Full Transcript Are Women Being Underdosed on Estradiol? 0:02 Why is this happening? Why are they 0:02 Why is this happening? Why are they being underdosed? I think there's 0:03 being underdosed? I think there's 0:03 being underdosed? I think there's probably still some skepticism of the 0:06 probably still some skepticism of the 0:06 probably still some skepticism of the dangers of estradiol. 0:12 Are women being underdosed on estradiol? 0:12 Are women being underdosed on estradiol? Hi, I'm Dr. Valerie Davidson from the 0:14 Hi, I'm Dr. Valerie Davidson from the 0:14 Hi, I'm Dr. Valerie Davidson from the Progressive Health Podcast. 0:15 Progressive Health Podcast. 0:15 Progressive Health Podcast. >> Dr. Mackey from the Progressive Health 0:17 >> Dr. Mackey from the Progressive Health 0:17 >> Dr. Mackey from the Progressive Health Podcast. Uh so I've had uh the privilege 0:20 Podcast. Uh so I've had uh the privilege 0:20 Podcast. Uh so I've had uh the privilege of doing a few consults this past week. 0:23 of doing a few consults this past week. 0:23 of doing a few consults this past week. And I would have to say that at least 0:25 And I would have to say that at least 0:25 And I would have to say that at least from a small sample size, uh but even 0:28 from a small sample size, uh but even 0:28 from a small sample size, uh but even women listening to the podcast, a 0:30 women listening to the podcast, a 0:30 women listening to the podcast, a resounding yes that women are being um 0:33 resounding yes that women are being um 0:33 resounding yes that women are being um sort of uh chronically underdosed. 0:35 sort of uh chronically underdosed. 0:35 sort of uh chronically underdosed. >> Yeah, from the for estradiol. Cuz
Why Estradiol Dosing Often Runs Too Low 0:37 >> Yeah, from the for estradiol. Cuz 0:37 >> Yeah, from the for estradiol. Cuz estradiol is a main hormone for women. I 0:39 estradiol is a main hormone for women. I 0:39 estradiol is a main hormone for women. I mean, we love estradiol. We need it. But 0:42 mean, we love estradiol. We need it. But 0:42 mean, we love estradiol. We need it. But I do find from other practitioners when, 0:44 I do find from other practitioners when, 0:44 I do find from other practitioners when, you know, we're doing consults with new 0:46 you know, we're doing consults with new 0:46 you know, we're doing consults with new patients or we get those of you writing 0:48 patients or we get those of you writing 0:48 patients or we get those of you writing in, the doses of their estradiol are 0:51 in, the doses of their estradiol are 0:51 in, the doses of their estradiol are pretty low. 0:52 pretty low. 0:52 pretty low. >> Yeah. 0:52 >> Yeah. 0:52 >> Yeah. >> And that's probably part of the reason 0:54 >> And that's probably part of the reason 0:54 >> And that's probably part of the reason why they might not be feeling well. And 0:56 why they might not be feeling well. And 0:56 why they might not be feeling well. And then you wonder, well, why is this 0:57 then you wonder, well, why is this 0:57 then you wonder, well, why is this happening? Why are they being 0:59 happening? Why are they being 0:59 happening? Why are they being underdosed? I think there's probably 1:01 underdosed? I think there's probably 1:01 underdosed? I think there's probably still some skepticism of the dangers of 1:04 still some skepticism of the dangers of 1:04 still some skepticism of the dangers of estradiol just, you know, from what from 1:07 estradiol just, you know, from what from 1:07 estradiol just, you know, from what from that WHI study and 1:08 that WHI study and 1:08 that WHI study and >> 2002, like 24 years ago. 1:10 >> 2002, like 24 years ago. 1:10 >> 2002, like 24 years ago. >> Yeah, I know. But, you know, that's 1:12 >> Yeah, I know. But, you know, that's 1:12 >> Yeah, I know. But, you know, that's stuck with us for a long time. There's a 1:13 stuck with us for a long time. There's a 1:13 stuck with us for a long time. There's a lot of women that just weren't even 1:16 lot of women that just weren't even 1:16 lot of women that just weren't even given the opportunity to have estrogen 1:18 given the opportunity to have estrogen 1:18 given the opportunity to have estrogen or hormones just because of that study. 1:21 or hormones just because of that study. 1:21 or hormones just because of that study. So now we're we're realizing, you know, 1:23 So now we're we're realizing, you know, 1:23 So now we're we're realizing, you know, how jaded it was and corrupt that women, 1:26 how jaded it was and corrupt that women, 1:26 how jaded it was and corrupt that women, you know, women do need their hormones 1:28 you know, women do need their hormones 1:28 you know, women do need their hormones for their longevity, you know, for their 1:30 for their longevity, you know, for their 1:30 for their longevity, you know, for their bones, brain, you know, our heart, our 1:32 bones, brain, you know, our heart, our 1:32 bones, brain, you know, our heart, our cardiovascular system. 1:33 cardiovascular system. 1:33 cardiovascular system. >> And just to feel better. 1:34 >> And just to feel better. 1:34 >> And just to feel better. >> Oh yeah, just not to mention just our 1:36 >> Oh yeah, just not to mention just our 1:36 >> Oh yeah, just not to mention just our general daily life and our metabolism. 1:38 general daily life and our metabolism. 1:38 general daily life and our metabolism. So now we're realizing that, but I do
Why Lab Numbers and Symptoms Both Matter 1:40 So now we're realizing that, but I do 1:40 So now we're realizing that, but I do feel like, you know, we've been working 1:41 feel like, you know, we've been working 1:41 feel like, you know, we've been working with HRT for over 20 years that some of 1:44 with HRT for over 20 years that some of 1:44 with HRT for over 20 years that some of these doses are just too low. 1:45 these doses are just too low. 1:46 these doses are just too low. >> Yeah, now we're going to get into this 1:47 >> Yeah, now we're going to get into this 1:47 >> Yeah, now we're going to get into this on another episode, but when you compare 1:49 on another episode, but when you compare 1:49 on another episode, but when you compare all the different uh forms of estrogen 1:52 all the different uh forms of estrogen 1:52 all the different uh forms of estrogen or estradiol, um this is where I think 1:54 or estradiol, um this is where I think 1:54 or estradiol, um this is where I think happens most of the time is all those 1:57 happens most of the time is all those 1:57 happens most of the time is all those forms because it's all estradiol for the 1:59 forms because it's all estradiol for the 1:59 forms because it's all estradiol for the most part they get lumped into the same 2:01 most part they get lumped into the same 2:01 most part they get lumped into the same bucket. Uh and if you've been doing 2:03 bucket. Uh and if you've been doing 2:03 bucket. Uh and if you've been doing hormone replacement for any period of 2:04 hormone replacement for any period of 2:04 hormone replacement for any period of time, they do not translate from one 2:07 time, they do not translate from one 2:07 time, they do not translate from one dosage form, let's say a patch, uh to a 2:10 dosage form, let's say a patch, uh to a 2:10 dosage form, let's say a patch, uh to a transdermal cream, to a gel. They are 2:13 transdermal cream, to a gel. They are 2:13 transdermal cream, to a gel. They are they are all independent of each other 2:15 they are all independent of each other 2:15 they are all independent of each other as far as the dosage and how a woman's 2:17 as far as the dosage and how a woman's 2:17 as far as the dosage and how a woman's going to respond to it. 2:18 going to respond to it. 2:18 going to respond to it. >> Yeah, it's like apples and oranges when 2:20 >> Yeah, it's like apples and oranges when 2:20 >> Yeah, it's like apples and oranges when you're looking at a dose of a patch 2:22 you're looking at a dose of a patch 2:22 you're looking at a dose of a patch compared to perhaps a dose of a biest, 2:24 compared to perhaps a dose of a biest, 2:24 compared to perhaps a dose of a biest, which is an estriol and estradiol 2:26 which is an estriol and estradiol 2:26 which is an estriol and estradiol combination, or to the dose of just an 2:28 combination, or to the dose of just an 2:28 combination, or to the dose of just an estradiol transdermal cream. So, or or 2:31 estradiol transdermal cream. So, or or 2:31 estradiol transdermal cream. So, or or gel, those doses do not equivalent to 2:34 gel, those doses do not equivalent to 2:34 gel, those doses do not equivalent to each other. So, that's where it has to 2:36 each other. So, that's where it has to 2:36 each other. So, that's where it has to be individually tailored to that, you 2:38 be individually tailored to that, you 2:38 be individually tailored to that, you know, that particular female. Now, I 2:40 know, that particular female. Now, I 2:40 know, that particular female. Now, I will say another reason I think that uh 2:43 will say another reason I think that uh 2:43 will say another reason I think that uh women are being underdosed is you know, 2:45 women are being underdosed is you know, 2:45 women are being underdosed is you know, we don't want to chase the numbers on 2:47 we don't want to chase the numbers on 2:47 we don't want to chase the numbers on lab work. I do feel like lab work is 2:48 lab work. I do feel like lab work is 2:48 lab work. I do feel like lab work is really important. Most people have 2:50 really important. Most people have 2:50 really important. Most people have access to blood work, that's probably 2:52 access to blood work, that's probably 2:52 access to blood work, that's probably the common form of testing the hormones. 2:53 the common form of testing the hormones. 2:53 the common form of testing the hormones. There are other ways to test hormones 2:55 There are other ways to test hormones 2:55 There are other ways to test hormones with saliva and dried urine, but a lot 2:57 with saliva and dried urine, but a lot 2:57 with saliva and dried urine, but a lot of women collectively have more access 2:59 of women collectively have more access 2:59 of women collectively have more access to doing their blood draws that I think 3:01 to doing their blood draws that I think 3:01 to doing their blood draws that I think sometimes a practitioner might be 3:02 sometimes a practitioner might be 3:02 sometimes a practitioner might be focusing too much on what that number 3:05 focusing too much on what that number 3:05 focusing too much on what that number is. So, they're chasing the number, or 3:07 is. So, they're chasing the number, or 3:07 is. So, they're chasing the number, or on the flip side, of course, we want to 3:09 on the flip side, of course, we want to 3:09 on the flip side, of course, we want to take symptoms into consideration and 3:11 take symptoms into consideration and 3:11 take symptoms into consideration and say, "Okay, we want to base your dose on 3:13 say, "Okay, we want to base your dose on 3:13 say, "Okay, we want to base your dose on your symptoms." But you don't want to 3:14 your symptoms." But you don't want to 3:14 your symptoms." But you don't want to just rely on that alone. So, I think 3:16 just rely on that alone. So, I think 3:16 just rely on that alone. So, I think both of those independently might be 3:18 both of those independently might be 3:18 both of those independently might be contributing to women being underdosed 3:20 contributing to women being underdosed 3:20 contributing to women being underdosed on estradiol because the practitioner's 3:22 on estradiol because the practitioner's 3:22 on estradiol because the practitioner's focusing too much on the the number on 3:24 focusing too much on the the number on 3:24 focusing too much on the the number on the lab work or too much on the 3:25 the lab work or too much on the 3:25 the lab work or too much on the symptoms. 3:26 symptoms. 3:26 symptoms. >> Yeah, now um now granted the maybe the
Matching Estradiol Form and Dose to the Patient 3:29 >> Yeah, now um now granted the maybe the 3:29 >> Yeah, now um now granted the maybe the art of HRT is knowing when to look at 3:32 art of HRT is knowing when to look at 3:32 art of HRT is knowing when to look at the patient. That's always our tendency 3:35 the patient. That's always our tendency 3:35 the patient. That's always our tendency is to you treat the patient, not a lab 3:37 is to you treat the patient, not a lab 3:37 is to you treat the patient, not a lab test. All right, that's our default. 3:38 test. All right, that's our default. 3:38 test. All right, that's our default. It's been that way, you know, since 3:40 It's been that way, you know, since 3:40 It's been that way, you know, since we've been in practice um because the 3:42 we've been in practice um because the 3:42 we've been in practice um because the patient is always going to be able to 3:44 patient is always going to be able to 3:44 patient is always going to be able to tell you if a dose for them is working. 3:47 tell you if a dose for them is working. 3:47 tell you if a dose for them is working. The same thing happens with thyroid, 3:49 The same thing happens with thyroid, 3:49 The same thing happens with thyroid, right? A patient knows when they're 3:50 right? A patient knows when they're 3:50 right? A patient knows when they're underdosed or when they're overdosed, 3:51 underdosed or when they're overdosed, 3:51 underdosed or when they're overdosed, and there's really no in between. The 3:54 and there's really no in between. The 3:54 and there's really no in between. The same thing happens subjectively 3:57 same thing happens subjectively 3:57 same thing happens subjectively with the individual when it comes to 3:58 with the individual when it comes to 3:58 with the individual when it comes to HRT. 3:59 HRT. 3:59 HRT. >> Absolutely. Like you said with the with 4:01 >> Absolutely. Like you said with the with 4:01 >> Absolutely. Like you said with the with the dosing. Now, one thing I kind of 4:03 the dosing. Now, one thing I kind of 4:03 the dosing. Now, one thing I kind of wanted to circle back to, which is 4:05 wanted to circle back to, which is 4:05 wanted to circle back to, which is something I was thinking about in the 4:06 something I was thinking about in the 4:06 something I was thinking about in the past, is 4:08 past, is 4:08 past, is when you're looking at the symptoms, 4:10 when you're looking at the symptoms, 4:10 when you're looking at the symptoms, it's not just about hot flashes and 4:11 it's not just about hot flashes and 4:11 it's not just about hot flashes and night sweats. Now, I know all of you 4:13 night sweats. Now, I know all of you 4:13 night sweats. Now, I know all of you listening and watching know that as 4:14 listening and watching know that as 4:14 listening and watching know that as well, but there's so many other symptoms 4:16 well, but there's so many other symptoms 4:16 well, but there's so many other symptoms that come into play when you're looking 4:19 that come into play when you're looking 4:19 that come into play when you're looking at the estrogen being or the estradiol 4:20 at the estrogen being or the estradiol 4:21 at the estrogen being or the estradiol being a little bit too low that may not 4:23 being a little bit too low that may not 4:23 being a little bit too low that may not be looked at where someone might say, 4:24 be looked at where someone might say, 4:24 be looked at where someone might say, you know, I'm having a lot of knee pain. 4:26 you know, I'm having a lot of knee pain. 4:26 you know, I'm having a lot of knee pain. Oh, go take an Advil or, you know, it's 4:28 Oh, go take an Advil or, you know, it's 4:28 Oh, go take an Advil or, you know, it's osteoarthritis. That's just what happens 4:29 osteoarthritis. That's just what happens 4:30 osteoarthritis. That's just what happens when you get older, but is it really? 4:32 when you get older, but is it really? 4:32 when you get older, but is it really? You know, I know a lot of people talk 4:33 You know, I know a lot of people talk 4:33 You know, I know a lot of people talk about the frozen shoulder. In fact, I 4:34 about the frozen shoulder. In fact, I 4:34 about the frozen shoulder. In fact, I was getting a little bit of some 4:36 was getting a little bit of some 4:36 was getting a little bit of some shoulder pain the other day or the other 4:37 shoulder pain the other day or the other 4:37 shoulder pain the other day or the other week. I was thinking it was from looking 4:39 week. I was thinking it was from looking 4:39 week. I was thinking it was from looking at the computer, which probably looking 4:40 at the computer, which probably looking 4:40 at the computer, which probably looking down at the computer is giving me a 4:42 down at the computer is giving me a 4:42 down at the computer is giving me a little tech neck, but at the same time I 4:44 little tech neck, but at the same time I 4:44 little tech neck, but at the same time I knew my estradiol dose was probably a 4:46 knew my estradiol dose was probably a 4:46 knew my estradiol dose was probably a little bit low, so I did raise it up and 4:47 little bit low, so I did raise it up and 4:47 little bit low, so I did raise it up and actually feels pretty good here. So, I 4:50 actually feels pretty good here. So, I 4:50 actually feels pretty good here. So, I think not looking at some of the other 4:52 think not looking at some of the other 4:52 think not looking at some of the other characteristics like joint pain, muscle 4:54 characteristics like joint pain, muscle 4:54 characteristics like joint pain, muscle pain, a brain fog. Sometimes people will 4:56 pain, a brain fog. Sometimes people will 4:57 pain, a brain fog. Sometimes people will say, you know, what? That's just age, 4:58 say, you know, what? That's just age, 4:58 say, you know, what? That's just age, you know, or you're stressed. You're 4:59 you know, or you're stressed. You're 4:59 you know, or you're stressed. You're forgetting things. You're walking into a 5:01 forgetting things. You're walking into a 5:01 forgetting things. You're walking into a room and you don't remember why you 5:02 room and you don't remember why you 5:02 room and you don't remember why you walked in there or you go into the 5:03 walked in there or you go into the 5:03 walked in there or you go into the grocery store and you forget five things 5:05 grocery store and you forget five things 5:05 grocery store and you forget five things on your list. So, I think there's other 5:07 on your list. So, I think there's other 5:07 on your list. So, I think there's other symptoms that come into play besides the 5:09 symptoms that come into play besides the 5:09 symptoms that come into play besides the hot flashes, night sweats, and of course 5:11 hot flashes, night sweats, and of course 5:11 hot flashes, night sweats, and of course the sleep disruptions. 5:12 the sleep disruptions. 5:12 the sleep disruptions. >> Yeah, you know, when you're using some 5:14 >> Yeah, you know, when you're using some 5:14 >> Yeah, you know, when you're using some of the and and again, we're going to do 5:16 of the and and again, we're going to do 5:16 of the and and again, we're going to do another video about the dosage or the 5:18 another video about the dosage or the 5:18 another video about the dosage or the form of estrogen that woman's using 5:21 form of estrogen that woman's using 5:21 form of estrogen that woman's using because as we just said, they're not all 5:23 because as we just said, they're not all 5:23 because as we just said, they're not all created the same. So, you have to know 5:25 created the same. So, you have to know 5:25 created the same. So, you have to know how to transition from one to the next 5:27 how to transition from one to the next 5:27 how to transition from one to the next if you're switching 5:28 if you're switching 5:28 if you're switching and know where those dosing levels 5:30 and know where those dosing levels 5:30 and know where those dosing levels should be. That's a whole 'nother 5:31 should be. That's a whole 'nother 5:31 should be. That's a whole 'nother episode that we'll talk about. 5:33 episode that we'll talk about. 5:33 episode that we'll talk about. >> Well, yeah, we'll do the math cuz you're 5:34 >> Well, yeah, we'll do the math cuz you're 5:34 >> Well, yeah, we'll do the math cuz you're right. Like a biased, which is a 5:36 right. Like a biased, which is a 5:36 right. Like a biased, which is a combination of estriol and estradiol, 5:38 combination of estriol and estradiol, 5:38 combination of estriol and estradiol, I'd say 5 mg of biased is different than 5:41 I'd say 5 mg of biased is different than 5:41 I'd say 5 mg of biased is different than 5 mg of estradiol, which is different 5:44 5 mg of estradiol, which is different 5:44 5 mg of estradiol, which is different than, you know, a 0.1 mg of an estradiol 5:47 than, you know, a 0.1 mg of an estradiol 5:47 than, you know, a 0.1 mg of an estradiol patch. also. So, that's one thing I 5:49 patch. also. So, that's one thing I 5:49 patch. also. So, that's one thing I think you're right. We'll go into the 5:51 think you're right. We'll go into the 5:51 think you're right. We'll go into the math. We won't bore you right now with 5:52 math. We won't bore you right now with 5:52 math. We won't bore you right now with that cuz then 5:53 that cuz then 5:53 that cuz then >> But 5:53 >> But 5:53 >> But >> But the But the math is really cool. 5:55 >> But the But the math is really cool. 5:55 >> But the But the math is really cool. >> But at the end of the day, you know, 5:56 >> But at the end of the day, you know, 5:56 >> But at the end of the day, you know, that's like it's whole separate topic, 5:58 that's like it's whole separate topic, 5:58 that's like it's whole separate topic, our whole separate episode, and that is 6:01 our whole separate episode, and that is 6:01 our whole separate episode, and that is knowing the differences and taking the 6:04 knowing the differences and taking the 6:04 knowing the differences and taking the individual, not across an entire 6:06 individual, not across an entire 6:06 individual, not across an entire population. That's where I think a lot 6:08 population. That's where I think a lot 6:08 population. That's where I think a lot of things um get missed as you're trying 6:10 of things um get missed as you're trying 6:10 of things um get missed as you're trying to treat an entire group of women, a 6:12 to treat an entire group of women, a 6:12 to treat an entire group of women, a whole cohort cohort of women that are in 6:15 whole cohort cohort of women that are in 6:15 whole cohort cohort of women that are in menopause or perimenopause with three 6:18 menopause or perimenopause with three 6:18 menopause or perimenopause with three dosages. Okay, maybe four maybe four 6:20 dosages. Okay, maybe four maybe four 6:20 dosages. Okay, maybe four maybe four dosages. That is really difficult uh
Transdermal Timing, Oral Estrogen, and SHBG 6:23 dosages. That is really difficult uh 6:23 dosages. That is really difficult uh because you there's no way to tell 6:26 because you there's no way to tell 6:26 because you there's no way to tell on the all the different forms now, 6:28 on the all the different forms now, 6:28 on the all the different forms now, which is great. There's a lot of a lot 6:30 which is great. There's a lot of a lot 6:30 which is great. There's a lot of a lot of um dosage forms available for women, 6:33 of um dosage forms available for women, 6:33 of um dosage forms available for women, but there's no way to tell prior to a 6:35 but there's no way to tell prior to a 6:35 but there's no way to tell prior to a woman starting something which one is 6:37 woman starting something which one is 6:37 woman starting something which one is the best option for her. 6:39 the best option for her. 6:39 the best option for her. >> Well, I think what we're maybe talking 6:40 >> Well, I think what we're maybe talking 6:40 >> Well, I think what we're maybe talking about two different things here. So, 6:42 about two different things here. So, 6:42 about two different things here. So, you're talking about maybe with the 6:44 you're talking about maybe with the 6:44 you're talking about maybe with the estradiol patch, there's five different 6:45 estradiol patch, there's five different 6:45 estradiol patch, there's five different choices on that, but there's so many 6:47 choices on that, but there's so many 6:47 choices on that, but there's so many other different forms like we had talked 6:48 other different forms like we had talked 6:48 other different forms like we had talked about a biased or a transdermal um 6:51 about a biased or a transdermal um 6:51 about a biased or a transdermal um estradiol, and I think a lot of women, 6:52 estradiol, and I think a lot of women, 6:52 estradiol, and I think a lot of women, which we get that right into us, don't 6:54 which we get that right into us, don't 6:54 which we get that right into us, don't really know what their actual dose is. 6:57 really know what their actual dose is. 6:57 really know what their actual dose is. So, for example, um you know, someone 6:59 So, for example, um you know, someone 6:59 So, for example, um you know, someone might say, "I'm in a biased 50/50 ratio 7:01 might say, "I'm in a biased 50/50 ratio 7:01 might say, "I'm in a biased 50/50 ratio or 80/20 ratio." That doesn't really 7:02 or 80/20 ratio." That doesn't really 7:03 or 80/20 ratio." That doesn't really tell you much other than the ratio of 7:04 tell you much other than the ratio of 7:04 tell you much other than the ratio of the estriol to the estradiol. So, any of 7:06 the estriol to the estradiol. So, any of 7:06 the estriol to the estradiol. So, any of you watching, feel free to put in if 7:08 you watching, feel free to put in if 7:08 you watching, feel free to put in if you're doing a biased or transdermal 7:10 you're doing a biased or transdermal 7:11 you're doing a biased or transdermal cream of estradiol, put put it in there 7:12 cream of estradiol, put put it in there 7:12 cream of estradiol, put put it in there and we'll um we'll show you what the 7:14 and we'll um we'll show you what the 7:14 and we'll um we'll show you what the actual dosage is cuz I love doing all 7:16 actual dosage is cuz I love doing all 7:16 actual dosage is cuz I love doing all that math. 7:17 that math. 7:17 that math. >> And maybe I think we probably have some 7:19 >> And maybe I think we probably have some 7:19 >> And maybe I think we probably have some old um topic clicks around. We can even 7:22 old um topic clicks around. We can even 7:22 old um topic clicks around. We can even show on the screen. We can even show 7:25 show on the screen. We can even show 7:25 show on the screen. We can even show what it looks like and break down the 7:27 what it looks like and break down the 7:27 what it looks like and break down the actual numbers on there because you have 7:30 actual numbers on there because you have 7:30 actual numbers on there because you have a biased 7:32 a biased 7:32 a biased uh 50/50 or 80/20. That doesn't tell you 7:34 uh 50/50 or 80/20. That doesn't tell you 7:34 uh 50/50 or 80/20. That doesn't tell you anything. 7:35 anything. 7:35 anything. >> Yes, write down every number on there. 7:37 >> Yes, write down every number on there. 7:37 >> Yes, write down every number on there. >> comes down to what the milligram amount 7:39 >> comes down to what the milligram amount 7:39 >> comes down to what the milligram amount is and then how much you're applying 7:41 is and then how much you're applying 7:41 is and then how much you're applying every day, at least is one example. Uh 7:43 every day, at least is one example. Uh 7:44 every day, at least is one example. Uh right? But honestly, I've crossed the 7:45 right? But honestly, I've crossed the 7:46 right? But honestly, I've crossed the board, um you know, and this has been 7:48 board, um you know, and this has been 7:48 board, um you know, and this has been going on for 20 plus years that women 7:49 going on for 20 plus years that women 7:50 going on for 20 plus years that women are just chronically under-dosed all the 7:51 are just chronically under-dosed all the 7:51 are just chronically under-dosed all the time. 7:52 time. 7:52 time. >> And one thing too, just before we wrap 7:53 >> And one thing too, just before we wrap 7:54 >> And one thing too, just before we wrap this up, is and you've run into this, 7:56 this up, is and you've run into this, 7:56 this up, is and you've run into this, and granted, you know, practicing HRT is 7:58 and granted, you know, practicing HRT is 7:58 and granted, you know, practicing HRT is literally a practice. Every practitioner 8:00 literally a practice. Every practitioner 8:00 literally a practice. Every practitioner has their own philosophy. But I know 8:02 has their own philosophy. But I know 8:02 has their own philosophy. But I know when someone's doing a transdermal 8:04 when someone's doing a transdermal 8:04 when someone's doing a transdermal cream, whether it's a biased or an 8:05 cream, whether it's a biased or an 8:05 cream, whether it's a biased or an estradiol, is you want to do it twice a 8:07 estradiol, is you want to do it twice a 8:07 estradiol, is you want to do it twice a day. We've run across a few people that 8:09 day. We've run across a few people that 8:09 day. We've run across a few people that are saying, "Oh, I'm just putting on my, 8:11 are saying, "Oh, I'm just putting on my, 8:11 are saying, "Oh, I'm just putting on my, you know, my estrogen in the morning, or 8:12 you know, my estrogen in the morning, or 8:12 you know, my estrogen in the morning, or I'm just applying my biased in the 8:14 I'm just applying my biased in the 8:14 I'm just applying my biased in the morning." By the evening time, it really 8:16 morning." By the evening time, it really 8:16 morning." By the evening time, it really is out of your system, and then you're 8:17 is out of your system, and then you're 8:17 is out of your system, and then you're sleeping with no estrogen. And that's 8:19 sleeping with no estrogen. And that's 8:19 sleeping with no estrogen. And that's not great for sleep, or just for our 8:20 not great for sleep, or just for our 8:20 not great for sleep, or just for our cells and cellular turnover. So, I will 8:22 cells and cellular turnover. So, I will 8:22 cells and cellular turnover. So, I will say that is, you know, this is, what is 8:24 say that is, you know, this is, what is 8:24 say that is, you know, this is, what is it, education, not for medical advice. I 8:26 it, education, not for medical advice. I 8:26 it, education, not for medical advice. I have to say that. But if you're doing a 8:28 have to say that. But if you're doing a 8:28 have to say that. But if you're doing a transdermal cream, twice a day is really 8:30 transdermal cream, twice a day is really 8:30 transdermal cream, twice a day is really what you want. 8:31 what you want. 8:31 what you want. >> Yeah, right. Like our default, most of 8:32 >> Yeah, right. Like our default, most of 8:32 >> Yeah, right. Like our default, most of the time, 99% of the time, we're going 8:35 the time, 99% of the time, we're going 8:35 the time, 99% of the time, we're going to do have them do with the topic click, 8:37 to do have them do with the topic click, 8:37 to do have them do with the topic click, we're going to have them do two clicks 8:38 we're going to have them do two clicks 8:38 we're going to have them do two clicks twice a day. Right? And then now dosing 8:41 twice a day. Right? And then now dosing 8:41 twice a day. Right? And then now dosing can change, number of clicks can change, 8:43 can change, number of clicks can change, 8:43 can change, number of clicks can change, all those things. But then if we make 8:45 all those things. But then if we make 8:45 all those things. But then if we make that adjustment, then it goes back to 8:47 that adjustment, then it goes back to 8:47 that adjustment, then it goes back to the two clicks twice a day. And then now 8:49 the two clicks twice a day. And then now 8:49 the two clicks twice a day. And then now we sort of start that process over 8:50 we sort of start that process over 8:50 we sort of start that process over again. Um so, you start them at a 8:53 again. Um so, you start them at a 8:53 again. Um so, you start them at a certain point, and then that dose gets 8:54 certain point, and then that dose gets 8:54 certain point, and then that dose gets titrated up. Uh so, there's a little bit 8:57 titrated up. Uh so, there's a little bit 8:57 titrated up. Uh so, there's a little bit of a step-wise process on how to get 9:00 of a step-wise process on how to get 9:00 of a step-wise process on how to get them get them to arrive at their own uh 9:03 them get them to arrive at their own uh 9:03 them get them to arrive at their own uh perfect dose. 9:04 perfect dose. 9:04 perfect dose. >> So, you were talking about ramping up 9:06 >> So, you were talking about ramping up 9:06 >> So, you were talking about ramping up the dose, so starting at one or starting 9:08 the dose, so starting at one or starting 9:08 the dose, so starting at one or starting a lower dose twice a day, and then 9:10 a lower dose twice a day, and then 9:10 a lower dose twice a day, and then increasing up the dose as you're working 9:12 increasing up the dose as you're working 9:12 increasing up the dose as you're working on it to really get these women at a 9:14 on it to really get these women at a 9:14 on it to really get these women at a good level of estradiol. One quick thing 9:16 good level of estradiol. One quick thing 9:16 good level of estradiol. One quick thing I want to say before we, um like I said, 9:18 I want to say before we, um like I said, 9:18 I want to say before we, um like I said, I I could talk for hours about this. I 9:19 I I could talk for hours about this. I 9:19 I I could talk for hours about this. I just I love this. But the if you're 9:22 just I love this. But the if you're 9:22 just I love this. But the if you're doing an oral, you know, an oral form of 9:24 doing an oral, you know, an oral form of 9:24 doing an oral, you know, an oral form of HRT in terms of an estrogen or an 9:26 HRT in terms of an estrogen or an 9:26 HRT in terms of an estrogen or an estradiol oral, and there are 9:28 estradiol oral, and there are 9:28 estradiol oral, and there are some people that do that, and that's 9:30 some people that do that, and that's 9:30 some people that do that, and that's okay. But know that when it goes through 9:32 okay. But know that when it goes through 9:32 okay. But know that when it goes through the liver, it can cause your sex hormone 9:34 the liver, it can cause your sex hormone 9:34 the liver, it can cause your sex hormone binding globulin to go up, which 9:35 binding globulin to go up, which 9:36 binding globulin to go up, which sometimes makes the the free hormone a 9:38 sometimes makes the the free hormone a 9:38 sometimes makes the the free hormone a little bit low, so it might even seem 9:40 little bit low, so it might even seem 9:40 little bit low, so it might even seem like they're Oh, that dose seems pretty 9:41 like they're Oh, that dose seems pretty 9:41 like they're Oh, that dose seems pretty high, but they're really not getting 9:43 high, but they're really not getting 9:43 high, but they're really not getting access to it cuz of that sex hormone 9:45 access to it cuz of that sex hormone 9:45 access to it cuz of that sex hormone binding globulin. But, we can go into 9:46 binding globulin. But, we can go into 9:46 binding globulin. But, we can go into other different hormones and testing at 9:48 other different hormones and testing at 9:48 other different hormones and testing at a different podcast. 9:49 a different podcast. 9:49 a different podcast. >> Yeah, we'll definitely talk about 9:50 >> Yeah, we'll definitely talk about 9:50 >> Yeah, we'll definitely talk about There's been a lot of chatter, a lot of 9:52 There's been a lot of chatter, a lot of 9:52 There's been a lot of chatter, a lot of discussion about sexual SHBG, sexual 9:54 discussion about sexual SHBG, sexual 9:54 discussion about sexual SHBG, sexual hormone binding globulin, so we'll 9:55 hormone binding globulin, so we'll 9:55 hormone binding globulin, so we'll definitely come back and do an episode 9:57 definitely come back and do an episode 9:57 definitely come back and do an episode about that as well. 9:58 about that as well. 9:58 about that as well. Um, but if you have any questions, write 10:00 Um, but if you have any questions, write 10:00 Um, but if you have any questions, write them down in the comments. Uh, we expect 10:02 them down in the comments. Uh, we expect 10:02 them down in the comments. Uh, we expect that this would be a little bit of a 10:03 that this would be a little bit of a 10:03 that this would be a little bit of a lively topic. Uh, you know, we're at 10:05 lively topic. Uh, you know, we're at 10:05 lively topic. Uh, you know, we're at least hoping so. Uh, so, uh, 10:08 least hoping so. Uh, so, uh, 10:08 least hoping so. Uh, so, uh, uh, we'll definitely, uh, 10:10 uh, we'll definitely, uh, 10:10 uh, we'll definitely, uh, probably come up with some other 10:11 probably come up with some other 10:11 probably come up with some other episodes based on the comments that we 10:13 episodes based on the comments that we 10:13 episodes based on the comments that we see cuz this should be a little bit of a 10:15 see cuz this should be a little bit of a 10:15 see cuz this should be a little bit of a lively discussion, so 10:16 lively discussion, so 10:16 lively discussion, so >> Absolutely. 10:17 >> Absolutely. 10:17 >> Absolutely. >> appreciate everyone watching. Uh, 10:19 >> appreciate everyone watching. Uh, 10:19 >> appreciate everyone watching. Uh, comment down below like I said. Till 10:20 comment down below like I said. Till 10:20 comment down below like I said. Till next time, I'm Dr. Maki. 10:21 next time, I'm Dr. Maki. 10:21 next time, I'm Dr. Maki. >> And I'm Dr. Valerie. 10:22 >> And I'm Dr. Valerie. 10:22 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
Comments