Latest / The Dr Louise Newson Podcast / 62 – How hormones change your brain - Dr Jay Jagannathan

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62 – How hormones change your brain - Dr Jay Jagannathan · The Dr Louise Newson Podcast

• 0:02
  So Jay, I'm very excited for this podcast.
• 0:04
  We're recording it on a Sunday night because you're super busy.
• 0:07
  I'm quite busy. But you are a neurosurgeon, so
• 0:11
  you are the Creme de la Creme of medicine.
• 0:13
  I should be bowing and cursing in front of you.
• 0:17
  Well, thank you for having me. I'm a big fan of your podcast
• 0:19
  and so I think the the the value you provide, you know,
• 0:23
  particularly for women in a perimenopausal phase, I my
• 0:27
  grandmother passed away of a heart attack that went
• 0:28
  undetected after men after obviously after menopausal age.
• 0:31
  My mom is a early I developed breast cancer shortly after
• 0:35
  menopause. I think it's very critical,
• 0:37
  valuable information and I really I really applaud your
• 0:41
  work. So I'm it's.
• 0:41
  Not a beer. Thank you.
• 0:43
  Well, I always try and think differently about things because
• 0:46
  I think it gets people thinking in different ways.
• 0:49
  And that's what I'm doing about hormones, about menopause.
• 0:51
  But some people listening know that I actually wanted to do
• 0:55
  oncology many years ago. I wanted to do cancer medicine
• 0:59
  and I, I only changed my career for lifestyle because I've got
• 1:01
  three children and I wanted to see them grow up.
• 1:04
  But, but my father actually died of a glioblastoma, so a brain
• 1:09
  tumor when I was 9. And I remember going to the
• 1:12
  operating theatre. I was so desperate to meet the,
• 1:15
  when I met him when I was 9, but didn't really remember him, but
• 1:17
  the neurosurgeon, Professor Watkins in London.
• 1:20
  So when I was a medical student, I went and watched him operate
• 1:23
  and met him and spent time with him.
• 1:25
  And, you know, it's, it's incredible when you see
• 1:29
  someone's brain like you do it every day.
• 1:32
  But you know, for most of us, it's an area that we'll never
• 1:35
  see and we don't think about often.
• 1:36
  I don't think we take our brains for granted.
• 1:38
  Yeah, I think it's, it's one of the the biggest privileges in
• 1:42
  for me in, in medicine is being able to operate in that part of
• 1:44
  the of the body because I think every part of the body obviously
• 1:47
  is, is important, but to to kind of be in an area which controls,
• 1:50
  you know, so much of your, of your personality.
• 1:52
  Everything that you know about a person is, is truly unique and
• 1:55
  it's something you, you never really lose the all of seeing
• 1:58
  that, no matter how many, how many years you have done it for.
• 2:00
  So it's, it's a privilege. And I think the other part, you
• 2:03
  know, with respect to things like GBM is our knowledge, You
• 2:06
  know, the, the prognosis for GBM in the last, you know, 100 years
• 2:09
  with all the advances beyond robotics, AI, hormonal therapy,
• 2:13
  you know, has really hasn't increased substantially.
• 2:17
  You know, it's gone up maybe about four to six months over
• 2:19
  the course of, of, of many, many years.
• 2:21
  So he teaches you how much we have that's left to learn.
• 2:23
  And I think, you know, when we look at topics such as what
• 2:26
  we're discussing here, you know, effects of hormones on brain
• 2:29
  health and chemistry on tumors, things like that, I think what
• 2:33
  we're talking about today, five years, 10 years, will be
• 2:35
  completely different from what what people will be talking
• 2:38
  about then. Yeah, I hope so.
• 2:39
  I'm, I'm very interested in the world, the role of hormones
• 2:43
  throughout our body, but especially our brain.
• 2:45
  And I'm also very interested in inflammation and about how our
• 2:49
  hormones can reduce inflammation in our bodies, but in our brain
• 2:52
  as well. But a lot of people think once
• 2:55
  our brain is developed, there's a lot of talk, isn't there,
• 2:57
  about children, adolescents, you know, their brain, how it
• 3:00
  develops. And then people think it's
• 3:02
  almost quite stagnant after then.
• 3:04
  But there's neuromodulation going on all the time, isn't
• 3:08
  there? In our brain, You know, our
• 3:09
  brain is constantly almost rewiring.
• 3:12
  The brain is constantly rewiring.
• 3:13
  There's certain parts of the brain obviously that tend to be
• 3:15
  more, more fixed. There's certain parts of the
• 3:16
  brain that tend to do to develop over the course of age.
• 3:20
  And the size and the shape of the brain changes too.
• 3:22
  You know, with all of us as we get older, the brain mass tends
• 3:24
  to tends to decrease there, there changes in proportions of
• 3:27
  areas such as Gray matter and white matter that happen as we
• 3:31
  get older as well. And there are effects of
• 3:33
  hormones such as estrogen on those factors.
• 3:35
  I'm sure we'll discuss in this podcast as well.
• 3:38
  And even aside from the structure, there are areas in
• 3:41
  the brain such as fluid spaces, the metrical things like that,
• 3:43
  that change in terms of size and in terms of compliance as we get
• 3:46
  older. And all those have a significant
• 3:48
  impacts in terms of cognitive function and in terms of
• 3:51
  behaviour and other things. Which is so important to know
• 3:54
  that, you know, we can constantly improve our brain
• 3:57
  function, we can improve the way the cells work and and also the
• 4:01
  communication between different areas of our brain, because
• 4:05
  different areas of our brain have different roles, don't
• 4:07
  they? Yeah, exactly.
• 4:09
  You know, I mean, every part of the brain obviously has an
• 4:11
  extremely valuable role. I mean, the frontal lobe is area
• 4:14
  that kind of controls, you know, impulsivity, you know, the
• 4:16
  cognitive thinking, what we think about personality, stuff
• 4:19
  like that. You know, there are areas of the
• 4:21
  brain such as a temporal lobe that controls more language,
• 4:23
  more spatial orientation, things like that brain stem, which
• 4:26
  controls critical functions such as breathing, things that we
• 4:29
  don't even know that we're doing, but are absolutely
• 4:30
  critical for, for life. Other important connection is
• 4:33
  that within these parts of the brain, there are different types
• 4:36
  of neurotransmitters. Neurotransmitters are the
• 4:37
  chemicals, almost the currency that the brain uses to
• 4:40
  communicate with different parts and, and these parts play
• 4:42
  significant roles in the overall internal milieu of the brain, as
• 4:46
  well as a communication with external hormones within the
• 4:48
  brain itself. And that that also plays a role
• 4:50
  in those shifts also play a role in terms of how our brain
• 4:53
  developed over the course of both in our youth and in our as
• 4:56
  we get older. Now, the one thing that is true
• 4:58
  when we are very young is the brain's capability of remodeling
• 5:01
  is a lot more rapid. So you have something called
• 5:02
  plasticity, which is the ability of these, these premature cells
• 5:06
  to really be able to remodel. We don't fully understand that
• 5:09
  obviously, but certain areas of the brain to hippocampus,
• 5:11
  occipital lobe are, are rapidly modeled.
• 5:14
  For example, in a, in a child with a brain tumor, I'll never
• 5:17
  forget for my training, we took out a, a tumor in the occipital
• 5:19
  lobe of, of a child that encompassed basically the whole
• 5:21
  occipital lobe. And in an adult, if you're
• 5:23
  taking that out, the patient wouldn't blind it for life.
• 5:26
  But this, this child had it in, in, in infancy and by the time
• 5:30
  she was two years old was able to have pretty much normal
• 5:32
  vision, you know, so there is a degree to develop there, but
• 5:35
  obviously that does change as time goes on.
• 5:37
  But I think you're absolutely right that the, the overall
• 5:39
  functionality of the brain is, is, is incredible and it does
• 5:42
  change. And you know, that's something
• 5:44
  that we we utilize for our benefit as well in terms of
• 5:49
  treatment and other things as patients get older.
• 5:50
  Yeah, and so when I, umm, was experiencing my own
• 5:55
  perimenopausal symptoms about 10 years ago, the biggest thing
• 5:59
  that, well, the thing that worried me the most is my brains
• 6:02
  didn't function. You know, I was really
• 6:04
  struggling to remember. I couldn't multitask.
• 6:07
  I couldn't remember drug doses. I couldn't remember patient
• 6:11
  names, really basic things that, you know, were bread and butter
• 6:14
  really to me. But it was almost like thinking
• 6:18
  through treacle. It's really, really scary.
• 6:22
  And you know, we've, we've now got data from hundreds of
• 6:26
  thousands of women who use our free Balance app.
• 6:29
  And the commonest symptoms are poor memory, low mood,
• 6:33
  irritability. You know, it's right.
• 6:35
  It's the brain that's affected most with hormonal changes.
• 6:38
  Sure, there's so there's an umbrella.
• 6:39
  You know, I'm listening to your podcast.
• 6:41
  I use the term brain fog, which is a common term that people use
• 6:44
  in relation to menopause. And there are several areas that
• 6:47
  may play a role in that. I mean, I think #1 decreasing
• 6:49
  estrogen level has been shown to affect glucose levels in the
• 6:52
  brain. As we know throughout the body,
• 6:54
  a glucose is an extremely important tool that the body
• 6:57
  uses for energy production. And that's, that's extremely
• 6:59
  important in the brain as well. That's why when somebody, we
• 7:01
  have an athlete and you know, they're, they're kind of losing
• 7:03
  the energy, you give them a drink, a Gatorade or something
• 7:06
  of that to help with that. So that's one factor there.
• 7:08
  Studies have also shown that structurally the brain changes
• 7:12
  with respect to decrease in estrogen.
• 7:13
  Specifically, studies in the past couple of years looking at
• 7:16
  functional MRI treatments have shown that Gray matter matter
• 7:19
  areas in the Gray brain. The Gray matter is the area that
• 7:22
  contains neurons. The neurons are what's fire that
• 7:24
  help us control the brain activity.
• 7:26
  The the, the, the, the supposedly the, the circuitry of
• 7:30
  the brain itself that those can that those tend to diminish as
• 7:34
  the estrogen levels tend to go down.
• 7:36
  And then there's also changes that happen with respect to
• 7:40
  neurotransmitters themselves. Estrogen has been shown to have
• 7:44
  a stimulatory with neurotransmitters such as
• 7:46
  acetylcholine with serotonin, which dopamine which are
• 7:49
  extremely important in terms of pleasure responses, in terms of
• 7:52
  alertness, in terms of activity. And similarly, interestingly,
• 7:56
  progesterone levels have been shown to be correlated with
• 7:58
  GABA, which is an inhibitory neurotransmitter that's they've
• 8:01
  been shown to be related to things like relaxation and stuff
• 8:05
  like that. So that combination of effects,
• 8:07
  clearly there is a relationship between hormonal changes and
• 8:10
  both the brain chemistry and the brain structure that happens
• 8:13
  after menopause that the clear or many of those symptoms you
• 8:16
  discussed. Yeah, which is so important
• 8:17
  because once you understand the basic neurophysiology of
• 8:20
  hormones, it makes it so much more obvious why people are
• 8:23
  experiencing symptoms and you know, the way that the
• 8:26
  neurotransmitters work together. A lot of people will have heard
• 8:29
  of serotonin and dopamine but don't realise that actually all
• 8:32
  three hormones, progesterone, estradiol and testosterone, you
• 8:36
  know, their levels really can change the levels of, of
• 8:39
  neurotransmitters such as dopamine and, and, and glutamate
• 8:44
  as acetyl and so forth. And so there's no surprise that
• 8:47
  we have so many symptoms affecting our brains.
• 8:50
  Yeah, absolutely. Yeah.
• 8:51
  And I think there's definitely a relation.
• 8:53
  I think obviously the structural and the functional relationship
• 8:55
  play a role as well. So I think these changes in
• 8:57
  neurotransmitters likely also play a role in terms of how the
• 9:01
  the Gray matter changes and stuff like that, that we see as
• 9:03
  well. And I think as the technology
• 9:05
  with respect to imaging improves and I think that's the main
• 9:07
  thing we're we're seeing now in terms of MRI technology and and
• 9:10
  the ability to kind of link with AI, the functional and the
• 9:13
  structural aspect, I think we'll see more of this data coming to
• 9:15
  light. Yeah, which we need to, really,
• 9:17
  because, you know, one of the problems is that makes me feel
• 9:20
  very sad at least, is that women aren't believed.
• 9:23
  You know, if I had a rash, I could show you my rash and you
• 9:26
  could diagnose it. You could give me sympathy if I
• 9:28
  tell you that I'm not thinking clearly, You know, is it because
• 9:32
  I've just had a bad night's sleep?
• 9:33
  Or is there something structurally going on?
• 9:35
  And a lot of people are very scared of, you know, am I
• 9:39
  missing something else going on in the brain?
• 9:41
  And lots of women come to us and think that they have dementia.
• 9:46
  But you know, there are lots of conditions in the brain that can
• 9:48
  cause memory problems, personality changes as well,
• 9:51
  aren't there? Right.
• 9:52
  So any, any kind of symptoms that are different from the norm
• 9:56
  warrants further investigation, you know, irrespective of
• 9:58
  whether you're a male or woman, gender, race, whatever it is.
• 10:02
  So it does, I mean, I think one of the things we often see, you
• 10:04
  know, both you and I in our respective fields from people
• 10:07
  are embarrassed or shy or they've been told to brush these
• 10:09
  symptoms aside. And obviously that's, that's not
• 10:11
  the right answer. I mean, I think nowadays one
• 10:13
  thing we have nowadays, so we didn't have even 20 years ago,
• 10:16
  is we have the ability to order testing and ability to
• 10:18
  investigate these things much better than it then than it was.
• 10:21
  So I think that's, that's the first part of it, specifically
• 10:24
  as it relates to menopause. I mean, I think a lot of those
• 10:27
  changes, there are treatments, right?
• 10:28
  I think the important part about it is that there are, uh, you
• 10:31
  know, maybe not definitive solutions, but there are
• 10:33
  treatments such as hormone replacement, things like that,
• 10:34
  that can be a benefit. Absolutely and I often say to
• 10:37
  patients, you know, once I've rebalanced your hormones, you
• 10:40
  know, usually all three actually progesterone, estadiol,
• 10:42
  testosterone and wait for a bit because they can take a world to
• 10:45
  have an effect and then let's see what else is going on.
• 10:49
  Umm, but I remember reading a few years ago that the first
• 10:52
  thing, or one of the first thing that happens in our, if we have
• 10:54
  a head injury or stroke is that our brain produces more
• 10:57
  progesterone, men and women actually.
• 10:59
  And it's very, it's very repairing.
• 11:01
  It's, it's, it's a very repairing hormone restorative.
• 11:05
  And it's interesting. I mean I used to work in a
• 11:07
  stroke ward many many years ago and never ever crossed my mind
• 11:11
  about progesterone in these women.
• 11:12
  Mainly women that had strokes, but men as well actually.
• 11:15
  Right. So progesterone, yeah, I mean,
• 11:17
  doesn't protective effect on the brain and we talked about the
• 11:19
  relationship with that and GABA, GABA inhibitory
• 11:21
  neurotransmitter. You know, as I think we talked
• 11:24
  about before we got on the podcast, there's a lot of data
• 11:26
  that was progesterone. So when you look at brain
• 11:29
  tumors, meningioma specifically benign brain tumors, up to 90%
• 11:33
  of them will have progesterone receptors and a progesterone
• 11:36
  receptor positivity. Meningioma has been shown to to
• 11:39
  be correlated with a decreased risk of recurrence.
• 11:42
  So there is positive effects of estrogen from that progesterone
• 11:45
  from that standpoint as well. Yeah, and, and increasingly we
• 11:48
  give progesterone to women who've had a hysterectomy.
• 11:50
  I feel a bit embarrassed. As a doctor for many years, I've
• 11:52
  been told only give progesterone if a woman has a womb.
• 11:55
  But actually all women have brains and we know they, you
• 11:57
  know, progesterone has an important role in brains.
• 12:00
  And a lot of people like the effects of progesterone.
• 12:03
  You know, I it's all about getting the right dose and type.
• 12:06
  And often when, when we talk about progesterone, people group
• 12:11
  all hormones together. Whereas when I talk about
• 12:13
  progesterone, I just mean an exact replica of our own
• 12:16
  progesterone hormone. Whereas there are a lot of
• 12:18
  synthetic progestogens or progestins, you say in the US,
• 12:22
  which are not the same chemical structure, and they often can
• 12:27
  really negatively affect people's mood, memory and so
• 12:30
  forth. And then you also mention
• 12:34
  meningiomas, which are benign brain tumors.
• 12:37
  But there does seem to be an increase incidence recently.
• 12:40
  We don't really know why, but there has been some association
• 12:44
  with some synthetic progesterone and whether it's because they're
• 12:48
  blocking the natural progesterone or they have their
• 12:52
  own sort of always toxic on the brain, we don't really know, do
• 12:55
  we? I do think you're right in terms
• 12:57
  of synthetic progesterone especially, that is a concern
• 13:00
  because obviously you know, we know that there may be enough,
• 13:04
  there may be enough variation in terms of the receptor itself
• 13:07
  that maybe in terms of how it binds to the receptor might be
• 13:09
  different or might bind to a different receptor site.
• 13:11
  Obviously these are speculative things I'm saying, but it may
• 13:13
  have a different effect from a natural progesterone that maybe
• 13:16
  maybe has has a protective effect.
• 13:18
  Yeah. And we know that, for example,
• 13:19
  even if you look at the cardiovascular system,
• 13:22
  progesterone is very good and anti-inflammatory, whereas the
• 13:25
  progestins increase risk of cardiovascular disease and
• 13:28
  increase inflammation. And having an estradiol and
• 13:32
  progesterone receptor is actually good because we have
• 13:34
  them naturally anyway. So it's, it's, but it's, there's
• 13:38
  so much we don't know because people have been scared away
• 13:42
  from hormones, especially when you talk about hormone
• 13:44
  replacement for, for decades. I mean, I don't know how much
• 13:47
  training you got when you were a junior doctor or a undergraduate
• 13:51
  about hormones. Probably not enough, you know, I
• 13:53
  mean the problem, you know, and I feel like neurosurgery, you're
• 13:55
  so focused on the, on the certain technical aspect of
• 13:58
  things, you know, the general part.
• 13:59
  But you know, one question I I have for you is that some, some
• 14:02
  patients I've talked to or some physicians I've talked to
• 14:05
  dealing with patients who have these symptoms, these
• 14:07
  perimenopausal symptoms advocate early replacement of estrogen.
• 14:10
  They say if you wait longer, the effectiveness can go down.
• 14:13
  Is that something you see in your clinical practice?
• 14:15
  So it's really interesting actually, because it really
• 14:17
  varies the response to hormones. And I, I, I was taught many
• 14:22
  years ago that there's some methylation of the receptors and
• 14:25
  actually people who have longer without hormones will less
• 14:29
  likely to respond, especially in the brain.
• 14:32
  But then Lisa Moscone's work, who's a neuroscientist, as you
• 14:35
  know, found that actually when people are deprived from Estadel
• 14:39
  for a long time and then have it back, their brain responds very
• 14:42
  quickly. And I certainly see women, we
• 14:45
  sometimes see women who are in their 70s, eighties, who have
• 14:47
  had 20-30 years without hormones and then deciding they want them
• 14:51
  often to improve their bone density, but their brain just
• 14:56
  works again. And, and so, so I think it all
• 14:59
  varies. And also it's not just the
• 15:01
  estrogen, it's also the progesterone.
• 15:03
  But in our experience, testosterone makes the biggest
• 15:06
  difference to brain, especially cognition and, and mood.
• 15:09
  Actually, so often it's not until all three hormones are
• 15:13
  balanced. OK, OK, sure.
• 15:15
  And yeah, I did. I think on that note, you know,
• 15:17
  the other area of, you know, with that we deal with it from a
• 15:19
  neurosurgical perspective is the effect of of these hormones on
• 15:22
  the spine, right? And there's a, there's a lot of
• 15:24
  data when it comes to things like back pain, you know,
• 15:27
  osteoporosis, things like that. How you know that that I see
• 15:29
  kind of later on in in the course where obviously these are
• 15:32
  factors that you have to take into account with respect to
• 15:34
  hormonal replacement therapy in particular as it relates to the
• 15:37
  perimenopausal period. You know, the affected, the
• 15:39
  protective effect of estrogens within in terms of bone density
• 15:42
  and things like that, as well as as changes in estrogen can
• 15:46
  affect ligamentous, you know, ligamentous factors and stuff
• 15:50
  like that can lead to things like back pain and things like
• 15:51
  that in patient tests. And I'm really pleased you
• 15:53
  mentioned that because one of the things I'm most scared of
• 15:56
  actually being menopausal is osteoporosis of my spine.
• 15:59
  I, I mean, I wouldn't like an osteoporotic hip fracture, but
• 16:03
  it's my spine. And I think people underestimate
• 16:05
  the importance of the spine until there's a problem and
• 16:08
  they're really painful. Like you say, those fractures,
• 16:11
  sometimes they can be repaired, but not all.
• 16:15
  But the other thing is that our hormones can modulate the pain
• 16:18
  receptors as well. You know, they actually
• 16:21
  stimulate the opioid receptors. So a lot of people would have
• 16:24
  heard of opioid drugs such as morphine, but actually our
• 16:28
  estradiol, progesterone and testosterone are can modulate
• 16:32
  pain in beneficial ways, which a lot of people don't don't
• 16:36
  realize, but also reduce inflammation and let you say
• 16:40
  correctly to strengthen the bones, so reducing the incidence
• 16:44
  of osteoporotic fractures of the spine.
• 16:47
  Right. So, yeah, I think I think for
• 16:48
  the osteoporotic fractures, I mean that's something obviously,
• 16:50
  you know, women do tend to a lot significantly higher incidence,
• 16:53
  particularly later in life when compared with men.
• 16:56
  You know, and, and a lot of times, you know, what we see
• 16:59
  particularly now in patients who aren't necessarily on hormonal
• 17:01
  replacement stuff like that, is that they tend to come back
• 17:04
  with, with more of these fractures.
• 17:05
  And, you know, they, they do get harder and harder to treat.
• 17:07
  They not only cause pain, but they can affect posture, affect
• 17:10
  balance, affect walking, things like that as well.
• 17:12
  So I think I definitely in, in, in addition to the hormonal side
• 17:16
  of it, I think kind of keeping track of that, you know,
• 17:18
  measuring bone density is extremely important in addition
• 17:21
  to to appropriate training and resistance training and in low
• 17:24
  degrees things like that have been shown to have major
• 17:26
  positive effects when it comes to preventing those kind of
• 17:28
  fractures. Absolutely.
• 17:30
  And and your job isn't just the brain, obviously you've
• 17:33
  mentioned the spine, but also the peripheral nerves as well.
• 17:37
  It's really important because a lot of people get pins and
• 17:39
  needles and, and, and even restless legs.
• 17:44
  And so people forget actually that the signals from the brain
• 17:49
  to the nerves and muscles have to be kept firing very quickly
• 17:53
  so we can be very responsive and reactive.
• 17:55
  And I'm very interested in the myelin sheath, so that if you
• 17:59
  can you explain what the myelin sheath is.
• 18:01
  Yeah, so the myelin, you know, if you think of a of a of a
• 18:04
  nerve is kind of like a giant wire, you know, and basically
• 18:06
  you have a cell body, that's what receives the impulses from
• 18:10
  the outside. And you know, nerves are, are
• 18:11
  similar structurally both in the central nervous system,
• 18:14
  peripheral nervous system. What's different is how they're
• 18:16
  enveloped and how they're protected and, and the internal
• 18:18
  milieu. But so you have a cell body that
• 18:21
  contains basically dendrites, which are little fingers that
• 18:25
  get neurotransmitters, which are signals that are sent to other
• 18:27
  from other nerves. It's processed from the cell
• 18:30
  body and then it's transmitted out through a thing called an
• 18:32
  Axon, which is a giant wire that basically connects to other
• 18:35
  nerves. So you can have one nerve that
• 18:37
  that supplies a million other nerves that kind of get signals
• 18:41
  to the rest of the body. So the myelin sheath is
• 18:43
  basically kind of an insulation over the Axon.
• 18:46
  And what it's meant to do is to provide increase rate of
• 18:50
  conduction within within the nerve itself.
• 18:53
  You can think of it as an answer.
• 18:54
  This conduction is called saltatory conduction.
• 18:56
  Saltatory just means it's jumping.
• 18:58
  So tends to jump from the node from node to node along the the
• 19:01
  myelin sheath and that's significantly increases the rate
• 19:04
  in which impulses are transmitted.
• 19:05
  So understandably if the myelin sheath is infected, which it can
• 19:08
  be affected both for hormonal changes, diseases, just multiple
• 19:11
  sclerosis, things like that can affect it as well.
• 19:14
  Those that slows down to transmission.
• 19:16
  And, and as I was mentioning, you know, if you think of a
• 19:18
  nerve having a as a, as a relay station that connects to
• 19:21
  millions of other relay stations in the body, a damage even to a
• 19:24
  small number of degree of the myelin sheath can cause
• 19:27
  catastrophic repercussions when it occurs downstream.
• 19:30
  Could may not just be happening with, with one muscle, it may be
• 19:33
  happening with millions of muscle fibers.
• 19:35
  And that that's why, you know, the myelination is important.
• 19:37
  And and as you mentioned, the hormonal changes can play a
• 19:40
  significant role in that. Yeah, I think it's so
• 19:42
  interesting. Several years ago now, I was
• 19:44
  giving a presentation about multiple sclerosis and the
• 19:47
  impact of hormones. So I went off and read quite a
• 19:49
  lot of papers. And once I realized the
• 19:51
  importance actually especially of testosterone to really
• 19:54
  rebuild the myelin sheath and and keep it as as good and
• 19:58
  strong and, and healthy as possible, it then made me think,
• 20:02
  what I wonder is that why more women than men are likely to
• 20:06
  have multiple sclerosis, which we know is a condition that can
• 20:10
  the myelin sheath can be negatively affected.
• 20:12
  And actually, some studies have shown that men with low
• 20:15
  testosterone are more likely to have multiple sclerosis.
• 20:18
  Yeah, that's absolutely true. And the other thing that's
• 20:20
  really interesting about that is men who've been on anti androgen
• 20:22
  treatment have also been shown to have some increased risk of
• 20:24
  disease like miss and same actually interestingly with
• 20:27
  meningiomas too. You know, it's kind of a
• 20:29
  interesting area because it's, it's, you're right.
• 20:32
  It's, it as much boils down to the testosterone as it does to
• 20:35
  the estrogen. It's a balance, you know, and
• 20:37
  it's a very, very delicate balance that when it gets
• 20:39
  disrupted, you know, can have significant ripple effects
• 20:43
  downstream. It's so interesting because, you
• 20:45
  know, any condition that happens more commonly in women in the
• 20:48
  late 40s, we've got to be thinking about hormones.
• 20:50
  But a lot of women who are younger have low testosterone,
• 20:53
  you know, in their 30s and 40s and they're still not thought
• 20:57
  about unless it's thought about in conjunction with estrogen and
• 21:00
  progesterone. So I feel very soon we have to
• 21:02
  be thinking about these hormones separately because they have
• 21:05
  different functions and roles in the brain and the body.
• 21:08
  They work together, of course, but then they work with other
• 21:10
  hormones as well. And you know, like, like you
• 21:13
  say, you've already said glucose for insulin and thyroxine, for
• 21:17
  example. But there's so much we don't
• 21:21
  know. But we just need to know, don't
• 21:22
  we? Because we, if we're anything we
• 21:24
  can do to improve our brain function is is key.
• 21:28
  Sure. And yeah, I think, I think, I
• 21:30
  think those are extremely important points.
• 21:32
  I think the other one point I, I really, really want to
• 21:34
  emphasize, you know, we've talked so much about
• 21:35
  symptomatology related to hormones, about brain structure,
• 21:38
  about brain chemistry, and you guys, you know, because social
• 21:41
  media has a tendency to kind of probably kind of myths.
• 21:45
  The important thing to keep in mind is things like
• 21:47
  intelligences are not affected by, by these changes.
• 21:49
  You know what I mean? I mean, the symptomatology can
• 21:51
  be bad. Those are areas we can treat.
• 21:53
  But it's important to it to note that even at the perimenopausal
• 21:56
  ages, in terms of, of being able to, to, to function in a, in a
• 21:59
  job capacity or anything like that, there's really, you know,
• 22:02
  there's really no reason why you can't be able to do that just
• 22:04
  because of these changes. These are symptoms that can be
• 22:07
  treated, but in terms of overall IQ, intelligence, stuff like
• 22:09
  that, there's no reason to to think that you know, that women
• 22:13
  going through those changes have any decrease compared to their
• 22:16
  male counterparts. Yeah, I think when they're
• 22:18
  untreated, though, I know hand on heart, I wouldn't be working
• 22:21
  as a doctor if I didn't take hormones.
• 22:23
  And in fact, I, I was, I changed, I used, I've been on
• 22:27
  testosterone for about 10 years and I use a cream, but recently
• 22:30
  I changed to the gel just because it's slightly cheaper
• 22:33
  and I thought, oh, I'll just try it and see.
• 22:35
  And it, and it, I could tell when I rubbed it on, it was
• 22:37
  floating off my skin. And it, it only took about 3 or
• 22:41
  4 days where I was just as shell of myself.
• 22:43
  And my husband was like you, you just don't seem to be listening.
• 22:46
  What's going on? You can't.
• 22:47
  And it's, it's really quite scary, actually.
• 22:51
  And, and I also get migraines as well.
• 22:53
  And, and if my hormone levels aren't at the right balance and
• 22:56
  migraines are so intense and so severe.
• 22:58
  And that really affects the way that I not just think that I
• 23:01
  slur my speech. I, I can't, you know, function
• 23:04
  at all. Yeah.
• 23:05
  What do you what do you think the reason between the cream and
• 23:07
  the gel in terms of so do you think in terms of absorption
• 23:11
  it's not as good or what is that?
• 23:12
  It's all, it's all absorption. You know, we use the estradiol
• 23:15
  and the testosterone through the skin because then it, there's no
• 23:19
  clot risk, it goes straight in. We container the dose, but it's
• 23:22
  the absorption and people's skin type is very, very different.
• 23:25
  You know, it could be skin temperature, skin thickness,
• 23:28
  there's all sorts of things that some people absorb better than
• 23:31
  others. And we've published some data to
• 23:33
  show about 1/4 of our follow up patients need higher than
• 23:36
  license dose is just to get adequate penetration through the
• 23:39
  skin. And, and we, we, we see it a
• 23:42
  lot. I'm one of those people that
• 23:43
  just, I don't know, I've got the skin of a rhino.
• 23:45
  It just doesn't really feel very well.
• 23:48
  And you know, we can measure levels to make sure that
• 23:50
  they're, the levels aren't high. It's not we're, we're having
• 23:53
  high amounts in our bodies. It's just to try and get it
• 23:55
  through the skin. But having the right dose is
• 23:59
  really important because we know also that studies have shown
• 24:02
  that if the estradiol level is low in the body, then there's
• 24:05
  more inflammation in the in the body and there's increase in
• 24:09
  evidence, isn't there, about neuro inflammation.
• 24:12
  So inflammation in the brain being associated with all sorts
• 24:16
  of conditions, including psychiatric conditions.
• 24:19
  So we, we want to be, as you know, our inflammation in our
• 24:23
  bodies and brains needs to be as low as possible really for
• 24:26
  longevity reasons. Yeah.
• 24:28
  And and you know, as, as, as we know more and more about it, a
• 24:30
  lot of those neurotransmitters we talked about earlier too,
• 24:33
  things like dopamine and stuff like that have been shown to
• 24:36
  have very critical importance in terms of the pleasure of pain
• 24:39
  responses and things like that. So given that we know that these
• 24:42
  factors are related to the the hormones we mentioned earlier,
• 24:45
  likely it has a very important effect not only on inflammation,
• 24:48
  but in terms of our perception of the inflammation as well and
• 24:50
  how we how we respond to it. Yeah.
• 24:52
  It's it's crucially important that we look after our brains.
• 24:56
  And obviously hormones are important, but you know what?
• 24:58
  We eat, how we exercise, whether we drink or smoke or drink
• 25:02
  alcohol rather than smoke. All these things can really
• 25:04
  affect our brain function, can't they?
• 25:06
  Yeah. So lifestyle changes, I think
• 25:08
  that's a very important point that you know, the lifestyle, I
• 25:11
  wouldn't say changes, but lifestyle in general plays a
• 25:13
  significant role. We talked about things like
• 25:15
  resistance training, you know, 1 area I was curious is whether
• 25:18
  with testosterone supplementation, we're talking
• 25:20
  about whether you see an increase in muscle mass, mass in
• 25:22
  women when, when they're getting that because that obviously is
• 25:25
  a, is a critical area in terms of functionality.
• 25:27
  A few other things, Diet, Mediterranean diet, you know, in
• 25:30
  terms of all 'cause mortality has been shown to be decreased,
• 25:33
  kind of focusing, you know less unprocessed foods and olive oil,
• 25:38
  things like that. You know, I think decrease in
• 25:41
  alcohol, tobacco consumption or critical factors as well.
• 25:44
  I think particularly staying on top of bone density, we talked
• 25:46
  about that earlier, you know, particularly in postmenopausal
• 25:49
  women are is very critical as well.
• 25:51
  Really interesting. Yeah, I mean, with testosterone,
• 25:53
  because we're using the natural body, identical testosterone,
• 25:57
  muscle mass really only increases when people exercise.
• 26:00
  You know, the synthetic testosterone is quite different.
• 26:02
  You can get, it's an antibiotic steroid, whereas natural
• 26:04
  testosterone isn't to the same extent.
• 26:07
  A lot of people find that they can exercise better.
• 26:11
  You know, maybe they've got less muscle and joint pain, they've
• 26:13
  got more stamina, they've got less fatigue.
• 26:15
  But they, you know, it's easier to build muscle, but not to a
• 26:18
  ridiculous way. But we know our muscles are
• 26:21
  metabolically active as well, aren't they?
• 26:23
  So if we've got better muscle function, it's not just the
• 26:26
  strength, it's actually they they function better and that
• 26:29
  can improve the way our whole body and brain work.
• 26:32
  Exactly. And I think the core, core
• 26:33
  muscles, particularly when it comes to the spine, the core
• 26:35
  muscles, the paraspinus muscles, extremely critical in terms of,
• 26:39
  of, of a balance, in terms of what you call sagittal balance,
• 26:42
  because your ability to stand up, right.
• 26:43
  And we know as we get older, you know, with arthritis for
• 26:45
  degeneration, been men and women, but more pronounced than
• 26:47
  women because of these fractures and stuff that we discussed
• 26:49
  earlier. That's extremely important in
• 26:51
  terms of minimizing stress in other parts of the bodies, the
• 26:54
  hips, the pelvis, the femur, things like that.
• 26:57
  And so I think that type of strengthening, you know, doesn't
• 26:59
  necessarily have to be going to the gym and, and, and doing
• 27:02
  deadlifts, but it's in terms of core strengthening and posture
• 27:04
  strengthening, yoga, Pilates, things like that, swimming, even
• 27:07
  swimming is very good low impact activity.
• 27:09
  Those can significantly decrease build build core muscle
• 27:12
  strength, improve posture, and improve decrease the long term
• 27:15
  effects of some of these changes when it comes to the spine.
• 27:18
  There's lots we need to do. I'm very grateful for your time,
• 27:21
  but before I finish I always ask for three take home tips as a
• 27:26
  neurosurgeon. With all your experience of the
• 27:28
  brain, what are the three things that anybody listening can do to
• 27:32
  really look after their brain for as long as possible?
• 27:35
  Number one, never ignore your symptoms.
• 27:36
  As we mentioned earlier, any kind of new symptoms changes.
• 27:39
  There's no, no such thing as I think we and I but both agree
• 27:41
  there's no such thing as a stupid question.
• 27:42
  When you, when you see your physician, always pay attention
• 27:46
  to that #2 lifestyle and brain health are, are integrally
• 27:50
  related. Your brain is, is, is controls
• 27:53
  every aspect of your life. So things like diet, exercise
• 27:55
  are extremely important and play extremely important role in
• 27:58
  terms of the overall health of the brain and, and the nerves in
• 28:01
  general. And, and #3 you know, I think
• 28:05
  the crux of here is that hormonal levels do change,
• 28:08
  particularly in women after time.
• 28:10
  I think these symptoms are are are are are expected as as you
• 28:14
  get older. So don't don't be ashamed to
• 28:16
  talk to your doctor about hormone replacement, about other
• 28:19
  options are available to you, particularly when you get to
• 28:21
  that age if you're having symptoms related to to menopause
• 28:24
  and other things. Lovely.
• 28:25
  Thank you so much for sharing your knowledge today.
• 28:27
  It's been great. Thank you very much.
• 28:29
  Thanks for having me.