Ep. 111: Hot Takes on HRT with Esther Blum

If you've ever left a doctor's office feeling dismissed, confused, or wondering if you're asking the wrong questions, you're not alone. We sat down with menopause expert Esther Blum for an eye-opening conversation about hormone replacement therapy, why so many women struggle to get the care they deserve, and what every woman should know about advocating for herself. This conversation challenges outdated beliefs, tackles common myths, and explores why so many women are being told they're "fine" when they know something isn't right.

We also unpack the long-term impact hormones can have on brain, bone, and cardiovascular health, why finding the right provider matters, and what changes need to happen so future generations of women receive better care. Whether you're already navigating perimenopause or simply want to be informed before you get there, this is a conversation you won't want to miss.

Episode Highlights
[0:03] - Welcoming Esther Blum and introducing her TEDx talk on the "prescription pad of misogyny."

[0:56] - Why so many women are being dismissed, gaslit, and offered outdated menopause advice.

[5:02] - Laura shares her own experience trying to access hormone therapy and asks the question so many women are asking: when is the right time to start?

[8:16] - Esther explains early signs of perimenopause, why waiting for severe symptoms isn't necessary, and the importance of early intervention.

[12:49] - We discuss the frustration of receiving completely different advice from different providers—even menopause specialists.

[18:32] - Practical strategies for finding a hormone-literate provider and becoming your own best advocate.

[24:20] - Esther shares resources, recommended testing, and why education is one of the most powerful tools women have.

[29:30] - We unpack testosterone pellets, alternative treatment options, and common misconceptions about hormone therapy.

[34:05] - Esther shares her advocacy work to improve menopause education in medical schools and create better access to care for women everywhere.

[39:05] - Where to connect with Esther, learn more about her work, and watch for her upcoming TEDx Talk.

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Transcript

Colette Fehr: 0:44

Welcome to Insights from the Couch, where real conversations meet real 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. And our midlife masterclass is now open. If you're looking to level up, get into action, and make midlife the best season yet, go to insightsfromthecouch.org and join our waitlist. Now let's dive in. All right, so let's get right into it because we started chatting before we hit record, and I'm already so excited for how much of what you have to say. Can you just start out by sharing with everyone what your TEDx talk is about and when it's going to be available?

Esther Blum: 1:36

Yes, as we record this, it should be dropping any day now, and it's called the prescription pad of misogyny, which is antidepressants, birth control pills, and wine. And I created this talk because it embodies the conversation I have with virtually every single woman who comes into my private practice who is completely gaslit by her provider, yet who often knows more than her provider, and currently our educational system for medical school is not equipped to teach doctors how to prescribe HRT, even though many hormones are available and are FDA approved, and doctors still don't feel safe prescribing them. They're taught maybe an hour or two if you're lucky about nanopause. Some medical schools are now teaching up to a week, but it's like it's basically unheard of. So women are going to their doctor. They are told, and these are actual clients from my stories that are in actual clients in my practice who have told me these stories, and this is in the TED Talk. But they will go to their provider and say, "You know, I'm having really low libido, and they hear, "I kid you not, just change sex positions, like from a doctor, from a doctor, or one of my clients said, you know, I'm having a lot of trouble with insomnia, and her doctor said, well, just take a shot of Benadryl every night. That's what I do, or have a glass of wine, or you need to relax. Which f that relax? Oh my god, give me a break. Yes, and then when I would, but then my own gaslighting story was when I went to my provider at the height of my perimenopausal insomnia. He was like, "Listen, you need to sleep. Just take Xanax every night. It's not addictive. Which spoiler alert, it's addictive and then

Laura Bowman: 3:35

highly addictive,

Esther Blum: 3:37

highly addictive. And then wait for it, he literally went to his drawer in his cabinet pulled out a copy of the Kabbalah and told me to put it under my pillow.

Colette Fehr: 3:48

Wow! So what? This first of all, in addition to the travesty against women, this also highlights the fact that doctors are seriously not mentally healthy, and we need to we need a whole movement on that. Wow! But this is the experience women are having when they go for help, right?

Esther Blum: 4:07

Yes, and often listen, women are we're Gen Xers. We're not taking this sitting down, so we're going to YouTube, we're going to TikTok, we're going to Instagram, and we're saying, "What am I going to do? These are all my symptoms, which, by the way, pull right up on Google, and what do I do? And all these, you know, there are influencers, but there's actual credible providers. I like to include myself in that list of credible providers who are educating, who are empowering women, and then they go to their providers, and their providers are still quoting this stupid 2002 Women's Health Initiative study, which was not interpreted properly, it was not designed properly, and which has been the the final position papers on that were updated twice in 2018, again 2022, by the Menopause Society, which is a very conservative organization. So it's like all of that information, even the black box warning labels, were taken off estrogen products in 2025, and so and still providers are still not hip to it. And I'm a dietitian. I'm like, how do I know more about the research days than your own doctor? That's even the most egregious. So, women are rightfully and collectively enraged, as they should be. But at the same time, when a provider literally won't hand them a prescription, it's like then there's a real crisis happening. When they know what's happening in their body, they know what they need and what they want, and they still can't get it. And any man. Can go get a boner pill 24/7.

Laura Bowman: 5:43

Wow! Yeah, most of commercials are everywhere on TV too. Like the little loop. I'm like, why are we seeing this? But there's nothing for women, and honestly, like my experience was the same. Like, and I want to ask you about when you know to go and everything because I'm 48, soon to be 49, and I went to my doctor, and she's like,"Well, these pill, this is not for you. She's like, "You, you know, you had preeclampsia. You have like a history of high blood pressure. These aren't for you. That's what she said, and basically, like, we're not going to be taking this route. Like, she had decided for me, and I thought, "Huh, like I, I, I think there's like multiple ways of taking these medications. Like, she like foreclosed the conversation, and then the second part was it was like, when do you know? Like, I mean, I'm in that phase where like my sleep is a little choppy, but I'm not miserable. I mean, my libido is a little like low, but it's not awful. Like where, where's the line for like going? Okay, I'm doing this. Is it an age? Is it a set of symptoms? Or can you just hang out in like a gray zone and sort of be fine?

Esther Blum: 6:57

Okay, so we're never settling for fine. Never settling for fine, we deserve exquisite menopause care, and we deserve optimization. We don't deserve norm, quote unquote, normal, which is based on like the labs of Homer Simpson. It's not based on optimization. So, a what we know from research, and I've seen this in my practice again and again, is that hormones actually lower blood pressure. They help with vascular function. They help prevent the laying down of arterial plaque. And it's not just estrogen; it's also testosterone has incredible cardiovascular benefits for women. Testosterone is the predominant hormone in a woman's body prior to menopause, actually, so nobody even knows this. Nobody knows testosterone helps bone density, cognitive function, so many things. So, number one, your provider's already not coherent or updated in her recommendations or her research. But number two, just because you've had a risk of hypertension, blood clot, stroke does not disqualify you from transdermal estrogen, which has zero increased risk. But even oral estrogen, which is considered a higher risk, it's still a very, very tiny risk. And we have to remember that it's the delivery form. Even in that Women's Health Initiative study, that there was an estrogen-only arm where they only used estrogen. They didn't, and it was synthetic, like it was Premarin, which is derived from the urine of pregnant horses. It wasn't even bioidentical, and women had health benefits, and they had lower risk of cancers as well, which is even more wild. So, if you're taking oral bioidentical estrogen, even with a history of blood pressure, it does not mean you are going to stroke out. But I would say start with transdermal first. Right. So, your second question is when do you know when to bring it in? Yeah, it's really good to notice your cycles. You're already noticing, Laura. Like, hey, my sleep is less. Hey, my libido is starting to tank a little bit. If I always tell women, if you notice changes in the length of your cycle, if it shortens or gets longer, if you notice you're getting more clots, more like surges, crime scene periods, or your sleep is really disrupted, or your mood really you're like a different person during the luteal phase of your cycle, the second half of your cycle. That's a time when you want to start bringing in oral micronized progesterone. It's called Prometrium. It's FDA approved. It's covered under insurance. It starts at 100 milligrams. It goes up to 200 milligrams. That's the time to bring it in the second half of your cycle. And you can do it even if you're on a birth control pill or even if you're on an IUD. Why is early intervention so important? Well, a quality of life because if you're not sleeping the second half of your cycle, that's two weeks out of the month where you're not your best self and you're exhausted and irritable and brain fog. But number two, we want to also offset the tremendous mental health effects that perimenopause and menopause can have on our anxiety and depression, because there are women who, many women who have committed suicide during perimenopause and that transition, we want to offset that. And oral micronized progesterone raises our feel-good neurotransmitters. It raises our GABA levels, which are very calm. Neurotransmitters helps us fall asleep. Helps us. It's like nature's chill pill. It opposes that wild estrogen roller coaster that's happening. We also want early intervention because we want to maintain our bones. We want to maintain our brains. I just recorded a podcast about how Alzheimer's starts in our 50s, it shows up in our 70s, but two out of three Alzheimer's patients are women because they have lost gray matter in the brain during the hormonal transition, during the neuroendocrine storm. So early intervention-it's not just for your quality of life, but it helps prevent so many diseases of chronic aging. It prevents bone loss. It prevents loss of gray matter. It maintains our pelvic floor. It maintains our cardiovascular health. And the sooner you get in, the better benefits you have. You can take hormones at any time. There's women who start them in their 70s, 80s, but you lose that really critical window, especially for bone and muscle and brain. You really get the most benefits early on.

Laura Bowman: 11:48

So we should all be doing this, most of us,

Esther Blum: 11:51

most of us. I mean, some women choose not to, and that is their choice, right? We, I think, we should be educated and empowered. Some women are actively getting chemo. Some women, though, there's a lot of and and say no, I can't do this, or their oncologists take them off. Now, there is so much emerging research that shows how how protective hormones are even when getting chemo, and there are women who lie to their oncologists and don't say they're taking hormones, and they don't tell their prescribers that they have cancer. It's like they have to, you know, sort of compartmentalize their health concerns depending on the provider if they want to continue. But again, there's so much emerging research to show that going off hormones, a it wrecks quality of life, but b it's hormones that have been in our bodies our whole lives aren't necessarily the root cause of our cancers aren't necessarily feeding them, and it's such a long nuance conversation. But we don't necessarily have to go off of. But yes, as often as you can, you should get educated, informed, empowered, and yes, if it feels aligned with you, then yes, you should. Because I, I would be like Gollum curled up under my desk, like you know, if I wasn't on hormones, I would not sleep or have cognition. I'd be up all night half lashing and just not sleeping At all, so yeah, I'd probably be peeing my pants too. Like it just, I function much better on hormones.

Colette Fehr: 13:29

But you know, listening to you, I think it's so interesting because I have been in on the hunt for a better provider. So I've seen a number of people recently. I hear something completely different from each one. Completely different to the point of contradictory. That's crazy-making. And then I have a unique situation because I've had an ablation, so it's impossible to know what's happening by the marker of my period. And also, I don't really have symptoms. I do have a little bit of night sweat or waking up in the night, but I've also had that my whole life. But I don't feel bad, and when I have said to people, and you know, doctors really prescribe a lot based on symptoms, and there is so much value. Obviously, the symptoms matter, but there's so much value to our organs, our brain, our risk of cardiovascular disease. That this is a challenge for some people too, because the first thing they say to me is, "Well, if you don't have symptoms, then we don't need to worry about it. And it just cuts.

Laura Bowman: 14:33

I've heard the same.

Esther Blum: 14:34

Yeah, yeah, and I'm going to be 53 in a couple months. So, well, yes, and that's the most dangerous part. Is if you're not having symptoms, because bone loss is not symptomatic until you fracture your hip and break it. So number one, you can get your FSH and LH-that's your follicular stimulating hormone and your luteinizing hormone checked. You can get your SHBG checked, your sex hormone bidoglobulin, to see where you are in the perimenopause highway, okay, or menopause. You're clear if you're hot flashed your whole life, but especially now, or you're noticing some.

Colette Fehr: 15:13

No, I haven't hot flushed my whole life. I haven't. Okay, and I don't have hot flashes. I have night sweats. Maybe that's a hot flash family. But I've woken up in that. Like I've been a bad sleeper my whole life. the The night sweat thing appears to be new. I'm on low dose HRT, not testosterone. I did it for a while. I didn't notice any difference in anything. Yeah. The current doctor was like,"Oh, don't bother with testosterone." I don't think that's good. I mean, it's just maddening trying to figure out, even among experts, or even when you have a doctor. This person I'm seeing now is one of those menopause certified practitioners, so it's very hard. I've been the one to go in and say, "Look, I want to take HRT because of what I've learned about how good it is for me long term, regardless of symptoms. But I've had to really fight for that, and then it's still hard to get clear answers.

Esther Blum: 16:14

Yes, and often that menopause certification doesn't always mean that they are hormone literate, and the fact that already there are gaps where you're having to fight, you're having to push. A lot of menopause quote menopause trained providers are still taught to put women on birth control pills. Birth control pills are not actually FDA approved to treat menopausal symptoms. Wow, they do not prevent loss of gray matter in the brain. They don't prevent cardiovascular disease. They, to a degree, may prevent some bone loss. They may prevent crime scene periods, and they may prevent some hot flashing. But again, I always say menopause is not a birth control deficiency. It's a hormone deficiency coupled with you know yes we have to adapt our diets alcohol and caffeine may not be so good for us anymore you know or as tolerated as they were before we're going to have to bump up our protein and a fiber we're going to have to you know manage our stress better strength train all the great pieces. HRT alone is not the magic pill, but you're clearly right. Like you said, Collette, not getting optimal care because if if I was a doctor and you came into my practice, I would say, great, we're going to bump up your doses of this, and then we're going to retest your blood in six to eight weeks, and then we're going to adjust accordingly. And these are your optimal ranges for. I'm going to give a I'm going to give a shout out to two of my colleagues who are licensed in the state of Florida, who I love. One is Dr. Anat A N A T Sapand S A P A N, and one is my colleague and friend Jen Goldstock, J E N N Goldstock. Both are licensed in the state of Florida and are completely hormone literate, because you shouldn't have to be suffering if you're still on HRT but having these symptoms. That means you're not on the right dose, and you need to bump up.

Colette Fehr: 18:19

And she, I even said that to her to this particular, I think she's a nurse practitioner, and she said, "Oh well, you know, I wouldn't even. I had to beg even to have my blood work retested. She said, "I don't really see the need for that. You know, you're menopausal, and therefore we don't expect you to have hormones. And even having a low dose is probably good enough, unless she did say if you're having more symptoms. Now, at the time, I hadn't started having night sweats. I, I, by the way, have an appointment with a new doctor in a couple months. I've been waiting to see, but it's just so interesting that even for those of us who are getting this information online, have read the books, are are seeking it, it's still really hard to get clear, accurate info. Yeah. Do you have any tips for people of where to start, who to trust? Like, how do we begin?

Unknown: 19:12

Yeah.

Esther Blum: 19:13

And unfortunately, I feel like there's a big issue with equity too, because the best providers I know don't take insurance because they spend an hour with you, and so it shouldn't be that way. It shouldn't be if our doctors were privately trained. It could be insurance based easily. So a couple of things. One is we're going to talk about the two different tracks that you could take. So first and foremost, if you're going to your regular provider, schedule a separate visit to talk about hormones. Don't wait until your doctor's face is between your legs doing your pap smear to say, "Oh, by the way, let's talk about hormones. That's a separate visit entirely. Okay. Number two, though, save yourself time and heartache. Call providers ahead of time and say, "Does this provider, nurse practitioner, naturopath, D O M D, you know, does this provider prescribe hormones regularly? Are they hormone literate? Are they comfortable doing that? Because if they're like, no, or oh, we prescribe birth control pills, then run your ass away because you're just going to be lost and wasting time. So there are insurance-based doctors that do prescribe hormones. There are also providers that will let you drive their care, like Colette. You drove your care. You are a perfect example of saying, "I want this, and you were poo-pooed, but you got the prescription anyway. But she's not titrating your dose up. She. Not monitoring you, you're the one asking for it, and ultimately switching providers. It sounds like, so that step one is you want to make sure that doctors understand hormones don't cause cancer. There are no, there are literally zero studies that prove hormones directly cause cancer, right? Doctors are prescribing wine every night. Wine carries a far greater risk of cancer. Doctors are

Colette Fehr: 21:06

literally still prescribing wine. That that shocks me. I mean, it is so definitive that alcohol is so damaging and cancer causing. How is this still happening?

Esther Blum: 21:16

Oh well, mr. Epstein filed. Doctor Peter Atia prescribed wine every night, so therefore it must be true. I mean, it's so egregious. Yeah, my husband came up to me and he's like, "I just want you know, Peter Atia says I can have a cocktail every night. And I said, "Peter Atia is full of shit. No, that's not true. Peter says

Laura Bowman: 21:36

you can eat like tons of meat, like red meat. You know, I mean, I don't know. I'm just. But

Colette Fehr: 21:43

alcohol is way worse than red meat. I mean, alcohol. Yeah,

Esther Blum: 21:46

red meat.

Colette Fehr: 21:47

I haven't given up drinking, but it's bad for

Esther Blum: 21:49

Jesus.

Colette Fehr: 21:49

Like I know I'm drinking poison when I'm having my glass of wine. Yeah, and

Esther Blum: 21:53

listen, time and place. I don't. I'm not alcohol free either. But it's used judiciously. I certainly don't drink like I did when I was 20. Now it's like once or twice a month at best. But yes, that's a hangup,

Laura Bowman: 22:07

Esther. Is it like that these doctors are afraid of liability, or is it they just don't know how to monitor the process?

Esther Blum: 22:14

They just don't know. They have no training in medical school, and you couple that with a large ego and a patient coming in saying they know more than you, and the hackles go up, the defenses go up, and I always say, God gave us two ears and one mouth. We're supposed to listen to our patients. If doctors just listened and stopped dismissing and gaslighting, which is really an ego-based response in both male and female doctors. It's ego-based. It's lack of knowledge. My own gyn recently. I have a functional medicine gyn, but she's one of my best friends, so I don't have her doing my Pap smears. Right? She doesn't need to be in that part of my anatomy, and so I go to just a regular garden variety doctor who says she's hormone literate. And last time I went, you know, I I take a high dose of compounded sustained release progesterone because that is what I need, like like a horse. I need to be knocked out, right? So she was like, you know, that can you know high dose progesterone, which is 400 milligrams. She goes, that can, you know, I could put you an increased risk of cancer, which is not true for bioidentical progesterone. It's only true of the synthetic progestins. And I looked at her point blank, and I said, not sleeping will give me a far greater risk of cancer.

Colette Fehr: 23:36

Yeah, and that she agreed with because

Esther Blum: 23:38

I was like, oh, lady. But so let's say that you do have a little bit of financial flexibility. Let's talk about your options there. Number one, calling your local compounding pharmacy. Every state has at least one compounding pharmacy. Call them up and say, "Hey, what providers do you know have really happy patients who are really hormone literate who prescribe hormones across the board. You'll get at least a couple names that way, but number two, which is great. Number two, there are some online platforms that prescribe. A lot of them don't provide testosterone, and I have to say my patients have had very mixed reviews through those platforms, so I do not endorse any one platform at all, unfortunately. But it is an option, and some of them do take insurance. But again, you will not be getting that testosterone prescription, which is really helpful.

Colette Fehr: 24:34

Can get it through MIDI at least in Florida because I used that for a while. But I didn't overall I didn't like the experience, but I was able to get testosterone. Yes, yes. I've tried everything. I swear to God. Yes,

Esther Blum: 24:48

yes,

Colette Fehr: 24:50

yeah. But I love the idea of finding your compound pharmacy. We have several here in this area, and and calling them to find out who's that's such a great hack.

Esther Blum: 25:01

Yeah, it's a really good hack. I also wrote a book called "See You Later, Avya Later, and oh, it's right here. Hold on, I'm gonna pull it up. It's called and it has mastering menopause, mastering menopause with nutrition, hormones, and self-advocacy. So I've given this to my own doctor. There's studies, there are research studies in the back of the book, so you can also advocate for yourself. And he has to your doctor and say, "I have the research studies that show hormones will benefit me. Here is why. This is why I want to start hormones. And so again, it's it is it's hard to find the right one. Just because someone has been, you know, certified by the Menopause Society does not mean they're not going to prescribe birth control pills, unfortunately. And I have spoken in rooms where Menopause Society doctors have been present, and who objected to me advocating for hormones for women, and who said, "Well, we still don't feel that women truly need hormones, and I was like, "Oh

Laura Bowman: 26:03

my god, my

Esther Blum: 26:04

god! It was, and it was really quite frustrating to hear that they're not updating their standards of care either. I'll be fully transparent.

Laura Bowman: 26:12

I I want to ask you about your advocacy work in just a second because I'm so curious about that. But one thing I want to like not skip over is like where do do you just request those tests you mention from your doctor, like the one about your, you know, sex hormones, and can you just say because I can just hear my doctor not wanting to do those or

Esther Blum: 26:33

100% yes. I mean, often if I ask women to have their you know estradiol, progesterone free and total testosterone, and DHEA, pregnenolone, and FSH and LH doctors will say, "Well, you're in perimenopause, and your hormones can fluctuate between 30% on any given day. That's

Colette Fehr: 26:55

what they tell me,

Esther Blum: 26:56

which is accurate. Which is accurate. However, if you test, if your cycles are regular and you test between 19 days 19 and 21 of your cycle, you will still have a baseline. Or if your cycles are all over the place, you're skipping months. You could test days one through five after your cycles start. Like you can get enough of a consistent base to know. So yes, you can ask for those blood tests, and your doctor may say you don't need them. In which case, you could say if insurance like I'll sign a waiver. If insurance doesn't cover these, I'll pay for them because they're not that expensive. And

by the way, pro tip: 27:35

if labs charge you 1000s of dollars, I've appealed it every single time because I get my patients. I think it's seven vials worth of blood work. I run it through LabCorp for 300 bucks, and then they can submit that to insurance. So yes, I work my practice. I do. I get everyone access to these blood tests if they can't get it from their provider, and plus I do a Dutch test, which is a dried urine test for comprehensive hormones, and it shows me your urinary metabolites of hormones. So that, and you do it five to seven days after you're ovulating, or if you're on the pill, or really not, you know, if you you could do it any time, basically. But it shows me what your body's producing and how you're detoxing those hormones as well, which is important because if you have a risk of cancer, if you have a family risk, or you yourself have a risk, you want to see how hormones are moving through your liver so that you can properly metabolize them, and that lowers your risk for genetic expression of cancer as well. So I do all those tests because, yeah, it's it's a shame. I wouldn't have the practice I had if modern medicine practiced the way it was supposed to,

Colette Fehr: 28:55

right? But I built it

Esther Blum: 28:56

out of necessity because women. I was like, screw this! I'm going to build the practice that I would have wanted when I, you know, I figured it all out myself. But I, it's just it's infuriating that it has to be this way. It's infuriating that equity. It's not equitable. It's not fair. Things are not covered the way they should be because hormones are not profitable.

Colette Fehr: 29:20

So actually, I want to ask you something about that before we get into the advocacy piece. Yeah. So on the flip side, another problem I've noticed in my journey, and I've heard from other people, is doctors who are making this whole process profitable because there is a lot of attention now on the menopause experience, and there are people turning this into like very expensive clinics and forcing things on people in some cases. So I'm just curious your opinion too. On for example, I left one doctor who the only type of testosterone he would give me was the pellet, and I did not want the pellet. And I'm curious what you think about the pellet per se because I hear mixed things personally. The experts we've had on here so far have not been fans of them. What's your take on the pellet?

Esther Blum: 30:11

Yeah, I align with that because I align with not starting there at all. Imagine that you're driving a very lovely, reliable Kia, which is a good car. It's going to get you from where you need to go, but it doesn't have a six-cylinder engine, right? So then imagine somebody puts you in a Maserati, which I don't know if it's six or eight-cylinder. I don't. My son would know this, not me. But anyway, you go from zero to 120 down the highway. That's what pellets are in a woman's body who has had no testosterone. Her testosterone production has been declining since her 30s, so she gets to perimenopause or menopause in a very depleted state. And all of a sudden, you are putting pellets in. The clients of mine who have done that as a first pass of treatment, have gained on average 10 pounds, have enlarged clitorises that don't that don't recede, and lose hair on their head and grow it from their face. Okay, so

Colette Fehr: 31:14

nightmare, nightmare, nightmare, nightmare, nightmare.

Esther Blum: 31:17

I have yeah one client

Colette Fehr: 31:19

who was like humping the like signposts on the street. She's like, I turned into

Laura Bowman: 31:25

money.

Esther Blum: 31:25

Oh my god! Yeah.

Laura Bowman: 31:28

Oh my god, humping. Yes, humping. Oh, she said she was sitting on. She wanted to sit on a fire. Fire hydrant.

Colette Fehr: 31:34

That's what it was.

Esther Blum: 31:36

Ooh. Oh, I gotta try that one. That sounds. That sounds fun.

Colette Fehr: 31:41

It's just right. You don't know how you're going to react to be way too much. And then what about the fact that it's a foreign object in your body that doesn't dissolve? Right. It

Esther Blum: 31:51

dissolves over six months. So what happens is after about three to four months, as you're you feel great at first, you're like, all right, fully charged. As your levels decline, you're still. If you have your blood drawn, it's going to be at a supra physiologic level, way above what your baseline needs to be. But as you're coming down, you feel withdrawal and you feel fatigued again, and low libido, and all these things, and then you have to wait two more months till you could get the next set. It's also a surgical procedure every time. It's an incision in your butt muscle, so there's risk of infection. And at the end of the day, topical works for I would say on average 80. Don't quote me on these stats, but from what I've seen in my practice, you know, 80 to 90% of women respond beautifully to topical applications, just on the inside of your forearms, your lower abdomen, inner thigh, back of your arm, or injections. Injections are the next step because those only last for a week. So again, you can really titrate the dose, and then I literally had one client in my practice who put herself on the palate. She went and found a provider. I was like, I never recommended this to you. And her, when I look at her blood and Dutch, it's crazy high. I've spoken to her physician, you know, but like she won't stop. So, but most women just don't need that. Remember, in menopause, we're not looking to establish the hormones we had in our 20s and 30s. We're just looking to establish a dose where we offset chronic diseases of aging, and it really works out to about a fifth of the dose of birth control pills. I mean, it's a really, really, really tiny dose.

Colette Fehr: 33:39

But that's a great way to look at it and to sort of summarize it right there. What I've had to say proactively is offsetting the risk of these diseases, right? That to me is the bottom. Obviously, if you're having a lot of symptoms, that matters too. But there are some of us who don't have a ton of symptoms. You know, I probably would just not do it if it wasn't for the disease and the organ health and my brain and that matters to me. I breaks my heart that my mom never got. She was part of that window of that erroneous study or the erroneous interpretation of that study where you know it never happened and she didn't have symptoms either. So I just think it's really a shame. I mean, osteoporosis alone, Alzheimer's, brain decline-like there's so much to this. So tell us about because obviously a lot needs to change. And I hope I have two daughters. That when my daughters are my age, this is a very different conversation. This is being taught in medical school. So what are you doing? Because it sounds like you're doing a lot of cool stuff to try to change things.

Esther Blum: 34:46

Yes, at the public policy level, I am. I have initiatives in place to really that are currently in a proposal stage to a update medical school curriculums to fully teach menopause. And by the way, like there's brilliant doctors like Rachel Rubin who did a four and a half hour curriculum to educate physicians. It's not something that needs to go on for months, weeks, weeks, months, and years. It's something that you can doctors can go to conferences that I go to and learn how to prescribe hormones, how to monitor, how to adjust the dosages, and all the accompanying research. This is not something that is out there. It's not something that's not supported by science. So we can do that. But my goal is my. In the sky, high level vision is a we update medical school curriculums. B we update all the disciplines who are currently practicing. We monitor all the psychiatrists who are prescribing SSRIs instead of saying, "Hey, wait a minute, have you skipped a period? Have you are you having trouble sleeping? Are you noticing temperature and mood changes? Are you noticing heart palpitations? You doing a symptom checklist when women say, "I'm not feeling like myself. I don't know what's happening. I want to kill my husband. I don't want to hear anybody's chewing. Like get away from. I want to move to an island.

Laura Bowman: 36:22

I have that one,

Esther Blum: 36:24

right? So we need to educate a multidisciplinary. Have a multidisciplinary approach. We also desperately need to update the knowledge of oncologists. My God, what is? It's unbelievable. Like cancer and hormones. It's so desperately needs research. So then, we also need to get testosterone FDA approved for women. You may have seen just this past weekend as we record this. Of course, the men have all the removal labels off testosterone. I'm like, effing hell, get women testosterone. It's so ridiculous. Like men's starting dose is 10 milligrams, women's is like point five milligrams. That is the starting dose for testosterone for women. So we need that. And last but not least, we need to bump up production of hormones. Only 4% of women, 4% Maybe that number's bumped up to five since the black box warning labels have been removed. Such a tiny amount of women are even on hormones now because a access, right, equitability, knowledge, all there's so many barriers to them. Fear, so many barriers to women getting hormones, but then when they are right now, women are. I too have been running to multiple pharmacies to cobble together where I'm going to source my hormones. We need to bump up production. We know this is possible because we did it with COVID vaccines. Like overnight, vaccines were available. We can do this with hormones too. I find it

Laura Bowman: 38:02

very hard to believe that somebody doesn't want to make a ton of money off of this. Like I can't believe any drug is not being rushed to production.

Esther Blum: 38:10

Yeah. Well, hormones don't have a high profit margin. In fact, pharmacies often okay that are money with hormones. I mean, my I use for example a femring, which is a 24/7 delivery of systemic estrogen via a vaginal ring because I had such bad genitourinary symptoms of menopause that having a 24/7 dispensary of it in my body, like that is the only thing that works. We tried patches, we tried cream, we tried estrin, which is a vaginal estrogen ring. We tried all these things. Guess what? That product is $980 to $1,100 retail for a three month supply. So I get coupons for it, and I get down to 180 for a three month supply. But like, I'm a classic example of the pharmacies losing money because, and my doctor had to contest it and write letters to the insurance company, and they kept turning us down. I mean, we had to fight to get that and say we've tried every other route. So, yeah, drug companies don't make money, so no money, no incentive to get it done for women.

Colette Fehr: 39:19

Well, I'm so glad you're doing this advocacy work because this really needs to change. I just can't believe it's still so hard, but I am glad at least it's become a huge part of the conversation. Women are not being silent about it, and people like you are really leading the charge as we greatly, greatly need. So, can you tell our listeners also how they can reach you, connect with you, your books, your TEDx talk again, all that good stuff.

Esther Blum: 39:45

Yes, well, find me@estherblum.com. That's e s t h e r b l u m, but also on Instagram at gorgeous ester. And my TEDx talk, the prescription pad of misogyny, will be up on YouTube imminently, and

Colette Fehr: 40:01

probably by the time this episode drops, yeah. God willing, Knockwood,

Esther Blum: 40:05

and then I too have a podcast that Colette will be on tomorrow on Thursday called the Midlife Realignment.

Laura Bowman: 40:11

Nice. So yes,

Esther Blum: 40:12

tune in. Yes, for all things hormones. All or as my my brother always says, you know, hormones make a hormone. I'm like, oh god, that's

Laura Bowman: 40:23

a good one.

Colette Fehr: 40:24

How have I never heard that before? Okay, that is the perfect note to end to

Laura Bowman: 40:28

end on.

Colette Fehr: 40:30

I am so excited because even I learned some new things in this talk that I'm going to add to my repertoire and advocating for myself, and I'm sure you. Guys, listening did too. This has been so helpful. I mean, Esther, you're such a wealth of knowledge and everything that helps us get out there and get the treatment we deserve. Right? Fine isn't good enough. We deserve excellent care, and it's not just about hot flashes. This is about longevity and living well and feeling good while we're here. So, thank you so much, and thanks everyone for listening. We hope you got some great insights from our couch, and we'll see you next

Esther Blum: 41:10

week.

Unknown: 41:11

Bye, guys.