The Home Secret to Better, Sleep, Mood & Energy

In this episode, host Emily Brewer, DCNP, welcomes a special guest, Laura Chastain, NP, to unpack one of the most misunderstood topics in women’s health: hormones. Together, they dive into the real-life challenges of PCOS, perimenopause, and hormonal imbalance, and why so many women feel like they're not being heard or helped.

From common symptoms like brain fog, mood swings, and irregular periods to deeper conversations around hormone replacement therapy, insulin resistance, and fertility, this episode clears the confusion and offers science-backed, compassionate insight. You’ll also hear about natural supplement options, the role of lifestyle, and why patient-led care and shared decision-making matter so much.

If you’ve ever said “I just don’t feel like myself,” this episode is for you.

For more information, visit www.thedermcentertn.com or schedule an appointment here

Transcript

SPEAKER_00: 0:00

They were discussing kind of bringing some of this information out to the media, and they were like, wait, this is going to let the genie out of the bottle. We might not be able to get this genie back in. There was a study done looking at this phrase, I don't feel like myself. And that phrase was Googled over 5 million times.

SPEAKER_02: 0:16

That is such a powerful statement, too.

SPEAKER_00: 0:18

And I hear it every single day. We're seeing a lowering of testosterone levels across the board. When men come in with low testosterone levels, the one thing I'm really looking for is mood and brain. We see men struggle with brain fog, lack of motivation.

SPEAKER_02: 0:40

Laura, thank you so much for being here today.

SPEAKER_00: 0:42

Thank you for having me. This is super exciting to get to be on this end of the microphone. I know, we've switched since last time we

SPEAKER_02: 0:48

did a podcast together. So today I'm excited to talk about a topic that I feel like Sometimes in the healthcare arena, just it doesn't get the attention that it deserves sometimes. Absolutely. Today we're going to talk about hormones. Yes. So tell me, you know, when it does come to hormones or hormone replacement, why do you feel like that could be an area that just doesn't really get the attention that it deserves?

SPEAKER_00: 1:13

Well, I think there's a lot of reasons. I think it did get some attention back in the late 90s, early 2000s with the Women's Health Initiative. And it got some negative attention around that study. You know, the NIH spent$1 billion on that study. So it wasn't something they wanted to let go of real easily. For sure. And they were like, wait, this is going to let the genie out of the bottle. We may not be able to get this genie back in. Oh, wow. When they were looking at things about breast cancer and heart attack and stroke. And the principal investigator had even been quoted saying earlier that he wanted to put the brakes on hormone therapy. So I think for a long time, hormone therapy has been seen as a negative. But we are seeing a rewriting of this story with the introduction of, well, first of all, just going back and looking at that data. And then some of those claims are being restated. Yeah. because these women were much older it was synthetic versions so we really are now seeing that come to the forefront and it was with the writing of a book called estrogen matters we talk about it all the time in our clinic but it was a breast oncologist that actually he treated breast cancer for years and his wife got breast cancer wow so it's very personal for him yeah absolutely and she went through treatment and because of her treatment was was put into menopause and then she was so miserable with her symptoms she told him i'm going to take hormones and he said absolutely not you're not you know know it leads to breast cancer because he was relying on those older findings and so

SPEAKER_02: 2:59

I think still do

SPEAKER_00: 3:00

yes absolutely and it's a very complex issue we don't you know make light of it at all but we do have to look at the science behind that and that's what exactly what he did he went back and he looked at that trial and that's where he saw you know these risks were not reported accurately these were much older women they had other comorbidities and he wrote a book called estrogen matters and it's his name is Dr. Avram Blooming and so he really kind of got the ball rolling Yeah, absolutely.

SPEAKER_02: 3:37

So I know in the dermatology world, I mean, we get a little bit into hormones just with some of the things that we see. Acne, certainly, we see a lot of hormonal acne, we call it. PCOS is something that comes up, polycystic ovarian syndrome. We see that as a very common occurrence in the dermatology world. What's interesting, though, about PCOS is, you know, so many patients, once we kind of dive into, you know, how long have you had it? What were your symptoms? How have you been managing it? It actually will come out that patients will say, well, you know, I haven't officially been diagnosed with it. My doctors just think that I have it. Right. Is it difficult to actually diagnose it?

SPEAKER_00: 4:16

It can be because it can be present, you know, it can present different ways. And then, you know, I worked in a GYN office for about 15 years. So we got to know each other. Exactly. So, but that's how, and I referred a lot of people to you and vice versa. Yeah. Yeah. Um, but you know, people would come into the GYN office with irregular periods and we would be like, you have PCOS. We didn't connect the pieces a lot of times that this is also mean that you probably have low lying inflammation. You have some insulin resistance. You might have acne, abnormal hair growth, mid abdominal weight gain at the root of PCOS is something inflammatory, you know, or insulin resistance. And it can be caused from lots of different things, genetics, environment, our lifestyle. And so it's not just one little one size fits all. It's not like you can just check a lab or do an ultrasound and there you go. Well, we do get some like findings on ultrasound. Like we'll see like at the string of pearls sign where you have follicles around the edges of the ovaries that lead us to be suspicious for PCOS. Do you

SPEAKER_02: 5:20

always see that though, even in the presence of PCOS?

SPEAKER_00: 5:24

No, Not always, you know, but you'll see elevated androgen levels. You have to have two out of the three to get this diagnosis. So elevated testosterone, irregular periods. And so a list of symptoms will then help us to determine, yes, this is PCOS. We look at labs. We look at the pituitary hormones, LH and FSH, and those should be in an appropriate ratio. And when they're not, then we say, this may be PCOS we're looking at. It doesn't really affect whether it is or not. It doesn't really affect how We're still looking at insulin levels and testosterone levels and progesterone. And really, we find that progesterone is low in those women. And so sometimes if we can come in with some cyclical progesterone, we can normalize periods. We can help them, you know, feel like some of their symptoms are under control and get that ovulation back into a healthier state. There's some supplements we can recommend as well. And so we kind of look at it from all different angles, lifestyle, exercise, diet. So those are all helpful when we're looking at trying to control those things that are sometimes really difficult for the patient.

SPEAKER_02: 6:31

Yeah. So you touched on it for a second, just with fertility. So 70 to 80% of women with PCOS, what I read, I believe earlier today, actually, it said that they struggle with fertility. Why is that the case with PCOS?

SPEAKER_00: 6:44

Well, you have low levels of progesterone from lack of ovulation. So we just have unhealthy ovulation. So two things we have to have for conception is healthy sperm and ovulation and healthy eggs. And so when you're not ovulating regularly, then fertility becomes much harder to achieve. That makes sense.

SPEAKER_02: 7:05

So in treating PCOS, obviously we love to have the hormonal approach because that seemingly is the best way to get things under control. But for patients that don't want to go that route, that are looking at things like supplements, a natural alternative, what does that look like for you?

SPEAKER_00: 7:22

So there are some supplements that will tar get that inflammatory process that's occurring around the ovary. And the best one that I have seen in studies and research would be a combination of myoinositol and d-chiroinositol. And there's some supplement products by Thorne. It's called Ovarian Care. And then there's another one called Sensitol made by Designs for Health. There's one called Ovisense. These all have the appropriate ratio of the inositol products in them that help to support healthy ovulation and blood sugar stability so some of the things that we're really trying to manage and there is a long list of other supplements depending on the symptom that we're trying to manage around very patient specific it is very patient specific you know a good magnesium to restore great sleep you know because our hormones are highly impacted by basically four or five things there's a prominent urologist I love to listen to Dr. Cara and he says you have these four pillars of hormone health they are diet Diet, exercise, sleep, and stress. just hormone health in general in men

SPEAKER_02: 8:55

and women. So in the introduction of these GLP-1s, especially for patients with PCOS, metabolic issues, insulin resistance, how have you seen the positive impact of what those have brought to the market?

SPEAKER_00: 9:09

You know, they get a bad rap in the media sometimes. They do. I don't understand it. There seems to be some negative connotation around the use of them, but in this specific population alone, I have seen such great results because we use metformin a lot for PCOS and insulin resistance but metformin is not always tolerated and you know there's a lot of GI side effects that can go along with metformin berberine is another great option that's a supplement that is similar to metformin and so we see both of those used but to really with the the effectiveness of the GLP-1s in this population for weight loss and for lowering the insulin levels is significant and therefore what we see is some return of ovulation with these patients. So if we can break that vicious cycle of high insulin, low progesterone, no ovulation, I'll give you a case example. I had a patient who had a baby early in her, I think she was in her 20s. She had a child. And then she went about 18 years with little to no period. Wow. And had tried to get pregnant for about 18 years. And then she was in her early 40s, had been on a GLP-1, had lost some weight. because we, again, restore that insulin sensitivity by lowering those insulin levels. And so it's targeting that insulin resistance. And she was one of our patients. And then she said, you know what, I'm going to try to get pregnant now because my periods have come back after about 18 years of very irregular cycles. So that's yet to be seen whether that happens. But, you know, it restores some of that ability to think and give hope to a population that has really struggled. And we are just fighting these challenges with them and they're you know trying to fix lifestyle diet stress and sleep to kind of target that so it's just another tool in the toolbox yeah it's not a magic bullet you know nothing we do for our hormones we all have there's tools you know and so it's a complex multifactorial issue when we're trying to manage or balance hormones

SPEAKER_02: 11:14

I've seen incredible results with patients that have gone down the road with the GLP-1 products and you know it has seemingly really impacted their lives in a positive way so I'm sure not for everyone. Right.

SPEAKER_00: 11:25

Right.

SPEAKER_02: 11:26

It is something that I think can be very effective.

SPEAKER_00: 11:28

It's definitely something you should, you know, or you could consider. Absolutely. Given your family history, your personal history. So it's not all negative. We see really great positive results from these two. For sure. So let's move a

SPEAKER_02: 11:40

little bit into the perimenopausal. group. Yes. Talk a little bit about the age group that we're talking about with perimenopause.

SPEAKER_00: 11:49

Okay. It's probably my favorite group. Yeah. I'll just say that because for years, I saw women change over the lifespan. Being in a GYN office, seeing women from age in their teens up into their 70s or 80s, I saw a lot of change happen even before I got there myself. And so I knew that this was a really difficult time for women. And we didn't have a them, yeah, looks like you might be in perimenopause. And they would say, well, what does that mean? What do I do? Well, you know, we didn't really know. We didn't really have the information to give or the encouragement to give. So I saw a lot of frustration. And so for me personally, that is a great age range. I feel like we see great results. But the age that we think about with perimenopause is 45. Most women are there by age 45. Most are there earlier. And I'll say that because the average age of menopause is 51. So we back that up by 10 years. And it really is highly dependent on when your mom went through menopause.

SPEAKER_02: 12:53

Interesting.

SPEAKER_00: 12:54

That is the strongest indicator of when you will go through that as well. So you're getting all of that information when you're being carried in the womb. And so what your mom does in her pregnancy is affecting your ovarian health. You're born with the amount of eggs you're going to have for your life. And so we get that, you know, genetic code from our mom for how we're going to go through menopause most, you know, mostly. And so if your mom went through earlier, then you can back that up by 10 years. And that's possibly when you're going to start seeing some perimenopausal changes. So

SPEAKER_02: 13:26

you're saying the age that your mother was at less 10 years. Wow. Yeah. I mean, yeah.

SPEAKER_00: 13:31

And that's not always the case. It's going to vary depending on lifestyle and some of the other things that, you know, we do. But that's a good indicator as to when you might start to experience experience perimenopausal changes. What would those symptoms be? There was a study done looking at this phrase, I don't feel like myself. And that phrase was Googled over 5 million times.

SPEAKER_02: 13:53

That is such a powerful statement, too. And I

SPEAKER_00: 13:55

hear it

SPEAKER_02: 13:56

every

SPEAKER_00: 13:56

single day. It can be mental. It can be physical. I mean,

SPEAKER_02: 13:58

that can mean a lot of different things.

SPEAKER_00: 14:00

I've already heard it this morning. My first patient in the morning, you know, listening to her story. And she says, you know, I just don't feel like myself. And so that is my key that we've got to look to see. And I already have some clues based on age. in other symptoms but when I hear that I'm like okay let me tell you about this study that they looked at that phrase it was googled over five million times and they correlated that with a list of multiple symptoms the average age that googled that was 47 okay so you know I mentioned earlier 45 is an often times when we see we know someone's in perimenopause I see early 40s a lot in my office with these symptoms so we know it varies greatly but there were about five areas that they kind of narrowed that down like what does that mean I don't feel like myself well that's your sleep okay brain fog joint pain and inflammation or body aches low sex drive and then usually like mood anxiety so we see mood changes so PMS will worsen but what's happening in perimenopause is we're seeing progesterone levels fall so progesterone falls and that's your mood stabilizer that's what's helping you feel like all is well in the It's considered the happy hormone. It's what helps you get through a good night of sleep and feel like you're rested the next day. So when you hear I wake up at 2 a.m. or 3 a.m. and I can't get back to sleep, I'm thinking about the emails I need to return or this child needs to get to this practice. You know, just your to-do list starts. Yeah, yeah. Yes, yes. Then you finally get back to sleep and the alarm goes off. And so then you feel tired and exhausted the next day. So that's perimenopause. And so we see those symptoms in a regular periods often will follow that but sometimes we see these symptoms first and so the progesterone falls often see we oftentimes we see testosterone fall as well but then what's really happening is we are having erratic estrogen levels and we don't always see that on labs because if I check your labs when you're having a good month it'll look normal and that's why you'll hear well your labs look normal

SPEAKER_02: 16:09

that is so frustrating I know that patients get so frustrated with that and I've seen said it to patients. It feels so discrediting. You know what I mean? It feels like something's wrong with me. It's frustrating because you know yourself better than anyone else, any practitioner is ever going to know you. And it is very frustrating to feel like I have all of these symptoms, but all of my blood work is normal.

SPEAKER_00: 16:33

What the

SPEAKER_02: 16:33

heck? There has to be something.

SPEAKER_00: 16:35

There has to be something. So I often tell patients, I'm probably not going to see this on your labs right away. We will see it. But this is from the clinical literature and from these studies, we know this is happening based on your age, based on your symptoms. And that phrase, I don't feel like myself, it helps us as providers to have some confidence in offering, going ahead and offering some options to a patient, knowing that that correlates highly with perimenopause. Yeah. So

SPEAKER_02: 17:01

in thinking through options for these patients, what does that look like? Do you go with hormones? Do you go with natural alternatives? I actually saw a post on your Instagram recently where it said birth control is not hormone replacement. Right. Right. So birth control in this, you know, 30, 40 age range, is that something that's considered for these patients?

SPEAKER_00: 17:22

Well, it can be. Or hormone replacement. Right. So it can be. It's definitely not the same. If you think about a birth control pill and the ingredients in that, it's the synthetic versions of estrogen or progestin, not progesterone. So these are not your natural bioidentical hormones. These are not what our body produces. These are synthetic versions, like similar, not... In the same way, but similar to what was studied previously, those synthetic versions. And so it's those, they kind of take over the system. If I check hormone levels, I'm going to see... very distinct levels that kind of signal me that signal to me that this patient takes a birth control pill and it's because their natural own hormones are not being portrayed in that lab report I'm seeing the birth control pill right so in this age range you can still ovulate so birth control is needed you can still get pregnant right so a lot of times that is offered for birth control but it is not treating the hormonal concern or the hormonal cause you know and so So you have to decide, what am I going to do for birth control during this time if needed? It's such

SPEAKER_02: 18:30

a difficult age range. I mean, aside from the perimenopausal issues, I mean, technically, like you said, you can still get pregnant during perimenopause, even if you're having your regular periods, right? So that is a challenge because for a long time, even for myself in school, it was a thought of, okay, if you've got a patient that's 35 plus, birth control is not an option for those patients because it's a risk, a stroke risk. Right. So it is It's hard to know at that age what to do,

SPEAKER_00: 18:57

what to do. And so you have to think when, when I went through school, we had less options for birth control. There are a lot of different options for birth control now, much lower doses. So I often will sometimes transition a woman off of a birth control pill onto hormone replacement therapy. It, the difference is it is bioidentical. The doses are lower and it often targets those symptoms that we're really struggling with.

SPEAKER_02: 19:21

Right.

SPEAKER_00: 19:22

And it's our own, it's chemically structured like our own hormones. When we say bioidentical, or body identical those are the same thing and it's the chemical structure is just like your own and so it's not made from a synthetic source and we just tend to respond to those in more positive ways sometimes right plus then I can see their hormones on labs I know what's happening at the level of the pituitary or the ovary when I look at hormone levels if we're using bioidentical versions so in perimenopause we offer oral progesterone it's a capsule you you take it bedtime. It promotes or stimulates GABA in the brain that helps to promote that calm, deep, restful sleep. So you feel restored the next day. You're not waking up at two and three in the morning. You're getting that good night's sleep. It's great for mood. It's great for anxiety, that happy hormone. It takes the edge off, helps you to feel good night of sleep alone. I know. I know. I know. I know. And you know, the best part of my day is when someone texts me and says, you put me on progesterone. You You said it would take two weeks to see a result. And that's, I think, a general phrase we all say, right? You know, take this for two weeks and let me know. She said it took two nights. And she sent me her sleep score. And it went from 70 to 93. Wow. It's actually a measurable improvement that she had. Well, she was like watching her sleep score. That's amazing. She said this is what it has done for me. It has really changed my life. So progesterone is powerful. And it's so helpful in perimenopause. The other thing we often do is look at testosterone because there was a study that looked at Minus estrogen and progesterone, just adding testosterone to women. And they did it in the form of a transdermal. During perimenopause. Yes, during perimenopause and menopause, I guess. I don't recall the actual age of the patient, but menopausal woman in that transition phase. They looked at 12 indicators for mood, just mood alone. They kind of took out like body composition, weight gain, sex drive. Right. They just looked at anxiety, irritability, crying, feeling overwhelmed, all the things that we kind of described during that time

SPEAKER_01: 21:31

and

SPEAKER_00: 21:32

they gave testosterone for four months to these women and then at the end of the 12 or I'm sorry the end of the four months they looked at those 12 parameters again they had all improved every single one of them not one had gotten worse and so impressive unfortunately there's not a lot of studies around testosterone in women we're getting more we're looking at testosterone in the brain how it improves gray matter in the brain how it improves blood flow to the brain in perimenopause and then in menopause also but We're looking, you know, we have a great neuroscientist in this kind of realm of menopause looking at hormones in women's brains. And so she had a study just this year that came out looking at that. So we see all these positives around using both progesterone and testosterone in perimenopause. And then as we get closer to menopause, as we're watching those estradiol levels change, we'll come in and give a small dose of estradiol when it's time. But it's the last one to the party. It's the last one that we add to the picture because of those erratic levels there's months you're going to be making estradiol and it's going to be normal. So we don't want to give you estradiol during that time, you know. You're making your own. We only want to come in with that when we need

SPEAKER_02: 22:38

to. That makes sense. It's interesting just in the dermatology world seeing patients when they come in and they are taking testosterone and, you know, they come in and they're struggling with some symptoms that are associated with testosterone use. Increased cystic acne. They'll struggle maybe with some facial hair. They're losing hair on their scalp. And it's a difficult conversation honestly to have with these women because they feel so much better taking the testosterone and you know sometimes those symptoms can only really improve by discontinuing the testosterone or lowering the dose and that's a really hard conversation to have because it's one of those moments where it's like well you kind of have to have to pick in some ways what are we wanting

SPEAKER_00: 23:20

what are we wanting to treat absolutely and I think that's why it's important to have someone who specializes in hormone therapy because there are ways we can dial that down we can change the form we can change the dose we can change the location of where you apply the cream you know

SPEAKER_04: 23:37

there's

SPEAKER_00: 23:37

a lot of things we can do to mitigate those symptoms or side effects and honestly in my office I don't see too many thankfully if I see anything it's usually acne and I often tell patients I'm wanting to go low and slow with your dosing because there's a sweet spot there's a place you're going to respond without a side effect especially in women you know men tend to tolerate these higher doses better and tend to do really well with that and that's a whole other subject yes for women we don't need as much But we do need some. A little. A little helps. It helps with stamina. I explain it's not a superpower. We're not going for super physiological doses or levels. We're going for that stamina that you had before. We go through this transition and we're exhausted. But we have learned to power through as women. That's so true. We're still going to take care of the people

SPEAKER_02: 24:31

around us. Which I think, honestly, is exactly why I think these symptoms get overlooked. Or they just get dismissed as, oh, well, you're busy. This is part of life. It's part of life. It's part of life. This is normal. That's right. You've got a lot going on. And while that all is true, there are these underlying things that are still happening too that there is help for.

SPEAKER_00: 24:50

Absolutely. And if a patient has testosterone side effects, there are some things we can give in addition to testosterone if we can't figure out a way to lower that dose where they still want to get that, like using spironolactone for facial hair. We use that. irregardless of testosterone sometimes. You know, we use that for just like the peach fuzz that develops on the face and the thinning of the scalp hair. You've helped me with that. That was your topic on my podcast. Anyone who

SPEAKER_02: 25:21

knows me knows that spironolactone, it's great. It works and it's effective. I did not realize though that taking the spironolactone with the testosterone

SPEAKER_00: 25:31

could be

SPEAKER_02: 25:31

beneficial. My mind always kind of thought it might be canceling

SPEAKER_00: 25:34

out. Yeah, and it doesn't really not in a menopausal woman. So it's kind of buffer those side effects that still give you some benefit with testosterone I

SPEAKER_02: 25:42

love that

SPEAKER_00: 25:43

and then you know acne you know can be caused from multiple things you know like I got acne going through menopause and I wasn't even taking testosterone you know it's just like the change of our skin I was like what's happening yeah didn't get it in puberty so you know there's multiple factors I guess is what I'm saying around symptoms a lot of times and teasing that out working with someone who will spend the time to tease that out and dial in your dose dial in your labs give you a precise you know prescription plan that's unique to you is so important if you if you want to live optimally right without having to deal with some of these challenges

SPEAKER_02: 26:26

right you know right right that's what I love about being able to have you know someone like yourself who I can call on with a patient and say hey I've got this patient taking testosterone but they're having some acne and and then being able to have a collaborative approach with a patient. Absolutely. That is everything.

SPEAKER_00: 26:44

Well, and hormones need to be looked at in a collaborative fashion. Absolutely. I don't think they have been. In health care, we've not done really well at combining specialties. I agree. We've siloed health care in general. But hormones especially, there's 300 estrogen receptors in a female's body. So it affects everything from their hair to their skin to their teeth, their joints. Yeah. And so... I follow many, you know, thought leaders in this realm and read lots of information. And so a lot of my information comes from other specialties like orthopedic surgeons and urologists and dermatologists, you know. And so it's important that we look in all these specialties and find, you know, the solution for women because frozen shoulder, for instance, will show up in an orthopedic office. Well, that's often seen in perimenopause, menopause. Frozen shoulder. Did not know that. No way. Yes. Inflammatory markers go up when we go through menopause. And so we see more arthritis, more inflammation in general. And a lot of times that's a sign that the hormones are falling. So sometimes if we come in and treat from a hormonal perspective, of course, we still have to address the frozen shoulder,

SPEAKER_02: 28:02

you

SPEAKER_00: 28:03

know, but hopefully we can kind of buffer that and make that a little bit better outcome in general. But there's a lot of overlap in these specialties and just getting the education out there and creating some awareness around this is one of our passions you know it's one of my passions it's what i had to do it for myself when i kind of faced some of these changes in my own life so i'm kind of like walking through this myself too and then it's what i have to do for my patients because you know we can't silo health care where our bodies are so

SPEAKER_02: 28:35

connected absolutely in fact i'll tell my patients you know if there's a question and it involves you know a question about hormones that i don't know the answer to i'll tell them you know i don't know the I know that answer, but I will find someone who does. Yeah, exactly. Same here. And, you know, we work together to get those answers for our patients. Yes. And that's, I think that is what makes healthcare strong. Absolutely. Certainly, it puts the patient at the center of it as they should be. And our community's strong,

SPEAKER_00: 29:00

you

SPEAKER_02: 29:00

know. It does. It helps

SPEAKER_00: 29:00

create, you know, collaboration. Right. And, you know, the American Urology Association just came out with some guidelines around vaginal estrogen, for instance. And, you know, you don't think about urology and vaginal estrogen, but with urinary symptoms that we see change in this menopausal, these menopausal years like leakage or overactive bladder, prolapse, recurrent UTI. They literally just the week came out with some guidelines. Wow. The number one statement that caught my attention was that whatever, what we're doing as specialists and in this realm, it should be in shared decision-making with our patient. And so that is like the number one guideline. And so whatever you do in your life for, for your healthcare, shared decision making, find someone who will let you share in that decision, give you the tools you need to educate yourself and empower you to go make a decision that you're confident with.

SPEAKER_02: 29:53

I love every part of that because I approach it the same exact way with my patients. You know, it's not my responsibility to tell them what to do. Right. You know, I love to present the options and put together different plans and say, here's what's available. Right. And they can make decisions that are informed and are based on fact and they Data and education. I think that's very important for the patient to be involved. Absolutely. And then they can leave in

SPEAKER_00: 30:20

peace. Absolutely, yes. There's so much confusion in the hormone world. There's so many terms. First of all, there's different options, different ways to take it. Everyone will have an opinion or an experience that they'll want to share with you. And so then to tease that out and make your own informed decision is important. I brought this book today, Emily, this Estrogen Matters book that I referenced earlier every woman every woman in their mid 30s late 30s early 40s needs to read this yes or listen to it on audible this is going to tell you the story behind hormone therapy and why your grandmother may not have taken that

SPEAKER_02: 31:01

I love this because on the very cover it it talks about exactly what my personal concern always has been and you know to some degree still currently is around this breast cancer situation so many women women, I think we're going off of this old data, this old information. And when we think about hormone replacement, the first thing that comes to mind is, well, I don't want breast cancer, so I'm not going to do that. Right. So kind of jumping to the menopausal stage, talk a little bit about for the women who are seeing these levels of hormones decrease over time that choose to not have any hormone replacement. What could the negative impacts of that decision look like?

SPEAKER_00: 31:42

That's a great question. In fact, I often And. remember or try to remember to tell patients if you decide against hormone therapy you're also making a decision that's right and so first it's the acute symptoms we have to you know figure out well how are we going to deal with our brain fog or our hot flashes you know or vaginal dryness or whatever the case may be but then we have to think about some long-term health conditions that we often don't see show up until like 10 years past menopause and then it's all it's not too late But it's a little more complex. You don't want to ever feel like you're behind. Right. You know what I mean? You are a little bit behind. And the decision is a little bit harder to make because we've lost some of those benefits of hormone therapy. And that would be around your brain, heart, and bones. Estrogen is FDA approved for the prevention of osteoporosis. So osteopenia, osteoporosis prevention, that's one of those things. musculoskeletal symptoms of menopause that i was referring to earlier like arthritis and inflammation where you have the bones for instance we have to think about so then we have you know the brain for years women were told well hormone replacement may worsen or lead to dementia well that was based on these old trials and again much older women different versions now there's a neuroscientist that literally came out with a book last year called the menopausal brain and she's looking at the activity of estradiol in the brain and she developed a tracer to be able to determine the level of estrogen in the brain. And what she found was that when you go through menopause, that 10-year transition time, these receptors get really active. And she said it's as if they're starving for estrogen. And so why is this important? Because there's two times the rate of Alzheimer's disease in women. There's two times, I believe, the rate of brain tumors, brain inflammation, dementia in women. Women are twice as likely to get some brain disorders. And so she is a neuroscientist, Dr. Lisa Moscone, out of Arizona who is looking specifically at female brains and she's dedicated her life to this work. And so she's written these books around estrogen in the brain. So we have to think about our brains and then we have to think about our heart. Heart disease is the leading cause of death in women ahead of breast cancer. Right. And so, and not to, again, not to minimize that, you know, breast cancer is a very real concern. You know, the rates are high, but there's multiple factors around that too. So when we think about heart disease alone, as I mentioned, heart, brain, and bones, that's kind of where we focus as far as the benefit of estrogen. So if we don't take estrogen, then we think about the changes in cholesterol panels, the plaque development in the heart, the arteries around the heart, and then worsening insulin resistance. When we lose estrogen, we lose the ability to process carbs and sugars as well. We lose some of our insulin sensitivity. So insulin resistance, increased cholesterol, heart disease, all of those become a real concern as we age. And sometimes women don't see this until they're past that 10 year mark. And then they're thinking, Oh, maybe I should have, yeah, maybe I should have treated earlier. You know, if we don't treat perimenopause in the perimenopause timeframe, then women will come back to us with some comorbidities about five to 10 years later. Wow. That's significant. Yeah. Yeah, it is. And so if we don't decide to do hormones, which not every woman decides that based on other risk factors, family history, personal history, then we've got to really target those areas a little more specifically. And I had one patient say, yeah, my doctor said, do you want to be on 10 meds or do you want to take hormones? And I don't use that analogy because that's not always the case, but that is something that we have to think about you know as we're making this decision

SPEAKER_02: 35:33

absolutely and definitely on the front end of it yeah not the reactionary part of it right you know right right so for women who choose to not go the route with hormone replacement who are looking for things that are more naturally found yes what do you recommend for those patients do you treat really just by the symptoms or are there things that they can take preventatively

SPEAKER_00: 35:54

you know I asked this question too when I went through menopause I really did not want to take hormones that's my personal story excuse me I really wanted to go the natural route and I went to a specialist a hormone specialist and I asked that question and she said Laura nothing's going to replace your estradiol so I still didn't do hormones right away you know I had to think about it I had to educate myself so we work a lot with nutrition world and we you know promote them in our clinic because we have a lot of the same philosophies we're not aligned to them business wise but we rely on them to be the supplement experts in this area. And they recommend four basic supplements for all people. And that would be an omega-3, which is your fish oil, a vitamin D3 with K2 for bones, magnesium glycinate, which helps with mood and not, I shouldn't say cognition, helps with mood and sleep and just recovery. There's like eight different kinds of magnesium, but that one specifically, and then a multivitamin to get those basic minerals that you need. Also, we are big proponents of weight-bearing exercise Getting good quality sleep, you know, lowering your endocrine disruptors, all the things I talked about for hormone health. It's not going to replace your estrogen. You're still going to face some challenges. But, you know, can it be done? Yes, people do that and do decide that. So you just have to know that you might be looking at some other comorbidities as you age.

SPEAKER_02: 37:20

Weighing risk and benefit. Absolutely. It's a tough decision. It is. Because I don't know. It's so funny when you think about the decision to take hormone replacement. It feels like something that's going to happen. such a big scary decision in many ways but then at the same time it's like you know especially with these new GLPs that have come out onto the market most people don't even think twice you know what I mean it's like oh great yes let's inject that or a birth control pill it's kind of like yes let's make that decision and do it but for whatever reason with hormone replacement it feels like such a much bigger decision to make it does and I think it's because of

SPEAKER_00: 37:52

those original trials and then lack of education and so you know we love to get out in the community and talk about, you know, the latest findings in hormone health. In this area, there are new studies coming out all the time. Yeah. And so we're seeing, you know, new data around brain health, inflammation, inflammatory markers, autoimmune conditions, things like that that we see become more prominent in that transition time.

SPEAKER_02: 38:18

Yeah. So let's switch gears just a little bit. Yeah. Let's talk about men. Okay. Because with hormones, it's easy, especially as women, to kind of let that be our focus. But Hormones affect men too. I think about what the symptoms are and when to start intervening. Talk a little bit about that. Okay.

SPEAKER_00: 39:07

So men in general have, have lower testosterone levels now than they did, let's say a decade ago. We've seen a lowering. they aren't really sure other than possibly the endocrine disrupting chemicals that we are faced with in our foods and our daily products. That's scary. It is. It is. And so those are powerful, even just in the plastics. You think about just what you use every day. And so we're seeing a lowering of testosterone levels across the board. And so when men come in with low testosterone levels, the one thing I'm really looking for is mood and brain. Testosterone is a brain hormone. We see men struggle with brain fog, lack of motivation. Um, they say

SPEAKER_02: 39:53

age, what age do you see this starting?

SPEAKER_00: 39:55

It depends. It's typically in the forties, late thirties, early forties, but it's not like a woman. We don't have like a timeframe specific. It's decade over decade. You'll see a lowering. And so we've often said it'd be great if we had a baseline to go by in men, you know, like a 25 year old man to get his testosterone level check just for a baseline alone would be nice to have because then we know what to compare that to interesting because

SPEAKER_02: 40:23

even when you draw a testosterone panel on a male the normal range is so vast it's big it

SPEAKER_00: 40:29

is so big yes 264 to 916 is considered normal that's a huge range huge range and so if you have a 300 you're normal or if you have an 800 you're normal right but I can promise you those two do not look the same in a clinic you're right and so we see the same sort of thing the brain fog the lack of motivation the mid-abdominal weight gain, the difficulty with recovery from like if you're going to go work out, then you might not recover as well.

SPEAKER_02: 40:53

Oh,

SPEAKER_00: 40:54

interesting. You might need more rest. You might need more time to kind of let– your body be ready for the next workout kind of thing you know and so just being able to have like make executive decisions we see that change you know I have a gentleman that comes to see me and he wrote me a note and said you know or did a little review for me and said you know what I've been able to start a business since starting on testosterone he said I could not get off the couch before so that's why I say it's a brain hormone in a lot of ways because we see it impact the ability to make decisions be motivated you know kind of like seize the day sort of thing. But along with that, we see changes in cholesterol panel. We see insulin resistance worsen with low levels. So the metabolic condition of the man worsens when we have low levels. So we can replace that or we can restore it depending on the age of the man. So like if we had like a 20, let's say we had a 28 year old come in and have low testosterone, which I've seen, you know, and a lot of times it can be lifestyle dependent, you know, like they're not eating the right foods they're not getting sleep they're staying up late maybe you know with their friends or playing video games or you know all those four pillars i talked about they're not in place you know and so they have low levels but let's say one day they want to have children well then we don't want to give testosterone necessarily why is that that can impact fertility okay and so you know it's one of for not for women but for men it will over time kind of turn off those signals in the brain where the body says oh i need this testosterone because i can't produce my own

SPEAKER_02: 42:30

that's very important i think because there is all of this now interest i think in males at a younger age wanting to explore testosterone and i think that's a very important thing to understand is while in your early 20s maybe you want to have that increase in testosterone that can have long-term negative side effects too

SPEAKER_00: 42:48

yes absolutely it depends on the length everybody is so different in the way your body responds to it and depending on the length of therapy but if a if a man says you know i want to have children, then we will offer some options for restorative therapy. Okay. Some things we give like clomiphene or HCG that impact the directly the LH or the pituitary or the hypothalamus to get those messages to the body to say, improve the testosterone. And those are very effective for that. And then in that timeframe, I always, always, always talk to them about, let's look, let's work on your lifestyle. You don't want to have to be on this for forever. You know, let's look at ways we can improve your testosterone So

SPEAKER_02: 43:28

this is something used for short periods

SPEAKER_00: 43:30

of time? for women, you know, but a much higher dose, much higher dose. And so we do that and we monitor levels regularly and we see such great improvement in body composition, energy levels, libido, all the things that we see improving women, we see improving men. That's amazing. Yeah.

SPEAKER_02: 44:15

I had an interesting situation with a patient one time. I saw this woman, we were treating her acne. She was coming in and it was very, you know, hormonal type acne and very much like what I would see in someone who is taking testosterone. testosterone or you know whatever and we kept asking her you know are you taking testosterone she was like no I'm not we checked her levels she was elevated all signs pointing to that she was taking it long story short her husband was actually using a testosterone gel yeah she was touching it so inadvertently she was taking testosterone she just didn't

SPEAKER_00: 44:49

realize it and that's a caution we always give to men absolutely yes that if you are going to use a transdermal product like a cream or a gel you You've got to be careful about where you put that and when you use it. Yeah, all those things.

SPEAKER_02: 45:04

So as we sort of wrap this up, so if you could have one take-home message for the people that are listening as it pertains to hormones, what would that be?

SPEAKER_00: 45:15

You know, I think it's hard to narrow that down to one. Maybe I'll give you three.

SPEAKER_02: 45:20

I'll take

SPEAKER_00: 45:20

three. I think for one, we've got to look at the way we live our lives on a daily basis. You know, it's not just a one decision kind of trumps all, but in our lifestyle, that's super important in our foods that we eat to the exercise we do to our sleep schedule and our stress loads and that sort of thing. So that's super important for young women. I have a teenager, so I try to get that message across to her and we try to work on those things. And then as you move through the hormone transition in your life, be man or woman. be educate yourself, you know, look for someone who can provide education to you or go get that education yourself. And then when it's time to make a decision, you can be confident in that. Yes. And so I think educating, therefore empowering yourself, even if you have to find a professional to help you, that can give you that shared decision making is so important. And that would be my message, you know, whether you do hormones or not is your personal decision. And so, you know, that's never anything that we want to like pressure someone into making that decision. So it's a personal decision and we want to support you in that journey. But we want you to know kind of what you're going to be faced with or what you're faced with now.

SPEAKER_02: 46:40

I love that. The education part is so important and for patients to know that they can, you know, come and speak to you and to know that it's not going to immediately end with that, well, here's a prescription for some hormones. Right. It's a collaborative approach with your patient to formulate a plan that works for them, that gets them gives them the results that they're after that can have some really positive long-term benefits too. Yes. I love what you're doing.

SPEAKER_00: 47:04

Thank you so much for having me. This has been wonderful. It's great to share this message to get it out there. The more we can talk about it and talk about our experiences and stories and what we've learned across professional lines and across our patient lines, I think we're going to improve the health of our community overall. I totally agree. Thank you, Laura. Thank you. Thank you.