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Navigating Menopause: A Comprehensive Guide · The Science of Skin

• 0:05
  SPEAKER_02: Hi, I'm Dr.
• 0:06
  SPEAKER_02: Patty Ferris.
• 0:07
  SPEAKER_02: I'm a board certified dermatologist.
• 0:09
  SPEAKER_02: I'm your host for this episode of Skin Care Confidential.
• 0:13
  SPEAKER_02: We're very excited at this time of year because our medical meeting, the Science of Skin Summit, is coming up in Austin, Texas, September the 5th through the 7th.
• 0:22
  SPEAKER_02: And my guest today, Dr.
• 0:23
  SPEAKER_02: Doris Day, will be attending the summit and speaking on several things, actually, that she's an expert in.
• 0:31
  SPEAKER_02: And one of those things is the subjects of today's podcast, and that is menopause.
• 0:36
  SPEAKER_02: So I'm going to start, Doris, by reading your very lengthy bio, so I'm going to have to abbreviate it because otherwise it would take up all the time.
• 0:43
  SPEAKER_02: But anyway, Doris practices in New York City.
• 0:46
  SPEAKER_02: She has a longevity beauty practice.
• 0:49
  SPEAKER_02: She's a clinical professor of dermatology at NYU.
• 0:53
  SPEAKER_02: She's won lots of awards and has been voted two years as one of Newsweek's top three cosmetic dermatologists in the United States, a well-deserved accolade, I might add.
• 1:04
  SPEAKER_02: And she's also a top doctor at Castle Connolly.
• 1:08
  SPEAKER_02: She lectures nationally and internationally.
• 1:10
  SPEAKER_02: We've had lots of fun traveling together and doing that together over the years.
• 1:14
  SPEAKER_02: She's a member of all the major societies, served on the board of the American Academy of Dermatology, and also serves on advisory boards for lots of uh cosmetic companies, lots of the big ones, Lori L S D Lauder, among others.
• 1:27
  SPEAKER_02: She's written five books, Doris.
• 1:30
  SPEAKER_02: I think the most recent is Rebooting the Biome, which I read.
• 1:33
  SPEAKER_02: And if you all have not read it, check it out because it's very interesting.
• 1:37
  SPEAKER_02: Some of my other favorites were Forget the Facelift, and then she has a hundred questions and answers about acne.
• 1:42
  SPEAKER_02: All great subjects and worth the read.
• 1:45
  SPEAKER_02: A little known fact is that Dr.
• 1:47
  SPEAKER_02: Doris Day actually has a master's degree in medical journalism.
• 1:51
  SPEAKER_02: And this is probably explains why for the past 15 years she has been the host on Dr.
• 1:57
  SPEAKER_02: Radio's Serious XM show.
• 1:59
  SPEAKER_02: And she's got a huge following there, including me.
• 2:01
  SPEAKER_02: And Luke, as you know, my significant other, loves it and listens to you every single week.
• 2:06
  SPEAKER_02: So, Doris, welcome.
• 2:08
  SPEAKER_02: What an exciting topic we have.
• 2:11
  SPEAKER_02: I mean, I think we could both agree that menopause is having a moment.
• 2:16
  SPEAKER_02: Finally.
• 2:17
  SPEAKER_00: This is something I've been trying to get on the radar for 20 years and well before I was there myself.
• 2:25
  SPEAKER_00: And the pushback from colleagues, even now, is crazy.
• 2:29
  SPEAKER_00: And I think one of the biggest problems around the conversation with menopause is one, is bad information, bad interpretation of studies by uh both journalists and then scientists who picked up on that and who didn't want to touch it.
• 2:42
  SPEAKER_00: But it's also that doctors don't want to own menopause.
• 2:47
  SPEAKER_00: So GYNs don't want to go there, internists don't want to go there, endocrinologists don't want to go there.
• 2:52
  SPEAKER_00: So nobody has this space.
• 2:54
  SPEAKER_00: And then when I, as a dermatologist, who I'm a medical doctor, you know, as DERMS, we're medical doctors.
• 3:00
  SPEAKER_00: We have a practice uh uh licensed practice medicine and surgery.
• 3:04
  SPEAKER_00: When I comment on it, so many people start writing, why are you talking about menopause?
• 3:08
  SPEAKER_00: You're a dermatologist.
• 3:10
  SPEAKER_00: So I think in reality, all doctors should own menopause, all doctors should be proficient in menopausal hormone therapy because it affects every organ system.
• 3:20
  SPEAKER_00: And we shouldn't point there, there, there, they're there to see that it's somebody else's domain and and that we shouldn't be touching it.
• 3:27
  SPEAKER_00: So um, so I this is something that I'm very interested in.
• 3:31
  SPEAKER_00: I've been studying it closely, and I don't right now prescribe hormone therapy, but I will.
• 3:37
  SPEAKER_02: I love that um assessment of it.
• 3:39
  SPEAKER_02: You're 100% right.
• 3:41
  SPEAKER_02: I I will credit some of the uh OBGYNs who are as specialists in menopause for getting on social media and really starting to educate people.
• 3:51
  SPEAKER_02: And I think that them as well as you and other dermatologists who are speaking about this are really moving the needle and really making paving the way for patients.
• 4:01
  SPEAKER_00: So well, they've given me the courage to talk about it more because when there's four of us and people that I respect in the OBGYN, but just the fact that you had to say OBGYNs who specialize, it's not a specialty.
• 4:14
  SPEAKER_02: I know.
• 4:15
  SPEAKER_02: It should be in the purview of every OBGYN.
• 4:18
  SPEAKER_02: And look, as dermatologists, we know we see these patients every day.
• 4:22
  SPEAKER_02: And I'm sure you've had the experience like I've had.
• 4:25
  SPEAKER_02: You have a woman come in, she's maybe in her late 40s, she's like, I know I'm in perimenopause, but they check my labs.
• 4:31
  SPEAKER_02: My labs are normal, they won't give me anything.
• 4:33
  SPEAKER_02: And they start complaining of a myriad of complaints that we all know are associated with perimenopause.
• 4:39
  SPEAKER_02: So, how do we deal with these patients?
• 4:42
  SPEAKER_02: How do you deal with a perimenopausal patient?
• 4:46
  SPEAKER_00: One of the biggest things, and I think one thing that makes it so gratifying to be a dermatologist, is that I help women understand that that's where they're at.
• 4:55
  SPEAKER_00: And women will come in and they'll say, one day my face just fell apart, or I feel like I'm looking old.
• 5:00
  SPEAKER_00: And then, and it's out of nowhere.
• 5:02
  SPEAKER_00: It's not that a birthday's coming up or an event, it just hits them.
• 5:06
  SPEAKER_00: And then when I start asking more and I start going into the details, you know, are you a little bit more grumpy than used to be?
• 5:12
  SPEAKER_00: Like I always make the joke, are you are you feeling like you're more bitchy or people are more stupid?
• 5:17
  SPEAKER_00: Like it's there's all of these things that women in perimenopause get that at a level that people not at perimenopause don't get.
• 5:24
  SPEAKER_00: And then it's also my joints are a little achy, or I'm more forgetful, or I'm gaining weight where I didn't used to, or it's not as easy to stay in shape.
• 5:30
  SPEAKER_00: All these things you put together, all these non-specific findings.
• 5:34
  SPEAKER_00: My skin is drier, I'm breaking out like a teenager, I'm all over the place, my sleep is off.
• 5:39
  SPEAKER_00: Every single organ system is affected.
• 5:41
  SPEAKER_00: And when I start to ask more of those questions, I I sort of hint at it.
• 5:45
  SPEAKER_00: I think, well, you know, it sounds like you're a perimenopause.
• 5:48
  SPEAKER_00: And um, and a lot of times they're baffled.
• 5:51
  SPEAKER_00: And then the whole conversation goes around that project of managing their perimenopause and finding doctors who I trust who for now can prescribe it until I feel comfortable doing it myself.
• 6:03
  SPEAKER_00: But they're so relieved.
• 6:05
  SPEAKER_00: And the hardest part for me is there's two hardest parts.
• 6:09
  SPEAKER_00: One is the patient pushback, saying, Well, it's not for me, or I have a family member who had breast cancer, or I get migraines, or I have factor V light, and something that will be an excuse for them not to do it when it's not relevant.
• 6:23
  SPEAKER_00: And then the second is the doctor's pushback.
• 6:25
  SPEAKER_00: So many doctors will say, you know, don't talk to me until you haven't had your period for a year.
• 6:31
  SPEAKER_00: Or um, or you know what, you have this family history, or you have migrant, like the same things the patient complains about.
• 6:37
  SPEAKER_00: It seems like that many of the doctors for now are not any more educated than the public on how to manage perimenopause and menopause, and when to start hormone therapy, and what labs to look for, and what symptoms that they should manage.
• 6:51
  SPEAKER_00: So um, so I think that we're having a moment at the best possible time because more and more women are entering this phase of life.
• 6:59
  SPEAKER_00: And my philosophy and feeling around longevity is I don't want you to just look better, I want you to be better.
• 7:05
  SPEAKER_00: And when we manage perimenopause systemically, when we manage it as a whole body effect, and when we add in the skin benefits, whether we adjust their retinol or add in more exosomes or adjust our treatments, how we do them, what we supplement those treatments with to get the most out of it in terms of cellular renewal and longevity, then altogether they start realizing that they're going to continue on this healthy, beautiful path.
• 7:31
  SPEAKER_00: Things will be different, the effort will be different, but it's going to be amazing.
• 7:35
  SPEAKER_00: It's not a time to fear, it's a time to celebrate because so much good comes with this period of time.
• 7:41
  SPEAKER_00: We just have to manage it for what it is.
• 7:44
  SPEAKER_00: It's like saying you're gonna give a newborn solids.
• 7:48
  SPEAKER_00: No, you're not gonna do that.
• 7:49
  SPEAKER_00: You're going to do what's appropriate.
• 7:50
  SPEAKER_00: And with every stage of life, there are transitions, there are appropriate things that we should be doing, and they change.
• 7:57
  SPEAKER_00: So we we have to manage it in that way.
• 7:59
  SPEAKER_00: And now I'm trying to get my younger patients to prepare for that and to even in their 30s at pre-perimenopause to really work out and to use sun protection and take good care of themselves so that when they hit this phase of life, the transition into it is going to be um easy and smoother.
• 8:17
  SPEAKER_02: Yeah, an easier transition.
• 8:19
  SPEAKER_02: So you sort of alluded to changing skincare regimens.
• 8:23
  SPEAKER_02: Let's talk a little bit about skincare first, and then of course I want to talk to you about nutraceuticals as well, because I know you're so well versed in that.
• 8:29
  SPEAKER_02: But so as they enter perimenopause and go into menopause, what sort of changes do you make?
• 8:36
  SPEAKER_00: In terms of skincare.
• 8:37
  SPEAKER_02: So skincare first.
• 8:38
  SPEAKER_00: Yeah.
• 8:38
  SPEAKER_00: So with skincare, I I tend to transition from prescription retinoic acid to combining that with over-the-counter or cosmoceutical level retinol.
• 8:50
  SPEAKER_00: So what we know now is that there's this pathway called mTOR.
• 8:54
  SPEAKER_00: So mTOR is a developmental pathway that's essential for life.
• 8:58
  SPEAKER_00: So if you look at mTOR, it stands for mechanistic target of rapamycin.
• 9:02
  SPEAKER_00: It's essential for cell development.
• 9:04
  SPEAKER_00: It has two pathways, mTORC1 and two.
• 9:07
  SPEAKER_00: One is around cell turnover, cell renewal, and two is more for development and longevity.
• 9:14
  SPEAKER_00: Throughout evolution, mTORC1, as you're evolving, is essential for children to grow into healthy adults.
• 9:22
  SPEAKER_00: At pre-perimenopause, when you're fertile, it's important for follicular cell turnover and for reproductive health.
• 9:29
  SPEAKER_00: But then when you're at perimenopause and postmenopause, evolution doesn't really have a purpose for us anymore.
• 9:36
  SPEAKER_00: We've sort of served our functional good.
• 9:38
  SPEAKER_00: We've had our children, we've raised our children, and now evolution doesn't really care what happens to us.
• 9:43
  SPEAKER_00: So the problem with mTOR at that point is that it becomes dysfunctional.
• 9:47
  SPEAKER_00: That when you do things that worked earlier, like intermittent fasting or stimulating the fibroblast or working on things that cause cell turnover, using retinoic acid, all of those affect the mTOR pathway.
• 10:00
  SPEAKER_00: But when it becomes dysfunctional, that means it's not responding appropriately.
• 10:04
  SPEAKER_00: And the mTOR1 pathway, as it hyperstimulates, leads to breakdown and accelerated aging.
• 10:12
  SPEAKER_00: So a lot of what I look at is how do we preserve that pathway and how do we use products that are going to minimize the hyperstimulation of the cells, and this involves estrogen as well.
• 10:25
  SPEAKER_00: When you add in estrogen, estrogen is anti-inflammatory, it's not carcinogenic.
• 10:29
  SPEAKER_00: You have estrogen receptors in your skin, mostly estrogen beta receptors.
• 10:33
  SPEAKER_00: You have the highest concentration of estrogen-beta receptors on your face, neck, and scalp more than anywhere else on your body practically.
• 10:40
  SPEAKER_00: So these receptors decline at perimenopause and menopause.
• 10:44
  SPEAKER_00: They decline.
• 10:45
  SPEAKER_00: The receptors decline as your estrogen declines.
• 10:48
  SPEAKER_00: And if you're not careful in helping to stimulate those, you have trouble making collagen from your fibroblasts because you need estrogen for that too.
• 10:56
  SPEAKER_00: So understanding all these pathways and how complicated they are and learning to supplement them using things like exosomes, peptides, doing things like ultrasound energy to stimulate, but not cook and burn, which is why I've sort of moved towards things like softwave over more aggressive things like all therapy.
• 11:16
  SPEAKER_00: I find that I see a difference in my older patients.
• 11:19
  SPEAKER_00: And when I do a CO2 laser now, I never just do the laser, I always combine it with topical support that's going to help those fibroblasts recover instead of just trying to kill them off and count on the stem cell reserves to make more when I know those reserves are depleted.
• 11:35
  SPEAKER_00: So the whole process from A to Z of the patients, it starts one with sun protection, aggressive, because now we're not making new collagen so much.
• 11:45
  SPEAKER_00: We're having to count on preserving and repairing what we have.
• 11:48
  SPEAKER_00: So sun protection is critical.
• 11:50
  SPEAKER_00: I ramp up how much sunscreens, the type of sunscreens, how often you reapply, being sun smart, staying in the shade, wearing a hat, sunglasses, all those things.
• 11:58
  SPEAKER_00: And even starting in your 50s, 60s, 70s, it still makes a difference.
• 12:02
  SPEAKER_00: Exosomes, topical antioxidants, peptides, retinol combined with retinoic acid intermittently, so it's a different concentration of those.
• 12:10
  SPEAKER_00: And keeping the process simple in many ways, I'm listing off a lot of things, but it's not doing, but they're often combined in a molecule.
• 12:18
  SPEAKER_02: Do you do you prescribe topical estrogen, which is also having a moment right now?
• 12:24
  SPEAKER_00: Yeah, you know what?
• 12:25
  SPEAKER_00: I'm I'm looking at it.
• 12:26
  SPEAKER_00: I'm starting a study with um Dr.
• 12:28
  SPEAKER_00: Leslie Cark Loser on um topical estrogen.
• 12:31
  SPEAKER_00: We're looking at a specific formula of it, so I'll have more data.
• 12:35
  SPEAKER_00: I I do think it's safe because of what I said about binding to the estrogen beta receptors.
• 12:40
  SPEAKER_00: So there's a couple of things.
• 12:42
  SPEAKER_00: When you use a topical estrogen, there's there's not a significant significant amount of absorption, and it's binding to the beta receptors, and the reproductive organs have estrogen-alpha receptors.
• 12:54
  SPEAKER_00: And we even know that if you use a topical estrogen on areas like the face and the neck, they can even knock off estrogen from the alpha receptors.
• 13:02
  SPEAKER_00: So I'm not saying they have protective effects, but they're probably more protective than they are harmful.
• 13:07
  SPEAKER_00: So, I mean, if you're going to use it, use it on the whole face.
• 13:10
  SPEAKER_00: It's a small body surface area.
• 13:12
  SPEAKER_00: And if you believe it's safe to use, and certainly if you're doing hormone replacement therapy or menopause hormone therapy, as we're now calling it, then I mean there's no it should drop in the bucket.
• 13:23
  SPEAKER_00: Yeah, and um and vaginal estrogen, I think, is really important for most women as they have perimenopause because they they lower the risk of UTIs, which are a significant course of morbidity and even mortality for women at this stage of life.
• 13:37
  SPEAKER_00: So I think vaginal estrogen is great.
• 13:40
  SPEAKER_00: I we don't have an FDA-approved topical estrogen for the face, but I think we will see some.
• 13:45
  SPEAKER_00: And with that, we should see some data of how it affects the estrogen receptors.
• 13:49
  SPEAKER_00: Does it help upregulate them?
• 13:50
  SPEAKER_00: And does it have um is it safe?
• 13:53
  SPEAKER_00: And then when you combine it with products that are now coming, one that I'm working on that affect the mTOR pathway, you can even have an added benefit for cellular longevity.
• 14:03
  SPEAKER_00: And then what we need is a test, because when you're talking about longevity, so people who take coercigen, we're gonna go over all the things that I take, but when people take these supplements for longevity, you don't necessarily look in the mirror and go, oh, look at me, I'm younger.
• 14:16
  SPEAKER_00: You have to have a test.
• 14:17
  SPEAKER_00: You look for markers.
• 14:19
  SPEAKER_00: So we need to create biologic markers for the skin so that we can see that what we're doing has an effect.
• 14:25
  SPEAKER_00: Um, and the idea of these is that they're going to supplement the retinols and the other products we're using and sort of help them work even better because they're going to have the next step.
• 14:35
  SPEAKER_00: So if you're putting um, let's see, what's the analogy?
• 14:39
  SPEAKER_00: If you're if you're adding all the ingredients, but you don't have a bowl, like you're making a cake, but you don't have a bowl to put it in, they're all going to be all over the place.
• 14:46
  SPEAKER_00: You're not going to be able to make what you need.
• 14:48
  SPEAKER_00: So if you're adding vitamin C and retinol and all these ingredients, but you don't have the estrogen, and if your empty is dysfunctional and you don't have the fibroblast to build the collagen, all you're doing is being destructive.
• 15:01
  SPEAKER_00: So you need to have your foundation supported, rebuilt, repaired, so that when you use those other products, you can actually get the benefits that those products are trying to provide in this more mature skin that's now sometimes depleted.
• 15:18
  SPEAKER_02: Yeah, estrogen deficient skin.
• 15:20
  SPEAKER_02: Let's let's transition to the nutraceuticals or the supplements because I know you love those and you have a lot of experience with them.
• 15:27
  SPEAKER_02: So if you had a say menopausal or postmenopausal patient, how would you approach them with supplements?
• 15:35
  SPEAKER_00: Well, I always give them a list of things that I think are basic.
• 15:39
  SPEAKER_00: I think vitamin D with vitamin K is basic, magnesium, I think magnesium L3N8 and magnesium glycinate is important.
• 15:47
  SPEAKER_00: Um those are my very, very basic ones and um and also omega-3s.
• 15:52
  SPEAKER_00: So that becomes important.
• 15:53
  SPEAKER_00: And there's omega-3s you can get with CoQ10, which I think are also helpful.
• 15:59
  SPEAKER_00: So let's see, I brought the things that I take that that are helpful.
• 16:03
  SPEAKER_00: So um I take um true niogen, which has NMN and NMR, so that's a precursor of NAD, which is an essential uh component of your um mitochondrial pathways and repair.
• 16:16
  SPEAKER_00: Um, I take berberine with silimarin, and uh, berberine has a lot of uh great information on um on cell renewal and and overall minimizing inflammation.
• 16:27
  SPEAKER_00: I take a GLP1 probiotic because I think gut health is really critical.
• 16:32
  SPEAKER_00: And now I was just reading a story, uh report about how um we know we think now that multiple sclerosis is caused by a gut bacteria.
• 16:41
  SPEAKER_00: So um there's the gut is critical.
• 16:44
  SPEAKER_00: So for all my patients, I talk about probiotics, and I like this company called Pendulum Health.
• 16:50
  SPEAKER_00: The the doctor, the PhD who is behind it is so serious.
• 16:54
  SPEAKER_00: She's so serious that she doesn't even really have a sense of humor, which I love about her.
• 16:58
  SPEAKER_02: And um and a real scientist.
• 17:01
  SPEAKER_00: Yeah, and she so she um is behind pendulum health that makes a DLP1 probiotic, and they make one that's a pro-version, and they have acromancia as well.
• 17:10
  SPEAKER_00: Um acetylcysteine is also important for gut health, um, for mitochondrial health, rather.
• 17:17
  SPEAKER_00: Um mitopure is urolithin, which is also important for energy and health.
• 17:23
  SPEAKER_00: A lot of what I'm talking about is about being anti-inflammatory and supporting mitochondrial health, which every cell has them.
• 17:30
  SPEAKER_00: It's the energy-producing powerhouses of our cells.
• 17:33
  SPEAKER_00: We need them.
• 17:34
  SPEAKER_00: It's my favorite organelle.
• 17:35
  SPEAKER_00: And I love that the mitochondria were at some point not us, they were invaders.
• 17:40
  SPEAKER_00: They still have some of their own DNA, which shows how inclusive we have to be.
• 17:44
  SPEAKER_00: And then this is a dual-MAD complex.
• 17:47
  SPEAKER_00: Um, so one of the newest things I've added, um, so I have a vitamin B that's methylated.
• 17:53
  SPEAKER_00: So if you have the MTHFR mutation, you probably should have methylated vitamins, and you can get that test.
• 17:59
  SPEAKER_00: But this is the newest one I've added.
• 18:00
  SPEAKER_00: It's called glutaryl, it's a spray.
• 18:03
  SPEAKER_00: So this is also really important.
• 18:05
  SPEAKER_00: It's a glutathione precursor.
• 18:07
  SPEAKER_00: So a lot of people get glutathione by IV, which is very short-lasting, and it's an IV, and who needs the infusion?
• 18:13
  SPEAKER_00: So this actually has great systemic absorption, and um, and I'm not related to any of these companies.
• 18:19
  SPEAKER_00: Um, and it smells not so good when you first put it on, and it's a little bit sticky, but you do two sprays twice a day, and you um you can spray it anywhere, but uh the energy difference from this is really crazy.
• 18:33
  SPEAKER_00: So if you're finding that your energy is low, uh glutarol spray is a good one, and I can give you the company where I get it from.
• 18:40
  SPEAKER_00: So um that's that's about it for my main supplements.
• 18:43
  SPEAKER_00: I take TA65 at night as well, which is um which is telomerase, which helps with uh keeping your telomeres long.
• 18:52
  SPEAKER_00: I've been doing that for decades.
• 18:54
  SPEAKER_00: So these are things that I've done.
• 18:56
  SPEAKER_00: I sort of move them around.
• 18:57
  SPEAKER_00: Once in a while, I'll take quercetin as well, but I don't take it every day.
• 19:01
  SPEAKER_00: I don't think it's good to take it every day.
• 19:03
  SPEAKER_00: And that's the other thing with these supplements, is we put these supplements out there, but some of these should be cycled and not taken necessarily every day indefinitely.
• 19:11
  SPEAKER_00: I think quercetin is one of those.
• 19:13
  SPEAKER_00: The ones that are daily are vitamin D, uh, the berberine, I think could be cycled, the um the omega-3 should be every day, coQ-10 should be every day, the Nacetylcysteine, and I think the true niogen, the NMN NMR, I'm still kind of deciding if it's every day or if it should be cycled, but it's ongoing research and learning.
• 19:34
  SPEAKER_00: So these are things you should look at.
• 19:35
  SPEAKER_00: But I always tell my patients that I will keep following with them.
• 19:39
  SPEAKER_00: I'll make them a list of what I take, I put the must-haves and then the nice to haves, and then we incorporate it with skincare and then in-office treatments and then exercises.
• 19:49
  SPEAKER_00: The one thing that I think is the single most important thing.
• 19:53
  SPEAKER_00: If you're not going to exercise and work on your diet a little bit, there's no point in taking a supplement.
• 20:00
  SPEAKER_00: A supplement is not going to replace diet and exercise.
• 20:05
  SPEAKER_00: Once you get those things down and you start doing resistance training, which is the most important thing at perimenopause, is lifting weights.
• 20:12
  SPEAKER_00: Bone health needs resistance training, jumping up and down, weighted vest, lifting weights.
• 20:19
  SPEAKER_00: And one thing I've started to do because I don't like lifting weights, but I love cardio, um, is I just keep weights around and then I do five minutes here, five minutes there, and before I know it, I've done 20 minutes.
• 20:31
  SPEAKER_00: I've done my weights.
• 20:32
  SPEAKER_00: You don't have to go to the gym, you don't have to dedicate an hour.
• 20:36
  SPEAKER_00: On a commercial on TV, do a plank for a minute, or just do it for the commercial.
• 20:39
  SPEAKER_00: Like make yourself a simple way of doing it in between stuff so that you sneak in your workouts.
• 20:46
  SPEAKER_00: So in your office between patients, do a plank for a minute.
• 20:49
  SPEAKER_00: There's there's ways to build in your exercise to fit into your day and then just make it work for you.
• 20:57
  SPEAKER_00: And then when you get excited about it, you can go to the gym and get a trainer and do all that stuff.
• 21:01
  SPEAKER_00: But if you're not that person, it's okay.
• 21:03
  SPEAKER_00: I got cross rope, which is a ropeless jump rope that has weights on the end and it has an app, and they have 15-minute classes.
• 21:11
  SPEAKER_00: Who doesn't have 15 minutes?
• 21:13
  SPEAKER_02: Yeah, love that.
• 21:14
  SPEAKER_00: Yeah, so just have to sneak it in.
• 21:16
  SPEAKER_00: Don't don't actually exercise, just do a minute here or there.
• 21:19
  SPEAKER_02: And before you know it, you've done your I must be a unicorn because I love to lift weights, and I've done it for years.
• 21:25
  SPEAKER_02: And I remember you and I were on the podium together not that many years ago, and somebody was lecturing, wasn't a dermatologist, but he made a comment that I thought was so good, and that is that muscle is the currency of youth.
• 21:36
  SPEAKER_02: That's right.
• 21:37
  SPEAKER_02: If you allow your muscle to go, it's over.
• 21:41
  SPEAKER_02: I mean, you lose your stability, you get your bone health goes bad.
• 21:45
  SPEAKER_02: So I I mean, I always thank God I do love to lift weights.
• 21:48
  SPEAKER_02: I do a lot of Peloton app.
• 21:50
  SPEAKER_02: They have a you know weight train.
• 21:52
  SPEAKER_02: You know, you can do a 10 minute, you can do a 30 minute, 15 minute, I love it.
• 21:56
  SPEAKER_00: Have you just have you worked with Adrian on there?
• 21:58
  SPEAKER_02: Yeah, oh yeah.
• 21:59
  SPEAKER_00: He's my favorite.
• 22:00
  SPEAKER_02: Yeah.
• 22:00
  SPEAKER_02: I I'm a Jess Sims girl.
• 22:02
  SPEAKER_02: I'm going to be honest.
• 22:03
  SPEAKER_02: I adore her.
• 22:04
  SPEAKER_02: And she just like jazzes me up.
• 22:06
  SPEAKER_02: There's something about her.
• 22:07
  SPEAKER_02: She's just a cool chick.
• 22:08
  SPEAKER_02: And I love her.
• 22:09
  SPEAKER_02: And I mean, I'll do it in my bedroom.
• 22:11
  SPEAKER_02: I don't go to the gym.
• 22:12
  SPEAKER_02: I'm in my bedroom.
• 22:13
  SPEAKER_02: I throw mat out.
• 22:14
  SPEAKER_02: I've got weights, and I'm done.
• 22:16
  SPEAKER_02: So I agree with you.
• 22:17
  SPEAKER_02: That that is so important.
• 22:19
  SPEAKER_02: And I love your comment about don't look at supplements as a way to get around eating healthy and exercising because you know they're like the icing on the cake, but they're not the cake.
• 22:30
  SPEAKER_00: No, you know what?
• 22:31
  SPEAKER_00: I confess I tried that.
• 22:32
  SPEAKER_00: And then my doctor was like, this is not working.
• 22:36
  SPEAKER_00: So I learned that there's no shortcuts.
• 22:38
  SPEAKER_02: There is no shortcut.
• 22:39
  SPEAKER_02: And you know, exercise lengthens your telomeres and does all kinds of great things.
• 22:44
  SPEAKER_02: I want to ask you one other thing, just to give us a general sense.
• 22:48
  SPEAKER_02: How did you get into all of this longevity?
• 22:51
  SPEAKER_00: Oh, it started when I was a child.
• 22:53
  SPEAKER_00: My dad was the, I think, original longevity guru, and he always used to tell me we should all die young at an old age.
• 23:01
  SPEAKER_00: And then I've sort of added on to that.
• 23:03
  SPEAKER_02: Oh, I love that.
• 23:04
  SPEAKER_00: Yep.
• 23:04
  SPEAKER_00: And I added on to that, and we should look good doing it.
• 23:08
  SPEAKER_00: So um we should all die young at an old age and look great doing it.
• 23:13
  SPEAKER_00: But he always talked about diet and exercise.
• 23:16
  SPEAKER_00: And he would say diet is for um weight management and exercise is for health.
• 23:22
  SPEAKER_00: You don't exercise for weight management.
• 23:24
  SPEAKER_00: You exercise for health and you diet for weight management.
• 23:27
  SPEAKER_00: So that was his key thing.
• 23:29
  SPEAKER_00: And then he also was a real um foodie, but a healthy foodie.
• 23:34
  SPEAKER_00: Like every harvest season, he would make this amazing harvest stew with all the great harvest vegetables, and we would get pomegranates by the crate.
• 23:42
  SPEAKER_00: He would order them, and we would actually have so many pomegranates, and we would take a whole pomegranate and just roll it on the table and squeeze and squeeze and squeeze it, and then make a hole in it and just drink the juice.
• 23:51
  SPEAKER_00: Um he would, yeah.
• 23:53
  SPEAKER_00: So we was a renaissance guy.
• 23:55
  SPEAKER_02: I know he was.
• 23:56
  SPEAKER_02: I know how important he was to you as a mentor.
• 23:59
  SPEAKER_00: And he was very and he intermittent fasted from a young age.
• 24:02
  SPEAKER_00: He would sit, um, brush his teeth and say, Okay, after you brush your teeth, no more eating.
• 24:07
  SPEAKER_00: But he would do it early in the day.
• 24:08
  SPEAKER_00: So he did all these things.
• 24:10
  SPEAKER_00: We didn't have names for it then, but we we did all those things.
• 24:13
  SPEAKER_00: We the intermittent fasting, the getting up early in the morning and following a circadian rhythm, all of those things were just common sense.
• 24:23
  SPEAKER_00: You didn't need textbooks to explain how to do that.
• 24:26
  SPEAKER_00: You just knew that a food or fruit and vegetable is in season for a reason, and that's when you're supposed to eat it.
• 24:34
  SPEAKER_00: And exercise not just feels good, but is healthy for you.
• 24:37
  SPEAKER_00: And even into his 90s, till the day that you know he couldn't anymore, he was walking eight to ten miles a day and lifting weights.
• 24:45
  SPEAKER_00: So, um, so yeah, so he managed to sort of live the life that he always talked about.
• 24:50
  SPEAKER_00: But one day we were sitting at the table and we had these French pastries that looked, they were so delicious.
• 24:55
  SPEAKER_00: I mean, they were amazing.
• 24:56
  SPEAKER_00: And my dad just didn't touch it.
• 24:58
  SPEAKER_00: And I said, Dad, these are so beautiful and so delicious.
• 25:01
  SPEAKER_00: Why wouldn't you even just have a bite?
• 25:02
  SPEAKER_00: He goes, It's not good for me.
• 25:04
  SPEAKER_00: Why would I like it?
• 25:06
  SPEAKER_00: So, you know, he had such a great philosophy about food, is that it it kind it isn't medicine, but you eat the right food, so you won't eat medicine.
• 25:14
  SPEAKER_02: Yeah, that's a hundred percent true.
• 25:16
  SPEAKER_02: What was his specialty?
• 25:17
  SPEAKER_02: Was he an internist?
• 25:19
  SPEAKER_00: He was an anesthesiologist.
• 25:20
  SPEAKER_00: Oh, he's anesthesist.
• 25:21
  SPEAKER_00: But he also did ENT because back then you could specialize in multiple things, but he was a dermatologist wannabe.
• 25:28
  SPEAKER_00: I mean, he was still always teaching me dermatology and sending me articles till really the very end.
• 25:33
  SPEAKER_00: He'd say, I know you know about the melanoma, but did you read this?
• 25:37
  SPEAKER_00: And then, oh my god, nanotechnology, he was obsessed.
• 25:40
  SPEAKER_02: I love that accent.
• 25:43
  SPEAKER_00: It was very cute.
• 25:44
  SPEAKER_01: It was yeah.
• 25:46
  SPEAKER_02: Let me let me ask you one last thing because of course I knew this was going to go so fast.
• 25:51
  SPEAKER_02: A big question that we get asked by our perimenopausal menopausal patients is about hair loss, loss.
• 25:57
  SPEAKER_02: And I know this is like a huge subject, but I want to touch on it for those that are listening because it's such a big part of it, and so many women lose their hair.
• 26:05
  SPEAKER_02: So, how do you approach those patients?
• 26:07
  SPEAKER_00: Well, I tell them we can manage it in lots of ways, but it's hormone therapy.
• 26:12
  SPEAKER_00: It's estrogen, progesterone, and testosterone.
• 26:15
  SPEAKER_00: And one of the signs of testosterone deficiency is hair loss.
• 26:19
  SPEAKER_00: So too much testosterone isn't good, but you need testosterone.
• 26:22
  SPEAKER_00: And I think we we think of testosterone as a nice to have, like a feel-good sort of hormone, but it's not.
• 26:30
  SPEAKER_00: It's really important for physical health and for hair and for muscle building.
• 26:34
  SPEAKER_00: So um, so my attitude is you start by adding estrogen, estradiol, the topical or um patch or cream, but I'm not a big fan of the pellets.
• 26:45
  SPEAKER_00: I don't think you can control the dosing.
• 26:47
  SPEAKER_00: And then once you have your estrogen balance, you add the progesterone.
• 26:51
  SPEAKER_00: And even if you don't have a uterus, progesterone is important for brain health.
• 26:55
  SPEAKER_00: So um it's a great sleep aid for most people, but for people who don't tolerate it that way, and if they have a uterus, they can get a progesterone IUD.
• 27:02
  SPEAKER_00: Once you get the test the estrogen and progesterone balance, then you add testosterone, ideally as a cream.
• 27:08
  SPEAKER_00: So there's no testosterone that's FDA approved for women, which is why I don't like the pellets.
• 27:13
  SPEAKER_00: It's way too high a dose.
• 27:15
  SPEAKER_00: So the estrogen cream you can have made for you and just put a uh a pea size amount behind your knee um once a day.
• 27:23
  SPEAKER_00: And if if you have too much, you'll see, you'll break out, you'll have issues.
• 27:26
  SPEAKER_02: So you just gonna say we've all seen those women with acne and hirsitism from those stupid pellets because just getting too much testosterone.
• 27:34
  SPEAKER_00: Right.
• 27:34
  SPEAKER_00: It's just doctors trying to make it easy, but not good for you.
• 27:38
  SPEAKER_02: This is not a mass-produced it's gotta be tweaked for every individual patient.
• 27:44
  SPEAKER_00: It can be, every individual patient, and then retweaked over time.
• 27:48
  SPEAKER_00: I remember waking up and having feeling like I was a little achy when I got up, and I told my doctor, yeah, you know, I feel like I might be getting arthritis.
• 27:56
  SPEAKER_00: He just upped my estrogen.
• 27:57
  SPEAKER_00: One day it was gone.
• 27:58
  SPEAKER_00: And that's the last point I'll make because I know we have to go, but when you adjust your estrogen and progesterone, you feel better in a day.
• 28:06
  SPEAKER_00: I mean, the difference is one day to the next day.
• 28:08
  SPEAKER_00: You're like, wow, this is life-changing.
• 28:11
  SPEAKER_00: When you add testosterone, it can take months to see a difference.
• 28:15
  SPEAKER_00: So the testosterone benefits take time to see.
• 28:19
  SPEAKER_00: But the estradiol and the progesterone, and you want bioidentical.
• 28:23
  SPEAKER_00: They're synthetically made estradiol um and progesterone, they're but they're bioidentical.
• 28:29
  SPEAKER_00: So there's older versions that are horse urine-based or that are I don't think they use that anymore, do they, premarin and all that?
• 28:35
  SPEAKER_00: I they still you'd be so?
• 28:37
  SPEAKER_02: Okay.
• 28:38
  SPEAKER_02: They still do.
• 28:39
  SPEAKER_00: So just don't look, make sure you don't do those.
• 28:41
  SPEAKER_02: Yeah, I agree.
• 28:42
  SPEAKER_02: All right, so you have to promise me you'll come back because we could talk for another half hour, let's face it.
• 28:48
  SPEAKER_02: This is so interesting, and Doris.
• 28:49
  SPEAKER_02: I appreciate it so much, and I can't wait to see you in Austin, Texas, and tell Michael if he doesn't come.
• 28:56
  SPEAKER_02: I'm gonna be very upset.
• 28:57
  SPEAKER_02: I've invited him every year.
• 28:59
  SPEAKER_02: Tell him he's gotta come.
• 29:01
  SPEAKER_02: So thanks again, and everybody enjoy and remember Science of Skin Summit, Austin, Texas, September 5th through the 7th.
• 29:08
  SPEAKER_02: And we'll look forward to having Dr.
• 29:10
  SPEAKER_02: Doris stay back on again.
• 29:12
  SPEAKER_01: Thanks.