Health Longevity Secrets

Is Bioidentical Hormone Replacement: The Missing Piece to Your Health Puzzle?

• Robert Lufkin MD • Episode 218

Share episode

What if the key to feeling better at 45 than you did at 25 isn't about accepting "normal" lab values, but about optimizing your hormones to their ideal levels? In this eye-opening conversation, Dr. Lauren Fitzgerald—a board-certified anesthesiologist who now specializes in bioidentical hormone replacement therapy—challenges conventional medical wisdom about hormone health.

Dr. Fitzgerald breaks down the critical difference between bioidentical hormones and non-bioidentical versions. This distinction isn't just academic—it has profound implications for safety and effectiveness. While your doctor might tell you your hormone levels are "normal," those ranges often represent the average of an increasingly unhealthy population, not optimal levels for vitality and longevity.

Contrary to lingering misconceptions from outdated studies, bioidentical hormone replacement therapy has been shown to decrease cancer risk, protect cardiovascular health, prevent osteoporosis, and support cognitive function. For both women navigating perimenopause and men experiencing age-related testosterone decline, properly administered bioidentical hormones can transform quality of life. 

Whether you're struggling with brain fog, fatigue, weight issues, or just don't feel like your vibrant self anymore, this conversation offers a roadmap to reclaiming your energy and zest for life through evidence-based hormone optimization.

https://larimarmed.com/.  @worldlink

https://worldlinkmedical.com/education/conferences/academic-summit-2025

Lies I Taught In Medical School : Free sample chapter- https://www.robertlufkinmd.com/lies/
Complete Metabolic Heart Scan (LUFKIN20 for 20% off) https://www.innerscopic.com/
Fasting Mimicking Diet (20% off) https://prolonlife.com/Lufkin
At home blood testing (20% off) https://siphoxhealth.com/lufkin
Mimio Health (LUFKIN for 15% off) https://mimiohealth.sjv.io/c/5810114/2745519/30611

Web: https://robertlufkinmd.com/
X: https://x.com/robertlufkinmd
Youtube: https://www.youtube.com/robertLufkinmd
Instagram: https://www.instagram.com/robertlufkinmd/
LinkedIn: https://www.linkedin.com/in/robertlufkinmd/
TikTok: https://www.tiktok.com/@robertlufkin
Threads: https://www.threads.net/@robertlufkinmd
Facebook: ...

Speaker 1:

Dr Lauren Fitzgerald's education includes a BA in biology from the University of Texas at Austin and MD from the University of Texas Health, san Antonio, as well as an anesthesia residency at the same school. She's board certified in anesthesiology and and hey, lauren, welcome to the program.

Speaker 2:

Thank you, it's so good to be here.

Speaker 1:

I'm so excited about today. What we're going to be talking about is bioidentical hormone replacement therapy. That's really important for both men and women, and we're going to talk a little bit about those and actually, before we do that, I'm so excited Our paths are crossing at an upcoming conference in San Diego. You and I are both going to be speaking at the World Link Medical Conference down in Coronado.

Speaker 2:

Island, I think it is. It's a beautiful spot.

Speaker 1:

We can plug it here. We'll put links in the program. It's really just out of full disclosure. It's aimed. As I understand it you were there last year is aimed at more practitioners than patients? Yes, but yeah, what was it like last year?

Speaker 2:

Well, it was really great. We had some great speakers. Obviously, you're going to be awesome this year, but I will say that if you are any kind of medical provider whether a doctor, a PA, a nurse practitioner, pharmacist, naturopathic doctor, even a chiropractor and you're interested in learning about hormones, but you're not quite ready to pull the trigger to do the whole certification, this would be a great place to just see what we're about at WorldLink Medical and I'm not paid by them, I just love what they represent. They're the first group of medical providers that are like-minded, that think outside of the box, like I have for a while, and after reading your book, I know that you're an outside of the box kind of doctor as well. I I call myself a recovering anesthesiologist I'm not sure if you call yourself a recovering radiologist, but but neither of us follow that that stereotypical allopathic doctor path at this point that we're at in our lives, Right.

Speaker 1:

Yeah, yeah and it's, it's so. It's so satisfying to see this space of health and wellness, like we talked about offline. A little bit is just exploding so many people realizing that they can take control of their health. And for sure, you know, doctors, while they're important, health is really on you and I as patients.

Speaker 2:

It's on me, absolutely, and I find that the more doctors like you and myself that I meet, we all have a very common, similar story. I just met another one. He's out of Malibu, dr Darshan Shah, who is a surgeon, and he too had his own, you know, like health issue, that what he had learned in med school really wasn't helping him. And that's when, oftentimes, we're thought to or forced to think outside of the box Like well, what, what did I not learn? Like, why am I not able to be the healthiest version of myself based on all of my medical knowledge? And it brings a lot of us to this place where we're like okay, there's more and and let's, let's see how we can help other people do the same thing that we've done in our own lives. Right, yeah?

Speaker 1:

yeah, I mean that's such a familiar journey, I mean I certainly went through that and many, many people, both practitioners, but also patients, are discovering it as well. For sure, but maybe we take this opportunity as a segue and tell us a little bit about your journey and how you came to be interested in this fascinating area.

Speaker 2:

Well, I, so I've always been interested in health and fitness. I was that weird person that I started teaching fitness when I was like in my teenage years. I've always been obsessed with the health and fitness stuff and so I thought it was the net next natural position to go to med school, cause I've always, you know it was smart in school so I could use my brain to help people, you know, be healthy. And then it was, you know, I guess, in the middle of residency, that I realized like, oh, this is not, I'm not really helping people get healthy, I'm just putting people to sleep. And I'm in this system that obviously I didn't come up with this phrase.

Speaker 2:

But there are health care systems, actually a sick care system, and I found myself I was only practicing my, my anesthesia career for six years before I realized, like this is not what I wanted to do as far as you know, helping people in medicine, no-transcript. And I knew it wasn't what I was eating, it wasn't whatever. And that was when I first saw a functional medicine practitioner. And that was the whole concept of insulin resistance, which I'd never heard of. And here I'm an MD and I'm learning this from you know, someone that is, you know, in this functional medicine world, which I had no idea what that even meant integrative medicine, functional medicine and that was in my mid thirties and now I'm 45. And I mean it's, it's changed my life. I'm healthier at 45 than I was at 25.

Speaker 2:

And I find a lot of patients that have a very similar story. They're doing all of the things right and yet they're still either having problems with weight or brain fog or energy or, um autoimmunity, and they have been failed by the traditional healthcare system. Because, as you know, um the that system is is the. It teaches us how to treat everything with pharmaceuticals, procedures and surgeries, but does not give the patient that's motivated, that wants to heal themselves. It doesn't give them any tools.

Speaker 1:

So here we are doesn't give them any tools. So here we are, yeah, and, and right now. I mean, obviously you're an expert on bio identical hormone replacement therapy. You practice in, it turns out, st Charles, illinois, which is where I played basketball for the Naperville Redskins. I don't know what they're called now or if they're even around.

Speaker 2:

I don't know. I don't know what they're called now or?

Speaker 1:

if they're even around. I don't know if they're even around, so we overlap in that. But practice is actually national, so you don't have to live in St Charles or Illinois, correct, anywhere in the country people can come to you.

Speaker 2:

I've got lots of telemedicine patients that I've never met.

Speaker 1:

Actually, in person. So that, yeah, that's the world of medicine today. It is. It's very convenient now to access the best, even if you're not in the location where they are. So let's start on hormone replacement therapy. You want to start with testosterone, or for men or for women.

Speaker 2:

What would you like to? Do Can we actually just for the listener, because I can we define bioidentical? Because I am embarrassed to admit this, but I am. I've been a medical doctor for 20 years and it wasn't until the recent past that I actually fully understood the difference between bioidentical hormones and non bioidentical. So I assume that most of your audience knows. But for the ones that are too embarrassed to admit, like I don't really understand the difference, can I just define that first?

Speaker 1:

Yeah, it's a great point, and I want to make this as a sort of an introductory lecture, so assume that.

Speaker 2:

I don't know anything, we don't know anything.

Speaker 1:

Take us through it from the beginning. Love it.

Speaker 2:

So when I use the word so I think hormones is a umbrella term, and hormones can be bioidentical, so matches exactly the chemical structure, what the body makes so our ovaries, your testes or non-bioidentical, very similar to what the body makes but a little bit structurally different. And the difference is big pharma can patent one and can't patent the other, so big pharma cannot make money off of the same structural compound that our body makes. So progesterone is a great example that is bioidentical what our ovaries make. And you take a progesterone molecule, change it a little bit and you have a progesterone molecule. Change it a little bit and you have a progestin which does not match what the body makes. And there is so much confusion around that so they don't teach us that difference in med school and it wasn't literally until almost 20 years later that I had to understand. Like I think that that's intentional for them to not want us to understand the difference between bioidentical and non-bioidentical. And I know that you are probably not the only one that has heard this before, but a lot of medical providers are told that it's just a scam, it's a marketing ploy or whatever. So for the longest time before I understood that no, bioidentical is actually the way that you're describing the actual hormones that you're taking and non-bio identical versus bio identical. There's a big difference, and the big pharma companies don't want us to understand the big difference, because the big difference has everything to do with risk. That are known. So, for example, birth control pills. Birth control pills have progestins not bio identical progesterone, but progestins and estrogens that don't match what our body makes. Everyone knows like people are. Females are put on birth control without even thinking about it, and you know that you have an increased risk for clots. So that's, that's a known side effect, but no one explains to you. Well, it's because the non-bioidentical sex hormones that are in these birth control pills that are suppressing your ovulation are actually linked to increased risk of clots. They're linked to increased risk of breast cancer, all sorts of bad stuff. But patients are not really given true informed consent when they're started on these.

Speaker 2:

Synthetic or some people use the word synthetic, I like to use the word non-bioidentical, so it's a little bit more clear but synthetic or non-bioidentical sex hormones, right? So little bit more clear. But synthetic or non-bioidentical sex hormones, right? So when we're talking hormone replacement therapy, I always specify bioidentical hormone replacement therapy. So if you're following me on social media, I typically will say the four letters B-H-R-T, because I don't prescribe hormones that are not bioidentical, right. So when we're talking any kind of hormone replacement therapy, you need to ask your provider do you only do bioidentical or do you do both? Because the most common one that was used for a very, very long time was Premarin, and Premarin is a great example of a hormone that they take. Literally 88% of the estrogens from Premarin don't match what the human female body makes, and they are. They come from literally pregnant horse urine. So that's where the CEE comes from conjugated equine estrogens, and those estrogens don't match what the human estrogens make in the body, and so there's just a lot of confusion around that. So is that kind of clear?

Speaker 1:

Yeah, yeah, yeah. So we need to request bioidentical hormone replacement therapy, absolutely.

Speaker 2:

Absolutely. The safety profile when comparing bioidentical versus non bioidentical hormone replacement therapy Absolutely, absolutely. The safety profile when comparing bioidentical versus non-bioidentical is very clear, but you have to know where the literature is, because they don't want you to understand the difference between the two.

Speaker 1:

And and let's see so. Um now, hormone replacement is something that all women essentially will need for half of their lives, assuming they live to a good old age and men. Many men will also need it. It decreases over age with men, but all women will need it. But a large percentage of men also right.

Speaker 2:

True. So let's clarify, though, need versus want, because I can go. I'm 45 and I'm definitely. I started perimenopause around 40. I could go the rest of my life and never replace hormones and be relatively healthy-ish, but I will not have the same quality of life if I don't replace my hormones to optimal levels. So it is not a need, it's a want, and, you know, not everyone wants to take hormones in this stage of life, but I do believe that everyone would benefit from it.

Speaker 2:

We just live in a world where we are bombarded with so many things that disrupt our hormones. So a man that's in his 60s, 100 years ago, had really great levels of testosterone 900 to 1,000 or more. Now we're seeing men that are in their 20s that have really low testosterone. Is that because of one thing? No, it's probably because of a lot of different things that mess with our hormones. But I do believe that you can be doing all of the right things eating super healthy, exercising, prioritizing sleep and still not have optimal levels of hormones, and that's why I believe that most people, once they hit midlife, are going to benefit from adding on hormones bioidentical of course to their regimen.

Speaker 1:

And for women, postmenopausal women where basically the hormone production really bottoms out. Would you recommend that all women be on these?

Speaker 2:

Absolutely, absolutely. I mean just the prevention of cardiovascular. The number one killer of females is everyone's worried about breast cancer, but that's not the number one killer of us. It is cardiovascular disease. And once our ovaries are done making estradiol, which is the protective, the cardiovascular protective hormone, then our increased risk of having heart attack, all of that go up postmenopausal. So we can prevent cardiovascular disease, we can prevent osteoporosis, we can prevent dementia. A lot of people don't realize that osteoporosis is actually reversible with bioidentical hormones.

Speaker 1:

They're not taught that you know hormones. They're not taught that you know. Yeah, there's this view. I think it started in the early 2000s. Actually, marty Makary, who's a colleague that you know, just got elected to the FDA. Hopefully we're going to get him on the show, but he's a great guy. He has a great book called Blind Spots.

Speaker 1:

And he talks about bioidentical. He talks about hormone replacement therapy and something that happened in the early 2000s with the Women's Health Initiative study about the association with breast cancer and hormone replacement and it basically ruined a generation of women that didn't get access to that. Can you talk about that a little?

Speaker 2:

bit. Oh, my mom's generation is the generation that missed out on it. So, knowing everything that I know now, it really makes me angry because if I would have known, I would have started my mom on hormones when she was in perimenopause to have all the long-term benefits. Now my mom post-menopausal almost 20 years and I still started her on hormones when I did all of my training, because it is never too late to reap some of the benefits. But if you really want to get all of the long-term benefits, for us females it's ideal to actually start in perimenopause instead of waiting until menopause.

Speaker 1:

Mm-hmm, and so that scare about or the issue about hormone replacement therapy in women causing increased rates of breast cancer was incorrect.

Speaker 2:

Is that right and it was basically before, before, before this media got a hold of it. It was not adequately interpreted and basically it changed a whole generation of misinformation. And still to this day there are a lot of doctors that still believe that HRT leads to breast cancer and it's just not right. Bioidentical hormone replacement therapy there is actually decreases risk of cancer, so that we we've got to get that out there, because the fear of breast cancer, I think, is the number one reason why a lot of women don't even like consider doing HRT.

Speaker 1:

Yeah, and so so we can, we can cross that off.

Speaker 2:

Are there any?

Speaker 1:

other contraindications for a woman, uh perimenopause now considering a hormone replacement Are there?

Speaker 2:

there are very there are very few contraindications and honestly it it's if a woman is actively fighting cancer. That would be the only one and honestly it is only because medical, legal, because we, we don't, we haven't had studies of someone actively fighting cancer and being on bioidentical hormones. So it's more of a because, if it, if it were my brother, my sister, my, my aunt, my uncle, that I wouldn't have to worry about them suing me, I would actually probably still have them on bioidentical hormones even in the midst of fighting cancer. But that's right now really the main contra indication of starting hormones and it's really to cover our butts.

Speaker 1:

And that's for cancer. It's not all cancers, it's just breast cancer, correct, correct, correct and sort of jumping around with hormone replacement therapy for men. Talking about cancers, we have the association with testosterone and prostate cancer, and it used to be that men who had a history of prostate cancer, even if it was treated, would not take testosterone. What, what's the thinking on that now? Has that?

Speaker 2:

changed at all? Yeah, it 100% has changed. It's actually protected. The only man that that should not be on testosterone with with prostate cancer is someone that has a super, super low level of testosterone but anything above I believe it's 250 or higher it's actually protective against it and we've seen that with both prostate cancer and breast cancer. There is she's still alive a breast cancer surgeon, dr Becky Glasser, who has done tons of studies on testosterone in her breast cancer patients and it's a peptotic, so so we know it's actually protective. So if you know, god forbid if my dad ever had a prostate, well, he's already on good dose of testosterone, so I imagine he probably won't develop it because I already have him on that protective level of testosterone.

Speaker 1:

Oh, that's interesting. And how about for for patients who've had prostate cancer and then they've gone through hormone replacement? Or they've gone through androgen suppression and then so safe afterwards. Right, so you just don't want to do it during active disease? I presume Correct.

Speaker 2:

And again, it's more medical legal, because if it were my dad, I would still have him on it during treatment.

Speaker 1:

honestly, Because if it were my dad, I would still have him on it during treatment, honestly, yeah, yeah. And so for men, we talked about some of the women's symptoms of lack of these hormones. What are the men's symptoms for lack of testosterone?

Speaker 2:

So I really feel like both men and women kind of have some very similar things that they complain about. Obviously, men don't have the hot flashes like women do, but the brain fog is very common for a lot of people at midlife just low energy, low motivation, lack of desiring the usual stuff that used to bring them happiness. Um, testosterone, you know, testosterone is great. I, when I explained testosterone to both men and women, I explained that we've got sexual benefits and non-sexual benefits. I believe that there's a lot of married couples that at midlife go through divorce and if they would have just gotten hormonally optimized, they could have avoided that Truly truly.

Speaker 2:

I, you know it's. It's known that women go through the change, but men, you know, the antropause is is very real too. It's not quite as distinctive as our menopause, but there are midlife hormonal changes. That I mean if you get a man hormonally optimized, he is a different person, and that I love working with married couples. Those are my favorite. Typically it's I start with the female and the female is like oh honey, you're going to have to join me because you're going to. You need to catch up. But, but, but truly. I mean you get both people hormonally optimized and their world changes. You know the people think I'm being sarcastic when I say life-changing. I'm like no, it, it really is life-changing.

Speaker 1:

Yeah, and I've heard people talk. Therapists in the field talk about when they're working with couples like that. If they're going to treat one, they need to treat the other one Otherwise it could be a source of discord.

Speaker 2:

Exactly, exactly, yep no just just this morning, my one of my three month follow-ups. She's like, yeah, my husband's already like, uh, I think I need to get an appointment with her because I can already tell a difference just in three months. I'm like, yeah, just wait the first year when, when they do hormones with us, we make them enroll for a full year, because, as you know, nothing is fast with hormones, right. And so some people feel, I would guess probably about 50% already feel better in the first three months, about probably 75% by six months and then almost a hundred percent by the nine month mark. So and this is, you know, true for both men and women.

Speaker 1:

What are the some of the biggest misconceptions about this space that people get wrong or that prevent them from coming in and getting the help that they need? What do we need to? What do we need to correct out there in sort of people's understanding of it and and practitioners too, for that matter, you're going to be like speaking at this course.

Speaker 2:

Yeah, for sure, talking to practitioners about this.

Speaker 2:

One thing that I really appreciate about WorldLink Medical is that we are taught that the understanding of these different medical society guidelines are actually just opinions. Okay, follow me on this. So each society. So let's use the menopause society right. The menopause society comes out with their guidelines every year, or not every year, I think, it's every five years maybe. So you would think that the most recent guidelines are based on the most recent literature and the highest quality of literature, but it's not always the case. In fact, big pharma has influence on these, these societies guidelines, and so these society people that are medical providers that follow guidelines instead of actually listening to the patient, oftentimes will lead to patients not feeling their best. But but we're following guidelines.

Speaker 2:

So therefore, like, for example, thyroid, if you follow in endocrine society guidelines or thyroid society guidelines, you can't even consider treating a patient with thyroid unless they have a TSH above like five or something. Well, my literally free T3 is what's active at the cellular level. It's almost a hundred percent of the time. If they have a low T3, they have so many of the symptoms of a suboptimal thyroid. So I will explain to them. I'm going to start you on thyroid hormone, not because you have hypothyroidism, but because you have suboptimal thyroid and so that, but that's you know, against guidelines because their TSH is within normal limits. But but I'm listening to the patient and the patient is positive for literally every single symptom of a suboptimal thyroid. So why, why would we not treat the patient and their symptoms versus a number? I mean the amount of patients that have come to me and said I have an endocrinologist and they say my numbers are fine, but I have, you know, weight gain difficulty, losing weight, I'm cold all the time, I've got low energy, I've got brain fog, I can't remember names, words or numbers. I've got dry skin, my hair is falling out, I've got brittle nails, I've got constipation, I've got depressed mood, like these are all very stereotypical thyroid issues.

Speaker 2:

We take them off of their synthetic synthroid, which is levothyroxine. We put them on a good, natural, desiccated thyroid that has T1, t2, t3, and T4. And then we get them to the dose that make those symptoms go away and it's like magic and they think that I am literally the best thing since sliced bread and they're firing their endocrinologist of 10 plus years. And this happens over and over again. And that's what I appreciate about WorldLink is that they teach us that the guidelines are really influenced by big pharma and if you don't just look at the guidelines but you actually treat the patient and their symptoms, you will literally change their lives. And that's why I mean people that just go to a standard OBGYN that follow guidelines. Some hormone replacement therapy is better than none, but almost never are they feeling optimized by the time they get to me.

Speaker 1:

Yeah, and another place I hear a lot about that is in testosterone replacement, like what is the, what's your, what's your philosophy on that Sort of the, the, the, the number to hit, or how do you, how do you evaluate?

Speaker 2:

that. Well, this was in. So WorldLink has four different parts of their BHRT training and each part is a full three days right. And so in part four they taught us and I had never heard this before but we actually didn't even measure thyroid and testosterone until the late 1970s. So literally doctors would just treat based on symptoms. So if you have symptoms of a low testosterone or thyroid, we just hey, guess what? We increase it until the symptoms go away.

Speaker 2:

It's kind of crazy thought but literally most men I will always tell men you're probably going to feel all of the symptoms of an optimized testosterone and it's going to be labeled too high, labeled super physiologic, and that's typically where the symptoms of low testosterone go away. And the same goes with with testosterone and females as well. So I always explain at the initial consult that at the end of working, at the end of 12 months working with me, most of your labs are going to be bolded and labeled too high and that's typically where people feel best and that's where I'm going to keep them at because I know the safety profile of that is very, very well studied. So let's take females, for example, right, our upper limit of normal on the labs, I think is like 70. Well, dr Glasser, who I talked about earlier, she literally looked at I think she'd had more than one study where she looked at that the total testosterone level, where the symptoms of low testosterone started to come back, were below like 250 in a woman. So that's, you know, super physiologic.

Speaker 2:

But I've found this totally true in my clinic where if a woman has their testosterone total testosterone somewhere between 200 and 300, all of those symptoms of a low testosterone are gone. But you look at the lab and a doctor that's not used to working with hormones they'll freak out and they'll be like it's too high, okay, and we have 30 plus years of data studying two high levels of testosterone in women that want to be men, and we know how safe it is. So so if we get super physiologic levels, I will always tell my female patients, both female and male, but specifically with female, when we get our levels a little on the higher side, sometimes we can get the unwanted side effects, so some shin hairs, maybe some acne, maybe some hair shedding. But oftentimes, if that's not the case, then I will tell them you feel good at this dose, I don't care that it's labeled high, that's where you feel good, we're good to go.

Speaker 1:

Yeah, and we so many times. We're hearing more and more of this about how, um, as healthy people, we don't want to be in the normal range for lab values or anything. We want to be in the optimal range.

Speaker 2:

Exactly.

Speaker 1:

Normal in this country, sadly is being overweight or obese.

Speaker 2:

It's pre-diabetic.

Speaker 1:

It's metabolically unhealthy, certainly so. We hear that all the time, all the time, all the time. Can you speak a little bit about your approach to roots of usage? You know, injections, creams, yeah for sure, what's your? Philosophy on that and what should people be aware of there?

Speaker 2:

So when it comes to testosterone, I give patients an option and I explain why one is my favorite over the other. So, like when testosterone, there's multiple ways to give testosterone. The most common ones are either pellets, injections or creams. Right, oral is sometimes, but I've actually personally never prescribed oral because I like other options better, which I'm about to explain. But I give the patient the option because if, at the end of the day, they're hearing why the difference of delivery of testosterone, if they still want a pellet, I will put a pellet in them. I think pellets are good for a certain patient population, like the little old lady at the nursing home that's not going to inject yourself or put a cream on Right. So, yeah, there there's certain patient populations.

Speaker 2:

But when we are trying to get your hormones optimized, we're trying to mimic what your hormones looked like when you were hormonally optimized. So that means when you were 19 or 20 years old, what? What did your hormones look like? Right? And with testosterone it peaks and troughs every 24 hours. So daily cream is my favorite way to do that and it doesn't involve needles, which I'm not afraid of needles. But if you're going to be on testosterone, you're probably going to be on it forever. Once you realize how much better you feel when testosterone is optimized, do you really want to be injecting yourself once or twice a week the rest of your life with testosterone? I did injectable testosterone, felt decent, but I like cream so much better and, again, most closely mimics that daily peak and trough every 24 hours versus peak on day one of your injection and trough over the next seven days. Right, so I explained to the patient and let them ultimately decide. But I typically talk them into creams, both men and women.

Speaker 1:

Yeah, yeah. So and and your your practice. If I'm a telemedicine patient, let's say, what would they experience from your practice, or how? How would the encounter be set up and what would that look like?

Speaker 2:

Yeah, the initial appointment is about an hour. We look at their labs. I typically, if it's telemedicine, I'll share my screen and we'll look at how their normal labs are not optimal apps. The whole like there is literally a book written by Dr Neil Rousier called normal is an optimal. And so I go through explaining how their normal labs are not optimal labs, because they're telling me all of these symptoms, and this is why, once you're, for example, your free T3 is within optimal range, it's going to be labeled too high, but that's when all of your suboptimal thyroid symptoms are going to go away, right? So at the end of the appointment, I will explain to them all, right, after looking at your labs, these are the hormones that I think would be best to replace.

Speaker 2:

I like to do them all at once. There's some patients that want to just start with one hormone at a time. Again, my goal is to give them the information if I meet them where they're at. So I have some patients that just want to. Which hormone should I start with? Well, let me, let me give my best, you know, suggestion, but I like to hit them all with one or at once. So like, for example, my perimenopausal women. Almost all of them need testosterone, progesterone plus or minus DHEA, and almost all of them need thyroid. So those basic three to four hormones. I like to hit them all at once and typically by that first three month appointment, because I see them quarterly in the first year of their hormone management program. They're feeling, if they're not optimized yet by three months, they're definitely feeling better by three months, right? So I'll explain to them.

Speaker 2:

And then the compounding pharmacy that we use. It's a good quality compounding pharmacy that's used to working with world link medical providers like myself. So they don't get excited if they see a higher dose of testosterone for a female, like, for example, females that have high sex hormone binding globulin. So I have I'm, I'm super fit and typically the the metabolically healthier you are, you have higher sex hormone binding globulin. Well, that means that I'm going to need a higher dose of testosterone because I've got so much sex hormone binding globulin and ultimately my free testosterone is what matters. So this, this pharmacy, is not going to freak out when they see my higher dose of testosterone. That's not your standard dose for a female, but that's where I feel best and that's where my free testosterone gets into that optimal range, which always is labeled too high, and that's where I feel best and that's why I look and feel my best at 45.

Speaker 1:

replacement, if you could looking forward. I had a crystal ball looking forward five years, 10 years. Where do you see this space, or where do you? What are the changes?

Speaker 2:

Or what would you hope for in this space? I hope, because I always say hormones are bullets. They're not magic bullets. So if you really want to feel your best, it has to be combined with nutritional approach, with exercise, with sleep management, stress management all of those things really do matter. A more holistic approach of all of the things getting a person to their very best.

Speaker 2:

I mean my mom. She's 70 years old. She just had her total knee replacement and I literally was the least worried about her going into the surgery than ever, because she is in better shape, healthier at 70 than she was even 10 years ago when she got her other knee replaced right. So it's never too late to optimize your health and feel your best. And, man, obviously the earlier that you can start the better, because quality of life when you're in your elderly years has everything to do with how much muscle mass you have and we need to start building that muscle because it's not easy to build. But you know, getting your hormones optimized with all of the things really will equal just an abundant, healthy quality of life.

Speaker 1:

And talking about muscle mass, we talk about that on this show a lot and I never set foot in a gym, I mean in a weightlifting gym prior to like two years ago, and now I go every day.

Speaker 2:

I love it.

Speaker 1:

It's like it's it. It seems like it's so important. How do you see it fitting in with your, with your practice?

Speaker 2:

Oh, I require patients to lift weights. We we actually we established from day one that if they don't do what we ask, we will fire them because we don't want their bad results to look, make us look bad. Right, and we, we know that weight training is really important. You know, minimum of three days a week. You don't have to lift weights every day, but minimum of lifting weights three days a week. And I will tell patients if you are not comfortable in a gym, hire a personal trainer for three to six months. Literally start there, because you don't want to injure yourself, obviously, but you also want to have someone that will teach you how to do it and challenge you so that you can actually start building muscle. And then, of course, if you're on hormones, it's going to be a lot easier to build muscle.

Speaker 1:

Now we hear a lot about muscle, with you know metabolic health and insulin and brain-derived neurotrophic factor for the brain health and all. How does it tie into hormones? It sounds like muscles are separate from that.

Speaker 2:

No, it's all interrelated, for sure. For sure I mean your quality of life in your elderly years has everything to do with how much muscle mass you have. And I always tell my patients I want to be able to give you the blessing of having a life like my great grandmother. She was 98 and still mowing her own lawn. She lived to 105 and she literally, but she had great muscle mass. She was, you know, she had no fear of doing hard labor. She wasn't lifting weights, like traditional she was.

Speaker 1:

that was before that day, but she did her own form of resistance training. Well, I want to be respectful of your time, Lauren. Is there anything we haven't covered that you wanted to mention in this presentation?

Speaker 2:

Yes, I want to address the idea of overdosing hormones because there's no. When I, as a former anesthesiologist, when I hear the word overdosing, I think death. Right, If you overdose someone on insulin, you can literally kill them in the OR. That was literally taught to me day one by one of my faculty members that this is something that if you don't understand the right dose of insulin, you can literally kill the patient on the OR table if you overdose them. Right, If you overdose on our narcotic, you will literally suppress your respiration to zero and die. Right, there is no such thing as overdosing hormones.

Speaker 2:

So if we overshoot, let's say, testosterone, testosterone or DHEA, the two androgens right In females, we can get some extra chin hairs, some pimples, some hair shedding, some androgenic side effects right, but are you dying from that? No, and is that reversible? Absolutely, it's just tweaking. But this whole concept of hormones being dangerous bioidentical hormones the safety profile is very, very real and you can't overdose it. It's just finding the right dose that gives you all of the therapeutic benefits of the right dose, and everyone is different, but you can't really overdose on bioidentical hormones. So I wanted to make sure that that was very clear because there's so much fear around it and especially with testosterone and just primary care doctors that are not comfortable with it. Like I'm not fearful of too much testosterone, you know you cannot overdose on any of these bioidentical hormones.

Speaker 1:

Yeah, that's a great point Coming from an anesthesiologist who knows dosages and everything Exactly.

Speaker 2:

Exactly, Exactly, coming from an anesthesiologist who knows dosages and everything that's uh, exactly, exactly, exactly that that word is thrown around and I just, I just want to make sure that any providers that are in this space understand that that is really not a word that's appropriate to be used in the bioidentical hormone world.

Speaker 1:

Yeah, yeah, that's great. Well listen. I want to thank you so much, lauren for being on the program Before we leave, could you tell everyone, our audience, the best way to follow you on social media, the best way to find your website? We'll put it in the show notes also, but for anyone who's just listening on the podcast, maybe you could. Yeah, for sure.

Speaker 2:

So I do most of my teaching on Instagram. My Instagram handle is Dr Lauren Fitz, so it's D-R-L-A-U-R-E-N-F-I-T-Z. My last name is actually Fitzgerald, but everyone calls me Dr Fitz, right? And then my website for my medicine. My medical clinic is called Laura Mar Med, and Laura Mar just means tranquility and healing. It's a stone out of the ocean in Dominican Republic that has all the shades of blue, and that's what we represent. We represent tranquility and healing in the journey. So so laramarmedcom is our website. If you're looking forward to working with us, you can send my staff an email at info at laramarmedcom and they'll be able to guide you from there.

Speaker 1:

I already feel more tranquil just hearing that I love it. Well, I'm looking forward to seeing you in September in San Diego at the World League Medical Conference That'll be a blast, me too, absolutely, and hopefully we'll get you back on the podcast again, but thank you so much for joining us today, Lauren.

Speaker 2:

Thank you for having me, it was my pleasure.