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The Resurgence of Topical Estrogen for skin aging · The Science of Skin

• 0:09
  SPEAKER_00: Hi, I'm Dr.
• 0:10
  SPEAKER_00: Patty Ferris.
• 0:11
  SPEAKER_00: I'm a board certified dermatologist, and I'm your host for this episode of Skin Care Confidential.
• 0:16
  SPEAKER_00: Just as a reminder, and I know that most of you know this at this point, but Skin Care Confidential is an extension of our medical meeting, the Science of Skin Care Summit, which is going to be held September the 5th through the 7th.
• 0:27
  SPEAKER_00: We're going to be in Austin, Texas again this year at the Fairmont Hotel, which we moved into last year, and it was a great venue.
• 0:34
  SPEAKER_00: So if you're interested in taking a deeper dive in any of the subjects on the Skin Care Confidential podcast, check us out at ScienceofskinCare Summit.com.
• 0:42
  SPEAKER_00: Registration's now open.
• 0:44
  SPEAKER_00: So today I'm super excited because my good friend Ellen Gendler and I have been trying to schedule this podcast for six months.
• 0:52
  SPEAKER_00: And here we are.
• 0:53
  SPEAKER_00: Woo! We got it done.
• 0:55
  SPEAKER_00: And it's it's really great when you have good friends on.
• 0:58
  SPEAKER_00: First of all, I learned so much from my friends and about my friends.
• 1:01
  SPEAKER_00: So I'm going to start with Ellen's bio.
• 1:03
  SPEAKER_00: And there's a lot of stuff in here I didn't know, Ellen.
• 1:05
  SPEAKER_00: I know you're very accomplished.
• 1:06
  SPEAKER_00: You have a huge practice in New York City.
• 1:08
  SPEAKER_00: You're a board-certified dermatologist.
• 1:10
  SPEAKER_00: You're a leading authority in cosmetic dermatology and also in topical skin care.
• 1:15
  SPEAKER_00: You have been voted many, many times as one of the best doctors in New York magazine.
• 1:20
  SPEAKER_00: I know that's a coveted list by you, New York doctors.
• 1:23
  SPEAKER_00: And you're also most known, I think, for your interest in injectables, neurotoxins, and fillers.
• 1:29
  SPEAKER_00: And you've been a trainer as long as we've known each other, which is a very long time.
• 1:33
  SPEAKER_00: You're also a clinical associate professor at NYU Longdon Medical Center.
• 1:38
  SPEAKER_00: You continue to teach there, which is wonderful.
• 1:41
  SPEAKER_00: And you served as a co-director of the Contact Dermatitis Division for many years there.
• 1:45
  SPEAKER_00: That I did not know.
• 1:46
  SPEAKER_00: I did know that you yeah, it's very interesting.
• 1:49
  SPEAKER_00: Um, I did know that you were the director of the cosmetic symposium for at least a decade.
• 1:56
  SPEAKER_00: And my first talk at the American Academy of Dermatology was when you invited me to talk about retinols.
• 2:03
  SPEAKER_00: And I remember you looked at me and you said, Do you think it works?
• 2:05
  SPEAKER_00: And I said, That's the title, Retinol, Does It Work?
• 2:08
  SPEAKER_00: And that was the first talk I ever gave.
• 2:11
  SPEAKER_00: I loved it.
• 2:12
  SPEAKER_00: It was so much fun.
• 2:13
  SPEAKER_00: But anyway, that the rest is history on that.
• 2:15
  SPEAKER_00: Something that's not in your bio that I do want to mention is you have garnered a very large social media presence, especially on Instagram.
• 2:23
  SPEAKER_00: And one of the things that you I think are known for is your sort of no-nonsense approach.
• 2:28
  SPEAKER_00: I always say, I love it when you say, Are you kidding me?
• 2:33
  SPEAKER_00: And you make me laugh every day.
• 2:34
  SPEAKER_00: So if you guys want to have a wonderful time and learn a lot about what works and what doesn't work, follow Dr.
• 2:41
  SPEAKER_00: Ellen Gendler.
• 2:42
  SPEAKER_00: And that sort of brings us to the subject today that we're going to talk about because something that you have talked about on social that I think has really propelled it into popularity is topical estrogens.
• 2:55
  SPEAKER_00: And you were into this long before anybody else was into it.
• 2:58
  SPEAKER_00: So I want you to start by telling me how in the world did you get interested in topical estrogens?
• 3:04
  SPEAKER_01: Well, let me just introduce one little thing about my contact dermatitis history, which I think you probably will find interesting.
• 3:10
  SPEAKER_01: Back in the day, that's what I did.
• 3:11
  SPEAKER_01: And I did extra training in London with attained cronies.
• 3:14
  SPEAKER_00: I saw that at St.
• 3:15
  SPEAKER_00: John's.
• 3:15
  SPEAKER_01: Yeah.
• 3:16
  SPEAKER_01: And I co-directed the contact derm clinic at NYU for years.
• 3:19
  SPEAKER_01: And that was the era before any of this.
• 3:22
  SPEAKER_01: There were no cosmosceuticals, or there were very few.
• 3:24
  SPEAKER_01: But then as they began to develop, we started to see reactions.
• 3:28
  SPEAKER_01: So we would be testing people, and as a result of that, I got to know about all the cosmosceuticals that were around.
• 3:34
  SPEAKER_01: That led me into fillers, so that I was the principal investigator for the first HA filler that went on, and that's how my whole thing started.
• 3:41
  SPEAKER_01: But the world of cosmosceuticals and cosmetics is a completely different world than when you and I began this whole journey.
• 3:48
  SPEAKER_01: Oh my gosh.
• 3:50
  SPEAKER_01: So it was kind of crazy, and there really was very little.
• 3:52
  SPEAKER_01: I mean, retinoids were the first thing.
• 3:55
  SPEAKER_01: They're probably going to be the last thing too, right?
• 3:57
  SPEAKER_01: But um, but the way that estrogen came to me was kind of a weird story.
• 4:02
  SPEAKER_01: I had this elderly um socialite New York City patient, and she was like spectacular looking.
• 4:09
  SPEAKER_01: And I, and you know, we just didn't we didn't really have things tooth.
• 4:12
  SPEAKER_01: And I said, Your skin is amazing.
• 4:14
  SPEAKER_01: And she looked at me, I said, What do you what do you do?
• 4:17
  SPEAKER_01: And she said to me, Well, I use my estrogen cream on my face.
• 4:21
  SPEAKER_01: And I thought, what?
• 4:23
  SPEAKER_01: I mean, that's you know, that was even before the WHI study had had its heyday or its green cream.
• 4:28
  SPEAKER_01: Screwed everything up.
• 4:29
  SPEAKER_01: Right, screwed everything up, but you know, Nay Day perfect.
• 4:31
  SPEAKER_01: Nay Day.
• 4:32
  SPEAKER_01: Right.
• 4:32
  SPEAKER_01: But but it was really interesting.
• 4:34
  SPEAKER_01: And I think I was probably 40 at the time, maybe something like that.
• 4:38
  SPEAKER_01: And I had this idea in my head, and I thought to myself, you know something?
• 4:42
  SPEAKER_01: What if I'm not gonna schmear it all over my face?
• 4:45
  SPEAKER_01: What if I got some?
• 4:46
  SPEAKER_01: I'm gonna try using it around my eyes, because that seemed to me to be a really good place to test it out and see how it did.
• 4:53
  SPEAKER_01: And I'll tell you, I I I mean, I've never had surgery on my eyes.
• 4:57
  SPEAKER_01: Um, and until I started using lash serums and dissolved all the fat around my eyes, it was really amazing to me how my eyes looked.
• 5:05
  SPEAKER_01: Now, that was that a controlled trial?
• 5:08
  SPEAKER_01: It wasn't, but it led me into a whole, you know, rabbit hole of learning about how estrogen topical treatments became a thing.
• 5:17
  SPEAKER_01: And, you know, I'm sure you know a lot about this too.
• 5:20
  SPEAKER_01: You know, back in the day in the 40s and 20s, and maybe even the 30s, you know, the cosmetics companies were using vaginal estrogen to schmear on women's faces, and they had those crazy commercials about only, you know, your husband will love you more and all those things, and your skin looks so smooth.
• 5:34
  SPEAKER_01: And this went on for a long time, before I think maybe the 1940s, when the FDA came down and said, you know, we don't have any studies on this, we don't know what this is.
• 5:44
  SPEAKER_01: Before we're going to allow this in cosmetics, you need to, you know, the studies need to be done.
• 5:48
  SPEAKER_01: Well, once that happened, there wasn't anybody gonna do this.
• 5:52
  SPEAKER_01: Correct.
• 5:52
  SPEAKER_01: It kind of went away.
• 5:53
  SPEAKER_01: And then the WHI study came, and that was goodbye for everything like this.
• 5:58
  SPEAKER_01: So that's really how this topical estrogen thing hit.
• 6:01
  SPEAKER_00: It's so interesting.
• 6:02
  SPEAKER_00: I I I really didn't know that.
• 6:04
  SPEAKER_00: But yeah, and no, so you have a lot of experience though, because you adopted that into your practice.
• 6:10
  SPEAKER_01: I did, and I was giving I've been giving it to my women patients.
• 6:13
  SPEAKER_01: Now remember, I'm talking about using it around the eyes.
• 6:16
  SPEAKER_01: I never advocated for anyone to use this all over their body.
• 6:19
  SPEAKER_01: Never, never, never.
• 6:22
  SPEAKER_00: You know, all these compounding companies are selling it estrogen.
• 6:26
  SPEAKER_00: Talk about so everybody understands what are the benefits of using estrogen?
• 6:29
  SPEAKER_00: What does estrogen do?
• 6:31
  SPEAKER_00: You know, we know we talk about estrogen-deficient skin, which all of us at our age have.
• 6:35
  SPEAKER_00: Right.
• 6:35
  SPEAKER_01: You know, starting in perimenopause, we're becoming estrogen deficient, and there are very, very solid studies to show what a lack of estrogen does to the skin.
• 6:45
  SPEAKER_01: It makes the skin less thick, it makes it more dry, it diminishes your sebum, it makes it less elastic, it makes it heal slower.
• 6:53
  SPEAKER_01: It does anything you don't want is what estrogen decline does.
• 6:56
  SPEAKER_01: It does everything bad, okay?
• 6:58
  SPEAKER_01: So, you know, it it stands to reason that replacing estrogen might be helpful.
• 7:03
  SPEAKER_01: Now, I never say that taking systemic menopausal hormone therapy is to be done for the skin.
• 7:10
  SPEAKER_01: And the studies are not all that impressive in women who take menopausal hormone therapy, common in the past called HRT, that whether there's really significant differences between those women and those who don't in terms of their skin.
• 7:25
  SPEAKER_01: But um, but there seems to be a benefit to using topical estrogen on limited areas of the skin.
• 7:33
  SPEAKER_01: And we can get into it.
• 7:34
  SPEAKER_01: And um, I would love to know how you feel about this as we start talking about it, because there are a lot of naysayers.
• 7:41
  SPEAKER_01: Most of the naysayers appear to me to be the nerve influencers, shall we say, who are 30 years old to some of whom have never practiced, but they really don't have a patient base, in my opinion, that would lend itself to seeing how people do over the course of a decade, you know.
• 7:59
  SPEAKER_01: I mean, you and I know what women look like as we get older.
• 8:02
  SPEAKER_01: Yeah, we start out gorgeous when we're 30, and then we end up like us now.
• 8:07
  SPEAKER_01: You know?
• 8:08
  SPEAKER_01: So if you things you can do to stem that, it it may be reasonable.
• 8:11
  SPEAKER_01: But we could talk about this forever.
• 8:13
  SPEAKER_00: So I think that's the one of the big issues on estrogen are the systemic absorption issue, and I know you're well versed in it, so let's talk about that because that's one of the reasons people throw this under the bus.
• 8:24
  SPEAKER_01: Okay, so let's talk about that.
• 8:26
  SPEAKER_01: There have been countless studies, countless studies and reports saying that it doesn't get absorbed when used in the doses that we're talking about.
• 8:37
  SPEAKER_01: Okay.
• 8:38
  SPEAKER_01: And so there's this endless studies, and even with vaginal estrogen, right?
• 8:42
  SPEAKER_01: You know, vaginal estrogen is used in women with breast cancer.
• 8:46
  SPEAKER_01: And there are studies to show that when you use vaginal estrogen, if you insert it in the outer third of the vagina, it's absorbed even less than when you when you do it on the inner third of the vagina.
• 8:57
  SPEAKER_01: So there's a but there's so many safety studies on this, so many.
• 9:01
  SPEAKER_01: And so I feel like I get it, I understand why people worry because it's not a real controlled environment when you tell a woman to you know put estrogen cream on her on her skin, how much is she going to use?
• 9:13
  SPEAKER_01: And there need to be safeguards put in place.
• 9:15
  SPEAKER_01: But, but, but, but there are there are a few reports and everyone talks about the same reports.
• 9:22
  SPEAKER_01: And I really want to address those before we get into the good things about it.
• 9:26
  SPEAKER_01: And there have been, there was really one report that got a lot of attention, and now there's even a second report, and both of them are bad reports.
• 9:34
  SPEAKER_01: Let me tell you, there was a report by Kamori, I believe it was 2009, maybe it was 2008, and it was get ready for this one.
• 9:41
  SPEAKER_01: Hold on to your hat here.
• 9:43
  SPEAKER_01: It was a 93-year-old woman, 93, who had been using a topical estrogen cream, ethanyl estradiol cream.
• 9:53
  SPEAKER_01: I don't even know what that is, but using that, you're ready for this?
• 9:57
  SPEAKER_01: Three times a day on her face and entire body for 45 years.
• 10:05
  SPEAKER_01: And at 93, she developed breast cancer.
• 10:08
  SPEAKER_01: And so that's considered a report of a neck.
• 10:11
  SPEAKER_01: Okay.
• 10:11
  SPEAKER_01: That's considered a well, whether she would or she would.
• 10:14
  SPEAKER_01: Okay.
• 10:15
  SPEAKER_01: I said, so, but there that's there's one case report, and I just recently was made aware of another one.
• 10:20
  SPEAKER_01: This one was a killer, too.
• 10:22
  SPEAKER_01: You ready for this?
• 10:23
  SPEAKER_01: It was a uh uh, I forgot what year this was, forgive me, but it doesn't really matter.
• 10:27
  SPEAKER_01: It was a like a three-year-old or 36, like a three-year-old girl whose mother, mother used hormone-containing hair lotions, and the girl slept with her mother and cuddled with her mother and played with her mother's hair all the time.
• 10:46
  SPEAKER_01: Then when she was done playing with the mother's hair, she would play with the empty bottles, and then she would play with the mom's combs.
• 10:52
  SPEAKER_01: And she started having some vaginal bleeding, got tested, and she had a hyperestrogenic syndrome.
• 10:58
  SPEAKER_01: And this is considered another piece of evidence that it's dangerous.
• 11:02
  SPEAKER_01: Now, come on, and they tested in in that situation, they ended up testing the mom and the daughter, and they had high levels of estrogen.
• 11:08
  SPEAKER_01: But you know, let's be re reasonable.
• 11:11
  SPEAKER_01: These don't matter, these are not appropriate.
• 11:12
  SPEAKER_01: So let's case reports.
• 11:14
  SPEAKER_01: They're case reports and they're silly, okay?
• 11:16
  SPEAKER_01: Because that's not what we're advocating.
• 11:17
  SPEAKER_01: I don't make too much of that.
• 11:19
  SPEAKER_01: The the the the uh first woman, the 93-year-old, do you understand how much she was using?
• 11:24
  SPEAKER_01: Let me describe.
• 11:25
  SPEAKER_01: I'm trying to see if I can let me pull up a tube of some Rando cream.
• 11:29
  SPEAKER_01: Yeah, but this is an amount, okay.
• 11:31
  SPEAKER_01: This is what's considered a fingertip, okay, amount of cream.
• 11:36
  SPEAKER_01: That's 0.4 grams.
• 11:39
  SPEAKER_01: Now, that is so much that if I tried to schmear this all over my face and hands, it's tons.
• 11:45
  SPEAKER_01: So that it the equ she was using the equivalent of like three tubes a day of a 30-gram tube.
• 11:51
  SPEAKER_01: It's insane.
• 11:52
  SPEAKER_01: Well, let me ask you a question.
• 11:54
  SPEAKER_00: Yeah, those case reports again.
• 11:56
  SPEAKER_01: This is this is hand cream, so don't think it's estrogen.
• 11:59
  SPEAKER_00: I'm just curious, can you use a topical estrogen when you're on HRT?
• 12:05
  SPEAKER_00: You absolutely you can.
• 12:06
  SPEAKER_00: Absolutely.
• 12:07
  SPEAKER_01: Number one, women on HRT are using vaginal estrogen.
• 12:11
  SPEAKER_01: Vaginal estrogen.
• 12:12
  SPEAKER_01: And there have been quite a few studies that have shown, uh have that looked into, excuse me, comparing women on HRT who used topical estrogen and those who didn't, and comparing the skin, you know, the the skin benefits of topical estrogen in both in both groups.
• 12:29
  SPEAKER_01: And the ones who use topical in addition to systemic had better results.
• 12:34
  SPEAKER_00: What are the differences in the types of estrogen that you use?
• 12:38
  SPEAKER_00: Well topically.
• 12:39
  SPEAKER_00: I mean, okay, so here's the here are the right.
• 12:41
  SPEAKER_01: So let's talk about the kinds of uh estrogens that there are.
• 12:44
  SPEAKER_01: There's estradiol, there's estriol, and there's estrone.
• 12:48
  SPEAKER_02: Right.
• 12:49
  SPEAKER_01: And they they're at different times in your life.
• 12:51
  SPEAKER_01: You know, estradiol is is at a different point.
• 12:54
  SPEAKER_01: Estrone is the is the um hormone that's uh found when you're pregnant, and um estriol is uh is a weaker one.
• 13:02
  SPEAKER_01: Estrone is the weakest than estriol than estradiol.
• 13:04
  SPEAKER_01: So most vaginal estrogens are most vaginal creams are estradiol in the prescription world.
• 13:12
  SPEAKER_01: There are other topical estrogens, as you know.
• 13:15
  SPEAKER_01: There's premarin cream, which is conjugated equine estrogens, which we could talk about that as well.
• 13:21
  SPEAKER_01: And that's not estradiol, and no one actually knows what it is, but it's a mixture of different estrogens.
• 13:26
  SPEAKER_01: And then there are other formulations.
• 13:28
  SPEAKER_01: There's transdermal, there's patches, there's sprays, there's gels, all other ways of delivering estrogen in different doses.
• 13:37
  SPEAKER_01: But those delivery systems are for systemic hormone therapy.
• 13:41
  SPEAKER_01: They're different from the doses we're talking about in topical.
• 13:44
  SPEAKER_01: So when we say topical, I don't mean your patch that you put on or your gel that you spray on your arm as your systemic hormone.
• 13:52
  SPEAKER_01: I'm talking about vaginal estrogen doses.
• 13:55
  SPEAKER_01: That's generally estradiol 0.01%.
• 13:59
  SPEAKER_01: However, in Europe, they don't use estradiol for whatever reason.
• 14:05
  SPEAKER_01: I don't know the reason, and I think maybe in Asia, same thing.
• 14:08
  SPEAKER_01: They use estriol, 0.03%, and that's what's approved for vaginal use.
• 14:13
  SPEAKER_01: And many of the companies now that are compounding topical estrogen are using estriol.
• 14:20
  SPEAKER_01: Estriol.
• 14:21
  SPEAKER_01: Right.
• 14:21
  SPEAKER_01: Which is a weaker estrogen than estradiol.
• 14:24
  SPEAKER_01: Estradiol.
• 14:25
  SPEAKER_01: Right.
• 14:25
  SPEAKER_00: Wasn't there a study comparing the two?
• 14:27
  SPEAKER_01: There's been many studies comparing them.
• 14:29
  SPEAKER_00: But I mean topically for skin.
• 14:32
  SPEAKER_00: That's what thought.
• 14:33
  SPEAKER_01: And and there was a recent one that was done by one of the companies that makes a compounded version called Aloy, and they found no diff that both estr estriol and estradiol had benefits to the skin that were very similar.
• 14:48
  SPEAKER_01: Neither one had systemic absorption of any significance.
• 14:52
  SPEAKER_01: Um and so that was an interesting, that was an interesting report.
• 14:56
  SPEAKER_01: Now, was it in a peer-reviewed journal?
• 14:58
  SPEAKER_01: Not yet, but it probably is going to be.
• 15:03
  SPEAKER_01: Exactly.
• 15:03
  SPEAKER_01: It was a very deep, it was a really decent study, and it was a you know a reasonable amount of time, 12 weeks.
• 15:09
  SPEAKER_01: So, so, you know, it they showed their endpoints were met.
• 15:13
  SPEAKER_01: Now, nobody is saying that this is a home run miracle.
• 15:18
  SPEAKER_01: No one is claiming that.
• 15:20
  SPEAKER_01: So let's just get that out of the way.
• 15:22
  SPEAKER_01: You know, this is not going to transform.
• 15:24
  SPEAKER_00: I think there are probably some people saying that.
• 15:26
  SPEAKER_01: There probably are some people, but they're they're wrong.
• 15:28
  SPEAKER_01: That's not, that's that's not.
• 15:30
  SPEAKER_01: This is just this is like an adjunct to all the other things that we use in skincare.
• 15:34
  SPEAKER_01: And you know better than anyone, most of the things that we use are the the benefits are modest at best, other than things that we are you know sure of, like retinoids and things like that.
• 15:45
  SPEAKER_01: And topical estrogen is in no way meant to substitute for retinoids.
• 15:50
  SPEAKER_00: Well, people say, you know, retinoids boost collagen in a different way than estrogen.
• 15:57
  SPEAKER_01: And we don't even know, right?
• 15:59
  SPEAKER_01: And we also don't know how how estrogen boosts collagen.
• 16:02
  SPEAKER_01: There's so many things about estrogen that are interesting, fascinating, that we don't know.
• 16:06
  SPEAKER_01: So I'll say I'll tell you a couple of things that fascinate me.
• 16:09
  SPEAKER_01: Number one, you know, we have estrogen receptors all over our body, every organ has them.
• 16:13
  SPEAKER_01: And there's alpha and beta receptors.
• 16:16
  SPEAKER_01: Okay.
• 16:17
  SPEAKER_01: So the beta receptors are more prevalent in the skin.
• 16:21
  SPEAKER_01: Alpha receptors are the ones that you worry about when you talk about um reproductive cancers.
• 16:29
  SPEAKER_01: Okay.
• 16:30
  SPEAKER_01: So that's an interesting point because when the skin is stimulated, it's most likely not stimulating the same locus as what's needed to provoke or prolong or um worsen endometrial or breast cancer.
• 16:47
  SPEAKER_01: So that's important, that's important.
• 16:49
  SPEAKER_01: They're hitting different receptors, is what you're saying.
• 16:51
  SPEAKER_01: Okay.
• 16:52
  SPEAKER_01: As far as we know, that's true.
• 16:54
  SPEAKER_01: Um, the other thing that's interesting, and this I find really fascinating, there are some studies that showed that estrogen antagonists seem to do some of the same things that the topical estrogen estrogen did does.
• 17:08
  SPEAKER_01: So that some people posit a possible mechanism that we just don't know, that maybe that topical estrogen activates something else that helps the skin.
• 17:20
  SPEAKER_01: It still is unclear.
• 17:23
  SPEAKER_01: And a lot of the studies are done in vitro.
• 17:26
  SPEAKER_01: You know this as well as I that these are they're difficult to try to prove something when you're doing something in vitro because it doesn't always translate into in vivo.
• 17:33
  SPEAKER_00: No, of course not.
• 17:35
  SPEAKER_00: Of course not.
• 17:36
  SPEAKER_00: So talk about some of the studies.
• 17:38
  SPEAKER_00: I know you've reviewed them all.
• 17:39
  SPEAKER_00: I know Zoe Dreilos did one.
• 17:41
  SPEAKER_00: Some of the studies that really substantiate the benefits.
• 17:44
  SPEAKER_01: There are so many.
• 17:46
  SPEAKER_01: Now, some of them are small studies, some of them are pilot studies, some of them are observational studies, but some of them are placebo-controlled, um, double-blinded.
• 17:55
  SPEAKER_01: There, and and it's there are so many, and they go back really into the 1990s, which interested me because I didn't realize anybody was even looking at this back then, but but they started, you know, Phillips and Hall started way back in the late 90s looking at estrogen-deficient skin and then having the concept that maybe you could replace estrogen topically and see whether or not it was helpful.
• 18:17
  SPEAKER_01: So there have been many, many studies, virtually all of them have shown some degree of improvement in all the parameters that we're looking at.
• 18:27
  SPEAKER_01: The skin became thicker, the pores became smaller, there maybe might have been a little uh increase in sebum production, the skin became more elastic, maybe some lines look better.
• 18:37
  SPEAKER_01: Now, there were some studies that didn't show a big difference, you know, in how the wrinkles appeared.
• 18:43
  SPEAKER_01: And all of this, in my opinion, uh, while yes, estrogen is technically a drug, this almost falls into the cosmosceutical arena in the sense that when we gauge what cosmetics do to our skin, Patty, tell me if you disagree.
• 18:59
  SPEAKER_01: You know, many of the results are subjective.
• 19:02
  SPEAKER_01: So a woman could say, Ah, I love my skin with this, and we could measure everything possible and and show no difference, but the woman thinks she looks better.
• 19:11
  SPEAKER_01: Well, most of these studies had observational studies where someone else said it looked better.
• 19:16
  SPEAKER_00: So we're not really saying they weren't the investigator was looking at the changes.
• 19:21
  SPEAKER_00: Correct.
• 19:21
  SPEAKER_00: Because then you're than what the subject thinks.
• 19:25
  SPEAKER_00: The subject always thinks it works because you gave them a free tube of cream.
• 19:29
  SPEAKER_00: That's right.
• 19:29
  SPEAKER_01: But there were some studies where the the the subjects didn't think it helped, and the observers did think it helped.
• 19:37
  SPEAKER_01: So that's interesting.
• 19:38
  SPEAKER_01: We're not talking about causing a facelift to happen.
• 19:41
  SPEAKER_01: We're talking about improvement in the quality of the case.
• 19:43
  SPEAKER_00: It's always good when the subject self-assessment and the physician or the clin the investigator self-assessment parallel.
• 19:50
  SPEAKER_00: Correct.
• 19:51
  SPEAKER_00: That's always good.
• 19:52
  SPEAKER_00: You don't want to see one go one way and one go the other.
• 19:54
  SPEAKER_01: Right.
• 19:55
  SPEAKER_01: But you know, the things that they look at, you know they look at skin thickness and they use all the all so many studies, and I I know it's difficult when I'm not citing individual studies, but there are countless studies, that's what I'm telling you.
• 20:06
  SPEAKER_01: And there were only a few, like a handful, that didn't show improvement in these parameters.
• 20:13
  SPEAKER_01: And and so I decided, let me just look at these studies and see what were they?
• 20:18
  SPEAKER_01: There was one study from Korea that did that used estrogen cream around the eyes on the crow's feet, and they saw no improvement in lines.
• 20:27
  SPEAKER_01: Well, why would you expect to see improvement in lines?
• 20:30
  SPEAKER_01: You we know that the only thing they need neurotoxin.
• 20:32
  SPEAKER_01: Exactly, you need neurotoxin.
• 20:33
  SPEAKER_01: So that was a dumb thing to look at.
• 20:35
  SPEAKER_01: You know, or you yeah, or you need, you know, retinoids to do something.
• 20:38
  SPEAKER_01: So then there's some that looked at changes in pigmentation.
• 20:40
  SPEAKER_01: Well, why should this improve your pigment?
• 20:43
  SPEAKER_01: There's no reason for it to improve your pigment.
• 20:45
  SPEAKER_00: Exactly.
• 20:46
  SPEAKER_00: So this is sort of the way I see it.
• 20:48
  SPEAKER_00: And I was gonna start here, but I wanted to jump into estrogen.
• 20:52
  SPEAKER_00: This is a treatment for intrinsically aged skin.
• 20:56
  SPEAKER_00: I I've put this in the category of this is intrinsic aging.
• 21:00
  SPEAKER_00: This is the aging that happens as a result of birthdays.
• 21:03
  SPEAKER_00: It's not because of the sun, it's not for brown spots, it's not for the clinical stigmata of photoaging or what we call extrinsic aging, which is actually a way more caused by many more things than just UV, as we know now, the whole exposome.
• 21:19
  SPEAKER_00: But this is something for intrinsic aging.
• 21:22
  SPEAKER_00: So has somebody studied it, and I know somebody must have, like crepiness.
• 21:28
  SPEAKER_00: Like this is how many women come into your office and go, oh my God, will you fix this?
• 21:32
  SPEAKER_00: I'm begging you to fix one million a day.
• 21:34
  SPEAKER_00: A million a day.
• 21:36
  SPEAKER_01: But so, but the here's the problem.
• 21:37
  SPEAKER_01: Here's a conundrum.
• 21:39
  SPEAKER_01: Because this is what does that mean?
• 21:41
  SPEAKER_01: Wait, let's talk about it.
• 21:42
  SPEAKER_01: Should help.
• 21:43
  SPEAKER_01: To me, I don't think of topical estrogen as something to reverse what's already there.
• 21:50
  SPEAKER_01: Oh, you think that it's more of a prevention?
• 21:52
  SPEAKER_01: That's how I look at it.
• 21:53
  SPEAKER_01: Because you have your arm and you know, you see this.
• 21:55
  SPEAKER_01: Don't look at my blood test.
• 21:57
  SPEAKER_01: I'm thinking.
• 22:01
  SPEAKER_01: Right.
• 22:01
  SPEAKER_01: But how no, I'm doing it because look at my husband drew my blood and nearly killed me.
• 22:05
  SPEAKER_01: Oh my gosh.
• 22:06
  SPEAKER_01: Um but I mean how do you expect a topical cream to reverse this?
• 22:09
  SPEAKER_01: No.
• 22:09
  SPEAKER_01: So I view it as something that you do this for the long haul, and this is where I it's fascinating to me.
• 22:16
  SPEAKER_01: So many of the things we use in dermatology are to see results that you can actually visualize, like treating pigmentation with hydroquinone or with lasers.
• 22:27
  SPEAKER_01: You know, you have brown pigment or brown spots and you get rid of them.
• 22:30
  SPEAKER_01: There one day, gone the next, right?
• 22:34
  SPEAKER_01: You know, um retinoids.
• 22:36
  SPEAKER_01: You see your face is all mottled and scaly and what you use retinoids, and then your skin is smooth as silk.
• 22:41
  SPEAKER_01: Those are visible changes you can see.
• 22:43
  SPEAKER_01: What we're trying to help with estrogen topically is to help prevent the signs of intrinsic aging.
• 22:49
  SPEAKER_01: We're never going to stop it completely, but if you can help it, that's a that's a boon.
• 22:55
  SPEAKER_01: However, there's been many studies about, you know, looking at this on sun protected versus photo-damaged skin.
• 23:02
  SPEAKER_01: And the results with topical estrogen are in protected skin.
• 23:07
  SPEAKER_01: It doesn't appear to do the same thing for photo-aged skin.
• 23:11
  SPEAKER_00: No, aren't those studies super interesting?
• 23:13
  SPEAKER_00: I know Voorhees published one years ago.
• 23:15
  SPEAKER_00: Several people did.
• 23:16
  SPEAKER_00: We can publish one.
• 23:17
  SPEAKER_00: There's a so interesting.
• 23:20
  SPEAKER_00: Think about that.
• 23:21
  SPEAKER_00: I think we have we have to put it in the right place for people who are listening to understand this isn't your brown spot treatment.
• 23:28
  SPEAKER_00: This isn't to treat chemically damaged skin.
• 23:31
  SPEAKER_00: It's yeah, it's not a retinal.
• 23:33
  SPEAKER_01: I hate to be one of those interrupters, but I'm going to be an interrupter here.
• 23:37
  SPEAKER_01: This is how I got to my concept of using it around the eyes.
• 23:42
  SPEAKER_01: Because you know, women come in, come the first thing they complain about is their eyes.
• 23:47
  SPEAKER_01: The first thing, you know, okay, you see on social media that women are getting thing.
• 23:53
  SPEAKER_01: Uh they're around here.
• 23:54
  SPEAKER_01: Oh, then the neck, but also here, this thing, but this thing.
• 23:58
  SPEAKER_01: The neck gets worse later.
• 24:00
  SPEAKER_01: I mean, you know, you gotta have a few more years on it.
• 24:02
  SPEAKER_00: We're later.
• 24:03
  SPEAKER_01: We're later.
• 24:04
  SPEAKER_01: We're later.
• 24:04
  SPEAKER_01: We're later, you have every 40-year-old in my office is talking about it, okay?
• 24:09
  SPEAKER_01: But now they've been getting toxic.
• 24:11
  SPEAKER_01: Tell them go get your eyes done.
• 24:12
  SPEAKER_01: Just go get your eyes done.
• 24:13
  SPEAKER_01: But my but my premise was let me pick an area of thin skin on the face that really isn't sun damaged, because we don't really see that much sun damage, particularly around the eyes.
• 24:24
  SPEAKER_01: You know, people wear glasses, but whatever, you know, this is what we see sun damage.
• 24:27
  SPEAKER_00: So you know, your brows really kind of protect this area.
• 24:30
  SPEAKER_00: Yeah.
• 24:30
  SPEAKER_00: And you know, it's not, but this is you know, this is where you get it, where the correct prominences are.
• 24:35
  SPEAKER_01: But this is the area that's super thin, and that's where I came up with the concept for myself to try to use it there and see if maybe I could help not get have to have a blephroplasty at the age that most people have them.
• 24:46
  SPEAKER_01: And I think I succeeded.
• 24:48
  SPEAKER_01: Now, this is an N of one, but I tried it on so many people, so many women.
• 24:53
  SPEAKER_00: Are there eye creams being sold by these internet companies with estrogen?
• 24:57
  SPEAKER_01: Well, there I think there's one that's going to create an eye cream, but what's the magic in an eye cream?
• 25:04
  SPEAKER_01: You and I will always say that eye creams are BS for the most part.
• 25:08
  SPEAKER_01: So to me, I always use my premer, my vaginal premerin cream, and that's what I use under my eyes.
• 25:13
  SPEAKER_01: And for whatever reason, the base is nice enough.
• 25:16
  SPEAKER_01: Um, it's not something I would have smeared all over my face, but the base is nice, and I use it as my eye cream for 25 years.
• 25:22
  SPEAKER_01: That's what I've used as eye cream.
• 25:23
  SPEAKER_01: I've never put another eye cream on.
• 25:25
  SPEAKER_00: Remember, I had a conversation with you after you gave the talk at our meeting, and I said, Why don't you write these this up?
• 25:32
  SPEAKER_00: Because you probably have more experience with it than anybody.
• 25:36
  SPEAKER_00: I mean, I don't know anybody else who was really doing it over a long period of time.
• 25:39
  SPEAKER_01: Right.
• 25:40
  SPEAKER_00: And I mean, it's it's hard to do these retrospective things, but I know you take a lot of before and after pictures, and you could probably come up with a decent cohort of patients to we could, but you know, it's hard to it's really hard when you think about it.
• 25:51
  SPEAKER_01: Well, I'm gonna take a picture of myself when I was 30, and then myself today.
• 25:55
  SPEAKER_01: Now, the rest of my face doesn't look that great.
• 25:58
  SPEAKER_01: So how are you gonna judge?
• 25:59
  SPEAKER_01: I haven't been using it.
• 26:00
  SPEAKER_00: Don't you use retinoids?
• 26:01
  SPEAKER_01: I do, but I'm saying retinoids for years.
• 26:03
  SPEAKER_01: No, no, but my skin is beautiful, my skin's really nice, but my it I don't the I haven't had surgery, so my skin is loose, and that's what we would be using.
• 26:11
  SPEAKER_01: Estrogen is not to get rid of brown spots, to get rid of sunscreen.
• 26:14
  SPEAKER_00: It's not gonna tighten your skin.
• 26:15
  SPEAKER_01: No, it's not gonna tighten.
• 26:16
  SPEAKER_01: So what how how if I could have done half of my face for 20 years and the other half not, maybe then.
• 26:22
  SPEAKER_01: But it's so it's really hard to do that.
• 26:24
  SPEAKER_01: But but as women, we are taught we're and as men, that's not fair, we're told start doing sunscreen when you're 15 so that when you're 50, you don't have a problem.
• 26:34
  SPEAKER_01: And I view this as one of those situations.
• 26:36
  SPEAKER_01: But the areas where we complain about crepiness, other than under the eyes, on the neck, and the arms, if you start smearing estrogen cream all over your arms, then you're talking about using too much estrogen, in my opinion, because we have no way of documenting what you're getting.
• 26:51
  SPEAKER_00: I have any way of knowing.
• 26:52
  SPEAKER_00: Now, there are some studies with peptide creams that have looked at crepiness and seen some improvement, at least, you know, according to the studies.
• 27:00
  SPEAKER_01: I don't believe a word of them.
• 27:02
  SPEAKER_00: And I don't know about retinoids.
• 27:03
  SPEAKER_00: I'm sure I know I'm sure retinoids have been looked at in crepiness, but I can't think of a study.
• 27:07
  SPEAKER_00: Actually, maybe not.
• 27:08
  SPEAKER_01: But they did they have used if they have used retinoids in really good studies for photoage skin on the forearm.
• 27:14
  SPEAKER_01: They have.
• 27:14
  SPEAKER_01: But we're not talking about that.
• 27:16
  SPEAKER_00: And no, I'm talking about crepiness specifically because it's the problem.
• 27:20
  SPEAKER_01: Show me the money.
• 27:20
  SPEAKER_01: I want to see one study that re that helped crepiness in any way.
• 27:24
  SPEAKER_00: I'll send you one.
• 27:26
  SPEAKER_00: And I believe it was um I believe it was elastin.
• 27:29
  SPEAKER_00: I know.
• 27:29
  SPEAKER_01: I've been using the elastin transform.
• 27:32
  SPEAKER_01: Okay.
• 27:34
  SPEAKER_01: Exactly.
• 27:35
  SPEAKER_01: I'm not seeing a hell of a lot yet.
• 27:37
  SPEAKER_01: No, but I use it anyway.
• 27:38
  SPEAKER_01: It's not Patty, it's not going to reverse my crepiness.
• 27:42
  SPEAKER_01: I'm hoping that it helps it from prevent helps prevent it from getting worse.
• 27:46
  SPEAKER_01: I'm not looking to change it because I know that's not going to happen.
• 27:50
  SPEAKER_01: But the other thing I started to do, and let me just digress for a second in the estrogen world.
• 27:56
  SPEAKER_01: So there there's topical estrogen creams, estradiol, estriol.
• 27:59
  SPEAKER_01: Now, there are some CERMS, SERMA.
• 28:03
  SPEAKER_01: Selective estrogen receptors Exactly.
• 28:06
  SPEAKER_01: Selective estrogen receptor modulators, and those are interesting compounds that are not estrogens, but they somehow work to act on the estrogen receptor, but in a different way.
• 28:19
  SPEAKER_00: So what's what are the common ones?
• 28:21
  SPEAKER_00: Soy, right?
• 28:22
  SPEAKER_00: Soy, genocide.
• 28:24
  SPEAKER_00: And now sperotroll is a phytoestrogen.
• 28:27
  SPEAKER_01: Sort of, yeah.
• 28:28
  SPEAKER_01: And then there's another one, and there's there are some that are in studies for for systemic cancers, you know.
• 28:33
  SPEAKER_01: I think one's called liquidrol, one's called equal.
• 28:36
  SPEAKER_01: Like these are these are systemic things they're studying.
• 28:38
  SPEAKER_01: But then there's that other topical, cosmeceutical, that's called MEP.
• 28:42
  SPEAKER_01: Yeah.
• 28:43
  SPEAKER_01: Yeah.
• 28:43
  SPEAKER_01: So it's MEP.
• 28:44
  SPEAKER_01: MEP.
• 28:44
  SPEAKER_01: Methyl, right.
• 28:45
  SPEAKER_01: Methyl, um, methyl, asperdiol, propononoid, I think it's called.
• 28:51
  SPEAKER_00: Proponoids, right.
• 28:52
  SPEAKER_01: Yeah, right.
• 28:52
  SPEAKER_01: And it's it's not a very powerful thing.
• 28:55
  SPEAKER_01: The studies on it are not great.
• 28:57
  SPEAKER_01: I think it was 14 weeks, uh 12 or 14 weeks, a very small number of patients.
• 29:03
  SPEAKER_01: It was unclear where they came from, what they exactly what they did, and they saw some improvement, but we don't really know.
• 29:09
  SPEAKER_01: What we do know, it does not increase your systemic estrogen levels.
• 29:13
  SPEAKER_00: That's what I really think the studies were for, to make sure that didn't cause any change.
• 29:17
  SPEAKER_01: But what I started to do because it we know it has no effect whatsoever on systemic estrogen levels.
• 29:24
  SPEAKER_01: So I'm never going to be smearing my premarin cream all over my arms.
• 29:28
  SPEAKER_01: Right.
• 29:28
  SPEAKER_01: But what I started to do is I do.
• 29:30
  SPEAKER_01: That's what I've been doing on my forearms and my, you know, my my arms.
• 29:35
  SPEAKER_01: And let's see how I'm let's see how it goes.
• 29:36
  SPEAKER_01: I'm doing it on one arm, I've been doing it maybe for a year, and I'm gonna see how what if there's any difference in in another year.
• 29:42
  SPEAKER_02: I love it.
• 29:43
  SPEAKER_01: But I think that's a reasonable suggestion.
• 29:45
  SPEAKER_01: I personally think if you're gonna do it, you know, do it.
• 29:49
  SPEAKER_01: So either if you want to try using estrogen around your eyes, and you want to put a tiny dab on the tops of your hands, which is another place, you know, that that happens.
• 29:57
  SPEAKER_01: That that's how I recommend it.
• 29:58
  SPEAKER_00: So if you're on a desert island and you could pick one cosmosceutical to have, what what would it be?
• 30:04
  SPEAKER_00: It would be retinoids.
• 30:05
  SPEAKER_00: Retinoids.
• 30:06
  SPEAKER_00: Yeah.
• 30:06
  SPEAKER_00: You too.
• 30:07
  SPEAKER_00: Well, I think we all have the most confidence in retinoids, they've been studied for so long.
• 30:11
  SPEAKER_00: And the proofs in the pudding standard.
• 30:13
  SPEAKER_01: But you know, you have patients that you've that you've had retinoids for 20 years and you they walk in and they're 80 years old and their skin's gorgeous.
• 30:21
  SPEAKER_01: So you just see it.
• 30:22
  SPEAKER_01: That's what it's like.
• 30:23
  SPEAKER_01: If they stay out of the sun and they use the retinoid.
• 30:26
  SPEAKER_01: Right.
• 30:26
  SPEAKER_01: So, so you know, the people who are naysayers and they look for negatives, and I don't blame them because this is an important subject to look for, you know, problems with.
• 30:34
  SPEAKER_01: But remember, so many of the things that we use in medicine are used, quote, off label.
• 30:39
  SPEAKER_01: So if something's approved by the FDA and you might notice something that happens, or you might have an interesting thought and use it and see if it helps.
• 30:47
  SPEAKER_01: We, you know, case in point with hair growth, monoxidil, oral monoxidil, right?
• 30:52
  SPEAKER_01: Bematoprose.
• 30:53
  SPEAKER_01: Remember back in the day, I still remember my first AIDS patient who had CMB retinitis and they would use the Lumigan drops for the for their eye.
• 31:02
  SPEAKER_01: And I had a series of pictures with my my AIDS patients had eyelashes that came out to hear, hitting.
• 31:07
  SPEAKER_01: And so we learned, and so that's how that developed.
• 31:10
  SPEAKER_00: Sure did.
• 31:11
  SPEAKER_00: Right.
• 31:11
  SPEAKER_00: We learned, and then we had to unlearn because all of that fat atrophy that happened.
• 31:15
  SPEAKER_00: Oh my God, when I that that killed me.
• 31:18
  SPEAKER_00: I was that was really bad.
• 31:19
  SPEAKER_00: And that's unfortunately not something that you can go back on.
• 31:22
  SPEAKER_01: But there are lots of naysayers about this, and now and on social media, anytime something comes up, right, there's going to be people who talk about it and try to make money from it, and there are gonna be people who try to put it down, particularly if they can't make money from it, which is really annoying.
• 31:38
  SPEAKER_01: So, what's the reason not to do it, not to use topical estrogens if you're a woman?
• 31:42
  SPEAKER_01: I well, if you if you're on social media.
• 31:46
  SPEAKER_00: If it's just your eyes you want to deal with, it's it's reasonable.
• 31:49
  SPEAKER_00: I mean, I look I would say it's an eye cream if at that point, if you don't feel comfortable using it all over the face, it's just an eye cream.
• 31:56
  SPEAKER_00: Use it with something, use something else.
• 31:58
  SPEAKER_01: Uh, the thing is that when the those who say don't use it, and they cite these these concerns.
• 32:04
  SPEAKER_01: The one uh the two I mentioned before about system, you know, breast cancer and whatever, or this little baby who ate her mother's hair lotion.
• 32:11
  SPEAKER_01: But the other one is that exactly.
• 32:13
  SPEAKER_00: Well, there's gotta be there's gotta be large cohorts of patients that we can look at.
• 32:16
  SPEAKER_00: Use topical estrogens, vaginal, and the vaginal mucosa is more absorbent than the skin.
• 32:22
  SPEAKER_00: It is corneum is a better barrier than the mucosa.
• 32:25
  SPEAKER_01: But you know, what also was interesting with that is they found that the levels of absorption when you first started to use vaginal estrogen were higher at the beginning than they were after several weeks when the vaginal epithelium thickened, which is what it's intended to do vaginally by using it.
• 32:42
  SPEAKER_01: So that so I think that also may stand to reason with our skin.
• 32:46
  SPEAKER_01: But the but there's a lot the the negative things you hear now are one of the big ones is it causes or exacerbates melasma.
• 32:54
  SPEAKER_01: Now, you and I know this report.
• 32:56
  SPEAKER_00: That's all I've known about.
• 32:57
  SPEAKER_00: There's one case report.
• 32:58
  SPEAKER_01: But but when you know when you listen to some of these people who talk about, oh, many people reported.
• 33:03
  SPEAKER_01: I don't know.
• 33:04
  SPEAKER_01: Do you do we know if people actually have melasma?
• 33:07
  SPEAKER_01: The case report that everybody cites is m melasma on the arm, okay?
• 33:14
  SPEAKER_01: And it was with top with a transdermal estrogen, and it was on a woman in Florida, and we have no idea what this woman did as far as sunscreen.
• 33:23
  SPEAKER_00: So it's not only case reports.
• 33:25
  SPEAKER_00: I think we could say that about most case reports.
• 33:27
  SPEAKER_00: Case reports are case reports, they're not.
• 33:28
  SPEAKER_00: But they keep citing it and they talk and then people cite well, you can cite case reports, but it's not a study.
• 33:34
  SPEAKER_01: I mean, that's true, but that that should not necessarily deter people from it.
• 33:38
  SPEAKER_01: I what I tell my patients is if you have a history of melasma, then maybe you should use topical estrogen with caution because we know that it can uh it it spurs the the production of melanin, you know, estrogen itself, whether it doesn't say, and and this is totally on a different subject, but it brings me to this.
• 33:57
  SPEAKER_00: One thing that is very trendy is clean beauty.
• 34:01
  SPEAKER_00: And one thing these clean beauty I know you and I have from feel the same, but one thing that clean beauty enthusiasts are all up in arms of is endocrine disruptors.
• 34:11
  SPEAKER_00: I mean but the and look at the sunscreens, what they've done and how they vilified chemical sunscreens that we all know have been used for so long and we believe they're safe.
• 34:21
  SPEAKER_00: But they vilified them because of endocrine disrupting.
• 34:24
  SPEAKER_00: So I think that the world has to turn 180 before it would be really accepted that using something that's that endocrinologically active items.
• 34:36
  SPEAKER_01: Well, I don't know because I don't know about that because there is a proliferation of online um women.
• 34:42
  SPEAKER_00: I'm sure people are using it like crazy.
• 34:43
  SPEAKER_01: Yes, and these there's you know there's so many companies that's like crazy.
• 34:46
  SPEAKER_01: Yeah, so I don't think that that's I think there's gonna be a group group of people.
• 34:52
  SPEAKER_01: Absolutely.
• 34:53
  SPEAKER_01: But the the the online companies that are um dispensing women's health now they do menopausal hormone therapy systemic because apparently there are is a lack of access.
• 35:02
  SPEAKER_01: And the WHI really ruined it for many women because we were we were not given an opportunity to you know to take hormone therapy, thinking everything bad would happen.
• 35:12
  SPEAKER_01: But the a lot of these companies are now coming out with their own topical versions, and um you know this the only one company that I know of has actually studied it.
• 35:23
  SPEAKER_01: That's the what we talked about, myeloy.
• 35:25
  SPEAKER_01: And they did a very well-designed study for 12 weeks with someone very reputable.
• 35:30
  SPEAKER_01: It has not yet been published in a peer-reviewed journal, but it was a really well-designed study.
• 35:35
  SPEAKER_01: Like I said, they should study, they should publish it.
• 35:38
  SPEAKER_01: It's still compounded, and so you need to know what the compounding pharmacy is doing.
• 35:44
  SPEAKER_01: And I I investigated with my alloy, and they do batch testing to make sure that you're getting what you says, because that's where you run into trouble.
• 35:52
  SPEAKER_01: You know, when the FDA regulates drugs, you know what you're getting.
• 35:56
  SPEAKER_01: You're in a compounding pharmacy, you might not know what you're getting.
• 35:59
  SPEAKER_01: That's really important.
• 36:00
  SPEAKER_01: So you need to vet your source, and you also we have to hope that these companies do not randomly give you endless tubes of this stuff.
• 36:10
  SPEAKER_01: Apparently, when you go on to register, you need a doctor or a nurse practitioner who, you know, provider.
• 36:17
  SPEAKER_01: These are prescriptions.
• 36:18
  SPEAKER_01: They're prescriptions.
• 36:18
  SPEAKER_01: So you have to get that.
• 36:19
  SPEAKER_01: But I'm trying, I'm worried that is there's some way of getting around it and they send you more, you register with two names, but apparently that's not possible because you need to set driver's license and IDs before you can get prescription.
• 36:30
  SPEAKER_01: So there are precautions in place.
• 36:32
  SPEAKER_01: And I hope you know they they give FDA-approved hormone treatments.
• 36:37
  SPEAKER_01: You could get Viagra online, you could get Benet on, you can get all these things online.
• 36:41
  SPEAKER_00: I know you can.
• 36:41
  SPEAKER_00: I've got to wrap because we are so over, but it was so much harder.
• 36:45
  SPEAKER_00: I knew we were gonna talk.
• 36:46
  SPEAKER_00: I know.
• 36:46
  SPEAKER_00: I didn't even look.
• 36:47
  SPEAKER_00: I thought we had an hour.
• 36:48
  SPEAKER_00: So what's eight minutes?
• 36:49
  SPEAKER_00: No, I usually do 30 minutes, but this was worth it.
• 36:52
  SPEAKER_00: It's worthy of longer time.
• 36:54
  SPEAKER_00: But anyway, thank you for joining me today.
• 36:56
  SPEAKER_00: This was so much fun.
• 36:58
  SPEAKER_00: I hope everybody enjoyed this episode of Skincare Confidential.
• 37:01
  SPEAKER_00: We'll see you all next time.