Latest / The Resting Stitch Face Podcast / Resilience, Rhythm and Reinvention w/ Dr. Adrienne Towsen

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Resilience, Rhythm and Reinvention w/ Dr. Adrienne Towsen · The Resting Stitch Face Podcast

• Erin Sheffield: Welcome back to another episode of the Resting Stitch Face podcast. I'm your co-host, Dr. Aaron Sheffield, here with Sarah Harding: Doctor Sarah Harding. Erin Sheffield: Welcome, welcome. Sarah Harding: Welcome back for another episode. Today we are joined by the beautiful Dr. Adrian Towson. She's a board-certified orthopedic surgeon, turned entrepreneur and health optimization physician. After completing her orthopedic surgery residency at Allegheny General Hospital and a sports medicine fellowship at the Thomas Jefferson University, she spent 21 years practicing in Chester County, Pennsylvania. A single mother of two daughters, Adrien built her surgical career while raising a family and later discovered a passion for a competitive. Ballroom dancing. There you go. Which sparked a deeper interest in performance, recovery, and longevity. Following a private equity acquisition that transformed her practice environment, she made the bold decision to leave orthopedic surgery after more than two decades to reinvent her career, which we love. Today, she is the founder of Towson Clinic, a health optimization and performance medicine practice in Westchester, Pennsylvania, serves as a clinical advisor in the peptide education space. Adrienne Towsen: you Sarah Harding: And consults within the surgical technology industry. Through her work, Adrienne helps people optimize their health, performance, and quality of life while proving that it's never too late to begin again. I love that. What a great bio. Wow. Hey. I know. Well, welcome. We're so glad to have you here. Adrienne Towsen: Yeah. Hello. Erin Sheffield: I so much I wanna talk about already where we Adrienne Towsen: Thank you, I'm really glad to be here. This will be fun. Sarah Harding: Yes. And this is so interesting, just the intersection of medicine and dentistry. We're all surgeons here, right? And so we in dentistry talk a lot about this private equity takeover because we've seen it happen in medicine. We've seen it with hospitals. We've seen it all over the place. And it's happening in dentistry, and people are just falling for it. You know, like it's like this wonderful thing. And Adrienne Towsen: Yeah, don't fall for it. Sarah Harding: Don't fall for it. Right. And so, but I understand, right? Because I do understand. and so I love that you are in this space and talking about it from the physician standpoint of lessons learned and miseries suffered. So Erin Sheffield: Yeah, so you really pivoted. So you got bought out by private equity, which eventually forced you out of your chosen profession. So can you tell us a little more about that transition and what happened there? Adrienne Towsen: Yeah, sure, I'd be happy to. So yeah, I was with a wonderful group that I loved for 19 years. So it was my second job out of fellowship. yeah, so my first job out of fellowship was 2004 to 2006. And I was hospital employed at just a little hospital. And then in 2006, I joined the practice that I left a year ago. So and it was a wonderful private practice in the community here in Westchester, Pennsylvania. So we're not that far from Philadelphia. And it was actually looking back on it now, especially like my dream job. I mean, I felt that for many of the years, but you we were a small private practice initially, which then just with the evolution of healthcare, we ultimately became part of like a bigger super group, probably about four five years after I joined. And that was just the way everything was going. was always the bigger is better, right? and I will say like, it was a good move ultimately, like we even resisted that, but you know, we were still a private practice, just a much larger private practice. But then that was kind of the stepping stone to ultimately doing a private equity deal several years later. And again, it was all in the name of really, we still have to get bigger and we have to grow. so again, we're not far from Philadelphia. So there's a couple of big health systems in our area that are continuing to, of course, move out more and more into the burbs and whatnot. Sarah Harding: Mm-hmm. Adrienne Towsen: We had a pretty good hold in our market share, you know, in our area, but nonetheless, the leadership of our like super group was like, well, this is our next step. And the next step being we need like a private equity, you know, partner. They're not really a partner, but we need, you know, we need to keep expanding and all of that. So to make a very long story short, there was a lot of skepticism about it, but by and large, kind of like you said, they do print a paint kind of a Sarah Harding: Right. Adrienne Towsen: pretty picture and I call it the best like smoke and mirror show around because they tell you what you want to hear. And by 2022, we did this private equity deal. so, and then within the first three years, I was there for three years under let's say the private equity regime. Sarah Harding: Yes. Adrienne Towsen: And year one was not so bad, just not much changed really. But then year two and three, it was very obvious that their goals were way different from our goals and their values were way different from our values. Not that maybe we didn't know that ahead of time, but I think a lot of physicians are very, first of all, we're maybe a little naive. Some of us, maybe not all of us. I I admit that I'm not a business or money person at all. So I kind of believe what we're being told. Sarah Harding: Mm-hmm. And we weren't taught to be, right? Adrienne Towsen: And I think to a point where it can obviously come to our detriment. so we all of a sudden were being charged all of these exorbitant fees that weren't really fully laid out upfront. Or if they were, they were hidden in all these contractual things that maybe, although we have lawyers and accountants and all of that, it just ended up not being the deal that we thought we signed up for, let's say. then it was. Sarah Harding: Right. And at this point, how many partners did you have in that practice? Adrienne Towsen: Yeah, so we were my division. So we were still like multiple divisions within this like big super group. But the super group itself was probably about 75 docs. And then six months into our acquisition, they did acquire a second smaller group that was all hand and upper extremity surgeons in our region. So then the total of the group was probably closer to 90. And then my actual division, there was 10 of us. So my division was the second largest of the super group itself. And so, and we always prided ourselves. We were a very high quality team. We all got along. You know, I was the only woman, but that's been the way through my whole career. just, you know, yeah, exactly. You know, but all like my brothers, like we were all like good friends and whatnot, which can be hard with a group of that many, like. Sarah Harding: That's how we roll. Adrienne Towsen: orthopods because there's a bunch of egos and jocks and all that. you know, we all got along. We were, you know, really had developed this amazing practice. And so it was very sad. was very devastating when it was becoming brutally clear and in our faces that we were no longer in control at all of what was happening. And that was on the operational side, on the financial side. Sarah Harding: Yes. Opinions. Right. Adrienne Towsen: millions of dollars leaving the practice each month, you know, to go to pay these like management fees and other, again, hidden fees coming out of the woodwork. The physicians were essentially left with the scraps. We had no control over our employees anymore. Like they were now employees of the bigger entity. And so, and that was also really hard for us because we had many people who'd worked with us for years. And, you know, I mean, there was a lot of loyalty there. And then we started having like a revolving door of staff too. And it was just... the patient experience was suffering. The operational stuff that they changed was terrible. It was clear that they didn't really care about the patient experience or the physicians. And so it just became unsustainable from a financial standpoint and just a patient care standpoint from my point of view. I wasn't the only one to leave. There's a lot of guys that still stayed and it's not like the practice has gone under yet, although there were times where we thought that was going to happen because we were in such financial peril at times, but the company would never give us a reprieve on anything. They didn't really help us. The answer was always they needed to get their money and we just needed to work harder. And when you're already working 10, 12, 14 hour days and doing as many cases as you possibly can in a day, bringing charts home at night, all the stuff that we do and trying to do more, you just can't. Sarah Harding: It's unsustainable. Yeah. And it's funny because you had the experience before of being self owned. And you're like, I know what it takes to run this practice and I understand how much I need to work in order to make this much money. Now I'm working twice as hard and making less money. This makes no sense. Adrienne Towsen: Yeah. Erin Sheffield: I remember when our group was being looked at to get bought out as well by a bigger group, I asked specifically when when what we get paid is based on what I make. Like what I do, what I produce as a surgeon, I'm essentially the product. How does bringing in an extra group make Adrienne Towsen: Right. Mm-hmm. Erin Sheffield: my product more profitable. Like to me that doesn't make any sense. And they like acted like I was so dumb for asking that question. But essentially my product is just getting chopped up into more and more pieces and getting dispersed to other people. But then I have less control over my product as well. And so it's it's frustrating. really medicine I think should it should be a little bit protected from like the business profits side. You know, we owe more to patients. We do a lot of things not because it's the most profitable thing for me to do. It's because you need to get done. And we all do procedures and things that maybe we don't like to do as much or don't make as much money as this other thing. But we have a duty, you know, as community members and as people who have taken on this calling and healthcare to do what the patient needs. And so it's frustrating when you lose that autonomy and that ability to help in that way. Adrienne Towsen: Yeah, yeah, absolutely. And so, yeah, so I mean, it was a very difficult decision, but I, you know, I would have been with this practice until I retired. I would have anticipated being there like 10 more years ish. I mean, I just turned 55 a couple of weeks ago. but thanks, thanks. Appreciate it. But I, you know, I just couldn't. mean, I just, you know, from my standpoint, like I couldn't. Sarah Harding: Dang girl, you look good. Adrienne Towsen: work those many hours for what I was getting paid. And I just, you I was one that because I was a single mom and I was not like probably very good with investing and all of that, like I didn't have like a big, you know, something to fall back on from a financial standpoint too. Like I relied on my salary. So then try living on your salary, you know, half of your salary, which is basically what it was for two years. And I had literally just put both of my daughters, I was finishing with my second daughter going through college and of course they both went to, mean they're smart, wonderful young women and went to these super expensive private schools and I just finished putting my second daughter through NYU and I'm like, wow, you know, that was a big hit, you know, to me and I just couldn't, I couldn't keep working and burning the, you know, candle at both ends or whatever you want to call it. for the money I was making. I was like, have to figure something else out. so I leaned in really hard to like networking on LinkedIn, which I hadn't done in the past very much at all. And then that really saved me because when I left, I didn't know what I was gonna do. I left without a plan. I'm like, I know I just can't do this anymore. And so I just, I had a really like... busy kind of not great weekend on call. That was November of 2024. And I can remember that Sunday night I've been operating on hip fractures all weekend and whatever came home and was like, I think I just volunteered my time, you know, based on what I'm actually going to get paid for this. So like, can't keep doing it. I just can't. So I wrote a letter. was, it was brewing, you know, over the months prior to that. But was like, that was kind of like the straw that broke the camel's back was like this call weekend. Sarah Harding: Yeah. Adrienne Towsen: We're in a community hospital, but a busy community hospital. So our weekends, we're like always working all day, Saturday, Sunday in the OR and whatnot. So I was like, I can't keep doing this. And I wrote the letter and then Monday morning I sent off the email and that was that. And then I was there for six more months and left in May of last year, May of 2025. So it's just now been a year. Yeah. Yeah. Sarah Harding: Yeah. Erin Sheffield: Who decided to leave orthopedic surgery altogether? What made that decision rather than just starting your own own orthopedic practice? Adrienne Towsen: Yeah, well, a few things. So one, when I left, I was like, I know what I don't want to do. So maybe I didn't know exactly what I wanted to do, but I knew what I didn't want to do. So truth be told, right before the private equity acquisition happened, like for a year or two before that, I was kind of getting a little bit burnt out. I mean, I do love ortho. I was an athlete in the past, still an athlete with my dancing, but had ACL surgery myself, had some amazing mentors. So it was all about ortho. was a little burnout also just of the rest of the healthcare system with insurance issues and all of that, know, prior to private equity and then just, you know, got dumped on with that. So, but we had a two-year non-compete and a very, very large geographic area. So, 10 miles, but we had so many locations because of, so it wasn't just like, I my division had three offices and that's, you know, the only spots that we worked, but the entire super group Sarah Harding: How many miles was it? What was the radius? mm-hmm. Adrienne Towsen: I mean, I don't even know what the miles, mean, that you draw it out on a map and like, would have to drive at least an hour and a half to work, you know, probably. And I was like, you know, not at this stage in my career, like not willing to do that. Like I had lived 40 minutes away from where I worked for a long time and that was fine. That was doable and whatever, but I didn't want to have to drive that far. I did not want to join a health system. So the health system that owned the hospital where we, took call and did our work, they had, reach outside of our non-compete and they were offering us, jobs and whatnot, but I didn't, I didn't want to do that and sort of exchange one corporate nightmare for another, so to speak. And, you know, I'm very flattered. I got offered many jobs actually where I would have to move though, you know, so again, like through my networking on LinkedIn and whatnot too, I met a lot of other orthopods in different areas, different states and, you know, felt very flattered like, come, come join us, come join us. And it was nice, but I'm like, Sarah Harding: Yes. Adrienne Towsen: I don't wanna move. I love where I live and I'm a single person. So I've been single since my kids were one and three and I have a social network here and 21 years in the community, tons of relationships, tons of patients who know me and all of that. So I'm like, I don't wanna give that up. So then I was like, well then how do I stay and not do, I can't do ortho here Where I want to. Sarah Harding: Yeah. Adrienne Towsen: or I want to be. So, and then I had started to look into like, you know, what else might interest me. And, you know, because I had just recently gone through menopause because I am a, you know, 50 something year old, like competitive athlete, because I was a sports medicine specialist also within ortho. So my patient population ortho is often like, I did high school and college athletes, but I did that 40 to 60 year old was like the mainstay of my population. And so I just was used to being in that, the adult who wants to stay active and like do their sports and whatnot. And so then I started learning more about all of it, menopause and hormone therapy and started remembering all the hip fractures I took care of and all these ladies that were suffering. And I thought, you know what, this is very interesting. And I'm gonna dive into something new and I'm gonna stay right here. and I'm gonna help people in a different way. And then I didn't know for sure if maybe after the non-compete I'd go back to ortho two and kind of do both. But the more I get into this, I just love it. And I missed the OR initially a lot, but less so as time goes by. So I really think this is what I'm supposed to do now. Sarah Harding: Yeah. How? Adrienne Towsen: Mm-hmm. Erin Sheffield: think that's something people don't think about as much as maybe we should in medicine, that these non competes sometimes are really difficult. Adrienne Towsen: Mm-hmm, yeah. Erin Sheffield: you build a life and you come and in your instance you had a practice that you were all in for, not just for like six months and it didn't work out. You'd been there for a couple of decades and when it doesn't work out because of some bad business deal, now you're forced to move away and leave your support system and leave everything you built. Like that's so devastating. Sarah Harding: Yeah. Or totally abandon your career and progression and profession that you've made. Right? It just doesn't make any sense. Erin Sheffield: Have to start over and Adrienne Towsen: Yeah, yeah. I will say, like, I mean, you can, whatever little cliche phrase you want to use, you know, there's find your silver lining or, you know, close one door, open another. I will say that, I mean, believe me, I went through my timeframe of being very mad, very sad. I was devastated, like all of those things. I mean, I cried my eyes out the morning of my last day of work. I'm like, you know, as much as I was like, okay, I need to... Erin Sheffield: It's mystery. Sad. Adrienne Towsen: this is what I needed to do. And I knew it and it was six months coming. I I could barely get myself out of bed the last day, my final day at work, May 9th of last year. Thank goodness one of my daughters was home and she helped prop me up and get me out the door. She was like, I'm gonna be okay. I was like crying my eyes out when I woke up because it was a huge, mean, we also, it's our identity, I think. I mean, yes, I was a mom. Sarah Harding: Yeah. Adrienne Towsen: That's a big part of my identity. Ultimately became a dancer. That's another part of my identity, but I'm an orthopedic surgeon. mean, still, like people ask me what I do. I'm like, yes, I'm a clinic owner, but I'm like, I can't, I can't not say I'm an orthopedic surgeon. Like it's just, that's what comes out, you know? So, but, but all that being said, people also tell me now they're like, wow, like you're like so excited when you talk about what you're doing and learning something new. Cause you know, I mean, yes, there are advances in surgical techniques and we're always doing our, you know, courses and CME and whatnot, but Sarah Harding: Right. Yeah. Adrienne Towsen: learning something really new, it's been a while. So it was really... Sarah Harding: Yeah. And actually feeling like you're making a difference, not just patching problems, right? Adrienne Towsen: Yeah, for sure. Absolutely. It's been really fun to see people who are invested in their health and want to be proactive. And I do have, it's a direct pay cash-based practice. So when people come in, we do a 90 minute initial consult. Whoever gets 90 minutes with their patients, right? And sometimes I think, their problem's a little more focused or whatever. Don't you know, every single time we are spending 90 minutes, if not more. And I tell you, people just sit down, and just kind of like take a, like have a sigh of relief almost and just, you know, and just talk. And it's great. I mean, I always like to talk to my patients before as much as I could within the confines of my 10 minute appointment slot, you know, but this is a completely different ball game. And I do love it. Yeah. I really. Erin Sheffield: Well, it's kind of an unexpected pivot. Think of how few people in medicine have any training or comfort in like women's health and especially like cause care to have then someone from basically like the most male dominated profession coming into the year. So like kudos to you for, you know, getting over imposter syndrome or any of that to pivot. Adrienne Towsen: Mm hmm. Yeah. Yeah, absolutely. Yeah. Sarah Harding: Yeah. Adrienne Towsen: Yeah, for sure. Yeah, and it was there big time. was never so nervous as like my first couple of consults here, you know, I was like, of course I know how to talk to patients, take care of patients, formulate a plan. I, you know, had gone through and have a certification in peptide therapy, a certification in hormone therapy, and I'm always looking to do more and learn more. And I'm involved with a peptide education platform now and it's really cool. But yeah, those first couple of visits, I was like, my goodness, I'm not sure where I'm headed, what to say. I'm not sure if I'm gonna make the best plan, but they always will say to like, our patients can be our best teachers and really like listening to people and people just feeling heard. And I'm not exclusively a women's health clinic, I see men too. It's probably a little heavy women, but it's almost balancing out. It might be like 60 % women, 40 % men, but certainly have a huge passion for the women's health part, having also just gone through menopause not long ago myself and dealt with a lot of symptoms there. So, and all the stuff that I saw in ortho too, that like when I start putting all the dots together now, I'm like, gosh, I wish I could have done better for some of these women that I treated, you know? And so being able to talk to a woman in her 40s about osteoporosis and how not to get it. is so huge, you know, and being able to talk about everything and then having people be interested in it and like being proactive about their health. I do think we're going to see, some of the real experts out there who I am just in awe of and I've been to many conferences and met Wanda Wright and Mary Claire Haver and Heather Hirsch and like I'm like a disciple of theirs I definitely have learned a ton from them met them all in person and you know this is this movement especially in women's health but in general Sarah Harding: Yeah. Adrienne Towsen: to that health optimization or just wellness and preventive care, I think is so huge. And I think maybe this next generation of women, hopefully there's not gonna be so many hip fractures and chronic UTIs and all of these things, let's hope. Sarah Harding: Right. Erin Sheffield: Yeah, definitely. Sarah Harding: Yeah. Well let's talk a little bit about what your what is your practice now? Like how did you set it up? How many employees do you have? And then what do you do? And can we start also with the osteoporosis thing? How do you prevent it as a gal in or forties? Adrienne Towsen: Mm-hmm. Yes. Yeah. Get on estrogen. So yeah. So mean, basically I term my practice like a health optimization or quote unquote, like performance medicine practice. So it is just me right now. So I am just a one woman show. I'm doing everything myself. I think people, they kind of know like when I'm on the phone with somebody, I'll tell them that, but I think still it's always funny when they answer the phone. I'm like, yeah, it's Dr. Talzin. You know, we named the clinic Talzin Clinic. Sarah Harding: Okay. Adrienne Towsen: on purpose for my recognition of my name, you know, here in the community rather. We came up with some others. So I work, I say we because I work with a business coach. Um, and so that was like very intentional so that it was recognizable. And then, but people are always like, Oh, I'm like, yeah, it's actually Dr. Talzin. They're like, you're answering the phone. I'm like, yeah, I'm like, I do a little bit of everything. And they were, come through if they, mean, there's a of pictures of me on the website. So even if they don't know me before they come in and they, think at the front desk, then they expect it of course to be someone else. And I'll stand up and introduce them. Oh, and then like, I'll go to the door to bring them back. Like still me. I wear every hat in the clinic and people are very gracious about it, but they're like, this is great. Can't wait till you can expand and whatnot. So presently, it is just. me in the clinic, have a small office space that's literally in the medical office building right next door to the hospital where I worked all this time. So I stayed, you know, right smack dab in the middle of my community. And I was very happy about that. There was a space available. It was perfect. It just needed to be kind of renovated. And so that all got started at the end of last year. And then very into February is when I actually opened. So basically just staying in my lanes of hormone therapy for both men and women, peptide therapy, the GLP-1. So sometimes that's in conjunction with something else or I have some patients that are just really in the weight loss sector. And then, I I do some lifestyle counseling. Certainly I don't claim to be a nutritionist or I'm not like a personal trainer or anything like that. I have enough background and worked enough with those types of folks that I think I can give reasonable. suggestions and then hopefully, when I expand, would love to, include a nutritionist, include, some type of a trainer or athletic trainer or somebody who can help a little bit more for those people who need to develop the strength training programs. And then I have a whole team waiting to join me. I have someone from my front desk who I've worked with in the past. I have a nurse who I worked with at one of the surgery centers who wants to come. I have a PA who I want to bring with me. it's just a question of, self-funded all of this. And when I left my practice, I was pretty screwed financially, full disclosure. So I took a big chunk of money out of my 401k, which is really crappy to do. Don't recommend it at all, but I had no other choice. And so that's what I lived on, and that's what started this clinic. it's very bare bones, kind of in going. Sarah Harding: Mm-hmm. Adrienne Towsen: I just studied a ton, developed some initial protocols, tweaking things as I go, but basically it's again cash-based, so I'm not dealing with the insurance piece. And of course, some of the things like some hormone therapy, of course, could be insurance covered. The peptide stuff, not so much. But yeah, I'm just trying to offer the whole package in that kind health optimization space. so far it's been very well received. I've been very lucky to have Sarah Harding: Yeah. Adrienne Towsen: A lot of acquaintances or friends, you know, be like my initial patients, which is very nice. And some people I've worked with before, but we're, it's getting out now. We haven't really done like a ton of marketing. mean, I'm on social media a lot, like more than I want to be, but it's sort of a necessary piece of it. And I don't dislike it. I'm just, you know, trying to get better at it. And, Yeah, and then just the word of mouth, because again, one of the reasons I wanted to stay here so badly is because I have so many relationships and know so many people. 21 years in this community, I you build a lot of relationships here. So, so far so good. And, I'm just kind of taking it as it comes, but getting, busier as each week goes by more and more initial consults, coming in. So that's what I'm doing. Sarah Harding: Wow. Erin Sheffield: I love the pivot part of your story. I actually always proud of people when they leave their initial job in medicine, whether it's going to a different specialty or changing their clinic in some way or going fee for service or whatever, because I think We put so much into our training and into developing that identity and especially I think as a surgeon to get to that point, it takes so much of you that it's really scary to drop all of that and to do something else. And a lot of us will continue to punish ourselves and be absolutely miserable because this took this much time, it took this much money, it took this much of me to get here. So this is just who I am. And so I think that was so brave and is to be applauded that you were willing to just totally reframe and start again and do something else and to choose something that's like lighting you up and bringing you hopefully joy. Sarah Harding: Yeah, I often think about this too, because I think as a physician, and this is coming from my like little sister syndrome that I have, but I feel like physicians have an easier time pivoting because you just have so many other things at your disposal. So as a single degree oral surgeon, you know, I don't have an MD. And so In Cal in the state of California, I can't do anything cosmetic. I can't do without getting an additional cosmetic writer, which they make you go through the ringer to get. And I can't do Botox as an oral and maxillofacial surgeon, but I can go to my friend who's a pediatrician or an OBGYN and they can give me Botox. You know? And I'm like, this is so bizarre. Right. Yeah. And so I just think it's so bizarre, but I think about it a lot. Like, what would I do? Because you're really able to use all of your expertise and all of your experience in order to have created this pivot with so much basis of knowledge. And you're like, now I can really apply the full picture. But so I think I often think, what could I do in a pivot that would utilize all of my knowledge, but that I would still be able to perform with my single degree, dental degree? And it's hard, you know? It's really hard. Erin Sheffield: Figure that out. Adrienne Towsen: Yeah, mm-hmm, yeah. Yeah, no, I felt like these kind of paths did align somewhat, and I'm finding out more and more as I dive into this. And part of it, I think, was my subspecialty within ortho as well, since I was a sports medicine surgeon. so, again, it made sense the more that I kind of moved forward and said, okay, what else can I do? That being said too, think also as a woman in ortho, I will say, it was hard to sort of let it go, because it is almost like a badge of honor that you wear, go through, I was the first woman in my residency, the first woman in my fellowship, first woman in my group, all of that. And so I don't know that I ever was trying to promote that or that was like, Sarah Harding: Yes. Adrienne Towsen: a big piece of it for me. However, in hindsight, I look at that and say, yeah, that was a big accomplishment. so not that it's gone from my life. mean, it's there. It'll always be there. But I always think about my kids because my kids will always say to me, mom, because I have two girls. And they were like, when people ask me what a mom does, we don't just say you're a doctor. We say you're a surgeon. And they were always super proud of that. And so I'm like, well, what are you going to say now? I still am a surgeon, but you could say, I guess I'm like a clinic owner. maybe that's good. Or maybe just being a doctor certainly is enough, right? But it's just interesting that distinction they were always so proud of that. yeah. Sarah Harding: Yeah, I understand that. I don't I like you just saying it, I feel it like right down and deep in my soul. And I don't even introduce myself as an oral surgeon ever. You know, that's just 'cause I try so hard to make sure that it's not part of my identity, you know. So Adrienne Towsen: Right, right. Yeah, no, hear you. Mm-hmm. Yeah. Erin Sheffield: So can you tell us more about what it was like being a woman orthopedic surgeon? I mean, the numbers are still very low. I assume twenty years ago when you were going, like you said, you were the first numbers were even lower. I feel a tie to orthopedic women because I feel like our specialty is similar and the numbers also maybe you're offended, but I always call myself like a a oral orthopedic surgeon. Like phone surgeons too. So Adrienne Towsen: Yeah. Yeah, I think that's great. Yeah, for sure. Erin Sheffield: Tell us all the tea. What was it like coming up in that? Has it gotten better over time? What do you think as a woman in that field? Adrienne Towsen: Yeah. Yeah, I I think I had a pretty good experience compared to some. And what I mean by that is I ended up in programs that were, even though I was the first woman, they were very sort of female friendly, if you will. So yeah, I I I graduated med school in 1998, so 90s. And I was, so I went to med school in Philly. It was MCP, Medical College of Pennsylvania at that time. They merged with Hahnemann. While I was there and now it's Drexel. So my like med school is went through this evolution But when I was there they had an affiliation with Alligator General Hospital in Pittsburgh So that's where I did my residency and we could do our third and fourth year clinical rotations out there Or you could go back and forth between a hospital in Philly hospital in Pittsburgh So there were a lot of perks to go to Pittsburgh kind of a nicer hospital and they gave you housing and all this stuff So I went to Pittsburgh for the whole two years which was huge for me because then I got in with the guys in ortho there and they had one, there was one female surgeon, she was pediatric ortho on staff at Allegheny General. So they had, again, they had some exposure to a woman in orthopedics. They just had never had any residents in their program yet. But I did some research and made a little name for myself with that department and so then I ended up matching there. And so I will say I knew ahead of time, a lot of the attendings And so they were great to me. And we had a small program, it was just two residents a year. So I'm still really good friends with the guys that I did residency with. I mean, it wasn't easy, but it's five. then I did a one-year fellowship, but I was newly married. for me, like the ortho part, being the one in ortho, like, Sarah Harding: Is that a six year program? Five. Okay. Adrienne Towsen: Again, I had great people around me, great guys around me. some programs I interviewed at, you could tell that they were not female friendly, for sure. so there was definitely, the bigger boys club sense or, the bro, whatever mentality and some other programs where I interviewed and there was one, I don't even know why they interviewed, but they were like, yeah, well we had a female in our program once, you know, and it was kind of like left at that. And I was like, okay, I guess that means you're not having one again. So why I'm even here, you know, but. Sarah Harding: Yeah. Adrienne Towsen: But anyway, and like back then, probably the statistic was like between five and 6%. I mean, it's not that much more than that now. It actually in practice, mean, a higher percentage of females coming through in residency. But it was more the strain probably that it put on my marriage. And that could be any surgical residency, know, not just Wortho, because I was newly married and then I had two kids. had both my daughters during orthopedic residency. that was, yeah. Sarah Harding: Wow. Adrienne Towsen: So there's that. So yeah, so that, I don't know. I mean, I don't know if there was ever a perfect time, right? So, know, residency, then fellowship is like so key and then early years in practice. And then, I don't know, I was really wanting to have kids younger because my parents were a little bit on the younger side. So. And it happened easily, so I felt lucky. yeah, so that was tough to do for sure. And I think I was so scared to tell everybody. So I hid both of them for as long as I could, to be honest with you. But they were super supportive. I everybody was great. I was very lucky to have not really be super sick or anything throughout my pregnancy. Sarah Harding: Wow. Adrienne Towsen: But I think, yeah, I'm not sure I would recommend that or at least not to within five years of ortho residency. But I did it. But then my marriage failed. And so by the time I was a fellow, I was getting divorced. And so I had a one year old and a three year old. And so my parents kind of came to my rescue and we lived as a three generation household. So yeah, but again, in my fellowship, I was lucky because I one of the attendings in my fellowship was like my actual like mentor. Sarah Harding: It's amazing. Adrienne Towsen: who's the reason I went into orthopedic surgery in the first place. So I had an ACL injury playing lacrosse in college and he was the surgeon who did my surgery. So he was one of the attendings in my fellowship. And so I was really having a kind of crappy chief year because I had just had a baby and then my husband left two months later and I didn't know what I was gonna do. And so he really came to my rescue as far as facilitating me getting a spot in the fellowship, know, kind of. circumventing the match and everything, know, truth be told. So I could be secure and move back to the Philadelphia area and do a fellowship under him and others. So that was great. And once again, it was just two fellows a year then and four different attendings we worked under and they were all super supportive. I mean, even though I was the first woman, but I was, with two little kids and going through a divorce and I think they would have been supportive if that wasn't the case too, but they were very, very good to me. And then, You you just, think for me, I didn't have any bad experiences. So you just get kind of used to being the only girl around. I remember going to, courses or other things or just being in our conferences. And, I just look around like this, what one thing is not like the other, you know, but it didn't phase me after a while. So, and I know there's plenty of other stories that are, some difficult times for women in ortho. And I hate to hear that, but. I will say, you I got pretty lucky, I guess. And I certainly think it's, you know, a more popular choice for women. I don't think it's ever going to be, hugely popular. And that's fine. But, I loved it. There was nothing else I wanted to do, going through med school. So, and I got lucky. Erin Sheffield: Do you pick the comments like we do? 'Cause people are always asking us if we're strong enough to take out teeth. And it's funny 'cause I'm imagining, like, are you strong enough to dislocate a hip? You know, like tell us about those experiences with patients. Adrienne Towsen: Yeah, for sure. yeah. Sarah Harding: Yeah. Adrienne Towsen: Yeah, so for sure, ortho without a doubt, I think, certain subspecialties more so than others, but going through residency or doing general ortho or taking general ortho call. I mean, yeah, there's certain things that you definitely have to have a little bit of strength. By and large, a lot of it's though technique related and it doesn't have to be brute force. the strength a lot of times comes from the size of some of our patients and moving patients and stuff, which I would always help. And that's, that'd be always the joke. It'd be like, why is the only lady orthopod, the one who's willing to move the patients and stuff. They're like all your partners, you can't find them anywhere when it's time to move. Yeah. So, but for sure, you know, I, Sarah Harding: Mm-hmm. Right. Erin Sheffield: the bros when we need them. Sarah Harding: Yeah. Adrienne Towsen: would get some of those comments from patients absolutely, even when I was like 10 years or more in practice, get the comment after talking to the patient for 15 or 20 minutes about the surgery, they're like, and you're the surgeon or like you're the one doing the surgery, I would get that plenty of times. Yeah, so there'd be that or I'd hear, and you think in these day and age or even 10 years ago or 15 years ago, Erin Sheffield: The student going to come in, yeah. Adrienne Towsen: people are gonna like Google you, people are gonna know, like see a picture or something. mean, truthfully, my name could be a guy's name too, although it's spelled differently. There are male Adriens, but anyway, like people would come in, I'd hear my MA like putting them in the room and she'd be like, okay, she'll be in, you know, in a few minutes or whatever. And I'd hear him say like, like she, I'm seeing a woman, like, you know, and I'd be like, how did you not know? Like, did you not see my picture on the website when you went to check, but maybe not, I guess not. So there's still that, or I'd be... Sarah Harding: Right. Adrienne Towsen: This was earlier in my career, I think, like rounding on the weekends or something, you know, go in, see a patient that one of my partners had done a knee replacement or whatever. And I'm like, are you Dr. Simmons nurse? And I was like, no, I'm Dr. Simmons partner. But anyway, so there was certainly, you know, a good bit of that sprinkled through, you know, with patients over the years. And then there'd be the patients who were like beyond thrilled to find a female orthopedic surgeon, you know. Sarah Harding: Mm-hmm. Adrienne Towsen: And certainly the high school college girls for sure often felt more comfortable. But a lot of times it'd be an older guy who was know, just happy to have a woman or some women patients who are like, always want women doctors or whatever and find it hard to find a female orthopedic surgeon. So there's a lot of grateful people who'd be like, you know, I'm so happy to be able to see a woman doctor. So, yeah. Erin Sheffield: Yeah. Sarah Harding: Yeah. I see that. And so then in your space now, it's just really nice. Cause we often find that people come and they introduce themselves by saying they hate the dentist. Right? You know, and you know, so we all have our own little quips about that. and I remember going with my sister to a med spa and she had a little Melia or something on her face, and the gal took a needle and Adrienne Towsen: Mm-hmm. Yeah. Yeah. Sarah Harding: you know, went and just like opened it up and and my sister was so grateful to be there and I'm like, This is insane. Like people hate to come see me. They're scared of the needle, but here we are at this place because it's aesthetically pleasing. And you know, they're happy to have needles in their face. Adrienne Towsen: Yeah. Erin Sheffield: We so grateful to get poked in the face with a needle. You know, acupuncture, they like let you poke them with hundreds of needles and pay cash. Adrienne Towsen: Yeah, yeah, for sure. Yeah, it certainly is something that is truly preventable if you start at the right time. so much of what happens with our bone metabolism over the years is due to loss of estrogen and a little bit testosterone as well. I think estrogen really is the only, let's say, Sarah Harding: Right, right, yeah. So osteoporosis. Adrienne Towsen: medication, if you will, that's shown to be able to prevent transition also from osteopenia to osteoporosis. So I think it's so important as soon as women start, whether they're noticing symptoms or not, but certainly if they're noticing symptoms in their even late 30s or early 40s in perimenopause to consider menopausal hormone therapy to some degree, because that loss of estrogen will certainly catch up with you. that, course, in addition to strength training, weight bearing exercise, all the things that you hear about are excellent to do. But the estrogen loss is really one of the biggest pieces of the puzzle right there. So I think it's huge. And even me personally, I mentioned, I'm 55. I went through menopause probably three years ago, technically. And I didn't start any hormone therapy until just about a year ago. And it's because I just didn't, number one, didn't really have symptoms very much in perimenopathy. I had significant symptoms when I actually hit menopause and then was just working a ton. Private equity came in, it was all happening. was like the perfect storm right around that time. And I just put everything on the back burner and I knew I was super stressed out too. And then I had some of the classic symptoms and I put on weight and all these things. I was just like, don't have time to deal with it. I'm just going to just push forward. And then when I left, I not only did this whole professional reset, but I did my own health and whatnot, reset for myself and, got on hormone therapy and got a trainer and, got back into strength training. Cause I was dancing. I've been dancing for eight years, but, I wasn't really doing much else. And so was like, you know, better in my mind, like, you know, better. And I had done, you know, here and there, but I wasn't doing something routinely. I'm like, this is something you need to prioritize now. And I just. went for it all and I'm a completely different person like a year later and it was even six months later, know, so, but I think that's the biggest, the biggest piece right there is the estrogen piece because then, you know, I look at every woman, nearly every woman that I treated with a hip fracture also came in with a chronic UTI, many with, you know, some degree of dementia. And so all of that, you know, can be, let's say at least an attempt at prevention and certainly, you know, the course can be changed in a big way. If we have women starting hormone therapy in their, let's say 40s, early 40s, as long as there's no true contraindication and for the vast majority of women, there isn't, you know, so. Yeah, of course it's. Erin Sheffield: The study, the women's health study that got it wrong and that scared a whole generation away. It's it's one of the worst public health cases. Adrienne Towsen: Mm-hmm. Yeah. It really is. It really is. there's so, and I see it. Yeah. And I also see, I see women age 60, 65, coming in now to see me and they're like, yeah, my doc told me that I'm too old, which you're not, you know, to start hormone therapy. I mean, yes, you will lose some of that protective benefit the later that you start it, but that doesn't mean that you still can't get some benefit, you know, to stabilize where you are. And then also some of these women are still having some degree of symptoms even too. And so there's a lot of information that's outdated now and whether it was actually wrong. Erin Sheffield: Well, we were so focused on the the breast cancer risk, which has been essentially shown to be negligible. In the meantime, how many hundreds of thousands of women have died from heart disease or osteoporosis? And I don't think I don't think lay people on even me, I'm just starting to kind of realize like osteoporosis, just sound like you got softbones, big whoop. No, it's a killer, right? A huge Adrienne Towsen: Mm-mm. After it's rapture. Mm-hmm. Mm. Absolutely. Erin Sheffield: Huge percentage of people will die shortly after breaking hip. And then a huge percentage of people don't ever get back to the life that they had before. So this is so important for women. You know, I I got a DEXA scan for my body composition, but it didn't say anything about my bones. They usually don't recommend you getting that until you're older. But is there Adrienne Towsen: Yeah. Sarah Harding: Mm-hmm. And then I sorry. Adrienne Towsen: Yeah. Erin Sheffield: a benefit for younger people to get a baseline DEXA just so we kinda know. But it seems like, man, if I'm thirty and I see, ooh, it's not the best, maybe start addressing it. Or is it gonna change so much with hormones that it it's not really helpful to get that information? What do you think? Adrienne Towsen: think absolutely it would be nice to have a baseline somewhere maybe in your late 30s or early 40s. you know, of course, for the most part, probably insurance is not going to cover that. So it ends up being an out of pocket expense for people. And, you know, while I don't think it's absolutely mandatory to do, certainly would be nice to see where you are. And, you know, it may be able to. if there's any concerns there or also look at what your family history is. And of course the family history could be skewed by having females in your family that never had opportunity or exposure to hormone therapy. But nonetheless, I think it is nice to have that baseline. Similarly with labs, but especially with the DEXA. mean, labs during perimenopause can be not so helpful, of course, because there's changes throughout different times of the month and whatnot. Having that baseline to work off of, think, is a smart move. But yeah, I mean, because to your point, I'm sure you know the statistics. They're often publicized and Bondurite does an amazing job of this, but like 70 % of all hip fractures are in females. then 50%, and I saw this, I I lived this every weekend on call and 50 % of those women don't get back to their normal level of independence. you see people in facilities and then you see, of course, staffing stretched thin and whatnot. And then you see people coming back in six months later, breaking the other hip. And it's just a terrible, terrible cycle. And then, again, many of these women have chronic UTIs. many, two thirds of the Alzheimer's patients are women. And again, I lived at so many times of seeing people who, it's so sad when you think about it. And while I thought it was sad at the time, it was kind of like, let me fix the hip and move on to the next one. And I would have, it would always be nice if there was like an attentive family member there, which didn't happen all the time, but it happens sometimes. And then you come in for the post-op visit and be like, well, why did my mom... Erin Sheffield: Yeah. Adrienne Towsen: break her hip and you talk about osteoporosis and they'll be like, okay, well, what can we do about it now? And she's 85 and like, maybe not a lot, know, but then I was also like, well, you need to go back to your regular doc and talk about it. And is that ever going to happen? Probably not, you know, and is anything going to change? Probably not. And is it like, you know, too late, which is really sad to say, but maybe, and then, you know, there's another 30 % of people who won't live, you know, one year past having a hip fracture. And so it's just, yeah, it's so, it's really a devastating injury. And then Sarah Harding: Finn. Adrienne Towsen: And it wasn't uncommon for people to not only have like a hip fracture, but then maybe have like, you know, a vertebral body fracture or a pelvic fracture or a proximal humerus. So I was, shoulder was one of my, you know, main joints to operate on. So I can't tell you how many times there was the combination of a hip fracture and then also a proximal humerus fracture. And then, you know, they can't use a walker the right way. It's just, it's just a horrible, horrible cascade. And that's all fragility fractures. I mean, it's all like, you know, the soft bones. And what does that mean? That means your life is, your life as you knew it is over. Erin Sheffield: Yeah. Sarah Harding: Yeah. Adrienne Towsen: pretty much, you know, and so. Sarah Harding: Yeah. Erin Sheffield: Right. We have a friend who is in her early fifties and she got a scan a couple weeks ago and she was devastated to find out, like, no, I have bad osteoporosis and she's usually pretty fit and stuff, but she's kind of fallen off the wagon. And so how much can you come back from that if you identify that like in the fifties? Like I know doing things like jumping and weight bearing exercise and things like that can help, but is it enough? what do you think for that? Age group. Adrienne Towsen: Yeah, I mean, I think again, I would certainly add the hormone therapy at that age group. I mean, I might add if they haven't already, you know, a true like osteoporosis med, you know, and I've seen that a couple of times. I've had a couple of patients who have told me. just in giving me their history that they, a little bit younger, that they did have a scan with osteoporosis and were able to reverse it back to osteopenia. I mean, I don't think we can rely on estrogen to do that alone at all or do that at all, but I think, yes, exactly, the weight-bearing exercises, but it may be worthwhile, of course, to be on some type of an osteoporosis med at that point, especially the younger that you are. And those are meds that, of course, I didn't use to prescribe and don't now, but I do think that that would be a piece of the puzzle there as well. Erin Sheffield: Sarah's having anxiety attack talking about that now. Sarah Harding: I know, I know, I'm having so much anxiety. Adrienne Towsen: I don't know about that. It fun. It was fun. Sarah Harding: Thank you for thank you for calling me out. I was like, I know. Yes. Yes. And so as oral surgeons, when you say these things, we're like Erin Sheffield: We probably have to go there, right? The bisospenates, the proleas, all of those. Adrienne Towsen: Yeah. Sarah Harding: Because we see the downstream effects. Yeah. Adrienne Towsen: And for two, mean, then there's some atypical fractures that occur with people on bisphosphonates. And I treated one of those femur fractures within the last like six months before I left. so, yeah, so the best possible answer is starts early with your hormone therapy, your strength training, your weight bearing exercise for sure. and that's, so I said, have two daughters, they're only in their twenties, but I'm like, Sarah Harding: Yeah. Adrienne Towsen: You better be ready because your mother's gonna outline everything that you need to do from the time you hit 38 years old or whatever and we're gonna protect you as best we can. Sarah Harding: Yeah. I'm so envious because I've gotten like no guidance at all from you know. I'm like, d what did you do about this? I don't really know. I didn't really have any symptoms. I didn't really do anything. And I'm like, not helpful. Thanks. Erin Sheffield: Yeah. Are we laying down most of our skeletal development, like prevention you know, like is it our teens and twenties that we're really developing that hard skeleton and then we just have to kind of maintain and how do you do that for your daughters? What do you recommend for that? Adrienne Towsen: Well, no, I mean, think in that age, I mean, so yes, like teens and twenties, I mean, that's kind of when you're at your like peak bone mass. And then, you know, we will start to lose a little bit over the years. But then once we hit perimenopause and menopause, you know, then it starts to be an increased percentage year by year. if we're not doing the hormone therapy. So, ahead of that, think, obviously it's like good dietary intake to calcium and vitamin D, that's part of it. And then it is for sure, I think incorporating some strength training and whatnot, even her. So I'm thrilled to see my 25 year old daughter is in the gym and she's doing my 23 year old, not so much, we gotta get her. I corralled into doing a little bit of weightlifting, but my 25-year-old for sure, she enjoys it. And so it's part of her routine already. So I think that's huge. then I do think again, by your late 30s, nobody would exactly know when, unless they start to have, let's say, obvious symptoms from it, when they may truly enter perimenopause, because we're not going to know until you get to that menopause day. What was 10 years before that? What was seven years before that? I think late 30s, early 40s, by sure, for sure like is a good time to be thinking about, know, at least doing some menopausal hormone therapy. And again, you know, the replacement and even they're getting away from the term replacement, right? So it's more menopausal hormone therapy, even in perimenopause because you're just giving low doses back, but you're giving doses that are effective and helpful on the protective side. So that's important. Yeah. Erin Sheffield: Yeah. Well Sarah Harding: Yeah. Erin Sheffield: that's so important. And I think we again, 'cause we are so afraid, and people still are afraid. Doctors still are afraid. And it's so hard. I think the message is getting out there on social media and other things that like hormones are protective for the most part and they're really helpful for so many people. And we don't necessarily have to be afraid of it, but we've been masking with all these other things like here's some calcium supplements and here's Adrienne Towsen: Yeah. Hmm. Yeah. Erin Sheffield: Prolea, bone density drug when we could have been giving hormones and we wouldn't have to worry about your job dying. Adrienne Towsen: here's a sleep aid, here's an antidepressant, here's all these other things when we, yeah, first of all, yeah. And I do, I hear it every day on the phone conversations that I have and whatnot too. I got a 42 year old woman call me the other day and she's like, yeah, I went to my doc and he wanted to give me an antidepressant for the symptoms I was complaining of. And she had already kind of done her research and she was very interested in hormone therapy and then she brought it up and then she was told she was too young. So despite. Sarah Harding: Right. Erin Sheffield: Right. Yeah, yeah. Yeah. Adrienne Towsen: And maybe it's just because obviously I'm in this world now and like all of my feeds are, you know, kind of filled with all this. And I'm like, how do you not know? you know, thinking to my fellow clinicians, like, how do you know? But yeah. Erin Sheffield: couple weeks ago, a specialist and she was asking me about all these things and I said, Well, I wonder if it's perimenopause. And she's like, No, you're too young. And I'm like, I'm almost forty three. And I said, Isn't like the average menopause like fifty and it starts like ten years before, so I'm definitely not. And she was arguing with me, like, No, you're too young. And I'm like, but I'm really not and she's like, You're too young. I'm like, but I'm really not I think Sarah Harding: Yeah. Do I need to show you my rage? I can show you my rage. Erin Sheffield: Can't you tell? My skin is flaky and peely every day now. Isn't that part of it? My dermatologist said it was, you know, so it's frustrating when you have to argue with your doctor and she's younger than me. And I remember giving a lecture at our association meeting on women's perimenopause health. Like here I am as a world surgeon talking about perimenopause and Adrienne Towsen: Yeah, right. Agreed. Erin Sheffield: As I was doing the research, there's so little research in med school. Most people get an hour or less, and that includes women's health specialists. Which is absolutely bonkers. Adrienne Towsen: Yeah. Yeah, right. Exactly. Yeah. Erin Sheffield: But the women taking care of women know nothing about this stuff either. And so I was like I met Mary Claire Haver and I was teasing her, like, I'm one of the gurus like you, 'cause I gave one lecture. So I know more than most of the people in medicine and I'm a dentist. So hey denty, you know, I know more about this. And that's really sad. Like it should be a whole year long course or a whole special and a whole specialty or something. Like we should be devoting something. Adrienne Towsen: Yeah. Yeah. Sarah Harding: Yeah. Erin Sheffield: hours and hours. This is something that most people like fifty-one percent of the world are gonna go through if you survive. And not only is it just like a comfort thing, but it's a health thing. Like it's major health detrimental effects. And we just we don't care. Let's spend billions of dollars on Cialis and Viagra. So frustrating. So Adrienne Towsen: Right, now you're right. Yeah. Yeah. Yeah. Sarah Harding: So where have you seen peptides fit into all of this and how do you incorporate that into your practice? Because I'm all about this. I can't wait to hear about it. Adrienne Towsen: Yeah. Yeah. Yeah. That's amazing. yeah. So I, it really depends. I have like a little bit of like a clinical framework. refer to it like a pyramid. So peptides are certainly at the top of that pyramid, meaning they're like adjuncts, they're tools, but they're, they're great options. As long as people are willing to take them for what they are, meaning I mean, I have my opinion and my slant on it as someone who uses them and prescribes them and finds them to be very helpful, despite the fact that you could have the other side, if you will, that argues, well, for many of them, there's not good human data. There aren't enough clinical trials, blah, blah, blah, which is true. I've been lucky to be involved with a platform called Truth Tides. which is this incredible peptide education platform that is really focused on compiling all of the best literature that's available. So all the top studies that are out there, as well as anything up and coming into a site that's very user friendly for either physicians or patients. So you can like enter their site. either a physician or a patient. And then they have all the compounds, essentially. mean, there's like 30, not all, I who has all, but like 30 of the most commonly used or prescribed compounds and they give them a grading system. So it's graded from like, know, A plus to D through. the evidence that's available for them. So it's a very nice, objective way to look. And they're only discussing the literature that's available, the top studies, nothing questionable. then letting you know, you can enter, you can ask any questions, even like as a patient, get like, what does BP 157 do? So you type that in and it can give you the answer. It'll give you its grade, say. you know, it's super popular, but it gets a C plus because the evidence behind it is all animal based. And that doesn't mean that it's not useful and your evidence informed. but here's what's available. And so do with that what you want. Okay. So again, I find that, you know, they're very helpful in certain situations. I mean, obviously I haven't been doing this for too, too long yet, but I really feel like they are great. in there's a musculoskeletal kind of category. There's sort of different categories that we lump them into. And so, you I know you guys know for anybody listening who doesn't know, like peptides are these little messenger molecules that many of them exist normally in our body and then they just decline with age. So that's kind of this common theme, right? So in the midlife, when we're trying to optimize, we are often trying to give ourselves back. things that we used to make more of and that were important for the different functions and different systems in our bodies. So that's really hormone therapy kind of in a nutshell. Same with many of them. Sarah Harding: Mm-hmm. Adrienne Towsen: The class that people know the most about, of course, would be the weight loss, know, GLP1s or GLP, GIP. So, you know, somaglutide, trisepidide. So I have an arm of that in my practice, you know, so there are certainly people coming in who very often it's in conjunction. It's that midlife woman or guy, you know, who has a weight loss goal because metabolism is changing, insulin sensitivity is changing in large part due to hormone changes. And so with my clinical framework, we're starting at the foundation always and reviewing everybody's lifestyle. So we're always talking nutrition, exercise, strength training, sleep, stress management. that's the first conversation. That's why these conversations take 90 minutes, like every bit of the 90, because like we go through all of this. And even the people that I have that are pretty dialed in that maybe even already have tried some peptides and whatnot before they come in. A lot of times we can still tweak something there, you know, and find Sarah Harding: Right. Adrienne Towsen: know, ways to improve something on the foundational layer. And, so we always start there. And so once again, like somebody who just comes in, they're like, I just want, you know, a prescription for Tessa Morland or whatever. like, okay, well, hold up a little bit. Let's like, let's start from the beginning and figure it out, you know, and see if that really makes sense. Okay. So foundations. And then I think next is the hormone piece. Okay. So, I mean, I've had some guys come in who either Sarah Harding: Yeah. Mm-hmm. Adrienne Towsen: have a bias against testosterone replacement for some reason, or they've had a buddy that had a bad experience or whatever it might be. And so they have a lot of symptoms that could be explained by low testosterone, but that wasn't their first goal. They're coming in and they're like, I want BPC 157, I want TB 500, want test some oil, I need to get better in the gym, I need my body composition. So they're all. you know, also coming in with often a good amount of knowledge, sometimes correct, sometimes incorrect, sometimes more like influencer type knowledge, right? So it's kind of like, you know, have to sift through that and figure out what they know get that from them and regroup, okay? So we look at the hormone piece though, first for men and women. And I think that's the next thing that you really do have to balance that because chances are many of the symptoms could be improved on that level. Okay. And so then if we know that that's like pretty good, or if for some reason they really just don't want to do that, like, okay, fine. But then we get to that next level. And so whether that's a GLP-1 type thing, because weight loss is part of their goal. Of course, those get an A plus on truth ties because they have absolutely... full on randomized clinical trials behind them, plenty of evidence that supports it in human studies. But then we talk about some of the others and we talk about recovery and tissue repair categories. For me, again, as an orthopedic surgeon, the musculoskeletal complaints that people have, will expand upon more. We certainly have in menopause or in guys who are going through, let's say, andropause or in that midlife where they're having. A lot of minor injuries at the gym or dealing with like more tendonitis or muscle issues or little injuries that seem to pop up all the time. We have a pretty, significant discussion about the option of BPC 157, TB 500. There's some other blends, some other peptides that can sometimes be in blends with these two. A common one is GHK copper. So, you know, which is a little bit more of like the beauty peptide or the aesthetic peptide, you so we have that because it really works on collagen and connective tissue and, you know, can be helpful with skin, hair, nails, like that type of thing. So we really try to just zero in on their exact goals. And I'm not one who wants to also like give people a bunch of things at once. It's, you know, a stepwise thing. So we find what they're, if the foundation is good, the hormone level is, the layer is good, we get there. It's like, okay, what's your top goal here? And if I have the questionnaire, like what are your top three goals? And if the top goal is better performance at the gym or improved body composition or longevity, like sometimes that's the goal, right? Like healthy aging. So then you decide maybe if they wanna dive into peptides, what's gonna be the most appropriate category? And then the question is kind of just choosing something, starting with it. There's various protocols. mean, with the GLP ones, there's very specific, dosing guidelines and whatnot, very easy to follow. With some of the others, not as much. mean, there are some protocols out there, some ways to start with dosing. I tend to be very conservative. The peptides I use the most presently are BPC157, TB500, sometimes together in a blend with the copper peptide. I've used a little bit of the growth hormone, secretagogues, not that much, but that's also, that's another category for people that are, so. I consider the BPC 157 TB 500, that's certainly more the musculoskeletal. It's good for the GI tract as well, but more for, you know, tissue repair, tissue recovery, the minor injuries, recovery from, workouts and things like that. Then we have the growth hormone secretagogues, which, you know, can help some in tissue repair as well, of course, but that's a little bit more body composition reduction in visceral fat. improved sleep, and so secondary benefits could be a little bit of cognitive clarity, executive function, things like that. So that's kind of another common category. It's testimoralin, simoralin, ipimoralin. Then we have, you can kind of venture off into other categories and there's like the longevity or let's say the healthy aging. And that's where we often talk about NAD+. which technically is not a peptide, but is often grouped in with this discussion for cellular turnover, DNA repair, energy, and that's been a very commonly requested one as well. So those are the ones that I've kind of used most commonly thus far. And then there's others, of course, out there. There's lots of others and who knows what's gonna be. There's MOTC for cognition, CMAX and CellLink. And there's a bunch of different ones that I've sort of dabbled in. But I think the bottom line with peptides is they are a top of the line tool, if you will. And with them, there's a certain amount of evidence available. And people need to be informed of that and understand that long-term studies and long-term human data doesn't exist for most of them. Yet that doesn't mean that they're unsafe to use. just means you have understand that. the dosing, tend to be very conservative. Like I was mentioning, some of them have protocols and things you can follow. And some of the longevity docs that have been doing this a lot longer than me have things that they've published in different protocols out there. And some of them are just cycled or just used for eight to 10 weeks at a time or eight to 12 weeks at a time. So a lot of them aren't necessarily long term use or you go on it for a while, then maybe go off it for a bit then back on it. I mean, we could talk about this for hours. I'm sorry, I'm like, Sarah Harding: I know. I love it. Erin Sheffield: You guys can't I'm all I'm like what are you even talking? Like thousands. Adrienne Towsen: So I personally, Sarah Harding: Like all in. Adrienne Towsen: yeah, I take a blend called Klo, K-L-O-W, which is BPC 157, TB 500, GHK copper, and KPV. KPV I think gets a D on the grading scale, and that's fine. But it's put together in this blend. And so I actually have had two surgeries on one knee. I have a fairly arthritic knee, which sometimes with my dancing is a little bit of an issue. who doesn't want the copper peptide? I was like, you know, again, I'm 55. I actually do a face cream that has the GHK and Estriol in it too, which is pretty cool. So anyway, but it's been very, very helpful for me. And, you know, I'm very much into like, I practice what I preach and, you know, I'm on hormone therapy, of course, as well. So I think that's also very helpful for patients. You know, they feel a little bit more reassured to be like, look, this is what I'm on presently. Sarah Harding: yeah. Adrienne Towsen: probably gonna try some NAD too. I haven't done it yet, but that's something I wanna do as well. And I think as long as you present it appropriately, discuss it appropriately, again, I'm involved in this education platform and we're actually developing a CME course for physicians too. So I think that'll be super helpful. I mean, there's of course others out there and whatnot, it would be, I don't know, it's just like kind of a developing that clinical framework for yourself, I think is so key, but. I'm definitely pro-peptide. think that, you know, there's a lot of benefit there. Yeah. Sarah Harding: I agree. I agree. I'm a little bit anxious about the FDA approval because I always just feel like I think that's a good thing. But then I also feel like then it again puts it behind a paywall that makes it inaccessible. And so just like hormone replacement therapy or, you know, menopausal hormonal therapy, I think it's just one of those things where there has to be a better access to care and a better education system. Adrienne Towsen: Right, right, yeah. So it's coming, I think, I hope, and it's fun to be and exciting to be kind of part of it just with this particular platform. So I'm very excited to see what we can all do together moving forward. Erin Sheffield: Can we make sure you add this one thing to your protocols for all of your patients that I bet you're not doing? Do you know what I'm gonna say, Sarah? Do you wanna say it? You wanna tell her? No. Will you add to all of your protocols that they need to be flossing every day? Adrienne Towsen: Hmm. Sarah Harding: Yes. No, you do it. Adrienne Towsen: yeah, absolutely I will. Yeah. Erin Sheffield: Because inflammation is a huge thing and we're spending like hundreds of dollars a month on peptides and we're doing the cold plunges and we're doing all of the things. And yet this is like the cheapest, like pennies a day, takes like one minute a day, and no one's doing it. Like ninety percent of adults have gingivitis, which is inflammation of their gums. And we are learning more and more that that actually has some health impacts, you know, cardiovascular disease. Adrienne Towsen: Yeah. Sarah Harding: Yeah. Adrienne Towsen: Yeah, sure. Sarah Harding: Huge, yeah. Adrienne Towsen: I will. I would do that. Erin Sheffield: Baby Al Alzheimer's risk, all these things. It's so important. It's such a easy, simple biohack. It's like the ultimate biohack and everyone's missing. Sarah Harding: Right. And it's so easy. Yeah. And it's insane because you just recognize that because our mouths are so connected, they're connected to our GI tract, our faces are so vascular, our mouths are so vascular. And when you have this just sort of subacute, subclinical inflammation always, and then you go and brush your teeth, or you bite into an apple, or you bite into a steak or a piece of bread, you're introducing all of that into your bloodstream. And every day you're just swallowing. Right. And so you're expecting your body to be optimized when you can't you can't. Adrienne Towsen: Yeah, yeah, yeah. So yes, yes ma'am, I sure will, because you're right. I mean, I don't talk about it now, but we'll add that in there. Erin Sheffield: Yeah, that should be on every post up paperwork. Adrienne Towsen: Yeah. Yeah. Sarah Harding: Yeah. Erin Sheffield: You can call you can thank us. You can call like the Sheffield Harding protocol thing. Adrienne Towsen: you Sarah Harding: Yeah. Adrienne Towsen: All right, we'll do Sarah Harding: Yeah. The resting stitch face pro protocol. Yeah, it's good. Yeah. Is there anything else that you wanted that you wanted to share with our audience? I think they're gonna find this incredibly helpful and enlightening. And I love all of your story. Like it's just empowering and and really cool. And I know that it was hard. So we appreciate you going through it and showing us that it can be possible. Adrienne Towsen: I love it. Erin Sheffield: We can put that. Yeah, exactly. Adrienne Towsen: Thank you. Yeah. I mean, I think that's just the biggest thing, I think that it's never too late, to do something new, to reinvent yourself, whether that's professionally, whether it's personally. mean, again, I took up ballroom dancing at 46, which everybody always assumes I was dancing since I was a kid and I wasn't. So I think I've done it a couple of times over now. And I just think that, it's something that could be a little bit scary or challenging, but. the reward is huge. So it's really never too late and midlife is such an amazing time. Cause I think you have a good bit of experience and wisdom and I'm really enjoying after a pretty shitty year. You know, this it's so much better now. And, I could have never imagined, and it's just like forge ahead, take some, take some risks, do some things you didn't think you were going to do and see how it goes. You know, it's likely to work out pretty well. Yeah. Yeah. Sarah Harding: Love it. Well, how can people find you if they're looking for you? Adrienne Towsen: Yeah, sure. So I'm active on, most active on LinkedIn. So it's just my name is my profile on LinkedIn, but my clinic or my name, just Adrienne Towson MD, I'm on all the other platforms now. you know, content creation has become huge. So even though I'm on TikTok, Instagram, Facebook, so you can find me by my name on any of those. And then the Towson Clinic is my clinic and it's just the website is towsonclinic.com. Sarah Harding: Awesome. Well, thank you so much. This has been really wonderful chatting with you. And I'm just so glad that we got connected. Just so cool. Yeah, for sure. All right. Well, thank you again. Adrienne Towsen: Yeah. Yeah, me too. Thanks so much for having me. Erin Sheffield: Yeah, thanks for joining us for another episode of the Resting Stitch Face podcast. As always, please like, share, and follow. Until next time. Sarah Harding: Bye.