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?

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: 
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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, 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: 
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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 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:
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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 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
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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, 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

Michelle’s Questions: I am 52 years old going through menopause since 48. I had a hysterectomy at age of 36 and kept my ovaries for the hormones. My ovaries are nonfunctional now. I was on Premarin, but when I sought out a specialist for hormone therapy, I was prescribed: Estradiol 0.5 Estriol one milligram, which is technically Bios. It’s the combination of estriol and Estradiol. Estradiol was 0.5 milligrams, Estriol is one milligram. And I am also taking a hundred milligrams of Progesterone.
I take this at night. I’ve had a weight gain of 40 lbs and suffer from anxiety at night since starting menopause. I was prescribed Propranolol, which is technically a blood pressure medication, but it does help with reducing anxiety. But she has prescribed the propranolol for this and it seems to take the edge off. I have poor sleep as well, where I used to sleep very well.
What am I missing? Am I on the right track? I feel deconditioned fatigue and brain fog to mention a few. I feel poorly when I used to be a happy, healthy person. Please help with recommendations. Would testosterone help? My levels were not terrible enough to prescribe.
Answer: 
In this episode, we discuss a question we received from Michelle that was started on Premarin but then transitioned to 1.5 mg of Biest cream. Of course, we are not fans of Premarin and would never prescribe this for our patients. However, we do prescribe Biest all of the time. There is very little similarity between Premarin and Biest. When transitioning from a tablet form of estrogen like Premarin to a transdermal cream, the dosing of the Biest needs to be definitely increased. For most women, our starting Biest dose is typically 3 mg to 5 mg.
Full Transcript PYHP 073 
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the progression health podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: So just as a warning before we get jumping into the episode, we are in our home office recording this. Our dog is with us as well. He’s always with us. We can’t really go anywhere without him, but he’s laying on the floor with a bone. So, if you hear any strange noises or any banging around, he’s just either repositioning or trying to find another bone. We can’t really go anywhere without him. And he’s happy as long as we’re close by.
Dr. Davidson: In some ways. He’s kind of our first dog, ’cause our other one was a poodle, which they always say once you have a poodle, all the other ones are just dogs. So, he was completely different from this one. He follows us everywhere so if you hear him chewing, he’s chewing on a bone. Thank goodness he doesn’t chew on other things. It’s just his bones.
Dr. Maki: No shoes, no clothes, no furniture. Just bones. So, we’re good, we’re lucky about that. All right, so, now this episode and the next few, we know enough to