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Should You Start Hormone Therapy? Here's How to Decide · Doctor Turned Health Coach

• 0:00
  Welcome to doctor-turned-health coach.
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  My name is Dr. Ashwari, a board-certified family medicine physician,
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  talking about everything related to health, health coaching,
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  and primary care medicine, especially for people in their 30s and 40s.
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  Well, exactly in our 40s is when many of us are going to have to face the dilemma
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  of starting hormone therapy.
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  This is often referred to as hormone replacement therapy. For men,
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  it's usually just testosterone, but of course, other hormones like HCG or different
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  hormones may be necessary.
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  For women, it's often a combination of estrogen, progesterone, and testosterone.
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  So I'm going to give you a framework to think about hormone replacement therapy.
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  In my practice, there are patients that I start on hormone replacement therapy,
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  but I often leave the more complicated cases or more nuanced discussions up
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  to my endocrinologist experts,
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  urology experts or gynecology experts, because these topics really are nuanced.
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  The good news and the most important thing that i can say is that the majority
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  of hormones that we use are quite safe and the majority is of course the hormones
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  i already mentioned testosterone.
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  Estrogen progesterone those are safe you can we know how to dose them we have
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  safe versions of them and we know who should and should not get those hormone
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  replacement therapies for men it often happens in their 40s.
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  Sometimes their testosterone can drop rapidly, and the symptoms will be fairly obvious.
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  A lot of fatigue, brain fog, inability to heal from injuries,
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  poor recovery time, and then there's blood tests that we can check.
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  To determine if this person really needs testosterone replacement.
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  For women, it's a bit more complicated because hormones play a much bigger role.
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  They affect many other things, from genital urinary symptoms,
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  to libido, to energy level, to functional thinking and functional day-to-day
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  activities, to muscle mass, to bone health.
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  A lot of different things are affected. In fact, some studies even say that
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  cardiovascular disease is now at the heart of hormone replacement therapy for
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  women, sometimes referred to as MHT, menopause hormone therapy.
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  If i was a woman in my 40s 50s
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  and i was trying to figure out what do i need do i need hormone replacement
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  therapy or not oftentimes the best place to start is to make some slight modifications
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  to lifestyle diet sleep and stress and really measure the outcome of that do
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  you notice anything different?
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  For men, it would be change your stress level and sleep, change your exercise
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  routine, change your diet around.
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  Do you feel different? Do you feel like, oh, I can finally gain my muscle mass
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  again, the hair on my skin is coming back, or I can think more clearly I'm less fatigued?
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  If these interventions don't make a difference, most people are probably going
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  to be safe to start with some small amount of therapy.
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  For mood and sleep changes for women, sometimes beginning a small dose of progesterone
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  can be a good way to see if you'll see good results.
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  And if you do, at least you know you're on the right track.
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  For genitourinary symptoms for women, topical vaginal estrogen can be a great
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  start, and that can make some differences.
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  And for men, there's many different versions of testosterone.
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  Most people seem to do quite well with subcutaneous injections.
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  And yes, there is the problem with fertility because men tend to stay fertile longer.
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  When you do start testosterone, you have to be aware that it is a very potent
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  birth control medication, essentially.
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  And for many men, it may not be reversible.
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  So those are things to consider. Of course, these are deep discussions to have
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  with your treating physician.
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  However, I'm creating this podcast episode because I want to kind of dispel
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  a lot of the myths that's out there.
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  Hormones are bad. They're dangerous. They're going to increase your risk of
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  cancer, strokes, blood clots, prostate cancer, breast cancer, endometrial cancer.
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  Over the years that we've done the studies with these hormones,
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  it seems that it's not as clear cut that there is this direct effect.
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  One can say it's the same thing with microplastics. Yes,
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  microplastics are associated with certain medical conditions,
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  but if we give humans a little bit more microplastic than another group of humans,
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  we're probably not going to see a major change.
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  There's going to be so many other factors that are relevant that you can't really
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  associate microplastics alone or make them the big culprit.
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  And this is good news. This is good news.
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  Many medications like ibuprofen, Tylenol, we have to figure these things out over time.
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  Most people are going to do okay with ibuprofen.
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  And ibuprofen can have some serious side effects from bleeding issues to kidney
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  damage to even mood changes and fluid retention in the legs. We call edema.
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  So, if you believe that you are experiencing some problems with hormones,
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  I hope you feel empowered enough to try some things yourself to see if that makes a difference.
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  And if you don't, have that discussion with a clinician, with a physician,
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  who's comfortable prescribing these meds. That's the first question to ask.
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  Dr. Oshori, do you prescribe testosterone?
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  Yes. Do you prescribe estrogen? Yes. Are you comfortable treating these conditions?
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  And are you comfortable managing these medications? Yes, great.
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  Based on that, we can now have a discussion to see if this patient,
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  this patient now can ask me like, hey doc, do you think I'm the right fit to start this treatment?
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  If you go to a doctor who doesn't manage these medications, doesn't treat patients
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  with these hormones, well, your conversation is just not going to go very far.
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  So I hope this is of value to you guys. As always, please go to my website,
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  drashori.com. If you want to book an individual session, the information is
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  in the show descriptions below. And thanks for listening.