Latest / Gladden Longevity Podcast / Unlocking the Secrets of Hormonal Health - Episode 285

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Unlocking the Secrets of Hormonal Health - Episode 285 · Gladden Longevity Podcast

• 0:00
  Welcome everybody to this edition of the Gladden Longevity Podcast.
• 0:04
  I'm your host, Dr.
• 0:05
  Jeffrey Gladden, and I'm here with a preeminent scholar and lovely individual, Sarah, Dr.
• 0:13
  Rett, Dr.
• 0:14
  Sarah.
• 0:15
  So welcome to the podcast.
• 0:17
  Hi, Dr.
• 0:18
  Jeffrey.
• 0:18
  Thanks for having me.
• 0:19
  Appreciate it.
• 0:20
  absolutely.
• 0:21
  So let me, we're going to talk about hormones and we're going to talk about them in some really interesting ways that maybe the audience hasn't heard about or thought about.
• 0:29
  So I'm excited for that conversation, but how did you get into hormones?
• 0:34
  I'm sure, um you know, when you were five years old, you thought, well, when I grew up, I want to be a hormone doc, right?
• 0:39
  So how did that actually happen?
• 0:41
  You know, it's, like, was minding my own business.
• 0:43
  I was a pathologist.
• 0:45
  So always interested in the pathophysiology of the body science, like math, engineering.
• 0:50
  This is what I did before, like I was in residency.
• 0:53
  And then I started going through my own health problems in my thirties.
• 0:58
  Like I had delivered my son and then just really just the wheels fell off the bus and all of the things that I knew and had been taught that like, I really had to like relearn,
• 1:07
  like throw it up in the air.
• 1:08
  And like, learned it all because I had not learned any, none of the tools that I'd learned in medicine could even help me feel better.
• 1:14
  I could not get well.
• 1:16
  had autoimmunity.
• 1:17
  I was like sick, right?
• 1:19
  Like I really was struggling and didn't even know how to heal like autoimmunity.
• 1:24
  Like how can you go through an entire pathology residency and not understand the immune system enough in order to reverse autoimmunity?
• 1:30
  Medicine does not do this, right?
• 1:31
  So these were the challenges that I was faced and I was determined to feel better.
• 1:35
  I wanted to be young and feel young and feel 36.
• 1:38
  And I think the problem is that there's nothing for women.
• 1:41
  And we can talk about this discrepancy, but when I really got into it, when I realized it was hormonal, and then I realized that I probably had problems my whole life.
• 1:50
  And if we look at like, we don't even understand some women.
• 1:54
  then I've learned that I was a fast metabolizer of hormones.
• 1:57
  And this is where we have not studied a lot of this metabolism, these genes and these SNPs that.
• 2:03
  Right.
• 2:04
  make us different.
• 2:04
  Why was I different than my other friends who maybe weren't going through something at age 36?
• 2:08
  And when I tried all of the products on the market, literally all of them, I began to realize that we have been ignoring this problem for women for decades.
• 2:16
  We have solutions for menopause.
• 2:18
  And when we look at women, we'll help them.
• 2:20
  Like if you're menstruating and you are having your period, we do not intervene.
• 2:24
  Your solution is birth control period.
• 2:26
  And then once your period has stopped and your menopausal for a year, you get hormone replacement therapy.
• 2:31
  We don't tell men that they, won't give you testosterone until you're done making sperm.
• 2:36
  You have to be done making sperm for a year and then we'll give you testosterone.
• 2:39
  But we tell women that they can't have hormone replacement therapy until they're done having their period.
• 2:43
  And then we know a lot about pregnancy, right?
• 2:46
  We can help women get pregnant, with OB-GYNs are trained to deliver babies.
• 2:49
  So these two populations, we help a lot.
• 2:51
  If you're trying to get pregnant or if you're done with your period.
• 2:54
  But this whole age group of women who are doing neither of those and menstruating.
• 2:59
  has no solutions, no products, nothing.
• 3:02
  If you try it, patch and a pill and then modern day formulations for HRT, they're not gonna work for a 36 year old.
• 3:07
  And this is where my journey began.
• 3:10
  Okay.
• 3:10
  Well, yeah, that makes a lot of sense.
• 3:13
  You know, when you think about it, just listening to what you're saying there, I think that hormone issues for women can almost begin at puberty, quite honestly.
• 3:21
  Not everybody has a smooth cycle, right?
• 3:25
  I mean, there's a lot of things that go awry early on.
• 3:28
  um Things like endometriosis and PCOS and, you know, all kinds of things that kind of flare up or get started early in life, quite honestly, and people are left kind of
• 3:38
  dangling just saying well just kind of I don't know what they tell girls but something so Yeah,
• 3:45
  traditional doctors are doing.
• 3:46
  And women, young women are being disproportionately impacted by the environment over men.
• 3:52
  And it's like we have plastics, phthalates, which are fragrances.
• 3:55
  We have a beauty, we're indented with a beauty routine.
• 3:58
  We have chemicals, pesticides.
• 4:01
  These bind to the estrogen receptor.
• 4:03
  We call them estrogens, which drives me crazy because they're not estrogen.
• 4:07
  They bind to the estrogen receptor.
• 4:09
  and they prevent your own estrogen from binding.
• 4:11
  And that's why women are having these really heavy periods when they're 16 and 17.
• 4:16
  And yeah, so you're right.
• 4:16
  This is really impacting us early on.
• 4:19
  Putting them on birth control is making the problem worse.
• 4:22
  Now you have a woman who's 25 who's been on birth control for 10 years and full blown endometriosis.
• 4:28
  Yep.
• 4:29
  No, it's a mess.
• 4:30
  Yeah.
• 4:30
  These hormone disruptors are really a huge thing.
• 4:32
  They're actually a big thing for men and women, quite honestly.
• 4:35
  mean, sperm counts are going down, right?
• 4:36
  Infertility is going down.
• 4:38
  Testosterone levels are falling.
• 4:41
  So there's a lot of environmentally driven hormone disruptors, let's call them, that are hitting both sides of the fence um a little bit differently.
• 4:51
  But nonetheless, I think humanity is suffering.
• 4:53
  ah
• 4:54
  right.
• 4:54
  And it's like a crisis.
• 4:55
  Like we need to be looking at it and realizing that it is a crisis.
• 4:59
  I feel like even smart people, when we talk about it, the doctors that are hormone replacement therapy specialists and longevity, they still refer to these chemicals as
• 5:08
  estrogens.
• 5:08
  And so we're still giving this message that estrogen is making men lose their sperm.
• 5:12
  Estrogen is making women have the endometriosis.
• 5:15
  And this is really damaging because it's not estrogen that's doing this.
• 5:18
  It's the chemical that's doing this.
• 5:19
  That's right.
• 5:21
  No, you're right.
• 5:21
  You're absolutely right.
• 5:23
  um yeah, let's talk.
• 5:27
  You know, it seems like there's so many forks in the road when it comes to women in estrogen, right?
• 5:31
  Because you have, or women in hormones, because you have people that are going down the path of PCOS.
• 5:37
  You have women that are developing endometriosis, things like that.
• 5:41
  Do you want to give us maybe, and it may be impossible to answer this question, but is there kind of a unifying?
• 5:48
  thesis here that kind of holds this all together in your mind.
• 5:52
  a hypothesis that I'm not like, necessarily going to be right, but I feel like you can, we can tie it together.
• 5:57
  And if you were to say that one, all the whole root of all of these problems are one thing, endometriosis, PCOS, early perimenopause, menopause, menopause, like all of it,
• 6:08
  heavy painful periods, like it's a spectrum of disease.
• 6:11
  So you could even be having endometriosis symptoms, but not have any metriosis.
• 6:15
  can have PCOS symptoms, but not have PCOS, you know, it's a spectrum and they're all caused by.
• 6:20
  low estrogen and progesterone say in women?
• 6:23
  And why does it impact some women more than others?
• 6:26
  And I think this is a question that we should really be asking and it could be genetic and it could be these snips that we're not studying that we need to study.
• 6:32
  So for example, let me paint a picture of a woman for you that has ADHD.
• 6:38
  She's thin, she's um has a lot of anxiety in her 20s, and then she develops endometriosis later, heavy painful periods.
• 6:46
  And then she goes on to develop like she doesn't get any help, maybe even has surgery.
• 6:50
  and still develops early perimenopausal or ADHD symptoms get worse.
• 6:53
  She's put on pharmaceuticals, antidepressants, anti-anxiety medication, birth control to stop her period, everything gets worse.
• 7:00
  Why did this woman develop endometriosis instead of PCOS when probably it was all the same reason?
• 7:05
  And these could be, the reason could be these underlying genetic factors.
• 7:09
  Like what if this endometriosis patient had COMT, the fast metabolizer, and this is what gave her this clinical picture as opposed to a PCOS picture where you're growing hair on
• 7:19
  your face and losing your hair.
• 7:20
  gaining weight, becoming insulin resistant, your testosterone's getting high.
• 7:24
  These two women diverged and went into completely different directions, even though the problem was the same problem, and maybe even the treatment is the same.
• 7:33
  why did it, and it could underlie the way the hormones are being metabolized, and we're not paying attention to it.
• 7:39
  We think that the liver just metabolizes estrogen, and it's done.
• 7:43
  But we know that actually there's probably methylation pathways that we could look at.
• 7:47
  The estrogens being methylated in different tissues in the brain and then being eliminated really quickly.
• 7:52
  so, you know, along with dopamine, so she's becoming worse.
• 7:56
  Her clinical picture is severe with endometriosis.
• 8:00
  And then you have other women who, their hormones might drop, but they're not metabolizing it as quickly.
• 8:04
  So they kind of fly under the radar until menopause.
• 8:07
  Like, why did I do worse than another woman?
• 8:10
  was healthy, you know what mean?
• 8:12
  And so I'm a carrier of a COMT gene, right?
• 8:15
  So this is a SNP.
• 8:17
  So this is like fascinating something that we should do research.
• 8:21
  Women are not being researched enough.
• 8:22
  Yeah, I agree with you.
• 8:25
  don't think people are deconstructing these problems sufficiently, right?
• 8:29
  That's the way that I tend to think about it.
• 8:31
  And there are a lot of interlacing snips here, right?
• 8:34
  So there are snips that really predispose you to anxiety and predispose us to depression or things like that.
• 8:41
  There are also genes that predisposes to insulin resistance or being late to the party, as I call it, where really, increments don't...
• 8:51
  get released when sugar comes in and you really don't really start releasing insulin until your sugar is already spiked, right?
• 8:57
  And then, so there's lots of different genes that play with each other here.
• 9:01
  And I think probably the interplay of the various genes probably determines some of the phenotypic expressions, right?
• 9:07
  Which pathway you go down.
• 9:08
  um But I think it's for each individual, it's kind of a knot that you have to unravel.
• 9:15
  You have to look at the genes related to all those features um and then say, okay.
• 9:21
  Here's how we take care of all of this, right?
• 9:24
  That's kind of how I would think about it, so.
• 9:25
  agree.
• 9:26
  I think it's also important to remember that genes are, I mean, excuse me, hormones are so powerful that they directly impact and influence genes.
• 9:35
  So like gene expression, you can literally express and turn off certain genes on hormones.
• 9:40
  So for example, there's a gene that women have the ability to make choline because it's so important for baby and baby development.
• 9:49
  And we can make choline.
• 9:51
  And estrogen turns on that expression of that gene.
• 9:54
  So when you get pregnant, your estrogen gets to 40,000, you're able to make more choline.
• 9:58
  When you get through menopause and your estrogen goes to zero, like our choline also, production goes to zero and nobody's eating eggs because apparently we're told that eggs
• 10:05
  are bad or something.
• 10:06
  So nobody's eating eggs.
• 10:07
  then women's gallbladders become very, very bad and sluggish.
• 10:11
  And they have to get them out and get gallstones.
• 10:13
  And people are blaming it on estrogen.
• 10:14
  I'm like, no, the problem is there's no estrogen to protect your gallbladder.
• 10:17
  There's nothing there to make choline for you.
• 10:20
  And so these, like gene expression with hormones, like this is what also gives us like feminine and male features.
• 10:26
  Like these are powerful, hormones are very powerful.
• 10:28
  You know, when you think about the fact that more women suffer from dementia than men also, right?
• 10:35
  And we know that, again, genes that interplay with each other, right?
• 10:40
  APOE4, APOC1, Tom40, genes like that that are predisposed to Alzheimer's, that it's really, really critical for men's brains and women's brains to have adequate estrogen.
• 10:53
  And so a lot of men get testosterone, they get put on anastrozole, then...
• 10:57
  their estrogen levels go down and you know, cardiovascular impacts, bone density impacts, even abdominal obesity is worse and their brains don't function well, right?
• 11:07
  So there's a lot of disservice being done on both sides of the fence here, I think, because it's not really adequately deconstructed.
• 11:14
  It's you're right.
• 11:15
  Like we're saying the estrogen is bad and it's bad for men too.
• 11:17
  And so you're right.
• 11:18
  Actually estrogen makes their skin glow.
• 11:20
  It protects them from disease.
• 11:22
  We know that at night when we're sleeping, estrogen helps the cerebral spinal fluid like cleanse the brain.
• 11:28
  And that's possible.
• 11:29
  Maybe it works in men.
• 11:30
  I know it works that way.
• 11:31
  And does this, you know, it's like this really complex neuroendocrine system in the brain is hormone dependent and like
• 11:38
  all this when you look at the studies like they're they're they're answering this question of can we prevent dementia in like a 55 year old we should be thinking about you need to
• 11:46
  prevent dementia is like a 35 year old like you need to keep that mental clarity and sharpness and prevent the brain fog and keep this going at a very young age not like
• 11:55
  postmenopause
• 11:56
  I actually think when a baby's born, we should be doing genetic testing, right?
• 12:00
  And we should understand, okay, where are the liabilities?
• 12:02
  Where are the assets?
• 12:03
  How are these SNPs going to play together?
• 12:06
  Is there something weird we don't know about so we can at least be aware of it?
• 12:10
  And then, you know, then you start to play the orchestration of that, right?
• 12:14
  Okay, you're hitting puberty.
• 12:16
  Okay, well, let's actually start measuring hormones and hormone metabolites because it's one thing to know you're a fast metabolizer, but I've been impressed that you can measure
• 12:24
  how the...
• 12:24
  Metabolites are coming out.
• 12:26
  may not match the genetics also.
• 12:27
  Apparently there's some other override that can happen.
• 12:30
  So um maybe we start testing more comprehensively hormone profiles in people at younger ages, maybe even 10 year olds.
• 12:38
  Or I know I'm thinking 10 year olds pre puberty.
• 12:41
  Maybe you have to go down to eight years old.
• 12:42
  I don't know.
• 12:43
  But to get an idea where you're headed right so you can actually help people have a good, good, healthy life here.
• 12:50
  I love it.
• 12:51
  Like it would take this like idea that we need to start realizing that hormones are protective and beneficial and that we need to keep them optimal at all times.
• 12:58
  And it's almost like people are not there mentally.
• 13:00
  They need to keep, make that leap first before we're testing.
• 13:03
  But I agree.
• 13:03
  It's the best way to personalize it.
• 13:05
  I had a doctor friend who did test his 12 year old son and his testosterone levels were 1800.
• 13:11
  at 12 years old.
• 13:13
  knowing just like when they peak, making sure that that child does undergo puberty, that is peaking and it's doing what it's supposed to be doing.
• 13:20
  And then when it falls off in the 20s so that you can maintain health.
• 13:23
  It's about maintenance and prevention.
• 13:25
  If you can maintain your health and be optimal.
• 13:28
  But like we still have this like problem with women and birth control.
• 13:32
  Like women, birth control suppresses hormones.
• 13:35
  and then you're not going to ever be, but we have a women do not want to get pregnant.
• 13:39
  I think we do have to need to address this for them and like, because yeah.
• 13:42
  I agree, but they have, you you end up with progestins and you end up with no testosterone.
• 13:49
  And I mean, it's really, it's almost like, uh, it feels like the worst thing you can possibly do to a human being.
• 13:54
  the worst thing you can do.
• 13:55
  Like, I don't know, one, I mean, one would argue that getting pregnant is the worst thing that could happen to them.
• 14:00
  Okay.
• 14:00
  So in that, in this case, the birth control risk.
• 14:04
  Yeah.
• 14:04
  Okay.
• 14:05
  So that's what it's for.
• 14:06
  word thing, so to speak, but nonetheless, it's still on the bad side of the ledger here by a long way.
• 14:11
  control for everything, like to fix everything.
• 14:12
  you have acne, let's give you birth control.
• 14:14
  Like, you have a mood disorder, we'll give you birth control.
• 14:16
  And birth control, like when women have understood that it's probably the worst thing you can do for your health because it is taking away your protective hormones.
• 14:22
  It is not hormone.
• 14:23
  It is like doing the opposite for you.
• 14:26
  And even if we could get women to understand, there's no informed consent.
• 14:29
  Doctors are not telling them in this, like, I'm going to take away your hormones.
• 14:35
  I don't think doctors know, like, I don't think they get it.
• 14:37
  They don't understand.
• 14:38
  Yeah, they don't.
• 14:39
  I think it impacts bone density.
• 14:40
  It certainly impacts or can impact libido in many respects.
• 14:44
  I don't, you know, and then some people have difficulty with fertility when they try to come off them.
• 14:48
  Right.
• 14:48
  Of course.
• 14:48
  So.
• 14:50
  Yeah.
• 14:52
  talking gut health, like it interrupts your entire gut health.
• 14:55
  But I think the biggest thing is mental health for women.
• 14:57
  We see this huge wanting suicidal ideation, they get anxiety, they get depression, they do not feel well.
• 15:04
  Mental health when you start birth control is humongous, and this is probably the biggest problem I see.
• 15:09
  You can deal with a little bit of gut health probably issues, but when you feel suicidal or not, well, this is not good.
• 15:15
  Mm hmm.
• 15:16
  Yeah.
• 15:17
  So if you were going to outline kind of, let's just say you have carte blanche to actually redo the system, how would you, how would you actually set it up?
• 15:30
  I see a future, a world where you would have a healthy population if you were to maintain these optimal hormone levels your whole life.
• 15:37
  This is something that we know that you can maintain your metabolic fitness this way.
• 15:41
  um And I think people would probably push back and argue that it's not, that I do think it's the root cause of gut problems, leaky gut, SIBO, cortisol.
• 15:51
  um We see when your hormones drop, you start aging.
• 15:55
  Like it is foundational to the longevity period.
• 15:58
  when you like your hair and skin and wrinkles, is like estrogen is your best anti-aging longevity drug and progesterone is there to counterbalance it and make sure that it's like
• 16:09
  in check because you need them both.
• 16:11
  But um if in a perfect world and if I could redo it, everybody would be healthy because we would and we really these chemicals that are like, they absolutely need to be not ignored.
• 16:22
  We need to address that they're binding to the hormone receptors and completely disrupting people.
• 16:28
  Yeah, I think that's right.
• 16:30
  think cleaning up the environment is kind of the place to start because um
• 16:35
  I also think that like in a perfect world, we would recognize that reference intervals and laboratory testing are not accurate to dose hormone replacement therapy.
• 16:46
  That we really should be looking at what the brain is thinking in these feedback loops with FSH and LH and what does the brain think?
• 16:52
  We tend to think like that hormone levels are high, but women feel great on it.
• 16:56
  So what is the problem?
• 16:57
  And also we don't even know what high is.
• 16:59
  haven't established them.
• 17:00
  We should be looking at genes.
• 17:01
  Like we're talking about how do you metabolize it?
• 17:03
  Are you fast?
• 17:04
  Are you slow?
• 17:05
  This, we would be able to optimize hormone replacement therapy better right now.
• 17:08
  It's a lot of guesswork.
• 17:10
  It's shooting in the dark.
• 17:11
  It's telling women that it's safe.
• 17:13
  Like, it's really scared.
• 17:14
  Like, weird.
• 17:14
  They're scared of it.
• 17:15
  You know, like, I think we need to get to a place where we really have fine, like, hormone medicine and longevity, it's like its own thing.
• 17:23
  The doctor, we need to really make it an excellent field.
• 17:27
  It has the potential to be.
• 17:29
  We just got a hold of a new test from Vibrant America.
• 17:32
  I don't know if you're familiar with the lab, Vibrant America.
• 17:35
  um They do a lot of really sophisticated testing, um gut testing.
• 17:40
  um And now they just came out.
• 17:42
  A lot of their tests carry the moniker Zoomer, right?
• 17:46
  So it'll be like a gut Zoomer or an oxidative stress Zoomer or whatever.
• 17:50
  So some reason they've attached a Zoomer.
• 17:52
  So they just came out with a hormone Zoomer, right?
• 17:55
  Which is actually, I just looked at the report because we...
• 17:59
  We do a lot of hormone testing here, genetic testing, hormone testing, hormone metabolite testing, right?
• 18:05
  Urine metabolites, things like that.
• 18:07
  And uh I was really impressed with the quality of this test.
• 18:11
  I mean, it's really kind of breaking things down.
• 18:13
  um And I have no financial ties to this company, but I think it's interesting to see that in the functional medicine, longevity space, that the labs are starting to realize the
• 18:28
  need here.
• 18:29
  And coming out with tests where you can go do a single test.
• 18:33
  And if you work with a doctor that knows how to interpret the test, right, you can actually get some really, really useful information just from a single test because it's
• 18:43
  so comprehensive.
• 18:45
  I don't think this particular one is doing genetics.
• 18:48
  have to go back and look at it.
• 18:49
  I know with the oxidative stress one, it does include oxidative stress genes as well, right?
• 18:54
  And then
• 18:54
  giving you markers across different compartments like lipid oxidation and DNA damage and oxidation, things like that, right?
• 19:01
  So super helpful.
• 19:03
  But I think it would be interesting to uh do genetics on kids so you actually know what cards they're holding and then actually start doing something like this, zoomer test,
• 19:15
  hormone zoomer test, several times during their childhood and then certainly when they hit puberty and then sort of...
• 19:22
  you know, marrying the things together between the genetics and their symptoms and and what you're measuring and get a feel for kind of how things are developing for them.
• 19:30
  Because I think you could avoid a lot of pain, quite honestly, for people.
• 19:35
  um It's impressive to me how many, you know, not being female, of course, but it's impressive to me how many women really struggle at various points in their cycle.
• 19:44
  Like I just I'm off for three days.
• 19:47
  I'm off for a week.
• 19:47
  I just don't feel like myself for, you know, however long it is.
• 19:51
  And
• 19:52
  If there are ways to understand that and mitigate that, know, maybe it's some adjunct progesterone or something, right?
• 19:59
  I think it'd be, I don't know, I'd be a big fan of us doing that, not waiting until people are, you know, 45, right?
• 20:07
  I have like, think that this, it's not normal to be so out of it for seven days.
• 20:13
  And just to like say that my period, because hormones dropped to like zero during the period and then a seven day period where you can't function and go to work.
• 20:21
  This is not like how our ancestors probably functioned.
• 20:23
  It was probably a very light, I mean, they wouldn't like have survived, but they were bleeding the way that women are today with like really heavy periods.
• 20:30
  uh And you would, I think that we also need to completely redo this cycling.
• 20:36
  idea that women, those studies were based on radioactive immune assays, which are very outdated.
• 20:41
  We would actually reject those papers today because the laboratory testing is so outdated.
• 20:46
  We don't even look at these papers anymore.
• 20:49
  But yet we still tell women that the estrogen peaks this way and progesterone peaks into cycle.
• 20:54
  Doctors base their practice on it.
• 20:56
  They're trying to get women to just take progesterone the last half of the month and to try to mimic this cycle.
• 21:01
  This cycle that's not based on
• 21:04
  current science is based on like 1950 year old immune assay science.
• 21:09
  We just need to like, does this how women really cycle what's happening?
• 21:12
  Because what should probably happen is if the hormone levels are optimal all month, she shouldn't notice like a five day drop in them.
• 21:19
  Because every tissue should still be functional and fine.
• 21:22
  And then when they start picking up again, she should feel good again.
• 21:25
  If she feels terrible for seven days of the month, they were low to begin with.
• 21:29
  you know, that's like, it makes sense that they were low all month.
• 21:32
  It's just now they're completely gone.
• 21:33
  and she's feeling terrible.
• 21:35
  um
• 21:36
  we can do testing where a person can actually test their hormones every day of the cycle.
• 21:41
  Right.
• 21:42
  We've done this for a few people to help them get pregnant, let's say, so we can actually map what's happening.
• 21:46
  um
• 21:47
  The is the variability and analytical variability, biological variability, hormones are being shuffled around.
• 21:52
  So mean, they can give you kind of a picture, sort of, and if you can do it every day like that, can kind of, maybe.
• 21:59
  And this is probably a lot more accurate, but I think they also need to be taken into account that it's what, like hormones are not supposed to be in the blood.
• 22:07
  It's like thyroid.
• 22:08
  If your thyroid's in the blood, it's supposed to be in the tissue and you can't measure what inside the cell what's going on with thyroid.
• 22:13
  oh
• 22:14
  That's right.
• 22:15
  thyroid conversion happens in the cell as well.
• 22:18
  So like the metabolism of the hormone is also in their end tissues that we're not measuring, right?
• 22:22
  Like in the brain and the uterus, like if the uterus is storing all the progesterone and we're measuring the blood, what are we doing?
• 22:27
  So I even think we need to look at like how we're thinking about the hormones and measuring them for it to make sense, because if they're in the blood, that's probably
• 22:34
  means are they being on their way out to being metabolized and getting rid of them?
• 22:39
  Like, why are they in the blood?
• 22:40
  Is that a peak?
• 22:41
  know, so this...
• 22:42
  there's going to be some in the blood, just like there's going to be some thyroid in the blood.
• 22:45
  But to your point, you know, what we have found with thyroid is that the blood work is not terribly reliable when it comes to actually managing somebody's thyroid.
• 22:56
  It's really resting metabolic rates, right, that we look at so that we can see what's happening at a tissue level.
• 23:01
  And then we look at genetics like the DIO2 in the brain, right?
• 23:04
  Can you...
• 23:05
  take the iodine off and make T3 in the brain because that's different than making it epistemically, right?
• 23:10
  So when you put all those pieces together, all of a sudden it's like, oh, we can get somebody feeling great again.
• 23:14
  I wish we had the equivalent of a resting metabolic rate for hormones, right?
• 23:19
  because you're right.
• 23:20
  Like we are not like you've perfected.
• 23:22
  Like I've never heard that before for thyroid and it sounds so much better than the way that other doctors are like chasing these lab tests.
• 23:27
  And it sounds exhausting when I don't do thyroid.
• 23:29
  That's not my specialty, but I do know that it is a complicated and I see that you have to chase and uh it's like I don't see it hair shedding, huh?
• 23:38
  We never chase the blood numbers.
• 23:40
  We never chase them.
• 23:41
  What we do is we do resting metabolic rates and we look at their genetics.
• 23:44
  And then we do look at that to see if there's reverse T3 or, you know, something like that, or if there's antibodies against the thyroid, like they have Hashimoto's.
• 23:52
  So we look at it for that.
• 23:53
  And we'd like to see that the TSH isn't zero, right?
• 23:58
  But we really base it on the resting metabolic rate.
• 24:01
  That's the set point.
• 24:02
  That's where the...
• 24:04
  thermometer is set or the thermostat
• 24:06
  We need like a comprehensive view of hormones that makes sense, especially for this very mental causal phase.
• 24:12
  Like we're telling women that they're estrogen dominant.
• 24:14
  your estrogen is high, but it's like, why did we get that high measurement to begin with when you're 45?
• 24:20
  You know, it doesn't even make any sense.
• 24:21
  And like, we're not thinking about it.
• 24:22
  We're just telling her that she doesn't need estrogen.
• 24:24
  Let's block it.
• 24:25
  Let's give her dim.
• 24:26
  It's wild.
• 24:27
  Like what we've not really have developed a very, for women, especially, I feel like for men, it's not perfect.
• 24:34
  But at least we've established those reference intervals based on like FSH.
• 24:38
  And we know that if I give you this much and kind of like, you know, we're shutting off this pathway, we've not done that for women.
• 24:43
  Like I want women to not pay.
• 24:44
  Like this has not been done for you.
• 24:46
  So if a doctor says that your estrogen's high, like what are they basing that off of?
• 24:51
  their own fear.
• 24:53
  It's like, it's actually, I'll tell you, it's their own fear of estrogen.
• 24:56
  I don't know how to do it.
• 24:57
  I don't know how to do HRT.
• 24:58
  So I'm going to fear it.
• 24:59
  It's not based on any, we have no science.
• 25:01
  Like I've seen, that's great.
• 25:05
  for especially for lab testing and establish like perimenopausal.
• 25:08
  We even tell women perimenopausal is a clinical diagnosis because the labs are so bad.
• 25:13
  Like this is embarrassing.
• 25:14
  But we need to have like a better way to like be able to tell a woman that she's perimenopausal.
• 25:19
  Yeah, I agree.
• 25:20
  You know, one of the things we are concerned about for men, of course, is developing prostate cancer, right?
• 25:26
  So we're, you know, we're pretty meticulous about looking at urine hormone metabolites, dihydrotestosterone, 4-hydroxyestrone, 16-hydroxyestrone, you know, making sure people can
• 25:37
  methylate, getting the COMT gene to work properly, you know, things like that.
• 25:42
  um And certainly many women uh are concerned about
• 25:47
  the risk of breast cancer because there are estrogen receptor positive breast cancers, right?
• 25:52
  And so, and there are genetics for men that um can make ah prostate cancer flourish in the face of androgens, right?
• 26:02
  So there's a lot of sort of balancing in people's minds here that goes on too.
• 26:07
  I know my mom who's now passed away would never take hormone replacement because she was so worried about breast cancer.
• 26:13
  She died from.
• 26:15
  you know, osteoporosis essentially was repeated falls.
• 26:17
  So, you know, uh it's almost like pick your poison a little bit, but.
• 26:22
  um
• 26:23
  I think it's like we, that whole breast cancer thing too, like if it's an ER positive, em if you have a receptor for estrogen progesterone on your cancer cell, this is a good
• 26:34
  thing.
• 26:35
  It's like, it means that the body has not lost its receptor and it's still responding to normal cellular body signals.
• 26:41
  If you lose those receptors, that cell is completely malignant and dangerous.
• 26:45
  And so like, but we look at in vitro studies where they grow in the presence of estrogen.
• 26:50
  but this is not what's potentially happening in the body where you have progesterone that suppresses growth potentially.
• 26:55
  So when you look at in vivo and like all the different mechanisms that are involved in cancer growth, and then we're simplifying it and saying that estrogen just makes your
• 27:02
  cancer grow.
• 27:03
  I feel like it's gross oversimplification.
• 27:05
  We're not doing any justice to women by keeping them away from estrogen.
• 27:09
  When these large scale like studies show that it's protective, like I think we really need to challenge this ER positive like.
• 27:16
  Pathologists, when they mark those and they just mark you are positive, they're just looking at stains, in-putro stains.
• 27:21
  But doctors interpret that as, if I give you estrogen, your cancer is going to grow.
• 27:26
  Can we just look at that and see?
• 27:28
  know what I mean?
• 27:28
  A little bit closer for women.
• 27:30
  Because even if we were like, you can't have hormone, like we do for men, if you have prostate cancer, you don't get testosterone replacement therapy.
• 27:38
  But if you're in remission, it's a choice for you.
• 27:40
  We don't do that for women.
• 27:42
  you ever have breast cancer, like,
• 27:44
  Forget it, nobody's ever gonna prescribe you hormone replacement therapy, but if you're in remission, you should be a candidate.
• 27:50
  Yeah.
• 27:50
  And I think, I think your point about combining it with progesterone, I think, you know, to balance it really, think, you know, biology is an economy of balance.
• 28:00
  It's not about pushing on one lever all the time.
• 28:03
  Right.
• 28:03
  So I think if you are going to use estrogen, I think if you're going to do any hormone replacement, it's important to really get the constellation of hormones.
• 28:12
  So I'm a big advocate of, you know, some DHEA, some testosterone, some progesterone, some estrogen, all of those.
• 28:19
  kind of working together and getting those balanced out for an individual.
• 28:22
  in men, you know, it's really about giving the testosterone, allowing them to make the estrogen, then making sure they're metabolizing it appropriately and helping them do that.
• 28:31
  um Make sure the DHT doesn't go too high, you know, things like that, that we don't want to be, you know, increasing risk.
• 28:38
  But if you balance it out and you give people the cocktail, if you will, of the hormones that they need, um I think that's the healthiest approach.
• 28:46
  At least that's our approach.
• 28:48
  You're absolutely, I completely agree with you.
• 28:50
  Like let the body do what it's normally doing.
• 28:52
  And you're just going to make sure that if you over make DHT that you block, just want to say that how important that is that you're just letting it.
• 28:58
  It's like, Hey, I'm to put you on tests.
• 29:00
  That's what I do for men too.
• 29:01
  When I used to treat them in clinic, I don't anymore, but it was like, Hey, I'm to put you in.
• 29:04
  And it's not my specialty, like, but I'm just saying, I'm also not a dad guy, but it's like, I'm going put you on testosterone and then I'm just going to see what your body
• 29:10
  does.
• 29:10
  Like if you get breast tenderness and nipple pain, then yeah, maybe you need to block a little bit of estrogen, but otherwise that estrogen is not doing you any harm.
• 29:17
  Or if you're, you know, like, and make sure you don't convert to DHT from that too.
• 29:23
  I agree.
• 29:23
  And then also when we look at men, like we understand the formulations.
• 29:26
  Like if I were to give a man testosterone cream, that more heavily converts to DHT.
• 29:31
  So you're more likely to like lose your hair and get acne.
• 29:33
  We know that pathway conversion, but we put women on testosterone cream all day long and they're like, know it's converting to DHT and potentially causing their hair to fall out.
• 29:41
  But yet we'll, so we, that's why we tend like for multiple reasons, we'll put men on.
• 29:45
  injections, one, don't want the cream to get all over the house, but like injections we know will more likely to convert to estrogen, right?
• 29:52
  And so even an injection is more appropriate for a woman for testosterone than a cream, you know, I mean, I don't know what your, but it's like, need to think, it doesn't matter.
• 30:01
  It's just kind like, we need to think about these formulations and they impact the way the hormones are converting to one another.
• 30:06
  We need to think about that before we give them a formulation.
• 30:09
  Formulations matter.
• 30:10
  We can't just like take it by mouth or put it through the skin or something and
• 30:14
  that outcome is gonna be completely different for that person.
• 30:17
  so people, doctors don't think about it.
• 30:19
  They're just like, for women at least, it's like a patch and a pill and a low dose vaginal cream and I'm done with you, go exercise, whatever.
• 30:25
  Yeah.
• 30:26
  You see these patches that have testosterone, progesterone and estrogen, you know, E2 and E3 and varying ratios.
• 30:32
  it's a little bit, know, progesterone is not that well absorbed through the skin, honestly.
• 30:39
  Right.
• 30:41
  Exactly.
• 30:42
  So it's, we find it all a little bit sad, really.
• 30:46
  I was going to say comical, but it's a little bit sad is really what it is.
• 30:49
  Yeah.
• 30:53
  Yeah.
• 30:53
  We do injectable testosterone for women also.
• 30:56
  uh We have we've done that many, many times.
• 31:00
  The one thing we bump into is some people just don't want to take an injection.
• 31:04
  Right.
• 31:04
  So then you're a little bit stuck because we don't want to give them oral testosterone either.
• 31:08
  That's a little rough on the liver.
• 31:09
  So then we do use, you know, gently use some topical and see where we go and track it.
• 31:14
  oh But, yeah, I think if you're listening to this, I think, you know, it sounds like a lot of.
• 31:21
  a lot of hormone soup here, I suppose.
• 31:23
  But really the bottom line is you want to work with somebody that can actually deconstruct this for you to where you understand your genetics, you understand your family history,
• 31:32
  you understand the risks that are there.
• 31:34
  And then you actually understand uh the risks of what it is for you not to have hormones.
• 31:39
  Right.
• 31:40
  And and you have somebody that can talk you through that, whether it's dementia or bone density or muscle mass or, you know, lots of other things.
• 31:48
  uh
• 31:49
  and then work with them to actually uh test it appropriately.
• 31:53
  So I think that's the key.
• 31:56
  Um, yeah, some, yes and no.
• 31:58
  Like I, I agree with all of that, but like testing, would say like, yes, you can get tests, like, but more importantly, work with the provider that will ignore the tests.
• 32:06
  Like they'll test you, but then they'll also ignore it if they need to be that they understand that the limitations of the testing and they're like, and then I'm listening to
• 32:15
  you and you're telling me, feel amazing.
• 32:17
  I'm going to ignore your tests or you're telling me that there's still something wrong with you.
• 32:20
  Let's try to dive into it, even though your labs are completely normal and good providers will do that.
• 32:25
  They can understand.
• 32:26
  That's right.
• 32:27
  Now you treat the patient not to test is what you're saying.
• 32:30
  And I think that's right.
• 32:31
  think, yeah, what I'm trying to say is that ah it's a complex enough situation that it's nice to have some testing to give you some sense of where you are relative to some of
• 32:39
  these things.
• 32:39
  So, yeah, yeah, no, that's good.
• 32:42
  That's very good.
• 32:43
  So what about starting hormones for younger people?
• 32:48
  Talk to us about that a little bit, because I think, you know, you started off talking about how
• 32:53
  People didn't get hormones until they were a year after their last menses or last period.
• 32:58
  um And now really, people are understanding that kind of in this pre menopause, peri slash early peri, let's call it menopause, that hormones can be really, really impactful.
• 33:12
  Talk to us a little bit about that.
• 33:14
  Yeah, I would even argue that it should be 21 and above, know, or 18 and above, that we really don't need to like pigeonhole women into these definitions.
• 33:22
  Like we don't call it men, we don't say men are andropos and periandropos and like we don't pigeonhole women, we're just like, you have all this.
• 33:29
  not giving them testosterone either.
• 33:31
  We're kind of just counting on biology to do its thing, right?
• 33:34
  Sometimes, but it's not like, you know, maybe it recovers faster than men too, but I think we don't need to like wait until a woman is perimenopausal either.
• 33:42
  Like if she has clear signs and she's in her twenties, that she needs it and she's tried to eliminate all that.
• 33:47
  She's tried everything.
• 33:48
  Like she deserves hormone replacement therapy too.
• 33:50
  Like, and so we do not need to be waiting until she's 40 and like clearly perimenopausal and has been suffering for eight years.
• 33:57
  And so like, but I agree with you that you're saying you're just trying to make the argument to like start earlier, like your I was giving you I was just like being
• 34:04
  difficult.
• 34:07
  What you really are is you're being an advocate for women and I appreciate that.
• 34:11
  But I think I'm just trying to say, okay, well, we're not going to necessarily give every 16 year old hormones, right?
• 34:18
  So then there's got to be some either sign symptoms or test result that starts to push you in that direction, I suppose.
• 34:27
  Yeah.
• 34:28
  you.
• 34:28
  I would assume that people aren't looking for me unless they've been sick for a while looking for me.
• 34:33
  If they're a 21-year-old, they've been having problems for a long time before they would do that.
• 34:36
  ah having a little bit lower threshold for women to understand that hormones are safe and beneficial, and that it's OK, and it's a lot better option than birth control, which is
• 34:47
  what traditional doctors will do.
• 34:48
  I'll just put you on birth control.
• 34:50
  But bioidentical hormone replacement therapy could be an alternative option to birth control and may be helpful, right?
• 34:55
  Like if you want to stop a heavy period or something.
• 34:57
  How do you like to prescribe your estrogen?
• 35:00
  How do I prescribe it?
• 35:03
  So my formulation is vaginal, all of it.
• 35:06
  It's, because vaginal delivery is systemic.
• 35:09
  It's highly systemic and we know it is.
• 35:12
  yeah.
• 35:14
  But I think that you nailed it when you were like, this is something that we can prevent.
• 35:18
  know, like if you can start it early, like women, think they also, when I talk to women, they're like, well, they think hormone replacement therapy is like, once I started, I'm
• 35:26
  like done.
• 35:27
  I can't have kids.
• 35:28
  I can't do anything.
• 35:28
  It's like the end of everything.
• 35:30
  Mm-hmm.
• 35:30
  we can look at hormonal placement therapy as like maybe you can even take it postpartum in between pregnancies.
• 35:35
  We need to think of it as like that it doesn't may potentially not impact your fertility that we do need more studies to see if it impacts your fertility, which we know that it
• 35:42
  doesn't in certain levels.
• 35:44
  Like if you're not giving her too much, we shouldn't make her infertile.
• 35:48
  Like with men, like for example, if the testosterone doesn't get too high, they still make sperm.
• 35:52
  So there is like an area there that we can be intervene like as a physician and still be helpful, but not.
• 35:58
  Yeah.
• 35:58
  And so
• 35:59
  this women getting this idea that I just want to wait forever until I'm miserable.
• 36:04
  Like, and then I'll start HRT.
• 36:06
  They shouldn't be thinking of it that way.
• 36:07
  We should start to see the decline in their health states.
• 36:09
  Like they're 32 and they've really been like gaining weight.
• 36:13
  Their gut health is a mess.
• 36:14
  They've tried the, you know, all the functional medicine stuff isn't working for them, which is what you see.
• 36:20
  A lot of them really trying to fix their gut problems and cortisol and his skin and hair looks terrible in their moods.
• 36:26
  This could be like, am I ready and should I be starting this earlier?
• 36:29
  They really need to, like you said, even if they knew their levels and that they've been declining, then they can make a better informed decision about when to start.
• 36:35
  Right.
• 36:36
  What about progesterone?
• 36:38
  you also applying that intravaginally or yeah?
• 36:41
  Okay.
• 36:42
  Do you find that it gets absorbed?
• 36:45
  Okay.
• 36:46
  Interesting.
• 36:47
  Interesting.
• 36:48
  I've kind of equated that more with topical and we have people that when they take it orally, of course they metabolize it.
• 36:54
  They get a nice sleep benefit from that.
• 36:56
  Right.
• 36:56
  that's why a lot of them have just started.
• 37:00
  And this is kind of sad as well.
• 37:01
  I'm not saying it's you.
• 37:03
  I'm saying this is very much in the field where topical progesterone doesn't protect the uterus.
• 37:09
  We know that it doesn't go into the skin and protect the uterus, especially when you combine it with estrogen.
• 37:13
  If you're just doing topical progesterone alone, maybe you'll get a little bit of help with your anxiety, but you're not taking estrogen anyway.
• 37:20
  But um with your taking estrogen and you do an oral progesterone,
• 37:24
  you get like, just puts women to sleep because 80 % of it is metabolized into metabolites that make you and have an anesthesia effect on the brain.
• 37:33
  But a lot of women feel groggy the next day.
• 37:34
  They don't feel like themselves.
• 37:35
  They don't feel well.
• 37:36
  They do get bloated.
• 37:37
  They get side effects, but they sleep and this helps.
• 37:39
  Like sleep is sometimes everything.
• 37:41
  Like if they're sleeping, they're going to feel better and doctors are trying to help and they see that they're sleeping.
• 37:45
  They want to help, right?
• 37:47
  They're not trying to do anything.
• 37:48
  yeah, yeah, of course.
• 37:49
  so I think that, but I just use oral progesterone as a sleeping pill.
• 37:53
  I'll even give it to men.
• 37:54
  They love it.
• 37:54
  Like, I'll give a man 100 milligrams of oral progesterone, they're gonna fall asleep and that's gonna convert to testosterone and they're gonna be like a happy guy.
• 38:02
  So like oral progesterone is like one of the most, the best like sleeping pill ever, but it's not for hormone replacement therapy.
• 38:08
  It's just a sleeping pill.
• 38:10
  really interesting.
• 38:11
  That's really interesting that you're bringing that to light.
• 38:14
  um So really transvaginally, because we've used transvaginal uh hormones before, ah but we may need to rethink that and think about it a little harder.
• 38:24
  So yeah.
• 38:26
  hundreds of studies.
• 38:27
  It's like something that we, that the formulations just need to be like addressed.
• 38:32
  Like we just need, it doesn't really, I think it's fine.
• 38:34
  Like whatever people choose, but at least it's like informed.
• 38:37
  Like, okay, I'm going to pick a pill for you because this is like, you know, and it helps you, know?
• 38:41
  And so I'm picking the formulation, knowing the way that it's metabolized.
• 38:44
  And that's why I've chosen that formulation.
• 38:46
  Okay.
• 38:47
  I have a friend who's a gender.
• 38:48
  for a main physician, like she does like teenagers.
• 38:52
  And her, like if she's transitioning a female to a male, she picks the formulation because she knows how it's going to act in the body.
• 38:59
  She'll only do testosterone cream because it converts to DHT and because they're trying to turn into a man, right?
• 39:06
  Like, so she doesn't pick a testosterone injection for them because it will convert to estrogen and they are trying to get rid of feminizing features.
• 39:12
  like, she's just, the doctor is using the formulation to her advantage.
• 39:17
  And not all doctors are looking at that way.
• 39:19
  They're not looking, they're just like, you know what I mean?
• 39:21
  And I think we need to like, not, yeah.
• 39:24
  Yeah.
• 39:24
  Cause a female genetically is going to have a higher, although we've been impressed that some men actually aromatize pretty highly, quite honestly.
• 39:32
  It's really, there's a spectrum.
• 39:33
  ah
• 39:34
  it in the skin?
• 39:35
  Because I've also heard from compound pharmacists that they're like when you put a unique of a man topical.
• 39:40
  Okay.
• 39:41
  oh
• 39:43
  men really aromatize it quite strongly and others don't, right?
• 39:46
  It's really a spectrum.
• 39:48
  And so that's where you need to understand that.
• 39:50
  Like, I don't know.
• 39:51
  I used to just wait until they had breast tenderness, like men.
• 39:54
  And then I would be like, okay, well, let's take a look at this.
• 39:57
  Otherwise.
• 39:57
  we look at the metabolic pathways.
• 39:59
  We see if they're flooding, you know, the estrone pathways.
• 40:02
  And if they are, then it's like, okay, well, let's back that off a little bit.
• 40:05
  uh You know, we're giving them testosterone, testosterone is going down relative to estrogen going up.
• 40:10
  like, oh, they're heavy aromatizers.
• 40:12
  Then we will use a little inastrozol to kind of balance it out.
• 40:16
  That's right.
• 40:16
  We're trying to balance the system.
• 40:18
  uh
• 40:19
  at these absolute levels, because I've seen some physicians will be like, oh, 40s too, well, I'm just making, it's like 40s too high, we need to lower it, you know what I mean?
• 40:28
  no, no, we're an ecosystem kind of thought process here.
• 40:31
  Like you're trying to balance the ecosystem, not trying to get a number.
• 40:35
  Right.
• 40:35
  So that's how we're thinking.
• 40:36
  And it's perfect.
• 40:37
  This is how like, and we need to look at feedback loops, how, this is the perfect way to do it for somebody and it's more personalized and they're going to get, you're just going
• 40:44
  to get a better result.
• 40:45
  Like, so patients can work with somebody who even just talking the way that you're talking and then you're going to get a better result with your HRT.
• 40:51
  Right.
• 40:52
  So give us an idea of what kind of dosing are you using uh transvaginally for testosterone, estrogen, progesterone.
• 40:58
  And I know it varies, but I have a sense of it orally, but for some of these things, but give me an idea of what you're using.
• 41:05
  Yeah, they don't really translate well.
• 41:06
  like, and the other thing too is putting things like astriol or testosterone vaginally, you're going to get different results because one testosterone has been shown to really
• 41:18
  disrupt the vaginal microbiome.
• 41:20
  And when you're putting things vaginally, you do have to care about the microbiome.
• 41:25
  So like, for example, lactobacillus acidophilus, like when we talk about, and I'll just, I know you know this, but like for your listeners, like the, when we talk about
• 41:34
  diversity, like microbiome diversity, we don't want diversity in the vagina.
• 41:38
  We want like one or two strains that maintain the pH very low.
• 41:42
  And one of those is lactobacillus acetophilus.
• 41:44
  We only really want that one there mostly.
• 41:48
  And that bacteria needs estrogen to make its food.
• 41:52
  So if estrogen is low, that bacteria goes away and you really get a disruption and we call it BV.
• 41:58
  Like BV is really just like, even skin flora can populate the vaginal cavity and then you get like...
• 42:03
  bacterial vascular diagnosis.
• 42:05
  Doctors will tell women that they're sexually active and this is why, and it's not true.
• 42:08
  It's just that the estrogen is gone and now you're getting this disruption of the microbiome.
• 42:13
  When you introduce testosterone there, you're not going to always get this heavy enough conversion.
• 42:19
  Estrogen will help.
• 42:20
  Some of them will say that it helps with libido, but the testosterone itself disrupts this microbiome over time.
• 42:25
  We even see these from the transgender literature.
• 42:28
  you're using testosterone topically outside the vaginal vault.
• 42:32
  that what
• 42:32
  need extra testosterone generally.
• 42:34
  So like when you do extra testosterone, like injections or topicals, it can get too high for them.
• 42:40
  And like sometimes the wheels fall off the bus.
• 42:42
  So like you have, it's like estrogen with ferment.
• 42:45
  Like would you ever give a man estrogen?
• 42:48
  Well, we wouldn't, but testosterone turns into estrogen.
• 42:51
  progesterone converts to testosterone.
• 42:55
  So like you, you know, I would never like tell a man, estrogen is so great for you.
• 42:59
  It's going to make your skin glow and it's going to make you lose weight and it's going to help you with dementia.
• 43:03
  I'm going to have you inject test estrogen.
• 43:05
  But yeah, have women inject testosterone.
• 43:07
  Like, where's the breakdown?
• 43:09
  So what you're advocating and what you're doing is basically to use topical or intervaginal estrogen and progesterone.
• 43:16
  That's what I'm hearing.
• 43:17
  forgesterone converts to testosterone enough that you can get like some of it.
• 43:22
  And then like there's this where this variation is.
• 43:24
  Like when you're talking about an individual that with especially with libido and women, I would say is very variable.
• 43:31
  And I know you work with women and like, and you hear it like, okay, well, whatever I did for her, it worked for her libido.
• 43:36
  How come it's not working for you?
• 43:37
  And it's like all the stars have to be aligned for women and libido all the hormones have to
• 43:41
  right?
• 43:41
  And you can optimize libido later.
• 43:44
  So if her testosterone doesn't get high enough, let's say that her, she's not a heavy converter, just like some, you said some men convert into estrogen a lot.
• 43:52
  Some women convert too much testosterone and they get side effects.
• 43:55
  Some women don't convert enough.
• 43:57
  And so now you're like trying to like either block or reduce or optimize this.
• 44:00
  And then women who need a boost, like there's subtle ways to do that.
• 44:05
  Well, you could always do like a cream or an injection on top of that.
• 44:08
  But it wouldn't necessarily, if you introduce it as the first hormone, it would be similar to you giving a man estrogen first.
• 44:15
  of, know what I but you're not, you're at your, instead your approach is to be like, see what the body.
• 44:20
  is you start with estrogen and progesterone transvaginally, and then you basically monitor the client.
• 44:29
  I assume do some follow-up testing to kind of see where the numbers are coming.
• 44:33
  And then you might top it off with a little testosterone if need be.
• 44:37
  optimize it.
• 44:38
  And there's like a lot of the herbs, like as you know, work really well or DHA.
• 44:41
  You even mentioned DHA can be a way to do that for women and a lung tractors will easily do DHA.
• 44:47
  And that can get high pretty quickly too.
• 44:49
  You have to be careful with that one.
• 44:51
  Yeah.
• 44:52
  We think about DHEA more for testosterone than we do for testosterone per se.
• 44:56
  yeah.
• 44:58
  Yeah, exactly.
• 44:59
  So like it's easy.
• 45:00
  So women are like concerned.
• 45:02
  I want to raise my testosterone.
• 45:03
  I'm like, that's the easiest one.
• 45:05
  Like, just want to like, let you know that actually that is like the out of all three hormones, like I'm not no problem like raising your testosterone.
• 45:12
  It's the, it's the other two that are like really challenging for women.
• 45:15
  And I think even for men, like we can get your testosterone up, but like you said, it's making sure that everything's balanced.
• 45:21
  The ecosystem is right.
• 45:23
  And if you
• 45:24
  if it's not a black box, giving somebody testosterone, you're not doing that either with men.
• 45:28
  So why would we do that with women too?
• 45:30
  You have to do the same approach to get the,
• 45:33
  Yeah.
• 45:34
  Nice.
• 45:34
  Okay.
• 45:35
  Well, good.
• 45:35
  I love that.
• 45:36
  love that.
• 45:38
  Well thought out.
• 45:39
  Obviously you have a uh tad of experience with that.
• 45:42
  yeah.
• 45:43
  like, and this is where, you know, it's like we've been ignoring, I would think.
• 45:50
  I think that those studies like that, know, have initially like, I think there's doctors like there's doctors that obviously are doing it because they know that they're wrong.
• 45:58
  But we have a lot of work to do to catch up to, I think, men's performance.
• 46:02
  You know, we still have, yes, forward thinking and innovation to do and uh research to do so that we can catch up.
• 46:11
  No, I agree.
• 46:12
  I think one of the other takeaways for me in this is the idea of wouldn't it be great if we had a resting metabolic rate equivalent for hormone levels.
• 46:23
  be?
• 46:23
  like, is your, what is, don't, I guess I think I read.
• 46:25
  So what is the resting metabolic rate really showing you that, and it varies.
• 46:29
  Well, it's basically, it's basically showing you a level of thyroid activity at the nuclear level, right?
• 46:34
  uh T3 goes into the nucleus, modifies a lot of genetic expression, which ultimately changes the metabolic rate.
• 46:42
  So that's a good surrogate marker for the fact that there's adequate thyroid activity.
• 46:47
  I mean, it's still not, it's still a surrogate marker, but, but that's how we tend to think about it.
• 46:53
  uh What would be, what's that?
• 46:57
  never heard that before, actually.
• 46:58
  That's very clever, because then you're using something that is a...
• 47:00
  uh
• 47:03
  That's actually fantastic.
• 47:04
  We love it.
• 47:05
  We do it for everybody.
• 47:06
  Because thyroid is so mismanaged, we find all the time, all the time mismanaged.
• 47:12
  think hormones are mismanaged too, right?
• 47:14
  So
• 47:14
  well, like, they're intertwined, you know, like when I see, I don't do thyroid hormone online, but yeah.
• 47:20
  thyroid will change the metabolism rates of the hormones.
• 47:24
  And then when you enter, like I see women come to me that are on thyroid that's being mismanaged and then they'll start the hormones and then their hair will shed because
• 47:33
  they're on like the absolute highest value or dose of thyroid.
• 47:37
  And I'm just going to tell them that they need to go over to the thyroid doctor and like change their, like lower it maybe.
• 47:42
  And they think it's the estrogen again, because we're blaming estrogen.
• 47:45
  They blame estrogen.
• 47:46
  You're just like, dude, I think it's a thyroid.
• 47:48
  I'm pretty sure it's your thyroid that made your hair fall out, but I don't know how to like, it's really.
• 47:52
  It's, it is interesting, right?
• 47:54
  Typically, if there's a problem, the finger gets pointed at estrogen, right?
• 47:59
  Right.
• 47:59
  It does.
• 48:00
  it's because we're blaming women, right?
• 48:03
  This is your fault.
• 48:04
  You're the problem.
• 48:06
  I'm not.
• 48:07
  But you know, it seems to be that uh estrogen dominance, know, all these kinds of things, right?
• 48:12
  So is that the real thing?
• 48:14
  So,
• 48:15
  it's a real thing that we are blaming estrogen.
• 48:17
  instead it's almost like a cop out.
• 48:18
  We're just like, hey, I'm not going to address your thyroid or like figure out what's going on with you.
• 48:23
  I'm just going to blame it on this estrogen problem.
• 48:25
  And it's really like not.
• 48:26
  if you're listening to this, I would say get your genetics done so you actually know what you're dealing with from that perspective.
• 48:32
  It's not the absolute answer, but it's really helpful.
• 48:36
  And then I would say get your thyroid looked at and have a resting metabolic rate done as well as a complete thyroid panel.
• 48:41
  um And then I think get your hormones tested and have your metabolites tested um also so you can get a feel for that um as to how you're actually metabolizing.
• 48:52
  a grain of salt because like most of the time they come back just telling you you're estrogen dominant.
• 48:56
  like remember that they don't.
• 48:58
  not the case.
• 48:59
  No, not at all.
• 49:00
  No, not at all.
• 49:01
  We and you can fine tune the pathways, right?
• 49:04
  The 16, four, two hydroxy, you can fine tune those pathways.
• 49:08
  So, no, I would I would say that's a safety.
• 49:10
  That's a safety net.
• 49:11
  I would I'd be an advocate for that, quite honestly, to look at the metabolites.
• 49:16
  But I think if you put all that together, I really like this idea of using the um the transvaginal progesterone and estrogen and then
• 49:26
  maybe some DHEA if that's required.
• 49:29
  Maybe that's really kind of the thing.
• 49:32
  if the thyroid's not dialed in, the other hormones aren't going to work as well either, right?
• 49:38
  You have to, like, I think that is the thyroid is like very, and when you first start, don't know if you see when for all who's everybody's listening, if you've tried a hormone
• 49:47
  replacement therapy and you started it with somebody and they didn't address your thyroid, for example, or just even tell you to address it, you can get slight these side effects
• 49:54
  like water retention or you can get hair shedding and it's most likely your thyroid is, you know, and it's very hard.
• 50:01
  I would say thyroid is challenging for sure.
• 50:04
  hmm.
• 50:04
  Yeah.
• 50:05
  For us, it's become easy.
• 50:07
  We feel like it's easy, at least, at least in our minds.
• 50:10
  It's easy, right?
• 50:11
  It's probably never as easy as saying, just like you feel like the hormones have gotten fairly easy because of the way you do it, right?
• 50:16
  And we're always, you still don't have, we still don't have the equivalent of a resting metabolic rate for hormones, which would be really great.
• 50:24
  So
• 50:24
  It would be great.
• 50:25
  Yeah.
• 50:26
  Like it would be amazing.
• 50:27
  Like even if we had like a bigger snapshot, you know, it'd be nice if we had something to measure every day.
• 50:31
  But I think even just like a longer snapshot than like an absolute value would be nice.
• 50:35
  Like even FSH has its limitations.
• 50:39
  so we don't really have anything.
• 50:41
  And then testing is, I don't know if I trust it as much, like urine metabolite testing is not gold standard, you know, and you're comparing it to a gold standard.
• 50:49
  so just, you have to kind of like.
• 50:52
  look at it and you could trust it but you've heard it.
• 50:56
  between them.
• 50:57
  I agree.
• 50:58
  It's an ecosystem.
• 50:59
  think FSH and LH, let's talk about that.
• 51:02
  So basically pituitary hormones that are signaling you to make ah estrogen, uh sperm counts, things like that, testosterone release for men.
• 51:12
  think um in menopause, those are very elevated.
• 51:19
  um And in andropause, they're very elevated.
• 51:22
  Like the body is
• 51:23
  is craving more hormones.
• 51:25
  So it's really kind of sending out the signal, please, please make more hormones.
• 51:29
  Because of course the ovary can't do it at that point.
• 51:31
  The lytic cells can't do it.
• 51:32
  um So we tend to use it as kind of a feedback loop.
• 51:36
  When the hormones are optimized, FSH and LH will fall back into a, oh we're happy now kind of level.
• 51:42
  um And I think that's important to have tested as well, not just the hormones.
• 51:47
  So we do that in every panel also.
• 51:49
  I think that it's more important and like really it gives you a better idea of what the brain and that feedback loop is doing.
• 51:54
  It's like a TSH, like you wouldn't just measure the absolute values of your thyroid, you would measure your TSH too, just to see what that feedback loop is doing.
• 52:03
  And FSH is, even though we need work on establishing what that number is, like I think we do know that that feedback loop is really important and women and menopause, that could be
• 52:14
  something that they could be looking at.
• 52:16
  um
• 52:16
  So even if those absolute values are like all over the place, they can look at that FSH and that tells you what the brain is feeling or thinking.
• 52:25
  Yeah.
• 52:25
  Does the brain think that there's enough hormone around?
• 52:27
  Because if that FSH is elevated, the brain does not feel like there's enough.
• 52:31
  Regardless of what your lab test or your doctor says, your brain is freaking out.
• 52:37
  And so I think like we can make it more personalized that way.
• 52:40
  We can trust that the brain knows if there's enough hormone around.
• 52:44
  and doctors are not relying, I'll get, well, doctors barely ever order this test.
• 52:48
  Like it's on your panel, you said, but they're not using it.
• 52:51
  I think we could do better than that, but it's definitely a marker on the panel, you know, like in the picture.
• 52:57
  I think if you're listening to this, um know, work with somebody that's actually takes this more comprehensive view really is kind of what you're going for.
• 53:04
  It's easy to get this wrong.
• 53:07
  It's wonderful when you get it right.
• 53:08
  um And it's easy to get it wrong.
• 53:11
  So you want to work with somebody that's kind of got their arms around all of it.
• 53:14
  And HRT and like, this is not a side job.
• 53:17
  Like these are not like when you go to, you have to go to a doctor who has like done it and is doing only this.
• 53:23
  it's different.
• 53:24
  think you'll agree.
• 53:25
  Like when I tell everybody, I think they know it's different training.
• 53:28
  Like when you're OB-GYN, it's like a side thing.
• 53:31
  They're mostly doing OB-GYN stuff.
• 53:33
  They don't think about, they just have like their regimen or birth control that they're going to give you.
• 53:37
  They're not thinking about hormones like all day long, like you and I are, might be thinking about them.
• 53:41
  No, we think about it all the time for every client, right?
• 53:43
  We think about it for every client.
• 53:45
  So it's not the only thing we do, but we think about it for every client.
• 53:49
  yeah, perfect.
• 53:51
  Sarah's been lovely chatting with you and quite the journey and educational and fun at the same time.
• 53:58
  So I appreciate that.
• 54:01
  Yeah.
• 54:01
  Awesome.
• 54:02
  Thanks.