Boost Your Mood- Power of Hormones

In this insightful episode, Dr. Spencer Zimmerman sits down with Dr. Lorraine Maita, an expert in integrative and anti-aging medicine, to discuss the profound impact of hormones on brain health. They dive deep into how hormones like estrogen, progesterone, and testosterone are not just about sex and reproduction but play essential roles in cognitive function, mood regulation, memory, and overall neurological health.

Key Takeaways:
✅ Hormones Are Brain Regulators – Estrogen, progesterone, testosterone, and DHEA function as neurosteroids, directly influencing mood, cognition, memory, and mental sharpness.
✅ Menopause & Brain Fog – Fluctuations in estrogen and progesterone during perimenopause and menopause can lead to memory lapses, mood swings, anxiety, and depression.
✅ The Testosterone Factor – Women actually have more testosterone than estrogen, and low testosterone in both men and women is linked to anxiety, depression, and reduced confidence.
✅ Testing Matters – Many healthcare providers prescribe hormones without proper testing. Blood, saliva, and urine tests are necessary to accurately assess and adjust hormone levels.
✅ Bioidentical vs. Synthetic Hormones – Bioidentical hormone replacement therapy (BHRT), including estradiol patches and micronized progesterone, is safer and more effective than synthetic alternatives.
✅ Your Lifestyle Impacts Your Hormones – Diet, stress, exercise, and environmental toxins all play a role in hormone balance and brain health.

Dr. Maita also debunks common hormone myths, including the misconception that estrogen causes breast cancer and shares how proper hormone management can reduce risks of dementia, osteoporosis, and cardiovascular disease.

Transcript

Lorraine Mehta, MD, welcome to the show. Thank you so much for having me. It's such an important topic. I mean, where would we be without our brains? Exactly. You know, most important part of the body, but yet most people kind of go through life just hoping it's okay up there. And if it's not, they just don't know what to even do. Exactly. Exactly. That's why we have to treat the whole body, not just, you know, your heart or your lungs or your skin or your gut. It's the whole body you need. And the brain is sort of your central station there. Yep, absolutely. You know, and so people come to me and we do a lot of neurological rehab, but that's one side, right? You can improve the brain by going directly to the brain, but there's other things in the body that that impact the health of the brain. And that's what we're gonna talk about now is hormones. So very first thing, you know, everyone thinks about hormones, right? Like, oh, for a guy, testosterone's about libido and getting jacked, right? Whereas females, oh, they, you know, they're just, you just have hormones so you can have babies and that's kind of it. So- Obviously that's not true or else we wouldn't be having this conversation. So what can you tell us about these hormones and how do they impact the brain? Well, the sex hormones are not just about sex. I mean, we know that they build bones, they enhance muscle strength, they can lower lipids, and they can do a lot, a lot of other things. But hormones are actually made in the brain. Estrogen, progesterone, testosterone, DHEA are made in the brain from cholesterol. And they are potent neurosteroids and neuromodulators. So they act on the brain cells and they all act in somewhat different ways, but they act synergistically to keep your brain healthy and to keep you functioning well. Yep. Absolutely. I know whenever I've looked at some of the research studies, they actually see kind of the volume of the brain even shifts during a female's menstrual cycle, you know, depending on what's happening with her estrogen and progesterone levels, you know, which is kind of one of the things I kind of, I'm like, Oh, and someone's like doing, you know, I'm doing the pill and I'm like, I don't know, like, like are there long-term issues that we're going to see with the brain? Because it's, know if the brain's meant to oscillate you know I don't know how much I like messing with that now I want to kind of break these down a little bit more into each one right so let's start with estrogen and I and I think as we talk about this it's really important to note that as we go through these hormones guys you're not exempt because we talk about estrogens and females you're not exempt when we talk about testosterone um all hormones matter for everyone and if it didn't matter you just wouldn't have any It always surprises women when I ask what is the most abundant hormones that female have in their bodies? It's testosterone. And they're all shocked because all of our estrogen is made from testosterone. And men, you have estrogen, but the men with the big boobs and the big belly don't. they're turning their testosterone into estrogen. And, you know, that comes from inflammation, being overweight, drinking alcohol, not having enough vitamin D, not having enough zinc. So the hormones convert into each other because it all starts with cholesterol. It goes to pregnenolone, then it goes to progesterone and progesterone can branch off to DHEA, which could go to testosterone, and testosterone, which can go to estrogen. So they're all interconvertible. And men have the enzymes to keep testosterone as testosterone. Women turn their testosterone into estrogen. And all of them are necessary for overall health, not just neuromodulation, but the hormones affect your mood, your cognitive function, meaning your ability to think quick on your feet and your memory. So what I see happening, just think hormone surges. Think of a teenager. Their brains are not ready for the hormones and the hormones are like ramping up and surging. So you have the boys that are aggressive and the women that are irritable and snappy, the young teenage women and the teenage boys, their hormones are causing different effects. So it, you know, it could cause when a young man is not used to testosterone surging, it can cause rage and anger and irritability and women's hormones when they fluctuate, which, you know, when you're starting to ramp up your cycle, they get anxious and irritable. And one minute they're nicey nice. And the next minute they're cutting, they're biting your head off. Right. But estrogen starts to decline and it fluctuates a lot in perimenopause. So I call them the four Ps, postpartum, perimenopause, well, the three Ps, and postmenopause. So estrogen is fluctuating a lot. Like after postpartum, it will go down and then it will start to ramp up. In perimenopause, it's all over the place. And in menopause, you're starting to sink. So this is when women are like, um, um, um, what's your name? Uh, that thingamajig, that little thingy. They're not, they can't find the words, right? So they can't find the words and they feel slower. They can't, they're not quick on their feet. They can't do, remember certain things and memory becomes poor. their quickness is, is gone and they're moody, they're tired, they're irritable. And, you know, they have a very significant increase in anxiety and depression. And a lot of it is hormonal. Yeah, I mean, that's so true. And unfortunately, you know, whenever they get some of that depression and anxiety, if they go the regular route, It's like, oh, well, here's your Prozac or here's your some, you know, some Balta, your Isitelepram, whatever, versus being like, you know what? Why don't we just kind of give you some hormone replacement therapy and then it takes care of it for a lot of these individuals, which will kind of go a bit more into that as we progress through this. But first, you know, are there some distinguishing symptoms someone may have if we compare like estrogen dysfunction imbalance compared to like progesterone? Estrogen, I call it the hormone of energy and growth. And when your estrogen and progesterone is peace and calm. So estrogen is like the gas pedal. Progesterone is like the brake. To drive a car, you need both. You need to be able to modulate between. And this is why you can have stable moods when they're in balance. And in perimenopause, we run out of eggs, right? And the eggs that are left are getting tired and old, and they may not make sufficient progesterone to balance the estrogen. So what women start to feel in perimenopause, and then it also goes into menopause, because you can even have low estrogen and not have enough progesterone to balance that. And you get that excess energy can feel like anxiety, irritability, impatience, insomnia, That's the energy part. The growth could be growth of the breasts, cysts of the breasts, tender breasts, growth of the uterine lining, which could cause bleeding and spotting. You can have growth of fibroids, growth of ovarian cysts. You can have weight gain in the female places, breasts, hips, and thighs. So it's that hourglass Marilyn Monroe type of growth. appearance so and then in menopause you still have the anxiety and the irritability and you can have depression in both and you know you start to get achy the words don't don't you can't find the words this is this is really what happens the memory starts really going and the energy starts going and women tell me they feel like somebody pulled a plug on them like they went from feeling lively and alive to like blah went from technicolor to gray and they lose their libido and that a lot of the symptoms in menopause occur in perimenopause the difference is the definition of menopause is a whole year without a period in perimenopause your periods can be heavy or light coming sooner or coming later or skipping periods you're irregular and the mood swings go along with that and My hypothesis is in midlife, women get anxious and irritable and they're in your face. Men's testosterone starts to go down and they get more withdrawn. So you have one person going at you and the other one pulling back and you know my theory is that's midlife crisis and I used to have couples come to me and I would you know describe the symptoms and they'd both be nodding their head and describe this issue and they'd both be nodding their head it's a theory I mean there's no scientific evidence of that but it's after forty years of observing people and seeing what they go through it, I do think that hormones play a huge role in how you see life and how you feel about yourself and how you feel about others. Yep. Yeah. I mean, that's, that's true. You know, I mean, we know, especially on like testosterone, there's been research on that side. Um, but the hormones do play a big role and I, Want to go back to something you talked about, right? It really is more of the symphony of the hormones because sometimes you're like, well, which hormone is it? Is it going to help me sleep better? Which one's going to help with my anxiety? It's like, yeah, yeah, yeah. Well, some people, they notice more benefits with a progesterone because they take it at night, but then others it's, it's really, it's not about which one it's about the right combination. And I think the, which one comes from the medical marketing. right? It's like, here's your pill for this. And it's like, well, that takes care of it all when it's like, you know, it's really not that simple because even with an estrogen, we know there's different estrogens that depend on where you're at in your cycle, pregnant or not pregnant. And even as you age, you know, you get shifting of that balance. So that's really important to note. Now, one of the things that I, I'm kind of curious on, you know, is the whole definition of menopause. It seems that eventually that definition has got to change. I mean, the amount of people with IUDs and other things where they're like, honestly, I can't even tell you, right? And so unless you check their labs, which a lot of the times it never gets checked, they have no clue. Like maybe they went into menopause three years ago or maybe... know and it's like you know what I guess do we know yet how iuds are impacting stuff because we have at least a little bit of an understanding of what the birth control pills are doing from taking it exogenously um but on the iuds do we really know a lot yet about what that's doing and let's relate it to brain health Well, they act differently on the brain. And then, you know, for example, like not necessarily with IUDs, but different, some progestins have androgenic effects. And think of testosterone, you get testy. So people get snappy and irritable. And I had one woman who's on two antidepressants But she's on, I think, too much. She came from somebody else. Too much progesterone plus progestin, which is synthetic. That is very known to cause depression. So too much progesterone can cause depression. It's a break. You know, when you have too much, you're groggy, you're foggy, you're depressed. It's a break. You can't get going. You can't get motivated. And she was on... One of the synthetic progestins that is very well known to cause depression. So she's on too much of the hormones, both of which too much can cause depression. And one, even if it's not too much, can cause depression. And then she's on two antidepressants to counter that, right? And that nobody measures, right? And if they do, they measure the wrong way. And now, a lot of women have been deprived of hormones because of fear. And they shouldn't fear hormones. They now know that estrogen does not cause breast cancer. That's the biggest fear, right? Oh, my God, it's going to cause breast cancer. You know, I give anybody who comes to me the studies, right? So because I say to them, if you decide to go on, first of all, I want you to make an informed decision. You should see the studies first. You should read them. And you are going to refer to these every time – One of your friends, your relatives, your health care providers, your doctors, anybody comes at you and said, these are dangerous. Don't take them. here's the studies. They're new. They're not the ancient Women's Health Initiative study from I mean, I was around doing bioidentical hormones before then. And I was around when all the women came off their hormones. And it was a disaster. It was a total, total disaster. And, you know, by and large, you know, somebody hijacked that study, came to conclusions before the scientists could you know, presented properly and it became like viral misinformation and no amount of studies after that changed it. And even the principal investigator came out with a paper in twenty seventeen. That's, you know, fifteen years after the study saying it was debunked. This is not what it doesn't cause that. And nobody listened. Now people are listening. Now people are starting to listen because they have newer studies on the bioidentical hormones, which means the exact same chemical structure as your body. And they, we know when to give it. We know how to give it. We know that there are differences. Yeah. Yeah. I mean, I can, you know, it's probably thirty, forty percent of the patients I put on hormone replacement therapy are all like, but is it, you know, is it going to give me cancer? And it's like, no, no, that that's not what the research is showing. You know, but we do know it really is best to start hormone replacement therapy somewhere in the perimenopausal early menopause years. You know, you're you know, you don't want them to be deprived for twenty years. I'm like, OK, let's do this now. you may hit more bumps on the road because it's it's just kind of a shock to the system It is. Perimenopause is the hardest time in a woman's life. And women don't realize, everybody thinks you lose bone only in menopause. No, if you have an ovulatory cycles, meaning you do not ovulate and it do not make progesterone, your bones are weaker. When you have progesterone, progesterone also helps bone grow and it helps stabilize bone. It stops the bone breakdown. So you need to start that early. You need to start that in perimenopause. And you know, there's no clear definition. I mean, it's a clear definition with menopause. Okay. One year without a period check, but perimenopause, it fluctuates so much. Women just don't know what's happening to them. All they know is something is different. When I was in perimenopause, my best friend said, your personality has changed. And I was like, Oh, and that, that hit me because I was under tremendous stress and, um, I just thought it was stress. And the minute I took progesterone, oh my God, I was a different person. I could cope. I could sleep. I was calm. I didn't snap at people or I didn't hold, you know, I always chose the right words with my staff, but there was an underlying irritation tone. You know, you could tell. Right. And, you know, I lost some friends and I got people like, you know, I'd walk into a room in the office and people would part like the Red Sea. They'd be like, oh, no, what kind of mood is she in? Right. And I'm thinking I'm always trying to be nice. I am. I'm polite. But that that somebody said to me, it's your tone. It's there's some underlying tension there. Right. Yeah, and perimenopause is just really this, especially now in today's world, it's very chaotic because it's not a, oh, well, you're going to have normal cycles, and then you're going to have perimenopause for a year, and then you're going to make the full transition because of the lack of sleep, the overexertion, the amount of stress that people are dealing with, the amount of chemicals. I mean, you'll get people who will be in perimenopause for what seems like five to ten years. And it's because of all of these exposures and things that challenging their system, you know, I don't know the research shows, but I would assume perimenopause was never supposed to be a ten-year thing. But yet there's more and more people who are like, my cycles have just been off. Because we even know that in teenagers and athletes, right? Those teenagers who play very aggressive sports where they're running a lot, even that throws off their cycle. And so you basically have people heading into perimenopause earlier. And one of the things, as we're talking about brain health, is there's been research that shows the earlier someone goes into menopause the greater the likelihood they end up with dementia or alzheimer's yeah right and so probably something that can be offset with hormone replacement therapy and and we'll come back to some of that um but there was something you said earlier that I want to get to and that was the amount of people that you see and I see many of the same people who come in they're on hormones maybe they're in menopause and they're on hormone replacement therapy maybe they're in the perimenopause state and they don't even get their labs done or if they do their labs done once and then from there the provider basically just manages on symptoms Yeah. So I want you to kind of talk through that because this is something I routinely see that creates a ton of issues for patients. And then they have to go through a period of not liking us as we try to get them back. Yeah. Yeah. Yeah. Well, you know, you know, a lot of women come in with fatigue. There are. More than twenty reasons for being tired. Is that is that menopause? It may not be, you know, and it could be cortisol or it could be lack of testosterone. It could be lack of DHEA or it could be you have a viral infection or you have, you know, Epstein-Barr or whatever. So I had a woman, I'll tell you a story. She we were trying to. I'm managing her and when we, I try to have women be able to titrate, meaning, you know, adjust the doses based on symptoms until I get to measure, right? Because I can start ten women on the same dose and they're all going to react differently even regardless of what their levels are because their absorption is going to be different, the way they respond is going to be different. So in the first two months, because it takes two months for hormones to reach their peak effect, I have them adjust the dose by their symptoms. And this one woman, she was very dramatic. She was like, my breasts, they're so tender, they're awful, whatever. So I actually, because she was super, super sensitive, I actually had her test her urine using, you know, some of those pregnancy apps will tell you, are you ovulating? Do you make progesterone? What's your estrogen? We both determined that breast tenderness had absolutely nothing to do with her hormones. She was so off with the symptoms. And the same thing with when your bleeding is irregular, you might start to bleed. But I've had women with cervical polyps. Polyps don't respond to hormones. Hormones are not going to stop the bleeding from a polyp, and they're not going to start the bleeding from a polyp. They're their own thing and you have to know when to look. So I, I always measure and it's because you could make the wrong call. And I have some women coming into me with, you know, all those symptoms of perimenopause and their hormones are great. They're stressed out, except maybe their cortisol is off or they're not eating properly or they're exposed to different toxins that are not very good for your brain or your overall health at all. But there's too many reasons to have those symptoms. And unless you measure, you can't know. Correct. There are too many reasons, you know, because one of my frustrations, and this is both traditional medicine and even functional medicine, is there's a lot of overcompensation for hormone replacement where people aren't measuring as much or they're pushing people into these insanely high levels. I'm like, look, even near their menstrual cycles, they would have never produced that much estrogen. And they're shooting them sky high. And one of the big things I see, especially when people are doing oral estrogen, which we can talk about the different types of replacements that can be done, is oral estrogen tends to increase thyroid binding lobulin. So I've had people come in and they basically get hypothyroid from their oral estrogen that they were prescribed. And I'm just like, okay, we've got to get you to a different type. We've got to get you on the dose. So let's talk about that. You know, what are the different I'm going to say progesterone is pretty easy. There's a good pill, works well for most people. There is a topical, but for estrogen, what are the different things? Because there's a lot of different confusion out there on it. Well, I would never give oral estrogen because oral estrogen is... can cause clots. It goes first pass through the liver. You, you know, you swallow it and it gets going to go through your liver first and the liver is going to make clotting factors and it definitely increases the risk of clots. And this is one of the reasons they stopped the women's health initiative early because they had an increased risk of heart attack and stroke. Now, if you give estrogen through the skin, whether it's a cream, it's a gel, it's a, it's a patch, you don't get the clots. The risk of clots is negligible because it's absorbed right into the capillaries and taken to your system. And they did show that it's safer, that there is no increased risk of cardiovascular disease with what they call transdermal, through the skin, estrogen. So there's, I tend to use the patch, because it's covered by insurance you can cut cut it to to you know adjust the dose uh sometimes people are sensitive to the glues or they might get itchy or the patch doesn't stick well I might use the gels and in others that are super sensitive I have a you know I I tease her because we we have a very good relationship she we call her I call her the princess and the pea If I change the dose, even a mill, a milliliter, she reacts, right? And so we keep her at a dose that makes her comfortable and they, they don't make a patch small enough and she can't even like use a sliver. So then I'll have a cream compounded and this way it's gentler. And I, that's the only time I do that. But why give a woman, I had a woman who, who wanted to come to me, and she was on Triest. Triest is Estrone, which you don't want. Estrone is made in your fat and adrenal glands during menopause. It's very inflammatory, and Estrone has shown to increase the risk of breast cancer and also increase, if you develop breast cancer, metastases. And estradiol, the really nice estrogen that gives you back your brain, your bones, your lipids, helps your heart, that will displace the estrone so that you're signaling with the good stuff, not the bad stuff, right? And you're giving the right signals that your body wants. And, you know, the interesting thing is the women that had breast cancer in my practice were not on hormones, right? Right? Women not on hormones get breast cancer. But women on hormones can, but maybe for other reasons. It has nothing to do with the estrogen. Progestins, you asked about intrauterine devices, and a lot of them are progestins, synthetic progestin. That's been linked to breast cancer. Natural bioidentical hormones, and there are papers on this, are found to be safer. progestins increase the risk of breast cancer. Yet no one would bat an eye to give a young woman, and even an older woman, and even a menopausal woman, the pill, which is synthetic. And A, it causes clots, and B, it increases the risk of cancer, as well as gallbladder disorders and other things. So nobody's hesitant about taking the pill, but This is what we're finding. No one would admit it for a long time. Yeah, and I think there's some key takeaways. One is it's not estrogen. It's the route of administration matters. Because one of the things people ask me is, they'll get their estrogen patch which is typically what I'm using as well right insurance usually covers it and it's and even if they don't it's actually pretty cheap through good rx or other things or else if they're sensitive you know because I do have some people sensitive to the adhesives that you do the cream and they're like but it says like it could cause this is like remember all side effects they put on there are based upon the fda approval off the pill of estrogen not versus the current route of administration you are getting and we see the same thing in testosterone or anything else and so based upon that initial approval um because they do have people who start freaking out they're like oh no it says this and you told me it's not I'm like different route of administration you know it's not that big of an issue now one of the things I do want to ask because people do wonder this is there's a lot of people using the term bio identical um so for example the patch is the patch considered bioidentical Yes. Estradiol. You have to see what it says. Estradiol is bioidentical. It's the exact same estrogen that your body makes. That's why the bio, it's your biology. It's identical to your own biology. And if the word progesterone has anything before it or after it, except for the name micronized progesterone, it's progestin, it's synthetic. And that's what confuses a lot of people because the press is going to call progestins or progestogens, which are synthetics, they call it progesterone. And it's not. There's only one progesterone. It's progesterone, plain and simple. Progesterone, right? Not medroxyprogesterone or norethrodrone or whatever. It's just plain progesterone. And for a long time, they were not able to, to make that. And once they were able to make micronized progesterone to take orally, and I prefer the oral route, not everybody can take the oral route, because it's calming. It's, it allows you to sleep. And it has very, very calming effects on the brain. And you know, we've used progesterone, well, not me personally, because I don't take care of these people. But When your brain gets injured, your brain is going to make more progesterone to protect your neurons. And it's been used, progesterone has been used in stroke and people with traumatic brain injuries because it protects the neurons. It lets them, you know, it gives pain relief. It decreases the amount of damage. And, you know, it's been used for some, I don't have a lot of studies on this, With MS, it remyelinates and it protects nerves against damage. So progesterone is really a quite important hormone. So you can't have one without the other, right? The knee bone is connected to the thigh bone is connected to your hip bone. You can't walk with half a foot and no knee. You need it all. You need it all to work together. And those estrogen, progesterone, testosterone, DHEA, cortisol, they all have a very big role to play in your brain health and in your overall health. Yep. Yeah, so two takeaways is one, estradiol patches are bioidentical. Two, oral progesterone micronized is also bioidentical. Now, sometimes people do have to do compounded on the progesterone because they only go down to a hundred milligrams and some people actually have to do a lower dose. But I did want to clarify that because for some reason in the natural health space, specifically on the patient side, as they're looking for like, oh, well, is it coming from the compounding pharmacy? It's like, well, look, it's okay. Like these actually can be bioidentical and not come from a compounding pharmacy. They don't necessarily get a monopoly on that. And then as far as the progesterone, even though I do treat a ton of brain injuries, I haven't necessarily used it on that side. Just because the results really are bad. pretty mixed in the research there's there's not yet a solid agreement and there's other things that do work really well more predictably and but let's talk about now testosterone the most abundant hormone in everyone Well, DHEA is actually more, but testosterone too. But testosterone is a very potent neuromodulator. And men who have low testosterone have much more anxiety and depression. And women, testosterone decreases. There's maybe twenty percent of women as they head into menopause where testosterone actually increases. You know, the lady with the beard, the beard and the mustache. I'm Mediterranean in origin. So, you know, my whole family has that. But in most women, it goes down. And when women it goes down, it increases anxiety. And men have more. Women have more anxiety and depression than men. And we think it's due to all these hormone fluctuations and the fact that they have less testosterone and the androgens, testosterone and DHEA. very calming they are anxiolytic they decrease anxiety they lift moods you know I say to my ladies you know because they'll ask about testosterone and sometimes I don't want to start people on everything all at once because it you know your liver has to handle all of this and and you may not need it so I say to women if you are more sensitive to things, things that didn't bother you before bother you now. If you are less self-confidence, less self-esteem, you have no libido, then you'll benefit. You'll benefit from testosterone. And again, you have to measure because I had a woman whose hormones were perfect. And she said, Dr. Meda, I came to you because I don't have libido and I still don't have a libido. I said, well, your hormones are perfect. What about women? If you're tired, you're ill, you have pain, you're stressed out, or you have any anger or resentment, the first thing to go is like a libido. I never forgot the slide where they showed a slide of men, testosterone on, off, right? Women, it's the airplane cockpit. There's so many things that go and go into that. So when we had a deep dive into that, she said, yeah, you know, my husband travels a lot. And when he comes home, he's too tired and he doesn't pay attention to me. And I do present that. And they worked on it. And you know what? Her libido came back. And years later, sad to say, her husband ended up dying. She met somebody new. And wow, great libido. There was never an issue and it wasn't testosterone, but it can help your libido for sure. And it helps you with self-confidence, self-esteem and decreasing anxiety and depression in men and in women. correct yeah testosterone's great and and like you said the psychological factors that the the mental health the mindset plays a massive role in libido and sometimes people like oh well you know I'm not it's like no look you know what's happening with your stress what's happening with your sleep right what's happening with all that that can definitely play a big role and you know as we've talked about right we've talked about testosterone estrogen progesterone and and really the role that these playing in health and trying to get things to an appropriate level because these are all so critical for really almost every aspect of health from immune system to bone health, to cardiovascular, to neurological, there's, you know, there's research on testosterone, the higher the levels, actually the less likely enough with prostate cancer. I mean, like there's, there's a ton of stuff out there on it. And, and there's something you've hit on multiple times that, you know, I think we wouldn't do this justice if we didn't talk about it was testing. Yeah. Right. Like definitely. how do people go about getting some of these tested? Because as we've talked about, we both see patients on a, you know, on a regular basis who, when they come to us, we're the only people who are actually repeating tests or even doing the initial tests to begin with. Yeah. Well, I test three ways. You know, I say to people, if I were to do your financial plan, I'd have to look at your bank account, your savings and your income and expenses to do a good job. Right. So if I just looked at your blood and that's like your bank account, well, you know, there's the most studies on blood. I say, oh, you have enough, right? But we don't know where it's going in your body and where your body's doing it. I do sometimes match blood with saliva because I do have some people that they're low in blood, but they're high in saliva or they're high in blood and they're low in saliva or they're equal. It's measuring something completely different. It's measuring the free, saliva's free hormone and blood is free hormone, which is what the only thing that gets into the cells and works is bound to protein so that people who are on oral estrogens or the birth control pill, they make more of something called sex hormone binding globulin. And that is going to hold on to their estrogen. And it's also going to lower thyroid so that whatever the level is, it may not be as effective because the protein is holding it. And I say it's like counting the people in the train station and the people in the train with the doors closed. like the estrogen bound to sex hormone binding globulin, they're not free to go to work. So you take estrogen orally, you're increasing the sex hormone binding globulin, and you're decreasing the free hormone that's actually going to work. So that I measure blood and I measure blood and saliva. And then when the levels are adequate, then I will measure urine because the Dutch test. Because, you know, I see too many people measuring it. And there's a time to measure it when you're not on hormones anymore. Um, but if it's, if the estrogen is too low, it's not going to be very accurate, but I use that to look at how your body breaks down the estrogen and your liver is like a recycling plant. It's going to break it down either. clean recyclables like benign two hydroxy estrogen, or something's a little, um, sixteen hydroxy, which is semi-toxic or four hydroxy, which is quite toxic and known to damage DNA. So knowing that, wouldn't you want to know that? Because if you make the toxic form, you can change that into less toxic form by supplements and diet. And I have to say that what I've been seeing in practice correlates with the studies. Women who make two hydroxyestrogen they almost never had a history of breast cancer or a family history of breast cancer. The women who make the four hydroxy estrogen had a family history of breast cancer or a history of breast cancer. So let's fix that. And also just like you wouldn't throw your garbage out on the curb without bagging it or putting it in a container, your body needs to methylate it. That's like putting it in a bag so your body can dispose of it. So that urine test is going to tell me that. And it's also going to tell us, Is your androgen breakdown going to give you more masculinizing effect or less? Or is your progesterone going to make you more tired or less tired? Are you making free cortisone? I mean, there's so much information in that test that I feel like it's not a good thing not to test that because you want to know. Yeah, and I think you did a good job. And I just want to clarify for people as distinguishing almost when a test would be performed and kind of what for. I've had people who come in, they've seen other providers, they've had the Dutch, and they're actually trying to prescribe them based off the Dutch. And I'm like... You know, I don't know that I'd use the Dutch to actually prescribe someone, right? So you're, you know, so it's like blood's probably the best for prescribing, even though salivary is there kind of as an extra. And with blood, you know, I always tell people if you can get free levels of, you know, LC-MS is what it'll say on the labs. And then you're coming around on the back end and saying, okay, how well do you break it down? Because as you said, right, our liver has to break these hormones down and have the appropriate balance of them And then come in with the right dietary support if needed, right? Calcium D glue, great. And all, you know, dim and other things like that can help with the different pathways in the liver with getting these to more of an appropriate spot. Um, It's the same with men, men with prostate cancer, they make more of the four hydroxy. So I do it on men too, because your men have to have some estrogen for memory, you know, and if they're turning, if they are taking that estrogen and making it into four hydroxy estrogen, they have an increased risk of prostate. cancer. So I do it on the men too. It's not just, this is not just about women and you have to be careful how you give the hormones to men as well. I used to see men who came in on the injectables and they would come in and they'd be in a rage when it's high. And then they'd come a week later, like, Oh God, I'm like so depressed. They'd have these wild mood swings. They had increased red blood cell counts, which, you know, the more red blood cells you have, it gets kind of crowded in your arteries and you have an increased risk of clots. And, um, they would have elevated liver enzyme because it's not bioidentical so I tend to like giving testosterone through the skin as well and um I I never see high red blood cell counts or liver enzymes elevated and and it's a steady dose so you don't see those mood swings it makes such a difference yep yeah I mean having that balance is important because if there's one hormone for both sexes that's fairly consistent it is testosterone you know and so having a good consistent way you know whether it's more frequent injections versus topical right but not having to spread out because that's just much more of a roller coaster um you know this has been really good what's one takeaway you want the listeners to have from our conversation on this, that if that's all they remember, you're like, you know, that's going to serve them well. Well, everything affects your hormones, what you eat, what you drink, how much you exercise, the stress you're under, the toxins you're exposed to, and even what you think can affect your hormones. So you have to look at the whole picture. And when you check off all the boxes and you do it right, sometimes the hormones just come back into balance on their own. But if you're going to be on hormones, make sure you measure and you make sure you take it the right timing, the right dose, in the right way. Correct. Yep. Because as you do it, as we talked about, right, you reduce potential risk of side effects. You get the most benefits out of it. And then, as you said, you know, the body, nothing in the body exists in isolation. And so you just listed a ton of things that we know impact hormone levels. And I'll often tell people, they're like, Well, my testosterone is really low. I was like, well, you kind of got two options, right? We can either replace it or two, we start working through the system because there's not just one thing you've, you know, sometimes there's one thing you fix it and their testosterone shoots back up. Other times it's like, honestly, there's a lot of stuff that normally weighs on the system and we have to work through those things to reduce the outside stress that's impacting our body's ability to produce. So Dr. Mehta, it was great having you here and sharing your wisdom with my audience. Well, I love to get the word out because I hate seeing people suffer and people are suffering needlessly. And there really is a lot of myths that we have to break. And thank you so much for inviting me. Yep. You're welcome. And then just, you know, one last thing is if people wanted to learn more about you and the work you do, where would they do that? Okay. My New Jersey has funny laws. My medical practice is vibranceforlife.com. And my courses and coaching practice is the feelgoodagaininstitute.com. Plus Lorraine Mada MD is on Facebook and at Lorraine Mada is on Instagram. I'm also on YouTube and you know, you can just Google my name and you'll find me. I've been around for a long time. You'll find me. Awesome. Sounds good. Thank you so much. Thank you.