Hormones 101: The Shocking Truth About Balance, Gut Health, & Aging with Dr. Pamela Smith

I'm so excited today to have a world renowned hormone expert as well as one of the first people to get into the functional medicine world years and years ago. So we're just going to do a quick introductory to Dr. Pam Smith and we'll go from there. Dr. Smith spent the first 20 years of her practice as an emergency room physician in a level one trauma center with the Detroit Medical center. Then she spent 29 years as a functional medicine and personalized medicine specialist. She's an internationally known speaker and author and she holds a Master's degree in Public health as well as a specialization in toxicology along with a master's degree in metabolic nutritional medicine. Dr. Smith is in a private practice and is the senior partner of the center for Precision Medicine with offices in Michigan and Florida. She has been featured on cnn, PBS and many other television networks, has been interviewed in numerous consumer magazines, and has a host of two of her own radio shows. Dr. Smith has one of the featured physicians in the PBS series the Embrace of Aging as well as an online medical series, Awakening from Alzheimer's and regain youn Brain. Dr. Smith is co director for the Personalized Medicine certification at the Morsani College of Medicine at the University of South Florida. She's the author, author of 14 bestselling books. Her book what yout Must know about hormones second edition was actually released in 2022. And her book Maximize youe Male Hormones was released 2023. Her book what you Must Know About Thyroid Disorder on Second Edition was released last year. And her newest book, how to Prevent Breast Cancer before and after is out due out this fall. So look out for that. I'm kind of excited about that one coming out here. She has, she has newly been appointed as the Chief Growth Officer and Chief Educational Officer at MD Lifespan, a cutting edge medical practice with offices around the country and specializes in the removal of toxins in the body. Dr. Smith, welcome.

Oh, I'm very, very happy to be here. Thank you.

Yeah, I've been following you, listening to you. Whether it was my training, you know, I started the IFM and A form and now I'm actually doing the Personalized Medicine Fellowship at usf. So super excited to have you here to talk about all things hormone. But before we dive into that, you had super impressive resume. You know, 14 books. Would you just tell a little bit about how does you know? It's really interesting. Dr. Jensky, he works in the practice with me is a, I call it a rehabilitating emergency room physician. So how do you go from an ER physician to personalized medicine. Like, what's that transition? Can you walk us through a little bit of your history so we can understand a little better kind of where you're coming from?

Absolutely. Honestly, I was very, very happy being an ER physician at Detroit receiving. I got to work for Dr. Ronald Crone. Most people do not know that the specialty of emergency medicine actually started in Detroit. And so I got to work for Ron Crome, himself, the father of emergency medicine. I thought I would never leave until one day I could not sleep. I literally went to 11 doctors, and none of them could help me. They all take a sleeping pill. I went to a conference, and there I was. Second seminar, second slide. Women without progesterone frequently have insomnia. I did the first saliva test in the Midwest 35 years ago. Started on progesterone, slept like a baby. And then I realized I loved emergency medicine. But I had another calling, and it had to do with looking at the cause of the problem and not just treating symptoms, which is why I love personalized medicine. You get to look at the cause.

Gotcha. And so one of the things I wanna talk about briefly is the concept and what you're known as an expert in is hormones and all things hormones related. And I feel like in my practice, a lot of people will come in and that they come in with that goal, like, I want you to fix my hormones, but they don't, you know, respect the process. I get there's. There's actually a hierarchy called the hormonal hierarchy. Would you walk us through that? Because I. I've. I feel like a lot of people, even now, after years and years and years, just don't quite understand hormonal hierarchy and how, you know, your adrenals and thyroid and insulin playing with gut health and then the icing on the cake, so to speak, which you need that icing, right. Are the sex hormones. Could you walk us through that?

Certainly. And thank you for pointing out that people really need to look at the entire hierarchy because it's not just about one thing. So the conductor of the hormonal symphony is thyroid. And thyroid has to be perfect and have to be optimal and not just normal in order for the patient to be healthy, stay healthy, and also have the rest of the hormones functioning optimally as well. The stereotogenic pathway, which is what this pathway is called, that looks at the sex hormones, starts with the hormone that is hard to say and hard to spell. It is called pregnanolone. So for those of you out there who've Never heard of this. It is your hormone of memory. It's P R E G N E N O L O N E. So P R e G N e N o L o N E. Pregnanolone. It is literally your hormone of memory. It is made from cholesterol. And a lot of times cardiologists forget this. In order to make pregnanolone, you have to have enough cholesterol. So your total cholesterol on the blood does have to be 140 to make pregnanolone to make the other hormones. So pregnanolone does make estrogens, progesterone, testosterone, dhea, the stress hormone, cortisol for both men and women. But again, is it good to have a total cholesterol of 104? Not really. It needs to be 140 to make the rest of these hormones too. So it's not just about the heart. It's. It is about the whole body.

Gotcha. Now, with them, you said the thyroid needs to be like, spot on. Could you tell us what those numbers are for? Like, what would you look at? Are you looking at just TSH and T4? Are you looking at, you know, other labs? And if so, what. What do you consider an optimal, optimal range with those?

Great question. We look at tsh, which is really not thyroid hormone. It stands for thyroid stimulating hormone, the hormone that stimulates your thyroid hormones to be produced. And perfect is the lowest limit of normal at the lab. Something in the range of 0.35, up to 2, unless you're above the age of 75. And then we go up to 2.5. That's the perfect range. Otherwise, some labs say that it can go up to 4, it can go up to 4.5 or even 5. If you go up that high, then usually your memory's not rapid fire. You don't have a lot of energy. You do have symptoms of low thyroid function called hypothyroidism. Then we measure free T3 and free T4, which are the two thyroid hormones themselves. We also measure reverse T3, which tells us if thyroid is getting into the cell and available for the body to use, and then thyroid antibodies to see if the thyroid is producing antibodies against itself. So if you have low thyroid function with antibodies being produced, that would be Hashimoto's, you can have Hashimoto's thyroiditis, meaning autoimmune disease, even if you have normal thyroid function. And then if you have too much thyroid being produced with positive antibodies, that is called Graves disease. And we even see commercials now on television for graves eyes disease, et cetera. So we are starting to talk more about this in a commonplace world.

Now, sometimes I'll see labs when patients come in from the endocrinologist and lab, the thyroid index, and they'll have these other labs that are not what you mentioned. My understanding those are labs that we've done back in the day. Actually, I was trained back when I was going to medical school from like 96 to 2000. I was trained on those labs. Actually, could you talk about the transition from those labs to what you're talking about? Like, what's the discrepancy there?

Well, sometimes we do measure those in thyroid binding globulin, which is how the thyroid is bound, et cetera. But endocrinology more goes into those when there may be a discrepancy of what is going on with the thyroid itself. And sometimes we have been measuring these other labs, very importantly with people with long havid. 50% of people who get Covid do get Covid long haul, meaning after 90 days they may have a residual issue that occurs. And sometimes it's related to the thyroid, even thyroiditis with inflammation of the thyroid. Thyroid may not be working too well or overproducing positive thyroid antibodies. So those sometimes we get into those extra tests when we have another diagnosis, like long haul Covid.

Okay. And you tend to see like in long Covid or similar fatigue analysis. Do you tend to see the elevations in reverse T3 in those patients as a marker for mitochondrial function issues?

We do. And for those of you who do not know what mitochondrial function is, you probably do if you listen to this podcast all the time. But mitochondria are the engines of the body, literally meaning the car engines. So the body does function like a car. What happens if you don't have enough nutrients? Then it's like a Mercedes functioning on low octane fuel. It doesn't work very well. Breaks down, dies early. Your body does the same thing if it doesn't have fuel. And so the mitochondria are the engines and there are different nutrients that fuel those engines. And there's different reasons why you may not have enough nutrients. And maybe because you exercise every single day, then you might get deplete. It may be because you had a virus, it may be due to the aging process and other things. But when we look at reverse T3, it tells us a lot of times if we need those extra nutrients to help the thyroid work better in the body.

Gotcha. Gotcha. Now with the cortisol, you Mentioned, Sorry. With the cholesterol you mentioned 140. Needing 140 to make pregnant alone, is there like, what's the best cholesterol number from your perspective for having optimal. Your body having optimal sterogen, so the optimal ability to make these hormones. What's. Is there a. A cholesterol that's ideal for that, or is it just over 1 40?

Over 140. But perfect, honestly, is 140 to 180. But people need to understand that having high cholesterol is not the cause of heart disease. Is inflammation of cholesterol that causes heart disease and statin drugs working by decreasing inflammation because inflammation does cause most disease after the age of 42. So it's not evil to have cholesterol. Your cell membranes are made of cholesterol. We just don't want them to be inflamed. But ideally 140 to 160, 140, 180. Certainly I'm 70, so the perfect level for me, per a functional medicine cardiologist, would be 180, not inflamed.

Gotcha, gotcha. So we talked about thyroid, and there's two other hormones, cortisol and insulin, that are at the kind of top of the formula hierarchy. Could you briefly talk about insulin and cortisol and how they interact with thyroid to affect your overall? These are the hormones without which we die, right? Without cortisol we die. Without thyroid, we die. Without insulin, we die. How do they interact downstream to affect gut and ultimately to play with your sex hormones?

That's such an excellent question, because it really is all about balance. And I sincerely mean that insulin is the hormone that the body produces to regulate blood sugar. But most patients, unless they see a functional or personalized medicine doctor, never have that hormone measured. They measure the blood sugar, and normal blood sugar is 70 to 90. Anything above 90, insulin is probably not working effectively in the body. They have hemoglobin A1C measured, which is your blood sugar over 90 days. But they never have the actual hormone insulin measured. Perfect. Is 6 too little or too much, then insulin is not working effectively in the body, which can lead to insulin resistance and it can lead to diabetes. Thyroid is still the conductor of the hormonal symphony. That includes how insulin works in the body and whether you regulate blood sugar well or not. But it's very much also related to cortisol, the stress hormone. I mean, who isn't stressed in today's world? Everybody is stressed. But you have to be able to mitigate that and really balance it in the body and we measure cortisol, the stress hormone, by saliva testing. And it's always best to get what we call a four point cortisol. Eight in the morning, 12 noon, 4pm, 10 to 11pm you really do have to have cortisol to live. If you don't have cortisol, you die in a week. So your body will preferentially make that hormone above all the other hormones. So you can be 24 and have brain fog because your body will take pregnanolone, that hormone of memory, make cortisol deplete itself of pregnanolone and then you won't have rapid fire memory no matter what age you are due to stress. So cortisol needs to be dead center of normal. When you're first stressed, cortisol elevates and you make too much. When you've been stressed for a long time, you make too much, too little. But then cholesterol, blood sugar, blood pressure start rising, you put on weight, your thyroid doesn't work as well, insulin doesn't work as well, you feel overwhelmed. A lot of things can happen in the body and that happens in both men and women. I honestly discuss all of this in my book what you must know about women's hormones, the second editions. And for men, of course, we can't leave them out. If we fix her hormones, we have to fix his. So maximize your male hormones. For men, you notice it's a lot thinner. My publisher did convince me that men would probably not read a 450 page book on hormones. But it's just as important for men to have normal hormones as well, whether it's their sex hormones, pregnant alone, melatonin for sleeping on the immune system, cortisol, insulin, they're all just as important.

Now, one thing I was thinking about as you're talking, some of my patients have actually been coming to me. I think this is actually coming to the public consciousness. A cortisol response, morning cortisol response. Could you talk about that briefly? Because that's also a marker for resilience, like how someone, how much cortisol pops up in the morning when they wake up. Could you talk about that response and how that plays into resiliency?

Absolutely. Cortisol is supposed to be higher in the morning and so you can measure the cortisol response. It's very much predicated on how you slept. If you do not sleep well, that response will. Cortisol will not be higher in the morning than it is the rest of the day. And if you go into REM sleep Immediately and you sleep for six and a half to seven hours in rem, even if you're stressed. When you wake up in the morning, cortisol almost always is normal and then insulin is normal as well. All of those hormones really are tied together. So it really is about managing stress to have that normal response curve we get with cortisol being higher.

And you mentioned melatonin and something else that I think that people don't think about is oxytocin as well. Could you. These are like less well known, more obscure hormones that kind of interact. Could you talk about briefly about melatonin and oxytocin and what are these and how to look at them and how they affect your health.

I think everybody has heard about melatonin in relationship to sleep, but it's also very much part of our immune system. In fact, we even use some hormones like melatonin to treat things like breast cancer. Great studies because it's an immune modulator, it regulates the immune system. Wonderful studies on big doses of melatonin for stage four breast cancer and then stage three, stage two and stage one. We use huge doses of melatonin to treat Covid. That's severe and long haul Covid to really help to regulate the immune system. Melatonin is best measured also by saliva at 8 in the morning, 5pm and 3am with the lights off. So it's not just about sleep. Melatonin does change with age. So you want it to be perfect for your immune system as well as sleeping. When it comes to looking at oxytocin, it is the hormone that most people think about is very important for the mother and, and child to have an attachment. It's also a cuddling hormone and it's regulated by thyroid just like the rest of the hormones are. We are discovering that toxins and endocrine disruptors, hormones that are changed by toxins in the environment, are becoming a big issue with all these hormones we discussed today, whether it's oxytocin or melatonin or thyroid, estrogen, progesterone, et cetera.

Yeah, and that was something I was going to bring up later on, but since you kind of mentioned, you know, the idea of chemicals as horns, these things, neuroendocrine disruptors, I think a lot of people are. It's now coming to public consciousness. I feel like in the last month or two where people actually are, it's actually in the mainstream news now where there's plastics and phthalates and benzenes and PAHs and all these acronyms getting Thrown around, but ultimately just chemicals in our environment. Can you talk briefly about, you know, how those can affect hormones, particularly in young women? And you know, we're seeing this crazy. I think what I read a while ago in the 18 mid-1800s, the average age of starting a cycle for a young lady was 16. And now in certain age groups it's nine. Like could you talk about the whole idea of neurocrine disruptors? And I don't want to open up too big of a bag of worms, but I feel like this is something that people are now starting to ask about and starting to come to finally to public consciousness.

It is. And let's just stick with one bpa, which is an endocrine disruptor. So we keep it simple. But there are thousands and thousands of chemicals that are toxins to the body. But a very common one is bpas, which is an estrogen like chemical. So it can actually raise estrogen in the body and undesirable forms of estrogen. If you have high DPAs, which, which is best measured by urine, if you have a high BPA level, then it can increase your risk of heart disease by causing plaquing in the vessels of your heart. It can cause you to have cognitive decline when you're a young woman if you have BPAs in the system. Some of the newer science is showing that it goes through the breast milk, it goes through the placenta, and may increase the risk of add, adhd, autism. It definitely increases the risk of different autoimmune diseases. They're looking at a number of them. When I was in med school, there was only 27 autoimmune diseases. There's now 108. So all of that has changed. And PCOS, polycystic ovarian disease, is an autoimmune disease. So I'd like to spend a second talking about that if that's okay.

I was going to ask you, so please, please.

So pcos, polycystic ovarian syndrome, used to be called Stein Leventhal. And I was told in medical school I would see four cases. In my whole life I see 10 cases a week. It is one of the most common endocrine disorders, meaning the hormones are disrupted. And this occurs in young women. We can diagnose this at the age of 16, 18, et cetera. And the hormones are best measured by saliva and the hormones jump up and down in younger women. So we like to do a 28 day saliva test or measure the hormones on day four, 14 and 21 of the cycle. With day one being the first day a woman starts bleeding with PCOS, she ends up with high testosterone, commonly low progesterone, sometimes high estrogen, and then her cycles are not regular. She may not even cycle at all. She has a major increased risk in infertility. She has what we call hirsutism, meaning that she may have some facial hair, some hair in places that she doesn't want. It increases her risk of breast cancer, uterine cancer, ovarian cancer, meaning cancer of the ovary. She becomes inflames when she has pcos. She has an increased risk in insulin resistance and diabetes. The great news is we can change all of this. We can take a patient who's 20 years of age, diagnose PCOS, and by salivary testing and looking at an ultrasound of the ovaries, and we can actually change the course so she can get pregnant. So she does have a normal risk of having diseases like cancer and heart disease, et cetera. So the good news is we now can diagnose it and treat it effectively in the body.

Now, it's really interesting with PCOS and everything you've mentioned before, because we haven't even talked about estrogen or sex hormones yet. The next part is this hormonal hierarchy is your gut. And I actually did not realize you were doing stuff with MD lifespan, with the whole detoxification stuff. And I think it's a nice transition to go to the gut, which is a big detoxification organ. Could you, like, go into some of the nuances of gut health detoxification in regards to, in regards to hormones? Because I think a lot of people don't realize how important the gut is for hormonal health.

In order to be healthy, your hormones have to be balanced, but equally important, your gut has to be healthy. And that doesn't mean, oh, you don't have reflux, gerd, diarrhea, constipation, ibs, et cetera. People think if, oh, if I don't have any of those things, then I don't have a gut problem. Totally untrue. So let's take an idea of acne that is commonly either high testosterone and, or a problem with your gut eczema. There's a lot of different diseases that are related to gut health. In fact, all autoimmune diseases, every single one of them, are tied to your gut not being healthy. So it's really important that everybody have a gut health test, because 70% of your immune system is in your gut, 90% of serotonin, your happy neurotransmitter is made in your gut. Your B12 is made in your gut. Many of your hormones are processed in your gut, as are many other things in your body. So if your gut's not healthy, you're really not healthy in relationship to cortisol and thyroid. If those hormones are not normal, then your gut becomes unhealthy. If that happens long term, you get what is called leaky gut syndrome. And when you have leaky gut, the membrane that you have in the body does not keep bad things out. Your membrane, that's there is supposed to be what we call semipermeable, meaning that good things stay in, bad things stay out. When that semi permeability changes, then you can even get your medications twice. So we want that gut to be really, really healthy. So I always tell people, all my patients take three things. And then we go from there. They all take a probiotic for a healthy gut. They all take good quality fish oil to decrease inflammation in the body, and they all take a multivitamin because even if you eat really healthy, it's hard to eat everything you need in a day.

Yeah, yeah, that's. Could the gut health. Could we take a little dive into the microbiome aspect of that? Because the way that plays with detoxification, you know, if your gut is healthy, you're. It's really. I was reading this interesting. This is while ago talking about half of all pharmaceuticals are actually detoxified other bacteria in your gut. And there's that. There's one in one of those advanced tests, there's actually a thing called like beta gluturonase level, which is actually measuring for a byproduct of a bacteria that actually affects estrogen levels. So can you take a little talk a little bit about the actual bacteria, not just, you know, the big concept, but what lives in your GI tract, how that affects these things, and then how do you ultimately impact what lives in your gut?

First of all, people need to look at the idea. Is it important to see a gastroenterologist if you have a gut problem? Yes, you may need scoping. And there is a total place for what you may call traditional medicine. But from a functional to personalized medicine approach, what we're talking about when we say a gut health test, it is a stool test. And yes, we're looking for parasites, but we're also looking for good diversity in the gut, meaning alpha diversity, beta diversity. So you have the right kind of bacteria. One of the bacteria we've been talking a lot about is achromasia. And they're talking about that because you need that bacteria in order to lose weight. It is a very important bacteria. We also have what's called the estrobolone, the relationship of estrogen and other hormones and what goes on in the gut. It is an intimate relationship. So it's very hard to have your female or male hormones to be balanced without your gut also being healthy.

Yeah. And so let's. Let's talk about the icing on the cake, which is sex hormones. Estrogen, progesterone, testosterone. Finally, after all that we've talked about, people usually come in, right? They come in for their. Their bioidentical hormones or their testosterone pellets or shots or whatever. So let's talk a little bit about balancing the hormones. What does that mean? Because I think a lot of people means you just need more of something, like I need more testosterone. But they don't really talk about actually, you know, you can have lower levels of hormones that are balanced and be way better off than someone who has high levels that are imbalanced. So could you talk about some of the nuances of. Of these hormones and what balancing actually means?

Perfect. Let's discuss women first, because women are more complicated creatures. I think everybody would agree with that. So women make three estrogens. E1 estrone, E2 estradiol, and E3 estriol. Or you can just call them E1, E2, and E3. E3 is the one that, as we age, if we get more of, increases our risk of breast cancer. E2 is the 400 functions in the body. Yes, estrogen does have 400 functions for women. It's taste, touch, smell, hearing, skin tone. It lowers cholesterol, blood sugar, blood pressure. It literally is your memory. It's related to the gut and so much more in the body. So that's estradiol, the E2, E3 estriol for tri. That one is the one that is. It helps with bone structure, prevention of heart disease, but very importantly, helps prevent breast cancer. And a lot of people think this is new information. The first article came out on Estriol in Jama 100 years ago. So we have known about this hormone for a long time. So as we age, if your estrogen gets low and you're a candidate for natural hormones. We only use natural hormones in the body, meaning the same chemical structure that God gave you to begin with. We always use E2 and E3 and put it on the skin, and we do a saliva testing to determine the amount that you need. If you're seeing a practitioner for hormones right now, and you're not having salivary testing, then you're probably seeing a practitioner that was not trained in this field. It's not just a weekend course. Both of us have done extensive work in this area where we have taken multiple courses and really gotten certifications and even master's degrees in this field. But an easy way to determine if you've seen someone who's really trained in this field is are you having a saliva test to determine your hormone levels and your subsequent doses of hormones that you may need. So estrogen is very, a very important hormone, 400 functions in the body, but it does have to balance with progesterone. Even if you had a hysterectomy, you still need progesterone for balance. The symptoms of progesterone loss are anxiety, irritability, insomnia, mood swings, depression, heart racing, bladder problems, gut disturbances, and more. If you get too much progesterone because the person you're seeing doesn't do saliva testing and they prescribe too much, you can get those same symptoms. From too much, you can get the anxiety, irbility and weight gain. And then testosterone is really important for women. PCOS is a high testosterone state. So high testosterone increases the risk of heart disease and drives up your blood sugar. So we don't want to leave it high. We don't want. We want to make sure you're not prescribed too much either. About 40 to 50% of women never lose testosterone in their life. At 70, I haven't lost testosterone, so I don't use testosterone. I probably will never need it if I haven't lost it by this age. So it's not. It's a great hormone. It's yes, your bone strength, it is your bone structure, it's sexual interest, it's self confidence. It's a lot of different things in the body. But too much is bad, too little is bad. We want a dead center on that saliva test. Like we like the estrogen and the progesterone. So yes, with estrogen, if you have too much, you can get breast cancer. If you have too much, you can get breast tenderness. So the balance of all these hormones are key. And those hormones are all made in the ovaries. It does balance with DHEA and cortisol, made in the adrenal glands, the glands that sit above the kidneys. But that balance is even more important because DHEA makes, makes estrogen and testosterone. So there's an interplay between all of these hormones. DHEA is related to stress, but it's also related to the aging process. So as we age, DHEA does go down. In the case of anybody's wondering, yes, a woman's skin and everything else is very much related to what happens with her hormones. Take the ones that the person needs. At 70, my estrogen is low. And even though I have breast cancer on both sides of my family, am I afraid to use bioidentical hormones? No, because we use physiological doses. The amount that is personalized for you. Do I use progesterone for balance? I do. You just heard me say I don't need testosterone. I don't use it. Do I use dhea? I do. I use a special form called dhea, keto dhea. And we use that form for women who have normal or high testosterone or if they're acne prone, because it doesn't make a lot of testosterone. And then it does balance our stress hormone cortisol. Again, all of those are made from pregnanolone. That's the only one that is a blood study. I personally don't take pregnanolone. Mine is still normal. Some people have abnormal pregnanolone. At 45, mine is still fine, so don't need that hormone. So that's kind of the down and dirty for women. Perimenopausally and menopausally, pms, pcos, pmdd, all these terms you hear endometriosis, A lot of fibroids tend to be low progesterone states. So you can have low progesterone at any age. Infertility is a low progesterone state. So it's important at any age that you have normal hormones. In fact, this great study came out last year showing the following. If you cycle every single week when you're not pregnant and your cycles are about 28 days apart, if you cycle all the time and you have normal progesterone, no matter your family history, doesn't matter if you have breast cancer or not, just cycling and have normal progesterone throughout your life, you have an 88% reduction in ever getting breast cancer. So really important to look at those hormones. Whether you're 17 or 88 years of age, your hormones need to be balanced. For women, how about men? Do men make estrogen? They do. They have to have estrogen for bone structure and memory. Too much estrogen, it increases their risk of heart disease and prostate cancer. So we do salivary testing in men as well. We look at their three estrogens, we look at progesterone, which is important for Their myelination and nerve endings, of course, testosterone for sexual interest. It builds their muscle mass, lowers cholesterol, blood sugar, blood pressure. DHEA and cortisol and pregnanolone do the same thing in men. So do we look at all these hormones in males as well? Absolutely.

So you mentioned a couple things about estrogen and breast cancer. And so that's another thing I feel like finally is coming to public consciousness. You know, the Women's Health initiative back in 2000 came out and went from a. A sea change of oh my gosh, everybody needs hormones to like, we cut them all off for maybe 20 years. And now we're kind of realizing, wait a second. You know, I was reading this interesting study. It was really interesting. If you were on Estra estradol when you were diagnosed with breast cancer, you actually had a better outcome than if you weren't on it. So could you, I would say, dispel some myths, maybe help us understand what happened in 2000? How do we get it wrong? I guess maybe also maybe explain that. Cause I don't think a lot of people understand the snafu that happened that's resulted in 24 years basically of probably under treating a lot of women. And now I feel like it's just starting to come again to the public consciousness.

It is. And part of that, honestly, is because the science is here. When I wrote my first book in 2003 called HRTB Answers, it was only 74 pages because that's all we knew about women's hormones. When I wrote the first edition of this book, it was half the size. In 2010, it was half that size with the references because that's all we knew. This is the current edition. The references aren't in here because there's so much science. The references are online. They don't even fit in the book. So part of it is the science is really now here. And part of that is predicated by people measuring hormones incorrectly. So just to be clear, if the hormone is put on the skin, and for women, estrogen and testosterone are all on the skin. For men, we do use the skin now as a preferential mode of application. If they're put on the skin, they do not show up in the blood. So please make sure that your prescriber is not using blood studies for any hormones that are put on the skin. People didn't know that for a long time, so that was part of the issue. Salivary testing is the way to go. And there's a new group out there now talking about Urine testing. Is it important to look at urine testing? It is. You need to look at the breakdown of the hormones. Both men and women break down estrogen into 2, 4 and 16 hydroxy estrogen, the two I lovingly call the good one. That's the one you want Most of the 16 you need a little bit of for bone structure for both men and women. Too much increases the risk of prostate cancer. And then four hydroxy, that's the really bad one. If you break down into that one, there's an increase in breast cancer and an increase in prostate cancer. You probably guessed with my family history, breast cancer on both sides. When I looked at my estrogen breakdown 35 years ago, I broke down into the 4 hydroxy. The great news is we can fix everybody. Everybody can have perfect estrogen metabolization, otherwise known as breakdown. So we can do that for both men and women. The Women's Health Initiative trial didn't look at saliva testing. They didn't look at three estrogens, they didn't look at estrogen metabolization. The science is really now here, so I'm not sure they got it wrong as much as the science wasn't here until now.

Yeah, it's really kind of interesting. Some of the labs you were mentioning, salivary versus urine versus blood. I feel like, you know, the. Everything comes in waves, right? There's sometimes where, you know. For example, right now I feel like urinary testing is really picking up as far as popularity. What's the purpose of urine? You mentioned the metabolites. What else can you find in urine for hormones? Are there other things like urinary cortisol or even toxic products? What, what would, what would be the biggest reason to do urine or is there not one over saliva or blood?

Well, when we do the 2, 4 and 16 hydroxy, that's a first morning urine. There is a 24 hour urine which looks at the breakdown of all of these hormones. So for example, pregnanolone or progesterone breaks down into oligopregnanolone. So we sometimes need to know those breakdown products of all of the different hormones in the body. And again, that is a 24 hour urine, but it's a breakdown product. So we don't dose off of urine. And I know some people are doing that, but then you're not dosing off of the actual measurement of the hormone. So there was an article that came out in Menopause Medical Journal in November and it suggested you dose off of urine. I actually wrote the rebuttal to that article, so that came out in April of this year, and what the rebuttal showed is that if you do urine testing, the amount of estrogen that it takes to even show up in the urine is so high, that amount actually causes heart disease, According to a 2019 study, instead of estrogen preventing heart disease. Because there's hundreds of articles showing that estrogen lowers cholesterol, it decreases plaque, it decreases the overall risk of heart disease by 20 to 30%. I mean, it's a calcium channel blocker. All these words that you hear of medicines, it's a calcium channel blocker. All these things estrogen does. But you can't dose off of urine because it's a breakdown product. And so that article in menopause that came out last year in November has now been refuted because that's not where the science is important, to do urine testing and looking at breakdown products, but not to dose off of urine.

So maybe the summary is you kind of sort of have to do it all. Like you need blood for pregnant alone, for sex, hormone bonding, globulin for LH and fsh, which I actually want to ask a couple of questions about that. You need saliva for the best, for cortisol, you need it for your estrogen, but. And then you need urine for metabolites. So it's kind of like almost you have to. You have to, you need them all different times. I wish there was a test that did them all, to be honest with you. This one thing that did them all and you, you have that snapshot. But unfortunately, I don't know that test. And so you have to kind of stagger it a little bit.

Look. And sometimes I think it's important to stagger it. And the reason for that is twofold. Number one, if you try doing everything at once, the body gets confused. And number two, honestly, the patient gets confused. So we do like to separate them out when we look at these different categories so that we can have a better balance. I didn't measure vitamin or mention vitamin D, but it is a blood study. And vitamin D is literally a pro hormone. So it's just as important as these other hormones are perfect. Vitamin D. For most people, there's a few exceptions that your doctor or other healthcare provider will know about. But for most people, vitamin D needs to be 55 to 80 to help prevent breast and prostate cancer. And that's from many people's studies, from Vasquez to Grant to garland, going back 50 years.

Gotcha. Now, with luteinizing hormone LH, I had actually heard a lecturer talking about this at the annual conference I went to in Vegas and I tried to go do it most years this past year for a 4am and they talked about luteinizing hormone. When you, when you dose hormones, getting the luteinizing hormone less than like in the 20 to 30 range to maximize hippocampal size. Could you talk about that? Was I mishearing that? Or could you talk a little bit about those numbers and how estrogen can impact basic memory? Hippocampus is where your memory sits well.

And that's a very interesting study. It would be interesting to look at further studies on that. Usually we measure FSH and LH to look at whether a patient is menopausal or not, or for men andropausal or not, meaning they have gone into what we call male menopause. And that's probably where the science is. Now they are looking at FSH and LH for other things. But if you really want to look at the current science, what is really new this year is we are now able to the first time in history to actually be able to get rid of toxins that are phytoestrogens and estrogen disruptors in the body. And that will become a bigger part of health care as we go forward. Even for women, when they have a planned pregnancy, you want to get rid of the toxins before you have kids. And then when we look at the idea of prevention and treatment of memory loss, heart disease, autoimmune diseases and, and much, much more, including gut health, it is going to become more about toxins. And that reason is inflammation. So estrogen, progesterone, testosterone, dhea, cortisol, pregnenolone and melatonin are all anti inflammatory. Toxins are inflammatory. When we get rid of those phytoestrogens, you even lose weight because your body becomes less inflamed when you're overweight, you're inflamed by definition. So a lot more to come in all of this.

Yeah, so this is the anecdotal story for myself. I think like this is one of the reasons why you have to do things personalized for patients. I had a patient who travel a lot from Boston to Texas and he used a topical testosterone. And when he was in Texas he biked a lot. And when he was in Texas his testosterone levels always plummeted. And he felt horrible and was in Boston he also felt amazing. And that what I figured out was he was one climate was dry, he was absorbing more of the testosterone one climate he was Sweating a lot, and it was humid, and he was swaging off. And so that was something that I clinically kind of figured out with him. And we changed his doses eventually based on where he was traveling. But, you know, there's so many nuances to it. Just to have, like a algorithm just doesn't quite work in my experience.

It does not. And I would totally agree with you. It is about a personalized approach. In our offices, we have five in Michigan and one in Florida. There's no patient, male or female, that gets the same dosage. It is very much a personalized approach. In fact, when you look at testosterone in men, it varies by season. So in the summer and in the fall, the testosterone tends to be a little higher, and then it goes down and the other two times of the year. So it's not just location and whether you're perspiring or not. It's even the time of the year as to when testosterone would be up or down in men.

That's interesting.

Cool.

All right, so I want to do that. I feel like we kind of went through the hormonal hierarchy, and so the next thing I want to do is, like, ask you some questions because you've written, you know, 14 books. I wanted to talk about. Actually, let's first hold off on that real quick. I'm really intrigued by some of this toxicity stuff because you'd mentioned this. I saw you in person maybe six or eight weeks ago in Richmond. I forget how longer that was. And we talked about detoxification. Can you talk about detoxification a little bit? Cause I feel like that's something that. When I have patients come to me from hormone experts or other, you know, there's other. There's a. Other functional people in my local area that do hormones, and they all do blood and they do pellets. They don't do metabolites. So could you talk a little bit about, like, detoxification? Because that's another thing. I feel like people just don't, you know, even functionally trained people aren't really looking at detoxification as a part of someone's hormone balance.

Absolutely. And I'm not anti anything. I don't do pellet therapy because, in all honesty, I've never had to. There's no one that you cannot get hormones into without doing a pellet. Being a longevity doctor, I'm kind of. I do a lot of aesthetics. I'm kind of anti. Causing a scar. When you put a pellet in, it does cause a scar. It also causes fibrosis so you've got to get a lump. If you've given too much to the patient, you can't take it back. So sometimes, plus pellets are very, very expensive, and most people overdose when they give a pellet. So pellet therapy can be difficult. The hardest patient I see is two kinds of patients. Someone with chronic Lyme and somebody who's been overdosed by a practitioner who is really not good at giving hormones. In fact, a patient came to me from an attorney who was age 41, great lady. She had no high cholesterol, no heart disease in her family, no high blood pressure, nothing. And she had had three heart attacks from having testosterone pellets that were overdosed. So just to be clear, I'm not anti pellet. I'm just anti overdosing. A patient don't need to give a pellet because they make special bases that you can put testosterone in just for testosterone so you can get it right into the body very, very easily without having a pellet. When we go to looking at hormones being too high, either because you are producing too much or you were given too much hormone, male or female. There are three phases of detoxification. Phase one and phase two are in the liver. So the liver has to function perfectly. If it's not, we can help get those hormones out of the body by doing a group of nutrients that are commonly powdered and you drink it, and it helps the body go through both phases. That's about 75% of hormones are cleared through that way. The other 25 or so are cleared through the gut. And so we may have to do what we call phase three detoxification and do a gut health test, a stool test, and fix that part of the body as well.

Do you ever do. Because I tend to love saunas. There's really interesting studies looking at sauna therapy and how that improves detoxification. The textbook for Environmental Medicine, actually, Dr. Walter Trinion's work, actually, really, he had a nice little section in there about how they used to do, like, sauna for like six hours a day. It was crazy. But if you talk about basic, which is to me, just sweating, no one sweats anymore. Breath work, breathing, you know, hydration with, with, you know, depending on what you look at, kidneys being a part of that phase three detox with some of the stuff they do. Could you talk about some of those, like, secondary things again, that I don't think we talk a whole lot about, about sauna, sweating, kidney stuff, breath work as a part of a detoxification regimen for hormones.

It is, it's really important. Even we can start with air in your house and whether you have purified air or not. We can talk about water purification. And you really do need to have very, very, very pure water. Otherwise it can have lead, mercury, et cetera in it, going all the way to liver detox, et cetera. Dr. Crinian was one of my best friends. Unfortunately, the world lost him at the age of 65, way too early. A brilliant naturopath, really looking at detoxification of his area of expertise. I wish we still had Walter here to help people. And I wish he were here to see the new research that is coming forth now with the ability to get rid of toxins. We've always thought that sauna was a great idea, always, because you are able to get rid of BPAs and Teflon and some of the other things through sweating. But that's only about 5 to 7%. Uh, with the new studies, we're able to get rid of about 95% in most patients. But do I have a sauna at my house? I do. Do I recognize men's sauna for my patients? For both male and female? I do. We have infrared sauna in our office. Uh, it is an important aspect of being healthy.

Gotcha. And, um, one you mentioned, the testosterone base, was that Versa base that you're referring to or is it a different base to improve the testosterone absorption?

That's a great question. Most of the hormones we put in what's called Versabase, and if you want it to be a 90 day prescription, in most states, that would be Versabase Anhydrous, meaning it has a water base to it. There is a special base called Atrevis A T R E V I S and that's for testosterone only. And so if you can't get testosterone into the patient, then you can change bases. It works very well. There's other kinds of bases. There's Zimatop. Zematop is a great base for people with really sensitive skin. So if you tend to be sensitive to soaps and perfumes, we can put it in Zimatop. And then when we talk about mucous membranes, whether it's your mouth or the vaginal area, those are both mucous membranes. There's a special base even for that called Mucoox, and we can use that as well. So there's great company pharmacies have great basis to help practitioners get hormones and other things into the body.

That's, that's good information. I want to make A transition now to, like, go through a couple of your books real quick. I don't want to take too much of your time up. I want you to ask you some questions, maybe being a little selfish a little bit. One of your books was why you can't lose weight, why it's so hard to shed pounds, and what you can do about it. And I have with hormones, women come in, I'll be working with the hormones, and it's just this interesting phenomena where you'll give them a little bit of estrogen, testosterone, and all of a sudden the breasts get super tender, they feel awful, they get acne, and you're like, just tiptoeing around that. Could you walk us through some of the complexities of hormones and weight and particularly in women?

Absolutely. If you get too much estrogen, you gain weight. If you get too much progesterone, you gain weight. Because insulin does not work effectively in the body. If you have too much testosterone, you gain weight. If you have too much dhea, too high or too low cortisol, you gain weight. So all of those are very much tied into what people weigh. Toxins are related to weight as well. We have the new drugs out, the GLP1s, which do help a lot of people work through the weight issue. Unfortunately, most people, if they are put on a GLP1, commonly have to stay on one for the remainder of their life to have the weight that they need to be. You do have to eat, right? The bane of my existence, honestly, everybody is chocolate. I do love chocolate. I still eat chocolate. I try not to eat as much. It's hard for me. That's hard. I don't drink any alcohol because alcohol increases your risk of breast cancer if you have it on both sides of your family. Everybody else, moderation is the key to health. But when it comes to chocolate, that's a hard one. We all have one of those in our life that I think can be difficult. But that's not the whole weight issue. I mean, if you're just plain old stressed and you don't work by taking a multivitamin and adaptogenic herbs like ashwagandha, ginseng, rhodiola, doing stress reduction techniques with prayer, meditation, tai chi, yoga, qigong, exercise, massage, breathing techniques, acupuncture, acupressure, if you don't work on cortisol, it doesn't matter what else you do, you probably are not going to lose weight. And just as importantly, keep it off.

Yeah, I feel like recently I've been having. I feel like everything Goes in cycles. Right. There's, you know, like in the emergency room, there's a season for appendix size and a season for gallbladder issues in the area. These seasons. I feel like I'm in a season right now from having some weight loss and some left knee operations. And I'm kind of getting to the root cause and I'm finding trauma, finding they have some significant life trauma stressor. Is that legit and how do you work on those patients if you feel like a trauma, past trauma, Trauma is a part of their weight loss hormone issue.

It is PTSD or trauma. Post traumatic stress disorder comes by many names and really different ways. It's very, very, very difficult to work through. And we all have those in our life. Some are more severe than others. And from my personal experience, and in 46 years of practice, honestly, a patient is not healthy until there are three things. They're physically healthy, emotionally healthy, and spiritually healthy, whatever that may mean to them. And I find in today's world that a lot of people forget about the spiritual part, that people do need to have a spiritual component to their life in order to reduce stress and really help work through those bad things that can occur. If you sit down and talk to somebody. There isn't anybody that hasn't had major stress in their life. They're just different for everybody.

It's like really that sense of meaning and purpose and value can give pers. Can give, can make you more resilient to whatever stressors are kind of going on in your life. Is that a way to kind of.

Say does and really helping others? And when you help someone else, I mean, this hurricane that has occurred, so many people have helped others. They've jumped into the water, they've gone out and they have taken and taken and helped get rid of the debris and they're helping put back in windows in people's houses doing all those things. Believe it or not, if you measured cortisol right then and there, that helping that patient's cortisol will commonly go to normal. Because just the act of helping someone is so key. And people not being stressed. Yeah.

And so find purpose, value, meaning. Giving back, I guess is a more maybe common parlance where we say giving back to your family, your friends, your culture, your society, your place of worship, whatever that might be for you.

It is because people sometimes forget we have unfortunately become a more selfish society. It's never about you. It isn't. It is about everybody else and how you can help them. You think it's all about you then you've missed the boat in life. And will your stress hormone be normal? Probably not.

Yeah, I think it's a great way to end our conversation. All these high level science and gut health, but realizing ultimately purpose and value, meaning stress, which plays, which plays very keenly into stress reduction, is really, you know, one of the foundations of functional medicine. If you have that sense of purpose and value, meaning whether it's family, friends, your place of worship, your, your belief system, whatever, your belief in God, you know, whatever that might be for you, if you're, if you have that, that can give you a lot of resilience so that when stressors come, they have less impact on you and ultimately that impacts your entire health. It's literally one of the foundations of functional medicine.

It absolutely is. It's a key component for everyone. And honestly, I do want to also say this. Everybody deserves a personalized approach to healthcare. The science is now here to have everybody involved in this kind of approach. And I do hope over time that insurance does cover more, more of this kind of medicine, more of this kind of testing, because all of us deserve to be healthy and stay healthy.

Absolutely. I'll start. Well said, Dr. Smith. I want to respect your time. Thank you so much for sharing and being generous with your time to come talk to us today about hormones. I feel like we've hit like almost a little bit of everything and ended up farewell. If people want to know more about you, what you do, your books, your, your four things, how can they where and how can they find more about you?

Actually, probably the easiest way, you can always go to my website and it's exactly what you would expect it to be. Okay. So no surprises there and I really do encourage you. My books are on Kindle and I kept them all paperback after I wrote the first couple so that it was very affordable for everybody. So this is the one on male hormones. There's a thyroid one. This is the one on female hormones. And they're written in a really, really easy style for everybody to understand. They're not designed to be a literary work. I did major in English in college. My English teachers would probably kill me. They really were designed to help people to be healthy and stay healthy.

Maybe that's part of your ER background. Get right to the point. You know, you don't have time to dilly dally around, dilly dabble around.

So I really appreciate this interview today and being able to be on this podcast. You've have a fabulous podcast. You've helped so many people and I consider it an extreme privilege to be part of this.

Thank you so very much. And thank you for those kind words, and we will see you later.

Have a great day.