Latest / The Dr Louise Newson Podcast / 04 - Dr Felice Gersh on oestradiol, natural vs synthetic hormones and standing by your beliefs in medicine

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04 - Dr Felice Gersh on oestradiol, natural vs synthetic hormones and standing by your beliefs in medicine · The Dr Louise Newson Podcast

0:02
Hello, I'm Doctor Louise Neeson and welcome to my podcast.
0:06
I'm AGP, menopause specialist and founder of the free Balance
0:11
app. My mission?
0:13
To break the taboos around Women's Health and hormones,
0:16
shining a light on the issues we've been too afraid to talk
0:19
about. From contraception, sex and
0:22
testosterone to menopause related addictions and beyond,
0:26
we're covering it all. I'll also be joined by experts
0:30
and inspiring guests, sharing insights and real stories, as
0:34
well as answering your questions and tackling the topics that
0:37
matter to you the most. Today on the podcast I've got
0:43
with me Doctor Felice Gersh, who's Jewel accredited from the
0:47
US. She's a gynaecologist, so OBGYN
0:50
trained, but she's also trained in integrative medicine.
0:54
We really do unpick about hormones, especially estradiol,
0:58
but we also talk about why it's so hard in US, especially to get
1:02
natural hormones and how easy it is to get synthetic hormones.
1:06
There's lots of conversation that's really great in this
1:09
podcast. So Felice, you're here in real
1:15
life because last time we did a podcast remotely.
1:18
I can't remember how long ago, but it was a while ago.
1:20
Because I remember I was sitting in my husband's study and
1:23
talking about heart disease and hormones.
1:27
And, you know, you're one of the few people I can really geek out
1:30
with. I can really talk on a cellular
1:32
level about hormones, which is great.
1:34
But now you're in real life. You've been to my house, you've
1:37
been to my clinic, and now you're here in the studio.
1:39
Well, you invited me to come and I just jumped at the
1:42
opportunity. It's like, this is so fun and
1:45
yes, we can talk about everything and we are so
1:48
aligned. It's just fantastic.
1:50
It's great because tomorrow we've got a conference and
1:52
you're coming to speak and you spoke.
1:54
We have monthly meetings for all our clinicians and you came and
1:57
spoke and it was just brilliant because as you were talking,
2:01
lots of them are whatsapping me to go.
2:03
Oh my goodness. How did you meet Felice?
2:05
She's brilliant. She's so knowledgeable because I
2:08
think in medicine, and I'm sure it's the same for your training
2:11
in the US, but certainly in US, we're just taught this is the
2:14
condition, this is the treatment, ask no questions.
2:17
And as you know, I've got a pathology degree as well.
2:20
So I did three years as an undergraduate, then I took a
2:23
year out and did a pathology degree.
2:26
And it was then that I really learnt about cell processes and
2:30
I really learnt about very basic things, about receptors, about
2:35
our immune system, about mitochondria, the powerhouse of
2:39
our cells. And it was really such an
2:42
interesting time. And I, we're saying to my
2:45
husband who's also got a pathology degree as well, I
2:49
forget that lots of people didn't do that degree.
2:52
They don't have that knowledge. They don't have that basic
2:54
science. So if I'm stuck in medicine, and
2:57
I've always done it, if I'm working why someone got raised
3:01
blood pressure, I will go back and work out how do the kidneys
3:04
work? What's happening, What's
3:05
happening with their different processes that are going on in
3:08
their body. But if you don't have that basic
3:11
knowledge, it's really hard to move forwards, isn't it?
3:13
It is and a lot of it, honestly, I had to acquire by doing a lot
3:19
of my own reading and research because I went to school a long
3:23
time ago and I am so into exactly what you were saying,
3:28
mechanisms, what's happening at the cellular level.
3:31
How is this working? Because only then can you really
3:35
think it through and think independently and not just do
3:40
what like, here's the protocol, follow the protocol and without
3:44
even thinking, not mindfully like working it through, like
3:47
why is this the protocol? How did it get established?
3:50
Does it even make sense? Is there a better way?
3:53
So I think that's what both of us have been striving for,
3:56
looking for. Are there better ways and not
3:58
being stuck in established protocols without like thinking
4:02
them through and looking at the foundational pathways and
4:07
mechanisms and so on, which makes it so exciting and really
4:11
fun trying to figure out how a woman's body works, for example.
4:15
And it's so true. I mean, you've been a
4:17
gynecologist and OBGYN for many years and then, you know, sort
4:21
of reinvented, re educated yourself quite a few times on
4:26
your professional journey, haven't you?
4:28
I have, I call it my different chapters.
4:30
So there was a chapter when I did thousands of deliveries.
4:33
I was just a prolific surgeon and always learning and
4:37
different techniques and working with new medical devices, some
4:40
of which were horrible. And now we're off the market.
4:43
Thank goodness. And then when I moved on from
4:47
doing obstetrics and lots of surgery, I went back to school
4:50
and I did a two year fellowship in integrative medicine at the
4:53
University of Arizona School of Medicine and really took a lot
4:57
of other courses in functional medicine, learning about
5:00
mitochondria and never look back.
5:03
So I just say that I have what I call my expanded therapeutic
5:07
toolbox. Which is amazing.
5:09
It makes it so much easier to practice too when you have more
5:13
resources to draw from to help your patients.
5:17
And it really is. I love my new chapter,
5:20
Educating, Traveling, writing, writing papers, and I'm still a
5:26
clinician, though I work every day.
5:28
When I'm in my office, I'm working every day, which I
5:31
think, like we talked about this earlier, keeps us really
5:34
grounded and really understanding what it means to
5:38
take care of patients. So many people make
5:40
recommendations about patient care and yet they're not even
5:43
seeing patients and haven't for many.
5:45
Many years I totally agree. And you know, being a doctor is
5:49
such a privilege. Seeing patients is the best part
5:52
of the but it does keep it real. And also individualization of
5:57
care is so important. So you might know all the
5:59
biology, all the Physiology, all the pathology, and then you have
6:03
a real patient who has real, you know, they have different diets,
6:06
they have different stresses, they have different things going
6:08
on in their lives and individualization of care is so
6:11
crucial. One of the things that I,
6:13
there's lots of things I respect you for, Felice, but one of the
6:15
things you were saying the other night, it just makes me realize
6:18
how strong you are. And when we're talking about the
6:21
health of women, hormonal health, I think you have to be
6:24
really strong to stick to your principles when you know you're
6:27
right. So you were saying to me the
6:29
other night about the mesh. So some of the people might have
6:33
heard of the mesh repairs that were now been taken off market,
6:37
but these mesh for gynaecological surgery and you
6:40
were going to train other people.
6:42
So you were taught how to do the mesh.
6:45
And so that's quite a privilege, being selected to be a teacher
6:49
and then you were taught and then what did you do?
6:53
I said no way this stuff is going to harm women just feeling
6:57
it and looking at it. And the kits they had blind with
7:00
trocars like these like pokers that you would blindly poke to
7:05
establish like the try to secure this mesh into the tissues.
7:09
And it was a synthetic material that was really thick and harsh
7:13
and putting it into really fragile delicate tissues.
7:16
I said this is going to erode, which it did.
7:19
And so I was taught on all these different mesh kits from many
7:22
manufacturers, and I said I'm not going to use it.
7:25
I absolutely won't use it. So I walked away from the
7:28
opportunity to train and use it. And I said I'm going to use
7:32
native tissue repair. Sometimes I'll use bovine or a
7:36
cadaver fascia when I really need to, but I'm not going to
7:39
put all this artificial tissue and implant it permanently into
7:43
women's delicate tissues. And that was a good decision
7:48
because there are many, many lawsuits.
7:50
Many women were harmed. Many women live with chronic
7:53
pain and disability and many really tragic stories and many,
7:59
you know, just sad tales. And it was finally taken off the
8:03
market. And this is part of really what
8:06
I'm scrutinizing. So I used to be, Once Upon a
8:10
time, an early adapter of new pharmaceuticals.
8:13
Like, I know about it. I'm like, so trendy.
8:16
I know about everything, but now I'm really not.
8:18
I look at it and I want to know everything about the drug, how
8:21
does it work, What's the mechanism?
8:23
And there's always collateral issues.
8:26
There has to be because you can't interfere with an enzyme
8:29
pathway or a peptide. You can't and then think it's
8:33
only going to work in one part of the body because everything
8:36
has multitasking. There's not one thing that's in
8:39
one place doing one thing. And sometimes you have the same
8:42
peptide, for example, doing different things simultaneously.
8:46
You'll have high levels in one part of the body, low levels in
8:49
another part. So I'm very cautious now.
8:52
Yeah, which is so interesting. And it's the same US and UK with
8:56
the meshes. You know, it was a massive
8:58
scandal actually. And Chris Hardy, he's been on my
9:00
podcast before. He has taken out so many meshes.
9:03
You know, it's awful. But it's very hard in medicine
9:07
if everyone say, well, yes, no, come on, let's do it, let's do
9:09
it. And it's sort of a bit of a mess
9:12
with hormones in that it's sort of gone the other way really,
9:16
that people are now scared of natural hormones, which really
9:20
worries me. And in fact, my mother, who's
9:22
not a medic, said to me a few months ago, Louise, I think you
9:25
need to talk more about what hormones are because most people
9:28
don't even know we have hormones in our body.
9:31
And I thought, oh, bless mum, I'm sure they do.
9:33
And actually, she's probably right.
9:34
You know, years ago, the first medical writing I did was about
9:38
breast cancer, and I was supposed to be writing about
9:41
tamoxifen for women. And I spoke to my mum and she
9:44
said people don't know what cancer means.
9:46
And I went, oh, don't be a ridiculous mother.
9:47
And I said, OK, I'll ask a few women.
9:49
And the women I spoke to had had breast cancer, many for several
9:52
years, and they'd said cancer means death.
9:56
I said what? I said, well, what about
9:57
chemotherapy? No, that means hair loss.
9:59
Like they didn't know. And as medics, we use all these
10:02
words and we forget that people don't know.
10:05
So when people talk about hormones, they often think it
10:08
means breast cancer because they think it's HRT equals breast
10:11
cancer. They don't think about hormones
10:14
such as insulin. They don't think about
10:16
thyroxine. They just think about hormones.
10:19
And I got a message today from someone in Brazil to say there's
10:23
a big campaign against testosterone in women in Brazil
10:26
by the gynecologists and endocrinologists because they're
10:29
so cross that people are talking about testosterone.
10:32
And I think, goodness me, there's a lot more in life to be
10:34
crossed about than a natural hormone.
10:36
So we've got in a mess, I think that is becoming really hard to
10:41
unpick. And it's gone on for over 20
10:43
years since the WHI, the Women's Health Initiative study came
10:46
out. And just to be clear to people
10:48
listening, this was using synthetic hormones.
10:51
They've been chemically altered and we can talk a bit more about
10:54
that in a minute, but they're not the same as our natural
10:56
hormones. The data went to the press far
10:59
too early. It hadn't been analysed
11:01
properly. The headline was it causes
11:03
breast cancer, it causes heart attacks, terrible.
11:06
HRT prescribing was about 40% of menopausal women in the US.
11:11
It was about 30% of menopause women in the UK.
11:15
Now Fast forward, we've got natural hormones, we know there
11:19
are plenty of benefits to our future health, symptom control,
11:22
so forth. In the UK it's less than half,
11:26
it's 14% of menopausal women. And in the US, some of the
11:29
figures of the the licensed HRT or MHT menopause hormone
11:34
treatment is like 1.8%. Like it's fallen off a Cliff.
11:38
Everyone's scared, aren't they? Well, in my practice, it's
11:41
extremely high, but from what I'm reading as well, it's under
11:45
5%. And that's the 5% is women like
11:49
in their 50s, you go 60 plus is nothing.
11:53
They don't even have data, but it's going to be very minute
11:56
percentages. And that's very sad.
11:58
I mean, we're both very sad about that and we're both like
12:01
really publicizing, you know, banging the drum to help women
12:06
to understand that all hormones, the word hormone is also
12:10
misused. It really drives me crazy too,
12:13
because they use the word hormone and they apply it to
12:16
what technically are endocrine disruptors or xenoestrogens.
12:20
Like they're not ever found in nature, in a human, ever.
12:25
And they actually interfere with real hormone production or
12:29
distribution, degradation, elimination, some fashion with a
12:34
receptor function and they're different.
12:36
And yet they're all put into the same bag as if they're all the
12:39
same when they're really night and day different and how they
12:43
in so many ways. And of course, that's the whole
12:46
really tragedy of the Women's Health Initiative, the way the
12:50
data which was misunderstood in the very first place and wasn't
12:54
anywhere near as terrible as they made it out to be, not even
12:57
close. But it has been applied to
13:00
different products, to our own natural bioidentical hormones.
13:05
And it's not a fair comparator when you're it's like totally a
13:09
different product. So we were talking in the car
13:13
yesterday about how you chemically alter something and
13:16
it can make such a huge difference.
13:18
And I use the graphite pencil lead and compared to diamond,
13:21
it's just one bond different. They're made of carbon.
13:24
But you used a great analogy as. Well, mine was water.
13:27
So water is H2O and if you just make a little change and you
13:32
turn it to H2O2, that's hydrogen peroxide.
13:35
You wouldn't want a glass of that.
13:37
So that's, and I said you're molecularly like doing your
13:41
analogy. I'm doing elemental, but you
13:43
know, you make the tiniest change and it's completely
13:48
different from something that's life sustaining to potentially
13:52
life ending, I mean, a poison from something that's wonderful.
13:57
So we have to really understand that that these are different
14:00
molecules. And if we had a little, you
14:03
know, whiteboard, we could draw, you know, the molecules, they're
14:06
not the same and of course they have different effects on the
14:09
receptors throughout the body. And I just wish we could just
14:13
walk away from that Women's Health initiative like shut the
14:15
door, lock it, bolt it and never look back.
14:19
So. What it is especially like, it
14:21
was AUS study, it was a billion dollar study.
14:23
It was probably the biggest study that's ever been done on
14:25
women's house, but it still showed that women who took
14:29
hormones, HRT had a lower risk of bowel cancer.
14:33
Well, yeah, why are we not? Why aren't there sort of grown
14:36
up people out there saying actually this was the wrong
14:40
study, It was the wrong type of hormones in the wrong type of
14:43
women given to the, you know, like, and the results actually
14:46
were badly reported. I don't understand why we keep
14:49
them back in time. Nor do I Why we and you're
14:51
right, there actually were shockingly beneficial effects
14:55
that were very minimized. For example, in the group in
14:58
their 50s, it showed a 30% reduction of all 'cause
15:04
mortality. There's no pharmaceutical that
15:06
lowers your risk of dying. But by 30% from everything
15:10
overall, I mean, so and yet that wasn't talked about.
15:13
And like you said, colon cancer was reduced and bone health was
15:18
dramatically impacted in a beneficial way.
15:21
And that is really a very leading cause of morbidity and
15:26
mortality in women is everything related to muscular, skeletal
15:31
health. And yet that was downplayed.
15:34
So the benefits were ignored and the negatives were completely
15:39
misconstrued. In fact, the whole thing about
15:42
it increases myocardial infarctions was dropped and the
15:46
issues with strokes and dementia was related to the extra really
15:52
high increase in clotting from using the conjugated equine
15:57
estrogens, which increased clotting, spontaneous clotting
16:00
risk 400%. So not too small, you know,
16:04
shabby of an increase. So if you increase clotting,
16:07
then yes, you're going to increase potential strokes and
16:11
microvascular clotting can cause vascular dementia.
16:16
Yeah. So it's going.
16:16
To mean. It's hard to explain.
16:17
And also the synthetic progesterone because the
16:19
progesterone they use was is not a very nice progesterone at all.
16:23
With oxy progesterone acetate it's.
16:25
Two thumbs down, yeah. Totally so.
16:27
So it isn't a surprise, but I don't know why we're just, I'm
16:31
translating that, if you like, to 2025 when we've got natural
16:34
hormones. But when I started HRT nine
16:37
years ago, I was 45. So if I went to go and see a
16:41
doctor even today if I was 45, which I'm not now, but if I was
16:45
aged 45 going to see an average US doctor with some hormonal
16:50
change, am I more likely to be put on the contraceptive pill or
16:55
hormone replacement? Oh, by far more likely on the
16:58
contraceptive pill, Absolutely. And in fact the pills are used
17:04
up until it's supposed to be for lower risk women.
17:07
But I've seen women on blood pressure medications and have
17:11
insulin resistance. But presumably lower risk women
17:15
up to the age of 55. Yes.
17:17
And that is the preferred US approach to perimenopause.
17:22
That plus some antidepressants like we were talking about.
17:25
Yeah, so. If I had started we can't go
17:27
back in time, but if we did and I was in US and didn't see you
17:31
hasten to add another doctor was given contraceptive.
17:34
Now that is synthetic. That's the graphite or the
17:38
hydrogen peroxide or whatever you think.
17:41
So it's synthetically manufactured.
17:43
So it's going to block my estradiol receptor, it's going
17:46
to block my progesterone receptor.
17:48
It's going to stop any testosterone I have working in
17:50
my body pretty much. And it's also going to increase
17:54
my risk of heart attack, stroke, cancer.
17:58
Only small amounts. But then if I went to go and see
18:01
you aged 45 and you gave me natural estradiol, natural
18:05
progesterone, natural testosterone if I needed it,
18:09
then there isn't a risk of clot. There isn't a risk of stroke.
18:12
There's a lower risk. You say 30% of mortality,
18:15
probably at least it will reduce inflammation in my body.
18:18
Like you can tell me on a molecular level how those
18:21
hormones work because I've had them in my body for years.
18:24
We know how they work, don't we? But I don't understand, like why
18:28
as a doctor, would you give me something that's more risky?
18:31
Not you, but a doctor. It's just pervasive lack of
18:35
understanding. And after the Women's Health
18:39
Initiative came out and it just created just a fear and fear.
18:44
It was unbelievable. I was in practice at the time
18:48
and I begged my patients to stay on hormones.
18:50
I was so opposed to these widespread negative conclusions
18:56
about the use of hormones. And about half of my patients
18:59
stayed on hormones, Yes, and about half of them didn't.
19:02
Some of them started having terrible symptoms.
19:05
And then ultimately a year 2-3 later came back to me, but some
19:09
didn't. Some came back ten years later
19:11
and said I wish I had never gone off the hormones, but I couldn't
19:16
convince him. The fear was so powerful.
19:20
And after that, the newer doctors and the studies say that
19:25
currently 80% of medical practitioners would be nurse
19:29
practitioners, doctors and so on. 80% of them were not in in
19:33
the midst of practicing what medicine.
19:36
Maybe some of them were in the beginning of training, but they
19:38
weren't actually practicing medicine 23 years ago when the
19:41
Women's Health initiative came out, and the education that
19:45
followed since then has been marginal to 0.
19:49
So they know nothing. The doctors, nurse practitioners
19:53
who are currently in practice were taught nothing literally,
19:57
and what they were taught was all negative.
20:00
And many of them just don't seem to have the curiosity.
20:03
That you'd like to have them have to go and learn it on their
20:07
own, but they're not, they're like, and then they're just
20:10
embedded in this institutionalized medical
20:13
practices that are all in the US.
20:16
Most of the doctors are employed now working for big entities
20:20
that create protocols. And they, the protocols are
20:24
hostile to hormones and they're very limiting.
20:27
Or some of them are bending a little bit now, a little bit of
20:30
softening. But it's still the FDA in the
20:35
US, the only use that's approved for hormones for vaginal for
20:42
now, it's called genital urinary syndrome of the menopause and
20:44
which does not have a level that's enough to get absorbed
20:48
and create any systemic benefits.
20:49
So it's a local effect. And the other is just for
20:54
prevention of osteoporosis, which almost nobody actually
20:57
does. It's like even the
20:59
endocrinologist never even think of it because they're still
21:02
afraid. And the other is suppression of
21:05
the night sweats and hot flashes.
21:07
That's it. There is not any medical society
21:10
that's advocating for hormones, for cardiovascular health,
21:15
neurological health, musculoskeletal health, other
21:18
than and not, you know, looking at muscles and joints, none of
21:22
that is happening. And so when you're protocol
21:25
driven and you're only using for FDA approved use, but off label
21:30
use is totally legal. So it's not like you're breaking
21:32
a single law to say you want to use it for something beyond this
21:37
limited use. And it's the same here, MHRA,
21:39
exactly the same. You know, it's licensed for
21:43
menopause, not perimenopause, for flushes, sweats, prevention
21:47
of osteoporosis, which by the way effects one in two women.
21:49
So you know, even 50% of women would be a lot better than we're
21:53
doing now. But I used to write a weekly
21:55
column in AGP. It was a magazine, but it was
21:59
gave free to every GP in the country.
22:01
So I used to write an evidence based column once a week for
22:03
them. And I found some of them
22:05
recently and I found the ones from 2002 and I actually found
22:10
some that I written in 2001. So pre WHI and I'd written about
22:14
HRT, about the benefits for bone and heart and you know, all the
22:17
things that we knew then. And then 2002 I said, oh, this
22:21
WHI study had come out, but actually there's no big deal.
22:24
Doesn't show us anything that we didn't know already.
22:26
Still really good for bone protection, really good for
22:28
symptoms. But I was in my little bubble
22:31
then. I was just working in general
22:32
practice. There was no social media I
22:34
didn't really like, really wasn't paying much attention to
22:37
outside what was going on. And my patients just carried on
22:40
taking HRT because they knew the benefits.
22:42
They understood, they said, oh, well, this risk of breast
22:44
cancer, if it is there is really small, but I've got all these
22:47
other benefits as well. Why can't women have a choice?
22:51
Like, why is it like you're saying the endocrinologist don't
22:53
like using these hormones? Or why is some doctors saying
22:56
have contraception? Why can't women decide what they
23:00
want when they know it's better for them?
23:02
And you know, one of the things you said to me a while ago on
23:04
the phone was we know that eating fruits are really good
23:07
for us and no one will disagree that eating fresh fruits good
23:10
for us. So do we limit it?
23:13
Do we say to people you can only eat fruit for a few years?
23:16
Because, you know, do you remember saying that?
23:19
And I thought that's great. Try to drive home the point in a
23:23
way that's simple and and really clear.
23:26
And I think that what is happening in the US is what's
23:31
driving the increase in interest in hormones and even prescribing
23:36
of hormones is the groundswell of women.
23:41
It's not from the top down, it's the bottom up.
23:43
And what this is creating in the US is a business driven model of
23:49
hormone prescribing, which actually has some benefit.
23:53
But it's actually makes me very sad in a lot of ways because
23:57
these new like a lot of online like dispensaries for hormones,
24:02
they're driven by business people.
24:05
They're not started largely by anyone who has a medical degree
24:08
of any kind. These are business driven.
24:11
They see that there are a lot of women who want hormones and the
24:15
medical establishment isn't providing it.
24:17
So they're creating these online dispensary companies and they're
24:21
hiring different people to then prescribe who don't really have
24:25
a foundation like we talked about how does the cell work?
24:28
What is this doing? They really, they don't have
24:30
that. They're just given these little
24:32
protocols. They're given like this is what
24:34
you prescribe. There's not the
24:36
individualization that we talked about.
24:38
They're not monitoring levels. They're responding to symptoms
24:42
that when they develop from the treatment, but they don't really
24:45
know what to do either. And they're trying to give the
24:48
very smallest doses to try to have the fewest problems.
24:53
So they're not about optimization at all.
24:56
And this is what many women in the US are now turning to
24:59
because they go to their own gynecologist or family doctor
25:03
and they're told, no, this is going to give you cancer.
25:06
How could you even think of it? They're still back in this old
25:09
wrong thinking. So they feel I have no options.
25:12
So they turn to these online companies and then they get what
25:16
I call a whiff of estrogen and a little bit of progesterone.
25:21
Never testosterone. No, because they can't do that
25:24
online. And so it's something.
25:27
So sometimes I like to think it's better than nothing.
25:29
It's better than nothing. But it's not ideal but.
25:32
Not even close to ideal. But this is what's happening in
25:35
the US and it's all business. Financially driven, but the
25:40
impetus is coming from the groundswell of women wanting
25:45
hormones, not from the doctors educating from the top down and
25:51
the educational, you know, environment in medical schools
25:55
and postgrad work is still really limited.
25:58
They're not teaching. So when the professors don't
26:01
know, they're not teaching anything, it's really sad.
26:04
It is the same. It is the same in the in the UK
26:07
it is a lot led by women, which it shouldn't be.
26:10
And so many women are not listened to.
26:12
They're underserved. So one of the things is, you
26:15
know, online, lots of people trying to lose weight, they're
26:19
going to these GLP drugs, these GLP ones, these drugs that
26:23
supposedly will transform everybody.
26:26
We've seen a massive surge globally in these drugs, like as
26:30
MPIC. I'm very cautious as a doctor
26:32
like you, I've seen a lot of drugs come and go.
26:35
I want to know how do they work in the body?
26:37
What are their potential for harm?
26:39
What are their potential for benefits?
26:41
What are their long term outcomes?
26:42
What else can we do first before we're giving some drugs that's
26:46
new to the market? People are just getting them
26:49
like Smarties really online, which I have a worry because
26:52
it's not individualizing care. There's lots of reasons why
26:55
people put on weight and there's lots of things we can do, but we
26:59
know during perimenopause and menopause it's a metabolic
27:02
problem. We've spoken about it before.
27:04
People will often put on weight, they'll put down more adipocytes
27:08
which will produce estrone and inflammatory type of estrogen.
27:12
In my mind, maybe I'm too simplistic, so I'm keen to hear
27:15
what you know. Like in my mind, I will always
27:18
balance someone's hormones first.
27:20
I will look at their nutrition, I will look at their exercise,
27:23
wait for everything to have an effect before I'm even thinking
27:26
about any other drugs. I mean I don't prescribe these
27:29
drugs anyway but I wouldn't recommend them first line
27:33
because estradiol just explained has some really beneficial
27:36
effects doesn't it on our metabolism.
27:38
Oh, it's huge. Well, everything in the female
27:42
body is designed whether you want to have babies, don't want
27:45
to have babies, it's designed for reproductive success.
27:50
And it turns out that metabolism is critical for reproductive
27:55
success. So if think of metabolism, it's
27:58
the creation, utilization, storage, distribution of energy.
28:03
So it's critical for any Organism to have intake of
28:07
energy, also known as eating, that matches the needed
28:11
expenditures of energy, creating heat and you know, running all
28:15
the machinery of the cells and so on.
28:18
So it's all finely tuned. And there's these different
28:22
hormones and peptides that are all interconnected and sort of
28:26
like the yin Yang, you know, like there are hormones,
28:29
neurotransmitters, peptides that are involved in reducing
28:33
appetite, and there are others that are involved in increasing
28:36
appetite and they're all under the modulation effects of
28:41
estradiol. So I always think of estradiol
28:44
as the hormone of metabolic homeostasis.
28:47
So to keep things working smoothly and right when you lose
28:52
your estradiol, the systems that are involved mostly in the
28:55
hypothalamus of the brain become like offline, they're not
28:59
working properly. So the hormones and peptides
29:03
that are involved in nutrient sensing and the master clock
29:07
that triggers the control of the circadian rhythm, which is very
29:11
involved in metabolism, they all kind of start becoming drifting.
29:15
So you don't have things quite right, so you don't have proper
29:18
appetite regulation. And because the circadian rhythm
29:22
goes off, so women often will have the change in their
29:26
cortisol production, they'll have of more at night when they
29:30
should like lose their appetite and want to go to sleep so they
29:33
feel energized at night. But the take away is that
29:37
estradiol is key to regulating all aspects of metabolism.
29:44
So without it you lose your appetite control, proper control
29:49
of storing and burning fat, glucose transport, all these
29:53
things. So absolutely, the first thing
29:56
is to get women properly hormone balanced and get their
30:02
nutrition, all of that together and only then start thinking of
30:06
adding pharmaceuticals. Which is so important for people
30:09
to know. There's so much that we could
30:12
talk about. You will have to come back
30:13
another time. But just to finish three take
30:16
home tips. I would like to know your three
30:19
top reasons for considering estradiol.
30:23
Well, I would say the number one has to be brain health.
30:28
No matter what the condition of your cardiovascular system is,
30:32
if you don't have a functioning brain, forget it's right.
30:35
So estradiol is neuroprotective. That's another whole podcast we
30:41
could do. But the bottom line is to have
30:43
proper mood and cognition, you need estradiol.
30:47
So that would be #1 #2 would be actually the musculoskeletal
30:53
system, such an underplayed organ system that you know, in
30:57
terms of muscle and joints and bone for not just locomotion,
31:01
but these are, they create kinases.
31:04
They create like myokines from muscle, they create hormones,
31:08
bone makes hormones as well that help control cognition and fat
31:12
burning and glucose control. So the musculoskeletal system
31:16
would be my number 2 and #3 the cardiovascular system, of
31:21
course, because you have to have proper vascular health in order
31:26
to properly nutritionalize and oxygenate.
31:30
But I'm going to throw in one more.
31:31
I just can't stop the immune system.
31:34
Because, well, that's the basis of everything.
31:36
Exactly. I can't leave out the immune
31:38
system because we have to be able to repair, we have to be
31:41
able to fight off pathogens. So, you know, it's, we could
31:45
just go on. I just love estradiol.
31:47
Very good. What a great way to end.
31:49
You'll have to come back for more, but I'm because you've
31:52
come so far, I will allow you to have the 4th 1.
31:54
So thank you so much Felice. It's been great.
31:56
Thank you.