Laura’s Questions: I am on 25 mcg of Levothyroxine for 6 yrs with hypo symptoms, every one! My endocrinologist just took a panel, and the results are the following: 

TSH 2.36 uUI/mL        Reference Range = 0.45 to 4.5 uUI/mL 
Free T4 1.1 ng/dL         Reference Range = 0.82 to 1.77 ng/dL 
Free T3 2.9 pg/mL       Reference Range = 2.0 to 4.4 pg/mL

Should we up my dose of Levothyroxine to 50 or should I just switch to Synthroid or Armour? Thanks!
Short Answer: We typically don’t recommend or prescribe Levothyroxine or Synthroid for our patients. Both of these medications only contain the T4 hormone. This is referred to as T4 Monotherapy. These medications do a good job of lowering the TSH level but do not always help the patient feel better. We like to prescribe thyroid medication that contains both the T4 and T3 hormones. In our experience, our patients tend to feel much better on a combination medication, rather than on a T4-only medication.
In our opinion, we feel that sustained-release compounded thyroid medication is the best option most of the time. This type of thyroid medication gives the doctor many dosing options, which is certainly good for the patient and their overall symptom profile. Because this medication is compounded, the T4 and T3 hormones can be changed independently of the other hormone. With a commercial prescription, there are only so many dosing options, and both hormones are affected when raising or lowering the dosage. Also, the sustained-released nature of the medication helps to reduce any unwanted side effects that are common with commercial instant-release thyroid medications.
Related Podcast Episode: 
PYHP Episode 038 –  Do You Have a Low Free T3 Level? 
Check out Dr. Davidson’s new book – The Perimenopause Plan
Buy the book on Amazon.
If you have questions about your thyroid or any other hormone related issue, feel free to contact us.
The post Is Armour Thyroid Better Than Levothyroxine? | PYHP 120 appeared first on .

Patient Question: Why am I getting acne in my 40s?
Short Answer: Women’s hormones are always changing. From puberty to middle age, to when the ovaries cease producing hormones in menopause. When we hit our 40s, our progesterone starts to decline. And our estrogen levels drop slightly as well. But the androgens, which are testosterone and DHEA do not decline. That means that there is less progesterone and estrogen to buffer the effects of the androgens.
Testosterone and DHEA are great, useful hormones for a female’s body. They help with muscle mass, motivation, ambition, libido, bone density, and stress management to name a few. But in our 40s when estrogen and progesterone start to decline that makes the androgens the ‘leaders of the hormonal pack.’
There is no buffer against the negative side effects of androgens. One being, acne. Women in their 40s are usually still getting a period and cycling. So that means that the breakouts and acne are worse anywhere from 7-14 days before their period. That is because women really only make progesterone in the last half of their cycle. Those days being days 14-28.  Because of the decline of progesterone, acne can be quite prominent before a period.
But because the estrogen may have declined a bit in our 40s, we are still apt to have breakouts all month long. Because acne in the 40s is from the unopposed androgens, the acne is mostly on the chin and jawline. Although the neck and back are also common in a lot of women in their 40s. And the breakouts are more cystic in nature. They are deep and hard to “pop” (which we all know we should never ever do, and yes, I can’t help it either). And cystic acne lasts for weeks. So when one cystic pimple is starting to heal, aggravatingly three more show up. It is very frustrating.
In addition too unbalanced androgens, stress, and cortisol levels can exacerbate acne. Women in their 40s are busy. There are family commitments, work, home life, and trying to stay fit is certainly not as easy as it was in our 20 and 30s. Plus the drop in progesterone and estrogen lets the androgens (testosterone and DHEA) make us feel more easily ‘testy.’ The stress and unbalanced hormones cause cortisol levels to rise. Which unfortunately also makes the breakouts worse.
We really like to use Acnutrol and Inflammatone to help with breakouts.
Below are some other episodes where we discuss other issues related to Perimenopause.

Listener’s Question: Hello, recently my Nurse Practitioner recommended that I should start taking progesterone because she mentioned that I was estrogen dominant. I don’t have any real symptoms, so just want to make sure if I even need to take the progesterone. Thanks.
Short Answer: If you don’t have any direct symptoms, then progesterone would not be necessary. We prescribe progesterone to women of all ages, but usually, they have a symptom profile that justifies the prescription. It is not likely for a woman to be truly estrogen dominant without any noticeable symptoms (fibroids, endometriosis, heavy bleeding, etc).
If a cycling woman does her blood work around day 12 of her cycle. The estradiol will be higher, and the progesterone level will typically be less than one (<1.0). It could appear to be too much estrogen compared to progesterone, but this is normal. A woman’s body does not produce any progesterone until ovulation, which typically occurs about day 14 of the cycle. This is why it is important to know what day of the cycle the lab work was done in order to interpret the estradiol and progesterone levels. Once a woman enters the 40s, her body begins to change; however, we don’t prescribe progesterone simply based on a blood test. The patient’s symptom profile is a better indicator of whether or not to prescribe progesterone. Some of the common symptoms we look for are heavy periods, irritability, anxiousness, and poor sleep quality. Generally, for a woman dealing with classic perimenopausal symptoms, we will prescribe 100 mg of bioidentical, sustained-release progesterone capsule taken at night 60 minutes before bed. This is a good starting point but may need to be adjusted based on the woman’s response. We do get a lot of questions asking about progesterone cream, but in our experience, it does not seem to be as effective at resolving perimenopausal and menopausal symptoms as oral progesterone. For more information about progesterone, below are links to previous episodes. PYHP 101 – Can I Take Progesterone All Month?  PYHP 111 – Does Progesterone Help With Perimenopause?  PYHP 113 – Can Progesterone Cause Dizziness?  If you have more questions about progesterone or other female hormone issues, feel free to contact us. We are here to help.   The post When Should A Woman Take Progesterone? | PYHP 118 appeared first on .

 
 
 
 
 
 
 
 
 
Sarah's Question:
Hi I was diagnosed with ovarian failure at the age of 36. Its been 4 years now, I have been to a few different clinics, trying to figure out what works best for myself. Right now I am using estrogen patches, which do seem to work well, and Prometrium. My main problem that I still face is lack of sleep. The estrogen patches help my mood and sleep some but I have tried a few different progesterone creams and pills, and have not found any improvement in sleep from it. I am wondering what is the brand name of the slow release progesterone you described. Thanks
Short Answer: 
We almost always use bioidentical sustained-release progesterone from a compounding pharmacy. A typical dose we like to start with for sleep is 100 mg. The commercial form of progesterone available at big box pharmacies is Prometrium, which is an instant release. However, in a situation like Sarah’s being diagnosed with Ovarian Failure at 36, we would consider prescribing Rhythmic Dosing to restore her hormones to physiologic levels. This type of dosing protocol is intended to initiate a period in a menopausal woman that still has a uterus. If Sarah still has a uterus, she would also resume menstruating on a monthly basis. Estrogen is what makes a woman a woman. In many cases, the more estrogen a woman has, the better she will feel. The better she will sleep. For more information, below is another episode we did explaining the rationale and how Rhythmic Dosing works.
Episode 91: How to Cycle Bioidentical Hormones?
One of the best pharmacies we work with for Rhythmic Dosing is Harbor Compounding Pharmacy, located in Costa Mesa, CA. They are PCAB Certified and are currently licensed in 32 states.
Feel free to contact us if you have more questions regarding Ovarian Failure or Rhythmic Dosing.
The post Can Ovarian Failure Be Treated? | PYHP 117 appeared first on .

Megan’s Question:  This was great information. I have been 130lbs until I turned 48. Now up to 157. Weight gain all in my stomach, legs, arms, boobs and butt. I have still been working out intensely with weights and cardio and no weight loss . After listening to this is sounds like I should do less intense workouts and eat more. No period for 7 months now. I am soooo frustrated and want to loss this weight. Short Answer:  Many of the women we work with are desperate to stop the weight gain during perimenopause. As a strategy to lose weight, most women in perimenopause try to “eat less and exercise more.” This translates to going on a calorie restricted diet and engage in cardio-based exercise 4 to 6 days per week. This strategy works when your 25, but does not work after the age of 40. The simple mantra we discuss in the podcast is to “eat more and exercise less” in order to lose the desired weight. Also, instead of cardio-based exercise, we encourage women to start strength training as their fitness foundation and to eat more protein on a daily basis. Instead of trying to lose weight, the paradigm shift should be to build muscle instead. Exercising as a mode of “burning calories” in order to lose weight does not work well for women in their 40’s or beyond. Also, stress needs to be reduced and sleep quality needs to be improved before exercise is a priority. The decline of progesterone and lots of stress make women more responsive to cortisol, which contributes to the unwanted weight gain in perimenopause. So going on a diet and exercising a bunch only adds to the stress. This can make losing weight almost impossible. Check out Dr. Davidson’s book: The Perimenopause Plan Book on Amazon   

Question: I am forty-six years old and a 34A. Now, I’m a 34BC. My breasts hurt at least two weeks out of the month. Swollen, heavy, painful, have to take ibuprofen. It’s annoying as hell and it’s changed how I view my body. Not to mention, my midsection has changed too. I never wanted large breasts. I know BC cup is not large, but it is to me. And now I need to wear two sports bras to run. And I like to run all the time. And I feel like I did when I was nursing. This totally stinks. Does it get better? 
Short Answer: During a woman’s 40’s, there are many hormonal changes that are happening, which lead to a wide variety of symptoms. Progesterone is declining, and estrogen is still being produced and stress levels can be all over the place. These changes can lead to many unwanted symptoms. Breast tenderness and an increase in cup size is generally related to too little progesterone and proportionally too much estrogen. There is not necessarily an increased amount of estrogen production, but really just a lack of progesterone that leads to many of the symptoms of Perimenopause.
PYHP 115 Full Transcript;
Download PYHP 115 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 back, we’re back in the saddle do another podcast.
Dr. Davidson: We sure are.
Dr. Maki: It’s been a little while. We haven’t posted any for a little while. We apologize for that. But we’ve been very busy. We got a new puppy.
Dr. Davidson: We did get a new puppy, a poodle puppy.
Dr. Maki: Alright. So we’ve talked about Bob, our little co-pilot. He is having a little bit of a crisis. He’s kind of having a crisis with the new puppy. About one minute, it was really funny, we brought her into her first grooming sessions placed here in town called Bailey’s and she looked like a little bit of a shaggy mess. And then they just really didn’t do much because this is her first one. She’s only like four weeks old and she came back from the groomer with a nice blowout. She got her hair done. And Bob was all interested and her name is Vivi, Vivian, one of my relatives. Bob’s named after my dad, and Vivi, our new poodle is named after another relative. She was technically my great aunt, but more like my grandmother. So it’s Bob and Vivi. She came back from that groomer, a grooming session. And Bob was, he was very… he changed his