Dr. 50 Something
Whether you are in the midst of midlife or you want to prevent the physical and mental signs of aging that occur in midlife, this is the podcast for you! It is my passion for men and women to know that studied and safe ways to harness that elusive fountain of youth do exist. Aging is so much more than a number and encompasses, not only how we look, but also our energy level, and how long we can put off chronic disease and declining quality of life. In this podcast, we will explore many facets of aging and incorporate my experience in aesthetic medicine, preventative medicine, functional medicine and family medicine.
All of us should take an active role in how we age from an early age.
The length of time in our lives that we feel really good in terms of energy, aches and pains, and thought clarity has a definite impact on the mark we can leave on this world. My wish for my listeners is to always be mistaken for being fifty something (OR LESS) in mind, action, and appearance!
Dr. 50 Something
S1 E4 Decoding Perimenopause, Menopause, and Andropause with Body-Identical Hormone Optimization
Ever wondered why some days you just don't feel like yourself anymore? Those mysterious symptoms you've been attributing to "just getting older" might actually be completely treatable hormone deficiencies. After 80 hours of specialized training, I discovered that I had been suffering unnecessarily for 15 years—and I don't want the same thing to happen to you.
Hormone optimization represents one of the most powerful yet underutilized tools in preventative medicine. This episode dives deep into perimenopause, menopause, and andropause, explaining why hormone changes often begin much earlier than most people realize. For women, the gradual decline can start in their mid-30s with symptoms like weight management difficulties, sleep disruptions, irregular periods, and brain fog signaling drops in progesterone and testosterone long before hot flashes ever appear. Men experience their own version with the emergence of "dad bod," fatigue, workout plateaus, and eventually sexual dysfunction—all treatable conditions, not inevitable consequences of aging.
The most surprising revelation? There's virtually no "too late" to start hormone optimization. Whether you're just noticing the first signs of change or you've been post-menopausal for decades, body-identical hormone therapy can dramatically improve your quality of life, bone density, cardiovascular health, and cognitive function. For men, proper testosterone optimization not only enhances energy and physical performance but actually reduces the risk of serious conditions including heart disease and prostate cancer.
Ready to stop wasting precious years feeling less than your best? Visit our website to learn about our "Get Fabulous" women's program or "Get Firm" men's program. Your future self will thank you for taking this crucial step toward optimal health and vitality at any age.
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Welcome to the Dr 50-something podcast. I'm your host, dr Nicole Norris. Whether you are in the midst of midlife or you want to prevent the physical and mental signs of aging that occur in midlife, this is the podcast for you. This is a show where I share my knowledge gleaned in family practice, preventative medicine and aesthetic medicine, to shed light on aging or, better yet, how not to feel or look like you are aging. We should be taking an active role in how we age from an early age. We should not settle with growing old gracefully or letting nature take its course. How we age directly affects our confidence, which impacts all of our relationships with those around us. The length of time in our lives that we feel really good in terms of energy, aches and pains and thought clarity has a definite impact on the mark we can leave on this world. My wish for my listeners is to always be mistaken for being 50-something or less in mind, action and appearance. Let's go. Welcome to Episode 4 of the Dr 50-Something Show. In the last episode, we discussed the confusing language of hormones and why there is so much controversy about whether it is healthy to replace them or not. Now, if there is any question in your mind whether you should replace your natural hormones as you age. You really should go back and listen to episode 3 again.
Speaker 1:Last week my office team and I hosted an educational event where we discussed the basics of hormone optimization. We had such a phenomenal turnout despite crazy spring weather, and the excitement in the room was palpable as I answered everyone's burning questions about hormone optimization and how what my team does is different than what most providers do who replace hormones. Everyone asked such great questions, but the ones I thought that were podcast-worthy were these the first one was how do I know if I'm in perimenopause? Another good one was I know I'm in menopause because I haven't had cycles for years, but when is it too late to start body-identical hormone optimization? And then the last one that I thought was really good was what are the symptoms of andropause and how does my husband know if he needs natural testosterone replacement? So whomever asked these questions, you are definitely not alone in not knowing the answer. Until I did 80 hours of training last year, I actually did not know the answers either.
Speaker 1:So first, perimenopause Peri means around, so when we are around menopause age? Well, when are we around menopause age? The answer is different for everyone. So most experts agree that the average age of cessation of menses is 53. It can be 10 years before that or 10 years after that, and that would be normal. So an official diagnosis of menopause is when a female has not had a menses for 12 consecutive months. Her follicle stimulating hormone is greater than 50, her luteinizing hormone is less than 30. Her estradiol is usually less than 10. But you really don't know that you're in menopause until after the fact.
Speaker 1:Your ovaries just don't shut down production of our important sex hormones. They do it very gradually, and sometimes this shutdown starts in the 30s and sometimes it starts in the 50s. The ovaries first produce less progesterone and testosterone and then less inhibin, and then, lastly, estradiol production wanes and your menses stop. At whatever time a woman starts having symptoms of low testosterone, low progesterone or low inhibin is actually when perimenopause starts. So the symptoms are also very different for every single woman and when they start it's a crapshoot. So sometimes perimenopause is called no man's land, because no man understands it. And the other thing that hormone experts agree on with perimenopause is anything that happens in perimenopause is normal. So when you start losing testosterone and your levels are not the robust level of your 20s.
Speaker 1:Your symptoms could be trouble losing weight, doing the same things that you used to do. It could be having difficulty building muscle mass. It could merely be a decrease in your libido. It could be trouble having an orgasm. It could be trouble with having clear thoughts and just your overall energy level.
Speaker 1:When your ovaries also start making less progesterone, the number one thing you notice is some sort of irregularity of your menses. It could be they're a little more painful. They're more irregular as far as timing. They could be heavy one month and not heavy the next month, or just always heavy, but it's mostly the fact that it's a change from what your menses were like before. Another common symptom of progesterone deficiency is sleep disturbances. You can't fall asleep, you wake up in the middle of the night and you have trouble getting back to sleep. Lack of progesterone can also cause trouble with weight gain and trouble with bloating. Patients who don't have enough progesterone can also start having brain fog or just simple memory issues. They just may not be able to find words as quickly as they used to or think as clearly as they used to. Now, if a woman has polycystic ovarian syndrome, their symptoms of perimenopause can actually start sooner because this is associated with low progesterone as well. In some studies it is actually thought that 70% of women actually have PCOS and the majority don't even know they have it.
Speaker 1:This is going to be my next podcast. So when you start losing the hormone inhibin that is made by your ovaries, you start having those wonderful hot flashes and night sweats. It is not possible to replace inhibin directly, but if you replace progesterone and testosterone, your levels of inhibin actually improve. So the answer to when do I know if I am in perimenopause is when you have any of these symptoms I just described and you're still having a period, you are in perimenopause. And then the next, more pertinent question should be so if I am in perimenopause, then when should I start replacing my hormones? The answer is ASAP.
Speaker 1:I think I started perimenopause after my second baby, when I was 35 years old. It is not uncommon for progesterone and testosterone to plummet after pregnancy and sometimes it just never recovers. I did not know that I was perimenopausal that young and I did not know all the symptoms I had were treatable until last year when I was 50 years old. So that is 15 years of my life that I could have felt better, done more, been happier and had better mental health and even better intimate relationships. So don't wait to feel better. Like I did.
Speaker 1:Also, side note, birth control pills do not replace your natural hormones or make you feel better if you are having these symptoms. They will keep you from ovulating and keep you from getting pregnant. In most cases they will make your menses lighter and more regular, but they do not help any other symptoms of perimenopause and they do have possible side effects. In most women, birth control pills suppress testosterone production. They can increase your risk for blood clots and there are even some studies that show they do increase your risk of breast cancer. Biodentical hormones like the ones I prescribe in my hormone optimization practice do not act as birth control. They do help your menses to be more regular and not as heavy, but they can actually make you more fertile.
Speaker 1:So what is a sexually active perimenopausal woman to do if she does not want to have a baby? Well, there are lots of reliable, safer options than birth control pills, but that is a topic of discussion for each individual woman to have with her gynecologist. So, to sum it up, perimenopausal symptoms should be treated at any age when these symptoms start. In my practice, when a perimenopausal woman comes in, we discuss symptoms and we do check her levels of hormones in her blood with an easy blood test. However, we are mostly choosing which hormones to replace based on her symptoms, because in perimenopausal women the levels of hormones fluctuate constantly throughout the month with her menstrual cycle. So a woman who is having perimenopausal symptoms should have blood levels checked, but we are going to choose the hormone she's going to take based on her symptoms. Another thing is a woman who is still having periods. She won't need any estradiol. That is something that we typically wait to replace until she is officially in menopause.
Speaker 1:Okay, so if we're checking lab work, what levels do we aim for? In my practice of body identical hormone optimization, we definitely do check lab work, but we always treat the patient's symptoms and not the number. I want to aim for numbers that would be common for a woman in her 20s or a man in his 20s. So I want you to feel like you're 20, but you're smarter. We treat the woman until she feels fabulous. We use trends and symptoms and clinical decision-making based on our experience and training. There's really nothing about hormone optimization. That is cookie cutter medicine and that is why it is so challenging and fun for my team and I Okay.
Speaker 1:So what if you are officially post-menopausal and you meet all those guidelines I mentioned above? Your menses have stopped for 12 consecutive months, you are 53 or older and you have had all the lab levels come back that correlate with this, and very likely at this point in your life, you have some symptoms that we have already discussed. Plus, with the loss of estradiol, you could have some other symptoms as well, and these could be you had a bone density test and you have some thinning of the bone called osteopenia, or you have significant thinning of the bone called osteoporosis. Or maybe you haven't had a bone density test but you had a fracture and there wasn't really a ton of trauma associated. Maybe you have frequent urinary tract infections. Maybe you have painful intercourse because of atrophy. Maybe you have a history of high cholesterol and you really never did before. Maybe you've even had a heart attack or a stroke, or you have early dementia. Basically, if you are developing any of the medical problems that we associate with being an old lady, you definitely are having symptoms of low estradiol. Your labs will likely come back showing that all the hormones made in your ovaries are low Low testosterone, low progesterone and low estradiol. Many post-menopausal women also have associated low thyroid levels when we check their most specific level of thyroid hormone, which is called T3.
Speaker 1:No matter how long you have been in menopause, you are likely an amazing candidate for hormone replacement therapy. So another question that I often get is what is the age cutoff to feel better and replace your natural body identical hormones? Let me see. My usual answer is around 130. The reason I say that is that the oldest living woman today died at the age of 123 in France. So my cutoff is 130. I, by the way, am planning to live to 120.
Speaker 1:Okay, so now on to andropause. This is what is called when men start producing less testosterone in their testicles. Interestingly, this can start as early as the 30s, and sometimes even younger, due to hormone disruptors in our environment. Their symptoms are often trouble losing weight, accumulation of what's called visceral fat. Visceral fat is the fat that accumulates in our midsection. Often these guys who have this central fat, they look a little pregnant or a lot pregnant, or they have what's called dad bod. They can have signs of insulin resistance. They can have a thickened neck. They can have sleep apnea.
Speaker 1:Guys with low testosterone often have poor energy and they report taking naps during the day, or at least wanting to take naps during the day. They often report poor stamina with workouts and despite good protein intakes and regular weight training, they can't build muscles to save their soul. Eventually they also have some degree of sexual dysfunction, like erectile dysfunction. They often have mood changes, with lack of interest in things they used to enjoy doing. They can be easily angered and they can be anxious when they were not like that before. It is also common in men with lower testosterone that they report feeling achy and sore all the time and they often are getting injured with the workouts that they do. So in a nutshell, as a guy, the lower your testosterone is, the more likely you feel like an 80-year-old man. But I must warn you, testosterone will not solve all your problems.
Speaker 1:In our practice we always treat lifestyle first, but if you are already doing the foundational basics of eating clean, exercising regularly and getting good sleep and you're still having these symptoms, testosterone can be really helpful in reaching all of your health goals. Also, body-identical testosterone that we prescribe in my practice is not the same thing as Roids or Arnold's or Gym Candy. These are all forms of anabolic steroids that are not prescribed by a physician but are obtained on the street slash online, and are actually 10 to 100 times stronger than the ones that I prescribe. These illegal anabolic steroids are not body identical and have significant health risks. So I am not your girl if those are the levels and the results you are looking for.
Speaker 1:My goal is testosterone optimization to get men back to the levels that they had in their 20s. Testosterone optimization in men not only improves the above symptoms in men, but it is also crucial to their long-term health in decreasing their risk of heart disease. By decreasing their bad cholesterol and increasing their good cholesterol, testosterone actually can reverse atherosclerosis, which will decrease a man's long-term risk of stroke and heart attack. Taking testosterone can reduce the fat that accumulates in our midsection and also on our organs, which is a sign of insulin resistance and even diabetes.
Speaker 1:Some men on testosterone notice their blood sugars get better and, contrary to popular false beliefs that replacing testosterone can cause prostate cancer, it's actually the opposite can cause prostate cancer. It's actually the opposite. Taking testosterone as you age and keeping your levels healthy actually significantly reduces your risk of prostate cancer. So if you are a man listening, you need to get on this. If you are a woman listening who has a guy in your life you love and you want to help him add life to his years, and not just years to his life you should get your testosterone tested and optimized. It is really never too late. The only man I would be hesitant to treat with testosterone is one, of course, undergoing active treatment for cancer, and particularly prostate cancer. There are some prostate cancers that can be stimulated to grow more with testosterone. However, in all the men in our practice, we screen them regularly for prostate cancer with very specific prostate cancer screening tests at least yearly and sometimes more frequently. Side note men who are still planning to father children in their life cannot take bioidentical testosterone, as when you take testosterone, this actually creates a negative feedback loop and your testicles actually will stop making sperm and therefore you become infertile. So if you are experiencing symptoms of low testosterone and your levels are checked and they are low, there are actually other medications that can be used to boost testosterone without affecting fertility.
Speaker 1:Okay, I hope you all agree that those were podcast-worthy questions. I am almost positive that everyone who just listened to this podcast is thinking what do I do next? How do I get my levels checked and start treating these symptoms and how do I stop wasting my life away feeling like this? Well, if you are in the state where I practice, which is Illinois, I would recommend you go to our website in the show notes, where there is a link for our eligibility form for our programs. Get Fabulous is our preventative medicine program for women and Get Firm is our preventative medicine program for men. The best thing to do is to put your form in the mail to us and then, when we receive it, we can do a discovery call to go over all the ins and outs of our program and make arrangements to meet you in person or virtually. If you happen to be a listener from another state, please feel free to reach out through our website and I can help connect you with another provider in your state that practices hormone optimization like I do.
Speaker 1:Thank you so much for listening and don't forget to share this episode with the people you care about. Thank you for joining this episode of the Dr 50-something show. If you are intrigued by this show and never want to miss an episode, click follow. If you are a really great friend, share it. The content of this episode is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider to answer any questions you may have about your personal medical conditions. Until next time, get fit, get fabulous, get firm and take care of yourself.