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Peptide and GLP Pep Talk
A message from Dr. Maki

Peptides have become one of the hottest topics in medicine, but they've also become one of the most confusing.

If you've searched online, you've probably come across websites selling peptides labeled "For Research Use Only" or "Not for Human Consumption." At the same time, social media is filled with stories of remarkable results, making it difficult to separate quality medical care from marketing hype.

Our approach is different. We do not recommend purchasing peptides from research websites or unknown online vendors.

When peptide therapy is appropriate, we prescribe through PCAB-certified compounding pharmacies, where quality, safety, and sterile compounding standards are held to the highest level.

We believe peptide therapy should be individualized, medically supervised, and used as part of a comprehensive treatment plan, not as a one-size-fits-all solution.

Over the coming months, I'll be sharing more about the peptides we use, the science behind them, who may benefit, and just as importantly, when peptide therapy may not be the right choice.

Interested in learning more?

Simply reply to this email, and we'll send you our available peptide options, current pricing, and information about the exclusive discount available to newsletter paid-members.

Dr. Maki

Is My Estradiol Dose Too High?​
Dr. Valorie Davidson

Even though the old beliefs, dogma, and stigma of HRT have been lifted, women are still concerned about their estradiol dose.

• Is it really okay to use estradiol, or could my dose be too high?
• I need enough estradiol to support my bones, heart, and brain…but how much is too much?
• How do I know how much estradiol to use?
• I feel like I need more estradiol, but my practitioner won’t increase it
• I keep increasing my estradiol, and I still don’t feel any better
• I don’t feel well on my estradiol dose…or is this just my body adjusting?

If you have ever asked yourself any of these questions, you are not alone. These are some of the common concerns I hear from women in my practice, newsletter, YouTube, and social media all the time.
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For this article, I will walk you through common symptoms, blood work, dosing, and supplement considerations I use to help determine whether an estradiol dose is too high.

I love a good story for learning, so meet Jenny!​
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‘OMG I look like I’m 5 months pregnant! And my boobs feel ginormous! I absolutely cannot wear these jeans; they are so uncomfortable. They didn’t feel this tight last week; what is going on? Even my face looks puffy.

I look out my window and see my daughter jumping into her friend’s car with her dance bag. She looks so grown up and pretty. I tear up just watching them drive away. In fact, I’ve been teary all the time. I can’t even watch the Hallmark channel anymore.

Gosh, I feel so bloated, like I could just poke myself with a needle and I would pop.

What is going on with me?

Wait…wait a minute… I run to the bathroom; sure enough, I got my period!! Or some brownish spotting. What is going on? I haven’t had a period in two years. ​
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About two weeks ago, I sent a message to my online provider that I wasn’t really noticing any difference with my HRT. I mentioned that I have not lost any weight (that I have gained), my libido is still low, I've been feeling hot at night, feeling itchy/dry and achy, and I just feel sorta blah. So they recommended that I increase my estradiol patch from .075 to 0.1mg. ​
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Now, I feel worse. I have gotten bigger (it feels like water weight), and my breasts feel more full and are so tender.

My skin is even more itchy, and even my nipples are tender and itchy. And a period? I'd better go find a pad from my daughter’s bathroom.

What is going on? Is my estradiol dose too high? Or maybe I just need to give it time to adjust and get used to this dose?​
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Jenny’s estradiol dose is too high. Even just based on her symptoms, her dose is too high.

Estradiol is one of the best hormones in the world, but too much of a good thing… is well, not a good thing.

The goal is to find the right dose for Jenny. An estradiol dose that allows her to feel her best, while minimizing unwanted side effects.

It isn’t to find the ‘highest’ or ‘lowest’ dose. It’s to find the dose that is right for Jenny.

Symptoms of an Elevated Estradiol Dose:

Every woman responds differently to estradiol. Genetics, hormone receptor sensitivity, metabolism, estrogen metabolite patterns, absorption, other hormones (such as progesterone), and even where you are in your menopausal transition can all influence how you feel. Because of this, none of the symptoms below automatically means your estradiol dose is too high. Think of them as possible clues rather than proof.

• Breast tenderness:
  • Estradiol can stimulate breast ducts and tissue, leading to tenderness or soreness.
• Swollen breasts:
  • Estradiol can increase blood flow and fluid retention in the breast tissue. The breast tissue can feel fuller, heavier, or swollen.
• Bloating:
  • Estradiol can influence fluid balance (sodium and water), causing bloating in the lower belly or even the entire abdomen.
• Water retention:
  • Again, that sodium and water balance that estradiol affects can cause water retention, which you will see as puffiness in the hands, feet, stomach, and even face.
• Nausea:
  • High estradiol in some women can result in nausea. It isn't fully understood, but estradiol can interact with areas of the brain involved in nausea, and some women appear to be particularly sensitive to it.
• Headaches:
  • Estradiol can influence blood vessels and neurotransmitters, which can trigger headaches. Side note: low estradiol levels can cause headaches too.
• Migraines:
  • Women who are prone to migraines may be sensitive to an abrupt increase in estradiol, which can trigger migraines. This is also the case in low estradiol levels.
• Feeling "weepy" or easy tears:
  • Estradiol interacts with neurotransmitters such as serotonin, dopamine, and norepinephrine. If an estradiol dose is more than your brain responds well to, these signaling pathways may become temporarily overstimulated, causing emotions to feel more intense. Side note: this can happen with low estradiol levels and fluctuating estradiol in perimenopause.
• Spotting or bleeding:
  • Estradiol can stimulate the lining of the uterus to thicken. If the endometrial lining becomes too thick, that can cause bleeding and spotting. Endometrial hyperplasia, and over time, if the endometrium remains chronically overstimulated, can increase the risk of endometrial cancer in women who have a uterus. Side note: this can also happen without adequate progesterone dosing.

The symptoms above may suggest your estradiol dose is too high, but symptoms alone don't tell the whole story.

This is where lab testing, goals, and symptoms are a great triad to come up with a specific dosing strategy based on that woman, like Jenny.

Symptoms can provide important clues, but they are only one piece of the puzzle. The real question is how to determine whether your estradiol dose truly needs to be adjusted or whether another factor is contributing to how you feel.

In the full article, I'll walk you through the exact blood tests I recommend, when to have them drawn, how I interpret the results, and the lifestyle strategies I use to support healthy estrogen metabolism.

Next, we'll learn:

• Which blood tests I recommend when evaluating an estradiol dose
• When to have your blood drawn for the most accurate results
• How I interpret those blood tests
• How blood test interpretation differs with static versus rhythmic dosing
• Additional laboratory tests that can provide a more complete picture of your hormone health
• Lifestyle habits and supplements that support healthy estrogen metabolism

Continue Reading: Is My Estradiol Dose Too High? (Member Article)​

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When to test free testosterone? I don’t always test free testosterone in my patients. As with all blood tests, you want to use them all as clues to see the big picture.
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Sometimes availability issues, such as another practitioner not wanting to order free testosterone or perhaps cost being an issue (free testosterone is more costly than just a total), limit us to just seeing the total.

Which is just fine; I usually get a lot of info from a total testosterone alone.

For total testosterone, there are a lot of ranges that women feel good in. Some women feel great at a total testosterone of 25 ng/dL and others at 80-100.
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When I consider ordering a free testosterone:

• Low libido despite a normal total testosterone
• Fatigue or loss of muscle strength where androgen deficiency is a consideration
• Hair loss (temples and top)
• Acne
• Hirsutism: hair growing excessively in areas that it didn’t before
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Other tests to pair with the total and free testosterone to get the big picture:

• SHBG (sex hormone binding globulin)
• DHT (dihydrotestosterone)
• DHEA-Sulfate

My testosterone and DHEA naturally run higher; it always has. Recently I had my blood testosterone levels and DHEA-sulfate checked (I do not take either in my HRT protocol):

• Total Testosterone: 39.8 ng/dL (ref range: 7-55 ng/dL)
• Free Testosterone: 3.7 pg/mL (re range: 0.0-4.2 pg/mL)
• DHEA-Sulfate: 300.0 ug/dL (ref range: 41.2-243 ug/dL)
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I have pretty good conversion of DHEA to testosterone to free testosterone.

But if someone had the same total testosterone and DHEA-sulfate levels as mine, but had a low level of free testosterone, that could explain more androgen symptoms.

Every woman has her own "sweet spot." The goal isn't to chase a particular laboratory value but to understand how the hormones are interacting together and whether they match her symptoms. That is why I interpret testosterone as part of the whole hormonal picture, not as a single number.

Disclaimer

All content found in this newsletter, including text, images, audio, video, or other formats, was created for informational purposes only. The purpose of this website and blog is to promote consumer/public understanding and general knowledge of various health topics. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concern regarding this topic, then it is time to find a new doctor.