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 different way to dispense and dose hormones. Like Dr. Maki said it is not that we have one that is a favorite. It really just depends on the individual because with bioidentical hormones in general, I mean, you have to tailor it specifically to that person whether it is a male or female because you can cycle hormones with men, you can cycle hormones with females. In terms of the static dosing, that is where you are taking a particular dose of the hormones every day, same dose, twenty-four seven.

Dr. Maki: Yeah, right. Excuse me. The rhythmic dosing and as with most hormones in the body, if not all hormones in the body, they tend to have literally their own rhythmic pattern. They oscillate. They rise, they fall. They rise, they fall. They rise, they fall. In the static dosing, like you said, it is just the same dose every day. There is no change to that dosage over a course of a given month, or really, you might change the overall dosage from a certain, let us say from 2 milligrams to 3 milligrams, or 4 to 5 milligrams but it just stays the same every single day.

Dr. Davidson: Exactly. You might be doing an estrogen component for that hormone replacement like a biased, and you might be doing like Dr. Mackie said, maybe 2 milligrams twice a day, 2 milligrams once a day, but every day is the same. Granted, we have patients that “Oh, I forgot to take it today,” and that is okay. For the most part, it is pretty easy because you do not have to really think about it. You are just like, “Okay, it is time to take my hormones.” You know exactly what dose to take.

Dr. Maki: Yeah, right. Then, of course, with the estrogen component, there would be a pair with that, some type of progesterone. The way that we prefer to do it with the static dosing is we would provide some type of a capsule progesterone, usually 100 milligrams. Like you said, they would take their bias twice a day, morning and evening. They would take their progesterone at night. Unless we change the total amount of that dose over a course of a week or a month, or until that concentration was increased, the dose would never change.

Dr. Davidson: Now, we are talking about basically sex hormones. For women, it would be estrogen and progesterone, possibly a little bit of testosterone. For men, it would be testosterone. We are not necessarily talking about thyroid doses or that kind of thing, but with the hormone replacement for basically the sex hormones, static dosing is convenient. You can travel with it. You do not have to think about it. It is one way that you can dose the hormones especially for menopause, for menopausal females, because their ovaries are no longer producing hormones. It is a great way to give somebody some hormones without doing too much hormones but just enough to kind of help with the brain, with cardiovascular, with bone density, with anti-aging. Sometimes, I will pick more static type dosing if we are keeping the hormones a little bit to the minimum where we had talked about the rhythmic dosing, that actually is a little bit different because when you think about rhythmic dosing or actually just think about a cycling female, their hormones are being produced. You basically ovulate right around day fourteen. Your estrogen peaks on day twelve. Your progesterone peaks on day twenty-one. Really, in a cycling female, you do not make progesterone until after ovulation. When you are doing a rhythmic style, it is completely different than doing a static dose.

Dr. Maki: Yeah, right. The whole point of the rhythmic dose is you are basically trying to recreate the classic twenty-eight-day cycle for a female, and a female cycle is broken up. If you looked at it, if you graphed it out, and these are all over the internet. They are probably even if you go to the gynecologist office, they probably have these charts on the wall where you see the changes over the course of that twenty-eight days and how the hormones are changing as a result. Like you said, you have a peak on day twelve, that is where your estrogen level is the highest. That is kind of the hallmark of the follicular phase. You ovulate right in the middle, day fourteen, day fifteen, that usually coincides with the peak of testosterone. Then, day twenty, day twenty-one, you have a peak of progesterone, that kind of hallmark’s the luteal phase. Now, granted, that is a lot of moving parts for a woman for her hormones to be changing. That is why the cycle gets, sometimes, that is why there are problems with the cycle because there are so many moving parts. Men still have their own rhythm but it is not quite so convoluted like the female cyclist.

Dr. Davidson: Like Dr. Maki said, in that rhythmic dosing of the female hormones, you really are recreating the same levels of hormones in your blood in your body that you would be as a twenty-eight year old female. If you think, that can be a lot of hormones, and some women do amazing on it. They love it. It is great where maybe there is another individual that is more sensitive or we do not necessarily want to do those levels of hormones, then doing a static dose where you can have a little bit lower levels so when you do test it, their blood work, their blood work is still showing kind of age-appropriate. You just have a little slight increase in the hormones to help with whatever symptoms, and anti-aging, and moving forward with their own personal goals.

Dr. Maki: Yeah. The real big distinction, like how do you decide between static dosing as the practitioner or is the patient, how do you decide between static dosing and rhythmic dosing, and the really big thing, if I mention, and I know you would do the same, if you mentioned rhythmic dosing to a woman and you say, “Well, if you have your uterus still, you are going to get a period,” the majority of women, they do not want to be in their fifties and start their period again. If that is the case, if they are not interested in having a period, then the static dosing is their option. Now, that will work, like you said, as long as that dosage stays relatively on the lower side or if they start having some bleeding trouble because they still have their uterus, in some ways, it might be necessary depending on their symptom level, it might be necessary for them to transition to rhythmic dosing depending on how they respond to the dosing.

Dr. Davidson: Yeah. Like you said, a lot of women are like, “What? I am going to get a period back? Been there, done that, do not want to do that again.” At the same time, when you are cycling the rhythmic dosing of hormones with that female, the period that they are going to get is going to be a nice period, not like, “Oh my gosh, I had horrendous periods back in my twenties. I do not want to go through that again.” You will not go through that again. We cycle the hormones in a nice dose that it should have been level to create just a moderate period, but again, not everybody wants to have a period.

Dr. Maki: Yeah, right. Like you said before on other podcasts, estrogen is a great hormone but sometimes it can be a little bit of a runaway freight train. If a woman was estrogen-dominant when she was thirty-five, when we are trying to recreate what the body does, you are not going to necessarily become estrogen-dominant all over again and have all of those symptoms. More than likely, it is going to kind of balance out. It is going to be a little bit of a smoother transition. There still will be some “PMS symptoms” with the rhythmic dosing as there sort of should be, but the severity of those symptoms, the seven to ten days before you start bleeding, the severity of those symptoms give us a little bit of feedback and some information that things might not be in balance and now all those estrogen, progesterone levels, or something else, the adrenals, need to be adjusted a little bit. That way, she is not having so many PMS symptoms in the middle of the month.

Dr. Davidson: That also comes to testing as well. You think [inaudible] menopausal, the ovaries have retired. They have left the building rightly so. They deserve it. When you are going to test somebody’s blood, you could test it any day because your dose is the same every single day in a static dose. In a rhythmic dose, you are actually recreating that cycle, that twenty-eight-day cycle, that if you are going to test, you have to do it usually around day twelve. You are going to test the estrogen. Around day twenty-one, if you are going to test the progesterone. You actually have to do a little bit of timing there.

Dr. Maki: Yeah, right.

Dr. Davidson: That is our dog. If you are hearing a little clunkiness in the background, he is chewing on a bone. He is stretching. He is laying down.

Dr. Maki: Yeah. He is usually good for the first few minutes and then he gets a little bit rambunctious. Now, he wants to go outside or do something. Hopefully, he does not make too much more noise. Hopefully, it is not…

Dr. Davidson: It does not bother you, sorry.

Dr. Maki: Yeah, it does not [inaudible] but we cannot do this without him. If we left him outside the room or something, he would not rest until he was able to lay at our feet. He is underfoot constantly. If anyone has ever had an Australian shepherd, I think they are all that way. I think it is kind of a breed specific thing. The period is the big distinction, right? In the static dose, and we do not want there to be any bleeding, right, that is what their oral progesterone is there to do is to inhibit the growth of the uterine lining, so that is where we prefer to use a bioidentical sustained release progesterone capsule. Usually, 100 milligrams or something like that. That is going to inhibit the growth of the uterine lining as they are taking the estrogen, and that is enough to usually control symptoms, get rid of the hot flashes, get rid of the night sweats, improve insomnia, and then some of those other kind of, the brain, the bones…

Dr. Davidson: Yeah, libido, sex drive. Remember, the estrogen is always a cream. I mean, some people do some estrogens as capsules but we really avoid that because progesterone is fine to go through the digestive system as a capsule as an oral. For the estrogens, we always use it as a cream because it is very hard when you take it orally. It burdens the liver. You do not really absorb it very well. Know that when they are doing a static dose, they are going to do a separate type of, whether it is a bias or an Estriol, I mean, now, we do not do any kind of Estriol, but usually, it is a combination of Estriol and Estradiol. That is usually going to be a cream, and then you take that progesterone at night, and you have your same dose every day.

Dr. Maki: Yeah, right. Like in menopause, a woman is no longer cycling so her hormones basically fall to a, they kind of flatline little bit. There is no more peaks. There is no more elevation. It is the same all month long, and all we are trying to really do in a static dosing is just raise the baseline. That is usually enough to control symptoms and make them feel better. That is what most women are looking for. Now, if we kind of wrap that up a little bit, and if they are okay with having a menstrual cycle, now, they do not have their uterus, then in some ways, it is kind of the best of both worlds, right? They get the higher levels of the hormones but they do not have to deal with the period even though having the period still gives us some good information. It is a landmark. It tells us that things are in balance because of how smooth that transition is. The day that the period shows up whether it is a twenty-eight-day protocol, if it shows up on day twenty, the levels need to be adjusted. If it shows up on day twenty-five, twenty-six, twenty-seven, twenty-eight, that is usually pretty normal. It gives you, the practitioner anyways, it gives a lot of information, the fact that a woman is having a period. From a safety perspective, the fact that there is a predictable period every so often, that is what makes it okay. Now, that is a part that I think in some way is probably the controversial part. A fifty or a sixty-year-old woman still having a period, that kind of freaks some people out. Why would you do that on purpose? Because she is having a period is what makes it okay.

Dr. Davidson: Yeah, because you are cycling the estrogen and progesterone like it would be when you are cycling when you are twenty-five years old, when you are thirty years old. Having that cycle where you would never use those levels of hormones statically in a female that is taking it every single day and you want to test those hormones, you want to do some type of labs to make sure you are assessing on both sides, we love to do labs. We love to get the objective data, as well as your subjective information as well. At the same time, you are testing, and checking, and making sure the levels are where they are supposed to be, that they are not too high, they are not too low. Both, whether it is static or rhythmic, as long as it is being monitored and you are testing and you are also conversing with the patient to make sure that it is right for them, I would not say there is a favorite either way.

Dr. Maki: Yeah, right. Yeah. As you stated earlier, it is really tailoring it to the woman and what she is looking to accomplish, what her goals are, what her symptoms are, what her lifestyle is, all those factors basically determine which style she is going to use or which philosophy, so to speak, she is going to use and then how she responds later because that is the thing. The first thing you realize with hormone replacement is that every woman is different. Some women need and can tolerate a lot of estrogen, some women are very sensitive and cannot tolerate very much; that also factors into. If a woman is very sensitive, rhythmic dosing is not the right thing for her. She is going to probably not feel very good and she might have some unwanted side effects from the rhythmic dosing because the Estradiol level is actually quite high around day twelve. That might just be too much for some woman’s systems where she would be more appropriate on the static dosing.

Dr. Davidson: Or maybe everybody is different. You have an extremely busy lifestyle. You are forgetting to put on your estrogen. You are forgetting what day you are at because life can be a little wild out there because it is. You have a calendar. You look at what day. “Am I on day twelve? This is how much estrogen I am going to put on today. Oh, I am on day twenty-one. This is how much estrogen I am going to put on and how much more progesterone I am going to put on.” There is a little bit of a factor of you have to look at your calendar and know what day it is. I do think with the females, it is a little bit more complicated so when you are getting started on that, we have to have some good communication. We have to have some appointments. We have to keep a log on how you are doing where the static dose is a little bit where you can set them up and they are pretty much ready to go.

Dr. Maki: Yeah, right. Yeah. There is a little bit more. I would not say the rhythmic dosing is necessarily more complicated, but because the dosing is a little bit higher, the first three months, if they have never been on hormones before, usually that is going to be the transition period as your body is acclimating to those higher levels, and the levels do get quite a bit higher than they do in the static dosing for good reason because we are trying to establish, like you said, restore the hormone levels of a woman that is in her thirties, maybe late twenties or early thirties. On a blood test, her estradiol level is going to go up quite high compared to the static dosing.

Dr. Davidson: Rightly so, us ladies are complicated but we are so worth it. Whether you are doing static or rhythmic, it does take a lot of communication there. Now, with the fellas, you guys are not quite so complicated. Doing the rhythmic dosing for the testosterone I think is awesome. That absolutely I think in some ways I would say, “I would rather do that than the static.” The static is fine, but if a fella can do the rhythmic, I think they get so much more out of it.

Dr. Maki: Yeah, totally. I am not a fan of injectable testosterone. Going into the clinic twice a month or once a week and getting a big injection of testosterone, men usually do pretty well the first three to six months on something like that. They feel really good, like almost too good, almost like superhuman good. They feel amazing. After that, because hormone replacement is all about maintaining a receptor function. We talked about that on some other episodes. When they get these huge amounts of hormone right off the bat, their body is not used to it. Eventually, those receptors down-regulate. Meaning, they disappear. If the receptors disappear and you keep providing that same kind of bolus of hormone, eventually the body stops responding to it as a way to kind of protect itself from being over stimulated for too long. Same thing with pellets. I know pellets were kind of popular for a while. They are still there around a little bit. You do not hear about them as much anymore, but I think that men do not usually do so well on the pellets. It is easy. You get them implanted. You do not have to do anything once they are in, but again, they feel really good in the beginning and then they never feel quite as good as they did the first insertion of those pellets.

Dr. Davidson: So true. Like you said, the receptors down-regulate and they always say, “I felt so great in the beginning. Why cannot I feel that way now?” or “Maybe I have to keep increasing up my dose?” They felt like in the beginning, with a man, when you are cycling their testosterone, because it is moving around, you are basically cycling because men cycle their testosterone just like us ladies cycle our estrogen and progesterone. Your testosterone is changing more on a two-week level rather than a twenty-eight-day cycle. Men are more fourteen days where females are twenty-eight days but you are still cycling your testosterone. If you are cycling it, when the levels go down, those receptors say, “Hey, where did that go?” The body will up-regulate the receptors and then you supersaturate those receptors with the testosterone and then they feel really good. You are basically not letting the body get adapted or habituated to the dose.

Dr. Maki: Yeah. You are maintaining that receptor function. You are keeping those receptors open. If those receptors stay open on a long-term basis, then you are going to receive the benefit of that hormone as opposed to those receptors “down-regulating” and disappear. Once they down-regulate but you are still giving that same dose or have to increase the dose, you are actually creating in some ways more receptor fatigue or you are forcing to down-regulate even more. That is why I see a lot of men that have gone through some of those other types of therapies and their numbers are just chronically low even with the rhythmic dosing. It is really difficult. They might feel better, but to get their numbers to come back on a blood test can be very challenging.

Dr. Davidson: It usually takes a few months for the fellows. The first month are okay, but by month three is when they say they feel really good and men do not have a uterus so cycling it, there is really no negative aspect like the females. We have to talk about, “Hey, listen, we are going to cycle your hormones, and you have a uterus. You are probably going to get a period back.” We have to have that conversation. With men, it is pretty easy.

Dr. Maki: Yeah, right. Now, the thing that I like about the males, I always say this to my patients, women anyways, that the woman’s cycle is based on the lunar calendar. Technically, if you were going to do the rhythmic dosing, you would start on day one of the lunar calendar, twenty-eight days, follow it through. If a woman is still having her cycle, usually she is going to get off of that schedule a little bit. We live indoors. We are not sleeping under the moon so we are not really controlled that much like we used to be. If you look at a male’s testosterone rhythm and you overlay that over the female cycle, a woman’s ovulation peak right around day fourteen, fifteen is right around where a male’s testosterone is going to peak. A female’s libido goes up, a male’s libido goes up and there is more likelihood for intercourse and conception. In some ways, women rule the world, right, and men follow even though men like to think that they rule the world but women actually control men without men even realizing it, which is such a woman thing to do. It is just kind of like the little trick that women actually do control things from a very biological kind of reproductive approach. That is why men follow women whether they like to believe that or not. It is definitely true. I know they have done some studies around college campuses and nightclubs and trying to determine ovulation rates and different things. It is all done by pheromones and all these things that we do not really understand necessarily all that well, but the rhythmic dosing is kind of part of that process.

Dr. Maki: My point of extrapolating there is the man’s dose over the course of the twenty-eight days, it starts out low in the beginning of the month, it peaks out in the middle of the month, and then it lowers back off. You have this nice rise and a fall. Every season, winter, spring, summer, fall, it is the lowest in the winter and it is highest in the fall. You have this built-in, annual cycling both on a monthly basis and an annual basis, which I think is just brilliant to do. Women do not necessarily have the annual cycling. Their dosing stays the same every month but there is different levels. You can start out at the basic level and then you could add on a certain number of lines depending on her symptom picture. The more severe her symptoms, the more lines you add on. Usually, a woman will kind of average, most women kind of average out on the higher end. They do not usually stay in the basic. They usually end up somewhere towards the higher end of the dosing range.

Dr. Davidson: Yeah, because with the rhythmic dosing, just like with static, you can adjust the dose to fit that individual. What Dr. Maki was mentioning which is really cool is when you have a male-female couple come in and they want to do the bioidentical hormone replacement, putting them both on the rhythmic dosing, having them coincide their cycles together, it is just really beautiful the way that falls in line.

Dr. Maki: Yeah, right. You would start the woman on whatever her cycle is, whatever her pattern is, then the man’s cycle would mimic hers. Just like I said a few minutes ago, women control the world. She starts off that rhythm especially if she starts menstruating again, and now, you overlay his schedule on top of hers as opposed to them just doing kind of two random, now granted, that happens sometimes. Usually, you and I will see the wives first and the husbands will come in later. It may be a little bit harder to do that, but again, they both start on day one or whatever her schedule is, then the husband would start at the same time. Now, for the most part, they are kind of blended together at least hormonally from a certain standpoint.

Dr. Davidson: Yeah, no. I think it is really neat.

Dr. Maki: Yeah, yeah. From an anti-aging perspective, again, that is where some of the pushback comes from. For men, the more testosterone they have within reason, the better they are going to feel. The more they feel like themselves. They are going to have a better mood. They are not going to be grumpy. They are not going to be depressed. They are going to have more muscle mass. They are going to have less body fat. They are going to decrease age-related disease like diabetes, heart disease, cancer, dementia. The risk of all those things goes down by maintaining good testosterone levels. Same thing for a woman. Estrogen is what makes a woman a woman. It is not about having too much. It is about one finding, as the practitioners, about finding the right dose and making sure that she has enough. Most of the time, there is this in some ways kind of fear around estrogen that “Oh, you cannot give them too much. It could be dangerous.” We do not really believe in that at all. The female hormones are never dangerous by themselves. It is really more about making sure that she has enough estrogen so her brain, her body, everything works the way that she wants it to instead of being a little bit too conservative and giving her a very low dose of hormones, which really does not help her get to where she wants to go.

Dr. Davidson: Exactly. On a side note with the men and testosterone is taking testosterone, whether you are doing any kind of form, pellets, injections, creams, whatnot, that is going to lower a man’s sperm count. Now, for most of the couples that come in together, they are just fine with that because that is not an issue, but some men, they may want to have a baby or something, so then we usually just have them stop their rhythmic dosing testosterone so that that can get their sperm count to come up, and then they can procreate and all that jazz. Now, that is not a form of birth control because as Dr. Maki will tell you is there has been plenty of couples that have gotten pregnant with a man being on testosterone rhythmic dosing.

Dr. Maki: Yeah. Technically, when a man supplements with testosterone of any sort, you basically are shooting blanks at that point. You are not going to be able to conceive but as I stated, it has happened a couple of times and in a couple of cases. It was where they had really a lot of difficulty with their previous child, maybe it was a few years before. They had a really hard time. I can think of a couple of cases where they had a really hard time with fertility, put the husband on, worked on the wife first, the husband came in later, months later, put him on the Wily protocol or the rhythmic dosing, Wily protocol for men. Within six months, the wife was pregnant and they could not believe on how easy it was even though they had so much trouble before. Technically, it is not supposed to happen, but it does happen.

Dr. Davidson: Anything can happen, and there is probably a lot of different reasons behind that.

Dr. Maki: Yeah. Like I said, this is where it gets confusing. This is where it gets complicated because there are so many different options, but the wonderful part is that you can use all these different options to specifically find something that works directly for that particular person. As like you said earlier, you got three different dosing options. You got to pick one of the three for every patient that comes in. That is just so, I don’t even know, so archaic and so outdated when there is all these other possibilities that can really make people feel better, and not just feel better in the short-term as we talked about because when do people’s risk of age-related disease start to increase when all the hormones are gone? When men are in andropause and women are in menopause, all the risks for all those diseases we talked about, diabetes, heart disease, cancer, Alzheimer’s, that all goes up when the hormones disappear. If we can prolong those hormones to be around for a little bit longer, then we are not only making people feel better in the moment but we are also preventing disease in the future which I think is the best of both worlds.

Dr. Davidson: Exactly.

Dr. Maki: I talked to patients about this too. When I was a little boy, fifty-five was considered a senior citizen. I mean, I think AARP, it still might be fifty-five where you are eligible or something, I don’t know, but sixty-five was considered to be an elderly person when we were both little. Now, we have patients that are sixties and seventies and they are still moving strong and…

Dr. Davidson: They run in circles.

Dr. Maki: Yeah. They are running companies. They are running households. They are doing so many things that even a couple of one generation ago when we were little, that really was not really heard of. People’s quality of life is definitely I would say almost ten to twenty years different than it used to be when we were little back in the ’70s and ’80s.

Dr. Davidson: Exactly. People whether they are, like you said, running companies or they are retiring, they want to feel good. They want to have energy. They want to have a good weight. They want to have a good libido, not feel like they are getting arthritis or bone-density issues or cancer. We are not saying that this is some kind of treatment or prevention, disclaimer, disclaimer, but like Dr. Maki said is when those age-related, they call him age-related diseases. Are they really age-related or is it just a fact of the hormones declining?

Dr. Maki: Yeah, right. This is unfortunate. In medicine, they don’t really put a lot even though this declining hormone levels, which is very well documented, everyone knows it happens, but that is where the hormone replacement in a conventional setting, it does not really get discussed very often. Honestly, I mean, some doctors nowadays are testing men’s testosterone, but if a woman’s in menopausal, they will not even bother testing your hormones. Granted, testing your hormones which is in menopause does not really do much unless she is on hormones because her numbers are going to be, it always say less than thirty. It might be in the single digits. She is not going to be producing any estradiol so you can assume if she is not having a period where her hormones are but you put on hormones, then you test her levels and you can see the difference, and then of course you get the subjective on how different she feels. We have seen some amazing transformations. People come back and tell us. They are like, “I feel like myself again. My mind works. My body is cooperating. I got a sex life back with my husband. All these things happened because of the hormones. How can that be a bad thing and how is it not an important part of that aging population?” 

Dr. Davidson: Nowadays, their doctor might not be here this all the time. My doctor said, “Oh, I am just getting older. That is why I gained weight or that is why I feel this way or this is just normal. I have to deal with it.” Nobody needs to do that anymore. That is not an appropriate discussion to say, “Oh, you are just older. You just have to deal with it.” That just does not run right now. Now, it is like, “Hey, what can we do to help with longevity, to help be safe about it at the same time, and then help people feel better?”

Dr. Maki: Yeah, right. In the twenty-first century, just attributing everything to the aging process just like we talked about, people want to be active. Of course, everyone wants to live as long as they can for the most part, but it is really about the quality, not the quantity. I think everybody across the board would agree instead of living thirty years with some kind of chronic condition that minimizes your quality of life, we want to want to go full [inaudible] as long as possible. I think that we can accomplish that in the twenty-first century. That is what we all should be striving for. Practitioners should be striving for that across the board as well is not just being disease-free but thriving in the advanced years and minimizing some of those things that really tend to slow people down. I think people can understand we are a little passionate about it because we see the benefits that it provides people on a regular basis.

Dr. Davidson: Exactly. No, benefits, my goodness. More than that. Granted, what am I? I am forty-seven. You are forty-six. Like you said, a generation before us, you cannot treat it the same. It is 2020. It is 2020. Things have got to change.

Dr. Maki: Yeah, right. We talked a lot about static dosing, that is still the more common option when it comes to hormone replacement.

Dr. Davidson: It is still very good. It is very good. It just depends on the person.

Dr. Maki: Yeah, right. The rhythmic dosing is a little bit more controversial. It has some some pros and cons on both sides. We like it for men. I think it is the best way to go. Personally, it is the only way that I do testosterone for men is the rhythmic dosing. I do not even mess around with any other ones. I do not really encourage the static dosing. It is where you do testosterone cream. Men cannot do anything orally when it comes to testosterone. The doses are too high and it can cause some problems with the liver. Static dosing, let us say a five day on, two day off kind of rotation. You can not take it every day because men will have some testicular atrophy and it is just not a good way to do it. I like to do the rhythmic dosing for men exclusively. For women, they have a lot more options. Hopefully, this gives some insight. Hopefully, this answers some questions. Maybe if you have more, just let us know and we can do another kind of round of this of a little bit of a deeper overview or some of the more finer points.

Dr. Davidson: Oh, yeah. We love everybody’s comments, questions. I know we talked a lot here a lot. A lot of you might not have even heard of rhythmic dosing because it is really not that common. A lot of practitioners do not do it. If you have any questions or concerns, please reach out. Email us anytime.

Dr. Maki: Yeah. Until next time. I am Dr. Maki.

Dr. Davidson: Oh, I am Dr. Davidson.

Dr. Maki: Take care. Bye-bye.