Unlocking the Secrets of Hormonal Health - Episode 285

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Welcome everybody to this edition of the Gladden Longevity Podcast.

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I'm your host, Dr.

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Jeffrey Gladden, and I'm here with a preeminent scholar and lovely individual, Sarah, Dr.

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Rett, Dr.

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Sarah.

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So welcome to the podcast.

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Hi, Dr.

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Jeffrey.

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Thanks for having me.

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Appreciate it.

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absolutely.

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So let me, we're going to talk about hormones and we're going to talk about them in some
really interesting ways that maybe the audience hasn't heard about or thought about.

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So I'm excited for that conversation, but how did you get into hormones?

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I'm sure, um you know, when you were five years old, you thought, well, when I grew up, I
want to be a hormone doc, right?

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So how did that actually happen?

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You know, it's, like, was minding my own business.

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I was a pathologist.

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So always interested in the pathophysiology of the body science, like math, engineering.

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This is what I did before, like I was in residency.

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And then I started going through my own health problems in my thirties.

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Like I had delivered my son and then just really just the wheels fell off the bus and all
of the things that I knew and had been taught that like, I really had to like relearn,

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like throw it up in the air.

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And like, learned it all because I had not learned any, none of the tools that I'd learned
in medicine could even help me feel better.

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I could not get well.

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had autoimmunity.

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I was like sick, right?

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Like I really was struggling and didn't even know how to heal like autoimmunity.

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Like how can you go through an entire pathology residency and not understand the immune
system enough in order to reverse autoimmunity?

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Medicine does not do this, right?

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So these were the challenges that I was faced and I was determined to feel better.

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I wanted to be young and feel young and feel 36.

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And I think the problem is that there's nothing for women.

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And we can talk about this discrepancy, but when I really got into it, when I realized it
was hormonal, and then I realized that I probably had problems my whole life.

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And if we look at like, we don't even understand some women.

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then I've learned that I was a fast metabolizer of hormones.

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And this is where we have not studied a lot of this metabolism, these genes and these SNPs
that.

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Right.

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make us different.

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Why was I different than my other friends who maybe weren't going through something at age
36?

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And when I tried all of the products on the market, literally all of them, I began to
realize that we have been ignoring this problem for women for decades.

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We have solutions for menopause.

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And when we look at women, we'll help them.

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Like if you're menstruating and you are having your period, we do not intervene.

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Your solution is birth control period.

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And then once your period has stopped and your menopausal for a year, you get hormone
replacement therapy.

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We don't tell men that they, won't give you testosterone until you're done making sperm.

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You have to be done making sperm for a year and then we'll give you testosterone.

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But we tell women that they can't have hormone replacement therapy until they're done
having their period.

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And then we know a lot about pregnancy, right?

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We can help women get pregnant, with OB-GYNs are trained to deliver babies.

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So these two populations, we help a lot.

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If you're trying to get pregnant or if you're done with your period.

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But this whole age group of women who are doing neither of those and menstruating.

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has no solutions, no products, nothing.

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If you try it, patch and a pill and then modern day formulations for HRT, they're not
gonna work for a 36 year old.

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And this is where my journey began.

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Okay.

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Well, yeah, that makes a lot of sense.

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You know, when you think about it, just listening to what you're saying there, I think
that hormone issues for women can almost begin at puberty, quite honestly.

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Not everybody has a smooth cycle, right?

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I mean, there's a lot of things that go awry early on.

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um Things like endometriosis and PCOS and, you know, all kinds of things that kind of
flare up or get started early in life, quite honestly, and people are left kind of

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dangling just saying well just kind of I don't know what they tell girls but something so
Yeah,

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traditional doctors are doing.

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And women, young women are being disproportionately impacted by the environment over men.

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And it's like we have plastics, phthalates, which are fragrances.

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We have a beauty, we're indented with a beauty routine.

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We have chemicals, pesticides.

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These bind to the estrogen receptor.

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We call them estrogens, which drives me crazy because they're not estrogen.

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They bind to the estrogen receptor.

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and they prevent your own estrogen from binding.

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And that's why women are having these really heavy periods when they're 16 and 17.

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And yeah, so you're right.

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This is really impacting us early on.

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Putting them on birth control is making the problem worse.

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Now you have a woman who's 25 who's been on birth control for 10 years and full blown
endometriosis.

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Yep.

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No, it's a mess.

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Yeah.

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These hormone disruptors are really a huge thing.

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They're actually a big thing for men and women, quite honestly.

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mean, sperm counts are going down, right?

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Infertility is going down.

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Testosterone levels are falling.

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So there's a lot of environmentally driven hormone disruptors, let's call them, that are
hitting both sides of the fence um a little bit differently.

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But nonetheless, I think humanity is suffering.

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ah

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right.

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And it's like a crisis.

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Like we need to be looking at it and realizing that it is a crisis.

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I feel like even smart people, when we talk about it, the doctors that are hormone
replacement therapy specialists and longevity, they still refer to these chemicals as

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estrogens.

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And so we're still giving this message that estrogen is making men lose their sperm.

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Estrogen is making women have the endometriosis.

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And this is really damaging because it's not estrogen that's doing this.

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It's the chemical that's doing this.

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That's right.

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No, you're right.

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You're absolutely right.

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um yeah, let's talk.

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You know, it seems like there's so many forks in the road when it comes to women in
estrogen, right?

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Because you have, or women in hormones, because you have people that are going down the
path of PCOS.

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You have women that are developing endometriosis, things like that.

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Do you want to give us maybe, and it may be impossible to answer this question, but is
there kind of a unifying?

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thesis here that kind of holds this all together in your mind.

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a hypothesis that I'm not like, necessarily going to be right, but I feel like you can, we
can tie it together.

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And if you were to say that one, all the whole root of all of these problems are one
thing, endometriosis, PCOS, early perimenopause, menopause, menopause, like all of it,

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heavy painful periods, like it's a spectrum of disease.

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So you could even be having endometriosis symptoms, but not have any metriosis.

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can have PCOS symptoms, but not have PCOS, you know, it's a spectrum and they're all
caused by.

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low estrogen and progesterone say in women?

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And why does it impact some women more than others?

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And I think this is a question that we should really be asking and it could be genetic and
it could be these snips that we're not studying that we need to study.

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So for example, let me paint a picture of a woman for you that has ADHD.

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She's thin, she's um has a lot of anxiety in her 20s, and then she develops endometriosis
later, heavy painful periods.

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And then she goes on to develop like she doesn't get any help, maybe even has surgery.

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and still develops early perimenopausal or ADHD symptoms get worse.

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She's put on pharmaceuticals, antidepressants, anti-anxiety medication, birth control to
stop her period, everything gets worse.

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Why did this woman develop endometriosis instead of PCOS when probably it was all the same
reason?

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And these could be, the reason could be these underlying genetic factors.

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Like what if this endometriosis patient had COMT, the fast metabolizer, and this is what
gave her this clinical picture as opposed to a PCOS picture where you're growing hair on

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your face and losing your hair.

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gaining weight, becoming insulin resistant, your testosterone's getting high.

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These two women diverged and went into completely different directions, even though the
problem was the same problem, and maybe even the treatment is the same.

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why did it, and it could underlie the way the hormones are being metabolized, and we're
not paying attention to it.

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We think that the liver just metabolizes estrogen, and it's done.

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But we know that actually there's probably methylation pathways that we could look at.

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The estrogens being methylated in different tissues in the brain and then being eliminated
really quickly.

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so, you know, along with dopamine, so she's becoming worse.

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Her clinical picture is severe with endometriosis.

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And then you have other women who, their hormones might drop, but they're not metabolizing
it as quickly.

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So they kind of fly under the radar until menopause.

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Like, why did I do worse than another woman?

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was healthy, you know what mean?

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And so I'm a carrier of a COMT gene, right?

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So this is a SNP.

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So this is like fascinating something that we should do research.

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Women are not being researched enough.

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Yeah, I agree with you.

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don't think people are deconstructing these problems sufficiently, right?

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That's the way that I tend to think about it.

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And there are a lot of interlacing snips here, right?

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So there are snips that really predispose you to anxiety and predispose us to depression
or things like that.

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There are also genes that predisposes to insulin resistance or being late to the party, as
I call it, where really, increments don't...

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get released when sugar comes in and you really don't really start releasing insulin until
your sugar is already spiked, right?

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And then, so there's lots of different genes that play with each other here.

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And I think probably the interplay of the various genes probably determines some of the
phenotypic expressions, right?

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Which pathway you go down.

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um But I think it's for each individual, it's kind of a knot that you have to unravel.

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You have to look at the genes related to all those features um and then say, okay.

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Here's how we take care of all of this, right?

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That's kind of how I would think about it, so.

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agree.

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I think it's also important to remember that genes are, I mean, excuse me, hormones are so
powerful that they directly impact and influence genes.

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So like gene expression, you can literally express and turn off certain genes on hormones.

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So for example, there's a gene that women have the ability to make choline because it's so
important for baby and baby development.

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And we can make choline.

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And estrogen turns on that expression of that gene.

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So when you get pregnant, your estrogen gets to 40,000, you're able to make more choline.

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When you get through menopause and your estrogen goes to zero, like our choline also,
production goes to zero and nobody's eating eggs because apparently we're told that eggs

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are bad or something.

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So nobody's eating eggs.

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then women's gallbladders become very, very bad and sluggish.

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And they have to get them out and get gallstones.

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And people are blaming it on estrogen.

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I'm like, no, the problem is there's no estrogen to protect your gallbladder.

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There's nothing there to make choline for you.

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And so these, like gene expression with hormones, like this is what also gives us like
feminine and male features.

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Like these are powerful, hormones are very powerful.

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You know, when you think about the fact that more women suffer from dementia than men
also, right?

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And we know that, again, genes that interplay with each other, right?

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APOE4, APOC1, Tom40, genes like that that are predisposed to Alzheimer's, that it's
really, really critical for men's brains and women's brains to have adequate estrogen.

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And so a lot of men get testosterone, they get put on anastrozole, then...

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their estrogen levels go down and you know, cardiovascular impacts, bone density impacts,
even abdominal obesity is worse and their brains don't function well, right?

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So there's a lot of disservice being done on both sides of the fence here, I think,
because it's not really adequately deconstructed.

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It's you're right.

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Like we're saying the estrogen is bad and it's bad for men too.

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And so you're right.

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Actually estrogen makes their skin glow.

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It protects them from disease.

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We know that at night when we're sleeping, estrogen helps the cerebral spinal fluid like
cleanse the brain.

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And that's possible.

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Maybe it works in men.

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I know it works that way.

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And does this, you know, it's like this really complex neuroendocrine system in the brain
is hormone dependent and like

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all this when you look at the studies like they're they're they're answering this question
of can we prevent dementia in like a 55 year old we should be thinking about you need to

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prevent dementia is like a 35 year old like you need to keep that mental clarity and
sharpness and prevent the brain fog and keep this going at a very young age not like

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postmenopause

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I actually think when a baby's born, we should be doing genetic testing, right?

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And we should understand, okay, where are the liabilities?

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Where are the assets?

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How are these SNPs going to play together?

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Is there something weird we don't know about so we can at least be aware of it?

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And then, you know, then you start to play the orchestration of that, right?

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Okay, you're hitting puberty.

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Okay, well, let's actually start measuring hormones and hormone metabolites because it's
one thing to know you're a fast metabolizer, but I've been impressed that you can measure

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how the...

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Metabolites are coming out.

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may not match the genetics also.

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Apparently there's some other override that can happen.

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So um maybe we start testing more comprehensively hormone profiles in people at younger
ages, maybe even 10 year olds.

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Or I know I'm thinking 10 year olds pre puberty.

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Maybe you have to go down to eight years old.

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I don't know.

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But to get an idea where you're headed right so you can actually help people have a good,
good, healthy life here.

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I love it.

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Like it would take this like idea that we need to start realizing that hormones are
protective and beneficial and that we need to keep them optimal at all times.

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And it's almost like people are not there mentally.

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They need to keep, make that leap first before we're testing.

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But I agree.

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It's the best way to personalize it.

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I had a doctor friend who did test his 12 year old son and his testosterone levels were
1800.

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at 12 years old.

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knowing just like when they peak, making sure that that child does undergo puberty, that
is peaking and it's doing what it's supposed to be doing.

216
00:13:20,284 --> 00:13:23,656
And then when it falls off in the 20s so that you can maintain health.

217
00:13:23,656 --> 00:13:25,908
It's about maintenance and prevention.

218
00:13:25,908 --> 00:13:28,609
If you can maintain your health and be optimal.

219
00:13:28,970 --> 00:13:32,002
But like we still have this like problem with women and birth control.

220
00:13:32,002 --> 00:13:35,094
Like women, birth control suppresses hormones.

221
00:13:35,584 --> 00:13:39,174
and then you're not going to ever be, but we have a women do not want to get pregnant.

222
00:13:39,174 --> 00:13:42,949
I think we do have to need to address this for them and like, because yeah.

223
00:13:42,949 --> 00:13:49,142
I agree, but they have, you you end up with progestins and you end up with no
testosterone.

224
00:13:49,142 --> 00:13:54,779
And I mean, it's really, it's almost like, uh, it feels like the worst thing you can
possibly do to a human being.

225
00:13:54,779 --> 00:13:55,879
the worst thing you can do.

226
00:13:55,879 --> 00:14:00,482
Like, I don't know, one, I mean, one would argue that getting pregnant is the worst thing
that could happen to them.

227
00:14:00,482 --> 00:14:00,922
Okay.

228
00:14:00,922 --> 00:14:04,645
So in that, in this case, the birth control risk.

229
00:14:04,645 --> 00:14:04,995
Yeah.

230
00:14:04,995 --> 00:14:05,265
Okay.

231
00:14:05,265 --> 00:14:06,304
So that's what it's for.

232
00:14:06,304 --> 00:14:11,075
word thing, so to speak, but nonetheless, it's still on the bad side of the ledger here by
a long way.

233
00:14:11,075 --> 00:14:12,794
control for everything, like to fix everything.

234
00:14:12,794 --> 00:14:14,146
you have acne, let's give you birth control.

235
00:14:14,146 --> 00:14:16,497
Like, you have a mood disorder, we'll give you birth control.

236
00:14:16,497 --> 00:14:22,739
And birth control, like when women have understood that it's probably the worst thing you
can do for your health because it is taking away your protective hormones.

237
00:14:22,739 --> 00:14:23,670
It is not hormone.

238
00:14:23,670 --> 00:14:26,121
It is like doing the opposite for you.

239
00:14:26,121 --> 00:14:29,582
And even if we could get women to understand, there's no informed consent.

240
00:14:29,582 --> 00:14:33,924
Doctors are not telling them in this, like, I'm going to take away your hormones.

241
00:14:35,025 --> 00:14:37,566
I don't think doctors know, like, I don't think they get it.

242
00:14:37,566 --> 00:14:38,575
They don't understand.

243
00:14:38,575 --> 00:14:39,436
Yeah, they don't.

244
00:14:39,436 --> 00:14:40,987
I think it impacts bone density.

245
00:14:40,987 --> 00:14:44,179
It certainly impacts or can impact libido in many respects.

246
00:14:44,179 --> 00:14:48,302
I don't, you know, and then some people have difficulty with fertility when they try to
come off them.

247
00:14:48,302 --> 00:14:48,562
Right.

248
00:14:48,562 --> 00:14:48,962
Of course.

249
00:14:48,962 --> 00:14:49,783
So.

250
00:14:50,944 --> 00:14:51,754
Yeah.

251
00:14:52,103 --> 00:14:55,124
talking gut health, like it interrupts your entire gut health.

252
00:14:55,124 --> 00:14:57,795
But I think the biggest thing is mental health for women.

253
00:14:57,795 --> 00:15:04,607
We see this huge wanting suicidal ideation, they get anxiety, they get depression, they do
not feel well.

254
00:15:04,607 --> 00:15:09,428
Mental health when you start birth control is humongous, and this is probably the biggest
problem I see.

255
00:15:09,428 --> 00:15:15,912
You can deal with a little bit of gut health probably issues, but when you feel suicidal
or not, well, this is not good.

256
00:15:15,912 --> 00:15:16,773
Mm hmm.

257
00:15:16,773 --> 00:15:17,754
Yeah.

258
00:15:17,755 --> 00:15:28,798
So if you were going to outline kind of, let's just say you have carte blanche to actually
redo the system, how would you, how would you actually set it up?

259
00:15:30,227 --> 00:15:37,412
I see a future, a world where you would have a healthy population if you were to maintain
these optimal hormone levels your whole life.

260
00:15:37,412 --> 00:15:41,895
This is something that we know that you can maintain your metabolic fitness this way.

261
00:15:41,895 --> 00:15:51,163
um And I think people would probably push back and argue that it's not, that I do think
it's the root cause of gut problems, leaky gut, SIBO, cortisol.

262
00:15:51,163 --> 00:15:55,478
um We see when your hormones drop, you start aging.

263
00:15:55,478 --> 00:15:58,979
Like it is foundational to the longevity period.

264
00:15:58,979 --> 00:16:09,962
when you like your hair and skin and wrinkles, is like estrogen is your best anti-aging
longevity drug and progesterone is there to counterbalance it and make sure that it's like

265
00:16:09,962 --> 00:16:11,503
in check because you need them both.

266
00:16:11,503 --> 00:16:22,146
But um if in a perfect world and if I could redo it, everybody would be healthy because we
would and we really these chemicals that are like, they absolutely need to be not ignored.

267
00:16:22,592 --> 00:16:27,860
We need to address that they're binding to the hormone receptors and completely disrupting
people.

268
00:16:28,852 --> 00:16:30,425
Yeah, I think that's right.

269
00:16:30,425 --> 00:16:35,374
think cleaning up the environment is kind of the place to start because um

270
00:16:35,374 --> 00:16:46,074
I also think that like in a perfect world, we would recognize that reference intervals and
laboratory testing are not accurate to dose hormone replacement therapy.

271
00:16:46,074 --> 00:16:52,034
That we really should be looking at what the brain is thinking in these feedback loops
with FSH and LH and what does the brain think?

272
00:16:52,214 --> 00:16:56,414
We tend to think like that hormone levels are high, but women feel great on it.

273
00:16:56,414 --> 00:16:57,434
So what is the problem?

274
00:16:57,434 --> 00:16:59,554
And also we don't even know what high is.

275
00:16:59,554 --> 00:17:00,474
haven't established them.

276
00:17:00,474 --> 00:17:01,594
We should be looking at genes.

277
00:17:01,594 --> 00:17:03,854
Like we're talking about how do you metabolize it?

278
00:17:03,854 --> 00:17:04,574
Are you fast?

279
00:17:04,574 --> 00:17:05,574
Are you slow?

280
00:17:05,574 --> 00:17:08,954
This, we would be able to optimize hormone replacement therapy better right now.

281
00:17:08,954 --> 00:17:10,014
It's a lot of guesswork.

282
00:17:10,014 --> 00:17:11,234
It's shooting in the dark.

283
00:17:11,234 --> 00:17:13,414
It's telling women that it's safe.

284
00:17:13,414 --> 00:17:14,294
Like, it's really scared.

285
00:17:14,294 --> 00:17:14,674
Like, weird.

286
00:17:14,674 --> 00:17:15,574
They're scared of it.

287
00:17:15,574 --> 00:17:23,094
You know, like, I think we need to get to a place where we really have fine, like, hormone
medicine and longevity, it's like its own thing.

288
00:17:23,414 --> 00:17:27,894
The doctor, we need to really make it an excellent field.

289
00:17:27,894 --> 00:17:29,674
It has the potential to be.

290
00:17:29,924 --> 00:17:32,796
We just got a hold of a new test from Vibrant America.

291
00:17:32,796 --> 00:17:35,048
I don't know if you're familiar with the lab, Vibrant America.

292
00:17:35,048 --> 00:17:40,353
um They do a lot of really sophisticated testing, um gut testing.

293
00:17:40,353 --> 00:17:42,554
um And now they just came out.

294
00:17:42,554 --> 00:17:46,086
A lot of their tests carry the moniker Zoomer, right?

295
00:17:46,086 --> 00:17:50,181
So it'll be like a gut Zoomer or an oxidative stress Zoomer or whatever.

296
00:17:50,181 --> 00:17:52,682
So some reason they've attached a Zoomer.

297
00:17:52,703 --> 00:17:55,205
So they just came out with a hormone Zoomer, right?

298
00:17:55,205 --> 00:17:59,262
Which is actually, I just looked at the report because we...

299
00:17:59,262 --> 00:18:05,425
We do a lot of hormone testing here, genetic testing, hormone testing, hormone metabolite
testing, right?

300
00:18:05,425 --> 00:18:07,136
Urine metabolites, things like that.

301
00:18:07,136 --> 00:18:11,058
And uh I was really impressed with the quality of this test.

302
00:18:11,058 --> 00:18:13,340
I mean, it's really kind of breaking things down.

303
00:18:13,340 --> 00:18:28,168
um And I have no financial ties to this company, but I think it's interesting to see that
in the functional medicine, longevity space, that the labs are starting to realize the

304
00:18:28,168 --> 00:18:29,228
need here.

305
00:18:29,924 --> 00:18:33,524
And coming out with tests where you can go do a single test.

306
00:18:33,524 --> 00:18:43,864
And if you work with a doctor that knows how to interpret the test, right, you can
actually get some really, really useful information just from a single test because it's

307
00:18:43,864 --> 00:18:45,204
so comprehensive.

308
00:18:45,464 --> 00:18:48,004
I don't think this particular one is doing genetics.

309
00:18:48,004 --> 00:18:49,124
have to go back and look at it.

310
00:18:49,124 --> 00:18:54,124
I know with the oxidative stress one, it does include oxidative stress genes as well,
right?

311
00:18:54,124 --> 00:18:54,894
And then

312
00:18:54,894 --> 00:19:01,510
giving you markers across different compartments like lipid oxidation and DNA damage and
oxidation, things like that, right?

313
00:19:01,510 --> 00:19:02,971
So super helpful.

314
00:19:03,272 --> 00:19:15,632
But I think it would be interesting to uh do genetics on kids so you actually know what
cards they're holding and then actually start doing something like this, zoomer test,

315
00:19:15,632 --> 00:19:22,072
hormone zoomer test, several times during their childhood and then certainly when they hit
puberty and then sort of...

316
00:19:22,072 --> 00:19:30,258
you know, marrying the things together between the genetics and their symptoms and and
what you're measuring and get a feel for kind of how things are developing for them.

317
00:19:30,258 --> 00:19:35,261
Because I think you could avoid a lot of pain, quite honestly, for people.

318
00:19:35,261 --> 00:19:44,577
um It's impressive to me how many, you know, not being female, of course, but it's
impressive to me how many women really struggle at various points in their cycle.

319
00:19:44,577 --> 00:19:47,099
Like I just I'm off for three days.

320
00:19:47,099 --> 00:19:47,999
I'm off for a week.

321
00:19:47,999 --> 00:19:51,152
I just don't feel like myself for, you know, however long it is.

322
00:19:51,152 --> 00:19:52,242
And

323
00:19:52,356 --> 00:19:59,416
If there are ways to understand that and mitigate that, know, maybe it's some adjunct
progesterone or something, right?

324
00:19:59,416 --> 00:20:07,436
I think it'd be, I don't know, I'd be a big fan of us doing that, not waiting until people
are, you know, 45, right?

325
00:20:07,718 --> 00:20:13,792
I have like, think that this, it's not normal to be so out of it for seven days.

326
00:20:13,792 --> 00:20:21,356
And just to like say that my period, because hormones dropped to like zero during the
period and then a seven day period where you can't function and go to work.

327
00:20:21,356 --> 00:20:23,927
This is not like how our ancestors probably functioned.

328
00:20:23,927 --> 00:20:30,091
It was probably a very light, I mean, they wouldn't like have survived, but they were
bleeding the way that women are today with like really heavy periods.

329
00:20:30,091 --> 00:20:36,256
uh And you would, I think that we also need to completely redo this cycling.

330
00:20:36,256 --> 00:20:41,531
idea that women, those studies were based on radioactive immune assays, which are very
outdated.

331
00:20:41,531 --> 00:20:46,675
We would actually reject those papers today because the laboratory testing is so outdated.

332
00:20:46,675 --> 00:20:49,077
We don't even look at these papers anymore.

333
00:20:49,077 --> 00:20:54,502
But yet we still tell women that the estrogen peaks this way and progesterone peaks into
cycle.

334
00:20:54,502 --> 00:20:56,093
Doctors base their practice on it.

335
00:20:56,093 --> 00:21:01,838
They're trying to get women to just take progesterone the last half of the month and to
try to mimic this cycle.

336
00:21:01,838 --> 00:21:03,950
This cycle that's not based on

337
00:21:04,142 --> 00:21:08,762
current science is based on like 1950 year old immune assay science.

338
00:21:09,142 --> 00:21:12,822
We just need to like, does this how women really cycle what's happening?

339
00:21:12,822 --> 00:21:19,782
Because what should probably happen is if the hormone levels are optimal all month, she
shouldn't notice like a five day drop in them.

340
00:21:19,782 --> 00:21:22,322
Because every tissue should still be functional and fine.

341
00:21:22,322 --> 00:21:25,202
And then when they start picking up again, she should feel good again.

342
00:21:25,202 --> 00:21:29,282
If she feels terrible for seven days of the month, they were low to begin with.

343
00:21:29,282 --> 00:21:32,102
you know, that's like, it makes sense that they were low all month.

344
00:21:32,102 --> 00:21:33,902
It's just now they're completely gone.

345
00:21:33,902 --> 00:21:35,113
and she's feeling terrible.

346
00:21:35,113 --> 00:21:36,386
um

347
00:21:36,386 --> 00:21:41,871
we can do testing where a person can actually test their hormones every day of the cycle.

348
00:21:41,871 --> 00:21:42,240
Right.

349
00:21:42,240 --> 00:21:46,835
We've done this for a few people to help them get pregnant, let's say, so we can actually
map what's happening.

350
00:21:46,835 --> 00:21:47,444
um

351
00:21:47,444 --> 00:21:52,949
The is the variability and analytical variability, biological variability, hormones are
being shuffled around.

352
00:21:52,949 --> 00:21:59,884
So mean, they can give you kind of a picture, sort of, and if you can do it every day like
that, can kind of, maybe.

353
00:21:59,945 --> 00:22:07,552
And this is probably a lot more accurate, but I think they also need to be taken into
account that it's what, like hormones are not supposed to be in the blood.

354
00:22:07,552 --> 00:22:08,713
It's like thyroid.

355
00:22:08,713 --> 00:22:13,737
If your thyroid's in the blood, it's supposed to be in the tissue and you can't measure
what inside the cell what's going on with thyroid.

356
00:22:13,737 --> 00:22:14,922
oh

357
00:22:14,922 --> 00:22:15,882
That's right.

358
00:22:15,882 --> 00:22:18,022
thyroid conversion happens in the cell as well.

359
00:22:18,022 --> 00:22:22,182
So like the metabolism of the hormone is also in their end tissues that we're not
measuring, right?

360
00:22:22,182 --> 00:22:27,962
Like in the brain and the uterus, like if the uterus is storing all the progesterone and
we're measuring the blood, what are we doing?

361
00:22:27,962 --> 00:22:34,762
So I even think we need to look at like how we're thinking about the hormones and
measuring them for it to make sense, because if they're in the blood, that's probably

362
00:22:34,762 --> 00:22:39,262
means are they being on their way out to being metabolized and getting rid of them?

363
00:22:39,262 --> 00:22:40,162
Like, why are they in the blood?

364
00:22:40,162 --> 00:22:41,162
Is that a peak?

365
00:22:41,162 --> 00:22:42,720
know, so this...

366
00:22:42,720 --> 00:22:45,602
there's going to be some in the blood, just like there's going to be some thyroid in the
blood.

367
00:22:45,602 --> 00:22:56,337
But to your point, you know, what we have found with thyroid is that the blood work is not
terribly reliable when it comes to actually managing somebody's thyroid.

368
00:22:56,337 --> 00:23:01,560
It's really resting metabolic rates, right, that we look at so that we can see what's
happening at a tissue level.

369
00:23:01,560 --> 00:23:04,722
And then we look at genetics like the DIO2 in the brain, right?

370
00:23:04,722 --> 00:23:05,646
Can you...

371
00:23:05,646 --> 00:23:10,200
take the iodine off and make T3 in the brain because that's different than making it
epistemically, right?

372
00:23:10,200 --> 00:23:14,453
So when you put all those pieces together, all of a sudden it's like, oh, we can get
somebody feeling great again.

373
00:23:14,453 --> 00:23:19,875
I wish we had the equivalent of a resting metabolic rate for hormones, right?

374
00:23:19,875 --> 00:23:20,486
because you're right.

375
00:23:20,486 --> 00:23:22,565
Like we are not like you've perfected.

376
00:23:22,565 --> 00:23:27,411
Like I've never heard that before for thyroid and it sounds so much better than the way
that other doctors are like chasing these lab tests.

377
00:23:27,411 --> 00:23:29,873
And it sounds exhausting when I don't do thyroid.

378
00:23:29,873 --> 00:23:38,465
That's not my specialty, but I do know that it is a complicated and I see that you have to
chase and uh it's like I don't see it hair shedding, huh?

379
00:23:38,465 --> 00:23:40,335
We never chase the blood numbers.

380
00:23:40,335 --> 00:23:41,696
We never chase them.

381
00:23:41,696 --> 00:23:44,766
What we do is we do resting metabolic rates and we look at their genetics.

382
00:23:44,766 --> 00:23:52,539
And then we do look at that to see if there's reverse T3 or, you know, something like
that, or if there's antibodies against the thyroid, like they have Hashimoto's.

383
00:23:52,539 --> 00:23:53,539
So we look at it for that.

384
00:23:53,539 --> 00:23:58,790
And we'd like to see that the TSH isn't zero, right?

385
00:23:58,830 --> 00:24:01,891
But we really base it on the resting metabolic rate.

386
00:24:01,891 --> 00:24:02,832
That's the set point.

387
00:24:02,832 --> 00:24:04,272
That's where the...

388
00:24:04,546 --> 00:24:06,783
thermometer is set or the thermostat

389
00:24:06,903 --> 00:24:12,026
We need like a comprehensive view of hormones that makes sense, especially for this very
mental causal phase.

390
00:24:12,026 --> 00:24:14,958
Like we're telling women that they're estrogen dominant.

391
00:24:14,958 --> 00:24:20,132
your estrogen is high, but it's like, why did we get that high measurement to begin with
when you're 45?

392
00:24:20,132 --> 00:24:21,653
You know, it doesn't even make any sense.

393
00:24:21,653 --> 00:24:22,764
And like, we're not thinking about it.

394
00:24:22,764 --> 00:24:24,985
We're just telling her that she doesn't need estrogen.

395
00:24:24,985 --> 00:24:25,696
Let's block it.

396
00:24:25,696 --> 00:24:26,777
Let's give her dim.

397
00:24:26,777 --> 00:24:27,457
It's wild.

398
00:24:27,457 --> 00:24:34,862
Like what we've not really have developed a very, for women, especially, I feel like for
men, it's not perfect.

399
00:24:34,862 --> 00:24:38,122
But at least we've established those reference intervals based on like FSH.

400
00:24:38,122 --> 00:24:43,502
And we know that if I give you this much and kind of like, you know, we're shutting off
this pathway, we've not done that for women.

401
00:24:43,502 --> 00:24:44,802
Like I want women to not pay.

402
00:24:44,802 --> 00:24:46,242
Like this has not been done for you.

403
00:24:46,242 --> 00:24:50,662
So if a doctor says that your estrogen's high, like what are they basing that off of?

404
00:24:51,302 --> 00:24:53,262
their own fear.

405
00:24:53,262 --> 00:24:56,182
It's like, it's actually, I'll tell you, it's their own fear of estrogen.

406
00:24:56,182 --> 00:24:57,082
I don't know how to do it.

407
00:24:57,082 --> 00:24:58,182
I don't know how to do HRT.

408
00:24:58,182 --> 00:24:59,562
So I'm going to fear it.

409
00:24:59,562 --> 00:25:01,682
It's not based on any, we have no science.

410
00:25:01,682 --> 00:25:04,002
Like I've seen, that's great.

411
00:25:05,038 --> 00:25:08,341
for especially for lab testing and establish like perimenopausal.

412
00:25:08,341 --> 00:25:13,085
We even tell women perimenopausal is a clinical diagnosis because the labs are so bad.

413
00:25:13,085 --> 00:25:14,255
Like this is embarrassing.

414
00:25:14,255 --> 00:25:19,569
But we need to have like a better way to like be able to tell a woman that she's
perimenopausal.

415
00:25:19,854 --> 00:25:20,805
Yeah, I agree.

416
00:25:20,805 --> 00:25:26,460
You know, one of the things we are concerned about for men, of course, is developing
prostate cancer, right?

417
00:25:26,460 --> 00:25:37,920
So we're, you know, we're pretty meticulous about looking at urine hormone metabolites,
dihydrotestosterone, 4-hydroxyestrone, 16-hydroxyestrone, you know, making sure people can

418
00:25:37,920 --> 00:25:42,203
methylate, getting the COMT gene to work properly, you know, things like that.

419
00:25:42,203 --> 00:25:47,748
um And certainly many women uh are concerned about

420
00:25:47,748 --> 00:25:52,251
the risk of breast cancer because there are estrogen receptor positive breast cancers,
right?

421
00:25:52,251 --> 00:26:02,917
And so, and there are genetics for men that um can make ah prostate cancer flourish in the
face of androgens, right?

422
00:26:02,917 --> 00:26:07,690
So there's a lot of sort of balancing in people's minds here that goes on too.

423
00:26:07,690 --> 00:26:13,823
I know my mom who's now passed away would never take hormone replacement because she was
so worried about breast cancer.

424
00:26:13,823 --> 00:26:15,170
She died from.

425
00:26:15,170 --> 00:26:17,989
you know, osteoporosis essentially was repeated falls.

426
00:26:17,989 --> 00:26:22,622
So, you know, uh it's almost like pick your poison a little bit, but.

427
00:26:22,622 --> 00:26:23,559
um

428
00:26:23,559 --> 00:26:34,623
I think it's like we, that whole breast cancer thing too, like if it's an ER positive, em
if you have a receptor for estrogen progesterone on your cancer cell, this is a good

429
00:26:34,623 --> 00:26:35,324
thing.

430
00:26:35,324 --> 00:26:41,686
It's like, it means that the body has not lost its receptor and it's still responding to
normal cellular body signals.

431
00:26:41,786 --> 00:26:45,868
If you lose those receptors, that cell is completely malignant and dangerous.

432
00:26:45,868 --> 00:26:50,392
And so like, but we look at in vitro studies where they grow in the presence of estrogen.

433
00:26:50,392 --> 00:26:55,884
but this is not what's potentially happening in the body where you have progesterone that
suppresses growth potentially.

434
00:26:55,884 --> 00:27:02,956
So when you look at in vivo and like all the different mechanisms that are involved in
cancer growth, and then we're simplifying it and saying that estrogen just makes your

435
00:27:02,956 --> 00:27:03,766
cancer grow.

436
00:27:03,766 --> 00:27:05,754
I feel like it's gross oversimplification.

437
00:27:05,754 --> 00:27:09,428
We're not doing any justice to women by keeping them away from estrogen.

438
00:27:09,428 --> 00:27:16,280
When these large scale like studies show that it's protective, like I think we really need
to challenge this ER positive like.

439
00:27:16,280 --> 00:27:21,511
Pathologists, when they mark those and they just mark you are positive, they're just
looking at stains, in-putro stains.

440
00:27:21,832 --> 00:27:26,573
But doctors interpret that as, if I give you estrogen, your cancer is going to grow.

441
00:27:26,573 --> 00:27:28,090
Can we just look at that and see?

442
00:27:28,090 --> 00:27:28,553
know what I mean?

443
00:27:28,553 --> 00:27:30,204
A little bit closer for women.

444
00:27:30,204 --> 00:27:38,136
Because even if we were like, you can't have hormone, like we do for men, if you have
prostate cancer, you don't get testosterone replacement therapy.

445
00:27:38,136 --> 00:27:40,977
But if you're in remission, it's a choice for you.

446
00:27:40,977 --> 00:27:42,557
We don't do that for women.

447
00:27:42,898 --> 00:27:44,502
you ever have breast cancer, like,

448
00:27:44,502 --> 00:27:49,692
Forget it, nobody's ever gonna prescribe you hormone replacement therapy, but if you're in
remission, you should be a candidate.

449
00:27:50,104 --> 00:27:50,364
Yeah.

450
00:27:50,364 --> 00:28:00,410
And I think, I think your point about combining it with progesterone, I think, you know,
to balance it really, think, you know, biology is an economy of balance.

451
00:28:00,410 --> 00:28:03,521
It's not about pushing on one lever all the time.

452
00:28:03,521 --> 00:28:03,772
Right.

453
00:28:03,772 --> 00:28:12,366
So I think if you are going to use estrogen, I think if you're going to do any hormone
replacement, it's important to really get the constellation of hormones.

454
00:28:12,366 --> 00:28:19,640
So I'm a big advocate of, you know, some DHEA, some testosterone, some progesterone, some
estrogen, all of those.

455
00:28:19,694 --> 00:28:22,545
kind of working together and getting those balanced out for an individual.

456
00:28:22,545 --> 00:28:31,587
in men, you know, it's really about giving the testosterone, allowing them to make the
estrogen, then making sure they're metabolizing it appropriately and helping them do that.

457
00:28:31,587 --> 00:28:38,059
um Make sure the DHT doesn't go too high, you know, things like that, that we don't want
to be, you know, increasing risk.

458
00:28:38,059 --> 00:28:46,081
But if you balance it out and you give people the cocktail, if you will, of the hormones
that they need, um I think that's the healthiest approach.

459
00:28:46,081 --> 00:28:48,210
At least that's our approach.

460
00:28:48,210 --> 00:28:50,041
You're absolutely, I completely agree with you.

461
00:28:50,041 --> 00:28:52,461
Like let the body do what it's normally doing.

462
00:28:52,461 --> 00:28:58,693
And you're just going to make sure that if you over make DHT that you block, just want to
say that how important that is that you're just letting it.

463
00:28:58,733 --> 00:29:00,143
It's like, Hey, I'm to put you on tests.

464
00:29:00,143 --> 00:29:01,024
That's what I do for men too.

465
00:29:01,024 --> 00:29:04,114
When I used to treat them in clinic, I don't anymore, but it was like, Hey, I'm to put you
in.

466
00:29:04,114 --> 00:29:10,406
And it's not my specialty, like, but I'm just saying, I'm also not a dad guy, but it's
like, I'm going put you on testosterone and then I'm just going to see what your body

467
00:29:10,406 --> 00:29:10,676
does.

468
00:29:10,676 --> 00:29:17,460
Like if you get breast tenderness and nipple pain, then yeah, maybe you need to block a
little bit of estrogen, but otherwise that estrogen is not doing you any harm.

469
00:29:17,460 --> 00:29:22,812
Or if you're, you know, like, and make sure you don't convert to DHT from that too.

470
00:29:23,032 --> 00:29:23,423
I agree.

471
00:29:23,423 --> 00:29:26,174
And then also when we look at men, like we understand the formulations.

472
00:29:26,174 --> 00:29:31,176
Like if I were to give a man testosterone cream, that more heavily converts to DHT.

473
00:29:31,176 --> 00:29:33,297
So you're more likely to like lose your hair and get acne.

474
00:29:33,297 --> 00:29:41,820
We know that pathway conversion, but we put women on testosterone cream all day long and
they're like, know it's converting to DHT and potentially causing their hair to fall out.

475
00:29:41,820 --> 00:29:45,966
But yet we'll, so we, that's why we tend like for multiple reasons, we'll put men on.

476
00:29:45,966 --> 00:29:52,366
injections, one, don't want the cream to get all over the house, but like injections we
know will more likely to convert to estrogen, right?

477
00:29:52,366 --> 00:30:01,166
And so even an injection is more appropriate for a woman for testosterone than a cream,
you know, I mean, I don't know what your, but it's like, need to think, it doesn't matter.

478
00:30:01,166 --> 00:30:06,806
It's just kind like, we need to think about these formulations and they impact the way the
hormones are converting to one another.

479
00:30:06,806 --> 00:30:09,786
We need to think about that before we give them a formulation.

480
00:30:09,786 --> 00:30:10,606
Formulations matter.

481
00:30:10,606 --> 00:30:14,540
We can't just like take it by mouth or put it through the skin or something and

482
00:30:14,540 --> 00:30:17,353
that outcome is gonna be completely different for that person.

483
00:30:17,353 --> 00:30:19,245
so people, doctors don't think about it.

484
00:30:19,245 --> 00:30:25,812
They're just like, for women at least, it's like a patch and a pill and a low dose vaginal
cream and I'm done with you, go exercise, whatever.

485
00:30:25,940 --> 00:30:26,220
Yeah.

486
00:30:26,220 --> 00:30:32,803
You see these patches that have testosterone, progesterone and estrogen, you know, E2 and
E3 and varying ratios.

487
00:30:32,803 --> 00:30:37,785
it's a little bit, know, progesterone is not that well absorbed through the skin,
honestly.

488
00:30:39,746 --> 00:30:40,706
Right.

489
00:30:41,507 --> 00:30:42,267
Exactly.

490
00:30:42,267 --> 00:30:46,699
So it's, we find it all a little bit sad, really.

491
00:30:46,699 --> 00:30:49,480
I was going to say comical, but it's a little bit sad is really what it is.

492
00:30:49,480 --> 00:30:50,550
Yeah.

493
00:30:53,300 --> 00:30:53,944
Yeah.

494
00:30:53,944 --> 00:30:56,545
We do injectable testosterone for women also.

495
00:30:56,545 --> 00:31:00,766
uh We have we've done that many, many times.

496
00:31:00,766 --> 00:31:04,327
The one thing we bump into is some people just don't want to take an injection.

497
00:31:04,327 --> 00:31:04,637
Right.

498
00:31:04,637 --> 00:31:08,028
So then you're a little bit stuck because we don't want to give them oral testosterone
either.

499
00:31:08,028 --> 00:31:09,969
That's a little rough on the liver.

500
00:31:09,969 --> 00:31:14,490
So then we do use, you know, gently use some topical and see where we go and track it.

501
00:31:14,490 --> 00:31:20,802
oh But, yeah, I think if you're listening to this, I think, you know, it sounds like a lot
of.

502
00:31:21,046 --> 00:31:23,528
a lot of hormone soup here, I suppose.

503
00:31:23,528 --> 00:31:32,676
But really the bottom line is you want to work with somebody that can actually deconstruct
this for you to where you understand your genetics, you understand your family history,

504
00:31:32,676 --> 00:31:34,528
you understand the risks that are there.

505
00:31:34,528 --> 00:31:39,432
And then you actually understand uh the risks of what it is for you not to have hormones.

506
00:31:39,432 --> 00:31:40,352
Right.

507
00:31:40,413 --> 00:31:48,019
And and you have somebody that can talk you through that, whether it's dementia or bone
density or muscle mass or, you know, lots of other things.

508
00:31:48,019 --> 00:31:49,180
uh

509
00:31:49,358 --> 00:31:53,463
and then work with them to actually uh test it appropriately.

510
00:31:53,463 --> 00:31:55,949
So I think that's the key.

511
00:31:56,654 --> 00:31:58,714
Um, yeah, some, yes and no.

512
00:31:58,714 --> 00:32:06,854
Like I, I agree with all of that, but like testing, would say like, yes, you can get
tests, like, but more importantly, work with the provider that will ignore the tests.

513
00:32:06,854 --> 00:32:15,514
Like they'll test you, but then they'll also ignore it if they need to be that they
understand that the limitations of the testing and they're like, and then I'm listening to

514
00:32:15,514 --> 00:32:17,394
you and you're telling me, feel amazing.

515
00:32:17,394 --> 00:32:20,834
I'm going to ignore your tests or you're telling me that there's still something wrong
with you.

516
00:32:20,834 --> 00:32:25,174
Let's try to dive into it, even though your labs are completely normal and good providers
will do that.

517
00:32:25,174 --> 00:32:26,424
They can understand.

518
00:32:26,424 --> 00:32:27,345
That's right.

519
00:32:27,345 --> 00:32:30,006
Now you treat the patient not to test is what you're saying.

520
00:32:30,006 --> 00:32:31,167
And I think that's right.

521
00:32:31,167 --> 00:32:39,588
think, yeah, what I'm trying to say is that ah it's a complex enough situation that it's
nice to have some testing to give you some sense of where you are relative to some of

522
00:32:39,588 --> 00:32:39,972
these things.

523
00:32:39,972 --> 00:32:42,474
So, yeah, yeah, no, that's good.

524
00:32:42,474 --> 00:32:43,814
That's very good.

525
00:32:43,814 --> 00:32:48,497
So what about starting hormones for younger people?

526
00:32:48,497 --> 00:32:53,560
Talk to us about that a little bit, because I think, you know, you started off talking
about how

527
00:32:53,730 --> 00:32:58,745
People didn't get hormones until they were a year after their last menses or last period.

528
00:32:58,745 --> 00:33:12,479
um And now really, people are understanding that kind of in this pre menopause, peri slash
early peri, let's call it menopause, that hormones can be really, really impactful.

529
00:33:12,479 --> 00:33:14,210
Talk to us a little bit about that.

530
00:33:14,210 --> 00:33:22,499
Yeah, I would even argue that it should be 21 and above, know, or 18 and above, that we
really don't need to like pigeonhole women into these definitions.

531
00:33:22,499 --> 00:33:29,620
Like we don't call it men, we don't say men are andropos and periandropos and like we
don't pigeonhole women, we're just like, you have all this.

532
00:33:29,620 --> 00:33:31,060
not giving them testosterone either.

533
00:33:31,060 --> 00:33:34,860
We're kind of just counting on biology to do its thing, right?

534
00:33:34,860 --> 00:33:42,197
Sometimes, but it's not like, you know, maybe it recovers faster than men too, but I think
we don't need to like wait until a woman is perimenopausal either.

535
00:33:42,197 --> 00:33:47,241
Like if she has clear signs and she's in her twenties, that she needs it and she's tried
to eliminate all that.

536
00:33:47,241 --> 00:33:48,142
She's tried everything.

537
00:33:48,142 --> 00:33:50,544
Like she deserves hormone replacement therapy too.

538
00:33:50,544 --> 00:33:57,964
Like, and so we do not need to be waiting until she's 40 and like clearly perimenopausal
and has been suffering for eight years.

539
00:33:57,964 --> 00:34:04,946
And so like, but I agree with you that you're saying you're just trying to make the
argument to like start earlier, like your I was giving you I was just like being

540
00:34:04,946 --> 00:34:05,986
difficult.

541
00:34:07,412 --> 00:34:11,112
What you really are is you're being an advocate for women and I appreciate that.

542
00:34:11,112 --> 00:34:18,532
But I think I'm just trying to say, okay, well, we're not going to necessarily give every
16 year old hormones, right?

543
00:34:18,532 --> 00:34:26,552
So then there's got to be some either sign symptoms or test result that starts to push you
in that direction, I suppose.

544
00:34:27,692 --> 00:34:28,188
Yeah.

545
00:34:28,188 --> 00:34:28,797
you.

546
00:34:28,797 --> 00:34:33,071
I would assume that people aren't looking for me unless they've been sick for a while
looking for me.

547
00:34:33,071 --> 00:34:36,973
If they're a 21-year-old, they've been having problems for a long time before they would
do that.

548
00:34:36,973 --> 00:34:47,460
ah having a little bit lower threshold for women to understand that hormones are safe and
beneficial, and that it's OK, and it's a lot better option than birth control, which is

549
00:34:47,460 --> 00:34:48,863
what traditional doctors will do.

550
00:34:48,863 --> 00:34:50,392
I'll just put you on birth control.

551
00:34:50,392 --> 00:34:55,097
But bioidentical hormone replacement therapy could be an alternative option to birth
control and may be helpful, right?

552
00:34:55,097 --> 00:34:57,489
Like if you want to stop a heavy period or something.

553
00:34:57,528 --> 00:34:59,743
How do you like to prescribe your estrogen?

554
00:35:00,814 --> 00:35:02,375
How do I prescribe it?

555
00:35:03,896 --> 00:35:06,597
So my formulation is vaginal, all of it.

556
00:35:06,597 --> 00:35:09,719
It's, because vaginal delivery is systemic.

557
00:35:09,719 --> 00:35:12,600
It's highly systemic and we know it is.

558
00:35:12,681 --> 00:35:14,041
yeah.

559
00:35:14,041 --> 00:35:18,734
But I think that you nailed it when you were like, this is something that we can prevent.

560
00:35:18,734 --> 00:35:26,868
know, like if you can start it early, like women, think they also, when I talk to women,
they're like, well, they think hormone replacement therapy is like, once I started, I'm

561
00:35:26,868 --> 00:35:27,288
like done.

562
00:35:27,288 --> 00:35:28,079
I can't have kids.

563
00:35:28,079 --> 00:35:28,809
I can't do anything.

564
00:35:28,809 --> 00:35:30,340
It's like the end of everything.

565
00:35:30,340 --> 00:35:30,998
Mm-hmm.

566
00:35:30,998 --> 00:35:35,422
we can look at hormonal placement therapy as like maybe you can even take it postpartum in
between pregnancies.

567
00:35:35,422 --> 00:35:42,988
We need to think of it as like that it doesn't may potentially not impact your fertility
that we do need more studies to see if it impacts your fertility, which we know that it

568
00:35:42,988 --> 00:35:44,439
doesn't in certain levels.

569
00:35:44,439 --> 00:35:48,113
Like if you're not giving her too much, we shouldn't make her infertile.

570
00:35:48,113 --> 00:35:52,336
Like with men, like for example, if the testosterone doesn't get too high, they still make
sperm.

571
00:35:52,336 --> 00:35:58,081
So there is like an area there that we can be intervene like as a physician and still be
helpful, but not.

572
00:35:58,081 --> 00:35:58,721
Yeah.

573
00:35:58,721 --> 00:35:59,502
And so

574
00:35:59,502 --> 00:36:04,962
this women getting this idea that I just want to wait forever until I'm miserable.

575
00:36:04,962 --> 00:36:06,122
Like, and then I'll start HRT.

576
00:36:06,122 --> 00:36:07,482
They shouldn't be thinking of it that way.

577
00:36:07,482 --> 00:36:09,602
We should start to see the decline in their health states.

578
00:36:09,602 --> 00:36:13,282
Like they're 32 and they've really been like gaining weight.

579
00:36:13,282 --> 00:36:14,802
Their gut health is a mess.

580
00:36:14,802 --> 00:36:20,262
They've tried the, you know, all the functional medicine stuff isn't working for them,
which is what you see.

581
00:36:20,262 --> 00:36:26,572
A lot of them really trying to fix their gut problems and cortisol and his skin and hair
looks terrible in their moods.

582
00:36:26,572 --> 00:36:29,394
This could be like, am I ready and should I be starting this earlier?

583
00:36:29,394 --> 00:36:35,588
They really need to, like you said, even if they knew their levels and that they've been
declining, then they can make a better informed decision about when to start.

584
00:36:35,694 --> 00:36:36,504
Right.

585
00:36:36,584 --> 00:36:38,176
What about progesterone?

586
00:36:38,176 --> 00:36:41,690
you also applying that intravaginally or yeah?

587
00:36:41,690 --> 00:36:42,030
Okay.

588
00:36:42,030 --> 00:36:44,432
Do you find that it gets absorbed?

589
00:36:45,193 --> 00:36:46,054
Okay.

590
00:36:46,054 --> 00:36:47,174
Interesting.

591
00:36:47,695 --> 00:36:48,176
Interesting.

592
00:36:48,176 --> 00:36:54,031
I've kind of equated that more with topical and we have people that when they take it
orally, of course they metabolize it.

593
00:36:54,031 --> 00:36:56,543
They get a nice sleep benefit from that.

594
00:36:56,543 --> 00:36:56,996
Right.

595
00:36:56,996 --> 00:37:00,069
that's why a lot of them have just started.

596
00:37:00,069 --> 00:37:01,868
And this is kind of sad as well.

597
00:37:01,868 --> 00:37:03,122
I'm not saying it's you.

598
00:37:03,122 --> 00:37:09,057
I'm saying this is very much in the field where topical progesterone doesn't protect the
uterus.

599
00:37:09,057 --> 00:37:13,130
We know that it doesn't go into the skin and protect the uterus, especially when you
combine it with estrogen.

600
00:37:13,130 --> 00:37:20,046
If you're just doing topical progesterone alone, maybe you'll get a little bit of help
with your anxiety, but you're not taking estrogen anyway.

601
00:37:20,066 --> 00:37:24,586
But um with your taking estrogen and you do an oral progesterone,

602
00:37:24,586 --> 00:37:33,189
you get like, just puts women to sleep because 80 % of it is metabolized into metabolites
that make you and have an anesthesia effect on the brain.

603
00:37:33,189 --> 00:37:34,879
But a lot of women feel groggy the next day.

604
00:37:34,879 --> 00:37:35,800
They don't feel like themselves.

605
00:37:35,800 --> 00:37:36,520
They don't feel well.

606
00:37:36,520 --> 00:37:37,290
They do get bloated.

607
00:37:37,290 --> 00:37:39,881
They get side effects, but they sleep and this helps.

608
00:37:39,881 --> 00:37:41,652
Like sleep is sometimes everything.

609
00:37:41,652 --> 00:37:45,893
Like if they're sleeping, they're going to feel better and doctors are trying to help and
they see that they're sleeping.

610
00:37:45,893 --> 00:37:47,384
They want to help, right?

611
00:37:47,384 --> 00:37:48,587
They're not trying to do anything.

612
00:37:48,587 --> 00:37:49,560
yeah, yeah, of course.

613
00:37:49,560 --> 00:37:53,311
so I think that, but I just use oral progesterone as a sleeping pill.

614
00:37:53,311 --> 00:37:54,362
I'll even give it to men.

615
00:37:54,362 --> 00:37:54,892
They love it.

616
00:37:54,892 --> 00:38:02,255
Like, I'll give a man 100 milligrams of oral progesterone, they're gonna fall asleep and
that's gonna convert to testosterone and they're gonna be like a happy guy.

617
00:38:02,255 --> 00:38:08,957
So like oral progesterone is like one of the most, the best like sleeping pill ever, but
it's not for hormone replacement therapy.

618
00:38:08,997 --> 00:38:10,357
It's just a sleeping pill.

619
00:38:10,357 --> 00:38:11,699
really interesting.

620
00:38:11,699 --> 00:38:14,762
That's really interesting that you're bringing that to light.

621
00:38:14,762 --> 00:38:24,895
um So really transvaginally, because we've used transvaginal uh hormones before, ah but we
may need to rethink that and think about it a little harder.

622
00:38:24,895 --> 00:38:26,124
So yeah.

623
00:38:26,124 --> 00:38:27,084
hundreds of studies.

624
00:38:27,084 --> 00:38:32,016
It's like something that we, that the formulations just need to be like addressed.

625
00:38:32,016 --> 00:38:34,267
Like we just need, it doesn't really, I think it's fine.

626
00:38:34,267 --> 00:38:37,378
Like whatever people choose, but at least it's like informed.

627
00:38:37,378 --> 00:38:41,336
Like, okay, I'm going to pick a pill for you because this is like, you know, and it helps
you, know?

628
00:38:41,336 --> 00:38:44,611
And so I'm picking the formulation, knowing the way that it's metabolized.

629
00:38:44,611 --> 00:38:46,371
And that's why I've chosen that formulation.

630
00:38:46,371 --> 00:38:47,071
Okay.

631
00:38:47,071 --> 00:38:48,654
I have a friend who's a gender.

632
00:38:48,654 --> 00:38:51,994
for a main physician, like she does like teenagers.

633
00:38:52,194 --> 00:38:59,354
And her, like if she's transitioning a female to a male, she picks the formulation because
she knows how it's going to act in the body.

634
00:38:59,354 --> 00:39:06,134
She'll only do testosterone cream because it converts to DHT and because they're trying to
turn into a man, right?

635
00:39:06,134 --> 00:39:12,594
Like, so she doesn't pick a testosterone injection for them because it will convert to
estrogen and they are trying to get rid of feminizing features.

636
00:39:12,594 --> 00:39:17,644
like, she's just, the doctor is using the formulation to her advantage.

637
00:39:17,644 --> 00:39:19,637
And not all doctors are looking at that way.

638
00:39:19,637 --> 00:39:21,837
They're not looking, they're just like, you know what I mean?

639
00:39:21,837 --> 00:39:24,286
And I think we need to like, not, yeah.

640
00:39:24,286 --> 00:39:24,843
Yeah.

641
00:39:24,843 --> 00:39:32,277
Cause a female genetically is going to have a higher, although we've been impressed that
some men actually aromatize pretty highly, quite honestly.

642
00:39:32,277 --> 00:39:33,683
It's really, there's a spectrum.

643
00:39:33,683 --> 00:39:34,844
ah

644
00:39:34,978 --> 00:39:35,771
it in the skin?

645
00:39:35,771 --> 00:39:40,825
Because I've also heard from compound pharmacists that they're like when you put a unique
of a man topical.

646
00:39:40,825 --> 00:39:41,306
Okay.

647
00:39:41,306 --> 00:39:43,052
oh

648
00:39:43,052 --> 00:39:46,232
men really aromatize it quite strongly and others don't, right?

649
00:39:46,232 --> 00:39:48,172
It's really a spectrum.

650
00:39:48,792 --> 00:39:50,530
And so that's where you need to understand that.

651
00:39:50,530 --> 00:39:51,453
Like, I don't know.

652
00:39:51,453 --> 00:39:54,982
I used to just wait until they had breast tenderness, like men.

653
00:39:54,982 --> 00:39:57,058
And then I would be like, okay, well, let's take a look at this.

654
00:39:57,058 --> 00:39:57,648
Otherwise.

655
00:39:57,648 --> 00:39:59,109
we look at the metabolic pathways.

656
00:39:59,109 --> 00:40:02,330
We see if they're flooding, you know, the estrone pathways.

657
00:40:02,330 --> 00:40:05,331
And if they are, then it's like, okay, well, let's back that off a little bit.

658
00:40:05,331 --> 00:40:10,103
uh You know, we're giving them testosterone, testosterone is going down relative to
estrogen going up.

659
00:40:10,103 --> 00:40:12,194
like, oh, they're heavy aromatizers.

660
00:40:12,194 --> 00:40:16,115
Then we will use a little inastrozol to kind of balance it out.

661
00:40:16,115 --> 00:40:16,635
That's right.

662
00:40:16,635 --> 00:40:18,116
We're trying to balance the system.

663
00:40:18,116 --> 00:40:19,278
uh

664
00:40:19,278 --> 00:40:28,140
at these absolute levels, because I've seen some physicians will be like, oh, 40s too,
well, I'm just making, it's like 40s too high, we need to lower it, you know what I mean?

665
00:40:28,140 --> 00:40:31,653
no, no, we're an ecosystem kind of thought process here.

666
00:40:31,653 --> 00:40:35,107
Like you're trying to balance the ecosystem, not trying to get a number.

667
00:40:35,107 --> 00:40:35,487
Right.

668
00:40:35,487 --> 00:40:36,972
So that's how we're thinking.

669
00:40:36,972 --> 00:40:37,583
And it's perfect.

670
00:40:37,583 --> 00:40:44,504
This is how like, and we need to look at feedback loops, how, this is the perfect way to
do it for somebody and it's more personalized and they're going to get, you're just going

671
00:40:44,504 --> 00:40:45,276
to get a better result.

672
00:40:45,276 --> 00:40:51,714
Like, so patients can work with somebody who even just talking the way that you're talking
and then you're going to get a better result with your HRT.

673
00:40:51,714 --> 00:40:52,425
Right.

674
00:40:52,425 --> 00:40:58,442
So give us an idea of what kind of dosing are you using uh transvaginally for
testosterone, estrogen, progesterone.

675
00:40:58,442 --> 00:41:05,004
And I know it varies, but I have a sense of it orally, but for some of these things, but
give me an idea of what you're using.

676
00:41:05,004 --> 00:41:06,976
Yeah, they don't really translate well.

677
00:41:06,976 --> 00:41:18,986
like, and the other thing too is putting things like astriol or testosterone vaginally,
you're going to get different results because one testosterone has been shown to really

678
00:41:18,986 --> 00:41:20,907
disrupt the vaginal microbiome.

679
00:41:20,907 --> 00:41:25,811
And when you're putting things vaginally, you do have to care about the microbiome.

680
00:41:25,972 --> 00:41:34,030
So like, for example, lactobacillus acidophilus, like when we talk about, and I'll just, I
know you know this, but like for your listeners, like the, when we talk about

681
00:41:34,030 --> 00:41:38,810
diversity, like microbiome diversity, we don't want diversity in the vagina.

682
00:41:38,810 --> 00:41:42,790
We want like one or two strains that maintain the pH very low.

683
00:41:42,790 --> 00:41:44,850
And one of those is lactobacillus acetophilus.

684
00:41:44,850 --> 00:41:47,910
We only really want that one there mostly.

685
00:41:48,550 --> 00:41:52,770
And that bacteria needs estrogen to make its food.

686
00:41:52,870 --> 00:41:58,010
So if estrogen is low, that bacteria goes away and you really get a disruption and we call
it BV.

687
00:41:58,010 --> 00:42:03,798
Like BV is really just like, even skin flora can populate the vaginal cavity and then you
get like...

688
00:42:03,798 --> 00:42:05,339
bacterial vascular diagnosis.

689
00:42:05,339 --> 00:42:08,731
Doctors will tell women that they're sexually active and this is why, and it's not true.

690
00:42:08,731 --> 00:42:13,624
It's just that the estrogen is gone and now you're getting this disruption of the
microbiome.

691
00:42:13,624 --> 00:42:19,018
When you introduce testosterone there, you're not going to always get this heavy enough
conversion.

692
00:42:19,018 --> 00:42:20,349
Estrogen will help.

693
00:42:20,349 --> 00:42:25,752
Some of them will say that it helps with libido, but the testosterone itself disrupts this
microbiome over time.

694
00:42:25,752 --> 00:42:28,884
We even see these from the transgender literature.

695
00:42:28,994 --> 00:42:32,180
you're using testosterone topically outside the vaginal vault.

696
00:42:32,180 --> 00:42:32,859
that what

697
00:42:32,859 --> 00:42:34,841
need extra testosterone generally.

698
00:42:34,841 --> 00:42:40,807
So like when you do extra testosterone, like injections or topicals, it can get too high
for them.

699
00:42:40,807 --> 00:42:42,829
And like sometimes the wheels fall off the bus.

700
00:42:42,829 --> 00:42:45,652
So like you have, it's like estrogen with ferment.

701
00:42:45,652 --> 00:42:47,874
Like would you ever give a man estrogen?

702
00:42:48,526 --> 00:42:51,310
Well, we wouldn't, but testosterone turns into estrogen.

703
00:42:51,310 --> 00:42:53,952
progesterone converts to testosterone.

704
00:42:55,234 --> 00:42:59,378
So like you, you know, I would never like tell a man, estrogen is so great for you.

705
00:42:59,378 --> 00:43:03,041
It's going to make your skin glow and it's going to make you lose weight and it's going to
help you with dementia.

706
00:43:03,041 --> 00:43:05,303
I'm going to have you inject test estrogen.

707
00:43:05,303 --> 00:43:07,625
But yeah, have women inject testosterone.

708
00:43:07,625 --> 00:43:09,396
Like, where's the breakdown?

709
00:43:09,860 --> 00:43:16,724
So what you're advocating and what you're doing is basically to use topical or
intervaginal estrogen and progesterone.

710
00:43:16,724 --> 00:43:17,754
That's what I'm hearing.

711
00:43:17,754 --> 00:43:22,476
forgesterone converts to testosterone enough that you can get like some of it.

712
00:43:22,476 --> 00:43:24,876
And then like there's this where this variation is.

713
00:43:24,876 --> 00:43:31,019
Like when you're talking about an individual that with especially with libido and women, I
would say is very variable.

714
00:43:31,019 --> 00:43:36,140
And I know you work with women and like, and you hear it like, okay, well, whatever I did
for her, it worked for her libido.

715
00:43:36,140 --> 00:43:37,311
How come it's not working for you?

716
00:43:37,311 --> 00:43:41,346
And it's like all the stars have to be aligned for women and libido all the hormones have
to

717
00:43:41,346 --> 00:43:41,946
right?

718
00:43:41,946 --> 00:43:44,348
And you can optimize libido later.

719
00:43:44,348 --> 00:43:52,172
So if her testosterone doesn't get high enough, let's say that her, she's not a heavy
converter, just like some, you said some men convert into estrogen a lot.

720
00:43:52,173 --> 00:43:55,795
Some women convert too much testosterone and they get side effects.

721
00:43:55,795 --> 00:43:57,396
Some women don't convert enough.

722
00:43:57,396 --> 00:44:00,968
And so now you're like trying to like either block or reduce or optimize this.

723
00:44:00,968 --> 00:44:05,110
And then women who need a boost, like there's subtle ways to do that.

724
00:44:05,110 --> 00:44:08,706
Well, you could always do like a cream or an injection on top of that.

725
00:44:08,706 --> 00:44:15,357
But it wouldn't necessarily, if you introduce it as the first hormone, it would be similar
to you giving a man estrogen first.

726
00:44:15,357 --> 00:44:20,528
of, know what I but you're not, you're at your, instead your approach is to be like, see
what the body.

727
00:44:20,528 --> 00:44:28,968
is you start with estrogen and progesterone transvaginally, and then you basically monitor
the client.

728
00:44:29,088 --> 00:44:33,348
I assume do some follow-up testing to kind of see where the numbers are coming.

729
00:44:33,348 --> 00:44:37,778
And then you might top it off with a little testosterone if need be.

730
00:44:37,778 --> 00:44:38,278
optimize it.

731
00:44:38,278 --> 00:44:41,738
And there's like a lot of the herbs, like as you know, work really well or DHA.

732
00:44:41,738 --> 00:44:47,698
You even mentioned DHA can be a way to do that for women and a lung tractors will easily
do DHA.

733
00:44:47,698 --> 00:44:49,898
And that can get high pretty quickly too.

734
00:44:49,898 --> 00:44:51,390
You have to be careful with that one.

735
00:44:51,390 --> 00:44:52,131
Yeah.

736
00:44:52,131 --> 00:44:56,063
We think about DHEA more for testosterone than we do for testosterone per se.

737
00:44:56,063 --> 00:44:57,934
yeah.

738
00:44:58,595 --> 00:44:59,647
Yeah, exactly.

739
00:44:59,647 --> 00:45:00,518
So like it's easy.

740
00:45:00,518 --> 00:45:02,648
So women are like concerned.

741
00:45:02,648 --> 00:45:03,957
I want to raise my testosterone.

742
00:45:03,957 --> 00:45:05,830
I'm like, that's the easiest one.

743
00:45:05,830 --> 00:45:12,613
Like, just want to like, let you know that actually that is like the out of all three
hormones, like I'm not no problem like raising your testosterone.

744
00:45:12,613 --> 00:45:15,694
It's the, it's the other two that are like really challenging for women.

745
00:45:15,694 --> 00:45:21,607
And I think even for men, like we can get your testosterone up, but like you said, it's
making sure that everything's balanced.

746
00:45:21,607 --> 00:45:23,138
The ecosystem is right.

747
00:45:23,138 --> 00:45:24,288
And if you

748
00:45:24,288 --> 00:45:28,752
if it's not a black box, giving somebody testosterone, you're not doing that either with
men.

749
00:45:28,752 --> 00:45:30,293
So why would we do that with women too?

750
00:45:30,293 --> 00:45:33,266
You have to do the same approach to get the,

751
00:45:33,807 --> 00:45:34,288
Yeah.

752
00:45:34,288 --> 00:45:34,829
Nice.

753
00:45:34,829 --> 00:45:35,359
Okay.

754
00:45:35,359 --> 00:45:35,830
Well, good.

755
00:45:35,830 --> 00:45:36,672
I love that.

756
00:45:36,672 --> 00:45:37,672
love that.

757
00:45:38,595 --> 00:45:39,396
Well thought out.

758
00:45:39,396 --> 00:45:42,742
Obviously you have a uh tad of experience with that.

759
00:45:42,742 --> 00:45:43,724
yeah.

760
00:45:43,724 --> 00:45:50,380
like, and this is where, you know, it's like we've been ignoring, I would think.

761
00:45:50,380 --> 00:45:58,448
I think that those studies like that, know, have initially like, I think there's doctors
like there's doctors that obviously are doing it because they know that they're wrong.

762
00:45:58,448 --> 00:46:02,871
But we have a lot of work to do to catch up to, I think, men's performance.

763
00:46:02,871 --> 00:46:10,618
You know, we still have, yes, forward thinking and innovation to do and uh research to do
so that we can catch up.

764
00:46:11,053 --> 00:46:12,013
No, I agree.

765
00:46:12,013 --> 00:46:23,060
I think one of the other takeaways for me in this is the idea of wouldn't it be great if
we had a resting metabolic rate equivalent for hormone levels.

766
00:46:23,060 --> 00:46:23,472
be?

767
00:46:23,472 --> 00:46:25,909
like, is your, what is, don't, I guess I think I read.

768
00:46:25,909 --> 00:46:29,240
So what is the resting metabolic rate really showing you that, and it varies.

769
00:46:29,240 --> 00:46:34,342
Well, it's basically, it's basically showing you a level of thyroid activity at the
nuclear level, right?

770
00:46:34,342 --> 00:46:42,225
uh T3 goes into the nucleus, modifies a lot of genetic expression, which ultimately
changes the metabolic rate.

771
00:46:42,246 --> 00:46:47,438
So that's a good surrogate marker for the fact that there's adequate thyroid activity.

772
00:46:47,438 --> 00:46:53,070
I mean, it's still not, it's still a surrogate marker, but, but that's how we tend to
think about it.

773
00:46:53,070 --> 00:46:57,194
uh What would be, what's that?

774
00:46:57,194 --> 00:46:58,186
never heard that before, actually.

775
00:46:58,186 --> 00:47:00,879
That's very clever, because then you're using something that is a...

776
00:47:00,879 --> 00:47:03,238
uh

777
00:47:03,238 --> 00:47:04,819
That's actually fantastic.

778
00:47:04,819 --> 00:47:05,359
We love it.

779
00:47:05,359 --> 00:47:06,310
We do it for everybody.

780
00:47:06,310 --> 00:47:12,123
Because thyroid is so mismanaged, we find all the time, all the time mismanaged.

781
00:47:12,123 --> 00:47:14,114
think hormones are mismanaged too, right?

782
00:47:14,114 --> 00:47:14,483
So

783
00:47:14,483 --> 00:47:20,937
well, like, they're intertwined, you know, like when I see, I don't do thyroid hormone
online, but yeah.

784
00:47:20,937 --> 00:47:24,482
thyroid will change the metabolism rates of the hormones.

785
00:47:24,502 --> 00:47:33,077
And then when you enter, like I see women come to me that are on thyroid that's being
mismanaged and then they'll start the hormones and then their hair will shed because

786
00:47:33,077 --> 00:47:37,289
they're on like the absolute highest value or dose of thyroid.

787
00:47:37,289 --> 00:47:42,172
And I'm just going to tell them that they need to go over to the thyroid doctor and like
change their, like lower it maybe.

788
00:47:42,172 --> 00:47:45,958
And they think it's the estrogen again, because we're blaming estrogen.

789
00:47:45,958 --> 00:47:46,624
They blame estrogen.

790
00:47:46,624 --> 00:47:48,576
You're just like, dude, I think it's a thyroid.

791
00:47:48,576 --> 00:47:52,844
I'm pretty sure it's your thyroid that made your hair fall out, but I don't know how to
like, it's really.

792
00:47:52,844 --> 00:47:54,277
It's, it is interesting, right?

793
00:47:54,277 --> 00:47:59,418
Typically, if there's a problem, the finger gets pointed at estrogen, right?

794
00:47:59,418 --> 00:47:59,919
Right.

795
00:47:59,919 --> 00:48:00,527
It does.

796
00:48:00,527 --> 00:48:03,602
it's because we're blaming women, right?

797
00:48:03,602 --> 00:48:04,815
This is your fault.

798
00:48:04,815 --> 00:48:06,515
You're the problem.

799
00:48:06,529 --> 00:48:07,099
I'm not.

800
00:48:07,099 --> 00:48:12,554
But you know, it seems to be that uh estrogen dominance, know, all these kinds of things,
right?

801
00:48:12,554 --> 00:48:14,635
So is that the real thing?

802
00:48:14,635 --> 00:48:15,366
So,

803
00:48:15,366 --> 00:48:17,450
it's a real thing that we are blaming estrogen.

804
00:48:17,450 --> 00:48:18,932
instead it's almost like a cop out.

805
00:48:18,932 --> 00:48:23,160
We're just like, hey, I'm not going to address your thyroid or like figure out what's
going on with you.

806
00:48:23,160 --> 00:48:25,293
I'm just going to blame it on this estrogen problem.

807
00:48:25,293 --> 00:48:26,822
And it's really like not.

808
00:48:26,822 --> 00:48:32,696
if you're listening to this, I would say get your genetics done so you actually know what
you're dealing with from that perspective.

809
00:48:32,696 --> 00:48:36,238
It's not the absolute answer, but it's really helpful.

810
00:48:36,238 --> 00:48:41,761
And then I would say get your thyroid looked at and have a resting metabolic rate done as
well as a complete thyroid panel.

811
00:48:41,761 --> 00:48:52,350
um And then I think get your hormones tested and have your metabolites tested um also so
you can get a feel for that um as to how you're actually metabolizing.

812
00:48:52,350 --> 00:48:56,315
a grain of salt because like most of the time they come back just telling you you're
estrogen dominant.

813
00:48:56,315 --> 00:48:58,532
like remember that they don't.

814
00:48:58,532 --> 00:48:59,253
not the case.

815
00:48:59,253 --> 00:49:00,533
No, not at all.

816
00:49:00,533 --> 00:49:01,333
No, not at all.

817
00:49:01,333 --> 00:49:04,754
We and you can fine tune the pathways, right?

818
00:49:04,754 --> 00:49:08,555
The 16, four, two hydroxy, you can fine tune those pathways.

819
00:49:08,555 --> 00:49:10,916
So, no, I would I would say that's a safety.

820
00:49:10,916 --> 00:49:11,916
That's a safety net.

821
00:49:11,916 --> 00:49:15,997
I would I'd be an advocate for that, quite honestly, to look at the metabolites.

822
00:49:16,097 --> 00:49:26,616
But I think if you put all that together, I really like this idea of using the um the
transvaginal progesterone and estrogen and then

823
00:49:26,616 --> 00:49:29,542
maybe some DHEA if that's required.

824
00:49:29,542 --> 00:49:32,767
Maybe that's really kind of the thing.

825
00:49:32,789 --> 00:49:38,198
if the thyroid's not dialed in, the other hormones aren't going to work as well either,
right?

826
00:49:38,198 --> 00:49:47,271
You have to, like, I think that is the thyroid is like very, and when you first start,
don't know if you see when for all who's everybody's listening, if you've tried a hormone

827
00:49:47,271 --> 00:49:54,433
replacement therapy and you started it with somebody and they didn't address your thyroid,
for example, or just even tell you to address it, you can get slight these side effects

828
00:49:54,433 --> 00:50:01,685
like water retention or you can get hair shedding and it's most likely your thyroid is,
you know, and it's very hard.

829
00:50:01,685 --> 00:50:04,266
I would say thyroid is challenging for sure.

830
00:50:04,385 --> 00:50:04,865
hmm.

831
00:50:04,865 --> 00:50:05,786
Yeah.

832
00:50:05,786 --> 00:50:07,347
For us, it's become easy.

833
00:50:07,347 --> 00:50:10,531
We feel like it's easy, at least, at least in our minds.

834
00:50:10,531 --> 00:50:11,257
It's easy, right?

835
00:50:11,257 --> 00:50:16,416
It's probably never as easy as saying, just like you feel like the hormones have gotten
fairly easy because of the way you do it, right?

836
00:50:16,416 --> 00:50:24,334
And we're always, you still don't have, we still don't have the equivalent of a resting
metabolic rate for hormones, which would be really great.

837
00:50:24,334 --> 00:50:24,982
So

838
00:50:24,982 --> 00:50:25,782
It would be great.

839
00:50:25,782 --> 00:50:26,082
Yeah.

840
00:50:26,082 --> 00:50:27,113
Like it would be amazing.

841
00:50:27,113 --> 00:50:31,844
Like even if we had like a bigger snapshot, you know, it'd be nice if we had something to
measure every day.

842
00:50:31,844 --> 00:50:35,705
But I think even just like a longer snapshot than like an absolute value would be nice.

843
00:50:35,705 --> 00:50:38,806
Like even FSH has its limitations.

844
00:50:39,506 --> 00:50:41,687
so we don't really have anything.

845
00:50:41,687 --> 00:50:49,869
And then testing is, I don't know if I trust it as much, like urine metabolite testing is
not gold standard, you know, and you're comparing it to a gold standard.

846
00:50:49,869 --> 00:50:52,160
so just, you have to kind of like.

847
00:50:52,788 --> 00:50:56,560
look at it and you could trust it but you've heard it.

848
00:50:56,633 --> 00:50:57,432
between them.

849
00:50:57,432 --> 00:50:58,114
I agree.

850
00:50:58,114 --> 00:50:59,774
It's an ecosystem.

851
00:50:59,995 --> 00:51:02,296
think FSH and LH, let's talk about that.

852
00:51:02,296 --> 00:51:12,522
So basically pituitary hormones that are signaling you to make ah estrogen, uh sperm
counts, things like that, testosterone release for men.

853
00:51:12,522 --> 00:51:19,245
think um in menopause, those are very elevated.

854
00:51:19,245 --> 00:51:22,957
um And in andropause, they're very elevated.

855
00:51:22,957 --> 00:51:23,990
Like the body is

856
00:51:23,990 --> 00:51:25,551
is craving more hormones.

857
00:51:25,551 --> 00:51:29,194
So it's really kind of sending out the signal, please, please make more hormones.

858
00:51:29,194 --> 00:51:31,286
Because of course the ovary can't do it at that point.

859
00:51:31,286 --> 00:51:32,667
The lytic cells can't do it.

860
00:51:32,667 --> 00:51:36,830
um So we tend to use it as kind of a feedback loop.

861
00:51:36,830 --> 00:51:42,655
When the hormones are optimized, FSH and LH will fall back into a, oh we're happy now kind
of level.

862
00:51:42,655 --> 00:51:47,399
um And I think that's important to have tested as well, not just the hormones.

863
00:51:47,399 --> 00:51:49,430
So we do that in every panel also.

864
00:51:49,430 --> 00:51:54,584
I think that it's more important and like really it gives you a better idea of what the
brain and that feedback loop is doing.

865
00:51:54,584 --> 00:52:03,300
It's like a TSH, like you wouldn't just measure the absolute values of your thyroid, you
would measure your TSH too, just to see what that feedback loop is doing.

866
00:52:03,460 --> 00:52:14,448
And FSH is, even though we need work on establishing what that number is, like I think we
do know that that feedback loop is really important and women and menopause, that could be

867
00:52:14,448 --> 00:52:16,049
something that they could be looking at.

868
00:52:16,049 --> 00:52:16,980
um

869
00:52:16,980 --> 00:52:25,737
So even if those absolute values are like all over the place, they can look at that FSH
and that tells you what the brain is feeling or thinking.

870
00:52:25,737 --> 00:52:25,907
Yeah.

871
00:52:25,907 --> 00:52:27,848
Does the brain think that there's enough hormone around?

872
00:52:27,848 --> 00:52:31,822
Because if that FSH is elevated, the brain does not feel like there's enough.

873
00:52:31,822 --> 00:52:36,645
Regardless of what your lab test or your doctor says, your brain is freaking out.

874
00:52:37,386 --> 00:52:40,158
And so I think like we can make it more personalized that way.

875
00:52:40,158 --> 00:52:43,430
We can trust that the brain knows if there's enough hormone around.

876
00:52:44,118 --> 00:52:48,202
and doctors are not relying, I'll get, well, doctors barely ever order this test.

877
00:52:48,202 --> 00:52:51,284
Like it's on your panel, you said, but they're not using it.

878
00:52:51,285 --> 00:52:56,809
I think we could do better than that, but it's definitely a marker on the panel, you know,
like in the picture.

879
00:52:57,394 --> 00:53:04,962
I think if you're listening to this, um know, work with somebody that's actually takes
this more comprehensive view really is kind of what you're going for.

880
00:53:04,962 --> 00:53:07,324
It's easy to get this wrong.

881
00:53:07,324 --> 00:53:08,806
It's wonderful when you get it right.

882
00:53:08,806 --> 00:53:11,389
um And it's easy to get it wrong.

883
00:53:11,389 --> 00:53:14,572
So you want to work with somebody that's kind of got their arms around all of it.

884
00:53:14,572 --> 00:53:17,244
And HRT and like, this is not a side job.

885
00:53:17,244 --> 00:53:23,108
Like these are not like when you go to, you have to go to a doctor who has like done it
and is doing only this.

886
00:53:23,889 --> 00:53:24,429
it's different.

887
00:53:24,429 --> 00:53:25,150
think you'll agree.

888
00:53:25,150 --> 00:53:28,352
Like when I tell everybody, I think they know it's different training.

889
00:53:28,352 --> 00:53:31,274
Like when you're OB-GYN, it's like a side thing.

890
00:53:31,274 --> 00:53:33,896
They're mostly doing OB-GYN stuff.

891
00:53:33,896 --> 00:53:37,359
They don't think about, they just have like their regimen or birth control that they're
going to give you.

892
00:53:37,359 --> 00:53:41,817
They're not thinking about hormones like all day long, like you and I are, might be
thinking about them.

893
00:53:41,817 --> 00:53:43,829
No, we think about it all the time for every client, right?

894
00:53:43,829 --> 00:53:45,240
We think about it for every client.

895
00:53:45,240 --> 00:53:49,563
So it's not the only thing we do, but we think about it for every client.

896
00:53:49,924 --> 00:53:51,505
yeah, perfect.

897
00:53:51,646 --> 00:53:58,972
Sarah's been lovely chatting with you and quite the journey and educational and fun at the
same time.

898
00:53:58,972 --> 00:54:00,513
So I appreciate that.

899
00:54:01,194 --> 00:54:01,995
Yeah.

900
00:54:01,995 --> 00:54:02,536
Awesome.

901
00:54:02,536 --> 00:54:03,446
Thanks.