Root-Cause Dermatology: An Integrative Approach to Acne, Eczema & Psoriasis

In this episode, Dr. Mamina Turegano and host Dr. Jaclyn Smeaton examine root causes for skin conditions and discuss how hormone balance, gut health, stress levels, and diet can impact skin health. 

This episode also highlights: 

• The links between gut dysbiosis and acne, rosacea, and psoriasis 
• How the balance of estrogen, progesterone, and testosterone can impact the skin 
• Theories on the rise in adult female acne 
• The effect of environmental toxins and endocrine disruptors on skin health 
• Skin as a systemic signal of gut health, hormone health, stress, and diet 

Show Notes 

Learn more about Dr. Mamina Turegano and follow her on Instagram @dr.mamina! 

Learn about easy at-home collection for patients with DUTCH Direct. 

Become a DUTCH Provider to get access to comprehensive patient reports, peer-reviewed and validated research, and expert clinical support. 

Transcript

00:00:00:00 - 00:00:09:02
Dr, Mamina Turegano
I can't help but think that, like, our hormones are being disrupted by something that's in our environment, whether it's the microplastics or chemicals being used in like cleaning products.

00:00:09:02 - 00:00:34:11
Dr. Jaclyn Smeaton
Welcome to the DUTCH podcast, where we dive deep into the science of hormones, wellness and personalized health care. I'm Doctor Jaclyn Smeaton and Chief Medical Officer at DUTCH. Join us every Tuesday as we bring you expert insights, cutting edge research, and practical tips to help you take control of your health from the inside out. Whether you're a health care professional or simply looking to optimize your own well-being, we've got you covered.

00:00:34:13 - 00:01:03:12
Dr. Jaclyn Smeaton
The contents of this podcast are for educational and informational purposes only. This information is not to be interpreted or mistaken for medical advice. Consult your health care provider for medical advice, diagnosis and treatment. Hi. Thanks for joining me this week on the DUTCH podcast. My guest this week is Doctor Mamina Turegano. She's a dermatologist who was conventionally trained but then started to go into more root cause and integrative modalities that she incorporated into her practice.

00:01:03:14 - 00:01:31:15
Dr. Jaclyn Smeaton
She was so informative and we really talked about all the different aspects of dermatology, from pathologies like psoriasis and acne, through some of the more cosmetic aspects of skin. Then, of course, we focused on hormones and the impact of hormones. But what I really loved about this conversation was it's really clear that Doctor Mamina has this global look at all the things that really go into play when it comes to having healthy skin.

00:01:31:17 - 00:01:57:10
Dr. Jaclyn Smeaton
It's not just about your hormones specifically, but all these other contributing factors from gut health, environmental toxins, your diet, your stress level, all of these pieces. And she really made a lot of great connections for me. And I know for you as a listener, you're going to find the same where we just I'd had so many fabulous takeaways, and I got her to share her top tips for women who want to have healthy skin as they age.

00:01:57:10 - 00:02:15:16
Dr. Jaclyn Smeaton
As a dermatologist, what is she recommended to her patients every day, and she dropped her seeds and gave us even her favorite brands. So you are going to absolutely love this episode. Let me tell you a little bit more about Doctor Turegano now. Doctor Mamina Turegano built her practice in New Orleans around a realization that took shape over years of medical training.

00:02:15:18 - 00:02:39:12
Dr. Jaclyn Smeaton
And that is. And you're going to hear that throughout the course of the podcast today. Skin problems are rarely just skin problems. She's a triple board certified dermatologist, internist, and dermatology pathologist, and she treats both the visible surface of the skin, but also the internal biology behind problems that drive it. Really blending conventional derm with an integrative whole body lens.

00:02:39:13 - 00:03:01:19
Dr. Jaclyn Smeaton
She also has a huge social media presence. I'm sure many of you have seen her work before. She's got an audience of over 2 million followers across social media platforms, where she really leverages her experience and expertise as a dermatologist, and pairs that with wellness insights. She's been published in leading medical journals and regularly contributes her expertise to major press and TV and beauty publications.

00:03:01:21 - 00:03:34:02
Dr. Jaclyn Smeaton
We are so lucky to have her today. I know you're going to learn a lot because I certainly did. So let's go ahead and get started. Well, I love all the things you have to say about, really the connection between hormones and skin health and okay, the fact that you look at skin as more than just skin, you know, and I think that's really what I'm hoping to learn today, is really the understanding of all of the different facets that come in to how people should be caring for their skin, and particularly the connection point between hormones and some of the things that you talk about are really, I think, expand people's understanding of

00:03:34:02 - 00:03:45:16
Dr. Jaclyn Smeaton
skin and skin aging. And so I'm just really thrilled for those of you who are only listening and not watching this on video. Your skin is unbelievable. So whatever you're doing in teaching, it works.

00:03:45:18 - 00:03:48:02
Dr, Mamina Turegano
Thank you so much. Thank you.

00:03:48:04 - 00:04:01:04
Dr. Jaclyn Smeaton
So what started? Before we dive into the details, I'd love to know more about what led you into this more holistic or integrative approach to dermatology. And because it's different from that kind of purely conventional model that exists today.

00:04:01:06 - 00:04:25:15
Dr, Mamina Turegano
Definitely. I actually have been so interested in taking a more holistic or integrative approach to health in general, from a young age. Well, I decided, like, I want to get into that field when I was in college, but I always had an interest in alternative forms of medicine and looking at nutrition from from my childhood days because of my mom.

00:04:25:17 - 00:05:05:14
Dr, Mamina Turegano
My mom was Japanese and she would incorporate eastern medicine sort of practices when it came to our health. Like, you know, if if we had constipation, she would massage like a certain pressure point on our hand, or if we had a fever, she would take other measures other than Tylenol, like she would, have. As I said to me, that still doesn't sound right or healthy, but she would warm up like Saki and put a raw egg in it, and she would make us shoot it down and she would just cover us with blankets, sweat out the fever, and we would wake up the next day feeling like a million bucks.

00:05:05:16 - 00:05:32:20
Dr, Mamina Turegano
So I don't know. So she just kind of put that into me. I also grew up with a lot of I grew up in a very interesting setting. I had a lot of like Korean cultural exposure as well. I had a lot of moms who were Korean who I grew up with, and I also went to boarding school in Korea, and I got to see other practices there, like moxibustion and yeah, even acupoint acupuncture.

00:05:32:22 - 00:05:55:01
Dr, Mamina Turegano
And so when I was in college, I didn't know that I wanted to go into medicine, but when I was in college, I was really, really interested in taking a more holistic approach. I was like, maybe that's like medical school, as opposed to conventional medical school or allopathic medical school. But I was like, you know what? If I have my medical degree, I could always practice integrative or holistic medicine.

00:05:55:01 - 00:06:27:19
Dr, Mamina Turegano
And so my plan was to do primary care. But when I was doing my internal medicine rotation, it was in a subspecialty called rheumatology. And in rheumatology there were a lot of patients with autoimmune skin issues. You know, people with drop out of my situs or lupus, scleroderma. And I was really drawn to those patients and I was like, wait, maybe I need to look into dermatology, because I was really fascinated by the skin and had so much empathy for how debilitating it is for people who had skin issues, or how much it also affected them mentally or their confidence.

00:06:27:19 - 00:06:54:07
Dr, Mamina Turegano
And and I just fell in love with derm. It just encompassed everything. It has adult and pediatric care. It's a little bit of surgery. It's it's there's also a lot of pathology. There's dramatic pathology which I ended up also specializing in. There's cosmetic derm but there's complex medical derm. Loved it. And I decided to pursue derm. And my love for integrative for holistic medicine really carried through.

00:06:54:09 - 00:07:12:02
Dr, Mamina Turegano
And one of the other reasons why I was really drawn to dermatology is that I think the skin says so much about what's going on internally, and I love that. And I think that it is such a great field to practice integrative health. And so, yeah, that's sort of a long winded way of how I got to where I am.

00:07:12:07 - 00:07:33:19
Dr. Jaclyn Smeaton
I love that. Thank you for sharing. I got chills like twice when you were talking to and I think, you know, we I definitely have always thought about they teach at a not for profit school as well. Like skin is kind of the window to what's happening on the inside. Yeah. And that's still not something that's really well recognized or it's not approached or treated that way because so many treatments are suppressive on the skin.

00:07:33:19 - 00:07:45:14
Dr. Jaclyn Smeaton
Yeah. Without fixing what's happening behind. So can you describe a little bit about how the approach you take is different from what people might have experienced with a regular conventional dermatologist?

00:07:45:16 - 00:08:12:18
Dr, Mamina Turegano
Yeah. When somebody comes in with, you know, one of the common inflammatory skin issues, whether it's acne or eczema, psoriasis, even hair loss, I go through a very extensive medical history, as I think most derms do, but I also ask about diet. Like what do you eat for breakfast, lunch and dinner? What is your sleep pattern? Are you somebody who goes to bed really late or do you not get much sleep?

00:08:12:18 - 00:08:35:21
Dr, Mamina Turegano
What's your stress level? What are you dealing with? Like what are you doing at work and really taking all those into consideration? Of course looking extensively at medication history and supplements and yeah, other. Yeah. Anything else and their lifestyle. And I will probably order bloodwork more than the average derm as well. And like I mentioned earlier, I am a fan of the doctor's.

00:08:35:21 - 00:08:55:18
Dr, Mamina Turegano
I'm a fan of, looking at the gut microbiome, I will recruit the help of another like functional medicine practitioner or a natural apothic doctor to work alongside me to help get to the root cause if the patient is interested. Some patients are like, you know what, just give me the drugs I just need that's gone now, which I appreciate too.

00:08:55:20 - 00:09:21:21
Dr, Mamina Turegano
And that's what I really also love about conventional treatments. I mean, I don't love the fact that it's just symptomatic control, but I do appreciate that, you know, a lot of these skin issues, you know, are keeping them up at night, whether it's causing a lot of itch or whether it's really affecting their confidence. And so it's nice to have a tool to be able to shut down, you know, the issue symptomatically while we're figuring out what's going on.

00:09:21:23 - 00:09:23:03
Dr, Mamina Turegano
Underneath.

00:09:23:05 - 00:09:41:21
Dr. Jaclyn Smeaton
Yeah. I couldn't agree more. I mean, I think there is a time and a place for suppressive therapies and I it is remarkable just how and I know this from my patients, but from my own personal experience as well, things that affect your hair and your face and just your persona and how you bring yourself out into the world, they're so impactful.

00:09:42:00 - 00:09:52:00
Dr. Jaclyn Smeaton
It's not minor. I mean, maybe the condition itself isn't medically threatening or life threatening, and instances, but when you think about conditions that really impact your life.

00:09:52:02 - 00:09:52:17
Dr, Mamina Turegano


00:09:52:17 - 00:10:07:21
Dr. Jaclyn Smeaton
Things that, you know, keep you from going about your day to day or feeling confident, feeling good in your skin, they're not small, they're hugely impactful. They cause so much stress and strain and change in your behavior, change in your relationships. I mean the impacts can be so big.

00:10:07:23 - 00:10:25:04
Dr, Mamina Turegano
Definitely. And yeah, you said stress too, like skin conditions will stress people out and then so they're they'll have this another level of like chronic smoldering inflammation from the mental stress itself. So there is like also physiologically, inflammation happening from just the stress of dealing with this.

00:10:25:06 - 00:10:35:19
Dr. Jaclyn Smeaton
So can you talk a little bit about like from a systematic perspective, what are the main culprits that are hidden root causes for skin conditions.

00:10:35:21 - 00:11:04:12
Dr, Mamina Turegano
Yeah I think one of the biggest ones is the gut I think there, and we're seeing so much more. When I was in residency, I mean, this was, I don't know, 15 years ago. So they were teaching us. I wonder if they're they're teaching more now because there's so much more coming out with the connection between gut health and the skin and how there's kind of an overabundance abundance of unwanted bacteria or bacteria that really are not good players.

00:11:04:14 - 00:11:31:04
Dr, Mamina Turegano
And, and, less of the good players. And yeah, we're seeing that in acne and psoriasis and eczema and so, so taking a look at that and oftentimes, you know, from my end because, because I'm not ordering like a GI map or like a microbiome testing. But I will definitely look at their diet, look at their antibiotic history, look at other medications that they could be taking that could be affecting their gut.

00:11:31:04 - 00:11:58:14
Dr, Mamina Turegano
And, you know, and also stress affects the gut. There's so many things that can impact the gut and ask about like various GI symptoms to. And then of course I think hormones are huge as well. Definitely more so in conditions like acne, rosacea, hair loss. And so we'll ask about other questions that could potentially bring to light hormonal issues symptomatically.

00:11:58:16 - 00:12:38:13
Dr, Mamina Turegano
Yeah. And going into that and then I will order some hormonal bloodwork if there are symptoms, call for it. But most of the time it's negative in conventional bloodwork. So that's when I may like, refer them out to do a DUTCH test as well to do like more extensive work up there. And then and then I think there's like the mental component as well, which is also tied to like gut and hormones, but I will look at, you know, like I mentioned, their stress, their sleep and, you know, it depends on the person and how open to it.

00:12:38:13 - 00:13:10:05
Dr, Mamina Turegano
But like, sometimes like certain past traumas in their life as well. And, how sometimes that could like manifest as certain inflammatory issues with their body. But yeah, so looking at that and, and making sure that they are supported in that way, I can't like be their therapist, but making sure that they have somebody to go to, that they have a community and weight and like outlets for them to help manage their stress and then say diet, which is also sort of connected to the gut.

00:13:10:07 - 00:13:32:10
Dr, Mamina Turegano
But just looking at that and talking about what I find to be more common, common culprits, it may they may not be sensitive to gluten, but it's something that we can see with certain patients with psoriasis or with acne, you know, dairy being a common culprit. They may not be sensitive to it, but it's something like I just want to bring attention to them.

00:13:32:10 - 00:13:49:10
Dr, Mamina Turegano
And then if needed, they, can potentially either work with a functional medicine doctor to get more testing or work with a nutritionist to, like, help them with, you know, with their meal plans. Those those would be the big pillars that I look at.

00:13:49:12 - 00:14:11:21
Dr. Jaclyn Smeaton
Yeah. I want to talk about food allergies. That's an interesting one, because when I was in naturopathy school, when we learned derm that was drilled so hard into us of like, almost always there's a food, a food component, and it's not something that I really saw bear out. I was a general family practice as well, but you could have patients kind of chasing down and eating very restrictive food plans.

00:14:11:21 - 00:14:30:00
Dr. Jaclyn Smeaton
And now I think we have so much more data on microbiome that a lot of times, maybe the food changes that come with the elimination diet impacts the microbiome. And you might see some changes in some people, but I know Julie Greenspan enough, you know, she's an indie that does a lot of term. And, she's been on the podcast before and we've talked about that.

00:14:30:00 - 00:14:43:10
Dr. Jaclyn Smeaton
It's like almost it's just a broken paradigm to have this food intolerance chase down. It's a factor for some people. But she doesn't think it's the main factor for most people. And I think a lot of practice knows to practice as though it is.

00:14:43:12 - 00:14:58:17
Dr, Mamina Turegano
Yeah, I agree with her. I'm a fan of hers, and when I did my integrative Dermatology certificate program, she was one of the faculty in. And it was lovely, like learning so much from her. And by the way, we are coauthors for a book called The Holistic Psoriasis Management.

00:14:58:22 - 00:15:04:23
Dr. Jaclyn Smeaton
And I know that I should have known that. Well, we'll make sure we link to that to the two of you. Yeah, curious on that.

00:15:05:01 - 00:15:32:19
Dr, Mamina Turegano
But yes, I know I think the food thing is, is more nuanced. Because, yeah, just because you potentially have a test for an allergy to it doesn't necessarily mean it could be problematic. And then of course, that allergy can go away. And like you said, with elimination diets, you can shift your microbiome like I think it's just a constant moving, flowing piece.

00:15:32:21 - 00:16:01:05
Dr, Mamina Turegano
Like, I don't think that people should eliminate certain food groups like, their entire life. I mean, I mean, unless there are like. Yeah, like something like celiac disease, where. Right, it is something that they do really need to minimize. But, yeah, it's it's more, I'm more. So I used to test actually for food. I don't even know if it's allergies because it was more like the IgG and complement testing.

00:16:01:07 - 00:16:25:00
Dr, Mamina Turegano
I don't do that as much now because of how much I feel like I see it shifting. And, it also may not completely be clinically relevant as well. So, I like to have them try to be a detective as much as possible and really pay attention to their symptoms and pay attention to what they eat and just try to notice patterns.

00:16:25:00 - 00:16:57:11
Dr, Mamina Turegano
It can be hard and sometimes it's nice to have the hard data to look at. And so sometimes I might give in and order tests. But but to me, I think it's looking at what they're eating, but something else that I did learn to over this is that when people get really consumed with like, or obsessed with like trying to minimize a certain food group or, not eating it, and it affects their relationship with food and, and then like that causes another level of stress.

00:16:57:12 - 00:17:10:10
Dr, Mamina Turegano
And, sometimes I feel like when they're a little bit more, comfortable with their food and not super restrictive, that that can help, too.

00:17:10:12 - 00:17:24:05
Dr. Jaclyn Smeaton
Yeah. It gets so complex in your neck, all those layers. Now, when we talk about gut health and microbiome, are there certain microbes that you see show up in the gut that you see associated with different conditions in the skin?

00:17:24:07 - 00:17:51:16
Dr, Mamina Turegano
Yeah. So I don't think that we have, like, good data to say that this is something that we see more often, but kind of more like anecdotally, is I think we see higher levels of candida yeast in a lot of skin issues, in psoriasis. And we see it also in the skin microbiome, more so, in acne.

00:17:51:18 - 00:18:04:14
Dr, Mamina Turegano
And then rosacea and then Helicobacter pylori. We could see higher amounts in acne and rosacea. And then beyond that I feel like it's a mixed bag.

00:18:04:16 - 00:18:18:11
Dr. Jaclyn Smeaton
Sometimes even like a deficiency dysbiosis where you just lack the good microbes. And there that kind of keeps stability and manage inflammation. Ultimately, that's such a big piece of it is a gut is so responsible for immune regulation for sure.

00:18:18:12 - 00:18:19:11
Dr, Mamina Turegano
Yeah, yeah.

00:18:19:13 - 00:18:43:04
Dr. Jaclyn Smeaton
And this isn't woowoo science anymore. If you guys have no like follow the microbiome data, I mean, you're talking about like science major, like every major journal publication is publishing and talking now about the impact of the microbiome on health, where it used to be something considered. So woo woo. And now it's really, I would say, one of the leading contributors to disease and gut health.

00:18:43:04 - 00:18:45:17
Dr. Jaclyn Smeaton
And that's being studied right now for sure.

00:18:45:17 - 00:18:56:12
Dr, Mamina Turegano
Yeah, I'm excited for there to be more like integrated into like medical curricula and for it to be a part of conventional medicine.

00:18:56:16 - 00:19:16:16
Dr. Jaclyn Smeaton
Yeah, it's funny, my son is a type one diabetic and he was diagnosed at the he's 14 now, so five years ago so would have been 2021. And we went to Boston Children's. I'm here in Boston. And one of the first things the endocrinologist said to us is you know, the way we understand this is that this really starts with the microbiome imbalance that probably started at birth.

00:19:16:16 - 00:19:50:07
Dr. Jaclyn Smeaton
And, I mean, I could have told him that, but I was shocked to hear the endocrinologist. Yeah, like the hospitalist share that with us. And yeah, I thought, wow, okay. Things really are trickling in that, you know, from an autoimmunity perspective, even in pedes, they're really starting to talk more about that. And the role, you know, maybe it was just them personally, but I mean, it was on the hospital documentation and they encouraged us to be working on microbiome balance in addition to all of the standard, you know, insulin and the other therapies that he was given, which was really eye opening and welcoming to see.

00:19:50:07 - 00:19:53:15
Dr, Mamina Turegano
Yeah, that's inspiring to hear. I'm so happy to hear that.

00:19:53:15 - 00:20:10:12
Dr. Jaclyn Smeaton
Things are shifting. Yeah. Well, I want to talk a little bit about the role of hormones as well, what you mentioned as a contributing root cause. Let's start by just talking about what hormones matter when it comes to skin health. And then maybe you can describe a little bit about how they contribute to health in a balanced environment.

00:20:10:12 - 00:20:11:15
Dr. Jaclyn Smeaton
First.

00:20:11:17 - 00:20:36:23
Dr, Mamina Turegano
Yeah. The main ones that we look at and I think as derms, we look at it a little bit more broadly, but the main ones that we look at are estrogen and progesterone and testosterone, which I think many people are familiar with. And we, we well that's tradition. Estrogen does a lot when it comes especially for women.

00:20:37:01 - 00:21:00:23
Dr, Mamina Turegano
It just does a lot for overall skin health. It increases hydration in the skin. It works on the fibroblast to keep the collagen produced and plump and healthy. It works on the epidermis, which is that top, top layer of the skin to keep it thick. And yeah, it's it. We also it's also like anti acne too.

00:21:00:23 - 00:21:09:13
Dr, Mamina Turegano
So so we like to make sure that we have that proper balance between all the hormones with enough estrogen to also help with things like acne.

00:21:09:15 - 00:21:13:20
Dr. Jaclyn Smeaton
Is it anti-acne because it tends to act in the most a balancing way to androgens?

00:21:13:22 - 00:21:25:11
Dr, Mamina Turegano
Yes. Okay. More so that way. Yeah, yeah. I don't think estrogen supplementation is something that we would do, but but yeah, like making sure that we have that right balance.

00:21:25:13 - 00:21:27:19
Dr. Jaclyn Smeaton
Great. And then tell us about progesterone.

00:21:27:21 - 00:22:01:17
Dr, Mamina Turegano
Yeah. So progesterone it's we also like it. But we want it to be in a good I guess ratio with with the with estrogen and testosterone. So you know with with when testosterone goes I'm trying to think if sometimes. So sometimes the estrogen can not the estrogen. The progesterone can make the estrogen not as noticeable in the skin like if the progesterone is is higher.

00:22:01:19 - 00:22:29:17
Dr, Mamina Turegano
And that can actually potentially lead to more acne breakouts. Okay. And then also potentially hair loss too. So that's something that we do see. Something that we see often is people who have IUDs. And with IUDs, a lot of them like release progesterone too. And so with that, it's and it's not everyone. It's it's a matter of like what other hormones are looking like in balance.

00:22:29:18 - 00:23:04:01
Dr, Mamina Turegano
But if they're testosterone levels are a little bit higher as well, that that higher level progesterone with the testosterone is going to like really outweigh that estrogen. And so we will see like kind of more androgen activity with that. But you know, we if if there's enough we also want progesterone too. Because that works too in concert with, with estrogen to keep our skin healthy, to decrease, trans epidermal water loss, which is what can lead to dehydration in the skin.

00:23:04:01 - 00:23:22:06
Dr, Mamina Turegano
So we we love progesterone, but we just also want to make sure that, it's in a good balance with the estrogen and that you don't have too much testosterone in your system as well with it, because then you'll see more the androgen effects, right, with, with the progesterone.

00:23:22:08 - 00:23:35:22
Dr. Jaclyn Smeaton
Okay. Great. And then let's talk a little bit about testosterone. And I mean, I think people generally associate testosterone with problems in the skin. Yes, like acne and hirsutism. But does it have a role in supporting skin health as well?

00:23:36:00 - 00:23:57:11
Dr, Mamina Turegano
Yes. It does so well. Yeah. I mean, you know, it increases oil production. So that's good and bad right. With acne, if you're prone to acne that's where it can increase like clogging of your pores and then more inflammation in the skin with acne breakouts and hair loss too. But but when we lose testosterone, that's when we also get dry skin, thinner skin.

00:23:57:13 - 00:24:22:16
Dr, Mamina Turegano
And so we we it's such a as you know, it's such like a very fine tuned balance of of making sure that we have enough, but not too much. But I would say that's the main benefit of testosterone is like making sure our skin is like moisturized. But otherwise, yeah, a little bit too much. We, we see the issues with higher testosterone.

00:24:22:18 - 00:24:46:18
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00:24:46:20 - 00:24:49:19
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Welcome back to the DUTCH podcast.

00:24:49:21 - 00:25:09:13
Dr. Jaclyn Smeaton
Can you talk a little bit about premenstrual acne? Because I think, you know, you have like the hormonal acne in women, like with, PMS, PCOS, but it's even different, like a lot of women get just that cyclical acne. What is causing that? I mean, obviously there's a hormonal shift there, but do they understand what the mechanism is behind that?

00:25:09:15 - 00:25:37:01
Dr, Mamina Turegano
Yeah. It's it's it's you have to. So there's that. The there's a graph. I know people in the medical field have seen this graph all the time of like of the different levels of your estrogen, progesterone, testosterone over that 28 day cycle, for example, on average. So, you know, when you're ovulating, that's when there's like this bump in estrogen and there's a little bit of a bump with a little bit with progesterone.

00:25:37:01 - 00:26:00:07
Dr, Mamina Turegano
It's rising too. So sometimes we see some acne breakouts. And during ovulation that's not common in everyone. But that's like if their progesterone is going a little bit higher than that estrogen. But anyways when when you get that plummet in estrogen right before your period, that's when the progesterone at the testosterone levels can go above it. It doesn't happen to everyone, but when it goes, you know, substantially above your estrogen levels.

00:26:00:07 - 00:26:27:13
Dr, Mamina Turegano
And if the testosterone is exceeding the progesterone, that's when you're going to see the monster breakouts. So it's just that it's the balance between the plummet of the estrogen and then the rise of the progesterone and the testosterone. So if yeah. And it's it can be a very delicate it's a very delicate dance. And if it's just a little bit higher, if the testosterone is just a little bit higher above those levels, that's when the breakouts come out.

00:26:27:15 - 00:26:53:12
Dr, Mamina Turegano
And yeah, and it's so frustrating because there's yeah, it's it's there's a lot of potential factors at play that's causing that that more that notable balance that's leading to breakouts. I literally actually just released a YouTube yesterday on all my theories because a lot of it is still was still being studied, like, why are we seeing more adult female acne today than we did 30 years ago?

00:26:53:13 - 00:26:58:14
Dr, Mamina Turegano
But yeah. And and like I said, there's there's a lot of there. I have a lot of theories that I like.

00:26:58:14 - 00:26:59:15
Dr. Jaclyn Smeaton
What are your theories on that?

00:26:59:15 - 00:27:00:18
Dr, Mamina Turegano
Okay. Yeah. I can totally.

00:27:00:20 - 00:27:02:19
Dr. Jaclyn Smeaton
Link to your YouTube video on it too. So we can give you.

00:27:02:19 - 00:27:32:17
Dr, Mamina Turegano
Yeah, yeah, but but yeah. So why is it that this abnormal ratio is happening right before your period. So just going through I'll start with stress. I do think that there's more stress today than there was 30 years ago. And I don't know if it's like we're just making a bigger deal of things or if like, I don't know if it's social media, like if there's just a lot more happening in our brains that we're just that we're just being consumed with.

00:27:32:18 - 00:27:52:06
Dr, Mamina Turegano
And stress increases cortisol. Cortisol can actually affect the composition of your sebum. It can make your sebum more sticky, so to speak, where like when it's more sticky, then it's going to clog your pores more easily. And of course, with with stress, it can increase other inflammatory signals. And that can lead to more breakouts. So there's that.

00:27:52:06 - 00:28:05:05
Dr, Mamina Turegano
And then of course, the cortisol can also have an interplay with your other hormones too. And then there's okay, well there's diet. I was going to talk about caffeine as part of that. But for talking.

00:28:05:05 - 00:28:07:06
Dr. Jaclyn Smeaton
About please, we're not talking about caffeine, all right.

00:28:07:06 - 00:28:30:21
Dr, Mamina Turegano
No, I don't want to. I don't yeah. Well, first I want to talk about the main two food groups that we have seen associated with acne, and that's sugar and dairy. Okay. And I don't know if there's necessarily been a higher consumption of those food groups, but I just wonder if the way that dairy is being processed, like if, like if hormones, there's more hormones given to cows or.

00:28:30:23 - 00:28:37:15
Dr, Mamina Turegano
Yeah. It just I'm just I'm just wondering, like if there's something that's different in agricultural practices too. Yeah.

00:28:37:15 - 00:28:57:07
Dr. Jaclyn Smeaton
It does seem to be more inflammatory now than it was before. And I know there's like the a2 milk is one thing that a lot of people excuse me. Will try that. Yeah. I think the types of cows that we get milk from now are just so everything's so industrialized. There's a diversity. There's lack of diversity in the cows diet.

00:28:57:08 - 00:29:05:12
Dr. Jaclyn Smeaton
You know, in comparison to where it was before. And we are in this place where I totally think dairy is, you know, just far more inflammatory for a lot of people.

00:29:05:13 - 00:29:27:09
Dr, Mamina Turegano
Yes, yes. And then like, like the way that, yeah, more antibiotics are given to cows because of potentially the like the practices in the, in the dairy, in the farms. So I don't know. But but I meant caffeine because I all I also am concerned about like coffee culture. So I think that there's a lot of benefits to coffee.

00:29:27:09 - 00:29:57:19
Dr, Mamina Turegano
The polyphenols I think some caffeine is beneficial. But but it's it's becoming more rampant and and a couple things I just wonder if people are drinking more caffeine than they need. Caffeine can create almost text. Caffeine can create stress in the body, right. And sometimes it's unnecessary stress. And so there's that component. There's also like, oh, are we also consuming more dairy because we're adding milk to the coffee or sugar to the coffee.

00:29:57:19 - 00:30:25:01
Dr, Mamina Turegano
Or are you consuming more sugar. So but I, I that's one of my little hang ups is, is caffeine. And just like overworking the adrenals. And in some women, and then, then there's, there's supplements. So, we've seen certain b-complex vitamins like B12 as well as, like biotin, which is B7, that can potentially make acne worse.

00:30:25:04 - 00:30:49:14
Dr, Mamina Turegano
And then whey protein, if people are like working out more, that's something to think about. Or testosterone supplementation. And then there's also just this influx of endocrine disrupting chemicals in our world. And it's it's hard to pinpoint, you know, what what are the main players that are causing all the issues? Because, I mean, alongside higher acne, we're also seeing higher rates of hypothyroidism.

00:30:49:14 - 00:31:06:21
Dr, Mamina Turegano
We're seeing higher rates of infertility. So I can't help but think that, like our hormones are being disrupted by something that's in our environment, could, like we mentioned, the dairy, but are there other things, whether it's the microplastics or chemicals being used in like cleaning products or.

00:31:06:23 - 00:31:28:08
Dr. Jaclyn Smeaton
Yeah, or yeah, we, we, we, we know that's the case. And I think it's really tough to pinpoint because they're all studied individually. But you see it out in the world where like in farming areas, for example, there is very high rates of like hermaphroditic fish, for example, things that are very clear that have changed over the course of time since the use of specific agricultural.

00:31:28:10 - 00:31:52:13
Dr. Jaclyn Smeaton
I don't know if it's chemicals, pesticides, I don't know the specific class, but if you think about it affecting animals because it's in the water. On a smaller scale, there has to be impact on other types of species, including humans. Even if it's not quite as demonstrable or like as obvious to see when you look at it, as I call it, a chemical soup, you know, you're you look at one thing at a time.

00:31:52:13 - 00:31:54:15
Dr. Jaclyn Smeaton
But ultimately we do live in a chemical soup.

00:31:54:17 - 00:32:20:22
Dr, Mamina Turegano
Yeah, yeah, yeah. So, I can't help but think that that's also playing a role with acne and and, like, you know, our hormone, our hormone levels. And then, and then, of course, we mentioned the gut earlier. So gut microbiome imbalances are just more rampant today for so many potential reasons. Stress can even cause it. Processed foods affect our gut microbiome.

00:32:20:22 - 00:32:36:20
Dr, Mamina Turegano
Just a history of antibiotic use. And you know, one of the ways that we will treat acting is with doxycycline, which is an antibiotic which is so ironic, right? I think a lot of germs are actually moving away from that. Which is which is reassuring. But look at.

00:32:36:20 - 00:32:41:07
Dr. Jaclyn Smeaton
This use long term. Right. So it's like a daily almost preventive treatment.

00:32:41:09 - 00:33:04:22
Dr, Mamina Turegano
Yeah. Yeah. And we're now seeing the, the, the aftermath of that. So, so we are trying to move away. But, but yeah. And then like even like chronic NZ use which you know we do see in a lot of women. So there are a lot of factors. And then kind of tying back to the diet piece to just less fiber in our diet, we are seeing how fiber is actually helpful to acne.

00:33:04:22 - 00:33:12:11
Dr, Mamina Turegano
Like all my acne pieces, I counsel them about how we can incorporate more fiber into your diet. So, just like, yeah.

00:33:12:13 - 00:33:31:14
Dr. Jaclyn Smeaton
I love that I took that last suggestion because especially if you're not supplementing and you're getting it through food, you're getting just this diversity of plants, it really forces you. And it is a fun game. I will do this with patients sometimes where I'll challenge, because I work with a lot with fertility and hormones and, you know, gut health comes up so much.

00:33:31:15 - 00:33:49:07
Dr. Jaclyn Smeaton
Yeah. And so, you know, generally I tell people to aim for like 35g of fiber a day, which can be challenging to hit that a lot of fiber. But it becomes fun to try to see what different types of plant foods you can eat. And it when you focus on fiber, it encourages diversity of diet. It encourages a plant based diet.

00:33:49:07 - 00:34:03:05
Dr. Jaclyn Smeaton
And along with the fiber, rides all of these vitamins, nutrients, polyphenols, and other phytochemicals and phytonutrients that are so healthful that I love that fiber suggestion because it's something people can look to.

00:34:03:10 - 00:34:03:20
Dr, Mamina Turegano
Yeah, but it.

00:34:03:20 - 00:34:08:05
Dr. Jaclyn Smeaton
Ends up having this swell of benefit that yeah pulls behind.

00:34:08:07 - 00:34:34:14
Dr, Mamina Turegano
Yes, yes. With fiber come comes a multitude of benefits. So yes. But yeah. So that's a suggestion that we all make always make for acne patients. And then, you know, there's a there I feel like is kind of a controversial topic, but there's birth control and people going on and off birth control. I think that that can make a mark on your hormones too.

00:34:34:14 - 00:35:01:21
Dr, Mamina Turegano
Like and it's I think there's a lot of nuance to that aspect as well. Everyone's different. The type of birth control you're on can play a different impact on and how you're like your normal hormone levels sort of kind of bounce back from after being on birth control. But I would say that, like just having different hormonal shifts in one's life will lead to more adult acne.

00:35:01:21 - 00:35:28:18
Dr, Mamina Turegano
And I think that birth control is an example of course, like we'll see issues postpartum or in the perimenopause stage where like hormones are just doing wacky things. Well, you know. Yeah. Postpartum, usually there's a plummet in like, all the hormones, but in some people we can see more acne if that imbalance is, is there? So, those are I think those are my main theories.

00:35:28:20 - 00:35:33:06
Dr. Jaclyn Smeaton
What about insulin resistance and metabolic dysfunction? Does that contribute to skin problems?

00:35:33:07 - 00:35:38:20
Dr, Mamina Turegano
100%? Yes. Yeah. And that fits in. And you mentioned and dairy.

00:35:38:20 - 00:35:43:14
Dr. Jaclyn Smeaton
So I mean I'm assuming that rides along with it. But I didn't exactly research on that to for sure.

00:35:43:14 - 00:35:51:11
Dr, Mamina Turegano
Yep. We definitely see it alongside insulin resistance. And yeah, with the dairy with the sugar consumption.

00:35:51:12 - 00:36:11:20
Dr. Jaclyn Smeaton
Why is it that some people seem to be more, or their skin seems to be more hormonally reactive, like if we take women, you know, every woman has a menstrual cycle. For the most part, they're functioning and everyone goes through that same hormonal drop. But it does seem like there's different sensitivities, and maybe it is all the other factors you described.

00:36:11:20 - 00:36:18:20
Dr. Jaclyn Smeaton
But do we understand why that would affect some women and other women seem to skate through with no problem.

00:36:18:22 - 00:36:48:01
Dr, Mamina Turegano
Yeah, I well, I do have to say genetics does play a role when it comes to our ability to secrete oil like some. Yeah. After practicing for so long, it's there's definitely a genetic component. Some people are just oilier people and there's some benefits to that actually. It helps minimize wrinkles and stuff. But and yeah, like, just like how we have different color hair, like we have sometimes the composition of our oil is slightly different from one person to the next.

00:36:48:03 - 00:37:16:00
Dr, Mamina Turegano
But, obviously I think environment is playing a really big role with how that ends up playing out. And, and I think it's, it's yeah, if you are a little bit more susceptible to acne. And, and like I said, like I mentioned, I don't know, eight different potential factors. And there could be so many more that like, are out there that are playing a role.

00:37:16:01 - 00:37:28:18
Dr, Mamina Turegano
That and there's also so many degrees like, like if, if somebody's a take out for like 15 years of their life where they're getting soup delivered in the plastic container. I'm just thinking about me during residency.

00:37:28:18 - 00:37:44:17
Dr. Jaclyn Smeaton
Actually, I know, and that that particular thing makes me so sad because we live in the community that has, like, such great Asian food. And it's I even, you know, we go out for pho and then you like, go to take it home and you're like, yeah, I know it's terrible. You know, I try not to get it to go, but it's still pretty hot when you take it home after eating it.

00:37:44:21 - 00:37:54:23
Dr, Mamina Turegano
Yeah, yeah. And so yeah, I was like like drinking like Tom yum J soup, like, Thai food and and, but it's.

00:37:55:04 - 00:38:15:08
Dr. Jaclyn Smeaton
Another big one with that is when you get back to a coffee culture, getting coffee, you know, in paper cups. I think every people do that every single day. And they don't realize, like the cup looks paper, but it's lined with plastic. That's my coffee table. It was only paper. The coffee would come right through. So you are drinking hot beverages out of plastic every day that you do take out.

00:38:15:08 - 00:38:35:19
Dr. Jaclyn Smeaton
Or if you brew coffee in a curry machine and you're using these plastic pods, like there are things like that where you're taking scalding hot liquids and put it in the plastic, and it has such an easy switch to make, whether you just bring your own cup, if you still want to hit Starbucks or your favorite local coffee shop, or just brew it at home and save the money.

00:38:35:21 - 00:38:57:16
Dr, Mamina Turegano
Yeah, I love that you said that too. Because like, I feel I because I think coffee is wonderful and I, I feel bad when I say like, think about coffee. But the only one of the big reasons why I brought it up is because it's one of those huge cultural phenomenon like phenomenon that I think is different today than it was 30 years ago.

00:38:57:16 - 00:39:07:01
Dr, Mamina Turegano
Like, I'm just trying to think of big things. The other thing, too, that I forgot to mention is like like the rise of using like the, like, blue light, our circadian rhythm being disrupted, that totally can have downstream effects on our other people.

00:39:07:01 - 00:39:09:04
Dr. Jaclyn Smeaton
I'm so glad you brought that up.

00:39:09:06 - 00:39:10:09
Dr, Mamina Turegano
There's so many things to talk about.

00:39:10:15 - 00:39:18:07
Dr. Jaclyn Smeaton
I know, and as we were, let's finish the coffee piece. But then I definitely want to talk about blue light and, like, using devices so close to your face and stuff like that.

00:39:18:07 - 00:39:44:20
Dr, Mamina Turegano
Yes. Yeah. But, yeah, like, we were just talking about, like, why are some people more susceptible? But yeah, I think that, like, the load of exposure is so wildly different from person to person. Like, yeah, somebody who drinks Starbucks and or paper cup with a plastic lid, like every day that is going to look different for somebody who, you know, like eats dairy all the time, and doesn't have the genetics for, for oily skin.

00:39:44:22 - 00:40:07:19
Dr, Mamina Turegano
Like for me, I'm going to give myself as a case or case report. I'm, I'm blessed in that I'm, I don't have the genes for oily skin and I am more dry skin prone, but I definitely was exposed to a lot of stress. You know, I did 30 hour shifts when I was in residency, so I would just down these monster energy drinks at 3 a.m., like, it was horrible.

00:40:07:19 - 00:40:34:05
Dr, Mamina Turegano
So bad sleep did take out heated things in the microwave and plastic containers. And that affected my thyroid. So I had thyroid issues from that. So I think like depending on what you're predisposed to genetically is, is I think how all of these environmental stressors are going to manifest itself. And so for those who have like more oily skin, who do the coffee, then it will manifest that way.

00:40:34:07 - 00:40:53:05
Dr. Jaclyn Smeaton
Yeah. It's interesting because I do I agree with you. And I think conceptually all of us have like systemic weakness. Like for someone, it's their skin, for someone else, it's they get a urinary tract infection or they get bronchitis or whatever. There's so many. And I think probably you guys listening can relate. You tend to get the same thing when you're down.

00:40:53:10 - 00:41:06:17
Dr. Jaclyn Smeaton
Yeah. Right. And exactly. So it's nice to have those that with the skin you could really notice it right away. Yeah. And use it to take action. And in my experience if you try to ignore it normally it's like whack a mole. Something else will pop up.

00:41:06:23 - 00:41:07:06
Dr, Mamina Turegano
Yes.

00:41:07:06 - 00:41:23:03
Dr. Jaclyn Smeaton
Well with the coffee thing I do think just on some tips on that because I think people are like, they don't want to give it up, but there's a lot of different things you can do that are smaller with those. And I would think about these types of changes not as something to be catastrophic about, but to think, oh, how can I do this smarter?

00:41:23:03 - 00:41:48:17
Dr. Jaclyn Smeaton
So for example, if you're going to order coffee out, you could bring a mug, but if that's too much effort, you could get an iced drink, not a hot drink. Right. And that's going to be a little bit less exposure. Or if it's a hot drink, take the lid off to drink it. Be careful not to spill, but when the lid is on, if you've ever taken one off, you know it's covered in water because the coffee steams, then it condenses on the surface and then of plastic, and then that drips back into your coffee.

00:41:48:17 - 00:42:04:05
Dr. Jaclyn Smeaton
You are brewing plastic into your coffee in that way. So think about just these incremental changes that you might be able to make. Or if you get one and you go home, pour it into a mug. When you get home, it's less time in the coffee cup. So just you don't have to do this all or nothing approach.

00:42:04:07 - 00:42:04:15
Dr, Mamina Turegano


00:42:04:15 - 00:42:07:20
Dr. Jaclyn Smeaton
Just be as thoughtful as you can about it.

00:42:07:20 - 00:42:20:22
Dr, Mamina Turegano
Yeah exactly. I know it's it's almost impossible to avoid a lot of these things in our society. But but yeah I love like the just the little tips just to minimize that the, the burden.

00:42:21:00 - 00:42:36:02
Dr. Jaclyn Smeaton
Okay. Let's shift gears and talk about our phones because I think, you know, probably every everyone listening, myself included, we like go to bed and we're like scrolling on Instagram with the lights off or whatever. You have this light on your face. What does that do to our skin?

00:42:36:04 - 00:43:06:12
Dr, Mamina Turegano
Well, it's it's a little bit mixed in terms of the, like like the harms of blue light on skin issues. The main example that we do have evidence for is, is melasma like hyperpigmentation on the skin, just blue light getting emitted. Otherwise I think there's just more like indirect effects of just the circadian rhythm disruption and the hormones being disrupted.

00:43:06:12 - 00:43:30:11
Dr, Mamina Turegano
And then that playing a role in like sleep being disrupted and all that stuff, and then that playing a role with all the other inflammatory skin issues that we see. But but in terms of like light directly affecting skin, we, we do see issues with melasma. Blue light interestingly, can be beneficial for acne. But I don't know about blue light from your screen.

00:43:30:16 - 00:43:50:03
Dr, Mamina Turegano
It it's like a specific wavelength of blue light. So I'm going to tell people to yeah. Don't like put your cell phone to your face for acne. But but yeah. In terms of the, the light exacerbating certain skin issues directly, that's the mean. The melasma is like the main one that I can think of.

00:43:50:05 - 00:43:58:16
Dr. Jaclyn Smeaton
What about red light therapy as a treatment? I've seen so many people. I mean, they're all over the place. What do you think about that? Those masks that you put on that give you the red light?

00:43:58:22 - 00:44:18:21
Dr, Mamina Turegano
Yeah, I'm definitely pro red light therapy. Just because it does have some anti-inflammatory effects. It also boosts like cellular energy. So your cells work, work better and it can even help with things like melasma. But basically you're just overall giving your cells a little extra boost so that they work better. I think it's rejuvenating to the skin.

00:44:18:23 - 00:44:33:12
Dr, Mamina Turegano
I think it's nice a complementary treatment alongside doing your your skin care. I would make sure that you invest in a good one if it's like really cheap and emits some heat that can do more damage, that can make melasma worse.

00:44:33:14 - 00:44:34:23
Dr. Jaclyn Smeaton
The brands that you like.

00:44:35:00 - 00:44:48:14
Dr, Mamina Turegano
I do. I like current body, I like Therabody, the Lux, those are the those are the main top three that I consistently recommend.

00:44:48:16 - 00:45:11:08
Dr. Jaclyn Smeaton
Cool. The other thing that I want to talk a little about is like hormone therapy, postmenopausal for women. You've talked a little bit about the there's really two avenues I want to really talk about. One is estrogen. And are there skin benefits when women do systemic estrogen in menopause. And then I also we're you're hearing a lot of trending of women using their vaginal estrogen cream on their faces.

00:45:11:08 - 00:45:18:04
Dr. Jaclyn Smeaton
Yeah. Or utilizing some I know there's cosmetically available estrogen creams. I'd love to start by talking a little bit about that.

00:45:18:06 - 00:45:43:05
Dr, Mamina Turegano
Yes, there definitely are benefits with systemic estrogen replacement therapy for the skin. Estion, like I mentioned briefly earlier, does play a really big role with hydration in our skin. It helps with collagen production. It helps with the thickness of our skin. You know, as we get older, we notice like maybe like more that creepy wrinkly, like tissue paper, like texture of the skin.

00:45:43:07 - 00:46:04:16
Dr, Mamina Turegano
That's because our epidermis has gotten a lot thinner. So it it keeps our epidermis thicker. It minimizes more water loss like progesterone. And yeah, so you get more plump, hydrated, smooth skin like who doesn't want that. So yes, it it definitely does help systemically as well as topically.

00:46:04:18 - 00:46:10:00
Dr. Jaclyn Smeaton
Great. Topically. Do people utilize just the same prescription creams?

00:46:10:01 - 00:46:36:13
Dr, Mamina Turegano
You mean as, like, the vaginal estrogen creams? So some people do, but there are, like, compounding pharmacies now that make it more geared towards the, the facial skin because it's, you know, in a vehicle that's a nicer sort of moisturizing vehicle. But yes, I mean, people definitely use their vaginal estrogen cream on their face. And I would say there's a mixed it's it's there's a mixed community.

00:46:36:13 - 00:47:04:11
Dr, Mamina Turegano
Some, some docs are really concerned about the potential systemic absorption of these topical creams. I am on team topical estrogen. My understanding is that the absorption is, definitely on the lower end of not like pretty minimal to nonexistent. And so I think that there's benefits, I think with the, with the real cream, you see like around 0.3%.

00:47:04:11 - 00:47:12:13
Dr. Jaclyn Smeaton
I was going to ask about that because you see, I see a lot more all creams in the kind of over-the-counter market compared to estradiol.

00:47:12:15 - 00:47:36:21
Dr, Mamina Turegano
Yes. I'm pretty sure it's all creams. I, I use a compounding pharmacy and I just like, automatically prescribe, the, the one cream that they have available because I trust the dermatologist who, manages this, this pharmacy. But let me just I'm pretty sure it's the real cream that we use. Yeah, yeah. But yeah.

00:47:36:23 - 00:47:53:21
Dr. Jaclyn Smeaton
The other thing that I want to ask you about is testosterone replacement therapy, which is being used a lot in women as well. Now. Yeah. You know, for low libido, postmenopausal females, it's like kind of a, recommended for off label use, not FDA approved, but it's in a lot of practice guidelines. But women are using it for a lot of other things as well.

00:47:54:03 - 00:48:16:20
Dr. Jaclyn Smeaton
And you hear a lot of risks raised that it could cause these terrible side effects predominantly skin changes and vocal changes and things like that, if it's too high of a dose. Are you seeing problems in women on testosterone therapy, postmenopausal with their skin, or is that something that is relatively uncommon?

00:48:16:22 - 00:48:36:18
Dr, Mamina Turegano
I do I do see issues. I do think it's relatively uncommon. So as a derm I might be biased because like when if somebody has a problem then they'll see the dermatologist. So then I'll see these cases. But it's probably, you know, in the grand scheme of things, you know, in the grand population of people taking testosterone postmenopausal, it's not that common.

00:48:36:20 - 00:48:51:10
Dr, Mamina Turegano
But for sure we do see whether it's increased hair growth in unwanted places, like hair loss in on the top of the scalp where we don't want hair loss. And then we'll see. The main thing that I see though is acne.

00:48:51:14 - 00:49:09:23
Dr. Jaclyn Smeaton
So I want to talk a little bit about DUTCH test with this because of course with DUTCH, as you can see estrogen and progesterone. But the androgen part of the DUTCH report I think is so helpful for skin because you can see testosterone and DHEA, these parent hormones. But you can also see a lot of downstream metabolites, including DHT.

00:49:10:01 - 00:49:35:22
Dr. Jaclyn Smeaton
And I think the most exciting marker is five alpha interesting diol, which is it's how DHT essentially leaves the cell. And so this is a, the how much DHT and five alpha andro you make as a result of how much testosterone there is in your body, but also how you metabolize it, which this is where you get into things like differences in genetics and environmental exposures and weight and all of the complexities that we've talked about earlier.

00:49:36:00 - 00:50:03:15
Dr. Jaclyn Smeaton
So we can see women who make a lot of five alpha andro from a DUTCH report before you even put them on testosterone. And what we've seen just anecdotally is that you can really start to predict women who might have more of a side effect profile from administering testosterone, because they make these very androgenic metabolites. And a lot of people don't realize the metabolites of androgens are like around three times more potent than testosterone itself.

00:50:03:15 - 00:50:31:18
Dr. Jaclyn Smeaton
Like DHT. So it's a really interesting piece to be able to screen women before they think about getting on hormone therapy. And also, we see it a lot when you look at blood levels and your like, testosterone and DHEA look fine. So I'm not sure why they have this high androgen picture. We see a lot where the parent levels are fine, but the metabolites are super high and they just metabolize down this potent alpha metabolite pathway.

00:50:32:00 - 00:50:33:15
Dr. Jaclyn Smeaton
That's it's really interesting.

00:50:33:16 - 00:50:44:05
Dr, Mamina Turegano
To know actually. That's great. I know whenever I refer for that says it's usually like women in their 30s or 40s with adult female acne. But that's such a helpful tool for.

00:50:44:06 - 00:51:00:08
Dr. Jaclyn Smeaton
Yeah, I'll walk you through if you want to see maybe offline, just to show you kind of what that report looks like, because we see it a lot with women who also get misdiagnosed, where are they're told they don't have PCOS or PMS because they're like biochemical labs don't show high androgens, but they have this high androgen picture.

00:51:00:08 - 00:51:10:22
Dr. Jaclyn Smeaton
And the clinicians are like, why do they have hirsutism and acne? Because all their hormones are fine. It's you see it in the metabolism of what happens at the tissue level really.

00:51:11:00 - 00:51:12:11
Dr, Mamina Turegano
That makes sense.

00:51:12:13 - 00:51:34:01
Dr. Jaclyn Smeaton
I would love to just kind of as we wrap and think about wrapping up, you know, I just am really inspired by this kind of inside out approach to health care. How does this look in your day to day practice when patients are coming in to see you? And how are you combining like you talked about? Sometimes you need a suppressive therapy, but then you're also wanting to make sure you're addressing root cause.

00:51:34:04 - 00:51:37:16
Dr. Jaclyn Smeaton
How does that come together with what patients experience working with you?

00:51:37:18 - 00:52:01:12
Dr, Mamina Turegano
Yes. Because I'm in a conventional practice model, it not every patient wants, you know, the full kind of diving deep into what's going on. And a lot of my patients, they're coming in for skin cancer screening. So I'll just look at them from head to toe. Of course, if if they are at risk for a lot of skin cancers, we talk about supplements that can help, reduce their risk for skin cancers.

00:52:01:17 - 00:52:31:19
Dr, Mamina Turegano
But for my acne, eczema, psoriasis, hair loss patients, which are probably the top for like inflammatory skin issues, I see I will and trying to fit this in, you know, within like 15 to 20 minutes. But in addition to doing an extensive history, I will, you know, of course, look at their medications. I will do like a full examination with everything that's going on and, you know, talking to them.

00:52:31:23 - 00:52:50:18
Dr, Mamina Turegano
Of course, I will give prescriptions almost to everyone. Most people are amenable to prescriptions. There are still a small handful of people who don't want them, or have had a history of side effects to the ones that I would want to give them. So, but for the most part, I am giving everyone a prescription because I'm like, let's, let's try to get rid of this work on this now.

00:52:50:20 - 00:53:15:00
Dr, Mamina Turegano
But in the meantime, I will also give them like a diet prescription. I'll give them supplements as well, like a supplement regiment to do alongside it. Sometimes I'll do bloodwork too, before I even recommend those things. And I can't go in-depth into their sleep and stress habits besides telling them to to minimize the stress or to work on their sleep.

00:53:15:02 - 00:53:36:04
Dr, Mamina Turegano
I will sometimes give them resources if it seems like they really do need help in those areas, but I just like to bring attention to to those things. Unfortunately, I feel like I don't have enough time to yeah, really counsel them on those things. I think diet and supplementation is where I focus on more when it comes to the more like, holistic aspect of treatment, in addition to great options.

00:53:36:06 - 00:54:10:01
Dr. Jaclyn Smeaton
And I think I, my friends, would probably be really mad at me if I didn't ask you this last question, which is for people who maybe don't have a skin issue, but they want to be proactive about just that anti-aging approach to skin. What are maybe the heaviest hitting things like you have so much supplements that are marketed to women, whether it's collagen or, you know, all these different categories of things, different nutrients or combinations, then you have topicals, you have prescription topicals, like knowing what are your favorites that are just I know you can't make a specific recommendation, but what are your go tos that you're consistently recommending or you're telling women, don't waste

00:54:10:01 - 00:54:11:11
Dr. Jaclyn Smeaton
your time with this one.

00:54:11:13 - 00:54:30:07
Dr, Mamina Turegano
Yeah, consistently in the morning after washing your face, I would recommend a good antioxidant serum. The most studied is vitamin C, so a good vitamin C serum, the top two common ones that are out there are those with ascorbic acid, one of the gold standard ones like the skinceuticals C, E ferulic.

00:54:30:12 - 00:54:32:04
Dr. Jaclyn Smeaton
I love that one. It's so expensive.

00:54:32:04 - 00:54:33:23
Dr, Mamina Turegano
But so annoyingly expensive.

00:54:33:23 - 00:54:35:07
Dr. Jaclyn Smeaton
I've used it for a long time now.

00:54:35:09 - 00:54:56:21
Dr, Mamina Turegano
It's a good one, yes. And then the other form of vitamin C that I like is is FD ascorbate, which is in a couple of brands that I love. Also really expensive, but skin better science has one. They're alto advanced and then revision science has one there C plus correcting complex. But over the counter there's some lovely ones, whether it's by Servia or Vichy, or La Roche per se.

00:54:56:23 - 00:55:16:17
Dr, Mamina Turegano
And then sunscreen. We have so much evidence. How? Sunscreen. I mean, if you had to pick one thing in your regimen, it would. It would be wearing some sort of SPF, doing something to protect your skin. You could do all of these other things. But if you're not protecting your skin because it's important to be outside. So if you're not protecting your skin, then it just kind of counteracts like anything else that you're doing.

00:55:16:17 - 00:55:33:06
Dr, Mamina Turegano
So it's very important. And then in the evening, I think it's really important to make sure that you're washing your face adequately. I'm a fan of the double cleanse method because of all the buildup from the day. Whether it's the pollutants, the grime, the oil, the dirt, whatever that is a stressor to your skin cells that can accelerate aging.

00:55:33:06 - 00:55:53:05
Dr, Mamina Turegano
So make sure you're washing all of that off your makeup, like there's all the random chemicals in your makeup to get all that off. And then definitely recommend a retinoid. So retinoids are the umbrella term for these vitamin E derivatives, whether it is prescription retinoids, which are which tretinoin aka retina, there's the over-the-counter ones, retinol being the most common, retinol aldehydes.

00:55:53:05 - 00:56:17:00
Dr, Mamina Turegano
Another one, over-the-counter retinol has to get converted to retin aldehyde. So technically retinol, it's a little bit more potent right now. Allied then gets converted to tretinoin. So so tretinoin is fast acting. I do love tretinoin. It's a prescription. It can be irritating for some people. So I think a retinol is definitely great. And there's a lot of amazing retinol.

00:56:17:00 - 00:56:41:01
Dr, Mamina Turegano
There's even some that I think are comparative to tretinoin when it comes to efficacy after using it for a few months. So yeah, and then there's some wonderful ones over-the-counter. You don't, don't feel like you have to spend a ton of money, but yeah, there's there's a lot out there. And I would say if you're interested in prescription, there's easy access.

00:56:41:03 - 00:57:01:09
Dr, Mamina Turegano
I, I guess it's a little plug. I am a co-founder for an online, skin prescription platform called derm click. So if you need, if you would like tretinoin. There is a retin aldehyde topical that I helped co formulate that I am a huge fan of as well. It's by a company called Beauty Pi and it has an encapsulated retin aldehyde.

00:57:01:09 - 00:57:18:19
Dr, Mamina Turegano
So it's great for even people with sensitive skin and it. Yeah. So there's a lot of other goodies in there too anyways. So and then a good moisturizer I do recommend looking for a moisturizer. So after your retinoid using moisturizer that also has peptides. And the word peptide I think can mean so many things to so many people.

00:57:18:21 - 00:57:44:21
Dr, Mamina Turegano
So there's peptides that are used in skincare that can send signals to your skin to increase collagen production. There's so many different peptides in skincare, but, there are some that are specifically made to increase your production as well as increase hydration in the skin. So a good peptide moisturizer at night, there's also a bunch of other fun stuff you could do, like growth factors, DNA repair enzymes, and a lot of other fun like antioxidant type of serums.

00:57:44:21 - 00:58:07:18
Dr, Mamina Turegano
But there's also but I would say not to over I don't want to overwhelm people. So in the morning, vitamin C with sunscreen in the evening, a retinoid and a moisturizer. If you can do that, like you'll be way ahead of the game. And this is just with skincare. I know there's a lot of different supplements out there when it comes to like, anti-aging.

00:58:07:20 - 00:58:35:06
Dr, Mamina Turegano
And I think it's it's hard to make like a blanket recommendation, like, oh, you need to be on this NAD precursor and you need to be on your health and a and you need to be on these analytics. I do think that collagen supplementation is beneficial and worth doing. Collagen peptides I and there's a lot out there. I am a fan of a specific, trademark collagen peptide called various.

00:58:35:08 - 00:58:55:21
Dr, Mamina Turegano
All the sol, which is in a lot of different brands like Vital Proteins has, has there's all collagen and some of their products. There's a brand called Sparkle Wellness that I use. There's also yeah, I mean, there's other ones that are beneficial as well. But just if you want to just find something easy, that's just something to to try.

00:58:55:23 - 00:59:14:22
Dr, Mamina Turegano
When it comes to picking out of the thousands of different options out there, and then I do think that postmenopausal women do benefit from creatine as well when it comes to skin health. And then like I mentioned, there's all the other fun things like the knee precursors and stuff. But I'm not going to say that you have to be on those.

00:59:15:00 - 00:59:20:00
Dr, Mamina Turegano
I would say collagen and creatine are my first two when it comes to anti-aging for supplements.

00:59:20:02 - 00:59:36:18
Dr. Jaclyn Smeaton
Some people are going to love to have that list. So thank you so much for talking us through it. I mean, I really appreciate you covering all of this with us and just your approach to care. I mean, it's always so and amazing for me to hear about providers who are conventionally trained do that, are starting to adopt these.

00:59:36:18 - 00:59:54:02
Dr. Jaclyn Smeaton
And, you know, like you. Well, oftentimes it's because you have a personal experience and you realize there is more to to what can be done to help someone versus, you know, sometimes the fastest therapy or the thing that's taught conventionally. So, I really appreciate your time with me today.

00:59:54:04 - 00:59:57:10
Dr, Mamina Turegano
Yeah. Oh my gosh, thank you so much. I enjoyed this. Love chatting with.

00:59:57:10 - 01:00:04:15
Dr. Jaclyn Smeaton
You. Yeah. Me too. If people want to learn more about you, you have a humongous social platform. Can you share where people can connect with you?

01:00:04:17 - 01:00:14:06
Dr, Mamina Turegano
Yes. I am very active on Instagram, TikTok and YouTube. My handle is Dr.Mamina. I also have a website DrMamina.com.

01:00:14:08 - 01:00:34:01
Dr. Jaclyn Smeaton
Fabulous! Well thank you so much and thank you guys for listening today. I hope you loved this conversation with Doctor Mamina as much as I did. If you want to listen to more conversations about hormones and different areas of health, certainly we invite you to follow us as well. At DUTCH Test on all the social platforms, and we release a podcast every Tuesday.

01:00:34:01 - 01:00:39:16
Dr. Jaclyn Smeaton
So make sure you subscribe wherever you're listening today so you can catch us next week. We'll see you then.

01:00:39:18 - 01:00:52:12
DUTCH Podcast
Thanks for joining us on the DUTCH Podcast. Join us every Tuesday for new conversations with leading functional health experts. If you like what you've heard, be sure to like, follow, and subscribe wherever you get your podcasts.