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 of people with low T3 are missed. Either their doctor won’t test their free T3 levels. Or they fall in the low normal on the lab reference ranges. The reference ranges for Quest are 2.3-4.2 pg/mL and for Labcorp are 2.0-4.4 pg/mL. These are pretty vast ranges and if one falls anywhere below 3.0 can have symptoms of low T3. But we have seen plenty of people fall in the high 1.0s of their free T3 and are frustrated because their doctor will not address it.
But we believe that low T3 levels should and need to be addressed for optimal health.
Focusing on lifestyle and possibly medication or both. As with low T3, you cannot just take a pill and expect everything to get better.
In Kelli’s case, she has T1D. 60% of T4 to T3 conversion occurs in the liver. Insulin can have a huge burden on the liver. If there is a liver burden, then T3 conversion will be compromised. Kelli doesn’t say how many units of insulin she is taking, but in most cases, T1D tend to be taking too much. The goal in T1D is to take as little insulin as needed to keep the blood sugar balanced. That would also be incorporating healthy dietary, trying to eliminate refined or processed foods. Many processed gluten-free foods have a huge glycemic load.
Kelli is feeling very fatigued. That can be in part to the low T3. But mostly, she is feeling tired because of T1D. Using large units of insulin can cause a lot of fatigue.
Also, weight resistance exercise like weight lifting and muscle strengthening can increase the bodies response to insulin. By increasing, insulin sensitivity can help reduce the units of insulin Kelli is using. Intense cardiovascular exercise can actually cause cortisol and glucose levels to rise. Which is not conducive to insulin management.
Caloric restriction will dramatically reduce T3 conversion. We can look at labs and see a normal TSH, normal T4 and a reduced, very low T3. That can show up when someone is on some kind of caloric restricted diet. And if you are a regular listener of the Progress Your Health Podcast, you know how we feel about caloric restriction.
Using lifestyle and dietary at a tool for glucose and insulin management could have a significant effect on Kelli’s symptoms.
More than likely, Kelli is also on thyroid medication. Because she has such low levels of free T3, then she is most likely on T4 monotherapy. T4 monotherapy means they are taking Synthroid or levothyroxine. Kelli is probably on 100mcg or more of levothyroxine, which is an instant release thyroid. What we like is a compounded sustained release T4/T3 combination. Doing a compounded form as a sustained release means it doesn’t have an impact on the heart or negative side effects that an immediate release of T3 has.
We never use an instant release T3 medication because of the side effects. With an autoimmune disease, the compounded T4/T3 has less of an impact on the immune system. But some people with Hashimoto’s disease do really well on the porcine thyroid such as Nature thyroid, Armour, NP thyroid. These are made from a pig’s thyroid and is immediate release. It is important to work with the patient and get labs to find the best thyroid medication for them.
Another treatment that we might use with Kelli or anyone with autoimmune disease is Low Dose Naltrexone. LDN is a good treatment option, fairly affordable with a low list of side effects. Functional medicine docs like us are using LDN for autoimmune diseases like MS, lupus, rheumatoid arthritis, celiac, Crohn’s, and Hashimoto’s to name a few. It is even helpful in certain cancers.
I know we talked about a lot in this episode. And while Kelli’s case might at first seem complicated. I think everyone is unique and complex. But by breaking down some of her conditions and symptoms, there is a lot that we all can learn from Kelli’s case. Thank you, Kelli!
If you have any questions, please leave a comment below or send an email to [email protected]
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Discover the common and unfamiliar symptoms that you might be experiencing. Get access to cases of real women with hormonal conditions.
Protecting your `heart health` is crucial, especially during `menopause`, when risks can increase. In this `women’s health` episode, Dr. Valorie Davidson and Dr. Robert Maki share essential `health tips` and insights into how `hormones` impact cardiovascular well-being. Learn about important lab tests and supplements to safeguard your heart. You’ll learn: ● Why heart disease in women is often a “silent” problem until it’s serious ● The difference between general “heart disease” and atherosclerosis ● Coronary calcium scores: what they are, what the numbers mean, and when to consider one ● Why total cholesterol alone is useless (and often scary for no reason) ● The key markers that matter more: ○ Triglycerides ○ HDL ○ Triglyceride HDL ratio (and why 1.5 is a powerful insulin-resistance clue) ○ ApoB ○ Lp(a) ○ hs-CRP (cardio CRP) ○ Blood pressure & insulin resistance ● How estrogen decline in perimenopause & menopause affects cholesterol, visceral fat, inflammation, and heart risk ● How rhythmic dosing and thoughtfully prescribed HRT can support metabolic and cardiovascular health ● Visceral fat vs “roly poly” fat: why where you store fat matters more than the scale ● Foundational supplements for heart protection (education only, not personal medical advice): ○ Omega3s (EPA/DHA) ○ Vitamin D 2 ○ CoQ10 ○ Curcumin/turmeric ○ Magnesium Red yeast rice, bergamot, berberine & more metabolic support ○ Nitric oxide support (beet root, citrulline, etc.) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Can You Do Rhythmic Dosing After a Hysterectomy? Short answer: Yes, but there are some other factors to take into consideration to make sure someone is a good candidate. In this episode, Dr. Valorie and Dr. Maki explain how rhythmic dosing works without a uterus, why it can be an excellent option after total hysterectomy (with oophorectomy) or surgical menopause, and when a simpler static approach might be better. We cover candidates, myths (like “no uterus = no progesterone”), brain and bone benefits, and how to personalize dosing for real-life outcomes—sleep, mood, cognition, libido, and long-term bone strength. What you’ll learn ● Rhythmic dosing 101 (mimicking a 26–28-day cycle) ● Hysterectomy types: uterus-only vs. total (with ovary removal) ● Why rhythmic dosing can still help—even without a period ● Customizing estrogen + progesterone to symptoms and goals ● Brain fog & sleep: why declining estradiol hits cognition ● Bone density protection in the first 5–7 years post-menopause ● Endometriosis & fibroids: nuance, not one-size-fits-all ● When rhythmic dosing may not be ideal (e.g., 60 and off HRT for many years) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Confused by your DEXA scan results? Not sure if your T-score is “normal,” “osteopenia,” or “osteoporosis”or what to actually do about it? In this episode, Dr. Valorie Davidson and Dr. Robert Maki walk through three real viewer examples to show You exactly how to interpret bone density scores in your 50s and beyond. You’ll learn: ● How to read your DEXA scan: T-score vs Z-score in plain English ● The cutoffs: ○ 0 to -0.9 → normal bone density ○ -1.0 to -2.4 → osteopenia ○ ≤ -2.5 → osteoporosis ● Why two women in their early 50s can have completely different bone density ● What a T-score of -3.7 or -3.8 really means—and whether it’s reversible ● How surgical menopause, long-term steroids, vitamin D deficiency, RA, and genetics impact bone health ● Why your 50s are really about protecting your 70s (fracture risk, independence, and longevity) ● How weight loss, GLP-1 meds, and low muscle mass affect bones ● Practical foundations to protect and improve bone density: ○ Smart movement: walking, weighted vests, strength & resistance training ○ Protein targets & why bone = “calcified protein” ○ Stress, cortisol & steroid impact on bone loss ○ Vitamin D + K2, food-based calcium & targeted bone support formulas ○ Where HRT—and rhythmic dosing—fit into a long-term bone strategy If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Many women confuse cycling static HRT with rhythmic dosing, but they’re not the same thing. In this episode, Dr. Valorie Davidson and Dr. Robert Maki from Progress Your Health break down the difference between the two, why it matters for your safety, and how to do hormone therapy the right way. In this video, you’ll learn: ● What “rhythmic dosing” actually means ● Why cycling your static HRT is not rhythmic dosing ● How improper dosing can impact mood, energy, and breast tenderness ● The risks of trying to adjust hormones on your own ● Why rhythmic dosing must follow the body’s natural ovarian rhythm ● How men and women can use synchronized rhythmic dosing safely If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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 Part 2, we go symptom-by-symptom so you can sleep through the night again. Dr. Valorie and Dr. Maki cover night sweats, frequent urination, heart palpitations, muscle cramps, headaches, itchy skin, vivid dreams, and when to suspect sleep apnea (under-recognized in women). You’ll hear practical tactics—electrolytes, targeted magnesium types, phosphatidylserine timing, glycine, L-theanine, and smart melatonin use—plus when HRT helps and how to pair data (CGM, wearables) with your sleep plan. You’ll also discover practical, science-backed fixes like: 💧 Smart electrolyte balance & targeted magnesium types 🧠 Phosphatidylserine timing for cortisol control 😴 Glycine, L-theanine, and optimal melatonin use 💊 When HRT makes sense—and how to pair it with CGM or wearable sleep data What you’ll learn ● What nighttime urination signals (estrogen & ADH, electrolytes, cortisol) ● Palpitations in midlife: estrogen link, when to see cardiology, calming strategies ● Cramps/headaches/itchy skin—common causes & quick fixes ● How/when to test for sleep apnea at home (and why it’s missed in women) ● Fine-tuning supplements & dosing; when HRT is the lever Still not sure what’s really causing your sleepless nights? Find out if you’re in the In-Between stage of perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Why midlife wrecks your sleep—and how to fix it naturally. In Part 1, Dr. Valorie and Dr. Maki unpack the hormone triad behind women’s insomnia: shifting estrogen/progesterone, cortisol dysregulation, and blood sugar/insulin resistance. You’ll learn the difference between trouble falling vs. staying asleep, how low progesterone affects GABA (hello 2–3 a.m. wake-ups), and the daily habits that reset your circadian rhythm. What you’ll learn ● The hormone triad driving midlife sleep loss ● “Vampire / Zombie / Ghoul” sleep patterns—what they mean ● Why blood sugar swings trigger nighttime cortisol spikes ● Morning fixes that help nights: protein breakfast, light exposure, movement, temperature ● Starter supplements & how to think about them: magnesium (glycinate, L-threonate), L-theanine, glycine, phosphatidylserine, melatonin If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
