Hormones, Testing, and Treatment: Separating Menopause Facts from Fiction

In this episode of The Menopause Hour with Winona, Dr. Cat explains hormones on a deeper level. This new episode provides listeners with a better understanding of progesterone’s role in treatment and sheds light on the facts surrounding testosterone support. The conversation also explores hormone testing, weight management, and personalized care, all of which are among the most common questions Winona doctors receive from patients.

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Transcript

SPEAKER_01 0:00

Welcome to the Menopause Hour, your go-to source for answers to your burning menopause questions, the ones you won't get from your OBGYN. Brought to you by Winona, where menopause care is made easy. Download our free Winona community app where thousands of women connect and access exclusive content, expert-led courses, exciting events, and more. It's time to take the guesswork out of your hormonal journey.

SPEAKER_00 0:25

Hello, hello everyone, and welcome to another one of our live QA's. I'm so excited to see you all here tonight. I see we have a couple more people that are jumping in as we're getting started as well. So we'll give everyone kind of a minute to get situated and get in. But just wanted to say, really like welcome. We're so glad you're here. We're gonna have, I think, a great discussion today. We're gonna talk about all of your questions. Um if you've never met me before, I'm Maddie. I am the community manager here at Winona. I've probably seen your face somewhere in the app, whether you've just joined or you've been posting. Um, I usually keep a pretty, a pretty good eye on kind of the people that are around. But I'm so glad that you made it to one of our live QA's. These are some of my favorite events that we do. Um and I think they're just super exciting, super insightful, fun, great to connect with other other women as well. Um, just want to give a note as well. If you've never been to one of these before, um, kind of how they work is we will go through your questions. Um, you're able to ask anything you might be wondering. Um, and when we say anything, we really mean anything. You throw it in there, we'll get to it. There's no question that's off topic, no question that's too detailed, throw it in there. Um, but you're gonna find a chat button at the bottom of your screen. Um, so if you click on that, you'll find a little chat section will pop up. Um, and I'd recommend you just go ahead and start typing your questions in there now because it does usually start to get a little bit busy. Um, and then we'll start to go through those. You're also welcome to send more questions throughout the time if you have one that pops up. Um, but just wanted to point that out for you as you all are kind of thinking through. Maybe you have some questions ready, maybe you want to think through them a little bit. Um, but that is there for you, and we will get to your questions. But to start off, we'll kind of start off with some introductions. Um, so obviously I just said my name is Maddie, but we also have the wonderful Dr. Kat Brown here with us tonight. Um, she is always quite amazing at these events, but I'll let her give a little bit of an introduction of who she is, and then we'll kind of jump into things.

SPEAKER_02 2:38

Well, thank you so much, Maddie. So, yes, so for those of you who haven't seen me and hadn't haven't seen my face on your Instagram feed or on your face Facebook feed, because I think I'm on quite a bit of the ads right now. Um, I'm Dr. Kat Brown. I am one of the um prescribing physicians here at Winona, but I'm also the medical director as well. Um, I do in my job as medical director, I do a lot of outreach. I do a lot of podcast interviews, education, um, also curate some of our medical content for um education for patients, which is available to all of you on our website. Um I'm a board-certified OBGYN, um, practiced in the Army and trained in the Army, moved around in the Army for a little bit, and then now I settled back in the Philadelphia area, which is where I'm from. Um, and so I still practice at a hospital. I still do deliveries and practice as a laborist. And then I also do the telemedicine here at Winona to help take care of GYN patients as well. Um, women's health has been my passion and my love for my whole career. Um, and as I've aged and as have I've gone through my own women's health journey, um, my focus is kind of changing and evolving. And as we are all getting older and we're realizing that not enough focus and education was given to us, you know, when we were younger to be prepared for this stage in life. Um, this is kind of a passion project for me as well to help myself, but also to help you, because I feel like you know, we really have been ill-equipped to really be prepared and get the answers that we need. And so that's why we do these. Um, that's why we have these live QAs, just to make this information available to all of you. And on a personal note, about 30 minutes ago, I was still in my garden trying to pull weeds and trying to take care of things. That's my one of my favorite things to do is to be outside when the weather's nice. I also have three kids and I love to travel. Um, so I'm a real person too. So just a disclaimer, you might see a cat fly by me or a dog or a child may try to pass me a note while we're doing these live Q ⁇ As. Um, because I'm a real person and I'm I'm broadcasting from home. So that's me in a nutshell.

SPEAKER_00 4:49

I think it's so great just to hear a little bit of who you are as well, Dr. Kat. I don't know. That's one thing I like love about these is getting to see, I don't know, like a little peek behind the curtain as well. I feel like that's always, I don't know, adds so much to kind of what life is all about, especially I think you know, at Winona, we believe so much in like what it looks like to be in menopause holistically or perimenopause holistically. And I think getting to see everyone's like the behind the scenes of that, getting to meet the people that work at Winona and kind of what that looks like, I think is so special. Um, let's see, we've got a few questions to start us off tonight. Um first question is from uh Micah. Um and Micah is wondering, she says, hi, she says, I've read differing opinions regarding whether progesterone is reliably absorbed through the skin. Can you share any scientific references regarding the specific formulation used by Winona?

SPEAKER_02 5:45

Well, I don't know if we're gonna get in the nitty-gritty of scientific formulation, but the basic thing is that when you compare our female hormones, progesterone itself is a large molecule. Um, and so that's why there's some people that believe that it really shouldn't be absorbed through the skin. However, there's something that can be done to the progesterone, which is micronization, which is something that's done in the preparation of the progesterone to help it to be more readily absorbed. Um progesterone has been used transdermally throughout, you know, women's health as far as other functions in IVF and you know, vaginal progesterone, um, all different sorts of things. But it's up to you. I think ultimately you have to feel comfortable with your treatment. Um, we feel very confident that the doses of micronized progesterone that we use at Winona are safe, and we've had thousands of patients on our combination cream do very well without any bad outcomes. Um, so I personally think that if progesterone wasn't being absorbed well, we would have seen some untoward effects by now because we've been in practice now since 2021. Um, and so I trust, and you know, talking to our compounded pharmacist and how they make our cream, um, he's one of the smartest people I've ever talked to. And the way that they describe how they process that progesterone and how they get it in the cream, I trust it. I believe that it's a high enough dose to protect that uterine lining. And that's the main reason for taking progesterone when you're taking hormone therapy. So, for those of you who still have a uterus, anytime you're going to get prescribed estrogen, which is really your heavy hitter, that's what really attacks a lot of your symptoms of perimenopause and menopause. That's something that needs to be counterbalanced by progesterone if you have a uterus, because the progesterone's main function is to help help keep that uterine lining thin. Because the one bad thing that estrogen can do is it makes that uterine lining kind of fluff up and thicken. So if you don't counterbalance it with the progesterone, you can leave it can lead to abnormal cells in the uterus. So that's why we use the progesterone.

SPEAKER_00 7:46

Absolutely. Thank you so much for that clarity, Dr. Kat. Um, we have another question from Judy. Um, Judy says, hello, she says, why are not more physicians better prepared to handle menopause? She says, My GP is learning from me, which feels very odd.

SPEAKER_02 8:04

Yeah. So when you look at medical education in America, you know, we're trying to squeeze in in four years everything that someone needs to know about the human body, both male and female. And it's really in the residencies, you know, which is our advanced training. So, you know, medical school is four years, and that's where you get your basic core education to be a general practice doctor, but still it's not enough. So then when you want to be a you know, GP or family practice physician or internal medicine physician, you have to do an additional three years of training to then expound upon that education. Um, so when you're looking at the scope of what you're learning in those medical um residencies, there just there hasn't been a focus on women's health as much in the internal medicine fields, um, you know, in the general practice fields and OBGYNs as well. I think that most of the practice and most of the education is focused on fertility, contraception, management of abnormal bleeding. Um, it's not been focused on. I'll tell you, in medical school myself, I remember gave getting maybe one or two hours, you know, and four years of education on menopause. It was really just not enough. Um, and this is something that we're trying to change. In fact, the menopause Society of America just got a huge grant, um, actually from I forget the name of the foundation, but Bill Gates' wife, ex-wife, you know, puts money and donates money. Um, they I they gave millions of dollars to try to change this, to try to help expand education to more providers and more physicians. Um, and for right now, it's unfortunate, but you know, kudos to you for helping your GP learn because it's really as patients when we demand better and we demand that we want help, that it's going to force our doctors to kind of get on board or not. Um, you know, because if if not, then we're gonna keep going to someone else until we find the answers, which is why Winona exists. You know, really we exist because a lot of patients out there just did not have access to get the help that they needed. And so that's you know, that's how telemedicine really helps in this situation. So if you have an in-person doctor near you who can't help or doesn't have the experience, platforms like ours exist to help with that and help you through this.

SPEAKER_00 10:24

Absolutely. And our next question tonight is from Jennifer. Um, and Jennifer says, she says, I've been using the cream for one week, but I haven't noticed any changes. She says, What should I be looking for? And or how long should it be before I notice changes? She said, I also I only have one ovary and no uterus.

SPEAKER_02 10:46

So one week is just too soon. I mean, that's the that's the bottom line. It's really early. So in the first couple weeks of starting hormone therapy, you're just trying to get your body adjusted to taking the medication and to getting the hormones at to a good level in your body. So it usually will take a few weeks before you really notice some changes. Usually the early-on changes that women notice are improvements in sleep, improvements in the experience of hot flashes or the frequency of their night sweats. Um, and so some of the, those are some of the early things that we see some benefits with. And then the longer that you're on it, and you know, we get you on a good dose, then you'll start to notice some of the other benefits, you know, maybe some weight disistribution, you know, your mood might improve, um, you know, so many other things that could get better with taking the hormone therapy. But it's this is a long haul game. It's not like an instant fix where, you know, taking it for a couple days that you would really notice a difference or taking it a week. You need to give it some more time for your body to get acclimated.

SPEAKER_00 11:45

Absolutely. And our next question is from Katie. Um, or I guess it's a little bit more of a statement, but it might be helpful to expand upon, especially for those people who aren't experiencing maybe those changes right away. Katie says that she started the oral progesterone in estrogen and noticed a difference right away. Why might that be well, some patients, you know, are taking so long or take a while to have those changes, and some might notice it right away.

SPEAKER_02 12:17

I mean, it's it's it's unlikely that the medication is working right away, like within the first day or two. Um, but I think that sometimes the other thing that comes into play is that most women that are seeking treatment have been waiting for so long. I mean, on average, most women go through at least three doctors before they find the help that they need. And so I think sometimes just getting the medication almost reduces your stress level, reduces your stress hormones, and sometimes some of those symptoms will start to get better just with the relief that you know that help is on the way. Um, and so I think that that could be part of it too. Or you're just really, really lucky. Bottom line.

SPEAKER_00 12:57

That would be great. Um, and it looks like our next question is from Cynthia. We got two thumbs up on this one. So I think this is a um a hot topic tonight. Nice. Cynthia says, she says, Hi, Dr. Kat. Um, and Maddie, she says, Why or why not? Um, and when is testosterone recommended as part of HRT? And is DHEA an alternative?

SPEAKER_02 13:22

Yes. So we'll start out, we'll answer this question kind of backwards. So DHEA is an alternate way to help gently raise your testosterone levels, and that's what we use at Winona. The reason being is that testosterone is a key hormone in women's bodies, and I don't think a lot of women realize that. So we have our female hormones, but our body also creates and has its own testosterone as well. And the testosterone is responsible for a lot of other functions in our body other than the estrogen. But in America, testosterone is only formulated for men, it's only manufactured for men. Um, and it's been widely abused for a long time because if men take high doses of testosterone, it's a performance-enhancing drug and makes them stronger, it makes them run faster. Um, so athletes, soldiers, you know, I saw it a lot in the army when I was practicing in the army. Um, it can make you be a much better version of yourself as far as you know when a man takes it. So as a result, it has been treated as a controlled substance, kind of like a narcotic. Um, and so it's something that is monitored. Um, you have to check levels pretty regularly. And we still to this day don't have an FDA-approved product that's specifically formulated for women when it comes to testosterone. So for any physician who's going to prescribe testosterone as part of a hormone therapy plan, we're actually going to be taking a male product and trying to extrapolate and fit that to a woman's body. So, you know, maybe taking a tenth of the dose that a man would typically take. Um, and so that's something that we really can't do safely through a telemedicine platform. You know, we need a little bit more monitoring when it comes to that. So that's why we use DHEA as an alternative. Um, so the DHEA is a precursor hormone that your body has in itself, um, that your body creates. But if you're not creating enough of it, um, it can also lead to lower testosterone levels. So when the DHEA gets processed in your body, it gets broken down into low levels of estrogen and testosterone. And so that's our way of gently raising your testosterone when you take our hormone therapy through our platform. Absolutely.

SPEAKER_00 15:31

And our next question is from Susanna. Um, and Susanna says she says, um, I have been using the, she says on the 9th of June. So coming up next week, I will have been using the Winona pill and cream treatment for a month, but I've started to experience itching at night. She says, feeling like an allergic reaction between my legs and on my ankles. And she says, I've also developed some acne on my face that I didn't have before. Could you give me some insight on what might be happening here?

SPEAKER_02 16:02

Well, the acne can be related to the DHEA supplement. So, you know, that's some it's it is a known side effect for some women to experience acne and changes in their skin when they start the DHEA. Usually it's short-lived, usually it's a temporary phenomenon, and usually it will get better with time. Um, however, the allergic reaction between your legs. So I guess the question is if you're applying the cream on your legs. Most women will apply it to the forearms, you know, on their forearm. Um, but if you're applying it to the legs and you're noticing an allergic reaction, I would definitely reach out to your Winona doc. You know, when you're having a response like that that's kind of negative to a medication, you want to go right back to that prescribing physician and let them know that you're having an experience that you think might be related to the medication so they can talk to you about alternatives.

SPEAKER_00 16:49

Absolutely. And our next question is from Trinity. Um and Trinity says, after starting the 50-50 cream, the DGA, how long can it take to get sexual desire back?

SPEAKER_02 17:02

This is a hard question because I think that, you know, sexual desire is different for you, it's different for me. Everybody's libido is totally different. And um, I think that it's you know related to so many different factors in our life, our relationship, our stress levels, how well we're sleeping, um, so many things can go into that. So it's not purely a hormonal, you know, answer. Um, but if if your low sexual desire is related to low female hormones and low estrogen, low testosterone, then typically you'd expect that after a few weeks of the medication, you should maybe would start to notice some improvement. But every woman's on her own timeline. That's the hard part about this, is that we can't give you some hard and fast rules about, you know, at week three, you're gonna notice this improving, and at week four, you're gonna notice this because everybody's body is different. We're all unique. Um, but I would hope that you know, within the first few weeks that you start to notice some improvement there, but it might be longer. Um, and this is where I might go into my own diatribe about sexual desire. So for women, it's so important that everything kind of be aligned and we have to be in the right head space to even feel desirable to have sexual desire or to have an interest for sex. So, part of the hard part with perimenopause and menopause is that so many women make the you know statement that they feel like not comfortable with themselves or they're not comfortable in their own body. There's so many different symptoms happening. So sometimes we have to get all those other symptoms improved before you start to feel back like yourself and the sexual being that you are. Um, and you know, notice that the desire might be coming back. And also it's important that you think about like the brain is actually probably our most powerful sex organ as women. So if there's other things in your relationship or in your life that could be interfering with intimacy, those might need some work too. So it's not all related to the medication.

SPEAKER_00 18:58

Absolutely. And our next question is from Anju. Um and Anju says, I was 10-year post-menopause, and I started estrogen and progesterone simply for muscle and broke bone protection. She says, but since then I've become moody and more depressed. Um, I was never like this before. It's been a year now of me being on it. She says, I'm considering taking six months off and seeing if my mood gets any better. Do you have any suggestions? She says, I had no symptoms before starting.

SPEAKER_02 19:30

Well, here's the the hard part of this, you know. So taking hormone therapy just for muscle and bone protection to me, sometimes might not be worth, you know, if if you're not experiencing significant symptoms, you know, anytime we think about a medication, you have to think about the risks and the benefits, right? So I wouldn't recommend someone go on hormone therapy solely for bone protection. If they're not experiencing hot flashes, if they're not experiencing night sweats, um, not dealing with any of the other symptoms that are bothersome to their day-to-day life, by taking a medication purely for its preventive benefits, you're then setting yourself up for side effects and problems. Um, and so I think that, you know, I if I was if I was the one taking care of you, I may have counseled you differently. Um, but also you could always go back to your prescribing doctor too and talk to them about what's going on. Maybe the dose isn't right for you. Normally, with with women's bodies, we are most prone to mood swings when our hormones are fluctuating the most. Um, and so depending on how you're, you know, what form of treatment you're taking as far as uh, you know, estrogen and progesterone, sometimes it might be changing the formula. Um, also 10 years after menopause, I should kind of put this in there too. That's kind of our magic window that, you know, after the 10-year mark, it can be more dangerous to start hormone therapy if you've waited too long because there can be a slightly increased risk if you start more than 10 years after your last period. So a lot of things to think about there. But I would ultimately I would go back to your prescriber and let them know how you're feeling and what's going on to see if something needs to be tweaked. Absolutely.

SPEAKER_00 21:16

And our next question is from Angela. Um, Angela says, Um, she said, I had a hysterectomy, um, but I I have both my ovaries. But my issue is with weight gain. She says, Can I combine Winona treatments with a GLP1?

SPEAKER_02 21:32

Absolutely. And actually, more and more research is coming out that you know they're kind of synergistic, that hormone therapy and the GLP1 medications actually work very well together and give patients the most benefit when it comes to weight loss. So women on a GLP1 alone will lose a decent amount of weight, but when you combine that with hormone therapy, most women have better results when they combine the two. So, I, you know, in my mind, they kind of work together and we're learning more about this. We didn't know about this when the GLP ones first came out. Um, but the longer that these medications are around, we're you know we're seeing more and more people doing research on it and looking at outcomes, and that's one of the benefits that we're seeing is they can work together.

SPEAKER_00 22:16

And our next question is from Andrea. Um and Andrea says, I've been on HRT for about two months and have noticed significant positive improvements in my symptoms and overall well-being, which is awesome, Andrea. That's great to hear. Um, but she says, I'm wondering when I should have um wondering when I should have when I should have uh follow-up lab work done to check my hormone levels and determine whether any medication adjustments are needed. Is there a recommended timeline for repeat testing at this stage of treatment?

SPEAKER_02 22:48

So here's where we get to go in the diatribe about testing. So actually, hormone testing isn't needed at all before starting your own hormone therapy. It's not something that's very helpful. There's no defined level at which we know that for one woman compared to another, that they're gonna experience improvement in their symptoms. So it's really not useful information. So it's actually more beneficial for us and for me specifically, you know, to look at your symptom diary, to look and see how you're feeling. So quantitatively, you know, objectively, if you're feeling better, you're sleeping better, your hot fleshes are reduced, your other symptoms that were bothering you are getting better, then that's enough. You don't need to get a hormone level checked to determine if you need to change your dose. It's really not helpful to do that. In fact, providers that do that and check levels and try to tweak medications, it's kind of like chasing your tail. You're not getting any valuable information, and it's really not helpful to get the level to then adjust medication. Um, and it's not just my opinion, it's not just Winona's opinion. This is something that's endorsed by the American College of OBGYN and the Menopause Society. They all recommend against routine hormone testing. The problem is hormone testing is a big business, and a lot of places will want to do hormone tests for you maybe several times, and then they'll charge you several hundred dollars. Um, it's just not useful information, and the experts don't recommend it.

SPEAKER_00 24:12

Absolutely. And I know, I know that's a question that we we tend to get a lot on these calls to, Dr. Kat. So I think it's always obviously a very prevalent question that's happening. I think, especially to your point about it being a big business.

SPEAKER_02 24:26

Because I think in every other arena in medicine, like if you're feeling weak and tired and you get your blood drawn and it shows you're anemic, you can look at an anemia level and know that you need to take iron, right? Thyroid hormones, you can have an underactive thyroid and they check the levels and then they tweak your medication based on that. The problem is female hormones are released in such an erratic fashion that they don't behave like anything else in our body. And so that's why the labs are just not as useful. They can the levels can vary from day to day, from the time of day. Like if you were to get your blood drawn in the morning and then drawn again in the evening, the levels might be totally different. And so um it's really just not helpful information for us.

SPEAKER_00 25:05

Absolutely. And I see that there's a few people typing, so I'm gonna give them a second to see if there's any more questions for them to throw in the chat. But Dr. Kat, I would love to know from you as well. With someone who's maybe kind of just getting started on either with Winona or on HRT or kind of on that journey, what do you think is the most important thing for someone to to kind of know about getting in, getting into HRT and beginning that whole process?

SPEAKER_02 25:35

Yeah. I mean, I think the big thing first is to choose a treatment form that is going to fit into your lifestyle the best, right? So there might be experts on the internet, you might see women talking about that this is the latest and greatest and they love this, but you have to think about what works for you. Like, so you know, a patch might work for one patient, a cream might work for another, but maybe you're somebody who already takes pills and it's just easier to just add another pill to your day-to-day regimen. Um, and so that's the first thing, fitting it into your routine. And then the second thing is starting to make it a habit and taking the medication regularly once you receive it. Um, that's one of the hardest things to do is to get used to taking the medication regularly because if you're not able to do that, it's gonna take your body longer to get adjusted. Um, and that's one of the hardest hurdles for a lot of women to get over. Um, and then also knowing that the medication alone and hormone therapy alone is not the only answer. It works in conjunction with other things like lifestyle modifications, behavioral changes. So it's not like a magic pill that's gonna be a cure, all right? You still have to take care of yourself. You still have to try to optimize your sleep, you still have to try to stay hydrated, um, you know, focus on your nutrition, making sure you're getting enough protein, enough fiber, getting all the nutrients that your body needs to stay healthy and strong. Um, and so I think that, you know, you have to do all those things. You kind of have to hit it from all angles. This really isn't like a, you know, a bad time in life that all of a sudden you're attacked and you have to get these medications on board. I kind of see it as like a call to action. Like now, like, okay, ladies, we need to wake up and we need to start taking care of ourselves as we're aging so that we can live our best life, right? You know, it's it's about refocusing our energy from outward on everything else we're doing back into ourselves and focusing on ourselves to get ourselves feeling better. Absolutely, yeah.

SPEAKER_00 27:28

Yeah, no, I I think that's so important to remember. I love that you uh did you call it a wake-up call? Is that right? I love something like that.

SPEAKER_02 27:35

That's like a good way to put it. It's a call to action, you know? It's like these little symptoms that start creeping in and start to bother us so much. It's like our body like asking for help, right? It's kind of like a wake-up call.

SPEAKER_00 27:48

Yeah, absolutely. Well, I think that that looks like that might be all the questions that we have were tonight. Um, but I just want to say thank you everyone for coming. If anyone does have any last minute questions, feel free to throw them in the chat and we'll oh, never mind. We do have one more. It's like perfect timing. Um, all right. Well, we have a question from Whitney. Um, and if anyone does have any more questions while we're answering this one, feel free to throw those in there as well. We'll get to them. We've still got some time left, so we'd love to answer any of the questions you've got. Um, but Whitney says, I am exhausted all the time, like I can barely stay awake during the day. She says, I did pellets with estrogen and testosterone, but I didn't like the roller coaster feeling I got with my hormones. Um, will DHEA work as well as testosterone injections? She says, I have done pellets for four years since I was 35, um, as well as sublingual progesterone. Um, she says the the the PO for the PO form, is that correct?

SPEAKER_02 28:50

Yeah, that's that means by mouth in the medical world.

unknown 28:53

Perfect.

SPEAKER_00 28:54

Awesome. Whitney, you know your lingo. I love that. She says, as well as the PO form, um made me really nauseous. She says, I just want something that will give me more energy during the day, help me sleep at night, and give me the drive uh to want to do things that I used to enjoy doing.

SPEAKER_02 29:10

Yeah, so I think the hard part is, I mean, I think we should start off talking about pellets in general and the difference in pellets compared to traditional hormone therapy. Um, you know, I'm I'm not a big fan of pellets, um, mainly because it's an invasive procedure. And the doctors that are doing pellets, some of them do them very well. And I know patients and I have had friends that have used them and done very well, but for the most part, my general consensus and most of the patients I've talked to that have had a pellet experience, describe what you're describing, this roller coaster, right? So they're taking their best guess of what to give you, and they're giving you three months of medication in a reservoir, like a pellet. Um, think about, you know, when we do like identification and we do the scanning, that we insert that thing for our dogs so that we can track them if they get lost. Think about that as kind of like a pellet. So it's a big large bore needle that holds this reservoir of medication, and they're injecting it into your body, and then you're stuck with it, right? So you're gonna experience the real, you know, the medication, you're gonna get the medication as it's slowly released over time. But depending on where it's injected, you know, where the pellets put in your body, you might metabolize it differently. You might have days where you know you might be more active, you might get more medication out of the pellet, and it might be up and down. But the really downside is that when you're the patient who gets a pellet and then is having horrible side effects, you're stuck with them until that pellet completely dissolves, right? I don't like that. I don't like not having control to be able to change things, you know, do things differently. Um, so that's why I'm not a huge fan of the pellets. Um, and also for most doctors doing pellets, their thought is to give you very high doses of testosterone because our body will convert some of the testosterone into estrogen as well. And so sometimes they'll go really high on the testosterone, which helps your energy, helps all these things, but you can also have the risk of having masculinizing side effects from the testosterone if your body doesn't convert it, meaning that you could get male pattern hair growth, get a mustache, get a beard. Um, you could start notice male pattern balding, you could start having changes in your voice. Um, and if you're exposed to too high levels of testosterone for too long, your clitoris can actually get enlarged, like almost like it's trying to grow into a larger penis. Um, so yeah, some bad things can happen to patients when they get too much testosterone. So, you know, I think that it's going to be interesting for you to change to different form of medication if you've been on that, you know, for four years. But I think it's worth trying something different to see how your body responds. Um, and I think that going on a good dose of estrogen would significantly help with your symptoms. Um, but you might notice a change going from those high doses of testosterone down to the low levels of the DHEA that we use, which are much lower doses because they're safer to be used in conjunction with the other parts of the hormone therapy. Um, but I think it's worth the try. You never know how your body's going to respond until you try it. And medications, a lot of the times are not guarantees, right? So it's very much trial and error, and it's kind of like trying on clothes. You know, you never can't like look at a pair, you know, an outfit in a store and say, I want that and this size and just go home with it. Who does that, right? Maybe you go home with it, try it on, and then take it back. But most of us have to try it on. Same thing with medication. You have to try things on and see how your body responds. Um, and that goes for any medication, not just hormone therapy. You know, if you're getting headaches and someone gives you medication for headaches, you try it for a little while, doesn't work, you go to plan B, you go to the next medication. So, same thing. We sometimes have to tweak things until we get it right, until we try it to find the right formula for you. And that's why your treatment should be individualized. Um, and you should work with a with a doc directly to kind of go back and forth to find what works best for you. And we'd be happy to do that for you if you're willing to give it a try.

SPEAKER_00 33:10

Absolutely. Um, yeah, I think we maybe we talked about this some other time, Dr. Cat, but I love how you said like it is, you know, everything is best of all the time when it is individualized on that end. Because I do think, you know, perimenopause and menopause, it's such an interesting conversation because everyone go every woman will go through menopause. We all have that same experience, but everyone's journey is going to be different. Um, so I think you're completely, I mean, I I think that's like great to hear like the medical side of that as well. You know, there's like that emotional side, but there's also like the medical side of what the journey of menopause looks like that way. Absolutely.

SPEAKER_02 33:45

Yeah, for sure.

SPEAKER_00 33:47

Well, I think that is all the questions we have tonight. But thank you so much, everyone, for coming out and just making a little bit of time out of your evening to be here, to ask your questions, to listen, just to really think about the journey that you're in right now. I think that that says a lot about um what you're doing to kind of take control, take the reins of your medical journey. Um, I think that is a huge thing. Um, I do just want to point out as well, if you're interested in some more resources like this, or you want to listen to some more conversations, um, hear questions from other women, uh, we do have lots of episodes like this. Well, we we do these events, um, we have live QA's every month. We also have doctor dialogues where we have an expert guest come. So we'd love to see you at those. Um, we also have the menopause hour on Spotify. Um, it is our Winona podcast. We have a lot of these episodes on there, so you can listen to them at the gym, you can listen to them in the car while you're making dinner. Um, we do also have some other episodes as well where we do interviews with some of our ambassadors or real patients. So I always think those are really interesting just to kind of get some deeper insights to dive into conversations. So would definitely recommend checking out those. And then also just remember that if you are a one-ona patient or if you become a one-ona patient, your one on a doctor is always available 24-7 for you in your patient portal. So it's essentially a lot like this where you can send them a message, put all your information in it. I know sometimes, especially when I would go to the doctor, I would have to like write down to remember everything, and then I would still forget, you know, to like say something. It's kind of nice this way because you can like make sure that you have all the information and then add other things in later if you want. So just a reminder that that is always available. Your doctor wants to help you. Um, they want to hear what you're going through, and they'll really help you find a great path forward. Um, so those are just a couple resources that are available. There's also lots of resources in the Oneona app that I recommend checking out, um, as well as so many other things, including we have workouts, we have our Winona 101, um, lots of different events and uh resources, whether that's journals or symptom tractors that you can you can check out as well. So definitely recommend checking those out. But thank you so much, everyone, for coming tonight, for making the time. So great to see you all. Um, and thank you, Dr. Kat, for giving your time tonight as well.

SPEAKER_02 36:18

Yeah, no, thank you so much for coming out. These are always good conversations and there's always good questions. So yeah. And don't forget to, you know, follow us on social media if you're into that. Um, you know, on Instagram, you can find me at Dr. Catob. Um and yeah, Dive Wanona website too. So there's so much good information. Like if you just want to like look up symptoms, it's much better to go to buywinona.com and search for your symptom and read a curated medical article that's been validated and is good medical information rather than just Googling too. So absolutely.

SPEAKER_00 36:54

Well, I was gonna say, Dr. Kat, I love your account. So would definitely recommend following Dr. Kat. She has some great information on there. So um always fun. And I love to like get to see like little bits of your life and kind of what that looks like too. So I think that's a great, it's a great thing to check out for sure. Well, I hope everyone has a great rest of your night, and hopefully we will see you at the next one of these. Um, and just as a note too, I think like Dr. Kat was saying, everyone always has such great questions, and there's always so many new questions that I love, um, so many wide varieties. So that is also the cool thing about these, is they'll never be the same event. Um, so you can come, you'll always learn something new, new information. You're not, you don't just have to come to one, you can come to as many as you want, and it will be like a new experience. So hopefully we'll see some of you all at the next one. Um, but I hope everyone has a great rest of your night. Um, and we'll catch you next time.

SPEAKER_02 37:50

Yeah, sounds good.

SPEAKER_01 37:52

Good night, everyone. All right, good night all. Thanks for spending time with us. We hope today's conversation helped you feel more informed, more supported, and a lot less alone. If you're ready to go deeper, download the Winona app. It's free, it's for you, and it's filled with resources, real stories, expert insights, and a vibrant space to connect with women navigating the same season. Have questions? Join our next live QA. Until next time, take care of yourself. We'll be here when you're ready for more.