dr. phuli's blog


Monday, April 28th, 2014

If you’re not enjoying sex and want to, if you’re not having mind blowing orgasms like you used to, but your healthy in every other way, I have good news for you. Your return to a full, lush, and exciting sex life is at hand. Read on.

The vagina can be mysterious- particularly in us women over 50.

As you age, estrogen and progesterone are no longer coursing through your veins and vaginal walls at high levels. Eventually the vaginal walls thin and bladder pipes become more easily irritated. Vaginitis, bleeding, itching, urinary frequency and infections can occur. Orgasms, if you’re lucky enough to have them, lose intensity.

There are a plethora of lubricants on the market but none will actually improve the health of your vagina, and prevent infections. For that you need the bioidentical hormone, Estriol.

Estriol is a very weak, naturally occurring form of estrogen that any doctor can prescribe, using a compounding pharmacist. All women, including women who have had a history of breast cancer can use vaginal Estriol safely without increasing risks of cancer.

Estriol should be used instead of vaginal Estradiol (i.e. Premarin, E ring, or Estrace), because it won’t stimulate the lining of the uterus and cause bleeding or fibroids, and it won’t increase breast cancer. It has been prescribed safely for decades by physician’s worldwide.

How do you get some? You will find Estriol over the counter as vaginal/facial creams (yes it lessens wrinkle too!). In general, these over the counter preparations can work but the doses are usually too low. The typical dose is a 1 mg Estriol suppository, prepared by a compounding pharmacy.

Ask your doctor and, if your doctor is clueless, (1) find a compounding pharmacy in your area and ask them about it and which doctors in your area are prescribing it, or (2) ask your doctor to call the compounding pharmacy and prescribe it and (3) refer your doctor to my book, The Natural Hormone Makeover, (I have lots of references in it), or (4) give your doctor this article reference to read, (Menopause 2009: 16: 978-83).

Never heard of a compounding pharmacist? They are pharmacists, trained to prepare individualized medications. They can make creams, lotions, suppositories in what ever dose your doctor recommends. Compounding pharmacists are in all states. You can locate one in your area from this website: http://www.pccarx.com/contact-us/find-a-compounder

I recommend starting with 1 mg Estriol suppositories daily for 7 to 10 days. Once the vagina and sex is comfortable again, then maintain your vaginal lining by inserting a suppository ever 2 to 3 days.

If you start using vaginal Estriol and orgasms are not as intense as they used to be explore DHEA. Have your doctor measure a DHEA-S blood level, (any lab can do this). The level should be over 150 ug/dL. I’ve posted about DHEA before- but it is a hormone made by the adrenal glands and converts into testosterone. DHEA is available over the counter, but should be monitored by your doctor.

The great news is that DHEA can safely be used vaginally to enhance orgasm. I usually prescribe 25 to 50 mg in a vaginal suppository and have women use ½ to a full suppository before sex or once per week. Its thicker than estriol so if it feels uncomfortably messy use less, or ask the compounding pharmacist to make smaller doses and use it more often. Vaginal use won’t raise your blood level so prescribe both vaginal and oral DHEA if a woman has a low DHEA-S blood level. DHEA definitely improves sex drive and vitality if your levels are low.

Don’t be scared to enter the world of bioidenticals vaginally. Educate your doctors and your friends and enjoy sex again!







15 Comments  |  Permalink  |  Posted in Adrenal Hormones, Estrogen, Hormones, Menopause, Natural Hormones, Sex, sex



Wednesday, November 6th, 2013

Hair seems to grow upside down as we age, with more on our chin and less on our head! By the time they are 50, at least one-half of all women in the United States, have some problem with hair thinning. Just take a look at the dwindling scalps around the supermarket.

Hair problems break down into two categories: Shedding and Female Pattern Hair Loss.

SHEDDING is when hair loss is happening from the entire scalp. You see hair coming out when you brush, comb or wash your locks. You notice the drain is clogging like never before. Causes of shedding are:

1. Thyroid problems: too much or too little
2. Medications: Many drugs can cause hair loss including commonly used Ibuprofen, Aspirin, Cimetidine, (Tagamet), blood pressure medications and antidepressants.
3. Excess Vitamin A
4. Poor diet, or excessive dieting
5. Chronic sleep loss
6. Chronic Yeast imbalance.
7. Emotional and physical stress: Typically hair loss occurs 2 to 3 months after a major stress such as divorce, death, surgery, or illness.

FEMALE PATTERN BALDNESS is due to an imbalance of sex hormones. There is hair loss from the top of the head, not all around. The hair is usually thinner, causing wimpy ponytails or a wider midline hair part. Many women also develop pimples, acne, or facial hair. The problem here is too much male hormone compared with female hormones. Some women’s bodies make too much testosterone known as DHT, (Dihydrotestosterone). DHT is good and bad- good because it gives us a strong sex drive, bad because too much can thin our hair and give us a moustache.

If you are using testosterone without enough estrogen you can also develop this problem.

Finally, the problem can be inherited. Check out your Mom’s scalp, consider your grandmother’s locks, any similarities? If so, consider hormone testing and bioidentical hormone support.

Have your doctor take some blood tests. Exclude mineral deficiency by measuring iron stores with a CBC, ferritin, and also check magnesium levels with a red blood cell magnesium. More minerals can be measured by specialty labs, but insurance may not cover these. Exclude thyroid problems with a TSH, free T3 and free T4, and a reverse T3. Check your DHT and androstenedione level. Take this article to your doctor.
MY NUMBER ONE HAIR LOSS SUPPLEMENT is Biotin, 15-30 mg/day. Unfortunately you’ll have to wait 2 to 3 months for the hair to grow up the hair shaft to see results. If you have an inherited female pattern loss you may need Zinc 25-50 mg/day and Saw Palmetto 320 mg/day. Be aware that too much zinc can lower your copper- so I recommend working with a knowledgeable integrative health practitioner.

So ladies don’t put up with dwindling scalps- eat well, sleep soundly, and make sure your hormones are balanced.

4 Comments  |  Permalink  |  Posted in Hair, Menopause


Isn’t Your Health is Worth More than Your Car?

Monday, October 21st, 2013

Do you spend more money on your car than on your health? Many of us do. I know because every now and then, when I want to do a specialty test or prescribe a compounded hormone that is not covered by medical insurance, I get push-back. So then I have talk about money and health with my patient. I call this my “you take better care of your car than yourself,” talk.

As your car ages, you will have to pay for new tires, break pads, routine oil changes, etc and you know darn well that when you hit the 50,000 mile mark you’ll spend even more to keep your engine humming.

Your body is no different. You should just expect that at 50, 65, and beyond you are going to need preventive and reconstructive work to keep yourself well tuned, just like those costly 65,000 mile tuneups.

There’s good and bad news. The good news is that we baby boomers are destined to live into triple digits! Most of us will live beyond our 90th birthdays. The bad news is that its going to cost you if you want to enjoy these “bonus” years. You’re going to need preventive treatments and testing to ensure good health. Individualized therapies like natural Bioidentical hormone support, good quality supplements, neurotransmitter evaluations to measure and support serotonin, dopamine and other brain chemicals, genetic panels to help avoid individual weaknesses, and digestive analyses to make sure your bowels and liver detox are working. Such specialty testing may not be entirely covered by your insurance, but for the best older age, it’s worth it. You must plan and budget for high quality preventive care to ensure graceful and enjoyable aging.

It may be time to invest as well in lifestyle changes. Learn to meditate, join a gym, hire a trainer or life coach, get acupuncture or a massage, eat more organic fruits and vegetables.

To stay healthy after 50 means you may have to start spending more money to care for your body than you routinely spend on your car. Here’s my check-list of goals to be addressed for overall good long term health:

Adequate energy
Solid sleep
Stable moods
Stress management
Weight management
Regular bowel movements
Fulfilling relationships
Regular physical activity
Prevention of chronic illnesses such as diabetes, heart disease, bone loss, and dementia

In order to address the above list you will need to budget for testing and treatments. The first step is realizing that long-term health is a priority and research how you can best afford to keep yourself as well tuned as your car.

1 Comment  |  Permalink  |  Posted in Hormones, Menopause, Natural Hormones


Menopause: Half a Lifetime

Tuesday, September 24th, 2013

Did you know that women are destined to spend one half of their lives in menopause? And guess what? Contrary to common lore, it’s a time that you can begin to feel your best. No longer are you at the mercy of monthly mood changes, weight gain and all the evils that can accompany rising and falling hormones.

Ancient Chinese sages were among the first experts in menopause. They wrote about a woman’s “tides” shifting, so that a woman was no longer giving out into the world, but rather gathering her inner strength. It is a time of introspection and enhanced intuition.

Menopause is a time to take stock of your life physically, emotionally and spiritually. What are you doing with your time and energy? Its time for you to come first and prepare for the second half of your life.

Its a great time to write the bucket list, prepare a vision board, interview a life coach, create a woman’s group, start a journal, and see an educated anti-aging doctor.

I repeat, see an anti-aging doctor. If you are proactive about your physical and emotional health, you will enjoy your second act much more. Tests can be done at most labs to provide you and your doctor with a comprehensive overview of your health risks and preventive needs going forward. I recommend the following tests:

For bone health: Measure your bone density. Your Vitamin D3 (25 OH) levels should be around 60, but not over 80.

For breast health: I recommend having an annual mammogram, and, because many women are deficient in Iodine (which can predispose to breast cancer), please request a random urine or blood iodine test. I give all of my patients a multivitamin with iodine. My favorite is Nutrient 950 (without iron at our age), by Pure Encapsulation.

For gastrointestinal health: Its important to be up to date with your screening Colonoscopy screenings. These should be done every 5 to 10 years depending on your history. Also if you haven’t had one, have a hepatitis B and C screen.

For heart health: Ask your doctor for a thyroid screen, including measurements for free T3, free T4, reverse T3, and TSH. Your TSH should be between 1.0-2.0. Other important tests to get are: Homocysteine, MTHFR (genetic marker), cardio-CRP, diabetic screen with HbA1c, and fasting lipids.

For overall vitality: Ask for these blood tests:
DHEA-S (see my prior blogs), CBC, red blood cell Magnesium, and IGF-1 (indirect measure of growth hormone).

Many of your questions about all of this are answered in my book, The Natural Hormone Makeover.

Take this blog to your doctor and make sure to follow through after the results are in. Take the time to meet with your doctor to review the results and make a plan. It takes a team and a commitment- after all, you would do a 65,000 mile tune-up for your car. You deserve nothing less.

To your health and a great second act!

1 Comment  |  Permalink  |  Posted in Bone Health, Breast Disease, Heart Disease, Hormones, Menopause, Uncategorized


Tuesday, June 18th, 2013

It’s a little known fact but we wear our hormones on our face!

You can get all of the face work and Botox in the world but hormonal health is how to keep your skin looking as young as possible.

Too little hormones will leave you looking (and feeling), tired. Estrogen, testosterone, thyroid, Growth Hormone, melatonin, and the adrenal hormone DHEA (the most abundant hormone in us), keep our skin bright, supple, moist and less wrinkled.

The small creases that crowned my upper lip convinced me to become an anti-aging medical physician. When I was a mere 43 years old I was plucked from the audience as an example of “premature aging.” To my surprise, the lines on my face told the story of what was happening inside…..my thyroid was underactive, my adrenal glands were too stressed to make enough DHEA, my ovaries were not making much estrogen and testosterone, and growth hormone and melatonin were no longer pulsing in me. I was literally drying up.

Here’s a brief list of what happens to your skin and hair when certain hormones are too low:

Low Estrogen: fine lines form around your mouth, your skin and eyes become dry, your hair thins, crow’s feet form, and forehead wrinkles multiply

Low Testosterone: causes facial wrinkles to increase at a faster rate

Low Thyroid: you’ll notice dry, scaly skin, thinning eyebrows- especially the outer brows, your hair becomes brittle and thin, and your face/eyelids can look puffy

DHEA: the plus side of low DHEA is less leg and underarm hair, but with that your skin and hair is depleted of its natural oils, losing sheen and healthy glow

Melatonin: in addition to poor sleep, low melatonin makes you look generally older than your age

Growth Hormone: lack of growth hormone causes your upper lip to thin and makes the jaw line look smaller. It also causes deeper skin wrinkles.

Hormones have been given bad press but it’s time to set the record straight. Did you know that the WHI study which damned hormones did NOT show any increase in breast cancer in women taking only estrogen? Only the women in the WHI study who used synthetic progesterone (Provera) had an increase in cancer.
Despite the safety of natural hormones, the media hype surrounding this 2001 study caused hormone backlash. Millions of women stopped all forms of hormones causing epidemics of bone loss, insomnia, depression, and sexual dysfunction, not to mention a lot of sad skin and bad hair days.

Ask you doctor to measure these hormones:

DHEA-S, for adrenal DHEA
TSH, free T3 and free T4 Thyroid hormones
IgF-1 for growth hormone

Sex hormones such as Estrogen and Testosterone are safe to use if you use bioidentical forms, in a balanced way, (always use progesterone with estrogen). Never eat estrogen, take it by the skin. Melatonin and DHEA are available over the counter in most pharmacies.

European studies have shown that using bioidentical estrogen by skin lotion, balanced with natural progesterone was safe. Educate yourselves and your doctors about safe uses of hormones so that you can look and feel even better after 50.

6 Comments  |  Permalink  |  Posted in Adrenal Hormones, Estrogen, Hormones, Menopause, Natural Hormones, Uncategorized