Erika Jayne's "Hormone Imbalance" & How to Know if You Have One Too

Dr. Amber Klimczak and Dr. Beverly Reed discuss Real Housewife Erika Jayne’s “Hormone Imbalance”. They discuss what exactly a hormone imbalance is. They discuss how to use your menstrual tracking to know if you have one. They discuss what lab tests are important to check for a hormone imblance and they discuss treatments available. They also touch on hormone pellets and whether women need extra testosterone.

Transcript

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I am Dr. Beverly Re. And I'm Dr. Amber k Clack. And we are two pizzas in a pod pizza. Well, hi everybody. Welcome back. We got a few weeks off, didn't we? It was nice. Yes. Okay. We both went on spring break. Did you have a good spring break? So much kids had a blast. Good, good. My just really enjoys vacation. It's good to be back. We gotta get back to it. And I read a funny story. You know I'm all into celebrity news. I read a funny story. I went to share it with you. So this is about Real Housewives, and so I know you don't watch Real Housewives, but there's all different franchises based on the city. So this is Real Housewives of. There's on there named Erica Jane, and she's a very fabulous character. Okay. So she was married to this very wealthy man, but then he got in trouble because he was allegedly stealing money from his poor clients. Oh gosh. And that's how they were so wealthy. He was a lawyer. Yep. And he was trying to, you know, help his clients get settlements, but then I guess he was allegedly keeping it himself. Okay. They, you know, left all of this claiming and. Why he took their money and everything and, and all the rest of it. So she's like moving on with her new life, single Erica Jane. And how much older is he than she's Oh, way older. Probably. Probably like the dementia thing is not lining up probably age. Okay. Um, and so it's interesting, so apparently she was talking to the ladies on the show and tells the ladies. She due to taking hormones for menopause. Um, and then one of the other ladies responded, of course, in at a separate time in her own confessional interview, she. Oh, our hormone spelled O-Z-E-M-P-I-C, Ozempic. And I laughed and I thought, oh my gosh, that's actually, I feel like has some truth to it. Yeah. And so I thought maybe today we could kind of talk about hormone imbalances. What are they? How can you test for them? How can we treat them? Um, and, and really a lot of it is because this comes up on Real Housewives all the time, so, you know, I'm sure you've heard these women are very dramatic. They've got many things going on, and it's often a feature of the episode that, oh, I need to get my hormones checked, and maybe that's why I'm the way I am. You're acting a little Yes. You know, hormones. Quite dramatically. So I think we should all learn from that. Um, but, but first I just kind of wanted to touch on this and I just wanted to ask you, what is a hormone imbalance? I know, I actually think this is kind of, I mean, this super relevant question. I agree. I had so many of my patients come to me and I'm really worried about a hormone imbalance. Um, but hormone imbalance is not really a medical. Whole term. I know that that doesn't sound, you know, right. It doesn't sit well. I think with our listeners and maybe patients out there, but when we went to medical school or residency for ob gyn, we're not, there's not like some diagnosis that you look up that says hormone imbalance, and that's what's going on. Right? Mm-hmm. This is sort of an umbrella term, really more used like in. Overview of something being off, right? Yeah. With your menstrual cycle, so there's no diagnosis Yeah. That we've ever written or coded to insurance. Yeah. That says hormone imbalance. Yeah. For a patient, which is kind of hard to swallow, I think. I know, and it's so true. I'll say for the most part, if I see somebody on social media touting, do you have a. 95% of the time that person is not actually a board certified hormone doctor. Yeah. Um, which blows my mind. And sometimes there's specialties you would, I mean, you're like, why are you a dentist treating hormone I balancing life? You know? Yeah. Um, and so I think that brings up an important point when you're taking advice from anybody. You always want to look and see what are their credentials? Who is this person, what, you know, are they a, not even just a doctor, but are they a physician? Um, what did they train in? You know, I, I also think it's a bit bizarre that you have sometimes doctors that didn't even train in anything that has to do with hormones, and now suddenly they're claiming to be hormones. Specialist. Um, and so, you know, maybe some doctors just made a later in life change, but I think it's important for you to at least know and understand their background if you're gonna be taking advice from them. Right? Absolutely. And for a safety thing. Yeah. Before you take any medications or anything. Yeah. But I kind of feel like maybe it's a way of almost taking advantage of common problems that. Certainly as we get older. Mm-hmm. Because I'm entering that age, we can be more tired, we can have trouble losing weight, we can have mood swings, all these things. Right. And it's such an easy answer for people to constantly tell them, you need to have your hormones checked. You have a hormone problem, you know this and this. Mm-hmm. And as women wouldn't, we love to believe such an easy, oh. I wish that was the case, don't you? Yeah. Don't you wish it was that easy? Yeah, definitely. I'd be giving myself all types of hormones. Um, and so I think the truth is, and something we really need to know and face is that hormones are incredibly complex. And here's what's important to hear too, because you see all. We are double board certified hormone experts. And I'm here to tell you, we don't know everything about hormones yet. It hasn't been discovered very true in our field. We're still trying to figure it out. Very true. And so it's important to know that, so that anybody who's appearing to seem like they know all the answers, um, that's probably not the case. Right. Very, very true. Mm-hmm. Yeah. Mm-hmm. And I think the term hormone imbalance. Implies that there's this perfect recipe Yeah. For every person, and that if you're fitting this perfect recipe, that you're gonna feel normal and your cycles are gonna be normal, and maybe that's gonna get you pregnant if you're having trouble with fertility. But the truth of the matter is, there's not just some tests that we can run and see that you're imbalanced and then rebalance them, and that corrects everything. Yeah. You know, I think that's what the perception of a hormone imbalance. Yeah. Yeah, and I do think it makes it seem like these hormones stay the same levels all just. And what I really want you to see is the graph showing your estrogen, your progesterone, your lh, your fsh, and see how dramatically they're changing all throughout the month in a normal woman, right? So it's normal. And so I've seen cases where a patient comes in and she says, well. I saw this expert from social media and they said, I have low, and I look and I say, well, period, everybody has, when you're on your period, that's why the time. And so it's just an example to show you. Hormones are dynamic. They change, and they're supposed to change. That's what they're supposed to do. And so I feel more so concerned if your hormones aren't changing like they should, right? Yes. Hormones are dynamic, and I always explain to my patients, they're released in a pulse, right? Yes. So they're, you get a little spurt, it goes away. You get a spurt, it goes away. It's not just a constant release of hormones. So anytime you're getting your hormone levels checked at one precise. Time, it's kind of difficult to interpret, right? With just one data, data point. You really need to see something trending over time to understand is something truly deficient or not. Yes, absolutely. And all of this. And, and I'm not trying to say that there aren't women with hormonal issues. There certainly are, but I guess what I'm saying is to me it's almost portrayed that 80% of women have these hormonal issues. Mm-hmm. And I would estimate it's more like 15% or something like that. Right? Yeah. Um, and so it's not to be dismissive at all. There are certain women who definitely need an. Think that there's necessarily anything wrong with them, just because all your friends and family are saying, oh, it's probably hormones. You need to get your hormones checked. But I do love how this example from, um, Erica Jane that I just told, showed I do believe a lot of times it's the hormone, but not that, right? It's the hunger hormone that can really over a. Essentially caused us to have insulin resistance. And insulin resistance has been shown to cause fatigue and increase in, um, abdomen fat and all sort, all sorts of issues like this. And so I think maybe that's where we've really missed the mark over the years is we're telling women, oh. You need estrogen, you need progesterone, or whatever the case. No. Is she, Dori is probably right. A lot of people probably need some ozempic, which we're happy to be able to offer that these days to, to people as well. Yeah, definitely. Mm-hmm. Mm-hmm. And I always use an example too of, think of a 10-year-old child, right? A 10-year-old child is full of energy. They're usually pretty thin. They're usually pretty cheery. They're not grumpy, they're not having mood swings or anything. And what are their hormone levels? Levels are zero, right? They haven't gone through puberty yet. Yeah. And so that alone should tell us it's not all about hormones. In fact, once the hormones kick in, that's when sometimes people start getting a little grumpy. Yeah. So, I dunno that filling people with hormones all the time is necessarily the right answer to treat some of of those symptoms. Um, either so. Okay. That being said, how can we tell if somebody has abnormal hormones? Like what kind of evaluation should we do on those patients? Is there even anything they can do? Hormones? One of the first things that I always sit down and do with my patients is I just. Listen to their history, right? Mm-hmm. Um, so we take a really thorough history. I wanna hear about what your symptoms are. What are your menstrual cycles doing? Are you having regular menstrual cycles? Have your menstrual cycles changed over time? Are they different than how they used to? To be in your younger years. And so history is really important and most of our women are pretty good at tracking their, their health. You know, especially now I think women have a lot more awareness about their menstrual cycles and keep track of them with apps and things like that. So one of the tools that I think is really helpful and pretty straightforward is just tracking your menstrual cycle. On an app so that you have some data for me to see over time. Okay. Yeah. And is it persistently changing or persistently off? Um, over several months. That really helps me to understand because it can be more common to maybe have a one off cycle that was a little bit off for you. Right. But when you have something trending over time, it's really helpful for me to interpret. Yes. Yes, absolutely. And I think that's important for people to hear because I do feel like a patients in this situation are targeted with marketing ads on Instagram and all the rest need my fancy, all the rest, all these devices nowadays. But when somebody asks me, do you recommend this? I usually say, no, you don't need to do that because if you have been tracking your cycles, you can have me let look at it and I can make a lot of conclusions based on that history alone. And lemme tell you, if you are listening out there and you are not having periods at all, you need help. You need evaluation because not ovulating. Usually for us to be help pattern period is. Or if they're super close together too. And um, or like you said, if they're irregular, sometimes they're close together, sometimes they're, you know, spread out. These are all really important clues to us that there is some kind of dysfunction going on with that ovarian hormone pattern. And the good thing is, I would say usually these are very treatable conditions too, when compared to. And when we look at the history, I think the other kind of misconception is that sometimes patients think, oh, well we just need to add back this hormone. I need more estrogen, or I need more progesterone. Yeah. And this is gonna fix all of these problems. But I think the difference about what coming to see a reproductive endocrinologist or a senior. Um, can help you with is that we really target the source of the problem, right? Yes. Um, I explain it to my patients as, you have a wound that's bleeding. Mm-hmm. Right? Like, something's going really wrong. Yeah. And we can't just slap a bandaid on it, right. We gotta go in there, look at it, you know, sew it up, fix it properly so that we can have correction moving forward. So we can't. Throwing the hormones back on. We have to really investigate what's the source of the problem? Why are you having changes in your menstrual cycle? Why are you missing your periods? Why are your, all of a sudden your cycles getting closer together? Absolutely. Absolutely. And so when patients ask me about these fertility monitors, I say, well, I don't recommend them, but. Course if anybody wants to use a fertility monitor, we're never against that. But I'll caution you because people bring us, um, our, the results quite a bit. I've already seen some of them be incorrect or wrong. Definitely, because, you know, some of them will be panicked and they'll come in and they say, look, I ovulate, but my monitor is saying I had no estrogen. And I said, that's actually impossible to grow a dominant follicle and ov and have inaccurate. So we'll prove it to them. We'll check the level, the actual blood tests and have and feel reassured by that. But it does kind of bother me to know that even in the short period of time that these have been out, I have been able to see some incu in that really stress our patients out. I mean, and these are direct to consumer tests, right? These are not tests being administered by a doctor or a hospital, so they don't have the validation requirements that blood level tests have to have. And so again, like that can be risky for you, right? If on. The other thing that I really see that happens to my patients is it adds more stress to your daily life. Yeah, right? If you're already trying to get pregnant, maybe things are not going as you expect, and then you start having to do daily hormone monitoring and tracking, and you're trying to take control over it. I think that's exhausting. Like I think doing the LH Ovulation kick. Kids are exhausting enough, you know? Yes, yes. Um, this is hard work, you know, and sometimes I say, you don't this anymore. Like, take this off your plate. This is my job. Yes. Up testing. So a lot of ovulation. Well, really probably all ovulation kids are detecting your, that comes from your pituitary G and usually of this. But there's a condition that many have called pov. Their LH levels are chronically elevated. And for those women doing that, um, testing is so confusing because they'll have times where they're testing positive for days on end. If it's a true LH surge, you usually shouldn't be positive for a day or two, and then that LH goes back to normal. And so that's another example where the, at. Yeah. Mm-hmm. And then you're still sitting there trying to monitor it. Yeah. And you're like stressed out about it. Yeah. Yeah. And keep buying more tests, which I'm sure the companies love. Yeah, exactly. Yeah. Um, and so I've really found sometimes in patients who have been doing a lot of home monitoring, when they do come and see us and we're able to do ultrasounds and. They get to see. You can actually see on the ultrasound your follicles growing. We can even bring you back later if you wanna see that. They popped and ovulated, and I found that regardless of whether you get pregnant or not, it's such kind of a relaxing phenomenon to get to know for sure what is actually going on with your body. Mm-hmm. Yeah. I've actually started doing a little bit more monitoring of natural cycles with my patients, especially patients. Just unusual histories, you know, and, and, um, maybe aren't ready to start treatment. Yeah. We'll spend just like a month kind of looking with ultrasounds and blood work. Yeah. And just seeing what they do naturally. And then I think it's interesting because it's not something we do on a regular basis. Yeah. We're not monitoring a ton of just regular natural cycles. Yeah. Yeah. Um, so it's interesting for me to gain my own data too, about how, I mean, it's just. It's highly variable. Yeah. I think is the other thing that you just really have to be reassured about. Um, maybe your hormone tracking at home is actually appropriate for you and your body's doing exactly what it needs to do. Yeah. And there's, there's not something abnormal going on. Yeah. You know, and then when we bring you in, you're doing everything that you're supposed to be doing. We can see ov. Fluctuate are slightly different than average. Yeah. Now this may grow some people out. A's of follicle makes, ES actually helps make fertile discharge, so discharge. Right before ovulation will probably become more copious and clear and stretchy. And so if you see that, that's a great hint right there. That, hey, your estrogen level is looking really good and you're probably gonna be ovulating very soon. And then after you ovulate, if you look at your discharge issue, also change characteristic where it becomes more of like a thick and. Your, um, ovulation and if when you have periods you have cramping, if you have all those symptoms, those are called luminal symptoms, there is a 95% chance that you're ovulating. So just knowing that information alone without doing an ovulation test is often just reassuring to let you know, Hey, it does sound like your body is at least in the right pattern overall. Mm-hmm. Um, okay, so let's say we've got a patient and let's say she's. So, um, usually I start with blood work and an ultrasound working, try and investigate for some of the common causes that are leading to not ovulating. Um, so on blood work, we'll often check things like your prolactin levels. Sometimes that's a hormone that can turn on on your brain on its own without really the signal to occur and that can cause you to stop. Your thyroid could be off and preventing you from ovulating, not having, um, pregnant. That's true. Sometimes they feel like that's not even a possibility. We check some, um, testosterone levels. Look for maybe symptoms of PC Os, um, which we talked a little bit about polycystic ovarian syndrome. Um, so there's a lot of these common reasons why someone wouldn't cycle and is not ovulating on a regular basis. On ultrasound, we look at the ovaries in uterus. The ovaries can sometimes give us a hint to do they look kind of like this polycystic appearance or not. Um, occasionally women could run early you ovarian insufficiency in their levels and. Indicative things are very, very low. Um, I, I believe that's less common that they totally stop having cycles. Mm-hmm. But sometimes I see that too. Yeah, absolutely. And one of the things that's really helpful for us to sometimes, um, differentiate between different conditions is checking our pituitary hormones called FSH and lh. So in women who aren't having period ovaries. Kind of in and of themselves undergoing insufficiency or is it that they're just not getting enough of the signal from the brain in order to produce the eggs like they need to? And so, um, in particular, if we check an FSH level, and if it's really high, then that does give us some concern for maybe premature ov insufficient. Or sometimes even normal. Sometimes we even say that's inappropriately normal if the patient's not having periods, and there's all sorts of causes that can cause, um, your brain not to communicate properly with your ovaries, including sometimes not having enough calories in your diet or maybe exercising too much or maybe you had some sort of brain trauma from a. And that's why, kind of circling back to what we were talking about in the beginning, it's important that we don't wanna be dismissive to anybody who says they wanna have their hormones checked. Because if you're not having periods, we agree you need to have your hormones checked. Um, but again, we just wanna make sure that we're kind of distinguishing that from just telling any and all women who are having symptoms that, oh, it's because of your hormone. Yeah, absolutely. Mm-hmm. Mm-hmm. I would say the other pattern, um, that I think is important address to address for sort of a hormone imbalance, um, that we'll see quite frequently is that sometimes women report that their cycles are getting short. Yes. Getting. Um, and so this is one of those times also that you might be monitoring your hormones at home and you're like, something's not right. My levels aren't getting up to where they used to be. Yeah. You know, um, sometimes people, this is when people might perceive that they have low progesterone or their ob, GYN might have checked like a progesterone level and you have a low level. Um, and this can all be a sign of ovarian aging, right? As we quality and of. Go down. One of the first signs is actually that our cycles get close together and so they shorten up. Um, and especially when the quality of the egg and the follicle that you're developing are lower as you get older, it can really throw off some of these levels and even the absolute levels of hormones that you're checking. Um, sometimes I have women who have really low egg quality, um, or low egg reserve, and even when should ovulate. Plenty of progesterone, it doesn't do that properly. Mm-hmm. And they really, truly can have, I would say, a hormone imbalance. Sure, yeah. You know, a hormone deficiency, we don't, we don't use that term, but like I would say that that would qualify. Right. Yeah. Their hormones are not acting as they should at the proper time in the cycle. Yeah. Um, and that's something that it's tricky. Sometimes it doesn't help just to give extra progesterone or extra estrogen to it. Mm-hmm. Sometimes you have to start back at the beginning and figure out what else can we do mm-hmm. To help improve the whole nature of the menstrual cycle. Yeah. And we do have really cool ways of hacking that too. Um, absolutely. But, um, I do wanna, it kind of just made me think of this too, you know, we're kind of talking about fertility patients, but. Um, you know, sometimes they will say they're frustrated because, and I will say this is how I was trained as a regular ob gyn before I was a fertility and hormone doctor. Um, this is how I was trained many years ago, is they said, you don't necessarily need to check labs. Mm-hmm. And that seems to frustrate patients a lot because they feel like, oh, well my doctor's not listening to me, but no. She is having hot flashes and irritability and um, and she thinks that she's in perimenopause or menopause. Believe her, she's, you know, if she's in her mid forties or fifties, she's in perimenopause. You don't need to check blood work. You believe her and give her hormones. You know, and I think there's a lot to be said about that because I feel like it. Framed in a different way sometimes where people would be like, my doctor's not listening to me. They won't check my hormones. It's not that I think they're resistant to hormones, but I think what they're saying is, look, we don't need to believe a blood test. We believe you and we're to treat you for your symptoms because if you're having symptoms is enough for us to know we wanna. Right. Mm-hmm. Absolutely. And I, I mean, I think there's something to be said as to something can be really, really common Yeah. Right. For a woman, but whether or not we're gonna interpret that like as normal Yeah. And acceptable to live your life, because it's really your perception of what's bothersome to you. Women experience perimenopause or hormone fluctuations, right. As we get older in all different ways. Yeah. There are some women who will go through meno perimenopause and menopause and not have any perception that it's bothersome to them. Yeah. There are other women that are miserable. Yeah. Right. And so it's, I think it's really hard when you go to your doctor with. For your age. You know, we get this like in all phases in our life. You know, when you're pregnant, you're, you're miserable when you're pregnant, right? Yeah. Totally normal. You know, like we, we write off a lot of things, right? But I think that's frustrating being the patient where you're like, this doesn't feel normal for me. Yes. You know, this, even though this might be extremely common. I'm not happy the way that I'm experiencing this time in my life. Yes. Are there any treatments available to me to Yes. Pull. Right? Yeah. It's a lot about lifestyle during that time in our lives. Yeah. Um, you know, our diet and our exercise and activity level mm-hmm. Um, can affect these things. But hormone replacement therapy can help a lot of women. Yes. And so to be told it's normal. Mm-hmm. Keep on living your life. I think that's. Extremely irritating. Right? Absolutely. And so I, I do think those are the patients that deserve to be mad and to be dismissed. As you came to your doctor with a problem, they didn't do any labs and they didn't give you any treatment. Now that's not okay. Right? Yeah. They need to be doing one or the other or both, you know? Um, but I think, you know, really, I just wanted to reassure patients. That for the most part, if you're gonna a reputable doctor, yeah, they do believe you. We know this is a common issue and yeah, there are treatments that can help you feel better, both hormonal and non-hormonal treatments. Right. That can help things like hot flashes and things like that too. Mm-hmm. So, yeah. Um, okay. So let's say we've done our evaluation. We know what's going on now, what are. I always tell my patients, you know, your diagnostic testing really dictates your treatment options, right? Mm-hmm. So again, I really like the way that I like to treat my patients is very precision method based. Mm-hmm. I look and see what's the source of their problem and how do we correct it. So it really depends on what do we find on your testing, right. Is it that your brain is shut down? Is it that you have PC os? Is it that you have low ovarian reserve? And then what are your goals? Mm-hmm. Are you just trying to feel better, you know, you just feel like your hormones are off or are you trying to get pregnant? Um, you know, it depends on which, which kind of timeline and goal you're on. Yeah, absolutely. Um, can I share with you some of my pet peeves? So one of'em is progesterone. And here's the thing, you know, I love progesterone. Okay? I get progesterone out like candy. Mm-hmm. Okay? But here's the thing, guys. Please listen to this. You should not keep yourself progesterone without being under the supervision of a doctor or a physician. And I would maybe even say a board certified fertility expert or somebody who know what they're talking about. And it was because they were giving themselves birth control. Mm-hmm. Without knowing it. Because here's the thing, when I give progesterone to patients, I'm giving it to them usually about three or four days after they've ovulate. You take progesterone before you ovulate. Progesterone can lower your LH level and keep you from ovulating and give you a cyst sometimes too on your ovaries. And so I truly had a patient who came to me one time. She said, my chiropractor said my progesterone is low. I've been taking this progesterone cream. For months. The creams are very common. Yeah. People, the creams, because they can get them themselves, right? Mm-hmm. Take the cream and I said, okay, let's stop the cream. She stopped it, she got pregnant immediately. She thought I was a miracle worker, and I'm like, Nope, I just stopped your birth control. Um, and, and so it is really important. Don't take progesterone every single day. Not before ovulation. Even after ovulation. I think you should check with your doctor because maybe not all people need it. Mm-hmm. Um, and, and so that's definitely one of my pet peeves for hormones. Yeah. How do you feel about, this is a tricky question, I think for Dr. Re, women taking testosterone. Okay. This is tricky too, and oh my goodness. Don't get, I actually published a paper on this, ID up on this, so it depends. But what I think we should is actually learn nature on. So one of the most common things in the Dallas Fort Worth area are these little low T clinic that pop up everywhere, low testosterone. And look, you have everybody, men, that all problems in life are because. So I highly disagree with this. I think those clinics are very scammy. They're there to make money off of you and they may, uh, actually create health problems for you. And so I'm not a fan, but the hard part is because everybody's so worked up about hormones these days, not even just low T clinics. Everywhere you go, there's people trying to give you hormones, including testosterone. My biggest pet peeve is not only testosterone, but testosterone pellet. Mm-hmm. Where your provider wants to surgically implant a testosterone pellet in you, and they often give you either unpredictable or physiologic levels of testosterone in women, and I'm. Do you feel better? Well, probably that's why athletes take steroids. Like you feel great. Okay? But should you take steroids long term? No. That's gonna be really bad for you. And some of the things you have to think about is if you've been given a testosterone pellet that puts your levels in male testosterone level ranges, guess what's gonna happen to you over time. Turn into a man, you're gonna, your voice is gonna get deep. Your shoulders are gonna broaden. You're gonna have, um, a male appearance. You're gonna grow facial hair. You're gonna, you can grow a micro penis. You can get, and some of these changes are not reversible. Okay? Now people may say, why have a pellet that didn't happen? Well, it doesn't happen to you in one day or three months. It happens, it starts happening about two years, probably after you've been having testosterone pellets. And what's crazy to me is the solution from these people who put the PEs in say, oh, you're having side effects. Let's put you on S. This is a testosterone blocker. Okay, I'm sorry. You're gonna put somebody on testosterone and then block the effects. Why would you do that? That doesn't even make logical sense. And here's the sad truth of it, is I know a lot of these are just good doctors, but they've been brainwashed by companies who wanna make a lot of money and sell these to pellets. And here's how, you know, if your doctor says you need testosterone, which is debatable anyways, okay? If they say you need testosterone, ask them, okay, does it have to be a pate? Right? Could it be testosterone gel or some other form? Because here's the great thing about testosterone gel. It's revers. If you don't like it, you can stop it. It's gonna wash outta your system quickly. It's adjustable. You can, you know, change the dose anytime you need. Right. So why would you force somebody to have a, a put in that you cannot take out? Yeah, once it's in there, if you have side effects, good luck. It wears off, you know, after It's surprising that they can convince patients to do it. Yes. I'm like, who signs up for this? I know. Just, you know, and I've even seen a patient who, um, had a pill placed and they didn't know she was pregnant. And then she said, oh my gosh, is this gonna affect the pregnancy and everything? And look, you know, probably not, but here's the thing. Yeah. Right. Um, and so, woo, that gets me worked up about pellets. Now, of course, people who sell pellets will argue about this, right? But again, from double board certified true hormone specialists, I would never let anybody place a pellet in my body. Never. Now, I will say for fertility purposes, I am really into testosterone lately for certain women. So if I've done IVF on somebody and their response is suboptimal, if, um, they, if they have really low egg counts, sometimes I'll prime them with testosterone. But here's the difference. Number one, it's testosterone gel. I can stop it at time. I can adjust the dose. I. On testosterone replacement in women is, I don't think any study in the literature is longer than 12 weeks. And so what we really need to know is what happens to a woman if she's been put on years of testosterone? We know comparing men to, to women, that women live longer, we tend to be healthier than men, right? So why are we trying to be like them? It should be the opposite, right? Yeah. Um, and so yes, you got me all worked up. I know, I mean, I think it's, it's, it's a very controversial but interesting topic that we're still researching and looking into, especially, you know, in women going through menopause because there, I mean, there is a lot of data. Your ovary does release androgens, testosterone throughout, um, your reproductive life. Mm-hmm. Your ovaries. You know, start to slow down and you know, go through menopause. Certainly those levels of androgens will drop as well. Like is there some utility in replacement during that time? That's what we're still investigating, but like Dr. Reed said, we don't have enough data. We haven't been doing this for long enough, so it's certainly risky if you're gonna kind of dabble in that testosterone replacement. Yeah. But I do wanna say I'm totally supportive of, um, low doses of estrogen. Mm-hmm. And menopausal women. I think that's great. I will likely plan to do that. And if you're on progesterone and you have uterus, you also need pro, uh, progesterone as well. Sorry, if you're on tro, need progesterone as well. Um, so I'm definitely supportive of all those things. If somebody's gonna be on testosterone, which again is debatable on. Mm-hmm. As women are testosterone levels, usually like 30 or five. We do not need testosterone levels of Um, oh and okay. One more point about it. So back to looking at nature. Mm-hmm. Let's look at women who have PC Os. PS women have naturally high levels of testosterone, right? So ask a patient with ps. So we could ask you, do you feel great all the time? Okay. And maybe it's a little different in your case, but a lot of women have difficulty with PS actually losing weight, right? So when somebody's trying to sell you a hormone pellet, because. These are things we can learn from Nature itself is we can see many women who have high testosterone levels, testosterone did not fix all their issues. In fact, they often really have a lot of side effects from the testosterone, hair growth, acne, um, feeling bad, feeling tired and, and all those things. And so I would say it's just more complicated and we don't have all the answers yet, but that is not the answer. Yeah. I mean, and certainly association and. It's scary to try and mimic being a PCS patient. Yeah. I wish that I didn't have high androgen levels because high androgen levels also means you're, you're struggling with prediabetes and high blood glucose and um, high insulin levels, which we know is gonna shorten lifespan and quality of life over time. So, yeah, it's not something. Okay. Well I wonder if this is gonna be a controversial one. Do you think we're gonna get some bad comments about they're gonna come after us or something, but, um, but okay, well, we'll wrap it up for the week. Thank you guys so much for listening. If you have any special request of things you want us to talk about, please let us know. 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