Maria’s Question: 
Hello, I’ve been reading the articles on BHRT, and I have questions. Does the body or will the body develop tolerance to hormones? Whether progesterone, testosterone or estrogens, will I eventually have to increase my dose to get the same effect, progesterone for sleep, estrogen for hot flashes, testosterone for energy and libido… Thank you very much.
Short Answer: 
There are many factors that go into a BHRT dosage for a patient. This includes age, gender, lifestyle, stress level, and severity of symptoms. Typically, when we work with a patient, their BHRT dosage will increase over time. A patient does not necessarily develop a tolerance to bioidentical hormones; however, a lower starting dosage may not be effective to manage symptoms and a slight increase may be needed.
PYHP 083 Full Transcript: 
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Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the progression podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson. 
Dr. Maki: So, we’re going to kind of dive right in. This is another question. This one comes from Maria. Again, looks like she found us on a blog post on how does bioidentical progesterone help. So, Dr. Davidson want to read the question from Maria.
Dr. Davidson: Sure, sure. So, I know we’ve been doing a lot of reader questions lately. Only because we’ve been getting a lot of questions in and I do think that they’re important, but know that we’re going to do a combination on what questions, topics, concerns.
Dr. Maki: Yes, yes. Like I said, we have a kind of a backlog. And these are very specific type questions. And we know, which is why we’re doing them that these kind of answers to these questions are next to impossible to find on the internet, you can’t just type in a question that we get and be able to find that answer. You have to look and look and look and then when it comes to hormone replacement in general, there’s a million different opinions, right? There’s not just one way to do a bioidentical hormone replacement therapy. 
You talk to 10 doctors. You’re going to have 10 different opinions, which makes it even more confusing for the patient. Because, well, their doctor does one thing, we say another, another doctor says something else. How does the average person make any sense of any of that, okay? But we have our approach. We have what works for our patients. And a way to when problems arise like on the last episode, when something comes up, knowing how to, which is also an issue that comes up quite a bit. Sometimes doctors do a dose or do a prescription or do a treatment plan, but then something comes up that is not favorable, and they don’t know how to fix it. That’s also why we’re kind of doing this podcast as well, because we end up seeing a lot of those people because they got it, they went to see somebody else, and they just didn’t get the results they wanted and they end

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: 
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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:
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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: 
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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: 
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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?