2026-05-19 - How to Find Relief Call with Dr. Tracy Page Transcript
This transcript captures a live Q&A session led by Dr. Tracy Page, moderated by Michelle Arant and Kris Plachy, focusing on midlife women’s hormonal health. The discussion covers practical guidance on IUD management during perimenopause, progesterone and testosterone replacement (including dosing, timing, and safety), comprehensive thyroid testing (the “four‑tire” panel of TSH, free T3, free T4, reverse T3), adrenal support with DHEA, vitamin D optimization, and the construction of a core lab panel (FSH, estradiol, progesterone, free/total testosterone, thyroid panel, fasting insulin, HbA1c, CRP, lipid sub‑fractions, TPO antibodies). Dr. Page explains fasting requirements, optimal morning draw times, and how to interpret results. She also addresses PMDD, neurotransmitter testing, GLP‑1 agonist use (including emerging agents and safety with thyroid disease), and the differences between functional/integrative and traditional medicine, emphasizing patient‑centered language and advocacy when requesting labs. Practical tips for communicating with primary‑care providers, dosage ranges for bioidentical hormones, transdermal estrogen for clotting disorders, and the importance of monitoring for side effects (e.g., beard growth, hematocrit) are provided. The session ends with logistical notes about licensing, telehealth reach, and resources for patients.
Topics
IUD Management in Perimenopausal Women: Hormonal Impact and Decision Framework
Guidance on whether to keep, replace, or remove a progestin‑based IUD during perimenopause, linking IUD presence to systemic progesterone levels, FSH thresholds, and breakthrough bleeding.
Progesterone Replacement: Dosage, Timing, and Symptom Correlation
Recommendations for nightly progesterone dosing (100‑300 mg), timing relative to menstrual cycle or continuous use, and its effects on sleep, anxiety, and mood.
Testosterone Assessment: Free vs Total, Therapeutic Ranges, and Safety Concerns
Explanation of why free testosterone is the key metric, target physiological ranges (middle‑to‑high thirds), low‑dose injection protocols for women, and monitoring for beard growth, hematocrit, and clotting risk.
Four‑Tire Thyroid Panel: Comprehensive Evaluation Beyond TSH
Advocacy for testing TSH, free T3, free T4, and reverse T3 (plus antibodies) to uncover hidden hypothyroidism that can mimic menopausal symptoms.
Adrenal Support with DHEA: Role in Energy and Vitality
Discussion of DHEA as an adrenal marker, its supplementation when levels are low, and its impact on stamina and mood during hormonal transition.
Vitamin D Optimization: Target Levels, Immune Benefits, and Cancer Correlation
Recommendation to maintain 70‑80 ng/mL vitamin D, rationale for bone, immune, and breast‑cancer risk reduction.
Lab Ordering Strategies: Fasting Requirements, Morning Timing, and Core Panel Composition
Practical advice to fast 12 hours, draw hormones in the morning, and request a standardized panel (FSH, estradiol, progesterone, free/total testosterone, thyroid four‑tire, fasting insulin, HbA1c, CRP, lipid sub‑fractions, TPO antibodies).
PMDD Pathophysiology and Targeted Supplementation
Overview of PMDD’s impact on serotonin, dopamine, GABA, and cortisol, with suggestions for higher progesterone doses and taurine supplementation.