The Truth About Menopause, Hormones & GLP-1s | Dr. Al Sassoon

Alexandria Filingeri sit down with renowned NYC OB-GYN surgeon Dr. Al Sassoon for an in-depth conversation about menopause, hormone therapy, vaginal rejuvenation, GLP-1 medications, and the physiological changes women experience as they age.

From hot flashes and hormonal shifts to insulin resistance, weight gain, pelvic floor changes, and intimacy concerns, this episode breaks down the realities many women face but rarely talk about openly.

Topics Covered:
• What actually happens to the body during menopause
• Hormone replacement therapy explained
• Vaginal rejuvenation & pelvic floor health
• The “Mommy Makeover” and body confidence
• GLP-1 medications, metabolism, and visceral fat
• Insulin resistance and inflammation
• Why listening to patients matters in modern healthcare
• The importance of transparency, trust, and individualized treatment

Dr. Sassoon shares decades of experience helping women navigate these changes with compassion, honesty, and evidence-based care.

If you’re interested in women’s health, hormones, longevity, body composition, or understanding how menopause truly impacts quality of life, this conversation is packed with valuable insight.

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The content shared on the “We Got Your Number” podcast is for educational and informational purposes only. It is not intended to provide medical advice, diagnosis, or treatment. Always seek the guidance of your own qualified healthcare professional with any questions you may have regarding your health, nutrition, or medical care.

Transcript

SPEAKER_01 0:00

Hi, I'm Dr. Thomas Romo, a plastic surgeon in New York City, and I'm here with my associate, Dr. Alexandria Phil and Jerry. And we got your number podcast. And today we're very excited because we have Dr. Al Sassoon, a board-certified Obi Gen surgeon in New York City, an instructor, resident teacher, and now a concierge uh practice in Obi Gen on Park Avenue. Uh so Dr. Al Sassoon, hi Al, how are you?

SPEAKER_00 0:29

I'm good. How are you? Thank you for having me.

SPEAKER_01 0:32

Absolutely. Uh we uh wanted to start off with we have so much to talk about uh with you, but uh let's jump right into some of the changes that we see with menopause. Uh you do this every day in New York. There are current uh uh problems, concerns that women have. So uh the the floor is yours.

SPEAKER_00 0:52

Thank you so much. What I thought we would do first before we jump into menopause is talk about a new buzzword that we're hearing, especially between women between the ages of 40 and 50, is mommy makeover. Um I'm sorry?

SPEAKER_02 1:08

Tell us, tell us about the mommy makeover. Yeah, we agree with you.

SPEAKER_00 1:10

Yeah, it's a hot topic. So it is a very hot topic. You have um these women who have had their children who've breastfed and now look in the mirror and say, What happened to me? Where was I ten years, you know, how come I don't look like I was 10 years ago? And they actually look great, but to them they don't. So they really feel what's important for them is to do what's called a mommy makeover. And what I want to talk about is not just the mommy makeover, but an extension and something called vaginal rejuvenation, which we hear about a lot as well. Correct. So in general, the mommy makeover is either a breast reduction or a lift or implants, and then the abdominal portion is something where they um reduce the uh bring back the rectus muscle, they flatten the stomach, that's called an abdominal plasty.

SPEAKER_01 2:00

Correct.

SPEAKER_00 2:00

But the third part is really important, and that's called a vaginal uh rejuvenation. And there's two parts to a vaginal rejuvenation. The first part is called something called vaginal tightening. What happens a lot of times is after multiple vaginal deliveries or just getting older, um your vaginal becomes looser, it becomes more lax. You become, you know, discomfort in its in its um irritation and its stretchness, as well as you have changes in sexual sensation. So what happens occasionally is the rectum pushes into the vagina and you get prolapse outside the vagina. There's this bulge that you're feeling that's really coming out the vagina. The same thing happens with the bladder. You have what's called a cystical, where the bladder drops into the vagina, and you have another bulge. So basically, your whole vagina is distorted. Right. And so the procedure is called an anterior-posterior repair. We do not use any mesh. Um, we bring back the walls of the vagina by separating the vaginal mucosa from uh the vaginal mucosa from the uh rectum and the vaginal mucosa from the bladder, remove the excess tissue at that particular point in time. We restore the perineum, that's the area between the vagina and the rectum that becomes totally distorted. We now build it up, and really the vagina is like a pre-pregnant vagina. So there's a lot of self-confidence in this, and that's really, really important.

SPEAKER_01 3:34

Well, the other portion of the I'm sorry, but I mean it it it's obviously there's individuality of it, it's part of the aging process, the the vaginal floor and the pelvic floor, one thing, probably the number of vaginal deliveries as opposed to C-sections, not causing the same amount of trauma going through there. Uh so there are vagaries in that, uh, and it's just driven by the diagnosis.

SPEAKER_00 4:00

And there's some women that don't have any issues whatsoever. And there are other women that do. I mean, it all depends on the um laxity of the vaginal tissue. Some women have more propensity for laxity than others, and some women even have cesarean sections and still have laxity in the vaginal uh canal. So it's really about how you feel and about how you feel about yourself and how confident you want to feel. Right.

SPEAKER_01 4:25

Now go ahead.

SPEAKER_00 4:26

Continue, Dr. Romo.

SPEAKER_01 4:27

No, no, I I was thinking about is this an external abdominal kind of an endoscopic, or does this does this require No, no, no.

SPEAKER_00 4:35

This is this is a vaginal surgery. This is not endoscopic, this is actually just the vagina. We separate the vaginal mucosa from the rectum and the vaginal mucosa from the bladder, remove the excess tissue. There's no mesh placed in. I don't believe in mesh, and we restore the entire walls of the vagina.

SPEAKER_01 4:54

So it's a relatively, we don't like to say simple, but it's not as invasive as some type of abdominal approach would be.

SPEAKER_00 5:01

That's correct. This is not done abdominally, it's not done endoscopically.

SPEAKER_01 5:05

This is done So the heel the heel time, it's always you know variable, but I mean their their uh their inability to get back to the to the gym or their ability to get back to work four to six weeks.

SPEAKER_00 5:17

Absolutely.

SPEAKER_01 5:18

Uh-huh.

SPEAKER_00 5:18

Four to six weeks.

SPEAKER_02 5:20

So when a woman comes into your office, right? Um, you know, we know about other types of mommy makeovers, but when they're coming in for this type of makeover, how does the patient typically present? Um, are they nervous?

SPEAKER_00 5:33

Are they so that's a good question because a lot of women don't want to talk about it.

SPEAKER_03 5:38

Right.

SPEAKER_00 5:40

You know, they feel they feel insecure about it. They they don't want to talk about it. And that's why it's getting so much buzz. Because why should women feel insecure about a portion in their body that that should be really taken care of? Look, they they're very easy to talk about their breasts, they're very easy to talk about the abdomen. Absolutely. Yeah, but this is just an extension of the mommy makeover. I call it the trio. You know, it's important. But yes, I and sometimes what I when I'm comfortable enough with a patient or a com a patient feels comfortable comfortable enough with me, then I say to them, How do you feel? You look a little lax, right? Tissues are bulging. Does this bother you? And they say to me, Wow, I'm so glad you brought it up. Like they're so happy that they can actually talk about it. I think that's so important. You know what? I'll just deal with it, and I don't want to undergo the surgery. And other people say, Please. I tell you, I have people coming from Miami, from California, from the Midwest, and the letters that I get are just incredible. They're so grateful having the procedure.

SPEAKER_02 6:47

Yeah. I think that's so important because for such a long time I feel like um women didn't even really understand that they had these types of resources. Um, and then also being able to sit down with a doctor, and a doctor say things like, You're, you know, we talk about your breast, we talk about your abdomen, but we don't talk about this, and you should feel comfortable. This is part of the three.

SPEAKER_01 7:08

I think that that is like so essential, and nobody talks about that for the most part. No, we don't hear about that much with mommy makeover. That's why you're here.

SPEAKER_00 7:17

But we're getting to be hear more and more about it. We really are. The other aspect of vaginal rejuvenation is labioplasty.

SPEAKER_01 7:25

Okay.

SPEAKER_00 7:25

So when women are born, their labia, we're talking about the labia minora, not the majora, the inner lips of the vagina. Yes. Some are born with underdeveloped, not well, we when they become adolescent, they're born with underdeveloped labia, one versus the other. Sometimes the alternate, the other side of the labia is much larger. Sometimes both labia are extremely large, and you know, that can be cumbersome. That can be irritating with infections, that can cause issues with oral sex, it can cause issues with um intercourse. You know, I have 18 and 19-year-olds very grateful because you know they change in the locker room and they feel that they're embarrassed because they have a bulge. Right. And you they can't wear the clothes they want to wear. They can't wear their sh their their tight shorts.

unknown 8:16

Okay.

SPEAKER_00 8:16

So after these procedures, and it's it's it's you know, it's a procedure that takes about an hour and a half pro labia. It's cumbersome, uh, it's intricate. But you know, after four to six weeks, again, the letters I get, they're so grateful. They feel comfortable, they can walk around in the gym, they can wear the bathing suits they want, they can wear the clothes they want. And you know, it's it's a procedure that that can be done in the right hands pretty well. Now, there's two types of procedures. There's one called the trim technique and the one called the wedge technique. Now, the trim technique basically I feel causes scalloping and doesn't really address the issue. I'm a firm believer in making the labia streamline on both sides, and that's when I feel that the wedge technique is the most appropriate technique because it does streamline the inner lips of the vagina, and that's called a labioplasty.

SPEAKER_01 9:11

Um well, these are these are great topics. I mean, I mean, as a friend, but as a practicing uh OB gen in New York City for many years, uh, you've seen these problems. Uh, you also um you know with the relationship that you have with your patients, uh you would think that they would pretty have pretty much have full disclosure with their uh Obi-Gen or gynecologist. Uh, but yet they've still at the same time, what you're saying is many times they don't bring these things up because they're not supposedly discussed. Hopefully, and using something like this media and getting these words out here, people are gonna get the treatment that uh that they should get.

SPEAKER_02 9:53

I also think, and Dr. Susteon, I'm really interested in hearing your perspective. I also think it's um, you know, the amount of time that the doctor gets to spend with patient, right? If it is a very quick 15-minute visit, especially, you know, post-menopausal visit, going in to see their gynecologist, there may not be time or there may not be enough trust to have these conversations. So it sounds like in your practice that you have both the time and the trust with the patients to have these conversations, but I do see how if it is in more of a rushed environment, these could be things that aren't discussed fully.

SPEAKER_00 10:30

Absolutely. Look, the other portion is I care.

SPEAKER_03 10:33

Right.

SPEAKER_00 10:33

And you know, we we come from that generation. Dr. Romo and I come from that generation, you know. Yes, we do take time with our patients, we care about our patients, we call them back. Yeah, it's not like the you know, the patient calls up and they hear an answering machine, or they maybe get a nurse or a PA, or they'll never get the doctor, but that doesn't happen in my practice. You know, we're old-time docs that really care about their patients. And I've sat down sometimes with patients for over 45 minutes to an hour. Um, and it's it's important, it really is. Well, it's patient care and uh I take the time and and and patients are very, very happy about it.

SPEAKER_02 11:13

Yeah, absolutely. So we found the best doctor. So I got to meet Dr. Roman, then Dr. Roman got to introduce me to some of the best doctors, and and that's always the theme that I hear is we really care about our patients, we really care about the evidence, we really follow the evidence, we do the procedures that are actually gonna benefit our patients.

SPEAKER_01 11:30

Um contemporary keeping uh abreast of what's going on uh new and uh and and then bringing up.

SPEAKER_00 11:38

The other thing is it's being transparent with the patient, explaining to them, like in a labioplasty, there's no perfection.

SPEAKER_03 11:45

Right.

SPEAKER_00 11:45

There's you know, with with a labioplasty, you're not gonna have exactly the same labia on each side. You sometimes have one side that's more pigmented than the other side. You try to correct it as much as you can, and I show them pictures before and after, so they'll fully understand that there's gonna be no perfection here, and that's what's important, being transparent with the patient.

SPEAKER_01 12:08

Transparent and honest, uh and we do the same thing with uh uh maybe at the other end of the uh spectrum when we're doing a rhinoplasty, uh there is no perfection, but there's definitively improvement. Uh and we try and get we try and get as close uh as we can. Uh so uh as you're as we're jumping into uh this these topics with menopausal changes, what else do you have what else do you hear all the time?

SPEAKER_00 12:33

Well, let's talk about menopause. Yeah, because I think that's important. I think um let's define what menopause is first. Okay, it's an abatement or a cessation of your menses for a year, right? And or your FSH follicle stimulating hormone, depending on what lab you used over a certain amount, six months apart.

unknown 12:54

Okay.

SPEAKER_00 12:55

So let's back up and talk about what estrogen does to the vagina, and then we'll talk about what happens during menopause. Right. So you know, the estrogen itself maintains the thickness, the elasticity, it supports natural lubrication, it keeps the pH of the vagina healthy so you don't get infections, and it sustains blood flow in the vagina, and it allows sensitization, it allows a woman to feel her partner. Um what happens uh during men after menopause is the complete opposite. Right. You get dryness of the vagina, you have uh a situation where it's reduced lubrication, loss of elasticity, the vagina becomes tubular. So it it it it it's very painful during intercourse and you get pH uh changes or you can get multiple infections. And the biggest thing is this genito-urinary syndrome of menopause, where these women lack estrogen in the muscles of the urethra. And they feel like they have to urinate all the time, but they don't have a UTI, they don't have a problem with their the the angle of the urethra, they just lack estrogen. And you know, that's that's that's a big thing, and this is where we can help them. Um again, this is a very big topic now. Uh there's been a cultural shift about um menopause in general, about how women feel and how how we should listen to what women feel about. So in the beginning there was total neglect in the 50s and 60s, and then come the 70s and 80s, we got over-enthusiastic. We gave them so much estrogen that things began to happen breast cancer, blood clots, cardiovascular diseases. And then in the late 90s and 2000, we had the um uh a report that was coming out, and uh they did the wrong study on the wrong group of patients. Right. And they said, Oh, this is terrible, it's it's it's gonna cause a multiple increase of breast cancer and clots, as I said before, and then there was a global shutdown of estrogen, yes. Right. And it was only until the past like 10 to 15 years when estrogen became more prevalently used. Now, estrogen it can cause issues. So the issue with uh with putting somebody on estrogen replacement hormonal therapy is uh very prevalent now, except you have to be careful because you have to take a family history, you have to make sure that there's you know, putting somebody on replacement hormonal therapy is depending on how they feel regarding their quality of life. So I have women that come in and say to me that they have to change the sheets twice a night because they're dripping so much. Right. That yeah, that they're going and giving lectures and they have to bring a change in clothes. That's affecting the quality of their life. That's where the risk benefits are.

SPEAKER_01 16:05

So that's sweating. That's what you're talking about. They're they're sweating and hot, they're so they're so hot, yeah. Typical really hot woman that uh is sweating.

SPEAKER_00 16:14

Yeah, the vasomotor symptoms that we talk about. Yeah, um but you have to be careful because not everybody can go on estrogen replacement hormonal therapy. What I do in my practice is I make sure they try to get what's called genetic cancer screening. We want to make sure they don't have any uh BROCA mutations or any other uh mutations that increase the chance of of uh breast cancer. Now there's some women that don't want to do this because they're afraid that if they come down with with a with a gene, that the insurance companies will no longer allow treatment in the future because they're they're they're flagged. But I also besides the genetic cancer screening test, I also get a transvaginal sonogram, I get a good history, um, family history of breast cancer, I look at their body habitus, um, I look at their alcohol use and their breast densities. So not everyone is a good candidate. Now, as far as the vagina is concerned, we do have estrogen cream, we have pellets, we have something called an estering. These are for individuals that can't take the full estrogen replacement hormonal therapy.

SPEAKER_01 17:28

Yes.

SPEAKER_00 17:29

Um, they work well, they don't get absorbed in the sit in the body, uh, it's a local effect.

SPEAKER_01 17:36

It it's not you know the end-all uh well it's not systemic, so they're getting it topical. Again, just quickly, uh I saw something on social media again on this. This is so hot topic, you're right on point here, uh, about there being uh uh a reduction or a paucity of patches with estrogen patches.

SPEAKER_00 17:57

Well, that's for individual. That's my preference right now. But going back to the the the creams and and the estering, those are really for individuals that can't go on estrogen replacement hormonal therapy. Right. Um there are some women uh who just won't go on anything, they just tolerate the the discomfort. Um my preference for the vehicle of giving estrogen is really the patch. Um the patch you put on twice a week, uh Mondays and Thursdays, and um you must take progesterone if you have a uterus because you want to negate the negative effects of estrogen on the uterus. So you take a progesterone every night. Now, the progesterone helps you sleep, so that really is um helps in both ways. Yes, but yeah, I mean I I I'm a firm believer of giving estrogen plus replacement hormonal therapy to those individuals who really need it.

SPEAKER_02 18:50

Right. So it sounds like there's that um, you know, that process, right? That medical evaluation to see what the risk is, conversation with the patient, and then prescription to those that benefit. Have you seen? Because there's, you know, there's been, I think, in um, you know, many social circles and even in like medical circles of people that we collaborate, there's definitely more knowledge for women. So women that are in this perimenopause-menopause phase, they're knowing that they should or they should at least go have a conversation with their provider. So have you seen that trend over time, especially nowadays, that more women are coming into your practice saying, What is my option in this perimenopause-menopause space?

SPEAKER_00 19:29

I would say it's up at least 70%.

SPEAKER_02 19:32

Yeah.

SPEAKER_00 19:33

Uh, women between the ages of 45 and 55 come to me and say, 'All my friends are on estrogen,' right? Should I be on estrogen? Right. Yes, absolutely. I see it quite often. But again, you know, it doesn't any medication we take have its pros and cons. Of course. And I want to preface this by saying one thing. Uh my word is not gospel. You need to speak to your physician and make sure that you're the right candidate. And with my patients, I try to make sure that they are the right candidate. And I explain to them there is a slight increase in breast cancer. You know, there's some studies that show that 21 in a thousand in the normal normal population come down with breast cancer. Maybe it's 27 um in a thousand in individuals, even if they don't have any uh positive um markers or or uh anything like that.

SPEAKER_01 20:23

Yeah, you don't have I'm sorry, markers or any type of uh markers, genesiters or what have you.

SPEAKER_00 20:29

Yeah, they'll come, they still have uh that risk. Yeah.

SPEAKER_02 20:34

Following that um WHI study in 2002 that changed you know the the data, right? The scary data that came out on older individuals um that we've now proven was probably not the best, you know, evaluation of the data. Did you see a deprescription at that time among colleagues?

SPEAKER_00 20:52

I'm sorry, say that again.

SPEAKER_02 20:53

So following the um WHI study that was published in the 2000s, right, that had that scary data that we understand, right, it was the wrong patient population. It probably wasn't the best way to gather data um on women in this life stage. Did you see a de-prescription? Did you see fellow colleagues in the field um taking away the estrogen or or being afraid to prescribe it based off of the data that they had at that time?

SPEAKER_00 21:17

Absolutely. Yeah, 100%. Yeah. And women were suffering for it, and I felt I felt bad for them. But you see, that study just, like I told you, was a global shutdown of estrogen. And it was wasn't until 10 years later when people just said, you know what, we're gonna try this and we'll use a select group of people and see what happens. Now, there isn't even some studies that show women on just estrogen alone really don't have an increase of breast cancer, but it's got to be given within two years of menopause and only for a short duration. It can't be given indefinitely. But the problem is once you have somebody on estrogen, they don't want to go. Oh no, okay. They're not giving you that passionate. I tell them you have to be careful. Now, everybody on estrogen in my practice gets a mammogram, breast sonogram, and a transvaginal sonogram every year.

SPEAKER_01 22:12

Well, it's safety as follow-up.

SPEAKER_00 22:15

I think every woman over the age of 50, 52 should get a transvaginal sonogram because we can examine you, but we can't see the small little follicles that might be abnormal in your ovaries or some small growth inside the uterus until it's too late. The whole idea is prevention. That's the whole idea here. And we should be able to treat women and take care of them and make them happy and make them self-confident and make them bring back their security in their life in whatever we do as physicians. But you need to be transparent and you need to be visual.

SPEAKER_01 22:51

Great, great uh statements, great uh information. Uh uh Al, that's why you have great practice and people uh come to you. Um so uh continuing on, Allie, what are you thinking about uh with so I want to talk the weight gain on people?

SPEAKER_02 23:08

Yeah, so I want to talk about because this is you know something that of course I see in in my practice, and um, you know, women as they're going through perimenopause and menopause, you know, you talked about vasomotor symptoms, which are quite debilitating. Um I we often hear often about you know menopause and weight gain, and I think it's just such a um robust time in a woman's life where there's so many things that are happening, right? Their bodies changing, their physiology is changing, um, their life is changing too, right? They're dealing with aging parents, aging kids. Um so when women come into your practice, um, you briefly spoke about body weight and alcohol, but I would love for you to just touch a little bit more on it. Um, what do you say and and why is it so important?

SPEAKER_00 23:55

I have to tell you, um, I have a large group of patients that I've seen since uh 25 years.

SPEAKER_03 24:02

Right.

SPEAKER_00 24:03

Um, I delivered their babies. I'm now delivering their babies. Wow. Um, it's a great feeling, it really is. But I'm also noticing when they're coming in that they're complaining about their body habits. That now they have the breasts that are that that are enlarged that they've never had before. That they're they have this tire around their stomach that they've never had before. So basically it has to do with a multitude of things, but exercise is important. A lot of them don't exercise anymore.

SPEAKER_03 24:39

Right.

SPEAKER_00 24:40

The shift of fat from their thighs to their stomach is increased. But one of the most important things is insulin. Insulin insensitivity. And insulin insensitivity with the wrong diet just increases your insulin level and it doesn't work anymore. And even cardiothoracic surgeons and cardiologists feel that this insulin insensitivity increases inflammation. And the inflammation affects your gut and affects your heart. Not the patient who wants to lose five, ten pounds to get into a bathing suit, but the patient that's needs to lose 30, 40 pounds because they're now hypertensive, they're diabetic, um, they have an increase in stroke. Those are the individuals where these GLP ones will help a lot. Um, I'm surprised at our own government. We spend all this all this money on paying for Medicare and Medicaid. We should be giving these GLP ones to reduce hospitalizations for for um dialysis, for hypertension. It's just the the cost of medical care will go down immensely. But for the right individual, for the right individual.

SPEAKER_02 26:00

Doctor, I have to say that um you said this podcast, most of our favorite words, right? And uh I'll explain that a little bit more in detail. But um, I really appreciate you talking about the physiology of what happens to a woman's body. Um, because when they're coming to you and they're like, what is this tire that's around my abdomen? And you know, you're explaining to them like that is the accumulation of visceral fat, and then explaining, and you said it so perfectly, right? Um, with insulin resistance and the improper diet, they it's a perfect metabolic storm for weight gain.

SPEAKER_00 26:32

Um absolutely like whatever morsel you put into your body when you were 40 or 35, yeah, you used to metabolize it. One, two, three. Yeah. Now when you're 45, 50, 55, you have to be careful about every little thing that goes in your mouth.

SPEAKER_02 26:47

And thank you.

SPEAKER_00 26:48

It's not just women, it's men also.

SPEAKER_02 26:50

Right. True. I appreciate you talking about um the use of GLP1s in this patient population. Um, because I've seen them, I think we've all seen them as you know, such critical tools um for doing those things, decreasing risk of cardiovascular disease and um, you know, decreasing visceral fat. I mean, we look a lot at body composition um and seeing, you know, really dramatic and impressive shift in body composition. But what I have to say, and I have to say it, of course, if I'm sitting in the room with two physicians, how can I not say it? Is you know, of course, right? The woman is put on um, you know, menopause replacement therapy and GOP1s, and then is given the right tools to know how to manage their diet when they are on these medications. That's the magic piece there.

SPEAKER_00 27:34

It's called behavior modification.

SPEAKER_02 27:36

Oh, yeah.

SPEAKER_00 27:37

You have to get on an exercise program, you have to be able to watch what you eat, you have to watch your alcohol intake. See, this is where I disagree. A lot of these women go on these GLP ones, they look in the mirror and say, Wow, look at me now. But they're but they're not changing the behavior. So then what happens is they stay on this medication, and it's it it they shouldn't have to stay on this medication. They should have behavior modification to limit what their intake is, to do exercise, to limit their alcohol, as well as saying, okay, maybe I can go on a lower dose for every two weeks. But I always test my patients for thyroid problems, for pancreatic problems, and for liver problems. Everybody gets to I don't give the GLP ones, but when I feel when I see my patients are on it, I always test it. And you know what? Just like estrogen, they don't want to go off it. Of course, they don't want to go off it.

SPEAKER_01 28:30

Yeah, Allie has a huge practice of um advising people who are on GLP ones, particularly now, uh, and uh the colleagues that we have working with her uh and the patients. Uh that's her expertise.

SPEAKER_02 28:43

Uh I have to say I'm biased though, because you know, my patients, like they of course, like I get that group of patients that they are exercising, they are eating properly, they are learning how to change like those cognitive distortions that they have with food and body and all of those things. So I think left unmonitored doctors as soon. I think you're right, right? They're not given tools for success in the long term, um, where they're able to maybe potentially at some point um, you know, choose a different intervention. Um, but I really appreciate the in-depth evaluation you do of those patients. It really shows that like they're in fabulous hands.

SPEAKER_01 29:21

Absolutely.

SPEAKER_00 29:22

You know what the most important thing a physician should do? Yeah, listen to your patient. Yeah, yay, listen to your patient because you can't poo-poo any symptoms, right? You have to listen to them and then go down that road with them until you've either come to a solution or prove to them that everything is okay. You gotta listen to your patient.

SPEAKER_01 29:48

Well, Al, it's um it's great. Uh you're you're a friend for many years, and it's like you said, uh, I I practice, try to practice the same way of listening to our patients uh and uh look for outcomes and uh uh care about our patients. And it's wonderful having you here today. Um it's a pleasure. Really it really is. Uh Allie, don't you think it was great?

SPEAKER_02 30:10

So so wonderful. I can't wait to share this message with our audience. I think that it's so needed, um, and it's going to be you know so helpful. So thank you so much for contributing your knowledge. And we would love to have you back because I think there's so many things that we'd like to talk to you about.

SPEAKER_01 30:27

We are so we got your number podcast, Dr. Phil and Jerry, and myself, and Dr. El Sassoon. Thank you for being here, Al.