Latest / The Body Pod / Should We Be Taking Estrogen, Progesterone, AND Testosterone with Dr. Heather Hirsch

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Should We Be Taking Estrogen, Progesterone, AND Testosterone with Dr. Heather Hirsch · The Body Pod

0:00
Speaker 1: Hey everyone, This is Haley and I'm Lara, and welcome
0:03
Speaker 1: to the Body Pod. Doctor Heather Hirsh. We are thrilled
0:14
Speaker 1: to have you on. I have been counting down for
0:18
Speaker 1: this podcast and I literally have just been perusing everything
0:22
Speaker 1: that you've ever written and your menopause course, the Thrive Method.
0:27
Speaker 1: I mean, I have been just diving deep into all
0:31
Speaker 1: of it. And I have to say I was just
0:34
Speaker 1: at a conference last weekend with Kelly Casperson, who's my favorite,
0:39
Speaker 1: and you know vonder Wright and everyone there was just amazing.
0:44
Speaker 1: But Kelly was like, she got asked a bunch of
0:47
Speaker 1: times people are like, well, what about you know, a
0:49
Speaker 1: menopause course, and she was like, Heather, Heather, Heather, so incredible.
0:54
Speaker 1: I'm buying it right now and getting in there. So
0:58
Speaker 1: thank you for being on.
1:00
Speaker 2: Oh I am so so excited. This is my favorite topic.
1:05
Speaker 2: And let yeah, let's get into all the things.
1:09
Speaker 1: Yes, okay, So all right, let's talk first of all
1:15
Speaker 1: about your Menopause Masterclass and why you I mean, because
1:20
Speaker 1: it's available to any female. This isn't just like for
1:23
Speaker 1: trainers and coaches, and I love that because I feel
1:27
Speaker 1: like there's so much information that clients ask me, and
1:30
Speaker 1: I'm like, I don't know, I'm not quite year. I mean,
1:33
Speaker 1: I'm definitely perimenopausal, but you know, it was just a
1:37
Speaker 1: wealth of information. So tell us about how you came
1:42
Speaker 1: up with this course and what reclaiming metopause is.
1:47
Speaker 2: Yes, okay, I I was just telling my last patient
1:53
Speaker 2: that I saw that I love teaching so much and
1:55
Speaker 2: for so many years, you know, especially when I worked
1:58
Speaker 2: at Harvard, I really felt like they really wanted me
2:01
Speaker 2: to become a researcher. And I tried, and I tried,
2:04
Speaker 2: and I tried, you know, to fit in and to
2:06
Speaker 2: fit the mold. But I loved teaching. I was just
2:10
Speaker 2: such a natural at it and I really really loved it,
2:14
Speaker 2: and so I really started to lean into it. And
2:17
Speaker 2: so during the pandemic, I started you know, youtubing, podcasting,
2:21
Speaker 2: making tiktoks, and that turned into just so many women
2:25
Speaker 2: from all across the country asking me all these questions
2:29
Speaker 2: that I just felt like every woman should know what
2:32
Speaker 2: their body is going through in the perimenopause to menopause transition.
2:37
Speaker 2: So from there, I came up with the concept of
2:39
Speaker 2: just making a course. I even went and took a
2:42
Speaker 2: really fancy course on how to make a course which
2:45
Speaker 2: actually was really really helpful. And so the Reclaiming Menopause
2:50
Speaker 2: Masterclass really was a way to get help with your
2:54
Speaker 2: own clinician. This was back when I worked at the
2:57
Speaker 2: Brigham and Women's Hospital in Boston, because I wanted all
3:00
Speaker 2: women to have access to this knowledge, and I knew
3:03
Speaker 2: that their clinicians also needed this knowledge. So then I
3:07
Speaker 2: went on to make a course for clinicians as well.
3:09
Speaker 2: And you know, I hope that I can in some
3:13
Speaker 2: way shape or form help women who maybe even never
3:15
Speaker 2: see me as their clinician per se, but get them
3:19
Speaker 2: to where they need to go with all that I've
3:22
Speaker 2: learned along the way.
3:24
Speaker 1: Yes, I love it. So the Thrive method, let's break
3:29
Speaker 1: that down because again, all of these questions about when
3:33
Speaker 1: to take hormones, what hormones to take, I feel like
3:39
Speaker 1: everyone kind of gets into progesterone and estrogen, but then
3:43
Speaker 1: testosterone is kind of like, you know, the little sister
3:47
Speaker 1: that doesn't get invited to the party A lot of
3:49
Speaker 1: the times, like change those and when would we apply
3:54
Speaker 1: any and all of them?
3:57
Speaker 2: Oh my goodness, yes, Well, so the Thrive it really
4:00
Speaker 2: was my way of thinking through like what I really
4:03
Speaker 2: do with my patient. So TA stands for tracking, and
4:06
Speaker 2: that really helps us even know where to get started.
4:09
Speaker 2: Like we may know that there's these three sex hormones estrogen, progesterone, testosterone,
4:14
Speaker 2: and they decline, so we're like, okay, we need to
4:17
Speaker 2: replace them, well in what order and what route and
4:20
Speaker 2: what formulation? You know which one does what, and so
4:23
Speaker 2: you got to start with the basics. Was is just
4:25
Speaker 2: tracking because what STO might bother Laura may not bother
4:28
Speaker 2: like her best friend, and so it could be that
4:31
Speaker 2: you're feeling hot and dry, it could feel like a
4:34
Speaker 2: brain fog, could feel as though you're gaining weight, or
4:37
Speaker 2: your libidos dropping, and tracking the base on if you
4:41
Speaker 2: still are in perimenopause, your cycles, and if your menopause,
4:44
Speaker 2: if there are certain you know, times of day that
4:46
Speaker 2: things are worse for certain foods that trigger it. So
4:49
Speaker 2: it's tracking. The age stands for health history. So then
4:53
Speaker 2: what are you a good candidate for? You know, is
4:54
Speaker 2: there anything that's contraindicated for you? Our stands for research,
4:59
Speaker 2: And this is where we dig into, like specifically in
5:01
Speaker 2: my course, how safe hormone therapy is. And you got
5:05
Speaker 2: to remember I made this course I think in twenty
5:07
Speaker 2: eighteen or twenty nineteen, and that is like five years
5:11
Speaker 2: ago at this point, which seems like yesterday on one hand,
5:15
Speaker 2: and now there's a plethora of data really on this
5:17
Speaker 2: safety of hormone therapy. Oh it's still really confusing. So
5:20
Speaker 2: we really want to go through the research so that
5:24
Speaker 2: we feel confident. Because my thing is is that as
5:27
Speaker 2: a woman or as a patient myself, if I don't
5:30
Speaker 2: feel confident in my treatment, someone just says like, yeah, yeah,
5:33
Speaker 2: it's safe. Yeah, yeah, that's what you need, I don't
5:36
Speaker 2: feel like that's enough. So I want to make sure
5:38
Speaker 2: everyone really knows their research, and then I will stay
5:42
Speaker 2: on the eye. This is investigating, and investigating is really
5:45
Speaker 2: where we say, Okay, maybe your symptoms are more low progesterone,
5:48
Speaker 2: so let's trial progesterone. Let's investigate that. Maybe it's really
5:52
Speaker 2: low testosterone. You're very athletic, you've been athletic your entire life.
5:56
Speaker 2: You're used to a slightly higher testosterone. Maybe we investigate
5:59
Speaker 2: the test ostroone. And then I kind of have this
6:01
Speaker 2: hormone stacking method because I like to do one thing
6:04
Speaker 2: at a time. I can tell you I've seen so
6:07
Speaker 2: many women, they come to me an estrogen progester in
6:09
Speaker 2: to stoson and they're still having cycles and they're like,
6:11
Speaker 2: I don't know what's doing what And I'm like, totally
6:13
Speaker 2: fair and totally fine. We're going to start from scratch
6:15
Speaker 2: so that you know what each one's doing. So that
6:18
Speaker 2: gets us up to the thr I where we really investigate,
6:22
Speaker 2: because I think while I went on a little bit
6:24
Speaker 2: of a long winded answer the question of like how
6:27
Speaker 2: do I even know where to start or what hormone
6:29
Speaker 2: to start with? Really taking it back to tracking, what
6:33
Speaker 2: are you a good candidate for feeling really confident about
6:36
Speaker 2: it and then investigating like probably one hormone at a
6:39
Speaker 2: time based on your most problematic symptom.
6:42
Speaker 3: So I have a question about how do people know
6:47
Speaker 3: if they are in perimenopause? What test do you recommend
6:52
Speaker 3: if someone comes to you, I don't know?
6:55
Speaker 2: Am I?
6:55
Speaker 3: Am? I not?
6:56
Speaker 1: What do you do?
6:58
Speaker 2: Well? You know, I'm laughing because the answer is like
7:01
Speaker 2: you're gonna hate the answer, and so well, listeners, It's like,
7:05
Speaker 2: if you're asking, you're probably in perimenopause. Or you have
7:08
Speaker 2: a joke like if you watch Save by the Bell,
7:11
Speaker 2: you're probably in perimenopause. You so there is no great test,
7:18
Speaker 2: and that's like the speaking point because for diabetes, we
7:22
Speaker 2: know it's an a one C or elevated glucose level.
7:27
Speaker 2: For blood pressure, we know it's like greater than one
7:31
Speaker 2: forty over ninety. Whereas perimenopause, there's no one number or
7:37
Speaker 2: test that rules it in or rules it out. I
7:41
Speaker 2: hear so commonly my doctor said my labs were normal,
7:44
Speaker 2: and I'm too young, so everything must be fine. If
7:48
Speaker 2: you've heard that and you don't think it in yourself,
7:50
Speaker 2: you're probably in perimenopause. So the real answer is it's
7:55
Speaker 2: really a clinical diagnosis, which means the clinician actually makes
7:58
Speaker 2: the call base on you're good tracking, if you've been
8:02
Speaker 2: tracking irregular periods, if you're tracking symptoms of low estrogen,
8:07
Speaker 2: which is typically more hot and dry, hot flashes, night sweats,
8:10
Speaker 2: dry skin, low mood, and then low progesterone, which could
8:15
Speaker 2: be spotting in between periods, heavier periods, anxiety, insomnia. Those
8:21
Speaker 2: are the kind of things that a clinician is like, Okay,
8:24
Speaker 2: this is perimenopause. There's just not enough of us and
8:29
Speaker 2: so so many women that the frustration continues because they're like,
8:33
Speaker 2: I checked my lab. My doctor says, cappy, that you know,
8:37
Speaker 2: and I you know, so so I know. It's not
8:41
Speaker 2: the most satisfying answer. There are some labs that you know,
8:45
Speaker 2: I do sometimes check, but we track them over time
8:50
Speaker 2: and then we put them in contact. So there is
8:52
Speaker 2: no lab that's like, yes, you're in perimenopause. It's more
8:55
Speaker 2: of a what is the context in which this is
8:57
Speaker 2: all happening over a persistent period of.
8:59
Speaker 3: Time and being body aware, like you said, tracking and
9:04
Speaker 3: knowing that you are having brain fog or you are
9:07
Speaker 3: having hair loss or different issues.
9:11
Speaker 2: Yeah, exactly. So tracking is like where I always take
9:14
Speaker 2: it back to, like if there's one actionable item, it's
9:19
Speaker 2: really starting with just tracking because that gives you so
9:23
Speaker 2: much knowledge. It also is a great starting point when
9:26
Speaker 2: you go to your own clinician to say, all right,
9:29
Speaker 2: the last six months, you pull it out and you know,
9:31
Speaker 2: you're like, I've noticed hot flashes before my period, my
9:34
Speaker 2: peers are only lasting two days, my hair is falling
9:37
Speaker 2: out and drove literally here's pieces of mine. I'm having
9:42
Speaker 2: low libido and vaginal dryness. I've tried this, this, this
9:45
Speaker 2: and this, and then the doctor's like Okay, okayt gaslight you.
9:48
Speaker 2: There's nothing else I can say. You got all the
9:51
Speaker 2: information right at your fingertips.
9:54
Speaker 1: Yeah, okay. So if we start on if we're in perimenopause,
10:01
Speaker 1: which I think, well Laura and myself both are because we're.
10:05
Speaker 3: The same and we watched Save by the Bell, so.
10:08
Speaker 2: We know who Dipney empathesim is you do.
10:13
Speaker 1: So if like, do you ever start women on hormones
10:18
Speaker 1: before they're completely menopausal?
10:24
Speaker 3: Oh?
10:24
Speaker 2: Every single day, every single day, every single day, every
10:32
Speaker 2: single day. And this is such a myth. I'd love
10:35
Speaker 2: to dig into this, like in terms of what you hear,
10:39
Speaker 2: but hormone therapy is something that can be used in
10:43
Speaker 2: perimenopause and is often extraordinarily effective. So when I was
10:49
Speaker 2: talking about the you know that Thrive method, the I
10:51
Speaker 2: where we kind of got stuck. I think there's a
10:54
Speaker 2: V in an e, which stands for victory, and then uh,
10:58
Speaker 2: you know, he is basically just how to use hormone
11:02
Speaker 2: therapy longer term. But if we say it that I
11:05
Speaker 2: a lot of women, what I do with them as
11:08
Speaker 2: their clinicians help them investigate if they're in perimenopause, the
11:11
Speaker 2: use of postmenopausal hormones in perimenopause to see how that
11:15
Speaker 2: really changes or alleviates their big symptoms. So I do
11:19
Speaker 2: it every day. And this myth that you have to
11:22
Speaker 2: be one year of no periods before you can start
11:25
Speaker 2: hormone therapy is something that's very pervasive. I actually don't
11:30
Speaker 2: know where it came from. And this is probably based
11:32
Speaker 2: on my training because I, like, you know, never went
11:37
Speaker 2: to med school saying I was going to be a
11:38
Speaker 2: menopause actor. I did a two year fellowship training in
11:41
Speaker 2: midlife and Menopause in twenty fourteen at the Cleveland Clinic,
11:44
Speaker 2: and so I always just learned to prescribe HRT in perimenopause. So,
11:49
Speaker 2: you know, as more women were speaking out on social media,
11:53
Speaker 2: I learned that this myth is out there that they're
11:56
Speaker 2: they hear we can't do hormone therapy until you're in menopause.
12:00
Speaker 1: M well, we got to get rid of that. That
12:02
Speaker 1: uh totally rumor.
12:04
Speaker 2: I guess.
12:05
Speaker 1: So when do we add in because again, testosterone, how
12:09
Speaker 1: many what percentage would you say of women need testosterone
12:14
Speaker 1: or that you prescribe because it's it's not as you know,
12:18
Speaker 1: everyone kind of does if they're doing hormones they get
12:20
Speaker 1: the estrogen progesterone, But why isn't testosterone. I know it's
12:25
Speaker 1: harder to get and that's its whole separate issue, but
12:28
Speaker 1: what what what percentage? Would you say?
12:34
Speaker 2: So this is a fantastic question. And as doctor Casperson
12:39
Speaker 2: coins in a class that she's now teaching, is that
12:43
Speaker 2: we kind of call testosterone a data free zone, where like, gosh,
12:47
Speaker 2: like how many women need it? I don't know the answer,
12:49
Speaker 2: but I'll start with in my practice. So I founded
12:56
Speaker 2: the haw the hershem D Collaborative, which is a telemedicine practice,
12:59
Speaker 2: and almost all fifty states, I have amazing clinicians that
13:03
Speaker 2: work with me. Yeah, they're just amazing. And because I
13:09
Speaker 2: couldn't see everyone, and it's just been wonderful to expand.
13:12
Speaker 2: So there's so many amazing clinicians available in again, almost everything,
13:16
Speaker 2: we're missing like three and we're trying to get there.
13:20
Speaker 2: But about a third, maybe I would say on any
13:24
Speaker 2: given day, about a third if my patients are on testosterone.
13:27
Speaker 2: So it's not everybody, but it's certainly not so few
13:31
Speaker 2: and far between that I'm counting them on my fingers.
13:35
Speaker 2: A lot of women will trial testosterone and see if
13:39
Speaker 2: they get benefits. Some women find that they're great when
13:42
Speaker 2: we just start estrogen progester and they're like, hey, Heather,
13:44
Speaker 2: I feel perfect. I don't want to add anything else.
13:46
Speaker 2: I don't need anything else. A lot of women will
13:50
Speaker 2: find their testosterones low, and they may have in the
13:54
Speaker 2: most common or the boat the most well studied indication,
13:58
Speaker 2: which is low desire. But they may also find that
14:01
Speaker 2: it gives them some other benefits like energy or cognition.
14:06
Speaker 2: We don't know, and we think that it might also
14:08
Speaker 2: help bone. So there's a lot we don't know in
14:10
Speaker 2: this data free zone. So I think the majority of women,
14:13
Speaker 2: if anything, could trial testosterone to see if it helps.
14:19
Speaker 2: Not all women stay on it for the long term,
14:22
Speaker 2: but I would say at any given time about a
14:24
Speaker 2: third of my patients are on it, which gives you
14:25
Speaker 2: a good sense of like, how many women really do
14:28
Speaker 2: feel the benefits of testosterone. It's a conversation totally ripe
14:34
Speaker 2: for just a lot more discussion, because of course, if
14:37
Speaker 2: we hear testosterone, we think, isn't that a guy thing?
14:39
Speaker 2: Isn't that a male thing? No? Absolutely not. Women make
14:43
Speaker 2: testosterone and it's really an important hormone, you know, do
14:48
Speaker 2: we have data on what exactly does and the female body.
14:51
Speaker 2: Of course not why would we have that right, but
14:55
Speaker 2: as we are using it in clinical practice a lot
14:58
Speaker 2: of us who are clinicians, the researchers, you know, I
15:01
Speaker 2: tried that. Nope, I'm a teacher and a clinician. First,
15:04
Speaker 2: we see our patients often get a lot of benefit.
15:07
Speaker 2: And you know, again as a clinician, we want to
15:08
Speaker 2: make sure your levels are still safe. We're not putting
15:11
Speaker 2: you any long term risks. You're not going to lose
15:13
Speaker 2: your hair or grow a mustache, et cetera. I should
15:16
Speaker 2: end this by saying there's a small percent of women
15:18
Speaker 2: where testosterone can actually go up, and this is because
15:21
Speaker 2: it can be a stress response. The body is like
15:23
Speaker 2: where's the aesterrod and where's the asterrod? And where's the estrogen?
15:26
Speaker 2: And me Adrina Glance will start making cortisol and sometimes testosterone.
15:30
Speaker 2: So if you ever, you know, are like why am
15:32
Speaker 2: I getting a chin hairs or a mustache?
15:35
Speaker 4: Like what is this?
15:36
Speaker 2: It could actually be a stress response and you could
15:38
Speaker 2: actually be making testosterone. And so there are some women
15:41
Speaker 2: where actually we want to lower your testosterone.
15:46
Speaker 3: And you I read and listen to one of your
15:49
Speaker 3: podcasts on testosterone, and I feel like it's great advice
15:55
Speaker 3: that people don't advise. Usually doctors don't advise you the
16:00
Speaker 3: pellet because it's hard to dose it correctly. So do
16:06
Speaker 3: you usually just prescribe the cream? And do you ever
16:10
Speaker 3: do an injection for someone who doesn't want to do
16:12
Speaker 3: a cream, like they'd give it themselves a shot once
16:15
Speaker 3: a week or something.
16:18
Speaker 2: Yes, I actually do both. The majority of my patients
16:21
Speaker 2: do use what we do and actually what the Menopause
16:27
Speaker 2: Society recommends and what the there was in twenty nineteen
16:32
Speaker 2: a position statement from both the Menopause Society the Endocrine's
16:38
Speaker 2: Society on Testosteronews and Women, and the recommendation was transdermal
16:44
Speaker 2: as first line. That way, it's really easy to control
16:48
Speaker 2: those levels because if you're putting a cream on every day.
16:51
Speaker 2: My patient, her levels were just kind of creeping up
16:54
Speaker 2: and she was like, I'm getting some pimples. Doctor hers
16:56
Speaker 2: I said, I go to every other day. That's easy
16:59
Speaker 2: to then drop those levels with pellets, which last for
17:03
Speaker 2: about three months. And they're very very popular, and I
17:06
Speaker 2: understand why they're popular. One you feel amazing, but like
17:10
Speaker 2: it's too good to be true. There's probably a reason,
17:15
Speaker 2: and for a lot of women you cannot adjust it,
17:19
Speaker 2: which is like as a as a hormone doctor, that's
17:21
Speaker 2: like my worst fear is someone calling me and saying, Heather,
17:24
Speaker 2: I'm having all this breast tenderness or my hair is
17:27
Speaker 2: falling out, or I'm getting pimpled and not being able
17:29
Speaker 2: to just saying like, well give it a few months,
17:31
Speaker 2: like they're going to breach through the phone and you know.
17:34
Speaker 2: So that's really the problem is they're so hard to adjust,
17:37
Speaker 2: and some women metabolize and slow. Some women metabolize them fast.
17:41
Speaker 2: So you could put a long a very long lasting medication,
17:45
Speaker 2: like a three month injection. You don't know what you
17:48
Speaker 2: are literally experimenting with your body. It's crazy. Now this
17:52
Speaker 2: is different. There are actually weekly injections of testosterone that
17:58
Speaker 2: can be done. And again these are all menus. So
18:00
Speaker 2: men have more solutions available to them than we do.
18:04
Speaker 2: We just dilute them. So even with you, I do
18:07
Speaker 2: have a handful of patients on the injections. They just
18:09
Speaker 2: found that the cream didn't do anything either. They would
18:12
Speaker 2: pour absorbers through the skin and they didn't get any benefits.
18:16
Speaker 2: So then we'll go to the injection. Usually we're doing
18:19
Speaker 2: one a week because again, the longer you go, the
18:22
Speaker 2: more variation and loss of control you have over the dose.
18:26
Speaker 2: So you don't want to go like, let's do a
18:28
Speaker 2: high dose and make it last a month. That would
18:30
Speaker 2: give me anxiety. So we usually do a low injection
18:33
Speaker 2: about the tenth or an eighth of a male dose
18:37
Speaker 2: every week. And that's another way that could be done.
18:41
Speaker 2: That's great.
18:43
Speaker 1: If we move on to like vaginal topical estrogen, Yeah,
18:50
Speaker 1: how does like how many women? Because I feel like
18:53
Speaker 1: it's a no brainer, like just go ahead and use it,
18:56
Speaker 1: you know, as Kela Casperson says, it's skincare for the
18:59
Speaker 1: fit for skin I don't care for down there.
19:01
Speaker 2: Yeah, So do you feel like you're.
19:03
Speaker 1: Always recommending that? Oh yes, relation with any of the
19:09
Speaker 1: systemic hormone doses.
19:12
Speaker 2: Let's talk about this. It's it's a forty percent of
19:16
Speaker 2: women who are on systemic or whole body estrogens. What
19:20
Speaker 2: systemic means also really need local vaginal estrogen because you
19:26
Speaker 2: know that tissue, whether it's external tissue like labia, clitorist
19:30
Speaker 2: et cetera. Those are like external tissue, like it's just
19:33
Speaker 2: not going to absorb it. And has the highest density
19:36
Speaker 2: in those receptors, so it just needs TLC. So forty
19:40
Speaker 2: percent or even which is pretty much close to half
19:43
Speaker 2: half of the women that take systemic, which is you know,
19:46
Speaker 2: recent reports say two three five percent women take systemic
19:50
Speaker 2: hormone therapy, so that's not even high to begin with,
19:53
Speaker 2: but fifty percent of them also are on local vaginal estrogen.
19:57
Speaker 2: And I hear so many myths about this. I hear
20:00
Speaker 2: patients say, well, my doctor wouldn't prescribe me vaginal estrogen
20:03
Speaker 2: because I'm already on systemic, and I'm like, what, of
20:06
Speaker 2: course you can use it, and then of course you
20:08
Speaker 2: probably need it. I also hear like a complete other
20:12
Speaker 2: myth that vaginal estrogen will help you know, hot flashes
20:15
Speaker 2: and night sweats, of which it won't because it doesn't
20:17
Speaker 2: get absorbed systemically. So because it doesn't get absorbed systemically,
20:20
Speaker 2: that's why you can absolutely use both. They're not like
20:22
Speaker 2: adding to each other, and it's just, you know, so helpful.
20:27
Speaker 2: I absolutely wish it was over the counter. It is
20:29
Speaker 2: so safe, despite the fact that the FDA still slaps
20:33
Speaker 2: a black box warning on it that it doesn't apply
20:38
Speaker 2: to that medication. It came from the results of the
20:40
Speaker 2: Women's Health Initiative on oral Premarin and prem pro, which
20:43
Speaker 2: has nothing to do with using local vaginal estrace cream,
20:47
Speaker 2: you know. So it's no wonder that like we're podcasting
20:50
Speaker 2: about this for now in years to come, because it's
20:53
Speaker 2: like nonsensical, Like you know, I'm like, baginal estrogen's so safe.
20:58
Speaker 2: Most women need it, even know they're on systemic hormone therapy.
21:01
Speaker 2: It should be over the counter. You should get a
21:03
Speaker 2: tube of it when you go home after you've had
21:05
Speaker 2: a baby. You could use it after you've had or
21:08
Speaker 2: before your period when your estrogen drops, or definitely in perimenopause,
21:12
Speaker 2: and for you know, every day until Kingdom come once
21:15
Speaker 2: we're in menopause. Yet it's still so confusing. Nah, it
21:20
Speaker 2: angers me just like getting all that out. So everyone
21:23
Speaker 2: should be on vaginal estrogen, I think, So I guess
21:28
Speaker 2: the better questions like who shouldn't you know? I mean,
21:32
Speaker 2: it's great prevention, you know, even if we're thinking it's
21:36
Speaker 2: not just the vagina, it's the bladder and the urethra.
21:39
Speaker 2: So it's The American Neurologic Association recommends it as first
21:42
Speaker 2: line for recurring track infections. I don't know how many
21:45
Speaker 2: year ologists are prescribing vaginalstrogs. They're probably prescribing antibiotics. It
21:51
Speaker 2: really is great preventative, even if you do it once
21:53
Speaker 2: a week to keep the tissue healthy. So the only
21:56
Speaker 2: people that shouldn't. I do have a couple people where
22:01
Speaker 2: creams and anything in the vagina just causes like we're
22:03
Speaker 2: current itis, like yeast or bev or just like something
22:07
Speaker 2: that irritates them more. If it irritates you more, then
22:10
Speaker 2: let's figure out something else. There's actually a couple of
22:12
Speaker 2: other options, like there's an oral medication actually that's non hormonal,
22:17
Speaker 2: but there's very few people who shouldn't use it. And
22:20
Speaker 2: even that's not harmful per se, it's more annoying.
22:24
Speaker 1: Oh so oh right, we have estrogen receptors on the face. Yes, yes, Okay, I.
22:30
Speaker 2: Know where you're going with this one.
22:34
Speaker 1: I'm like, is there a difference between what you would
22:36
Speaker 1: put on your face versus what you put on the vagina?
22:42
Speaker 2: So amazing question. I you know, I'm pretty known for
22:47
Speaker 2: telling my patients that's no secret that they can use
22:50
Speaker 2: vagil estrogen on their face, of which many of them have,
22:53
Speaker 2: and many of them do, and it's funny because if
22:56
Speaker 2: they don't. As soon as I do a poster or
22:58
Speaker 2: a podcast, they all emailed me right away, Hey, Hather,
23:01
Speaker 2: can you send me some vagel it can Maybe they're
23:03
Speaker 2: on this appository, or maybe again they felt like they
23:06
Speaker 2: didn't need it. So let's het the record straight. There's
23:10
Speaker 2: no FDA indication for any current estrogen product, be it
23:15
Speaker 2: compounded or ESTRAI scream for your face. However, if we
23:19
Speaker 2: extrapolate its safety, and if you're using a p size amount,
23:24
Speaker 2: you know, maybe every day or every other day to
23:26
Speaker 2: your face of vaginal estrogen, the data from dermatologist does
23:32
Speaker 2: show that it is likely to be safe. And again,
23:34
Speaker 2: I want to be really careful about my words. I'm
23:36
Speaker 2: not saying it's one hundred percent proven. I am, you know,
23:39
Speaker 2: saying each to their own. Have I used yes? Okay,
23:44
Speaker 2: so right, I know. It's like I want to also
23:47
Speaker 2: make sure we talk about the science and the facts.
23:49
Speaker 2: But this is also a data free zone. We don't
23:51
Speaker 2: have enough data on this now. There are telemedicine companies
23:56
Speaker 2: that also offer a compounded version, and that's also very similar.
24:02
Speaker 2: I hear, although I've not used it, that's it feels
24:05
Speaker 2: a little bit smoother per se or maybe just better
24:08
Speaker 2: consistency than the vaginal estrogen. So all of those are
24:12
Speaker 2: ways that you could with your doctor you shared decision
24:17
Speaker 2: making to talk about if you could use estrogen for
24:19
Speaker 2: your face. I'm just like crazy, what the hell?
24:24
Speaker 1: Might as well do it?
24:25
Speaker 2: Anyways?
24:25
Speaker 3: I know I'm with you.
24:28
Speaker 4: You.
24:30
Speaker 2: Know if we talk about it. Yeah, what's happening is
24:33
Speaker 2: as we lose estrogen, we're losing the quality of collagen
24:36
Speaker 2: which keeps our face looking structured and young. We're losing
24:42
Speaker 2: the elasticity which is giving us the appearance of wrinkles,
24:46
Speaker 2: and also we can see those like aging spots or
24:48
Speaker 2: dark spots right, And we're losing that hydration, which is
24:51
Speaker 2: what makes which is why fillers look. We like fillers
24:54
Speaker 2: because it looks women look hydrated and you know, etcetera.
24:57
Speaker 2: So therefore that's all the things that estra does. So
25:00
Speaker 2: it's not so far off to think if you added
25:02
Speaker 2: the tiny bit of topical estrogen to your face. Now
25:06
Speaker 2: I've had someone ask me, hey, doctor, could I use
25:09
Speaker 2: divagel on my face. Divagel is systemic estrogen, and I
25:16
Speaker 2: wouldn't recommend that on your face. One, it's probably it's
25:20
Speaker 2: meant for something different. So it's gonna potentially even go
25:23
Speaker 2: through your skin or be fast or absorbed. And so
25:26
Speaker 2: I wouldn't recommend that you use like estrogen gel that
25:29
Speaker 2: is meant to be systemic hormone therapy to your face.
25:32
Speaker 2: But I've gotten that question as well.
25:35
Speaker 1: Okay, so while we're on this topic here, does every
25:39
Speaker 1: will every female have GSM?
25:44
Speaker 2: Or does that?
25:45
Speaker 1: Just like does it does some woman? Bypass that?
25:48
Speaker 2: You're asking my favorite questions so fast. I used to
25:54
Speaker 2: teach it when I taught residents, you know, Harvard. I
25:57
Speaker 2: would say, research says that fifty percent of women will
26:00
Speaker 2: experienced GSM, but one hundred percent of women will have
26:04
Speaker 2: GSM because what genito urinary syndrome of menopause really is
26:10
Speaker 2: is as we lose estrogen, which inevitably we do if
26:14
Speaker 2: we live long enough, the pH of the tissue goes
26:16
Speaker 2: from an acidic pH of five to a basic pH
26:19
Speaker 2: of around six or seven, and therein lies what really
26:24
Speaker 2: causes GSM is the change in the pH. At that
26:28
Speaker 2: different pH the cells are just like not happy, they
26:31
Speaker 2: don't want to function, they don't want to work. It's
26:33
Speaker 2: like the winter. They're like, no blood flow is not
26:36
Speaker 2: coming in it's not replenishing the tissue. This is why
26:40
Speaker 2: women can notice, for example, like difference in orgasm. It's
26:45
Speaker 2: not so much that all of a sudden it's not
26:47
Speaker 2: as fun. It's just that you're not getting good blood flow.
26:49
Speaker 2: You're not getting all the pH of the tissue isn't
26:53
Speaker 2: where it's meant to function best. So it's not your fault,
26:56
Speaker 2: and it's not your partner fault. It's your freaking peach
26:59
Speaker 2: and so vaginal estrogen that lowers the pH again and boom.
27:04
Speaker 2: So moisturizers are great. I love a good moisturizer. You
27:08
Speaker 2: know that's going to help just keep the tissue a
27:10
Speaker 2: little bit more hydrated, But it won't reverse the pH
27:13
Speaker 2: from that basic PG where we don't want it back
27:16
Speaker 2: to the acidic pH where it's happiest. You really need estrogen.
27:19
Speaker 2: So I hope that answers the question. Not all women
27:21
Speaker 2: may experience pain with intercourse or you know, dryness or
27:26
Speaker 2: urinite tract infections. But also I don't know in that
27:30
Speaker 2: research how many women are one being honest, because you know,
27:33
Speaker 2: you might not want to say that, I don't know
27:36
Speaker 2: how many women, right, how many women are actually like
27:39
Speaker 2: I think if it was like, it's okay, it's not
27:41
Speaker 2: going anywhere like it might that number might be higher.
27:44
Speaker 2: I don't even know where that name number came from.
27:46
Speaker 2: But if you ask me, in my opinion, one hundred
27:49
Speaker 2: percent of women will have the changes that are from
27:52
Speaker 2: the pH from the loss of estrogen that will correlate
27:54
Speaker 2: with genitorser a, menopasorgism.
27:58
Speaker 1: Oh okay, so that answer right there. But when we
28:02
Speaker 1: look at the dosing and I like, how in your
28:06
Speaker 1: program that you talk about the plan A, Plan B,
28:10
Speaker 1: Plan C, potentially Plan D where we go in with
28:13
Speaker 1: like the first line of defense and talk about it.
28:17
Speaker 1: But then you know, how often would you go back
28:19
Speaker 1: to your physician to get checked or to see if
28:22
Speaker 1: it's like.
28:23
Speaker 2: Oh, you guys are like music to me.
28:26
Speaker 4: I love all of these questions because I've got like
28:29
Speaker 4: really good answers, I think, but you know, because how
28:33
Speaker 4: how often should you how much tweaking should you do?
28:37
Speaker 2: Is like maybe the question and I think, if you know,
28:42
Speaker 2: for me love, I will tweak with patients till Kingdom
28:46
Speaker 2: come like tell they're like Heather, I cannot take another change,
28:50
Speaker 2: like this is great where I am. But you know,
28:52
Speaker 2: I always say to give an easy answer. I hope
28:55
Speaker 2: that all of my patients. My goal is at least
28:58
Speaker 2: at minimum you feel seventy to eighty percent better and
29:02
Speaker 2: it fits into your lifestyle and you're really confident about it,
29:05
Speaker 2: because if any of those things are off, like, you're
29:08
Speaker 2: always gonna kind of wonder. So I see patients routinely
29:11
Speaker 2: for a second opinions like, well I found like forty
29:14
Speaker 2: to fifty percent better, and not that I'm I'm not
29:17
Speaker 2: at all trying to talk down about other clinicians. I
29:20
Speaker 2: think the medical system is a mess. There's you know,
29:23
Speaker 2: not enough information on this. We don't teach doctors, visits
29:26
Speaker 2: your way short like it's no one's fault. We'll blame
29:29
Speaker 2: this system. But I'm like, girl, if we're on hormone therapy,
29:32
Speaker 2: we should feel eighty percent better, like not just a
29:35
Speaker 2: little bit better, Like let's optimize it. So you know,
29:38
Speaker 2: and either it's the dose is too low, or maybe
29:41
Speaker 2: they're like, well I kind of do forget to take
29:43
Speaker 2: it and you're like okay, great, and they're like, well
29:45
Speaker 2: I didn't know there was a patch and they're like yeah.
29:47
Speaker 2: So you know, it has to fit into your lifestyle
29:50
Speaker 2: and you want to feel really confident about it. And
29:52
Speaker 2: so those are the things where I feel like I
29:55
Speaker 2: like to see my patients every two to three months
29:57
Speaker 2: until we're really really close to that. I think all
30:00
Speaker 2: women deserve that. I know, it's just you know, harder
30:03
Speaker 2: said than done or easier said than done, because there's
30:07
Speaker 2: so much that goes into that little statement of I
30:09
Speaker 2: want to spend so much time with you on your
30:11
Speaker 2: hormone therapy so that you feel so good already We're like, oh,
30:16
Speaker 2: that's the dream, but that's I feel like that's what
30:18
Speaker 2: women really need.
30:21
Speaker 1: But this is why you you really started your online
30:24
Speaker 1: practice then, because I feel like, like, I mean, I'm
30:27
Speaker 1: in this space. I'm not obviously not a physician, but
30:30
Speaker 1: I am well connected, and I went to my obgu
30:34
Speaker 1: I N and it was like not helpful at all.
30:38
Speaker 1: So such a benefit to be able to you know,
30:43
Speaker 1: like you said, it was in almost every state, so
30:46
Speaker 1: if it's in your state, then you can just pull
30:48
Speaker 1: in and do this, you know, yeah, via.
30:51
Speaker 2: Tell Tell Medicine. Mm hmm, exactly. I love Tell Medicine
30:56
Speaker 2: for this because you know, of course, the pandemic really
30:59
Speaker 2: kicked this off, but even before when I was recruited
31:01
Speaker 2: to Harvard. I was like, we should be doing telemedicine
31:04
Speaker 2: and they were like, oh, I don't know, that seems
31:06
Speaker 2: so new. Well, then we all know what happened in
31:08
Speaker 2: twenty twenty and so we all got our wish. But
31:12
Speaker 2: so much of what we're doing is talking. It is
31:15
Speaker 2: mental health. It is you know, changing old perceptions about
31:19
Speaker 2: hormone therapy. It's talking about weights, talking about life stressors,
31:23
Speaker 2: you know, things that you do as well if you're
31:27
Speaker 2: as we're training women, et cetera. We're thinking about them holistically,
31:31
Speaker 2: their whole life, their family. When do they wake up,
31:33
Speaker 2: when does the you know, when do the kids get up,
31:35
Speaker 2: one of the kids leaving the house. All that's like
31:37
Speaker 2: really important and so much talking that it was really
31:40
Speaker 2: ripe for telemedicine, and then you could feel more comfortable
31:43
Speaker 2: talking about these things wherever you want. I mean, we
31:46
Speaker 2: do visits in basements, closets, addicts, cars, you name it.
31:50
Speaker 3: Yeah. Well, and that is one of the first questions
31:53
Speaker 3: anyone asks once they're not feeling great. It's who do
31:56
Speaker 3: I go to? Who do I go to to get
31:58
Speaker 3: my hormones checked or that can advise me on hormone
32:02
Speaker 3: replacement therapy? So I love that you started this too.
32:06
Speaker 2: It is so much fun.
32:08
Speaker 1: Yeah, I'm making an appointment, Like when I get off
32:12
Speaker 1: the same I'm ready, I'm ready to do something. How
32:17
Speaker 1: do you feel about adaptogens for women that potentially don't
32:21
Speaker 1: want to go on any kind of hormone therapy? How
32:27
Speaker 1: do adaptogens Obviously they're not the same thing, but they
32:30
Speaker 1: help solve some of the syndrome or the symptoms.
32:36
Speaker 2: Oh, definitely, absolutely, And I love that you asked me this.
32:40
Speaker 2: And I know it's probably getting towards the end of
32:42
Speaker 2: our episode, but just because thinking about I think this
32:47
Speaker 2: is so important to say right here too, is that
32:50
Speaker 2: I talk about hormone therapy all the time because there's
32:53
Speaker 2: so many questions, but you are not doomed if you
32:57
Speaker 2: don't want to take hormone therapy or you can't take
33:00
Speaker 2: hormone therapy. And I think of adaptogens as a really
33:03
Speaker 2: important strategy in one of my three buckets. So if
33:06
Speaker 2: the third is hormone therapy, let's work backwards. The second
33:09
Speaker 2: is fday proved medications that are non hormone therapy, and
33:13
Speaker 2: the first is lifestyle supplements, complementary and alternative medications. And
33:19
Speaker 2: so you know, really I want to make sure that
33:22
Speaker 2: I cause I think this is really really crucial to
33:24
Speaker 2: say that there is not one right answer and you
33:27
Speaker 2: are not doomed if we choose not to take hormone therapy.
33:31
Speaker 2: But adaptogens can be extremely helpful a lot of my
33:35
Speaker 2: patients in it. This also might be a lot of
33:39
Speaker 2: self selection, because I tend to see patients who have
33:42
Speaker 2: tried a couple of things before they come to see me.
33:45
Speaker 2: And so it's amazing how much more knowledge women have
33:50
Speaker 2: at the start of their visit now versus five years ago,
33:52
Speaker 2: versus like eight years ago when I was doing this,
33:55
Speaker 2: And so there's so many good supplements that can really help.
33:59
Speaker 2: And you know, I like to kind of go buy
34:01
Speaker 2: symptoms when we think about you know, ashwaganda is fantastic,
34:06
Speaker 2: Rubiola green tea extract, a lot of them can be
34:10
Speaker 2: really really helpful, especially if there's like anxiety or there's insomnia.
34:14
Speaker 2: And then some of the more herbs are really great
34:16
Speaker 2: for hot flashes and dryness and et cetera. So absolutely
34:20
Speaker 2: everything has a role and everything is really important.
34:25
Speaker 1: So what is the role of for osteopenia or osteoporosis.
34:32
Speaker 1: Hormone therapy has been shown to help with this.
34:36
Speaker 2: Right, Yes, hormone therapy has actually been is FDA approved
34:42
Speaker 2: to treat osteopenia, which is the precursor to osteoporosis. And
34:46
Speaker 2: I was just teaching yesterday when I said something we often,
34:51
Speaker 2: I think as women or women are always if if
34:53
Speaker 2: they get diagnosed out osteopenia, they're told, oh, you've got
34:56
Speaker 2: a little bone lost, take some vitamin D and calcium.
34:59
Speaker 2: That's all women should be taking. Vitamin dan kelcey. And
35:02
Speaker 2: it's not necessarily adequate for osteopenia. And it's like, we
35:06
Speaker 2: care so much about pre diabetes, like, oh, we don't
35:08
Speaker 2: want you to become diapatic. We've got met for every day,
35:10
Speaker 2: we got this and D. But so why don't we
35:13
Speaker 2: do the same thing when it's like pre bone loss?
35:16
Speaker 2: And you know, I think if more, this is where
35:20
Speaker 2: I almost like the medical field is feeling women, because
35:22
Speaker 2: it's not so much that women think like, well, why
35:25
Speaker 2: didn't he give me estrogen? They're not being told that
35:27
Speaker 2: estrogen is treatment for osteopenia and can prevent osteoporosis. So
35:33
Speaker 2: I went off on a tangent there because you can
35:35
Speaker 2: see them so passionate about like all of these questions.
35:37
Speaker 2: You guys are just like giving me the best questions
35:42
Speaker 2: because these are real scenarios. It's not after you approve
35:45
Speaker 2: for osteoporosis, so once you're there, it's not necessarily proven
35:50
Speaker 2: to help you get out of osteoporosis zone. But again,
35:53
Speaker 2: if you so many I diagnose so many women with
35:56
Speaker 2: osteopenia because we're delaying bone densities, or their doctors have
35:59
Speaker 2: told just take some calcium and vitamin D. And I
36:02
Speaker 2: am just like, oh my gosh, why do we do
36:04
Speaker 2: this to women? We downplay this, but we wouldn't downplay
36:08
Speaker 2: pre hypertension or pre diabetes or if you had pre cancer.
36:12
Speaker 2: Look what we do to you for pre cancer. Why
36:15
Speaker 2: is it just that bones are like, oh you sweet thing,
36:18
Speaker 2: You'll be fine. It's so patriarchal.
36:24
Speaker 1: Really comes into play there. And strength training, which I
36:28
Speaker 1: think the message is getting across very strongly. Thank goodness
36:33
Speaker 1: to social media, but that plays a huge role in
36:39
Speaker 1: turning that ship around.
36:42
Speaker 2: Immense, immense and I think that that message is so
36:47
Speaker 2: important of strength training. And you know, again, I think
36:52
Speaker 2: you're absolutely right. I have you know agree. I mean
36:55
Speaker 2: I just started strength training again and I feel like
36:57
Speaker 2: oh gosh, it's so hard cardio.
37:00
Speaker 5: Baby for so long, but you know it's it's I
37:04
Speaker 5: I I think that you know, again, if you grew
37:08
Speaker 5: up and you know Tim, Tiffany Emberthesanis and you watch
37:10
Speaker 5: Stay by the Bow, it is more likely that you.
37:13
Speaker 2: Know low car low e carbs, low fat right and
37:17
Speaker 2: cardio right. That's what I was trying to say, and
37:20
Speaker 2: switching that mindset, I do think that it's it's getting
37:24
Speaker 2: around and a lot of women know. Increase the protein,
37:27
Speaker 2: increase the fiber, add the weight bearing. So I think
37:29
Speaker 2: we're doing a really good job.
37:31
Speaker 1: Yes, well, Heather, as we wrap this up, what advice
37:36
Speaker 1: would you give to a female that maybe is somewhere
37:42
Speaker 1: in between Perry, maybe even post metopause, that that maybe
37:47
Speaker 1: hasn't been on board with hormone therapy but now is
37:50
Speaker 1: like okay, well I want to I want to give
37:52
Speaker 1: it a shot, or I want to have a conversation
37:55
Speaker 1: about it.
37:57
Speaker 2: Yes, you know, my advice is always this one. Never
38:01
Speaker 2: stop advocating because you know, now we have a lot
38:05
Speaker 2: of telemedicine practices and there's you know, lots of options
38:11
Speaker 2: if you don't feel comfortable with your clinician and the
38:14
Speaker 2: other piece of advice. I think that's really helpful for women.
38:17
Speaker 2: And I say this to my patients a lot is like, hey,
38:21
Speaker 2: we don't have to go on hormone therap we can
38:23
Speaker 2: just trial it. Like you're trying on a pair of jeans, right,
38:26
Speaker 2: you try them on before you buy them. I mean, listen,
38:29
Speaker 2: you can buy jeans before we're trying them on. But
38:31
Speaker 2: half the time, half the time that works. Now the
38:33
Speaker 2: time it doesn't. But I think there's pressure of like
38:36
Speaker 2: we can try like glasses, maybe glasses, this is better
38:39
Speaker 2: than jeans, right, Like put the prescription on and see
38:42
Speaker 2: what the world feels like, and then we can make
38:45
Speaker 2: a longer term decision, so you don't have to be
38:48
Speaker 2: all in or all out, Like you can trial it
38:51
Speaker 2: for a few weeks and see if it is improving
38:54
Speaker 2: your quality of life, because that is what it's meant
38:56
Speaker 2: to be doing. And if you've got a good clinician,
38:59
Speaker 2: not only is it hopefully improving your quality of life,
39:01
Speaker 2: they're helping you make the right decision, and they're increasing
39:04
Speaker 2: your confidence in safety, which is usually where that sort
39:08
Speaker 2: of hasency comes from. Because for two decades we didn't
39:11
Speaker 2: talk about it as kryptonite. So I think that's my
39:14
Speaker 2: piece of advice is that you don't have to be
39:16
Speaker 2: all in or all out. You don't have to be
39:17
Speaker 2: for it or against it, but you definitely got a
39:20
Speaker 2: great clinician, you can trial it, and then through that
39:24
Speaker 2: process you will learn a lot about your body, whether
39:26
Speaker 2: you want to take it long term or you don't.
39:28
Speaker 2: What symptoms it helped with, symptoms it didn't. It's so helpful,
39:33
Speaker 2: So try it. You can trial it, you can you
39:36
Speaker 2: can do the short term subscription. You don't have to
39:40
Speaker 2: do it for life.
39:42
Speaker 1: Yes, you're not committing forever.
39:44
Speaker 2: So I really like.
39:45
Speaker 1: I think it was in the investigate stage of Thrive
39:50
Speaker 1: where you gave like a print out that you can
39:54
Speaker 1: take to your doctor and you have questions on there
39:56
Speaker 1: to actually ask your doctor, because some of it is
39:59
Speaker 1: like I, I don't know what to say, and if
40:01
Speaker 1: they're not really well trained in it, then it's easy
40:07
Speaker 1: to kind of just walk away being like I'm not
40:10
Speaker 1: really sure what to do still, even though I just
40:13
Speaker 1: went to my physician. So I love that you can
40:16
Speaker 1: print that out when you take the course and take
40:19
Speaker 1: that and that's huge. Yeah, it eliminates a lot of
40:23
Speaker 1: the barriers there.
40:25
Speaker 2: I really wanted to make it so that my dream
40:28
Speaker 2: when I did this again, which was, you know, I
40:30
Speaker 2: started this before I even had my own clinics, so
40:33
Speaker 2: you could really only see me at the time if
40:35
Speaker 2: you lived in northeastern you know, Massachusetts, was that you
40:39
Speaker 2: could really be successful and having a conversation with even
40:42
Speaker 2: the most either biased or a knowledgeable clinician. And I
40:47
Speaker 2: wanted to give you all the tools so that you
40:49
Speaker 2: could do that, especially because you know a lot of
40:51
Speaker 2: women love their clinician. This is just the one area
40:54
Speaker 2: they weren't trained and they're like, it's kind of like
40:56
Speaker 2: your hairdresser. You're like, oh, she could only do bangs,
41:00
Speaker 2: but you know she could, It'd be fantastic, she could
41:02
Speaker 2: do everything. I think that people there are still those
41:05
Speaker 2: people who love working with their clinician for everything, but
41:08
Speaker 2: this and my thought was that also, here's my secret.
41:14
Speaker 2: If along the way, like Laura, you know you and
41:18
Speaker 2: you're you know, you're kind of on this journey and
41:21
Speaker 2: you walk through this with your doctor and your doctor
41:23
Speaker 2: learned something, you are now changing the lives of the
41:27
Speaker 2: next thousand people that he or she might see. And
41:31
Speaker 2: there's kind of this back thing that's happening, which is
41:33
Speaker 2: where you are kind of teaching your clinician along the way.
41:36
Speaker 2: And I do think that for a couple of years,
41:38
Speaker 2: like three, four or five more years just depends that
41:41
Speaker 2: many many women know more than their clinician. But this
41:45
Speaker 2: is actually crucially important to speak up in a nice
41:48
Speaker 2: way because then those clinicians are like, ah, I need
41:52
Speaker 2: more training and they're going to catch up.
41:53
Speaker 3: Then yeah, powerful, good point.
41:57
Speaker 1: Well, Heather, thank you so much for for joining us.
42:01
Speaker 1: I really wish that we had more time today. Where
42:04
Speaker 1: can people find you? Where can women find you and
42:08
Speaker 1: get their own appointment online through this telehealth if they
42:11
Speaker 1: need it?
42:12
Speaker 2: Absolutely so. It's joined the Collaborative dot Com, just like
42:17
Speaker 2: a sound joined the Collaborative dot Com. You can also
42:20
Speaker 2: find me on Instagram. I'm at Heather hirsh MD and
42:23
Speaker 2: across all my socials at Heather hirsh MD. And I
42:28
Speaker 2: also have a new website where all my courses live,
42:31
Speaker 2: which is Heather hush Academy and that's heatherhish Academy dot com.
42:35
Speaker 2: That's where all my courses are. I know, everything's just
42:37
Speaker 2: really grown and it's so exciting because again I want
42:41
Speaker 2: to I'm sort of, oh gosh, I want to strike
42:44
Speaker 2: while the iron's hot. You know, people, women are really
42:47
Speaker 2: galvanized around this topic, and so I want to do
42:49
Speaker 2: everything I can to make women's lives better.
42:53
Speaker 1: Yes, well you are, you are, And thank you so
42:55
Speaker 1: much again for your time today. I know that you're
42:58
Speaker 1: so busy, but we have just loved having a few
43:01
Speaker 1: minutes of your time and being able to introduce a
43:05
Speaker 1: lot of this to our listeners. So thank you so
43:07
Speaker 1: much for joining us.
43:09
Speaker 2: Thank you so much for having me. This was amazing.
43:11
Speaker 2: Thank you, thanks for listening.
43:15
Speaker 3: If you enjoyed this episode, please consider giving us a
43:18
Speaker 3: five star review and sharing the body Pod with your friends.
43:22
Speaker 1: Until next time,