So...Which Hormone Therapy Is Best For Me?

Episode Summary

In this episode, Nadine & Cynthia interview pharmacist Shari Patterson about Hormone Replacement Therapy (HRT). They discuss various methods of HRT delivery, including oral pills, patches, gels, creams, injections, and pellets. The conversation covers the importance of understanding how each method works, the historical context of HRT, and the factors that influence the choice of delivery method. They also address common concerns and questions women have about HRT, emphasizing the importance of patient advocacy and personalized treatment options.


Takeaways

- HRT is designed to replenish falling hormone levels during menopause.
- Different delivery methods include oral pills, patches, gels, creams, injections, and pellets.
- Transdermal methods bypass the liver, potentially leading to better absorption.
- Historical stigma around HRT stems from past studies and synthetic hormone use.
- Choosing the right method depends on individual health profiles and lifestyle.
- Pellets offer a long-term solution but require careful dosing considerations.
- Regular monitoring and communication with healthcare providers are essential for effective HRT.
- Bioidentical hormones mimic natural hormones but are not necessarily more natural.
- Patients should advocate for their health and explore all options available.
- It's important to address any concerns with healthcare providers to find the best treatment.

Chapters

00:00 Introduction to Hormone Replacement Therapy (HRT)
02:15 Understanding HRT Delivery Methods
06:24 Comparing Oral and Transdermal Hormone Absorption
10:08 The Impact of Liver Metabolism on HRT
12:37 Historical Context of HRT Delivery Methods
14:25 Commonalities in HRT Delivery Methods
18:37 Exploring the Use of Pellets in HRT
20:42 Adjustability and Flexibility of HRT Doses
24:40 Patient Responsibility in HRT Management
27:13 Factors Influencing HRT Delivery Method Selection
33:24 Understanding Hormone Application Methods
41:44 Bioidentical Hormones Explained
49:48 Navigating Hormone Replacement Therapy Concerns
58:15 Empowering Women in Healthcare Decisions

Disclaimer

Breast Intentions is intended for informational and entertainment purposes only. The content shared on this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Any views or opinions expressed by the hosts and guests are their own and do not necessarily reflect the views of any affiliated organizations. Always consult with a qualified healthcare provider for medical advice or concerns.

Resources & Mentions:

• Find Shari on Instagram (@Shari.asprescribed) 

• Follow us on Instagram and Facebook (@breastintentionspodcast ) 

Connect With Us: Have a topic or guest suggestion? Email us at breastintentionspodcast@gmail.com

Transcript

SPEAKER_02 0:00

Twenty-five years ago, what was the method of delivery for HRT?

SPEAKER_05 0:03

Twenty-five years ago, I think, is where a lot of the stigma and the the scare and you know all of that, the fear was really brought in from that terrible study. Yeah. Yeah. And you know, at the time, they it was primarily oral and they were using more oh this was the horse urine. Yes, the ecoin. It was more different from um animals and similar but not exact. And so they were what we call synthetic. That's it. Which is what you know buzzword everyone thinks being bioidentical and stuff like that. That's where all of that came from, right?

SPEAKER_00 0:47

Welcome to Breast Intentions, the podcast where we take off the prop expectations and dive into honest, empowering conversations. We're your hosts, Nadine and Cynthia, two Canadian girls who swap boots for flip-flops in the Cayman Islands. This is your space to feel seen, supported, and a little less alone. So grab a cup of coffee or a glass of champagne and get ready for your weekly handful of truth, wellness, and empowerment. Welcome back to Breast Intentions. Today we're sitting down with Shari Patterson, a pharmacist dedicated to women's health, guiding us through the various methods of HRT and offering clear, evidence-based insight so you can approach your hormone health with confidence and intention.

SPEAKER_02 1:30

So in today's episode, we have Shari Patterson, who is a pharmacist down here on the island. Welcome to the show. Thank you for having me. Well, thanks for coming on and for talking to us about HRT, the different methods that can be used, the different ways that they can be used. I find it very, very fascinating for myself, just on my own HRT journey, I'm sure you do as well.

SPEAKER_00 1:57

So yeah, I hadn't really thought about it until we started really thinking about it and getting the questions together. And then I was like, oh yeah, oh yeah. Yeah. So I think this can be very interesting. Yeah.

SPEAKER_02 2:06

Um as women. Yes. Yeah. Well, and I think it it all started for me when I put my patch on. You didn't know where to put it. No. And then I put it on, and I'm like, this is not good. Yeah. Um on my butt cheek. And then every time I would sit, it would feel like it was ripping. But then when I would stand, it would like crunch up. Um, but I didn't know really what else to do. So um, yes, so that was my story. I'll talk a little bit more about that too. Um, maybe what we'll do first is uh get you to explain to our listeners um what hormone replacement therapy, HRT, means from a pharmacist's perspective and why does the method of delivery matter?

SPEAKER_05 2:55

Okay. Um so from a pharmacist's perspective, we consider HRT to be a symptom management uh approach. So a symptom management approach that is designed to replenish falling levels of hormones like estrogen, uh progestogen, testosterone in women during different phases, perimenopause, menopause, and postmenopause. Um instead of using a single drug, it's more of a therapeutic strategy to help alleviate uh the symptoms like the hot flashes, uh, sleeplessness, the vaginal dryness. And also it helps to protect long-term health. So, like the bone density, it helps to keep that in check and it does have cardiovascular benefit as well.

SPEAKER_02 3:40

Yeah, we talked about that. We had a holistic cardiologist on the show too. And that was a big eye-opener as well. So walk us through the main ways that hormones are delivered. So we have a number of different ones, and tell me if I'm missing any. So there's the oral pills, the patches, the gels, the creams, um, injections? Is injections right? Oh, I guess like testosterone.

SPEAKER_05 4:07

A couple, there are a couple injections and then pellets as well.

SPEAKER_02 4:11

Um, and how does each one of them enter the body?

SPEAKER_05 4:15

Okay, great question. So for the orals that everybody is more familiar with, that's your tablets, sorry, capsules. Once you swallow it, it goes into your digestive system. From there it's absorbed, sent to the liver, it's processed by the liver, and then sent into the bloodstream to go and work. Um, for the transdermals, they basically are all the same. Whether it's the patch, the gel, the cream, you're applying it to the skin, it's being absorbed through the skin and it enters the blood vessels uh that way. Um and then we have the injections uh in a similar fashion, are deposited whether into the skin, under the skin, or under the muscle, or into the muscle to then be absorbed again directly uh into the bloodstream from there. And then finally, we have the pellets, which is more of like an implant that the doctor will make a small incision and insert it, and it will just stay there like this all.

SPEAKER_02 5:17

It's like three months or something, or is it a different?

SPEAKER_05 5:21

Usually three to about three to six months.

SPEAKER_02 5:23

And I was told it looks like a little piece of rice.

SPEAKER_05 5:26

Yes, just a little rip, just some crystallized hormones, and they make it into just like a grain of rice there about with your therapeutic dose, and it's inserted usually in the hip or buttock area, it's just put in the layer of fat and it just stays there and slowly dissolves.

SPEAKER_02 5:45

Right. Okay. That's neat. Yeah, it is. And I think we are both on different methods, somewhat. I think different. You're on the patch. Yeah. I'm on the patch. And then I do the progesterone tablet. Okay. And then um testosterone gel. Okay. Oh, okay. You're not on the testosterone yet.

SPEAKER_00 6:06

Not yet. I'm hoping that's in my next follow-up. Yeah, yeah. Uh, because I think I need it. But um, yeah, I have an uh an IUD, so I don't need the progesterone. Oh, right. Yeah. I just get the estrogen in the patch.

SPEAKER_02 6:17

Which is another topic, yeah. Yeah, yeah.

SPEAKER_05 6:21

Yeah. So you do need the progesterone, and that actually is a double, it has double benefit because, for example, women who are perimenopausal and will still get a bleed every now and then it could be a kind of it works as a contraceptive for them and it still protects the the lining of the uterus with the estrogen therapy. So, yeah.

SPEAKER_02 6:40

Right. Oh, I know so many different things. Um and I have more questions, and I I'm not sure if you're going to be able to do that. Yeah, I think we'll get to them, right?

SPEAKER_00 6:49

If not, if not, we'll just keep fire.

SPEAKER_02 6:53

So, how does hor how does taking hormones by the mouth differ from absorbing them through the skin in terms of how they're processing in the body? Now, I have kind of uh some questions with regards to this too, because I've noticed a bit of a difference.

SPEAKER_05 7:06

Yes, okay, so the the big difference is that when you take it orally, um, it does go to the liver and it goes through what we call first path effect or the first path metabolism where the liver uh breaks down a huge chunk of it. And so because of that, you usually need uh uh to start with a bigger dose. So that after the liver does break down that chunk of it, then you still have enough for what we call like a therapy that will have therapeutic value. Um whereas with the transdermals initially they don't go straight to the liver, the uh active uh hormone gets straight into the bloodstream and so it gets to go around and get absorbed, uh, so you don't need as as big of a to start with as big of a dose just because before it goes to the liver, it will get used or it's already in the main bloodstream.

SPEAKER_02 8:01

So I don't know if you'll be able to answer this, but is it fair to say, like, you know, you get a lot of people that will say HRT doesn't work for me, like I tried it, it didn't work for me. Could this possibly be where a person has maybe some um backup in the liver where they're taking like a progesterone pill or something like that and it not being absorbed properly because not being a high enough dose?

SPEAKER_05 8:28

Yeah, there's actually like several things that can impact uh an oral dose. So we can start with the digestive system before we even get to the like a person's gut health, yeah. Your gut health. Uh people with chronic conditions like IBD, IBS, Crohn's would already have a different uh baseline than absorption than a normal quote unquote uh person.

SPEAKER_02 8:57

So then is it also fair to say that doctors like to go down the route first of the patches because let's quote unquote like maybe a bit safer, like not safer, but it's like more of a sure bet that it will get into the system better?

SPEAKER_05 9:14

Well for each woman, you know, we are gonna take everything into consideration. So there's so many things that we're gonna take into consideration before we just say the patch is best. You're right to say that it does bypass a lot of those like initial red flags or biomarkers that a physician would have to screen for um to make it more suitable. But some people don't want a patch either, you know. Um some people have sensitive skin. So this is where we're going again, where you know everything will add up because maybe I have good gut health, but I have sensitive skin, right? You know, so now every time I wear a patch, it irritates me, it's itching, it's red, it leaves a rash, and stuff like that. So it's really personalized in in every way you can think of.

SPEAKER_00 10:11

But also just I think I'm only right now realizing that any medication we take first goes through the liver. I don't think I noticed that. I don't think I knew that. I mean, no, I don't think I knew that to the point of wow, like that would have could potentially have an impact on the liver. I mean, I don't know it's his job, but I and I guess I mean that's completely off topic.

SPEAKER_05 10:38

Taking ibuprofen, yes, this is where I'm because I've heard like people can get very, very sick or and and so another thing to consider would be are you already taking a drug that is probably more like that it'll like interact with it?

SPEAKER_00 10:56

Well, no, it's not it's like more like it's it's doing it's making the liver do a job.

SPEAKER_05 11:02

Yeah, so like I don't want to say it's more important, but what if you're taking something else that is already heavily processed by the liver, yeah, um, or multiple things, because you know, we're getting up in age, and so at that time we're already having uh multiple illnesses and multiple factors. So for somebody who is say diabetic, hypercholesterol, hypertension, and already taking so many things, you know, considering adding, like you'll hear people say, I just cannot take another pill, right? Yeah, right. I just can't add another pill, and then that's another thing again, designed by your lifestyle, right? To say, okay, yeah, I'll try the patch, I'll try the cream because I just can't take another pill.

SPEAKER_02 11:48

Yeah, yeah, that makes sense. Um, actually, maybe I'll ask this one. Um there's different sizes of patches as well. Like I've seen that people have different sizes of patches. It does it just depend on who made them, or yeah, pretty much it's just a brand.

SPEAKER_05 12:04

So I think the bigger ones were like the OGs. Oh, okay. I guess.

SPEAKER_00 12:10

Okay, it could be dose too, because I've gone up a dose in mine and it's slightly bigger. Yeah, I can't.

SPEAKER_05 12:16

And then they make there's some brands that made it specifically like that's their marketing, like it's so much smaller than the regular ones, and it's the same thing, same thing. So yeah.

SPEAKER_02 12:30

Do you happen to know? And this isn't an a question that we have on here. It's gonna happen a lot, I think. Um 25 years ago, what was the method of delivery for HRT?

SPEAKER_05 12:43

So that's I love that you asked that question because 25 years ago, I think, is where a lot of the stigma and the the scare and you know, all of that, the fear was really brought in from that terrible study. Yeah. Yeah. And you know, at the time, they it was primarily oral and they were using more.

SPEAKER_02 13:08

Oh, this was the um the horse urine. Yes, the ecoin.

SPEAKER_05 13:14

It was more germ from um animals and similar but not exact, and so they were what we call synthetic. That's it. Which is why the whole um you know, buzzword around things being bioidentical and stuff like that, that's where all of that came from, right? So, yeah, 25 years ago they were more synthetic, not as sim similar to the hormones that we have now, which more mimic the ones that you're losing from your body. Okay. Um, and that's where a lot of the uh side effects came from as well. Right. Because as if it's not identical, then the body kind of still will flag it, you know, as foreign. So I think that's where a lot of the issues came from at that time. Yeah.

SPEAKER_02 14:03

Okay, okay. So it really like back then was only just in pill form?

SPEAKER_05 14:07

Um from what I from what I could tell, yeah, it was mostly mostly oral.

SPEAKER_02 14:12

So now between the patch, the gel, the pill, um, and let's even say the pellets, what and I know that every woman is different, but are there any signs that you can see that there are commonalities between women that they would see in terms of um like differences if they were to take one? Like a patch versus a pill.

SPEAKER_05 14:38

I think there's several things to consider, like um the dosing regimen, so how often you do it, and um cytophy or the cytophy profile, I think, would probably be two of the major ones. So for the pill, they you have to take that every day and you have to try and remember to take it around the same time every day to keep the concentration um constant within your body.

SPEAKER_02 15:03

And and maybe one thing that I should add, and if we kind of go back a little bit, from a pill perspective, should only be a progesterone, right? Not not an estrogen.

SPEAKER_05 15:14

Um, there are women who take an estrogen.

SPEAKER_02 15:16

Is there the estrogen? Oh, really? Okay. It was just something that I had learned where I feel as though I don't want to say that it was more harmful or something, but there was more of a risk.

SPEAKER_05 15:30

So because of the processing by the liver, yeah, and because you have to take a larger dose, okay, it the process itself triggers the production of some inflammatory markers that can in some women in uh with like family history of like CBT and clause and stuff like that.

SPEAKER_02 15:49

And that's that's what I heard.

SPEAKER_05 15:51

So it it does carry uh a slightly higher risk than if you were to do the patch. But there are women who still, I think maybe now most uh well, I don't want to speak for them, but um yeah, from that standpoint, if a woman then has a certain red flag, let's call them, that would make a pill not suitable, then of course there's the patch uh which we consider safer just because it's not a big of a dose to start with and it doesn't do that first classifier. So it kind of bypasses a lot of those uh issues.

SPEAKER_02 16:25

And then from a cream and a gel perspective, it can be in testosterone form, gesterone, registerone, and estrogen, yeah. Okay, so you can kind of do all of them if you wanted to in um gels and creams. Yes. I will even say, um, and we talked about this a couple of podcasts ago, that I originally was on the sequential, right, which uh for anyone that's listening, it was two weeks of just the estrogen in the patch, and then two weeks of estrogen and progesterone in the patch. And then I just swap and swap and swap. And um I struggled with sleep so badly. Um I had a twitching eye, my leg even was like twitching. Um, and it it put my sleep like very, very light. So any, and it was only during the second half, which was during um the estrogen and the progesterone. And so I rolled that out for about three months, gave it an honest effort, and um switched over to just the estrogen patch full time, and then um two weeks of the progesterone pill, it was like night and day. Um, and I have read and been told that the progesterone pill has more of a sedative effect to it. Yes. Now the other thing that I had read as well, um, and I think it's probably different for everyone, is the progesterone pill acts a little bit more like a diuretic than the pagesterone in the patch. So, um, and I was told that when it's the progesterone in the pill, because it has to go through the stomach, more water gets pushed in, um, which causes you to basically just pee more. So it's not actually a diuretic, but you just happen to pee a bit more. Um and oddly enough, I did actually notice that as a difference between the sequential patch and then swip switching over to the progesterone pill as well.

SPEAKER_05 18:32

Um in some women it can it can definitely cause uh increased urination because of the same method that you um explained. And to answer your sleep question, I think with the dosing of the progesterone in the patch and the pill is larger. So for some women, if that was not like an issue, I think I watched that episode and you said you were sleeping fine before, and then yes, not so much with um it was almost like I was um completely revved up and um just couldn't allow my body to just to just wind up naturally.

SPEAKER_02 19:14

Yeah, yeah. Oh, so you think it it's because there was just more progesterone in the patch as a delivery than in the pill.

SPEAKER_05 19:23

In the pill more in the pill than than in the patch. Progesterone in the patch, the dose I don't think is usually high enough to help with that.

SPEAKER_02 19:35

Oh, I see. Okay.

SPEAKER_05 19:37

And I think even in some women, I read that it starts breaking down in the skin, like before it even gets into the um into the bloodstream. So interesting. Yeah. So many things.

SPEAKER_02 19:51

That's why it's so important to have you on.

SPEAKER_05 19:54

Some women will take the pill and can't take it because they wake up like so foggy the next morning and they feel so drowsy.

SPEAKER_02 20:01

Because it you sleep like the dead. It's unbelievable how um how much of a deep sleep that I actually have a client um that was like that, and she has to take her progesterone pill like right after dinner instead of right before bed because it carries into the morning.

SPEAKER_05 20:19

Yes, like yes, that's what we normally recommend.

SPEAKER_02 20:22

Yeah, yeah. It's really neat. Okay. Um, pellets. Yes. So this one's a very interesting one. Yeah. When someone hears pellets, what exactly does that mean from a pharmacy and medication delivery standpoint? We kind of talked a little bit about it.

SPEAKER_05 20:36

A little bit about it, yes. Um, so pellet can actually mean two things in pharmacy and medication delivery. It can be an engineered version of a pill, which is meant to last longer, or it can be the implant like we're talking about now. And so they do compress these crystallized hormones into like like as we said, like as small as a grain of rice based on your dose. The doctor will make a little bit of an incision um under the skin and just insert it in that area. Um, the only thing with the pellets is once it's in, it's in.

SPEAKER_01 21:14

Yeah, exactly.

SPEAKER_02 21:16

Yes, exactly. And that's what I've heard too, is that like you don't want to start on something like that because if that dose is wrong, yeah, you're hooped.

SPEAKER_05 21:27

So usually you would want to like know your range or what your dose is before. Um, or you start lower because you can always add another one if it's not enough. But if you start higher, then you'll just have to write out the symptoms and side effects until it dissolves three months later. So it's it's convenient. Right. It's nice to just sit and regulate, kind of. You know, you don't have to remember to take anything or do anything, but then yeah, that would be the only downside.

SPEAKER_02 21:57

Are there any differences in how

SPEAKER_05 22:00

adjustable or flexible each method is of dose like no matter whether it's like um the patch or the progesterone pill or you know obviously like creams and gels you can pump a little bit more that in um and we know that the pellets you can add a little bit more you can't take away right but with the patch and the pill is there like different um amounts yeah so the patch the thing with the patch is it comes in standardized strength so like your 25 50 75 like that so usually it's it's flexible in the in terms of you can just get another one but then obviously you'd have to speak to your physician get a new prescription come back to the pharmacy whereas like with a gel or a cream as you said you can just do one one more pump or one less pump if I don't think I would trust myself I know me either no not by yourself obviously like consult with your physician and you guys decide to get no it's not like oh it looks a little dry not right no no yeah it's always a discussion with your physician first um okay right because sometimes you know as you mentioned like you wrote it out for your three months like we normally recommend like give it give it some time to see yeah where you're at um unless it's like really like no right um I think just being honest and then in terms of the pill same thing you would have to get a different prescription come for another strength um and so forth and would that be based off of I don't know if you can answer this one would it be based off of symptoms or based off of lapse? It could be either I mean based on it it depends on the physician's approach you know some physicians especially you know if it's experience they already know what you're talking about right once you have that conversation with them like hey I'm really not sleeping it's my third day like what do I do I'm dying they will know you know how to make that adjustment or um if it's where you guys were probably making adjustments all along then maybe they'll be like oh let's look at the bloods I mean I think annually for most people or even biannually for some you retake your bloods and stuff like that to just make sure you're still because you're again you're getting older so as you're you might find a dose that's working right now in a year from now that's what I'm using less so you you always need to check is it fair to say then that most people will always probably have to like go up in strength because it's it's really individual isn't it?

SPEAKER_02 24:46

It really is. Yeah it really really is so I guess maybe how to answer that would just be like pay attention to your symptoms be in touch with your doctor get your labs done once or twice a year. Because I know like people back in Canada their doctor will give them a prescription and they sometimes won't even see them like for a year when they initially start as well. Yeah because they're just it's Canada University.

SPEAKER_05 25:17

Well I mean it's it's great if it's working that would be great if it's working because then you're just like oh at least I don't have to go for another year but then if it's not then you will have to be like hey actually I feel like can I come in because that's where I think people are like this isn't working for me.

SPEAKER_02 25:32

Yeah I feel like you know I feel like crap. Yeah so just gonna chuck it and just say you know instead of maybe asking the doctor if it's worth trying a higher dose.

SPEAKER_05 25:43

Yeah or just asking you know what what are my options like I feel like for us now even as as patients we really have to you know take a lot of initiative on your health and it's it's your life it's your quality of life and we are literally here to serve you so we can only go off what you tell us. So if you took one month and you're like I don't feel great I'm gonna stop but then you go to the review in three months or six months and then you're telling the doctor oh I still don't feel great so the doctor is calling me and saying can I opt the S prescription but doc since you only fill the prescription once oh yeah yeah you know you're again we're working off what you tell us so the doctor is now assuming that you've been on this thing all for three months or next month that you're still miserable you're going up in those but you don't really know how you're reacting necessarily to the first the first regimen that you are getting okay so then how does a doctor or a healthcare provider decide which delivery method for each patient? So I think the first thing they would look at is the risk profile because we always want maximum benefit minimum risk lowest dose short life duration even so I think that would be the first thing do you have a history of breast cancer do you have a history of stroke stroke CBT are you a smoker even like other comorbidities again obesity um things like that would probably be the first and then next it would probably be lifestyle if you know go to the gym or sweating a lot I sweat a lot a patch probably wouldn't work for me because if you're sweating a lot and the heat to the patch it might change how that sticks. So you might find your patches falling off or some women naturally have like more oily skin or what if you're a swimmer you know like then that would also determine how um what what you want to start with so your lifestyle risk factors cost. Yeah um cost is a big one to um do you have good insurance that will cover you the entire time or are you gonna run out mid year right um you know lots of things to consider.

SPEAKER_02 28:27

Do you have any issues with your patch? None no I don't either I had a a girlfriend question me about it and she's like well what do you she was just starting she's like how do you swim with one and I was like the sucker is not coming off I know it's crazy.

SPEAKER_00 28:41

I the first time I you know opened it and I was like this is it like this little sticker is gonna give me the hormones that I'm needing okay and put it on and I like I sauna I work out I walk on like so I do all these things and I'm just like wow yeah shower everything one thing though that um I did notice I don't know if I talked about this on on the last podcast but there was one time when I was like still sticking it on my butt um it didn't go on properly so it kind of cranked up and then so I like um peeled it back.

SPEAKER_04 29:21

It doesn't stick again.

SPEAKER_02 29:22

Yeah there is no way so I had to re-tick it yeah yeah so I learned my lesson to just leave it and not yeah um I'm more careful with putting it on now but yeah I definitely learnt my lesson they do not restick.

SPEAKER_00 29:35

No, I believe that yeah yeah while we're talking about the patch um there are different places that we can put them that is okay right like I do put it on my butt but more like upper yes so I'm not sitting on it and that's okay.

SPEAKER_05 29:50

Yes so we usually recommend below the waistline so even lower abdomen but not in like where your belt or your waist of anything like with underwear or anything would sit. You can do it on your hips so like the side of your thighs upper and then you can do it on the upper part of your buttocks those are the three uh three spaces that we normally recommend you to put it and of course rotating it you don't take off one fashion put it back in the same place.

SPEAKER_00 30:20

So this I do have a question about this too because I you hear that I hear that I've heard that from my pharmacist and from the pamphlet thing that you get inside it. But we're changing it twice a week. Yes. So the I do eventually have to go back to that same place.

SPEAKER_05 30:38

Yes for sure at least give it a break for a couple days. At least for a week you don't use back the same spot. So I mean even if you're using um your lower abdomen you can go all the way across because it's so small. Same with you just put it a little bit you know okay a little bit further to the side or the next side swap. That's okay yeah okay um yeah it's just that when you take it off there's still some like in our residue oh like residue kind of like in the skin it's I see okay there's still some there and also there it can increase like the risk of irritation like you know you're saying you have to rip it off and you put it there you have to rip it off again you're kind of still damaging like the top layer of the skin so you just give it a little bit um and that can decrease any irritations that can arise from that.

SPEAKER_02 31:28

Okay. Okay so then going off of that um testosterone gel because this just became um a topic of conversation on social media recently um about putting it uh I can't remember who it was but she was talking about putting it in your inner thigh um and she was saying that it was like a no no to do that.

SPEAKER_00 31:48

I can't remember who it was oh I don't know that one influencer yeah yeah like an HRT influencer Mary Claire Mary Claire or whatever.

SPEAKER_02 31:59

But because I was like uh oh because I I put mine in my inner thigh for the um testosterone but I think what they were saying is that you just can't go up too high too close to the yeah um which I guess you don't want to do um but but how close is too close right like an inch too yeah an inch or a foot I guess um bit weird maybe just not entering into like that pelvic crease area so oh okay now I'm just okay anyway okay and then you can also do the in um the inner I thought it was like here I think you have to do like on your side you can do it on the inner you can do it on the inner or the outer is just for people who like come and get them pets and like worry about transfer. Oh okay um yeah usually just put it on the inner oh that makes sense and it can also go in here as well so from here to here or oh here to it's just um like an hour or so that you just don't want to come in contact with like hugging a child or a a partner or or something like that. So I guess then also like don't go and put your testosterone gel on at night and go and have sex. Yeah. So obviously it would rub off onto if you're putting it on your thigh and then yeah.

SPEAKER_05 33:22

Yeah yeah and then you want to give it time to dry as well before you even put your clothes on even if you're not coming in contact with anybody so the gels typically take maybe about five minutes or so. Okay. And then the creams take a little bit longer like maybe ten.

SPEAKER_02 33:36

Oh really okay and why do you not want it to come in contact with your clothes? Just it'll rub off people up at your dose yeah okay so many questions.

SPEAKER_05 33:47

I know is there anywhere else that people put um the gel or the cream it's usually the arms are the thighs so you can do outer thigh inner thigh outer arm inner arm that's usually I think lower abdomen is still okay um if you need we usually stick to the thighs and the arms I was also told with testosterone that it you can grow hair in those places.

SPEAKER_02 34:10

You can some women can some women do like where you put it okay is that just testosterone it's not with the it's mostly test yeah it's testosterone I guess estrogen doesn't it's not gonna make it no right yeah I had also heard that i if you take testosterone you could lose hair on top of your head and grow hair on other parts of your face I I have heard that have you heard that too well um so um not with the taking testosterone but if you take it and it um increases your levels too high is when you would start to oh because like you already have some in your body and then your levels are gonna just went too high I see yeah from a blood perspective.

SPEAKER_00 34:56

Right yeah we don't Jerry's still out on that one. Okay. Um while we're still talking about this before I move on to something else um so we we change for me like for the patch I'm taking the patch I assume it's similar to like a cream or a gel as well um change them twice a week. Yes. Uh I do I don't know if this is correct because I didn't ask the pharmacist um like say if I take it Monday morning I'll take it again change it Thursday evening because that's exactly halfway through the week. Well I can do other seven days right so three and a half three and one that's oh I do three and a half yeah you did tell me that you do three so is or does is it okay does it matter should I be doing three and a half? Is it okay to go three and four? Is it okay to change it up?

SPEAKER_05 35:41

So we recommend that you stick with two days the same two days yeah so the same three and four yeah it's just consistency. Um you don't have to I mean I love that you're yeah I love that your brain works that way right down to the minute but anytime in the day is fine as long as you stick to the same two days okay in particular because that reservoir is there. So until you start to get more from the other patch you still have some from the old patch that's working in the skin it's just that by the time that runs out you want to already have the other one on I see yeah there are even once a week patches.

SPEAKER_00 36:19

Oh are there so yeah what if we forget like what if I take it one Monday and Wednesday and then I or Thursday and then I forget one Thursday and like oh my you just put it on as soon as you remember you'll change it as soon as you remember and then go back to your regular schedule.

SPEAKER_05 36:34

Don't try to like make a new schedule go back to your regular schedule.

SPEAKER_00 36:38

So if it's just one day sorry oh okay I would be then counting three and a half days later.

SPEAKER_02 36:46

And then every time you forget regiment so the same thing for like a progesterone pill I a couple weeks ago I actually forgot one night before I went to bed and I didn't remember until like noon the next day and so I didn't take it because I always take it at night. Yeah. But then like a week later I woke up at four o'clock in the morning. So I would normally take it at you know nine or whatever. And I actually no it must have even been like three in the morning and then I took it because I knew that it was like just a shorter window. Right. But I was like oh shoot I need to be a bit more on this. So I can see where there's those advantages to just having the patch not having to worry about taking a pill, swapping a patch, putting the gel on that kind of thing. And I've had people say that like clients to me say that as well and um so then they were like almost considering going off and I'm like if you want to feel the way that you were feeling before or do you know what put a notification on your phone to remind you because you know that it does make you feel yeah yeah good.

SPEAKER_00 38:00

That's a good idea putting a notification on your phone. Yeah. Cause especially like if you are taking something like the doing doing the patch changing the patch that's twice you have to remember a week and maybe you're taking something else too you have to remember that two times a week you have to remember that every day you have to it's it just ends up getting to be a lot.

SPEAKER_05 38:16

Yeah so it can take the help where you can get the help I think you know what's that like take the help where you can get the help so you can reminder like yeah especially if it does make you feel that much better.

SPEAKER_02 38:29

Right.

SPEAKER_05 38:30

Yeah and you you did do the right thing closer to when you miss a dose if it's close to the time for your next dose you wouldn't bother to take it um but if it's really close to the time that you would have had your dose then you can go ahead and take it and then just go back to your regular time.

SPEAKER_02 38:46

And that works with pretty much every yeah now is this where someone could end up with like breakthrough bleeding or something like that? Maybe I don't know if it's called breakthrough bleeding but um let's say all of a sudden you went two days and you forgot to put the patch on or something like that. Can you have breakthrough bleeding?

SPEAKER_05 39:08

Like would it force you to get your period for someone to get their that gets their period I think that would more happen if you're on like a continuous regimen and then you forget and you kind of um on the sequential usually it is designed to mimic your your own hormone cycle so if you are going to get a bleed you would still the progesterone then wouldn't like cause necessarily a bleed.

SPEAKER_02 39:33

Oh this is actually my other question. We're full of questions I know someone that has had a hysterectomy that is on HRT would only use the continuous like one that has estrogen they wouldn't have one that has progester is that right or am I wrong?

SPEAKER_05 39:54

So you're right except um so continuous means like continuous can be estrogen only or estrogen and progesterone all the time all the time there are some women who do progesterone and estrogen all the time.

SPEAKER_02 40:12

Is that someone that still gets through period?

SPEAKER_05 40:14

That doesn't that doesn't okay for the most part anyways okay and then the sequential would be the half estrogen and then half estrogen and progesterone and so women who have had a hysterectomy don't need the progesterone because the progesterone part is really the main main thing is to protect the lining of the woman from the thickening that estrogen can cause and prevent um cancer uh so if you don't have that then yes you don't need it.

SPEAKER_02 40:51

What's a partial hysterectomy? What does someone do? Same thing?

SPEAKER_05 40:54

No they they don't take the ovaries or something with a partial hysterectomy if you still have the ovaries same thing same thing as in as in you wouldn't you wouldn't you wouldn't need the progesterone okay because it's really for the uterine lining got it so even if you still have your ovaries um you don't have the the lining okay okay got it yeah okay let's move on um so the term bioidentical hormones we hear that out there not exactly sure what it means um from a pharmacist's lens what does the term actually mean and what could be some common misconceptions sure so bioidentical basically means or now we're calling it body identical as well to see it basically means the molecule that we're um taking is an exact molecular replica of what your body would produce naturally um so a common misconception is that it is more natural yes um in the natural form but to be honest while we do get it from plants whether the soy or the wild yams then it is processed in the lab to get that molecular structure so it's not necessarily more natural but it in in origin but it's more natural in terms of it fits the body structure just like your own hormone that your body can produce.

SPEAKER_02 42:30

Right.

SPEAKER_05 42:30

I think there's a huge confusion yeah yes yeah and the other misconception is that if you are getting it compounded it's more bioidentical than uh for example one you would get in the pharmacy. So while we do have some newer synthetic ones in pharmacy um we also do have bioidentical ones. So a lot of the patches the estrogen that's in it is considered bioidentical or body identical um the benefit though with the compounded ones is that it's specifically made for you um and you can combine things so instead of having uh estrogen patch and a progesterone gel and a testosterone you know like you could really just tap that into one thing. Right. And again it is meter dosing so dialing up or dialing down your dose based on your response is also really easy um between you and your physician again.

SPEAKER_02 43:36

Yeah right um so but we consider them both so one of the things that I learned in um the program that I was in this menopause program is when we were talking about bioidentical that's made in a compounding pharmacy you have a risk correct me if I'm wrong so Let's say they're they're making a cream or a gel. Um you do run the risk of if you are to scoop a bit out or pump a bit on, it may not necessarily be mixed evenly every single time you use it, where if you're getting um a non-compounded one, I guess. Like a standardized it is exact every single time. Is that correct to say?

SPEAKER_05 44:30

I have also um heard that heard the same thing, you know, that's like uh but it's really for us, it's just one that's more regulated. Okay. Because I do believe that in the lab as best as possible, where you're gonna mix it. Um you're gonna have I mean you don't have a regulatory body coming in and testing it, but you're gonna follow all your good operating uh procedures to to keep it as homogeneous as possible to make sure that you know Okay, so it's not as actually as much of a concern as people are making it out to be. I I wouldn't think so. You know, we're all trained and and even to be a compounding pharmacist, like um there are programs and there are a lot of considerations that you have to take. There are as you know, manufacturing processes and stuff that you are following, you have the machinery. Um, you know, maybe if I do something quick in like to make a little liquid or something in the pharmacy, um, as opposed to, you know, they have they have their machines designed, like they get everything to really set up their compiling lab, you know, it's not just like somebody off on the side.

SPEAKER_02 45:54

So I think stir in the pot, like you know, a little bit of this, a little bit of that. Okay, no, it's actually really good.

SPEAKER_05 46:03

You're using skills, you're using um formulae to to really do it the same.

SPEAKER_00 46:10

Okay, so that's like compounded formulations is something that the pharmacist does. Yeah. Okay. Uh this is news to me. So this is like if you like when Nadine was doing like the pat did patch. No. Because those were different patches. Sorry. You'd had the the estrogen and progesterone in the patch, but they were different patches for each of that yeah.

SPEAKER_02 46:38

The the first two weeks are just estrogen. So that's and then the second two weeks are estrogen and progesterone in the same way.

SPEAKER_00 46:44

In one patch. So that's a compounded, no. Oh, yeah. We that manufacture, yeah. Okay.

SPEAKER_05 46:52

Compounded would be compounded would be like biased. I don't know if you've heard of like biased. No, um uh so compounded would be basically you take your prescription to me, I have the raw materials. The doctor says I want this in an oil base or a cream base or a gel base at this percentage, at this dose, I want each pump to give me this. And I would say, okay, so if I'm gonna make 18 a hundred grams of this or 30 grams of this, because she's gonna use like, say, I'm gonna put her dose in one gram. So she 30 grams would last her the month. So then I'm gonna make a batch, I'm gonna work it out like how much powder do I need, how much base do I need, and I'm gonna put it together, put it in the packaging. Right. And then I'd give it that to my label on it and give it so you it wasn't sent to me from the company that was in the box, it's not pre-packaged from a manufacturing company.

SPEAKER_01 47:52

Okay.

SPEAKER_02 47:53

So compounding can't be a patch. Like you can't make a patch.

SPEAKER_05 47:58

Um I don't think we do. No, just informed. Even the pellets. Um, before they had um commercially available pellets, uh compounding pharmacists wouldn't use them.

SPEAKER_00 48:12

Okay. And so both of these, I guess, wasted like the biodenical hormones are FDA approved. Are they products?

SPEAKER_05 48:22

I don't so the there the commercial product is FDA approved. The uh raw material that the compounding pharmacist uses would be like FDA or whatever regulatory body approved. But that final batch that I'm giving to Nadine and like there's nobody testing right, right, right. Okay, what the concern is.

SPEAKER_01 48:48

Got it.

SPEAKER_05 48:49

But you know, we're professionals, we were trained to do these things. I don't really feel like there's I understand that people want to feel um how do you say, secure? Yeah. And in knowing that somebody else checked this, but yeah, yeah, I see now.

SPEAKER_00 49:09

Okay, yeah, yeah. That helps greatly. Is there anything women should know about how long the different methods stay active in the body? Yeah, if they stop or if they change treatment.

SPEAKER_05 49:20

Sure. So for pills, just because of that whole um first pass and everything, they start losing efficacy almost not immediately, but a big chunk of the dose is lost there. So and you're taking it every day. So where that is concerned, once you stop taking it or you miss a dose, in probably like a day or two, you'll you'll probably start to see um symptoms again. So if you're having if you're having that flashes and you, you know, you stop, then they might come back in full, full force just within a couple of days. Um for the patches, it usually takes a little bit longer, maybe up to like a week, to see. So I mean your body is actively clearing it, but remember the patches and like the gels, the creams have that little bit of reservoir that's there in your skin still. So it just takes a little bit longer because that's not yet in your bloodstream, right? So once it gets there, then um it takes a little bit more time to just process out of your body. Um, same for well, not same, but like the pellets, obviously, that's gonna be there for months. And I think most of the injections are like weekly or bi-weekly, so those might take like a couple weeks or so to really fully come out of your system.

SPEAKER_00 50:43

From your experience, what are the most common questions or concerns women bring to the pharmacy when they're prescribed HRT?

SPEAKER_02 50:51

They probably ask you more questions than they ask the doctor.

SPEAKER_05 50:55

Sometimes. Uh sometimes, you know, some women are like, no, I'm great, good to go. And then some obviously have heard about the study, they're worried about their they're just checking again. I I told my doctor that I was taking this medication, or you know, my mom did have, are you sure this is still reassuring? Yeah, yeah, okay. You know, and then the next would probably be like, where do I put the patch? Like, what do I do? Like, you know, we have to tell you when you take it off, fold it into itself so it doesn't stick to an body else or anything like that.

SPEAKER_00 51:29

I stick mine on the next pack that I'm because I just rip it, rip the rip it open, sure. And I just stick it on the outside of the pack I'm taking the next one from.

SPEAKER_05 51:40

As long as adhesive is not like you know exposed like that. Um, and then next thing is like a lifestyle. So um if the patch is not sticking, then they're gonna, hey, I'm actually having to refill this early because I lost my patch early. Actually, what do I do when my patch falls off early? Great question. I'm gonna say Yeah, that's a good question. So when your patch falls off early, you put another one on immediately, and then you go back to your regular schedule.

SPEAKER_00 52:08

Okay.

SPEAKER_05 52:09

Okay. Um, and so then we can tell somebody who that's happening too often, but they want to stay on the patch. We have like um, I call them sticky wipes. So it's like yes. Put that on your skin first, it makes your skin more tacky, and then you stick the patch on. Um, also, some women don't know that you when you put the patch on, you should like really leave your hand over it for like a good 10 seconds because the warmth from your body just kind of helps to activate like the adhesive onto your skin, so you can try that too.

SPEAKER_02 52:42

I usually do it when I get out of the shower, so my skin's usually um still warm, not wet, but still warm. And um, I have not had any issues with my patch falling off. I have the bigger one. Do you have like the little one? I've seen the little ones on people before.

SPEAKER_00 52:58

My yeah, my first dose was quite tiny. Oh. So I was like shocked. Like the how does the sticker work? Yeah um and the second, like now that I've increased a dose slightly, um, it's a little bit bigger, but it's still not very big.

SPEAKER_02 53:12

Another question for you. I just read about it. Um there it's on Instagram. Um is there starting to become a shortage in patches? Can you answer that one?

SPEAKER_05 53:28

We have had I remember in the past, yeah. We have had issues in the past, and you know, it's usually just with that, like there's a main brand that a lot of people are on. But there are generics available that are the same dose, same hormone, just from a different company. So I wouldn't like want to worry too much about like I feel like it was like a worldwide thing.

SPEAKER_02 53:52

Yeah, yeah.

SPEAKER_05 53:54

But it was like mostly for the most part, just one particular brand. Is that what I'm saying?

SPEAKER_00 53:59

And so, like, if that did happen, we could like our pharmacist would probably say to us, Are you okay getting this different brand?

SPEAKER_05 54:05

And if you want, yeah, yeah. And you know, if you want to check with your doctor first, that's also sure. But I mean, once it's the same dose, we have um authority to just put you from a brand to the generic. Some doctors do have preferences though.

SPEAKER_02 54:19

Um, so I've seen that actually sometimes on their sheets that they fill out. Um, there's like a checkbox if you want it to swap to G. Okay. Yeah. Yeah. Yeah. Okay. Yeah.

SPEAKER_05 54:31

Um, another question is like, will I gain weight? Yeah. Um we always want to know if we can gain weight, can I drink, you know, like that. Yeah. Um, and so the recommended, like exact, for example, for drinking, like we just stick to the recommended uh limits for women, um, which is usually like I think two small glasses of wine or like one alcohol unit a day. Um, it doesn't interact. I wouldn't take it like at the same time, like say if you're taking a pill, um, especially for some women if the estrogen is causing like any um the oral estrogen is causing like any nausea or indigestion or anything like that. You wouldn't want to take alcohol right with that.

SPEAKER_02 55:18

Or another thing, yeah. Sorry, yeah. Uh, that has been brought up by um clients before is a client of mine was taking the pedesterone tablet and was getting really bad acid reflux, so they swapped it to take it vaginally. Have you heard of them doing that before? I have. Um like I guess whether you're getting acid reflux or not, you can take the pagesterone tablet vaginally. Yes. Yeah, yes.

SPEAKER_05 55:52

Um, so that capsule is actually made for several delivery methods. So you can take it by mouth, you can take it vaginally or even rectally. So it just goes into the blood system from there. Um, and the dose is still different, like if you were taking a patch, it's still the same oral dose, basically, just taken vaginally.

SPEAKER_00 56:19

Yeah, I know, right? Very interesting. Yeah. Yeah. Okay. Um, if a woman feels unsure or overwhelmed by all of these different options, um, are there questions that you can recommend that she could be asking her healthcare provider uh to make a more informed choice?

SPEAKER_05 56:36

Sure. I think if someone is feeling like overwhelmed or stressed with this decision, I think the first thing I would recommend her to do is to just make a list of her uh concerns or any changes that she's observed. And you know, if you're skeptical, make the list for a little while. And then when you go into the doctor, you're starting from there. You're starting from honesty, you're starting from yourself because again, the physician is treating you, the person. Um, you don't necessarily have, I wouldn't necessarily recommend you to do any research on your own if you're already skeptical. Um, you can, but you might get more overwhelmed with all the information that you're getting that you probably don't even need because it doesn't apply to you. Yeah. So um you're gonna ask about, hey, do I have any respect or so you're gonna look like, do you think there's any method that's not suitable for me? What do you think is most suitable for me? What if I just want to do supplements first or try nutrition first? Like, what do you recommend? Like, what do you think? You know? Um, I really feel like as women and people, we just have to get um comfortable with advocating for that speaking up for ourselves. And and you know, if you go to a physician or any healthcare practitioner, you come to a pharmacist and you don't feel like you were listened to, you don't feel like you were heard. There's so many of us, exactly find an email. Exactly.

SPEAKER_00 58:16

There are so many, especially that makes you especially here. Like I find, like in other places of the world, like maybe in Canada, it's not that easy to find a family doctor, like you might have your family doctor and it's your family doctor, and to get on a wait list for another family doctor is a whole thing. Yeah, um, but at least here, like if if we're so lucky, we can we can easily go to a different doctor, yeah. Um, or go or change pharmacy, go to a different pharmacy. Um, because there are so many options that it is literally that easy.

SPEAKER_02 58:46

Yeah, it's wonderful. We're very lucky.

SPEAKER_00 58:49

We are, yeah. Do you have any more questions for Charlie?

SPEAKER_02 58:54

I should have came here with my list, right? It just there's just so many different stories that you hear, and um and and I've had conversations with women over the years of like even them changing to different. So there was um a woman that I knew where um I ran into her. I usually saw her like a couple times a year, and I had ran into her, and I'm like, wow, she looks different, but I couldn't pinpoint what it was that that looked different. Um she was a spray tan client, and um, so started tanning her, and then I noticed the little patch on the bum. And so it kind of opened the floor for me being like, oh, I saw that you have like a patch. And and she's like, Yeah, I was struggling. I think she was like mid early 50s or mid-50s or something. And I'm like, you know, you just you look different, but I can't pinpoint what it is. And she's like, Do you know what I didn't gain any weight, I didn't lose any weight. She said, but my biggest symptom was that I was so dry. And she's like, and I mean dry everywhere. Um, even her eyes were dry. And she said, because of the HRT, the hydration came back in her whole body. And I'm like, that's what you look like. She just looked really, really good.

SPEAKER_01 1:00:15

Yeah.

SPEAKER_02 1:00:15

And um, so then like maybe nine months went by or something like that, came back, didn't notice the patch. And I had said to her, I was like, Oh, did you like stop using the HRT? And she said, No, she goes, I moved over to the pellets. So um, from her experience, she felt as though she it was almost like she couldn't go any higher in like the the patch anymore, and so they had to swap her over to um the pellet, the pellet. But I think what happened was there was like some really bad like bleeding. Um, and that's one of the things that I have had some people tell me is that like all of a sudden they're now having bleeding when they never had before. So I don't really know. Is that just because it's not as effective or like why does a woman start bleeding like that?

SPEAKER_05 1:01:08

You know, that's a good question.

SPEAKER_02 1:01:11

If like the patch in the pill or the patch on its own was just not enough or not effective anymore.

SPEAKER_05 1:01:19

I don't know if it would be the bigger dose or just the more consistent flow of a dose because even though the patch is pretty uh consistent, it's relying on you to change it on and up and so forth. And you know, the palate is just there and the body just yeah, not that it's absorbing too much, but you did mention that she did go on a bigger dose. And you know, sometimes so many little things can so many little things, different things can just be stressed. Yeah, it could be anything, really. Um some people do the IUDs and then they start to get a bleed, you know. Um, so it it can be a lot of things, to be honest.

SPEAKER_02 1:01:58

You're right.

SPEAKER_05 1:01:59

What I really wanted to, I think my intention was to just let women know that unless it is your, you know, like we were talking about before, unless it is your decision that you do not want to do hormones and you do not, you're just not interested in HRT, sure, great. We're as we said, we're not trying to like convince you. But if you have been on HRT and you felt like it wasn't working, and you feel like your friends are talking about it and they're doing so great and you're not doing so great, and when you tried it, you didn't love it, or you know, it's just like we want you to know that there are options. There's so many things that between your physician and your pharmacist that you can, you know, try. You don't have to live with the the symptoms just because it's a natural part of the aging process or or anything like that, you know.

SPEAKER_02 1:02:49

Yeah, so I agree.

SPEAKER_00 1:02:50

Yeah, and take your like if you're apprehensive, um, ask questions and take your time and sit with it. And um, like Nadine and I have said before, we're not trying to say that HRT is the best and that's what everybody should be on. We both happy to be on it, but that's not what this podcast is about. We just want to give get the information out there so that people can make the right decisions for themselves. Um, and this was very helpful. Like I would say, if they if people do have questions or um if they're taking a certain HRT, I suppose, um, talk to their pharmacist um if they do have questions, in addition to their doctor, obviously. Um, but this was so great. Um, and we got a lot of our own questions answered today. Um and yeah, it was it's great. Thank you so much for coming today. Appreciate it with a good conversation. Thank you guys. Good. Thanks for joining us on Best Intentions. We hope you felt seen, supported, and maybe had a few laughs along the way. Don't forget to share, subscribe, rate, and review us. Your support keeps the conversation alive. Follow us on social media for more insights, behind-the-scenes fun, and updates on future episodes. Got a topic you want us to dive into? We'd love to hear from you. Remember, life's too short for bad bras, toxic relationships, and kill you don't actually like. So until next time, stay bold and keep your best intentions exactly where they belong. Front and center. Now go crush midlife, or at least today's to do list. Cheers!