67: Are We Getting Hormones Wrong? – The Shocking Legacy of the Women’s Health Initiative with Dr. Christian Jenski

The broad general idea of optimization for me means not just within the normal range of parameters that you can pass. So where within that normal range do you consider it to be best and best for that patient? So that involves testing serially over time, but also clinical correlation could have some patients that feel amazing when their progesterone is this level and some that feel horrible when it's that level. So it's individualized. But there are certain parameters like thyroid, the range is way too big. So for me, even though normal goes up to 4.5 for a TSH, if my patient is above 2.5, I tell them that that's too high. So optimization is, can be a little bit generalized, but it always has to be personalized and it depends on parameters, clinical correlation and where you are within normal.

Welcome back once again, everybody. I'm super excited to be here with my friend, colleague and partner in crime, Dr. Christian Jensky. And we are going to talk about all things hormones over the next three episodes. I feel like this has become a really important topic because even in the integrative and functional medicine world, what I'm seeing is not hormone optimization, but hormone replacement. And it's kind of like the integrated version of green allopathy where if you're deficient in this, you take that and not actually getting to the root of what's going on. So we're going to talk about that and hopefully you'll learn a lot about this. If this information is helpful, please, like share, subscribe. That's how we get this information out there. As always, this information, we cannot diagnose or treat any medical condition. This is for educational purposes only. As always, talk with your personal healthcare provider. And with that, let's begin. You know, we were, we actually started talking going into this.

I know we should have recorded what we were just talking about. I, I feel like we'll cycle back to what we were just touching on because this is not, this is not a rare conversation, right? This is something we're having often and this is a conversation that I imagine you have with your patients daily. It is absolutely, probably one of the most confusing things out there with regards to information, I think. I mean, how would you define optimization? What separates that out from what's being done here?

Let's talk about hormone replacement therapy first. What's going on? You know, we just, in the last year, I feel like, had a window to open in the last 25 years that it's now becoming acceptable to do bioidentical hormones, to do a hormone replacement yeah. Do a lab, test the low, give back what's lacking, you know, and let's talk about that briefly before we talk about optimization. Because since the Women's health initiative in 2000, when we were misled to think that bioidentical hormones would cause cancer, cancer and things like that, maybe we should start the conversation there. That's.

That's a great.

That's where we get off track.

Yeah.

So maybe I'll fill in historical gaps for you, but tell us about the National Health nhs. What? Tell us what that was.

Yeah.

And then maybe we can together talk about what was so bad about it.

Tear it down, because that's where it belongs. So the Women's Health Initiative was actually run. It was a study run by a cardiologist. And the cardiologist's goal was to determine if hormone replacement therapy decreased cardiovascular risk in women. And the average age of the woman in that study was 65 years old. So just by that demographic alone, you knew the study results were going to be skewed. So during the study, one of the arms of the study, it was the synthetic progestin arm, which is a drug still used today, by the way, showed a slight uptick in breast cancer. And so this person came out and said all hormones cause cancer. And everybody believed them. And generations of women were. Had their hormones taken away or were not offered hormones. And really since I think 2019, it's been walked back. So six years ago. And they basically said, just kidding, we were wrong. We revisited the study. Our bad. So sorry for all of the damage that you all have suffered. It was just the progestin arm and that still stands, yet still prescribed. And hormones may be useful and helpful in certain situations, but it's patient dependent. And that's about the extent and specific nature of which they would say, like they didn't come out and say they're beneficial. They didn't come out and say they will absolutely help you with your heart or your brain or your bones. They didn't specify, but at least they weren't saying they're going to kill you, don't use them.

It's more sinister than that. Yeah. So maybe sinister is the wrong word. I need to be more show more grave.

Politically correct.

Yeah. But there was a significant number of the females who were smokers, which we know hormones and smoking do not mix. And the strange thing about it was, you know, during the pandemic we saw a lot of pre publication releases. And what happened was there was kind of one of those pre publication releases that Happened where the media kind of took it and put it out there that, oh my gosh, this is horrible, before it's published. So the media had a two week, you know, lead time on the publication, the actual study. So all of a sudden, for two weeks, death, dying, you know, mayhem kind of stuff. And it actually came out and people like myself, like you, like a bunch of other people read it and we're like, wait a second. We started noticing that the primpro, it was oral estrogen, equine hormone, plus the medjoxy progesterone, which causes tumors in rats, which is prothrombotic. Why was it oral? Why were these doses then the estradiol arm was actually preventative. We started actually seeing that at week three, but the damage was done. And because it was so widespread and this is where, you know, with social media even a thing back then, I forget 2000, I don't think it was, but just the way media and the way things work, the scare factor was so severe. It was just. And it's literally taking 19, maybe 25 years for us to finally. I feel like now I'm finally in a place where people are like, I think I've heard that bioidentical hormones actually might be good for me. And it's really interesting. There's a book, Blind spots, by Martin McCary. He wrote, talking about, and he mentioned this very topic in his book. And he actually quotes a study around the same time, 2019, that showed that if a female was on bioidentical hormones and they were diagnosed with breast cancer, it was less aggressive. Yeah. So wait a second. These are maybe, maybe breast protective. The exact opposite. Yeah. And this, this blind spot, this mischaracterization, I wish it was less common in medicine. I wish I could say, oh my gosh, I had no idea this happened in medicine. Happens all the time, sadly. And so that has changed for almost a quarter of a century, how we deal with women's hormones to the detriment of over half of our population.

It's horrible. It's literally. We were just talking about this. I feel like we both become medical feminists in the process of treating predominantly women in my practice. And I think yours is the same. It's like you hear these horror stories over and over again and still like, it's, it's better, but it's not good. And there's still misinformation, there's still misguiding. I feel like my patients often feel, sadly, like they're stuck between a rock and a hard place because they have me telling them what I believe to be the truth. And this is the truth and data driven about the safety and risk stratification of using hormones appropriately, how to monitor them and things that we're going to talk about. And then their other provider, whether that's an endocrinologist or an ob GYN or the primary care doctor who's telling them something different and what they're being told by this other person is usually in the context of fear mongering and not informed consent, in my opinion. And so it's really, really hard. I mean I have a conversation about the Women's Health Initiative all the time. We talk about. Because there's a lot of misinformation also about just how you're supposed to do these hormones. Because there's no standardization at this point in time. Right. There's no. This is the true right way. We think we know that, we think we have good idea. And I think being more thorough is always the right way in the way of testing. But I think we're kind of getting into that.

And one thing, if you're going to personalize hormones, it can never be standardized. Yeah, I have female patients who are on 0.025 milligrams of topical estradiol and they still have high levels and have women on 0.5, not quite 1 milligram and the numbers are off the charts. And so how does your skin absorb it? How do you metabolize it? Is your skin dry? What's your hydration status? Percent body fat? These things are stored in body fat. If you're an older female, is very slender, has no fat, stuff's going to go right into your tissues. There's no place for it to sit. If you're an overweight female, you've got lots of storage place so you're gonna need higher doses. You cannot individualize and personalize in a random, by definition, in a randomized placebo controlled trial hormone therapy.

So too many moving parts. I think standardization would come with what formularies and what the testing should be. That that's what I think. If there was uniformity there be so much clarity. You should check if using this, check serum and saliva. If using this check just saliva and for all of them check metabolites to make sure they're detoxing well. Oh, by the way, here are the formularies of estrogen that are safe. Here are the formulary. Here is the formulary of progesterone that is safe. Right. And that way there's not all this confusion, because I see an attempt, I see a desire by conventional medicine to want to do this right. They don't test right. They don't test enough or at all. But at least they're using estradiol a little bit and micronized progesterone instead of progestin. So I'm seeing this trend and I'm a little hopeful, but I'm also like, eh, you got a lot of work to do.

It took us 25 years to figure out that that was wrong. It took us 30 years to figure out hand washing was a good thing. Yeah, it took us.

Smoking was bad.

It took us 50 years. Right now we're in the midst of this vaping thing. I'm not gonna go down that pathway.

Cause.

Yeah. Get canceled. Because evidently on social media, people love vaping right now. But, you know, for. Since 2006, 2007, it's been a big thing. I have a feeling, based on what I'm seeing in the literature, in 10 years, we're gonna be oops. And one of our goals is not to be the people who say poops. So hormone replacement versus hormone optimization. So in general terms, you know, we talked about that briefly. So what is hormone optimization? Tell us the three big parts. Maybe the fourth part, the neurological system. Like, when we say optimization, what are the big picture things we're thinking about?

So just to be clear, hormone replacement is you have a deficiency and we're giving you some back, right? That's what you're referring to. So you're getting hormones back. And for very few select individuals, not many that I treat, you just give them back that hormone and all is right. Usually it's a bit more complicated than that. And I think that that's probably true for most patients. And that means that the optimization thing that we're about to speak about is really not happening. And for me, optimization is how that hormone is being kind of utilized, processed, you know, metabolized, et cetera, by the body. So things like the gut are involved. Things like the. The influence of these endocrine loops are involved. The autonomic nervous system or neurologic system in general is involved. You know, that hormone hierarchy of adrenal, thyroid, sex hormones. All of these things play a role, whether it be mitochondrial function, toxic burden. There's so many layers that might affect the way in which this person feels when they use hormones or not. And so you have to kind of see this big picture and make sure that the hormones are being delivered properly. The hormones are being utilized by the body properly? Are they bound up, Are they free? Are they getting into that bioavailable space? Are they being metabolized appropriately? Are they being neutralized appropriately? Are they being excreted appropriately? And that involves a lot of those pathways that I was just mentioning. I'm sure you have some other things to say.

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I mean, you know, the three big things I think about are with optimization is first thing you mentioned the system 1, which is your adrenal thyroid insulin, like the survival hormones impact survival sex hormones are icing on the cake. You do not need them to be alive. Without the survival hormones, we die. So these have to be optimized first, then the organs of detoxification. Because where these get kicked out and where these get kicked out, if those are mucked up and we start pushing these buttons, things mess up and then there's the actual giving you the hormones themselves, which is in my book the, the last thing I do a new. You know, one thing you briefly alluded to is the autonomic nervous system which works through neuroendocrine, you know, nerve hormone system. It affects our gut, it affects our like your entire body. And when someone's in sympathetic overdrive, they have trauma. Those, these are actually some of our most difficult patients with hormones when they have trauma and stress. So cortisol's high, like this is high, but it's from trauma and stress and whatever. And when that's really elevated, those are the people who do really poorly. When I start messing with the hormones, if I have not addressed that stuff first and then there's filling in the holes, there's a lot of nuances you, you alluded to environmental toxins and chemicals, neuroendocrine disruptors, nutritional status. I mean for me, like, you know, obviously working on gut, working on stress, working on sleep, working on the foundations of functional medicine. If your vitamin D level's low, if your magnesium's low, if your potassium's low, I mean, how are hormones gonna work without Magnesium and calcium being balanced, you know, all that.

Insulin receptors don't work without mag.

Yeah.

And so thyroid receptors don't work without vitamin D. Yeah.

And A and iodine, you know, you know, amino acids like tyrosine. And it's really interesting as well. I mean, how many of our patients, how many are hypermobile? If you're hypermobile, all of a sudden, you're going to be, you're going to be, have a tendency towards deficiencies and a lot of amino acids, vitamin C, trace minerals, and you're going to tend to have low vitamin D levels. So all of a sudden, if you have someone in, you know, according to the literature, I look at maybe 20% of our population is hypermobile all of a sudden. If you're not addressing those things, I just jump to hormones. And maybe that's one of the reasons why this group of people, the hypermobile people, when they go through pregnancy, sometimes people, they dis, they start dislocating body parts because their progesterone's high and their tissues can't quite deal with it. So, so optimization is that kind of stuff. So, you know, we, we don't do, you know, hormone replacement. We do hormone optimization.

Yeah. I would layer also into that. Like the broad general idea of optimization for me means not just within the normal range of parameters that you can test. So where within that normal range do you consider it to be best and best for that patient? So that involves testing serially over time, but also clinical correlation could have some patients that feel amazing when their progesterone is this level and some that feel horrible when it's that level. So it's individualized, but there are certain parameters, like thyroid, the range is way too big. So for me, even though normal goes up to 4.5 for a TSH, if my patient is above 2.5, I tell them that that's too high. So optimization is, can be a little bit generalized, but it always has to be personalized. And it depends on parameters, clinical correlation and where you are within normal.

And then there's the nuance of where are you at in your hormonal lifespan? Yeah. You know, are you 25 to 30 with abnormal hormones?

Talk about that. Talk about hormonal age and chronological age.

Ye, exactly. So if someone's like, if you're 20, 25, you know, you haven't had any kids, you should be able to fix your hormone issues without hormone replacement. It becomes an issue of what's going on in your gut. Stress, sleep, cortisol issues, you know, trauma, sleep, Wake cycles. What's your diet look like? A lot of these individuals have undiagnosed pcos. They'll have endometriosis. And so all of a sudden the hormone issue is part of metabolic syndrome. So we have to work on insulin resistance. We have to work on. And again, they, I won't say always, but they almost always have low vitamin D levels and have elevated inflammatory markers. So all of a sudden the goal with those people that are early in their hormonal lifespan, we need to work on all this other stuff. And then there's a span from like probably 30 ish to early 40s where and this is, can be affected by how many children you have. But you tend to see is testosterone levels will start to come down a little bit initially. Progesterone will then start a little later on will start to come down a little bit while estrogen is maintained. And the typical, if there is such a thing female, usually if everything else is balanced, it's not gonna have a massive impact. But if, and I will see this sometimes, particularly in my hypermobile patients, nutritional status is poor. You have two or three kids, they suck all the nutrients out of you. They pull your calcium, your protein, they cause massive nutrient deficiencies. You know, it's really interesting how many women will have dental issues and gum issues after their second or third kid because they didn't have their nutrient status and they had these massive stressors. So now the gum lines are receding, they're getting cavities and you start talking to them and you're like. And it's more so when people that are hypermobile but non hypermobile individuals can have that happen. And those are the people who, once you fix all the things we've talked about, you know, maybe doing a touch of progesterone, a touch of testosterone can be helpful to balance things out after you've done all that stuff. Where it gets really tricky is when women are on that perimenopausal phase. I have a picture in my head of estrogen. One of the textbooks I was reading a while ago that, you know, shows when women first start cycling, their estrogen's kind of all over the place. So you're 11, 12, you know, however old you are when you start. And that might take 2, 3, 4, sometimes it doesn't normalize to 19 or 20 cycles are off a little bit, but that usually normalizes and stays pretty even for these are average estrogens. Until you're like, you know, when you're getting close to your period, then it goes crazy again. And when you're in that stage, giving estrogen can call make things worse because you don't know where you're at in this cycle. So it really becomes supporting estrogen with nutrients, with adaptogenic hormones. Someone has usually things like Chase Berry. There's a lot of herbal things that can be used to help estrogen receptors balance out, to help with detoxification in the peaks. And then it's really easy once they're menopause. That's like you.

Yeah. You just giving back at that point.

Yeah. At that time it's. It's just.

Perimenopause is a moving target, is the best way I'd describe it and like moving more. So with estrogen, like you described, progesterone, it's usually on its way out and you can kind of give it back. And most people feel good. You just gotta find that sweet spot dosing, which also might be a little bit of a moving target, but so safe, so bioavailable. If you give it orally, it converts into allopregnanolone, which is calming. So it helps with anxiety associated with that transition, helps with sleep, which is a huge issue during that time. And then plus or minus little testosterone. But you always have to be weary because that T in a biological female is going to want to convert into estrogen if they're carrying weight. That adipose tissue is estrogenic, meaning upregulated aromatase. This is all a fancy way of saying, you know, if you're metabolically off, your body is going to push towards making more estrogen. And sometimes that comes from testosterone. But that. That moving target. Yeah, you're right. It's hard to replete when they're low. So you just kind of support that area and when it's high, really ramp up, detox and then wait for it to kind of level off and then. Okay, we're good. Now maybe we can give you a little bit back or catch it right. As its own way out.

And one thing I also want to talk about as well, there's a little bit of misinformation and some newer information coming out. You know, we've known since our training that during the first two years during menopause and after menopause is when women will lose most of the bone tissue during that point in time. So the first 10 years is like the most important time to do hormonal support. But then the question is, at what age is it too old to get hormone optimization?

I think never.

Never. You are correct, sir. You know, estrogen is directly related to maintenance of your hippocampus, which is where your memory is. How many women want to lose their hippocampus?

None.

None. It's also related with cerebral volume cardiovascular risk, reasons why women are 10 years younger than men for cardiovascular risk. So like a 65 year old male, female heart risk is roughly equal to a 55 year old male, plus or minus. You know, whatever else is going on is because of estrogen. And so as a female, would you want to maintain that health advantage that estrogen gives you? Yes. And there's a really interesting nuance. And this is, you know, I don't want to get too much into this because this actually somehow becomes political. But it's interesting how in women, testosterone. Let me rephrase this. In women, estrogen doesn't women what testosterone does in men. And in men, estrogen does in men what testosterone does in women. So it's almost like we're opposites in some way. And so the concept that women don't need progesterone in menopause, we give them just estrogen. You don't have a uterus, so we don't have to. That was a mantra I was taught. You know, uterus is gone and it's like, well, oral progesterone, which forms metabolites, including allopregnilone, is breast protective. Yeah. And so is breast protection bad, so why would we not do that? And then with the way estrogen works at estrogen receptors, progesterone actually helps augment that. And so, and also we mentioned the survival hormones cortisol, you need. Progesterone actually has a balancing act with cortisol. And so extremes, if someone gets too much progesterone, it can really jack up.

The cortisol if they're stressed during that time. Yeah, that's the other thing is, that's why it's a hormone hierarchy. That's why you gotta address stress before or concurrently with addressing these other things. Because if you go high up in the food chain to pregnenolone, and pregnenolone can stay as pregnenolone or become progesterone. And then those can become one or two of the life saving hormones, aldosterone, mineral corticoids, right. Salt and water balance or cortisol. And so if you're giving someone pregnenolone or progesterone and they're stressed and you're not helping with that stress, they're just going to push that into cortisol. So you gotta pay all all of that attention and kind of work with that person. But it's all right there, I think, whether they have had a mastectomy or a total hysterectomy or what. Like, I still give em progesterone. I don't give anybody unopposed estrogen. Progesterone is the counterbalance. Progesterone also has bone protection. Progesterone also has cardiovascular risk reduction. It's just one of these things where I just don't understand why you wouldn't. And there's such a safety profile along with it. And then estrogen can work better, but in a safer way. You can kind of find that Goldilocks sweet spot. And I think the body just balance is better when you do that.

And we could talk about this for hours alone. I want to go to the next part of this section, which is testing.

Yeah.

So why don't you just tell us, walk through blood testing, spit testing, urine testing, all different testing types, like what's out there, what are the different types of tests, and then briefly talk about some of the issues with those. And I'll kind of fill in some of the gaps after you do that.

So urine is something that I do on all my patients, and I think it's probably something that should be the standard of care in reproductive women at least once in their life to assess detoxification. And the reason being that it's looking at metabolites. So metabolites are like these downstream markers. You have this parent molecule, in this case an A hormone, estrogen, and then it has to be broken down into these other types. And estrogen has three subtypes. It's estradiol, estro and estrone. The final common pathway is to estrone, which has then got three subtypes of its own, and it's 2, 16 and 4 hydroxy estrone. And those are called the good, the not so good and the ugly. We used to call them the good, the bad and the ugly. And you really wanted to go down these right pathways and away from the bad pathways. And I think we'll talk more on that. So urine is basically about assessing detox and metabolites. Are you doing it well? Are you neutralizing it? In this case methylating it. And then gut would be, are we excreting it? So that's one way. So I count gut as part of that. Two is saliva. And saliva is showing me what's in the intracellular space, like what's at the site of the receptor, what's bioavailable. So salivary Testing is what I do when I'm kind of assessing someone's levels that I'm replacing the way of phy. Identical hormone replacement therapy. And then there's serum. And serum is another way of saying blood. Blood is what's most routinely tested in conventional medicine. They're not really doing saliva, they're not really doing urine metabolites. Serum is great for kind of the bigger picture. It's looking at total. You'll see bound, but you're not necessarily aware of what's free. With testosterone, you can measure total and free. You can look at sex hormone binding, globulin or other binding proteins to see what's stored and what's maybe on the, the delivery truck. But you don't know that it's getting into the tissue if you're not measuring at a tissue level, which is what saliva is. So for me, for everybody, they get all three. I look at their detox first and foremost, and then I look at serum to see where they're at. And then I'm looking at saliva, depending on what I'm repleting. And collectively that gives me all the information I need to really optimize that person.

And the thing about, you know, what you're saying is that urine is not for dosing. No, it's. And so that's one of the things, I think that is a misnomer that people are using it to dosing. It's, it's a qualitative test, it's not a quantitative test. You know, the way I explain it to people is like the bullseye is a lcms, which is a liquid chromatography, mass spectra, salivary test is like the, you know exactly where it's at.

Yeah.

The circle around that is the EIA serum is a little bigger. And then the urine is like, okay, we're. You've got, you know, metabolites. And so if I'm trying to dose someone in the micrograms, picogram, dosing with stuff, which is how, you know, these things are measured, then I don't want to, you know, ballpark. I want to know exactly where I'm at.

You want that ballpark?

Yeah. And so the urine is useful, but as you know. What are you doing with it? I usually do the urine. It's like, usually for me, it's usually one of the last things I do once I've balanced people out to see what you're doing with it. Because once I got your levels squared away, then the question is, okay, am I lowering your risk for Breast cancer or increasing it, doing all the principles we do and then I do the urine and then it's like, oh look, this is. You're 16, four, whatever. The interesting thing about that with some of why we see these patients all the time is, you know, you can, in the precision medicine world, it's doing the serum is a little bit frowned on because we're not ultimately going to be dosing patients on that. But if someone comes in and they're not on bioidentical hormones, you can start with serum testing to get your general ballpark of where people are at. But there are some things you pick up like LH and fsh, which is your brain's response to what you're.

It's getting huge.

Sex hormone binding globulin, which is the primary protein made by your liver that binds up all the hormones. Like you mentioned, free bound pregnenolone.

Yeah.

You know, just, it's.

I even like getting a dheas. I think that's helpful.

Well, correct. And that's, you know, not available except with, with blood. And so the serum has this utility and then even with the salivary you have different people have different levels of accuracy. But the thing I think where we get in trouble is when someone comes in taking an oral estrogen. And we talked about this before. What are your thoughts about this, Dr. Jinsey? Someone comes in oral estrogen and gets serum blood testing. And do you really know what's going on based on the blood test?

No, of course you don't. And you're also increasing that person's inflammatory risk. It's going to, anytime you're taking oral estrogens, your body's going to respond by having an increased clot risk, an increased stroke risk, increased interleukin 6, which is one of your major inflammatory immune markers or cytokines. And you're also going through first pass metabolism through the liver. So you're not gonna get, you're not gonna get true values. So I, I just think anybody that's on oral. I have a patient that came in on oral and she was actually seeing someone who claimed to be functional and it's sublingual. And I said, well that's still oral. She said, but it's sublingual. And I said okay, I get it, but you're swallowing some of it. And her estrogen levels are through the roof and the numbers are off. And I checked saliva as well. And so we're converting her to a topical. But orals should not be done. In my opinion, topical is the way to go. And that's the safer way because you don't carry all those other risks that we were talking about. And I don't think you're getting the same value when you're looking at these labs to talk on the serum. I mean, besides FSH and LH and pregnenolone and dheas, Although you're not necessarily using it for dosing, it does give insight, in my opinion, especially with like, total and free testosterone and then seeing whether or not that's getting to the cell by looking at saliva. But as I am looking at salivary levels to change someone's dosing, I can currently look at their serum levels so that eventually, at some point in time, I can maybe use their serum levels to kind of gauge where their saliva levels might be. Although it might change your transition. I just feel like in this situation, because there's been such confusion for so long and there still is more is better when it comes to testing. The more information you have, the better off you're going to be at assessing this person's health, but also getting them what they need and then optimizing that.

And the only caveat that would be just it becomes hard for the patient because, like, while my blood estrogen was low or undetectable. Yeah. But my salary level was high. You know, it took me probably six months to really get a really good handle on this. I spent. I'm working on a personalized medicine fellowship right now through USF and spent six months just taking a deep dive into all things hormone. And it's really interesting, Dr. Zava, he's the actual medical director at ZRT Labs, looked at tens of thousands of tests. It's really interesting. When you take progesterone on the skin, you'll see the numbers spike in the serum and they bomb out. So by the next day, they're almost gone. And so if you're putting like, like a topical on or an oralon using that serum test, you're almost always going to miss it. And it's really interesting. If you, if someone has a topical patch of estradiol, which is slow release, you can use a serum, um, and you'll see that that stays pretty stable. But if someone's doing a topical bioidentical, what happens is within like five to 10 minutes, the stuff goes into the blood and into the tissues. So it's really hard to catch in the blood. And then you the salivary levels and it's like sky high. And so those little nuances help me kind of Conceptualize my brain, like when. And let's talk about pellet therapy a little bit, because I feel like that's like, you know, in some ways the band of my existence.

Yeah. Pellets. I don't, I literally don't let, like, I don't, I can't say I don't let. Like, if a patient of mine is on pellets, I heavily attempt to convince them to not do them anymore. Yeah, I had one come in with pellets and like, you just get this massive surge, this super physiologic dose. You get this really high level and of course you feel great and that's why you like them. And then it peaks and it plateaus and then it comes crashing down. And so it's, it's not mimicking normal physiology and it's just kind of all over the mat.

Theoretically, pellets should be amazing. They should put the hormone estrogen, testosterone, right in your soft tissues, your fat. It should be a slow release. And then based on your immutates in your skin, you'll break down the testosterone based on all these things. You should see these beautiful undulations and even a little bit of a diurnal. It should change a little bit. Just almost like natural, theoretically.

Yeah.

I don't see that.

No.

And so I remember when I was doing my training, they're like, I was like, oh my gosh, I'm going to do pelts because they're so amazing. So I went down the pathway of starting doing some training with it and then started looking and I started seeing patients coming here with pellets. I'm like, why are they all so crazy high?

Yeah.

And then it was then Dr. Smith, who's one of the people I'm doing some training with, she's been doing this for 40 years. And she's like, she ha. She's like, we don't do pellets for this very reason. So sometimes I defer to people who've been doing this for a really long time that it's like. And what I seeing is what I'm seeing. True. And I've talked with multiple people and yeah, I mean, the people doing this for a while aren't really doing pellets. Unfortunately, pellets are still done. They, they're still done. They, they reimburse well, they're easier to manage. Cause you just put them in and don't worry about it.

But if it's not best for the.

Patient, not best for the patient.

And that's what's just important.

Yeah, agreed. So the goal of us talking about hormone optimization is not to answer everybody's questions, but to give people a feel for if someone's doing the hormones, some of the conversations they should be having, or at least some of the questions they should be able to ask and discuss with the provider. So I'm gonna start. We almost stop right here. I think next we'll talk about the hormonal hierarchy and what that actually means, how it plays into some of the stuff. If people have questions about the hormones, please drop it below. We'll we tend to do question answers after our sessions. Information was helpful. Please, like share, subscribe. And now I'm actually excited to talk next about hormonal hierarchy, what it is. And we'll leave it at that. We'll be back soon. Yeah.

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