Insights from the Couch - Real Talk for Women at Midlife

Ep.64: Everything You Need to Know About GLP-1 Medications at Midlife with Amy Wrenn, NP

• Colette Fehr, Laura Bowman • Season 5 • Episode 64

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If you’ve been hearing all the buzz about GLP-1 medications like Ozempic, Wegovy, or Zepbound, and you’re wondering if they could be the right fit for you at midlife, this is the episode to press play on. We brought on nurse practitioner and health optimization expert Amy Wrenn to demystify what GLP-1s actually are, how they work, who they’re for, and what you really need to know about taking them during perimenopause and menopause. Amy is passionate, informed, and totally relatable—she cuts through the hype to bring clarity to a topic that’s been wrapped in confusion and judgment.

In this conversation, we get real about our own experiences, bust some myths, talk side effects (yep, we go there), and explore the broader context of hormone therapy, weight gain, metabolic dysfunction, and the importance of doing what works for your individual body and life. Whether you’re curious, cautious, or already on a GLP-1, this is a must-listen packed with valuable insights.

 

 

Episode Highlights:

[0:00] - Welcoming Amy Wrenn and kicking off our deep dive into GLP-1s
 [3:10] - What exactly are GLP-1s, and how do they work in your body?
 [5:00] - Understanding insulin resistance, perimenopause, and why midlife changes everything
 [6:57] - Real-life examples of "metabolic mayhem" that hits out of nowhere
 [8:03] - Challenging the lazy stereotype: GLP-1s are not a quick fix
 [10:08] - The far-reaching benefits: inflammation, PCOS, cognitive health, and more
 [12:10] - Social media hype vs. safe medical prescribing—know the difference
 [13:46] - Compounded medications vs. name-brand prescriptions: what to watch for
 [17:33] - Who qualifies for GLP-1s, and what do providers look for?
 [20:43] - It's not about skinny—it's about healthy: the real goal of treatment
 [22:34] - Common side effects: what to expect and how to manage them
 [25:25] - Nutrition matters: prioritizing protein, avoiding high-fat traps
 [26:38] - Surprising benefits: reduced alcohol cravings, better food boundaries
 [28:12] - Coming off GLP-1s: what it looks like, and when it’s okay to stay on
 [31:48] - Does your body adapt over time? Amy explains habituation and dosing
 [33:32] - The power trio: GLP-1s, HRT, and resistance training
 [36:08] - Hormone therapy explained: symptom relief vs. long-term prevention
 [40:51] - Why we’re not getting this info from our doctors—and how to change that
 [42:24] - Where to follow Amy and keep learning more

 

 Links & Resources

Follow Amy Wrenn, NP on Instagram: https://www.instagram.com/np_wrenn 

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Colette Fehr:

Marc, welcome to insights from the couch, where real conversations meet real

Laura Bowman:

life. At midlife, we're Colette and Laura, two therapists and best friends, walking through the journey right alongside you, whether you're feeling stuck, restless or just unsure of what's next. This is a space for honest conversations, messy truths and meaningful change.

Colette Fehr:

And our midlife master class is now open. If you're looking to level up, get into action and make midlife the best season yet. Go to insights from the couch.org and join our wait list. Now let's dive in. So let's dive right into this episode on GLP ones everything you need to know about taking them at midlife, we've got nurse practitioner, Amy Wren, here with us today. We're so excited. We're gonna get into it all de stigmatize, demystify and give you all the info you need to know to make decisions that are right for you. Amy, welcome and thank you for being here.

Amy Wrenn:

Thank you. Thank you for having me. I'm so happy to be here.

Colette Fehr:

Yeah, we're so excited to talk about this with you. And maybe you could start out by just tell us a little bit about yourself for our listeners.

Amy Wrenn:

Sure, sure. So I am a nurse practitioner. I've been in the medical field for over 20 years. I started out my career in Obstetrics and Gynecology, and I now am in the integrative med space. I specialize in health optimization, so that looks like anything from weight loss to hormones to peptides, anything we can do to make you be the healthiest version of you, is what I specialize in.

Unknown:

Oh, I love so cool. I love that. Yeah,

Colette Fehr:

and are you available online or only in office?

Amy Wrenn:

So actually, this past year, I haven't been seeing patients. I've taken a little detour, and I am now consulting, doing education and training for practitioners, because there is a huge gap, which I'm sure you guys know, and what patients want, what they need, and what providers understand and know. So especially in the perimenopause, menopause space, even in the weight loss space providers are just not taught this in medical school, and so I am trying to bridge that gap and be a resource for providers who want to do right by their patients and give them updated, safe medications and treatments. So I'm really finding that to be super fulfilling, and it doesn't mean that I won't be back at the bedside at some point, but just for the last year I've been doing this, and I'm loving it.

Colette Fehr:

That's wonderful. It's so needed. It's so needed. Yes, yes, yeah, as you know, all right, so let's dive in and talk about GLP ones. Can you start out by telling us what they are like. Let's say a woman's not only heard about it from her friends or through the grapevine. What are these drugs and how do they work in the body?

Amy Wrenn:

Okay? So if you're listening right now, when we say GOP ones, we're talking about those shots, those diet shots. So if you've heard of ozempic, or we go V zip bound mongero. That is what we're talking about, these weight loss injections. And a GLP one stands for glucagon like peptide one receptor agonist. That's the long scientific version of that. And actually we produce GLP ones in our bodies. All of us produce GLP ones in our bodies, and they have created this medication to mimic that. So it's the same thing that we already have in our bodies. And you may

Colette Fehr:

I did not know that. I'm sorry to interrupt you, but I've been on this I've been on Z bound for a year, and this is the first I've heard of that. So already I've learned something. Yeah.

Amy Wrenn:

So you think, Well, why, if we already are making it? Why do we need it? Well, in life, if we have metabolic dysfunction, and metabolic dysfunction can look like insulin resistance, PCOS, type two diabetes. It really hits women and perimenopause and menopause, because once we're not making as much estrogen, we can become insulin resistant. So people who have maybe never had an issue with their weight all of the sudden are like, I don't I don't understand what's happening to me. I haven't changed my diet. I haven't changed my exercise. I'm gaining weight. You know what is wrong? And it's because our brains aren't getting the message from the gut. So the gut creates this peptide, this GLP, one sends the message to the brain. And think of it like a text message, like your gut is sending a text message to the brain, but the brain needs glasses and the text is so small it can't see it. Then you get this exogenous. Exogenous means from outside the body. So endogenous is what your body creates. Exogenous is something that we bring in, and you give yourself a shot of this now that text message is blown up. Big brain has glasses, and it's like, oh, says we're full, says we're full, and it says we're going to do this with the sugar, and we're going to do this with our fat. And so it's a tool that we have in our toolbox to help patients lose weight, to help get that message to the brain that they weren't receiving. And I've told a lot of patients that it's the equivalent of, have you tried unplugging it and plugging it back in? It just kind of resets everything in the body.

Laura Bowman:

Can Can we double click on the piece where you say, you know, when we go into perimenopause, our estrogen is reducing, and all of a sudden our brain isn't getting the signal. Is that is, is the gate weight gain? Because we're not getting the same signal and we're overeating. I mean, are we changing anything? Or is it literally like systems in the body are dealing with the same amount of food, but they're dealing with

Amy Wrenn:

it differently. They're dealing with it differently. And yes, you can overeat, but it's dealing with it differently, because the insulin, insulin is a hormone, and the body is not responding to it anymore, and that is called insulin resistance, and that truly can happen at any age, but you can take a person who's never had that, and once they enter perimenopause or menopause, then they will, they will most likely get that.

Colette Fehr:

Oh my gosh, Amy, exactly what you're saying, you guys. I just talked to a good friend who was like, I saw her for the first time in a while, and she said, Oh, my God, I am going out of my mind. I have put on 25 pounds. She's about 5455 years old. She's been naturally thin her whole life, like she's never had eating issues. She's never had to think about eating. She's just one of those people who genetically has been relatively thin and not had to focus on it. She said, I've gone through all of these hoops where I've dieted, counted calories, increased my exercise to five to six times a week. She said, Nothing is making me get the weight off. And she said, and I'm not even overeating or eating any differently, and she's thinking about GLP ones something, she said, You know, I'm really afraid. And I tried to give her some reassurance. I mean, my experience has been mostly very positive, but she said, it's unbelievable how nothing's changed, and I have never had a weight problem my entire life. So it sounds like something like what you're describing is probably what's happening for her. She She

Amy Wrenn:

sounds like the the poster child for this. I've had so many patients come to me and they have tried everything, and that's where I get very I get very protective of these patients when I hear people out in the community that have bias against the medication. Because these aren't lazy people. They're not lazy people. These are people who have tried counting calories, counting macros, eliminating certain foods, doing keto, cardio, cardio, all day and night, and nothing is changing. They and they and they're going out of their minds, and they're so discouraged and so and a lot of them have been to a primary care who just says, Hey, why don't you eat less and move more? Have you tried that? And do

Colette Fehr:

you know what my primary care told me to do, like, five years ago to get my fitness pal. I was like, I've had it for 15 years, yeah, and Weight Watchers, yeah. And I can only speak, of course, to my personal experience, but I have had weight fluctuations through my throughout my whole life. So this is not unique for me to this phase of life, but what I've experienced firsthand being on these drugs, first of all, I'm not somebody who has no appetite, even now on GLP ones, like, I'm still hungry. Like, it's not I still have to be intentional about what I eat. It's not just been this magic bullet for me, like you hear out there, oh, you have no appetite. That's not my experience. But what is my experience is that my brain is getting that message at a reasonable place, I'm no longer thinking about food. This, for me, has helped so much, and it doesn't feel like a crutch in any way. And the idea that people taking this drug are lazy is so ridiculous that I if anyone has that viewpoint like you, just don't. You have some of these struggles, then good for you. But like that makes me infuriated to even think that anyone could hold that view.

Amy Wrenn:

Yeah, it drives me crazy, too. And everything that you were just explaining about yourself, that your brain was not getting the hormone signaling, right, you know, you would eat, and then later you were hungry, so you didn't have satiety. So there's a lot of hormones that go with that, leptin and ghrelin, yes, and so this helps, like I said, it's like unplugging it and plugging it back in. It just kind of resets all that and improves signal signaling to your brain, which, you know that's such a that's such a disadvantage for people that metabolically have that issue. Yes, we should be offering them something if we have it, to help with that, because it doesn't just help with weight loss. It helps with inflammation, which is huge. It helps with things like PCOS. They've done more studies now it helps with cardiovascular disease, cognitive impairment, fatty liver. It helps with kidneys, and it helps with addiction as well. So yeah, there are a plethora of disease processes that this medication is proving to be beneficial for

Laura Bowman:

I used to hear about these drugs, and it would be like, ozempic was the first one, the big Hallmark one. And then that was for people who were diabetic. And then they came out with, like, Zep bound, and we go, V and that was more for weight loss. Now I'm hearing everybody literally talk about wanting to be on some sort of peptide. I don't the latest one is red, a true tide. Have you heard of this one? Yes, red, a true tide is not FDA approved yet, and it's still in the study phase of it. Okay, but what I'm getting at is like, I feel like it's now being mass marketed for kind of all people. And I'm just wondering where you, where you fall down on like, is everybody in the future going to be on some kind of, some form of a GLP one?

Amy Wrenn:

So no, because not everybody is a candidate for it, and not everybody will need it. Yeah, but do people want to use it regardless? I guess I have turned away patients. I have had more than 104 pound patient walk through my door and want to be on this medication, who I have turned away. And it was really it was very interesting that particular instance was because all of her friends were doing it, so she wanted to do it as well. This at the end of the day, this is a medication, and it needs to be prescribed by a medical provider. So I just will, I this is something I definitely wanted to address. And since we're already kind of here, social media right now is insane, and there's a lot of Tiktok influencers who are promoting these medications, and follow my link and use my code if you can purchase this.

Colette Fehr:

Yep, I see it all the time on my feet too.

Amy Wrenn:

Do not get this medication from a link from an influencer. That medication they have was not made in a pharmacy. It was made in a lab. It will say on the bottle, not for human use, research chemicals and people. I know people who are injecting themselves with this stuff, so that is my just big warning. Please don't fall into a social media rabbit hole. You need to find a provider who specializes in this to prescribe it for you.

Colette Fehr:

I'm glad you said that. Yeah, that is chilling to know that that's what's going on. I see those links all the time, and obviously I'm on prescription Z bound. I know a lot of people use compound drugs, so let me ask you about that. What I hear anecdotally, from some people. I've heard from some people, oh, I'm doing great on the compound drug, I micro dose. There are a lot of people going to these medi clinics where they're giving them a whole bunch of stuff, including some kind of GLP one compound and charging a fortune. You know, I hear from other people, Oh, I was on zip bound, and now I'm doing the compound because it got too expensive and I'm having more side effects. What's your thought on the compound versus the prescription route?

Amy Wrenn:

The compound will depend on the pharmacy the quality of your medication. I use compounded pharmacies. I have some that are fantastic. There are some that I would never use. So your provider will, hopefully, if they're going to use compounded medications, have a good quality compound now, ozempic is semaglutide. If you go to a compounding pharmacy. You're not getting the name brand. So ozempic is like the name brand Kleenex or band aid, right? It is just a brand name those medications, when you get it that is typically needs to be through your insurance. Not everybody will be approved through insurance, and insurance is a whole nother podcast, but because people have a hard time getting approved

Colette Fehr:

these medications, I couldn't get approved, and I had an obesity weight, and I'm on zip bound, which is not for diabetes, so I met the prescribing criteria, and my insurance, and I have good insurance, and they did not approve

Amy Wrenn:

it, right? And so Zep bound and mongero, those are the same medications. Those are trezepatide and one under a brand name has been approved for diabetes and one under a brand name has been approved for weight loss. It's the same medication. It's just an insurance FDA, yes, yes, so you can get compounded. But the difference between like following Tiktok person to their link. Those are made in a lab. If you get compounded, that's still a pharmacy. They have to follow the State Board of Pharmacy. They get inspections. They have a sterile license. Those are still safe, good. The other big difference is that when you get the commercial brand, it will come in a pen, and you just inject it, and it's one dose. When you get it from a compounding pharmacy, it comes in a vial, and it's a multi dose vial. So you can draw up, they can they can switch up how much you're taking at a time, so you have a little bit more leeway and titrating the medication. Yeah,

Colette Fehr:

right, right. And so then we go, V and ozempic are the same, right? They're the same drug, yes, some of them, one is for weight loss and one is for diabetes, okay? And then same thing with Manjaro and Zep bound, yes. So it's really key. What I'm getting from this is to get it from a medical professional to make sure that the medication is indicated for you, because there are a lot of people, especially women, with disordered eating patterns, God knows it's drilled us into us from society. You know, my BMI was not normal. I am just now a year into the drug where I have a B A normal BMI, and I'm still on the high end of a normal BMI for my age, and I know BMI isn't everything, but you know, if you're 104 pounds, you probably don't need to be taking a diet shot. Maybe that's another issue going on there, right, right? For

Laura Bowman:

sure, where is the prescribed like? And when you do an intake of a new patient, what? What is? Because a lot of women. I mean, I've even hit a plateau where it's, you know, I've been kind of the same weight for a long time, but I can feel that it's

Colette Fehr:

harder to lose weight where you're not overweight. Are you trying to lose weight? I

Laura Bowman:

mean, I'm not trying to lose weight, but I can just see that it's, it's getting a little harder to maintain my weight, and I'm and I'm just wondering, where is the line, that line between somebody who wants to lose 20 pounds, or it just feels like it's harder to lose weight, where you send somebody away, or you bring somebody in. So

Amy Wrenn:

there is a BMI requirement for if you're going to get it commercial, commercially. And they lower that BMI to 27 if you have comorbidities. So if you have, like, insulin resistance, or you're pre diabetic, if you use the compounded method, where somebody is paying out of pocket, you don't have to go through insurance. You can get away from the some of those constraints, what I did, personally, I was very fortunate, and I had an in body scale, because I'm not a fan of BMI, because it really doesn't tell us, yeah, it really doesn't tell us. It only tells us your height and your weight, but it doesn't tell me how much fat you have, and there and there really is skinny fat, that that is a real thing where somebody looks they look thin, and then when you put them on that scale, they have no muscle. The majority of their weight is fat. And

Colette Fehr:

that might be me, that might be me, even still, I'm gonna change it, but I think I'm, I'm almost skinny fat.

Amy Wrenn:

So, so, yeah, so i i being somebody who was very fortunate and smaller my whole life, until I hit 40, and then I hit that where I started gaining weight and had zero coping skills, and I did not take the shot at the time, but because I had had that struggle, I had a lot of sympathy for the skinny, fat girls too, which a lot of people don't have sympathy for those girls, but those those women are at risk for for having bones break when they're older in life. So their bone density is a real problem too. So I personally would. Treat those patients who had 20 pounds, because 20 pounds is 20 pounds. That's not nothing different. Yeah, and so you're that is going to be something that's a little bit more particular to the provider that you're seeing. It really just depends. But I do feel like there is a place for those patients as well, because at the end of the day, we're not trying to get skinny, we're trying to get healthy, right? And that that is, that is huge, and if you do have 20 extra pounds of fat that is really contributing to inflammation, and at the end of the day, inflammation can be a precursor to cancer. So we want, we want to be the healthiest versions of ourselves.

Colette Fehr:

I'm so glad you made that distinction too, that we're really trying to get healthy. I mean, I'm not saying there's no vanity in it. For me, it's affected. It affected my mental health. It doesn't feel good to not feel at your best, or to have your clothes fed, or to never like a picture of yourself. I mean, there's an element of that psychologically, but that is really my biggest motivation, is I want to feel good and be healthy in mind and body. I've lost 30 pounds over a year, and for me, it was very slow. I never lost more than a pound and a half in a week the entire time that I've been good though, yeah, yeah, I've been at a plateau for a while now, but regardless, it's just been 30 pounds down. It's life changing. So I think it's really a positive from that front. It's not just about how you look in the mirror.

Amy Wrenn:

I can tell you I would do baseline labs with my patients, because they were coming in for all over health. And so I would look at everything, and when we would start this medication, and I would do some follow up labs. A few months later, I was floored, especially when I first broke into this cholesterol levels were better. Obviously, blood sugar was better. People were coming off their blood pressure medications, fasting insulin was better, the inflammation markers were better. Sometimes even thyroid was better. It really blew my mind.

Colette Fehr:

It's really amazing. So let's talk about a little because it sounds like so many great benefits, but talk to us a little bit about side effects horror stories, like so many people are afraid, what's the real deal with what people can expect for side effects that are typical? How scared to people need to be, that kind of stuff.

Amy Wrenn:

So I My advice to providers is that we really need to go low and go slow, because the side effects can be intense. The number one side effect is nausea. And I cannot figure out why. Some people get nausea and some people don't, but most people get at least a little bit in the beginning. Every once in a while, you'll have somebody who is very symptomatic, and they are vomiting with it. So we really want to start low and slow on it. So Nausea is the number one. Number two, I would say, is constipation, because it slows gastric emptying. It slows down how fast you move that food from your stomach down into your bowels, and so that can just slow everything down on its way out as well. Occasionally, some people will have diarrhea with it, but most of my patients had constipation with it. Another key piece of information is when you are first starting this medication. And this may be two weeks. This may last up to six weeks, but low energy initially, and that is because your body is used to running on sugar for fuel, and we are taking its fuel source away. We are really deplenishing the amount of sugar that your body gets. So your body's just like, Are you kidding me? You want me to what? You want me to work. You want me to walk. I'm so tired I don't have my energy. What are you doing with it? But eventually the body's like, wait a minute, I'm going to use this fat for fuel instead of that. Okay, I'm going to use the fat for fuel. And fat is a more efficient energy source. So you go from having no energy to having more energy than you used to have. I don't feel like enough providers warn their patients about the energy slump in the beginning. So if you're going to start this, be prepared for that, and you can supplement with like B vitamins to help kind of mitigate that energy deficit. There. Another big, important thing. So I've had patients who were doing keto, and they loved keto, and they wanted to stay on keto. That is okay, but fat bombs are not okay. So in the Keto world, yeah, I don't know what they will eat. They. Will make fat bombs, like a butter coffee or something. Yeah, it will high, high fat, and they feel like that helps them get into ketosis. Do not do that on this medication, your body is going to be burning the fat from your body. If you are putting extra fat into your system, your gallbladder is not going to have a nice time.

Colette Fehr:

I've the times I've gotten sick have been when I ate like, higher fat food than I'm normally accustomed to, and I just couldn't digest it, or just made me really sick. That's not happened often, but, but it doesn't feel good. Yeah,

Amy Wrenn:

yeah. I had a patient learn that the hard way, and I didn't know she was intentionally eating high fat. So you want to prioritize protein while you're on this medication, because we want to support our muscles, and that is, that is very, very important. So prioritizing protein, I have even heard anecdotally that it helps with some of the nausea. With that, other side effects that are kind of positive are people are I don't drink as much. I used to want a glass of wine every night, and now I don't need the glass of wine. I'm not craving ice cream after my dinner. I'm not so it really, it works on the hypothalamus in the brain, and it works on cravings, so vaping, smoking, alcohol, all of those things, not everybody, but most people tend to not need those things anymore, because it affects that reward part of your brain.

Laura Bowman:

That's fascinating. So nice, yeah, yeah, yeah. I have had a couple of patients. I've had two clients who have lost their gallbladder to this process. I know there's like their gallbladder, yeah, they had to

Colette Fehr:

have their gallbladder out. Two clients lost their gallbladder because of taking a GLP. One,

Amy Wrenn:

yes, this is another reason why you really need to be with a good provider who's going to talk to you about nutrition. I tell my patients, you're not going to just take this shot, sit on the couch and eat nothing but saltines because you're not very hungry. You have to be mindful still about moving your body, and you have to be mindful about the things that you eat. We have really need to focus on eating for nutrition. So if we can avoid now, I'm not saying not to not ever have treats or fun things, but if most of your nutrition can come from Whole Foods, so nothing out of a box, a bag or a can, that is what's going to nourish your body, and that's what we need to focus on. Because if you want to come off this medication one day, we need to build the habits now, while you're on it, while you have this tool, so that we can maintain the results

Laura Bowman:

later. Yes, I've heard, I've heard it be called renting your results. And it's like, that's a good way of putting it.

Colette Fehr:

I don't see it that way personally,

Laura Bowman:

but I mean, that's the way, that's the way they talk about it. Sometimes that you don't want to rent your results. You wanna build and buy them. You wanna buy them. Best invest

Colette Fehr:

is the word, yeah, yeah. Okay, I see what you're saying. So we, let's talk about that, getting off of them. Because I kind of have to Laura's point, even though I'm saying I don't see it that way. I kind of have in my mind, I guess I feel like I've bought my results, but that it's like a lifetime thing. I am terrified of the idea of ever going off this drug.

Amy Wrenn:

Okay, you don't have to come off of it. Okay, let's say that first, you don't have to come off of it. But some people, some people, need it for a lifetime, and some people don't, okay. So if that makes sense, yes, if you're looking at 20 pounds, that is probably going to be a shorter term, and that might look like anything from six months to even 18 months. And then I like to taper my patients off. We don't just pull the plug, and I really hand hold during that time, because I want them to maintain the habits that they built. If they stopped drinking a glass of wine every night, if they stopped having ice cream after dinner, if they stopped having a snack at 3pm you have to maintain that afterwards. You have to maintain that when the food noise comes back, because the food noise will come back if you have food noise before. So you really you've flexed and built this muscle while on the medication, and now you have to maintain that off. And I've always given my patients, I like them, well, I have them give me a red flag number, and that number needs to be more than five pounds, less than 10 pounds. I'd like them to keep track of their weights. At home. They don't have to weigh themselves every day but weekly, because we want to have an idea of what's going on. And if you get to say if you gain seven pounds. Yeah, and you're there for at least two weeks because there's inflammation, there's there's different reasons why you may gain some water weight. So we really want to make sure that's fat weight. Then I want you to come back. And we could start on a low dose. It may be once a month, it may be every other week, it may be, we're just going to be on it for two months. But I don't want you to come back at 20 pounds overweight, and there is a list of reasons why somebody may gain the weight back. Maybe you have somebody in the hospital. Maybe you broke a leg. Life will come and punch you in the face, and you have to You're in survival mode. You can't think about is this nutritious? Is I gotta hit the Chick fil A, because this is my only opportunity to eat today. So both in there. Yeah, same. So we have, we want to we I don't want to just leave anybody once you're done by, I want to them to be able to come back and get back on the medication if they need to, even if it's just short term, but you are safe staying on the medication. There is a group of people, especially if they struggle with obesity, that they will need to be on it long term. And if you have metabolic issues, then you may need to be on it long term. And that's okay. I mean, people are on all sorts of medications long term. Yeah,

Colette Fehr:

it's really more to me a function of the way my brain works. And that food noise for me has always been so loud it doesn't go away when I eat super clean. It's reduced a little when there's nothing I'm not taking in anything that makes my brain ping, and I just don't know that it's super realistic for me to be off it, but I'm glad to hear you say that I don't have to be. And right? So everyone's on their own journey.

Laura Bowman:

Is there a habituation effect to the drug, though? I mean, is it? Do you have to continually, like, bump it

Amy Wrenn:

up? So I feel like on semaglutide, there's less of that, where I've had patients be able to get to a point, and they stay there, and they're good on trizepatide, I feel like people have had to keep going up on it to maintain the results. That is just what I've seen and practice. But most patients, when they get to a maintenance phase. Can just stay on whatever they're on. Now, if you have a little bit more weight that you want to lose, and I don't know where you are on on dosing, but you may have to tweak it and bump it up a little bit, and then you can, once you get there, you could maybe move it back down and see how you do on that. But yes, for and if you have somebody who's gonna lose like, 100 pounds, they're going to have to keep moving up that ladder, and they're going to need to stay on it long term, more than likely.

Colette Fehr:

Well, I've had to, I've had to on the tours appetite. I've had to go up and up and up

Amy Wrenn:

and up I see I see that more with trizepatide than the semaglutide. But I can tell you, and I don't know your your medical history at all, but the patients who do hormone therapy in addition to a GLP one, have the best outcomes per the studies and for what I have seen and practice. If you add in resistance training to that, it's it's just out of sight, how the benefits,

Colette Fehr:

okay, that's really exciting to hear you say that if this is an issue for you, and a GLP one could be helpful for your situation and your weight. The total picture that taking doing HRT, a GLP one and doing really good resistance training can be the sweet spot for women in this phase of life,

Amy Wrenn:

I have had women who do that, who come to me afterwards and cry because they're like, I'm me again. I am me again. That's how I feel. That is like the greatest emotional paycheck I could ever get is having somebody just cry and be so thankful because they feel like themselves again. Yeah, yeah.

Colette Fehr:

Oh, my God, that's so rewarding for you, right? Because you're really helping people change their lives, change how they feel about themselves. And it's true. I think somehow this, like the it started with this ridiculous Hollywood ozempic thing, and the way it was discussed in the media is, like all of these stars who are obsessed with, you know, we see people like Demi Moore, who looks amazing, and I don't know what she's done and hasn't done, but it started to get conflated with this idea of women who are obsessed with being thin at any cost, and that they're willing to, like throw themselves on the fire of dangerous practices to be thin, and that's really not what this is at all. People, and that was just a media interpretation of something, perhaps based on an element of Hollywood, maybe not even I don't know what those people's situations are, but we're talking about something very different here, which is being in the best health you can be at midlife, and that this may be something that's really indicated for you and really helpful, but you've got to have a true medical practitioner guide you.

Laura Bowman:

I guess what's coming up for me, because I'm like, in this, like, weird, no man's land of like, I do weight training three times a week, and I do run all the time, and I walk all the time, and I, I can tell that midlife is creeping up on me. And I wonder, I guess the question is, where I was listening to you talk about this is like, do I, am I at one point going to have to be optimized? Am I going to have to, like, do hormone replacement, some sort of help, just to, like, I feel like I'm running to stand still, is essentially kind of where I'm at. And I'm like, is it the only way you get there eventually is through optimization of hormones and insulin, and can I even do that naturally?

Amy Wrenn:

So first of all, nobody, nobody has to do anything that they're not comfortable with, but there are options out there for you, and it does the older you get, I feel like it's playing Whack a Mole. Personally, you fix this, then that goes, you fix this, then then that goes. But just speaking from the bio identical hormone replacement therapy scope, that is a two parter. You have the one part where you have patients take it because they're very symptomatic. They might have intense brain fog. They may have intense depression, or even like slight depression, they may have the weight gain, the loss of libido, and so it'd be hot flashes, and they really want to treat those symptoms, because it's interfering with their everyday life. So they will start on some hormone therapy to help with that. Now, not everybody is symptomatic. Most most people are at least a little bit. But not everybody is some people are terrible, and so the people who aren't symptomatic, but they get started on hormone therapy, those people tend to do it because they want to preserve the last decade of their life. They have seen a family member with frailty, broken hips, dementia, having to have somebody else take care of them. And they want to be vibrant and independent as long as possible. And the studies have shown that if you start hormone therapy within 10 years really, if you could get it within five years of menopause, that you can prevent things like cardiovascular disease, which, by the way, is leading cause of death of women. You can prevent dementia and Alzheimer's. You can prevent osteoporosis, which kills women as well. You can also prevent UTIs. I think I could go whole UTI rabbit hole. But I don't think women realize that once they are in menopause, the rate of UTIs and that a UTI is not what it was in your 20s. It's not like burning and an urgency. It's I'm seeing things, I'm hearing things. I'm hallucinating. It's a whole nother ball. So it is to prevent those things. And I would say that bioidentical hormone therapy is natural because it is the same chemical compounds that the hormones your body produced. So it's not like birth control, which is kind of like estrogen, kind of like progesterone, but it's, it's not the same thing. And so and it's, it is so strong that it shuts down your own own ovaries, where hormone therapy is just a little bit it's just like a supplement to ease the symptoms and to help prevent those long term disease processes, sorry, rabbit hole, yeah, we

Laura Bowman:

have to have you back on to talk all about this, because I feel like this could be its own episode. But I guess what I'm hearing from it is like, I feel like this again, it's coming up for me is like, there's going to be a difference between women who optimize, and you can make that mean whatever, like, variation of things you do, and women who don't like there's going to be a difference for sure.

Colette Fehr:

Yeah. So obviously, menopause is happening. I'm turning 52 this year. So I'm in it. And if I had known what I've learned since Laura and I started the podcast and started having guests on who are better educated like yourself about the realities of perimenopause and menopause, we're going to Dr Vonda writes conference on menopause. Those things opened my eyes to stuff I was not getting from my doctors at all, and you know, I can't do anything about the time I've lost, but I'm trying to get myself on track now, and my personal motive for hormones is really about exactly what you said, bone health, heart health. It's not really so much about how I feel right now or my sex life, and nothing wrong with that either, but it's really about the future and wanting to do whatever I can that's the healthiest for my body. And I just didn't understand how important these hormones are to all of that. Until recently, the

Amy Wrenn:

misinformation is out of control with social media. There's there's so much out there, but Dr Vonda right. She is fabulous. She's actually my I see her myself for a hip injury. She is absolutely wonderful. And if, if for listeners, you cut this out if you want, but if you want to follow somebody on social media who's really giving legit information. Dr Vonda Wright, follow her on on social media, because she puts out so much and she's she's not a gynecologist. She's an orthopedic but, and she's passionate about it, because she sees these frail women with all these broken bones. So I would definitely say follow her and anybody she recommends,

Colette Fehr:

right? And Dr Kelly Casper son, too. She's amazing.

Amy Wrenn:

Is my favorite. I know you guys spoke with her, and I'm so jealous. I would fan girl so hard.

Colette Fehr:

I definitely love Dr Vonda Wright and the work that she's doing to bring all of these great women to the forefront. It's so important. I think that conference last year was life changing, yeah, yeah, yeah. We'd love to have you back on again too, because there's so much more to discuss. This has been so helpful. Before you go. Can you give our listeners an idea of how they can find you, where they can follow you, that kind of good stuff.

Amy Wrenn:

Sure, I am on Instagram at NP Ren, and I think it's just at NP Wren, and Wren is spelled W, R, E, N, N, and I try to put out some educational material. I'm not great at putting it out all the time, because I am working with providers a lot, and I've I've made a course recently, a BHRT course, online course for providers, and I'm currently working on an advanced medical weight loss course for providers as well. Which GLP ones is a part of it, but it's not the whole thing, because, certainly they're not for everybody. Not everybody's going to qualify. And I want providers to have all the resources available to help their patients. So I'm working on coursework a lot, but when I'm not doing that, I do try to put some helpful tips out on Instagram as

Colette Fehr:

well. I love your Instagram, and by the way, it is NP, underscore, W, R, E, N, N, and we'll also have this in our show notes too. Thank you, and I hope, selfishly that you'll start seeing patients again at some point, because it's needed, yeah, and that you have the whole picture, and that's what is missing in so many providers, even these great, well educated doctors like you said, people are not learning this in medical school and nursing school in the past, so we're all trying to get up to speed, and you know, it's going to be different for everyone. But we're so grateful to you for all of this wonderful information that's going to help our listeners so much. Thank you for being here.

Amy Wrenn:

Great. Thank you guys so much for having me. I thoroughly enjoyed it. Well

Colette Fehr:

we did too, and we hope all of you out there listening got some great insights from our couch today. We will see you next week.

Laura Bowman:

Bye, guys. You.