Latest / The Science of Skin / Skin Longevity, HRT & Anti-Aging Science with Dr. Hillary Lin

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Skin Longevity, HRT & Anti-Aging Science with Dr. Hillary Lin · The Science of Skin

• 0:08
  SPEAKER_00: Hi, I'm Dr.
• 0:09
  SPEAKER_00: Patty Ferris.
• 0:10
  SPEAKER_00: I'm a board certified dermatologist, and I'm your host for this episode of the Science of Skin Podcast.
• 0:16
  SPEAKER_00: I'm very excited today to welcome somebody who I greatly respect, and I can't wait to have a conversation, and that's Dr.
• 0:24
  SPEAKER_00: Hillary Lynn.
• 0:26
  SPEAKER_00: She's a Stanford-trained internist on a mission to close the gap between cutting-edge longevity science and what actually reaches patients.
• 0:35
  SPEAKER_00: Such a great mission statement.
• 0:37
  SPEAKER_00: I love that.
• 0:38
  SPEAKER_00: She specializes in the biology of aging, cellular senescence, hormonal decline, and metabolic health, and how systemic interventions affect health span from the inside out.
• 0:48
  SPEAKER_00: She's a frequent speaker at a variety of meetings, including HLTH and the Buck Institute Longevity Global Summit, and hosts her own podcast, The Longevity Show, and also writes her newsletter, the Longevity Newsletter.
• 1:05
  SPEAKER_00: So welcome, Hillary.
• 1:07
  SPEAKER_01: Thank you so much for having me on, Patty.
• 1:09
  SPEAKER_01: This has been a long, you know, it's something I've looked forward to because I think too much we separate skin from the rest of the body, and it really is one in the same.
• 1:20
  SPEAKER_00: Yes.
• 1:20
  SPEAKER_00: And that's this is how why I'm so excited to talk to you because I think you really appreciate that interconnection there.
• 1:27
  SPEAKER_00: So let's start by talking a little bit about you.
• 1:30
  SPEAKER_00: So you're trained as an internist.
• 1:32
  SPEAKER_00: Were you practicing internal medicine and sort of pivoted into longevity?
• 1:36
  SPEAKER_00: So tell us about your career.
• 1:38
  SPEAKER_01: It's such a longer story, actually, but I'll hear it.
• 1:42
  SPEAKER_01: Yeah.
• 1:42
  SPEAKER_01: Well, as you said, I trained as an internist.
• 1:45
  SPEAKER_01: I was at Stanford for over a decade, and then I actually started my career as an oncologist.
• 1:50
  SPEAKER_01: That's what brought me here to New York City, where I'm based at Columbia for a hot second, before I actually decided that I had to give it a shot as a full-time entrepreneur.
• 2:00
  SPEAKER_01: And that took me out of traditional medicine for quite a while.
• 2:05
  SPEAKER_01: I mean, my per portfolio and activities today are still somewhat unusual.
• 2:09
  SPEAKER_01: But during that time, you know, I was a mental health founder for quite a quite some time.
• 2:14
  SPEAKER_01: I ran a company called Curio, which was focused on psychedelic assisted therapy.
• 2:19
  SPEAKER_01: And then a couple of years ago, around 2024, I transitioned to focus more on, you know, this deep passion of mine, which is now being called longevity.
• 2:29
  SPEAKER_01: But in my mind, it's always the art of practicing medicine while like thinking holistically, systemically, and preventatively.
• 2:38
  SPEAKER_01: So that is what brought me to this field.
• 2:41
  SPEAKER_01: But all along the way, as you mentioned before, I've built up a bit of a content base.
• 2:46
  SPEAKER_01: I've also started a new company in the space, and the mission really is to democratize longevity care.
• 2:52
  SPEAKER_00: Nice.
• 2:53
  SPEAKER_00: And the name of your company?
• 2:55
  SPEAKER_00: It's called CareCore, yeah.
• 2:58
  SPEAKER_01: And you know, our approach is we know that there are a lot of practitioners out there, whether licensed professionals like MDs or coaches and adjacent like fitness instructors.
• 3:09
  SPEAKER_01: And really what we're doing is enabling them to offer medical infrastructure because too much, and I'm sure you see this all over in skincare, people are falling towards what I I think are more unscientific.
• 3:21
  SPEAKER_01: And uh, you know, by nature, because they're not able to, you know, offer prescription grade or clinical grade products a lot of times, they fall back to uh less scientific oftentimes.
• 3:34
  SPEAKER_01: Not that everything has to be prescription grade, but our whole infrastructure enables businesses, brands, individuals to have the medical backing, the doctors who are there to provide the medical oversight while they and their brand are the the face of a longevity um business.
• 3:51
  SPEAKER_00: Oh, that's so interesting.
• 3:53
  SPEAKER_00: And that's such a great service to provide.
• 3:56
  SPEAKER_00: Um, I'm sure you see it in your arena as well, but we have a huge interest in this whole longevity field in cosmetics and aesthetic medicine.
• 4:07
  SPEAKER_00: It's just literally taking us by storm and probably going a little bit, we're ahead of our skis for sure.
• 4:13
  SPEAKER_00: But it really represents a paradigm shift for us as dermatologists and aesthetic physicians because, you know, we're not into the quick fixes anymore, we're not into the wrinkle erasers, and we're looking way more upstream at how we can really influence skin aging and skin longevity and how we can affect those cellular molecular processes that we know start to degrade with age.
• 4:34
  SPEAKER_00: So you alluded to it a little bit, but you know, you said something to me, and I don't know if we were DMing or we were texting somewhere along the line about how you thought a lot of what goes on in longevity really starts in the skin.
• 4:46
  SPEAKER_00: Absolutely.
• 4:47
  SPEAKER_00: Yeah.
• 4:48
  SPEAKER_00: So talk about that because I found that statement so fascinating.
• 4:51
  SPEAKER_00: Yeah.
• 4:52
  SPEAKER_01: Well, I more think of it as the skin is a window into what's happening inside.
• 4:56
  SPEAKER_01: It's the most visible part of our body by nature.
• 5:01
  SPEAKER_01: And so, you know, for what it's worth, some some internists and and other physicians of other specialties might like poo-poo the cosmetic side.
• 5:09
  SPEAKER_01: But I'm like, it, you know, we care about it for uh some vain reasons, but also some good reasons.
• 5:15
  SPEAKER_01: Like it is the most obvious window into what's going on inside.
• 5:19
  SPEAKER_01: And often it's highly correlated.
• 5:22
  SPEAKER_01: It's it's not frequent that you see somebody who's got, you know, really aging, damaged skin, and there's not something similar happening inside.
• 5:30
  SPEAKER_01: Uh, you know, I can think of only a couple of examples, maybe the outdoors person who's like always outdoors, not taking good care of their skin in that way, but um is otherwise really fit on the inside.
• 5:42
  SPEAKER_01: But other than that, most people we show our health on our skin and so forth.
• 5:47
  SPEAKER_01: And so, and it's connected based on the same exact mechanisms of oxidative stress, mitochondrial dysfunction, cellular senescence, chronic inflammation, AGEs, glycation, hormone decline, and then our extracellular matrix is remodeling, both on the outside and on the inside as well.
• 6:05
  SPEAKER_01: There's a lot of stuff going inside.
• 6:07
  SPEAKER_00: So absolutely.
• 6:08
  SPEAKER_00: So it's so interconnected.
• 6:10
  SPEAKER_00: And then you've got the microbiome and all of that piece of the puzzle, too.
• 6:14
  SPEAKER_00: Um, you're sort of alluding to the hallmarks of aging, which we're now seeing becoming really more forefront and center in the role of their role in longevity medicine.
• 6:25
  SPEAKER_01: I I think it's so important to take that into account.
• 6:28
  SPEAKER_01: It's holistic, it's you know, multi-system, multi-factorial.
• 6:32
  SPEAKER_01: We all are learning more and more in every specialty.
• 6:35
  SPEAKER_01: We we all grew up in a medical system that tried to subspecialize us, but really we need to turn around and relearn what is important to every single system.
• 6:44
  SPEAKER_00: Yeah, it's so important, so true.
• 6:47
  SPEAKER_00: Um, there's lots of medications, as you know, and supplements that are now being touted at everything from rapamycin to all these supplements, the NAD precursors, urolithina, spermidine, we could go on and on, all the antioxidants.
• 7:01
  SPEAKER_00: And I think it's created so much confusion.
• 7:04
  SPEAKER_00: There's so much hype on social media.
• 7:07
  SPEAKER_00: And so, you know, give our listeners a little bit of a hint of, you know, where do you think we lie with these things and where do which ones fit in the longevity toolbox and which ones really don't have the data to support them?
• 7:20
  SPEAKER_01: Yeah, well, uh, before I even dive into that, I just want to say actually, despite all of the excitement around these new sort of anti-aging specific kind of compounds, I find myself falling back to a lot of what you and I and everyone might consider more the basics most of the time.
• 7:39
  SPEAKER_01: So I want to say that up front because it could be so attractive to go to the new thing.
• 7:44
  SPEAKER_01: But you know, the tried and true is protection like, you know, tinted sunscreen, uh, having a great antioxidant like vitamin C and a retinoid that works well.
• 7:55
  SPEAKER_01: That sort of a thing is still the foundation and 99% of everything else.
• 8:00
  SPEAKER_01: But going into the compounds that everyone's excited about, I do think we're early.
• 8:06
  SPEAKER_01: Like there's a lot of really exciting research behind things like topical rapamycin.
• 8:11
  SPEAKER_01: So, for folks who haven't dove into it mechanistically, we're really trying to reduce cellular senescence signaling when we do that.
• 8:19
  SPEAKER_01: So, uh, folks who are deep in the longevity world, you know, I am one.
• 8:23
  SPEAKER_01: We we use systemic rapamycin intermittently for whole body uh senescence signaling prevention and reduction.
• 8:31
  SPEAKER_01: It works for ovaries.
• 8:32
  SPEAKER_01: Like uh that's a really fascinating bit that also impacts the skin, and I'm sure we're gonna dive into it.
• 8:38
  SPEAKER_01: But the topical version, uh, it it just directly impacts your skin senescence signaling.
• 8:44
  SPEAKER_01: And so that's the theory behind it, but it's still very early in terms of evidence.
• 8:48
  SPEAKER_01: So worth trying.
• 8:50
  SPEAKER_01: It certainly seems like, especially in the skin care products, it's not harm like significantly harmful in any way.
• 8:57
  SPEAKER_01: There's not really a theoretical harm that I'm worried about there.
• 9:00
  SPEAKER_01: So it's a good one.
• 9:02
  SPEAKER_01: For the mitochondrial type of skincare, it's uh targeting the oxidative stress and mitochondrial dysfunction.
• 9:09
  SPEAKER_01: And that's definitely real.
• 9:11
  SPEAKER_01: I think it's more about whether the topical ingredient actually makes it into the cells and whether that matters enough for you to actually see it, see a real difference.
• 9:22
  SPEAKER_01: So I think the jury's still really out there, but I see it all the time in ingredients, everything from like NAD precursors to the urolithin A that you've mentioned above.
• 9:34
  SPEAKER_01: Um, and then I'd be remiss if I didn't, you know, touch on peptides because everyone's so excited about peptides.
• 9:41
  SPEAKER_01: Peptides everywhere.
• 9:43
  SPEAKER_00: Stacking your peptides.
• 9:45
  SPEAKER_00: What's your stack?
• 9:46
  SPEAKER_01: Yeah, well, honestly, I'm not, you know, myself super.
• 9:50
  SPEAKER_01: I I find that uh because I'm confronted with so many things out there, I'm I try to be a minimalist, and I say that, you know, with a straight face, even though I'm taking honestly, like, I don't know, a dozen pills a day, and that's you know how I've combed it down.
• 10:06
  SPEAKER_01: I've actually streamlined it quite a bit, but I don't do any sort of wild like uh injection stack or anything like that.
• 10:14
  SPEAKER_01: And the reason is because I think about what really makes a big impact and what is just fluff at top.
• 10:20
  SPEAKER_01: And most of it, most of the time, peptides for most healthy people, it's a little bit of fluff.
• 10:26
  SPEAKER_01: Like there's reasons to take certain peptides which aren't super relevant for the skin discussion, uh, like for recovery of joints, uh, or perhaps you're trying to uh do body recomposition, and there's really, you know, obviously the GLP1 revolution, that's you know, real and it definitely works.
• 10:44
  SPEAKER_01: But for a lot of the other things, I think for skin, most often you're gonna see the copper peptides come up quite a bit.
• 10:52
  SPEAKER_01: And there's definitely great research there, but we're using those topically typically, unless unless you're um trying to deal with like a more whole-body sort of injectable.
• 11:02
  SPEAKER_01: And in that case, I actually feel like the research or the evidence is still a little bit early, um, unless you're recovering from like a giant wound sort of a situation.
• 11:14
  SPEAKER_00: Yeah, it's funny because I always wonder when they're talking about these are for recovery, BP 150.
• 11:18
  SPEAKER_00: I'm like, what are you recovering from?
• 11:20
  SPEAKER_01: Right?
• 11:20
  SPEAKER_00: Like no, I can't quite figure that all out.
• 11:23
  SPEAKER_00: Why we need all these recovery peptides?
• 11:27
  SPEAKER_01: And a lot of times, like it's uh confused because I I think about it as how people used to, I hopefully it's used to, and and people aren't still doing this as much anymore.
• 11:37
  SPEAKER_01: Take antibiotics for colds, right?
• 11:39
  SPEAKER_01: They absolutely don't work, it's a virus, but people people get better on their own, so they think it's the antibiotics.
• 11:45
  SPEAKER_01: So in a lot of these recovery situations, that's what you're experiencing.
• 11:49
  SPEAKER_01: You're going to recover eventually if you're generally healthy.
• 11:53
  SPEAKER_01: And the fact that you injected something or another might not have had anything to do with it in a lot of cases.
• 11:58
  SPEAKER_00: Right.
• 11:59
  SPEAKER_00: And unfortunately, we don't really have studies on this.
• 12:01
  SPEAKER_00: I've looked in the literature and tried to find the studies, and there's just not enough data.
• 12:06
  SPEAKER_01: Yeah.
• 12:06
  SPEAKER_01: Yeah.
• 12:07
  SPEAKER_00: So, and then who knows what you're getting when you're buying these online?
• 12:10
  SPEAKER_00: That's the other thing that concerns me is the sources are so vague, I guess is the word.
• 12:16
  SPEAKER_01: Yeah, there's a lot of contaminants.
• 12:18
  SPEAKER_01: Uh, people try to use these third-party testing platforms, which is a good start, but unfortunately, you destroy the very sample that you test.
• 12:26
  SPEAKER_01: So everything that you ever get tested, even if it says it's great, that is no longer usable.
• 12:32
  SPEAKER_01: So yeah, yeah, when you send them off to these like third party budget.
• 12:35
  SPEAKER_00: Yeah, of course.
• 12:36
  SPEAKER_01: So, and for these labs that are sort of sending things out in the gray market, they're not so stringent that every single lot is going to be the same.
• 12:45
  SPEAKER_01: Like people think, like, if I test one, the rest of everything else I buy from this lab must be fine, but that's simply not the case.
• 12:52
  SPEAKER_01: Um, I think if you're going to do anything, you know, work with a clinician and also get it from an FDA-regulated pharmacy here in the US.
• 13:01
  SPEAKER_01: Compounding pharmacies are fantastic.
• 13:03
  SPEAKER_01: Yeah.
• 13:03
  SPEAKER_01: So, you know, I think, you know, it's all about harm reduction.
• 13:07
  SPEAKER_01: I'm not like an anti-people, you know, trying things, especially if they've really gotten informed consent and they've balanced risk versus benefits.
• 13:16
  SPEAKER_00: Yeah, I agree.
• 13:17
  SPEAKER_00: And the other thing we're seeing a lot of is IVNAD.
• 13:20
  SPEAKER_00: Oh, yeah.
• 13:21
  SPEAKER_00: That's everywhere in spas and in get it anywhere.
• 13:26
  SPEAKER_01: Yeah, and you know, the it's definitely not really made much of an evidence dent in terms of actual anti-aging.
• 13:33
  SPEAKER_01: I heard it best actually from somebody who who's from the skincare world as well.
• 13:38
  SPEAKER_01: And he was like, you know, the body is like this Swiss watch.
• 13:42
  SPEAKER_01: And then all of these uh, you know, medication and supplement uh manufacturers are like, okay, we'll just throw mechanics, Swiss mechanics, into a broken watch and then it'll fix itself.
• 13:54
  SPEAKER_00: It'll work.
• 13:55
  SPEAKER_01: Yeah, and I'm like, that's just not how the body works.
• 13:57
  SPEAKER_01: You sometimes it's very complicated.
• 14:00
  SPEAKER_01: Like, um, you know, I I know the folks at the Buck Institute, they're doing really stringent basic lab research, and they know it's like it's not about feeding yourself more NAD.
• 14:10
  SPEAKER_01: NAD.
• 14:11
  SPEAKER_01: Yeah, you've got to fix the mechanisms that are leading to the decline of NAD.
• 14:17
  SPEAKER_01: So you might get a boost, and people do like report that they feel energy, like if they get the precursors or the NAD itself, especially if they're, you know, aging far far down the aging route, it can definitely give you an energy boost.
• 14:30
  SPEAKER_01: But my question is always like, well, you know, caffeine's a lot cheaper.
• 14:33
  SPEAKER_01: Like or exercise, by the way.
• 14:37
  SPEAKER_00: Exercise is great.
• 14:37
  SPEAKER_00: And exercise raises your NAD pretty reliably.
• 14:42
  SPEAKER_01: Yeah, yeah.
• 14:42
  SPEAKER_01: And it's the number one intervention for mitochondrial health.
• 14:46
  SPEAKER_01: So you can skip all the supplements, just you know, get your zone two in your hit in.
• 14:53
  SPEAKER_01: Yeah, exactly.
• 14:54
  SPEAKER_00: Yeah, it makes total sense.
• 14:55
  SPEAKER_00: You know, we use a lot of NAD precursors in Durham.
• 14:58
  SPEAKER_00: We, I should say, niacinamide has really found its way into our skin cancer prevention regimen.
• 15:04
  SPEAKER_00: So when you look at the literature on the sub the precursor supplements, a lot of times that's what they're quoting is what we have in the DERM literature.
• 15:12
  SPEAKER_00: So there's again, not a whole lot to support them for other health benefits at this point.
• 15:18
  SPEAKER_00: I mean, they say they have cardiovascular benefits and they have all these different benefits, but boy, it depends on what biomarkers you're looking at, what study you're looking at.
• 15:26
  SPEAKER_00: And you know, that sort of brings me to another question.
• 15:29
  SPEAKER_00: It's like, how do we assess this whole field of longevity, whether it's skin longevity, total body longevity?
• 15:36
  SPEAKER_00: I mean, is a biomarker an adequate way to tell if something's really working?
• 15:41
  SPEAKER_01: It's so hard because sometimes we don't have a clear biomarker.
• 15:44
  SPEAKER_01: For example, rabamycin is a very good example.
• 15:47
  SPEAKER_01: And yeah, it's it's we have mTOR.
• 15:50
  SPEAKER_01: I know.
• 15:51
  SPEAKER_01: We have no blood tests, other than just testing the level.
• 15:54
  SPEAKER_01: We can test the level of rhabomycin in your blood.
• 15:58
  SPEAKER_01: Uh but that doesn't tell you anything.
• 16:00
  SPEAKER_01: It just tells you how much you know you're absorbing from the drug.
• 16:04
  SPEAKER_01: Actually, similarly for NAD, there are now some tests that are uh targeting the cellular level of NAD that you can get.
• 16:12
  SPEAKER_01: Um, and that's interesting.
• 16:14
  SPEAKER_01: But again, we're just testing levels, and I think the best that that can tell you is if some supplement you're taking is working and in that it's actually being absorbed, it's bioavailable and so forth.
• 16:26
  SPEAKER_01: But at the end of the day, what is the symptom?
• 16:29
  SPEAKER_01: Like, you know, you're really probably just d detecting whether your energy has changed, or, you know, in terms of your skin, whether that's changed.
• 16:36
  SPEAKER_01: And you know better than I, like it's so hard when you're looking subjectively at something, like, oh, has has something actually changed?
• 16:44
  SPEAKER_01: And I would say, in in terms of these more frontier-edge ingredients, the jury really is out in terms of the skin results.
• 16:53
  SPEAKER_00: I agree.
• 16:54
  SPEAKER_00: We're still waiting, we're still hoping to get that data.
• 16:58
  SPEAKER_00: Um, I think we can switch gears for a second and talk about something I know you're passionate about and have a lot of expertise, and that is hormones.
• 17:06
  SPEAKER_00: And particularly, as we say, we're having the menopause moment for sure, where there's a lot of focus on menopausal hormone replacement therapy.
• 17:15
  SPEAKER_00: So, in the skin, of course, we know how important it is for collagen and how that drop in estrogen we see in perimenopause influences the extracellular matrix, and not in a good way, of course.
• 17:25
  SPEAKER_00: We lose lots of collagen during that time of life.
• 17:28
  SPEAKER_00: So, talk about how you use HRT in your longevity protocols.
• 17:33
  SPEAKER_01: Yeah, yeah.
• 17:34
  SPEAKER_01: Well, HRG is so important.
• 17:36
  SPEAKER_01: I'm so glad that we're we're returning to the light in terms of HRT after decades.
• 17:42
  SPEAKER_01: And, you know, the the basics for folks who haven't dug into it basically is that, you know, estrogen in particular is extremely helpful for all aspects of our health span.
• 17:54
  SPEAKER_01: So from bone health to our, you know, you know, like everything, our heart health, our vascular health, particularly in the skin, like you mentioned, it's the receptors are there in every sort of connective tissue, skin tissue, hair tissue, and it supports the collagen production, the hyaluronic acid synthesis, the thickness of our skin, hydration, elasticity.
• 18:16
  SPEAKER_01: Basically, that's why when you're going through perimenopause, unfortunately, all of the skin changes look like quick aging, fast aging.
• 18:25
  SPEAKER_01: Uh, and so I for your skin and for the rest of your health, I do think it's really important for folks, uh women, to undergo hormone therapy, you know, proactively, you know, not before you need it, but as soon as you do.
• 18:40
  SPEAKER_01: And that's that may be in your 40s.
• 18:43
  SPEAKER_01: Some people are entering much earlier.
• 18:45
  SPEAKER_01: I've seen quite a few patients, and you know, I've discussed this with colleagues who are more in the REI space.
• 18:51
  SPEAKER_01: There's a lot more premature uh ovarian insufficiency this these days.
• 18:55
  SPEAKER_01: It's a bit mysterious as to why we all think it might be endocrine disruptors in the environment, but you know, we don't have hard evidence yet.
• 19:03
  SPEAKER_01: But it is definitely clear that there's just more POI.
• 19:06
  SPEAKER_01: So people are experiencing perimenopausal symptoms and changes far earlier than you might expect.
• 19:12
  SPEAKER_01: So rather than just waiting until you're around 48, you might need to investigate what's happening in terms of your menstrual cycles, your symptoms, even in say your late 30s.
• 19:22
  SPEAKER_01: I've had patients, unfortunately, even in their 20s, who for some mysterious reason undergo this perimenopausal shift.
• 19:30
  SPEAKER_01: And so as soon as that happens, you you want to get on top of the HRT.
• 19:34
  SPEAKER_01: And uh, you know, that's estrogen and then progesterone.
• 19:37
  SPEAKER_01: Progesterone is important to help balance out the changes to your uterus when you're on estrogen, particularly.
• 19:43
  SPEAKER_01: And it definitely helps.
• 19:45
  SPEAKER_01: Um, I will just bring up because people are going to see this a lot, for the skin topical solutions, people often use estriol, which is a version of estrogen that is simply less systemically active.
• 20:00
  SPEAKER_01: It's just weaker, you can think about it.
• 20:02
  SPEAKER_01: And the reason we do that isn't because it's harmful to use the, you know, estradiol.
• 20:07
  SPEAKER_01: We use estrodiol topically all the time.
• 20:09
  SPEAKER_01: It's just that it may confuse the picture.
• 20:11
  SPEAKER_01: Say you want to raise your systemic levels of estrogen with estradiol, so you use that as a lever.
• 20:16
  SPEAKER_01: Whereas estriol, it's it's just there on your skin.
• 20:19
  SPEAKER_01: It's not really confusing the picture of how it's impacting your systemic levels.
• 20:24
  SPEAKER_01: Got it.
• 20:24
  SPEAKER_00: That makes total sense.
• 20:25
  SPEAKER_00: Yeah, it's becoming quite popular, and a lot of patients are asking about it.
• 20:30
  SPEAKER_00: So it's big on social media.
• 20:32
  SPEAKER_00: Yeah.
• 20:32
  SPEAKER_00: A lot of the data is kind of old, quite frankly, on topical estrogens.
• 20:36
  SPEAKER_00: So there, there's not a lot of new, you know, really good studies looking at the differences between the two and the like, but more to come on that for sure.
• 20:45
  SPEAKER_00: What about HRT in terms of like a lot of patients will complain that they have symptoms, they go to their doctor, their numbers are good, they're like, You're new, you don't need it yet.
• 20:56
  SPEAKER_00: So, you know, that's pretty common.
• 20:59
  SPEAKER_01: Yeah.
• 21:00
  SPEAKER_01: That's unfortunately the trouble with the slowness of the healthcare system.
• 21:05
  SPEAKER_01: Unfortunately, we all get indoctrinated in med school and our training, and we're being trained from by, you know, brilliant but extremely busy clinicians.
• 21:13
  SPEAKER_01: It's this apprenticeship, right?
• 21:15
  SPEAKER_01: And unfortunately, since everybody is so busy taking care of patients, very few people get updated frequently.
• 21:22
  SPEAKER_01: I feel very lucky, but it's also because I'm you know, only about 5% of my time is with direct clinical care these days.
• 21:30
  SPEAKER_01: So I have a lot more time spent on getting updated with research and you know, keeping up to date.
• 21:35
  SPEAKER_01: But most clinicians simply don't have that privilege.
• 21:38
  SPEAKER_01: They're, you know, day to day, you know, it's seeing people in and out, no matter what special goal you're in.
• 21:44
  SPEAKER_01: And and therefore, they're not gonna know the latest on HRT, even if it's like, you know, headline news out there sometimes.
• 21:52
  SPEAKER_01: So if you are one of these people going to your doctor and they really don't want to give you HRT, even though you obviously have symptoms already and you would benefit.
• 22:00
  SPEAKER_01: Fit.
• 22:00
  SPEAKER_01: You can advocate for yourself.
• 22:02
  SPEAKER_01: Bring scientific papers, is is often what I tell people because bring a paper to your doctor and say, Have you read this?
• 22:08
  SPEAKER_01: Yeah, yeah.
• 22:10
  SPEAKER_01: And uh if they don't have time even for that, then you know, unfortunately, you might have to find a new doctor, is the the reality.
• 22:16
  SPEAKER_01: So yeah.
• 22:17
  SPEAKER_00: Well, with the there, I think there's a lot of patient education going on.
• 22:21
  SPEAKER_00: A lot of it's going on on social media.
• 22:23
  SPEAKER_00: Yeah.
• 22:23
  SPEAKER_00: And I do give there's some gynecologists out there that are really putting out good information and really empowering female patients to be able to go to their doctor and don't go, hey, you know.
• 22:33
  SPEAKER_01: Yeah, and it's life-saving.
• 22:34
  SPEAKER_01: I mean, we didn't bring this up because you know it's a different part of the body, but vaginal estrogen is life-saving.
• 22:40
  SPEAKER_01: Absolutely.
• 22:40
  SPEAKER_01: Yeah, yeah.
• 22:41
  SPEAKER_01: Because, you know, when your vaginal tissue you know atrophies through menopause, you are at higher risk for UTIs.
• 22:49
  SPEAKER_01: UTIs.
• 22:50
  SPEAKER_01: Yeah, UTIs are life-threatening, especially at a certain time in life, like when they become systemic.
• 22:56
  SPEAKER_01: So I think uh we don't talk about that nearly life.
• 22:59
  SPEAKER_01: And not to mention the life life benefits, the lifestyle benefits for your sexual health and so forth.
• 23:04
  SPEAKER_01: Yeah.
• 23:05
  SPEAKER_00: Yeah, it's so important.
• 23:06
  SPEAKER_00: But again, that was not anything that was on our radar back when we were in med school.
• 23:10
  SPEAKER_00: They didn't talk about it at all.
• 23:11
  SPEAKER_01: No, no, yeah.
• 23:13
  SPEAKER_01: I think we got like half a second about hormones.
• 23:16
  SPEAKER_00: We did too.
• 23:17
  SPEAKER_00: We we didn't learn anything about it.
• 23:19
  SPEAKER_00: Um, let's talk about something you and I were sort of chuckling about, which is longevity washing.
• 23:25
  SPEAKER_00: You know, everybody's trying to find uh maybe a way to position themselves in this really fast-paced, extremely quickly growing market.
• 23:34
  SPEAKER_00: I mean, it's a monster market.
• 23:36
  SPEAKER_00: So, you know, again, the consumers get so confused.
• 23:40
  SPEAKER_00: I mean, we had greenwashing, all of that went on for a number of years in the cosmetic industry.
• 23:45
  SPEAKER_00: Now we have all this longevity washing.
• 23:47
  SPEAKER_01: Yeah, and it's subtle because unfortunately, it can take the appearance of a real mechanism and then blowing it up to 10,000 times the evidence level.
• 23:57
  SPEAKER_01: Right.
• 23:58
  SPEAKER_01: Yeah.
• 23:58
  SPEAKER_01: So, like, you know, that there's a nugget of truth there, but it might not be ready for commercial use, is how I think about it.
• 24:06
  SPEAKER_01: So, for example, a lot of the things we were talking about, like the the urolithine.
• 24:10
  SPEAKER_01: I'm just gonna use a perfect example.
• 24:12
  SPEAKER_01: Yeah, yeah, there's a real mechanism, it's a really remarkable compound, but we just don't really have the broad evidence.
• 24:19
  SPEAKER_01: And uh the best thing I can say is it's not you know shown to be harmful in any which way, except to your wallet, possibly, because you know, it's exactly so that's that's kind of the problem across the board.
• 24:33
  SPEAKER_01: So I I have a rough framework, which is you know, first you want to understand the broad mechanism, and anyone can learn mechanisms.
• 24:41
  SPEAKER_01: I know it sounds scary to people who maybe aren't scientifically minded, but you should be able to understand some sort of basic mechanism.
• 24:49
  SPEAKER_01: And then second, uh, what is the evidence level?
• 24:52
  SPEAKER_01: Is there a you know a cellular mechanism uh mechanism that's improved with data and evidence?
• 24:57
  SPEAKER_01: Is it in animal studies?
• 24:59
  SPEAKER_01: Is it in uh small human studies, or you know, in skin, it's hard to get the randomized controlled trial, but you know, it's uh we get them some, but we don't get them as much as we'd like to get them.
• 25:11
  SPEAKER_01: Exactly.
• 25:11
  SPEAKER_01: And then also see, okay, so this is a point that you know is tough because most skincare products have these like patented, mysterious ingredients, and you know, it's a trade secret or something, and the the studies are all done by the company themselves.
• 25:27
  SPEAKER_01: I find those like really tough.
• 25:29
  SPEAKER_01: It might be something that works, but oftentimes it's just uh mystery for mystery's sake.
• 25:34
  SPEAKER_01: And so I find myself gravitating more towards the the clear ingredients.
• 25:39
  SPEAKER_01: This is why like uh cream beauty has become so popular, or the style of cream beauty, which is very ingredients first.
• 25:46
  SPEAKER_01: You like uh you purchase a product with the clear ingredients that's on the label rather than you know looking for some sort of mixed compound that may or may not have actually effective ingredients.
• 25:58
  SPEAKER_01: So I'm not saying all you know patented ingredients aren't good.
• 26:02
  SPEAKER_01: I just think it's much harder to tell what's going on, especially if the only studies done are by the company themselves.
• 26:08
  SPEAKER_00: Yeah, and you know, independent labs don't want to study anything that it's not, you know, they're not gonna study that.
• 26:16
  SPEAKER_00: So we're we're pretty much beholden to the companies.
• 26:19
  SPEAKER_00: And I tell patients and consumers, you know, major cosmetic companies, they invest a lot of money in RD, they do studies.
• 26:27
  SPEAKER_00: You know, it's when you get into the smaller companies that starts getting a little bit fringy and you don't have the good data.
• 26:33
  SPEAKER_00: But but you're 100% right.
• 26:35
  SPEAKER_00: Sometimes it's very hard, even with the list on the back, to figure out the fact from the fiction.
• 26:41
  SPEAKER_00: We probably should not talk about longevity without spending a minute on creatine.
• 26:45
  SPEAKER_00: I mean, come on now.
• 26:47
  SPEAKER_00: We do, you know, that's like it's not we didn't even talk about it, but it's everywhere.
• 26:52
  SPEAKER_00: I mean, is it so great for brain health?
• 26:54
  SPEAKER_01: Is I mean, yeah, well, so I will say this.
• 26:57
  SPEAKER_01: I think creatine is great, and I do recommend it for basically, you know, all my patients who ask.
• 27:03
  SPEAKER_01: Yeah, it's it's not like a generally harmful thing.
• 27:05
  SPEAKER_01: I I always put out there my personal experience because I'm actually an outlier where I actually don't sleep well when I've been on the can happen.
• 27:14
  SPEAKER_00: I've heard about that.
• 27:15
  SPEAKER_01: Yeah, I'm quite sensitive to it.
• 27:17
  SPEAKER_01: I think it's a combination of genetics, you know.
• 27:19
  SPEAKER_01: I'm uh a sensitive sleeper, so I have low sleep pressure at baseline, which just means, you know, I'll wake up in the middle of the night or early morning.
• 27:28
  SPEAKER_01: And right now I'm in a good streak, so I've been sleeping really well.
• 27:32
  SPEAKER_01: If I have to go into the bathroom, I'll go back to sleep.
• 27:34
  SPEAKER_01: But when I'm on creatine, it's much more sensitive.
• 27:37
  SPEAKER_01: And the reason behind that is creatine is an energizer, it helps you build up more energy sources, ATP at the cellular level.
• 27:46
  SPEAKER_01: And that's why it's good for you in terms of your brain health, your muscle health.
• 27:50
  SPEAKER_01: Those are the benefits.
• 27:51
  SPEAKER_01: But in some people, like me, unfortunately, it means you get a little bit of insomnia and it's just not worth it in my case.
• 27:57
  SPEAKER_01: But for the vast majority of people, you know, there's different dose protocols you could use, and it's it's size dependent.
• 28:05
  SPEAKER_01: If you are a smaller human, you probably need less creatine.
• 28:08
  SPEAKER_01: If you're a larger human, you need more because it's a compound of saturation.
• 28:13
  SPEAKER_00: So people don't have to saturate the muscle and push it other places.
• 28:17
  SPEAKER_01: Exactly.
• 28:18
  SPEAKER_01: Exactly.
• 28:18
  SPEAKER_01: Basically, yeah.
• 28:19
  SPEAKER_01: So yeah, so that's why you can do much more, but um, also, you know, some people just have benign sort of side effects that they don't like.
• 28:27
  SPEAKER_01: Like, you know, they get bloated.
• 28:28
  SPEAKER_01: It's real.
• 28:29
  SPEAKER_01: Like if you get bloated.
• 28:30
  SPEAKER_00: You can get bloated from it, yes.
• 28:32
  SPEAKER_01: Yeah, and people don't like that.
• 28:33
  SPEAKER_01: A lot of a lot of women tell me they don't love it because you you feel like you've put on weight.
• 28:38
  SPEAKER_01: Uh, I mean, you definitely have put on water weight, but you can you can grab it.
• 28:42
  SPEAKER_01: So it feels like uh subcutaneous fat to them, and they don't like that at all.
• 28:46
  SPEAKER_01: So um, it just depends on your goals, I think.
• 28:49
  SPEAKER_01: But creatine in general is an absolutely good and it's not harmful, and you know, you know, it's been well studied.
• 28:57
  SPEAKER_01: Exactly.
• 28:58
  SPEAKER_00: So that's the that's the beauty of it.
• 28:59
  SPEAKER_00: But yeah, so many patients ask about uh creatine, and and consumers are just obsessed with it at this point.
• 29:06
  SPEAKER_01: It's it's just the latest hashtag, you know, like hashtag de jure.
• 29:13
  SPEAKER_01: Exactly.
• 29:13
  SPEAKER_01: It's gonna be something tomorrow, and you know, it's uh for all of these things, there's I always do, you know, what is the risk-benefit ratio?
• 29:22
  SPEAKER_01: In this case, there's very little risk.
• 29:24
  SPEAKER_01: So I'm like, I'll go for it.
• 29:25
  SPEAKER_01: But I also think like there's there's more things to your health, you don't want to like put all your eggs in one basket.
• 29:31
  SPEAKER_00: So no, like I said, if people would just do good nutrition and exercise, half of these things that we're talking about would probably not be necessary.
• 29:40
  SPEAKER_00: Recover well, sleep well.
• 29:42
  SPEAKER_00: Yeah, exactly.
• 29:43
  SPEAKER_00: Sleep is a problem.
• 29:45
  SPEAKER_00: Yeah, that's a whole nother that's a whole nother episode.
• 29:47
  SPEAKER_00: Sleep is a real problem for so many women, particularly.
• 29:51
  SPEAKER_01: Yeah, it's because it's the synthesis of every other thing happening in your body.
• 29:56
  SPEAKER_01: So if anything is wrong, like your hormones, or you know, too much creatine in my case, or like stress, you know, anything can can touch your sleep, unfortunately.
• 30:07
  SPEAKER_01: And then sleep in a vicious cycle impacts everything else.
• 30:11
  SPEAKER_00: So oh my goodness, yeah.
• 30:12
  SPEAKER_01: So I have a I have a quick hack I'll I'll just mention though.
• 30:15
  SPEAKER_00: Give it to us.
• 30:16
  SPEAKER_01: Yeah, so contrast therapy, temperature therapy, such as saunas, cold, yeah, uh, cold showers, and plunges, they actually drive recovery faster and more efficient.
• 30:27
  SPEAKER_01: So there's actually studies showing that it will make your sleep that night, for example, a lot more efficient.
• 30:34
  SPEAKER_01: Like I see in my own sleep trackers, like I'll have longer deep sleep, I'll have longer REM sleep, but like maybe the overall amount of sleep might be shorter, but your effective recovery during your sleep is more efficient.
• 30:48
  SPEAKER_01: Quality is better.
• 30:49
  SPEAKER_00: Qual the quality is better.
• 30:51
  SPEAKER_00: Wow, that is a good hack.
• 30:53
  SPEAKER_01: Right?
• 30:53
  SPEAKER_00: So I'm not sure I could take a cold shower before bed.
• 30:57
  SPEAKER_01: Oh, you definitely you need time.
• 30:58
  SPEAKER_01: You need time.
• 30:59
  SPEAKER_01: Like I would say, minimum, you want to be done 90 minutes before bedtime.
• 31:04
  SPEAKER_01: But I would go like four hours or more.
• 31:07
  SPEAKER_00: So okay, that makes sense.
• 31:09
  SPEAKER_00: Well, this has been as I knew it would be so interesting, so informative.
• 31:13
  SPEAKER_00: I'm sure all our listeners are gonna love this episode.
• 31:16
  SPEAKER_00: So thank you for sharing your expertise with us, Hillary.
• 31:19
  SPEAKER_00: So grateful.
• 31:20
  SPEAKER_00: And for those of you who are listening, thanks for listening.
• 31:23
  SPEAKER_00: If you like us, please give us a good review, share us with your friends, and everybody have a great day.