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

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

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

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.

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?

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

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.

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:

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