The Mind-Body Connection: Optimizing Wellness with Dr. Christine Vaccaro

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Welcome back to Ageless and Outrageous. Today I'm
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excited to speak with Dr. Christine Vaccaro,
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who is a double board certified and fellowship trained urogynecologist
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and sexual medicine specialist. She's been in practice
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for over 20 years. She is an associate professor
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of gynecologic surgery at the Uniformed Services
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University in Bethesda. She recently retired
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from the military where she was the program director for the urogynecology
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fellowship at Walter Reed. Now she practices at
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the offices of Dr. Rachel Rubin located in Bethesda,
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Maryland. She is also involved in multiple
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national medical committees and has extensively published
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in medical journals, medical textbooks and online.
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She is the medical advisor for the Sexual Health Education plus
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foundation, which is a non profit organization that supports women's
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sexual health through research, education, education,
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advocacy and grant funding. Let's explore
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her mind as she discusses the mind body connection
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for optimal wellness.
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Well, tell me a little bit about your training and background and
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how you got into this space. Yeah, it's such a great question.
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But briefly, I'm a urogynecologist similar to you. So did an
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OBGYN residency and then did my
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fellowship in Cincinnati with Mickey Koram, which was amazing.
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I actually had a faculty that was also interested
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in sexual dysfunction in my fellowship, which I feel like is really hit or miss.
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In the earlier 2000s, I feel like it wasn't kind of
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mainstream, so that was cool. So I got a little bit of female
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sexual dysfunction, testosterone replacement, things like that. We actually were
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a site that trialed testosterone for women in
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some preclinical trials. Of course that never came to market, long story there. But so
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I kind of got a little touch of it and kind of got excited in
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my fellowship. And then I'm
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a military, was a military provider. I just retired from Walter
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Reed. I was the fellowship director there for urogynecology and I tried
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to bring a little bit of that in. Right. But you
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know, it just, it's not conducive,
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long appointments and things like that to really getting into deep
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diving into sexual function. So it set me back a little bit.
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So I think, you know, and I think maybe we'll talk about it. But I
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sought out another training opportunity for myself.
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So right before I retired from the military, I did
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a three month sexual medicine fellowship which was just
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absolutely amazing. It just blew my mind. All the things that we
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as gynecologists and medical providers don't,
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no, don't talk about, don't discuss with our patients that are huge quality
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of life concerns. So yeah,
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so I really I love that fellowship, and I think we'll maybe get into that
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more. Oh, definitely. It's such an area that physicians
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are not educated on. It's glossed over. I mean,
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maybe you sort of hear a little bit about some sexual function in GYN
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or in urogyn, how the pelvic floor is related, but it's not a deep
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dive at all. Not a deep dive. Yeah. Right. But patients want
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the information they want to have, and,
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yes, a healthy sex life. And so when they find someone
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who even asks the question, they grab onto that
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and they're like, oh, my gosh, someone is interested. Let me talk about it.
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Absolutely. I 100 agree with you. Right.
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So obviously, as Eurogynes, we're always talking about the pelvic floor
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and all of the. I mean, this pelvic floor is amazing. I'm humbled
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by it all the time. But tell me a little bit about how
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you feel the pelvic floor functions in sexual function
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and how important it is. Yeah. So I think
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if we're talking about just the pelvic floor musculature, I'll just start
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there. You know, this huge, big bowl sling of muscles
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that a lot of women never even think about until there's
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a problem. Right. Just like our whole body's. Like, nothing is the problem until it's
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a problem. But these muscles are either able
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to relax and accommodate penetration.
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So if we're thinking, you know, cisgender, heterosexual partnerships
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here able to accommodate penetration,
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or they're not if they're too tight. So again, muscles that are
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too tight or painful, it's difficult to accommodate
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penetration. And then they also have to contract appropriately
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to allow for blood flow and engorgement,
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more sensation with penetration. So if these muscles
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are not having a full range of motion, and sometimes I use the analogy,
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you might do this as well, of a bicep. Right. A full range of motion.
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So women can, like, understand if the pelvic floor is
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chronically in a contracted state, it's hard for it to do what it's
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supposed to do, or if it's too relaxed and doesn't have any muscle strength,
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then it's hard for it to work, too. So sometimes use that analogy
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when I'm talking about the pelvic floor and how it functions, and it supports
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our bowel and our bladder and vagina and all the.
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All the things it needs to do to have the pelvic floor function properly.
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So I often, when I'm talking about that, I'm also trying to get them to
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see A pelvic floor physical therapist who are magicians in the pelvic floor for
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any pain disorder or just again,
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poor musculature. Because it's really hard to teach a woman in a
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really short visit how to contract their pelvic floor to make sure they're doing
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proper Kegels or pelvic floor muscle exercises. But they're
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super important muscle group. And I think
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we don't, again, focus enough on, in general, the pelvic,
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the pelvis and women or the pelvic floor. And then of course, we could talk
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about how, you know, bladder leakage and bowel
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leakage and other dysfunctions of the pelvic floor
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organs themselves can affect negatively sexual
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function. Of course, if a woman's having any sort of leakage,
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that's going to usually negatively affect their feeling
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sexy. And again, if there's
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any problems with the vagina, either vaginal dryness,
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you know, or fear of recurrent UTI because of
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sex. Again, these. All these concerns are always brought
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up in my patients about, you know, anything related to their
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pelvis and pelvic floor. Right, Absolutely. And, you know,
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leaking urine women are not happy with, in general,
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general leaking during intercourse is really distressing
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to them. Yes, yes. Nothing, nothing less sexy.
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You know, unless we're talking about squirting, which is a whole nother
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podcast, I'm sure. Not that.
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That is not the topic. Right. But you
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know, and fear of leaking, if they feel like they leaked once
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during a sexual activity, then they're going to have that
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worry, which unfortunately is gonna lead to them to tighten their
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pelvic floor, which now causes secondary issues of
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pain during sex. So it really. Not to
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mention getting. Not being in the right headspace of pleasure. And then
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they're in a headspace of fear, which just means you're not enjoying the experience,
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which is really hard for women to get out of the fear of
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either they're gonna leak or something's not right or their body image
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or et cetera, et cetera. Right. So a lot of women, unfortunately,
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aren't in that pleasure zone. They're in the worry zone or pain
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zone, which is not a good place to be. Right.
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And our muscles natural response to worry or history of
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pain or is to tighten up, which is the opposite effect
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of what we want happening for them during a positive sexual
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encounter. Totally. And again, I love analogies and stories.
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It's like the pelvic floor. I get on it. Use another analogy of just like
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if there was a neck injury, Right. And then the muscles just Start lifting
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and guarding. And then over time, it's like the muscles themselves
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become the pain source. And it's like, how do we get those
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muscles to relax again? By fragmented breathing, getting them to
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pelvic floor pt. But all these things are a lot of work and effort.
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There's no really quick fix.
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Maybe pelvic floor Botox, but that's again, for another maybe discussion.
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But how do we get these muscles
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to relax? And then how do we get them to contract appropriately
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and have a good range of motion? And I think it's a
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lot of work for women to do. Right. Is. Yeah. And I
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think, you know, everyone wants a quick fix or just give me a quick pill
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and it will take care of it. But many times by the time
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we see women, they've had not just days or weeks of
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pain, they've had years of pain. So it's such
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a great analogy. The neck pain and the shoulders coming up to protect it.
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Well, if those shoulders have been up for years, they're not just going to drop
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in a day or two. It's going to take a lot of work. And partnering
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with your patient and getting her to understand this is a journey, and I'm going
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to take it with you. And it's not going to be a short journey,
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but that's okay. I think even just letting them know that they have a partner
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on that journey is reassuring. Oh, my gosh.
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100%. I think these days, I think medicine is a
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little bit failing women, and they feel like they don't have
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a good partner. Right. They need to have that, like, provider that's going to,
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like, continue to follow them and help them through this journey. So I appreciate
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you saying that. I think that's a huge. A huge thing for women to feel
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like, you know what, Someone's listening, someone's validating my concerns, and someone
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is helping me on this journey. And I think as urogynecologists,
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we. We know that really well because we're all about quality of life.
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I find that a lot of women are getting gaslit in
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various different ways these days, and it's nice to have
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a doctor in your corner. So it is. And that's something I
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tend to say at the end of a visit. You know,
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this is the next step we're going to take. And there might be a lot
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steps, but we're in it together. And it's just really,
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really reassuring. And you can just see their faces relax and,
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like. And then they become much more open to the fact that
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it is a journey. And it's okay that it takes a long time or it
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may take many interventions to get them to where they
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want to be because they know you're not going to leave them along the way.
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Yeah, 100% right. Yeah.
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So, of course, it's not just the pelvic floor, but the pelvic floor works in
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our body, where we have hormones and blood flow and nerves, and it's a
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whole complex. And certainly not every patient
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needs to be have each of those pieces of the network
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addressed. But we know that hormones are a huge part
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of that network. So let's talk a little bit about hormones or
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testosterone specifically, because hormones is way too general.
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Testosterone specifically affects sexual function
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and the pelvic floor. Yeah. Oh, my gosh. This topic I think
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we could focus on for forever. But a
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few just to set the stage about testosterone, because I think there's
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so much misperception about it. I think
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people are fearful, even men sometimes are fearful of testosterone. They think it's
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like, you know, only for bodybuilders,
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or there's this negative connotation with it.
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It's a controlled medication. So there's this fear of, like,
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why is it controlled? It must be dangerous. Somehow we have
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made men and women afraid of something their body naturally makes.
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Which is, like, what, you know, we're all born with.
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Right. And the crazy thing that I actually didn't
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even learn until a few years ago with when talking with other urologists
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who deal with testosterone all the time is women have more
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testosterone than estrogen. And it's like, like, literally my
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mind wanted to just explode. I was like,
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what do you mean? Like, I was never taught that. That's like a foreign concept
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to me. And I think what's confusing for
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practitioners as well is testosterone.
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The units that are given back on a lab report are
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in not the same units as estrogen. So if you just look at
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the numbers, it looks like testosterone is lower. But then if you convert
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the units, it's like, oh, my gosh. No, it's actually like by tenfold,
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100 fold different. So it makes testosterone actually our more dominant
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hormone throughout our lifespan. Men have 10 times
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more than we do. So it's kind of like, okay, no, it's a male hormone,
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but really, no, it's a human hormone, and we have it,
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too. I sometimes tell my patients, like, estrogen is also a male
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hormone, meaning men have more estrogen than women
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after menopause, when women make zero almost. So it just
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kind of helps them realize that these are all human hormones.
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And they're not just for one gender or another. So to your question,
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testosterone receptors are all throughout the pelvis. So just like
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in men, the pelvic floor, the genitals are very androgen sensitive.
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In fact, the area of really heightened androgen
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receptors is right around the opening of the vagina called the vulvar vestibule,
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which another just kind of weird, interesting thing is
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that is the same as the male urethra. So if
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you look at embryology, which again, is like so crazy how
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our genitals are all sort of the same, just look differently, a little bit rearranged,
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but they're all the same tissue. It's the
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same tissue. So it's very, very androgen sensitive
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right around the opening of the vagina. Which is why we know
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that women that have taken oral birth control pills or
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oral hormones for pregnancy prevention a lot of times have
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a high risk factor having pain right around the vestibule,
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because birth control pills lower
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testosterone by a complex mechanism. So it makes sense because again,
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that's like starving the tissue of the hormone it needs.
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So women, again, will need either
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topical or full body replacement to help heal that tissue.
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There's also testosterone receptors in the vagina. There's testosterone receptors in
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the clitoris. Again, we could talk forever about the clitoris too.
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But again, these areas are very hormone responsive.
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Testosterone and estrogen is all
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over the pelvic floor in the genitals. So when
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women and men age in the late 20s,
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even testosterone starts dropping off and it just
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continues to decline. Takes a pretty big hit in the 30s,
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too. And that's when libido starts declining
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a little bit. But it's not until most women hit menopause
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that things get really wonky. And then we have this intersection of, like,
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both hormones declining at the same time that it's just like,
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you know, a crazy hit to usually for women and libido and
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other changes that are happening to their body. And that's generally when women
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come in seeking treatment for low libido arousal,
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orgasm concerns, because again, they're just not getting
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the hormones that their body is naturally making anymore
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to support their genitals and their brain, meaning,
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you know, how we feel. You know, libido is a thought, you know,
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more than a genital tissue issue.
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So hopefully that puts it a little bit in perspective.
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Certainly it's all about blood flow and supporting the tissue,
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the nerves, et cetera, just to make sure everything is functioning properly.
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Oh, yeah. Oh, my gosh, that's so much to unpack. And that's something,
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you know, imagine trying to go through all of that with your patient
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in a very short visit. You're never going to hit all that. But your first
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point, that both testosterone and estrogen are human hormones and they are
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not gender specific is so critical. And I think that
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message is trying to get out there. But I
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agree. I think until you start to really take extra
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time outside of traditional medical training and study this field,
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you don't see those differences where women's Testosterone
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levels are 100 times higher than estrogen at any given day
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in their life. And imagine if we took this hormone
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that is present throughout our entire adult life and start, you know,
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taking it away. When you look at the receptors from head to toe,
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that means women are going to feel changes from head to toe.
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And then the second thing I think that you said is that declining testosterone that
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even starts before menopause in again, both men and
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women. One of my favorite things to say is a lot of the symptoms
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that people attribute to aging are
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really waning hormone symptoms. Oh, 100%.
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Like the Menno belly. Like, all the changes, the shifting. And,
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you know, women are constantly telling me, like, I'm crashing at the gym.
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I'm like, weight training like crazy. I'm like, why can't
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I keep muscle in my body? Why do I keep getting more fat in the
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midsection? And it's just like, you know, again, we have this, like, collision of,
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like, lowering testosterone and then also the,
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you know, terrible sleep with perimenopause symptoms and all these things, right? And it's
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just this, like, really nasty, like, switch cheese.
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All the holes are just lining up perfectly where it's just like women are feeling
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miserable. And it's from, you know,
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it's from hormonal causes, right?
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We can help with, you know, if they're open to consideration.
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I think that's the. I think that's the biggest leap, right?
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It's like, what are women afraid of? How do we address their fears so that
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we can get them the help they want? Because I have so many patients coming
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in seeking treatment, but they're afraid.
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You know, they're like, they've been told hormones are scary. You know, there's still this
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prevalent fear of hormones. And it's just really, again, I feel
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shameful that we've made women afraid of something their body naturally produces.
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It's like, you know, we're not afraid of giving back thyroid hormone.
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It's a human hormone. We're going to give it back to women and
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men forever. Because again, like, if they're low in
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thyroid, we're going to give them back what their body's making to support their body.
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But for some reason when we talk about sex hormones, it's like,
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well, no, we can't do that. That's like, you know, kind of crazy
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and dangerous. And again, we've made people afraid of their own biology. And it's,
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it literally blows my mind every time I think about it, how we
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just treated this biologic
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function. No, I agree. And it, I love that
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thyroid analogy as well. I use that a lot,
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that if you had a thyroidectomy, you would be getting thyroid replacement in
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the post op recovery. We would say, we don't want you to be without thyroid
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hormone for one moment. Or if you look at the flip side of that
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coin, you could live without your thyroid and without those attendant thyroid
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hormones, but you would have a horrible quality and
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in shortened lifespan due to the lack of that critical
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hormone. And yet we let the entire population live horrible
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lives and lifespans because of the lack of their normal
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hormones. And Kristen, I don't know what it is. I've been, I obviously
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been thinking a lot about this lately. What is it
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with women and suffering? I feel like again, society is just
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like, we love women to suffer.
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Suffering is supposed to be just a part of the life. It's like pain with
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periods, heavy periods, you know, pain, pain, pain. And then with procedures
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like again, we've traditionally not given women
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adequate anesthesia and pain control during procedures.
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And then it's like menopause, it's like, nope, like, let's just suffer. So I don't
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know what this, you know, we need to change as a society this idea that
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women are supposed to suffer. And then again, also,
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like, how much suffering does a woman need to have
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until she can have a treatment? And again, I've,
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this has just recently clicked for me because I now have urology partners
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in my practice. And you know,
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a man comes in for a kidney stone, they ask
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about the kidney stone and they're like, well, how are your erections? How's sex?
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Like, they're not even coming in for these questions, these things.
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And they're like, you know, validating anything that
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could potentially happen to a man in the sexual realm. And we,
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you know, hardly ever talk to women about their sexual function or
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ask about it. And then if it comes up, you know,
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we usually, and I'm just generalizing here, dismiss it
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or under treat it. So I think again,
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in medicine, I'm actually giving another talk to my medical school later today where
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I'm going to talk about all these things. I mean, we need to change it
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from the ground level, from the medical school school, and stop
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being okay with just women suffering. Like, let's validate
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their symptoms. Let's offer treatments that are effective and
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also not just effective for their quality, but also, like, improve their
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quality of life, reduce their need of, you know,
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cardiac stents and other treatments for dementia and osteoporosis,
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fractures. Like all the things that we could actually help
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them prevent if we were considering menopause hormone
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therapy. So I think we're just really missing the ball.
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Yeah, I, Oh, I couldn't agree more.
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I think that's so prevalent in all fields of medicine where
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if a man presents with a pain symptom, it's immediately
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validated. Okay, you have pain, let's take the next step to treat that pain.
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And women get asked questions, well, how bad is it and
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are you able to work and is it disrupting your life?
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Well, she's in the doctor's office, so it must be doing something.
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It's clinically relevant. She's here. She made the appointment.
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That's right. She's here to talk about it. And she doesn't want to just discuss
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her pain. She wants to resolve her pain. She wants treatment
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options, please. Yes, she wants to get rid of her pain, get to the source
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of it and improve her life and then the sexual
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function as well. I actually accompanied a family
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member to a urology appointment, again talking about prostate,
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where the male patient was steered away from surgery. They said,
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no, you don't want to consider surgery because it might decrease your erections immediately.
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Sexual function was the first thing. Number one, you don't want this because it could
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negatively affect your sexual function. And I thought, when have
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we ever talked to a woman and said, hey, we're going to give you this
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antidepressant, but it might kill your libido. Do they ever
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even hear that, oh, Kristen. Or, or they're
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coming in for menopause symptoms and they get an antidepressant because,
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like, yes, there it is, an FDA approved
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therapy. But it shouldn't be the first thing that we reach for. It's just,
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to me, that just tells women you're crazy and we're going to
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give you the crazy medicine. And I'm sorry that you're now
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in the crazy zone. It just, it really frustrates me because again,
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this is just biology. It's just we need to support or at least offer and
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consider hormones as first line, not as the
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last possible option. Right. And I
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think it's the same fear of those hormones. I always
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think it's kind of hysterical when people are fearful of hormones. They'll say,
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well, don't take too much because it might cause
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cancer or it might cause stroke. And my feeling is,
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wait a minute, you think something causes cancer? So instead of
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giving them a lot, you'll just give them a little of something that causes
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cancer. Like, I'm sorry, do we give them a little arsenic or.
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No, none at all. If something is harmful, we shouldn't
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give it at all, but is not harmful, then we
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should use it properly. Absolutely. But that's kind
385
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of that underlying message that you get. Just use
386
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a little. Because I don't want to increase your cancer risk a lot.
387
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I just want to. I just want to get you out of my office by
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having you stop complaining about what you're talking about. No, totally. Or the corollary
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is like, well, we might give it to you for. In a little bit,
390
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and then we're going to take it away, even if it works really well in
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a few years, because we don't want to. It's like,
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so that at least some of those changes have fallen by the
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wayside. I think the menopause society now has some pretty
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strong statements about no need to discontinue hormone
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therapy now after a certain age. Again, this was like, all arbitrary
396
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anyway, so at least there's been some headway. But, man,
397
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and I'm sure you were there too,
398
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when this Women's Health Initiative study came
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out in the early 2000s, and it was just like a terrifying time for women
400
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and providers. It was like, what's going on? And so many
401
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women were taken off of their hormone therapy because
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00:24:24,206 --> 00:24:28,086
of a study that, of course now we all know has been debunked,
403
00:24:28,118 --> 00:24:31,884
but it was still wreaking havoc. And still, I think that prevalent fear
404
00:24:31,932 --> 00:24:35,400
of hormones, that's still there, sort of like mesh, you know,
405
00:24:36,180 --> 00:24:39,100
that's like, oh, there's a. It's a fear. And then we have to, like,
406
00:24:39,140 --> 00:24:42,332
talk through all the nuanced nuances of
407
00:24:42,356 --> 00:24:46,316
that. So hard. It's hard in society to take a thought
408
00:24:46,388 --> 00:24:49,532
out of collective consciousness once
409
00:24:49,556 --> 00:24:53,324
it's there. Right. It's true, but. And I.
410
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I think some of it will be newer generations
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of women who are not going to be accepting they're.
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Not going to suffer. Right. Of the suffering that their generations in
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front of them did. So, you know, our grandmothers and mothers suffered
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quite a bit. And I think our generation is starting to Say, wait,
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do we have to deal with this and feel horrible all the time? No,
416
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but I feel like the generations behind us are going to be like, no way.
417
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I'm going to demand the proper care. And I'm so glad that
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menopause certified providers are there and hopefully continuing to
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grow and get this message out and hopefully to younger patients so that
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they will know as they approach their 30s, 40s and beyond
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this is not the way life needs to be. And you can make it better
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with something very natural. Yes. And very safe. The most
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natural. Yes. The most natural, exactly. Yes. Which identical.
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The most natural. Yes. Right. But I mean, then we of
425
00:25:48,386 --> 00:25:51,866
course do need more research and data on it. Oh, for sure.
426
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Give patients actual information and evidence based
427
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information. I mean, I know that you and I use these medications all the
428
00:25:59,026 --> 00:26:02,842
time and we know there is a huge volume of information we can give
429
00:26:02,866 --> 00:26:05,690
to patients, but there's still a lot lacking yo.
430
00:26:05,770 --> 00:26:08,874
100%. 100%. I agree. So when
431
00:26:08,882 --> 00:26:12,698
you're approaching testosterone treatment with the patient, how do you
432
00:26:12,754 --> 00:26:15,674
talk to her about the safety and the benefits?
433
00:26:15,802 --> 00:26:19,402
Yeah, that's a great question, certainly. Right. I want to.
434
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The first thing I want to tell her is I don't want to get
435
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you in the male zone. Right. We're using, I want to use testosterone to
436
00:26:26,642 --> 00:26:29,962
keep you in the female physiologic zone. When you were like,
437
00:26:30,066 --> 00:26:33,722
you know, early 30s, feeling wonderfully vibrant,
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had a lot of energy, had great libido, it was easy to
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work out, you felt strong, all those things that you were feeling right earlier
440
00:26:41,714 --> 00:26:45,290
in your life, that's where I want to get you back. So I do
441
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follow the clinical practice guidelines from ISSWISH about
442
00:26:49,010 --> 00:26:52,272
checking a baseline testosterone level and
443
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I check a total testosterone, I check a sex hormone binding globulin and
444
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I calculate the free androgen index just to like give me a starting place
445
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to make sure we know that we're treating women
446
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actually has low testosterone and have a baseline.
447
00:27:07,264 --> 00:27:10,272
And then of course I follow those levels usually like six to eight weeks later,
448
00:27:10,296 --> 00:27:13,584
just to make sure, again, we're keeping her in the female physiologic
449
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range. So I explained this to her.
450
00:27:16,760 --> 00:27:19,552
So she, I think women want to know, like, I'm not going to turn into
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a man. Right. I'm not going to like start having a ton of facial hair
452
00:27:22,704 --> 00:27:25,100
and changes and like, you know,
453
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none of that. Right. So we talk over that. I do let them know
454
00:27:29,336 --> 00:27:32,976
though, for women that are starting on testosterone, it is really
455
00:27:33,048 --> 00:27:37,440
common to start getting a little bit oilier skin and
456
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Potentially a pimple or two. Right. And when they're starting because again,
457
00:27:41,240 --> 00:27:44,848
their body has been depleted of these hormones and it's
458
00:27:44,864 --> 00:27:47,440
like the body's a little bit waking up and it's like, oh, I'm doing that
459
00:27:47,480 --> 00:27:50,602
again. It's like oil production and like a little bit
460
00:27:50,626 --> 00:27:54,282
of clogged pores and I just let them know, like it's okay if it
461
00:27:54,306 --> 00:27:58,630
happens. Generally that goes away. Your receptors are just kind of waking up and
462
00:27:59,010 --> 00:28:03,034
usually that settles once we get you kind of receptors saturated,
463
00:28:03,082 --> 00:28:06,506
etc. Women, I think are always concerned
464
00:28:06,538 --> 00:28:10,138
about their hair. You know, like, oh my gosh, please, I can't have any hair
465
00:28:10,154 --> 00:28:14,330
loss. Because again, generally in this time frame women might be having been
466
00:28:14,370 --> 00:28:18,028
huge swings in estrogen and having hair loss. So we talk through that
467
00:28:18,084 --> 00:28:20,892
and generally what I say is, as long as we're keeping you again in the
468
00:28:20,916 --> 00:28:24,636
physiologic female range, we're not going to cause any sort of
469
00:28:24,708 --> 00:28:28,732
hair loss that's related to like again, male pattern baldness, et cetera. That's like
470
00:28:28,836 --> 00:28:32,012
again, really high levels of testosterone. But again, I always let them know, like,
471
00:28:32,036 --> 00:28:35,452
it's always a possibility, especially if you're using way too
472
00:28:35,476 --> 00:28:37,644
much, you know, that's why I want to keep you in the physiologic range.
473
00:28:37,692 --> 00:28:40,444
So if there's any concerns, I just, I do have them reach out to me.
474
00:28:40,452 --> 00:28:44,766
But in general. Right. This is a physiologic body
475
00:28:44,838 --> 00:28:48,638
identical hormone. So generally there's not any
476
00:28:48,694 --> 00:28:52,398
side effects above what I mentioned, oily skin and a pimple
477
00:28:52,414 --> 00:28:56,046
or two. Kind of like, you know, think like a corny teenager sort of
478
00:28:56,198 --> 00:28:59,950
concept. That's basically what we're starting to recreate once.
479
00:28:59,990 --> 00:29:03,438
And then again once we get saturated and it levels out to a steady state
480
00:29:03,494 --> 00:29:07,086
that those things go away in general, four months later,
481
00:29:07,158 --> 00:29:10,830
libido comes back. It does take a while though. I think that's another thing
482
00:29:10,870 --> 00:29:14,156
with testosterone is it's not like, you know, just flipping
483
00:29:14,188 --> 00:29:17,820
on a switch. It takes a little while for the receptors,
484
00:29:17,900 --> 00:29:21,132
especially in the brain, to kind of wake up and those thoughts and fantasies come
485
00:29:21,156 --> 00:29:24,268
back. So I tell them to stick with it.
486
00:29:24,324 --> 00:29:28,172
Like just stick with it. There is
487
00:29:28,196 --> 00:29:32,092
no FDA approved product for testosterone in the us. There is
488
00:29:32,116 --> 00:29:35,852
one in Australia. So again, it's not a safety issue. And in
489
00:29:35,876 --> 00:29:39,162
fact, that study I mentioned when I in my fellowship,
490
00:29:39,316 --> 00:29:43,310
we had five years of excellent safety data on women using testosterone in these
491
00:29:43,350 --> 00:29:46,610
clinical studies. And the FDA said, I'm sorry,
492
00:29:47,030 --> 00:29:51,210
I think we need five more years because we don't have Quite enough data.
493
00:29:51,830 --> 00:29:56,126
We're talking about women here. We need it to be really safe, so whatever.
494
00:29:56,238 --> 00:29:59,230
So it didn't come to market, but we had great safety data and again,
495
00:29:59,270 --> 00:30:03,290
it was very effective. We need to
496
00:30:03,910 --> 00:30:07,390
appreciate that there is not an FDA approved product for
497
00:30:07,430 --> 00:30:10,786
women, but that doesn't mean we can't use male FDA approved
498
00:30:10,818 --> 00:30:14,322
products. So in my practice we use a male
499
00:30:14,386 --> 00:30:16,930
FDA approved product, we just dose it for a female.
500
00:30:17,010 --> 00:30:20,162
So we use generic testosterone,
501
00:30:20,226 --> 00:30:23,650
1% in the, in the tubes and have a woman
502
00:30:23,690 --> 00:30:27,586
use a tenth of the amount a man would use the whole entire tube
503
00:30:27,618 --> 00:30:31,122
per day. Sometimes a little tricky to dose that out. So we
504
00:30:31,146 --> 00:30:34,610
have them use a 5ml syringe if it's, you know, very tricky. And again,
505
00:30:34,650 --> 00:30:37,760
this is like a topical gel, not an injection.
506
00:30:39,060 --> 00:30:42,252
And most women do great with that. And again,
507
00:30:42,356 --> 00:30:45,772
the nice thing is it's also very inexpensive to get
508
00:30:45,956 --> 00:30:49,532
testosterone gel generic. So that's also a
509
00:30:49,556 --> 00:30:52,684
nice benefit. But then of course there's compounded creams,
510
00:30:52,732 --> 00:30:56,316
right. If there's no FDA approved product for women, this is where compounding
511
00:30:56,348 --> 00:30:59,676
is also a nice way to do it. So compounded
512
00:30:59,708 --> 00:31:03,088
creams, again, still important
513
00:31:03,144 --> 00:31:07,152
to follow the blood levels to make sure again, they're staying in the right and
514
00:31:07,176 --> 00:31:10,352
the right zone. You know, I'm not
515
00:31:10,376 --> 00:31:13,568
a huge fan of pellets, but pellets are another option. Again,
516
00:31:13,624 --> 00:31:16,832
I think women are so in need of just any hormones that
517
00:31:16,856 --> 00:31:21,136
they'll go anywhere they can get help. And certainly pellets are convenient
518
00:31:21,168 --> 00:31:23,740
because it's like they work for several months at a time.
519
00:31:24,680 --> 00:31:27,786
I wish they were FDA approved for women, they're approved for men.
520
00:31:27,968 --> 00:31:31,734
So I just wish that we had a little, a little. I wish we
521
00:31:31,742 --> 00:31:34,998
had a better option for women. Right now we're still kind of in between
522
00:31:35,054 --> 00:31:38,934
using a female dose, female dosing
523
00:31:38,982 --> 00:31:42,970
for an FDA approved product for men, compounding or pellets.
524
00:31:43,470 --> 00:31:47,094
Hopefully one day we'll get somewhere.
525
00:31:47,222 --> 00:31:50,470
Yeah, I definitely hope so. For sure. And it's,
526
00:31:50,630 --> 00:31:53,920
I think one thing that a lot of people may not know is
527
00:31:54,070 --> 00:31:57,160
you can't patent a natural product.
528
00:31:57,460 --> 00:32:01,676
So body identical testosterone, body identical estrogen. No pharmaceutical
529
00:32:01,708 --> 00:32:04,908
company can own the patent for those because it's already in
530
00:32:04,964 --> 00:32:08,908
nature. And in order to own a patent, they have to change
531
00:32:08,964 --> 00:32:12,700
it or make it unique. But what the lesson has
532
00:32:12,740 --> 00:32:16,844
taught us from whi and on is when we start changing hormones,
533
00:32:16,972 --> 00:32:20,618
they do some of the things that the body hormone does,
534
00:32:20,674 --> 00:32:24,298
but then we get potentially things we don't want or things
535
00:32:24,354 --> 00:32:28,298
we aren't even aware of. So that's where when we get into the synthetic version
536
00:32:28,314 --> 00:32:31,690
of hormones, we have to be cautious because those
537
00:32:31,730 --> 00:32:35,610
are not comparing apples to apples, bioidentical hormones and synthetic,
538
00:32:35,770 --> 00:32:39,162
even though there are synthetic versions of estrogen at least.
539
00:32:39,186 --> 00:32:42,250
And, you know, that women can take. And I,
540
00:32:42,290 --> 00:32:46,594
and I love that you said that. I think again, everyone lumps estrogen,
541
00:32:46,642 --> 00:32:50,642
especially, right. All in one bucket when there's synthetic
542
00:32:50,706 --> 00:32:54,082
and there's, you know, there's literally bio
543
00:32:54,146 --> 00:32:57,938
body identical hormones available and then there's, you know,
544
00:32:57,994 --> 00:33:00,994
slightly modified hormones again. And it's,
545
00:33:01,042 --> 00:33:04,338
it's very confusing for women to know what they're getting.
546
00:33:04,394 --> 00:33:07,954
It's like all estrogens aren't the same. Just like, you know, all fruits
547
00:33:08,002 --> 00:33:10,914
aren't the same. You know, there's apples and bananas and, you know, but we lump
548
00:33:10,962 --> 00:33:14,538
them all together in one bucket and they're totally not
549
00:33:14,594 --> 00:33:17,350
one thing. So, again,
550
00:33:17,730 --> 00:33:20,906
the FDA insert for vaginal estrogen,
551
00:33:20,938 --> 00:33:24,954
which is a very, very, very safe product, has a black box warning
552
00:33:25,002 --> 00:33:28,650
for, you know, when women pick it up from the pharmacy that talks all about,
553
00:33:28,770 --> 00:33:32,970
you know, cancer and dementia and stroke. And it's really
554
00:33:33,010 --> 00:33:36,250
scary. And there's never been any evidence for that. But again, it's a
555
00:33:36,290 --> 00:33:39,802
class labeling where every estrogen product got this warning put
556
00:33:39,826 --> 00:33:43,498
on it. And, and they're not all the same. And it is hard,
557
00:33:43,554 --> 00:33:47,050
though, for patients to understand all this.
558
00:33:47,090 --> 00:33:49,946
Right? It's. Right. Very difficult, challenging.
559
00:33:50,058 --> 00:33:53,322
It's a lot to sift through. And that's why we need specialists,
560
00:33:53,386 --> 00:33:56,954
because you need to keep up with all of the information on all the
561
00:33:56,962 --> 00:34:00,410
different products. I mean, even in my training, I did not. When I
562
00:34:00,450 --> 00:34:04,522
graduated medical school and started practicing, I absolutely did not know all
563
00:34:04,546 --> 00:34:07,942
these differences between the hormones. And I
564
00:34:07,966 --> 00:34:11,542
just kind of thought, hey, this is the main one we prescribe. Premarin certainly was
565
00:34:11,566 --> 00:34:14,902
very popular. There was a patch called Prempro,
566
00:34:14,966 --> 00:34:18,454
and that was more convenient. So I was thinking about convenience
567
00:34:18,502 --> 00:34:21,846
for my patient and not about the molecule I was putting
568
00:34:21,878 --> 00:34:25,414
in their body. And now, 20 years later, we know
569
00:34:25,502 --> 00:34:28,982
so much more. And that's the point. Medicine advances, science advances,
570
00:34:29,046 --> 00:34:32,374
and we know more than we did 20 years ago. Yeah. And Kristen, I think
571
00:34:32,382 --> 00:34:36,054
that's another great point you brought up is, you know, as physicians,
572
00:34:36,102 --> 00:34:39,750
we don't just stop learning after medical school or residency. You have to keep
573
00:34:39,790 --> 00:34:43,050
learning and keep being curious and keep getting extra training.
574
00:34:43,950 --> 00:34:47,718
But unfortunately, because menopause has been like, no one
575
00:34:47,774 --> 00:34:51,510
has owned this midlife health section is kind
576
00:34:51,550 --> 00:34:54,838
of very random. Who decides that
577
00:34:54,894 --> 00:34:57,958
I, you know, wants to get more information or wants to be menopause,
578
00:34:58,054 --> 00:35:01,552
certified provider, etc. There was a study that came
579
00:35:01,576 --> 00:35:05,360
out that only 7% of physicians felt comfortable
580
00:35:05,520 --> 00:35:08,976
addressing any sort of menopause midlife care for women.
581
00:35:09,128 --> 00:35:12,160
And that is really shameful when we have a population of, you know,
582
00:35:12,200 --> 00:35:16,128
50% of, you know, of our population is eventually going to get
583
00:35:16,264 --> 00:35:19,440
to menopause if they live, you know, to that age. And,
584
00:35:19,560 --> 00:35:22,300
you know, we need to, we need to again,
585
00:35:23,080 --> 00:35:26,854
reanalyze how we are treating midlife women
586
00:35:26,942 --> 00:35:30,742
and prioritize their health. Right. And I
587
00:35:30,766 --> 00:35:34,806
think that it's okay if physicians don't know how
588
00:35:34,878 --> 00:35:39,398
to practice menopause medicine. I don't know how to practice cardiology
589
00:35:39,494 --> 00:35:42,854
or neurology, and I don't think of that as shameful.
590
00:35:42,902 --> 00:35:45,958
I just tell my patients that's not my area of expertise.
591
00:35:46,054 --> 00:35:49,446
Yes, I have a little more general medical knowledge about
592
00:35:49,518 --> 00:35:53,360
those conditions than you do, but I'm going to send you to someone who has
593
00:35:53,400 --> 00:35:57,120
dedicated their life to learning about that. Exactly. So I would
594
00:35:57,160 --> 00:36:01,184
just hope, kind of the same respect from our colleagues.
595
00:36:01,312 --> 00:36:05,136
If a menopausal woman says, hey, I'm suffering and I'm having all of these symptoms
596
00:36:05,168 --> 00:36:08,864
that we know are so related to menopausal transition, for that
597
00:36:08,952 --> 00:36:12,512
physician to say, you know, this is outside my area of expertise, I'm not
598
00:36:12,536 --> 00:36:16,160
going to weigh in on the benefit or risk of hormones because
599
00:36:16,280 --> 00:36:20,048
I don't have the knowledge. That's a much more fair statement than just
600
00:36:20,104 --> 00:36:23,680
saying, maybe you shouldn't take them. They might be risky. I'm not
601
00:36:23,720 --> 00:36:27,620
sure. Well, if you're not sure, get them to someone who is very confident.
602
00:36:28,120 --> 00:36:31,872
Because planting that little seed, even with the
603
00:36:31,896 --> 00:36:36,016
word might, is like, for a woman, like, nope, it's dangerous.
604
00:36:36,128 --> 00:36:39,312
Right. And I say this often when
605
00:36:39,336 --> 00:36:42,896
I'm teaching is the things that physicians say to patients are really
606
00:36:42,968 --> 00:36:46,630
important. They will hang on to your words forever.
607
00:36:47,130 --> 00:36:51,282
So make sure what you are saying is founded in evidence and,
608
00:36:51,386 --> 00:36:55,698
you know, not like these mights and maybes. And especially
609
00:36:55,754 --> 00:36:59,390
again, when it's not your area of expertise, just like you said.
610
00:37:00,410 --> 00:37:03,826
I think also medicine, we could use a little humility, like we don't know everything,
611
00:37:03,898 --> 00:37:07,730
and that's okay. But each provider has dedicated their
612
00:37:07,770 --> 00:37:10,962
life or their career to treating this X, Y and Z. And let's get
613
00:37:10,986 --> 00:37:15,040
you there so you get the best care you can get.
614
00:37:15,740 --> 00:37:19,540
I totally agree with you. That's such a great message for young training
615
00:37:19,620 --> 00:37:22,996
physicians or new physicians, because I'm sure we've
616
00:37:23,028 --> 00:37:26,436
both heard patients come in and tell me almost word
617
00:37:26,468 --> 00:37:29,940
for word, will my other doctor Said. And then they give me
618
00:37:29,980 --> 00:37:33,480
an entire monologue, and I'll think, oh, my gosh,
619
00:37:34,460 --> 00:37:37,892
just like you said, these patients are listening. They are hearing
620
00:37:37,956 --> 00:37:41,520
your tone. Even if it's not the words you say,
621
00:37:41,560 --> 00:37:44,912
it's how you say it. If you have a big hesitance,
622
00:37:45,056 --> 00:37:48,340
hesitancy, and you take a big pause or a big sigh,
623
00:37:48,680 --> 00:37:52,320
well, you can use them. I'm not
624
00:37:52,360 --> 00:37:55,360
saying you can use them, but, I mean, my goodness. Right,
625
00:37:55,400 --> 00:37:58,688
right. All of that body language. And it's important as
626
00:37:58,744 --> 00:38:01,952
physicians to understand that how we interact with our patients.
627
00:38:02,016 --> 00:38:05,312
Words, body language, tone. Yep. All a part
628
00:38:05,336 --> 00:38:07,907
of the care that matters. 100%.
629
00:38:08,122 --> 00:38:11,766
100%. Yeah. So. So let's. We talked
630
00:38:11,798 --> 00:38:15,174
about, obviously, if patients have issues with the pelvic floor too loose
631
00:38:15,222 --> 00:38:18,646
or too tight, they might have issues with sexual wellness.
632
00:38:18,838 --> 00:38:22,230
That needs to be improved. If they have hormone loss, which every woman
633
00:38:22,270 --> 00:38:25,798
is going to have hormone loss as we get older, that needs to be improved.
634
00:38:25,894 --> 00:38:29,670
Is there anything women can do on their own? Because I'm sure you also hear
635
00:38:29,710 --> 00:38:33,830
about, I want to be all natural and I want to do things all naturally.
636
00:38:33,910 --> 00:38:37,768
I mean, I know my answer for sure, but I love to hear everyone
637
00:38:37,824 --> 00:38:41,496
else's answer to this very question. Yes,
638
00:38:41,688 --> 00:38:45,416
I approach this with a little bit of cheekiness.
639
00:38:45,528 --> 00:38:49,304
So I asked them if they drive a car, if they wear
640
00:38:49,352 --> 00:38:52,460
clothes, if they wear glasses, if they wear shoes,
641
00:38:52,880 --> 00:38:56,440
because it would be natural to be naked and walk around with
642
00:38:56,480 --> 00:38:59,224
no clothing and no shoes and no glasses.
643
00:38:59,272 --> 00:39:02,402
And like, how natural are we talking?
644
00:39:02,466 --> 00:39:06,018
Right? We. We do things right. We have tools.
645
00:39:06,114 --> 00:39:09,058
We wear glass, like, to improve our quality of life,
646
00:39:09,114 --> 00:39:12,466
to improve our comfort. And so,
647
00:39:12,538 --> 00:39:15,106
yes, truly being completely naturally,
648
00:39:15,298 --> 00:39:18,658
suffering and feeling miserable. Right? But we take. We take
649
00:39:18,714 --> 00:39:21,746
Tylenol and Advil when we have a headache because we don't want to suffer.
650
00:39:21,778 --> 00:39:25,490
Right? And we. We do things to alleviate suffering. So I
651
00:39:25,530 --> 00:39:28,828
try to make it kind of analogies about
652
00:39:28,964 --> 00:39:32,684
being natural and kind of put it in perspective. I oftentimes
653
00:39:32,732 --> 00:39:36,560
again talk about thyroid because it just sort of clicks about other hormones.
654
00:39:37,700 --> 00:39:41,356
And then I talk about sometimes other hormones like,
655
00:39:41,428 --> 00:39:44,828
you know, vitamin D and melatonin, which are other hormones that we
656
00:39:44,884 --> 00:39:47,948
don't talk about, and those are just over the counter. Again,
657
00:39:48,084 --> 00:39:51,868
it's like there's all these other hormones that we have
658
00:39:51,924 --> 00:39:56,068
naturally in our body, but somehow, again, we've. We've just reserved these sex
659
00:39:56,124 --> 00:40:00,004
hormones as being something scary and that we should just be natural and
660
00:40:00,092 --> 00:40:03,440
suffer. So I talk a little bit about that.
661
00:40:04,620 --> 00:40:08,196
Kind of think of how else I phrase it. Of course, I Talk about
662
00:40:08,268 --> 00:40:12,212
again, I oftentimes actually show the exact chemical
663
00:40:12,276 --> 00:40:16,484
structure of estradiol, which is our main estrogen.
664
00:40:16,612 --> 00:40:20,372
And I show the chemical structure of progesterone. I show the chemical structure of
665
00:40:20,396 --> 00:40:23,674
testosterone. And I, like, tell them this is exactly
666
00:40:23,722 --> 00:40:27,990
what your body, your ovary makes. Three main things. These three main things.
667
00:40:28,290 --> 00:40:32,010
And if we're talking about being the most natural, we're talking about
668
00:40:32,050 --> 00:40:35,350
replacing exactly the same chemical that your body was making
669
00:40:36,450 --> 00:40:40,346
oftentimes. And I'm sure you get this, Kristen. Women come in with a gigantic
670
00:40:40,378 --> 00:40:41,790
bag full of supplements.
671
00:40:43,490 --> 00:40:46,906
And again, whole topic we could spend on supplements,
672
00:40:46,938 --> 00:40:51,578
but I think women are looking for a
673
00:40:51,634 --> 00:40:55,258
natural solution in supplements. But really, are those
674
00:40:55,314 --> 00:40:58,858
more natural than what your body is making? And how much money
675
00:40:58,914 --> 00:41:02,762
are you going to spend on certain supplements that are maybe going to target one
676
00:41:02,786 --> 00:41:06,602
or two areas that you're suffering? Is it your hair
677
00:41:06,666 --> 00:41:10,250
loss? How many supplements are there for hair loss? How many
678
00:41:10,290 --> 00:41:13,618
supplements for dry skin, dry eyes, achy joints,
679
00:41:13,754 --> 00:41:16,674
sleeping better and sleeping better. Like, it's just like,
680
00:41:16,762 --> 00:41:19,906
again, the anxiety and the depression and it's like, how many
681
00:41:19,978 --> 00:41:22,658
supplements? And then, of course,
682
00:41:22,714 --> 00:41:26,242
weight changes. Right. How many supplements does a one woman need to
683
00:41:26,266 --> 00:41:29,970
take to sort of overcome what her body is.
684
00:41:30,010 --> 00:41:33,330
Was naturally missing? So I kind of try to tell them,
685
00:41:33,370 --> 00:41:37,266
like, we could. We could take a handful of medications or supplements
686
00:41:37,298 --> 00:41:40,604
to treat all of your ailments that's happening in midlife.
687
00:41:40,652 --> 00:41:44,508
Or you could replace what your natural ovary was
688
00:41:44,644 --> 00:41:47,612
doing for you and doing it perfectly,
689
00:41:47,676 --> 00:41:51,436
meaning you have estrogen and progesterone receptors all throughout
690
00:41:51,468 --> 00:41:55,340
your body. And they're really important to keep
691
00:41:55,380 --> 00:41:58,988
all of them working. The genitals usually need more, which why we
692
00:41:59,124 --> 00:42:01,440
always, of course, love talking about vaginal hormones.
693
00:42:02,180 --> 00:42:06,240
But we need to think about this more holistically
694
00:42:08,030 --> 00:42:11,894
versus again. And I'm not saying all supplements are bad. I love
695
00:42:11,982 --> 00:42:15,686
certain supplements for certain reasons. But if we're thinking
696
00:42:15,718 --> 00:42:19,446
about natural, I do tend to try to focus women
697
00:42:19,518 --> 00:42:22,742
on their natural products their
698
00:42:22,766 --> 00:42:26,262
body was making. Yeah, I agree. I mean, I know
699
00:42:26,286 --> 00:42:30,662
we both feel there's nothing more natural than maintaining
700
00:42:30,806 --> 00:42:34,696
your body's optimized hormone levels, which is
701
00:42:34,768 --> 00:42:38,488
usually when we're in our 20s and maybe early 30s, when all of our endocrine
702
00:42:38,584 --> 00:42:42,008
organs are functioning at their best and we are feeling great
703
00:42:42,064 --> 00:42:46,184
and we are generally free from chronic disease. And all of those benefits
704
00:42:46,232 --> 00:42:49,592
we get from youth are really proper hormones.
705
00:42:49,656 --> 00:42:53,688
So if we can maintain that or return to that really
706
00:42:53,744 --> 00:42:57,192
is the most natural. Right, Right. And certainly if people
707
00:42:57,216 --> 00:43:00,920
are thinking about cost, I mean, there's A huge cost in the supplement industry.
708
00:43:01,040 --> 00:43:04,510
I also use supplements and I have, yes, quality ones that I
709
00:43:04,550 --> 00:43:08,142
believe in. But you also have to think about what do
710
00:43:08,166 --> 00:43:11,630
you get for your money. And whatever you're going to choose,
711
00:43:11,710 --> 00:43:15,518
I think you get the most bang for your buck. Replacing Your proper
712
00:43:15,574 --> 00:43:19,470
hormones 100% benefit list is going to be huge.
713
00:43:19,630 --> 00:43:23,342
Now it's not going to be maybe 100% right,
714
00:43:23,446 --> 00:43:27,230
all of your symptoms, but you're going to get the biggest percentage
715
00:43:27,310 --> 00:43:30,494
improvement using something like replacing your natural hormones
716
00:43:30,542 --> 00:43:33,866
versus a supplement for sleep, a supplement for weight, a supplement for hair,
717
00:43:33,898 --> 00:43:37,498
a supplement. Right. I couldn't agree, could not agree
718
00:43:37,554 --> 00:43:40,762
more. Yeah, that's, that's really important. But you're right,
719
00:43:40,786 --> 00:43:44,538
I think patients are thinking that they're doing it all
720
00:43:44,594 --> 00:43:48,778
naturally. Right. I just, you know, mixing up this cocktail of
721
00:43:48,834 --> 00:43:51,850
supplements that are probably not harmful necessarily,
722
00:43:51,930 --> 00:43:55,610
but may not be getting the job done. And I, and I love
723
00:43:55,650 --> 00:43:59,642
when a woman says, comes in and says to me, like I'm, I'm doing meditation,
724
00:43:59,706 --> 00:44:03,248
I'm journaling, I'm doing yoga, I'm being active, like doing
725
00:44:03,304 --> 00:44:06,688
all the things that are good for just general health. Right.
726
00:44:06,744 --> 00:44:10,384
So I never want to say like, well, don't do all those things. Like we
727
00:44:10,472 --> 00:44:13,760
clearly want you to do all of those other healthy things that are just really
728
00:44:13,800 --> 00:44:17,280
good for your mind and body. But again, the foundation for
729
00:44:17,320 --> 00:44:20,320
me, after good quality sleep,
730
00:44:20,480 --> 00:44:23,856
because the ultimate foundation, I think for health and wellness
731
00:44:24,048 --> 00:44:27,152
is the layer of hormones and then again it's exercise,
732
00:44:27,216 --> 00:44:30,352
nutrition, potentially then supplements if
733
00:44:30,376 --> 00:44:33,744
there's nutritional deficiencies, et cetera. But I mean, again, I think we forget
734
00:44:33,792 --> 00:44:37,184
about the foundation, you know, and if we don't have a strong foundation,
735
00:44:37,312 --> 00:44:40,140
nothing else is going to be going well.
736
00:44:40,520 --> 00:44:43,760
Right. And there's, there's data
737
00:44:43,880 --> 00:44:48,336
showing that those things like meditation and journaling and walking in nature
738
00:44:48,528 --> 00:44:52,192
naturally increase the correct hormone balance
739
00:44:52,256 --> 00:44:55,792
in our body. So we, if you want to do something naturally,
740
00:44:55,856 --> 00:44:58,922
that can do it. But I also tell patients your
741
00:44:58,946 --> 00:45:01,190
organs can only make what they can make.
742
00:45:01,890 --> 00:45:05,610
Your 70 year old ovary is not making any
743
00:45:05,650 --> 00:45:08,550
hormones, no matter how much meditation and journaling do.
744
00:45:09,490 --> 00:45:12,970
But certainly we make cortisol our entire lives
745
00:45:13,010 --> 00:45:17,098
and our adrenal gland works our entire lives and we can use things like meditation
746
00:45:17,194 --> 00:45:20,474
and music to keep that more healthy, but it
747
00:45:20,482 --> 00:45:23,882
can only give you what it can give you. So at some point we're going
748
00:45:23,906 --> 00:45:28,094
to have to help support those organs by replacing
749
00:45:28,142 --> 00:45:31,598
their natural hormones. 100%. Couldn't agree more.
750
00:45:31,734 --> 00:45:35,070
But and getting back to that, you know, things like meditation and all Those
751
00:45:35,110 --> 00:45:38,650
great things we talk about, they sometimes take work. I mean,
752
00:45:40,070 --> 00:45:43,998
I am definitely a person whose brain is going at
753
00:45:44,054 --> 00:45:47,614
110 miles an hour from the minute I'm up until
754
00:45:47,702 --> 00:45:50,814
I go to sleep. And I practice meditation.
755
00:45:50,862 --> 00:45:54,398
And I will say it is hard. It is hard.
756
00:45:54,454 --> 00:45:57,102
It is really hard work. Quiet your mind.
757
00:45:57,286 --> 00:46:00,526
If you are used to your mind. Always going, yes,
758
00:46:00,638 --> 00:46:03,918
yes, it's a practice. Right? I. I am still.
759
00:46:03,974 --> 00:46:07,006
I'm still trying to, trying to get there. Yes.
760
00:46:07,118 --> 00:46:10,542
Practice. Yes. Meditation. I always feel that every time my
761
00:46:10,566 --> 00:46:14,190
brain drifts off, I just have to tell myself,
762
00:46:14,270 --> 00:46:17,290
that's okay, just come back to here. Right. That's why.
763
00:46:17,830 --> 00:46:21,982
Right. That's why yoga is a practice. Not every yoga session. You're fabulous.
764
00:46:22,046 --> 00:46:25,482
Sometimes you're falling on your. That's okay. Even though you
765
00:46:25,506 --> 00:46:29,274
did those poses last week. And it's about
766
00:46:29,362 --> 00:46:32,794
just kind of getting into that zone where you can shut
767
00:46:32,842 --> 00:46:36,698
everything else down and, and really let your body be healthy.
768
00:46:36,874 --> 00:46:40,410
Totally. That's great. Oh, I love it. Thank you
769
00:46:40,450 --> 00:46:44,250
for all of your wonderful information. It's been really so
770
00:46:44,290 --> 00:46:47,994
fun. Yeah, I wish we were closer. I'd hang out with you.
771
00:46:48,082 --> 00:46:51,322
Oh, I would love that. That would be great. Yes. I'm going to send you
772
00:46:51,346 --> 00:46:54,834
my cell number. We can chat. I love it. I love it.
773
00:46:54,922 --> 00:46:58,082
Tell me about your day to day. Are you in clinic? Most days. Are you
774
00:46:58,106 --> 00:47:01,762
operating? Yeah. So because I just retired
775
00:47:01,826 --> 00:47:06,322
from the military, I'm in a new practice again with two urologists
776
00:47:06,386 --> 00:47:10,210
and our focus is mostly sexual medicine. So I would say
777
00:47:10,250 --> 00:47:13,314
before I retired I would do about 10% sexual medicine,
778
00:47:13,362 --> 00:47:16,978
90% Eurogyne. And now that is like flipped right now. So I'm building the urogyne
779
00:47:16,994 --> 00:47:21,310
side. So right now it's mostly clinic. And I do one
780
00:47:21,350 --> 00:47:25,230
little other thing just for public awareness that I feel like
781
00:47:25,270 --> 00:47:29,006
is greatly overlooked is in our practice
782
00:47:29,038 --> 00:47:32,206
we see a lot of women with muted
783
00:47:32,238 --> 00:47:35,886
orgasm, clitoral pain, delayed orgasm,
784
00:47:35,998 --> 00:47:40,046
and we find a ton of clitoral adhesions, which is
785
00:47:40,198 --> 00:47:43,010
never talked about. No one discusses.
786
00:47:43,510 --> 00:47:47,806
And so again, I'm doing a lot more procedures for clitoral
787
00:47:47,838 --> 00:47:51,610
pain and clobno in my
788
00:47:51,650 --> 00:47:55,898
practice right now it's mostly clinical building.
789
00:47:55,954 --> 00:47:59,130
The surgical side. I just spoke with
790
00:47:59,170 --> 00:48:02,842
a specialist out in Tampa. She does vulvovaginal diseases,
791
00:48:02,906 --> 00:48:06,042
lichen, sclerosis and other German. And we had
792
00:48:06,066 --> 00:48:09,594
a talk about clitoral anatomy and how
793
00:48:09,682 --> 00:48:12,826
overlooked it is once again in the routine
794
00:48:12,858 --> 00:48:16,186
GYN exam. Are you ever taught to examine the clitoris,
795
00:48:16,218 --> 00:48:19,858
push back, look at it. And I will
796
00:48:19,914 --> 00:48:24,066
be the first to say that for Many years. I also completely ignored
797
00:48:24,098 --> 00:48:27,298
the clitoris. Kind of went right to the Vegas.
798
00:48:27,394 --> 00:48:30,562
That's what we were taught. That's how we were taught. But then the
799
00:48:30,586 --> 00:48:34,386
more I talked to women and they started to have symptoms, I started looking
800
00:48:34,458 --> 00:48:38,146
on my own and then reading, you know, more research and finding these clitoral
801
00:48:38,178 --> 00:48:41,506
problems where I'm like, I can't even find your clitoris.
802
00:48:41,698 --> 00:48:45,488
It's amazing. It's. I would
803
00:48:45,544 --> 00:48:48,832
say one out of four patients that I see now has moderate to
804
00:48:48,856 --> 00:48:52,192
severe clitoral adhesions. We don't ever tell women how to take care of
805
00:48:52,216 --> 00:48:55,744
their bodies. You know, boys that have a penis are always. That have
806
00:48:55,752 --> 00:48:58,688
a foreskin. Excuse me, are always told, pull the hood back,
807
00:48:58,744 --> 00:49:02,128
pull the foreskin back. Right. Yes. We never tell women
808
00:49:02,184 --> 00:49:06,080
how to take care of their genitals. And I do believe if we did that,
809
00:49:06,120 --> 00:49:09,296
we wouldn't have so many adhesions. Certainly there's vulvar
810
00:49:09,328 --> 00:49:13,096
dermatoses that can also put women at risk for this. But in general.
811
00:49:13,248 --> 00:49:17,080
Right. Most of the women I see don't have any vulvar skin conditions. It's just
812
00:49:17,200 --> 00:49:20,904
adhesions. And I'm sure. Was it Jill Kraft, the one that you were talking with?
813
00:49:20,992 --> 00:49:24,392
Yeah, yeah, yeah. She's so great. And we talked about that
814
00:49:24,416 --> 00:49:28,376
exact thing. Right. Women don't get taught about their anatomy. We know it's eternal,
815
00:49:28,408 --> 00:49:31,672
but that doesn't mean we just ignore it. Of course, there's all
816
00:49:31,696 --> 00:49:35,544
the shame about it. And you know, keeping it hidden, that's a whole separate
817
00:49:35,672 --> 00:49:39,506
thought process. Right. When we should. I mean, I gave the.
818
00:49:39,608 --> 00:49:43,550
The point that I'll take 50 and 60 year old women and
819
00:49:43,590 --> 00:49:47,086
take a mirror out and my little Q tip and point around this clitoris.
820
00:49:47,118 --> 00:49:50,830
This is the clitoris. And they are in amazing.
821
00:49:50,910 --> 00:49:54,030
Mind blown. Right? Mind blown. Yes, I know, I.
822
00:49:54,070 --> 00:49:56,926
And they're almost embarrassed. I am 65 years old. I never,
823
00:49:56,998 --> 00:50:00,318
I never knew this. That's. That my urethra was there and that was this.
824
00:50:00,374 --> 00:50:03,054
And things that I'm sure for you and I, we feel like, okay, we look
825
00:50:03,062 --> 00:50:07,022
at it 10,000 times a day. Right. They do not look at their anatomy and
826
00:50:07,046 --> 00:50:10,780
they don't know. Or the flip side, for the very first time ever,
827
00:50:10,820 --> 00:50:14,172
they'll look at their anatomy and they're like, what is it? Has it
828
00:50:14,196 --> 00:50:15,400
always been like that?
829
00:50:17,300 --> 00:50:21,180
Yes. No. I think the power of a mirror cannot be understated.
830
00:50:21,340 --> 00:50:25,180
We also use a mirror and I'm always blown away by
831
00:50:25,220 --> 00:50:28,620
how powerful that is for women and encourage them to
832
00:50:28,660 --> 00:50:31,916
inspect often and frequent to make sure.
833
00:50:31,988 --> 00:50:35,512
Things are staying healthy. Definitely.
834
00:50:35,576 --> 00:50:39,512
Yeah. And I think we probably don't truly know
835
00:50:39,616 --> 00:50:43,080
the percentage of clitoral phimosis and adhesions because
836
00:50:43,120 --> 00:50:46,632
again, it hasn't been looked at and don't teach women to take care of their
837
00:50:46,656 --> 00:50:50,888
anatomy. So it makes sense. After a lifetime of not
838
00:50:51,024 --> 00:50:54,072
literal, hood maybe gets stuck. Yeah.
839
00:50:54,216 --> 00:50:56,820
So I'm actually really proud to say this.
840
00:50:57,440 --> 00:51:01,432
One of my prior fellows, we measured 150
841
00:51:01,536 --> 00:51:04,730
vulvar vulvas for all every single
842
00:51:05,390 --> 00:51:08,662
thing that could be potentially measured. And it's getting presented this month in
843
00:51:08,686 --> 00:51:11,862
Atlanta at Ithwish. And we found 15% of
844
00:51:11,886 --> 00:51:16,022
women have cloidal fibromosis that's moderate to severe with all
845
00:51:16,046 --> 00:51:19,558
comers, meaning they're not coming in for a sexual complaint. They're coming in for anal
846
00:51:19,614 --> 00:51:22,970
gyn exam, they're coming in for something else.
847
00:51:23,470 --> 00:51:27,446
So there you go. Hot off the press. Getting presented
848
00:51:27,558 --> 00:51:31,136
in two weeks 15 was congratulations.
849
00:51:31,248 --> 00:51:34,864
That is real information. All women, all ages,
850
00:51:34,912 --> 00:51:38,960
all genders. A really nice diverse group of women. So that
851
00:51:39,000 --> 00:51:42,512
is great. Yeah. Because that's the kind of basic work that we need that has
852
00:51:42,536 --> 00:51:46,368
been ignored. Right. Like, how do we not know this? It's like,
853
00:51:46,424 --> 00:51:49,824
oh, my gosh. Yeah. Yeah. There's actually an old
854
00:51:49,912 --> 00:51:53,200
study, I don't know if you've seen, where they measured the.
855
00:51:53,320 --> 00:51:56,672
In many women, the distance between the clitoris and the
856
00:51:56,696 --> 00:52:00,660
anterior vaginal wall and that, you know, leading to that whole discussion of why
857
00:52:00,700 --> 00:52:04,180
women cannot reach orgasm with penetration alone or
858
00:52:04,220 --> 00:52:07,380
when women can reach orgasm, maybe they have that shorter distance.
859
00:52:07,460 --> 00:52:11,172
Yep. It's really just clitoral stimulation during penetration
860
00:52:11,236 --> 00:52:14,452
that's happening. Clitoris. The other
861
00:52:14,476 --> 00:52:17,492
thing is the big thing that I always say too, when I'm showing the genitals
862
00:52:17,556 --> 00:52:20,692
together, male and female, is they said the penis is
863
00:52:20,716 --> 00:52:23,732
the clitoris. And the clitoris complex,
864
00:52:23,796 --> 00:52:26,404
it's the same as the penis. And we kind of look at the internal structures
865
00:52:26,452 --> 00:52:30,062
because again, I think all the women, it's like, mind blown. Like what?
866
00:52:30,166 --> 00:52:33,646
You know, like, I didn't know, you know, so it's,
867
00:52:33,678 --> 00:52:36,942
it's, oh, it's just basic. It's just, it's just the basics.
868
00:52:37,006 --> 00:52:40,530
And we're just, we're missing sometimes just the basic fund of knowledge.
869
00:52:40,870 --> 00:52:44,814
Women, I think, feel shame their whole life if they can't orgasm through vaginal
870
00:52:44,862 --> 00:52:48,206
penetration. And it's because they really need clitoral stimulation.
871
00:52:48,318 --> 00:52:51,710
So. Yeah, exactly. And I, I usually teach it to women
872
00:52:51,750 --> 00:52:55,134
the other way. Say, you know, if you were just stroking
873
00:52:55,182 --> 00:52:58,784
your husband's penis on the shaft and he Never touched the
874
00:52:58,792 --> 00:53:01,872
head of the penis. Yep, totally. I mean, it would feel nice,
875
00:53:01,936 --> 00:53:05,664
but you would do nothing for him, right? For many, that's what penetration
876
00:53:05,712 --> 00:53:09,168
is. Just. And they kind of have a life moment and they're like,
877
00:53:09,224 --> 00:53:12,064
oh my gosh, you're right. And I'm like, he needs to stroke the head of
878
00:53:12,072 --> 00:53:15,696
your penis. Yeah. What needs to happen? So totally true.
879
00:53:15,808 --> 00:53:19,376
We're just the same. We're the same animal, but just with
880
00:53:19,448 --> 00:53:23,200
our parts in slightly different areas, a. Little bit
881
00:53:23,240 --> 00:53:26,672
rearranged in different sizes, a. Little rearrange for a different function.
882
00:53:26,736 --> 00:53:29,612
But, you know, we can all get there if we just had little bit of
883
00:53:29,636 --> 00:53:33,628
knowledge. And that, you know, goes even back to teaching it correctly
884
00:53:33,724 --> 00:53:36,924
to kids, right? To younger kids. Oh, totally, totally.
885
00:53:36,972 --> 00:53:40,636
Well, when my kids were young, they, you know, their school had their sex education
886
00:53:40,788 --> 00:53:43,884
time. And I called up the director and
887
00:53:43,892 --> 00:53:47,612
I said, hey, I'm a GYN and a Eurogyn. I would love to
888
00:53:47,636 --> 00:53:51,692
teach your kids about proper anatomy. I'm a huge fan of using the proper words.
889
00:53:51,756 --> 00:53:55,452
Right. And stigmatizing the proper anatomical terms. And I
890
00:53:55,476 --> 00:53:58,814
said, let me talk to them. And they, they said, no,
891
00:53:58,822 --> 00:54:02,254
we haven't, you know, this is what we're going to talk about. Right? Was asking
892
00:54:02,302 --> 00:54:05,790
the kids to write down questions they had and answering them, you know,
893
00:54:05,830 --> 00:54:09,086
And I was like, yeah, that's. They don't know what information. They don't
894
00:54:09,118 --> 00:54:12,782
know. I know. Well, I have a quick, quick story.
895
00:54:12,886 --> 00:54:16,222
So my son, fifth grade, his family life, this was
896
00:54:16,246 --> 00:54:20,238
several years ago now, the very last day, this girl raised her hand and
897
00:54:20,294 --> 00:54:23,498
said, do girl have penises? The girls have penises.
898
00:54:23,694 --> 00:54:27,602
And my son, apparently the teacher tells me, my son sheepishly raises
899
00:54:27,666 --> 00:54:31,570
his hand like, oh, God, I can't believe I'm doing this. Right? And he says
900
00:54:31,610 --> 00:54:35,426
to the teacher, well, my mom's a vagina doctor. And she
901
00:54:35,498 --> 00:54:39,122
says that women have a penis like structure called the
902
00:54:39,146 --> 00:54:42,418
clitoris. I was like,
903
00:54:42,554 --> 00:54:46,050
that's it. My job is done. My life is complete.
904
00:54:46,210 --> 00:54:49,858
My son understands. And she calls me and she's like,
905
00:54:49,914 --> 00:54:53,246
in my 30 years of teaching, I have never heard
906
00:54:53,278 --> 00:54:56,926
that before. And that was so beautiful. She thought that was amazing.
907
00:54:57,118 --> 00:55:00,606
Thank you. You're welcome. I know. Hopefully we will have
908
00:55:00,678 --> 00:55:04,734
more of that. I'm the clerkship director for the FSU
909
00:55:04,782 --> 00:55:08,270
College of Medicine here in Florida. So I see all the third year medical
910
00:55:08,310 --> 00:55:11,534
students that come through and I, you know, I give them their weekly lectures.
911
00:55:11,582 --> 00:55:14,942
Obviously we have a syllabus. It's the same weekly lectures. And every time we get
912
00:55:14,966 --> 00:55:18,780
to the week where we talk about menopause medicine. I tell them this
913
00:55:18,820 --> 00:55:22,188
is going to be my legacy. I am educating a new
914
00:55:22,244 --> 00:55:25,468
generation of physicians. Do not be fearful.
915
00:55:25,564 --> 00:55:28,652
And just these things, you don't have to be an expert, but you need to
916
00:55:28,676 --> 00:55:32,284
send to an expert. And you have to make sure that we are giving women
917
00:55:32,372 --> 00:55:35,868
fair and balanced information and no longer fear mongering. I said that's
918
00:55:35,884 --> 00:55:39,404
going to be my med school legacy. This is my platform to get it
919
00:55:39,412 --> 00:55:43,164
done. I love that legacy. For you, for them,
920
00:55:43,252 --> 00:55:46,746
for women kind. I love it. Yeah, that's wonderful.
921
00:55:46,938 --> 00:55:50,602
You know, I started. My daughter is just turned 24 and I
922
00:55:50,626 --> 00:55:53,834
talk to her girlfriends all the time about things like this. And I just think,
923
00:55:53,922 --> 00:55:57,786
you know, I want more for them. I don't want them age exactly,
924
00:55:57,898 --> 00:56:01,786
having disease and having dementia and. And fracture or osteoporotic
925
00:56:01,818 --> 00:56:05,210
fractures. I want them to know and demand more because, I mean,
926
00:56:05,250 --> 00:56:08,602
I know that my generation didn't. And we just kind of did what we were
927
00:56:08,626 --> 00:56:11,892
told to a degree. Right. But I'm proud of
928
00:56:11,916 --> 00:56:16,004
them for pushing it, you know, and I want to contribute to that 100%.
929
00:56:16,092 --> 00:56:19,412
I couldn't agree more. Great. Thank you so
930
00:56:19,436 --> 00:56:23,268
much for taking time. This is really wonderful. We'll definitely have to do more
931
00:56:23,324 --> 00:56:26,240
about, you know, I mean, there's so many more topics to.
932
00:56:26,700 --> 00:56:30,132
We do one just completely on the clitoris. Oh, my gosh. I would love
933
00:56:30,156 --> 00:56:34,420
that. I would love that. Thanks so much for listening to today's episode.
934
00:56:34,580 --> 00:56:38,548
No information from this recording is intended as a diagnosis or treatment
935
00:56:38,644 --> 00:56:42,292
for any disease. If you are enjoying the show, please subscribe
936
00:56:42,356 --> 00:56:46,132
so you don't miss any of our exciting episodes. And we love
937
00:56:46,156 --> 00:56:49,780
to hear from our listeners and will be grateful for your positive review. We'll talk
938
00:56:49,820 --> 00:56:50,140
next time.