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Women's Hormone Testing, Treatment, & Q&A · Wits & Weights | Strength & Fat Loss Over 40

• 0:00
  Philip Pape: Hey Wits and Wits of Family.
• 0:01
  Philip Pape: Today is a quick bonus episode.
• 0:03
  Philip Pape: It's a replay of a conversation with hormone specialist Karen Martell about testosterone for women.
• 0:09
  Philip Pape: This was from early 2024, and I'm replaying this because Karen is joining us for a live QA today, exclusively in Physique University.
• 0:18
  Philip Pape: I wanted you guys to get a taste for the kind of specifics that she gets into regarding the mechanisms of our hormones, as well as how to test, how to interpret, what your doctor might be missing, how to treat it, what options are available.
• 0:31
  Philip Pape: So very short, under 10 minute replay today.
• 0:34
  Philip Pape: If you want to ask Karen questions about hormones, perimenopause, menopause, optimizing your health, join us in physique university, go to wits and weights.com slash physique.
• 0:44
  Philip Pape: Use my code FREEPLAN to get a free nutrition plan.
• 0:46
  Philip Pape: And when you sign up today, you can hop on the call at 12 Eastern.
• 0:51
  Philip Pape: If you miss it, there will be a replay.
• 0:52
  Philip Pape: But if you could join live, you'll be able to ask her your questions.
• 0:55
  Philip Pape: I also want to let you know I fixed a broken link in our most recent episode with Karen.
• 1:00
  Philip Pape: There was a link in the show notes to her hormone creams and oils that you can get without a prescription.
• 1:05
  Philip Pape: So that link is fixed in the show notes.
• 1:07
  Philip Pape: It's witsandweights.com slash Karen Martell.
• 1:09
  Philip Pape: And then use code Wits and Waits for 10% off.
• 1:11
  Philip Pape: I'll throw all that stuff in the show notes, but enjoy the replay on testosterone with Karen.
• 1:16
  Philip Pape: Let's go back to testing, right?
• 1:18
  Philip Pape: Because testing's always a point of confusion, especially in the traditional healthcare system where it's like, if you could even get them to give you a test, it's blood work.
• 1:26
  Philip Pape: And usually that's not adequate, but it might be for testosterone.
• 1:29
  Philip Pape: So let's let's break it down.
• 1:30
  Philip Pape: Exactly.
• 1:31
  Philip Pape: That's one thing that makes it easy, right?
• 1:33
  Philip Pape: So how should a woman get access, get tested, and then use the results properly.
• 1:39
  Karen Martel: So once again, some really shitty man-to-woman things here, which is testosterone's the only one that they'll ever test free and total.
• 1:50
  Karen Martel: Women would they won't do estradiol free and total or progesterone free in total.
• 1:55
  Karen Martel: It's only testosterone, which is a little bit frustrating.
• 1:58
  Karen Martel: But you can't, that's a very accurate way to test your testosterone.
• 2:01
  Karen Martel: And testosterone, we have a little bit of a peak right before we ovulate, I think to give us that drive to go out and have sex and procreate.
• 2:10
  Karen Martel: But pretty much we don't fluctuate like we do with our other hormones throughout the month with testosterone.
• 2:16
  Karen Martel: It stays pretty even keo.
• 2:18
  Karen Martel: We have that little flux on day 12 right before we ovulate on a 28-day cycle.
• 2:23
  Karen Martel: But you know, besides that, you can kind of just test whenever in the cycle.
• 2:27
  Karen Martel: You probably don't want to test on that peak day.
• 2:29
  Karen Martel: Day 21 is what I would recommend because that's where we test the esterdiol and progesterone in fertile women.
• 2:35
  Karen Martel: So might as well do your testosterone then too.
• 2:37
  Karen Martel: And so it is very accurate, but you definitely want to do both free and total in case your SHBG is too high.
• 2:44
  Karen Martel: And then test your DHEA sulfate in blood, test your sex hormone binding globulin.
• 2:49
  Karen Martel: So we see if it's elevated.
• 2:50
  Karen Martel: Because one of the things that's happening right now is that a lot of women are fasting and fasting like hardcore fasting, you know, one meal a day, two meals a day, and they've been doing this for a long time, or they've been eating a really low carb diet, or and when they're fasting and not eating that much, they're also really low in protein.
• 3:08
  Karen Martel: So low protein diets, low carb diets, too much fasting will all raise SHBG because it makes sense.
• 3:17
  Karen Martel: If we were back in hunter-gatherer days and there wasn't a lot of food around, so we're fasting, right?
• 3:23
  Karen Martel: Then the body is being told, don't get pregnant.
• 3:28
  Karen Martel: There's not a lot of food around.
• 3:30
  Karen Martel: And so SHBG naturally would go up because there's a food shortage.
• 3:35
  Karen Martel: So it wants to bind up your testosterone, bind up your estradiol, and so that you can't get pregnant.
• 3:42
  Karen Martel: And so too much of that starts to signal to the system, don't get pregnant, which is that's really the only reason why we're here.
• 3:50
  Karen Martel: So your body's gonna compensate for this, whether you like it or not, where whether you want kids or not, or care about being fertile, this is what happens.
• 3:58
  Karen Martel: So we have to be really careful with that.
• 4:00
  Karen Martel: So testing that's a good idea.
• 4:02
  Philip Pape: So a couple of things, because I actually just put together a new episode about carbs coming out.
• 4:06
  Philip Pape: And one of the interesting things about a higher carb diet was the increase in testosterone to cortisol ratio that they've seen, not in addition to the increase in IGF one that you talked about.
• 4:15
  Philip Pape: So the fasting and the low carb and the low protein, are you saying that that in general for most women that's not recommended because of this?
• 4:23
  Philip Pape: Or what are you saying there?
• 4:26
  Karen Martel: It's it's a fine line, is what I'm saying, because we also become more insulin resistance resistant because of the drop in hormones as we age, which means intermittent fasting can be a really, really important tool to start implementing because we will we need help being insulin sensitive.
• 4:44
  Karen Martel: It's that women are taking it too far, they get results, and then they're like, oh my God.
• 4:50
  Karen Martel: And then they stop getting results and they think, I better do it harder longer.
• 4:54
  Karen Martel: Right?
• 4:55
  Karen Martel: Like, I better, oh, if I'm eating two meals a day, I better eat one meal a day.
• 4:58
  Karen Martel: Oh, I should be doing a 36-hour fast or a five-day fast.
• 5:02
  Karen Martel: And you you hear this from a lot of like of the big practitioners that are out there on social media saying, like, you, you know, do five-day fast once a month, you know, do one 36-hour fast every single week.
• 5:14
  Karen Martel: And I'm like, no, most women can't handle that, especially in menopause.
• 5:18
  Karen Martel: It stresses the system out too much.
• 5:20
  Karen Martel: So you have to find that balance.
• 5:22
  Karen Martel: You have to know where your cortisol levels are, you have to know where your insulin's at.
• 5:26
  Karen Martel: So testing, of course, is super important.
• 5:28
  Karen Martel: We don't, we don't want to guess what's happening in the body.
• 5:31
  Karen Martel: So some women that are insulin resistant, their cortisol's okay, or let's say it's high, then I would probably say, you know what, you need to be intermittent fasting more, but you still want to make sure you're getting in the protein because if not, then that SHBG will go up and it'll bind up those hormones.
• 5:48
  Karen Martel: The other thing that will raise it is thyroid hormones.
• 5:51
  Karen Martel: So if somebody's on thyroid medication, which a lot of women are, they don't realize that that's actually binding up their hormones and sending them into menopause early, which is something that happened to myself and nobody told me.
• 6:04
  Karen Martel: And I was like, what?
• 6:05
  Karen Martel: What's going on?
• 6:06
  Karen Martel: My total levels of estradiol and testosterone are great, but yet I'm missing a period, I'm getting hot flashes, low libido.
• 6:12
  Karen Martel: And then I finally heard Peter Atia on who's huge, he was on Huberman Lab podcast, and he was talking about thyroid medication raising SHBG.
• 6:23
  Karen Martel: And I'm like, what the frick?
• 6:24
  Karen Martel: Why isn't anybody talking about this?
• 6:26
  Karen Martel: Like, how many women are on thyroid hormones?
• 6:28
  Karen Martel: So many.
• 6:30
  Philip Pape: A lot of yeah, it's this is why women are so frustrated, right?
• 6:34
  Philip Pape: And because it's I could just imagine like a piano of keys, and every single key is like a different hormone.
• 6:40
  Philip Pape: And as soon as you press one, the other one goes up or down, and they're all so interrelated, right?
• 6:45
  Philip Pape: Yeah.
• 6:45
  Philip Pape: Um, and even the thing about energy availability, which shameless plug, that's what we talk about on your podcast when my episode comes out, energy availability, is that you you need the energy there to support your hormones, but you don't want so much energy that you're gaining a ton of weight, right?
• 7:00
  Philip Pape: And that's where it's like this balance for women to find out.
• 7:04
  Karen Martel: Like we can't be, we got to get away from this one size fits all because even though we know that we're still doing it.
• 7:12
  Karen Martel: The majority of women are still going, what's the next best diet out there and trying it?
• 7:18
  Karen Martel: And oh, everybody's doing keto.
• 7:20
  Karen Martel: Well, I'm gonna do keto.
• 7:21
  Karen Martel: And it's like, but is that a good fit for you?
• 7:23
  Karen Martel: Like, where's your thyroid at?
• 7:24
  Karen Martel: Where's your adrenal system at?
• 7:25
  Karen Martel: Where are your hormones?
• 7:26
  Karen Martel: Like, you gotta look at this full picture and then decide, okay, I'm you know, inflamed, I've got PCOS, I'm insulin resistant.
• 7:35
  Karen Martel: Then yeah, keto could be great and it could reverse all of those things, but then you want to, you know, start carb cycling, and you know, there's there's a lot of nuances to it, and everybody has to find what's gonna work for them.
• 7:48
  Philip Pape: So going back to the blood work, uh, free and total testosterone, DHA sulfite, SPG, what else?
• 7:54
  Karen Martel: S HPG, yep.
• 7:55
  Karen Martel: And then of course you want to test your acidion progesterone as well, because there is some some evidence that shows that women should actually be like if you're gonna replace your hormones in perimenopause and menopause, there is some research that shows it's actually better to replace estrogen and progesterone first for three months, then put in the testosterone.
• 8:20
  Karen Martel: So I always want to see that full picture.
• 8:23
  Karen Martel: The other way that I I want people to test is through urine metabolite testing.
• 8:28
  Karen Martel: Now, oddly enough, testosterone is actually the least accurate on urine metabolite testing.
• 8:35
  Karen Martel: So you think, okay, well, then why are you saying that we should do this, Karen?
• 8:38
  Karen Martel: Well, in the a Dutch test, which is dried urine hormone testing, we have testosterone on there.
• 8:47
  Karen Martel: We've got the DHEA sulfate on there.
• 8:49
  Karen Martel: But if you have a genetic SNP where you're missing these enzymes called the UGT enzymes, you won't pee out that testosterone.
• 8:59
  Karen Martel: So it looks like you have none when you actually have plenty.
• 9:02
  Karen Martel: So I always want women to do blood work on the same day or the next day so that we can compare the two just in case it's more common in Asian backgrounds.
• 9:13
  Karen Martel: So if you're you've got, you know, if you're Asian yourself or you've got Asian in in your family history, then you may not have that enzyme.
• 9:21
  Karen Martel: I don't have it, so I always look like I have test low testosterone.
• 9:25
  Karen Martel: But the other piece of the puzzle that we want to see on a urine metabolite test that blood work won't show is something called five alpha reductase enzyme.
• 9:35
  Karen Martel: And so there's a fan gauge on the Dutch test, and there's five beta and there's five alpha.
• 9:41
  Karen Martel: If you are leaning towards a five alpha pathway, so the on the fan gauge, if you're way over to the five alpha, it means you convert your testosterone at a higher rate to what's called dihydrotestosterone, which is the most androgenic out of all the androgens.
• 10:01
  Karen Martel: And so that's where we'll see women, if they go on testosterone replacements, then they if that goes up, the DHT goes up, they start having the hair loss, the greasy skin, the acne.
• 10:15
  Karen Martel: And so that's not that's not pleasant.
• 10:17
  Karen Martel: Women can get whispers, have, you know, can start growing the clitinous, as I call it.
• 10:22
  Karen Martel: So your your P your clitoris can actually start to get longer.
• 10:27
  Karen Martel: And you Yeah.
• 10:28
  Karen Martel: Which is not fine.
• 10:30
  Karen Martel: And I've heard of women this happening to them, their voice cracking, and just from being on testosterone replacement.
• 10:36
  Philip Pape: And that's if you lean more toward the alpha side, you said?
• 10:38
  Philip Pape: Correct.
• 10:39
  Karen Martel: Yeah.
• 10:39
  Philip Pape: And does that mean you shouldn't be taking therapy if that's the case, or do you just have to modulate it and be more careful with the dosage?
• 10:45
  Karen Martel: Exactly.
• 10:46
  Karen Martel: And you have to possibly take something that's going to stop that conversion.
• 10:52
  Karen Martel: So it blocks the five-alpha reductus pathway.
• 10:55
  Karen Martel: There's herbals that do it.
• 10:56
  Karen Martel: There's also medication, uh, finasteride and doasteride that will block that conversion.
• 11:03
  Karen Martel: So a lot of women will take the medication so that they can get the benefits of testosterone without having the masculine features.
• 11:10
  Karen Martel: But there's lots of that, like saw palm meadows, really good for it, pumpkin seed.
• 11:15
  Karen Martel: There's a bunch of different things, ink, that can help.
• 11:17
  Philip Pape: That's it for today's replay.
• 11:18
  Philip Pape: If you want the full conversation with Karen, including natural supplementation strategies, treatment options, you can go back and listen to the full episode 135.
• 11:26
  Philip Pape: And remember, join us for today's live QA with Karen in Physique University.
• 11:30
  Philip Pape: Go to witsandweights.comslash physique.
• 11:33
  Philip Pape: Use my code FREPLAN again, witsandweights.comslash physique.
• 11:37
  Philip Pape: And I will see you tomorrow for the next full episode.