E140 | Life After Cancer: Health, Hormones, And Hope

You made it through treatment, heard the words “cancer free,” and then the questions started piling up: Why am I still exhausted? Where did my libido go? Why does my body feel like a stranger? We’re tackling life after cancer with a clear-eyed look at hormones, quality of life, and the difference between avoiding recurrence and actually feeling well.

We break down what survival medicine prioritizes versus what optimization requires, showing how blanket rules like “no hormones ever” fail many women. Not all breast and ovarian cancers are the same, and neither are your risks or goals. We talk through ER/PR-positive versus negative subtypes, BRCA considerations, and the real factors that should shape care: time since treatment, recurrence risk, symptom severity, and personal values. From there, we explore practical options with nuance—low-dose vaginal estrogen for genitourinary health, carefully dosed testosterone to support muscle, bone, mood, and libido and why doing nothing can carry its own risks for inflammation, insulin resistance, and cardiovascular disease.

You deserve individualized care, informed choice, and a plan built around your life. Tune in for evidence, options, and encouragement you can use now. If this conversation helps, share it with someone who needs it, subscribe for more grounded women’s health, and be sure to leave a 5-star rating and review to help others find the show.

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Transcript

Setting The Stage And Disclaimer

SPEAKER_01 0:00

Any views, thoughts, and opinions expressed on the Rejuvenating 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. Hey ladies, welcome back to the Rejuvenating Health Podcast. I'm your nurse practitioner, Lindsay. And as always, I'm here with Lakin. And before we begin this episode, I'm going to give a little medical disclaimer that this podcast is for educational purposes only and does not replace individualized care, especially this episode, because today we're going to talk about your health and hormones after cancer. And so hormone decisions after breast cancer or ovarian cancer are very complex and they must involve your oncology team, knowledgeable prescribing clinician, knowing your individual risk stratification. And so during this episode, we're going to discuss emerging evidence, clinical experience, and quality of life considerations and not universal recommendations. So what's appropriate for one cancer survivor may not be appropriate for another.

Survival Medicine Vs Optimization

SPEAKER_00 1:21

Yeah, lots, lots and lots of nuance, right? So like today's episode is for women who have heard the words like you're cancer free, right? So this is post-treatment. Um, you've been technically cleared for remission, right? But you are still feeling a lot of the things that were present before, including exhaustion, you know, inflammation, feeling very disconnected from your body is something that is very common in that state. Struggling with things like weight and sleep and libido or brain frog or a lot of joint pain, right? Like a lot of these things are still present. And so we want to make sure that there's an additional layer of support for that in place because a lot of times when you get to that place in your journey, you know, the doctor that you were dealing with is like, okay, well, you know, you're you have you're cleared, you know, we'll keep an eye on it and you'll come back for your checkups, but that's not all of the support that's needed. And so being mindful and aware that there is additional support that is available to you and that is often necessary is very important.

SPEAKER_01 2:24

Yeah. Yeah, because surviving breast cancer doesn't automatically mean that you're well. And honestly, like a lot of women feel abandoned after treatment ends. And there's this silent expectation to just be grateful that you're alive and not really ask what your quality of life is. Um, and that can be super. I mean, getting your hormones ripped away from you if you get your ovaries ripped out or you get put on hormone blockers is a very life-changing experience as far as your um mood and just quality of life, right? So it's important to have these conversations and know some things that you can do to improve your quality of life, maybe with hormones and maybe without hormones.

SPEAKER_00 3:13

Yeah, and not to say, not to compare at all, right? That's something that I I talk about a lot as far as comparative suffering, or women are very uh very uh quick to compare situations and not to compare cancer to any other scenario, but women do do this a lot, right? Where it's because I have to feel gratitude for the thing, the minimum that I've received, that means that it's too much to ask for more out of any given situation. And that's not the case. Like we're here to say, you know, you are allowed to want more than just survival in this particular circumstance. You're allowed to want energy and strength and vitality and intimacy and joy and clarity around your journey moving forward. That is not too much to ask, and both can exist. You can be both very grateful for what you have been given in that circumstance, and you deserve everything that you want and more moving forward.

Quality Of Life Risks Without Hormones

SPEAKER_01 4:10

Yeah, and this is particularly important for women because you're often shut down entirely out of fear about conversations around surrounding hormones and and all that type of stuff. So I first want to start with like, what is survival versus optimization, right? Because there is a very clear distinction in survival medicine, which is what your oncologist is kind is trying to do, is how do we prevent reoccurrence? How do we, you know, ovarian cancer, you're not gonna have reoccurrence because you got your ovaries removed, but doesn't mean it hasn't spread somewhere else. And breast cancer, you've had a massectomy or whatever, but it can still spread elsewhere. So how do we prevent reoccurrence? Where when we're looking at optimization or more of that like wellness, functional health route, we're looking at how do we actually help you live well, right? And those are not the same question at all.

SPEAKER_00 5:08

Right. And women are often told, well, you can't take hormones, so that's just how it's gonna be now, right? Which is a very uh blatant and unempathetic response, but that often leaves women in a place where they're gonna experience things like, you know, severe vaginal dryness or pain during intercourse or uh potentially bone loss, muscle wasting is very common, right? In this season, metabolic dysfunction is almost guaranteed. You're going to experience depression and anxiety. You're going to have this loss of identity that goes with feeling very, very disconnected from your body and a previous version of you that you are mourning, right? There is an identity shift in that. And all of those things are very important and need to be taken into consideration.

SPEAKER_01 5:54

And what we don't talk enough about is that poor quality of life has health consequences. So that inflammation, that insulin resistance, that immune dysregulation that happens because we took away your hormones. The number one killer of women is not breast cancer, it's cardiovascular disease. And when we rip away your estrogen and progesterone and testosterone, we're setting you up for cardiovascular disease, especially if you're in your 30s and and and younger, right? Inflammation and insulin resistance is one of the number one drivers of cancer. And hormones help protect against that. Now, I'm not saying that hor I am not saying that hormones are the answer for every person because a lot of this is lifestyle, right? A lot of this is doing the right things, but you have to have a healthy lifestyle to you have to be healthy in order to prevent cancer from reoccurring. It's not just about estrogen and progesterone, right? So I want to get like super specific and and say that not all breast and ovarian cancers are the same, because there are some people that have certain types of breast cancers that can go on hormone therapy and they have no issues. What we're talking about here is the ER positive versus ER negative breast cancers, right? So ER, ERPR positive means that your cancer was estrogen and progesterone receptor positive, meaning that that estrogen and progesterone were kind of causing that cancer, where the negative means that it's not hormone-driven cancer, right? There's um BROCA associated breast cancer, where that's more genetic.

SPEAKER_00 7:35

I feel like that's the one that most people are familiar with.

SPEAKER_01 7:38

Yeah, yeah. Um, and that's more of like a genetic type thing, right? So there's hormone-driven and non-hormone-driven cancers, right?

SPEAKER_00 7:46

So just like just to clarify it, Lindsay, with that, is it always only one of those two options, essentially, like hormone-driven or genetically driven?

SPEAKER_01 7:56

No, no, there's other like you can get like ductal, environmental, inflammatory, all those types of things, right? Um, but blanket statements like you can't ever have hormones because you have breast cancer are very overly simplistic because breast cancer is not simplistic.

SPEAKER_00 8:14

And fear-based, right? Like this, this is where we this is where we don't always agree or align or love uh standard Western medicine, right? Because when there is a lack of curiosity and continued education and um interest in areas that were historically not involving of women's health in particular, right? Then we start to see with, well, this is just the way that we've always done it and better safe than sorry. So we're not going to look into an alternative. And that's simply not a good enough answer.

SPEAKER_01 8:53

Yeah. I mean, decisions should be based on what was your cancer subtype? How long has it been since you've had treatment or since you've had that cancer? What is your recurrence risk? Like, I'm sure you were given a recurrence risk. What are your values, right? Like, what is your quality of life looking like? How severe are your symptoms? And this is where you need to be working with someone that has shared decision making. It's not yes or no, black or white. There's a lot of gray in this area, and there's a lot of decision making that needs to be shared between you and your clinician. And sometimes that means going outside of your oncologist. And I know that it's really hard to find someone sometimes, but it's freaking telemed now. Like it's 2025. You can find someone that can help you, right?

SPEAKER_00 9:40

We have more options than ever before. And it's also very important to keep in mind that you have got to be your own health advocate, which is why educating yourself on information such as this is so important, right? Because it's yes, it is good to rely on the advice of the professionals that you are seeking guidance from, and you should question everything, right? Because no one is going to be as worried about your personal health as you are.

Cancer Subtypes And Individual Risk

SPEAKER_01 10:09

Yeah. The oncologist is worried about you not getting cancer again. They're not worried about anything else, right? So I want to jump straight to something that shouldn't be controversial at all, and that's vaginal estrogen, right?

SPEAKER_00 10:22

Yeah, why is this so controversial?

SPEAKER_01 10:24

It shouldn't be. It's not controversial at all, but somehow it still is. Like low dose, vaginal estrogen has minimal, I mean minimal systemic absorption, and it improves your quality of life significantly. It improves vaginal tissue integrity. So you're gonna prevent yourself from getting urinary incontinence, recurrent UTIs, painful intercourse, vaginal dryness. No one wants to have intercourse if it's like sandpaper or down there, right? So it's gonna improve your sexual function, improve your pelvic floor health. And there's evidence to show, like the North American Menopause Society, NAMS and ACOG, they both acknowledge that low-dose vaginal estrogen can be appropriate in breast cancer survivors when other non-hormonal therapies help, right? Or fail, not help, right? And so there are tons of studies out there that show there there's no clear increase in recurrence rates with local vaginal estrogen use in survivors. And literally, how many old women? I don't know if you've never been to a nursing home, but like chronic UTIs, when you're old, it makes you crazy. Like when I was a nurse working in the hospital, like if I had an old patient that had a UTI, it was the worst night ever because they were like hallucinating and all kinds of stuff. And vaginal estrogen helps prevent that.

SPEAKER_00 11:49

Yeah, and it will just overall improve quality of life, you know, for a variety of reasons. And it's funny because when we think about, oh, like this shouldn't be controversial. I guarantee if it were something that were plaguing penis owners, that it wouldn't be. Yeah, exactly. Right, right. And that's that's the issue at hand is that most of these things are understudied, underfunded, and are not progressing. I mean, they are more now than they ever were before, but for years and years and years, that was very plateaued installed. And so we're having to play catch up a little bit in that now.

SPEAKER_01 12:18

Yeah, exactly. And many women with a history of breast cancer, like most oncologists now, if you're working with someone that's up to date, they're gonna tell you that it's okay to do vaginal estrogen. That you shouldn't be suffering, right? So vaginal estrogen is gonna help your libido, but then there's also testosterone, right? And nobody wants to talk about this after cancer because it let's be real, no one until the last like five years.

SPEAKER_00 12:49

So to say, I don't think people want to talk, most people don't want to talk about it, period, right? Like again, unless it's it if I were a man and my T was low, I could get it today.

unknown 13:00

Right.

SPEAKER_00 13:01

You know what I mean? It'd be super easy, it wouldn't even be contested. But this is something that's still like on that growing edge for women. There's still not forms of it that are approved for women to be able to use.

Shared Decision Making And Advocacy

SPEAKER_01 13:12

Yeah, exactly. It's like taboo out there, even with people that have no history of cancer. So then you drive into the cancer survivors, holy moly. So, but here's the truth testosterone is not estrogen, it's not progesterone. Like it plays a really important role for muscle mass and bone density and insulin sensitivity and mood and cognition and libido. And there is no high-quality evidence that demonstrates that taking your testosterone to a physiological level. So I'm talking about like the 50s, not the 250s, increases your risk for breast cancer. Some there is some studies that show androgens may be anti-prolifative in breast tissue under certain conditions. And if you get your testosterone too high, it can convert to estrogen. But if you're working with a clinician that is dosing appropriately, like conservative dosing, that's monitoring your estrogen, that is working one-on-one with you, and you give informed consent and you know that like this is helping your libido and your quality of life, it shouldn't be a no.

SPEAKER_00 14:26

Yeah. And women are gonna be losing testosterone pretty dramatically when it comes to perimenopause and menopause, period, but even more so after ovarian removal or chemotherapy or any of those other things are gonna disrupt hormonal function because that is one of our main sex hormones, whether, you know, whether it's highly regarded or not, not in the same level as um most people would estrogen or progesterone, but it it is something that's extremely important for our hormonal health.

Vaginal Estrogen: Safety And Benefits

SPEAKER_01 14:54

And this is this is where it becomes a risk versus benefit conversation, right? Is it risk-free? No. No, it's not, nothing is, right? But is doing nothing risk-free? No, because bone loss, sacropenia, metabolic disease, depression, I the toll it takes on your marriage and divorce and your mental health, like those all carry really long-term risks too. So as a provider, mine, uh the way I kind of treat testosterone, as long as you're one year out of treatment and we have an honest conversation that we're not gonna get you to these super physiological levels and we really dig into your reoccurrence rate and stuff like that, like vaginal estrogen and testosterone replacement therapy are things that definitely can be done in cancer survivors.

SPEAKER_00 15:50

Yeah. And if that's not an option, right? Like if we if hormones is not something that I feel is available to me or that I feel comfortable doing that I can do, it's like, okay, what can I do? So then let's shift to what's taken away to what's still available as far as a mindset space, right? Because in that season, it's very easy to focus on all the things that we're at a loss for, that we can't do anymore, that aren't associated with the identity that we used to have. And so instead, can we shift to what is available to me?

SPEAKER_01 16:19

Yeah, and this is where lifestyle medicine comes in huge. And this is exactly why I went back to school to get my doctorate in lifestyle medicine. And I'll be frank with you like there's a ton of women inside rejuvenating that we've helped that can't have hormones or that choose not to. Yeah. And we still get them amazing results. Some women choose to have hormones and some women do not. And you can completely get your quality of life back without using hormones, but it it means that you might have to work a little bit harder, right?

SPEAKER_00 16:48

Or it might take a little bit longer.

SPEAKER_01 16:49

Exactly. Like you're going to have to make sure you're getting in enough protein to preserve your lean muscle mass. Like resistance training is a non-negotiable for you. Keeping your blood sugar stable, have to do it. Anti-inflammatory nutrition. If you're a cancer survivor, anti-inflammatory nutrition should be the number one thing on your priority list. Number one thing. You should not be eating sugar and seed oils and stuff that feeds cancer. You should be getting sleep, right? Like that in eating an inflammatory diet and not sleeping, holy moly, your risk for cancer is just like skyrocketing for that.

SPEAKER_00 17:30

You have to regulate your stress. You absolutely non-negotiable. And not to say that HRT is going to be an easy button that alleviates these requirements, right? It's an and, not an or, like we always say. The HRT is going to be able to allow you to potentially collapse a timeline or be able to expedite the benefits that you're going to get from these lifestyle practices, or is going to be able to allow it to come with more ease, right? If I'm feeling better, I'm going to be more prone to being able to execute on the daily actions and habits that are going to get me this benefit of this lifestyle medicine. But that's where the health coaching becomes essential because it's going to be at a time where it potentially is going to feel more difficult. And so if you don't want to do the HRT or hormones are not an option for you because that's how you feel, then that's fine. But trying to hold yourself accountable in that season is going to be harder. And so if you have somebody that's in your corner that's a helping you to curate a plan and iron out what does that look like now in this season with your current capacity, that's worth looking into and knowing isn't doing. So it's like I can know how to do all these things for myself, but am I actually doing it? Am I showing up for myself in that way?

Testosterone For Women After Cancer

SPEAKER_01 18:40

Yeah. And one thing we can do too is look at the other hormones, right? Like it's not just estrogen, progesterone, and testosterone. Like when you take your estrogen, progesterone, and testosterone away, your thyroid's gonna take a hit. So let's optimize your thyroid. Maybe you need some T3, right? If we're gonna give you estrogen, estrogen has three forms estratol, estriol, and estrone. And estrone is the bad one. So maybe you're getting some low-dose estrogen and you're just making sure it's not converting to estrone, right? Or, you know, maybe you're doing the lifestyle stuff, but we can also add in a ton of other supportive things like supplements and peptides and supportive therapies, right? Like depending on the individual, like we can look at adding in creatine for muscle mass and cognition. An omega is a non-negotiable. You should be taking that because it's anti-inflammatory. Some magnesium. Exactly. Same with ADK, curcumin, right? Like those are all things. Um, you could do some vaginal DHEA in some cases, pelvic fluorotherapy. And again, none of this replaces hormones, but it can definitely help bridge a gap. And same thing with the GLP ones. Like GLP ones could be really good in people that have had a history of cancer because they reduce inflammation and they reduce blood sugar. And we know that both of these things increase your risk of cancer. So we can use a lot of different. Peptides and supplements and things like that. Right. And you, I think the number one thing that people miss entirely in treating breast cancer survivor is the emotional and identity layer of it, especially for those people that may have maybe had massectomies or you literally had your body part cut off. And we do not acknowledge the change in identity and emotional stuff that happens with that.

SPEAKER_00 20:30

Yeah. And we've touched on this, you know, a couple of times throughout this episode so far, but that component is not always something that's addressed during that journey. And depending on the access that you have to resources or what's available to you while you are receiving treatment or once you go into remission, that's something that does not need to fall by the wayside, right? Because we can't separate the two. Cancer does change your relationship with your body, it does um separate the way that you view yourself currently from the way that you used to view yourself. There is a different identity that needs to be embodied because similar, and again, not comparing, but just like if you go through a pregnancy and postpartum journey, your body is not the same as it was before and after that. It is a completely different body. You are in a completely different chapter of life. And same with cancer. Again, very different scenario. And you were in a different body before, and you are in a different body after, and you are different as a person. And so that requires a different identity to be embodied, and navigating that alone can be very difficult. And so being able to have someone that can help guide you through that and that personal rediscovery of yourself is very, very important.

SPEAKER_01 21:47

And I and acknowledging that it's okay to be grateful and to have grief at the same time. Both of those things can go coexist together. So you can be grateful that you're alive, which I'm sure you're told. Like, and I'm and that and that's what you're supposed to think. I'm grateful that I survived. I'm grateful to be alive, but it's also okay to feel grief, right? Yeah.

SPEAKER_00 22:10

If you're just trying to grit through all of the feelings of either hopelessness or comparison to before, or you know, struggling with these symptoms that we've mentioned throughout the episode, and you're just gritting your teeth through it because you're quote unquote supposed to be grateful for the outcome that you've received, that's not going to benefit you. And that's going to wreak mental havoc on your well-being and on your mindset.

unknown 22:33

Yeah.

SPEAKER_00 22:33

That's not, that's not whole healing, right? It's like your body may be healing.

Non-Hormonal Paths And Lifestyle Medicine

SPEAKER_01 22:39

Yeah. You're allowed to want pleasure and vitality and strength and confidence in your body. Like it's not selfish at all. It's healing and and you're allowed. You're allowed to have choices. Like that's the great thing about where we're at in medicine now, is that you are alive, you are allowed to be an advocate for yourself and to choose quality of life. And so if you take one thing away from this episode, let it be this. You deserve individualized care. You deserve to have nuanced conversations, and you deserve informed choice, not fear-based medicine. If you go to a provider and they completely shut you down without listening to you, go find a different one.

SPEAKER_00 23:28

Yeah, because survival is just the beginning of this stage of your life, right? It's not the finish line. Yes, it is a huge achievement and it is not to be diminished. And there's so much more, and you should want so much more for yourself for yourself, and you deserve so much more. And looking forward to what the rest of your life looks like and how great it can be is a really important component as opposed to, like we said, focusing on the lack or all the things that are different now or that you're missing.

SPEAKER_01 23:57

Yeah, I mean, optimal health after cancer is so possible, even if it looks different than what it did before. Right. Even if it looks different. So hopefully, if I I know this isn't gonna resonate with all of our audience because not everyone has has this experience, but I guarantee you know one or multiple people in your life that have gone through cancer.

SPEAKER_00 24:21

Yeah.

SPEAKER_01 24:21

And so share this episode with them, right? Be encourage them to not just be living in a shell and to really strive to live that functional, to live that optimal health and and be thriving in their post-cancer stage because you survive something really hard.

unknown 24:39

Yeah.

SPEAKER_00 24:55

Yeah. Right. If we're always tiptoeing around somebody because we feel like we should be in a state of grief or, you know, just be happy that they're alive moving forward, what how does that allow them to focus on what their life could look like moving forward or what achievements they're looking forward to, or the good things that they can shift into, right? It's like, ask those questions. Like, what are you excited about moving forward? What are you, you know, what are you going to do for yourself now in this next chapter? What are the ways that you're going to take care of yourself differently? Right. Like that can be, even if you are not personally going through this scenario, that's something that you can help with as far as that mindset shift and as far as that healing process goes moving forward.

SPEAKER_01 25:36

And I can tell you, like, the number one thing you can do as a cancer survivor is invest in yourself. Not saying it's with us, right? But something fed your cancer and it probably wasn't hormones. It was probably some inflammation and some stuff like that. So learn how to take care of your body. Work with someone to work through the trauma and the mental things that have happened because of your like that deal with your survivorship, right? You deserve to be healthy and happy and thriving after this. And so invest in yourself a little bit if you don't know where to start.

SPEAKER_00 26:13

Yeah. Can you look at it as an opportunity for a shift moving forward? Yeah.

SPEAKER_01 26:18

So share away, give us a five-star review. Um, like and subscribe, and we'll catch you next time.

SPEAKER_00 26:26

Bye, ladies.