Menopause Explained: Hormones, HRT & What Happens to the Body

What happens to the female body during menopause?

In this episode of Health Recoded, I sit down with @SharonLemoine-ARNP to discuss menopause, perimenopause, hormone replacement therapy (HRT), and some of the most common misconceptions surrounding hormone health.

Sharon is the founder of Gig Harbor Medical Spa and Concierge Medicine in Washington State, where she specializes in hormone optimization, menopause care, perimenopause, weight management, functional medicine, peptide therapy, and gut health.

Many women are told that symptoms such as fatigue, weight gain, brain fog, poor sleep, reduced libido, mood changes, and loss of muscle mass are simply a normal part of aging. However, hormonal changes during perimenopause and menopause can have significant effects on multiple systems throughout the body.

In this episode, Sharon explains the physiology of menopause, how hormone levels change during the transition, and what the current evidence says about hormone replacement therapy.

We cover:

- What happens hormonally during perimenopause and menopause
- Hormone replacement therapy (HRT) explained
- Common myths and misconceptions about HRT
- Practical ways to support health during menopause

If you're looking to better understand menopause, hormone replacement therapy, and women's health, this episode provides a science-based and approachable place to start.

Subscribe for more conversations that help you better understand your body and health. New episodes weekly.

Chapters

00:00 Intro
03:39 The differences with faith based healthcare
05:23 How has healthcare failed women in menopause?
07:35 What actually happens during menopause?
10:45 Why Testosterone Matters for Women's Health
13:00 How does HRT help with menopause?
17:19 When to seek care for hormone changes and menopause
29:09 Where to seek support for hormone changes
21:20 Common Myths About Hormone Therapy
25:32 How long should HRT last?
26:42 Supportive care for Menopause without HRT
29:01 Benefits and Risks of HRT
30:51 The difference between perimenopause vs menopause
32:52 Testosterone in Women
42:00 How to Support Your Body During Menopause
48:08 Key Takeaways

Transcript

SPEAKER_02 0:00

Welcome to another episode of Hellfree Coded. I'm Alex. I'm your nurse. And today I'm talking with Sharon Lemoyne, ARNP. Sharon works in Washington State and is the founder of Gig Harbor Medical Spa and Concierge Medicine. And she works with those going through menopause, perimenopause, hormone changes in general. And we're going to discuss HRT and some of the misconceptions and myths surrounding those topics. Let's dig in. Okay. Well, welcome. I'm excited to talk today. I think I'm going to learn a lot from you. I'm excited. Yeah. Um so just start off by telling me more about you. I was talking a little bit about what I've done, but your background and also who you work with and just a general understanding of that.

SPEAKER_01 0:46

Yeah, so um, as you know, my name's Sharon Lemoyne. I am a nurse practitioner. I was actually a bedside nurse for, oh goodness, 16, 17 years, mostly in emergency medicine, critical care, IV access, and really kind of had plateaued in my career and knew I wanted to do more. So I went back and got my master's uh while my kids were teenagers. So that was an interesting time. And while I was in perimenopause. So you take the hormones, teenagers, and full-time work and full-time school. That was um, yeah, by the grace of God, I got through that. So uh really went back with the intention of being a provider in emergency medicine because I truly loved that. And I was hired in a with a medical group uh here in Tacoma, Washington. Uh thrived, loved it. And in the state of Washington, nurse practitioners can work independently. And so I thought, oh shoot, you know, I'm gonna take advantage of the scope that I can work in. And I opened up a little aesthetic business on the side and I dabbled with, you know, Botox and fillers, and um, it was a great skill set to learn, but I quickly realized my passion was health and wellness. And as that side business grew, I really gravitated towards um, you know, health wellness. And, you know, backstory is I am a type one diabetic, and so it is so important for me to um let my patients know that they really are in control of their health and living with something like type one diabetes that you can't reverse. I work very hard to stay healthy and trying to uh advocate for my patients that there are so many things they can actually prevent and so many things they can actually reverse. So that really has been a driving force for me personally and has really helped me professionally. And so now our practice has grown. It is myself and another nurse practitioner as the providers. We have a full staff and we have full primary care. We specialize in hormone therapy, perimenopause, menopause education, weight loss, doing it the right way. Where we have a very strict program that I'm very proud of using GLP1s, but uh doing it under a strict medical guidance, and we've had a lot of success with our patients. And of course, then dabbling in peptides. So, really uh very, very blessed to be in this space. And first and foremost, my practice is known as a faith-based practice, and so I think that's really, as we discussed, um desired by our patients, very much needed, and and it is providers. It keeps us on track to make sure we're doing the work we're meant to do.

SPEAKER_02 3:39

Yeah, we were talking a bit about um how there's so much of a difference between faith-based practice and then when corporate healthcare takes over, it really changes it.

SPEAKER_01 3:51

Yeah, absolutely.

SPEAKER_02 3:53

What are the differences that you've personally noticed as you've gone more with the faith-based route with how patients approach you or their outcomes?

SPEAKER_01 4:03

You know, it's interesting. You're you're obviously taking a leap of faith as a business owner, as a practitioner, and the world we live in. Um, it is uh there's a lot. There's a lot going on. And so when you put yourself out there, it is a little bit of a vulnerability state to be in. And I have been met with so much appreciation by my patients. It just, you know, I'm dealing with menopausal women, perimenopausal women coming in already feeling defeated by what is going on through their bodies. And to step into a space knowing that our approach is faith-based, it just is like their wall comes down. And you know, they're coming from many, many backgrounds and many beliefs, but it I think really allows them to feel welcomed, non-judged, and in a very safe place to discuss all of their very personal and vulnerable states that they're in. So yeah, it's been wonderful. And you know, as a business owner, I stand very strong in my beliefs, and um yeah, God rewards me for that for sure. So uh yeah, I just I'm very, very blessed in just doing the work I'm supposed to be doing.

SPEAKER_02 5:18

That's always nice to feel aligned.

SPEAKER_01 5:20

Yeah.

SPEAKER_02 5:21

Yeah. Um, one of the things that I've really noticed as I've gotten away from the bedside, I feel like this conversation around menopause has really increased over the past few years. And I feel like with that, it highlights how little education has been provided to medical practitioners about this, because I will admit that even I myself know a limited amount, and I am a woman, and so I can only imagine well, it's more from a personal standpoint for me too, because I am working with it, just like you said, you're working with GOPs. A lot of the people that we're seeing are women that are perimenopause or menopausal or even post that are coming in and saying, I've gained 10 pounds around my abdomen and it is not going anywhere, or I don't feel like myself, or whatever these complaints are. And they've been to a doctor and they kind of get the shrug of like, that's life, that's your body. It's like, that's not acceptable.

SPEAKER_01 6:16

Right. Right. Yeah, no, that's so true. And that's very commonly one of the main reasons women are coming to see me is that weight gain. And these are women that they're they live very strict lifestyles, they're working out, they're doing everything they think they should be doing, watching their diet, um, you know, staying hydrated, taking their supplements. And, you know, quite honestly, we started doing weight loss in our practice. And that's what led me to hormones because I kept hearing the same story over and over. And I'm like, wait a minute, this is a much bigger picture than just gaining a few pounds. And as I shifted my education towards hormones, man, you know, those doors opened, and women are fighting this uphill battle. And and what what is frustrating for me as a provider is these women are coming in again, they feel defeated, defeated, they they keep trying harder and harder, and they aren't offered the true uh you know options for care to deal with that root cause that's causing the weight loss. And so much does focus around hormone imbalances.

SPEAKER_02 7:34

Yeah. Can you speak some about kind of the A and P as to why that's going on before we get into how people can help fix and adjust that?

SPEAKER_01 7:42

Yeah, so generally speaking, you know, kind of the hormone shifts in perimenopause and then of course menopause. Uh, the when we talk about hormones, I always address testosterone, estrogen, and progesterone. And again, coming from emergency medicine like yourself, you know, with your nursing experience, we were not taught hormones and menopause care. So when I am talking with patients, I remind them these were things, even as a provider, I did not realize. When we're talking about testosterone, we make as females 10 times more testosterone than we do estrogen. And it is a big piece of the puzzle. We always assume that's just a male hormone.

SPEAKER_02 8:27

Yeah.

SPEAKER_01 8:28

But when, and in relation to weight gain, as we age, usually when we hit 30, our testosterone is just a very slow decline. There's not huge fluctuations. So we're losing one to four percent of testosterone each year. So by the time you hit 40 or 50, you've had a big significant loss of testosterone production. That is important with weight gain because as you lose testosterone, you're you're you're losing muscle mass. And as we know, must more muscle, higher metabolism, less insulin resistance. So if you're killing yourself in the gym and you're trying to eat right, but you're fighting this declining testosterone, that is a big piece uh that we need to optimize so that you can see the gains in your workouts. You have better endurance, better recovery. You know, the other physiological thing that's happening with low testosterone is there there seems to be a set of symptoms that goes with low testosterone, and then there can be other symptoms that go with low estrogen and progesterone. And the first things we see in perimenopause, 30s, early 40s, is yes, the waking, irritability, anxiety, depression, testosterone, huge piece of our mental health. Uh night sweats, and um uh those, those are the big ones. And then, of course, libido. And so then we're not connecting and our sexual health is going down the drain. So, in the perimenopausal women, when they are coming in with weight gain concerns, first thing we do is a full hormone panel. And usually we'll start with just a sprinkle of testosterone. They don't need a lot, but giving them that replacement allows them to have more motivation to get up in the morning and go for that walk or go do that workout. And then they're gonna have a little bit better endurance and recovery and see some gains quicker than without. And then that just feeds the confidence and the energy levels, and then the health cascade of positive effects that follows is awesome to see.

SPEAKER_02 10:44

That's interesting. I thought it was mostly estrogen changes.

SPEAKER_01 10:48

So in perimenopause, I always say those ovaries are going rogue, and there are such huge fluctuations. And I'm a visual person, so I have these charts in my office so that I can show natural rhythm, natural flow of hormone fluctuations in a pre-menopausal woman. If you fast forward to menopause, those are just flat line. They're easy to treat, they got nothing. I sprinkle them with a little estrogen, testosterone, they just perk right up. Perimenopause is the tricky ones because I equate your ovaries to a car running out of gas. And picture you're just kind of cruising down this nice, beautiful road, and then you kind of putter out.

SPEAKER_02 11:29

Yeah.

SPEAKER_01 11:29

And then you'll cruise and then you kind of peter out. And that's the ovaries over your 40s slowly kind of petering out. So they'll work for a few months and then they kind of go dormant, and then they kick in again and they go dormant. And that's where the fluctuations you'll see changes in menstrual cycles. Lower estrogen can relate to midsection adiposity or weight gain, uh, joint pain, hot flashes, brain fog. Not a lot of people realize with estrogen, it bathes so many different types of cells in our body. Brain cells, hence the brain fog, uh, joints, ligaments, tendons, muscles. We need that estrogen to lubricate those tissues. So I've had women come in and their chief complaint was generalized joint pain. And I give them a little sprinkle of estrogen. Man, they're off to the races, they're doing their walks, they're doing their lifting in the gym. And then the health benefits follow. So uh there are a lot of fluctuations. That perimenopause, man, that is that that phase that can last 10 years before menopause. And uh, like you said, I think we are starting to recognize that more and more and not discount women when they say, I'm fatigued, I'm tired, I feel like I'm crazy, I can't sleep, I love my husband, but there's no libido. It is legitimate, legitimate uh symptoms, and I'm glad to be a part of helping women through that.

SPEAKER_02 13:00

Yeah, for sure. I feel exactly the same way. I didn't realize that perimenopause was such an integral part of it, right? Because you just kind of talk about, oh, it's menopause, you're just getting older. It's like, no, there's a lot more involved than just that. So learning about each piece, and it still seems to be a great area, but learning more about estrogen specifically and how it operates in the female body, and then understanding that it is so protective for our bodies. But with that, adjusting like what you're saying, learning how testosterone affects the female body, because we do not talk about that at all. Yeah. So are so you're essentially saying that when people start going through perimenopause into menopause, that the best thing is to start sprinkling in some hormones, or is that not required?

SPEAKER_01 13:47

You know, I I'm not gonna say 100% this is the recipe because as we know, it's so individual. However, typically in my practice, when I'm seeing those women coming in late 30s, early 40s, they are coming in with all the symptoms. The we do that full comprehensive workup. And you know, some of the symptoms they're coming in the fatigue, uh, can't sleep, you know, is it a cortisol issue? Is it a vitamin deficiency, mainly vitamin D. Good lord, the vitamin D deficiency I'm seeing is crazy.

SPEAKER_02 14:19

Um that's like nationwide, though, right?

SPEAKER_01 14:22

You know, it really is. Of course, I'm in the Pacific Northwest, so we have limited sunshine in the in the in the winter, but I think it's very much a gut issue. The foods that we're eating, that we are have inflammation, we are not absorbing the nutrients that we need. And so even my women coming in on supplementation are deficient, so we really need much more than we think.

SPEAKER_02 14:49

Um, so vitamin D specifically, or just in general, anything?

SPEAKER_01 14:54

Well, vitamin D, I see across the board, major deficiencies. And the the place and the function vitamin D has is pretty incredible. I mean, that's a whole podcast in itself.

SPEAKER_02 15:06

Yeah.

SPEAKER_01 15:06

Uh but when we're looking at these perimenopausal menopausal women coming in, yes, we can certainly start with hormone therapy, but we have to make sure we're not missing the obvious. And so that's why the comp anybody going in should be getting a comprehensive workup. And we don't want to assume it's all hormones. Uh, so we're looking at those vitamin deficiencies, um, ferritin levels, right? Iron stores is a big one. Uh, the other one is thyroid function, another big, big game player that you know, you might be normal. However, we can optimize those numbers for better overall functioning. So we do take all of that into consideration. But to answer your question, the women coming in um in perimenopause, yes, we usually will start with testosterone because again, their ovaries are still functioning and they're still getting little spurts of estrogen. And I like to go very slow and methodically with my patients. And so by giving them just a little smidgen, little uh sprinkle of testosterone, we pause and we see how they feel. And usually what I see right out the gates is improved mood, libido, sleep, motivation. That's a big one. And and then again, recovery from your workouts. And a lot of times, just testosterone will carry those women through the first phases of perimenopause. And then as we see more uh estrogen depletion is when we start sprinkling in a little estrogen and really trying to keep that all balanced through that transition. And the other big takeaway is starting hormone therapy early in menopause at a younger age is so much more ideal because we're preventing the aging process, we're preventing cellular death. And so by the time I have women coming into me in their 60s and 70s, we absolutely can treat them, but I can't reverse the damage over the prior decades. So perimenopause is a great time to get your hormones checked and try and balance everything out.

SPEAKER_02 17:18

Yeah. So what would you advise for people? Because you're saying you're seeing people kind of after the fact. So how would people know when to come in, if that makes sense? Like what would they be experiencing? When would they need to know? Like, oh, maybe I should actually get this checked sooner than later.

SPEAKER_01 17:35

Well, I think, you know, as women specifically, uh, and as medical providers, and we all tend to downplay our symptoms. Oh, I'm just stressed, or oh, I'm just raising that family, and yeah, I'm tired, but we just discount it. So, my first piece of advice is really be in tune with your body. Your body is trying to tell you something. If you go to your provider and you ask for a full hormone workup and they shy away or discount your symptoms, maybe that's not the right person for you. And I have to say, I never talk badly about other providers. I think we all truly want to do good by our patients. But if you're not specifically trained in this space, there's not a lot to offer or acknowledge when your patients are coming to you.

SPEAKER_00 18:24

Yeah.

SPEAKER_01 18:25

So don't discount your symptoms. Get a first, get a hormone workup and then make that decision. You should be having a provider lay out all the options of care, all the different lanes that we can take to address your symptoms. If you're nervous about hormone therapy, which we can talk about why some of those myths are out there, um, if you're nervous, let's start with optimizing hormone therapy or a thyroid therapy, uh, thyroid function, or optimizing vitamins and supplements. So there's a lot of different ways to approach it. But my women, man, they're desperate when they come in and they're like, give me everything you've got. And so it does typically start with hormone therapy.

SPEAKER_02 19:08

Yeah. That's what I feel like we're seeing too on my end of telehealth is people that have already tried everything and they're just kind of at a loss of where to go. And at least like on my end, I'm not working nearly as focused with the health or sorry, the hormone profiles that you are. So our focus is a little bit different. But like I personally went into a practitioner recently to get my own hormone lab work done, and they did exactly like what you're saying. People don't want to order labs for some reason, it seems. And so I guess my question here is is it best to go to a specialist? Or I know there's lots of systems that are um like just pay to get your lab work done or just kind of skip the doctor situation. Is there anything that you would recommend in this situation?

SPEAKER_01 19:53

You know, I certainly would. Uh I would hate to see patients wasting their time and money and efforts and not get the results they're looking for.

SPEAKER_00 20:02

Yeah.

SPEAKER_01 20:03

Uh I I can say a caveat to when I decided to go into the hormone space, I was really looking at opportunities of educating myself on this topic. Now, I am a biotea provider, meaning biotea is a company that offers hormone education to providers. And so uh I absolutely adore their providers, their level of education. And so what I tell other providers is go look for biotea training. Now, is there other programs out there? Absolutely. But when it comes to the patient, I tell patients Google a bio T provider near me because I can tell you the level of education they're getting in this space, and they address not just hormones, but wellness and all the different levels to that. Um, you know, a naturopath doctor, um, somebody that has specifically been trained. And you here's the thing: you can go to an OBGYN and they're phenomenal providers, but even those specialties have not had dedicated hormone education, education on menopause. And so you really have to do a little bit of homework to make sure you're going to the right person with the right education.

SPEAKER_02 21:22

Yeah, I was recently watching Diary of a CEO. You know that one. Love him. Yeah, Stephen. Yeah. He had um a practitioner on, and I cannot remember her name, but they were talking about this specifically about how the medical education system provided maybe 30 minutes total throughout all of their years on diet, but also menopause. That's like those are probably two of the most important topics. Can we have like years of education on that?

SPEAKER_01 21:51

Well, and and that kind of segues into the myths of hormone therapy. And I think that's where a lot of that is coming from.

SPEAKER_00 22:00

Yeah.

SPEAKER_01 22:01

If we go back into the mid-1990s, there was one of the biggest research projects done on women with, and they were looking at menopausal women on hormone therapy, and they had a lot of different hypotheses. They were looking at cardiovascular disease and lots of different arms to the research. And this went on over a few years. What they were studying is menopausal women, average age, I want to say was 65-ish of the participants with various uh medical histories that were on synthetic estrogen, premerin, prempro, like what our moms took, and synthetic progesterone, so progestin. And as the research went on, the researchers had thought they saw a small uptick in the occurrence of stroke and breast cancer. So they panicked, they held a press conference in I believe 2002 and said, Oh my gosh, we see this. Everybody stopped taking hormones. And that particular day changed everything. It scared the heck out of our patients. Everybody was flushing their estrogen pills down the toilet. It scared the heck out of the medical industry, and everybody stopped prescribing. And how many years are we into this now? 25 plus years. It has taken that long to look at that exact study and realize there was no statistical data to support that decision. There was actually arms of that study that were done on bioidentical estrogen, more natural options of estrogen and progesterone treatment that showed positive effects, that showed a little bit of breast cancer protection. And those same researches have come back and rescinded what they had concluded with their research. But now we are trying to change the industry's thinking and saying, you guys, this was not a good study. Some of the leaders in this industry have even said that was the biggest mistake medicine has ever made by that study being misinterpreted. And, you know, the other piece of that is as we're changing the messaging, that research has continued on. We have new research coming out showing that estrogen therapy, bioidentical, uh meaning matching our natural estrogen. If you look under a microscope and you look at bioidentical hormones and our natural production, they should look very, very similar, right? Versus the synthetic forms. But now they're showing that the new research shows estrogen is breast protective. And not only that, like you mentioned, and this is something I tell my patients all the time look, I'm gonna make you feel better now. But what are the long-term effects? We're reducing cardiovascular disease and dementia by 50%. That's what protective estrogen is.

SPEAKER_02 25:12

That's impressive, isn't it?

SPEAKER_01 25:14

Yeah, and so if we're forward thinking and we talk about preventative mess uh medicine, why not optimize hormone levels that your body is naturally making like you were in your 20s and 30s, and just continue those levels as we age. That's the big message.

SPEAKER_02 25:34

So once they start hormones, it would be a lifetime or a lifetime situation, or it wouldn't be something you taper?

SPEAKER_01 25:42

You know, it it should. In an ideal situation, there's nothing. Let me let me backtrack. There's no drastic things you're going to do to make you produce more estrogen and more progesterone and more testosterone. Now, there are lifestyle changes that maybe will slow down the depletion, but just the natural progression as we age. Those ovaries are not gonna keep making estrogen. So, yes, as we age, if we can try and balance everything out and continue therapy as we age, that's the whole idea. And I I uh give estrogen and progesterone and testosterone to to patients in their 70s and 80s, and they're out there active, healthy, socializing, having sex, like good for them, right? They're living life and uh and their health projections are so much better.

SPEAKER_02 26:37

That's good. Yeah. It's good to hear hope. Um, is there so it's not required in order to take the hormones, right? To in order to feel better. Like if for people that are maybe like absolutely no, I won't do it, even if the studies say that it's okay, what are things that people can do, or women specifically can do, if they are going through perimenopause, menopause, and post if they're not interested in the hormone replacement to help? Or is it just kind of they're just gonna feel like that?

SPEAKER_01 27:06

Great question. Now, first and foremost, before I promote anything, it is always number one going to be lifestyle. You cannot argue the benefits of, I mean, and we hear this all the time, right? Eat right and exercise. But the value of uh exercise and maintaining our muscle mass, you don't have to be a bodybuilder, but having dense muscle helps decrease dementia, it helps decrease heart disease, it strengthens and supports our skeletal system. Um, I can't say enough about weight resistance training and being active for prevention. You know, the the other pieces, of course, diet. Now, we live in a toxic world. So even people that are are working very hard to eat clean, we're exposed to chemicals and um all sorts of things in our foods, dyes, and uh walking around with vitamin deficiencies. So we can work very, very hard on our lifestyle, and again, that's number one. If I have patients that are saying, oh my gosh, I don't want hormones, of course, we do the education.

SPEAKER_02 28:14

Yeah.

SPEAKER_01 28:15

Uh, and usually by the time we do education, they do have a little bit of a different outlook.

SPEAKER_00 28:20

Yeah.

SPEAKER_01 28:20

Uh I respect where everybody's coming from and I never force anything, but I certainly want to educate them and allow them to make that decision once they're giving the correct information. So, to answer your question, if they don't do hormones, I'm not gonna sit here and say they're not gonna do well. But why not if you can have that extra protective layer for preventative health?

SPEAKER_02 28:48

Right.

SPEAKER_01 28:48

Right. So they might have to work a little bit harder, they might not get 100% of the results they're looking for, but there are people out there killing it and doing phenomenal and more power to them.

SPEAKER_02 29:01

Is the expectation when people start taking hormones to feel the same as they did before? Or is it more so like you've gone through this adjustment and this change and we're just trying to mitigate that response? Does that make sense?

SPEAKER_01 29:16

Yeah, I think it just depends on where we're starting. I do have some menopausal women saying, Hey, you know what? I never had the hot flashes and never had the joint pain, and I just breezed right right through it, which is an interesting statement. You don't get through menopause, you're in it that last third of your life. Menopause is defined as ovarian depletion. So for the last third of your life, you're making zero estrogen. Your partners, your husbands have more estrogen than you do in menopause, right? Okay. So when we say, oh, I got through menopause, no, you're you're in it. Um, so uh to balance that out would be like the best approach. Um so it just depends on where you start. If I have perimenopausal women coming in and they have tons of symptoms, yeah, within a matter of uh a few weeks to a couple of months, they're gonna have palpable differences in how they feel. And really, I need something to measure, right? I can look at numbers all day long in labs, but and which we do and we watch those carefully, but really ultimately I'm treating the patient and the symptoms. So if they come in and they're like, Well, I feel great, I feel fine, but I need hormones, I'm like, well, okay, we can certainly do your blood work. Um, and sometimes, rarely, but sometimes it is just for prevention and they feel great and they keep being rock stars.

SPEAKER_02 30:51

Hmm. That's interesting. You're saying menopause is the last third, because I guess my understanding was that you kind of go through a bit of perimenopause and then menopause, and then you're kind of through it, but it seems like it's reverse. It's non-pre, it's like premenopausal, perimenopause, and then just the rest is menopause. Is that right?

SPEAKER_01 31:10

Yeah, you know, it's interesting. So if you think about perimenopause, it's this phase where your levels are just all over the place and over time you're just kind of coming down to ovarian depletion. We define menopause as 12 consecutive months with no menstrual cycle. So if you think about it, you're in this crazy phase of your life. Yeah, and literally within one day, boom, I hit 12 months and now I'm in menopause. That doesn't make any sense. Yeah. Right? It really doesn't do the diagnosis justice.

SPEAKER_02 31:45

Yeah.

SPEAKER_01 31:45

Um, so what does that even mean? Okay, great. Now you've done 12 months with no menstrual cycle. Okay, good for you. But what is happening in your body? Bone loss, right? Higher risk for cardiovascular disease. One in three women after menopause will have a cardiac event. One in three, which is crazy. Uh, higher risk for dementia. Um, there's so many systems as we age that are being affected by hovering with this low estrogen level. And so the conversation has changed, with the question originally being, well, what's the risk of doing HRT? Now the question is, what's the risk of not doing HRT? Okay. I have women just really digging their heels in the sand saying, I'm not gonna do HRT. I'm like, hey, that's fine. But how are you gonna address all of these health risks that are right in front of you? You can't, you can't turn a blind eye to that because they're there.

SPEAKER_02 32:50

Yeah. You had talked about the um some of the myths, right? And how everything had changed with that uh one study. I've heard of that before, that previously they were very adamant about giving all the HRT possible, and it was kind of burgeoning research, and then it just like shut down, just like what you're saying. Are there other myths or misinformation that you are encountering or that you kind of battle that people should know about?

SPEAKER_01 33:21

Yeah, I my first thought is it goes back to testosterone because you know the women's health initiative really was speaking to estrogen and progesterone.

SPEAKER_00 33:30

Right.

SPEAKER_01 33:30

And there are some great leaders in the industry right now, and I could name 10 right now that I listen to in social media that are doing a phenomenal job in educating the population. Uh, but the first thing that comes to my mind is the myths behind testosterone therapy in women and a little bit in men. For the male side, people think, well, if I take testosterone, I'm gonna get prostate cancer. It's the same exact response to, well, if I take estrogen, I'm gonna get breast cancer. There are studies to show in both scenarios these can be protective hormones against those specific diagnoses.

SPEAKER_02 34:10

Okay.

SPEAKER_01 34:10

That's one myth, more so in men. And men are walking around not realizing that they are significantly low. So it's kind of, and and these are big, buff, strong guys and living life and doing all the things, and they come in and their testosterone levels are like in the toilet. And so um, that's always kind of surprising. For women, the myth with testosterone therapy is number one, the shock to a lot of people that we even are talking about this and that they need it. Um, of course, the myth is out there that, oh, you know, you're gonna look like a man, you're gonna sound like a man, you're gonna grow a beard. Um, and quite honestly, if it's not done correctly, that's not a myth. That's true. You can have voice changes, you can have more facial hair, you can have hair thinning. There are definitely side effects to testosterone therapy in women. Usually that is uh if their writing levels too high for too long, and if that starts to happen, because they feel great on it. Yeah. Uh, and I've had women, I've had to kind of talk them off the cliff a little bit, like, look, I know you feel like this rock star, but there's a safety range we're keeping you in. And if you're having these symptoms, let's just turn the dial. It again, it does not take a lot. A little sprinkle goes a long way. Uh, so I think once women sit down and have a conversation and realize what a big game player testosterone is, I can't say enough about it. Um, and then they experience how much better they feel with that optimized, there's no turning back.

SPEAKER_02 35:48

Yeah. That's really cool that it has such an effect in a positive direction.

SPEAKER_01 35:54

You know, and if you it what's really interesting, and again, this could be a whole nother podcast, but the correlation I have learned and seen in my practice is the strong correlation of testosterone therapy and our mental health.

SPEAKER_00 36:06

Yeah.

SPEAKER_01 36:08

My youngest male patient is 20 years old with a significant low testosterone. When I was first starting and learning, I was testing my kids and my nephews and nieces and everybody, and they were all in their 20s at the time. And all of them were significantly low, which made me pause and think, what in the world is happening here? Is it an environmental issue, chemicals, diet, is it a social media issue where we're just sitting on our phones and not being out there and active and interacting and using our brains and our bodies, right? Uh, there's so many stressors that young adults are are dealing with now that my generation was not.

SPEAKER_02 36:52

Yeah.

SPEAKER_01 36:52

And so the young patients coming in that they go to their primary care doctor, and the first reaction is putting me on an antidepressant. And so young people are on these SSRIs and antidepressants, anti-anxiety medications. And when I see them, we sit down, we do the full hormone panel, their levels are in the toilet, we treat them with testosterone and again a sprinkle, right? They have motivation, they're more uplifted, their mood is better, and more times than not, I'm actually able to wean their medications down and sometimes have them come off their antidepressants. And now we're not even worried about the side effects of those medicines. So not only do they feel better because their testosterone is better, is optimized, but they're not dealing with the side effects of those medications.

SPEAKER_02 37:45

Yeah.

SPEAKER_01 37:46

So that's a win-win, but it's concerning that we're seeing such young people, and again, it's the mental health that has been such an obvious piece in my practice that I've been able to address.

SPEAKER_02 38:00

That's a really interesting aspect. I've, again, as I've been digging more into hormones, it's become apparent that it's very much your mind and who you are and your psychology and how much it affects you. And I feel like, at least for me and my background, hormones are always played out to be more physiological. And I think that's such an interesting place because it really balances right between the two of those. But I know as a society, we do have chronically low testosterone as a whole. And I think they're saying like the normal is like 300, but it should be closer to like a thousand, right?

SPEAKER_01 38:35

Well, depending on males and females. So for males, yep. For males, if and this is a good point to make as well. If you get your blood work done, depending on what uh laboratory you're using, they the normal ranges can vary a little bit. But uh, I use lab core for my testing, and so a normal range for a male is roughly 300 to 850. That's a broad range, number one. Yeah, are you 18 or are you 80? It doesn't account for any of that, right?

SPEAKER_02 39:08

Yeah.

SPEAKER_01 39:09

So do I see a lot of young patients and older patients under that 300 mark? 100%. When we talk about optimizing, I actually will go a little bit higher. Again, I'm treating the patient and the symptoms. If I have to go a little bit higher to get that patient symptom-free, thriving, healthy, doing all the things, great. We watch them very carefully and they do beautifully. Same thing for women. If I look at testosterone levels for a woman for total testosterone, meaning how much testosterone does your body make? That range is four roughly to 50 for total testosterone. Now, what if I have a gal that comes in and let's say her level is, I don't know, 25, but she's hitting the top of every list of symptoms. I'm not gonna ignore that patient. I'm not gonna not treat that patient. She might feel better at a little bit higher level, where the next person might feel fine. So it's hard to make these hardstop rules. You're treating the patient and their symptoms in a safe, conservative approach. Um, and the other piece to that, when we're talking about testosterone and testing, the bigger, more important number to look at, and this is good information for patients to know and to ask for, is free testosterone. Meaning, how much of your testosterone floating around in your body do you convert to actually use? How much is getting into the cells where we utilize it? That's your free tea. So when we're talking in the space of hormone therapy and optimization, there's a lot of naysayers out there. There's a lot of people talking negative about what are you giving women testosterone for? Why are you giving their levels up so high? Nobody's talking about free tea.

SPEAKER_02 41:11

Yeah.

SPEAKER_01 41:12

Well, maybe that particular person's free tea is in the toilet. Their total is okay, but they just can't convert it. So that's when we have to look at what are they converting to actually use? So there's a little bit more in-depth picture that we need to consider when we're looking at testosterone. And the takeaway is there's the lab value, there's a therapeutic level that we can certainly shoot for, but ultimately somewhere in the middle, we're treating the patient and the symptoms.

SPEAKER_02 41:43

I think that's a really important thing to note because it's pretty common, I feel like, to go to a practitioner and they'll say, Well, you're within range. It's like, I still feel like crap. Like, can we pay attention to me and my symptoms? Like, I'm still a human being, like, quit looking at the paper. So yeah, that one, that one is frustrating. Um, you talked a little bit previously about um like maybe making diet and exercise changes, kind of going back to those that maybe don't want to do the hormone replacements. Are there any measures, whether or not somebody does or doesn't want to do the hormones? Are there any measures that you advocate for outside of muscle training, like diet adjustments or things that people should focus on that they're not?

SPEAKER_01 42:26

Yeah, the big takeaway here is protein intake. And we hear tons and tons of um influencers talking about this. And of course, the world we live in of GLPs is huge, right? And there is so much information out there, and there's so much access to these GLP ones, which in a way is great. Like, yeah, go get your GLP one, use it. But I mean, again, a whole nother podcast on the GLP ones.

SPEAKER_02 42:53

Oh, for sure.

SPEAKER_01 42:54

But in my practice, we are very, very strict about monitoring our GLP1 patients, actually, all of our patients, but specifically the GLP1 patients, that they are not burning muscle for energy. You have to maintain muscle mass. Where we have gone wrong is just spitting out these prescriptions for GLP1s. People are doing their weekly injections, they're not hungry, they don't eat, they get into those skinny genes, but half of the weight they have lost is muscle mass. And now metabolically, they're a hot mess. They're more apt to be type 2 diabetic, more insulin resistance. Yep, they're not healthy, they're skinny, they're not healthy. So, to answer your question, protein intake. And we need so much more than we think. And it's this it's not easy when you have a big appetite. If you're on a GLP1 and you cut that appetite in half, and now I'm telling you to go eat 100 grams of protein a day, or more, or more. Yeah, it is it's a task. For sure. So I think really the education is what does even 100 grams of protein look like in a day, right? Um, people don't even realize that we haven't done enough education on nutrition itself. What's a protein, what's a carb, what's a fat, right?

SPEAKER_02 44:15

Yeah.

SPEAKER_01 44:16

I can speak to that personally when uh I had been a nurse, gosh, five, six years. Um I was diagnosed with my type 1 diabetes at the age of 31, and I was working in the ER. And of course, now all of a sudden I have to really pay attention to nutrition. And even as a medical professional, I didn't have that down. I was always healthy. I always worked out, I always tried to eat salads and, you know, not fast food and all the things, but really understanding what's a good low-fat protein source, what's a complex carb, what's a simple carb. Uh, and of course, you know, I see it every day in my blood sugars, right on my iPhone. I can see my continuous glucose monitor, I can see, and I've learned over 25 years about nutrition. And that is a whole nother conversation. So there's so much education that has to be done with our patients that it's maintaining muscle mass and getting enough protein. Those are the two big ones.

SPEAKER_02 45:16

Yeah. Diet and nutrition education has been a huge unlock for me as well. Because I feel like the industry that really runs that conversation is like the fitness and wellness industry. And that changes so much because they'll say, do sugar or don't do sugar, or carbs are dangerous, or no, they're okay. And it's like when something oscillates that wildly, like, how can you expect to understand what you're actually supposed to eat to support your physiology? So I personally believe that food is medicine. What we put in, we're gonna get out. And just like you're saying, like eating clean sources of protein, and even people that are supplementing with other protein sources still aren't getting enough. And so I'll counsel my patients on GLPs and say, you need to be eating one gram per pound of body weight. Like that's the gold standard. And their eyes come out of their skull. They're like, I cannot do that. And then it's a bigger conversation of well, how do I do that? What am I eating? And it's it just I feel like really highlights again the education that hasn't been provided. And it's frustrating. I get it.

SPEAKER_01 46:19

Yeah. And there's there's a lot of damage happening out there. Uh, I would highly, highly stress if you're gonna be on a GLP one, and quite honestly, you know, we offer them in our practice, but I have patients that are getting them out off the internet, and I tell them, okay, you're gonna do you. I can't control that piece. But what I do expect them to do is come in once a month and get on my in-body scale, which is a body composition. So once a month they are coming in and we are measuring muscle mass and body fat percentage. Yeah. And then the lots of other things visceral fat, extracellular water. Um, it's a really comprehensive workup. But at least I know if they're gonna be in my practice, that somebody has got eyeballs on their body composition and that they are not gonna end up worse off. So I can't stress that enough. Uh if you don't want to go to a provider, find a gym where you can get on an in-body uh scale and at the very minimum make sure you're not losing muscle mass.

SPEAKER_02 47:22

Yeah. Yeah, that's the most important part.

SPEAKER_01 47:25

But yeah, the nutrition, I mean, look at we have nutritionist as its own specialty because it's so in-depth. Uh and I send my patients to a nutritionist. Uh, I have an awesome nutritionist uh close by in our community, and there's no way I could understand and do that because nobody can do everything, right? I'm focused on hormones and I can send those patients that need that extra layer of education to her, and she's focusing on gut health and nutrition, and we have to combine our specialties to really do the patients uh good.

SPEAKER_02 48:02

Yeah, it's definitely a teamwork environment. Yeah, yeah, for sure. Well, as we get close to wrapping up, is there anything that you want listeners to know to take away?

SPEAKER_01 48:14

You know, I think my passion is, and it's part of our vision in our office, is to really empower patients and make them truly understand they are in control of their health. It's not, it's not me, it's not you, it's not medical providers. We're here to hold your hand and support you and give you the tools. You have to do the work. You have to advocate for yourself. And again, in the space of hormone therapy, and we're dealing with middle-aged women, don't discount your symptoms. Listen to that voice in your head that something is off and be diligent about finding the right provider that's going to listen and validate and be able to treat your symptoms.

SPEAKER_02 49:05

Yeah. Yes, I think that's really a good message because that's why I'm here ultimately. I want to give people the information so they can make their own decisions because it's been for a long time, I think, practitioners telling people how to live their lives. And ultimately, that's not fair because everybody's situation is so nuanced. Right. So, yeah, so individual.

SPEAKER_01 49:27

And I will tell you too, coming from emergency medicine, 90% of what came through those doors was preventable. The cardiovascular disease, the strokes, um, the hypertension, the type 2 diabetes, these are things that people think, oh, I got diagnosed, so that's and I'm like, no, no, no, no, no. We can reverse that. It is preventable, but we have to put the work in.

SPEAKER_02 49:51

Yeah. Oh, cool. Thank you so much for your time. Um, where can people find you?

SPEAKER_01 49:57

So I'm located physically in Gig Harbor, Washington. This is where our practice is. So it's Gig Harbor Concierge Medicine. Uh, and uh again, I have a passion to educate, advocate, and validate my patients. So I'm on Instagram at the concierge and p and my YouTube channel, uh Health, Hormones, and Faith, is quickly growing. So anybody that wants to see more videos and this kind of content that you're doing, you can find a lot more information there. And and uh yeah, I'm glad to be a part of the community that you're in and really fighting for our patients' education.

SPEAKER_02 50:32

Thank you. I'm excited to be here. It's been fun and I think it's gonna go far. So I really appreciate your time today.

SPEAKER_01 50:39

Of course, and thank you for having me.

SPEAKER_02 50:41

Yeah, of course. Thank you so much for listening. I hope you enjoyed this conversation. If you found it helpful, please like and subscribe, or share it with someone else who might find it interesting. You can always reach out to me, leave a comment, or find me on Instagram at Health Recoded Podcast if you have any questions or any topics that you want covered. Thanks for listening, and I'll see you guys next week.