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The Truth About Andropause: Why Men Get Menopause Too | Dr Ambrish Mithal |Doctor vs Internet · Health Wealth

• 0:00
  Speaker 1: This is in today podcasts, Does it Happen with You?
• 0:06
  Speaker 1: Cap Phone Colla and what Zada's sweating? All these are
• 0:20
  Speaker 1: signs of menopause or peri menopause. Women have to just
• 0:29
  Speaker 1: ride the way for a therapy, the hormone replacement therapy,
• 0:35
  Speaker 1: cancer side effects and like and something changed in the
• 0:41
  Speaker 1: February of twenty twenty.
• 0:42
  Speaker 2: Six Menopausal District thirty five bleeding man.
• 0:50
  Speaker 1: Doctor's I can remember a top of my head, so
• 1:00
  Speaker 1: many women in my family hormone replacement.
• 1:05
  Speaker 2: Yoga, but amari and common. We got the first bonn
• 1:12
  Speaker 2: tesstameter in India in luck now, not in Deli or
• 1:15
  Speaker 2: Bombay in nineteen ninety seven.
• 1:19
  Speaker 1: So say doctor hey to parts breaking camp. This again
• 1:23
  Speaker 1: goes to prove that all up, I mean.
• 1:25
  Speaker 3: To do something.
• 1:28
  Speaker 2: H R.
• 1:30
  Speaker 1: But how expensive is it to those who are on
• 1:33
  Speaker 1: g l P one male Hey podcast? Because did you
• 1:41
  Speaker 1: know that there's something called manopause?
• 1:45
  Speaker 2: The test level actually starts reclining at thirty.
• 1:48
  Speaker 3: Is it true that a lot of men in Sound
• 1:50
  Speaker 3: Deli are.
• 1:51
  Speaker 1: Injecting themselves with testo stone boosters to feel young again?
• 1:56
  Speaker 2: I can't see a lot of but certainly some are
• 1:59
  Speaker 2: doing that.
• 2:01
  Speaker 3: Over abuse sick yeare side effects.
• 2:03
  Speaker 2: I have people undergoing divorces, well known people who underwent
• 2:06
  Speaker 2: a divorce for this reason.
• 2:07
  Speaker 1: How a man in their forty or a woman in
• 2:10
  Speaker 1: their forty is watching this? How do they know gear
• 2:12
  Speaker 1: regular fatigue, hair, it's just been a tough day, or
• 2:16
  Speaker 1: there is something clinically wrong na jails. They don't talk about,
• 2:25
  Speaker 1: you know, when you hit puberty. They don't talk about
• 2:28
  Speaker 1: issues during pregnancy. They don't talk about breastfeeding. Nobody tells
• 2:31
  Speaker 1: you how hard it is, and they obviously do not
• 2:34
  Speaker 1: talk about menopause as well.
• 2:36
  Speaker 2: What we're talking about today. Men need to be sensitized
• 2:39
  Speaker 2: to that. Ah. Yes, involvement of men and understanding of
• 2:43
  Speaker 2: about their partners issues around menopause is very important because
• 2:48
  Speaker 2: it will improve the couple's quality of life, not just
• 2:50
  Speaker 2: not just the lady.
• 2:53
  Speaker 1: Hello and welcome to talk to us as internet, I'm
• 2:55
  Speaker 1: sonour does it happen with you? Cap cameriuse phone callaq
• 3:08
  Speaker 1: Ki party mid sentence and bought zada sweating Well all
• 3:19
  Speaker 1: of you if you don't know already, all these are
• 3:22
  Speaker 1: signs of menopause or peri menopause. Like in SA, women
• 3:30
  Speaker 1: have to just ride the way yes, sah or eke therapy,
• 3:36
  Speaker 1: th hormone replacement therapy, cancerde effects and like in something
• 3:45
  Speaker 1: changed in the February of twenty twenty six f d
• 3:51
  Speaker 1: N A U S f d N A A kaa
• 3:53
  Speaker 1: KI Hormone replacement therapy CAKI cancer Risk direct NA go
• 3:58
  Speaker 1: in fact level come kardiakakua is salhi just stay up
• 4:05
  Speaker 1: doctor cafe. Sorry male, hey podcast here because did you
• 4:15
  Speaker 1: know that there's something called manopause. Women have a dramatic
• 4:19
  Speaker 1: cutoff date of fertility. Perhaps men don't have that date,
• 4:23
  Speaker 1: but maybema by apkouri endo chrinologist in fact, one of
• 4:38
  Speaker 1: the best known endo chronologists in the country.
• 4:40
  Speaker 3: Doctor how are you, sir?
• 4:42
  Speaker 1: Thank you, thank you so much for coming Hormone replacement
• 4:48
  Speaker 1: movies series on what women go through. But for years,
• 4:54
  Speaker 1: for twenty years, as far as I can remember, it
• 4:56
  Speaker 1: was considered unsafe. John, who are kaspar? What happened that
• 5:03
  Speaker 1: FDA said that we've got to revise our terms.
• 5:06
  Speaker 2: So thank you Sonal for having me here. May important
• 5:10
  Speaker 2: point A had that till two thousand and two, two
• 5:13
  Speaker 2: thousand and one endocrinology may hr T just go Hormone
• 5:19
  Speaker 2: replacement therapy both the third time estrogen replacement therapy actually
• 5:24
  Speaker 2: was strongly recommended the nineties. May endochronology may active the
• 5:30
  Speaker 2: so hormone replacement therapy use or indiamic Commusa Indians business
• 5:38
  Speaker 2: symptoms the problem you can worldwide guidance may hr T
• 5:43
  Speaker 2: or eer T was very much there to say a
• 5:47
  Speaker 2: Q patients symptom really for that was the main criterion.
• 5:50
  Speaker 2: And we also had some some data about bone and
• 5:53
  Speaker 2: we'll talk about that. But what happened in two thousand
• 5:58
  Speaker 2: and two, j up exactly saykar b Salce almost as
• 6:02
  Speaker 2: it was like almost studied the Women's Health Initiative twenty
• 6:09
  Speaker 2: seven thousand women study YA. Those groups there a Jinka
• 6:14
  Speaker 2: uterus remove aginka eutress has so those who had a
• 6:17
  Speaker 2: strict ME, who didn't have a strict and there were
• 6:20
  Speaker 2: two groups of patients. They were those who had had
• 6:24
  Speaker 2: his strict ME. They were kept on estrogen and the
• 6:28
  Speaker 2: other group was kept on estrogen plus progesterone. These are
• 6:32
  Speaker 2: both female hormones which are very important for the female
• 6:35
  Speaker 2: for everything puberty, pregnancy, menstrual cycle, and they're the ones
• 6:39
  Speaker 2: that decline at at menopause. So what they found was
• 6:45
  Speaker 2: that overall that there was an increase in breast cancer risk.
• 6:50
  Speaker 2: There was an increase in some clotting risk, including stroke.
• 6:56
  Speaker 2: You know, uh, these are the two main con They
• 7:00
  Speaker 2: were the minor ones, but there were the two main concerns.
• 7:02
  Speaker 2: Clotting in different parts like venus clotting or stroke and
• 7:06
  Speaker 2: breast cancer is both seemed to increase. What it did
• 7:11
  Speaker 2: find was that there was a relief in menopausal symptoms
• 7:15
  Speaker 2: entirely along expected lines with the symptoms. Our bone benefits
• 7:20
  Speaker 2: were there, so deep benefit. What you mean bone benefits.
• 7:25
  Speaker 2: We'll explain that. But our symptoms and benefits risks. Nick
• 7:30
  Speaker 2: lay to logan. We can't use it because is breast
• 7:36
  Speaker 2: cancer carri is but cancer word we say, or breast
• 7:40
  Speaker 2: cancer increasing in women.
• 7:41
  Speaker 3: We have the highest level of marking.
• 7:44
  Speaker 2: Yeah, or bay Shire stroke clotting PUSKO break down as
• 7:55
  Speaker 2: a chaos. Smith to Women's Healthy Initiative. The women age
• 8:01
  Speaker 2: group average age was sixty three. Okay, now, when is
• 8:06
  Speaker 2: the average age that you want to use these pills.
• 8:10
  Speaker 2: It's forty nine, fifty fifty one.
• 8:14
  Speaker 3: Menopausal are so in West.
• 8:16
  Speaker 2: In the West, the menopausal age average age is fifty one.
• 8:20
  Speaker 2: In India it's forty six. To forty seven, so we
• 8:23
  Speaker 2: are four years earlier. So why would you want to
• 8:25
  Speaker 2: use estrogen in a sixty three year old woman? So
• 8:30
  Speaker 2: it was a skewed, biased population. It was not representative
• 8:33
  Speaker 2: of the population. Rare we like to use these these
• 8:36
  Speaker 2: impudications and where you're looking for relief, right, So there
• 8:40
  Speaker 2: were people from fifty to sixty, but a lot of
• 8:41
  Speaker 2: people above sixty. And you know it was the whole
• 8:44
  Speaker 2: age group was fifty to seventy nine. An average was
• 8:47
  Speaker 2: sixty three.
• 8:48
  Speaker 3: You peak symptom yes.
• 8:51
  Speaker 2: So they were doing a very large study, but the
• 8:54
  Speaker 2: interpretation became skewed because the population was skewed. So that
• 8:58
  Speaker 2: was one The second major change there was that the
• 9:04
  Speaker 2: estrogen and progesterone preparations that were used were very crude.
• 9:08
  Speaker 2: What was commonly used at that time conjugated aquine estrogens
• 9:12
  Speaker 2: aquine meaning the estrogen came from the urine of pregnant mayors. Well,
• 9:19
  Speaker 2: I say what, I'll say, it's still used actually, but
• 9:23
  Speaker 2: they were not the natural estrogen that was seen that
• 9:28
  Speaker 2: was circulating in a woman's body. And the progesterone was
• 9:31
  Speaker 2: also a synthetic one, not close to the natural progesterone
• 9:35
  Speaker 2: that is being used. So these were two major things.
• 9:38
  Speaker 2: A the population was different, patient problem and the molecule
• 9:44
  Speaker 2: was different. So over the years, for example, in twenty
• 9:49
  Speaker 2: twelve or thirteen when they renalized, they found that if
• 9:52
  Speaker 2: you just look at the fifty to sixty age group,
• 9:56
  Speaker 2: you actually find that there is no increasion cardia risk
• 10:02
  Speaker 2: And if you look at people who have used estrogen
• 10:06
  Speaker 2: for even a combination for less than five years, there's
• 10:10
  Speaker 2: hardly any increase in breast cancer risky. And interestingly, if
• 10:17
  Speaker 2: in the estrogen only group there was no increase in
• 10:21
  Speaker 2: breast cancer okay. Is you know when when you don't
• 10:26
  Speaker 2: go into the nuanced nuances of a pertlet study and
• 10:29
  Speaker 2: just blanket for safeties reasons, just apply it across the board.
• 10:34
  Speaker 2: So what I'm saying is three or four things. Number
• 10:36
  Speaker 2: one jubb w h I say Lagaki breast cancer or
• 10:41
  Speaker 2: stroke or clotting at risk worth but hume women were
• 10:47
  Speaker 2: average age was sixty three. Jeb hum is co stratifi
• 10:53
  Speaker 2: fifty to sixty age group may to agur surf estrogen
• 10:56
  Speaker 2: use Kerrey to breast cancer risky, but rather the important
• 11:00
  Speaker 2: the breast cancer is quent up when estrogen and stone
• 11:03
  Speaker 2: were used to. Second thing is when we look at
• 11:07
  Speaker 2: this age group KOI cardiac chriskly but rather clotting or
• 11:10
  Speaker 2: cardiac heart attacks or I'm including heart attacks also in
• 11:13
  Speaker 2: the clotting because that's not exactly the same, but the same.
• 11:16
  Speaker 2: There was increason heart disease. So so breast cancer heart
• 11:20
  Speaker 2: disease you eliminated. So this said that we need to
• 11:25
  Speaker 2: just keep re looking at the data. So while the
• 11:28
  Speaker 2: FDA has said it now, this was brewing. It is
• 11:31
  Speaker 2: very clear that the increase in usage of h charty
• 11:35
  Speaker 2: had already staged a comeback in the sort of mid
• 11:39
  Speaker 2: say twenty fourteen fifteen area. But of course with the
• 11:43
  Speaker 2: FDA saying it now, people feel much more free to use.
• 11:46
  Speaker 3: It, much more safe. Yes as well, but.
• 11:50
  Speaker 1: BBIU study contradictory opinion Art Loki Farmer lobby. Because you
• 12:01
  Speaker 1: know the world, we have to take everything with a
• 12:03
  Speaker 1: pinch of fault. What is the current status of HRT.
• 12:07
  Speaker 1: How do you think it is it suited for Indian women?
• 12:11
  Speaker 1: Let me come to the India context.
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  Speaker 2: So there are few important points, which number one that
• 12:17
  Speaker 2: Indians women are getting menopause earlier. So that's one very
• 12:22
  Speaker 2: important point. So therefore there, and they're also now living longer,
• 12:26
  Speaker 2: so they have a greater span of years after their
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  Speaker 2: menopause to live healthy. We do realize that the importance
• 12:37
  Speaker 2: of quality of life in women in many areas is
• 12:41
  Speaker 2: only now being emphasized, and I do think, having seen
• 12:46
  Speaker 2: this change, I do think that we brushed aside many
• 12:50
  Speaker 2: menopausal symptoms of less aware and relatively less educated women
• 12:55
  Speaker 2: as SA just ignore it when actually probably the difference
• 13:01
  Speaker 2: in the symptoms between East and West, as we used
• 13:05
  Speaker 2: to call it, is not really that striking. So I
• 13:09
  Speaker 2: think Indian women, as they're becoming more empowered and more aware,
• 13:13
  Speaker 2: their awareness about their menopausal symptoms also is increasing. So
• 13:17
  Speaker 2: that is the second point. The third point, which goes
• 13:20
  Speaker 2: the other way, actually is that like menopause happening early,
• 13:24
  Speaker 2: even heart disease happens earlier here in women also, so
• 13:29
  Speaker 2: seven eighty years earlier, maybe six years. Definitely men and
• 13:33
  Speaker 2: women both there's an earlier onset of heart disease. So
• 13:36
  Speaker 2: you've got to balance that out by saying, we have
• 13:38
  Speaker 2: earlier menopause, but we also have earlier heart disease, so
• 13:41
  Speaker 2: you have to well, So I think in India, what
• 13:46
  Speaker 2: is happening is that with the increasing awareness about the
• 13:49
  Speaker 2: symptoms and also the increasing awareness about bone health which
• 13:53
  Speaker 2: wasn't there at all. I mean we got the first
• 13:57
  Speaker 2: bone tenesstameter in India which I was the sort of
• 14:01
  Speaker 2: first one to start doing that, I meaning the organization
• 14:04
  Speaker 2: in Luck now not in Delhi or Bombay in nineteen
• 14:08
  Speaker 2: ninety seven.
• 14:10
  Speaker 1: S L doctor he to what paths breaking Cam Currey.
• 14:13
  Speaker 1: This again goes to prove that all up, I mean.
• 14:15
  Speaker 3: To do something in life, I never fail to make
• 14:19
  Speaker 3: this point.
• 14:20
  Speaker 2: So so I think that is important. So now that
• 14:23
  Speaker 2: we look at it, we still have to look see
• 14:26
  Speaker 2: that there are there are many straight out within India,
• 14:29
  Speaker 2: many levels of awareness, many levels of monitoring and follow up.
• 14:34
  Speaker 2: So for the aware Indian woman who will observe the
• 14:39
  Speaker 2: correct monitoring and follow up methods, definitely HRT now it's
• 14:46
  Speaker 2: called MHD menopausal hormone therapy will actually stage will be
• 14:52
  Speaker 2: a major difference to their quality of life and long
• 14:55
  Speaker 2: term health. And again just stretching that again, when we
• 14:59
  Speaker 2: are using you know these MHD as you call it,
• 15:03
  Speaker 2: one extreme will like in everything say oh it will
• 15:06
  Speaker 2: improve your longevity. There's very little data about that, but
• 15:10
  Speaker 2: it will improve your quality of life and sort of
• 15:13
  Speaker 2: as you call health span. It's likely if used in
• 15:17
  Speaker 2: the right woman at the right time, But I don't
• 15:20
  Speaker 2: think in the Indian context it will be for the
• 15:23
  Speaker 2: masses as yet. I think I'll be a little careful
• 15:26
  Speaker 2: because you see a lot of India lives in its villages.
• 15:29
  Speaker 2: We're talking a lot of people who are struggling with nutrition,
• 15:33
  Speaker 2: struggling with so many other things. I wouldn't jump to
• 15:36
  Speaker 2: sort of prescribe MHD there, But a lot of India
• 15:40
  Speaker 2: is aware. A lot of India has access, you know,
• 15:45
  Speaker 2: living in urban environments, and the certainly should not be
• 15:49
  Speaker 2: deprived of MHD if they are candidates for that.
• 15:54
  Speaker 1: Now, this is actually true, But did you know this
• 15:57
  Speaker 1: that amongst all the mammals, amongst all the female mammals,
• 16:02
  Speaker 1: humans are perhaps one of the very few ach or
• 16:06
  Speaker 1: animal I'm forgetting which one I read about, which has
• 16:09
  Speaker 1: a very long life after the fertility is overs. Mostly
• 16:14
  Speaker 1: all mammals perish after their you know, reproductive age is over,
• 16:19
  Speaker 1: but humans continue to live, right, and when women are
• 16:23
  Speaker 1: men to live a long life even after fertility, you've
• 16:26
  Speaker 1: got to ensure that it's a good life.
• 16:29
  Speaker 2: So women live longer than men. In every society, in
• 16:32
  Speaker 2: every country, every part of the world, women live longer
• 16:36
  Speaker 2: than men. Now women are living longer than men. And
• 16:40
  Speaker 2: quite clearly that evolutionary think of your primary job in
• 16:46
  Speaker 2: life being to reproduce and pro create that has completely changed,
• 16:50
  Speaker 2: isn't it? So clearly there is a huge gap here,
• 16:56
  Speaker 2: and I expect with more improvements in druggeday development and
• 17:00
  Speaker 2: more improvements in monitoring, we will see a much better
• 17:04
  Speaker 2: use of MHD in India also MHD.
• 17:07
  Speaker 3: Okay, that's a.
• 17:08
  Speaker 2: Menoposal hormone therapy charity for Yeah, no, let's.
• 17:12
  Speaker 1: Call it MHD. Let's give people that information as well.
• 17:16
  Speaker 1: So not a basics issue. How many it established Korea
• 17:18
  Speaker 1: that if you are an urban, modern working woman working
• 17:22
  Speaker 1: or not actually, but if you're facing menopausal issues, it's
• 17:26
  Speaker 1: a good time perhaps to meet with your gayanak, to
• 17:28
  Speaker 1: meet with an endocrinologist and get cracking on this unka
• 17:32
  Speaker 1: basic saval Can you explain that very simply, y MHT, So.
• 17:42
  Speaker 2: In humans, in women, there is a decline in estrogen
• 17:46
  Speaker 2: now estrogen or progest main hormones, women's hormones estrogen amari
• 17:53
  Speaker 2: healthy am Of course, reproduction is dependent on the interplay
• 17:59
  Speaker 2: hormones are our always about complex interplay, so between estrogen
• 18:04
  Speaker 2: and progesterone. So our puberty starts with estrogen. Our reproductive cycling,
• 18:11
  Speaker 2: the menstrual cycle is dependent on estrogen and progesterone both.
• 18:17
  Speaker 2: Our pregnancy is dependent on estrogen, but a lot in progesterone.
• 18:20
  Speaker 2: Also the the two main hormones produced by the ovary,
• 18:23
  Speaker 2: of course, and then gradually after forty the levels of
• 18:29
  Speaker 2: these hormones start going down because the age of reproduction
• 18:33
  Speaker 2: is receding. I mean it's sort of that period is
• 18:37
  Speaker 2: going away, so you're not so the likely do reproduction
• 18:40
  Speaker 2: rather is receding. So therefore their role goes down. But
• 18:45
  Speaker 2: till they are there, till estrogen is there. It protects
• 18:48
  Speaker 2: our heart. One of the reasons why premnopositi women don't
• 18:51
  Speaker 2: get many heart attacks as compared to men in the
• 18:54
  Speaker 2: same age is estrogen. Thought to be estrogen very important.
• 18:58
  Speaker 2: It protects our bones. There is a rapid loss of
• 19:02
  Speaker 2: bone after menopause in women. Why do women get more
• 19:05
  Speaker 2: osteoporosis because they have a rapid loss of estrogen at menopause.
• 19:10
  Speaker 2: So all these things, you know, should make estrogen the
• 19:14
  Speaker 2: miracle hormone. It does much more than just reproduction. So
• 19:18
  Speaker 2: if it preserves heart health, preserves bone health, may also
• 19:21
  Speaker 2: preserve brain health and brain fog reduction to some extent,
• 19:25
  Speaker 2: then obviously it's remarkable and there would people who say
• 19:28
  Speaker 2: it it is a miracle. But obviously, as in medicine,
• 19:31
  Speaker 2: with everything, there is a downside which we have discussed.
• 19:34
  Speaker 2: But so what happens is that if these hormones are declining,
• 19:40
  Speaker 2: you start getting symptoms of what we call menopausal symptoms. Right,
• 19:46
  Speaker 2: what are How does one know what are menopausal symptoms?
• 19:49
  Speaker 2: So menopausal symptoms, the classic are what we call the
• 19:53
  Speaker 2: vasomotor symptoms. The vasomotive symptoms means sudden drop and estrogen
• 19:58
  Speaker 2: producing flashes. You're sitting in a meeting or you're talking,
• 20:03
  Speaker 2: you know, with your family, sitting in the living room,
• 20:06
  Speaker 2: and you suddenly feel very hot, like you're very uncomfortable.
• 20:11
  Speaker 2: You sometimes in extreme cases, you may have to go
• 20:14
  Speaker 2: up and get out, you know, get out of the
• 20:15
  Speaker 2: meeting for some time, go out of the meeting for
• 20:17
  Speaker 2: sometime and then accompanied by a profuse sweating. So that
• 20:23
  Speaker 2: is a classic menopausal symptom with palpitation and discomfort, and
• 20:28
  Speaker 2: it passes off in a few minutes, but enough to
• 20:32
  Speaker 2: sort of you know, it can be quite disabling for people.
• 20:35
  Speaker 2: That is vaso motor symptoms. You get sweating at night,
• 20:38
  Speaker 2: you're sleeping, provocation a condition, and maybe your partner is
• 20:49
  Speaker 2: not feeling hot, into those kinds of things, so night sweats,
• 20:54
  Speaker 2: insomnia in so you can't sleep properly. Then irritability, move changes,
• 21:01
  Speaker 2: depression like symptoms. All these can be indicators of menopause.
• 21:08
  Speaker 2: They also include sometimes very non specific symptoms like peculiar
• 21:11
  Speaker 2: body aches and people just don't feel the drive and
• 21:15
  Speaker 2: feel tired and they can't explain why everything is not
• 21:18
  Speaker 2: the same as it was a couple of years ago.
• 21:21
  Speaker 2: Similar yes with astroli.
• 21:25
  Speaker 1: Yeah, because instant follow that after you've pushed the baby out.
• 21:29
  Speaker 2: It just falls. So these are the symptoms that that
• 21:34
  Speaker 2: should warn you that maybe. Plus, it's not just that
• 21:38
  Speaker 2: if you have a family history of osteoporosis and fractures,
• 21:43
  Speaker 2: then you definitely are a candidate for evaluation at menopause.
• 21:47
  Speaker 2: So because if there's a family history of pone health issues,
• 21:50
  Speaker 2: then you also may be heading in that direction and
• 21:53
  Speaker 2: they're also and may want to consider. So these are
• 21:55
  Speaker 2: the things that happened to our body when estrogen declines suddenly,
• 22:01
  Speaker 2: it's not that sudden. That's also important. Just then periods
• 22:13
  Speaker 2: body may changes is term peri monopausal per peri maney
• 22:20
  Speaker 2: surrounding menopause, so actual periods just menopausal sal sal levels
• 22:31
  Speaker 2: come on, fertility coming over, literary cycles come on, overy,
• 22:39
  Speaker 2: follic co.
• 22:42
  Speaker 3: So meno pause.
• 22:43
  Speaker 1: Then clinically diagnosed SALTA periods correct perimenopause. Sorry symptoms why
• 22:51
  Speaker 1: getting erratic period?
• 22:53
  Speaker 2: Yes? Periods regular so almost for five years. You have
• 23:00
  Speaker 2: a lot of variation, but yes, it can happen. Be
• 23:03
  Speaker 2: a estrogen improve doctor a important perimenopaus so symptoms of
• 23:15
  Speaker 2: menopausal age group or up come menopause? You speriod may
• 23:20
  Speaker 2: you can be helped by judicious use of of hormones
• 23:26
  Speaker 2: like estrada.
• 23:27
  Speaker 1: So basically body may a hormone had you come or apic?
• 23:32
  Speaker 1: Doctor ke helps you say replenished? Is that a very
• 23:35
  Speaker 1: simplest way of understanding.
• 23:37
  Speaker 3: It's like, how do you.
• 23:40
  Speaker 1: Ensure that you're not overdoing it and not playing with
• 23:42
  Speaker 1: your bodies.
• 23:45
  Speaker 2: Little biology? Mosttant Let's not forget that ever, definitely and
• 23:54
  Speaker 2: Chronologist Beganiccologist her program the downside to HALKI no natural
• 24:10
  Speaker 2: hormone replaced monitor and I have corn log okay corn
• 24:21
  Speaker 2: log and breast cancer history obviously to swim extreme view,
• 24:30
  Speaker 2: are I quran cancer ray or Estralian negative cancer hormone dependent.
• 24:34
  Speaker 2: Now you have to shut up use but that breast
• 24:40
  Speaker 2: cancer history may number one. Number two up cor vaginal
• 24:46
  Speaker 2: bleeding unexplained, up coming a pause, beating, erratic breeding, estrogen
• 24:54
  Speaker 2: dependent cancers. You to college, simle the UPco. You don't
• 25:03
  Speaker 2: have to head towards uh, you know, using estrogen or something.
• 25:09
  Speaker 2: These are two very very important strict contraindications. Stroke history,
• 25:15
  Speaker 2: young clotting disorders history up venus from versus flights A
• 25:25
  Speaker 2: with the ko B clotting disorder history am recent cardiac
• 25:30
  Speaker 2: history EQUI to say jinko migrain migraine B reason I
• 25:39
  Speaker 2: avoid migraine.
• 25:41
  Speaker 1: Flare migraine what misunderstood je clinically diagnosed migraine not not
• 25:51
  Speaker 1: because you think, man, that it could just be some
• 25:54
  Speaker 1: wind trapped in your sister.
• 25:55
  Speaker 2: So migraine is also like a dump yard, and this
• 25:58
  Speaker 2: is everything you you can't very very so if you
• 26:04
  Speaker 2: have actual migraines, and of course if you have like
• 26:07
  Speaker 2: active liver disease. You would probably stay away from all this,
• 26:11
  Speaker 2: So that is the in loc Perjinko symptoms jobathai yeah,
• 26:17
  Speaker 2: Jenko family history, osteoporosis, your bone health problem, fractures history
• 26:23
  Speaker 2: unko doctor kai bar both women symptoms, pervo, menopaul long
• 26:35
  Speaker 2: term health may be a consider ka look in recommendation
• 26:41
  Speaker 2: be surf symptomatic. The only difference is kio symptoms classic
• 26:50
  Speaker 2: vasomotive symptoms, your night sweats hot flashes would he again
• 26:56
  Speaker 2: unexplained fatigue or tiredness or body aches or irritability, WOBE symptoms.
• 27:01
  Speaker 2: Manage that?
• 27:03
  Speaker 1: So how many estrogen progestidy may and then tie up
• 27:10
  Speaker 1: case use who is therapy can.
• 27:11
  Speaker 2: Then so progestone or estrogendy. They're a duo that manages
• 27:20
  Speaker 2: a symphony. Absolutely, it is a symphony very delicate, It's
• 27:24
  Speaker 2: very very The more you study these things and the
• 27:28
  Speaker 2: more you get on in years, the more you marvel
• 27:31
  Speaker 2: at the human body how delicately it balances all these things.
• 27:35
  Speaker 2: So yes, progesterone is important for us. Uh it's important
• 27:40
  Speaker 2: in particular in regulating our menstrual cycle. So women's menstrual
• 27:45
  Speaker 2: cycles are regulated by an interplay of estrogen. Estrogen stimulates
• 27:50
  Speaker 2: a uteruss lining to grow and progesterone then prepares it
• 27:54
  Speaker 2: for implantation. In the second half of the menstrul sort
• 27:57
  Speaker 2: of period twenty eight day cycle. The pest arts playing
• 28:00
  Speaker 2: a role around thirteenth fourteenth day and and then so
• 28:04
  Speaker 2: implantation the best period jabadaiyata ladys scope and they're planning
• 28:08
  Speaker 2: pregnancy or day twenty one years about their classic to
• 28:12
  Speaker 2: simmer progestone now yoga implantation, got it. So progesterone is
• 28:16
  Speaker 2: very important for our menstrual cycle. Also ustrogent kali probably
• 28:21
  Speaker 2: for bleeding sai a progesterone says prolyfication called progeston drop
• 28:29
  Speaker 2: ka the menstrual cycle. So estrogen rises first, prepares the
• 28:34
  Speaker 2: u trus, then progestons comes into play. Then both boom
• 28:37
  Speaker 2: they drop and then you get your period. So it
• 28:41
  Speaker 2: is important for regulating menstrual period. It's important for implantation.
• 28:46
  Speaker 2: It's important for you wouldn't be pregnantive with entire pregesteron
• 28:50
  Speaker 2: and then during pregnancy use both rolerata. Yeah, coffee very
• 28:53
  Speaker 2: important for pregnancy and other things. So I think this
• 28:56
  Speaker 2: is the main role of progesterone in our body. So
• 29:00
  Speaker 2: estrogen corol zadahevu continue progesterone capones may we roll theoretical
• 29:08
  Speaker 2: clinically proved.
• 29:09
  Speaker 1: Naval prove Also by I said symphony, because the woman's
• 29:15
  Speaker 1: body is so complex, unlike the advantage that men have.
• 29:20
  Speaker 2: That's what is very complex.
• 29:24
  Speaker 3: We talk about that also, we talk about menopause also.
• 29:27
  Speaker 1: But I want to come back to the fact that
• 29:30
  Speaker 1: a combination there is therapy, okay, fertility with the extend
• 29:36
  Speaker 1: the symptoms maintained.
• 29:40
  Speaker 2: What are birth control pills? Birth control pills are a
• 29:44
  Speaker 2: combination of estrogen and progesterone, Okay. So actually when we
• 29:48
  Speaker 2: take these hormones from outside, we are not improving our fertility.
• 29:52
  Speaker 2: We are contracept that we are actually inducing contraception. So
• 29:57
  Speaker 2: while the other things may improve the peripheral symptoms, the
• 30:00
  Speaker 2: fertility is dependent on the brain hormone, on the pituitary
• 30:03
  Speaker 2: hormones which are called l H and f s H
• 30:07
  Speaker 2: and those of you have been in this field would understand.
• 30:09
  Speaker 2: So spress laktai paradoxical, but as a hanni ya hormones
• 30:18
  Speaker 2: joe O hormones correct our fertility. K pituitary hypothalmus corol.
• 30:25
  Speaker 2: What different hormones inco stimulate. And again you're talking of
• 30:30
  Speaker 2: the symphony. That is that the symphony is controlled. The
• 30:33
  Speaker 2: conductor of the soul orchestra is the piture tree. So
• 30:39
  Speaker 2: by using progesterone and estrogen, we are treating the effects
• 30:45
  Speaker 2: of the peripheral deficiency deficiency organist. So fertility inhibit carey, Okay,
• 30:55
  Speaker 2: both control pills.
• 30:56
  Speaker 1: With and both control pills, say, but admits are the
• 31:00
  Speaker 1: midst peramic segment about mitsu bus.
• 31:05
  Speaker 3: Is bad perk.
• 31:06
  Speaker 1: Suppose I am a forty forty five year old woman,
• 31:10
  Speaker 1: I feel like I'm getting some symptoms of perimenopause, and
• 31:13
  Speaker 1: I come to your clinic to ask about it.
• 31:17
  Speaker 2: Sorry, symptoms, but I am in avomotor symptoms. The mood changes,
• 31:22
  Speaker 2: irritability could be connected. Now, Kali s a mild depression,
• 31:27
  Speaker 2: your mild anxiety? Are you to judgment? Blood test or
• 31:33
  Speaker 2: menstrual history more important? Test test blood blood levels of
• 31:39
  Speaker 2: all hormones, estrogen, progestone, l h F, s h A,
• 31:43
  Speaker 2: m H the various hormones you test, or ultrasound kurring
• 31:47
  Speaker 2: technically over ca forollicles. So that is what we would do. Typically,
• 31:53
  Speaker 2: is my first visit pay menstruation in them normal he
• 31:58
  Speaker 2: or hormone levels in a significant to shia thum or
• 32:03
  Speaker 2: three K rather than using hr T for every person
• 32:07
  Speaker 2: who comes with these symptoms in their forties.
• 32:09
  Speaker 3: Joe mal direct me, okay, you trist removal?
• 32:12
  Speaker 2: Why not.
• 32:16
  Speaker 3: Recommended?
• 32:17
  Speaker 2: So agur uterus removal? Ovary removed? Why one hundred percent? Then,
• 32:26
  Speaker 2: so that is the cleanest recommendation to be quick controversy.
• 32:31
  Speaker 3: Jub remove immediately, Yeah, removal.
• 32:35
  Speaker 2: Fifty but remo will typically forty forty one. Then he
• 32:42
  Speaker 2: had definition of premature menopause is below forty got it
• 32:48
  Speaker 2: but forty to forty five? Forty six? Struct me who
• 32:51
  Speaker 2: here or especially ovaries removed too? Doctor or he kiss
• 33:01
  Speaker 2: currently there. There must be some reason why they have
• 33:03
  Speaker 2: not described. First point about my patients, say patient didn't strict.
• 33:09
  Speaker 3: Correct because.
• 33:17
  Speaker 2: Symptoms and to the most least controversial MHD is in
• 33:27
  Speaker 2: those who had a historic mEq you traine bleeding or
• 33:35
  Speaker 2: managed and I have breast or cardiac to go up
• 33:39
  Speaker 2: and managed. So they are clear candidates.
• 33:44
  Speaker 1: I can remember a top of my head, so many
• 33:46
  Speaker 1: women in my family. You've got it done. But hormone replacement.
• 33:56
  Speaker 2: But ami and common patient comes to you at fifty
• 34:00
  Speaker 2: five with bones all crumbling, minopausal district thirty five pay
• 34:06
  Speaker 2: steck okay, the bleeding man doctor harmony the important area. Hey,
• 34:19
  Speaker 2: below forty no brainer. Anyone who's had a overarian removal. Actually,
• 34:25
  Speaker 2: I can say below forty five unless there is a
• 34:28
  Speaker 2: contraindication is a candidate, right and definitely below forty chair
• 34:34
  Speaker 2: natural menopausal. The person needs to be under regular follow
• 34:39
  Speaker 2: up even if overs are preserved, as you may need
• 34:43
  Speaker 2: a chart and it's quite safe for you. So it's
• 34:45
  Speaker 2: not because you don't need progestround them correct you see,
• 34:48
  Speaker 2: if you let me explain this uterus removal. So surf
• 34:53
  Speaker 2: estrogen valley h h safety better away those surf estrogen.
• 35:10
  Speaker 1: That treatment hormones, the bills, vaginal creams us forget my patches?
• 35:21
  Speaker 2: Ye a come look symptom which is a very common symptom,
• 35:28
  Speaker 2: which is problems in intercourse vaginal dryness disperuni. That is
• 35:35
  Speaker 2: a very common. Indian women often don't complain about it.
• 35:41
  Speaker 2: What important symptom is my life?
• 35:43
  Speaker 3: Come complain my life.
• 35:52
  Speaker 1: They don't talk about you know, when you hit puberty.
• 35:55
  Speaker 1: They don't talk about issues during pregnancy. They don't talk
• 35:58
  Speaker 1: about breastfeeding. Nobody tells you how hard it is, and
• 36:01
  Speaker 1: they obviously do not talk about menopause as well. So
• 36:04
  Speaker 1: I'm very glad you spoke about depleting sex drive, yes, and.
• 36:10
  Speaker 2: Painful intercourse and irritation itching. That's not uncommon at all.
• 36:15
  Speaker 2: That's a compon and there. If that is the only symptom,
• 36:20
  Speaker 2: then one can use vaginal preparations for genito urinary symptoms.
• 36:24
  Speaker 2: Genito urinary symptoms like genitals and urinary unitary symptoms you
• 36:28
  Speaker 2: are both commonly, vaginal creams work very well and they
• 36:33
  Speaker 2: have much less systemic side effects, if at all you know,
• 36:37
  Speaker 2: So it's a vaginal creams are a very important tool
• 36:43
  Speaker 2: by which to treat the symptoms related to either are
• 36:49
  Speaker 2: vaginal dryness and sexual discomfort and urinary symptoms both respond
• 36:55
  Speaker 2: well to that.
• 36:56
  Speaker 1: So you be doctor, decide correct You go to a doctor,
• 36:59
  Speaker 1: tell them symptoms, let them take a call.
• 37:01
  Speaker 3: Don't like no internet doctor.
• 37:05
  Speaker 2: Podcast important symptom, you know, but they're largely for local symptoms.
• 37:11
  Speaker 2: Vaginal creams available otherwise cause surf genity very problem. This is.
• 37:22
  Speaker 1: And course surf intercourse, painful hair, yes, sex stripe, r dryness,
• 37:26
  Speaker 1: head set round kari women on your treatment.
• 37:30
  Speaker 3: Pills get through the yes pills.
• 37:35
  Speaker 2: Cyclical that the doctor will explain. You can use if
• 37:40
  Speaker 2: you don't have a uterress upsurf est doctor your quick
• 37:47
  Speaker 2: quit stress you traine problems, uterress hair recent menaposit your
• 37:56
  Speaker 2: to surf second half of cycle or bilkol metopausecas bleeding
• 38:03
  Speaker 2: maintained cycles because not thirty eight, so you use a combination.
• 38:11
  Speaker 2: Otherwise you can use a fixed doors combination doctor. But
• 38:19
  Speaker 2: that leave that to the doctor. But if you don't
• 38:22
  Speaker 2: have a utress and estrogen alone is good. If you
• 38:24
  Speaker 2: have a utress, you have to use estrogen plus progesterone.
• 38:28
  Speaker 2: Correct how to do that?
• 38:29
  Speaker 3: The doctor will depending.
• 38:35
  Speaker 2: Important points. Since the libido or sex drive kibak a
• 38:40
  Speaker 2: both interesting area. Sex drive libudok main determinant and maybe testostroma.
• 38:50
  Speaker 2: I don't know to confuse people, but the fact is
• 38:52
  Speaker 2: that while estrogen will take care of the vaginal dryness
• 38:57
  Speaker 2: and local symptoms, the libido that is that is even
• 39:01
  Speaker 2: in women controlled by low doses of testosterone, which is
• 39:05
  Speaker 2: not popular at all in India. So we're not discussing
• 39:07
  Speaker 2: that at the moment, but just to know that as
• 39:09
  Speaker 2: it is with you. Oh god, yeah, yeah, it's not.
• 39:12
  Speaker 2: It's an approved indication. Yea.
• 39:15
  Speaker 3: So let's talk about menopause for a minute.
• 39:21
  Speaker 1: A viewers Hedge and koa podcast because a lot of
• 39:26
  Speaker 1: you will be surprised how many kids watch our podcasts
• 39:31
  Speaker 1: and then they recommend it to their parents because I
• 39:33
  Speaker 1: think India, I'm in a conversation. Is I think kids
• 39:37
  Speaker 1: these days and think about it and we tell our parents,
• 39:41
  Speaker 1: you know, try this. So for them, I want to
• 39:43
  Speaker 1: say men, It's not often spoken about, but women are
• 39:47
  Speaker 1: getting hot flashes. Men are getting angry. I've seen this
• 39:51
  Speaker 1: symptom a lot. We're just around the time when their
• 39:54
  Speaker 1: retirement hits mental kam heir this and that because men
• 39:59
  Speaker 1: are just you know't not so much involved in other things.
• 40:01
  Speaker 1: Either they have too much of a work drive and
• 40:04
  Speaker 1: they didn't, they tend to get very angry. Is that
• 40:07
  Speaker 1: is that a symptom of menopause?
• 40:09
  Speaker 2: So even before we move to menopause, all had one line.
• 40:13
  Speaker 2: But even with regard to menopause and what we're talking
• 40:16
  Speaker 2: about today, men need to be sensitized to that.
• 40:19
  Speaker 3: Ah. Yes, I think that's really very glad you.
• 40:22
  Speaker 2: Brought it up because otherwise, you know, the lady just
• 40:25
  Speaker 2: comes alone and you know, maybe what we are talking
• 40:29
  Speaker 2: to the woman doesn't even get sort of transmitted to
• 40:32
  Speaker 2: the husband properly or the person doesn't believe it also,
• 40:35
  Speaker 2: So I think involvement of men and understanding of it
• 40:40
  Speaker 2: about their partner's issues around menopause is very important because
• 40:44
  Speaker 2: it will improve the couple's quality of life, not just
• 40:47
  Speaker 2: not just the ladies.
• 40:48
  Speaker 1: Yeah, it's the same as postpartum. Right the minute you
• 40:52
  Speaker 1: as a unit, you as a family, you is a
• 40:53
  Speaker 1: spouse and a partner. Understand why your partner is feeling
• 40:57
  Speaker 1: what they're feeling, and it's not got to do with
• 40:59
  Speaker 1: your determination for woe handlenk. You know, life phase. It
• 41:04
  Speaker 1: could be postpartum, or it could be menopause as well.
• 41:07
  Speaker 1: It's import for the family to understand why it's happening.
• 41:09
  Speaker 1: And then it becomes like a disease problem. Yeah, and
• 41:13
  Speaker 1: then you're sport it right like so many things. So
• 41:15
  Speaker 1: I'm very glad you brought it up, so you donot
• 41:17
  Speaker 1: discussion can. I think while you hit your forties, both
• 41:20
  Speaker 1: men and women should visit it into chronologies and figure
• 41:23
  Speaker 1: out what's happened. The common causes or symptoms with I manopause.
• 41:29
  Speaker 2: So the joke amongst the medical fraternity is is there
• 41:32
  Speaker 2: anyone who can escape an undercrinologist. So you either have
• 41:37
  Speaker 2: you either have diabetes or obesity, if nothing, you'll have
• 41:41
  Speaker 2: a load testosterone or misbehaving, or you have menopausal things.
• 41:46
  Speaker 2: So as an example anyway, so what is manopause or
• 41:51
  Speaker 2: andropause as you sometimes call it, because androgen is the
• 41:54
  Speaker 2: male hormone thing, so I think, yes, it's uh. It's
• 41:59
  Speaker 2: also much talked about now. So unlike in women, there
• 42:03
  Speaker 2: is no sharp drop in testosterone, which is why it
• 42:07
  Speaker 2: is less understood. And you'll be surprised at this. The
• 42:13
  Speaker 2: testostone level actually starts declining at thirty very slow decline
• 42:20
  Speaker 2: every year, slowly, slowly, slowly. So by the time there
• 42:23
  Speaker 2: are a lot of variable estimates, but above between fourteen
• 42:26
  Speaker 2: fifty seven eight percent, men may already have a low testosterone. Okay, okay,
• 42:31
  Speaker 2: Now what happens when testostone declines is obviously the first
• 42:37
  Speaker 2: thing is is the libido that goes away. Now, there
• 42:40
  Speaker 2: can be a million causes for libido going down testostone
• 42:43
  Speaker 2: maybe just one of them, so proving it by a
• 42:46
  Speaker 2: low testostone level is very important. Again, don't go by
• 42:50
  Speaker 2: the symptoms alone. You have to do the laboratory test,
• 42:54
  Speaker 2: see your doctor and figure that out. And the other
• 42:57
  Speaker 2: predominant symptom in men is not irritably is fatigue. Oh yeah,
• 43:02
  Speaker 2: the loss of you can't yeah, the loss of sort
• 43:05
  Speaker 2: of the drive of feeling tired in the middle of
• 43:09
  Speaker 2: the day which you never did, along with the reduced libido.
• 43:13
  Speaker 2: That combination that can be a feature of just depression.
• 43:16
  Speaker 2: Both these things. So you have to see the doctor.
• 43:19
  Speaker 2: You have to get your blood levels measured, and clearly,
• 43:22
  Speaker 2: if that is the case, you will feel much better.
• 43:26
  Speaker 2: With testra stone replacement classically in men over fifty or sixty,
• 43:30
  Speaker 2: definitely common, not uncommon at all to have a low
• 43:34
  Speaker 2: testosterone which is pulling you down, which is affecting all
• 43:38
  Speaker 2: your metabolic health as well as your bone health. Again,
• 43:41
  Speaker 2: very very important. So you do it well.
• 43:44
  Speaker 1: How do you tell, like, you know, how a man
• 43:48
  Speaker 1: in their forty or a woman in their forty is
• 43:49
  Speaker 1: watching this, How do they know gear regular fatigue, it's
• 43:54
  Speaker 1: just been a tough day, or there is something clinically wrong, So.
• 43:57
  Speaker 2: That's the problem. There is no single sign that will
• 44:00
  Speaker 2: tell you. But whenever in men. If you have a
• 44:03
  Speaker 2: combination of reduced libido and these symptoms, get a testostone
• 44:07
  Speaker 2: level check. Talk to your doctor at least. Of course,
• 44:11
  Speaker 2: the caveat here is that testing of testosterone is actually
• 44:16
  Speaker 2: a little tricky, so you have to do it in
• 44:18
  Speaker 2: the right lab a am in the morning, fasting with
• 44:21
  Speaker 2: the correct technique. Very often people go for a hell
• 44:25
  Speaker 2: check and testostone is part of the hell check. The
• 44:27
  Speaker 2: sample was taken at eleven am. That's useless. Oh so
• 44:31
  Speaker 2: the little nuance is there, So there are criteria cutoff criteria,
• 44:35
  Speaker 2: say below three hundred dinagrams, we say that to your deftion.
• 44:38
  Speaker 2: So a combination of the symptoms. So if you have
• 44:42
  Speaker 2: persistent fatigue which you can't explain and you will pass
• 44:45
  Speaker 2: it off as midlife crisis of mid life fatigue and
• 44:48
  Speaker 2: all that, but get a testostroone check, and that may
• 44:51
  Speaker 2: well be the reason why you're getting pulled down in your.
• 44:54
  Speaker 1: Life, because if you look at both menopause and manopause,
• 44:57
  Speaker 1: for the example, it comes in your life when a
• 45:00
  Speaker 1: lot of life altering things are also happening. Your kids
• 45:02
  Speaker 1: have grown up, they've probably left the house now, they're
• 45:05
  Speaker 1: in community.
• 45:07
  Speaker 3: I mean they're in college, or they're in other places.
• 45:09
  Speaker 1: Right there is generally this is the time when men
• 45:12
  Speaker 1: and women or parents for the example, have to start
• 45:16
  Speaker 1: a new phase. Also a time interestingly where a lot
• 45:18
  Speaker 1: of divorces are happening this time around. If you look
• 45:21
  Speaker 1: at the Indian data, it tells you that a lot
• 45:23
  Speaker 1: of couples in metros are sort of parting ways post
• 45:28
  Speaker 1: just about retirement in their fifty sixties, that time right
• 45:30
  Speaker 1: where responsibility isn't ever done, and you realize there's nothing common.
• 45:34
  Speaker 2: You don't know what is really couples together?
• 45:37
  Speaker 1: Yeah yeah, right, So again, so to understand KII regular fatigue, KI,
• 45:44
  Speaker 1: you're saying, go meet your doctor, let them run a
• 45:47
  Speaker 1: test on you, and then only clinically understand if it's happened.
• 45:49
  Speaker 2: Right, So, what are the common causes the fittigue? You
• 45:51
  Speaker 2: have to look at all though, right, You have to
• 45:53
  Speaker 2: look at whether you are any make for example, if
• 45:55
  Speaker 2: you look at whether you're deficient in vitamin D twelve.
• 46:00
  Speaker 2: All those things have to be checked. And along with that,
• 46:02
  Speaker 2: when you're investigating for fatigue, when you're investigating for muscle loss,
• 46:06
  Speaker 2: sometimes men come with them shrinking. You know. Testrastone is
• 46:10
  Speaker 2: also very important, So.
• 46:11
  Speaker 1: Check up the testostrone a doctor. Nebola the only care
• 46:16
  Speaker 1: treatment time for men.
• 46:18
  Speaker 2: Yes, of course we replace testostrone classically. This is in
• 46:22
  Speaker 2: people over sixty, sometimes in fifty. Also we replace testosterone,
• 46:26
  Speaker 2: and there are ways to do it. There's an injection
• 46:29
  Speaker 2: that is taken once every few weeks, or there are
• 46:33
  Speaker 2: gels that can be used, and both are available. And yes,
• 46:37
  Speaker 2: and the again, I think the kind of gratitude you
• 46:41
  Speaker 2: get from some such patients when they get relief in
• 46:44
  Speaker 2: their symptoms is unbelievable. It also helps the bones quite
• 46:47
  Speaker 2: a bit. So remember that testostrone and estrogen both are
• 46:51
  Speaker 2: very important for bones, and so it's not just the symptoms.
• 46:55
  Speaker 2: You're also helping your ostroporosis again like an estrogen. Like
• 46:59
  Speaker 2: an est then we didn't talk about mammograms and monitoring
• 47:02
  Speaker 2: and all that, but that presuming is there, doctor will
• 47:04
  Speaker 2: advise you. I don't want to make it complicated. Similarly,
• 47:07
  Speaker 2: in testostone, also you have to look at prostrate. Its important.
• 47:11
  Speaker 2: A history of prostrate cancer is obviously then you avoid it.
• 47:15
  Speaker 2: There are other things, so you need to be sure
• 47:18
  Speaker 2: that you're not you're not taking it like randomly. I
• 47:22
  Speaker 2: do know of many people, some friends who you know,
• 47:29
  Speaker 2: very high achievers who take testos stone in their sixties
• 47:32
  Speaker 2: just to feel better and just to feel good, and
• 47:35
  Speaker 2: you know, they think they're acquiring more companies or buying more,
• 47:39
  Speaker 2: you know, or without a prescription. So people do that
• 47:45
  Speaker 2: to do that, and they're not advisable at all and
• 47:48
  Speaker 2: completely not advisable. And younger men are doing it in
• 47:52
  Speaker 2: all the gyms and everything. That's another story. Testostone misuse
• 47:57
  Speaker 2: abuse is very very common because it helps build your muscle.
• 48:01
  Speaker 2: So if you are if you're trying to be a
• 48:04
  Speaker 2: bodybuilder or you know, or weightlifter, all the steroid abuse.
• 48:08
  Speaker 2: The steroid you hear about is not the steroid that
• 48:11
  Speaker 2: we commonly use in COVID or something, you know. This
• 48:14
  Speaker 2: is the steroid means testosterone, which is also a steroid
• 48:17
  Speaker 2: and it's numerous metabolite. So for pumping up your muscle,
• 48:21
  Speaker 2: testostone is grossly misused.
• 48:23
  Speaker 1: Is it true that a lot of men in sow
• 48:25
  Speaker 1: deally are injecting themselves with testostone boosters to feel young again?
• 48:31
  Speaker 3: Is that happening?
• 48:32
  Speaker 2: So I can't see a lot of but certainly some
• 48:35
  Speaker 2: are doing that. Yes, So the craze for for looking
• 48:39
  Speaker 2: young doesn't sort of, It's not limited to women. Men
• 48:43
  Speaker 2: also are chasing youth and chasing the elixir of youth,
• 48:47
  Speaker 2: and some of them feel that testosterone may be it.
• 48:50
  Speaker 2: But I strongly recommend against uncontrolled and unsupervised use.
• 48:55
  Speaker 3: Of this over abusick side effects.
• 48:58
  Speaker 2: So just look, oh yeah, heki up. You went through
• 49:02
  Speaker 2: your thirties or maybe twenties pumping yourself and feeling great,
• 49:07
  Speaker 2: and then you have a partner or you had to
• 49:09
  Speaker 2: get married, and the same thing happens, like in oral contraceptives,
• 49:14
  Speaker 2: what happens when you are using testostone for a long
• 49:17
  Speaker 2: time in high doses, your test is can't produce sperm
• 49:21
  Speaker 2: then and then if you are using these drugs for
• 49:26
  Speaker 2: a long time and then you stop them suddenly, then
• 49:29
  Speaker 2: the body can't produce testosterone for some time, so your
• 49:34
  Speaker 2: your sexual function goes down drastically. You're not able to
• 49:37
  Speaker 2: produce sperm for fertility. And I have people undergoing divorces,
• 49:42
  Speaker 2: well known people who underwent a divorce for this reason
• 49:45
  Speaker 2: because the abuse of testostone like substances. And then once
• 49:50
  Speaker 2: you go off it, then you know you're not able
• 49:52
  Speaker 2: to perform and you know there's no sperm count. It's
• 49:56
  Speaker 2: all gone, oh gosh.
• 49:58
  Speaker 3: So ya.
• 49:59
  Speaker 1: But and so you get on the HRT therapy both
• 50:02
  Speaker 1: for men and women. We're moving back to Yeah, we're
• 50:04
  Speaker 1: moving back to women. Unless you've left something out on men.
• 50:09
  Speaker 3: I think this is yeah. I think we've got it.
• 50:13
  Speaker 2: I think I mean there are other issues again about
• 50:16
  Speaker 2: some in trees in cardiovascular disease or stroke, but that
• 50:19
  Speaker 2: has been largely put to rest by USFD. Again, they've
• 50:22
  Speaker 2: suddenly woken up to hormones in twenty twenty five six.
• 50:25
  Speaker 2: So that's why.
• 50:26
  Speaker 1: So having understood that about menopause and manopause, I thought
• 50:30
  Speaker 1: it's a good time to do a quick rapid fire
• 50:32
  Speaker 1: on mythbusting Bought says, get them Okay, subibla HRD causes
• 50:38
  Speaker 1: weight gain?
• 50:39
  Speaker 3: Is that true? Of false?
• 50:41
  Speaker 2: By large falls in the very small percentage people it can,
• 50:46
  Speaker 2: but more than ninety percent?
• 50:48
  Speaker 1: No?
• 50:48
  Speaker 3: No, wait, okay HRT is only for hot flashes.
• 50:53
  Speaker 2: No, I've described these symptoms associated with menopause where HRT
• 50:57
  Speaker 2: can be useful. And as I said, in addition to that,
• 51:01
  Speaker 2: a family history of osteoporocessor also drive you towards that.
• 51:04
  Speaker 2: So menopausal symptoms including hot flashes, but all the other
• 51:10
  Speaker 2: symptoms that go along.
• 51:11
  Speaker 1: Got it could natural supplements market maage and advertised Rajatai
• 51:17
  Speaker 1: Instagram reelschalty and that this will be a good substitute
• 51:21
  Speaker 1: for hormone therapy. Is there any such thing as a
• 51:23
  Speaker 1: natural supplement?
• 51:25
  Speaker 2: I mean, it's very difficult to actually substitute body hormones.
• 51:28
  Speaker 2: As I told you earlier, it's remarkable how the human
• 51:30
  Speaker 2: body functions, or each molecule is so complex. But there
• 51:34
  Speaker 2: are isoflevones containing things you know, which have some estrogen
• 51:38
  Speaker 2: like properties, and like soya is an example, and there
• 51:42
  Speaker 2: are others in the market. Some of them may help.
• 51:44
  Speaker 2: So if you really want to avoid HRD and your
• 51:47
  Speaker 2: symptoms are not like earth shattering symptoms, then maybe you
• 51:51
  Speaker 2: should talk to your doctor and try some of those
• 51:53
  Speaker 2: and maybe if you get partially leave it's okay only.
• 51:56
  Speaker 1: So yeah, not protein diet, not a heavy protein diet,
• 52:00
  Speaker 1: which anyways good for you.
• 52:01
  Speaker 2: So there's also this emphasis on as usual, on leading
• 52:06
  Speaker 2: a healthy lifestyle at that stage because it is midlife
• 52:09
  Speaker 2: and you are losing some muscle and you so yes,
• 52:12
  Speaker 2: of course, some people can help their health simply by
• 52:17
  Speaker 2: treating their obesity by treating their metabolic health, so that
• 52:20
  Speaker 2: is a given. We always push patients towards.
• 52:23
  Speaker 3: Yeah. Also there are questions about once you start HRD,
• 52:26
  Speaker 3: can you never stop.
• 52:29
  Speaker 2: In fact, the duration is very important, and conventional wisdom
• 52:35
  Speaker 2: tells us that five years is a good cutoff, and
• 52:40
  Speaker 2: why we're being conservative here. In individual people, you can
• 52:43
  Speaker 2: go up to ten years or more. We're just being
• 52:45
  Speaker 2: careful because whatever little increase in breast cancer happens starts
• 52:49
  Speaker 2: only at five years, so if you want to be
• 52:53
  Speaker 2: really safe, and also you're thinking of Indian women getting
• 52:56
  Speaker 2: heart disease earlier, all those things, so I think five
• 52:59
  Speaker 2: years the starting soon after menopause. Going up to five
• 53:03
  Speaker 2: years is absolutely safe. You can do a risk assessment
• 53:06
  Speaker 2: with your doctor and go up to longer periods. But no,
• 53:09
  Speaker 2: it's not for life.
• 53:10
  Speaker 1: Okay, If anybody wants to avoid doing HRT, what are
• 53:15
  Speaker 1: some healthy lifestyle picks you would want them to consider.
• 53:19
  Speaker 1: Suppose a thirty five year old woman walks into your
• 53:21
  Speaker 1: clinic and says that you know, I have a family
• 53:22
  Speaker 1: history of oustri prosis. I have seen my mother have
• 53:25
  Speaker 1: a very bad menopaustal face.
• 53:27
  Speaker 3: I want to avoid it. A lot of young Indians
• 53:29
  Speaker 3: think like that, what would your recommendation to them be.
• 53:31
  Speaker 2: I think the same healthy lifestyle we talk about in
• 53:34
  Speaker 2: the context of diabetes and obesity, the same thing. Obviously
• 53:39
  Speaker 2: healthy diet with lot of vegetables, maybe some fruits if
• 53:43
  Speaker 2: you're not a diabetic, vegetables and fruits. Definitely reducing refined
• 53:49
  Speaker 2: carbo headate, using high fiber cereals if at all, Definitely
• 53:53
  Speaker 2: increasing your protein intake, and physical activity which now obviously
• 53:58
  Speaker 2: with recent understanding, also includes strength training. So if you
• 54:02
  Speaker 2: lead that kind of healthy lifestyle and you're avoiding the
• 54:05
  Speaker 2: central bulge, then you're actually protecting yourself. That's the best
• 54:09
  Speaker 2: you can do.
• 54:10
  Speaker 3: Yeah, since you are here, I have to ask you
• 54:12
  Speaker 3: those who are on g LP one.
• 54:19
  Speaker 2: In fact, it's probably going to be one of the
• 54:22
  Speaker 2: most potent sort of compos to use in women in
• 54:25
  Speaker 2: mid life, I think, to improve their quality of life.
• 54:29
  Speaker 2: Got it?
• 54:30
  Speaker 1: How many ik online postal? Let me just go to
• 54:36
  Speaker 1: that there is one uh rack hr. But how expensive
• 54:44
  Speaker 1: is it?
• 54:46
  Speaker 2: So? I don't think chart in India is very expensive
• 54:50
  Speaker 2: and it certainly doesn't qualify as an expensive medication going
• 54:53
  Speaker 2: by the way things are. The challenge in India in
• 54:57
  Speaker 2: h Art at the moment that we are facing is
• 54:59
  Speaker 2: the lack of availability of estrogen patches. Now, patches are
• 55:05
  Speaker 2: very important because patches reduce the risk of clotting drastically.
• 55:09
  Speaker 2: Patch consumed, patch up change Korea happy maybe or absorber
• 55:22
  Speaker 2: blood make liverata to slotting risk recommendation may have patches
• 55:32
  Speaker 2: tho India, Milish room or I expect and I hope,
• 55:36
  Speaker 2: and we'll try to push companies to get patches to India.
• 55:40
  Speaker 2: Patches might be a little expensive. Just now, That's why
• 55:43
  Speaker 2: I brought this up.
• 55:44
  Speaker 3: The pills are not not expensive.
• 55:46
  Speaker 1: Okay, there's a question by Rivet Nayer. She says, I
• 55:49
  Speaker 1: hate menaposit thirty six relatively early, quite early. Yeah, I
• 55:54
  Speaker 1: am forty four now and still facing symptoms.
• 55:56
  Speaker 2: Should I go for ch Yes, unless there's a contra
• 56:00
  Speaker 2: indication at least next few years. Whatever. You can't undo
• 56:03
  Speaker 2: the damage that's been done, but you know, we can
• 56:06
  Speaker 2: certainly help you a lot by you can actually recover
• 56:09
  Speaker 2: some of the damage that's been done also, I mean
• 56:11
  Speaker 2: you can recover some of it. Not the symptoms, of course,
• 56:13
  Speaker 2: but the careiod is gone. But maybe you can help
• 56:15
  Speaker 2: your bone health. So you should definitely consider talk to
• 56:19
  Speaker 2: your doctor about it. It's not a contraindication. You're in
• 56:21
  Speaker 2: that zone, you should consider it.
• 56:23
  Speaker 1: Okay, all right with that, I think we've covered quite
• 56:27
  Speaker 1: a bit on HRT hotame Jupura understanding.
• 56:32
  Speaker 3: Hey, doctor ski, FDAQ would change.
• 56:35
  Speaker 2: Who we hear.
• 56:36
  Speaker 3: What is the one thing you want people to take
• 56:38
  Speaker 3: away from this podcast? Men and women?
• 56:44
  Speaker 2: I think it's the same thing for both. Around midlife,
• 56:47
  Speaker 2: people do face changes which may be completely unrelated to
• 56:52
  Speaker 2: what we're talking about, but the fact is that they
• 56:55
  Speaker 2: could well be related. The symptoms that you're facing well
• 57:00
  Speaker 2: be related to either estrogen or testosterone decline. And if
• 57:06
  Speaker 2: you fall in the category, that is, if you're a
• 57:09
  Speaker 2: candidate where these molecules can be used, these medicines can
• 57:13
  Speaker 2: be used, then you will face significant You will you
• 57:18
  Speaker 2: will have significant improvement in your symptoms just by replacing
• 57:22
  Speaker 2: these almost So, if you are getting that rundown, fatigue, feeling,
• 57:27
  Speaker 2: loss of libido, please talk to your doctor. Don't just
• 57:32
  Speaker 2: accept it as nothing.
• 57:33
  Speaker 1: Don't accept it as nothing, especially women. Don't do that
• 57:37
  Speaker 1: to yourself. There are things available that can help you.
• 57:40
  Speaker 1: Say FDA a band recommendation change. Topsy India MAKA adoption,
• 57:46
  Speaker 1: but up clinic may anecdotes.
• 57:50
  Speaker 2: Well as is usual. What happens in India is there's
• 57:54
  Speaker 2: a segment of the population, you know, the any segments,
• 57:58
  Speaker 2: so who have relatives and friends abroad and everyone who
• 58:02
  Speaker 2: has an American cousin or sister or friend. Says, Doc,
• 58:06
  Speaker 2: do you do a charity? How come? How come you never?
• 58:09
  Speaker 2: Says not at that stage yet you know, but certainly
• 58:13
  Speaker 2: if you're keen, why come how come Indian doctors don't prescribe?
• 58:17
  Speaker 2: So so definitely there are women who are coming with
• 58:21
  Speaker 2: their issues, sometimes with imaginary issues, sometimes with real issues,
• 58:26
  Speaker 2: and who will benefit with MHD or or charity, whatever
• 58:31
  Speaker 2: you call it. So that is one. Secondly, when you
• 58:34
  Speaker 2: have regulatory bodies that are respected worldwide, when when they
• 58:40
  Speaker 2: sort of remove certain or change their recommendations or remove
• 58:43
  Speaker 2: certain restrictions, obviously the average doctor also feels more confident
• 58:50
  Speaker 2: in prescribing. You knew it, but you was you know,
• 58:52
  Speaker 2: I FDA is restrictive, maybe there is something I don't know.
• 58:55
  Speaker 2: So once that happens, then definite cap yes, yes, yes, yes,
• 59:03
  Speaker 2: so that'd be encourage Let me tell you, I encourage
• 59:06
  Speaker 2: my patients to read up and come with all the
• 59:08
  Speaker 2: questions that they want, because if you're not going to
• 59:11
  Speaker 2: do that, they'll do that anyway and they will end
• 59:15
  Speaker 2: up much more confused. So I say, make your list
• 59:17
  Speaker 2: of questions and ask me whatever is in your mind.
• 59:19
  Speaker 3: Okay, I think mary list of questions we cover.
• 59:23
  Speaker 1: So if there is anything else that we have not
• 59:25
  Speaker 1: been able to cover in this podcast, to send in
• 59:27
  Speaker 1: all those questions in the comments. I'll text them and
• 59:30
  Speaker 1: I'll pester Docti Mythical to sort of answer all of
• 59:32
  Speaker 1: those and we'll put that out for you as well.
• 59:34
  Speaker 1: For the moment, I think we've done a pretty comprehensive
• 59:37
  Speaker 1: one and we've covered all bases on what exactly is
• 59:39
  Speaker 1: hormone therapy and why it's important for both men and women.
• 59:46
  Speaker 3: So we hope this answered all your questions for the moment.
• 59:48
  Speaker 3: Thank you so much, Doctor Mitel has always a pleasure
• 59:51
  Speaker 3: having you.
• 59:51
  Speaker 2: Thank you so