The PGspot - Top Five Hormone Misconceptions Debunked

Hormones play a vital role in how we feel, think, and function, but misinformation about them is everywhere. In this episode, we’re cutting through the confusion and tackling the top five hormone misconceptions I hear most often from patients. From the truth about hormone therapy and breast cancer risk to why vaginal estrogen isn’t just for people who are sexually active, we’ll unpack what the science actually says and why these myths persist.

Whether you’re navigating menopause, curious about hormone replacement therapy, or just want to better understand your body, this episode will leave you feeling informed, empowered, and ready to have evidence-based conversations about your hormonal health.

If you want to learn more about sexual health, sexual dysfunction, or how to improve your sex life, follow me on Instagram at @thepgspot or check out my website at doctorpattyj.com for blogs and resources related to sex positivity and real talk about sexuality.  As as always, stay curious, stay empowered, and stay you.

Transcript

Speaker 0:08

Welcome to the PG spot, where our goal is to take the X out of sex by breaking down the barriers that prevent open communication about sexual health. I'm Dr. Patty Jalomo, a dual certified nurse practitioner, pelvic floor therapist, and certified sexual counselor. I'm here to provide expert insights, debunk myths, and empower you to embrace your sexual wellbeing. Whether you're looking for answers or simply curious, join us as we open up the conversation around sex, intimacy and everything in between. I want to take this opportunity to acknowledge that some content may not be appropriate for all listeners. I'm a huge proponent of honest and accurate information regarding sexuality. But I'm also mindful that this should be age appropriate. Therefore, if you are under 18, this may not be the podcast for you. Additionally, some of the language used in this podcast may be offensive to some listeners. Please take these things into consideration before going forward with your consensual participation in this podcast. The opinions expressed by myself or my guests are just that, and these opinions are neither expected or required to be shared by all listeners. The information that is provided is for educational and entertainment purposes only, and should not be mistaken for individual medical advice if you do find the information that we cover in the PG spot. Helpful. Interesting or informative. Please rate and review the podcast wherever you're listening from. If you think this information is important, I would love for you to share it with your friends or family. This is a great way to get the information out to more people. So thank you for listening and let's get on with the show.

Patty 1:48

Hey everyone. Welcome back to the PG spot. I'm Dr. Patty Jalomo, and today we're going to talk about something I find myself saying all the time when talking to my patients in the clinic. whether you're perimenopausal, postmenopausal, or just curious about your body, these are the top five common misconceptions or questions about hormones that come up again and again with my patients. And honestly, I think everyone should know them. so, hopefully by the end you'll feel a little more informed and a lot more empowered. So let's get into it. Okay, let's start with one of my favorite topics, vaginal estrogen. one of the biggest misconceptions I hear is that vaginal estrogen is only for people who are sexually active, but that couldn't be further from the truth. So why is vaginal estrogen so important, and why is it not only something that menopausal women have to think about? There are several reasons for this, including nuances that haven't been considered much in the past. Certainly vaginal estrogen is important for women after menopause because after the ovaries stop producing hormones like estrogen and progesterone, the tissues in the vagina can become very thin, lose that elasticity and have a decrease ability to promote lubrication. This isn't the only time that this can happen. I certainly see it in perimenopause and also in breastfeeding moms or women who are or have been on an oral contraceptive pill. These situations also significantly affect the hormone levels in the body and can have a negative impact on these areas that are very dependent on estrogen. But keep in mind, it not only affects sexual function. Because the urethra and the bladder are also very dependent on this hormone. A lack of estrogen in the vaginal tissue can cause an increased risk of things like bladder infections, vaginal infections, and other urinary issues like overactive bladder and incontinence. Additionally, this lack of hormones can actually cause structural changes to the vulva. The labia can resorb. Um. And basically go away. The vaginal opening can get smaller, and this can cause painful penetration or painful vaginal exams. Also, the urethra starts to protrude. So this can cause an increased risk of infection and also pain. So yes, the lack of lubrication and vaginal dryness can affect sexual activity, but these hormonal shifts also impact urological health. Urinary tract infections, especially in the older population, can be life-threatening as it can turn into sepsis, which is a systemic blood infection. Actually, in April of this year, the American Urologic Association released a position statement that has been endorsed by acog, which is the American College of Obstetricians and Gynecologists, as well as the American Urogynecologic Society. This guideline recommends vaginal estrogen as a first line treatment for GSM, which is genital urinary syndrome of menopause and urinary tract infection prevention. So while vaginal estrogen helps maintain healthy tissue elasticity and moisture, it also helps to prevent irritation, itching, recurrent UTIs, and discomfort Even outside of sexual activity. It's local low dose, and it's safe for most people because it doesn't get systemically absorbed. Unfortunately, the FDA still includes a boxed warning on vaginal estrogen products that can scare women off. So I always wanna mention that despite the fact that this warning says that it can cause a multitude of horrible things like cardiovascular disease, dementia, stroke, blood clots, and breast cancer. None of this is true for the low dose topical estrogen that is being prescribed For that matter, most of those things are untrue, even for systemic estrogen. But that's another tangent that I won't go into right now. Um, if anyone is interested in geeking out to some excellent literature and information, just go to YouTube and search FDA Menopause Roundtable. This is a two hour round table discussion that includes eight or nine menopause experts who recently presented data to the FDA in an attempt to change some of these absurd and non-evidence based warnings on hormonal products for women. It is a great discussion and I recommend checking it out, especially if you want to be more knowledgeable about the data around hormones than most of your healthcare providers. So anyway, remember, local vaginal estrogen isn't the same as systemic hormone therapy. It doesn't raise estrogen levels throughout your body. It's safe and effective for virtually everyone, and it's so important to your health. It's not just about sex, it's about comfort, health, and quality of life. So think of it as part of your nighttime routine, just like you would put moisturizer on your face every night. Okay, next. This one comes up constantly. I'm always hearing something along these lines from patients when asking if they are having menopausal symptoms or interested in hormone therapy. They'll say something like, well, I can't use hormones because I have a family history of breast cancer. Or I was told that hormones can cause cancer. Or even worse, my last provider said that I shouldn't use hormones because of my age or my family history, or. Because I'm BRCA positive or something else. And then there's also my favorite. I'd rather stick with something more natural. I get it. It's scary and confusing when we've been told something for so long. But these things are based on data. That was number one, comparing a completely different medication and secondly, based on inaccurate interpretation of the data. So let's break this down a little bit. It. This myth largely comes from early interpretations of the Women's Health Initiative study, which has since been clarified. This study was the largest randomized controlled trial in history that involved hormone replacement. The purpose of the study was to determine if hormones should be used for prevention of cardiovascular disease. It looked at a synthetic version of two hormones. Premarin or conjugated equine estrogen and hydroxy progesterone acetate, which goes under the brand name Provera, which is a progestin, or in other words, a synthetic progesterone. The study enrolled women into three groups. So first there was the women who did not have a uterus, um, and this was the estrogen only arm of the study, which is because. If you have a uterus and you're taking extrinsic estrogen, it's mandatory that you're also taking a progestogen to mitigate the increased risk of uterine cancer. The second group of the study were the women with a uterus, and this was for the combination arm, which was a medication called Prempro. And thirdly, there was a control group that was taking a placebo, and they eventually stopped the combination arm of the study after five years Because some of the researchers claim to see an increased relative risk of breast cancer in this group. However, in reality, this increased risk was not statistically significant, so. Just to clarify for people who aren't really into research, statistically significant means that the results of a study are very unlikely to have happened just by a random chance. In other words, in order to be statistically significant, the researchers must find enough evidence to say that what they observed, like the difference between the treated group and the placebo group. Is probably real, not just a coincidence. And in this case, the data did not meet that criteria, but it was included because some of the researchers felt that quote, breast cancer was so scary to women, that they should basically lower the bar. End quote, and that's not good research. But anyway, this happened and they stopped the prempro arm of the study. After five years, The estrogen only arm continued for another two years, and then it also was stopped, but there really was no. Listed apparent reason for that. The media then found out that this combination arm of the study was stopped due to an elevated risk of breast cancer. And then the next thing you know is that everyone believes that estrogen, because when we think of hormone, that's what most people think of, but. Everyone believed that estrogen causes breast cancer, and the reality is that the estrogen only arm of this study actually showed a statistically significant decreased risk of breast cancer, but this never got out to the public. So in 2002, every doctor in the US fielded hundreds of calls from scared women who wanted to get off their hormones. The rest is history. Two decades of women suffering through hot flashes, mood changes, brain fog. Joint pain, vaginal dryness, and pain with sex. other points about the women's health initiative include that the average age of women in the study was 63. Um, a majority of them were overweight or smokers, and so they were already at an increased risk of not only cardiovascular disease, but breast cancer due to these modifiable risk factors. Menopause experts now prescribe very differently. We typically only prescribe bioidentical hormones, which simply means that they are molecularly similar to what a human body makes, and often opt for a transdermal method of delivery to avoid having to be metabolized in the liver, which is what can slightly increase the risk of blood clots with oral estrogens. So the takeaway here is Hormones don't automatically equal danger. It's about finding the right therapy for the right person at the right time. Different types of hormones and delivery methods matter. They are not all created equal. Modern hormone therapy can be safe and beneficial for many women, depending on individual risk factors. And lastly, the conversation should be nuanced and not fear-based. So speaking of hormones, let's talk about testosterone. In my experience, it's usually that either someone is wanting testosterone, but scared that it will get them horrible side effects or make them grow a beard or something. Or they could benefit from testosterone, but they're scared to try it because they think it's only for men and unsafe for women, Testosterone has been gendered to be a male hormone, but women have and also need testosterone. They've been told that because there is no FDA approved testosterone dose available in the US for women, it's not safe for women to use it. But we've been giving testosterone to females who are transitioning to males for decades And there's plenty of safety data for men now, unless you desire to transition to the male gender, the doses that a woman would get are much lower than what is given to men. While men have about 10 times more testosterone than women do, women who are in their reproductive years actually have about 10 times more testosterone than they do estrogen. So testosterone is important because it can help with energy, mood focus, and sometimes even with libido or sex drive. It's also important for bone health, and Reese's studies have shown it to decrease risks of dementia and Alzheimer's. It's important to remember that side effects often come from too much, too fast. So this becomes a discussion about how dosing is key. There are several ways to get testosterone and some pose more risks than others. Um, testosterone is available as a weekly injection as a subdermally implanted pellet that is done every three months as a topical gel or cream, or as a compounded tr, which is like a lozenge that is dissolved between your cheek and gum or even under your tongue. Now, while I'm not opposed to pellets or injections, It's not typically my go-to when a woman is starting out on testosterone. I've found that by using a cream gel or troche, women can more easily titrate up to a level that helps them feel better, but does not give them those side effects. It's easier to get super physiologic or high doses when using an injectable or pellet, especially if it's not well monitored. So key points to remember if considering testosterone would be that number one, female dose. Testosterone is much lower than what's used for men or for gender transition. And two side effects like hair growth, acne, or voice changes are rare when it's properly dosed and monitored. Testosterone in the right dose is about balance, not transformation. Next up, this is a big one, libido. I can't tell you how many times a patient says, I think I need hormones because my sex drive is gone. And while hormones can play a role, they're not the whole story. Female sexual function is multifaceted. Libido is influenced by and should be addressed using a bio-psychosocial model. And what that means is the biological part could be things like hormones, medications, health. The psychological component includes things like stress, anxiety, mood changes, and socially would be Looking at the relationship dynamics or the stage of life that somebody's in. So it's important to look at all of those factors when a woman presents with sexual concerns. Yes, it can be related to hormones, but it's not always just testosterone. If a menopausal woman is not sleeping due to night sweats or hot flashes, then they're probably not likely gonna be interested in sex. Additionally, if sex is painful due to genital urinary syndrome and menopause, then that needs to be addressed first and foremost. Other biological factors include looking at other medications that someone's using. SSRIs, for example, come with side effects of decreased libido. SSRIs are selective serotonin reuptake inhibitors. Common ones are used for depression, such as Prozac, sertraline, or Zoloft. Um, and they can cause significant, sexual side effects. it could just be that making changes in the medications, of course, with your healthcare provider's input is all that is needed to help increase that sex drive. Additionally, looking at the general health of someone is important, so things like lifestyle modifications, like increasing exercise or quitting smoking, these can have a huge impact on our sexual response. The psychological aspect involves stress, anxiety, and mood. So what else is going on? Um, that might cause increased stress in someone's life. if someone has increased work or family stress, they're not going to be able to shut their mind off and focus on being in their bodies when it comes to sex. And finally looking at the social aspect, that's important as well. What's a relationship like in general? Do you even like your partner? Do you feel heard, understood, like and equal in a relationship? Where are you in your life stage? These are all important things to consider when someone presents with decreased libido. So. Yes. While hormones may help some people, others may benefit more from addressing stress, communication, or physical factors. We have to remember that there's no quick fix, but there are many paths forward. So low libido doesn't mean that something's wrong with you. It may just be that your body and mind are asking for attention and care. So while hormones might be part of the conversation, they are usually not the whole answer. And finally, one that always makes me smile. A patient comes in who's having regular monthly periods and asks, can we check my hormones? So here's the thing, during perimenopause, hormone levels are like the weather. They're constantly changing. You could check them today and get one picture and then check again tomorrow and get something totally different. Now, that is not to say that I would just tell someone that their hormones are normal just because they're having regular periods, um, and dismiss their concerns. But hormone testing during perimenopause often doesn't really reflect the bigger picture. Diagnosis and treatment should really be based on symptoms and not just lab numbers. perimenopause is often more difficult to navigate than menopause is. Hormone fluctuations are real and they cause real symptoms. My first go-to is to try some nightly progesterone, which often makes a huge difference in how someone is feeling. It has a great side effect of making you sleepy, and many women come back saying that they're sleeping better. Um. Much deeper than they have in a long time or ever. Sometimes the addition of a low dose estrogen can be helpful, especially if the symptoms are more predominant during the luteal phase of the cycle or the couple weeks before your period starts. and testosterone could be a game changer in perimenopause, so it's always something that should be discussed. So, yes, hormone therapy can still help during perimenopause, but we base it on how the patient feels not necessarily a lab result. And if your healthcare provider doesn't take your concerns seriously, maybe it's time to find someone who's trained in managing menopause and perimenopause. But that doesn't necessarily mean that you need your hormone levels checked with labs. Remember, perimenopausal care is guided by your experience, not just your blood work. So let's recap the five things I wish everyone knew about Hormones. Number one, vaginal estrogen isn't just for sex. Number two, hormones don't automatically cause breast cancer. Number three, testosterone when dosed for women won't make you grow a beard. Number four, libido is complex. Hormones are just one piece of the puzzle. And number five, in perimenopause, we treat symptoms not just lab numbers. So I hope you found this helpful and you feel a little more informed and confident about your options. It's so important to educate and advocate for yourself. You deserve to understand your body without fear or shame, and part of that is understanding the role that hormones play into that. If you found this helpful, share it with a friend who might be struggling with similar questions or check out some of the blogs that I have posted on my website. If you have topics that you'd love for me to cover next, send me a message. So thanks for listening, and remember, hormones are not the enemy and being informed will help guide you in making the choices that are right for you. As always, stay curious, stay empowered, and stay you.

Speaker 21:02

That's it for today's episode. Thanks for listening, and be sure to rate and review the podcast on whatever platform you're listening from and share it with your friends. That's a great way to help reach new listeners and make this a more sex positive world. Also, I'd love your feedback and questions, so send me a message. It's at email@doctorpattyj.com, and that's doctor spelled out, D-O-C-T-O-R-P-A-T-T-Y j.com. Until next time, stay curious, stay empowered, and stay you.