reduced in the afternoon, also causing afternoon fatigue. Come evening time, cortisol levels rise. This makes it difficult to fall asleep. The rise in cortisol in the evening can disrupt insulin and blood sugar. This can cause sugar and carb cravings, which are almost impossible to resist.

How to Test Adrenal Function? | PYHP 067 Oct 14, 2019

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 testing. Typical blood testing for adrenals usually will show that a person doesn't have adrenal dysfunction, when in reality, they do. We are going to talk about the different methods for testing Adrenal Dysfunction. Let's start by talking about the most common testing method that most docs use, blood testing. Adrenal Blood Testing: Cortisol: Blood testing for cortisol is not accurate. Most, if not all people with Adrenal Dysfunction will test normal for cortisol blood testing. The reference ranges are vast and a blood test is only done once or twice in one day. And when you have a needle coming to stab you, automatically the body raises the stress hormones. So cortisol can be falsely elevated in a blood test. DHEA: DHEA is secreted mainly from the adrenal glands. In adrenal dysfunction, you will see lower levels of DHEA. DHEA reference ranges are vast and everyone falls in normal when doing a DHEA total blood test. But a DHEA-sulfate blood test is fairly accurate for evaluating levels of DHEA in the body. But again, those lab reference ranges are still pretty broad. But in general, terms, if the DHEA is low or low normal range then you can start to consider that a person has Adrenal Dysfunction. Testosterone: DHEA is secreted mainly from the adrenal glands and will convert to testosterone for females. In adrenal dysfunction, you will see lower levels of testosterone in women because of the reduced DHEA levels. In men with adrenal dysfunction, you will also see lower levels of total testosterone. Testosterone reference ranges are very vast. Quest has a reference of 2-45 for females and for males the reference range is 250-1100 ng/dL. These are pretty big reference ranges. But if someone has a low normal testosterone level you can consider that person has Adrenal Dysfunction. Pregnenolone: Pregnenolone is secreted from the adrenal glands and there is a small amount made in the spinal cord and brain making it very neuroprotective. Pregnenolone is accurate as a blood test. But like DHEA and Testosterone, the reference ranges for pregnenolone is huge. For Labcorp the reference range is anything less than 150 is norma

Do I Have Adrenal Fatigue or PCOS? | PYHP 066 Oct 03, 2019

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 this time, the female hormones can be changing due to perimenopause, and the body cannot maintain balance, so the PCOS and Adrenal Fatigue symptoms start manifesting. This is what you typically see in a Concealed PCOS Symptoms: May have a child, so it looks like there are no fertility issues Regular periods but might be more painful and cramping with terrible PMS Anxiety and fatigue: feeling wired and tired at the same time Irritability Thin Hair Slender until mid 30's to early '40s. Then it feels like they gain weight overnight. Especially in the belly area. No matter what they do, eating less/exercise more, the weight doesn't budge. What is Adrenal Fatigue? This name can be misleading. We actually like the terminology, Adrenal Dysfunction. Because it is the dysfunctional activity of the adrenal glands that creates all the symptoms associated with Adrenal Fatigue. Let's explain a little more about Adrenal Dysfunction. Like we mentioned earlier, the adrenal glands are not fatigued per se. They are healthy tissue and healthy glands. It is the hormonal secretion and function of the adrenals glands which are degraded or dysfunctional. We have all heard about cortisol. Cortisol is essential for life. But secreted inappropriately, can cause a lot of symptoms, specifically ones of Adrenal Dysfunction. Cortisol is supposed to be highest in the morning and then will slowly drop and will be very low at night. This allows us to be awake in the morning and daytime, but able to sleep at night. In Adrenal Dysfunction, you will see what is called a Reverse Diurnal Curve of cortisol. Meaning the cortisol is low in the morning and can be especially low in the afternoon. This causes morning tiredness and afternoon crashes in energy. Then the

What Type of PCOS Do I Have? Concealed | PYHP 065 Sep 27, 2019

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's to early 40’s. The female hormones are changing, and the body cannot maintain. This is typically what you will see in the Concealed-Type: May have a child, so it looks like there are no fertility issues Really irritable–all the time, and way worse before their period Yes, they have regular periods but the worst PMS Anxiety –it seems that they have a lot of low-grade anxiety all the time. Hair is thin Slender until they hit mid to late 30's to early 40’s. This is when they gain weight, especially in the stomach. No matter what they do, they cannot lose weight. Even with severe caloric restriction and lots of crazy exercise, there is no real budge to the weight. Carbohydrate cravings especially for sugar All these symptoms of the Concealed are blown off as genetics or lifestyle. I have had so many patients with Concealed PCOS say that their previous doctors did not believe that they had a healthy lifestyle. This is what their blood work typically looks like: LH : FSH ratio : the LH is higher than the FSH just a little. There is no 2:1 ratio like you see in the Classic-Types. High normal testosterone or just over the edge of normal testosterone. Let me explain again those ridiculous reference ranges for testosterone blood labs. Most labs have the reference range for testosterone to be 2-45, which is a very wide range. Those with Concealed PCOS will have a testosterone at 35-55. The average levels of testosterone for women regardless of age or menstrual status is about 25, so the Concealed are higher than the average. Low progesterone High normal DHEA-sulfate Lower thyroid function but not hypothyroid Low normal FreeT3 Normal FreeT4 Normal TSH If you would like more information, visit our website: pro

What Type of PCOS Do I Have? Common | PYHP 064 Sep 27, 2019

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 presentation, they may get missed in diagnosis. Symptoms that a PCOS Common-type will present with: Easy weight gain in the middle, the stomach, and the hips and thighs Thinning hair Irritable easily Some cystic acne on the chin and jaw area Trouble getting pregnant but is usually successful with fertility options or IVF May get random cysts on or in the ovaries. But there is no string of pearls or multiple ovarian cysts. May miss a period occasionally. Common-types are not regular in their periods. But they may get a period every month for five months then miss two. Or have very long cycles up to 45 days. Or they may have a period every other month. Common-types again, are not regular, but they do not miss multiple months like the Classic Types PCOS. Typical lab work for a PCOS Common Type: LH is double the FSH There is high normal to just slightly over the normal level of testosterone High normal DHEA-sulfate Insulin is in the normal range but may show up in the teens or anywhere above 9. Normal glucose Estradiol can be high, showing Estrogen-dominance or be normal ranges

What Type of PCOS Do I Have? Classic | PYHP 063 Sep 25, 2019

There are three main types of PCOS that we have seen treating patients since 2004. As you have heard from the past podcasts, PCOS is a spectrum of symptoms. It is a spectrum of symptoms coming from a set of hormonal imbalances. Every woman with PCOS might have some to all to a few of the symptoms of PCOS. That is because there might be varying degrees of hormonal imbalances. While there might be some disagreement, there are three types that we have encountered the most. And each of these three have different goals and treatment plans. These are the main types we have seen in treating patients with PCOS. As I mentioned before, PCOS is a spectrum. There can be some women that have all the symptoms to others that have just a few. This is a key concept for treatment. Someone with many symptoms is going to have a completely different treatment plan than someone that has some of the symptoms. The three types that we commonly see, we have named: CLASSIC, COMMON, and CONCEALED. Classic PCOS: Honestly, this is not seen that often. A Classic-PCOS, you will see all of the symptoms. Dark facial hair Chronic cystic acne. Thin hair, especially the top of the head and temples Weight gain–being it is super easy to gain weight and what feels like, impossible to lose High blood pressure High cholesterol High blood sugar High insulin: leading to insulin resistance and possibly diabetes, if not already diabetic. Irritability Terrible carb cravings, especially for sugar. Miss multiple periods for consecutive months in a row. They might get maybe two periods a year. These are the women that have many cysts in and on their ovaries. They have the Classic' string of pearls visualized on a transvaginal ultrasound. Infertility You will see the full gamete of the blood work readings: LH to FSH ratio is 2:1 or even more High levels of testosterone: well above the normal levels. You can see the testosterone anywhere up to 90 or more No progesterone levels Normal levels of estradiol and sometimes there can be higher levels such as Estrogen-Dominance from the conversion of testosterone to estradiol. High DHEA-sulfate High insulin, high teens to well over 20 High blood sugar and Hemoglobin A1c Hyp

What Tests to Diagnose PCOS? | PYHP 062 Sep 19, 2019

PCOS Testing and Diagnosis: In this episode, we talk about the testing and labs for a diagnosis for PCOS. These testing and labs are also a good way to monitor PCOS. Ultrasound: Checking for multiple cysts on or in the ovaries. It is still very common to have PCOS but have not cysts ( string of pearls ). LH: FSH ratio: 2:1 or more DHEA-S: DHEA-sulfate is the best way to test for DHEA levels in the blood. DHEA-sulfate is a metabolite of DHEA and is much more accurate to determine DHEA levels than a total DHEA level. DHEA levels are highest when we are young, around 25 years old. And will slowly decline with age. It is considered an androgen. The reference ranges for DHEA-Sulfate are very vast and are based on age. For example, a woman that is 35 years old gets her blood drawn for DHEA-sulfate. The reference ranges for a typical lab is 23-266 mcg/dL. For a female that has PCOS around 35 years of age, you will see the DHEA-sulfate at 200 or above. Commonly PCOS, the DHEA-s will show over 200 mcg/dL. Testosterone: The reference ranges for testosterone labs are huge. Quest has a reference range of 2-45 ng/dL. LabCorp has a reference range of 8-48 ng/dL. Testosterone levels at 35 or higher Estrogen Three circulating estrogens: Estrone, Estradiol, Estriol Vast reference typical reference ranges for most labs: Follicular Phase 19-144pg/mL Mid-Cycle 64-357 Luteal Phase 56-214 Postmenopausal

What Does PCOS Look Like? | PYHP 061 Sep 18, 2019

In this episode of the Progress Your Health Podcast, we are going to talk about PCOS. I know our last podcast was, PCOS, Questions to Ask your Doctor. We are still going strong on our PCOS information. But we are going to do things a little different than we have. We are going to do a five-part podcast series about PCOS. What PCOS Looks Like: What is it? (this podcast) How PCOS Can Be Detected: Testing and Diagnosis for PCOS Which Type of PCOS Am I?: Classic Which Type of PCOS Am I?: Common Which Type of PCOS Am I?: Concealed PCOS stands for Polycystic Ovarian Syndrome. It is not a disease but considered a syndrome. From the name, polycystic ovarian syndrome, it is easy to assume there are multiple cysts on the ovaries. But in fact, many women with PCOS do not have multiple cysts or any ovarian cysts. As a general statement, in PCOS, there are hormonal imbalances that can cause unwanted symptoms and conditions. That is why we consider it more of a spectrum as some women can have nearly most of the criteria of PCOS and other just a few symptoms. What are the Hormonal Imbalances present in PCOS? In PCOS, one of the hallmarks are elevated levels of androgens: testosterone and DHEA. A lot of time these can range from high normal to over the reference lab values. DHEA: comes from the adrenal glands Testosterone is from conversion from DHEA, ovaries and other peripheral tissues Progesterone levels from the ovaries are low to none Thyroid function can be low Elevated insulin Cortisol diurnal release is degraded. Common PCOS Symptoms: Multiple Ovarian Cysts: Just like the name states: Polycystic ovarian syndrome, there can be multiple cysts on the ovaries. It is normal and common to get small follicular cysts during our cycle. But in PCOS there can be actual cysts that stay on the ovaries almost indefinitely. While as the name states, polycystic. Many women with PCOS do not have cysts on their ovaries. Period issues: Irregular or lack of a period. In PCOS, there can be missed periods. Some women might miss a period or two in a year. And others can miss their period for up to six months or more. But of course, the goal is to balance the hormones, so the cycle is regulated and not painful or heavy. Infertility: Some women that have PCOS can have reduced ovula

Questions to Ask Your Doctor About PCOS | PYHP 060 Sep 17, 2019

In this episode of the Progress Your Health Podcast, we want to discuss questions you might want to ask your doctor when it comes to PCOS. PCOS stands for Polycystic Ovarian Syndrome. The name can be misleading. Polycystic means, having multiple cysts on or in your ovaries. While this can be true, many women with PCOS do not have any ovarian cysts. PCOS is a collection of hormonal imbalances that may result in cysts and other unwanted symptoms. During this episode, we talk about the diagnosis, symptoms, and questions to ask your doctor regarding PCOS. We explain that PCOS is more of a spectrum of symptoms as some women can have all the symptoms and others a few. This is why it is important to have clear communication with your doctor on how: PCOS is affecting your life. What your health goals are with PCOS. The proper treatment to help with PCOS. Before we move on, let’s understand the basics with PCOS. The common symptoms that are associated with PCOS: Common PCOS Symptoms: Cysts: if you have not had an ultrasound, request that your doctor order you transvaginal ultrasound. As mentioned earlier, many women with PCOS do not have cysts on the ovaries. But if there is any thought that you might have PCOS, then you do want to have a transvaginal ultrasound. This will give us information on the size of the uterus and ovaries. If you have any growths or cysts. It will even check the thickness of the lining of your uterus. Missing, Irregular Periods: It is very common in PCOS to miss periods for multiple months. Some women miss one month a year, and others can miss up to six months at a time. It is also common to have cycles that range from 25 days to 45 days. Weight gain: Weight gain is one of the most common frustrations with PCOS. It is very easy to gain and hard to lose. Even with strict caloric restriction and a lot of exercise, women with PCOS will be frustrated because they cannot lose weight. Hair loss: It is common in PCOS to have hair loss. Particularly on the top of the head and temples can appear to be especially thin. Hair growth on the face and other areas of the body (except for the head): While it might be easy to lose hair on the head. In PCOS there can be hair growth on other areas of the body. Most commonly, the upper lip, chin and jaw, chest and pubic area before the belly button. We are human, and humans grow hair on our bodies. But in PCOS it might seem a bit more extreme. Irritable: It is common to feel irritable not warranted for the situation in PCOS. Lack of Conceiving, Fertility issues: PCOS is one of the top causes of infertility. There tends to be a lack of ovulation in PCOS. But there are many women with PCOS that have children. But there is a link between fertility and PCOS. Elevated Blood Pressure: Some women with PCOS will have essential hypertension. Or eleva

Perimenopause, Why Am I Gaining Weight? | PYHP 059 Sep 05, 2019

This is one of the top concerns of women in Perimenopause. Perimenopause usually occurs in women between the ages of the late '30s to late '40s. An important note here is, Perimenopause is not Menopause. And while both Perimenopause and Menopause may have some of the same symptoms. There are also many differences between the two. It is of value to know this because treating and working with Perimenopause can be quite different from Menopause. The hormone changes in Perimenopause can cause a lot of unwanted symptoms. If you are interested in more in-depth information, and healthy options to deal with Perimenopause, check out our course, The Perimenopause Masterclass. But for this podcast, we focused on the unexpected, unearned weight gain that can happen in Perimenopause. In Perimenopause, it is common to hear women complain of feeling like they have gained 10-20 pounds almost overnight. They are stumped because they are unsure of where his added weight came from. We have many patients exclaim that they have not changed their diet or exercise routine, yet keep putting on weight. And this weight gain is almost always focused in the stomach and waistline. I cannot tell you how many patients I have had that say, they have never had a belly before. And now they have grown a gut for no reason. Well, there is a reason, it's your hormones. What do women do when they start gaining weight? Common response to weight gain is to eat less and exercise more. Bluntly put, this is the wrong response. There might be an initial drop in weight when you restrict your food and jump on the treadmill. But more often than not, in Perimenopause, restricting your calories and increasing your exercise will either result in no weight loss or even more weight gain. But this is what we have always been taught. Less calories in + exercise(calories out) = weight loss. Well, maybe in your 20's this might work. This will not work in your 40's. There is nothing more frustrating than to workout like crazy, eat like a rabbit, and not lose weight. Not to mention this not a realistic way of living. When you start to eat like a normal human, you will gain the weight back plus more at a rapid pace. Why doesn't eating less and exercising more in Perimenopause not work? It is about the cortisol-glucose-insulin love triangle. Yes, it is like an awful drama that results in the fatty belly that you never had. When you do intense cardiovascular exercise, it will raise your cortisol. When cortisol rises, it will mobilize glucose. When glucose rises, then your pancreas will release insulin. Insulin is a fat-storing-hormone in the body. This is really the real deal. You are doing some crazy intense, cardio exercise. This will cause your adrenals to increase cortisol. The cortisol will then mobilize glucose from your large muscles, such as your gluteus (bum) and quadriceps (thighs). The increase in glucose will cause your pancreas to pump out insulin. The insulin opens the door cell and allows glucose to enter. Now the glucose that is mobilized from your muscles gets turned into fat. That is why in Perimen

What Happened to Kavinace? | PYHP 058 Jul 08, 2019

Kavinace by Neuroscience is no longer available as a supplement. April 10th, 2019, the FDA issued a letter to several nutraceutical companies to discontinue supplements containing 4-amino-3phenylbutyric acid. The FDA has determined that 4-amino-3phenylbutyric acid, also commonly referred to as Phenibut is not a dietary supplement. We published a previous Kavinace article shortly after the FDA letters were sent out. As of the letter dated April 10th, the companies had 15 days to comply. This left people that had taken Kavinace safely for years in a bit of a quandary. Kavinace is, I mean, was a dietary supplement that many people took to help with staying asleep. It contained 950mg of a combination of taurine and 4-amino-3-phenyl butyric acid HCL per capsule. Most people did well on one to two capsules taken at night before bed. It wasn't a sleep medication, like Ambien or Unisom but did help to raise GABA to help with staying asleep at night. I used this myself and with patients to stay asleep at night. Commonly in perimenopause and menopause, women have trouble staying asleep. Often they fall asleep easily but will wake up in the middle of the night for hours. And by the time they are able to fall back to sleep, it is time to wake up for the day. Kavinace was very helpful because it contained 4-amino-3-phenyl butyric acid, which is a precursor to GABA. Meaning it is easily digested and can cross the blood-brain barrier to help convert to GABA and stimulate GABA receptors to stay asleep. One of the reasons that sleep is so important is terrible sleep can make you gain weight. People, especially women, will gain weight easily if they do not sleep well at night. Sleep is necessary for so many health reasons, it is also responsible in part for your metabolism. It really goes back to our adrenal glands. The adrenals secrete cortisol in a diurnal fashion. Meaning that cortisol is released highest in the morning and stays up through the day and drops at night so that you can sleep well. Commonly, (especially in hormone imbalance, perimenopause, and menopause) you will see cortisol rise in the middle of the night. That causes us to wake up in the middle of the night for no reason. Other than it is aggravating to be awake for hours in the middle of the night and tired during the day, the elevation of cortisol at night can negatively affect metabolism. Often we tell patients, forget waking up early to go to the gym. Just get that extra hour of sleep. One of the first things that we work on with patients is sleep. Sleeping properly is great for the waistline. Well you might be asking, Kavinace is no longer available, what do I do now? There are many options available to replace Kavinace and sleep well. Back when I first found Kavinace years ago, all we had available to us was GABA. GABA is a huge molecule that is not easily absorbed through digestion, so it was a waste to take. Now we have available, PharmaGABA, which can be absorbed through the digestive tract. PharmaGABA is a great alternative to Kavinace. You can take it as capsules at night or chewable tablets. If you are a tough sleeper, and still wake in the middle of the night, you can chew up 1-2 more t

Perimenopause vs Menopause | PYHP 057 Jun 26, 2019

It is common to mistake perimenopause for menopause and vice versa. Labs can be misleading. Doctors can be misleading in your concerns about whether you are in perimenopause vs. menopause. Even symptoms can be misleading. In this article, I am going to explain the differences between perimenopause and menopause. As well as information to help you determine which hormone phase you are in at the moment. Both perimenopause and menopause can start between 35 to 50years old. As the word states, perimenopause starts before menopause. While that might seem obvious, sometimes it is hard to differentiate between them. I have had many patients tell me they are in menopause but are really in perimenopause. You might be asking, ‘why is it a big deal to know the difference?’. That can come down to the treatment. Treating a woman for menopausal symptoms when she is in perimenopause can not only be ineffective. But can make the symptoms worse as well as new symptoms. Perimenopause usually starts in the mid-’40s, but I have seen it as early as the early ’30s. The average age of menopause is 51 years old, but I have often seen it occur in the mid-’40s. So while it seems that perimenopause and menopause can overlap, there are distinctions in the symptoms. Some distinctions between perimenopause and menopause: I will try to be as comprehensive as possible. Here are the most common differences in symptomatology between perimenopause and menopause. Periods: In perimenopause, if you still have your uterus, then you will be having a period. The periods can change from your “normal.” But you will still be having a regular period. What you might notice are periods might be heavier, longer, more spotting, more cramping. Often this can lead to low-iron/anemia. This is the time that women find out that they have fibroid(s). Fibroids are benign growths in the uterus and during perimenopause can become “active,” causing cramping, heavier periods and more spotting. This is usually the time women will get a hysterectomy. The periods are so “off” that most doctors only recommend a hysterectomy. Now that might correct the period “issues.” But it does nothing for the other symptoms. In menopause, the periods become less frequent. Might miss one or many months at a time. The period that you do have can come at any time. They might be light one month and then four months later a heavy, painful period. Hot Flashes and Night Sweats: In menopause, you will have lots of hot flashes and night sweats. But the distinction here is, in perimenopause you don’t have daytime hot flashes. But you will have night sweats, really bad night sweats. The night sweats in perimenopause usually happen anywhere from 7 to 10 days before your period. But once you get your period, the night sweats go away. Mood: In perimenopause, you are much more irritable than in menopause. That is one of the most common complaints in perimenopause. Short-fuse, low tolerance, very little patience for even minor offenses. The impatience and overwhelmed wound up feeling is not seen as much in menopause as it is in perimenopause.

Perimenopause or PMS? | PYHP 056 May 03, 2019

In this podcast, we talk about the difference between PMS (premenstrual syndrome) and perimenopause. We get this question all the time, Doc, I think I am going into menopause.' When really, they are nowhere near menopause, let alone perimenopause. What makes it so confusing is that there are so many similarities between PMS and perimenopause. But some distinctions are important to point out, especially when it comes to testing and treatment. PMS (premenstrual syndrome) is pretty much as it sounds. Symptoms appear prior (pre) to the period (menses). But usually, the symptoms appear in a cyclical pattern. The symptoms will appear anywhere from 14 days to just a couple of days before the period. The distinction between PMS and perimenopause, is the symptoms are present all month in perimenopause. Perimenopause is NOT menopause. It is the time before a woman enters menopause. It can be anywhere from age late 30's to late 40s. In perimenopause, you are still getting your period (it might be irregular, but you are STILL getting your period). But the symptoms between PMS and perimenopause are similar. So just to reiterate: Symptoms in PMS occur between 14 days to 2 days before your period. Symptoms in perimenopause occur all month long. Symptoms that are similar in PMS and perimenopause: Irritability: patience is short. Becomes easily irritated, even at situations that it is not warranted. Of course, you feel guilty after having a hormonal tantrum and cry and feel badly about the encounter. You are not crazy, it is your hormones. Acne Carb cravings Sleep issues –waking in the middle of the night and cannot go back to sleep Fatigue: low energy–both physically and mentally tired Anxiousness not always warranted for the situation Bloated: even though your bowels are moving fine Cramping before period even starts Symptoms that are different between PMS and Perimenopause All of a sudden your periods get weird. Periods come early or late. Your spot for days. One month your period is super heavy, and the next kinda light. Every month can be different in perimenopause. Crampy painful periods Symptoms all month long in perimenopause–it is like #pmsallmonthlong Symptoms 14 days to 2 days before your period Hair loss

How to Increase T3 Conversion? | PYHP 055 May 03, 2019

In this episode, we answer a reader question about her low T3. Kelli’s case is a bit complicated, but it sheds light on how important it is to address low T3 levels. We get this question all the time about the thyroid hormone, T3. Many will say, ‘my free T3 levels are low, but my doctor will not do anything about it’. We wanted to talk about low T3 and how there are many factors that can cause a low T3. Also on ways to increase your T3 conversion as well as some medications for low T3. We are also going to touch on autoimmune diseases such as Hashimoto’s, Type I diabetes and Celiac disease. Question from Kelli: My thyroid labs are all within the normal range, but I FEEL so depleted. My free t3 has never tested above 2.3. I have T1D and Celiac disease already. I know my body is prone to be difficult and function lower on some levels than most. How can I fix my free t3 if it is low and if the doctor says it’s not “treatable low.” One of our most popular blog posts is, ‘Low T3 levels”. This partly why we wanted to talk about Kelli’s concerns about her autoimmune diseases and her low T3. Kelli is one of a common predicament that we see all the time. Having low levels of FreeT3 but her doctor says it’s not treatable or just ignores it. Low T3 levels are very much treatable and should not be blown off. We really like Kelli’s questions because she also has Type One Diabetes (T1D) and Celiac disease. T1D is considered an autoimmune disease and shouldn’t be confused with Type Two Diabetes. T1D is where the immune system will attack the insulin-producing cells in the pancreas. So the pancreas cannot release insulin in response to elevated levels of blood sugar. Type One Diabetes is considered, insulin-dependent and most likely diagnosed before the age of 20. Kelli also has Celiac disease which is an intolerance to gluten. In the small intestines, there are little finger-like projections called microvilli which is what absorbs what we have eaten. Think of it as a long carpet/rug. You then squish up the rug together, so there are many undulations. This increases the surface area tremendously, and then there is more area to absorb nutrients. In celiac, because of the immune reaction to gluten will cause terrible damage to the microvilli. Causing the villi to erode consequently causing many symptoms including malabsorption and malnutrition. If Kelli has T1D and Celiac and Low T3 levels she very well may have Hashimoto’s. Hashimoto’s is a condition where the immune system creates antibodies attacking the thyroid and eventually causing lowered thyroid function. Hashimoto’s can be similar to celiac. There is a sensitivity to gluten in Hashimotos that patients do much better on a gluten-free diet. Hashimoto’s is similar to celiac bc gluten needs to be eliminated to reduce the Hashimoto immune response. Let’s back up a bit and explain about thyroid. The thyroid gland secretes mainly T4. T4 will travel in the bloodstream and convert to T3. Free T3 is the active form of thyroid. Even if you have perfect levels of T4 but low T3, then you could have symptoms of low T3. Doctors really don’t know what to do if the T3 levels are low. A lot

Can PCOS Occur With Regular Periods? | PYHP 054 Dec 07, 2018

For this episode, we wanted to answer another reader question. We love answering reader and listener questions. Also, we understand that you might not be getting answers from your docs and feel frustrated. Honestly, we really try to go into depth on answering these reader/listener questions as we want to be as thorough as possible on conditions, symptoms, dosing, and options. With that said, this is meant to be educational only and not meant for medical advice (there, my attorney will be very happy to have said that!). But as mentioned above, we want to be as thorough as possible in all aspects. This question is from Nickie. We love this question and really think others can relate to Nickie's situation. She has been told she has Polycystic Ovarian Syndrome and has been prescribed oral progesterone. She has concerns with taking progesterone, its side effects and the topical cream versus the oral. Nickie also has concerns with her symptoms such as trouble losing weight and thinning hair. So we are going to do our best to answer Nickie's questions as well as go into depth on forms, dosing, testing and options for PCOS. Nickie’s Question: Hi, I was prescribed 200mg of Prometrium a couple of weeks ago to take on day 20-30 of my 32-day cycle. I ovulate around day 16. Day 20 was the night before our vacation, and after reading some potential side effects, I decided to wait until this next cycle to take them for the ten days. They think I have PCOS, so I'm hoping it'll make it easier to lose weight. My main concern are the potential side effects of the pills. Do you think using the cream is significantly better/less side effects than taking the two pills at night? I'll also have a few drinks on the weekend and didn't know how that would interact with the medicine as well. I have about two weeks to decide which I want to do, so I'm looking for advice. Also a history I have many symptoms of low progesterone. Anxiety, thinning hair, inability to lose weight no matter what I do, and after having a miscarriage at 12 weeks last year, I had to take oral progesterone to stop the bleeding. Thank you! Dr. Davidson’s Response: First, we want to explain what PCOS is. PCOS stands for Polycystic Ovarian Syndrome. Which is exactly as it is described, being there are multiple cysts on the ovaries. In many cases of PCOS, the ovaries are likened to a string of pearls. Because there are so many cysts in the ovaries that it looks like pearls. However, there is so much more to it than just multiple cysts in the ovaries. Typically there are very high androgens, being testosterone

Is Progesterone Needed After Hysterectomy? | PYHP 053 Nov 16, 2018

This episode we respond to a reader question. Jayme had sent us a question earlier in the year based on an article we wrote. Now she has additional questions about taking progesterone as part of her BHRT. Jayme has had a hysterectomy and wasn't sure what dose of progesterone is best for her. Or for that matter, if she should even be taking it. Also, she has questions about her lab work and her estrogen dose. We really like Jayme's question, because we get similar concerns often. By answering Jayme's question, we hope to help other listeners understand a bit more about BHRT dosing, labs and progesterone with or without a hysterectomy. Just to throw it out there, this is not meant for medical advice and intended for educational purposes only… Jayme's question: Dr. Maki, Thank you for answering me. Recently my doctor increased my biest to 4mg twice a day. I also stopped my progesterone to see if it was making any difference and I felt exactly the same, so I have not continued it. I had a complete hysterectomy, do you have thoughts on taking progesterone? I was taking compounded progesterone 200mg/day. Before my biest increase, I had my labs taken twice in one day: morning and late afternoon because I was feeling like they wore off. I was correct: Jayme's Labs: Total estrogen 112 morning and 60 evening Estradiol 35.4 morning and

What Biest Ratio is Best for Menopause? | PYHP 052 Nov 06, 2018

In this episode, we respond to Karen. Karen read an article of ours on BHRT and sent these concerns about her menopause and hormone dosages. We love Karen's question because it shows how technical BHRT can be. As you will see from Karen's question, there are multiple aspects to consider when treating a woman with hormones. Karen’s Concerns: Her symptoms of weight gain, hot flashes, and night sweats The many avenues of dosing such as estradiol patches, hormones creams and the combination of taking progesterone, estrogen, and testosterone. What ratio of estradiol to estriol she should be taking. And even if she should bypass the static hormone dosing and take a rhythmic dosing schedule. Lab testing and what her levels may or may not be telling us. If she can apply estriol vaginally If estriol or some of these hormones are by prescription only Not to mention, understandably she is concerned about the risks of estrogen without sufficient progesterone. Karen's Question: I am struggling to find the right dosage and combination of BHRT. I believe that I am sensitive to Progesterone. I am 53 and started menopause at age 50. Hot flashes and weight gain are my two main symptoms (I was super thin my entire life, and now I'm 35 pounds overweight). I have 2-5 flashes a night not soaking, but they wake me (otherwise I would sleep fine) and always one at 4 or 5 am. During the day I have several not unbearable but that is only while on BHRT (when I stopped taking everything it was brutal). I have been taking some form of BH for about 2 years now. I tried the patch Estradiol started at .5 and increased to .75mg. My symptoms became tolerable, and the flashes were going away to the point that I only got the one early in the morning and maybe minor 1 or 2 during the day. But then I would take progesterone (pill) 100mg (and gradually tried to decrease). As soon as I took the progesterone, the flashes would increase in intensity and frequency. I switched to cream currently taking a combined cream of 5mg estradiol/gm, 30 mg/gm of progesterone, 6 mg of testosterone/gm 1/4 gm applied once a day. I still have difficulty losing weight, and flashes are still multiple times a night and throughout the day. (however, when I stop its 10 times worse). I'd like to switch to a biest and even cyclical dosing. I've read the Wiley protocol, but the dosing looks super high (at least to start).

Can Biest Cause Headaches? | PYHP 051 Oct 22, 2018

In this episode, we answer a reader question. This question is from Jen, responding to one of our articles. Jen's question is important because hormone treatment can often come as a prescription. And it is important to understand our prescriptions and if they are actually going to be beneficial. Jen's question relates to her current BHRT prescription that her doctor has recently put her on. She has side effects from her medication. Plus she is not noticing the effectiveness that she was hoping. Question From Jenn: Hi, I stopped cycle four yrs ago- for four weeks now – I'm taking E2/E3/T 1/1/4 (1/4 gr applied morning and 1/4 gr applied at night). If I am receiving 1/2 gram a day, I am receiving .50 mg E2 and .50 mg E3 & 2 mg of Testosterone. I am getting dull headaches at the back side of head 4 to 5 hrs before the 12 hours app time, but breast tenderness which I hate. I have asked my doc to up to 1.5/1.5 per gram still applying the same quantity (1/2 gram daily)- and request Testosterone in a separate compound. Meaning I will receive .75mg of each E2/E3 a day and hold off on Testosterone to see if headaches are lack of E for sure. After reading your responses, I wish I would have suggested a different ratio. Perhaps leave the E2 at 1mg/gr. Or drop to .50 and increase the E3 to 2.5 -3.0 mg. E3 might help w/breast tenderness? I take oral 1 mg prog at night. Your thoughts? Is 0.50mg/gr E2 which equates to receiving .25 mg of E2 a day too low, I want the benefits of E2 -hair skin happy, but don't want to feel fat and pregnant. Thank you in advance for your response and your thoughts. Jenn One thing we cannot stress enough is there is not a one-size-fits-all for BHRT dosing. Everyone is unique, and there are many aspects to developing an individualized BHRT plan. In our patient population, everyone's BHRT is based on their personal and family history, health goals, symptoms, as well as lab data. We then keep continuous follow up with them, because the body is not static. People's BHRT doses will change over time, whether it is age, change in health goals, stressors, symptoms, etc. It is important to keep close follow up with the patient to ensure their hormone doses are accurate and working well in their lives. We really like Jenn's message because her situation is common. She is on BHRT, but it is not quite working for her and alleviate her symptoms. Also, Jen is experiencing side effects from her prescription dosages. She is getting headaches and breast tenderness which is typical

What is Estriol Made From? | PYHP 050 Sep 21, 2018

When we started this podcast and writing articles, we were very naive about who would want to read this stuff. Honestly, I didn't think anyone would want to listen to a husband/wife couple-docs that only dealt with hormone balancing. Being an introvert, I am really pushing myself outside of my comfort zone with these articles and podcasts. I cannot believe how many readers and responses we have gotten. I am absolutely amazed at how many responses we have gotten from people outside of the USA. I am truly flattered and amazed that people from all over the world are reading and listening to our content. With that said, we have gotten lots of comments and questions from readers/listeners. It is hard to answer them one on one. So I wanted to write an article answering some questions that we have gotten. Some of these questions are from the states and others outside of USA. Regardless of where we are from, we still experience hormone issues. I believe these questions might help others going through the same hormonal imbalances. And help us to know that our concerns are valid and we are not alone. Question – Sherry Hi, What is Estriol made from? I know that Estradiol is from equine urine, and I stopped taking it for that reason and also it caused my breasts to get really large and very tender. I want a natural menopause supplement that isn't animal derived. Does Estriol fit this description? Thank you, Sherry. This is a great question. Many people are not sure of what BHRT and hormones are made from. Actual estradiol is not made from horse urine, or also known as equine estrogens. There are conventional hormone prescriptions that are made from horse urine. These are commonly called Premarin and Prempro to name a couple. But estradiol is a bioidentical hormone. But as we talk about on this episode, estradiol is the strongest form of the bioidentical estrogens. Estradiol is an amazing hormone. It helps with bones, mental energy, hot flashes, sleep, libido, and vaginal atrophy to name a few. But like I mentioned, estradiol can be quite strong. That is why Sherry is having the breast tenderness. For vaginal atrophy, we use estriol, which is the weakest, most gentle of the estrogens. It is great for vaginal dryness and atrophy without the side effects that estradiol can cause, such as breast tenderness and uterine thickening or spotting. So to answer Sherry’s question, both estradiol and estriol are bioidentical. But the estradiol may have been too strong for her, and that is why she had the breast tenderness. Question – Rachelle I have vaginal dryness, and I noticed a little bit of spotting today. I haven't had sex in over 3 yrs, but I do walk a lot. And I use cream from time to time. I also have a lot of burning off and on. The cream seems to help, but I don't want to use it too much. That laser sounds worth it but too expensive for me. I was concerned about the spotting. I just had my pap smear done, and it came back good. This questions came from an article that we wrote about vaginal dryness. The laser that Rachelle is referring to is a procedure that doctors are using to relieve vaginal dryness and incontinence. It works really well for both, and usually, only three treatments are necessary. But the drawback is that it can be costly, and insurance does not usually cover right now. We have seen many patients that have vaginal pa

What are the Symptoms of Low Cortisol? | PYHP 049 Sep 17, 2018

Question: Hello, I am an almost 41 yr old female and I just read an article about cortisol levels (vampire, ghost, and zombie) that you wrote, and I'm curious to know more. I think that I'm like the vampire the most, but not exactly. I had a saliva test done recently and the results said that my levels were extremely low in the morning, then went to normal around noon but then by 4-5 they were dropping again. My doctor put me on progesterone because my estrogen to testosterone ratio was pretty severe (high estrogen/low testosterone). Although I take them at night because they make me extremely tired, I can't but feel the struggle even more in the morning now. Will DHEA help? Or anything? Thanks, Jaime Jamie is referring to an article we wrote about cortisol levels, adrenal fatigue, and sleeping patterns. Cortisol is a very important hormone. Without cortisol, we cannot live. But having your cortisol levels balanced plays an important part in daytime energy and sleeping patterns at night. Cortisol is released from your adrenals glands in a diurnal curve . Meaning, cortisol is highest in the morning so you wake up bright eyed and bushy tailed , ready to start your day. Over the afternoon the cortisol will dip slightly. Come evening it will drop dramatically so you are ready to go to sleep and stay asleep all night long. In this episode, we talk about three dysfunctional cortisol curves that affect sleep and daytime energy. Having dysfunctional cortisol levels can create havoc on a person's quality of life. We didn't want to poke light at these dysfunctional patterns as these are serious issues. But to help with learning and teaching we created three types of dysfunctional cortisol patterns relating to adrenal fatigue. Three types of dysfunctional cortisol release patterns that affect and contribute to adrenal fatigue. We call these types, The Vampire, Ghost A / Ghost B, and The Zombie. Vampire: The Vampire has high cortisol in the evening and low cortisol in the morning. That makes the Vampire feel really good at night. Inevitability because Vampires feel so good at night, they have a hard time falling asleep. They will stay up late because they actually feel normal in the evening. But come morning, they have a hard time getting out of bed. These are the people that press snooze multiple times and usually takes them forever to get out of bed. Even though they reluctantly crawl out of bed, they still complain about brain fog and feeling tired until at least midmorning. Ghost: The Ghost is the person that falls asleep easily. They always say, I have no problem falling asleep. My head hits the pillow and I am out. But I always wake up a 2-4 hours later . That is because their cortisol is low in the evening. But will raise up in the middle of the night, waking them up. You will find your Ghosts roaming the house in the middle of the night. They might end up watching TV, eating, playing on their phones or even checking their email. Some get so fed up waking up in the middle of the night that they just get up and start their day. Most Ghosts feel fairly well in the morning. But they disappear and Ghost everyone in the afternoon. Between 1230 and 330pm

Testosterone Pellets vs Cream for Women | PYHP 048 Sep 05, 2018

We have have been getting a lot of questions regarding Bioidentical Hormone Replacement Therapy. We thought a good way to respond to these questions would be to answer them on the podcast. In this episode, we discuss a woman’s situation regarding her experience with testosterone pellets. Below is her exact email. Listener Question: Nina Hello there, I have loved reading all your info with regards to BHRT, Hypothyroidism etc. There are two things I would love to get your opinion on. Firstly a quick background.. I am on BHRT and have had two rounds of Testosterone Pellets. The first round, within 3 weeks of having it inserted I felt awful, couldn't sleep, cholesterol reading was high, cortisol readings were off the charts… and still only managed to get to my peak of 98 at 6 weeks( I believe the aim was to get to 150)… I swore I would never have it done again… however after 2 months and things had died down I decided to give it another go… this time my lovely doc increased the dosage to get me at my peak reading… this time around I was 10 times worse..my thyroid levels were bouncing around.. and had to increase my Synthroid from 75 mcg to 88 mcg and then to 100 mcg… couldn't sleep etc etc Have just had my thyroid levels checked again, I was edging toward being Hyperthyroid… so I'm now back to 75mcg…I am due for my 3rd round of Pellets and I've decided this is not for me. My GP just think this is all a coincidence when the Pellets are inserted.. my hormone doctor doesn't believe it either.. A friend s OBGYN said he dislikes the Pellets as he believes not enough study had been done on women, studies have come up that lipid and thyroid levels can go haywire… I'm trying to get info and coming up against a brick wall.. nobody seems to believe me… do you have any thoughts on this… I would REALLY love to hear them. Secondly.. I'm on Progesterone cream, have tried the tablets.. they were making me feel drowsy plus I was having some crazy dreams.. having said that after reading your article on uterine cancer and how it is better protected with oral progesterone, I'm willing to give it another try… My Hormone doc says I'm pretty sensitive to medication (which I am).. What do you think would be the best route for me to take with regard to drowsiness during the day. Hope I'm making some sense… Have bookmarked your page and will reread again and again… you seem to make so much sense.. I'm so glad I found you guys Many thanks – Nina The post Testosterone Pellets vs Cream for Women | PYHP 048 appeared first on

Why is Belly Fat Hard to Lose? | PYHP 047 Aug 27, 2018

In this episode, we talk about how to lose belly fat. Belly fat is one of the most common complaints we hear from our patients and listeners. Weight loss, especially in the stomach is very common and more of a consequence of hormones rather than food. This episode is an extension from our article, 11 Tips on How to Lose Belly Fat in Perimenopause'. Because of the popularity of the article we wanted to expand on belly fat and ways to combat it. This episode focuses on tips to help lose belly fat that you might not be aware of. That is because many of our tips go against the grain in the typical weight loss theory of eat less, exercise more. How many of you have gone on a diet ? I think I went on my first diet at 13 years old. For the majority of history, it has always been reduce your calories and exercise a bunch, and you will lose weight. While many do this over and over. The long game is, the weight might initially come off. But inevitably the weight loss will plateau and come back. How many of you have worked really hard to lose 15 pounds only to put most of it back on plus more, just by going back to a normal way of eating. You do not have to starve yourself and exercise like crazy to lose weight and maintain it. I have so many people complain that they are eating 1000 calories and do some form of intense cardio 5 days a week and they are actually gaining weight! I wish to lose weight that the simple math equation of calories in versus calories out acutally worked. That would be amazing. But there are too many variables, whether metabolic or hormonal that influence this equation making it obsolete. Reduce Stress: yes, this is easier said than done. But stress raises cortisol which then causes an imbalance of glucose and insulin. Insulin is the only fat-storing hormone. Stress can actually make your belly grow. Stress = Belly Fat. Get Better Sleep: getting enough restful, deep sleep will help prevent belly fat. Sleep is when we heal, and our cells recover. Not getting sufficient sleep will cause your cortisol to elevate at night. Which a mentioned above will alter the balance of glucose and insulin. I have had patients that we worked only on healthy sleep that lost weight. All they did was sleep better, and their pants fit better. Don't Drink Your Calories: we all know that we shouldn't drink soda or sugary drinks. Sure, we have all heard of a beer belly'. Yes, alcohol beverages like wine and beer can cause weight gain. But fruit juices are still loaded with sugar. Any drink with sugar will raise your glucose and then your insulin, then your belly. That goes for electrolyte sports drinks that are loaded with sugar. Even coconut water has a lot of sugar in it. Some protein powders are secretly loaded with sugar. If your protein shake/powder has more than 5 grams of carbohydrates, do not drink it. Ideally, find a protein shake that ha

How to Reduce PMS Symptoms Naturally? | PYHP 046 Jul 23, 2018

This episode of the Progress Your Health Podcast is a continuation to a recent blog post: 7 Tips on How to Cope with PMS. Most women have some PMS symptoms, but there is certainly a spectrum of symptom severity. For one woman, it might just be mild bloating, but for another woman, her cramps are so bad that she has to miss work due to the pain. Unfortunately, when you go see your primary care doctor, or even your Gynecologist, the only conventional treatment option is birth control and over the counter Midol. As we discuss in this episode, there a many things you can do to help reduce PMS symptoms. If you break down the word, Premenstrual Syndrome, it refers to the collection of symptoms that tend to show up prior to menstruation. It is common for PMS symptoms to show up somewhere in the 7 to 10 days before your period. This is time frame usually between ovulation and menstruation. As you might be aware, PMS symptoms can range from physical symptoms such as cramping and breast tenderness to emotional symptoms such as irritability and anxiety. Over the years, we have seen so many different types of PMS related symptoms. Some symptoms are obvious, but others can be less clear. If you seem to be having recurring symptoms every 2 to 3 weeks, it could easily be related to your cycle. Below is a list of some of the more common PMS symptoms. Symptoms of PMS: Sugar and carbohydrate cravings (especially refined processed carbs) Weight fluctuations (due to water retention) Gain weight easily during PMS, and then you have to work really hard to lose it Acne: especially around the chin and jawline Breakout on the neck, chest and upper back Bloated Constipated Breast swelling and tenderness Anxiety Spotting 4-8 days before a period Cramps Cramping can happen during the period or anywhere from 7-14 days before a period IRRITABLE! Angry outbursts, patience is nonexistent Crying Sad Trouble staying asleep Low sex drive

Can Thyroid Problems Cause Hair to Fall Out? | PYHP 045 Jun 25, 2018

When it comes to hair loss, the first question women ask is, “can thyroid problems cause hair to fall out?” The answer to this question is an obvious yes. The next question women will ask is, “can hair loss from thyroid problems be reversed? Again, the answer is yes, your hair will grow back, but the underlying hormone issue needs to be addressed. Something to keep in mind, hair loss is not always just a thyroid issue. When it comes to hormones, when one is out of balance, other hormones are also out of balance. For hair loss. this would include the major metabolic hormones and sex hormones. The hormones include cortisol, insulin, DHEA, Testosterone, estrogen, and progesterone. In this episode, we discuss ways to help hair loss from thyroid and other hormonal imbalances. For more information, you can read our article: Guide on How to Stop Hair Loss from Hypothyroid. We have seen many patients over the years and hair loss ranks towards the top of the list of importance. Women are so scared and desperate not to lose their hair and will do and try just about anything to make it stop. Unfortunately, many doctors are not interested, or not trained to treat your hair loss concerns. Patients have told us their doctor says nothing can be done, or simply refers them to a dermatologist. Hair loss is not just a consequence of aging. It is not something you have to simply accept, it is a symptom of an underlying hormonal or nutritional issue that can certainly be addressed. The thyroid gland plays a role with just about every system in the body. An underactive thyroid can lead to many symptoms, hair loss being a very common one that we see with many of our patients. When hair loss is due to hypothyroidism, it is from the root. It may be typically to find full pieces of hair all over the house. In the bathroom, bedroom, kitchen and even in the car. The hair will be thinning all over the scalp, but mainly on the top and the hairline. It is also common for people with hypothyroidism to be missing the lateral of their eyebrows, which is referred to as Queen Anne's sign. Below are some tips to consider in order to stop your hair from falling out. Ideas to help with hair loss from hypothyroid and other hormonal imbalances. No Dieting (lowers T3) Reduce cardio exercise (increases cortisol) Improve sleep quality (lowers cortisol) Thyroid medication with T3 hormone (raises T3 levels) Lower High Reverse T3 levels (due to T4 only medication) Improve Liver function (improves T4 to T3 conversion) Other issues that could be contributing to your hair loss:

Why do Uterine Fibroids Grow? | PYHP 044 Jun 18, 2018

Uterine Fibroids are benign growths inside the uterus. Some people do not know they even have fibroids and others have significant symptoms that can impact their quality of life. For more information, you can read our blog post about Uterine Fibroids. This podcast discusses: What are uterine fibroids? Typical physical and mental symptoms of fibroids. Causes of uterine fibroids What causes uterine fibroids to grow larger Uterine fibroids can be genetic, and you seem them run in families. Or it can seem out of the blue, and no one in the family has them except you. Either way, remember that uterine fibroids are not cancer. Uterine fibroids are benign growths. While fibroids are not cancer-causing, they can still affect a woman's quality of life. Fibroids can have many symptoms from minor to excruciating. Symptoms of Uterine Fibroids: Terrible period cramping. Seriously a 15 out of 10 on a pain scale. I have had some women that bring heating pads to work. Some women take so much Tylenol and ibuprofen that their liver and kidneys become compromised. Heavy periods. When I say heavy periods, I mean heavy periods. I have had some women that call in sick to school and work during the heavy days. I have had some women use two tampons at once (yes at the same time, inside) during the heavy days. Some women cannot even use tampons because the flow is so heavy, it will flush it out. The periods are so heavy that the women become anemic. Low blood iron levels from so much bleeding. Irregular bleeding. Fibroids can cause bleeding all month long. Spotting after exercise or finding blood on the toilet paper. There is nothing more of a buzzkill to sex is to notice bleeding. Mid-cycle spotting, spotting a week before and after a period. Some women can have one fibroid or many fibroids. Fibroids can be located all over the uterus. They are commonly found inside the uterus. But fibroids can also be inside the uterine muscle wall. Fibroids are inside the uterine wall can cause a tremendous amount of pain. I have had patients that have had hysterectomies because the pain is unbearable. There is so much more you can do for fibroids that removing the uterus. I understand, when there is that much pain and so much bleeding, a hysterectomy might be the best option. But there are other alternatives to help keep the symptoms low. And there are reasons for why the uterine fibroids actually grow in the first place. Lifestyle and food can cause existing fibroids to grow, creating more symptoms. And your own hormones can cause fibroids to grow, exacerbating symptoms. This podcast will explain in depth what lifestyle and dietary choices can increase the risk of fibroids. And what you can do to reduce the s

Will Endometriosis Return After Surgery? | PYHP 043 Jun 11, 2018

Endometriosis can be very painful. It can have a significant effect on a woman's quality of life. Below are few of the common symptoms of Endometriosis. Painful periods Pain with intercourse Heavy period Mid Cycle spotting Endometriosis occurs when the uterine tissue gets seeded outside the uterus. Removing the uterus can help tremendously with the following symptoms: Heavy periods lead to anemia Painful periods Mid Cycle spotting Bleeding outside of sync with your period Bloating As you probably already know, a Hysterectomy is the removal of the uterus. Leaving the ovaries inside and intact. Removal of ovaries is oophorectomy. Usually, with the hysterectomy for endometriosis, your surgeon will clean up and remove any endometrial tissue she/he sees in the pelvic area. Unfortunately, the endometrial tissue can grow back on the ovaries and elsewhere in the pelvic area in some people. It’s hard to say why. After a hysterectomy, you do not have the retrograde menstruation, but if there was any micro endometrial tissue, it can grow back. You still can get endometrioid cysts on the ovaries. Or elsewhere such as colon and bladder. The likelihood that endometriosis comes back or you experience the same pain as before the hysterectomy is much less. Women do say they have so much relief, but it can happen. Could be genetics, hormonal imbalance, lifestyle, or just luck of the draw. In the case of estrogen dominance that can exacerbate endometriosis. Estrogen likes to grow things. So if estrogen is high or there is not enough progesterone to balance estrogen, that can make endometriosis worse. Taking estrogen-only treatment or the dose of estrogen is high can cause endometriosis to flare to come back. The estrogen will grow the micro-lesions of endometriosis that your surgeon could not see. There are many factors that can increase inflammation and exacerbate the symptoms of endometriosis. Below is a list of factors that can increase overall inflammation: Smoking Sugar / High fructose corn syrup Processed and refined carbohydrates Alcohol High glycemic index foods Lack of healthy fats Below is a quick list of tips that can help endometriosis after hysterectomy: Reduce sugar Improve liver function (caffeine, alcohol, sugar) Low carb / ketogenic diet Increase healthy fats: olive oil, avocado, MCT, fish oil, Omega-3 fatty acids (EPA/DHA) Maintain a healthy weight Improve sleep quality Sometimes a Hysterectomy is the final option for a woman with endometriosis to get some relief. Typically endometriosis will improve significantly, but in some situations, it can reoccur after a hysterectomy. If you have any questions, please leave a comment below or you can send an email to help@progressyourhealth.com The post Will Endometriosis Return After Surgery? | PYHP 043 appeared first on .

What Does Endometriosis Feel Like? | PYHP 042 Jun 04, 2018

Endometriosis is a condition that affects many women. It is estimated that about 10% of females ages 15 to 49 are affected. I think this percentage of women with endometriosis is much higher than 10%. That is because the only sure way to be diagnosed with endometriosis is to have laparoscopic surgery. There are many signs and symptoms of endometriosis, but they tend to overlap with other hormonal imbalances. Often it is confused with fibroids, ovarian cysts, and painful, heavy periods to name a few. And like I said, the only sure way to know is having surgery and finding endometriosis in the pelvic cavity. What is Endometriosis? Endometriosis is the lining of the uterus has seeded itself elsewhere in the body. The top lining of the uterus is called the endometrium. It is the cells of this lining (endometrium) that is found outside of the uterus. Common places endometriosis is found: -Fallopian tubes: Sometimes it can cause scar tissue on the fallopian tubes reducing fertility or can contribute to an ectopic pregnancy (which is a health emergency). Ovaries: commonly it can cause ovarian endometrioid cysts. Colon Cervix Vagina Bladder Some rare reports have shown in the lung cavities and other organs Why is there Uterine Tissue Not in the Uterus? There are many conflicting theories on why the endometrium lining that is supposed to be in the uterus is elsewhere in the pelvic cavity. A long-held theory is in utero when cells are developing; uterine cells are seeded in other areas outside of the uterus. A more recent theory is there is a retrograde of flow during a period. The blood backs up and out of the uterus causing uterine cells to plant themselves anywhere in the pelvic cavity. New hypotheses are endometriosis is an extension of autoimmune and inflammatory diseases. But plenty of people do not have endometriosis. Why some do and not others? Like mentioned above it could be genetic, autoimmune, lifestyle, retrograde mechanical flow, etc. The old-school theory of developing in utero has pretty much been put on the shelf. Endometriosis often comes back after laparoscopic surgery. Sometimes it comes back slightly, moderately or its back with a vengeance after surgery. Which is why many women with endometriosis have had more than one surgery. The big question: What Does Endometriosis Feel Like? Pain: Pain is the number symptom that women with endometriosis are seeking answers. There are several types of pain that are experienced in endometriosis. And the pain is no reflection of how much endometriosis they have in their pelvic cavity. Some women have minimal endometrial lining seeded outside of the uterus. But report debilitating pain. Other women have stage fo

What Does Slightly Elevated Liver Enzymes Mean? PYHP 041 May 28, 2018

What Are Liver Enzymes? Liver Enzymes are made by cells throughout the body but are found in highest concentrations in liver cells. These enzymes are found inside liver cells, so when the concentration is elevated in the blood, usually indicates liver cells (hepatocytes) are inflamed, damaged for dying. Below is a list of the four common liver enzymes that are routinely tested on an annual basis or monitored due to certain medications, such as Statin drugs and acetaminophen. Liver Enzymes: Alanine transaminase (ALT) / Serum Glutamic-Pyruvic Transaminase (SGPT) Aspartate transaminase (AST) / Serum Glutamic-Oxaloacetic Transaminase (SGOT) Alkaline phosphatase (ALP) Gamma-glutamyl transpeptidase (GGT) Liver Enzyme Reference Range: (Quest Diagnostics) Liver Enzyme Test Male Female AST 10 – 40 U/L 10 – 35 U/L ALT 9 – 46 U/L 6 – 29 U/L ALP 40 – 115 U/L 33 – 130 U/L GGT 3 – 95 U/L 3 – 70 U/L What Does Slightly Elevated Liver Enzymes Mean? Something we have consistently observed with our patients over the past ten years is slightly elevated liver enzymes. Specifically, a slight elevation to AST and ALT. For example, on a routine Comprehensive Metabolic Panel (CMP), a woman will have an AST level of 54 U/L and an ALT level of 47 U/L. Both enzymes are slightly outside the normal range, but this often gets blown off by the primary care physician because the liver enzyme levels are not high enough to indicate major a concern. However, if the enzymes levels were in the hundreds, then the doctor would do some follow-up testing for some liver disease like Hepatitis.

Does Progesterone Make You Tired? | PYHP 040 Mar 19, 2018

Does progesterone make you tired? It is a lot more complicated than a yes or no answer. In this episode, we are going to explain this question in full detail. We are going to talk about: Types of progesterone replacement: creams, capsules, sublingual, troche Why progesterone is used to balance hormones When you usually take progesterone How much progesterone is a typical dose for treatment Progesterone is a common type of hormone replacement and is an excellent treatment for many of the symptoms associated with hormone imbalances that occur during Premenstrual Syndrome (PMS), perimenopause and menopause. We are also going to talk about how progesterone can help with symptoms of hormone imbalance. One of the most common symptoms is insomnia. Progesterone is fantastic for sleep. It is particularly helpful for helping women both fall asleep and stay asleep throughout the night. Many women complain of waking multiple times during the night or are awake for hours in the middle of the night. We are going to talk about how progesterone can help with healthy sleep. We are also going to talk about what forms and doses of progesterone help the most with sleep, mood, and energy. How some forms of progesterone do not affect energy or sleep quality, and other forms of progesterone can make you tired or sleepy. Why progesterone is used to balance hormones: Many of the symptoms associated with PMS, perimenopause, and menopause are related to an imbalance or a decline of progesterone. Types of progesterone: Of the different dosage forms of progesterone, we prefer to use bioidentical progesterone sustained release capsule with our patients. We have found this form to provide the most consistent results with our patients. In some cases, we might use a transdermal cream, but it depends on the situation. We rarely use sublingual tablets or progesterone troches. Capsules (either immediate or sustained release) Transdermal cream Sublingual tablet Troche How much progesterone is a typical dose for treatment? A common starting dose for women in menopause is 100 mg progesterone sustained release (SR) capsule. This amount can be increased or decreased depending on the response. For menstruating women, the dose can be as low as 25 mg and go up from there. When you usually take progester

How Do Hormones Influence Behavior? | PYHP 039 Mar 14, 2018

It may not always be obvious, but hormones have a significant influence on how we feel and our behavior on a daily basis. It is not something that is given enough thought to in medicine; however, it is something we pay a great deal of attention to because we understand the connections. Hormones dictate everything from eating to sleeping and just about anything else in between. When hormones are balanced, then our behavior normal. If hormones are not balanced, then emotions and behavior will suffer. For example, if someone is under heavy stress, cortisol will rise. Over time, the rise in cortisol can negatively impact the sleep process, resulting in chronic insomnia. Below are a few more examples of behaviors/emotions that are influenced by hormones: Sleep Hunger / appetite / food cravings Sex Drive (libido) Addiction Motivation/drive/ambition Focus/concentration Anxiety/depression Irritability Emotional/weepy Sad/melancholy Grumpy The relationship between hormones and behavior is a very complicated topic and one we will dive deeper on in the future. For now, hopefully, this gives you a bit more insight into how hormones influence our behavior. If you think that your hormones are having a negative impact on your behavior, please send us an email to help@progressyourhealth.com. The post How Do Hormones Influence Behavior? | PYHP 039 appeared first on .

Do You Have a Low Free T3 Level? | PYHP 038 Mar 05, 2018

Triiodothyronine also is known as T3 is the active form of thyroid hormone. T4 also known as thyroxine is made in the thyroid gland. T4 is then sent peripherally through the system, and mainly the liver will convert T4 to T3. You can have all the T4 in your body, but if your T3 is low, then you will have symptoms of low thyroid. If suspecting a case of low thyroid, thyroid disease, hypo or hyperthyroid your conventional doctor is going to run a TSH blood test. The TSH (Thyroid Stimulating Hormone) is a signal from the brain monitoring thyroid disease and the thyroid levels in the body. To put it simple: If the thyroid levels are high, then the TSH is low. If your thyroid levels are low, then TSH is high. As mentioned above the thyroid mainly makes T4, which is released into the blood and will travel in the body and be converted to the active form of thyroid, T3. Approximately 60% of this conversion occurs in the liver, about 20% is converted by gut flora and about 20% is converted by peripheral tissues, such as muscle. As we have always talked about before, your primary care doctor is looking for a ‘disease.’ If you have a ‘disease,’ your GP, internist, or endocrinologist can save your life. In the case of thyroid, your conventional doctor is going to run a TSH and perhaps a T4. That is because they are looking for thyroid disease, not low levels of T3. Many people with Low T3 get missed by their doctor because their TSH is in the normal range. They are told, “you are fine,” even though they do not feel fine. How do you know if you have Low T3? You can do a blood test for Free T3. Free T3 is the bio-available thyroid hormone ready for use. In checking for Low T3, you want to check the free T3 levels, not the Total T3 levels. Total T3 levels in the blood represent all Free T3 and bound T3 levels. Testing for total T3 levels is not going to be accurate enough to find out if you have Low T3. You may need to request blood testing for Low T3 from your doctor, or you may need to order it yourself if your doctor will not order it. Blood tests checking for Low T3 Level: TSH Free T4 Free T3 This is where it gets a bit confusing. The reference range for Free T3 is broad. Free T3 Reference Range: 2.3 to 4.4 (depending on the lab). If your Free T3 is under 3.0, we would consider this to be a Low T3 level. Testing results we commonly see in patients with Low T3: TSH: normal range usually between 1.0-3.5 (reference range is .45-4.5) Free T4: 1.1-1.4 (reference range is .8-1.8)

What is Subclinical Hypothyroidism? | PYHP 037 Feb 23, 2018

Here is a typical scenario: I don't know what to do I have all the symptoms of low thyroid. My hair is falling out. I am exhausted, no energy whatsoever. I have gained weight, even though I try to eat well and exercise. But honestly, I am too tired to exercise. Sorry for the TMI, but I am constipated, bloated and fiber makes it worse. I am feeling pretty low mood wise and so tired. My skin is really dry, and all I want to do is sleep. I went to my general practitioner, and she ran my blood work for thyroid. My doctor says my thyroid is fine. But I don't feel fine! Then she just told me to go on a diet and gave me a prescription for an antidepressant. I cannot tell you how many times I have seen this scene. That is because your general practitioner, endocrinologist, internist, PCP are looking for disease or if something is broken. But what if there is not a disease (thank goodness)? They really do not know what to do with you. To check for thyroid disease, your doctor will run a TSH (thyroid stimulating hormone). The TSH is a signal from the brain monitoring the thyroid status. If you have thyroid disease causing an underactive thyroid, the TSH will be elevated. And if you have an overactive thyroid, the TSH will be very low. But the TSH is checking for thyroid disease. We have a lot of patients that do not have thyroid disease but still have a subclinical, ‘hypofunctioning’ of the thyroid. Trying to keep this relatively simple, your thyroid gland makes T4 thyroxine, which is a very stable molecule and will travel in the system and mainly your liver will convert T4 to T3. Triiodothyronine (T3) is a very unstable molecule but is the active thyroid hormone. In Subclinical Hypothyroid, you will often see a normal TSH, normal T4 and a lower Free T3. Subclinical Hypothyroid: TSH reference range is .45-4.5 = see anywhere from .45 to 2.5 FreeT4 reference range is .8-1.8 = will see .8 to 1.1 FreeT3 reference range is 2.2-4.4 = will see 2.0 to 2.9 Again, your conventional primary care doctor, endocrinologist, GP, internist are looking to make sure you are not going to die of a disease. They are not going to check your Free T3. And rarely they may check your Free T4. But if they do, they do not know what to do if the TSH is normal. We find by optimizing your T4 and especially your Free T3; the Subclinical Hypothyroid symptoms go away. We still keep the TSH in the normal range but try to optimize the Free T3 to 3.5-4.4. This is done in many ways based on the patient's personal and family health history, their symptoms and goals. We might implement a combination of vitamins, minerals, glandulars, medication and lifestyle factors to treat subclinical hypothyroid. Hopefully, this has been informative and helpful to you. If you have any questions or personal stories, please feel free to email us at help@progressyourhealth.com. The post What is Subclinical Hypothyroidism? | PYHP 037 appeared first on

What is the Difference Between Estriol and Estradiol? | PYHP 036 Feb 17, 2018

Our bodies make three different forms estrogens: Estrone (E1) Estradiol (E2) Estriol (E3) Estrone is usually considered an unhealthy estrogen. It is still bioidentical, but you do not want loads of estrone around when you are balancing the hormones. Estrone is common in young girls when they first get their periods and after menopause. Estrone metabolites can raise the risk for cancer. This is why you do not want a high level of estrone, which can also cause moodiness, feeling munchie, puffy and grumpy. With bioidentical hormone replacement therapy (BHRT), we do not use estrone for the above reasons mentioned. Estradiol is the strongest of the three bioidentical estrogens. Estradiol is common in conventional hormone replacement in the form of oral, patches or transdermal. Premarin and Prempro are not estradiol and are not bioidentical. Because estradiol is the strongest of the estrogens, it has pros and cons to use. Pros of Estradiol: Great for keeping bones strong Eliminating hot flashes and night sweats Neuroprotective for the brain Great for short-term memory and memory recall Helpful for libido and sex drive Cons of Estradiol: Estradiol likes to grow things. (i.e. grow the lining of uterus, which can cause a risk of uterine cancer) Can cause spotting, bleeding, periods Grow breast tissue Cause breast tenderness Enlarge breasts which can be a risk factor Moody (weepy, irritable, anxious) Can be similar to a 24/7 feeling of PMS Weight gain Many women report gaining on average 6 to 8 lbs when taking conventional estradiol hormone replacement. It is primarily in the breasts and stomach. So how do we get the positive benefits of estradiol without the negative side effects? The best way to properly balance estradiol is to take estriol with it. Estriol (E3): Estriol is the gentlest form of estrogen. Some people refer to it as the weakest form, but I think that is a misnomer. When you combine estriol with estradiol you can get the beneficial effects of estradiol and estriol, without the negative side effects of estradiol.

What is Pregnenolone Used For? | PYHP 035 Feb 15, 2018

What is pregnenolone? It is a steroid hormone but is not a reproductive hormone like estrogen or testosterone. Pregnenolone is also made from cholesterol, which makes it a steroid hormone. It is also considered to be a pro-hormone,’ because it can convert into other hormones depending on the needs of the body. Recently, it has been discovered that pregnenolone is also produced in the brain and spinal cord, which makes it very potent on stimulating the central nervous system and having an impact on the brain. Pregnenolone is helpful for memory. It is stimulating to the brain for memory and learning, but at the same time, it is also neuroprotective. The brain is very complicated, and pages could be written on the process of memory foundation and degradation. What we are trying to say here is, pregnenolone helps with learning and also preserving memory by protecting brain cells. Other helpful uses for pregnenolone: Memory: short-term Brain fog Mental energy and mental motivation Helpful for learning new information Mood Focus Pregnenolone, like most hormones declines with age. However, pregnenolone can also drop in response to high levels of chronic stress. Whether that stress is mentally induced such as dealing with a family member's illness, PTSD or a stressful high paced life. Or physical stress such as intense daily cardiovascular exercise can diminish levels of pregnenolone. This is also known as ‘pregnenolone-steal.’ In times of chronic stress, the body will shunt the production away from the other steroid hormones to produce more cortisol. For women, the body will shunt production away from progesterone to make more cortisol. You can test for pregnenolone levels in the blood, but the lab reference ranges are so vast that most everyone will fall in normal ranges. Quest has a reference range of 22-237 ng/dL, and LabCorp’s is anything less than 151 ng/dL. Both are broad reference ranges. I like to see pregnenolone 80-100. If a pregnenolone blood test is less than 80 ng/ dL, I will treat the patient with pregnenolone. And after being on the pregnenolone for 1-3 months, I will retest the blood work to see where their levels are and how they are feeling. As we all know, too much of a good thing' is not-so-good. Taking too much pregnenolone can have side effects. There is not a lot of research on pregnenolone. There are some animal studies but not any real prolific human studies. For the layperson, there is not a lot of information about pregnenolone online. There are some contradictory statements on dosing, side effects, and safety. What I can tell you from my experience with patients, there are relatively little side effects with pregnenolone, as long as you keep the dosage uniquely prescribed for the patient based on their symptoms and the blood work readings. Pregnenolone is available over the counter/online without a prescription. Many pregnenolone doses are just way too high. I have had new patients walk into my office, and they are on 100mg or more of pregnenolone per day. There are a few exceptions based on

Do You Have a Dry Vagina During Sex? | PYHP 034 Jan 17, 2018

Painful intercourse is a very common complaint I get from patients going through or have gone through menopause. They do feel awkward speaking of vaginal dryness, especially with their male gynecologists. This is one of the most common symptoms of menopause, second to hot flashes and night sweats. Menopause is an inevitable course of life that all women will go through. In menopause, the ovaries are going to reduce and ultimately stop making estrogen and progesterone. The average age of menopause is 51.5 years of age. Also, commonly some women have had a complete hysterectomy and oophorectomy which is complete removal of the uterus and ovaries. This can be due to many health conditions such as Endometriosis, heavy/frequent bleeding, or fibroids. These women will go through what is called, surgical menopause,’ but either way, menopause can have a variety of symptoms. Unfortunately, dry, painful sex commonly occurs before, during and after menopause. A female may opt to take hormone replacement during menopause, or she might not choose to take hormones because she may not be a good candidate. This can be due to personal reasons, health conditions, family history, physician recommendations. Whether taking hormones or not for menopause, painful dry intercourse is a common symptom. It should also be noted that perimenopausal women can also have vaginal dryness. As we get older, our hormones inevitably decline. Even women as young as the late 30’s to early 40's can have pain with intercourse due to the slight drop in estrogen. Why is there painful dry intercourse due to menopause? Estrogen feeds the vaginal cells. Immature vaginal cells are called Parabasal cells. Having estrogen in the system will help convert the parabasal cells into mature vaginal cells. If you have vaginal atrophy, that means you have mainly parabasal cells in your vagina. If you have ever gotten the full report from your last pap smear, you will notice the report will say there is predominantly parabasal cells. The lack of estrogen in menopause is the culprit for painful intercourse and/or dryness. Options for vaginal dryness and painful intercourse: Personal lubricants are the first line of choice for painful intercourse, which can be helpful. However, in vaginal atrophy, the walls of the vagina can become narrow. You still might experience pain even with the lubricant, or the vaginal tissues are very fragile, and the lubricant cannot protect from the tearing. The next level of treatment is using estrogen topically. Your ObGyn may give you estradiol or Premarin cream/inserts for vaginal dryness. The problem with this is estradiol and Premarin are both very strong forms of estrogen. They usually enter the bloodstream if you use them vaginally. Estradiol is ‘bioidentical,’ but it is the most potent form of estrogen we make. So estradiol may not be appropriate for you or intended to be used long term. Premarin is made from pregnant horse urine and is not bioidentical. The entire ethical implications behind horse/animal treatment and Premarin is a whole other topic itself. For the appropriate candidate using estriol (E3) vaginally can help hydrate the vaginal cells and make them more resilient to tearing. Estriol is the most gentle estrogen that our bodies produce. Estriol is bioidentical and very helpful for skin and mucous membranes like the vagina. Unfortunately, your conventional doctor or ObGyn is not going to prescribe estriol for you. Now, this is where I am supposed to tell you: this information is intended for information only. It does not replace medical advice and it just at the disclosure of the reader. There is a product I like from the company Bezwecken, which is called

What Are the Best Supplements for Fatigue? | PYHP 033 Jan 16, 2018

As discussed before, fatigue is a broad topic with many multifaceted causes. I wish there were a magic pill that would help fatigue and was free from side effects or dependency, but there is not. Fatigue is commonplace, but a complicated symptom to address due to the many contributing factors. In our practice, the majority patients complaining about fatigue are relatively healthy and have no disease states, which is why their doctor has a hard time treating them. Unfortunately, there is no treatment specifically for generalized fatigue. In our practice, a typical triad of symptoms we see with almost every patient is the following: Low energy Stressed Weight gain (especially in the stomach) From our experience treating patients for the last 14 years, we wanted to share some supplements ideas that we have had success with increasing energy. Below is just a summary of some supplement ideas that have helped our patients. There are many other possibilities, and each practitioner has their preferred options. This information is not set in stone, but just some simple ideas that might be helpful to you. Something to also keep in mind, what works for one person, may or may not work from someone else. Liver/Insulin/Blood Sugar Support: Balancing blood sugar and improving insulin status will your energy. The better interaction between your liver, insulin, blood sugar, and cortisol, the better your energy and metabolism will be. The KCCP (keto-carb-cycling program) helps to balance the insulin/glucose/cortisol roller coaster. Supplements: Metabolic Xtra ChromeMate GTF Lipoic Acid Supreme Liver GI Detox Methyl B12 Adrenal Support: Adrenal support can also help improve energy and reduce fatigue over time. Restoring your adrenals helps to reestablish the stress response and HPA Axis, which is the brain / adrenal connection. Note: be careful with products containing glandulars, as they are not always needed. However, they can be helpful in the right situation. Supplements: Cortico B5-B6 (Vitamin B5) Adrenotone

Why Do I Feel So Tired All the Time? Pt 2 | PYHP 032 Jan 13, 2018

Fatigue and feeling tired is such a big topic. This episode is the second part of our podcast of ‘Why Am I so Tired All The Time.’ As we discussed, there are many reasons causing fatigue ranging from medication to having too much caffeine. Below is a list that with many (not all) of the causes of fatigue. Medications: such as antidepressant meds, anti-anxiety, heart meds. Liver – sugar, alcohol and overall number of medications Excessive amounts of Caffeine Anemia/low blood iron Insomnia/lack of sleep Stress: adrenal and thyroid Blood sugar/insulin imbalance Depression / Anxiety Stress / Cortisol Thyroid –hypothyroid, Hashimoto’s, Of course, fatigue is not just as simple as a list. We believe that fatigue is the interaction between the pancreas, liver, thyroid, adrenal glands, brain and reproductive organs. This interaction can also help explain adrenal fatigue or adrenal-dysfunction, which is such a vague term or concept. When you consider the interactions between the adrenals, pancreas, liver, and brain from outside factors, you can get some SERIOUS FATIGUE. Fatigue is one of the most common reasons why people visit the doctor. However, most of the time your conventional doctor cannot help you because the interactions of the organs/glands do not typically show up on a routine blood test. The stressful American Diet and lifestyle can make these glands and hormones react in a way that can eventually lead you to be tired. But in most cases, you do not have a disease. Because these organs are healthy, but behaving in a way that makes you tired. It is a complicated process to explain. To keep it simple here is a short list to explain how it works. Adrenals: High stress will cause an increase in cortisol, catecholamines (epinephrine and norepinephrine: aka adrenaline). This will cause ups and downs in energy, cravings for sugar and belly fat. Caffeine from coffee and black tea will also falsely increases cortisol and catecholamines (adrenaline) initially but will fall off over time. Pancreas: High glycemic foods and high levels of cortisol will raise your insulin. Insulin is the only fat storing hormone. Hence, causing weight gain and ups and downs in blood sugar. Ups and downs in blood sugar cause your energy to crash. Liver: The mitochondria in the liver become overwhelmed with high carbohydrate/sugar ingestion. This high carbohydrate/sugar will cause insulin elevation. Then you will not work as efficiently. That means the more sugar you eat, the more congested your liver is. The more congested your liver is, the less efficient it can work. An overburdened, congested liver will cause a drop in energy. Leaving you mentally and physically fatigued.

Why Do I Feel So Tired All the Time? | PYHP 031 Jan 10, 2018

One of the most common complaints we hear from patients is fatigue or feeling tired all the time. Unfortunately, fatigue is common, but a complicated symptom to treat. There are many possible reasons someone can be fatigued. Conventionally, when you go to your doctor, fatigue is all the same. There is no differentiation made; however, we see three different patterns of fatigue. Snooze Button: Are you one of those people who keeps pressing the snooze button in the morning. You are so tired and you just can't seem to get out of bed, so you keep pressing snooze. Every nine minutes, your alarm keeps going off, and before you know it you have stayed in bed for an extra 45 extra minutes. Afternoon Crash: Many patients mention they get really tired in the afternoon, usually between 2:00 to 5:00 pm. We refer to this afternoon drop in energy as the Thanksgiving Effect, which usually happens 30 to 90 minutes after lunchtime. Wire and Tired: In the evening, after a long day, many patients will mention their minds feel wired, but their bodies are exhausted. They want to sleep, but their racing minds won't let them rest. The stress from the day sets up this vicious cycle of poor sleep at night and fatigue during the day. Unfortunately, when we need to sleep the most, we often sleep the worst. In addition, this the 3 patterns mentioned above, below is a list of other possible causes of fatigue. This is also assuming that an underlying condition or diagnosis such as cancer or an autoimmune disease has already been ruled out by your doctor. Medications: such as antidepressant meds, anti-anxiety and beta blockers. Excessive amounts of caffeine and/or alcohol. Liver burden (meds, caffeine, alcohol, high fructose corn syrup) Iron Deficiency Anemia Insomnia Stress: cortisol Blood sugar/insulin imbalance Anxiety/ depression Hypothyroid, Hashimoto’s Allergies Autoimmune disease Cancer Of course, fatigue is not as simple as a list. Fatigue is very complicated with many contributing factors. For additional health resources, you can access our Content library and download the Keto Carb Cycling Program, which is intended to help you lose weight and improve your energy throughout the day. The post Why Do I Feel So Tired All the Time? | PYHP 031 appeared first on .

How to Resist Sugar Cravings? | PYHP 030 Jan 09, 2018

In our practice, one of the most common complaints we hear is about sugar cravings. Carb cravings are not only common but an obvious obstacle to our weight loss goals. How many of you have woken up in the morning and said, today is the day that I am going to eat healthy.' You start the day perfect. Breakfast is a good source of protein like eggs with some spinach and onions. Or maybe a smoothie with lots of greens, chia seeds, fruit and healthy protein powder. Lunch is a salad or yogurt. You drink lots of water because we all know that is healthy for us. And then BOOM! 3 pm hits. You feel a little tired, and then the carb/sugar cravings kick in. You have a little chocolate or a cookie. And then you have another and another. Dinner is protein and veggies and maybe a little carbohydrate like rice. You might eat a larger portion for dinner than you should, given the snacking before dinner. You are not alone when I say after dinner, you still want to snack. Full from dinner, you still want to munch on snacks. Then this entire cycle repeats itself the next day and the next. You feel like it's groundhog day. Unfortunately, this vicious cycle is about biology and has nothing to do with willpower. Sugar tastes great, but it can be addictive. Like little bursts of dynamite on your tongue and in your brain. But why, when we know it is not good for us, we still indulge? When you eat sugar or any processed carbs, it raises dopamine in your brain. Raising dopamine provides an instant feeling of pleasure. Dopamine is why people do drugs, gamble, sex addiction, and compulsively shop. When you think of dopamine, think of sex, drugs, and food. It's not called comfort food for no reason. Sugar and refined carbohydrates have a significant impact on the dopamine reward pathway. The more you have, the more you want. The best way to stop this vicious cycle is to stop sugar completely. That means no sweets, no treats, no refined carbohydrates, no processed food. Sounds simple, but it is far from easy. Trying to stop eating sugar and carbs can be hard. Again, biology is stronger than willpower. The saving grace is that if you can eliminate sugar and processed foods from your diet for two weeks, it gets easier the third week. If you can get to the fourth week without sugar, you are golden! Besides going cold turkey, there are some simple things you can do to help minimize cravings. First, we like to use the mineral chromium, which helps to take the edge off cravings. Below are a couple of options we have used with our patients. ChromeMate GTF FNX Zone With ChromeMate GTF, it supports healthy insulin levels and helps to balance blood sugar. The target dosage to curb sugar cravings is at least 1,200 mcg daily. With FNX Zone, it also helps to gently curb appetite and minimize cravings, making the evenings easier to handle. Please let us know if you are struggling with appetite or craving issues. Feel free to send us an email at help@progressyourhealth.com. You can also access our Content Library for more healthy resources. The post

What is Best Way to Lose Weight? | PYHP 029 Jan 05, 2018

The new year is here! And I am sure everyone has their new year's resolutions. The most common, eating better and losing weight. With the holiday season (speaking for myself), there has been way too much sugar, treats, alcohol and just too much food in general. It has also been wonderful to spend quality time with family and loved ones, but too much wine, dessert and too little/no exercise (again, speaking for myself). I am more than ready to eat better, exercise and stop wearing yoga pants all the time.We have a program to help you (and me) eat better, feel better, lose and maintain weight. Specifically belly fat, because that is where we have all gained it. This program is called the Keto-Carb-Cycling Program (KCCP). First off, caloric restriction is not going to work. We have all reduced our calories, suffered from hunger, cravings and being a little moody. Unfortunately, you lose a small amount of weight, which is mainly water, and muscle. Then binge and gain it all back. This program incorporates a keto diet, intermittent fasting with carbohydrate cycling. The whole point is to increase and balance your metabolic hormones. While at the same time, keeping you satiated and not restricting calories long-term. Individually, a Ketogenic Diet, Intermittent Fasting, and Carbohydrate Cycling are very popular and do help with weight loss. However, each has its pros and cons. After working with many patients over the last 14 years, we have found that by combining the three approaches together works best. It is more healthy to our systems and maintainable over time. Finally, you can start losing weight and keep it off. What is a Ketogenic Diet? A keto-diet is reducing your total carbohydrate intake so that you go into ketosis. Usually, our bodies run by glycolysis, which is the process of utilizing carbohydrates/glucose for fuel. By reducing your carbohydrate intake below 30 grams daily, your body cannot run by glycolysis. It must switch to burning ketone bodies for fuel, which is ketosis. When you are in ketosis, you are burning fat. So part of the KCCP is to put your body into fat-burning mode. Although, it is not ideal to be in ketosis for an extended length of time. Long-term ketosis is hard on the thyroid, can cause electrolytes/minerals deficiencies and drop neurohormones like serotonin. That is why we have combined intermittent fasting with carb-cycling to work together for weight loss, metabolism, and overall health. What is Intermittent Fasting: Intermittent fasting (IF) is eating your meals in a 6 to an 8-hour window and fasting for 16 to 18 hours a day. Commonly IF is eating meals between noon and 8 pm. A lot of people tell me they already do this eating style, but they can't lose weight. They skip breakfast and have lunch and dinner only. Most of the time, this pattern turns into chronic caloric restriction, which is why we recommend adding in more carbs on a strategic basis. What is carb-cycling: Carbohydrate cycling is adding starchy carbohydrate to the diet. The carb-cycling is done on a specific schedule and eaten only in the evening. A starchy carb might be a sweet potato, beans or rice. Having the carbohydrate at night will help keep neurohormones up such as serotonin and helps improve sleep quality. It also fills up your glycogen stores in your mu

Does the Ketogenic Diet Work? | PYHP 028 Jan 03, 2018

Welcome to the new year, 2018! It is going to be a great year. With the start of any new year, everyone is ready to eat better and lose weight. Since when did my fat jeans' become my regular jeans lol! With the holiday festivities behind us, it is time to get back on track with our eating and get back into our skinny jeans! Over the years there have been numerous diet' programs for weight loss. As many of us know, diets are not sustainable, which is why we might lose 15 lbs but gain it back and more. Or we lose a little weight only to plateau and feel like our efforts are fruitless. One approach that seems to have spanned the ages is, eat less, exercise more.' We all have tried it once or many times, even though it always backfires on us. People still keep trying to rein in their calories and exercise like crazy after the new year. Reducing calories is not a good strategy for weight loss. One of two things will happen when you cut calories: You will lose weight initially, and then you will gain it back plus more. Either by binging, because your body cannot take the starvation mode.' Or you eventually begin to eat like a normal human. The intake of normal eating' is too much for your already starved body that the weight come back. The rebound weight gain is inevitable. You initially lose 8-15 lbs, making you super encouraged. However, after that initial weight loss, it stops. You frustratingly stop losing weight no matter how little you eat or how much more you exercise. A few things that reducing calories can do to you: Caloric restriction will lower your thyroid function. If your body thinks it is starving, your thyroid function will drop, which will reduce your metabolism.’ Lower thyroid function can also cause hair loss, dry skin, and fatigue. Cutting calories can also force your body to break down muscle tissue, further lowering your metabolism. Caloric restriction will also Increase cravings for carbs and sugar. There are many hormonal and neurotransmitter changes that occur when you drop your calories. Specifically, a neurotransmitter called Neuropeptide-Y will increase, which makes you want to eat sugar and processed refined carbohydrates. Caloric restriction stresses the adrenal glands. Reducing calories will cause cortisol to rise. Elevated cortisol will also break down muscle tissue. Breaking down muscle tissue will raise your blood sugar, which in turn causes your insulin to increase. Insulin will take the blood sugar from the breakdown of muscle and cause you to store fat around your midsection. Essentially, you are trading muscle for fat. The Ketogenic Diet has been around for decades but is currently trendy for weight loss and overall health. There are many opinions regarding its viability as a dietary strategy. It is a low carbohydrate diet, but there are many more aspects to it. A Ketogenic Diet is much better than just reducing your calories for weight loss. What is Ketosis? When we eat carbohydrates, our bodies run by a process called, Glycolysis. This is the process of burning glucose/sugar is our primary fuel source for energy. When we dr

How Do I Get Rid of Belly Fat? | PYHP 027 Dec 29, 2017

Getting rid of stubborn belly fat is one of the main complaints I hear from patients. In particular, the female patients. More specifically, the female patients over 40 years old. Why is it you can eat a cheeseburger, fries and shake when you are 20, but forget it at 40? Why does it seem that the waistline keeps growing regardless of exercise and diet? This is where it becomes an issue of balancing metabolic hormones rather than eating less or exercising more. Our metabolic hormone balance at 20 is vastly different from 40. I know it sounds like age, but it is more about metabolic hormones. Even in younger women, there can be a metabolic hormone imbalance. It isn't really about age, but more about the chronic stress altering our metabolic hormones causing one of three things: Weight distribution changes Waistline enlarges, and legs get thinner Belly fat, muffin top, and back fat All of it: back fat, muffin top, spare tire and thin legs Chronic stress affects all of our hormones. Mainly causing insulin and cortisol to rise. The increase in insulin and cortisol will shift sugar/glucose storage toward fat storing rather than fat burning. What is chronic stress? And why is my insulin elevated because I am a stressed out hot mess? What is the solution to get rid of belly fat? If the goal is to get rid of belly fat, then you must reduce/balance insulin and cortisol. The next million dollar question: how do I reduce insulin and cortisol? Because my stressed out hot-mess of a life isn't going away! Let’s keep it simple! We have a program called the Keto Carb Cycling Program (KCCP), which we designed to help you lose that stubborn belly fat. You can download the KCCP for free from our Content Library. Then, all you have to do is follow it. Of course, this is easy said than done, so be gentle with yourself and take the necessary time to allow it to work. Visit progressyourhealth.com to gain access to our content library. The post How Do I Get Rid of Belly Fat? | PYHP 027 appeared first on .

How Much Do Bioidentical Hormones Cost? | PYHP 026 Dec 28, 2017

Two common questions we get all the time is: how much does BHRT cost? And will my insurance cover it? If I had a dollar for every time, I have been asked this question I might have a pair of those fancy Christian Louboutin heels. It’s okay because I can't stand heels anyway, but the cost of Bioidentical Hormones is undoubtedly a significant concern. People have budgets, so they need to know if their BHRT is going to cost them a car payment, nothing or something in between. Considering BHRT can be an ongoing monthly prescription, these are valid questions. I have been prescribing BHRT since 2004. In that time, the cost of BHRT and insurance coverage has changed a lot. Since BHRT has increased in popularity, some compounding pharmacies have started charging more and more. Injectable growth hormone is a perfect example. Per month growth hormone has gone from the price of a fancy dinner to more than a round-trip airline ticket to Hawaii. Also, we are well aware of the breakdown and many changes to our healthcare system. This change made what used to be almost 100% coverage of BHRT to pretty much 0%. I work with a few compounding pharmacies, and I am very particular which pharmacies those are. Price is an essential factor, but quality and safety is the main priority. BHRT is not a supplement or vitamin. BHRT are prescription medications. That means you do not want to take something that you might be questioning quality over price. Compounded thyroid medication is a good example. If the T3 (Liothyronine) dosage is altered by the smallest of micrograms, a patient can end up in the emergency room with a heart arrhythmia. So what are you going to pay for BHRT? Unfortunately, this is a loaded question without a definite answer. It depends on how many BHRT prescriptions you are taking. As well as what dosage and the type you need for your specific health goals. To be incredibly broad (sorry) each prescription is going to cost between $30 to $70. With the average cost of a prescription being right around $50. Sorry to break this to you, but insurance is most likely not going to cover any of it. Some insurances might cover a portion of the prescription, but usually not the full cost. Conventional hormone replacement can be covered by insurance, but these hormones cannot be tailored to the individual and have some unwanted side effects. This is why patients do well on custom BHRT, but unfortunately, there is going to be an out of pocket pricing. I understand this episode may seem vague and might leave you frustrated. But honestly, this is the best I can tell you. And I am sure the cost and insurance coverage will continue to change. If you have concerns, questions or even your personal story, please post in the comment box below or email us at help@progressyourhealth.com The post How Much Do Bioidentical Hormones Cost? | PYHP 026 appeared first on .

Who is a Candidate for BHRT? | PYHP 025 Dec 22, 2017

Traditionally when one thinks of Bioidentical Hormone Replacement Therapy (BHRT), they immediately think of menopause. That hormone therapy is used to treat menopausal symptoms such as hot flashes and night sweats. But in the last 10-15 years, hormone replacement has become more than a fix for hot flashes. But did you know that you can use BHRT for memory, energy and even libido? Did you know that men and women of all ages use BHRT? There are many other conditions that BHRT can treat. Below are a few conditions that BHRT can address that you may not know about. Hypothyroid: When people think of hypothyroid medication, you may think of Synthroid or the porcine thyroid (Armour/Nature Throid). However, Compounded Thyroid, which is a combination of Levothyroxine and Liothyronine, is an excellent option to treat hypothyroid. PMS: Using bioidentical progesterone helps to alleviate some of the symptoms related to PMS. You can use progesterone in many different dosage forms depending on the situation. From creams to capsules, to troches to vaginal suppositories. You can use bioidentical progesterone all month long or just part of the month or even a few days of a woman's cycle for PMS symptoms. PCOS: The conventional approach to PCOS is to prescribe birth control pills. However, this is such a limited treatment approach, and there are some potential side effects associated with birth control. But with BHRT you can individualize the doses of BHRT to the patient. This can help with PCOS symptoms but also help with the long-term effects of PCOS on the body such as the androgenic effects and fertility. Perimenopause: My patients in perimenopause describe it as feeling like they have PMS symptoms all month long. Plus, it is not healthy to use birth control pills in a perimenopausal female. Bioidentical hormones can be used effectively and safely to help women with perimenopausal symptoms. The symptoms range from irritability to trouble sleeping. From low libido to hair loss and acne. Bioidentical hormones can even help with perimenopausal weight gain. Low Testosterone aka Low T : Men can use Bioidentical Testosterone to address Low T. Conventionally low testosterone is treated with injections and gels, which can be expensive and cause some unwanted side effects. Besides, conventional testosterone cannot be tailored to the patient. Whether it is personal symptoms or family health history, hormone replacement therapy needs to meet the needs of the patient. Conventional this can be difficult to do. But with BHRT you can design the testosterone to the patient. Adrenal Dysfunctions/Adrenal Fatigue/ Adrenal Insufficiency: There is more to Bioidentical Hormone options besides just the reproductive hormones. You can use BHRT to treat Adrenal Fatigue. BHRT for adrenal fatigue can include pregnenolone, DHEA, and hydrocortisone. These hormones can also come in creams, sublingual, capsules, and tablets. Menopause: This is what everyone thinks of when they hear Bioidentical Hormone Replacement Therapy (BHRT). The great aspect of BHRT is you can make any dose you want depending on the particular patient's symptoms. For women in menopause, there are many different symptoms and goals for each person. For some women, their goals are to reduce hot flashes and night sweats. Other goals for women in menopause are low libido, vaginal dryness, and pain with intercourse. Others, it's dry skin and tonicity. Other women help with preserving bone density. With BHRT you can custom design the doses for the goals of the person. As you can see Bioidentical Hormones Replacement Therapy can be helpful for more than just menopause. BHRT can be prescribed for men and women of all ages. There are exceptions to who is and is not a candidate for BHRT, but that is another episode in itself. Develo

Do I Have Estrogen Dominance? | PYHP 024 Dec 20, 2017

As I have always stated before, us ladies are a symphony of hormones. If one hormone is out of tune, it is quite apparent. However, sometimes it is hard to hear what instrument (hormone) is out of tune because when one hormone is out of balance, others seem to follow suit. So remember, it is not a good idea to fixate on one hormone being out of balance. It's about balancing them as a whole. Patients tell me all the time, they have estrogen dominance.' They read on the internet, and their symptoms fit estrogen dominance.' Yes, their symptoms do fit estrogen-dominance, but It does not mean their estrogen is the only hormone that is off. I am going to go through some common estrogen dominance symptoms' that you might find on the internet. And I will explain what other hormones might be at work here besides estrogen. Later in another episode, I will delve into more detail, causation, and treatment to balance our hormones. PMS: “My PMS is off the chain 7-10 days before my period! . This is actually because the progesterone is too low compared to the estrogen level. It is not that estrogen is too-high, but because the progesterone failed to peak after ovulation or it dived too quickly before your period. Fibrocystic breast tissue: If your estrogen is high, it can cause dense breast tissue and fibrocystic breasts. Estrogen likes to grow things. So if estrogen is not balanced or is high, the breast tissue will thicken and can become fibrocystic. Also, caffeine can exacerbate or lead to fibrocystic breast tissue. This is because the progesterone level is to low for the amount of estrogen. Your estrogen levels might be “normal,” but because the progesterone is lacking it cannot hold back the estrogen. So estrogen will continue to grow that uterine lining. Headaches: This again is because the progesterone is too low for the amount of estrogen. A drop in progesterone can cause hormonal headaches starting at 14 days before your period. If you have headaches the last half of your cycle, your progesterone might be too low. Breast swelling and tenderness: Estrogen can cause water weight. Our breast tissue is very sensitive to estrogen. So if your estrogen is high, it can cause water retention in the breast tissue, making them feel full, heavy and, tender. Weight gain in the belly: Female hormones can contribute to weight gain, but not by themselves. It happens via the connection that estrogen/progesterone has with insulin and cortisol. High levels of cortisol and insulin will cause fat to accumulate around the mid-section. When the progesterone is low, or estrogen is high, that can cause insulin and cortisol to elevate. This will make you gain weight and also make it hard to lose. Mood swings: Feeling grumpy, snarky, irritable, weep, or sad. When the progesterone to estrogen balance is off, it can definitely affect our moods. If progesterone is low, that causes irritability. When you feel like everything it aggravating and you are quick to anger. That is low progesterone. If you feel weepy and nostalgic, that is high estrogen. Decreased sex drive: I think this is because the progesterone is too low and it makes us irritable. And us ladies do not want to have sex if we are angry or aggravated. High levels of estrogen do not drop the sex drive. Low levels of estrogen drop the sex drive. That is why sex flies out the window when we enter perimenopause or menopause. Fibroids/polyps/exacerbated endometriosis: Again, estrogen likes to grow stuff. If estrogen is high, it can also grow fibroids and polyps. It does seem to aggravate endometriosis. Cold hands/feet, hair loss, foggy thinking, memory loss: If you have any of these symptoms, then we want to look at your thyroid. Thyroid comes into play with estr

What Causes Heavy Periods? | PYHP 023 Dec 18, 2017

You know you have heavy periods when . When you have tampons everywhere. In every single purse, the glove box of your car. In the glove box of your friend's and spouse's car. In the kitchen drawers, all bathrooms, in your jacket pockets, even your grocery bags. You never wear white. You don't own white underwear because at some point they will no longer be white. You know exactly when and how much ibuprofen you can take. You have a whole bunch of the light tampons because you never use them from the box. You laugh at the purple Tampax lites. Because seriously, what magical woman actually uses them? And we hate her. You time everything around your period. How long can I stay in the meeting? How long is that exercise class? How long is that road trip and what are the stops on the way? You always get your period right before or during vacation. You devote an entire bathroom cabinet to super-heavy-plus tampons and those huge, bulky overnight pads. If you have heavy periods, aka menorrhagia, then you know quite literally what a pain it can be. From the pain of cramping to always knowing where is the closest bathroom. For the most part, heavy periods are benign, just bothersome. (But if you have heavy periods make sure to discuss with your doctor so that you do not become anemic and test for underlying diseases/disorders.) But what causes heavy periods? Below are some of the more common reasons women may develop heavy periods. Estrogen-Progesterone Imbalance: Having an elevated level of estrogen or lower progesterone can cause heavy periods. Estrogen is the best hormone in the world. Estrogens keeps your skin youthful and hydrated. Your own estrogen is good for your heart, bones, brain, hair, sleep, and libido to name a few. But she can be a runaway train if not balanced. Estrogen likes to grow-things. Estrogen grows our breast tissues and uterine lining. If there is an imbalance of lower progesterone to estrogen, she will grow the uterine lining so thick that you practically hemorrhage once a month. It is important to have your hormones checked and balanced if you have heavy periods. Low thyroid function: Hypothyroid can also contribute to heavy periods. The thyroid also helps to rein in estrogen's negative effects. If your thyroid is low, the estrogen will grow that uterine lining very thick. So that you will have heavy periods and also commonly spot through the cycle. It will also cause the period to last for what seems like FOREVER. If you have heavy periods, mid-cycle spotting, long periods, talk to your doctor about testing your thyroid.

How Much Do Blood Tests Cost? | PYHP 22 Dec 15, 2017

With all of the recent changes in health insurance, blood testing is more expensive than ever. Below are few questions and situations we get from our patients and thought it would be good to discuss. Do any of the following sound familiar? My Doctor Won’t Order Thyroid Function Test, What Should I Do? We see […]

Which Thyroid Medication is Best? | PYHP 21 Dec 11, 2017

Which thyroid medication is best? This is a question we get from patients quite often. Conventionally for hypothyroidism, there is one medication prescribed. Regardless of your gender, family/personal history, symptoms, goals. If you need thyroid replacement, you will get Synthroid. If you have had your thyroid gland radiated, now it is hypothyroid. If you have […]

How Do I Know If I Have Hashimoto Thyroiditis? | PYHP 20 Dec 09, 2017

Hashimoto Thyroiditis is an autoimmune process where your immune system will attack your thyroid gland. This attack will eventually cause the thyroid function to drop. Inevitably, Hashimoto’s disease causes hypothyroid. There are two primary blood antibodies to test for Hashimoto’s disease. Thyroid Peroxidase Antibody (TPO) Thyroglobulin Antibody (TgAb). If you have one or both of these […]

What Are The Best Blood Tests for Thyroid Function? | PYHP 19 Dec 07, 2017

The most common test for thyroid is the TSH, which stands for Thyroid Stimulating Hormone. Unfortunately, this is also the only test most conventional doctors use to screen for thyroid disease. If the TSH is elevated (above 4.5 mIU/L), you are hypothyroid, and if the number is low (below 0.45 ng/dL), you are hyperthyroid. […]

My Doctor Will Only Test TSH for My Thyroid | PYHP 18 Dec 06, 2017

“My doctor will only test my TSH level for my thyroid. He/She says my thyroid is normal based on my TSH level, but I feel I have a thyroid problem! I hear this all the time with my new patients. They have been to their internist, their primary care, and even endocrinologists, but they get […]

Why Do I Get Hot Flashes? | PYHP 17 Dec 05, 2017

First off, who gets hot flashes and night sweats? There are medical conditions, medications that can cause hot flashes and night sweats. But commonly, hot flashes and night sweats are a female thing. I know… us ladies are so complicated. But so worth it! Why do women get hot flashes and men do not? Why […]

Do You Have Trouble Sleeping? | PYHP 16 Dec 02, 2017

Do you have trouble falling asleep? There are many reasons that people have trouble falling asleep. Reasons for poor sleep quality vary from medications, menopause, chronic pain to travel. For this episode, we want to talk about stress and its effect on your sleep. Stress can come in many forms from physical to mental. Stress […]

What Are the Effects of Stress on the Body? | PYHP 15 Nov 30, 2017

As I mentioned, we recently moved to Washington state. It was a quick move to find a place to live, get an office and deal with some family drama. As well, we had to maintain our Las Vegas and California offices in the meantime. For me, it has been pretty stressful. I am certainly not […]

We Are Back | PYHP 14 Nov 27, 2017

First, an apology is necessary because we have been away for so long. Even though we have been away for some time, we are glad to be back. The Progress Your Health Podcast and all our listeners are very important to us. We enjoy providing you with hormone related information. As our loyal followers, […]

What is Leptin Resistance? | PYHP 13 Apr 13, 2017

What is Leptin Resistance? The body has an elaborate hormonal mechanism to regulate appetite and hunger. One of the major hormones is leptin, which is a satiety hormone produced by our fat cells in response to a meal. Once released, leptin signals an area of the brain called the hypothalamus. This signaling turns […]

What Does Cortisol Do? | PYHP 12 Mar 29, 2017

Generally speaking, hormones control how the body either loses or gains weight. Stress has a major effect on hormones, which also contributes to weight gain. Thus, cortisol, which is often referred to as the ‘stress hormone,’ plays a major role in this process. Cortisol is a glucocorticoid,’ because its effect on blood glucose. For example, […]

How Does the Body Balance Blood Sugar? | PYHP 11 Mar 15, 2017

The body spends a great deal of energy to balance blood sugar with a very specific hormonal mechanism. The two main hormones are insulin and glucagon. Insulin an incredibly important hormone in our bodies. It is released in response to glucose in the body and allows the glucose to enter the cell to supply energy. […]

Familial Adenomatous Polyposis – A Genetic Miracle Case Study | PYHP 10 Mar 01, 2017

Familial Adenomatous Polyposis Familial Adenomatous Polyposis, which is abbreviated to FAP, is a genetic condition resulting in a mutation to the Adenomatous Polyposis Coli (APC) gene. The APC is a tumor suppressor gene located on the 5th chromosome. Mutations to this gene result in an increased risk of developing colon and other types of cancers […]

Testosterone Replacement Therapy for Women | PYHP 09 Feb 15, 2017

For women, testosterone is not a reproductive hormone. Obviously, estrogen and progesterone are the main reproductive hormones. Testosterone is an androgen produced by the ovaries, adrenal glands and peripheral tissues. However, testosterone acts as more of an adrenal hormone, similar to DHEA, so the symptoms of low testosterone in women can mimic that of adrenal […]

Testosterone Replacement Therapy for Men | PYHP 08 Feb 08, 2017

Over the past few years, testosterone has become very popular. There have been countless ads for prescriptions, herbal products and clinics all over TV and the internet. This begs the question, does testosterone really live up to all the hype? Is testosterone the panacea as it has been claimed? The answer to this question is […]

Appetite Control Using Amino Acid Therapy | PYHP 07 Jan 31, 2017

One of the big challenges when trying to lose weight is our brain. We may experience an exaggerated appetite or cravings, which can sabotage any weight loss goal. Most weight loss programs are focused on caloric restriction and providing medications, one being phentermine for appetite suppression. A safer, more effective alternative is Amino Acid Therapy […]

What is Intermittent Fasting? | PYHP 06 Jan 30, 2017

Up until fairly recently, a popular dietary approach for weight loss was to consume several small frequent meals throughout the day. The rationale behind this strategy is that eating every 2-3 hours would increase metabolism and the pounds would drop off. A popular new dietary strategy called Intermittent Fasting is questioning this previous approach. We […]

Weight Loss is a Hormone Problem | PYHP 05 Jan 29, 2017

Why do we have so much trouble losing weight and keeping the weight off over time? This is an important question that millions of people are struggling with everyday. For decades, doctors, fitness professionals and even the government have promoted the idea that weight loss is simply a calorie problem. To have success, all […]

Why Do I Have PMS? | PYHP 04 Jan 28, 2017

A very common and obvious indication of a hormone imbalance is Premenstrual Syndrome. PMS is not actually a disease, but instead a collection of several physical and emotional type of symptoms that a woman can experience prior to the start of her period. For many women, the symptoms of PMS can begin 7 to 14 […]

Functional Approach to Adrenal Dysfunction | PYHP 03 Jan 27, 2017

Adrenal Fatigue is also known as Adrenal Insufficiency or Adrenal Dysfunction. There are many hormones released from the adrenals and it would take hours to go over all of them. In this episode we are going to give a overview about what Adrenal Fatigue is, where it comes from and options to work on this […]

Functional Approach to Hypothyroid Issues | PYHP 02 Jan 26, 2017

Over the last few years, there has been an increased awareness of thyroid conditions, specifically hypothyroidism. The proper thyroid evaluation has become somewhat controversial as well. For decades, a simple TSH (Thyroid Stimulating Hormone) test has been the conventional test of choice in screening most thyroid related issues. However, an ideal thyroid evaluation is […]

Welcome to The Progress Your Health Podcast | PYHP 01 Jan 25, 2017

Welcome to the first official episode of the Progress Your Health Podcast (PYHP). Previously, we published another podcast called The Dr. Rob Show, which is still on iTunes. The co-hosts of the PYHP is a husband and wife team of Dr. Robert Maki and Dr. Valorie Davidson, who are both Naturopathic Physicians and graduates of […]

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