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

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

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