Carrie’s Question: I am currently taking, .25ml’s Biest which is 1.25mg, 70/30 ratio per gram. I apply it to the labia and vaginal area at night, every night. About how long do I have to wait for it to absorb before having intercourse? I am getting conflicting reports. My doctor says I do not have to wait at all, as it will not affect my husband but the pharmacist says, it will affect my husband and not have sex for several hours after application. Thank you.
Short Answer: Carrie is taking a very low dose of Biest. However, she is applying the estrogen cream vaginally, so in theory, her partner could absorb some estrogen during intercourse, but Carrie’s applied dose is only about .30 mg. This small amount of Biest is barely enough to affect Carrie, let alone her husband. If the male partner is worried about the estrogen, simply skip applying the cream until after intercourse. If the Biest cream is being used to help with pain and discomfort during intercourse apply about an hour or so before activity. For vaginal use, we typically only recommend Estriol cream and not Biest, which has both Estradiol and Estriol.
PYHP 107 Full Transcript:
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: Well again, we are trying to do our best to get back in the swing of things back in podcasting land. It actually feels pretty good. On the last podcast, we talked a little bit about the book that you have coming out. I would just mention it real fast up for perimenopause plans, going to be available on Amazon. We will keep you up to date when that comes out. If you have any questions, just in general. You can always send us an email at [email protected].
We are going to do another question today again because we took some time off over the summer. We got a whole slew of questions for us to do, this one does come up quite often. Why do not we just dive into it? This question is from Carrie.
Dr. Davidson: We always change everybody’s names and personal information just for privacy, but this is a really good question. We are going to break it up a little bit, give the general answer to it. And then I am going to get probably a little nitpicky on it because I like the math part. But, this is from Carrie. “I am currently taking, .25ml’s biased[?] which is 1.25mg, 70/30 ratio per gram. I apply it to the labia and vaginal area at night, every night. About how long do I have to wait for it to absorb before having intercourse? I am getting conflicting reports. My doctor says I do not have to wait at all, is it will not affect my husband but the pharmacist says, it will. And she capitalizes ‘WILL’, which will affect my husband and not have sex for several hours after application.” Thank you. She is wondering which way should she go?
Dr. Maki: This one comes up a lot and I guarantee you that the husband is worried about the estrogen, right? Men are always worried about little estrogen, It is probably more of his concern, he is more of, what about that estrogen? He does not want to grow boobs or something. To be honest, every man is worried about that, but I do not think it is really that big of a deal. She might not want to apply it vaginally and hav

Joy’s Question: Is the Vivelle patch good to use? My gyno prescribed it for hot flashes, vaginal burning, vaginal itching, and mood issues during ovulation before my period. I have not tried it yet, though.
Short Answer: Some women do fine with the Vivelle patch. However, in our experience, many women do not tolerate the patch very well, or it does not provide full relief of menopausal symptoms. The key to this question is the fact that Joy was prescribed the patch, but is still having a regular period. We don’t agree with using the patch for women who are still menstruating. There are some better options that we discuss in this episode.
PYHP 106 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 am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: Well, we are back. It has been a little bit of a hiatus. We had a really amazing summer, right? You know, summer is always a fun time. So we took a little bit of time off on the podcast, but now the weather has changed a little bit. We are into fall, the perfect time to kind of get back into the podcasting routine.
Dr. Davidson: Definitely. Ready to hit the ground running. Although fall was really beautiful here with the leaves changing. So yeah, it is good. I am definitely ready to get back into the podcasting seat.
Dr. Maki: For some reason, when it was really nice out and the sun was shining every day, it was really difficult to come and sit down and do a podcast. It was really challenging, but nonetheless, we kind of decided ahead of time that we were going to do that anyways. But now we have lots of questions that people have reached out to us with. So we have just a tremendous– [laughter] in some ways, we probably should not have taken that time off because now we have so much work to do, but this is good.
These are legitimate questions that people are asking us, and we feel that without coming up with topics of our own, this makes it so relevant when people ask us question because we get to hear our listeners. We get to hear our readers for the blog post. We get to hear what problems they are actually dealing with.
And I think that is really valuable because now we have a chance to sit down, kind of discuss them, give everybody our opinion. So that one person really is helping a lot of people because now we are giving our answer to that very specific question to lots and lots of people.
Dr. Davidson: Exactly. When you write in or email us with your question, know that you are not alone. The question you have, trust me, we have heard it over and over and over again so it is really great to get it from a reader or listener’s perspective, and then when we can apply it to the masses, it helps everyone.
Dr. Maki: Yeah, right. So we are going to dive in this question. Now, we are changing everybody’s name just to keep it so there is no question about identity or anything like that. So the name that we are going to give is not the actual name of the person, but nonetheless–
Dr. Davidson: Just for protection, anything that looks like it would be something that– we would just change even if it is descriptions

Mary’s Question: I am 58 years old and lost my thyroid to cancer eight years ago. I am finding it impossible to lose weight and have thinning hair near my hairline and no eyebrows. I started Bi-est cream, 50/50 ratio, 2.5 milligrams; progesterone, a 175 milligrams; and testosterone, 1 mg. About a year ago, it was lower doses and then went up to those as recently my doctor had me using it twice a day, the cream, and then the progesterone, one pill at night, because my levels have shown that my progesterone is 7, estradiol less than 5, – that means it is not even in the bloodstream – free testosterone is 1.2, total testosterone is 6 . I am so afraid I am going to gain weight more or more hair loss from some of the things I have read. Please give me your opinion. I also take Tirosint and Cytomel for my thyroid. Do I have to worry about any medication interactions? Please help. Mary.
Short Answer: Typically, bioidentical hormone replacement therapy (BHRT) is not going to cause consistent weight gain. When starting BHRT, there might be slight water retention, but should not lead to consistent weight gain over time. If weight gain continues once on BHRT, pay attention to insulin status and stress level. For more information on our approach, you can download our Keto Carb Cycling Program.
PYHP 105 Full Transcript: 
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Dr. Maki: Hello, everyone. Thank you for joining us for another episode of Progres Your Health Podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: So what are we going to do later today?
Dr. Davidson: I do not know. Hopefully, get to go, maybe, for a hike or a long walk.
Dr. Maki: Yeah. Weather is good. It is August in Western Washington. Beautiful. It does not get too hot here. You know, we still have some patience in the Southwest. When I am getting ready to talk to them I look at the weather app and I see those triple digits: hundred and five, hundred and nine, hundred and ten and I have to say, it makes me cringe a little bit.
Dr. Davidson: I remember living in the Southwest and, August, I could not wait for August to be over with, like, come on, let us get to September. Let us get to the middle of September. And now I am like, I just want August to last forever. Please go slow go slow. [laughs]
Dr. Maki: Yeah. It is amazing how much of a contrast in you and I in the summertime. So June, July, August– it seems like, in the Southwest, Labor Day is when everything starts to change. You can feel it. Like you wake up one of those mornings and it is like, “Oh, okay. Summer is just–
Dr. Davidson: It is still pretty warm, but at least you are on the tail end.
Dr. Maki: Yeah, but you can start to feel like it starts to, you know, you get rid of some of those hundred and ten degree days and it will be in the upper 90s, maybe a hundred, and then it starts to gradually trickle down. But I remember you and I used to

Monica’s Question: Hi, I have been prescribed testosterone cream and I have been advised to apply it to my inner thigh. I was wondering, in doing so, will this reverse the results of my laser hair removal on my bikini line? As per you stated that someone had a similar experience to this. Should I apply it there or should I apply in another area? Thank you. 
Short Answer: Applying testosterone cream to the mid-inner thigh should not affect the bikini line. However, the hair in the area of where the testosterone cream is applied will get darker. There is no real way to avoid the hair from darkening. Switching thighs can help, but it will probably still darken in both areas.
PYHP 104 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 am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: So summer is moving along very quickly I cannot even believe it is almost the middle of August already. 
Dr. Davidson: I know summertime is so fun in Washington. 
Dr. Maki: We have got rain in the last couple of mornings which actually has been– We had quite a bit of rain in June at least it seemed like July was really nice and now the last couple mornings we had a really nice stretch with no rain at all. And now it was kind of nice actually with a little bit of drizzle in the morning. We have got this jungle in the back of our house. I know that you kind of went back there with little clippers and trying to– We have this little trail that leads up to another trail and you are back there a couple of days ago trying to clean up the trail. 
Dr. Davidson: Exactly. We have a beautiful trail up there and it is funny because I always laugh with my patients that summertime. It is almost, even though it is beautiful, it seems like it is harder to exercise and eat well because it is almost like you are just having too much summertime fun. Where the holidays, you can be a little bit more diligent because the holidays are one day but it seems like summertime fun. So we have been trying to rain it in and do some more exercise and eating a little cleaner

Mary’s Question: Hi. I just started estriol cream a couple of weeks ago. I am fifty-three years old and have been told I have PCOS for the past twenty years with a history of absent periods, heavy facial hair growth, and moodiness, and PMS. I have managed my PCOS through diet change, supplementation, and exercise. And I am told I am quite healthy. I began taking the estriol cream for bladder urgency and frequency and for the mucous membrane support for vaginal dryness. Sex had become very painful. I am experiencing some really wonderful positive benefits from the estriol. And in some ways, I realize I have probably been short of this for many many years likely due to the malfunctioning of my ovaries with the PCOS. The skin over my shinbones that has always been flaky no matter how much I moisturize, now, is soft, smooth, and supple for the first time in many years. The skin on my elbows, knees, and heels is softening. And it seems to have helped my skin tremendously. Even my facial hair is coming in much lighter. It seems to be reducing my belly fat in some ways. It is kind of a miracle. And I wish I had known about this years ago. The possible deal-breaker here is that I have become so painfully constipated over the past few weeks. And the estriol cream is the only thing that has changed. I also take bioidentical progesterone in a troche form which I have been taking for about ten years without a problem. The estriol is the only thing that has changed. The only time I can remember being this consistently constipated over a long period of time was during my two pregnancies. Any thoughts?
Short Answer: For constipation, the common advice is to drink more water and eat more fiber. However, for some, this does not work. It may seem strange to think that bioidentical hormones could impact digestion, but it is certainly possible for either progesterone or estrogen to cause someone to become constipated. We look at constipation as being a liver issue. Taking hormones can put a slightly extra burden on the detoxification capacity of the liver, which can slow down digestion.
PYHP 103 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 am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: So how is your summer going? 
Dr. Davidson: My summer is going great, although it is already August. So I feel like it is almost over. 
Dr. Maki: Yes. 2020 has been such a roller coaster. But yes. Weather is good. We are surviving everything. 
Dr. Davidson: How is your summer going? 
Dr. Maki: Well, it is a rhetorical question, because I know exactly how your summer has been, because mine has been pretty much the same as yours. So I cannot complain. But you are right. It is going by way too fast. I cannot believe it is already August. But we still have a couple of months of nic

Allison’s Question: I have opened a hormone wellness practice and came across your blog. You mentioned the application of estrogen cream to the face, neck, and chest to improve skin health. From what I found, it appears that .3% Estriol and .01% Estradiol is typically used. Do you recommend a once-daily application? Can this same dose be applied to the inner and outer labia for improvement of external skin appearance as well as the vaginal entrance to improve vaginal dryness, etcetera? Thank you in advance for any feedback you can provide.
Short Answer: We typically only use Estriol cream for the face and the vagina. For the face, we do recommend using estriol daily, usually as a nighttime moisturizer. As for vaginal use, we recommend daily use of estriol cream for the first 1 to 2 weeks depending on the severity of symptoms. After that, we suggest a frequency of 1 to 3 times per week. We don’t use estradiol for vaginal use. The dosage of estriol we typically use for both is is 4 mg/gram, but apply 1/2 gram with each application.
PYHP 102 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 am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: So I got an email back this morning from the designer. The kind of the first draft of your book cover. It was in my inbox this morning. What do you think about that? 
Dr. Davidson: I think I am nervous as heck. 
Dr. Maki: It is good. There are two different versions. I like a couple of things about each one of them. I will show it to you a little bit later, but it just came in right before we sat down to do this. Got to change the color scheme a little bit but so far so good. 
Dr. Davidson: All right, and the book is on perimenopause. 
Dr. Maki: This is the middle of summer 2020 so hopefully this will be available on Amazon probably, I am hoping within the next month but there are some other things we want to do prior to that. Maybe by Labor Day, I am thinking and to be conservative and to give ourselves a little bit more time to make sure we have all the things that need to be working, working properly. But we will definitely keep everybody posted.

Question: Hello. I am forty-five, perimenopausal diagnosed by blood work. I have my uterus and I am taking 200 milligrams of bioidentical progesterone each night orally by capsule. I do not take anything else for hormone balance other than evening primrose oil and some adrenal support. Neither of these is new to my regimen. What is new is the administration of the progesterone orally. Previously, I was using a progesterone cream, 40 milligrams per night. All nights of my cycle, no break. Doc suggested that I needed to be more cyclical with my administration and then I try oral progesterone instead. I am doing this. I go to sleep well but toss and turn a bit more than I used to, then wake up around four thirty-five and cannot sleep any longer. My body temperature seems to be all over the place. At some nights around that same time, I wake up hot, not really a hot flash per se but just hot, but the very next night, I can have on the same bedclothes, sheets, house temperature, et cetera, and will not get hot. She has me doing fourteen days, fourteen to twenty-eight, taking the oral progesterone. My trouble is the fourteen days I have to wait to take it, I have all the trouble sleeping and all the other symptoms while I am waiting for that fourteenth day to come so I can take my oral progesterone. My question, can I take it full-time during my cycle and never take a break or does that go against all medical wisdom and/or would be bad for my body not to have a break?
Short Answer: Based on a woman’s physiology, it does make sense to only take progesterone during the second half of the month. Typically, progesterone is produced from ovulation to the period and usually peaks around day 21 of the cycle. However, many women feel better when they take oral progesterone all month long. Oral progesterone helps reduce irritability, reduces anxiousness, and can improve sleep. Because of this, we most often prescribe progesterone to be taken all month long. Sustained Release Oral Progesterone is usually very well tolerated, but sometimes it can change a woman’s cycle. Based on how the cycle changes will determine if the dosage needs to be cycled or not. For example, we might prescribe 50 mg for the first half of the month and then increase to 100 mg during the 2nd half of the month. Then we have our patients stop the progesterone during menstruation.
PYHP 101 Full Transcript: 
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Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Prog

Alexis Question: 
Hi there, this forum is fabulous. Thank you. I am so confused with dosing. How much is one gram of Biet in mL – milliliters. So confusing. I use a one mL syringe. One mL is a lot of cream. It is an eighty-twenty ratio and I will split the dose. Reading that your recommended starting dose is three milligrams, how much exactly is that in cream in terms of milliliters or MLs? That cannot be three MLs, that would be three syringes. Sorry to be daft. I have tried to find the answer on Google but nothing is making sense to me. Maybe that is why I need bioidentical hormones. Anyway, Help. Thank you, Alexis.
Short Answer: 
1 gram is equal to 1 mL.
A BHRT prescription can be written in either mg/gram or mg/mL. For example, when we call in prescriptions to a compounding pharmacy, let’s say the Biest prescription is 3 mg/gram with an 80/20 ratio. This is the same as 3 mg/mL with an 80/20 ratio. The instruction we give the patient is to apply 1/2 gram, twice per day. If the patient is using a Topi-Click device, 1/2 gram is equal to 2 clicks. We like to have the patient apply 1/2 gram because they have to apply much less cream to the skin. We always recommend women apply their Biest to the inner thigh. We don’t recommend applying Biest to the arms, forearms, wrists, abdomen, or vaginally. If the patient is having any vaginal dryness, then we will provide separate Estriol (E3) prescription that can be used vaginally. We don’t like to have patients apply Estradiol (E2) vaginally, especially if they still have a uterus.
PYHP 100 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 am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: So it is the middle of summer, enjoying some beautiful weather.
Dr. Davidson: Gorgeous.
Dr. Maki: It is a little hard to get into the podcast room and actually sit down and record some of these. You know, summer gets a little distracting. But nonetheless, we are here. Actually, some questions came in recently that were really good. Good in the fact that they are the ones that come up a lot and we figured that these would be good to talk about.
Dr. Davidson: It would be helpful to the listeners. Should we just go ahead and start reading the question?
Dr. Maki: Yeah, let us dive into this. What is the name of the first one?
Dr. Davidson: Yeah. We always change the names of the questions, you know, just to respect the privacy of our Progress Your Health community. So this one, we changed to Alexis.
Dr. Maki: Why is it Andrea and then you said, Alexis?
Dr. Davidson: I like the name, Alexis. But I like the name Andrea too, but I like Alexis.
Dr. Maki: Yeah. Okay. Alright. This person, we will call her Alexis.
Dr. Davidson: Alexis. So do you want me to read it?
Dr. Maki: Go ahead.
Dr. Davidson: So again, this is from Alexis. “Hi there, this forum is fabulous. Thank you.” Well, thank you right back. “I am so confused with dosing. How much is one gram of bias in ml- milliliters. So confusing. I use a one-ml

Question: What are symptoms of thyroid problems in females?
Short Answer: There is a wide variety of thyroid symptoms in women. Some of the more common are fatigue, weight gain, constipation, and dry skin. Based on our experience, we have noticed many other hypothyroid related symptoms as well. These symptoms include heavy periods, infertility, anxiety, low libido, hair loss and low mood.
PYHP 099 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 am Dr. Maki
Dr. Davidson: And I am Dr. Davidson. 
Dr. Maki: So it is officially a little bit past the beginning of summer in Washington, although looking out the window right now, it certainly does not look like summer. It is raining kind of heavy right now. 
Dr. Davidson: I would say even though it is supposed to be summer, it seems like spring has officially started because it is really beautiful with the little deer out and the flowers are blooming, and I think it will clear up a little bit later. 
Dr. Maki: Yes, you know that I sent you the picture you saw but for the listeners, I was sitting here, you were upstairs and I was looking out the window and I saw a female deer and then she just took a picture of it. You know, that is great. A deer walks through the yard all the time and then she moved and there is a little, literally like a little fawn, a little Bambi right next to her and kind of following along and she hit the little white spots on the side and there. Eating little weeds in the yard and they walked over to the little garden over there and ate some things out of the garden. 
Dr. Davidson: I was so happy to see that picture because I saw that little fawn a couple. I think a couple of weeks ago right after it was just born with its mom walking through the driveway and then I did not see them again and well, little baby still. Okay, so it is really neat to see him or her a little bit bigger with those little white spots on the bum. 
Dr. Maki: Yes, right. That was that was nice. You know, we do not see the deer hardly at all winter long and then it seems like June, I remember where we lived. Now we moved in here lack last year and June came literally like June first I will send, the deer came almost every day. We are having deer come through the yard and sure enough, here is June again. I do not know where they go.
Dr. Davidson: Only because we do not cover up our garden beds. So we basically are growing a garden to feed deer. [laughing] Which is fine. 
Dr. Maki: That is okay. 
Dr. Davidson: They need to it. 
Dr. Maki: That is all right. Make sure the little one gets the gets a meal here and here and there. So on today’s episode, we are going to talk about thyroid. This is a question, this is actually a specific question from somebody