Unlocking Wellness: Hormone Therapy, Peptides & More with Megan Piersanti, DNP | Episode 19

In this episode of Fill Me In, Jon and Nicole welcome special guest Megan Piersanti, a nurse practitioner specializing in wellness programs.

Megan shares her journey into the world of wellness and discusses the intricate connections between aesthetics and overall health. The conversation dives deep into topics such as hormone therapy, metabolic plans, weight management, the benefits and intricacies of peptides like GLP-1 and NAD, comprehensive blood work, thyroid and vitamin testing, and the potential impact of lifestyle factors such as diet and environmental exposures on health. 

The episode is filled with insights on optimizing health, education on science-backed treatments, and practical advice for both men and women to achieve their wellness goals. Whether you're interested in aesthetics, wellness, or general health, this episode offers valuable information and actionable tips.

Megan Piersanti APN, FNP-C: Megan obtained her Doctorate (2021) & Bachelor of Nursing (2015) from Rutgers University and is a certified by the AANP as a Family Nurse Practitioner. She is the clinical lead of Exhibit Wellness and offers weight management, hormone optimization, and lifestyle management services. Her clinical background in cardiac and emergency medicine has provided a wealth of knowledge regarding health promotion across the lifespan. She has 2 young daughters, and a husband also in the healthcare industry, who have collectively inspired her passion of preventative care and wellbeing.

Book an appointment with Megan: https://exhibitmedicalaesthetics.com/

Follow Megan on Instagram: https://www.instagram.com/megaesthetic_apn/

On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.

Follow Fill Me In on Instagram!
https://www.instagram.com/thefillmeinpod/

Follow Nicole on Instagram:
https://www.instagram.com/aestheticnursenicole/

Follow Jon on Instagram:
https://www.instagram.com/injectorjon/

Exhibit Medical Aesthetics website:
https://exhibitmedicalaesthetics.com/

Tox and Pout Aesthetics website:
https://toxandpout.com/


Producer of Fill Me In: Joseph Ginexi

Chapters

• 0:00 Introduction
• 0:51 Megan's Journey into Wellness
• 6:14 Hormone Therapy and Weight Management
• 10:29 Patient Consultation Process
• 19:48 Testosterone Therapy
• 31:33 Peptides and Their Benefits
• 47:56 NAD Therapy: Benefits and Considerations
• 51:42 IV Hydration: Worth the Hype?
• 57:18 Essential Bloodwork for Optimal Health
• 1:13:07 The Impact of Birth Control on Hormones
• 1:22:35 Listener Questions
• 1:26:33 Final Thoughts

Transcript

  Welcome back to another episode of the Fill Me In Podcast, where we dive deeper into the world of aesthetics. It is Injector John 

and Aesthetic Nurse Nicole. 

And we have a special guest, right, Nicole? 

Yes. A very special guest. We have Megan. She's our nurse practitioner here. She does our wellness program.

Hello. 

Welcome. 

Thanks for having me, guys. Oh my God. Thanks for coming on. 

Yes. 

I got to say, we got a lot of, uh, questions from Instagram viewers and everything. Everyone's very excited for this episode, so. All right. Yes. So we're going to spend the next 45 minutes to an hour basically unlocking all things wellness, hormone therapy.

peptides, IV therapy, blood work, 

um, 

you know, all your good medical weight loss, all that fun stuff. So you guys know me and John, but I wanted to give Megan a little bit of time to kind of introduce herself and her story and how she kind of got into wellness. 

So go ahead, Megan. Sure. Um, I wanted to start by thanking you guys for having me on.

I am obviously a big fan, um, but it is very important that people understand that aesthetics and wellness go hand in hand. So it has been an excellent addition to exhibit. I'm so happy to be a part of it. And I know John in your corner, you have this going on a little bit as well. Um, and it's only getting bigger and better.

So I just wanted to explain. where I'm coming from and why I got into this, uh, which it's kind of a crazy path. So I have my doctorate in nursing practice. So yes, on paper, I am a doctor, but I do not go by Dr. Megan. I am a nurse practitioner, um, an FNP certified as a family nurse practitioner, and I have a background in cardiac telemetry nursing as well as emergency care.

So I was in the emergency room during COVID. I did my time as a bedside med surge nurse. And I ended up graduating after having my first daughter and sitting for my boards at that time as well. So I started to notice in the primary care setting and in the emergency care setting that we were doing a lot of reactive health care and a lot of disease management as opposed to disease promotion.

And as a 20 something year old, you know, going out on the weekends with my friends, eating what I wanted to eat when I wanted to eat and being fairly in shape. appearing. Um, it didn't really hit me until I started seeing the same trends happening over and over again, especially during COVID when all of our non essential medical tasks went out the window.

So the only patients we were seeing were true, true emergencies. And even at that, patients were terrified to come to the hospital. So we are actually still dealing with the repercussions of poor disease management from 2020 when patients were not getting their, um, chronic care. Delivered and managed properly.

We're still seeing the repercussions of that now. Um, and that's something that's very important to me. As I worked through my primary care clinicals, I was seeing the same thing in the primary care sector. So now I'm seeing it in the doctor's office, but I'm also seeing it in the acute side of things in the hospital.

I got very burnt down the ER. Very overworked, uh, just like any other bedside nurse doesn't  exactly. Um, I was actually breastfeeding my daughter at the time. So I was pumping in the bathrooms and doing things. I really, I just had to get it all done. Really wasn't taking care of myself, but became very interested in mental health, burnout, uh, eating better, feeling better, uh, and also just doing what's best for my kids and making sure I didn't pump them with all these artificial things that are coming out.

Uh, Coming out with my nurse practitioner degree at this point, I'm now board certified as an FMP, and I'm like, Oh my God, I want nothing to do with primary care insurance based medicine. I'm terrified of coding and not getting things approved, but I'm also overwhelmed with the thought that I'm going to be doing this for the rest of my career, right?

Writing prescriptions for pain meds, writing prescriptions for blood pressure medicine, writing prescriptions for statins, seeing the patient for five minutes. Cramming that appointment that's supposed to be a year's worth of information into five minutes, and then seeing my next patient,  hoping that I'm making a change in someone's life, but not really feeling fulfilled.

And I was already seeing that happening just in my clinical sector and in my emergency care background. Um, so fast forward, there were.  A couple of us in nursing school who said, you know what, let's just go into aesthetics. We just want to inject Botox. It's so much easier. We're just going to make people feel better about themselves.

We're so burnt out. You know, it's clearly not the case. It's actually much more challenging than, you know, and you two are well aware of that.  I started working at a medical spa that was really focused on bringing in GLP 1 therapy. Long story short, it blew up. It really took off and it was so amazing to see and feel that not only was I actually working in cash based medicine and not having to deal with insurance, but I finally felt like I was also helping patients and making them feel better about themselves.

Not with Botox and filler where, 

sorry, well, isn't it so eyeopening though that like people are coming in and paying out of pocket for these treatments. And I think that says a lot because especially for, you know, Botox for migraines for shoulder pain, you know, a neck spasm and blood for whatever people will come in and do anything.

They don't some, some people, no matter what the cost, if they're like, and if it helps me, I'll do it. Right. Right. I don't care. And, you know, to add to that, I mean, with weight loss and all the other benefits that they're finding with these GLP ones, I mean, people will do anything to feel better from within.

And what I noticed in the aesthetic space is, as you said, people are already spending the money, but as soon as they realize there's practitioners that are qualified and also passionate. And educated and interested in helping you and not letting you list a thousand reasons why they deserve it. It's like a chef's kiss because it's not that primary care is not. 

important, but I find that those providers unfortunately are so taxed. They're so rushed. They have a million things they're trying to manage at once and they get five minutes to do it. Right. That doesn't include charting. It doesn't include writing the prescriptions and the prior authorizations. So it honestly took off.

And the problem is I was only doing weight management. And that's not a problem, but it felt like I was pigeonholing myself because I felt very, um,  I didn't feel that I got the correct education or enough education, which most of us don't in hormone management and they go hand in hand, right? We learn about how to write a prescription.

As you guys know, we learn how to handle any infections and antibiotics and all these things, but we really don't focus on nutrition and vitamins and deficiencies and the long game, right? I feel like I'm 

a bobblehead. I'm just agreeing. Yes. 

Yes. Yes. 

Yes. Yes. 

Exactly.  So I felt like I was, I was finally like, Oh good.

I'm helping people. Oh wait. I feel like there, I keep seeing the same problems, the same symptoms and the GLP ones, the weight management, it's doing something for information. It's helping them lose weight, but why are they all still in midlife? Not feeling a hundred percent. So that's kind of way I'm here 

women getting pregnant quicker,  they're finding as well.

Yeah. Yeah. Right. 

Because it's decreasing inflammation. Yeah. So 

it's, it's helping with their blood sugar control. It's helping with insulin resistance. And I've actually personally had multiple patients. Uh, accidentally get pregnant. I swear one called me and she said, I swear we thought we were infertile.

I, I'm so sorry this happened. And I said, listen, as long as that caused no damage to your child, I'm so happy for you. If this is what you wanted in your life, I'm so happy for you. Right. And, and also so frustrated for you. Yeah. Yeah. That it took this long to find an 

answer. Yeah. Yeah. Well, it's 

so funny.

You know, I don't know if you guys have heard of CNY fertility. 

No, 

but there's this guy, Dr. Keltz, and you know, we can have his name or his picture put on here. He's a great guy. Um, I think he made a book called Plants Will Kill You or something, but he's very much all about the keto diet and what he preaches with fertility and how that decreases inflammation in the gut and in the body and getting pregnant.

And then when I started hearing about the GLP ones and how some women are finding that they're getting Um, pregnant and how it's helping with glycemic control and all of that. I was like, wow, this is kind of crazy, 

right? It all goes hand in hand. Yeah, it does. And I also find a lot in that same sector.

It's helping with inflammation. It's helping with thyroid. It's helping with chronic pain. I'm not saying it's. You know, a good old Percocet or Noxycodone is going to send you on your way. But they are seeing that there's so many more applications beyond what we're aware of, including gut health, Crohn's, autoimmune, I mean, the possibilities are endless if it's dose appropriately.

And unfortunately, the FDA approval is not yet there. You know, it's not there yet. So you're not going to have a lot of practitioners who are willing to go off label until they talk to 10 others that have done it. 

Right? Well, it's just crazy. I mean, it's the proofs in the pudding. Right? Obviously, I think it's all in studies.

You can probably add more to this. Right? I think, you know, my husband's a family physician and he has patients that are on the ones and, um, and Benjaro's a G. I. P. as well. Right? It is. It's the dual. It's the dual receptor 

agonist. Yes. 

Yeah. And he's obviously seeing the weight loss, which is great. He's seeing the glycemic control diabetes, but he's also noticing that their, um, cholesterol is better.

They're overall having a little bit more energy. Um, and definitely women in their forties, fifties, like you said, and we don't have HRT at my office you're doing yet. You guys are doing HRT, correct? Yes. 

Okay. 

And I mean, that's such a huge power having a GLP one and an HRT and you might, you can add onto this.

Do you find that, you know, that 40, 50, 60, this is what we're seeing in my office right now, that they're coming in and they just can't get rid of, they're like, I can't get rid of that 15 pounds. And of course we don't have. HRT. Are you starting? Obviously, you're getting labs. What's tell us your process a little bit.

Yeah. 

I think definitely like, so like wellness 101, what it's, what it means to be well, and it's not just physically well, but emotionally, mentally, socially, like all of that. And I think Megan really takes that holistic approach. So yeah, definitely kind of explain. I guess. Yeah. Your approach and answer my question.

Yeah. 

So if you want, I have a whole section on my like consultation process so I could skip to that now and just explain like briefly. Yeah. That's perfect. Yeah.  Okay. So. Because hormones and weight management go hand in hand, and I was identifying that in my patients, I decided I need to get away from, you know, how you guys do like filler or Botox.

It's no, you do the full face consultation, right? You hand the patient the mirror and you say, what do you hate about yourself? What do you want to improve? What do you want to Talk about today. What bothers you? 'cause I wanna hear what MA matters to you and then I'll tell you my thoughts. I do the same thing, but with the whole body.

I say they come in, it's a two step consultation. They come in and do a body composition using infrared technology, which looks at your lean mass, your bone mass, your body fat, all of your measurements, things like that. Not just your number on a scale. We also take your vital signs. We do a grip strength test because that's a marker of longevity and it's also really fun and a little competitive.

Mm-hmm . Um, my men get really into it, very competitive. Um, and that's all step one. And I also do their blood draw at that point. I try to get away from nitpicking about what labs to do for who, in my opinion, most patients are not getting the full show anyway, and they're more than happy. They'd rather do that full package knowing I did every possible option for them as opposed to cherry picking and then having to have them come back to do more if I find more things.

So I don't do. I don't go crazy, but I definitely do more inflammatory markers, more vitamin deficiency screenings, and more, um, like a fasting insulin. Things that your GP for the most part, they're not going to order just as a standalone test. After that blood work comes back, I then do either a virtual or in person follow up, and that's where I go over their, not only their results.

Even if they're considered normal, we talk about, hey, this is considered normal, but it's not optimal. And here's why. And here's what you can do. Because every patient that comes through this door, even if all their labs are green, I'm still not happy. I'm a perfectionist. And I'm like, listen, it says your vitamin D is 31 and that's okay.

Uh uh. Not in my world. You gotta have at least 50. And Nicole has so far has had my highest vitamin D to date. 51, baby. Tell her what yours was. Tell her what yours was. 

Sex.  

Get the man some sunlight. 

We gotta hit you up. We gotta shoot you up. So, so it's important because if you went to your doctor. I'm on 

supplementation now. I'm on the, I remember I'm in the care of. 

Yes, yes, yes. I went 

out. Care, what is that? What is that? Care encapsulations or? Oh, uh, 

pure encapsulations. Pure encapsulations, 

not care of.

Good. You might want to hit yourself up with some injectables too, because that's, that's, you're in the toilet. I can't wait 

for my labs in nine months. It's going to be interesting. I want the 2000 IU. So we'll see. 

So see what happens. Don't be discouraged or surprised if it's not as high as you thought, because it is so hard to increase that vitamin D.

It's a fat soluble vitamin. It does not absorb as well if you're not eating it with like a fatty food. Sometimes if you're drinking coffee, you know, things like that with it, it's not going to absorb. It's not going to absorb. So there's reasons why it might not go up as quickly as you think, um, and it's fat soluble.

So you don't want to overdose on it, but it's, I don't want to say it's hard to, but, um, anyway, I go over all their labs. I, even if it's good, I'm like this, I want you to understand why I'm drawing it. I want you to leave here educated. I want you to know everything about yourself. At that point, I then talk about their body composition.

We talk about treatment options and typically they fall into a couple buckets. They can fall into my metabolic plan, which is more of like my, um, hormone plan and maybe getting them an insurance coverage for the GLP one. Or if they can't get that covered, we still do compounding here and I'll send them to the compounding pharmacy.

They get a large amount at one time as like a 12 week supply. And then we kind of go from there. So I'm not trying to pigeonhole myself or the patient and feel like they have to choose. It's really more about what works best for you and what are your main concerns.  And then from there, if they decide they don't want to do an actual membership, they can always come back and follow up with me in three to six months, doing some work on their own and then redrawing some of those labs.

Hey guys, just podcast, please subscribe and don't forget to follow us on Instagram injector, John and aesthetic. Do 

you find, um, what is your main demographic? What would you say? Like, like your average 

middle age women. Yeah. 

Yeah. And explain why is it, is it the menopausal like that? What I explained to you like that 

it's, it's Perry menopause and nobody knowing anything about it and how to treat it and making these poor women feel like they have to earn this badge of honor to say, I survived Perry menopause.

My period is gone. I deserve the hormones and the GLP ones. I'm obese. Give it to me now. They should have gotten it 10 years ago. Right. Cause hormone menopause symptoms can start. As early as 10 years prior to your last period, so why are you waiting until you deserve it or earn it? That's what I'm seeing.

Right? Yeah. And in our previous episode, uh, Nicole, we were kind of talking about, and we wanted you to elaborate on this too, because I feel like a lot of people go to their PCP or their OB guide or whatever first, and they're talking about it with them first. And they're kind of poo pooing it. They're like, you know, you don't need that.

Like, you're fine. Or, and. You know, then they come to us, they sit in our chair, Nicole, and they're explaining it to us. And we're like, they said, what? This is crazy. Like, yeah. And, and from my heart of hearts, I kind of think that possibly. That that provider might either be scared or they don't know enough about it or they're just not educated.

So that way they're like, nope, you're fine. They just don't want to you to go there. Right. Am I right? I 

think that yes, it's multifaceted. It's a lack of awareness. It's a lack of specialization in just that 1 thing. They might be overwhelmed and know they've hit so many walls and so many barriers, and the patients are annoying to deal with because they might have a lot of side effects, or they might need a lot of dose adjustments, a lot of handholding, and they just can't provide that in the practice.

Um, and I also think it's, especially with the hormone management, it's definitely following antiquated old information and studies that have since been disproven or, um, just described as flawed. Right? Yeah. So they're holding on to that, 

right? Was it 2002?  

The Women's Health Initiative was published around 2001 2002.

It actually was discontinued early and they did a press release like springing to the masses. Don't prescribe hormones. We ended the study early. Participants got breast cancer. Just to summarize that study as a whole. First of all, they came out after reanalyzing the data and the publishers like the authors have actually come out and since redacted some of that information.

The other thing to think about is they use the wrong population. The population of women that they used were. Outside of menopause, they were like late fifties through sixties, and your average menopause age in the US is 51 to 52. And they also already had so many existing risk factors that no wonder you add hormones in.

Sometimes it can activate certain things, uh, like cloning  Yes, correct. It was a flawed cohort. It was a and it was a R. C. T. So you would think it would have been a poor well designed trial. Um, there was some positive stats that came out of it, but because the breast cancer one was so glaringly poor in their eyes.

It caused mass chaos, and since 2001, 2002, if you look at the rates of prescribing hormones, I'll send you guys some infographics that he can put on here.  Total tank, total fear, and you have providers out here that are still telling patients that they can't take hormones because their mom's sister's aunt had breast cancer.

Or, oh, your family member's brother had a history of a blood clotting disorder, so you can't have hormones. There's just so much misinformation. Or they'll say, you can take it for five years, but you have to come off of it. It's dangerous if you take it after age 55. Um, or people are still giving out Premarin, which is It's conjugated horse estrogen and, and, uh, at a synthetic form of progesterone.

So 

it's,  

that's one option out of so many others. Um, and it's very frustrating cause you have me, the fairly new nurse practitioner, not going through perimenopause,  working for a cash pay practice, looking like I just want your money. Um, when quite honestly, I'm just a nerd who wants to help people because it's my mom's generation that's suffering, right?

It's our mom's generation and our older sister's generation that's suffering. suffering because they were not given the same options that their parents were. No, it's so true. 

It's that baby boomers and that generation right underneath it. Yes. And 

it will be us one day. So educating yourselves and really finding out what works is going to be beneficial for all of us.

I truly feel like our generation, uh, how, how old are you? Meg? 

I am 32. Okay. I think, right. 

I'm 

like, I think I'm 31. 

I'm going to be 

32 in May. 

I'm 32 as well. And I feel like, you know, because of this. heightened awareness of they play a role in our w quality of life. I feel l  at our age taking it  seri that I'm going to my PCP my testosterone levels an you know, and you know, a  It's pretty good.

It's good, but it's like, it's like, it's good, but is it optimal in your words?  

Things you want to think about, because I am, again, we want to look at your total T, we want to look at your sex hormone bonding globulin, because that binds up all the total T's. We want to look at your free testosterone. We want to look at your albumin, not so much, but mostly your free, your total, um, and your sex hormone bonding globulin, knowing that if for, and I always tell my patients as any of the males I see, I always counsel them on, listen, I don't poo poo testosterone for men.

But I will say if you want to start supplementing with it, don't think you can just come when you want. It's not PRN. It's not as needed. It's you're on it or you're not because you can really cause a lot of havoc with your hormones if you're just shooting yourself up, not taking it for a few months and then deciding again, I want it.

You don't want those highs and lows. 

So one of my patients, he's. It's kind of similar body build to me. Like I'm six foot two and I'm one hundred and seventy six hundred eighty pounds, right? And he works out like a fiend, but his goal is to be a little bit thicker. Um, but he never could as much protein and how much, you know, he works out or like increases his weight.

He couldn't do it. So he actually started, um, he got his levels checked and they were actually right around mine and his, he went to a, um, wellness, uh, NP in the area and started him on the testosterone pellets. And now his levels are up to a thousand.  Um, and I mean, he is, he's, he's thick . He is. Um, 

and that's what he's, and that's what he wants.

He wants that, right? He does. So, and that's, 

he's thick, but not too, like it's, it looks very like, not Roy, right? He just looks, I don't know how to describe it. 

Yeah. But he looks better. He filled out, yeah, he filled 

out, yeah. Yeah. 

Testosterone pellets. Uh, I always.  Explain to patients for me. It's not ever my first line option.

I don't offer them currently. And I don't know if I ever will, especially because my focus is primarily on women. But I will say for a male patient who's looking for that boost, how he feels. At 1000 might be very different than what you would feel at 1000. Everybody's different. So I typically recommend for men that they start with something injectable first.

It's much easier to titrate that because once that pellets in you, it's in you. So imagine you're getting super,  super therapeutic levels of testosterone. You're done that you can't. And once it's almost like a, I don't want to say it creates a dependence because it doesn't, but when you're riding out that high of that testosterone of a thousand,  once you decrease it and you take, and that pellets done and you technically another, and you're like, oh, I'm going to wait and see how I feel.

You're going to crash hard. Yeah. Because now we're waiting for your body. to kick back into gear again and make it right. So for men, if they're willing to draw it up themselves twice a week, if they're willing to titrate it to how they're feeling, if they're willing to get their labs done and really be compliant, I prefer the injectables for men first, because I think it's a tighter control  and what's good for you might not be good for the guy at the gym.

And my women.  The pellets are causing just mass chaos because women are just so desperate to feel better. But can I tell you, there's so 

many women in our area that are on pellets.  So many. Now, is it good for some of them is my question, or my next 

question is what, what other forms like what? Yeah. How does it come?

Yeah. And what's, what do you find to be the best? solution. So 

pellets again for women, it's the same type of issue where if it's a testosterone pellet, once it's in their body, I can't do anything about it to help you decrease those levels if they become too high. That's the first issue. Second issue is some of the side effects that you can potentially get from pellets are not reversible for women.

So think of enlarging your clitoris.  Deepening your voice.  You can't undo it. Yeah. So that becomes a little bit scary. Other things like acne and hair changes, oily skin that you can work with. Yeah. But pellets are never my first line option. 

A lot of them hate that they're getting the hair, right? Or the acne.

Yeah. And their 

testosterone levels are being shot up to above 200. 

Their sex drives higher. That's for sure. It better be. 

Here's the other 

problem though. They're also going to be riding out that high. And if you tank them, Good luck because we're going to feel it. Yeah. 

No. And one of my patients literally, she took a break for a minute and it was like, her husband's like, um, hello, can you go back on it? Like we were, we were so fun, you know?

Yeah. And then, so she ended up going back on it, but  yeah, that's insane. So my 

options, what I recommend for women, I actually just had a discovery call with a patient, uh, who was a referral from one of the aesthetic girls. So like, she'd already known the practitioners here. She loves Nicole and Melissa.

She'd already been coming here. And she was like, I talked to Nicole. She told me you guys offer it. I just want to pick your brain. And, you know, my discovery calls are not official medical advice. They're just a little bit of an intro to see if we're a good fit. What I offer, you know, just a little bit of what's going on before they invest, right?

This patient is doing testosterone injections. If she's a female, not trying to transition, cause that's important to know too. Um, and she, her levels. Again, we're too high. She was doing a pretty high dose pretty often and injecting it directly into the muscle where so that's an option. But in my opinion, it was too high and she was starting to feel it.

She's like, my hair was starting to fall out. I felt a little bit different. We did my labs and lo and behold, the total T was above 200. And I did kind of educate her and explain. Listen, there's no official number. That means it's good or bad. It's a how you're feeling. Be your symptoms, but see, look at your free testosterone because if that sex, woman bonding globulin is high, you do need to have higher levels to get that free tea to where it needs to be.

But once you're injecting it like that, it's just very different. I, my first line option is always a testosterone gel. And this is, again, a little taboo. You'll hear people fight in the hormone world back and forth. I prescribe, retail pharmacy, go to your CVS, get the male version, get some testum, and I educate on how much to apply.

I use one tube for each patient. It's their own prescription, but if Nicole were to receive this prescription, she would take one tube, and where John would apply one tube in one day, Nicole's going to apply a tenth of that tube in one day. And then we're going to redraw her at 12 weeks and see where she's at and also correlate it with her symptoms.

That way we make sure she's not doing way too much. And nine times out of 10, she's not doing enough and we end up increasing it. 

I did not take into consideration the enlargement of the clitoris.  And the voice, but it, but hello, it makes sense. I didn't even think about that. I just thought like, cause all I hear are the good things, like next drive and this and that, or like they have more energy, which makes sense.

Of course. 

Like, duh. I hope so. Yeah. So I  

guess my question to you is, is. you know, you have a female that's 45 years old or 47. I feel like it's a hot number. They're coming in. Okay. And they're like, Oh my God, I'm working out, John. I'm eating healthy. I I just am plateaued. Like, I just feel like there's this pooch here.

Like, I just can't get rid of it. And what do you suggest we do? Like, what, where would you start with them? 

So I always, I never add in three hormones at once because then we don't know what's working. It's kind of like what you guys do with aesthetics, right? You don't want to add in too many procedures in one visit because now they're just overload their Swollen, they're panicking.

They don't know what's causing. Mm-hmm. What they don't know if they like it. Um, so I always start with one at a time for the most part. Um, but you really wanna correlate it with their symptoms, knowing which hormones. So you have your progesterone, your estrogen, and your testosterone. You wanna know where they're leaning.

Um, typically in perimenopause, the first thing to really change and become super erratic, like this is your progesterone. 

Mm-hmm . 

So progesterone is not really. It's not, it's poorly absorbed, so it's hard to test that in your blood work. And I make that very clear to patients. Blood work is just a snapshot.

It doesn't mean you earn anything by having certain values today. They could be here tomorrow. They could be here. Um, I typically start on a progesterone to get their mood, their sleep, their anxiety, um, maybe some mild hot flashes under control, not promising any changes to their weight at this point, but it is important to get their sleep under control because if you're stressed and you're not sleeping.

Good luck with your weight management. Um, and then I start counseling on, Hey, let's look at your testosterone levels. Let's do a female sexual function index. I actually did it with all the girls at the office. You want to know, are they reaching orgasm? Are they interested in their partner? Are they able to self pleasure, but they, they can't get to an orgasm or climax with their partner that matters.

Um, I recommend some books, some podcasts. There's a bunch of urologists I love. And then I also counsel on adding an estrogen supplementation in there. And I don't go for the birth control really ever because those are synthetic hormones. Um, and technically everything's chemically made in a lab, right?

But your synthetic versions of your hormones are what are found in birth control pills. I prefer the bioidentical and that does not mean compounded. That means I can still order them from CVS. So I typically add an extra dial, um, as like a step two, step three, unless they don't have a uterus. 

If 

they don't have a uterus.

technically, they don't need progesterone because they don't need to stabilize that uterus and provide the endometrial protection. And then I can go right to the estrogen, especially if they're having. If they've had a hysterectomy, you should always worry about estrogen because it's gone. Right. Um, but you want to worry about bone protection, uh, hot flashes.

That's more and cardiac risk factors like rising cholesterol. That's mostly your estrogen. So you kind of have to understand what hormones control what and that's why in that 30s to 40s. You see disarray. You see their bone scans are changing, right? Their bone density is changing. You see some fractures.

You see their LDL and their bad cholesterol and they're everything starting to change. You see their fasting insulin start to rise. You see their weight start to struggle. They're pissed off. They can't sleep. They're stressed out. Hello. It's like a hormone symphony. Um, so I love pairing a GLP one with that.

They don't need to deserve it. They don't need to earn it. I think 

with HRT. Okay. Okay. 

Yeah. 

All right. It's a lot. Yeah. I I'm like in love right now. I'm like, this is so great. Well, it's so 

funny, right? Like patients would always ask me like, are you guys going to bring on the GLPs? Like, are you going to bring on the weight loss?

Are you going to do wellness? And I'm like, We physically can't. If you're listening to this right now, imagine this is learning a whole new scope of practice.  

The goal for every practice is to find someone like you, Meg, that loves what they do and is so educated. Seriously,  it's so hard to find. But I didn't 

learn it in school, right?

And I, and I'm not, I'm not discrediting Rutgers University. I got all of my degrees from Rutgers. I've had my qualms with Rutgers. They didn't teach it at 

Lemoine College in Syracuse. No, I get it. 

but I will say I had one professor and I will never forget. She was like the primary care person. So I had her over and over again for my lectures.

She said to me, Women in midlife are so poorly misunderstood. They will thank you if you know how to manage their hormones. And I am so mad at myself for not saving that PowerPoint and that information because I swear she was the only, and she was midlife herself. She was the only professor that I had that actually really honed in and she was primary care.

And she said, if you can manage a woman's hormones and manage their menopause transition, you will have them for life.  

Yeah, it's 

so important and there's just so much fear, but there's also a lot of money to be made. And that is my other thing with the pellets is pellets are not ordered from a pharmacy like a retail pharmacy.

There's more money to be made in pellets and it doesn't mean they're not a great option for people who have failed other therapies. It's just not my first line choice because once it's in, you can't take it out and, and manage their symptoms as well. And they also are going to be chasing that high. Um, And I just don't love that, especially for my females who are so desperate to feel better, especially for the 

long term, right?

Right.  I hear you 

on top of hormones.  The new buzz is the peptides.  My husband went on one actually, um, we're like, it's perfect. He's our little guinea pig. He takes everything now.  But explain to the audience what peptides are, because I feel like it's a newer term and people don't really fully understand it or what they do.

And there's so many different ones and they do so many different things, so.  

So peptides are considered just chains of amino acids. And when you put them together, they can make proteins. So peptides can be a lot of things. And that's what gets a little bit confusing is they're the building blocks of other factors that exist in our body and you, your body makes peptides, right?

But. Things as simple as GLP 1, Ozempic, Wago V, Trazepatide, they're peptides. Um, you have FDA approved medications out there for libido, for multiple sclerosis, for many other things that are all considered peptide therapies, but only now are they really taking the world by storm. And I've noticed a huge change ever since the Semaglutide and Trazepatide came out because they started compounding them.

So these compounding pharmacies that were always making these peptides kind of under the radar. Um, and they were really only being used by like naturopathic and functional medicine and chiropractors. And it wasn't really in the primary care insurance based space because it was a lot of off label use.

I actually attended an A4M concert concert, an A4M conference last October. And it was the most interesting bunch of people, truly. I brought all my little fancy outfits. I brought, like, the few designer things that I have. I'm thinking it's gonna be like an aesthetic conference. 

No. 

People rolled up in their pajamas.

Like, I gave them so much credit, but they were so smart.  I felt this big. I was like, did I go to school? Like, am I, do I have a doctorate? Because these people are so intelligent and they know so much about this. And it was people from all over the world. 

And 

the unfortunate part of that conference is we attended the conference.

And then literally that weekend, the FDA announced they were honing in on peptide compounding and basically pulling the plug. So it was essentially. I don't want to say it's a useless conference, but so many of the peptides that I learned about were pulled almost immediately after that conference. Um, but some that are, that are, I like to talk about with patients and I have offered because they're still available and, or I hope that they're available soon.

Um, BPC is a really popular one. It's not really available anymore. It was available in the oral form in a capsule, really good for gut health, gut integrity. gut repair, think gastric ulcers, healing, um, and also injectable BPC was excellent for performance based injuries. So that's one of those ones I believe was on the band list for the, you know, Olympic and like NCAA.

I'm pretty sure those ingredients that are banned. I think I saw 

that. Yeah, 

but I actually did prescribe it in a couple of patients. It was excellent for recovery. Excellent for just ligament repair, things like that. So think about like your athletic injuries, if you injected it subcutaneous near the injury, it just speeds up your recovery process.

Um, CJC and epimoralin, these are also really hard to get right now, but those are both helping to stimulate the growth, um, like growth hormone in your body naturally, right? And samarelin, which Nicole's probably laughing, but that was the one that is still available pretty widely. And I actually put Kevin on that.

The problem with some of those is they make you eat like crazy because they are causing your body to grow. Right? So with that comes immense hunger. So a lot of these patients, we build them up. And then we cut them down with a GLP one safely in like small, small doses, right? Almost like a micro dose. Um, some other really nice ones.

Kevin's, 

um, we did his psyche, his body comp before and after, and his muscle mass did go up by like a decent amount. I forget the exact number, but we were like, damn, he 

didn't believe it. He 

was like, that's not possible. And they were like, Kevin. And I was telling him how much like fuller his arms looked.

And even we went to dinner with John and Corey, Corey was like, Kevin, you're so buff. And  

he goes, Oh, it's that peptides. He's like, he's like, you know, sorry about the pants. So they don't fit right. The thighs are a little thicker. 

Yeah. But then when 

we did the body comp and he was like, wow, it is it's muscle.

Yeah.  And you're eating. Think about how much more he was eating, even though maybe he wasn't making the best choices. My crunchy side is coming out. Not the best choice. learn how to do better an his body with the help of will have to focus on pro  all the things and he will  follow that, he's not gon he's not going to see res as simple as that.

Um, 

ye I have, well, he's kind of, can I talk about it? Isn't he a pre diabetic? Or is he a diabetic? Yeah. 

He was, he's pre, technically pre diabetic. Yeah. So he was on, he had been on that form in prior. Um, which is crazy. You'd never think that 

he was a diabetic, like looking at him. Yep. But, um, I have high cholesterol.

My LDL is 151. My HDL is like in the fifties and then my cholesterol is like in the two twenties and it was, it's slowly just gone up and I've incorporated working out. Yep. Yep.  I was eating healthy.  It's like middle ground now. Um, and I think definitely my stress levels have gone up too, which I think that's affected as well.

But with that being said, um, I love my primary care, but he didn't want to put me to go on a stat or anything yet, which is completely fine, but I love that for 

you.  

Oh, okay. Okay.  Talk to my husband. He thinks otherwise. Um, he's like, go on it now. I don't want you. You are, he just looks at me. He's Italian. He goes, as soon as he saw my LDL, he looks at me, goes open heart surgery.

And I'm like, get out. I'm like, leave. Um, but I just started, um, terse appetite, um, uh, the 2. 5 milligram dose. And, um, I'm going to be doing it every other week, just doing micro dosing just to kind of help. And obviously there's, It's in the works that they're performing studies, right? Um, cardiovascular benefits.

I know we've seen anecdotal research that, you know, data, anecdotal data that has shown that cholesterol improves the CRP, ESR, inflammatory markers have gone down. People with, you know, ulcerative colitis, lupus, other autoimmune disorders are finding that they're not having flare ups as much. So anyway, I just started it yesterday.

Okay. 

Yeah.  Fine. Fine. A little nausea today, but She's actually passed. Are 

you using a compound? 

Yes. Olympia Pharmacy. 

Oh, wait. Okay. Give me, I, listen, I got the hookup. I know all the good ones and all the tea. She does. 

If you 

ever feel like you can't tolerate that, some things to think about, and this is just like my little education, what I do with my patients is, and your husband probably told you all this, but it's why not add more to the, to the fire, right?

Um, the half life is seven days. So sometimes when patients try to do it twice, ever once every other week, they're missing that half life and they're not stacking off of the Joe's. So it's kind of in your system and then it drops out and then they're hitting themselves with another dose and they feel like crap again.

So consider true micro dosing would be like doing 1. 25 twice in that week.  

So 

breaking out your dose into 1. 25 on a Monday and then 1. 25 on a Thursday, that way you're not hitting yourself with a high dose. And then you're kind of just hitting yourself at little blips. Um, that's something I've done with my patients who can't tolerate higher doses, but they would benefit from it.

So 

I would do like, for instance, I think 2. 5. milligrams was 10 units for the insulin syringe. So I would do five units on Monday, five units on Friday. I just continue that. 

Yes. 

Okay. I was considering, I haven't told him yet, but I kind of, I do what I want to do, but I  was considering, um, actually doing it next week.

Cause I was, I knew of the half life of seven days and, um, actually had a patient in our office that, you know, took it. We went up, we went up to, um, for somaglutide, we went up to one. He took the first dose, was fine. And then the next week, took the second dose, then he started having vomiting. Yes. So he was like, why the first dose?

I'm like, well, let me explain. And I, you know, went through the whole thing. Um, but I was actually planning on taking trizepatide again. Next week and then going every other week, but you're considering me cutting it in half and then doing it by twice. Try 

and try another dose next week. But if you feel like it's building too much, like lower is always better.

The lowest, most effective dose is always better. And I find that patients start getting antsy and they're pushing up, up, up, up, up, and they're not getting creative because they really shouldn't be without their provider. But I've played around with so many different things. I find the sweet spot if you really want to spread it out a little bit, it's closer to like.

10 days, nine days, 10 days. So you're still catching the tail end. Well, 

in my, the reason for me is different. It's not weight loss. I don't wanna lose weight. For me, it's more for cardiovascular and glycemic benefits a little bit more for me. Right. 

Have you ever tried, because this is my new thing and I'm going to be doing it, I actually got them in the mail already.

Have you ever considered tracking your blood sugar with the CGM? 

Oh, the thing that goes. Yes. Okay.  Yeah. My husband's office has them and I think I'm going to do it.  

I think you should. It's a really good way to see how what you're eating might be impacting your blood sugar and things like sleep, stress, uh, exercise, not pairing your carbs with your fats and your proteins appropriately.

That can all cause blood sugar spikes, which in turn could be causing like insulin resistance. I don't know if you've had that. fasting insulin drawn. My other thought, just my little plug for your cardiac risk profile is considered doing and this is not official medical advice. Um, but for patients like you who, um, might have age on your side and don't want to rush to a stat in, we don't want to lower your HDL any further.

We want your HDL to be as high as possible. And we want your triglycerides to be as low as possible. We want to look at your LDL particle size. Because your, your small LDL particles are definitely more dangerous than the larger LDL particles and you cannot see that in a basic lipid profile. You also might want to consider like a calcium score, getting an echocardiogram.

I'm getting a calcium score. 

Excellent. 

Yes, there, there's that. And then I'm scheduled for an echocardiogram very soon. Look at you, good 

patient, good patient. I am. He's on it. Well, I  

have, I have a pectus excavatum, so the chest goes inwards and my heart's moved over a little bit to the left. So there was, you know, there's a whole story from my childhood, but I won't bore you with that.

But, um, but I was getting kind of echoes every three to four years and I could feel PBCs or PACs a little bit more. And I remember, you know, being a, uh, a med surge nurse, not drinking water, not eating. And I definitely felt like I was in like SVT or something and it would like freak me out. So, um, I was getting echoes probably every three to four years and everything's been fine.

But I know for me, I have more of a risk of, I think, is it right atrial enlargement or left ventricular hypertrophy? I can't remember just from, um, um, 

If you're compensating with any type of illness that you have to push the blood out past the vascular resistance coming out of the aorta, that's going to develop that hypertrophy over time because the muscle is working harder and harder, but specific to pectus exibium, I don't remember, but I know you have a separate risk factor.

I think it's an aortic. Aortic arch aneurysm. Like you can have dilation of the aortic arch or superior vena cava. Like, you can have a little dilation just because there's a little bit more pressure. Anyway, we're getting very sidetracked right now. We know, we know 

everything about John's heart 

now, just in time for Valentine's Day.

I can't help 

myself because like when I start talking to patients, I like listen to them listing all these things and my mind. I just, I probably am a little bit neuro, like I'm probably a little neuro spicy, but like my mind just goes into like, like all these things that I could like. So that's part of my like consultation is not just John, here's a GLP one goodbye, right?

John, based on all of your blood work, I think you should do more blood work on these things. I think you should see these practitioners. It's not just about me making all the money and coming back to see me all the time. I'm more than willing to say. I think you need more screening in these areas. Here's why take it or leave it.

Some of it I can order. Um, but because I'm cash pay, some of it gets a little bit tricky. So I'd rather you see your GP and then we can kind of work together. I want to be an adjunct. I don't want to be your primary care doctor. 

And I think Corey said the calcium scores are getting really popular. Um, they are and 

hopefully not too popular because even with some women, unfortunately with hormone therapy, going back to that topic, people are using it as a way to say, oh, well, she can't have estrogen because her calcium score put her at risk for X, Y, Z, right?

It's all that shared patient decision making. It's just another piece of the puzzle to help us understand clinically what's going on. Right. And I'm trying 

to remember cause it's not covered under insurance. I don't believe, I think Corey was saying, I think. I want to say it's like 350 or 400 in New York state.

I think my husband paid 

85. 

Okay. They're not covered 

by insurance and he paid 85. Move to New Jersey. 

Yeah, I might be wrong, but I think I heard those numbers coming from my husband's mouth, but it could be, it totally could 

be. 

Yep. 

Uh, before, before we move on, do you have any other peptides you want to touch on? 

I wanted to talk about, so GHK CU is a really popular like copper binding peptide that I thought was important to include for aesthetic purposes. Again, not a lot of like FDA approval slash availability because you can technically inject it, but it's not really, you're not going to be covered by anyone's malpractice for the most part for that, but they are using it for hair restoration.

They're using it for collagen induction. They're injecting it into the skin. skin. They're applying it topically. They're microneedling into the skin, which is a whole other. 

Mm hmm. 

Possibility. Um, but a lot of my international colleagues were talking about their use of that peptide in aesthetics.

Specifically, I have a whole PowerPoint on it. Um, and then the other two I found really interesting are the intranasal delivery of peptides because I think this is really important overall. We all know your delivery of these medications in general and peptides. It definitely depends on how you're taking them, right?

You've got your oral application, you've got your injectables and you've got your intranasals,  which means you literally do like a nasal swab. Spray. So Clan and Cmax are actually two really popular, brain healthy, um, peptides that are nice for mood, energy, focus, anxiety, and they're best given, um, intranasally because they're able to cross the blood, the blood-brain barrier more readily.

Um, and that's why it's really important to make sure you're not just ordering something off Amazon. Because they'll sell anything to you. But if it's not in the right vehicle or not the right delivery, um, it's not going to be giving you those end points that you're looking for. Same with an oral semi glutide versus an injectable.

We know that they work two different ways. Right. 

Right. 

Interesting. So those are, those are my peptide and I'm hoping, um, Again, like I said, the FDA really put the hammer down. We'll see what the new administration, not getting political, but we know there's been a lot of, um, advertising from certain parties about bringing peptides back and really kind of flipping the script on that.

And we'll have to see what happens. I'm very hopeful. I'm, I'm curious. I'm very curious to see, let's see what actually happens. Yeah. Now, 

Meg, did you hear about. The next, um, one that's coming along on the pipeline. That's going to be targeting three, 

right? A true tide. 

Yeah. Right. A true tide. Yeah. That's that looks really interesting.

So it seems right now in studies, I think they're in phase three. I could be wrong. I haven't looked it up in a while, but I think you're right. It targets three receptors. I think that again, it's only going to get bigger and better. I think it's going to be the same exact principles of if you overdo it, too much of a good thing is never a good thing.

We're already seeing patients overdoing the GLP ones and the GIPs. Um, but I'm excited. Uh, you still have some of your older medications, like your Lyra Glutide that's been out forever, and it's definitely not as effective in studies. Your, your Trezepatide, your Zepan, are by far For the most part in studies, more effective for weight loss.

Um, but I'm very excited to see how Reddit True Tide does. I've had a couple pharmacies acknowledge that they are dispensing it. Um, that's kind of do at your own risk because the actual brand name is not even FDA approved yet. So I'm currently not offering it. Um, I, I'm waiting to see what comes out and I would like to see more approvals come through before I really decide if it's worth, because it's an investment.

Yeah, it's investment for the patients. 

I think another popular one right now too is that NAD.  Any thoughts 

on that? 

Mm-hmm . 

So NAD, again, it's really hard because I'll have patients straight up come in off the street and be doing absolutely nothing to optimize their wellness. Right. And think that NAD is gonna fix everything.

Yes. So for patients that are already, again, if we optimize their thyroid, we've optimized their hormones, their vitamins are all, everything is in check. They're doing, they're eating clean, they're not eating refined sugars, they're not eating, you know. over processed foods, things like that, really doing their best.

And they're like, I really want to continue in on that direction. What are your thoughts? Sure. It's a great option to see how they feel. The two ways I recommend sometimes I like to load people up with the IVs  first with like a loading protocol, and then I'll recommend that they go into subcu administration because they can do that at home.

Some patients don't want to do the IVs. They don't have the time for it. They can't make the commitment and you can have some pretty uncomfortable side effects with IV, um, in terms of like GI and just feeling a little anxious if the doses are higher. Um, so they can do sub Q at home and it's a little bit less of that rush that you might get with an IV, but I will say they have done studies mostly for mood and cognition, but also in addiction.

So I think it's one of those things where you can't really decide today you want an IV and then never do it again, right? You kind of do it or you don't you load yourself up and then you kind of continue on with the subcutaneous. I have seen people do it intranasally again for that. The blood brain barrier crossover.

I will say that some people prefer taking the precursor, um, and hoping that it converts that way. But I think there's still a lot of research to be done. 

Now, Meg, what types of like screenings do you have to do prior to an NID? 

I mean, with any of these peptides, it's really important, especially even with like BPC and anything that's causing that secretion of growth hormone, right?

And anything that's causing more growth to be occurring. The big word around here, the C word is cancer and anything that's already growing.  It might actually help other things grow. You can't control exactly where the growth is coming from. So, I kind of just explain to the patient, it's shared decision making, it's not FDA approved.

I explain to them the risks versus benefits, that you have to be honest in your healthcare screenings of current conditions, not receiving any active treatments for cancer, things like that, but it's kind of a gray area. Um, and you really have to be careful about what dose you're giving these patients.

You can't just show up to an IV infusion place and say, I want the highest dose of any D available for my first time. You don't know. Some of those I just 

want 30 units of Botox and put it in  four different areas. It's like,  

Okay. No. Yeah. Yeah. Yeah. Yeah. So it's, it's, it's very wild, wild west. And that's why aesthetics and wellness have kind of merged because it, it's always been that way.

Um, and the studies and the statutes, the state guidelines, as Nicole knows, I'm the compliance queen. It's not, it's not catching up fast enough, so it can be a little bit. scary. I think that people just want to feel better, but they're not willing to put in the work, uh, and just do the basics, right? Sleep, water, protein, fiber, taking supplements when needed, but getting your whole sources of food, getting organic, uh, limiting your screen time, limiting doom scrolling, having healthy communication, prioritizing intimacy.

Like it sounds silly, but just monitoring your blood sugar for two weeks. You learn so much about yourself, but a lot of people don't want to know. Right. They don't want to know. They'd rather just do what they're doing and then just add more in that over consumption. Um, and I'm not saying I want to, I want to go out of business.

I'm here for a reason, but the people that do better and have better outcomes, especially with GLP ones and hormones, they're already doing a lot of the right things most of the time. 

Right.  What are your thoughts on IV hydration, like getting an IV bag, um, or like, you know, the things that you can give through an IV?

Do you think they're worth it? Do you think it's a little gimmicky? What are your thoughts on that?  

I think that it's worth it. Again, if you realize it's, it's essentially hydration and vitamins. Um, a really popular ivy that a lot of people do in aesthetic space is Meyers cocktail. And that's like your basics.

It can vary what they offer, but it's usually like magnesium, vitamin C, calcium. Um, sometimes they'll add like glutathione as a push. You have to be really careful though, because glutathione is another really good potent antioxidant. We make it naturally, but it's always nice to supplement it just like with NAD, but you can't be shooting glutathione into a vitamin C bag because they don't mix, they precipitate.

Right. So if the person administering your IV doesn't know that you're wasting your money, um, a lot 

of people that do 

so. Yeah. And that's, again, it's not their fault necessarily because there's limited literature out there. No one's really guiding us. I always recommend you call your compounding pharmacist, always ask them recommended doses, ask them vehicle of delivery.

IVs just to capitalize. I currently only offer one. We offer an immune boost here. I wanted to see if it would take off cause I don't want to throw out vitamins. And I do think it's great 

on the shelf for very limited time. Yes. 

And I,  I don't want to over over sell if that makes sense and under deliver.

So I think it's nice as an immune boost. I think if you're about to leave for a flight, if you're feeling a little under the weather, if you're hung over, if you just had a GI bug, I think it's great for hydration. Um, but it's not God's gift to earth. 

Yeah, right. I don't know what you guys program, what you guys offer for your, your wellness, like for your weight loss and stuff like that.

I know for us, um, for our patients, just because there are a lot of patients, obviously we're educating them to drink water, increase your fiber intake, you know, continue to exercise and all of that. But Especially if they're on, like, some of the higher doses, right? A little bit more for, and they're tolerating them well.

Sometimes they're not, their intake of water is lower, they're not getting enough nutrients. So we actually, um, you know, give a little bit of a discounted rate with our IV hydration with Myers Cocktails. It's that way, and we offer it monthly. Um, and it's really helped a lot of our patients too. 

I, I, at a place I had worked at previously, we had offered something very similar just to kind of help again.

It's just a nice adjunct. I'll be honest with you. Maybe it was just the area that we work in or whatever, because it's so oversaturated. It didn't really do as well as we thought it. Would it? We were basically offering it up like, well, you're here. Just come get one. And there wasn't really a need for it.

What I offer is I offer the complimentary, um, vitamin injection directly into the muscle as part of the weight loss and metabolic program because every single one of my patients is deficient in vitamin D. Um, and most of them are not optimal for their B12. Uh, and I also offer like a lipotropic  injection, like a methionine, acetone, choline.

So I love the idea of the IV infusion and if it's working and your patients are here for it. Yes. Hydration. They're terrible water drinkers, so it's a great option. Yeah. Um, I just, at that time, I'm not seeing no one's really Right. It wasn't, no one was biting mm-hmm . Yeah. Um, so I thought Okay. And people didn't wanna hang around, let's be honest.

Yeah. They were like, I gotta go. Yeah. Um, even though water, I just do injections. A lot of fun 

to hang out with  . 

Yes. Yes. I know. A lot of people don't want to lay there for 45 minutes to an hour, you know what I mean? 

Right. 

Yep. I hear you. 

Even though we give them, uh, we give them Netflix here.  

Oh, that's so nice.

So nice.  

I actually did a gut health test on a young girl, like my daughter's age, like a three year old the other day. And we were just trying to make sure that she could be the best sport that she could because we were doing, so we're drawing blood. So I was like, I looked at the mom and I'm like, I can put on whatever she wants on YouTube or Netflix, but I want to check with you first because you know, there's some crazy stuff out there.

So distraction is key. Being an FNP sometimes, yes, I can see kids and treat kids. So that can get a little bit like hairy in an aesthetic environment, but it does help to have that distraction because needle phobia, as you guys know all too well is definitely real. 

Absolutely. Now, now, how long would you say does.

Do the vitamins last? Like, if you're given an IV hydration, how long does it last in your system? I get a lot of questions about that.  

A lot. Some of it you pee out if it's in excess, right? Some of it you'll see it in your pee and you're like, why am I peeing orange? I don't tend to let people come back more than once or twice a month. 

Um, because there's certain vitamins that you're just, you're almost just wasting and you're, you should be getting them in your food. The injections like the intramuscular injections because vitamin D is fat soluble and you can technically overdo it. I do once a month, but that's because it's a pretty high dose.

It's like 50, 000, 25 to 50, 000 I use and you don't need to be getting that. 

Right. 

Every week. Yeah. So it definitely depends on what's in the IV but I see a lot of times with the accession of NAD because you do need to load with that if you're doing it based off of protocols that are currently out there.

NAD you come back in a series of like every few days and do a bunch at once over like five to ten days and then you do maintenance once a month. But your regular old IV infusions, I say like once every two weeks. So once a month,  but some people respond differently. Sometimes you do too much B12 or too much B complex.

They feel it. They get like that, you know, the amino acid sometimes with some of the metabolic IVs, they can, they feel it. Right. So you want to be careful. 

Right.  Um, before we go into, cause we did, we did post a Q and a before the episode. So we do have some questions from patients and people on Instagram. 

Nothing too crazy, I promise.  But I know that we wanted to touch on like essential blood work, like what you think is important. So we'll do that. And then we'll go into Q and A.  

Okay. So I will, I'm not going to bore everyone with the basics. I think your basic panel is excellent. Your A1C, your lipid panel, your CBC, which is like your blood count, your white count, hemoglobin, all of that.

your fasting sugar, kidney function, electrolytes. That's your basics. You'll get that any, any provider you walk into in primary care, they're going to order the basics. What I think is really important is going a little bit further than that and doing some vitamins. I always do zinc B 12 and vitamin D. Um, some other ones of importance, but I don't routinely test or chromium because there's an association between chromium deficiency and obesity.

Um, and I also think it's interesting to do your C reactive protein because that's a, yeah. underlying inflammatory marker. Some people do an ESR, which is another inflammatory marker, but I tend to go with the high sensitive C reactive protein. Um, I always do a fasting insulin, making sure they're fasting because that tends to sneak up way before your A1C and your fasting sugar are out of whack.

And it's not currently recommended by the diabetic association, which drives me crazy. It's a cheap test. Um, but I don't think the research is there yet and that's probably why they're not pulling the trigger. Um, the other ones that I like to talk about. again, this is patient specific, but if they have that lipid profile, that's a little wonky, kind of like yours, John, I then recommend that they get that particle test because it's available.

So why not? It is more costly. So I don't recommend it on every patient. Um, so that's really kind of what I do. I do hormones as well, telling the patient and educating that it is just a snapshot. There's a certain day of the month or time of the month. I want my women to come in if they're menstruating and they're not on birth control.

There is certain days in that you'd rather them come in.  testosterone. I do on everyone, men, women, doesn't matter what they identify as they're getting the testosterone checked. I always do a sex hormone binding globulin as well, because that's an important piece of the puzzle. And my big thing is the thyroid.

Most times when you go to primary, because that's what's covered by insurance. They'll only do your TSH and your T4. I had this conversation with Nicole. I do free T4, free T3 thyroid antibodies. I do reverse T3, which right now is very, Oh, it's. It's not real medicine. It's naturopathic, but if it's available and patients are willing to pay cash for it and we can interpret it and take it for what it is at face value and not spiral over it and kind of just look at big picture, why not?

Um, I just think it's important. That's what people want. That's why they're seeking us out. And if they have the means for it, you know, they're doing full body MRIs at this point, right? So if I can add on a fasting insulin for 2, I'm going to do it. That's why they want to come. Right. And I'm. seeing the same trends in every patient, higher fasting insulin, maybe their a one C's.

Okay. I'm seeing low vitamins. I'm seeing high cholesterol. These are people in their twenties. Like what's going on? Low testosterone. No one's testosterone exists.  What's going on here? Like why are we seeing the same trends over and over again? Why is everyone walking around inflamed?  Scary. 

And like you said earlier, like Normal doesn't mean optimal, so just because you're within that green bar doesn't mean it's a good value, and I've, now I'm being medicated for hypothyroidism, but it's something that I wouldn't have even known I needed to do if Megan didn't look at my blood work.

I have, I go every year and do my blood work, but. I had her review it obviously because we had her start here and she was like, your TSH is really high. I mean, it was like six or something. Um, and then she found out that I was pregnant. She was like, okay, we need to call the doctor. 

She just snuck it into me in the middle of me talking about my little spiel about testosterone.

I'm like, you know, if you're considering fertility, you know, we should wait on that, but just know as you get older, like for women, it's just as important. We stopped wasting inches. Well, I'm pregnant. And I was like,  I'm going to cry. No one's around me. Oh my God. What's happening? Oh my God. My testosterone was like zero.

Right? It was point. Your free tea was point one. Yeah. Yeah. Point two.  Which is, which I'm seeing in every female. You know why? Not the birth controls the enemy. The birth controls the enemy. At this point in my life, I genuinely feel that we are not educated enough on what these synthetic hormones that are given to us at age 13, 14, 15.

are doing for the long haul. It's affecting our gut health. It's affecting our micronutrients. It's affecting our testosterone. It's raising that sex hormone binding globulin. And then when you come off of it, guess what? In studies, it's not coming down the way that they thought it would. So we just have to be so careful about health promotion instead of disease treatment.

And that's why I love this because I finally feel like. I'm not being a hypocrite because I follow a lot of it myself. It just makes it that much easier to, to preach it to your patients. As you guys know, when you do the aesthetic treatments yourself, you can just promote it that much easier and the patients feel comfortable with you because they, they see you doing it.

Right, right. 

Yep. 

And I did, 

I went on birth control at like 14.  So did I like, it was like a normal thing. I had acne. They were like, this is going to clear your skin. I was on it for probably 10 or 11 years before I came off of it. And I was off of it for a while, but still it's like, it 

affects you for a long 

time.

And for women going back to the fertility conversation, why is fertility in the garbage? Why are men not able to, you know, produce healthy sperm as much? What do you think? 

What's the reason? Do you think it's the food that we're eating? Do you think it's like the guys or 

food? I think it's all the chemicals and all the hormones in our environment.

I think it's the fact that everyone's got 16 candles going and everyone's got Baccarat on and everyone's wearing, you know, we're all doing get ready with me is with like 10, 000 different steps and we're all using. Scented everything. How dare you talk about 

my life?  

Did I just call you out completely? I checked every box.

Oh, 

mine is the Baccarat, but oh my God. 

That's my, that's my, yeah. And don't get me started on alcohol, like alcohol consumption.  

Well, you saw the  Surgeon General just came out.  I mean, whoop dee doo, we knew that, but yeah. 

All of us are sober over here now at Xzibit.  

My 

gosh.  

Well, now I don't know what to say.

I think, I do think we need to do better at just doing the basics. I'm not saying you need to go throw out all of your, your stuff at home, all of your cleaning supplies, all of your shampoos and whatnot. But I think we need to stop walking on their head in the sand and act like we're not getting sicker because we are.

And there are definitely easy, cost effective ways. To do better for yourself. And it's just making simple swaps with your cleaning agents, your pans, your, your whatnot, and understanding  it's affecting your hormones. Let's be honest. And even things like marijuana, did everyone, 

did everyone smile back in the day?

Like, I'm sorry. Like. I like to smell good. Like, I like, I clean smelling house. Like, I don't have those plugins and don't worry. I don't have those. And I have, so I can't, you have those. 

No, but we were the axe generation. Oh 

my God. In seventh grade, like the whole like bog would just go through. Um, I remember like, I, my God, it's.

It's hysterical. Like when I go to my in laws, I love them to death. She loves the plugins. Like, and I'm like, and then Corey, when I started dating him, he goes, Oh, let's get these plugins. And I remember walking in one day and I'm like, it literally smells like his house. Like he grew up in it. I'm like, these aren't good.

These aren't good.  Are soy candles okay?  

Um, anything you're burning is just not great 

to get 

the 

terracotta. Like there's like these things, they're like made of terracotta and they make your house smell good and they're not, they're apparently not bad for you. 

You can make the batch of stuff on the stove and light the water and, and make like a natural potpourri.

That's not necessarily  for 

Christmas. Yeah. Yeah. 

It's, it's beautiful. Um, 

based on marijuana. What did you, what did you just say about that? I think because I mean, we are having. I mean,  there are so many dispensaries now that are legal in New York state and they're going up left and right. So touch base on that.

I actually looked at some studies about marijuana and sleep just because my parents were actually using edibles for sleep before my mom let me put her on hormones. Finally. Um, I got her off the edibles, thank God, but I don't have a problem with marijuana. I think there, there's a place for THC and CBD and whatnot.

I think that's is bad for you. So I'm ne on anythin  not good for your lungs. micro dosing, some edibles are not necessarily a bad for  pain management for s way better than alcohol i  just what they've demonst it's not something that y depend on or check out fr lay down and not, you kno involve yourself because you certainly can do that, but they are starting to tie in chronic marijuana use with testosterone and causing low testosterone.

Um, so it's just something to think about that. Interesting. Too much of anything is not necessarily a good thing. 

That was well said. I like that. Yeah.  

Yeah. Yeah. So I could, I mean, I could go on forever about just alcohol because it's becoming so socialized. Like COVID, COVID just put us in this, such a state of depression overall.

And we were all bonding over zoom parties and wine nights and it's, it's in every single event that you attend, whether it's positive, negative, whether it's for kids, for adults, like when are we going to realize that? Cause I just feel like we're 

seeing so much cancer lately and I mean, yeah, no, it totally makes sense.

Yeah.  

Stress, alcohol, no sleep, like we're not sleeping anymore, we're not exercising as much, we're sitting at our desks, there are studies about just moving around once an hour, even if you can't get to the gym, move around once an hour, we've got Apple watches, we've got Fitbits, we've got Oura rings, put one of those on, track your sleep, 

we walk, I'm constantly moving in my office, thank you Jesus, um, but, Yeah.

No. Yeah. It's important. 

It's definitely an important. 

Yeah. I think we all just think we're so invincible to these things, though. Yeah. Yeah. I mean? And then they happen and we're like, 

right, you 

know, 

but I do think the incidents of breast cancer and colon cancer in our friends, our family members at our age is starting to become scary.

And I, I am starting to see, I don't know, Cole and John about your like friend groups, but I am starting to see people really try to do better, even if they have a really hard time with it. Yeah. I've seen more and more people quitting alcohol. It used to be like you didn't quit drinking unless you were a straight up alcoholic.

Now people are giving up alcohol or severely limiting it  in droves. And, and I, and I hope that sticks because I do think they're trying to pull the, you know, they're trying to treat it like cigarettes. Now we realize finally cigarettes are bad for you. I really do think we're trying to push the needle.

Yeah. And we're trying to push it in that 

direction. When you think about it, there are people that have it every night. Like, you know, there's, there's our social drinkers, but then there's people that have a drink or a couple of drinks with dinner every night and, you know, it's probably not the best idea.

Yep. No, 

no, no. And I could go on the whole, like everything in moderation. I'm sorry. I, there is not a single positive benefit that I can list anymore because in my opinion, it's just a coping mechanism at this point, you're, you're, you're covering up something that, that you're not willing to acknowledge.

And, um, it makes me sad. I, Nicole knew me in high school.  I was a sorority girl, if I ever, if I knew these words were ever going to come out of my mouth, like all of my high school friends would be crying, laughing right now, whether they're 

not cool.  

Cause I was that girl. You're not it. You are not it. Yeah.

It's yeah. Oh my gosh. Y'all had that party phase.  I'm very excited just to see in the wellness and aesthetic space, I think we're only getting better. I think people are understanding. It's not about the scale. It's about how your clothes are fitting. It's about, it's about muscle. It's about, you know, inflammation. 

Yep. I love it. No, definitely. All right. So I want to segue into some questions.  Some of them I think we've already answered a bit. Okay. Um, this one is about NAD oral versus IV, which I think you did touch on.  For what was it or IV versus what versus oral for the NAD therapy? Is it, is it really like aging in reverse? 

I think that we do have NAD and precursors occurring in our own cells and it does have to do with our mitochondria health, which if everyone remembers from bio, it's like the, the, the cell battery. So I think over time as those NAD levels deplete, obviously you're going to see some mitochondrial dysfunction, so it's multifaceted.

I do think. Doing the I. V. versus oral. I think I. V. or sub Q. Injection is always going to be better because you're avoiding the gut. I'm not really sure about intranasal there, but yeah, I think if everything else is optimized, it's an excellent option, but I don't think it's worth investing all this money into an N.

A. D. infusion. If you're going to go out and, um. You know, go to Chick fil a and Burger King and the bar. Yeah. But there is some promising application for alcoholics with NAD. So, you know, I think they just need to do more research. 

Yeah. Um, this one says all things NAD, which we hit on. So that's good. Uh, how do you treat elevated testosterone in females?

I don't know that. Did we go over that? 

Elevated? 

Yeah. Oh, wait, I don't think we did. 

So, okay, so elevated testosterone in females, if it's not due to them receiving exogenous testosterone, meaning from pellets or from a gel or an injection, a lot of times when you see high testosterone, you, you can't assume, but you want to do some other tests to rule out PCOS.

That's been a big, like, trendy TikTok. Yeah. Everyone has PCOS now. Um, and again, I think that's because so many women were underdiagnosed  and they're poorly managed. A lot of times they're just given the birth control pill.  which yes, it regulates technically it's, it's stopping your cycle and giving it to you.

Right? It's forcing you in into their cycle. Um, but it also does lower testosterone indirectly because it rises your sex hormone binding globulin, which in turn will then bind up your free or your totalty and lessen your total, um, lessen your testosterone that's available. The other thing that a lot of people will be put on is  

spironolactone.

Um, so that can be used for patients off label for acne. As you guys are aware of an excess oil production and that has to do with, um, typically it's actually first line use for heart failure. That's a potassium sparing diuretic. I'm not a huge fan 

of that spironolactone. 

I actually was put on it.  Didn't go well, and I was also on birth control at the time.

So it could have been a little bit of 

that Yeah, I'm of the like I mean I worked internal medicine hospital as a nurse practitioner like I started patients with heart failure on that You know what? I mean? So like hearing that people are using a heart failure medication for acne I'm like, okay. 

Yeah. And I actually, I kind of pulled the rug out on it.

I actually made a post about coming off of Spiro and birth control and realizing that because 

I have so many of my, I'm serious. I have so many of my patients that are asking me to prescribe it for them. And, you know, there's a couple that I will, um, but for most of them,  you know, I'm just like, go to your PCP or DERM if possible, or there's some 

applications and hair loss with that as well.

So. I think there, I think again, it's that shared decision making and understanding that you might ruin your libido in the process, um, and you might pass out if you don't drink enough water that day. It might put extra stress on your kidneys, but sure, if the acne is really debilitating to you and you want to try it. 

Right. Go for it. But, but no, here's what comes with it. So in general. But 

there's a reason why the acne's happening. You gotta, you have to get down to the root cause of why. Totally. And people don't want to do that. They're like, I want a quick fix. It's just, you know, you can't. It's a journey. 

Yeah. I think high testosterone is tough with that because it's, it's limited in what for women they can do.

Yeah, I was going to say, it seems like 

it's a hard thing to treat. 

They do really well with like a metformin, which is like an oral first line diabetic medication if they don't want to try a GLP one, but I do love treating them as if they're a metabolic problem rather than a hormone problem. Okay.

Interesting. 

Very interesting. Okay. And 

if they have a pellet, then that's 

why. 

Right. 

Um, this one kind of relates to that. What happens when you stop birth control and what does it do to your body and, and your hormones? So I feel like we did touch on that throughout the episode, but maybe a little. Yeah.

Conclusion birth 

control basically tells your brain to stop communicating with your ovaries and that you cannot get pregnant and that your body should not be ovulating. Right? So your normal menstrual cycle, the hormones kind of surge at 1 point and then they drop and then you get your period. If conception does not occur, right?

Just the basics. So. birth control basically prevents that whole cycle. And it's providing hormones at either a fixed dose for typically 21 days, not always, but it's usually like a fixed dose for 21 days of synthetic progestin and estrogen, different types. And then that week of like a withdrawal bleed.

So you're not really getting your period you're having withdrawal bleed, right? So that's really important to understand. So when you're coming off of that, your body is like, Okay, I guess I have to try to regulate and go back to normal and it doesn't always happen as quickly as people think some people.

It does other people. It does not because with that comes a lot of havoc sometimes with your gut health, micronutrients and other deficiencies to your thyroid and whatnot that may have been worsened. By the birth control pill doesn't mean it's not an excellent option for people who don't have other choices.

Maybe they've failed other options. Maybe they really don't want to become pregnant and they don't want to try an I. U. D. or a, um, one of those inserts or patch or, you know, the next one on there's. Many things they could try if if birth control is what's best for them. Excellent. It's given women a lot of financial and personal fertility freedom, but I think it's highly overprescribed.

Kind of what John was saying. It's highly overprescribed in the derm and in other spaces without full counseling on what can also occur with that, right?  There's actually a book I'm reading right now by Jolene Brighton, um, that could put her face up here. It's called Beyond the Pill that actually was published before COVID.

So, and before, um, like the summer glue tide 

train 

took off. So I'm reading it right now. My mind is blown. 

So that'll be a good, yeah, that's a good resource then to. So I recommend 

that book if anyone's on the pill thinking of coming off of it or just wondering how they can kind of reset their body after coming off of it.

It's excellent. It's a little crunchy, but the, the message is 

excellent. Sorry. I feel like the older I get, the crunchier I'm getting.  And then I have one last question on here. Um, your thoughts on the ARMA colostrum and any other supplement supplements like that.  

So, I, I don't want to poo poo it completely because there are plenty of people in my space that are more functional medicine that love it and they swear provides good gut health benefits.

I think that there are certain other options like colostrum. There's IgG, um, which helps with gut restoration. We have to remember it's being derived from bovine, from cows, from animals. So if you have a sensitivity that you didn't know about, To any of these animals, you might want to be careful about who it's derived from, or if you have a milk sensitivity or a dairy sensitivity, and now you're taking colostrum, um, you just have to be, you have to think that's right.

And that's 

something right. Melissa did her, her fit test, her food intolerance test, and it came back that she was intolerant to it. Yeah. So 

she has a sensitivity  

case out there, not much,  but it's, 

it, it actually happens to me by accident.  

Bovine cows, right? Yeah. 

I had a patient that was sensitive to beef and  some of the.

the, um, things I was putting on her, like supplement recommendations. I had to scan through those ingredients because it's, it's sneaky. You're not really thinking about who some of these, uh, gut boosting vitamins and supplements are derived from and it's animals. Um, so no, I don't think that I don't, I can't sit here and say, Oh, I think it's silly to take colostrum.

I think that. babies. There's, there's more information out there than we've ever had before about babies who are breastfed and are delivered naturally versus babies who are formula fed and delivered via C section have totally different pathways because they were not, the C section babies were not exposed to mom's vaginal canal.

They weren't exposed to some of that good bacteria while passing through. They also don't receive the benefits of breast milk, which they've done wonders with formula. It's, it's honestly amazing. And it's an excellent option. But they will never be able to really, truly mimic colostrum and the benefits that occur from nursing versus formula.

I was a formula baby, not hating on it, fed his best, but we have to think. Me too. 

Maybe there's, maybe there's something about this formula. I think we're all did pretty good.  

I know, I don't know, but you know,  I was on Armoura. I did it for six months. I, I actually really loved it. Like, I, I loved it, loved it.

It was great. I remember when we went to Nashville. Yeah, you brought it. I had it. I brought it. It was great. Like, I did the dry scoop. I was doing that. I eventually kind of stopped, but I will tell you, I think I have a little bit of a lactose intolerance. Like, it's not all the time, but sometimes, or maybe it's more, but I just, I'm not thinking about it.

But there were times where I felt. like, you know, gassy or bloated, like afterwards, and I didn't actually feel great. And it kind of deterred me. Like, I think, I think it's also because I wasn't consistent with it. Yeah, 

I think also it's important. Like there's some, um, spore based pro and prebiotics that I recommend to patients and you really want to work your way up to it.

So like you said, consistency is key, where if you're just taking it half the time, you might not ever build up that, I don't want to say tolerance, but 

don't we say it consistency and everything in moderation. 

Yes, but you should do a fit test with me. I can mail it to your house. I would love 

to. I really would love to.

Yeah, because you might see right there. Usually the patients are right. If they think they're sensitive to something, even if they're not full on allergic.  Yeah. 

Okay. Yeah. I don't think I'm allergic to dairy. I would die. Oh my God. If you told me I couldn't have cheese, I would literally off myself. I think.

I mean, everyone here hates me. Every patient that leaves here does not leave smiling after the fit test because they're like, so what do I eat? Like, why did I do this? 

Guess, guess, guess what was online that I currently have right here. Shut up!  I literally have your fit test sitting, it's sitting right here, Nicole.

That's a plus three reaction. Plus three reaction. My 

husband, my husband told Nicole to have a banana last night.  

I was having heart palpitations. 

Yeah. And he, and literally she,  on her little. iWatch or whatever, whatever. She sends her EKG to my phone. She goes, can you look at this? Can you have Corey look at this?

I'm like, oh my God. I'm looking at it. I'm like, Hmm.  And Corey goes, you need a banana? Your electrolytes off. And I'm like, oh my God, I can't.  

Plus, it's worth it. That's probably why I have a headache today because I ate my plus three reaction banana maybe. But  

hey, it's worth 

it. It's worth it. Like we 

said, placebo or not Placebo 

or not?

It worked. , your 

heart stopped racing. So there's that  . Oh my God.  

But no, the fit testing is really cool 'cause it, it. It basically tells you what you're intolerant. You could share mine. You could show it if you absolutely. 

So this was Nicole's. 

Okay. 

So her plus her most severe reactions are up here. So she was  really sensitive to Lyme and arugula.

Oh, my God. 

And then her plus threes are banana and cilantro. And then her least reactive were cantaloupe, kiwi, peach, pecan, and brewer's yeast. And then it gives you a nice graph of visually  how screwed you are.  What's nice is her dairy egg and grains is excellent. I see this is probably the only one I've ever seen without a sensitivity to one, if not 

all.

Thank God I 

do. I do.  And then her gut, her gut barrier panel again. Once I found out she was pregnant, I was like, we shouldn't have done this because it does apparently change when you're pregnant and nursing, but her gut barrier panel was not great.  Showing some candida. Um, overgrowth. She has some of her tight junctions, like her intestinal permeability markers, like her occludon was positive in her IgG pathway, which just suggests that her innate immune system is, is, you know, a little bit in ruck.

It's, it's in chaos a bit right now in her, um, cell, her gut wall, I should say. Um, and then her lipopolysaccharide, which is found in the cell walls of gram, I want to say, yeah, gram negative bacteria, yeah. She had a positive reaction there as well. So she definitely has some repairing to do after she's delivered the baby, whether or not she decides to nurse and whatnot.

We'll put her on a gut repair protocol, which includes, you know, prebiotics, probiotics, certain ingredients. 

I want to do it. Yeah, do it. It's worth it. Yeah. Send it my way. We'll mail it 

to you. 

Yeah, I'll probably have to get my blood drawn. 

No, if I mail it to you, I'll just mail you a kit directly from the lab.

Then you can stick your finger, do a little finger poke, and then you put it on the card. You mail it in and then I get the results. 

Oh, my God. How long does it take?  

Seven days. Oh my God. Stop. 

This is still fine. I love it. I know you're saying 

that now you're saying that now, but I can promise you until you're intolerant tags.

If you tell me I can't have shrimp beef for teens, I'll be very upset. We're 

in trouble. 

Yeah.  

Did you have any quick questions? Um, John. No, I feel like we 

answered them all. I feel like I literally feel so fulfilled and this is a great, if I were. Me as a viewer, I felt like I was a viewer. Sometimes I feel like you answered so many questions.

You were so thorough with your explanations and just discussions. And then, um, I love that. We had people asking questions. I feel like some of those are really good. Yeah. 

Yeah. And if you want more, come see Megan,  

I am going to start trying to go live. I am working out. Some like presentations just for like, um, like some mom groups that I'm a part of and whatnot, just because my job and I feel the most fulfilled educating people, even if I never see them again, I want them to leave feeling like they know more and that they can advocate for themselves because women are highly.

Gaslight. Let's just say that we're misunderstood. There's minimal research on women. We're only breaking the surface and I'm so inspired by some of the clinicians in my space that I've met and networked with that. It just makes me want to do better and do better for us. And you know, our moms and for 

any.

For any men that are watching too, though, um, the kind of the opposite. They, they feel like they can't come forward a lot of times too. I feel like this is a kind of a vulnerable and women too. Like they sometimes it is very vulnerable talking about these things and even coming and sitting in our chairs.

But I think men they'll keep everything to themselves a lot of times because they have to be Mr. Tough guy. That's how society taught them to be. So I think for any men watching, you know, this is really great for them too. Yeah. 

And Megan has a. I've seen everyone's husband at this practice. Boyfriend, husband.

I have all the tea. It's, it's very therapeutic and it's also so important to establish that relationship with your patients because I agree with you 100 percent wholeheartedly talking to men about sex. erections, intimacy, and talking to women about the same things. Like how, what's the degree of your orgasm and how, you know, lubricated do you feel?

Nobody's asking them that. Like, and they almost laugh and I'm like, no, I really do care. I want to know, I want to help you. It's so important to have that conversation because. Intimacy and your genitals like, come on, it's,  it's important and you see a 

lot of your own patients, husbands to like, it's, it's like that referral system.

Like they get here, they feel good. They're like, okay, I'm sending my husband. He needs this. They bring a friend. They bring a 

friend. You guys have it in aesthetics. I see the women first and then their husband, fiance, brother, father in law, they come sneaking through the door. They look at 

Thanksgiving at Christmas or at events.

Like they talk about it. Like it's a normal thing. And I 

will say too, like, Megan's setup is very non,  like you don't feel like you're on stage with the bright lights. Like it's very calm in the room. We have very like lights, you know, it's very calming. It's dark. It's not like you feel like you're on display and, and she's never judgmental.

Like it's a very, it's a, it's a great console 

display. 

It's bright enough so that it doesn't feel inappropriate, like we're not, you know, we're not giving back to her parlor type vibes, but I don't like fluorescent lights. I hate them. I like the comfy little scene on the TV. It's very important. You're seen as everything. I don't wear a lab coat. I have one. I proudly have one.

I don't wear one. I. sit with the patients. Just like you guys, you know, report with your patients is everything. That's why they come to you because they're not intimidated by you and they trust you and they feel like they can be themselves. How many of Nicole's and Melissa's patients have I walked over there and spoken to and I have them crying because they're like, nobody's talked to me like this before.

Yeah. 

Yeah. So 

I hope you guys bring it into your practice because it's, Oh, you're only going to help people if 

it's, if it's not. It's not, what was I going to say? It's not if, it's 

when. It's not 

if, it's when. Oh my god.  Brain fart. Um, yeah, seriously. And I think with Corey, it's just he's working full time.

At his office. He's a family doctor. He's working four and a half days a week. He's at my office a day and a half a week. It's a lot. So he wants to make sure when he brings it on, everything is set. Like you, you know what I mean? Like very thorough. Cause he truly cares when we brought on the weight loss program, you know, we really wanted to make sure that we were doing it the right way.

There's so many people not screening people appropriately and you know, you're seeing, I know it's crazy. I mean, there's people getting weight loss medications online and not even seeing a physician or practitioner. So, um, yeah. So there's that. Yeah. 

So we're doing it the right way. That's right. Megan, where can everyone follow you? 

Uh, I have an Instagram. It's. I got to change it. It's at  it's doesn't match me anymore, but it's at Meg aesthetic, LOL underscore APN. So at Meg aesthetic underscore APN, um, I have a newsletter. That's in my bio. Patients can sign up and join my email list. And I also, like I said, I'm going to start. Getting more active in the podcast space soon and just talking more about this just again as an advocate.

I think that's huge Yeah, well, thank you so much for being on. Yes Happy to 

spill the tea any time. Oh my god, can you 

please? Thank you so much. Very 

very 

informative 

All right, guys, thank you so much for tuning in to another episode of the Fill Me In Podcast. I'm Injector John. And 

I'm Aesthetic Nurse Nicole.

And this is 

I'm MegAesthetic underscore APN. 

Thank you so much for tuning in. Until next time. Bye guys. Thank you.