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:

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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 [email protected].

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 having her course right away. Maybe allow a little bit of time but, honestly, it is not really that big of a deal for him if they were to do that, spontaneously or something, once in a while, maybe every night. I am sure they are not doing it every night.

Probably once in a while, that would not be a big deal. What are your thoughts?

Dr. Davidson: I think the general answer, exactly. “Hey, if that little bit of cream got on, south area, fellas always concerned about their area down there”. Do not worry. It is not going to turn into something else or as I said grow boobs, or making gets all emotional. But just at the same time, Pharmacist is the smartest people you will ever meet. They are brainiacs. They know everything, they are so smart, but they are also incredibly particular when it comes to things.

They are saying “Hey, it is a transdermal cream, if it is on you, it is on him. It goes to the same place”. But, at the same time, you got to think about, using this biased, which is actually a pretty good dose, in terms of vaginally. But honestly, it is pretty low. The amount of actual hormone, biased is a combination of Estradiol and Estrella, E2 and E3, and when it says a seventy to thirty ratio, that means they are seventy percent of Estriol, which is a very gentle, very weak estrogen. To thirty percent Estradiol, which is the strongest form of estrogen that humans make.

She is applying it to the labia and the vaginal area, which is actually a great place to put it, if you are looking at it, especially for vaginal atrophy, for vaginal dryness, postmenopausal vaginal atrophy would be, like dryness pain with intercourse, lack of lubrication. Applying it vaginally is a nice way to help with those symptoms. It does help also with sensitivity to that area. It would help carry have an orgasm, you have that stimulation there. I love that it is being applied there but I think the pharmacist, just gets a little extra picky.

Dr. Maki: Yes, right. and it is only, that you brought it up. It is only 1.2mg. There is hardly anything there. Anyways, if the husband has a big beer belly. As his body fat, probably making more estrogen than that, body fat creates estrogen. That is why sometimes men when their testosterone turn starts to drop, they start to aromatizing, that is the term in their body, convert that as testosterone and estrogen, and then, body fat alone. I think we have talked about it one time. It makes more Estrone[?] than it does estradiol.

Dr. Davidson: Just E1. And it is true. Adipose tissue is adipose cells, fat cells. It is like, it has its own endocrine organ. It produces all sorts of hormones, but in particular, Estrone[?], you said back, Carie’s dose of 1.2mg of biased, seventy to thirty ratio. 1.2mg would equal to .84mg of Estrariol[?] with .36mg of Estradiol, which is very low. And, she is only using a quarter of that. If I were-. Where is my phone?

Dr. Maki: Are you really doing the math?

Dr. Davidson: I Like the math. Math is the coolest part. Because math tells you, what you can change on someone, what you can raise because we do all ratios, all of the different ways of doing it. If she is on .84mg, She is on .21mg of Estrariol[?]. And then, the .36 mg, it is really literally, so teeny, .09 milligrams of Estradiol. Which on those vaginal tissues, those vaginal cells, they are sacred areas for us, their mucus membranes, they absorb that hormone-like crazy, and be different if she put that on her inner thigh, I probably would not go in very well. And she would not absorb it.

But like I said, it is a low dose, but it is a perfect dose for those vaginal cells, for lubrication, for resiliency, for the stimulation, or getting that blood flow. Being so low, if she put it on, and it was like “Hey, honey, what you, looking good?” And then it would probably just act more like a moisturizer to him.

Dr. Maki: Yes. The dose is low enough for it, would not do too much. That is why she is a little confused because the doctor tells her one thing, the doctor is the clinician, right? They understand these things. Pharmacists are not necessarily clinicians. As you said, they take everything to the nth degree. Everything is by the letter, which is good. You want your pharmacist to be that way.

Dr. Davidson: You want them to be extra particular.

Dr. Maki: Yes. If you have questions about that, usually depending on if it is a contraindication or something. Listen to your pharmacist, but when it is about this kind of stuff, listen to what your doctor says because in this case, the doctor is right. Not that the pharmacist is wrong. Certainly, we would not recommend, having intercourse, right afterward, but, she might need, if she is applying it, vaginally, she might need that. For the intercourse is not painful.

Dr. Davidson: Overtime. Using that cream will help those cells. But, I do not think it is not going to act like a personal lubricant.

Dr. Maki: No.

Dr. Davidson: Use your own personal lubricant.

Dr. Maki: It is not personal. It is not in a moment situation. It is meant to be overtime. For example, when we prescribe, we probably would not do the biased, vaginally, we would just do it, estriol, vaginally. Just straight E3, but she is taking relatively-.

Dr. Davidson: But it has such a low amount of Estradiol that it-.

Dr. Maki: Yes, right.

Dr. Davidson: And sometimes, we will do a little Estradiol, vaginally, in the beginning, if there is a lot of atrophy. And somebody had not been on hormones, or they are post-post-postmenopausal, and they meet somebody, and they want to have intercourse, and it is really painful. We might do that.

Dr. Maki: It kind of speeds up the process a little bit, helps to reinvigorate some of those cells a little bit, and it shortens the course. Because we have had some pretty tough cases over the years, where women were all miserable-.

Dr. Davidson: Can not even have penetration.

Dr. Maki: Not even that, some could not wear pants. They can barely sit down, it hurts to go to the bathroom. All these different things, some women, were contemplating different surgeries that a lot of those types of surgeries do not work very well. But, even for things like prolapsed uterus, and poll prolapse bladders, we have had some success just using hormone cream, but usually, we use a little bit of a higher dose. We want them eventually to get to where they are using it roughly, about one to three times a week.

Dr. Davidson: Yes, so they do not have to use it every day. But this is such a low dose, Carrie is using it every day. I would say if you are having intercourse that frequently-.

Dr. Maki: Good for you.

Dr. Davidson: Yes, awesome. You probably do not have to wait several hours, or you could have intercourse, and then put it on after before you go to bed after you tidy up, but a lot of people will say, “Why does not Carrie, just put it on in the morning?” and I will tell you when you apply cream vaginally, it is a cream. It is a little sticky. There is something down there that, putting it on in the morning, people do not usually like that feeling, of going around the day and they had that little extra cream there, and if you do put it on at night, which is I really do prefer it at night.

That is when ourselves, replicate[?], turnover and our immune systems really rallying[?], that is a really nice time for that absorbency.

Dr. Maki: Yes, right. The husband can rest easy. He is not going to have an influx of estrogen. Now, we have talked about this on other podcasts though, the other direction, when men are doing transdermal testosterone, and then there is going to be skin to skin contact with the wife, or the pets, or the kids. That is a big deal. Right? Because of the amount of testosterone that men used. Now, we do for men, we do strictly a rhythmic dosing method for men, and at certain times of the month, their testosterone level. What they are applying to their skin can be upwards of close to 400 milligrams daily for a few days of the month, that amount for a woman could be really problematic.

She is going to start growing facial hair. She is going to lose her hair. She is going to probably break out like crazy. Women do not want any of those things to happen, and then certainly the smaller the people, kids, and pets. Pets like to sit on laps, the kid likes to sit on laps. If a man is not careful enough. Granted once, we coach a patient and how to do it, it is not that big of a deal, as long as he is aware of it. He will wash his hands with hot soapy water.

We recommend some men actually use a surgical glove, so they can apply with the glove, and take the gloves off. There is no trace on their hands, and then if they are applying it always, we recommend for men and women to apply their estrogen, and/or testosterone to their inner thigh, nothing on the forearms. Nothing like that. And then usually, you can avert[?], pretty much all problems from that point. Men to women is a much bigger deal than women to men. Women to men, not a big deal but men to women certainly, that is where you need to be a little bit more careful.

Dr. Davidson: Exactly and like I said, it is such a low dose and it is really more for the vaginal area. It looks like to me, that it happens husband is going to be okay, but ideally, maybe if you did put it on, you want to wait about, thirty minutes, forty-five minutes and it would be just fine, even up to an hour. Or you could always put it on after intercourse.

Dr. Maki: Sure. But like I said if it spurs the moment and it is certainly celebrating spontaneity. That is great.

Dr. Davidson: Yes.

Dr. Maki: It is not going to be a problem. But, if you have a chance, as you are preparing for that spontaneity, if that is even really a thing. Then like I said half an hour, or forty-five minutes, an hour, it would be totally fun. This is relatively a short one. Do you have anything else to add about this? or?

Dr. Davidson: No. We get this question all the time. All the time. Where to put your creams. How to put it on. How long to wait, even to shower or take a bath, go swimming. We get these questions all the time. But like you said, it is funny with my female patients, their partners, their male Partners will be like, “Okay. I do not want any of that near me. I want to do that estrogen stuff” [inaudible] their southern parts-.

Dr. Maki: And their big babies. They do not realize that it is harmless.

Dr. Davidson: It is really okay.

Dr. Maki: Relatively pretty harmless. Again, we are still trying to figure it out, we would like to ask if you like our podcast, we like to ask for some reviews. We are on all the major platforms such as Spotify, iTunes, Stitcher, I Heart Radio. We are not on Amazon yet but will be on Amazon music, soon enough. Please give us a review. That is how people find us.

That is how we can grow our audience. We are going to promote that. We still have not figured out what that promotion is, to offer some incentives. We will be going to read the reviews on the podcast.

Dr. Davidson: As a thank you.

Dr. Maki: As a thank you, and we will pick somewhere. It would be a really nice way to connect with some people, especially if they like our podcast. And another shameless plug for the book. I know that makes you nervous every time I say it, I can see your face getting uncomfortable over there. Perimenopause Plans can be coming on Amazon as well, fairly soon. We will keep you up to date on that.

It is really, just a culmination of your experience and, how you are been able to help women, and like we said, previously that it is kind of an underserved situation for women that they do not really have lots of options. And we see a lot of them as patients, we get a lot of the questions from them, and it is our way to help as much as we can. Until next time. I am Dr. Maki.

Dr. Davidson: And I am Dr. Davidson.

Dr. Maki: Take care. Bye.