#51 Understanding Menopause and How HRT Can Help with Crystal (an NP)

Why are we talking about Hormone Replacement Therapy on a Peptide Podcast? Well, peptides and hormones go great together and now, you have access to BOTH with our telemedicine company. 

The topic is needed too. 80% of women show up to a menopause-related doctor visit and walk out with no treatment. Not “no hormones” no treatment at all. 

That stat frames a bigger problem we see every day: when you say “I don’t feel like myself,” the system often has no place to put you unless your labs or imaging scream in black and white. 

We sit down with the Nurse Practitioner Jess works with, Crystal Harter, an HRT expert who built her practice around the opposite model: more time, more listening, and real follow-up. We talk through:

• Why perimenopause can start years earlier than most people realize, 
• Why menopause is literally one date (one year without bleeding),
• Why the years before menopause can feel like living in hormone limbo. 

What about adding hormones to your blood work panel? Crystal days "don't bother." It's misleading during perimenopause because fluctuations make “in range” results meaningless for many patients.

We also get practical about hormone replacement therapy: why it’s rarely one-and-done, how dosing and delivery routes matter (oral vs transdermal), and why “HRT didn’t work for me” often just means the plan wasn’t managed long enough or tailored well enough. We cover prevention benefits like bone health and osteoporosis prevention, plus the bigger picture of cardiovascular disease, insulin resistance, and brain health. 

Men, we can't leave you out of the picture either. Men can be affected by  low testosterone, low libido, and more. When possible we highly recommend when you're in a partnership, both couples take a look at their hormones. We don't want either one of them to be out of sync.  

If you’ve been told you’re too young, your labs look fine, or your symptoms are “just stress,” press play and take notes. Subscribe, share with a friend who needs this conversation, and leave a review so more people can find real menopause and perimenopause help using hormones and peptides.

To connect with Crystal, visit her website at https://www.hudsonvalleybeautylab.com/estheticians-in-newburgh/1465-2/ or her Instagram at https://www.instagram.com/crystal_harter_np/

Where do you start with peptide therapy? What do you add next? If you're a go-getter, check out Dr. Kylie's new program AMPLIFY. You'll find it on the homepage of her website: drkylieburton.com

Ready to explore peptide therapy for yourself? Join through Jessica's platform at B2BwithJess.com/peptides or through Dr. Kylie's platform at drkylieburton.com/shop. 

Want to offer peptide therapy in your business? Whether you're adding it to your existing practice or building something new, learn how to get started—and how we'll mentor you along the way—at drkylieburton.com/peptidesaffiliate. You can also get started through Jessica's platform at B2BwithJess.com. 

Legal Disclaimer: This podcast is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider before starting any new health protocol. Dr. Kylie Burton and Jessica Briecke are affiliates and may receive compensation for referrals. Individual results may vary.

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Transcript

The Menopause Treatment Gap

SPEAKER_01 0:00

Peptides are powerful and often misunderstood. We're here to change that one conversation at a time. I'm Dr. Kylie Burton. And I'm Jessica Bricke.

SPEAKER_02 0:11

This is Pep Talk, Peptides Unpacked, Science Made Simple, Results Made Real. Before we jump in, I want to hit you with a number. Based on research covered by the Menopause Society from a 2023 study of nearly 5,500 women with a menopause-related doctor's visit, only about 17% were given any treatment at all. Not just hormone therapy, any treatment. 80 plus percent of women who showed up, said something's wrong, walked out with nothing. And remember, that's only women who actually went to the doctor.

Meet Crystal And A Better Model

SPEAKER_01 0:55

And that's exactly why I get to bring in my friend Crystal Harder. She's my friend, she's my colleague. She's also the person that is my HRT expert, which is why I trust her so darn much. She is a wizard. So Crystal has spent nearly a decade in healthcare, emergency medicine medicine, cardiology women's health. But here's the thing that made me really want to have her on our show. She's got just, like the rest of us, got tired of traditional medicine, dismissing women in midlife. So she built her own practice around doing something completely opposite of that. She put the whole model, and instead of seeing 20 plus patients a day in 15-minute chunks, which is ridiculous that you could get anything done in that, she spends real time with her patients, like an amount of time with each person that isn't just a normal thing in healthcare anymore. There's no insurance company that's telling her patients what they're allowed to need. It's just her sitting down, actually hearing what people are saying, hearing them out, and building a plan with them. And while she does work with peptides, her main focus is HRT, hormone replacement therapy for women in midlife or earlier, which is exactly why she's here with us today. So welcome, Crystal.

SPEAKER_00 2:14

Thank you. I'm so excited to be here with you guys. I love talking about anything women's health related in hormones. So thank you.

SPEAKER_01 2:21

You and I have talked on the side about this so many times with that stat that Kylie said about how, first of all, again, we're we're talking about the women that are bold and brave and not scared enough to go talk to the doctor about the symptoms because there's a whole category of women that won't do that. But 80% of women are not even being heard or treated. They're walking out with nothing.

SPEAKER_00 2:43

Yeah. And actually, if women have time to go to the doctor, right? Because they're the ones that are raising the children, staying home with the household working full-time now, so they're doing it all. And then when they find the time, you have to take off of work, you have someone to watch the kids, you finally go and you sit down and you talk to someone, you probably wait six months to get that appointment. And you kind of just tell them, and this is what happens a lot with them is

Symptoms First Not Lab Ranges

SPEAKER_00 3:00

I just don't feel right. I don't feel like myself. Something feels off. Modern medicine hates that. They're like, okay, what does that even mean? Let's do some blood work.

SPEAKER_02 3:08

There's no diagnosis for that.

SPEAKER_00 3:09

There's no diagnosis for that. I definitely can't build for that. Like, I need a code here. Let's do some blood work, let's do some diagnostic imaging. We love to see things in black and white, put it on paper and be like, oh, this is what's wrong, right? We run your hormones. Don't perimenopause. You're still making your hormones. They're fluctuating all around, which is causing the chaos. But on paper, they're gonna look perfect because they are in range, and those ranges are very low and very high. You're just gonna be somewhere in the middle, depending on what time of day it is. And whatever it is at two o'clock on Tuesday is not what's gonna be at five o'clock on Wednesday, and that's where they kind of get lost. They do blood work and they're like doctors of blood work's perfect, everything looks great, and that's it. And they're like, Oh, all right, okay, that's it. I guess you can't really find anything wrong here. And either they take that verbatim and they're like, All right, nothing's wrong, or that pisses them off, and they find a fire in that, and then they're like, No, something's not right. I'm gonna listen to myself. My own intuition is probably the most powerful thing you have in medicine. And I tell that to people all the time is even when they talk to me and I they say to me, like, what do you think? You're the expert. I'm like, whatever you think your body, your intuition is telling you, that's what we need to go with. Even if it's not what I think, we need to listen to your inner voice because that's strong.

SPEAKER_01 4:10

It's so refreshing that's your approach. Now, Kylie and I both obviously coming from a functional space, are a big believer in your labs are not telling you the story at all. And we don't even use traditional labs when we're looking and exploring what's going on with somebody. We're using those as clues from optimal ranges. So there's that. So when you have somebody that walks into your office and they're telling you, what do you think? What's your intuition? That's unheard of.

SPEAKER_00 4:34

Actually, I think, and it's hard for patients because they like they look confused. They're like, I brought my lab, I'm like, I don't want to see your blood work. They're like, But I'm like, put it down, put it somewhere else. We'll look at it, put it here. I'm like, tell me how you feel. How do you feel? And they go through it and I'm like, and then we'll then we can look at your blood work. But this number, I'm like, doesn't matter. It's like we're not gonna treat this number and start you on hormone based on how you're feeling. I have so many people that don't even know how bad they feel because they felt bad for so long that they don't truly know what it means to feel good. So when I'm asking them to really keep track of how they're feeling and come back with some data, they're like so confused. They're like, So should I do blood work before I come back? I'm like, forget the blood work. I don't want to see any of your blood work. It's very hard to get people off that hill. They were like, but should we check? And I'm like, for what? How do you feel? And they're like, If you can't tell me how you feel, I don't care what the blood work says because I'm gonna say, Yeah, your blood work looks great. Do you feel great? And they're gonna be like, Well no, all right, then that was a waste of time, right? They just so badly want to impress you with their blood work and be like, Am I okay? I think that comes from the way they used to do medicine, and the doctor always knew best, and your provider was always like, Oh, it's like homework, they want to bring it to you. Did I do a good job? And I'm like, No, you didn't. How do you feel? Do you sleep good? Do you have a good relationship with your family? Are you getting outside? Do you feel connected? You're not passing.

SPEAKER_01 5:42

So if we were to just back up with your approach to somebody, obviously your approach is symptomatic. That's the first line. But yeah, what are some of the things that you would see that is either a common thread with women that are experiencing this? And is there an age that we're

Perimenopause Versus Menopause Explained

SPEAKER_01 6:00

even talking about, which is really two questions I'm asking you.

SPEAKER_00 6:02

Yeah. So I do think there's a large population of people and even healthcare providers that don't even realize paramists, right? So we're all menopause. Menopause is just one date. It's one date, it's been one year since you've had any menstrual bleeding. That's it. One day. That's all. Paramenopause is everyone.

SPEAKER_01 6:18

Hold on, stop right there, because I've been in this world a long time, and what you just said is a new way to frame that for me. So you're telling me peramenopause is one date. So perimenopause is everything leading up to menopause.

SPEAKER_00 6:33

One date. Yeah, it's just one date, right? It's just that one year anniversary that says I have gone one year without menstrual bleeding. I'm officially a menopause woman. That's it, that's menopause. But what about everything before and after, right? We talk about menopause, it's just one thing. So perimenopause is everything before that, and then postmenopause is everything after that. I've never thought of it that way. Yeah, but weird perspective, right? Well, and yes, everything leading up to it is hard. So we're not recognizing, or at least we didn't, we're getting better, but still we're not recognizing perimenopause. That is definitely the harder issue there. And the question is, when does it start? It's different. Average age of menopause in the US is 51. So it could be 10 years before, could be 20 years before. I have women that are in their late 30s that for sure have all of the symptoms of perimenopause, and I treat them based on symptoms. What's interesting now is we're getting a lot of data from like app tracking. So people track their cycles, right, with all these different app technologies and they put all their symptoms in, and it's collecting that data and showing us a trend that perimenopause is starting basically this 35 and up is really where we're seeing a lot of it. So from 35 to 51, that's a long time to live in limbo and not feeling like yourself and hormone fluctuations. Crystal, just so you know, I'm 36.

SPEAKER_02 7:51

Oh, how old are you? I'm 36.

SPEAKER_00 7:53

And when you guys all start talking about like menopause hitting it, you're 35 and up, I'm just like, do do do do do you consider yourself lucky because now you know, and now you're like, okay, I'm not too young for this because that is an age-old thing, right? It's like you're too young, you're too young, you're too young. And I don't think I would have ever thought perimenopause in your 30s, right? I just turned 35 this month, so I'm right there with you. And if someone said to me, Oh, but you're probably perimenopausal, I'd be like, Are you not? Perimenopause is my. You're only 35 and you're treating menopause. I know. Also interesting, right? People always ask me, What how and why are you in a space that you haven't even been to yet? And I'm like, Thank god I am, because I can't wait till the day I'm perimenopausal and menopausal because I know what to do, and I'm so excited for that. But it just came from I worked in gynecology as a background, which was very new to me. Like Jess said, my background was emergency medicine, cardiac cath lab, not women's health at all, not even close. But when I was in NP school, you have to do a little bit of everything for a family nurse practitioner, and I had to do women's health rotation, and it was just like that before I was like, no, no, no, I have to do this, and I unexpectedly fell in love with it. So much so that I traded in my orthopedic trauma rotation where you have to pick what one you wanted to do, right? There's the modules you had to do, and then there's like what did you want to do? And I was gonna do an orthopedic trauma rotation because that's what I wanted to do. I traded that in and did women's health for a second time because I was like, Am I is this real? Do I really enjoy this? And I did. I loved it. So I fell in love with that. And then with gynecology comes hormones. And every woman that I saw, I see say 20 patients a day, more than half of them were either perimenopausal, post-menopausal, and didn't feel like themselves. They all had the same complaints. I can't sleep, I'm irritable. I hate my husband, but I really love him. He's a great guy. He's done nothing wrong to me. I love him, but I can't stand him. I don't have any patience with my kids. They drive me nuts. I'm gaining weight, I'm losing my hair, I feel this, I feel that way. And you're just like, okay, what do all these things mean? And after a while, you kind of realize everyone's saying the same thing, but no one's really doing anything about it. And it felt super uncomfortable to not have the answers and just to be like, oh, like oh, it's life or it's stress or it's your kids, or oh, it's probably that new job, or your mom's not well, or all that stuff. And after a while, you're like, is this really it? Am I gonna do this for the next 30 years? Am I gonna say this to people for the next 30 years? It is what it is. I'm like, I'm so sick of this answer. I'm either need to figure out the answer or I need to move careers. Like, I'm not gonna do women's health anymore because I don't have the answers for these people, and that drives me nuts. Not that I have to know everything all the time, but I like to have a good answer, right? At least pinpoint someone in the right direction if I don't know what the answer is. So I kind of went on my own rabbit hole of HRT because I asked some of the other providers that I worked with, and these providers have been doing this a long time, longer than I've been alive, really long time, really well respected in their practices. These people, their kids have seen them. It's grandmother's mother's kids. This one OB has been there so long. He's seen three or four generations of women. And I kind of asked them about like, do you guys do hormonal therapy for menopause and blah blah blah? And they were like, Oh no, it's not worth it, not worth the risk. It's just menopause, it won't last forever. The one provider for the me, I can count on one hand how many women I've ever put on HRT in my entire career. She's been doing this for so long that a wait list to see her is over a year. If you call for an appointment today, it will take a year. People love her, she's lovely. But I was like, what? So then I was like, Oh god, I can't be doing HRT. Clearly, this is a danger. Clearly, there's a reason no one's doing this, but it's not what I was finding, not in the data, not in the research, not in the papers I was reading, not in the books that I was reading, not in the podcast that I was listening to. And I'm like, I'm so confused. And if I'm in medicine and this is my background and I can't figure out what the hell is going on, how's anybody else supposed to figure out what's going on and who to trust? So then I just became obsessed with it. I was like morning, noon, and night, like listening to it in my car when I was going to sleep, when I was in the shower, it just obsessed. And I was like, wait, we've got it wrong. We've got this wrong. This doesn't make any sense. The FDA got this wrong. They're hurting women, no one's helping them, no one's owning this space. In G U A M. We would say, see your endocrinologist, your endocrinologist would say, see your G Y N. Then they'd send you to your primary, then they'd send you to a psychiatrist. Nobody would take accountability for it. We all kind of just like push them around because we didn't really know what to do about it. And that's when I was like, wait a minute, this is so wrong. There are so many women that need help. And you can't tell me with all of the medications that we prescribe people blindly, birth control, prozac, lexapro, that HRT is really all that bad. And I don't sit down with those people and have a 30-minute conversation of, oh, do you know the risks? And oh, do you know that? No, you write the prescription and tell them they're gonna feel better and they trust you, and that's it.

SPEAKER_02 12:14

And so don't even get into the vaccine space either.

SPEAKER_00 12:18

I was like, wait a minute. And my thing is to always, whether I agree with something or disagree with something, that's not my job in medicine. My job is to bring you the actual science, and then you make a decision. And it's your decision, whether the risks or benefits are higher or lower, it's gonna be different with every patient. It's your life. You only get to live it once. And if you feel better doing something or you want to try something, and I know it's not going to kill you, you're allowed to do that. It's not, I don't get to make that decision for you. We're not the gatekeepers. We are in a way, because hormones are a prescription. You can't have it unless they write you a prescription, but it shouldn't be looked at that way.

SPEAKER_01 12:50

There's so many unbelievable things that you just said in that it's hard to even pull just one thing out because every time you that you're like mic drop. Oh, wait, let me drop that again. Oh, so good. I want to just back up to the age thing for one quick second and then address some of those things, though, because I was such a 36 year just turned 35. You just had a baby. So I think when we're talking about the age with women that are entering the age of peramenopause, we're seeing women that are having babies later in life. It used to be like early, late teens, early 20s, and then it was kind of mid-20s to late 20s. And now we're seeing like mid-30s even older that are having first babies, not even just second, third, or more babies. So to consider that a woman is in perimenopause at that age when we're still seeing so many that are in childbearing years, it's really hard to wrap your head around that it isn't life that is creating those things because let's face it, stress does play a role in all of those things as well. But that perimenopause could be at play.

SPEAKER_00 13:54

Overlapping. So a lot of patients who are like perimenopausal and they're postpartum and they're perimenopausal. And it takes a couple of years for them to realize. I always say, I'm like, there's two different parts of perimenopause. There's early perimenopause where you have some vague symptoms, but periods are the same, your cycle doesn't remiss as a beat. So we really don't think hormones. And then there's late perimenopause where once the periods start getting weird, you're like, wait, did I miss my period? Oh, I came early. Oh, it was 10 days. Oh, it's three days. Then we start to be like, oh, it's my hormones. But in that early perimenopause phase, women are really not being like, oh, it's my hormones. It's my kids make me crazy. I work too much, I don't sleep enough at night, etc. But really, a lot of those symptoms are going to be perimenopause. And I would argue that a lot of anxiety, not sleeping, that's so easy to be like, it's life, it's stress, it's hard to pinpoint hormones, but a lot of times it can be hormone-only based.

SPEAKER_02 14:39

As we're talking with age, let's just reiterate the one fact that you've said, because I've never heard it said this plainly. And Crystal, I've podcasted over a thousand episodes. So the fact that you said it this plainly, menopause is a day event. Okay.

SPEAKER_00 14:58

So you're very menopause period for an entire 12-month process.

SPEAKER_02 15:03

That day where the 12 months hit, that's menopause.

SPEAKER_01 15:07

Now what? Now next day you're post-menopause. Yeah, yeah. I also think you need to coin a term for early menopause. You need to, we need to come up with a name for that because it's like there's a fourth stage.

SPEAKER_00 15:22

I've heard people call it cougar puberty, which is pretty funny. But it's medically, I don't know if that fits, but that's a pretty good one. I've heard that on social media is good and bad, and they've really had a field day with this whole menopause movement, as we're calling it. Some of the key providers and founders that I think have really pushed is called themselves the menopause, which is also pretty funny. So the phrases are out there, believe me.

SPEAKER_02 15:44

There's one thing is the menopause date thing. We got the pre, we got the post, we got all the stages

Prevention Benefits And Smarter Testing

SPEAKER_02 15:50

in between. You and I are at the point where it's yeah, it's on the horizon, and we know what's coming. We know how to help it, and we know HRT can help it. Before we get into the HRT, I want to back up and have you explain a little bit about the labs because women don't understand how much your hormones fluctuate, and how those, like you reiterated in the beginning, labs are almost irrelevant when it comes to your hormones. Because I ran I run labs all the time. I'm known for that. And I people are like, Well, hormones do you want me to run them? Like, you can run them, these are the ones you want to run, but they're not gonna give us anything.

SPEAKER_00 16:24

Yeah, exactly. And I still have some patients that are like they just need to see the numbers. And I say to them, that's fine. As long as you understand why we're not gonna assign you that number and why that number doesn't really matter, I'm fine with that. But it's always we need to have the conversation of why I don't care. And some people, I think it I've seen it all the time, the arguments back and forth on social media of my provider didn't even call draw labs and blah blah blah. They almost feel like it's medical malpractice because someone's not checking their labs. And I'm like, it's just because that you want the lab work to show you something that we can't prove on paper, and that's what's weird because modern modern medicine operates in the we'll show you in your lab work or your diagnostics what's wrong, and then we'll fix it. Oh, your thyroid's off, we're gonna fix it. Look, better, huh? Your cholesterol better, we fixed it. And hormones just don't operate that way. I've seen hormone channels that are beautiful on paper, perfect, beautiful. The patient doesn't feel beautiful, so it doesn't really matter. And that's where I tell people I'm like, you really need to trust your yourself. And in perimenopause, you have such high fluctuations that it's a moving target. So we're gonna do a disservice by trying to chase that. You'll be high estrogen one week, you'll be low the next week. So we'll be constantly doing dose changes, which is not gonna help anybody. In postmenopause, I do labs sometimes because we're looking for maybe some numbers for prevention, right? Because HRT largely I always tell patients you're gonna come to me for the symptoms, but I hope that you stay for the prevention. Most people aren't even thinking prevention, they can't even see that far down the road. They're like, I can't sleep, I have hot flashes, I'm achy, I'm gaining weight, I'm losing my hair, I hate my husband, I have no libido. That's where they're focusing on. Then we get those things better, and then do I have to take these forever? And I'm like, yes, so no, it's a personal choice. I hope you do, and let's talk a little bit about why I hope you do, right? Let's talk about dementia Alzheimer's, let's talk about cardiovascular disease and heart disease, still the number one killer of women. Let's talk about insulin resistance, let's talk about bone health, let's talk about osteoporosis, osteopenia. And then once we kind of talk about those things, they're like, oh, we can prevent a lot of these things, but we don't operate in a prevention medicine standpoint. Most people don't even know that actually estrogen has an FDA approval for the prevention of osteoporosis. Has anybody ever been prescribed estrogen for the prevention of osteoporosis before recently? No, never. Do you know how many high-dose, high-cost injectables that they try to put patients on in IV infusions for osteoporosis? Tons. So the prevention is really a key component. And for that, I do will do some blood work post-menopaulant to make sure that estrogen is getting absorbed. We want to see those numbers like going up progesterone as well, and then testosterone. Testosterone is a steady state that does not fluctuate with cycles. So we will kind of keep an eye on that with labs. So yes, they can be useful, but they're not as useful as we would like them to be.

SPEAKER_01 18:56

Well, preventive medicine isn't profitable. Of course, that's the same thing with us with all our peptide work. We get people that are feeling where are they going to make their money? Exactly. So of course there's going to be pushback on all of these things because there's not many

Hysterectomy IUD And Missing Period Clues

SPEAKER_01 19:10

people that are out there at all aspects of healthcare are not making the money if we're making people feel better because we're being preventative in the approach to how we care for people. That's wild. What about women like myself that are not? I had a hysterectomy, right? Right. So with having this mind for me, this mind-blowing moment of what menopause actually is one day. So I was thrown into menopause. My date is my surgery date, essentially. And then from that day forward, I'm now post-menopausal.

SPEAKER_00 19:42

It depends. So if your hysterectomy, if they just take your uterus and they leave your ovaries behind, then you're not technically thrown into surgical menopause. The thought of leaving the ovary or at least one behind is to spare some of the hormones, since that's where the hormones are made. However, fun fact women who have a hysterectomy will end up going through an earlier menopause. They actually don't have clear data on why it happens, but the theory is blood flow. There's a huge uterine artery that goes from the uterus to the ovary. And when that is no longer there, communication is no longer between the uterus and the ovary. That ovary does seem to decline a little bit quicker. So women that do have any type of surgery, including hysterectomy, tend to go through an earlier menopause, which they don't tell a lot of women, which is frustrating because they will feel like they have symptoms of menopause, and their doctors will be like, I left your ovary, you're fine, you still have your hormones, you're too young, you're 42. That's not it. I actually have a patient that I see now who's in her 40s. She had a hysterectomy at 27 who talking to her, she has been symptomatic probably now for years, like a long time. And I told her that, and she's but they left an ovary, so nobody told me. And I'm like, they never do. It's very frustrating. So this is where it's frustrating about how am I in menopause and how do I know if I don't have a bleeding profile? Whether you've had a hysterectomy, you have an IUD, you had an ablasion, etc. That's still the gold standard. That's still how they want to mark the menopause, but you can do some lab work, right? And get some different hormonal panels there to confirm that we're menopausal. Bleeding profile is not the only way to go, and we can't use that in everybody, but it is still the gold standard that they like to use. Interesting. Very okay. If all is so clear cut in every situation, yeah, I know. Nothing in hormones is clear-cut. I always tell people you gotta be real comfortable in operating in the gray space and be really comfortable with learning a new symptom every day or somebody experiencing something you've never seen before every day. You're just going to be in the unknown and uncomfortable every day. And I think that's hard for most people to operate. There's days still where I'm like, I've never seen that happen before, but I believe you because hormones are crazy, and I 100% believe this is happening to you. Never heard of it, never seen it. Doesn't make it not real. So, as providers, I think that's a weird space to be in to be like, hmm, I don't know what that is, but let's take a deep dive and kind of like backtrack and go over everything here and see if we can get a better idea of what might be happening.

SPEAKER_01 21:52

I had a doctor years ago, a specialist who said to me once, he's my favorite doctor. Any doctor that walks in and says to you, I know what wrong with you and I know how to treat it and it is so black and white end of story and then walks out of the room is not your doctor. You need to run. Now yes there are is there are cases obviously that we have we want somebody to give us that a serious diagnosis something going on and we want that. But largely in my case we didn't know what was going on back then and he just put it I'm a detective I'm trying to put all the clues that you're giving me together to create what is your body's needs and where it's going and what its needs which is exactly what you're doing.

SPEAKER_02 22:32

You are crystal harder perfect bridge into HRT.

SPEAKER_01 22:36

Good job, Jeff Yeah it's it is I am Crystal Harder nurse

HRT Takes Finesse And Iteration

SPEAKER_01 22:40

practitioner specializes in detective HRT work.

SPEAKER_00 22:43

Like yeah that's you detective should be part of your and I and it's I tell patients that too because it's confusing. I think that if we're a patient and you go to someone because they're an expert and you feel a certain way, you expect them to fix you. And I have a lot of women that come to me and they're like I came to you because my sister's on HRT or my mom and they said they should have never waited and they've never felt better. And I'm like that's great and I hope that for you too however everyone's journey is very different and very unique. There are some patients I start them on what I think is the right thing the first two things I try beautiful never have to change anything perfect. Never felt better and there are people we have tried every estradiol on the market every route every dose we have tried daily administrations twice weekly administrations we've taken this progesterone in progesterone out added testosterone and it takes six months until we're like all right I think we're in a good place. You feel good all right there's no negatives I'm always like I want it's not perfect. I want 70% better of the symptoms you come to me with and sometimes we can get all of them and but sometimes we have to like trade some for the other I hate that but are like all right so we got seven out of eight of them this this last one is still we can't quite get it under control but all right we got seven out of eight we don't have any negatives and the overall feel better. Sometimes that's a conversation but I'm always down for a trial and I think patients sometimes I always think do they think I don't know what I'm doing so I'm like let's try this let's try that and I think sometimes it seems like I'm just making things up but trial and error is huge in HRT because like I said I could not tell you I'm going to give you this dose of estrogen and this is how you're gonna feel I have no freaking idea. You might feel fabulous you might feel worse you might get anxiety you might be moody you might get the best sleep of your life it's that crazy. Everyone has such a different journey and I warn people of that I'm like it's not the same as your sisters or your moms or your friends. I hope it is I'm gonna have some patients that get really discouraged they're like I started this to feel better and I feel worse and they do feel worse for a couple weeks or a couple months and I just promise them to hang in there with me and we will usually get to a better place but it can take a lot of trial and error and I always just hope that they don't think I'm like does she know what she's doing why are we just trying things I'm like because people like should I try this I'm like how are we gonna know let's try we don't have to stick with it let's try it let's see how it feels let's try it on it's like clothes you go to the store and you try them on right sometimes you you think it'll fit the two things you got when you're remodeling your house gets worse before it gets better.

SPEAKER_02 25:02

Yes same thing and second asks us all the time do you treat this?

SPEAKER_00 25:07

Will this work for that I'm like I don't know try what do you got to lose I don't know and I think that's a conversation that normally when you go to the doctor they don't have they just write you a prescription and that's it. And I'm like I have no idea how and I'm very honest with that I'm very transparent. I'm like I don't really know how this is gonna go but this is what my gut is telling me or my expertise is telling me or I've seen this before and this is what I tried and it worked for that patient. Let's see how it goes for you. Or even sometimes if I'm like stuck at a fork in the road I'll say the patient what's the overwrite to you what is your gut telling you and they're like I feel like this I'm like then we should go with that. You know yourself best I don't know you any you know yourself best. I might be the expert in hormones but I don't know you I don't live in your body so we should do it with one thing.

SPEAKER_01 25:46

This is the most incredible approach to medicine. It's kind of how I talk to people about peptides too first of all I think that hormones should be optimized. We can optimize peptides too but it's the same thing there's no two bodies are going to respond exactly the same to the same doses to the same path and it's just having this open mind to okay we're gonna see what is your sweet spot because your sweet spot is not the same as your sister's sweet spot.

SPEAKER_00 26:10

So it kind of gives the power back to the patient which I think they're not used to they're used to the doctor saying this is what you have to do your cholesterol is high you need this your blood is hot you need this come back in six weeks. I'm like what do you want to do? What do you think? Or sometimes we can't pinpoint a symptom I'm like all right we have you're not sleeping and you don't have a libido. If you had to pick one tomorrow that was gone. Which one is it? And then they tell me I'm like that's the priority we're gonna work on that one and then we'll come back to the second one. But they're not used to having the power I'm like what do you want to do? They're like well what do you think I'm like what do you think? And they're like oh I'm like you're powerful you have to listen to your body we're so used to just telling having other people tell us what to do in medicine that we haven't learned how to trust our instinct and our intuition and have a voice and women are really finding it now which is fantastic but also not fantastic because there's shortages everywhere now because everyone's on HRT which is the best thing ever but it's a little bit tricky with that HRT for everybody but we need some more manufacturing that is true.

SPEAKER_01 27:02

We I think that that's one of my goals for this podcast and my social media platform and everything I do is to give everybody a voice to be their own advocate for these conversations about their own body. I want to ask our somebody we're doing our job so real quick men. Now you and I have a case that we have been doing together because I know men is not right now your primary focus. Women are that's where you've been but you have a strong interest in that but while we're getting really loud about women's needs there's this men's needs going on in the background I think we are quick to give a man a little blue pill so that they can get erections because we seem to only care about them and their sexual performance and I understand that for for men it's a little bit different when we're talking about that they have a physial thing that will then will start playing with their mind and they're not a man and there's all these other things that go along with it. But men have changes too and we joke about it manopause but I think what do you think about that space real quick?

SPEAKER_00 28:06

Yeah so I think that we think it's easier for men to get what they need but that's not necessarily true. Is it better than the women's hormone space? Yes but does it still suck over there? Yes. I think that they're not really listening to men low testosterone is real. They again will draw that and be like it's in range okay 200 to 900 and this happens to the women they're like oh it's 208 you're normal.

SPEAKER_02 28:24

I'd like it to be 800 I feel a lot freaking better than you have a lot of a testosterone of a 207.

SPEAKER_00 28:30

Yeah I'm like so that's annoying I'm like yes it's in range we gotta give them these stupid ranges so that's frustrating and my thing is if it was a woman I'd supplement her anyway all my women a lot of them have testosterone in a normal range and I'm still supplementing it to be at a higher range. So it's not great for men. And yes they have a little blue pill for men so they can physically perform but they don't treat the mood a lot and there's a lot of mental components for men as well. Actually I was just thinking about this the other day because I was listening to a podcast and there's actually two medications on the market now for women for low libido which is a mood right but for men there actually is nothing on the market for low libido right they don't have anything to treat libido which is a mood issue right so that's interesting. I'm like you're right they don't they can give them all the Viagra but if they don't want to perform or they don't want to be intimate that sucks they're not treating that or addressing that they just assume men if the physical organ works they're good to go. So that can be really frustrating. So it's not better there. And my thing is always I kind of want to look at I want to treat the couple so I see a lot of women who have really low veto and they feel bad because their husbands are just like they love them but they just don't want that physical connection anymore. And their husbands do but then their husbands have a little bit of maybe low T or they don't have the energy or the drive or the muscle mass that they used to and so they've always said will you see my husband and I'm like you know what I want to eventually because I want to treat the couple if I'm making you feel your best now I want your husband to match that energy so that you guys can be on the same page because I feel like one always gets help and not the other and I think we're so used to being like men get all the help but women don't which is kind of true. I think there's a statistic that's I think the population of men in America is like 90% are like heterosexual. So then I'm always like who are they sleeping with? Because no one's helping the women we're all going through menopause. We don't have a libido we have vaginal dryness we have pain with intercourse and now all the men are getting help who are they being intimate with because the women are broken right they're broken. So I would like to look at it as a whole my comfort is just women because that's what I've done and I think that women are kind of get the short end of the stick in healthcare because everything's been based around men. So not that I'm biased but I would like to help them eventually they're on my radar we have something that helps men.

SPEAKER_01 30:30

We have a podcast I should give that to you crystal so you can listen to because we had a couple that was on and they were talking about one of the peptide products that we have with our telemedicine company. It does have tadalophil in it it has oxytocin in it but it also has PT141 and that combination is and it's for men and for women and the dosing and what their sweet spots is like everything else is a little bit different. But it is hitting is it's hitting that I want to so it's the drive that it's hitting so it's impacting the mood it's the tab is impacting the actual physical response and same with 141 that's getting that to that peptide. So that's a really I'll have to I'll share that with you when we're and for anybody that is listening to this go back and look at Kylie you might remember the episode number but it's the interview that we do with Angela and Stig where they talk about their experience with that particular compound.

SPEAKER_02 31:30

I'll pull it up I'm pretty sure it's one of the number I'm thinking but let me pull it up just to make sure we can reference that. But yeah it's you know the funny thing is when we were at the conference

Men’s Hormones Libido And Couple Care

SPEAKER_02 31:40

I've never met Angela and Stig in person. They have known them for years but I've never met them in person and I'm standing there talking to someone and someone comes up to me and taps on my shoulder and says hey I'm looking for some PT141 do you know where I can get that Steag and I was like it's fun to see people when you haven't never seen them in person.

SPEAKER_00 32:01

And honestly I think it's so for me I'll I see all women right and they're so cute they want to help their husbands so they're always like will you see my husband will you see my husband because let's be real men are real quick they'll order something offline they don't know what it is they'll try it. Women are I think we're a little bit smarter than that. We're like I should probably see someone about this and so that's where I see the men's side as the women wanting to help their husbands which I think is adorable. So I'm like if I ever do men's health I think it would be like a that scenario I'd see the spouses of my women clients just to like keep it in the family. But yeah it's not great for them either. So they definitely it's better but not it's not great.

SPEAKER_01 32:33

It's a communication thing too men don't like to talk about it. It's very uncomfortable for them. They're not typically known to be good communicators in general and so when we're talking about a tough subject like this I think that just complicates first them going out to seek help and then second being comfortable enough to really lay out all the things that is in their head but they're embarrassed to say what's what might actually be happening.

SPEAKER_00 32:58

I'd start to see and I think it would happen with men before it would for women but low testosterone in men again a lot of disease linked to that right heart disease and diabetes and then also a lot of depression suicide things related to low testosterone in men I'd like for them to start doing screening testosterone levels on men. Like when they go to their primary at age 40 and they run tests like do testosterone in everybody I think some people are but a lot of people aren't and then understanding what does low T really translate into for prevention standpoint if it's ever going to happen where they're looking at hormones for prevention I think it would happen with men first. But they I don't think they realize outside of the sexual side effects that low testosterone has in their health overall they're kind of even saying like erections in men are probably the best indicator of their cardiovascular health than anything else. And so when those start to change and are different we should be looking at that and I know that's not what we're using as standard of care. So that's been interesting. And I like I said when men and their erections aren't where they want them to be people are going to listen right so I think it will start there and I hope that hormone standpoint will transition to women that we should be looking at this at a bigger picture. They're not just reproductive or sexual organs people are living longer than ever and if we're gonna live 40 years without our ovarian function what does that mean for us? This is a kind of a new space people haven't lived this long before and haven't lived well. As we say live longer better that's what we do. That's what we're here to help people do live longer better.

SPEAKER_02 34:18

Because what's the point if you're not doing it well right at episodes number 18 reigniting sexual desire at any age with Dr. Angela and Steve Graham and it was one of the it's one of my the best podcast episodes I've ever recorded so go back and listen to it. Number 18 those February episodes were all about sexual health and sexual wellness and I love that we continually come back to this because it's something that just gets hushed under the rug and on both sides men and women when it comes to testosterone I would love to see them break testosterone up as age groups like this is the healthy range for 20 year olds for 30 year olds for 40 year olds and because it's so different you're not you're saying 200 to 900 for every range every age it's crazy to me that we're treated like that.

SPEAKER_00 35:07

But we do 100% I agree with you definitely and testosterone and women they don't even they don't talk about it they don't look at it there are people who like actually I have patients that I talk about testosterone and like wait I have testosterone I'm like yes let me be the first to tell you that yes you do and it's important. So yeah testosterone just really gets kind of thrown under the rug with women I think that people don't know a that we have it what it does and what the benefit of not having it or not having it does and they don't know how to treat it. That's the hard part because testosterone is a controlled substance right in every state in New York as well it's a control to class two so it's in that same category as morphine and diluted and which is crazy. So it's controlled people uncomfortable why is that why is it in that same category largely came back because it was abused in the 1980s of the Olympics so it was like a very abused drug. So they put it on that list and it hasn't come off so it's uncomfortable as a provider because you have to write for a controlled substance you have to have a special license to the DEA to do it which not every provider does most do but not everyone does. And then from state to state the rules vary. So that that throws people off it's just an easy excuse for doctors to be like nope you don't need it not important because they don't know how to write for it. And then the next problem is there's not an FDA approved testosterone on the market for women right so now you're like you get through those two barriers and they're like all right we're gonna send your prescription to CVS no you're not because it doesn't exist there. They don't have it so now you have to go to a compounding pharmacy. It's a specialty pharmacy that's different for a provider if you've never done that before you have to know what dose you're looking for and how to prescribe it. And now it costs the patient money insurance is not going to cover it. So there's so many barriers for women to get testosterone it's just unbelievable.

SPEAKER_01 36:42

As you're saying that I'm realizing how lucky I am to have you I genuinely am like I am so lucky that I have you in my world to help me with all of these things because not everybody has this access.

SPEAKER_00 36:55

Yeah it gets complicated and access is huge. I was just on the phone before with a patient who didn't have an appointment today but she texted me this morning and said I don't feel right something just feels off for a little while now and I said let's chat do you have time for a phone call and I called her and we talked on the phone. She didn't have an appointment I didn't charge her for that but I'm her provider I'm her prescriber and I always tell my women if you don't feel right something doesn't seem right you get nervous about a symptom or a side effect don't Google it. Don't chat GPT it call me text me and I always say HRT is not about the prescription anyone can write something on pieces of paper and hand it to someone that's not hard. You have to have the license to do it but that's not hard. The hard part is the management being there for the patient access and that's huge. I tell people like you don't have to call the call center you don't have to leave a message I'm not gonna call you back. Just text me. You have my phone number and every single patient of mine does for that reason. And I think that's where women get lost on the HRT train sometimes is the management and the follow-up it really does need to do better in a small intimate space because things just kind of and some women will do great some women don't need that hand holding like I said they'll whatever we give them they're gonna do great on it and they're gonna be fine but the some nuances a lot of finesse those women fall through cracks and I have so many people that come to me and said I tried HRT it didn't work for me and I'm like what kind of HRT that's a really broad statement. Was it oral was it transdermal was it injectable was it biodental was it synthetic was it and they're like oh I don't know I'm like all right I'm like there's 1700 different options we can try. So that's the nuances with HRT and I always tell patients I'm like make sure you're going to someone who has a little bit of background on it and they know how to go through the how to manage the hard parts because that's where it gets weird with HRT is do they know how to manage the bleeding or when you have depressive thoughts or you need someone who knows how to navigate that not be like you tried HRT didn't work for you too bad.

SPEAKER_02 38:38

I feel like they're the exact same thing. Yeah people have they're trying to do this DIY style their pharmacy in their own kitchen that's crazy bizarre to me that somebody would do that. But yeah it's like let's start it and then let's have some assistance with the follow-up guidance guidance is everything.

SPEAKER_00 38:57

And I say this to women I understand how you got here because you were so desperate and people didn't listen to you. And the thing I think the same with peptides is conventional medicine is not working for them. They're not getting the answers they need people aren't listening to them and they're like I'm gonna figure this out on my own which I'm like I love that I see people being like I'm not taking no for an answer I'm gonna figure this out on my own but I'm like figure it out on your own have that drive to be like I need someone who listens to me but then someone who has a little bit of educational background that can guide you in the right direction I think is huge.

SPEAKER_02 39:25

Especially with the dosing yeah that's where you can't DIY this stuff. That's where people are you're seeing all these side effects when people are like oh HRT didn't work or peptides didn't work for me or that I have super bad negative side effects my first thought is what was your dose yep that's usually the problem. So very similar space here.

SPEAKER_00 39:44

100% I see women that come to me all the time with some HRT options where I'm like that seems kind of high. Did you have any of these symptoms and they're like yeah I'm like yeah I'm a very start low and slow and I'm more than happy to go up. I'm not afraid of estrogen we're gonna we're gonna go up but everybody starts at a pretty low dose and then we kind of work our way up work our way up because once you overshoot the mark it's really hard to go back but it's much easier to gradually get up to it. So I always tell people like it's worth the wait. You don't want to overshoot that mark seen with peptides and send it a little too hard and then have to deal with all the negatives and then you're gonna scare yourself. You're gonna make it didn't work

HRT Risk Myths And Finding Help

SPEAKER_00 40:15

I didn't like it. It was eh but it's really just poor management and protocols and dosing.

SPEAKER_01 40:19

Before we wrap up because I know we've gone really long here but I just want to ask you one more question because you just alluded to it there's a lot of people that have got a lot of misinformation when it comes to HRT and that they are automatically assumed that they've had breast cancer or they've had certain preconditions that have that rule them out or we've been scared into thinking that this is a really unsafe journey to go down. So what do you think about that?

SPEAKER_00 40:44

Yes so every patient I tell them they're gonna put a broad statement on risk factors what they don't do is individualize what that risk factor is to every single patient. Are you 40 or are you 80? Do you have X, Y, and Z medical condition or do you not? What is your family history? Did your mom have breast cancer and it was just environmental or was there a real gene there or a genetic mutation we can test for are you a carrier of something a lot of fear not a lot of fact and unfortunately a lot of that is still being continued through medical providers who have failed to update themselves on the current guidelines and the research it's very easy to get stuck doing what you've been doing every day and not learn the new stuff because it's hard believe me it's complicated but I always tell patients I'm like you can't apply one general risk to yourself. Everyone's very individualized and then we have to look at what hormones we're talking about. A lot of this came from a study that used synthetic versions of hormones which is very different than biodentical and that's where people get confused. Biodential is the most molecularly similar to your body's natural hormones so we're gonna say natural hormones. When we use biodentical which is largely what we use in perimenopause and menopause we're just looking to replace natural hormones that your body produced. We're not replacing with synthetics that carry a little bit different risks. I'm a pro for all hormones it's gonna be different for every patient what fits them and why they need certain things but the risk factors are not the same. So you have to be careful about what hormone you're talking about. If your doctor says to you you're not a candidate for HRT, well what one? Maybe you're not a candidate for oral estrogen, but you're a perfect candidate for transnormal estrogen. So we really need to be asking those questions don't let a blanket statement apply to you because you're not the same as everybody else. So I think that's probably the biggest barrier and then now information's easier to get podcasts, books, information online social media is huge. Is there a lot of misinformation yes but if there's a lot of good resources on there as well that's great. You're a great resource so where can they find you? You can find me probably Instagram is my easiest it's crystal harder NP so that's pretty easy otherwise I have a website to l.com and H V is in V is in Victor not V. So Hudson Valley the Hudson Valley Beauty Lab. That's where my office is on a private practice inside of Hudson Valley Beauty Lab and that's where they can find me.

SPEAKER_01 42:55

So my Instagram is my resource for my educational rants and talks and posts I love that one of the things that we are doing with our telemedicine platform is that we are introducing HRT. It is in the very infancy stages it is just beginning on a level for women that are postmenopause. I want to make sure that I am saying that correctly now that I have this word for menopause and postmenopause. So right now we are working with women that are just postmenopause. It will increase to other things and other needs other needs including men and it will include testosterone down the road but there are people that can come see you that are in New York that are I don't even know are you just in New York are you the tri-state area?

SPEAKER_00 43:41

Where are you? Who are you in New York I have licenses in New York New Jersey and Pennsylvania okay but what's complicated is when you start doing controlled substances like testosterone you can do Talahead health but really you have to see the patient in real life once something to keep in mind. So yeah if you're in New Jersey or Pennsylvania I can see you but you do have to make the trip to see me at least once there's some weird laws around that but yes I do telemedic in person.

SPEAKER_01 44:05

So and I think that's what's the delay on our program too is that if you can't get to see Crystal we are developing something Kylie and I can help you get access to that because there's pockets all over the place where there are not people that are even entertaining this conversation so we will be able to help you with that as well so you can see Crystal. If you are in the New York anywhere in New York pretty much you can do that. And then if you are in the tri-state area and commutable to her and you have different needs you can reach out to her but for sure follow her on her Instagram other HRT needs Kylie and I will be able to help you.

SPEAKER_02 44:39

You can find me on my Instagram I am jessb.talkshealth you can also find me on my website at b2bwiths.com you're gonna find me on my website drkylburton.com as well as my brand new program called Amplify this is pep talk peptides unpacked see you next time