E128 | Why HRT Needs Lifestyle: Science, Pitfalls, and Real Fixes

On today's show the ladies bring the heat again... (something about when Coach Laken is around...) They're tackling the controversial myth that hormone therapy fixes everything and show how sleep, strength, protein, fiber, and stress shape whether HRT works. We walk through labs that matter, real client wins, and a practical way to build habits that make hormones land.

Here are some of the key takeaways:
• hormones as messengers and why receptors matter
• terrain-first labs: insulin, CRP, thyroid, cortisol, ferritin
• nutrition pillars: 30g protein per meal, 25–35g fiber daily
• strength training for receptor sensitivity and bone health
• sleep timing, circadian rhythm, and recovery
• stress, pregnenolone steal, and adrenal-first decisions
• benefits with limits: lipids, insulin resistance, cancer risk
• habit sequencing, coaching, and individualized plans

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Transcript

Welcome & Why HRT Isn’t A Fix

SPEAKER_01 0:00

Any views, thoughts, and opinions expressed on the Redundae Health podcast are solely those of the speakers and are intended as such. Please consult your trusted healthcare practitioner for medical advice. Let's go, girls. Welcome back to the Reduvening Health Podcast. I'm nurse practitioner on Lindsay, your functional medicine and lifestyle medicine uh guru, and I'm back with Coach Lakin today.

Marketing Hype vs. Real Limits

SPEAKER_00 0:32

Hello, ladies, Coach Lakin here with all the stories, the words, the mindset stuff. And today we are gonna talk about something a little controversial, which I feel like we always do when I'm on. I don't know why that's the case, but it's also very important. So we're gonna talk today about why it is the case that you cannot, cannot do hormone replacement therapy without addressing lifestyle factors. It's really important. So we're gonna break down the science, we're gonna talk about the pitfalls, and of course, as always, we're gonna give you practical tips that you can start if this is something that you are either currently doing already or that you are interested in doing or looking into for yourself.

SPEAKER_01 1:14

Yeah, so the reason we're even gonna talk about this is because last week I went to LA and I went to a book launch for Kelly Casperton, and she just came out with her new book, um, The Menopause Moment. And so I got to listen to her speak for like an hour, and I was like super impressed in that she totally addressed this. And she addressed a lot of the like stoic mindset work um in that hormone replacement therapy is a tool, but there's so much more that goes along with it. And I think in the menopause space right now, we hear so much about hormone therapy. And I know as a provider, especially as a woman, women's hormone therapy, I see so many patients that think that hormones are the magic fix. Yeah. And they get on it and then they don't they don't feel any better. And they're like, Well, my hormones aren't working. Well, they're working, I promise you, but your uh messenger sites are the things that aren't working.

SPEAKER_00 2:12

Yeah. Well, it's just like anything else that's marketed to us, right? Like anything that's getting its 15 minutes, right? Which hormone therapy is getting its 15 minutes, well, menopause, I should say, is getting its 15 minutes, and then buy segue of that HRT. But anytime something is getting its shine and it's generating more money overall in circulation, we are going to hear what we want to out of that marketing. And so that's where I think it's being interpreted as the smoking gun or the magic bullet or the band-aid, which is really what it is, is a band-aid, right? If we're not implementing it correctly. And so that's where we want to take a deeper dive today and really talk about how helpful it can be and the potential things that it can solve for and that it can, you know, really improve for you, but that it there's more required to it than just getting the HRT itself.

Hormones As Messengers & Receptors

SPEAKER_01 3:02

Yeah, I feel like HRT is becoming the next GLP. Yes, right. You know, like everyone's like, I'm gonna get on a GLP and then they're not losing weight, and they're like, why am I not losing weight? Well, because again, it's a freaking messenger, and if your sights aren't working, like it's the same with hormone therapy. So, okay, let me explain this a little bit for you. So hormones, and there are million hormones, not a million, but there are a lot. It's more than just estrogen, progesterone, and testosterone. But all hormones are our chemical messengers, like that is what they are, and their effects depend on receptor sensitivity. So that means that they depend on your nutrient status, your liver detox pathways, your inflammatory levels. So you can have literally the best HRT protocol in the world, the best HRT doctor, menopause specialist. But if your lifestyle is creating inflammation, insulin resistance, poor sleep, those hormones, those messengers are not going to dock correctly on their receptor sites. So an example is estratol, which is E2, which is the bioidentical form of estrogen, it helps with vasodilation and glucose metabolism. So that's why we see when estrogen falls, you get more insulin resistance. But if you are eating tons of carbohydrates and your insulin is chronically high from poor diet, the metabolic benefit from that vasodilation and glucose metabolism is blunted.

SPEAKER_00 4:36

Yeah. So essentially, ladies, I want you to think about it like this, right? If we were to put this in like a like layman's terms, practical, relatable scenario, right? If you, if anybody likes plants, I've been dabbling in plant care as a plant mom over the last year and I've been very successful, right? But the the thing is, is if I were trying to water a plant and I have not been caring for the soil over the course of time, right? So this soil is like dry AF and it's like cracking. And if I go to water it, all that, all the nutrients of the water is just gonna run off, right? It's it's going to pan over the surface and run off the sides, and it's not going to be able to absorb down into get to get into the roots where it's actually needed. And so if your foundation isn't healthy, these hormones can't land where they're supposed to. So it's a waste of money, honestly.

Terrain First: Inflammation & Metabolism

SPEAKER_01 5:30

And yeah, because well, even if it is covered by insurance, like it's still gonna be expensive, and there's no testosterone covered by insurance at all. Um so you you really have to to work on some lifestyle stuff. So let's kind of list some issues here. So weight gain, like issues that you can have with starting HRT if your foundation isn't isn't correct. So you can get weight gain. And I like this happens a lot, right? People start on HRT and they're like, I gained weight, and I'm like, okay, well, estrogen dominance can happen, right? So estrogen dominance in women without proper progesterone countering it act can worsen fat storage if your insulin resistance isn't addressed. This is why PCOS patients have a really hard time losing weight, right? Um thyroid. HRT won't correct your thyroid, your master metabolism if you are nutrient deficient. So if you don't have enough iodine or selenium or you're stressed out, or your gut health sucks, like if it sucks, your liver, estrogen is metabolized through phase one and phase two detox pathways, which is your liver. So if you're drinking a bunch of alcohol and sugar or processed food, that the estrogen metabolites, they can't recirculate, and then you're like feeding your cancer risk, which estrogen does not cause cancer. But again, if you think of a fire, oxygen does not cause a fire. Like it doesn't. If it did, then the whole world would be on fire. But oxygen feeds a fire. Like if you cut off oxygen supply to a fire, then it it doesn't happen. That's the same with estrogen, right? Estrogen doesn't cause cancer, but it can feed it, you know. Um, and so if you're living in this crazy not healthy body, those estrogen metabolit can definitely feed cancer.

Labs That Matter More Than Sex Hormones

SPEAKER_00 7:36

Yeah, it's like if if I have any type of predisposition that's going to allow for cancer to show up, and I'm not addressing the lifestyle factors that are going to contribute to that, HRT is only gonna expand on that, right? It's not, it's not gonna do what it's what it needs to do. And we see this a lot, right? Like we'll hear women that'll say, like, I tried HRT and I still feel awful. And it's not necessarily that it could be that the HRT that they were doing was not properly dosed for their body or there wasn't an amount of retesting that needed to be done to check that the levels that they were using. But more often than not, what we see is that the terrain wasn't ready, right? Like they were not in a position where they were tracking lifestyle factors leading up to doing the HRT. So they wouldn't even know the variables that needed to move in order to get that dial to go in the right direction. So things like tracking your sleep, your stress, your movement, your nutrition, right? Ideally, one to two weeks before starting an HRT protocol, so you can get an idea of what your baseline is and you can see where it needs to go. So that way you know what needs to happen in order for the HRT to do its best job for you to get the most value out of it.

SPEAKER_01 8:44

And this is why I don't like starting HRT without labs. There are a ton of telehealth companies that will put you on HRT. Like you can go get HRT by filling out a form online, essentially, and not have lab work done. But you have no idea what your terrain looks like then. I don't even like truth to be honest, probably don't care what your hormone levels are before starting HRT. I care what your insulin is and your CRP and your thyroid and your cortisol and your ferritin levels are. Your hormones are helpful. Like, really, I can dose your hormones based off your symptoms, but I want to know what your freaking nutrients are, like, I want to know what your insides, your metabolic system looks like so I can know how you're going to how those hormones are gonna affect you.

Nutrition Pillars: Protein & Fiber

SPEAKER_00 9:29

Yeah, like what's the environment that you're gonna be introducing those hormones into? So that way it's more predictable of how they're going to respond, right? If we have all these variables that are all over the place across the board as far as biometrics, it's like putting something in there and then it's just chaos. It's like what we don't know what's gonna happen, right? Versus if all these things are in check and things are running smoothly as they should, and the metrics are in within ranges that are optimal and healthy, then we can better predict how the hormones are going to respond in the body and how their those messages are gonna be fielded back and forth. So let's talk about the lifestyle pillars that actually do impact HRT then.

SPEAKER_01 10:08

Well, protein. What? So no way. Um protein helps regulate your growth factor. So your IgF1, which helps support your lean muscle mass, which helps improve hormone utilization, right? Fiber helps you poop, it helps with estrogen clearance, right? So protein and fiber from nutrition are super important. So you really want to aim for 30 grams of protein at least per meal. I'm just gonna tell you this if you think you're eating enough protein, eat more because I've seen how much protein you guys eat and it's not enough. And then you want to eat 25 to 35 grams of fiber daily. And I'm not saying tomorrow go eat 35 grams of fiber because then you're gonna blow up like a balloon and your belly is gonna hurt like a lot if you eat 35 grams of broccoli.

SPEAKER_00 10:59

And then you're gonna say, I can't eat vegetables because I get bloated.

SPEAKER_01 11:03

Yeah, you gotta work your way up to that, sister, because most of you aren't eating any fiber.

SPEAKER_00 11:07

Yeah. Yeah, I think the average, so like the average American eats, I think 13 grams of fiber a day. So it's like less than half of the intake that we should be getting. And so that's another thing, ladies. Like if you think that you're eating enough vegetables, like I've seen it so many times where people are like, I eat fruits and vegetables with every meal. No, that's usually not the case. And if you do, yeah, it's like like you know, a banana doesn't count for your total fiber amount for a meal. So it's like choose the veggies, choose the leafy green ones, choose the ones that have more color in them, and be intentional about incorporating them. And whatever amount that you are eating right now, slowly increase the dose over time, like Lindsay was saying, but plan to increase that dose to a point where you're probably needing to eat double of what you're eating right now at some point in the future. Work your way up to it.

SPEAKER_01 11:53

Yeah.

SPEAKER_00 11:53

What else?

Strength Training, Bones, Androgens

SPEAKER_01 11:55

Protein and fiber. Um, you need to resistance train. You know, we haven't heard this before, but we when we resistance train, it increases our androgen receptor sensitivity. So it's gonna boost testosterone and it's also gonna boost your tissue's availability to like use that testosterone. Okay. It's also gonna improve estrogen's effect on your bone density. Like one of the main reasons we prescribe estrogen to menopausal women is to protect their bones. And one of the other number one things that you can do to protect those bones is resistance train.

SPEAKER_00 12:30

Yes. Yeah, you have to apply some type of resistance to the mechanism in order to strengthen it, right? Like we see that it's the same for muscles and it's the same for bones. And for your mindset, right? Like it is empowering. Movement teaches your body that you're able to have this confidence, that you're able to show up in these ways in your life. And it gives you that level of certainty that feels really, really reassuring, which can also be said about you know, your HRT and how you're handling that protocol and being really decisive about it and being really conscious of the choices that you're making. So that's an important component, too, that's not really talked about very much.

SPEAKER_01 13:08

And I'm just gonna add this to the end because it happened last night. We went to Gunnar's football game and then it was it was an away game, and it was the whole town was walking around weight vests on. Like it was weird, which wasn't it.

SPEAKER_00 13:21

Yeah, that's the new, that's the new trend.

SPEAKER_01 13:22

I know, but that is not weight training. Like, if you want to put a rucksack on and you want to go on a walk, okay, that's awesome, do it. It's not like, but it is not the only thing you need.

SPEAKER_00 13:33

Yes, it is not, and it's better than nothing. And so it's like, yeah, right. It's like, can we meet people where they are? Yes, with the goal of progressing, right? It's like that is what's uh trending right now, and it's like, okay, great, but it's still a walk.

SPEAKER_01 13:51

Yeah.

unknown 13:52

Right.

Sleep Consistency and Circadian Rhythm

SPEAKER_01 13:52

It just makes your heart rate go up a little bit higher. Yeah, yeah. Okay. Um, and then you need some sleep because sleep stimulates your growth hormone. It also stimulates cortisol and melatonin. And so all of those things intersect with HRG. So if you're not sleeping well, you're going to get a poor hormone response. Like it's just gonna happen. How do you get better sleep? I cannot stress to you how much can how important it is for consistent sleep and wait times. I know you all make fun of me because I go to bed at 7 a.m. and wake up at 3 a.m. and I even do it on the weekends, but like it messes like that trip to LA messed me up for like a week because my bed times were not consistent. So consistent sleep and wait times are really important. That means like turn your screen off an hour before bed so you don't have like blue light shining in your light, or you don't see something on social media that gets you all riled up before you're trying to go to sleep.

SPEAKER_00 14:50

Yeah, it's like you don't know how good it feels until you do it consistently, right? Like that's the common thing that we hear all the time. I don't need that much sleep. I feel great. You don't know. And one night to two nights out of the week getting good sleep and then trying to compare and contrast isn't gonna do it. You don't know until you do it consistently. I would say give yourself like a solid three weeks of consistent bedtime and wake time to build that circadian rhythm, get some morning sun in your eyes, go to bed at the same time, make sure you're deep down regulated before you go to bed. You will feel like a different woman.

Stress, Cortisol, and Adrenal Strategy

SPEAKER_01 15:22

Like yeah, yeah, yeah. And I did two client reviews today. Okay. Um and then I'm gonna I'm talking about this because we're talking about stress next, okay. And you have to control your stress. Like, if if you don't control your stress, your your cortisol steals prenetolone, it reduces your sex hormone production. It's known as the prenetolone steal, okay? Every patient I saw today had a cortisol of like five and like it is in complete adrenal fatigue. Um, they have no testosterone and their progesterone sucks.

SPEAKER_00 16:10

When was the last time you saw cortisol in a normal range, Lindsay?

SPEAKER_01 16:14

With our clients, I feel like it's never. I like literally like it's it's either really high or really low. That's what I'm saying.

SPEAKER_00 16:21

We're we're continuing to see this trend, right? And the variance, the split between gets bigger and bigger, where it's like either it's adrenal fatigue and their cortisol is in the tank or their cortisol is through the roof.

SPEAKER_01 16:31

Yeah. And so, you know what, with both of these patients, I didn't start them on hormones. I we're gonna fix their adrenal glands first. And then, because if I start them on hormones, this is where it gets a little bit tricky and you have to individualize it to each person. Like, it are you feeling so terrible that you literally can't function? So I need to give you hormones so you can feel better to eat healthy and and and function, or can we try to heal your adrenals first and then see if you even need hormones, right? So it does vary person to person on that. Like, I know, like sometimes I I know you guys hear us say, like, hey, like you need to weight train and you need to eat healthy and you need to control your stress, and you're like, I don't have the energy to do that. I I hear you. I hear you. And sometimes you might need a little bit of help with some hormones so that you can do that stuff, but you can't take hormones thinking it's gonna fix it and then not do the lifestyle stuff with it because you're not gonna get the benefit from those hormones.

SPEAKER_00 17:34

But it also doesn't, it's like going away from that all or nothing, also, too, right? It's because it doesn't mean that you have to do all of those things and get this, like these perfect check marks before being able to do HRT. It's like, can I improve any of these areas? Can I turn the dial a little bit, right? It's not about getting to a place where it's like, okay, I'm getting 10,000 steps a day, I'm resistance training for an hour, four days a week, I'm sleeping eight hours an hour, right? Like these boxes don't have to be perfectly checked before this is an option. It's just that if we can start getting these things in the right direction and make improvements in these areas, and then that way you can progress it once the HRT starts allowing you to feel a little bit better, but they can work in tandem, right? Not one or the other. It's not an or, it's an and.

SPEAKER_01 18:21

Yeah. So how I mean, I tell them they have high cortisol, and then you try to help them fix it. So what are you telling them to do?

Benefits With Limits: Heart, Cancer, Insulin

SPEAKER_00 18:32

Yeah, it's really a matter of looking at, like, we have to pan out to the big picture. You know, it's like so often we're running around chasing this never-ending to-do list all the time and then doubting ourselves with every decision along the way, versus like, I have to take a pause. I have to pan out a little bit, and I have to be able to look at what do I actually want my life to look like? And what is the small action step that I can take to get a little closer in that direction? I can tell you right now, it's not running a million miles an hour trying to get all the things done that aren't going to get done because you're fucking kidding yourself if you think that the to-do list is gonna get wiped clean one day. It's not, right? So we have to reorganize the way that we look at how we're tasking ourselves and we have to start to manage our priorities and our discipline in a way that feels better for our nervous system, as opposed to white knuckling through our day every day and then crashing with a glass of wine and Netflix every night, right? Because we're literally just upregulating and then suppressing, and we're on this freaking roller coaster every day, right? And instead, we have to get off that roller coaster and take a step back and take a look at that pattern and make a small adjustment. And it doesn't mean we're gonna stop it, right? That's the common misconception, is that well, I can't, I can't change anything about my reality. I have to do all these things. Okay, can we start to look at the story that's attached to that? And can we start to identify is that absolutely true? And can we find a little bit of evidence that says that it's not? And then can we lean in that direction? So it's small changes over time, but they will have a compound effect. Just like just like everything else. It's all on the dial.

SPEAKER_01 20:13

Yeah. And so when we think about HRT, we uh it right now we're hearing like all of these great benefits and in the media, and it has great benefits. Like cardiovascular disease is the number one killer of women, and estrogen helps protect against cardiovascular disease, like fractures and bone breaking are huge, and estrogen protects against that. Um, inflammation causes cancer, and estrogen helps helps against that. But here's the thing like as far as cardiovascular goes, like, yes, HRT can definitely improve your lipid profile. Then one of the first signs of perimenopause is a spike in your lipid panel. But HRT is not going to fix your lipid panel if you're still eating trans fats and sugar. It's not gonna correct that. You're still gonna end up needing a statin. With cancer risk, like yes, HRT can lower inflammation, but if your estrogen isn't metabolizing because you have not good methylation, which we've talked about before, where you're not getting enough B vitamins and choline, like your cancer risk isn't gonna be it's gonna be worse, actually. Um yes, estrogen can help improve insulin resistance, but it doesn't replace poor glycemic control. Like if you're eating a bunch of sugar and you're not moving your body, you can still get diabetes.

Case Studies & Habit Sequencing

SPEAKER_00 21:39

Yeah. And there's also an emotional risk, right? So if you have an expectation that hormones are going to fix you without having to change anything else, you are setting yourself up for disappointment. And that expectation and reality gap, that is where disappointment lies. And that's where it we go into this place of like nothing works for me. And I'm giving up and I'm overwhelmed, right? And that's where coaching be can be really, really beneficial for you because we can help to pan out, take that big picture look, see it from a different perspective, and then we can help you with the habits that will make your hormones work for you instead of against you, essentially, or what feels like against you.

SPEAKER_01 22:21

So, I mean, a lot of times we have patients that come with us on HRT already from their doctor. They're like, this HRT isn't working, right? So I can think of like one example where we've had a client that's on estrogen and they're still having hot flashes, but they didn't do any lifestyle stuff. So we worked with her and we added in strength training and some magnesium glycinate at bedtime and cut out alcohol. And guess what? Her hot flashes went away without having to like up the estrogen or figure out some other, some other thing.

SPEAKER_00 22:55

Right. Like I've had women that have come to me that are already on HRT when we start working on mindset, right? Like, they're super frustrated. They're like, I'm doing all these things, and you know, that's where I'm doing all the things and it's not working, right? And as soon as we can start to commit to taking prioritizing some time for yourself and looking at taking a daily walk without a device and downregulating your nervous system at least once a day and putting an intentional integration practice with that, right? Oh, wow, look at that. The hormones finally click.

unknown 23:24

Yeah.

SPEAKER_00 23:24

And they start working, they start feeling better.

Coaching, Individualization & Next Steps

SPEAKER_01 23:27

And like, listen, I know it can be overwhelming, and this is where it's going back really again, was talking about you don't have to check all the boxes. Like I saw some meme on TikTok today that was like, I'm 40 and I'm supposed to eat 120 grams of protein, strength chain, blah, blah, blah, blah, walk 10,000 steps a day, sleep seven to nine hours a day. Yeah, yeah, something like that. Like master the lowest hanging fruit and then work from there, right? Track one habit at a time. Like, if you're really struggling with sleep, like nail down your sleep routine and then move on to your steps and then move on to your nutrition. Like, what like again, that's where labs can help because we can help you pinpoint out what the lowest hanging fruit is and help you work with there. And yeah, ideally, like for some people, we're gonna work on all those things at once. But again, this is where individualized care matters, like looking at your lifestyle and what you're capable of doing at that time and making those small improvements to those things. Like, and that's where having a coach comes. Like, this is 110% why we don't do labs and hormones without a coach. Because you meet with me and I literally write out this treatment plan. I'm like, you need to do this and this and this and this and this. And then they get off and they're like, I can't do all that.

SPEAKER_00 24:37

Like that is, yeah, you have the what, but you don't have the how.

SPEAKER_01 24:40

And that is not feasible. So then you then your coach looks at it with you and they're like, okay, here's the plan. What can we attack first? And let's set up some smart goals, like with you to make sure that you can you can attain whatever you're whatever the plan says that you're getting thrown at you. Because what you can do the destination, right?

SPEAKER_00 25:03

It's like, okay, we gotta map out. This is where I am now, this is the destination that I'm going to. There are benchmarks along the way, ladies. We are not just taking a rocket ship there, right? Like you've got to adhere to your season of life where you are, what's on your plate, what are the things that you need to address along the way, and how can you progress so that way you can do this for the rest of your life.

SPEAKER_01 25:23

And it's and then it's and then you've built it up where it's maintainable. Because our goal is never to have you track your macros for three months and do this crazy restrictive diet, and then you quit working with us and you gain the weight back. That's we're not a diet. If you want a diet, you should go somewhere else. Um because we're not the right people for you. But the bottom line is that hormones are I love hormones. I'm on all the hormones. I think they are the right thing, sliced bread. Love them. But I also have my like I my body is metabolically like golden, right? And I know that hormones are not magic. And I see this every single day that if you don't have some lifestyle medicine, which is exactly why I'm getting my doctorate in lifestyle medicine right now, HRT is literally like you're literally building a house on the sand, on sand. Like you're it's never that structure is never gonna stand.

Follow, Share, Review, Subscribe

SPEAKER_00 26:22

Yeah. Versus when you bring in the lifestyle and ideally the coaching and HRT together, right? That's when you can get closer to that destination that you're looking for. So if that's something that you're curious about, ladies, if you want to know more about your hormones, about lifestyle foundation that's required for HRT, um, check out some of the links in the show notes. Make sure that you follow along with us, make sure you follow us online at Rejuvenating Health and at Coach Lakin, and that you are taking advantage of the free information that we're we're circulating all the time and the tips, right? But also, like feel free to reach out to us directly if you have any questions.

SPEAKER_01 26:58

Yeah, yeah. We love doing this or we want to be doing it. So um, share it with a friend, give us a five-star review. We're now on YouTube, so subscribe to that. And we will see you next week.

SPEAKER_00 27:12

Good one, baby.

unknown 27:19

Um