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 so much more than just the typical TSH blood test. The TSH reference range is 0.45 – 4.5 uIU/mL depending on the lab. This range is quite large and many people can exhibit hypothyroid related symptoms, but their TSH is within normal range.
Common Hypothyroid Symptoms:
Other tests for thyroid function include both Free T4 and Free T3. The hormone Thyroxine (T4), which is released by the thyroid gland is an inactive hormone. The body will convert T4 into T3, which mainly occurs in the liver. The free T3 is the active form of thyroid so it is very important to include this blood test for proper evaluation.
It is important to point out, that approximately 70% of all hypothyroid cases are of the Hashimoto’s Thyroiditis type, which is an autoimmune condition where the immune system is attacking the thyroid. With Hashimoto’s you want to work on the autoimmune component, which means beyond just medication.
The antibodies involved in Hashimoto’s hypothyroid are the Thyroid Peroxidase Antibody (TPO) and and the Thyroglobulin Antibody (TGab). It is important to test these antibodies in any thyroid patient to differentiate if they have Hashimoto’s or generalized hypothyroid. Often some patients have elevated antibodies but have normal values of TSH, Free T3, Free T4.
Thyroid Testing:
There are many different types of medications for hypothyroidism. Conventionally, the typical medications prescribed are Synthroid, Levothyroxine or Levoxyl. It is very common for many patients on Synthroid, Levothyroxine or Levoxyl to have a reduced TSH but also still experience hypothyroid related symptoms.
In most cases, we like to use medications with a combination of both T4 and T3. Conventionally, Cytomel is a T3 drug that is often prescribed, but it is an instant release and many patients do not tolerate this medication. A better option is Compounded Thyroid, which is usually a Sustained Release (SR) combination of T4 and T3. In addition, there is Armour and Nature-Throid, which are both porcine based medications that also included T4 and T3. There is no one-size-fits-all in hypothyroid treatment.
The thyroid and adrenal glands are connected and when one is low the other is compromised. Patients with adrenal fatigue sometimes cannot tolerate thyroid medication until you treat the adrenal dysfunction, making it important to work on the adrenals when you are being treated for hypothyroid.
Hypothyroidism also includes patients that have had their thyroid removed due to thyroid cancer. These patients do very well on compounded T3/T4 thyroid therapy.
Many doctors that practice “functional medicine” will be able to treat your thyroid condition more individually, looking more into functional blood testing for Free T3 and Free T4 as well as treating other systems of the endocrine system.
If you have questions, please feel free to leave a comment below, you can contact us directly.
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Are you gaining weight around your midsection during perimenopause or menopause—despite eating the same and trying everything? You’re not alone, and it’s not just about willpower: In this episode, Dr. Valorie and Dr. Maki dive deep into what’s really going on with that frustrating menopause belly. From insulin resistance to estrogen and cortisol changes, they break down the complex hormonal shifts that make weight gain in midlife feel inevitable—and nearly impossible to reverse. Here’s what we cover: ✔️ Why the “unearned weight gain” often starts in perimenopause ✔️ The truth about insulin resistance and menopausal metabolism ✔️ The role of estrogen, progesterone, and cortisol in midsection fat ✔️ Why muscle mass is your best metabolic insurance ✔️ Whether hormone replacement therapy (HRT) or GLP-1 meds (like semaglutide) can help ✔️ Actionable steps to reduce belly fat and improve metabolic health Plus, we’ll share why willpower alone doesn’t cut it—and how biology always wins unless you work with it (not against it). Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie and Dr. Maki tackle a common yet surprisingly confusing question: When is the best time to test your blood levels if you’re using hormone replacement therapy (HRT)? Lisa, a fellow Washingtonian, submitted a thoughtful Ask the Doctor question about testing estradiol and FSH levels when using a trochee or transdermal cream. Should it be 4 to 6 hours after application? Or 10 to 12? And what do the results actually mean? We’ll break down: The ideal timing for blood draws depending on delivery method (trochee, patch, cream) How estrogen and progesterone absorb differently Why testing too soon — or too late — can skew your results How to interpret estradiol and FSH together (and why context is everything) Why the number isn’t the whole story — and how you feel matters most Plus, Dr. Valorie shares insights from her own hormone journey, including rhythmic dosing tips and lab timing mishaps. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Is there really an age limit for hormone replacement therapy (HRT)? What if you’re in your 70s and still feel better on hormones—but your doctor says it’s time to stop? In this episode, we answer a great question from Mary, a 76-year-old woman who’s been on HRT for over 20 years. She’s dealing with weight gain, breast tenderness, and pressure from her gynecologist to quit hormones altogether. We break it down: Why stopping HRT just because of age isn’t always the answer What to consider when switching from a trochee to a cream Why estradiol levels matter more than total estrogen The connection between insulin resistance, weight gain, and hormones How to adjust HRT in your 70s to maintain quality of life without unnecessary risk Whether you’re well into postmenopause or just starting HRT, this is a must-listen if you’re wondering how long is too long to stay on hormones. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we’re answering a thoughtful (and very relatable) listener question from Kari, who’s been struggling with unexpected body pain and inflammation after starting hormone therapy. She wonders if she might be hypersensitive to estrogen—something most doctors don’t talk about. Dr. Valorie Davidson and Dr. Robert Maki unpack why this happens and what to do if you suspect your body is reacting to estrogen differently than expected. In this episode, we discuss: Why some women experience increased pain, fluid retention, or inflammation on estradiol—especially starting at higher doses too quickly. The importance of starting low and increasing slowly, especially for sensitive individuals How Dr. Davidson’s personal experience with estrogen sensitivity helped shape her approach The role of the liver’s phase 1 and phase 2 detox pathways in clearing estrogen metabolites Why form, dose, and timing of hormone therapy (cream vs. patch, AM vs. PM) can affect results What to consider when adjusting your Biest ratio (80:20 vs. 90:10) or Rhythmic Dosing HRT ✉️ Here’s Kari’s full question: “I used Biest 80:20 for 3 years and suddenly stopped absorbing. I’m not sure why, but I do know I didn’t always use it the same time every day. From the moment I went on hormone therapy I’ve had body pain and thought I had fibromyalgia. When my estrogen dropped due to the absorption issue I realized the body pain completely went away. I then went on a patch because my doc said we should change the method. Immediate body pain again and even worse. Terrible. I was on 0.025 and it was tolerable, but after raising it to 0.05 it got really bad. I think I may ask to go on the compounded cream again—maybe change the site that I apply it and be more consistent. I’m very frustrated because no one talks about a subset of people that are very sensitive to estrogen. They only talk about it making joint pain go away. Do you think I should use 90:10 instead? What would you recommend that I do? I’m so sad and frustrated.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki respond to a great listener question from April, who’s navigating hormone replacement therapy (HRT) while dealing with a history of endometriosis, polyps, and chronic cramps. April’s experience is all too familiar: spotting, cramping, hormone experimentation, and the frustrating search for symptom relief. So, can women with endometriosis safely use HRT—especially estrogen? The answer: Yes, but it has to be customized. �� In this episode, we cover: Why HRT is absolutely possible for women with endometriosis—but must be individually tailored The difference between static vs. rhythmic dosing and why rhythmic HRT may be better tolerated for some women Dr. Davidson’s personal story of having endometriosis, cysts, and polyps—and how she now uses rhythmic dosing herself without flaring The important role of progesterone in managing endometriosis and minimizing estrogen reactivity How to approach spotting, cramping, and cyst formation during HRT ● Why estrogen isn’t the enemy—but why it must be dosed thoughtfully ✉️ Here’s April’s full question: “Hi—I am a 57-year-old woman in perimenopause. My question is: is it possible for women with endometriosis or adenomyosis to do HRT? I started oral progesterone 2 years ago, got as high as 300 mg, but didn’t get much symptom resolution. Switched to a progesterone troche—50 mg morning and night. About 3 months ago, I added testosterone (0.25 mg once daily, 5 days/week) and Biest 80/20 (1 ml daily, can go up to 2 ml). Everything was good for a while, but now the cramping and spotting have returned. I’ve had heavy bleeding as long as I can remember. My main complaint is menstrual cramps throughout the month—not just during my period. I do not have fibroids, but I’ve had many cysts and polyps over the years and have had many ultrasounds and transvaginal ultrasounds because of this.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki dive into a hot topic: Does Hormone Replacement Therapy (HRT) actually slow down aging? While the short answer may surprise you, the real conversation is about something even more valuable—your quality of life. Here’s what we cover: How HRT can support energy, strength, and resilience as we age The role of hormones in brain function, memory, and mental clarity Why estrogen and progesterone matter for muscle tone and bone density ❤️ The powerful connection between hormones and cardiovascular health. Why HRT isn’t about extending your lifespan—but enhancing how you feel through the years Obviously aging is inevitable—but suffering doesn’t have to be. This episode is all about helping you feel more like you again, even as your hormones shift. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
