Latest / The Dr Louise Newson Podcast / 10 - Breaking down health taboos: Dr Karan Rajan on hormones, myths and patient power

Transcript

10 - Breaking down health taboos: Dr Karan Rajan on hormones, myths and patient power · The Dr Louise Newson Podcast

0:02
So I've been speaking to Doctor Karen on my podcast.
0:05
He is a author, he's a doctor, he's a medical educator, and
0:10
he's also a podcaster for Doctor Karen Explores.
0:14
I've met him before, but actually this conversation was
0:16
even better. We talk about responsibilities
0:19
of being educator. We talk about the joys and the
0:23
thrills actually of educating people so they can make
0:26
decisions that are right for them about their conditions.
0:29
We talk about lots of things, how medicine is sometimes a bit
0:33
institutionalised and how we need to be the best advocates we
0:37
can for our patients. It's a great conversation, so
0:40
enjoy it. So, Doctor Karen, you are in my
0:43
podcast studio, whereas last time I was like, in your seat
0:47
somewhere else, wasn't I? Hello, thank you so much for
0:49
having me. It's a really nice comforting
0:52
place to be. This is.
0:53
Yeah, well, you know, I love doing podcasts.
0:56
I don't know about you, but it's a real privilege to meet other
1:00
people and have a bit of time because we're all busy.
1:04
You never really get to know people properly.
1:07
You see them on social media, you see them, whatever, but you
1:09
don't really know the real person.
1:11
Yeah. So it's great, isn't it, doing
1:12
podcasts? It's.
1:13
Like a little confession box. It is.
1:15
Actually. It is.
1:17
It's good. So you are a doctor, You're a
1:20
health educator. And I was trying to think when I
1:24
saw you a couple of years ago, how many like minion followers
1:27
you had on Tiktok. It was, I think it was like 1
1:30
maybe? Something yeah, I mean, I I used
1:32
to care a lot more and look at the numbers, but.
1:35
But who cares really? But you know, it's quite
1:39
responsibility having a role of being an educator like, and I
1:45
think things have really changed.
1:46
I'm, I'm older than you, but education has changed for our
1:50
patients, but also for healthcare professionals as
1:53
well. And I've worked as an educator
1:55
for like 20 odd years, done a lot of evidence based medicine.
1:59
So I've written four books on evidence based medicine.
2:03
They were hot topics for MRCGP. So people doing the membership
2:06
at the Royal College of GPS, I, because I'm, I'm girly SWAT, I
2:10
made loads and loads of notes. And then when I got distinction
2:13
in the exam, I was like, well, I want to share them with everyone
2:16
else and everyone's really busy to read the guidelines and read
2:20
the papers. And because I've got a pathology
2:22
degree as well and I like basic science, I like to know what's
2:25
going on. So I thought, right, I will
2:27
write a book because the Internet wasn't really out there
2:31
quite the same. It was harder to get evidence.
2:34
So then I wrote the book, but then you have to write the
2:37
second edition and the 3rd and the 4th edition because evidence
2:40
changes, guidelines change. But actually I got a lot of
2:44
credibility for the book. It got in the number 10 for the
2:47
BMJ Bookshop. I was really proud of it.
2:50
But then I had my second child and I was like, I haven't got
2:52
time to write. But then when I started
2:55
menopause work, I started to educate by Instagram, by media,
3:00
just in different platforms. But somehow it doesn't hasn't
3:04
been so credible. Like people now sometimes refer
3:07
to me as a social media influencer and seem to forget
3:11
that I'm an academic, scientist, doctor.
3:15
But actually the people that I'm trying to educate, IE women,
3:19
men, doctors really like it. But it's weird, isn't it?
3:24
How the just because it's not a book, people think it might be
3:28
different? Yeah, I think if you look back
3:31
through history, things which are modern revolutionary, which
3:36
break trends are always, there's a lot of inertia behind those
3:42
sort of movements. When people were writing letters
3:45
and then when e-mail first came on, people probably thought, oh,
3:47
that seems really cheap and maybe unsafe.
3:50
But now it's the standard of communication for, you know,
3:53
business and other things as well, even entertainment.
3:55
So I agree with you that sentiment of social media is
3:59
cheap, It's fun. It's not real scientists, not
4:01
serious. I think we need to rethink that
4:04
because there are so many educators online.
4:06
It's the medium of choice for most people, not just, you know,
4:10
Gen. Z, Gen.
4:11
Alpha, but actually people in their 40s, fifties and 60s.
4:15
They're using social media as a search tool.
4:17
You know, it's the new Google. You're not going to look up on
4:20
Google anymore how to build a cupboard or how to cure acid
4:25
reflux. You're going to search on
4:26
TikTok, on YouTube, on Instagram.
4:28
So as educators and not just you and me because we have been
4:32
adopting it for years. As educators, again like you
4:36
know, as a collective, we need to look at those platforms
4:39
because in 5-10 years time there may be something else which is
4:42
even more bizarre and we need to be open to that.
4:45
Yeah, and I think it's, I feel, and I still do everyday, it's
4:49
such a privilege being a doctor. Like it's a massive privilege.
4:53
And, you know, I learn and I've learned so much from my
4:56
patients. I've worked in all sorts of
4:58
areas, very deprived areas in Manchester, which have been my
5:01
favorite jobs, actually reaching and talking to people that I
5:04
never thought as a, as a, you know, school child that I would
5:08
ever, you know, at homes that I've been to people I've spoken
5:11
to, you've done the same. And, you know, in hospital
5:13
people turn up in A&E and you're like, my goodness.
5:16
But then actually this power to be able to reach more people is
5:20
is even more of a privilege really.
5:22
And it's a responsibility as well though, isn't it?
5:25
Yeah. I mean, in a clinic, I might be
5:28
able to see 20 patients across three hours, and that's me going
5:32
really fast and probably not giving enough time to each
5:36
patient if I make a video online.
5:39
So the example I often sort of think about when I think about
5:42
this is back in 2020, I made a video about hemorrhoids.
5:46
Hemorrhoids is one of those embarrassing problems that a lot
5:49
of people suffer from. There's a lot of taboo
5:51
surrounding it because people don't want to own up.
5:53
They've got hemorrhoids. A lot of people listening or
5:55
watching to this probably have hemorrhoids.
5:57
They're probably sitting on them right now.
5:59
That video is not a sexy topic, but it got over 2 million views,
6:03
and I'm not egotistical enough to assume that 2 million people
6:06
are going to benefit from that hemorrhoid device I gave.
6:09
But even if a small fraction of a fraction, say 2000 people took
6:13
something away, that is a huge amount of people that I could,
6:17
you know, see across 100 clinics and still not get to that
6:19
number. Yeah, it's really interesting.
6:21
I, I used to work on Embarrassing bodies and my
6:25
husband's a genital urinary reconstructive surgeon.
6:27
So he was the penis doctor on Embarrassing bodies and he's
6:30
very, he's got very dry sense of humour.
6:32
And it went down very well on television.
6:34
And I worked as a medical advisor and there was like a, a
6:37
live phone in. So we'd answer questions and
6:39
that sort of thing. And that was, I think really
6:43
pivotal for the way the public learned things that, like you
6:46
say, were a bit taboo, a bit embarrassing.
6:49
Like, like, like piles. We've all had them at some
6:51
stage, especially women after childbirth.
6:54
Do I go to a doctor or do I buy something over the counter?
6:56
But then what do I ask? What do I do?
6:58
Do I pretend it's for a friend? You know, where is that
7:01
Actually, you know, it's amazing some of the calls that you got.
7:04
And, and I was finding it really interesting on those phones
7:07
because people would phone up. You're like, well, haven't you
7:10
spoken to anyone? Have you not?
7:12
Oh, gosh, no, I wouldn't talk to my doctor because he's my mum's
7:14
doctor or he's whatever. And it's.
7:16
And he's like, gosh, wow. This is why it's so powerful
7:21
that you are not judging anyone. Yeah, they are choosing to learn
7:25
from you as well, which I think is the other thing that and
7:28
people forget actually, when people are criticizing whatever
7:32
it's like, well, they're choosing to learn from you.
7:33
If they don't like the way you look or what you say, they can
7:36
unfollow. You can't.
7:37
They I think also the brilliant thing is that it democratizes
7:40
education so someone who maybe English isn't their first
7:44
language and would maybe be afraid to have this conversation
7:47
can get that translated into Swahili, French, Spanish, Farsi,
7:52
whatever they want because of the auto caption function on
7:55
most social media platforms. So it's almost like a guilty
7:59
pleasure, you know, that, You know, I wouldn't want to admit
8:01
to my friends that I love to listen to Taylor Swift.
8:04
But it's that guilty pleasure, like, Oh yeah, I'm watching this
8:06
hemorrhoid video in silence and no one's judging me.
8:09
I think so. I think it's so, so important.
8:13
And I like the way that you say about democratizing, like
8:17
knowledge and education, because as a doctor in the past, I was
8:22
Privy to reading all sorts of journals, all sorts of articles
8:26
that it was only me as a doctor was able to.
8:29
And then years ago, I started working for patient.info and
8:32
started writing patient information literature.
8:35
Now that sounds a bit weird now because everyone's got access,
8:38
but Tim Kenney, who set it up, was amazing.
8:41
Him and his wife were GPS and they talk.
8:45
They talked about the first patient they saw who realised
8:47
they needed more information was someone that had raised blood
8:49
pressure. It's very common hypertension,
8:51
isn't it? There's a choice.
8:53
You can have an ACE inhibitor, you can have a calcium
8:55
antagonist, different medication, but it's a lot in 10
8:58
minutes. So they decided to write a
8:59
patient information. What is hypertension?
9:02
What are the treatment choices? Give it to patients like This is
9:05
why you're having a blood test. And they said, gosh, it was
9:08
amazing. The consultations were so much
9:10
better afterwards. So then my job was to write
9:14
patient information, but we were always referenced to the
9:18
guidelines, to the evidence and I wrote about all sorts of
9:20
conditions. I did it for 20 years, it was
9:22
great. But then we realised after about
9:25
10 years that that doctors were reading it as it was coming out
9:28
of the printer going, oh, I didn't realize that was, you
9:31
know, first line treatment or whatever because it's hard to
9:33
keep up to date as a doctor. So then we wrote patient plus it
9:37
was called. So it was more detailed for the
9:39
doctors so they had more information.
9:42
But what was great about doing that was realizing that the
9:45
patients actually sometimes wanted the patient plus version
9:49
and patients want as much information often as we know.
9:53
And I think that's great, but some doctors just feel it's
9:57
quite threatening if patients are really empowered and
10:00
knowledgeable, don't they? Yeah.
10:01
And I think that's really the sort of really archaic and bad
10:04
way of thinking because that takes it this to this
10:07
paternalistic view of that doctor patient relationship.
10:11
And I think doctors shouldn't be gatekeepers of knowledge.
10:15
They should be an advocate for the patient.
10:17
And when I've seen patients in clinic, I want them to come to
10:22
the table on a level footing so they know a lot more than the
10:26
average person or then someone would expect a patient to know,
10:29
so they get more out of the consultation.
10:31
So the sad truth is that when we see patients in clinics, we'll
10:36
see them on ward rounds. You're not going to have more
10:38
than 510 minutes, 15 minutes at most with these patients.
10:42
So instead of going over the basics, wouldn't it be far more
10:46
useful to ask those specific questions like, OK, if this
10:49
happens, what do I do? And they're actually asking
10:51
really detailed personal questions to them.
10:53
And we're not going over the basics again because all of that
10:56
can be covered at home with these leaflets, but now in
10:59
video. Form of course.
11:00
It's really interesting. So when I started my clinic like
11:04
I only wanted to work one day a week doing menopause care.
11:07
This was like 9 years ago, 10 years ago nearly, I rented a
11:11
room in a hospital because I couldn't get a job in the NHS
11:15
doing menopause work because they said, oh, it's just
11:17
gynecologists and there's no interest and no money whatever.
11:20
And I wanted to get my friends off antidepressants.
11:22
So I said, OK, I'll just do this.
11:24
So I started to see women who were more than just my friends
11:27
who would travel a long time and they'd say, oh, doctor news and
11:29
I, I think I'm menopause and I haven't had a period for eight
11:32
years. They're having all these
11:34
symptoms. But I tell you what, I don't
11:35
want HRT. So I'd spend the whole
11:38
consultation educating them about what hormones are, how
11:41
they work, all the disease preventive effects, how we give
11:45
the natural body identical hormones different to synthetic,
11:47
all this stuff. And then I went home and I just
11:51
saw this is this is really like, I feel like I'm not
11:54
individualizing care. I'm just a robotic person
11:56
telling them the same things because they didn't have access
11:59
to any information. So that's when I started to
12:02
write my website. But then I'd come home and I'd
12:05
be dictating my letters and then I'd realise most people had
12:09
similar symptoms, especially mental health symptoms.
12:11
Most people had joint pain. Most people had given up their
12:14
job having really difficult times.
12:17
And then I thought, well, actually, it was my daughter.
12:19
We were just having supper one day and she was like, Mummy, you
12:21
keep telling me all these stories.
12:22
They're awful about these women's suffering.
12:25
You need to post on Instagram. And I was like, oh, I don't even
12:28
know. I'm really, really scared.
12:29
But she was setting up her Instagram account and I thought,
12:32
I need to just see what, what she's doing, you know?
12:34
And so then I got her to to like, help me find pictures and,
12:38
and to start to post. But then I started to get DMS
12:42
from women all over the world to say, you've struck A chord.
12:45
That is me. I had no idea.
12:48
I thought I had fibromyalgia. I thought I had chronic fatigue.
12:52
Maybe it's my hormones and it that like that sort of
12:57
sensation, like I love helping people that I don't know.
13:00
And I'm sure you get it sometimes where you're like,
13:02
wow, this is going to make a big difference to people's lives
13:06
actually. Yeah, I mean, people want their
13:09
pain points addressed. They want the relatability.
13:11
And then what you've done with the menopause education is
13:15
there's a lot of women who, again, don't want to seem like a
13:18
burden to doctors. And they've been perennially
13:21
told, traditionally told that those symptoms are just part of
13:25
life and they maybe have to suffer through them for this
13:28
period of time. And so they've been maybe
13:31
reticent to go to a doctor thinking, oh, they're just going
13:34
to maybe give me some antidepressants, they're going
13:36
to give me some painkillers or, you know, maybe do nothing.
13:39
So they actually suffer in silence.
13:40
But then when someone is educating them and say,
13:42
actually, there are some lifestyle factors I could
13:45
change, there's some, you know, things I could actually get
13:47
prescribed to improve my symptoms.
13:50
That's when it becomes becomes relatable and then they want to
13:52
seek out more information and ultimately someone will only be
13:55
educated if you provide them with the education.
13:58
There's a desire for it, but then if there's a lack of
14:00
education out there, then no one's ever going to raise their
14:03
level of knowledge. Yeah, but sometimes, I don't
14:06
know whether it ever happens to you, but I sometimes feel really
14:08
guilty for what I do because I do a lot of education for
14:11
healthcare professionals as well, which is great.
14:15
But you can only change people that want to change when you're
14:18
talking about, you know, evidence and, and prescribing,
14:21
especially when we're talking about testosterone as well as
14:24
HRT, lots of people are stuck and won't change the way they
14:28
prescribe. But a lot of my work like yours
14:31
is empowering people, women especially with hormone
14:34
problems. But then what really makes me
14:37
very sad is that I feel like I educate people and they say,
14:40
gosh, maybe I don't need antidepressants.
14:44
Maybe I could take hormones. They go to their Doctor Who
14:47
says, no, you're too old, you're too young.
14:49
Of course it's not menopause. Where did you get this
14:51
information from? Don't stop your entity foot.
14:53
Don't think that you're whatever that your joint pain, your poor
14:57
sleep is due to that. And then they become really
15:00
frustrated because they can't afford private care.
15:04
They're being told out of date information and then like
15:08
they're almost worse. It's like dangling a carrot over
15:10
them. And that's what I worry a lot
15:13
about. Like, have I got it wrong?
15:14
Should I have not done this? But then it's not fair that I've
15:18
got knowledge that others haven't got.
15:21
Yeah, I guess what you're saying is you're giving them this
15:23
forbidden fruit of knowledge, but then they can't access it
15:26
through their normal routes. And I think as doctors
15:29
sometimes, you know, the sort of medicine as an institution, it's
15:33
quite rigid. We're sometimes reliant and for
15:36
sometimes for good reason, relying on certain algorithms
15:38
and flows of treatment and the pathways.
15:41
And that's good because that's gives us the evidence base to be
15:43
safe. But sometimes that also limits
15:46
us in terms of how open we can be to new evolving evidence.
15:51
Just because something is emerging evidence doesn't mean
15:55
it won't work for some people. And I think, you know, that's
15:59
something I've softened my stance on a lot over the years.
16:02
So for example, you know, something like magnesium as a
16:05
supplement, you know, if you looked at use of magnesium for
16:11
sleep, there's not reams and reams of literature out there
16:14
saying that everyone should supplement with magnesium for
16:17
sleep. However, anecdotally, I've
16:19
benefited from it when I suffered with insomnia years
16:21
ago. And there are loads of people
16:23
who also benefit from taking magnesium.
16:26
And if you told those people there's no evidence, that's not
16:28
going to change their mind or stop them taking it.
16:31
So it's actually finding what works for different people.
16:33
And I think sometimes as doctors we need to be receptive to
16:38
looking at specific protocols and treatments for specific
16:41
people, because if we just dogmatically stick to
16:43
algorithms, we are losing people for whom the algorithm doesn't
16:47
work. And I think it that's it's so
16:49
right, because medicine is a science and an art, you know,
16:52
the science, of course, but the art is individualizing care.
16:57
But the other thing is, is that even our guidelines, people
17:01
often read the top level. So lots of people say, Louise,
17:04
you don't follow guidelines. Well, which bits?
17:07
And there aren't any bits. And you know, there's lots of
17:09
people that think the guidelines say something and you when you
17:13
question it, they're like, Oh no, but they told me there was
17:16
something about this like treatment pathway in this
17:20
guideline. Well, no, there isn't.
17:21
And I know the guidelines black and white.
17:23
So then it's the way that the guidelines are interpreted as
17:26
well. And in medicine, I think
17:28
sometimes, and I'm sure it's because people are busy as well,
17:31
there's a lack of professional curiosity.
17:33
Like if you said to me, the best treatment for hemorrhoids is, I
17:37
don't know, you're smelling some flowers in this, in this, you
17:41
know, in the field, I think, well, that's a bit weird.
17:43
But let's let's look at the evidence.
17:45
How does that work? Does it really make a difference
17:47
rather than saying no, that's absolute rubbish.
17:49
And you know, when a new treatment comes out, one of two
17:52
things happening that everyone starts to prescribe it with very
17:55
little evidence or everyone says no, that's rubbish.
17:59
And it all depends the way that what it, what's in the
18:01
guidelines, what you know, who's marketing it, whatever.
18:04
But I think sometimes in medicine, we get very siloed.
18:07
We get very focused and we don't have this professional
18:10
curiosity. And I think it's because people
18:12
are tired as well, aren't they? There's very little bandwidth,
18:15
isn't there to expand your mind when you're working full time.
18:18
Yeah. And I think that is something,
18:20
right. We were talking before about,
18:22
you know, you're publishing books, and then you have to keep
18:24
publishing further editions because as soon as you publish
18:26
something, it's out of date because of involving evidence.
18:29
And it's the same with what we learn in medical school is out
18:32
of date once we leave medical school.
18:34
A lot of it, I mean, anatomy is the same.
18:35
I mean, our bodies don't evolve in that short time scale.
18:38
But there are certain guidelines for managing specific conditions
18:41
with change. But yeah, as you said, if you're
18:43
working 12 hours a day as a doctor, as a healthcare
18:45
professional, what extra time do you dedicated to looking at new
18:48
research? And I think that's where it's
18:50
key. We actually have to say, hang
18:52
on, this sounds weird, but is there any evidence behind it?
18:56
Is it safe? What's the sort of risk benefit
18:59
ratio? Even if the evidence isn't
19:00
strong, could it work in a safe capacity and offer a relatively
19:05
low side effect profile to someone but have huge upsides?
19:09
And I think it's just being really open to, I don't want to
19:12
say experimental things, but things which, you know, won't be
19:17
suitable for the mainstream population, but for those
19:19
specific people for whom the mainstream treatment hasn't
19:23
worked, could it be an option for them?
19:25
So I remember when I came on your podcast before, you were
19:29
talking about times when people have had a surgical menopause.
19:32
So ovaries removed. It might because they've had
19:34
bowel surgery, they might have had endometriosis, for example,
19:37
and you've been involved as a bowel surgeon and the ovaries
19:40
have been removed and like many doctors, not always thinking
19:44
about actually removing their hormones as well.
19:47
And I remember you saying that was quite a sort of almost like
19:50
light bulb moment, thinking about the hormones that these
19:53
poor younger women weren't getting.
19:55
I mean, I think sometimes we get such tunnel vision, like as a
20:00
surgeon you think, OK, we've got to remove the cancer, got to
20:02
remove that organ, got to remove this disease.
20:05
And that's almost compartmentalising the human
20:08
body into specific parts. But as we know, everything's
20:11
interconnected. The ovaries are not just a
20:15
reproductive organ, it's an endocrine organ.
20:17
It's a metabolic, you know, it produces like various hormones
20:21
which influence metabolism, influence mood, memory, all
20:25
these other things. So the knock on effect of the
20:27
bowel surgery could be systemic. And for me, I didn't realize
20:33
actually chemotherapy, bowel surgery, removing, you know,
20:36
these organs can have ramifications beyond just that
20:40
target organ. And there's, you know, huge
20:44
cohorts of women who suffer from surgical menopause because of,
20:48
you know, those things aren't maybe pre planned or part of
20:51
that treatment conversation where the surgeon talks about
20:54
the complications for the bowel surgery.
20:57
But have you mentioned the gynecological, metabolic,
21:00
endocrine complications that could arise as well and that
21:03
could doggy for the rest of your life?
21:05
Yeah. So we did an audit which we just
21:09
presented at a conference looking, I won't say the names,
21:12
but three teaching hospitals in London.
21:15
These were young women that had a surgical menopause for benign
21:17
conditions, so not for cancer. They had their ovaries removed.
21:21
The guidelines are very clear. These women should have their
21:23
hormones replaced because of the long term health consequences of
21:27
not having hormones. Guess how many were offered or
21:31
prescribed HRT? On 10%.
21:35
Less than 5%? Wow.
21:37
And then how many do you think were prescribed testosterone?
21:40
Probably similar amount or less than 1%, maybe 00.
21:43
There's none. At all they Can you imagine
21:47
removing someone's thyroid and then never giving them thyroxin?
21:52
Yeah, that's that's really worrying.
21:55
But also I'm not shocked because in my own experiences of dealing
22:00
with these patients working as part of a team, it's not a
22:04
conversation that would be at the top of the radar.
22:06
So I also think you know how I was involved in that sort of
22:10
treatment flow over the years as well.
22:13
So it's not surprising. But you know, I said to my
22:16
husband a couple of years ago now, like Paul, if you remove
22:20
someone's testicles, both of them as a man, like if you
22:24
remove their testicles so they had no testosterone because
22:27
obviously testes produce testosterone, would that man get
22:30
testosterone replacement? Yeah.
22:34
He do you know what he said? He said, of course, these poor
22:37
men, they'd have awful symptoms. They would have brain fog, they
22:41
would have reduced memory, they'd poor concentration, they
22:44
would have erectile problems. Yeah, but that's what that's
22:48
what women are having. They're having a castration like
22:51
50% of our testosterone is in our ovaries.
22:56
And I think also, I guess, you know, interestingly, maybe for
23:00
men it becomes more, well, for men, the degradation and the
23:07
loss of testosterone production is insidious over many years and
23:11
you almost don't notice it. So a man in his 20s who
23:14
eventually becomes 5060, he's not going to notice an immediate
23:18
Cliff of a drop off. But in women, there is that
23:21
obvious Cliff of a few months or, you know, that sort of time
23:25
period in their life. But even despite those obvious
23:28
manifestation of those symptoms, it still strikes me as odd that
23:32
and even though there's more awareness now, there's still not
23:34
enough being done for enough women.
23:37
I don't understand, especially young women.
23:38
So young women really worry me because their risk of future
23:43
inflammatory diseases like heart disease, osteoporosis, diabetes,
23:46
dementia, mental health, clinical depression really
23:49
increases. Even study shows that women are
23:53
more likely to have Parkinson's disease, more likely to have
23:55
neurodegenerative diseases when they don't have their hormones.
23:58
The longer. So especially these young women,
24:00
but there were also studies from the 80s showing that women who
24:03
have testosterone in addition to estrogen after having their
24:07
ovaries removed have better well-being, better cognition.
24:10
But most women, if they get hormones, is only estrogen.
24:14
And there's this like myth about testosterone and I don't really
24:18
understand. I know it's labeled from the
24:20
testosterone but it's a female hormone as well.
24:24
Yeah, I think the problem is labeling those androgens or
24:28
those sex hormones as the male hormone, the female hormone.
24:32
I mean, men have estrogen as well.
24:34
They have a small amount of estrogen.
24:36
If you increase your adiposity or you're obese, you'll have
24:39
more estrogen. So I think, you know,
24:42
genderizing those hormones is also not beneficial as part of
24:46
educating people on that. And almost, you know, you this
24:51
really is evident in the fitness space where historically women
24:56
have shield away from weight lifting because they assume that
25:00
lifting weights will boost testosterone and boost their
25:03
muscle mass and they look muscly and not, you know, so aesthetic,
25:07
But it's not doesn't work as simple as that.
25:09
And I think it's, you know, almost saying testosterone is
25:13
the male hormone is not only wrong but also harmful and
25:17
misleading in the long term conversation.
25:19
Yeah, and I think also a lot of people, men more than women,
25:24
inject testosterone, which is synthetic.
25:27
So it's not pure testosterone. So when people worry about the
25:31
risks of heart disease, for example, yes, with a synthetic
25:35
chemically altered artificial testosterone, but not with the
25:38
natural. And I took me many years to
25:41
realise the difference between natural and synthetic.
25:43
The same with contraception, you know, denial estradiol, a
25:47
chemically altered artificial estrogen.
25:50
It's not going to be the same as estradiol.
25:52
They're completely different. But it takes a while to realise
25:56
that. And until you realise that it's,
25:59
it's very hard to sort of look at the difference and work out
26:02
the difference metabolically and with risks as well.
26:05
Yeah, I think generally when, you know, I've seen, I've
26:09
learned a lot more about menopause and the perimenopause
26:13
or the transition over the years because there's been more voices
26:17
like yourself talking about it. And so I think, you know, that's
26:21
actually is a positive thing. But it, you know, does that then
26:25
trickle to the people who need it most?
26:27
And sometimes you wonder, do you, does it just just reach
26:31
people who are in no certain echo chambers because then
26:34
there's still a huge population of people who it's not reaching.
26:37
Yeah. And because the people who
26:39
reached right now, they may already be educated, they may be
26:41
listening to podcasts like yours and already be doing the things
26:45
that you're telling people to do.
26:47
But what about those people who don't listen to those podcasts
26:50
and other things because they're going to get their education
26:53
from the average person who is bit more savvy.
26:56
So, you know, it's, it's sort of getting that information
26:59
trickling to everyone. And that's why it's great when
27:02
doctors like you, others will talk about hormones.
27:05
You know, you, you mentioned about endometriosis a while ago
27:08
and everyone's like, wow, he's talking about it, which is
27:10
brilliant. Sometimes though I've seen a
27:14
comment once on a video where I think I was talking about some
27:19
Women's Health thing and how it affects the gut or something
27:22
like that and someone commented. Great information, would prefer
27:27
if it came from a woman. Oh, really?
27:29
Yeah, and and I was just a little bit shocked.
27:33
I mean, like, why does my gender matter if the information is
27:37
still evidence based? And sometimes I feel that
27:42
comments like that could actually prevent, you know, more
27:46
male educators from talking about Women's Health issues if
27:49
they do get, you know, feedback like that.
27:52
You see, I think like a lot of my work is not thinking about
27:55
Women's Health. It's about thinking of health of
27:57
women. Yeah.
27:58
So then if I'm really worried about cardiovascular disease,
28:02
like I personally take hormones to reduce my risk of
28:05
osteoporosis. I'm really scared of
28:06
osteoporosis. Like you as a man, male doctor
28:10
should know everything about osteoporosis, whether it's in a
28:13
man or a woman. But if we talk about health of
28:16
women, I think it's fine that you're a man.
28:19
Somehow Women's Health is about argyny bits and it's a bit
28:22
embarrassing and oh, I don't want to talk about it.
28:24
So I think this genderised medicine really worries me
28:28
because then it's like thinking my ovaries are only about
28:31
reproduction. Of course they're not.
28:34
You know what, that's really good.
28:35
And I think actually reframing woman's health as health of
28:39
women is spot on because even if you if we continue to talk about
28:43
endometriosis, endometriosis is labeled as a gynecological
28:48
disease. It's not because number one,
28:50
it's probably part autoimmune, probably part inflammatory,
28:54
probably part dysbiosis of gut microbiome, genetic,
28:59
environmental, and the ramifications of endometriosis
29:03
are systemic. It affects hormones, metabolism,
29:06
mood. So actually it's a systemic
29:08
issue, not a gynecological issue.
29:11
Because then by labeling it a gynecological issue, you're
29:14
almost, you know, psychologically preparing women
29:17
to accept that the symptoms would be vaginal, pelvic pain,
29:22
things like that period related. But actually as we know, you can
29:26
get full body symptoms with endometriosis.
29:29
So actually your point of health of women is apartment for
29:32
basically anything. Anything.
29:34
I totally agree and I think having that mind shift then
29:38
hopefully will help doctors to be educated in different ways as
29:41
well because you know, I'm not a gynecologist.
29:44
It wasn't multi system enough if you see what I mean.
29:47
And being holistic as a doctor and an educator is really
29:50
important. I mean, meaning that I'm not a
29:52
gynecologist. I've had interactions with young
29:55
women who I've eventually referred to gynecologists.
29:58
I've scrubbed in in joint operations with gynecologists
30:01
and I've seen endometriosis. And honestly, when I first saw
30:04
endometriosis, I didn't know what I was looking at.
30:06
I called the gynecologist in, they said that could be
30:09
endometriosis. And I realized if I'm going to
30:12
be a holistic surgeon, I need to go to more gynecology operations
30:17
and look at what things could be overlapping with mine.
30:21
And that's again, part of that education that we're talking
30:24
about. I learned general surgery, but
30:27
general surgery is a very narrow field.
30:29
It requires input from vascular surgeons, urologist, gynecology,
30:34
sometimes cardiothoracic surgeons.
30:35
So actually going into those other surgery and learning more
30:39
about those things are as important as become a specialist
30:42
in your specific area. I totally agree.
30:44
I think the more we can work with others, collaborate, but
30:48
think about the person as a whole, it's so important.
30:51
There's so much really to unpick, but I just wanted three
30:54
take home tips. Is it possible three things that
30:59
you are most proud of that you've done as an educator?
31:04
I think #1 has to be advocating for people and patients and
31:10
knowing that they don't have to just accept information that's
31:14
given to them that they have, you know, the option to counter
31:19
that and seek second opinions and go to the table with more
31:22
knowledge. Secondly would be trying to
31:26
lamanize medical education as much as possible.
31:28
And I feel I, I've really kind of, you know, that's the hill
31:32
I'm willing to die on. I mean, I think that's what's
31:34
needed. There's a lot of jargon that we
31:36
still use, I probably still use as well.
31:38
And it's making that accessible to as many people as possible.
31:41
And thirdly, it's D tabooing the taboo, whether it's, you know,
31:47
health of women or weird things, talking about Constipation,
31:51
about bottoms, about discharge, about all sorts of other things.
31:54
And I think breaking the ice, so it's not that word taboo, should
31:59
not be associated with any disease or condition because
32:02
your mother, your father, your sister, your wife may suffer
32:05
from these things. So, you know, why should it be?
32:09
There are people who die of embarrassment.
32:10
You know, I had a patient of mine years ago who had
32:15
metastatic colorectal cancer. It's spread throughout the body.
32:18
It could have been picked up earlier.
32:20
They had six weeks of painless rectal bleeding and they were
32:24
just embarrassed about going to the doctor and it could have
32:26
been caught up then. So that person in that case was
32:30
literally dying of embarrassment.
32:31
You're at home, you've got bleeding and you're you're too
32:33
embarrassed. And I think that's also quite
32:36
something I'm proud of. Really important, so keep going
32:40
and keep educating. So thanks for coming today.
32:43
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