The HRT Conversation: Symptoms, Prevention & Optimal Aging

Hormone Replacement Therapy is one of the most talked-about topics in wellness today—and for good reason.

In this episode, Betsey and Ethan dive into the facts about HRT, including who may benefit from it, when it's appropriate to start, and the role hormones can play in long-term health and disease prevention. We discuss common symptoms that may indicate hormonal imbalance, the impact hormones have on energy, weight, mood, sleep, and overall quality of life, and why more women and men are exploring treatment options earlier than ever before.

Whether you're navigating perimenopause, menopause, or simply curious about optimizing your health as you age, this conversation offers valuable insights to help you make informed decisions about your well-being.

Tune in to learn how hormone optimization can help you feel like yourself again—and support a healthier future.

Transcript

SPEAKER_00 0:00

All right. Welcome back to the True Body Podcast. We're going to be talking about one of my favorite topics, which is HRT. Um, basically what patients need to know and maybe what they get wrong. So um I know we both are super passionate about this uh topic. Maybe partially because we've seen such a huge impact in our patients um with just kind of optimizing things just even subtly. Um and so we'll kind of dive into maybe each each hormone, kind of what they do. We'll probably give some stories along the way and kind of go from there. But um I think the biggest thing is is that patients who come in and we end up going this route are literally just feeling off. They have no energy, they have brain fog, they're they're gaining weight. Um, it's not like the simple, um, the most common symptoms of hot flashes and nights. What's in the things you would think of for hormones. So um, but yeah, I think um teasing some misconceptions about this isn't just for menopause.

SPEAKER_04 1:08

Absolutely. I don't know if there's a I don't think there's a topic that we see more often where the story is is people come to us for a second opinion. They were they were told I don't need hormones, hormones aren't for me, my numbers are fine, your symptoms are not related to hormones. I I mean it's all the time. And we just I mean every day we're having having patients come to us kind of with with that story, unfortunately. Um but also in the same day, we're having a lot of patients who when we when they sit down, and my question to them is how are you feeling? Oh, I feel great. Or guys are you know, guys and you know, males and females are like, I feel like I'm in my 20s again. Yeah, I feel like you know, I I haven't felt this good in forever.

SPEAKER_00 2:05

I mean I didn't know this was possible ever. Even at my absolute my height, I didn't know I could feel like this.

SPEAKER_04 2:11

Um so again, I don't I don't know, it's just a it's a broad topic. You know, the the HRT umbrella is is very broad. Um, and there's a lot uh things that we that we hear are are correct and and incorrect, and unfortunately. Um so I think just kind of um explaining it in in some details, why hormones are important, how they impact so many different areas around the body, you know, mental and physical health, um and just how we approach it, yeah, hormones in general, whether that's replacement or optimizing your body's natural production, or or both. You know, everybody's a little bit different. Um, definitely not a one-size fits all. Not not in too many areas of medicine, but definitely not when it comes to to hormones, which is yeah, I think part of the reason why we both like it so much.

SPEAKER_00 3:08

I think one of the biggest things to like maybe start with is like what is HRT? Everyone's like, oh, I'm on HRT, or have you considered HRT? And for somebody, they might not have any idea of like what is HRT? What do we even why would you come and talk to somebody about HRT, hormone replacement therapy?

SPEAKER_04 3:30

Simple definition would be we are replacing the hormones that your body is no longer able to make or able to make in in optimal levels. Um, but we are using your body's exact hormones, bioidentical. I mean, it's it's what it's what you have, it's what I have. Um we are we are giving your body those hormones. We're not doing synthetic hormones, it's not, you know, birth control or anything like that, which is uh unfortunately a common misconception. Um, I guess, but uh that would be the simple definition, is we are replacing your your body's hormones.

SPEAKER_00 4:14

And the most common ones being estrogen, progesterone, testosterone. We, you know, occasionally talk about thyroid and we kind of lump that in, especially when we're just like evaluating someone's levels. Um but yeah, I think usually when a patient comes to us, specifically a female, they're they're like, I just need to look at my estrogen. Um, that's kind of like what we know is true. And for men, it's I just need to look at my testosterone and not really thinking about all the other pieces with that and and what that looks like. Um I think another big thing is they have no idea that there's more than one option of a form of getting those things in. Um, you know, when I'm when I'm like, okay, well, we we've got you can do this estrogen in a pill, you can do it in a cream, you can do it in a patch, you can do it in a pellet. They're like, holy smokes, wait a second. What's the best one? It's a lot of information. What's the best one? It's that right there. Right. Yeah, it's like, well, there's there's maybe a lot of really best ones. I don't know, there's not like one more superior than another. There's some that have other risk factors associated with them. There's, you know, compliance issues with patches, um, creams, there's transference issues, there's there's a lot of different things. And so it's really just it's not like we'll ever force a patient to do one particular form. It's more of like what form works for you. I've got gentlemen who do two different forms throughout the year, you know, they do their testosterone and an injection, and then come hunting season, they do pellets to get them through because they're in the mountains. So it really is just like leveling with the patient and trying to decide like what's gonna be best for them.

SPEAKER_04 5:55

Absolutely.

SPEAKER_00 5:56

But yeah, there's a lot, not in just like the type, but then the form of it and the candidacy of it and all that, but um just kind of goes back to your point. Like, there is not a one size fits all, and there's not even just like a one season fits all.

SPEAKER_04 6:11

Yep, definitely. I when I'm talking with somebody, we'll just talk about testosterone. Um I guess before before even asking them um, you know, what do you want to do? Try to give them all the information. Or as as best as we can, you know, like you're talking about creams, yeah, compliance, can maybe you know, maybe be a little bit issue. Whereas on the opposite, pellets are easier, you know, it's a quick little procedure, but you it's it's in there, you don't have to worry about it. Um to somebody that might sound great. To another person, that might not sound that might freak them out like a great option at all. So I think just kind of laying out the the again the different options and then um you know allowing them to whether ask further further questions about that, but just simply trying to give them the information to make the decision uh for themselves of what what would fit their lifestyle, you know, schedule, daily habits. Yeah, I guess. Yeah.

SPEAKER_00 7:13

I think the other thing too is like when patients come in, they're like, I want to focus on my energy. And it's like, okay, well, there's not just one hormone that's gonna focus, like they're all they're they all overlap. And I think that's like another big thing is is there's not just like if we optimize one hormone, you're also gonna have problems, right? We have to like make sure there's not a, I usually say this to my patients, a queen of the castle or a king of the castle. Like we need everybody to have checks and balances, and nobody can be, you know, ruling the world. Everybody has to like work together. Um, because yeah, you're gonna get you're gonna get things. People come to us literally, we optimize their hormones, but they might come to us with like an estrogen dominance issue or like a dominant hormone that we don't necessarily want to suppress. We got to make sure it works for everything else.

SPEAKER_04 8:04

Absolutely. Yeah, just uh you know, estrogen progesterone alone. Um seeing two females with uh two very different treatment plans for both of those hormones. Yes, we want to optimize both of them, but we might be doing completely different things. Um there's definitely not a you know, you're you're coming to us, you're gonna get this and that. It's gonna be, you know, a very detailed approach about you know, usually they're coming to us because of symptoms. What symptoms, you know, are we having? Yes, we'll look at levels and and you know, kind of where somebody is at. You know, what we're doing with a 20-year-old is gonna be different than a 60-year-old or 40-year-old. Um, so really just trying to get it at their whole history, you know, exactly what's going on, what their goals are, um, and developing a very individualized treatment plan for that patient. Um so again, there's only you know, we're typically talking about estrogen, progesterone, testosterone. It's only three. You know, in males, we're usually not talking about progesterone, but only three hormones, but a variety of different ways we can go about it. I mean, it's it is very, very, it's all over the map of what we're what we're doing with with our different patients, um, which is exciting. It's fun. Yeah, it's critical thinking. That's why, that's why we got into medicine. Um yeah, oh it's just an exciting, it's just a it's just an exciting field topic.

SPEAKER_00 9:41

And in the fact that like everybody's a challenge, which I think is like super fun in some ways, because yeah, like um we have the studies that kind of like indicate, you know, what levels on average, you know, you'll feel like, you know, the energy, the endurance, the motivation, the libido, or um, you know, the hair, the skin, the nail changes, or you know, what levels are gonna protect you, you know, from Alzheimer's and cardiovascular risk and osteoporosis. We have like the studies and the data that suggest those things for females and males and kind of whatever we're looking at. But at the end of the day, everybody needs a different level. Um, we can give you what the averages are, but you might need to be extremely below average, and that's like your sweet spot or way above it. Um, and a lot of times those levels are not on the labs, right?

SPEAKER_04 10:28

That's a good point.

SPEAKER_00 10:29

The labs are gonna look like you're gonna come back and you're gonna feel like a million bucks. And the first thing we're doing is we're gonna pull up your levels and you're like, oh no, those are red. Yeah, either low or high. And you're like, oh, I've I've like overshot. And and the conversation is like, you're actually great, right? You're actually in a great range and you feel like a million bucks. Um, I always find it fun to ask them how they're feeling first. A lot of times they they kind of have like some push, they're like, Well, what do my levels say? Yeah, absolutely. What do my levels say? Take the words out of my mouth. Yeah. What how do you feel? How do you feel? And and usually like, okay, well, I guess if I can't look at my levels first, you know, I feel great. You know, and so then we open the levels, and yeah, they might be red or they might be, you know, within range. And and it's it's that whole like, we're not chasing a number. We're not chasing a number, we're chasing your symptoms for you.

SPEAKER_04 11:18

No, I'm glad you said that. I I I approach it the same way. I um it's because we've we've both been in the traditional primary care where usually you're walking in and you're saying, Hey, here's what your levels look like, here's what we're gonna do, or here's what you're gonna do, and and it's pretty quick and easy. But I mean, I try to get in the habit of I don't want to look at those levels right away. I want to sit down, ask them how how they're feeling, and you're right, it catches them off guard. It's like, well, what do you mean? Right. How are you feeling? Yeah. Um, are you feeling today? You know, a month ago, three months ago. And when we get that, when we when we find out how they're doing, yeah, we'll compare it to the labs. And if we need to adjust up, down, or or stay where we're at, then we'll go from there. Right. I mean, it's symptoms and and then levels is how I approach it, and right, obviously how you do as well.

SPEAKER_00 12:11

I think it's like a it's just ingrained in us. Like when you go to the doctor, the first thing you talk about is like your labs. Yeah, you just go through your levels and they're like, oh, your kidneys don't look good. Oh, your blood sugar's kind of high. Oh, cholesterol's not great. Yeah. And now we're gonna do a medication for that and a medication for that and a medication for that. Sometimes there's some lifestyle recommendations and things like that, which is great. Um, but like we're we're treating the number, we're not treating the person. Um, we sometimes forget that like the person's even there. We're just like, oh, this is red, and we need to like, what are we gonna do? And what drug is gonna be the best. Um, and so it's as the patient, you're just kind of used to that. You're just kind of used to like that's like how we start the conversation of what's wrong with me. Um, and you know, a lot of my patients will also just be like, so so everything looks good. Like, I don't have like cancer or anything. You're like, holy smokes. Like, if we're going off these levels, you know, if you do you feel good, you know. It's so interesting how we just think that like all these like numbers are just gonna give us this deep dive into your health when when you haven't even told us like how you feel or like what's even going on with you. Absolutely, it's a huge piece of the puzzle.

SPEAKER_04 13:26

Yeah, I think um the not to get too deep in the weeds, I guess, but I wish we could just eliminate the reference range on all our labs. Oh yeah. Um I mean, and to to be completely honest, the the conference I attended a couple months ago, or was that a few weeks ago, um taught me about the reference ranges, how how they're developed. It's it is a population reference range, meaning you know, the the the majority of our population is falling in that reference range. But if our if the majority of our population, you know, their levels aren't optimized, their unhealthy, you know, their their lipid panels aren't aren't great. I mean, if we're if if that's how we're determining what our levels should be at, I think that's completely incorrect. So I wish we could just and and unfortunately people want to look at those. They want to see where they're at in relation to the to the ranges. But again, if we're looking at averages based off of a population that unfortunately is not healthy, you know, a sick population, yeah, of course our numbers are gonna be in the red because they're gonna be a lot better, unf you know, higher typically. Um so I think again, it's just just need to retrain how we look at labs, how we how we're looking at these levels. And again, there's no best level we need to be at. There's probably a ballpark we want to get to, but what is great for somebody will be too high or too low for the for the next person. That's where the kind of the individual component is um important to look at.

SPEAKER_00 15:16

Right. I usually tell patients like don't even look over here, you know, don't even look at this side of the the the lab form um because it's gonna give you um probably anxiety or you know, kind of like a misinterpretation of where where you should be.

SPEAKER_04 15:32

Um or it's gonna make them kind of second guess. Absolutely.

SPEAKER_00 15:37

Yeah, and it's crazy because they're like feeling so good, but they're like, oh my gosh, should I like should I go back to where should I stop? That's a big break. While you came here for a reason, yeah. Yeah, you came here, yeah. Something wasn't great. Um, but yeah, I I think that's like a huge that's like my favorite thing is to go through their levels and give them the the averages or ideals for like gender and all the different things and really like open their eyes to like because there are literally that are like I don't need to be within that range. I don't have to be within that range. Um giving them permission to like live on the edge, you know, like it's okay. It's all right.

SPEAKER_04 16:19

But the red numbers are not always bad.

SPEAKER_00 16:20

Yeah, exactly. In fact, like give yourself a pat on the back, you like you're there, you feel amazing, and like look what you've accomplished at that range. Um, but I think yeah, like when so not only you know you go through their levels and all those things, but then um you're talking to them not always just about like your hot flashes and your night sweats um and things like that, but you're you're diving into like how's your metabolism? How is your sleep? How is your brain fog and your mood? How's your libido? Um, just kind of things that you don't normally think of, like your provider doesn't usually ask you about. Um, I don't know. The last time someone maybe went to their traditional provider um and and was like, hey, I'm tired. And they were like, oh, well, uh maybe we should do a sleep study. Maybe we should, I don't know, where should we start here? Um here's a sleeping, here's an ambient. You know, um, there's like not a lot of like workup sometimes or or thought of like where to even start with like that broad of a symptom. Um, and simply just like evaluating someone's hormones and making sure they're optimized can just like cure that, you know, um may not be perfect. Um, may there might be other external things you gotta work through too, but it's just it's incredible if like the the symptoms that patients don't think are associated.

SPEAKER_04 17:40

Yeah, absolutely. I guess if if somebody was gonna ask you, like, who is in in females, like when can I start HRT? Because I mean, traditionally it's menopause. And then maybe we'll do something. Maybe right, maybe we'll do something. But I see a lot of people in their 20s and 30s and and 40s who we're talking about we're talking about hormones. Yeah, it's a different conversation than somebody who is post-menopausal. Um with the same hormones, you know, we're talking about.

SPEAKER_00 18:16

Even young women young girls with like um irregular cycles, uh, heavy cycles, PC PCOS symptoms. Um it's not normal.

SPEAKER_04 18:26

Yeah, it's it shouldn't be normal. Right. Is there an age where we start talking about it? Absolutely not. Shouldn't be.

SPEAKER_00 18:33

Um there's not an age that we stop talking about it either.

SPEAKER_04 18:36

Well, the same thing for guys too. Uh the conversation might be different at 25, 30, 35, even, you know, compared to somebody who's 50 or 60. But again, we're talking about the same hormone, usually testosterone. Estrogen too is also important. But you know, is somebody too young to talk about hormones? Absolutely not. No, but again, we need to weigh who might be a good candidate for replacement versus hey, your body's still making it. Can we just like support it, you know, really support it? And we can do a number of different things. Um you know, very easy things, actually. That uh things that are not being talked about um in the traditional. Yeah, that's a good point.

SPEAKER_00 19:20

It's not always a pill or an actual hormone that we're like giving somebody when we're optimizing levels, absolutely.

SPEAKER_04 19:27

So I think my kind of key takeaway or what I try to educate people on is yeah, age doesn't matter. Um you know what symptoms we're are we having, um, what what do we want to improve, what are our you know health goals and based off of their answer and and potentially age, and there's a lot of factors that will just kind of determine where that conversation goes. But I don't think there you don't need to, there's no rules we need to follow, I guess, in terms of um, oh, you're too young to talk about this or too young to talk about. I I disagree with that 100%.

SPEAKER_00 20:07

Yeah, and I think I think there's also like a lot of education in like my perimenopausal females, which is usually around your mid to late 30s. You're starting perimenopause. Um, that you know, they're they're like, God, I don't know, am I like old enough to do this? Am I old enough to like start on this stuff? Um, obviously, like there's checks and balances, we're looking at your labs, we're evaluating your symptoms to determine if it is or isn't. And not always is that an actual hormone, sometimes it's you know, supplements, lifestyle, like different things that we're using to support it. Um, but I think what's really important for women to understand is when you start losing those hormones, you're putting yourself at risk and it's compounding for cardiovascular disease and osteoporosis and Alzheimer's. Um, and so cognitive function and all those things that start to slip just subtly when you're younger, like that eventually gets worse and worse and worse. And when you come in and see me at like 42 and we initiate some sort of therapy, it is so much easier for me to prevent something then than it is when you are 52.

SPEAKER_01 21:13

Absolutely.

SPEAKER_00 21:14

Um, and so you know, the the women who've had the hysterectomies prematurely and in their 30s, and you know, oh, we you still have an ovary, so you don't need to, we don't need to talk about, you know, hormones or or maybe they don't, but it's like, oh, you you only had hot flushes for a couple of weeks after that. Okay, you know, you're not really a good candidate. And it's like, man, what are we putting that person at risk for? That they have no idea until it's too late. I mean, we know based off studies that estrogen is like the number one preventative thing for osteoporosis, and yet it's the last thing we talk about. I mean it's the last thing we talk about.

SPEAKER_04 21:46

Somebody does adexa, they yep, osteopenia, osteoporosis. Here's vitamin D, here's calcium, bossum X, we'll check it again in two years. How about we actually look at why do they have osteoporosis? Oh, they lost such. Estrogen. Okay, well let's re let's fix it. Pretty straightforward. Yeah. Um but no, it's you know, medication, vitamin D, calcium, which again are important are important. We need them. A lot of people who are low in vitamin D, certainly, but osteoporosis, you know, I mean, how often do we see it or how how often do you hear about it? You know, somebody who was healthy, they trip, they fall, broken hip, pneumonia, they're not getting out of the hospital. Yeah. Yeah. I mean, the difference between it's just yeah, I don't know, sad.

SPEAKER_00 22:33

And it's yeah, for for something super like preventable. Yeah. Yeah. Um, and the same thing with your heart. I mean, you can look at the graphs, and it's like as soon as women hit, you know, 50 on average, that's when most women go through menopause, 51, 52 years of age. And um, cardiovascular risk like just starts to climb drastically. Yeah. Um, and it's directly correlated to, you know, you know, estrogen and and whatnot. And there's obviously other things. Um, we're not definitely gonna sit here and say that that's like the only thing that's gonna prevent you from having a stroke or heart attack. Yeah. Um but holy smokes, if we know it's a direct correlation, well, why wouldn't we be talking about it? Why wouldn't your cardiologist be talking about it? Why wouldn't your primary care doctor be talking about it? Um, everyone, everyone knows about statins right now. But does anybody know about those statistics of estrogen? No, they don't.

SPEAKER_04 23:25

Estrogen on its own. Plus, if we're combining that with uh testosterone, I mean bone density improves that much more. Um I mean, go down the list of symptoms, you know, just symptoms alone, not even talking about the you know, the prevention, the the heart disease, uh Alzheimer's, bone density, all the um, you know, kind of metabolic dysfunction, all the all those are gonna improve, or the risk for developing those will go down. But again, yeah, it's just not not something we're talking about, unfortunately.

SPEAKER_00 23:59

I think most women don't realize they should be on testosterone. They're like, that's a that's a dude thing. I don't need that. Why would I need that? Um, and it's like, holy smokes. I mean, the ability to just and most women who've hit the you know 45 and older um probably realize like how hard it is to gain muscle in the gym. Just, I mean, you could eat the best and you can do the heaviest of lifts and you can do those things, but to like physically even see in the mirror like a change is tough. That is so tough. Even to like lose the weight doing those things is super tough. And just replacing like a cigeon of testosterone can make a world of difference and allow you to, you know, actually like lose, you know, that visceral fat, you know, around your organs and remove that fatty liver and gain that muscle and help your bones. Um and you feel good. Absolutely. You feel like you want to, you have that confidence and that motivation and the energy in the stamina back.

SPEAKER_04 24:59

Yeah, the the the education part of it is so important. I mean, yeah, again, the it's not a male hormone. Um it is there is more in males, certainly, but how it impacts you know, a male's health, female's health, it's it's the same. I mean, it's having the same going down the same pathways in in in both males and females, and having those positive outcomes, both both now, but also the long-term, the long-term outcomes. Certainly. I mean, it's kind of funny on the we were talking about the reference range earlier, and if you look at in a female's labs, it'll say normal, zero to you know, whatever, 30. It's like is zero normal? Not, but when we're looking at a population where it unfortunately is, or it gets treated as it um as normal, yeah, it's gonna of course look like that in the reference range, or starting somebody on testosterone, a female, and then we get their labs, and then yeah, they're a little high according to that range, but they feel great, they feel really good. Um and it turns out, hey, we do very well when we actually optimize those levels, um, both males and females. So again, education is is a big part. And I think part of what we do.

SPEAKER_00 26:23

It's important to know too, like, we're not just trying to like get your levels as high as we can. And you know, yeah, a lot of people are gonna feel like a million bucks with like extremely high levels of testosterone. Some people won't, but that's not necessarily the goal either, right? Like within safe ranges, like we're monitoring these patients, we're making sure, you know, blood pressure is controlled, hematocrit ranges are within check. Um, like things are are no adverse side effects, they're not experiencing like acne or hair thinning or whatever the case is. Um, and you know, everyone, like we were saying in the beginning, is so individual on that that yeah, it's not a one size fits all. But um, yeah, looking at those reference ranges uh can be arbitrary in the whole scheme of things because of so many different factors.

SPEAKER_04 27:11

Absolutely.

SPEAKER_00 27:12

One of the biggest, I would say, um, questions I get from men is if I start testosterone, will I have to be on it for the rest of my life? Will I be able to stop it? What do you usually say?

SPEAKER_04 27:23

What I what I tell them is that when we start giving your body testosterone, it will turn down your own production. That is normal. Our brain recognizes it, our body recognizes it, says, Hey, we are getting it, we do not need to be on, or we do not need to be making it, it's gonna turn that off. So if if we're if we're basing it off of that, do we need to be on it for life? Not necessarily. If we stop it, your body will recover, it's gonna go back to the levels that we were at. It maybe, maybe, you know, before starting uh testosterone. But you know, the reason we're typically starting it is because we're having symptoms or um, I mean, variety of different symptoms, but yeah, it's they're they're coming to us and they are concerned because we're we're having these symptoms, we check levels, yep, they're low, we're gonna start it. They start to feel really good. And those are the people that are coming back and saying, hey, I haven't I haven't felt this good in in years or ever. They probably don't want to stop. Number two, if we're talking about all the positive benefits long term, um, you know, reducing risk of all these different chronic diseases, why would we want to stop? So that's kind of how I uh approach it. Um it gets a little bit more a little bit different discussion. Maybe if somebody's younger and you know, we're talking about um you know fertility and and family and this and that just a little bit different discussion, but uh but that's kind of the the the the two talking points I yeah I emphasize. Like we're we're probably gonna be feeling a lot better, but then also we're you know, we're trying to prevent all these different negative health outcomes. Um so yeah, usually we just usually we never really want to stop, is is typically my my discussion.

SPEAKER_00 29:21

Right. I think that's that that's the key, is like why are we having this conversation? Yeah. Um they came to us for a reason. Yeah, yeah. And and and the other thing too is like when we start losing our hormones, it is linear. Um, whether it's like a sharp cliff linear or very gradual, you know, decline linear. So if you were to start it and five years pass and come off of it, yeah, you'll go back to producing what you were, but it that linear decline is going to catch up. So you'll go back to whatever your body's capable of making at that moment, at that time, you know, where you're at. Um, and I think that that's just like, you know, that's just science. That's just us. But yeah, I mean, you'll go back, but gosh, if you feel this way now, whoo, can you imagine five years down the road? You know? And so yeah, I think, yeah, you can come off of any hormones whenever you wish. Um, nothing's a life sentence, nothing is permanent, um, nothing needs to be forever. And some people do and just need to like try it and see like, is this for them or is this not? Um, and do that whole that whole thing. But yeah, I think um if you're that worried about it, you know, maybe wait. You know, maybe wait. Yeah, if if it's gonna be if it's gonna be in your head. But yeah, I truly, I truly think you may not want to.

SPEAKER_04 30:36

I mean, when I'm seeing somebody for for the first time and we're talking about HRT, it's a lot of information in in a short amount of time. We spend a lot of time with them, but it's a lot of information packed into that time. Um, so I yeah, I tell people, hey, this is not something we need to decide today. You can absolutely think about it, you can message me, get more, you know, questions out, or or just you know, just think about it, you know?

SPEAKER_00 31:03

It's information. Yeah, it's like these are your labs. We just reviewed your symptoms. I'm gonna help you correlate with those things. Go home. Like take this information and marinate with it for a second, and and maybe maybe that's all you need to do. Maybe you come back in three years and that's when you're ready. Yeah. Um, there's really no pressure, it's just education is power, and the more you know about yourself, the better.

SPEAKER_04 31:23

Yeah, because I can, I mean, I can almost guarantee that the the the labs we're checking, the discussion we're gonna have about those labs and about your symptoms is more information than you've probably gotten in the years and years and years of you know previous um appointments. So yeah, it's gonna be overwhelming, which try to we try to you know make it as easy as we can. Yeah, but I don't think we'd be doing our job if we don't give all the information.

SPEAKER_00 31:51

What about um the men who um come and say, doesn't testosterone cause prostate cancer?

SPEAKER_04 32:00

No. Um the the study they I mean there there was a study. I mean, I don't I don't even remember. Was it a hundred years ago? Yeah. I just I was looking at it a little while ago. Um I mean the study was completely invalid. There was only a a few people, I believe. There's like two. And two three and one dropped out or something, yeah. Um but I mean, in the years, I mean, decades of of research and and decades of of HRT, there's no correlation between testosterone replacement and prostate cancer. And I and I believe the opposite is is true. It is is protective. It is not only against that, but um a variety of other chronic diseases that you know we we are are trying to prevent. Um so yeah, unfortunately one, you know, kind of miss I mean completely invalid study for whatever reason has just been it's just been carried on for so long.

SPEAKER_00 33:09

And unfortunately same with the women's health initiative, the 2002 study um that came out and basically before the study was even commenced, right? Was on the New York Times, uh, you know, estrogen causes breast cancer. And since I mean, I feel like that was one of the biggest reasons why providers stopped prescribing it, right? They were scared. Yeah. Um, patients who read the study called out their providers, like, how dare you put me on these medications when you knew? Um, no one cared to like look into the study further, though. They just like took that as gospel, which we're really good at. We're really good at listening to influencers, um, listening to some Joe Schmo who saw something somewhere and now he's stating it and it's his opinion is fact. Um, and we're not super great about doing our own research um on things. And so, so yeah, for forever, like my you know, my mom, my mom's mom, like people like that have, you know, gone their whole life without being, you know, given the opportunity of hormones and what a disservice. Yeah. Holy cow. Yeah. Um, you know, the the the things that could have been prevented, the quality of life um that could have been improved. It's just it kind of breaks your heart when you really think about all that. Yeah. And um, and it's it stinks because there's a stigma about, you know, hormones, um, even with providers, you know, still with hormones and just how they're afraid to prescribe them and afraid to do those things. And so that to me is one of the biggest reasons why I love educating about it and and really like debunking those things because like we know it's not true and we can prove it.

SPEAKER_04 34:51

How many SSRIs and other other meds have been prescribed because a 50-year-old's coming in with brain fog, they're not sleeping, and their mood's all over the place.

SPEAKER_01 35:00

Yeah, yeah.

SPEAKER_04 35:02

I mean, dear God. It's just it's sad. Yeah. Sad. There's I don't know, there's a no other way to put it, but I don't know.

SPEAKER_00 35:10

Hopefully we're hopefully we're turning the page and I think people are talking about it more, which is great. Absolutely. And um, there's like this huge movement that I think is happening, and and it's really allowing um people to feel more comfortable asking their providers about it. And I think providers who aren't even necessarily educated or trained in hormones are kind of being forced to look into things um that they haven't before, which I think is great. Yeah. Um, I will say there's definitely something to going to a provider who's trained in it. I will personally tell you, you know, before I did any of my training in hormones, and a patient would come in and be like, hey, I want, I want my hormones checked. I'd be like, Okay, great. Let me Google what I should run on you. And then when I got the results back, I was like, I don't even know what to do with this. Like everything's within range, but they're not feeling great, you know. Yeah. So yeah, it's like, how do I even talk to this person about something? I got maybe a week's worth of education in school on on menopause and hormones.

SPEAKER_04 36:08

Um, all the negatives, everything bad, everything bad. About how to approach it.

SPEAKER_00 36:14

Exactly. About how to get people off of them, really. It's like, how do we stop hormones? Um, and so, you know, I think I think going to somebody who's who's been trained in it is really important because they're they're gonna know all the literature, they're gonna know all the the nudest techniques, um, those reference ranges that aren't gonna be listed on the labs themselves. Um, they're gonna really be able to like dive into that a bit better um and probably give you a more comprehensive approach. And when they do prescribe something, know if you're getting a side effect, what it's I've had a lot of patients say, like, oh, my primary started me on this, but I like felt this immediately, and so I stopped it. And I'm like, Yeah, well, they chose the wrong dose and unfortunately ruined you on that. Yep. Had they started you here, you would have had a much different experience and maybe would have got there. And it's just it's just understanding that.

SPEAKER_04 37:04

Absolutely. Yeah, do we try to minimize the the side effects? Absolutely. But again, everybody's gonna be a little bit different. Um, I guess what I like to tell my patients is that you know, month one, two, three, we should be heading in the right direction. Might have to work on some things and uh you know, adjust here, adjust that. But I want six, twelve, eighteen months from now to be a lot better. And it's it's we we will get there. There's just gonna be some maybe some things we gotta work on. But yeah, I like what you said about the um the the side effects. If we get those, if we get a mess uh a message from from a patient saying, hey, I'm having this or that, we most of the time we know how to handle it. Yeah. And provide reassurance, like, hey, we we probably don't need to stop. We don't need to completely throw this out and and kind of redo you know our treatment plan. We might just have to tweak it a little bit. Um, whether that's going up or going down on a dose, or um, I don't know. There's just a lot of different ways we we can approach it. But just seeing seeing a provider who's comfortable with that um makes a big difference. Yeah. To help again minimize the side effect and all the headaches and cost and time and effort that could be associated with that is a big deal. It's really a big deal.

SPEAKER_00 38:30

There are like, you know, obviously people out there who are gonna take like all these like natural herbs and supplements and things like that. And and I don't want to say that that's the wrong approach, um, because I think that that can be powerful for some people. And I mean, that's what we're deriving supplements from, right? Is like things like that too. Um, but I definitely think like with caution, right, on some of those things. Um, a lot of things that supplement-wise that can affect our hormones can also affect a lot of other things and blood thickness and thinness and um, you know, cardiovascular risk and interactions with other medications, um, like your antidepressants and things like that. So I think getting some guidance there, even if you're like kind of hesitant on the actual hormones, but um want more of a natural approach, like we're still there for you. We're still gonna help you with that. We're still gonna give you the right recommendations and and still know what to monitor because just because it's a supplement doesn't mean we don't do labs, we don't check things. Yeah. Um, so I think that you know, those do-it-yourselfers out there, um, just be cautious. Um, know that there's still some risk and and not everybody's a candidate for certain hormones, you know, and it goes the same thing with certain supplements too.

SPEAKER_04 39:43

Yeah, I agree with that. Yeah. Yeah, we're definitely not against supplements at all. Again, if somebody is coming in and maybe their numbers do look pretty good, but they're just having a couple areas they want to improve. Um, and they're just maybe not at a a point in their life where they want to go down the full HRT route, I am a okay with that. Um we're still gonna have the the discussion about you know why and when we use HRT, just simply what are the what are the hormones for. Um, but then yeah, if they want to go down a more natural supplement route and um kind of be hands-off for a little bit, I am I am A-OK with that.

SPEAKER_00 40:24

Yeah, I had a a gal, she's is actually fertility, is why she came in. Um, she's an older female, she's in her 40s, early 40s, wanting to get pregnant, um, was you know worked up by her GYN, kind of did some fertility things. Her FSH was really high. And for patients out there, like when we're looking at your FSH, the higher that number, the more it can kind of steer us towards like you're kind of getting through, you know, menopause or kind of gives us an idea of kind of where you're at in that whole scheme of things. And she was not in a good place. She was like in the 80s. Um, and so you know, fertility for her was just really looking kind of negative. And for somebody who's wanting to potentially get pregnant, that's a very different approach on hormones, right? Like we're not gonna start testosterone, we're not gonna start a lot of things. But for her, it was really like understanding her cycle, understanding her like LH surges and her ovulation and when her FSH is surging and those kinds of things. But we purely just did a little bit of work with her progesterone and I started her on several different supplements to help with ovulation, um, very strategically, and also supplements from very reputable sources that are clinically strength. Yeah. Um, you know, you need like almost like a provider's permission to get certain supplements, right? Because they're so strong. Um, and we were able to, over the course of like six months, slowly but surely drop her FSH. And now it's like, it's like 4.2. And, you know, she's ovulating on time and things like that. And so supplements can be extremely powerful. Um, so you never want to discount that. Yeah, but they need to be, you know, monitored appropriately for sure.

SPEAKER_04 42:02

A question I get quite a bit is like when, you know, when will I start to feel a a difference or an improvement or you know, just kind of giving people a or people just want to know a timeline. Yeah, I guess. And understandable because they again, this is probably going on for years, right? They want to feel better as quick as they can, which is understandable.

SPEAKER_00 42:22

It's definitely different for everybody, right? Every single person is gonna have a different story. Um, certain hormones are also gonna work a little bit faster. You know, if I gave someone a progesterone, that night they're probably gonna notice difference in their sleep instantly. Like it progesterone is gonna help with other things too, their mood and their anxiety and um cycles and things like that, but like it really can help with their sleep. And so something like that, you know, you can have a quicker expectation. Something like testosterone, it's gonna be a second. It's gonna be maybe a week, maybe a couple of weeks, maybe a month. Um, kind of depending on the dose and the form. You know, same with estrogen, it kind of just depends. So, and for men, same thing. So it, yeah, it's hard. And also, like what symptom are you looking for improvement on? So yeah, is it is it your energy? Is it your libido? Is it those things? That's definitely gonna have a different time fine than um weight loss, yeah, you know, metabolism.

SPEAKER_02 43:16

Yeah.

SPEAKER_00 43:17

And so release like setting the appropriate expectation in office with them, I think is really important. Um, and not thinking like, as soon as I swallow this pill or inject this, you know, syringe of medication, I'm gonna feel amazing. It's it's not always gonna be that simple. But the end game will be worth it. Absolutely.

SPEAKER_04 43:36

The conference I was at recently, one of the providers, one of the speakers said something's just beautiful. Um, you kind of asked the question do we do we get old and lose our hormones? Or do we lose our hormones and then get old? Um and I I mean I think the answer is pretty clear. Yeah. Uh and that, you know, the losing of the hormones oftentimes is gradual, and you don't realize it, kind of, you know, months go by, years go by potentially, but then all of a sudden it's like, you know, what happened? Where did where did these symptoms symptoms come from? And and again, we can help prevent that, we can help potentially slow that decline, or just simply get them back to where we want to, you know, where they want to be. Right. Um I don't know. I just thought that summed it up beautifully in a in a very easy to understand concept.

SPEAKER_00 44:36

Well, we could literally go on probably for another couple of hours on this uh and get into the weeds, but um, I think the takeaway is like if you're curious um about your hormones, please just come see us, um, chat with us. We can do labs. Um, there's no pressure ever. Um, if you don't live here, you know, um, we can help guide you to maybe somebody who does something similar to us. There's a lot of us out there. Yeah. Um, we're definitely not like the diamond in the rough in this case. I mean, there's just there's a lot of really great, um, very educated people out there trained in this realm of medicine. Um, so yeah, feeling good is it's not a luxury, you know. It's it's your baseline. You can you can get there. Anybody can. Definitely.

SPEAKER_04 45:18

It feels good to feel good. You don't want to shoot for that. Yeah.

SPEAKER_00 45:22

Absolutely.