Latest / Clearly Hormonal / Ep 10: Myth-Busting Menopause Care with Dr. Naomi Busch

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Ep 10: Myth-Busting Menopause Care with Dr. Naomi Busch · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Bhatia Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health And recharge the conversations you are having with your health care providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your health care provider at your next visit.
• 0:39
  Dr. Komal Patil-Sisodia: Hi everyone, welcome back to Reset Recharge.
• 0:42
  Dr. Komal Patil-Sisodia: I am very excited to have Dr.
• 0:44
  Dr. Komal Patil-Sisodia: Naomi Bush here with us.
• 0:46
  Dr. Komal Patil-Sisodia: She is a menopause specialist based out of Seattle with a background in family medicine and has a great career that she's built over the last 20 years and has transitioned from family medicine into the menopause practice.
• 0:59
  Dr. Komal Patil-Sisodia: So welcome Dr.
• 1:00
  Dr. Komal Patil-Sisodia: Bush.
• 1:01
  Dr. Komal Patil-Sisodia: I just wanted to give you a minute to introduce yourself and tell our listeners about how you got to where you are in your current practice.
• 1:08
  Dr. Naomi Busch: Right.
• 1:09
  Dr. Naomi Busch: So, yeah, so in I don't even know how long it's been now, maybe 15 years ago or so I opened my own primary care practice here in Seattle called Green Lake Primary Care, and I did that actually because being a woman in medicine is quite difficult, and I found that I couldn't have the family that I wanted and the practice that I wanted.
• 1:30
  Dr. Naomi Busch: And so I built it.
• 1:33
  Dr. Naomi Busch: And I also built a place for five other physician moms to come and work with me.
• 1:38
  Dr. Naomi Busch: I got involved then with eating disorder care because again, people approached me and said that they didn't have any doctor to send their eating disorder clients to.
• 1:50
  Dr. Naomi Busch: So I went and I self educated and I went all to so many conferences, including one in Iceland, to learn about eating disorder care and high level residential care and all of these different aspects of eating disorder medicine.
• 2:04
  Dr. Naomi Busch: And then I proceeded to consult for, like, all the major players in Seattle.
• 2:09
  Dr. Naomi Busch: And then eventually I decided I didn't want to do both.
• 2:13
  Dr. Naomi Busch: So I sold my primary care practice to a really great friend of mine.
• 2:17
  Dr. Naomi Busch: And then I took a job as the director of medical services for one of the larger eating disorder companies in Washington state.
• 2:25
  Dr. Naomi Busch: Eventually my friends from a book club that we had resumed, we'd been a book club for like 20 years and we had taken a break for for children.
• 2:32
  Dr. Naomi Busch: We got back together and we were all now in our perimenopausal menopausal years and we started talking and they were asking all these questions I didn't know the answer to and that really bothered me.
• 2:41
  Dr. Naomi Busch: So then I decided I was, once again, I delved into this like self education and just to help them.
• 2:47
  Dr. Naomi Busch: But then when I tried to find a place to refer them to in Seattle that was accessible there wasn't one.
• 2:53
  Dr. Naomi Busch: So anyway, I talked to my husband and he was like, you should do that.
• 2:56
  Dr. Naomi Busch: And so then I thought that's, that's what I should do.
• 2:58
  Dr. Naomi Busch: And so then I decided to open up this clinic and it was I opened up Seattle Menopause Medicine.
• 3:03
  Dr. Naomi Busch: I did that twice, two days a week.
• 3:04
  Dr. Naomi Busch: And then I was still doing the, my director of medicine, medical services for this eating disorder company three days a week.
• 3:10
  Dr. Naomi Busch: And then I realized how much I loved menopause, and that I just needed something new.
• 3:13
  Dr. Naomi Busch: So I left my corporate job and now this is what I do.
• 3:17
  Dr. Komal Patil-Sisodia: Well, congratulations.
• 3:18
  Dr. Komal Patil-Sisodia: I mean, that is really incredible.
• 3:20
  Dr. Komal Patil-Sisodia: And I think that you know, amazing that your friends, just a simple conversation with your friends has led to such a big career shift.
• 3:30
  Dr. Komal Patil-Sisodia: And now we have a resource here in Seattle for women who are struggling with finding good care for menopause.
• 3:35
  Dr. Komal Patil-Sisodia: One, thank you for doing that.
• 3:37
  Dr. Komal Patil-Sisodia: I think that you've put Is it amazing what book clubs will will, Yeah, I know.
• 3:43
  Dr. Komal Patil-Sisodia: Do you guys actually read the books in your book clubs?
• 3:45
  Dr. Komal Patil-Sisodia: Because the ones I've been a part of, it's like 50 50.
• 3:47
  Dr. Komal Patil-Sisodia: Like sometimes we'll all do it.
• 3:49
  Dr. Komal Patil-Sisodia: The other time everybody's there for the vibes and the story.
• 3:52
  Dr. Naomi Busch: Right, that's exactly right.
• 3:54
  Dr. Naomi Busch: It's it's really and then now that we're all like in our 40s and 50s like it's become a non alcoholic wine club.
• 3:59
  Dr. Naomi Busch: Like we people bring non alcoholic wine and the non alcoholic seltzers because, you know, after one glass you can't drive home anymore.
• 4:07
  Dr. Naomi Busch: So then it's a really funny transition.
• 4:09
  Dr. Naomi Busch: But no, our book clubs are probably about four hours because we have to do a lot of editing and we spend about 20 minutes on the book.
• 4:17
  Dr. Naomi Busch: And a lot of time, we do it quarterly, so then a lot of time catching up.
• 4:20
  Dr. Naomi Busch: So yeah, we, and we've, it's been 20 years.
• 4:23
  Dr. Naomi Busch: It's a long time, so.
• 4:24
  Dr. Komal Patil-Sisodia: That's really wonderful.
• 4:25
  Dr. Komal Patil-Sisodia: That sounds incredible.
• 4:27
  Dr. Komal Patil-Sisodia: And out of that book club, this practice was born.
• 4:30
  Dr. Komal Patil-Sisodia: Yeah,
• 4:31
  Dr. Naomi Busch: it is.
• 4:31
  Dr. Komal Patil-Sisodia: Wonderful.
• 4:32
  Dr. Komal Patil-Sisodia: I always credit them.
• 4:33
  Dr. Komal Patil-Sisodia: I, Yeah, they edited my website.
• 4:36
  Dr. Komal Patil-Sisodia: They helped me out.
• 4:36
  Dr. Komal Patil-Sisodia: Well, I'm excited to hear more about your practice.
• 4:44
  Dr. Komal Patil-Sisodia: And really, now that you've been doing this for a while, what are some of the top things that you hear when coming into your office in terms of misconceptions around menopause or common questions that you're getting.
• 4:58
  Dr. Komal Patil-Sisodia: I'd love for our listeners to get a taste of, what can they expect when they go to see somebody who specializes in menopause like you and what are things that you can talk to them?
• 5:07
  Dr. Naomi Busch: So one of the big things that I've noticed is what people put down as their chief complaint.
• 5:16
  Dr. Naomi Busch: And sometimes their chief complaint is that they have been to five doctors and everyone tells them they're too young to seek help for menopausal symptoms.
• 5:28
  Dr. Naomi Busch: It
• 5:29
  Dr. Komal Patil-Sisodia: breaks my heart.
• 5:30
  Dr. Naomi Busch: Yeah, I know and it's in it.
• 5:32
  Dr. Naomi Busch: It pretty is.
• 5:33
  Dr. Naomi Busch: It gives me a job, but it also gives me a lot of sadness when I see that, because I know that it's not rocket science, like what I'm doing.
• 5:40
  Dr. Naomi Busch: So usually a young 40 year old, like between, 42 and 47 years old, they'll go to their primary care doctor or their GYN who are lovely human beings.
• 5:50
  Dr. Naomi Busch: I know a lot of them and they'll tell them they're having these symptoms.
• 5:53
  Dr. Naomi Busch: the patients have self educated.
• 5:55
  Dr. Naomi Busch: So they're advocating for themselves.
• 5:57
  Dr. Naomi Busch: They're not these people who don't know what's happening.
• 5:59
  Dr. Naomi Busch: And they'll say, I think this could be perimenopause and the, they're well meaning doctors and other providers will say, well, maybe, but you know, it's too early and your symptoms aren't bad enough.
• 6:11
  Dr. Naomi Busch: And come back when you are really struggling.
• 6:14
  Dr. Naomi Busch: And then maybe we can talk about hormone therapy.
• 6:17
  Dr. Naomi Busch: Or even they'll say, you know, if you're just too young, you have to wait until you're actually menopause.
• 6:23
  Dr. Naomi Busch: And I think that's a big myth is that you have to be, you know, in menopause, which is one year without your period in order to have hormone therapy or symptom management with whatever drugs you choose.
• 6:36
  Dr. Naomi Busch: That's a big one that I see.
• 6:37
  Dr. Komal Patil-Sisodia: Yeah and it's so true.
• 6:39
  Dr. Komal Patil-Sisodia: I see so many of those patients in my office thinking that it's their thyroid or their adrenals or some other endocrine thing that's going off the rails, and it's not.
• 6:49
  Dr. Komal Patil-Sisodia: It's perimenopause.
• 6:50
  Dr. Komal Patil-Sisodia: How do you talk these women through I guess understanding that it is an option for them?
• 6:58
  Dr. Komal Patil-Sisodia: Especially after they've been told five times in a row that that may not be, what does that conversation like that must be pretty enlightening for them and gives them some hope, I imagine.
• 7:09
  Dr. Naomi Busch: Yeah, I think obviously they're coming to a menopause clinic, right?
• 7:12
  Dr. Naomi Busch: So they already have kind of self selected.
• 7:14
  Dr. Naomi Busch: So they, there's a bias there, right?
• 7:17
  Dr. Naomi Busch: But I think I treat it.
• 7:18
  Dr. Naomi Busch: I, when I meet people, I do, I have a very comprehensive approach.
• 7:22
  Dr. Naomi Busch: So just like you, like I, Maybe it is their thyroid.
• 7:25
  Dr. Naomi Busch: Maybe it is their adrenal gland.
• 7:26
  Dr. Naomi Busch: Maybe they've been just so discounted.
• 7:27
  Dr. Naomi Busch: They haven't had those things checked or who knows what.
• 7:30
  Dr. Naomi Busch: So I just, I take a, yeah, I take a complete history and I just have them talk and tell me what's been happening and how they've been feeling.
• 7:38
  Dr. Naomi Busch: Before people.
• 7:39
  Dr. Naomi Busch: Come in to see me.
• 7:40
  Dr. Naomi Busch: I have them fill out a menopause checklist and I use the green climacteric checklist, which is I think 20 or 21.
• 7:48
  Dr. Naomi Busch: I can't remember symptoms that they rate on a scale of one to three.
• 7:52
  Dr. Naomi Busch: And then I have them do an intake, which is basically asks like, why are you coming today?
• 7:56
  Dr. Naomi Busch: And like their basic medical history.
• 7:58
  Dr. Naomi Busch: So while in talking like that, then I can you know, get them to realize in some ways as we talk about all these different symptoms they're having that, yeah, this really sounds like it's all keyed into, you know, perimenopause or menopause.
• 8:12
  Dr. Naomi Busch: Some of them are even in menopause.
• 8:13
  Dr. Naomi Busch: They don't even know it.
• 8:14
  Dr. Naomi Busch: And yeah, so we, that's kind of how I lead them down that road.
• 8:17
  Dr. Naomi Busch: And then in the end, like once we've kind of assessed, once I've assessed, where they've come from in the past and like what kind of medical issues they have and what kind of labs they've already had done and what their other providers have said to them and what they're doing, done a risk assessment for their own, self.
• 8:33
  Dr. Naomi Busch: Then we talk about, you know, what is it where you're hoping to get today?
• 8:37
  Dr. Naomi Busch: Like, were you interested in hormone therapy or were you interested in alternatives?
• 8:40
  Dr. Naomi Busch: And they usually are, they've self selected a doctor.
• 8:45
  Dr. Naomi Busch: So usually they're like hormone therapy.
• 8:47
  Dr. Naomi Busch: I'm like, great.
• 8:48
  Dr. Naomi Busch: And then we talk about it, but I don't just jump in.
• 8:50
  Dr. Naomi Busch: I want them to tell me their story so that I kind of have a full round picture of all of the things.
• 8:56
  Dr. Naomi Busch: Cause there's so many symptoms and they cross over to like so many aspects.
• 9:00
  Dr. Naomi Busch: And that's one of the reasons why I think being primary care, like internal medicine or family medicine, like we come from a much different.
• 9:08
  Dr. Naomi Busch: School of thought, like we take a more holistic, you know, I don't want to be holistic.
• 9:12
  Dr. Naomi Busch: That's like, not the right word.
• 9:14
  Dr. Naomi Busch: But we're looking at people from all sorts of angles, right?
• 9:16
  Dr. Naomi Busch: Not just, you reproductive health, right?
• 9:20
  Dr. Naomi Busch: So that's where I come from and we usually end up talking about hormone therapy,
• 9:24
  Dr. Komal Patil-Sisodia: which makes sense to your point, people who have done the work to educate themselves and are getting a better understanding that even some of their milder symptoms can be indicative of perimenopause is important.
• 9:37
  Dr. Komal Patil-Sisodia: I know when we were speaking earlier you were also talking about how.
• 9:41
  Dr. Komal Patil-Sisodia: People have been told about.
• 9:44
  Dr. Komal Patil-Sisodia: The severity of their symptoms, and that's almost like a gatekeeping tool for whether they can get therapy.
• 9:50
  Dr. Komal Patil-Sisodia: So what does that look like in your practice?
• 9:52
  Dr. Komal Patil-Sisodia: I think that's probably the next biggest myth that's walking in your door.
• 9:56
  Dr. Naomi Busch: One of the things that I have heard so many times is this whole concept of I am not suffering, you know, I'm not suffering enough to need treatment.
• 10:06
  Dr. Naomi Busch: And it's even interesting because people are coming to me, right?
• 10:09
  Dr. Naomi Busch: And they're telling me that even though they've self selected to come to me, right?
• 10:14
  Dr. Naomi Busch: And to pay out of pocket, yet they still say those words like I've been told that, but also I don't think I'm that bad.
• 10:20
  Dr. Naomi Busch: Like I think I'm not that bad and I'm and but yet I yesterday I had this woman who came in and like I said, I can't remember exactly how many items are on the checklist.
• 10:29
  Dr. Naomi Busch: But let's pretend there's 20.
• 10:31
  Dr. Naomi Busch: So that would be like a maximum score of 30.
• 10:33
  Dr. Naomi Busch: And this woman's score was like 38.
• 10:36
  Dr. Naomi Busch: And she tells me, yeah, I'm not that bad.
• 10:39
  Dr. Naomi Busch: And I was like, well, you don't have hot flashes that are really bad, but your mood, you're marking like the worst possible moods, the worst irritability, you're struggling in your relationship.
• 10:50
  Dr. Naomi Busch: You're struggling at home with your kids.
• 10:52
  Dr. Naomi Busch: You can't focus at work.
• 10:53
  Dr. Naomi Busch: You're not sleeping through the night.
• 10:55
  Dr. Naomi Busch: I think you're doing pretty bad.
• 10:57
  Dr. Naomi Busch: That doesn't sound like a good existence, right?
• 11:00
  Dr. Naomi Busch: That sounds like you don't like you don't have to be sweating through your sheets.
• 11:04
  Dr. Naomi Busch: We talk about that too, about the fact that menopause takes place both above the neck and below the neck, right?
• 11:11
  Dr. Naomi Busch: And I think that I would say, actually, I would say like 90 percent of people come to me for things that are happening above the neck.
• 11:19
  Dr. Naomi Busch: I
• 11:23
  Dr. Komal Patil-Sisodia: haven't heard it broken down that way, but I love that, so I'm just going to repeat that menopause occurs above the neck and below the neck.
• 11:30
  Dr. Komal Patil-Sisodia: I really like that.
• 11:31
  Dr. Komal Patil-Sisodia: I hope people cement that in their brains as they move forward to, to talk to their doctors.
• 11:36
  Dr. Komal Patil-Sisodia: It's a great way of breaking it down.
• 11:38
  Dr. Naomi Busch: Yeah, in a medicine, right?
• 11:39
  Dr. Naomi Busch: We would call it super territorial, right?
• 11:41
  Dr. Naomi Busch: There's so much happening in the brain.
• 11:43
  Dr. Naomi Busch: And so I always say hot flashes can be a sign of how impacted somebody is because they probably have a lot of other symptoms too.
• 11:50
  Dr. Naomi Busch: But then people, some people just really don't have that thermo dysregulation or they're not aware of it.
• 11:55
  Dr. Naomi Busch: They just tell me they don't feel.
• 11:57
  Dr. Naomi Busch: Oh yeah like they say I used to wear no sweaters and now I have to wear sweaters or I never wore sweater I mean I wear I have to take off my sweater so like they're they might say I'm like hot when I should be cold or cold and I should be hot but they're not having hot flashes or night sweats and I say oh no That's the same thing, right?
• 12:14
  Dr. Naomi Busch: It's just mild.
• 12:16
  Dr. Naomi Busch: The only reason I like, this sounds funny, the only reason I like when people have hot flashes is because it's really easy to monitor, right?
• 12:24
  Dr. Naomi Busch: It's really easy to know if the medicine I give you is effective if you're no longer sweating through the night.
• 12:29
  Yeah,
• 12:30
  Dr. Naomi Busch: but it's a lot harder.
• 12:32
  Dr. Naomi Busch: Although I would tell you on this checklist, it's people are very good at judging how they feel.
• 12:38
  Dr. Naomi Busch: But people would say well, mood is elusive.
• 12:40
  Dr. Naomi Busch: Like, how do you measure mood?
• 12:42
  Dr. Naomi Busch: But I can tell you it's pretty remarkable.
• 12:43
  Dr. Naomi Busch: I also saw a woman in followup yesterday whose score went from 38 to eight.
• 12:48
  Dr. Naomi Busch: So it's not like diabetes where you can send a one C change, right?
• 12:52
  Dr. Naomi Busch: Somebody really was like, is this normal for me to feel normal after, you know, six weeks of small amount of estrogen?
• 12:59
  Dr. Naomi Busch: And I was like,
• 13:00
  Dr. Komal Patil-Sisodia: yep.
• 13:02
  Dr. Komal Patil-Sisodia: It's really remarkable.
• 13:03
  Dr. Komal Patil-Sisodia: I've had so many patients tell me that their partners, their kids notice.
• 13:08
  Dr. Komal Patil-Sisodia: So even if you yourself are not a good barometer of change that's happening.
• 13:13
  Dr. Komal Patil-Sisodia: Because as women, we tend to be minimizers sometimes of what our symptoms are like.
• 13:17
  Dr. Komal Patil-Sisodia: And the women who are coming in and scoring 38 and saying, oh, it's not that bad, right?
• 13:21
  Dr. Komal Patil-Sisodia: It's terrible.
• 13:23
  Dr. Komal Patil-Sisodia: But you've minimized it to that point, but the people around you, the people that you're in relationships with, sometimes they're the first to notice.
• 13:30
  Dr. Komal Patil-Sisodia: So I've had women come in and tell me that my husband tells me I'm such a nicer person now.
• 13:35
  Dr. Komal Patil-Sisodia: My kids say that I'm more fun to be around.
• 13:38
  Dr. Komal Patil-Sisodia: And it's really remarkable because they're getting those relationships back and that is, that's just such a huge win.
• 13:45
  Dr. Naomi Busch: Yeah, I think one of my very first patients was, really skeptical because she didn't have a lot of physical symptoms, was really skeptical, and then when I saw her again, I almost didn't recognize her because she had this, you know, she was on a tiny bit of estrogen, like nothing, and she just had this Light in her eyes that she didn't have before and I would never believe it if somebody had told me like this is like the effect it could have such a profound effect on people's lives.
• 14:13
  Dr. Naomi Busch: It doesn't have that for everybody.
• 14:14
  Dr. Naomi Busch: I mean, I'm not trying to sell a bill of goods because I definitely see people like, yes, also yesterday I saw people in follow up who went from like a 30 to a 22 or maybe a 30 to like a 35 like maybe something happened that wasn't planned.
• 14:26
  Dr. Naomi Busch: wasn't positive, right?
• 14:28
  Dr. Naomi Busch: But I, I still think when you when it is really the underlying problem is perimenopause or menopause, it can really make a profound difference to be on hormone therapy.
• 14:38
  Dr. Naomi Busch: And I guess that brings us to our next myth or myth buster, I suppose is, if you can't be on hormone therapy, is your life going to be ruined?
• 14:48
  Dr. Komal Patil-Sisodia: Yeah, that is a great question.
• 14:50
  Dr. Komal Patil-Sisodia: And I think right now everybody's been so excited about this rejuvenated conversation that we're having around hormones because it's been so taboo for the last 20 years that we're inadvertently marginalizing all the women who can't have it for whatever medical contraindication they may have.
• 15:07
  Dr. Komal Patil-Sisodia: So I'd love to hear your thoughts on that.
• 15:11
  Dr. Naomi Busch: Yeah, no, it's pretty hard.
• 15:12
  Dr. Naomi Busch: When people come to me and they have their hopes high that they're going to hear a different answer from me it's pretty hard.
• 15:18
  Dr. Naomi Busch: The biggest no is, would be age and risk of cardiovascular disease as we age, like that 10 years past menopause or six, 60 and a, 16 above or 10 years past menopause and the risk of cardiovascular disease and then having, so it's not an absolute no, obviously, you just have to do a lot of work in order to be on hormone therapy and you have to have a good reason for it, right?
• 15:40
  Dr. Naomi Busch: Like at that point, you do have to have a good reason for it.
• 15:43
  Dr. Naomi Busch: It can't be a lot of the things that we think might, may Sorry, like this idea that hormone therapy can prevent a lot of issues like cardiovascular disease, Alzheimer's, there's a few others, but may or may not, pan out.
• 15:57
  Dr. Naomi Busch: I think it probably will pan out in the next 20 years.
• 15:59
  Dr. Naomi Busch: We need better research, on those prevention because prevention trials take forever.
• 16:03
  Dr. Naomi Busch: But we do know for certain that like, if you haven't had estrogen around for a long time, and then you want to go on estrogen, there is a risk, right.
• 16:12
  Dr. Naomi Busch: Right.
• 16:13
  Dr. Naomi Busch: Yeah.
• 16:14
  Dr. Naomi Busch: And so for those women you know, especially if they have a family, if they even have a double down risk of like having family history and things like that, then I'm kind of like, this is not worth it because you're going on it for a reason that you feel like you've missed the boat.
• 16:27
  Dr. Naomi Busch: And maybe you have vaginal dryness, or maybe you're having symptoms of low libido or something else.
• 16:32
  Dr. Naomi Busch: And you're thinking, estrogen therapy.
• 16:34
  Dr. Naomi Busch: And so then we talk about, if you're older, well, anytime you can always talk about vaginal estrogen.
• 16:38
  Dr. Naomi Busch: I mean, that's safe anytime you can take it from whenever you want to until 90 or whenever you want to, right?
• 16:45
  Dr. Naomi Busch: Like vaginal estrogen will always be safe.
• 16:47
  Dr. Naomi Busch: There are very rare, like there are some very rare sick situations with certain kinds of breast cancer, with certain types of treatment of breast cancer where you wouldn't want to take any estrogen, but that's very, very rare.
• 16:58
  Dr. Naomi Busch: So vaginal estrogen is like, pretty much always safe.
• 17:01
  Dr. Naomi Busch: But if that isn't working for somebody, right, then that's when they come to me and they want systemic hormone therapy or something.
• 17:07
  Dr. Naomi Busch: So then we talk about other products.
• 17:08
  Dr. Naomi Busch: So there are like other things for vaginal dryness that people can use.
• 17:12
  Dr. Naomi Busch: There's, it's hard to get and they're expensive, but yeah.
• 17:16
  Dr. Naomi Busch: Sometimes just switching brands.
• 17:17
  Dr. Naomi Busch: So if you come on, if you're on Premarin and it's not working, you could try Estradiol Cream, you could try the DHEA suppositories now they have I think the brand name is Prasterone which are really expensive, but can be really effective for vaginal dryness which is one of the big symptoms that people come with later on is incontinence.
• 17:36
  Dr. Naomi Busch: urinary tract infections.
• 17:38
  Dr. Naomi Busch: The other one is ospemathine.
• 17:40
  Dr. Naomi Busch: That is the new drug, a newer drug on the market that is just for vaginal dryness.
• 17:44
  Dr. Naomi Busch: And it's not for everybody, you know, you have to see your doctor and make sure that you don't have any risks of adverse events like with that medication, but it's an option.
• 17:54
  Dr. Naomi Busch: And so I think that there should be more.
• 17:56
  Dr. Naomi Busch: More conversation.
• 17:57
  Dr. Naomi Busch: You shouldn't just say, Oh, there's nothing we can do for you after after 60, right?
• 18:02
  Dr. Naomi Busch: And also younger women who can't take hormone therapy or don't want hormone therapy for whatever reason.
• 18:08
  Dr. Naomi Busch: There are lots of, there are other things to manage symptoms.
• 18:11
  Dr. Naomi Busch: And so I have a lot of younger women, who come in with oh, kind of symptoms of overactive bladders, what I would say, like peeing all night long, getting up three times at night.
• 18:20
  Dr. Naomi Busch: They have urge incontinence where, like, you go shopping and you don't have to go to the bathroom, but the minute you hit your house, the door, you have the hand on the handle and the bag of groceries in your other arm, you almost like pee yourself, right?
• 18:31
  Dr. Naomi Busch: Because you can't make it to the bathroom in time.
• 18:32
  Dr. Naomi Busch: So I have women like that.
• 18:34
  Dr. Naomi Busch: And Sometimes I use, I just use other drugs like oxybutynin, like ditropan that can work with hot flashes at night as well as the incontinence and your, overactive bladder.
• 18:44
  Dr. Naomi Busch: And I've had, had one woman come to me who didn't want hormone therapy, who I started on that medication and it like saved her life, and they're young and there's no risk of using it in younger women.
• 18:54
  Dr. Naomi Busch: So yeah, so there's other things we can do.
• 18:56
  Dr. Naomi Busch: That's really wonderful.
• 18:57
  Dr. Naomi Busch: I don't use a lot of supplements, like natural, like nutraceuticals, like I don't use a lot of those.
• 19:02
  Dr. Naomi Busch: I feel like there's enough people in Seattle who you could see if that's the advice that you wanted.
• 19:07
  Dr. Naomi Busch: Honestly, there's some experts in those, in that field.
• 19:10
  Dr. Naomi Busch: And I don't really, I don't use those as much.
• 19:12
  Dr. Naomi Busch: I think I would if we had run out of options.
• 19:15
  Dr. Komal Patil-Sisodia: That's fair.
• 19:16
  Dr. Komal Patil-Sisodia: I think that's really fair.
• 19:17
  Dr. Komal Patil-Sisodia: So there are, and that's what I want.
• 19:19
  Dr. Komal Patil-Sisodia: People to hear is that there are many options out there, and it's not a simple yes or no, depending on what your situation may be.
• 19:30
  Dr. Komal Patil-Sisodia: So what else are you hearing when people come into your office that you find interesting in terms of questions?
• 19:37
  Dr. Naomi Busch: I think something that people don't say, actually, that are interesting to me is that, you know, this is osteoporosis, like bone health.
• 19:47
  Dr. Naomi Busch: As a primary, as a family doctor and a primary care doctor and somebody who worked, you know, 13 years in the eating disorder space osteoporosis is, like, very important to me.
• 19:56
  Dr. Naomi Busch: I don't want anyone to have a hip fracture.
• 20:01
  Yeah.
• 20:01
  Dr. Naomi Busch: And and so I'm just amazed, sort of the lack of awareness of and also I'm appalled, by the fact that, Medicare won't pay for screening and, they, and insurances want you to get screened at 65.
• 20:12
  Dr. Naomi Busch: And I tell people that's too late.
• 20:13
  Dr. Naomi Busch: That's like the boat, the ship has sailed.
• 20:15
  Dr. Naomi Busch: So in my little intake, I ask if you've had a mammogram, a pap smear, a colonoscopy, or a dexa.
• 20:21
  Dr. Naomi Busch: I ask everybody, no matter what age they are, like those four screening tests, and then we talk about them.
• 20:26
  Dr. Naomi Busch: And for bone density, I think I always educate them around, nope, like you should, I believe that you should get a bone density screen When you're postmenopausal or reaching that like 52 or postmenopausal, right?
• 20:39
  Dr. Naomi Busch: And so you should ask your insurance company if I use this, postmenopausal code, will, can I get the screening exam paid for?
• 20:48
  Dr. Naomi Busch: I'm also family history of anyone in your family who's ever had like your mom, your dad, your close relatives who've had hip fractures or low bone density, like you should get screened before, definitely within the first five years of menopause, right?
• 21:01
  Dr. Naomi Busch: Like you need to get screened early and then we can talk about, estrogen therapy like for that.
• 21:07
  Dr. Naomi Busch: And again, if you aren't a candidate for high dose, like I wouldn't say high dose, but like regular doses of hormone therapy, you can still take, the lowest dose for bones is 14 micrograms, right?
• 21:19
  Dr. Naomi Busch: And they make a patch for that and it's very low dose, right?
• 21:23
  Dr. Naomi Busch: And I think that many people could take that and tolerate it as a preventative medicine for their bones.
• 21:29
  Dr. Naomi Busch: So I think that's a big thing for me at least.
• 21:32
  Dr. Naomi Busch: So
• 21:32
  Dr. Komal Patil-Sisodia: I would completely agree.
• 21:34
  Dr. Komal Patil-Sisodia: It's so frustrating to, to watch women have to wait that long to have their bones screened.
• 21:40
  Dr. Komal Patil-Sisodia: I saw a young woman recently who Had been a year post menopause at 47 and I had a horrible history of osteoporosis in her family.
• 21:52
  Dr. Komal Patil-Sisodia: And I said, you know what?
• 21:54
  Dr. Komal Patil-Sisodia: You have a lab abnormality that makes me think your bones are not doing well.
• 21:58
  Dr. Komal Patil-Sisodia: Let's get it done.
• 21:59
  Dr. Komal Patil-Sisodia: And sure enough She had a pretty bad osteoporosis and only at a year out post menopause.
• 22:05
  Dr. Komal Patil-Sisodia: I agree with you I think that that's something that we don't do nearly enough education on.
• 22:10
  Dr. Naomi Busch: So I asked people I don't know if you asked people this but what I ask people especially because you know I see only women now and Some of them are really, you know, they self select to come see me.
• 22:19
  Dr. Naomi Busch: And so I have a, I feel like I have a large population of very fit women.
• 22:24
  Dr. Naomi Busch: And so I asked him if they've ever lost their period ever in their life besides pregnancy, you know, have you ever gone without your period for longer than, a year six months to a year?
• 22:34
  Dr. Naomi Busch: Because that's another big risk for osteoporosis.
• 22:36
  Dr. Naomi Busch: And I think that we don't talk enough about, Eating disorders and your previous history of an eating disorder could impact your bone health now and so we should get you and that is an indication to for screening is a history of an eating disorder is a indication for anyway so it is like kind of my bad my bandwagon because I feel like if we prevent that bone density from getting so bad.
• 22:57
  Dr. Naomi Busch: If we can like prevent, that lack of estrogen from occurring, then maybe it'll buy them time, they might end up with osteoporosis, but maybe they'll have many more years without it.
• 23:07
  Dr. Komal Patil-Sisodia: And I totally agree.
• 23:09
  Dr. Komal Patil-Sisodia: I think my philosophy tends to be The better we can control your bone density and get it as close to normal as possible before you hit 75, it's going to save you from, falling, breaking your hip and then passing away from a hip fracture.
• 23:25
  Dr. Komal Patil-Sisodia: We've all seen that happen where people just don't rebound.
• 23:28
  Dr. Komal Patil-Sisodia: I think the stat is what, like 50 percent mortality.
• 23:31
  Dr. Komal Patil-Sisodia: It's like, if you have a hip fracture in the hospital, yeah, it's like, it's really high.
• 23:36
  Dr. Komal Patil-Sisodia: Yeah, it's a terrible number.
• 23:38
  Dr. Komal Patil-Sisodia: I think it's one of the worst stats we have in medicine.
• 23:40
  Dr. Komal Patil-Sisodia: So it's
• 23:42
  Dr. Naomi Busch: I saw a patient recently who told me their doctor told them just don't fall.
• 23:47
  Dr. Naomi Busch: I was like, okay, right?
• 23:50
  Dr. Naomi Busch: So yeah, and she changed, you know, she was like that.
• 23:52
  Dr. Naomi Busch: So I started hiking with poles and I was like, that's probably a good idea anyway.
• 23:56
  Dr. Naomi Busch: But that's really interesting.
• 23:58
  Dr. Naomi Busch: I mean, maybe he was being kitschy, you know?
• 24:01
  Dr. Naomi Busch: I, yeah, maybe, maybe.
• 24:04
  Dr. Naomi Busch: Perception is
• 24:04
  Dr. Komal Patil-Sisodia: everything though, right?
• 24:06
  Dr. Komal Patil-Sisodia: No, it's
• 24:06
  Dr. Naomi Busch: really true.
• 24:07
  Dr. Naomi Busch: It's really true.
• 24:09
  Dr. Komal Patil-Sisodia: What else do you think commonly that you're hearing that you'd like to clear up as a misconception for women that are coming in to seek this kind of care?
• 24:21
  Dr. Naomi Busch: Those are the, like misperceptions with hormone therapy itself.
• 24:26
  Dr. Naomi Busch: I think one of the big misconceptions is, and especially we hear this in Seattle a lot, is that there's something wrong with getting hormone therapy from the pharmacy and that you need to go get it from a compounding pharmacy that it's.
• 24:39
  Dr. Naomi Busch: That is better for you if you get what, the bioidentical hormones and one I do just like all podcasters, just like all people in the menopause space who are MDs or DOs, we will tell everybody that they are, the compound in pharmacies get the medication in the same way that the pharmacy, the regular pharmacies do.
• 24:59
  Dr. Naomi Busch: It's all estradiol pretty much.
• 25:01
  Dr. Naomi Busch: And yeah.
• 25:02
  Dr. Naomi Busch: It's, and you can get progesterone in both ways.
• 25:05
  Dr. Naomi Busch: And so I think one of, and actually this leads to me to my funniest misperception
• 25:10
  is
• 25:10
  Dr. Naomi Busch: that, so people come to me telling me that they're on hormone therapy because they're using yam cream.
• 25:19
  Dr. Naomi Busch: And so then I actually, I love that because I actually love the story of like where the bioidentical marketing term came from and like why, where the, these actual drugs came from.
• 25:30
  Dr. Naomi Busch: And so we, I educate them about organic chemistry.
• 25:34
  Dr. Naomi Busch: The favorite.
• 25:34
  Dr. Naomi Busch: I'm impressed
• 25:35
  Dr. Komal Patil-Sisodia: you still
• 25:35
  Dr. Naomi Busch: remember that.
• 25:36
  Dr. Naomi Busch: That was like learn and this is why organic chemistry matters to all of those pre med students.
• 25:43
  Dr. Naomi Busch: It's like, what is it with that?
• 25:45
  Dr. Naomi Busch: And I'm like, no.
• 25:46
  Dr. Naomi Busch: So they found something in the yam, right?
• 25:49
  Dr. Naomi Busch: The sterile backbone from which they could make in a lab.
• 25:54
  Dr. Naomi Busch: Naturally occurring.
• 25:56
  Dr. Naomi Busch: I mean, naturally, like the molecule progesterone, which is identical to what makes what you make in your body, but yet don't make that.
• 26:05
  Dr. Komal Patil-Sisodia: That's true.
• 26:06
  Dr. Komal Patil-Sisodia: I don't know if you ever saw that sex in the city movie where they were, I think in Abu Dhabi or somewhere.
• 26:12
  Dr. Komal Patil-Sisodia: And Samantha got pulled through customs and she'd lost all her progesterone yam cream.
• 26:18
  Dr. Komal Patil-Sisodia: So she was trying to make eating copious amounts of yams while she was there.
• 26:23
  Dr. Komal Patil-Sisodia: It was the most ridiculous, but yeah, you're right.
• 26:25
  Dr. Komal Patil-Sisodia: You can't get it from eating yams.
• 26:27
  Dr. Naomi Busch: So you can't get that.
• 26:29
  Dr. Naomi Busch: And then I tell them that, the yam this, but I can't remember the kind of yam it was, but it's this important, this is how we get medicine is through these, you know, organically grown veggies somewhere.
• 26:39
  Dr. Naomi Busch: And somebody finds some molecule who knows how they found it.
• 26:42
  Dr. Naomi Busch: I'm sure there's a story and then they develop these things.
• 26:44
  Dr. Naomi Busch: And so they, you know, they've actually, and it's the same thing they develop the estradiol from.
• 26:48
  Dr. Naomi Busch: It's like the sterile backbone from which they can build these hormones through organic chemistry.
• 26:53
  Dr. Naomi Busch: It's synthesized and people are then they get confused because you know you have people out there saying well things shouldn't be synthesized in a lab but you're like no this is a bio identical like this is exactly what your body makes and so your body doesn't know that it was synthesized you know other molecules not so much right but then i also tell people they, they're so afraid of like venturing away from progesterone, or, they'll tolerate all these side effects of progesterone that they may or may not have, so some people really have a lot of you know, side effects that other people don't have.
• 27:25
  Dr. Naomi Busch: That's what we know about all medicines.
• 27:26
  Dr. Naomi Busch: Right.
• 27:27
  Dr. Naomi Busch: Right.
• 27:27
  Dr. Naomi Busch: And so some people cannot tolerate progesterone.
• 27:29
  Dr. Naomi Busch: And so then we talk about the alternatives and I'm like, but they have this idea in their head that they're going to be toxic to their body because of this, social media, you know, bioidentical harassment.
• 27:41
  Dr. Naomi Busch: So yeah, so we do, I guess I try to myth bust the whole yam thing, because I'm like, no, you can't take your estradiol patch and yam cream.
• 27:50
  Dr. Naomi Busch: That is not, Unless somebody's putting progesterone into that yam cream, it doesn't have any progesterone in it.
• 27:55
  Dr. Naomi Busch: And then and then I kind of myth bust a little bit around, the other, these other medications are not bad.
• 28:03
  Dr. Komal Patil-Sisodia: Yeah.
• 28:03
  Dr. Komal Patil-Sisodia: And then I'm sure you hear a lot about, or maybe even get requests for testosterone pellets.
• 28:09
  Dr. Komal Patil-Sisodia: Oh, yeah.
• 28:10
  Dr. Komal Patil-Sisodia: My big pet peeve I've been seeing out there for multiple reasons.
• 28:16
  Dr. Naomi Busch: Yeah, I think that if they made a, you know, if they made a testosterone pellet that was something like a depo shot, like that we knew exactly how much was coming out and, Like we knew like how it worked, but I feel like there's too much of an unknown there and it's not regulated.
• 28:31
  Dr. Naomi Busch: It used to there actually, I think testosterone used to come in a pellet way back in the day and it wasn't related, but then I don't know how it like, it, It went off the market.
• 28:39
  Dr. Naomi Busch: And then now it's all in the compound and pharmacy world.
• 28:43
  So,
• 28:44
  Dr. Naomi Busch: yeah, I don't think we need to use things like that when we have other medications that are effective.
• 28:51
  Dr. Naomi Busch: Right.
• 28:52
  Dr. Naomi Busch: We didn't have any options.
• 28:53
  Dr. Naomi Busch: Sure.
• 28:54
  Dr. Naomi Busch: But the problem with those testosterone pellets is, yeah you like kind of shoot the moon a little, right.
• 28:58
  Dr. Naomi Busch: You end up with very high testosterone levels.
• 29:01
  Dr. Naomi Busch: You can't, it's very hard to fish out the pellets.
• 29:03
  Dr. Naomi Busch: I don't really have anything to do with them.
• 29:05
  Dr. Naomi Busch: And I tell people that.
• 29:06
  Dr. Naomi Busch: Right away, but I'm pretty testosterone happy.
• 29:09
  Dr. Naomi Busch: I think that testosterone is the next thing that we're going to learn about.
• 29:13
  Dr. Naomi Busch: And I think Australia Susan Davis is doing a lot of good research on finally, not finally for her, but finally that somebody's picked this up.
• 29:22
  Dr. Naomi Busch: I actually have a family member who works in helping medications and things get through the FDA anyway.
• 29:28
  Dr. Naomi Busch: Why isn't there a female testosterone in the United States?
• 29:31
  Dr. Naomi Busch: And he said it would cost too much money to get it through the FDA process.
• 29:36
  Dr. Naomi Busch: And they'd have to start all over again from the beginning with like phase one trials.
• 29:39
  Dr. Naomi Busch: It would be like a billion dollar industry, right?
• 29:41
  Dr. Naomi Busch: Like, why not?
• 29:42
  Dr. Naomi Busch: And he was like, he was like, maybe anyway, but he, It was interesting, like that's what he was thinking was the reason why we don't have it, like we can't just bring in, there is a testosterone made in Australia that is appropriately dosed for women.
• 29:56
  Dr. Naomi Busch: We can't just bring that in because it actually has to go through the FDA process.
• 29:59
  Dr. Naomi Busch: It would have to, they'd have to reprove it.
• 30:02
  Dr. Naomi Busch: They couldn't just use the studies they did in Australia, which it doesn't make any sense to me.
• 30:05
  Dr. Naomi Busch: I think that's a little rigid.
• 30:07
  Dr. Naomi Busch: It's
• 30:07
  Dr. Komal Patil-Sisodia: interesting.
• 30:08
  Dr. Komal Patil-Sisodia: I see that with any of the, I think it's the EDA the European version of our FDA.
• 30:13
  Dr. Komal Patil-Sisodia: They were like two years ahead of us on almost everything diabetes.
• 30:17
  Dr. Komal Patil-Sisodia: All of it goes through so much faster.
• 30:20
  Dr. Komal Patil-Sisodia: Our process is quite a bit slower.
• 30:22
  Dr. Naomi Busch: Yeah.
• 30:23
  Dr. Naomi Busch: And it's slower.
• 30:23
  Dr. Naomi Busch: And then I think it's also convoluted in that, well, that would be a whole another topic.
• 30:28
  Dr. Naomi Busch: But, um, you know, we're like, how come that got through?
• 30:32
  Dr. Naomi Busch: Like you look, I mean, and I'm going to totally insult people.
• 30:36
  Dr. Naomi Busch: But there's drugs like Addy, right.
• 30:38
  Dr. Naomi Busch: That got through the mark, the process which I, the name of it is it's a funny name, I guess I have it here somewhere, but here it is.
• 30:46
  Dr. Naomi Busch: It's libidin sirin anyways.
• 30:50
  Dr. Naomi Busch: And it got through the process and is on the market.
• 30:53
  Dr. Naomi Busch: It's really expensive.
• 30:54
  Dr. Naomi Busch: Many insurance companies don't pay for it.
• 30:56
  Dr. Naomi Busch: So then people are ending up paying out of pocket hundreds of dollars for it.
• 31:01
  Dr. Naomi Busch: And it's a medication that when you look at the studies, okay.
• 31:04
  Dr. Naomi Busch: Okay.
• 31:05
  Dr. Naomi Busch: Like sometimes in some studies, it's like 0.
• 31:07
  Dr. Naomi Busch: 5 more satisfying sexual events a month.
• 31:10
  Dr. Naomi Busch: So it's like less than one and it got approved.
• 31:13
  Dr. Naomi Busch: But then you have testosterone that's somewhere between like one and two, it's like not quite two, but it's better than Abby, it's more than one sexually satisfying event.
• 31:22
  Dr. Naomi Busch: And that's still not that much.
• 31:23
  Dr. Naomi Busch: But still, that's what the meta data shows with testosterone.
• 31:26
  Dr. Naomi Busch: And you're like, okay, so let's look at side effects, right?
• 31:28
  Dr. Naomi Busch: Like side effect profile.
• 31:30
  Dr. Naomi Busch: Okay, what terrible thing will testosterone at like these low doses do to you get maybe if you're like overdosing a little bit because you know, it's so imprecise, right, the measurement maybe you might get acne and maybe some hair loss, right?
• 31:44
  Dr. Naomi Busch: You're not going to get cardiovascular disease or hypertension or any of these things we think about with testosterone, because you're not going to have like, yeah, that I male dose of testosterone, you're going to have female dosing testosterone, right?
• 31:55
  Dr. Naomi Busch: Yeah.
• 31:56
  Dr. Naomi Busch: With Addy, like you can't, it's like my favorite line about it is that there's actually a warning on it about drinking alcohol and it basically says like you can't drink, and this is funny, right, because what do you think about like having a good night, right, like you're, you want to get it, you want to, you know, you want to, You're going out on a date.
• 32:15
  Dr. Naomi Busch: You want to be romantic with your husband, or your partner, or your boyfriend, or just some random person.
• 32:19
  Dr. Naomi Busch: You want to be romantic, right?
• 32:21
  Dr. Naomi Busch: And so you feel like this person is taking their Addy, and then it says you can't take it during the day.
• 32:27
  Dr. Naomi Busch: You have to take it at night.
• 32:28
  Dr. Naomi Busch: Okay.
• 32:29
  Dr. Naomi Busch: And then it says you, in, in terms of alcohol, the packaging says, wait at least two hours after drinking one to two alcoholic beverages to take the drug.
• 32:39
  Dr. Naomi Busch: If you've had three or more drinks, skip the dose until the next night, because you can just fall out.
• 32:44
  Dr. Naomi Busch: You become hypotensive and have a, and syncope.
• 32:46
  Dr. Naomi Busch: And so I was like, really?
• 32:50
  Dr. Naomi Busch: So this drug came to market and everyone was like, that's fine.
• 32:54
  Dr. Naomi Busch: But we're not going to allow women to get FDA approved testosterone.
• 32:58
  Dr. Komal Patil-Sisodia: Well, I was talking to one of my gynecology colleagues gosh, a few weeks ago, and she was telling me that back in the day there was in the United States and approved testosterone product for women that went off the market.
• 33:09
  Dr. Komal Patil-Sisodia: And I was, there was a pellet actually.
• 33:13
  Dr. Komal Patil-Sisodia: Yeah, I think she said it was something different.
• 33:15
  Dr. Komal Patil-Sisodia: It might have been a cream.
• 33:17
  Dr. Komal Patil-Sisodia: But I don't know.
• 33:17
  Dr. Komal Patil-Sisodia: She's a gynecologist and she couldn't remember the name of it either, but we went back and forth on it.
• 33:22
  Dr. Komal Patil-Sisodia: And so it really makes me somewhat apprehensive when you look at these things and you do a side by side comparison.
• 33:29
  Dr. Komal Patil-Sisodia: I know there's A lot of push now, to consider using the male testosterone formulations, the cream, the gels or creams and dosing them at a 10th which I've tried with a few patients.
• 33:39
  Dr. Komal Patil-Sisodia: It's been interesting.
• 33:40
  Dr. Komal Patil-Sisodia: Definitely
• 33:41
  Dr. Naomi Busch: makes.
• 33:41
  Dr. Naomi Busch: And sometimes I think, so this is the only, this is one of the few places that I think compounding, like a good compounding pharmacy that knows that's well known for hormones.
• 33:52
  Dr. Naomi Busch: There are there's some in our neighborhood, on the east side.
• 33:54
  Dr. Naomi Busch: There's a, there's one that's really great on the east side.
• 33:57
  Dr. Naomi Busch: I do think that I use both compounded testosterone cream as well as the gel, and I have had better luck with managing things with the compounded cream, because you can just say, I want two milligrams a day.
• 34:09
  Dr. Naomi Busch: And then they say, okay, is that going to be one click or two?
• 34:11
  Dr. Naomi Busch: And you're like one click.
• 34:13
  Dr. Naomi Busch: One click of two milligrams, right?
• 34:16
  Dr. Naomi Busch: And whereas if someone's measuring on their finger, and this tube should last 10 days.
• 34:20
  Dr. Naomi Busch: Good luck.
• 34:21
  Dr. Naomi Busch: Even then, it's not the same dose, right?
• 34:23
  Dr. Naomi Busch: So like, a tube lasting 10 days is five milligrams a day.
• 34:27
  Dr. Naomi Busch: Yeah,
• 34:27
  Dr. Komal Patil-Sisodia: We told patients to buy the baker's scales off Amazon that measure to 0.
• 34:32
  Dr. Komal Patil-Sisodia: 5 gram and put it in a little thing until they get 0.
• 34:36
  Dr. Komal Patil-Sisodia: 5 grams.
• 34:37
  Dr. Komal Patil-Sisodia: I mean, that was the only way we could think of doing it because the finger seemed so imprecise, right?
• 34:42
  Dr. Komal Patil-Sisodia: But, now you're telling people that they have to buy baker's scales.
• 34:45
  Dr. Komal Patil-Sisodia: I don't know.
• 34:47
  Dr. Komal Patil-Sisodia: I don't
• 34:48
  Dr. Naomi Busch: know.
• 34:48
  Dr. Naomi Busch: It works.
• 34:49
  Dr. Naomi Busch: I know.
• 34:49
  Dr. Naomi Busch: So my hack was just to have people get the tube form, right?
• 34:53
  Dr. Naomi Busch: And it's worded into a five cc syringe, like push, you know,
• 34:56
  Dr. Komal Patil-Sisodia: that's a smart idea too.
• 34:58
  Dr. Naomi Busch: And then just the air out.
• 34:59
  Dr. Naomi Busch: And then I said, now, you know, these are well, these are women who can do this.
• 35:02
  Dr. Naomi Busch: I mean, not every, this is a very privileged population we're working with.
• 35:05
  Dr. Naomi Busch: Right.
• 35:06
  Dr. Naomi Busch: So then I'm like, okay, look at the five cc or like, you could bring it in.
• 35:09
  Dr. Naomi Busch: If you don't know how to do it.
• 35:09
  Dr. Naomi Busch: I always tell people bring it in.
• 35:10
  Dr. Naomi Busch: If you don't know what I'm talking about, look at it.
• 35:12
  Dr. Naomi Busch: And then we'll have to divide it by 10.
• 35:14
  Dr. Naomi Busch: Okay.
• 35:14
  Dr. Naomi Busch: And then that's the dose you take.
• 35:16
  Dr. Naomi Busch: So if it's at the five, I don't even know how much liquid is in one of those tubes.
• 35:20
  Dr. Naomi Busch: That makes sense.
• 35:20
  Dr. Naomi Busch: Yeah.
• 35:21
  Dr. Naomi Busch: I've asked pharmacy.
• 35:22
  Dr. Naomi Busch: They're like, I don't know.
• 35:23
  Dr. Naomi Busch: And I'm like, what do you mean?
• 35:23
  Dr. Naomi Busch: You don't know.
• 35:24
  Dr. Naomi Busch: So I think it's probably not five CCs.
• 35:26
  Dr. Naomi Busch: I need to buy some testosterone and squirt it into a tube.
• 35:29
  Dr. Naomi Busch: And then I'll, we'll know how big.
• 35:32
  Dr. Naomi Busch: If it accidentally gets all over me, that's okay.
• 35:34
  Dr. Naomi Busch: But I do think that, so that's one way that I have had people measure it.
• 35:38
  Dr. Naomi Busch: And then I go back to like just simple primary care 101, which is you know, when we, when I was treating eczema or any other dermatitis with steroid creams, I would say we would measure it in finger, fingertip units.
• 35:48
  Dr. Naomi Busch: So I teach people how to.
• 35:50
  Dr. Naomi Busch: measure things on a fingertip, right?
• 35:52
  Dr. Naomi Busch: And I'm like, okay, so this is your fingertip.
• 35:54
  Dr. Naomi Busch: And so I want you, I'm like looking at their fingertip.
• 35:56
  Dr. Naomi Busch: I have to look at their hands and say, okay, I want you to use half of the fingertip.
• 36:00
  Dr. Naomi Busch: Yeah.
• 36:01
  Dr. Naomi Busch: And we do it on babies.
• 36:02
  Dr. Naomi Busch: We have been for years, I mean, decades using this idea of fingertip.
• 36:06
  Dr. Naomi Busch: Dosing, which all of a sudden when you go to testosterone, all of a sudden we're like, oh, it's not precise enough, but I'm like it seems precise enough for like high potency steroid cream, right?
• 36:16
  Dr. Naomi Busch: But, and so then I just think that's another way that we paternalize and trivialize like a woman's experience.
• 36:21
  Dr. Naomi Busch: It's she can't know how much she's taking every day.
• 36:23
  Dr. Naomi Busch: They know.
• 36:24
  Dr. Naomi Busch: Right.
• 36:24
  Dr. Naomi Busch: But I tell them, it's just that the problem is to me that those five, that it would probably be around five milligrams.
• 36:31
  Dr. Naomi Busch: And I usually start people on the compounding stuff on one to two milligrams,
• 36:35
  even a micro
• 36:37
  Dr. Naomi Busch: or micro dose.
• 36:39
  Yeah.
• 36:40
  Dr. Naomi Busch: So I have seen their testosterone jump from like 10 to like 50 with the fingertip with using a tube for 10 days.
• 36:49
  Yeah.
• 36:49
  Dr. Naomi Busch: Tell them to do it every other day if they want less.
• 36:52
  Dr. Komal Patil-Sisodia: Yeah.
• 36:52
  Dr. Komal Patil-Sisodia: Yeah.
• 36:53
  Dr. Komal Patil-Sisodia: Those are great tips.
• 36:55
  Dr. Komal Patil-Sisodia: I'm like, sure.
• 36:57
  Dr. Komal Patil-Sisodia: Thank you so much for sharing all of your information with us and having this conversation with me.
• 37:03
  Dr. Komal Patil-Sisodia: I think it's so intimidating when women go into ask for help for perimenopause or menopause.
• 37:09
  Dr. Komal Patil-Sisodia: You've broken it down in such a nice way.
• 37:11
  Dr. Komal Patil-Sisodia: I love your approach with patients.
• 37:13
  Dr. Komal Patil-Sisodia: Can you tell our listeners where they can find you if they happen to be local and in the Seattle
• 37:17
  Dr. Naomi Busch: area?
• 37:17
  Dr. Naomi Busch: Yeah.
• 37:18
  Dr. Naomi Busch: Sure.
• 37:18
  Dr. Naomi Busch: So if you're local in the Seattle area and you want to come and see me in person you can see me in Green Lake.
• 37:23
  Dr. Naomi Busch: That's where my office is, but my website is seattlemenopause.
• 37:26
  Dr. Naomi Busch: com.
• 37:27
  Dr. Naomi Busch: And I also do telehealth.
• 37:29
  Dr. Naomi Busch: So I have patients all over the state of Washington that come to see me and it's very fun.
• 37:35
  Dr. Naomi Busch: I don't think you need to be seen in person unless something's happening.
• 37:38
  Dr. Naomi Busch: And that it needs to be physically examined.
• 37:40
  Dr. Naomi Busch: So I think we can do a lot of menopause care telehealth.
• 37:43
  Dr. Naomi Busch: They can just go to my website and look at, click on schedule and see what my schedule is like.
• 37:48
  Dr. Komal Patil-Sisodia: All right.
• 37:49
  Dr. Komal Patil-Sisodia: Wonderful.
• 37:49
  Dr. Komal Patil-Sisodia: Thank you so much for your time.
• 37:51
  Dr. Komal Patil-Sisodia: This has been really enlightening and I'm excited to.
• 37:55
  Dr. Komal Patil-Sisodia: Send some of my friends and family your way so that they can get some relief for their symptoms.
• 38:01
  Dr. Komal Patil-Sisodia: It's great.
• 38:01
  Dr. Komal Patil-Sisodia: I mean that we have such a wonderful resource locally here.
• 38:05
  Dr. Komal Patil-Sisodia: So thank you for taking the time today.
• 38:07
  Dr. Komal Patil-Sisodia: Really appreciate it.
• 38:08
  Dr. Naomi Busch: No problem.