Laura’s Question: 
Dear. Dr. Maki, I read your article about progesterone cream versus oral format. I have used the cream with some satisfaction but not one hundred percent happy. My sleep has been my main complaint for the last six to eight months. I’m 44 years old, still menstruating with a lot of menopausal symptoms. Recently, I found a doctor in the Netherlands who did blood tests on me. She put me on oral progesterone and transdermal testosterone. The testosterone seems a little too high, one percent, but overall helped me a lot.  Four weeks into my treatment, the oral progesterone, on the other hand, is driving me crazy! So, shortly after I take it, I feel a bit sleepy and then around two AM, full wide awake. Today, I took it during the day and I still can’t fall asleep in the evening. It seems like I’m converting it into cortisol, the progesterone. Any thoughts about what to do? Thanks very much. 
Short Answer: 
The first question to ask is if the progesterone is sustained release or is it Prometrium. Sustained-release progesterone is often much more tolerated than Prometrium, which is instant-release. The next consideration of the progesterone is the dose. A typical dose for women in there mid ’40s is 100 mg. However, this could be too much for some. Reducing the dose down to 75 or even 50 mg might be helpful.
PYHP 089 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 you doing this morning? 
Dr. Davidson: I’m doing great! How are you doing on this beautiful, sunny, blue-sky day?
Dr. Maki: It is. It was actually raining like crazy overnight in Washington. It’s pretty common this time of year but woke up and looks like it’s going to be a really nice day today. So, be nice to be outside, which will probably go outside a little bit later but yeah time to get a podcast done. So, why don’t we kind of dive into that? We have a question from Laura. 
Dr. Davidson: Yes, Laura. So Laura is a reader. So she had read one of our blog posts about progesterone cream versus the oral. So this is her question, “Dear. Dr. Maki, I read your article about progesterone cream versus oral format. I have used the cream with some satisfaction but not one hundred percent happy. My sleep has been my main complaint for the last six to eight months. I’m 44 years old, still menstruating with a lot of menopausal symptoms. Recently, I found a doctor in the Netherlands who did blood tests on me. She put me on oral progesterone and transdermal testosterone. The testosterone seems a little too high, one percent, but overall helped me a lot.  Four weeks into my treatment, the oral progesterone, on the other hand, is driving me crazy! So, shortly after I take it, I feel a bit sleepy and then around two AM, full wide awak

Donna’s Question: 
Hello. I’m 62 years old with a uterus. Recently my nurse practitioner switched me from 6% progesterone cream to Prometrium capsules. The amount of cream I was using was 1/4 teaspoon two weeks out of the month. She also added in the Intrarosa vaginal inserts instead of the estradiol cream for vaginal discomfort. I do not have many symptoms other than occasional sleepless nights and occasional hot flashes. My question is are the Prometrium capsules safe? And is the cream safer than the capsules? Thank you, Donna.
Short Answer:
Both Prometrium and bioidentical progesterone are safe to take. However, many women do not seem to tolerate Prometrium very well. Prometrium is instant release, which seems to make it less tolerable for some women. In most cases, we prefer to us sustained-release progesterone, which is typically better tolerated by most women. This is important for women taking estrogen who still have a uterus. Estrogen causes the uterine lining to thicking and oral progesterone inhibits this thickening. Progesterone cream does not inhibit the growth of the uterine lining, which is why we prefer to prescribe oral progesterone for our patients.
PYHP 088 Full Transcript:
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Dr. Maki: Hello, everyone. Thank you for joining us for another episode of Progress Your Health podcast. I’m Dr. Maki. 
Dr. Davidson: I’m Dr. Davidson. 
Dr. Maki: How you doing this morning? 
Dr. Davidson: I’m doing great. Thank you. How are you? 
Dr. Maki: Pretty good. Pretty good. You were surprised by that question?
Dr. Davidson: Yes, a little bit [laughter]. 
Dr. Maki: Why are you surprised?
Dr. Davidson: Because we’ve been hanging out all morning. [chuckle] Now you’re asking me how I’m doing.
Dr. Maki: Well, we had to start over on this podcast a couple of times, so that’s okay. That’s…
Dr. Davidson: I felt like I had rocks in my mouth. So I’m like, “Just stop it. Let’s start it over.” So I think this one will be the one [chuckle].
Dr. Maki: Yes, yes. So this one is a question we have from Donna. So why don’t you go ahead and read it?
Dr. Davidson: Oh, okay. So yes, this is a listener question from Donna, it says, “Hello. I’m 62 years old with a uterus. Recently my nurse practitioner switched me from 6% progesterone cream to Prometrium capsules. The amount of cream I was using was 1/4 teaspoon two weeks out of the month.” So it looks like they were trying to cycle the progesterone or cycle the hormones. “She also added in the INTRAROSA vaginal inserts instead of the estradiol cream for vaginal discomfort. I do not have many symptoms other than occasional sleepless nights and occasional hot flashes. My question is are t

Lilly’s Question: 
Dear Dr. Davidson, I’m writing to say how illuminating your article on Estriol was for me. Especially your metaphorical descriptions of the actions of the 3 types of estrogens. I have a question, if I may. I am 49-years-old, I just entered menopause and started taking Botanical Phytoestrogens to help with the once a day hot flash. It helped for a month and then the flashes increased to several times a day. I then took Estriol, 5 milligrams and it helped. But since then that flashes have again increased and I’m using even more Estriol, 2 pumps morning and night. It’s made me feel very, very good, calm and a great sense of well being. My question is, is this too much Estriol to be using? What is the safe upper limit for Estriol in cream form? If I take progesterone and cream form as well, with this dull the good effects of the Estriol? Thank you for the possibility of asking these questions. Very best wishes, Lily.
Short Answer: 
Dosing for bioidentical hormones is dependent on the woman. It also depends on if she has her uterus or not. One of the rules of BHRT that we follow is that you never give a woman “unopposed” estrogen. This is especially true if she still has her uterus because estradiol and estriol will cause the uterine lining to grow. This is why progesterone is important because it helps to inhibit the growth of the uterine lining. For women that still have their uterus, we prefer to use bioidentical progesterone capsules, as opposed to progesterone cream.
PYHP 087 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 just getting ready to start talking and my mic and my headphones practically fell off my head. How you doing this morning? 
Dr. Davidson: I’m doing great. Maybe you shouldn’t wear your Golden Knights hat. 
Dr. Maki: Yes, shoutout to everybody in Vegas. 
Dr. Davidson: We’d love The Golden Knights.
Dr. Maki: Yes, it’s really ironic. We live there for so long never had any professional sports. And right when they got that team, the season was going to start. And we left pretty much like, right as the season started and they had like one of the, I don’t know if anybody out there is a hockey fan or not I’m from Minnesota. So of course, I’ve liked hockey since I was a little kid. But they had like this crazy season that no one’s ever had before, for an expansion team. 
Dr. Davidson: It was definitely inspirational. 
Dr. Maki: And it’s funny too, well have granted it’s kind of started off in tragedy with that whole shooting they had there in October. But there are people there, we have patients there. And none of them really care for sports all that much now. Everybody is into the Golden Knights, which is kind o

Nathalie’s Question: 
Hello Dr Maki, I am 45 full menopause and currently on biest 80:20 (0.5 mg) and progesterone 200 since July 2018. I was also given testosterone injection at the time and by Oct 2018 I was losing hair so we stopped that and no longer take it. I have been gaining weight steadily and even though we try to increase my estrogen slowly, I get too many side effects (constipation, weight gain, horrible bloating, hair loss-diagnosed with androgenic alopecia). My Thyroid is in normal range. Is it possible that a biest 90:10 would be more beneficial for me? I do like having my brain again and dryness cured but hate the bloating and weight gain. When I stop hormones completely I feel better, my belly fat reduced no more bloating and wgt loss happens. I tried DIM but my weight just kept on increasing. Thanks! 
Short Answer: 
The Biest dose of 0.5 mg is very low. I would not think this low of a dose could cause any side effects. Issues could be with the 200 mg of Progesterone. Changing Biest ratio to 90:10 would not really help either because dose is slow low already. However, for sensitive women, using just estriol only is an option.
PYHP 086 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: Let’s dive right back in. We have another listener question to do. This one is from, actually, her name is Natalie. Dr. Davidson, this one’s fairly similar to what we did recently for Monica’s, we’ve kind of thought this would be appropriate. I want you to go ahead and read the question. 
Dr. Davidson: Sure, sure. So, this is from Natalie. Hello, Dr. Maki. I am 45 years old, full menopause, and currently on 80/20 ratio, biased 0.5 mg, and 200 mg of progesterone since July of 2018. At that time, I was given a testosterone injection. By October of 2018, I was losing hair, so we stopped that. I no longer take the testosterone injection. Since then, I have been gaining weight steadily, and even though we try to increase my estrogen slowly, I get too many side effects such as constipation, the weight gain, horrible bloating, hair loss, diagnosed as androgenic alopecia. My thyroid is in normal range. Is it possible that a different ratio of bias, like 90/10, would be more beneficial for me? I like having my brain in the dryness cured but hate the bloating and the weight gain from the estrogen. When I stop the hormones completely, I feel better. My belly fat goes away. I have no more bloating, and the weight loss happens. I did try DIM, but my weight just keep increasing. Thank you, Natalie. 
Dr. Maki: Yes, right. This is a challenging one, right. I can understand where she might be frustrated. Even her doctor might be frustrated. She’s on a very low dose,  80/20 at 0.5 mg. Maybe, she talks of bloating quite a few times in that question. I’m thinking maybe it might be more related to the progesterone than it actually is to the bias. What do you think?
Dr. Davidson:

Monica's Question: 
Hi, Thank you for providing such great information regarding BHRT, this has been a great resource and one of the best sites I have visited. My question is: I am currently going through peri-menopause; while back in July my hormones levels tanked and I started having terrible problems with hot flashes and night sweats, after about 3 mos in and no period blood test confirmed my levels are very low. I decided to go with BHRT cream and within a week I could tell a huge difference. I do have uterus and my cream included Bi-est (50-50) plus P Plus T 1.8 mg plus 200 mg plus 5mg/ml cream. On my second month in I started my period within another 10 days I started bleeding again for about 3 weeks straight. During this time I was given a 7 day supply of 10 mg oral progestin this didn't help slow down the heavy bleeding and returned to talk back to my doctor. I was told most likely I was not absorbing the progesterone. I explained my concerns of not really wanting to take the oral progesterone and was changed over to 100 mg progesterone capsule finally after about 7 more days this meds had stop the bleeding. While during this time frame of a few weeks of bleeding, I decided to get in with my regular gyno for an ultrasound although I had one in 2018 for a side pain in which everything was healthy and looked normal. I want to make sure I am getting on track and taking the oral progesterone with using the cream is the better safer option. It was also mentioned that I might consider pairing the Mirena insert with BHRT cream I am not really crazy about that idea. I always had a regular cycle with no issues and only took birth control for a short time frame in my early twenties. At age 47 I am hoping I am on the right track to have a well balance and using the least I can and feel confident in making good choices. Any suggestions or feedback is greatly appreciated.
Short Answer: 
First off, for a woman new to BHRT, we don’t like to combine so many hormones into one cream. If issues arise and the dose needs to be modified, that inital cream can’t be used. Typically, we will not start a woman on a 50:50 ratio right away. We will start with an 80/20 ratio to see how she responds. We will usually wait on the testosterone for later, once the Biest dose is optimized. Finally, we will prescribe a bioidentical progesterone sustained release capsule, instead of using a cream. This is important if the woman still has her uterus.
PYHP 085 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 you doing this morning? 
Dr. Davidson: I’m doing great. How are you? 
Dr. Maki: Pretty good. Pretty good. The weather’s nice. We’re still in lockdown, but we’re getting a lot of podcasts done. 
Dr. Davidson: That’s certainly are.
Dr. Maki: Good thing, we're going to do another question. We have a few to catch up on so this is very appropriate. This one is from Monica. Dr. Davidson once you go ahead and read the question.
Dr. Davidson: Sure. I know we’re on this kind of trend answering questions, but we’ve

Marisa’s Question: 
Dr. Davidson and Dr. Maki,
 
I truly appreciate what you are doing to share your information with the public!! You are helping many people learn more about their body!!   
 
I wasn’t sure the best place to ask this question or where you may answer it, but I found your podcast after I have been digging into how to repair adrenals. 

I was elated once I found your Podcast #69 Adrenals affecting sleep. The Ghost, defined me to a tee and I wanted to learn more on how to get better from my symptoms you so clearly described.

 
My main concern is that I wake up almost every night at 2:00 – 4:00 am and my neck is tight and my heart is beating a little heavier.  If I focus on breathing, I can go back to bed shortly thereafter, but some nights it does take a little longer.  I may wake up another time or 2 after that as well.  Is this hormonal or adrenals?
 
All my hormone levels are low, except for progesterone is healthy (169.)  I have taken the ZRT test with almost normal cortisol levels. 
TSH is too high at 5.3, free T3 – 3.2, and free T4 – 1.2. 
I take Armour Thyroid at 60mg.   Vit D is 60.

I am 44 years old female.
My blood sugar is typically in the 80’s on my morning reading when I check it on a glucometer.  
I eat mainly vegetables and focus on all food groups. 
I have been focused on adrenals for the past 2 months and have been sleeping at 930pm and sleep for about 8 hours.  
I do exercise every other day, but take it easy to not wipe myself out.  Body weights and walking.    
Pharma Gaba/L’theanine has helped me get back to sleep, but not from waking up.
I also take Ashwaghanda and practice meditation and breathing exercises.

Again, any guidance on what to look at is appreciated.  All the tips you mentioned for how to help on the podcast I have alr

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