REVOLUTIONARY Hormone Hacks: How Bioidentical Hormone Therapy BENEFITS Everyone - With Karen Martel

My name is Ben Greenfield, and on this episode of the Ben Greenfield Life podcast.

So I like to use estradiol for most things because estradiol is our most important hormone for women. It's your— it's the equivalent to your testosterone. So estradiol is the one that is shown in research to be brain protective, like incredibly brain protective. Your risk of Alzheimer's and dementia drastically reduces from estradiol hormone replacement therapy, like between 77 to 79%. Isn't that insane?

Fitness, nutrition, biohacking, longevity, life optimization, spirituality, and a whole lot more. Welcome to the Ben Greenfield Life Show. Are you ready to hack your life?

Let's do this. Alright. So, you know when you're talking to a true expert when they just blow your mind with all sorts of cool information, in this case about hormones. And I was at Dr. John Laurantas Clinic a few months ago at an event there, and we all went out to dinner afterwards, a bunch of the speakers, to this great place. What was it called, Karen? It was Layla's?

Layla's or Layla's?

Layla's.

Isla Selas. Yeah, something like that.

Something like that. Anyways, one of the cool healthy places that we could hunt down in Sarasota. Yes. Good place if anybody gets a chance to go there. But anyways, Karen is an expert in hormones, specifically bioidentical hormone therapy and a holistic approach to addressing hormone dysfunction and endocrine issues in women during peri and post-menopause. I realize that's a mouthful. But basically, she filled me in on a ton of stuff during dinner and I thought, gosh, I got to get Karen on the show at some point to talk about all things women's hormones. So, as we go down the road of this discussion, please know I'll include juicy shownotes if you go to BenGreenfieldLife.com/Martell, which is Karen's last name, M-A-R-T-E-L. I'll link to her website, her programs,. If you want to work with her, all the information will be there in the show notes at bengreenfieldlife.com/martel. Karen, welcome to the show.

Thank you for having me. And you left out the part where of course, like all the labs come out at dinner showing me on your phone and you were supposed to follow up and send me some new labs, which you have not done yet.

So that's right. I know I'm slacking. I'm slacking anyways though. So, I'm just curious about how you came into this journey and how you personally have managed your own hormones as you go through aging. Yeah.

Well, it was like my whole life kind of led me to this point, like how it usually does with health practitioners. And when I was in my young 30s and I had my daughter, after I had her, I had a whole slew of hormone problems. And nobody, of course told me at that point, I'm 31 years old, like that it was my hormones and I was rapidly gaining weight without changing anything. I was having digestive problems. I couldn't sleep. I had chronic insomnia. I, it was terrible. And so what did I do? I went out and worked out super hard, harder than I'd ever worked out before in my life, was doing CrossFit, was starving myself, trying every diet under the sun because that's what everybody was telling me to do. And I only continued to get fatter and fatter and fatter until I was like, something else is going on here. And I decided that I had to figure it out for myself. And I decided, I think it has to do with my hormones. And so I had my hormones properly checked and sure enough, I had all this hormone dysregulation, fixed it all up, was good to go, lost the weight, felt awesome, and then became a weight loss coach for women and a nutritionist. And decided, you know what, there's got to be more women like me who are doing everything right, healthy eaters, exercising, doing all the things, and still can't lose weight or have weight loss resistance. And so I kind of went into that field of work for a long time and thinking like I had it all figured out. I'd been following a paleo-based diet now for over 10 years. I was like exercising all the time. I was— I felt great, looked great. And was like, oh yeah, menopause. Oh, it's gonna be so easy on me. Like, I've got it all figured out. And then I hit 42 and I hit early menopause and I started losing my cycle. I was having hot flashes and night sweats. I started gaining weight again without of course changing anything. And I was like, you've gotta be kidding me, this is happening again. And at that time I hadn't really dived super deep into hormones and I had it in my head like everybody else did that, you know, menopause was gonna be this kind of short stint. I was super healthy. It was gonna be easy to get through. And then, you know, I would explore maybe hormones down the road. And so I had to figure this out once again, all on my own, and then decided women are not getting this information. Like, it was hard enough for me to find out, even though I was in the industry, to find out good quality information. And I just went on this crazy deep dive and I ha— and it hasn't stopped. And so now I've I, you know, I started my own telemedicine company and we're helping women all through North America and around the world to get their hormones straightened out and getting the information out to them.

So what was your, your formal education at that point in medicine?

I was just a certified nutrition coach.

But now you have a, a doctorate, is that right?

Nope. I am just a, I, I've got another certification and then I've, um, now trained in the Menopause Method, uh, with another world-renowned gynecologist. I trained with, did her course. And so, I've done a whole bunch of different courses. And so, it's kind of this, I've gone out and taught myself from as many people as possible, which is to my advantage, I feel like, because I'm not stuck in one protocol, which you'll— we can talk about this later, but that's what a lot of women run into is finding people that are like, it's this way or no way. And, we really need to look at it from a holistic point of view and from an individual's point of view.

Yeah. How's that work as far as regulations go, like what you're allowed and not allowed to say if you're not an actual physician?

Well, lucky for me, I work with doctors and that do all the prescribing as well as a nurse practitioner who sees all the clients. I do hormone coaching, and so I can do all the holistic hormone coaching. I can make recommendations based on people's labs. I've been trained in lab lab reading and interpretation. So I can do all those things. I just can't prescribe. I can't be like, you have to go and take this or anything like that.

I, I leave that to the doctors.

Yeah.

You have doctors on your team who can do that though. Yeah. Do the, do doctors learn much of this stuff in medical school?

No. So I have read that in between 0 to 7% of doctors, medical doctors will learn about menopause. They do not learn about perimenopause and they do not learn about bioidentical hormone replacement therapy. Wow. Yes. So, that's sad.

So, when it comes to bioidentical hormone replacement therapy, we'll use the abbreviation BHRT to save us several minutes on this show. How do you actually describe that to people?

Well, it's best to kind of go back in history and kind of figure out where, you know, hormones kind of came from and where they came— when they came out onto the scene, which That was back in the 1950s, and it was hormone replacement therapy, and it was Premarin, which came from pregnant horses' urine. And so that was—

I've heard that.

Yeah. And it was like the— it was, it was great. It was, even though it wasn't bioidentical to our, our estrogen, you can imagine our estrogen does not look like a pregnant horse's estrogen, but it worked really, really well and still acted on our estrogen receptors. And gave us amazing relief, such great relief that, that by the time it was 1992, Premarin was the number one most prescribed medication in America, which is crazy. So number one, like by 1997, sales exceeded $1 billion and that was for Premarin. And so a big study came out. I'm sure you've talked about it probably on your podcast, but the Women's Health Initiative I haven't really talked about it, so you can fill people in. Yeah. So, this is where most women have a real fear of bioidentical hormones or hormone replacement therapy. And, whether they know it or not, this is where the fear comes from is the WHI study set out to prove that Premarin and medroxyprogesterone, which was a synthetic progestin, could help lower your risk of cardiovascular disease. They had 160,000 women in the study. There's two arms of the study that were on hormones. One arm of the study, the women had no uterus, so they put them on Premarin only because without the uterus they didn't need to protect the uterine lining. The other arm of the study, the women were on a combination of Premarin and medroxyprogesterone acetate, which is a synthetic progestin that did protect the uterine lining from overgrowth. From the estrogen. Estrogen and progesterone work very like yin and yang to each other. So study went on in about couple years, about 5 years into it, the WHO halted the study early, came out to the world with a report in JAMA saying that they had to stop the study because there was— they saw an increase in breast cancer, stroke, in cardiac events. And this word went out to the world and our— and women on hormone replacement therapy dropped by about 70%, literally overnight. Like, it was like every doctor pulled their patients off of it. It was like, oh, estrogen causes breast cancer. And that's all anybody heard. And it's all anybody hears still to this day. Well, the, the exact same people, the WHI people that ran the study, have now come out to say Whoops, basically, because they've reanalyzed it and they realized—

and when, when did they reanalyze it?

They've reanalyzed it several times, not just WHI, but many different institutions have reanalyzed this study. But they did— they actually right away came out to say, oh, it was the arm of the study where the women were on the medroxyprogesterone and the Premarin. And the arm of the study where the women were on Premarin only had a 24% reduction in getting breast cancer. Not only that, the women that did go on to get breast cancer by some unlucky chance, they had a 45% reduction in dying from the breast cancer. So it shows that the Premarin was breast protective, horse's estrogen was breast protective. And we have— they have come out that you can find this in PubMed. Do we hear about this? No. And women are still being told to this day by their doctors that they can't use estrogen because it's going to cause breast cancer. And if they have to use it, not— they can't use it until they're in menopause and only for a small amount of time in the littlest amount possible. Period. And so it's become this like death wish for women if they wanna go on HRT and they're so frightened of it. And this is very prevalent. I hear it every day in my practice. I had a woman just last week who's been bleeding for 3 years and she was gone to her physician, the gynecologist, a nurse practitioner. She's 50 years old and every single one of them told her she cannot start HRT until she's in menopause. And she can, she can only do the birth control pill. And guess what they put in her arm? The implant, medroxyprogesterone acetate pill. That's what is in birth control pills, ladies, is the same synthetic progestin. It's the same thing. And yet we're handing this out like candy to our teenage daughter. Oh, you're 13 and you've got acne? Here's your birth control pills. Here's women that are in menopause, not even sex, like can't even get pregnant, and they're being put on birth control pills instead of hormone replacement therapy, which is raising their risk of heart attack, stroke, breast cancer. It shrinks parts of your brain. It ruins your gut microbiome, destroys your natural hormones. And yet this is all okay. And so women are not being told the right information. And we know now, like, that, that study itself and those results are now, right now being replicated in a huge study called the 7 Million Study, where there's 1.5 million women that they're studying on HRT. And it's showing the same thing, that women that take Premarin only or estrogen only are having a reduced rate of breast cancer.

Now, I'm assuming that synthetic progesterone and Premarin from the— from horse urine is different than BHRT, than bioidentical hormone replacement therapy, right?

Yes. So now we have the option of bioidentical hormone replacement. You can still get Premarin and it's still the one that's been shown in the studies to have great breast protection. But now we have bioidentical hormones, which comes from Mother Earth, Mother Earth soy and yam plants. Which they can extract a chemical from there and make a hormone that is identical to your own. So your body knows no different. And so you can use it transdermally, which is much safer, and there's no increased risk of heart attack and stroke when you use estrogen on your skin or in a suppository form or injection. Just as long as you're not swallowing it. We don't want to ever swallow estrogen. And it looks exactly like our own. So this hormone, so you can imagine, unfortunately there hasn't been any study done on it, or very little study done on, uh, bioidentical hormone replacement therapy, estrogen and breast cancer. But it's, it'll hopefully be coming.

How do you know, like if you're a woman and you're listening right now, how do you know if you would be a candidate for something like that?

Very, very few women aren't candidates for it. And you have to, you have to always remember that these are hormones that you'll use— you produce in mass amounts from the time you're 13 to the time you're usually in your late 40s. And so through all these decades, these hormones are being produced every month in huge, large amounts, going up and down. And so if you've had these hormones your whole life and they've been safe for you and they've protected you, and they do way more than just help us to become pregnant and give us a period, then most women are safe to continue to use bioidentical hormones as, as long as they really want. Now, there is a small subset of women that have certain breast cancers that— so estrogen is a growth hormone. It does not cause cancer. However, if you have breast cancer cells in your breast and they're estrogen positive, Estrogen can make that proliferate. So that's where that like, well, but doesn't estrogen like cause breast cancer? That's where that's coming from, is that it can make that grow. So if you've had a history of breast cancer, there's still options. We know that testosterone therapy won't convert to estrogen in the breast tissue. It's very breast protective. Women can still use it in the— as a vagina suppository to have better vagina health. So there are options for women post-breast cancer that, you know, if they did still want, you know, if they want that relief, they could use it. And they are actually showing now, like, there's a great guy, Dr. Avram Bluming, who's a world-renowned breast cancer oncologist who is giving women estrogen replacement therapy post-breast cancer and having great success. And it's showing less recurrence when women use Estrogen therapy. So it's, you know, once again, we need more research and it's really up to the woman if she, you know, someone really, really suffer, Ben, like, I mean, really suffer. So a lot of them say, I, I want quality of life. And so without their estrogen, they feel so terrible that they're willing to still go and be on it. And they have to work with their oncologist and work with a trained hormone specialist and together, you know, come up with a plan that's gonna work for them.

Yeah, that's an important subtle nuance regarding the cancer. You see that a lot in nutrition and supplementation and medication research like the China Study by T. Colin Campbell that suggested that a high protein diet could cause cancer when in fact a large amount of protein and extensive stimulation of mTOR in rodent models with preexisting tumors that they initiated in studies then fed a high protein diet to that was an issue. And people took that and then said, "Well, high protein diet causes cancer." No, it doesn't. But if you have a preexisting tumor, you should be aware of not stimulating mTOR and not eating a high protein diet and maybe taking more of a ketogenic low-carb moderated protein approach. Or, a few years ago, there was another one with NAD. And I think this was NAD related to breast cancer. And it suggested that there might be, I believe, some type of angiogenesis or growth of tumors in response to high-dose NAD in people who had breast cancer. And again, the headline said NAD causes breast cancer. And so, there's these subtle nuances between the type of approach you take if you have cancer versus the type of approach you take if you don't. Does that make sense?

It does make sense. And I think you're, you're spot on. I mean, it's, there's so many nuances to these and cancer's complicated. There's a lot that goes into it. And I'm not claiming to be a cancer expert. I just know from the, what the research has told me, you know? And so if you've got breast cancer, yeah, you, you really do wanna work with somebody that knows what they're doing.

What kind of things do you look for in labs or symptom-based when a woman is, let's say in, you know, close to that early forties, time range that you alluded to, to know if they actually are going to need something like this?

Right. So, most women start to lose their progesterone in their late 30s, early 40s, and that's when we start to see symptoms of perimenopause starting. So, perimenopause can last anywhere from 10 to 15 years, which most women don't know that either. And, that's the worst part of it is the perimenopausal phase. And, a lot of women don't even— they don't even know to, to say that it's their hormones because it starts to creep up quite slowly. But the less you ovulate, the less progesterone you're going to produce. And at that point in time, so let's say you're in your late 30s, early 40s, and you're not ovulating very much anymore, like I wasn't, and my progesterone took a total nosedive. You can— there's nothing you can do to bring that back. Like, there's, you know, stuff you could probably do still in your 30s. You could take things like Vitex, and there's different supplements that can help nourish the ovaries and kind of squeeze out the last bit of those hormones. But once those hormones are gone, they're gone, and there's no amount of supplementation, diet, adrenal health, stress health that you're— that's going to bring these levels back. It just doesn't work like that. And so we're being told by social media out there that, hey, just eat a high protein diet, intermittent fast, do your cold plunge, do this, do that, and, and you'll be able to get through menopause. Watch your stress levels because your adrenal system will make your hormones once your ovaries don't. Well, your adrenals make these like little tiny baby amounts and that most women don't feel good about on, right? They don't— you, when you test them, they don't look like they have any. So the adrenal system doesn't— isn't this like great backup source of sex hormones. Once those hormones are gone, they are gone. And so if you are getting symptoms, there are some things that you can do to maybe damper down, tamper down those symptoms. But in most cases, 80% of women will have symptoms of perimenopause. And the best way to eradicate those symptoms is to start replacing the hormones and not wait until you're in menopause, which a lot of doctors will say, oh, just wait till you're in menopause and then we'll maybe give you some. That's not the way to do it. Do you wanna go 10 years with suffering, having your vagina dry up, dry up, you're no more muscle tissue, you know, your brain's gone, you gotta quit your job. Do you know how many women quit their jobs because their brain is so foggy? Because of the hormonal loss. And so, it's really about, yes, we want to see labs, Ben. We want to see like, "Okay, what's happening here?" You know, we want to get a baseline. It's always good to actually have the baseline done when you're still feeling good and you still have a regular cycle so you can go, "Okay, this is the window that I feel good in." Because every woman is different. I'm genetically— I'm really estrogenic. So, when I start dropping in estrogen, I get all of the symptoms. I get the weight gain, I get the night sweats, the hot flashes. When my sister, she's super androgenic, she's little tiny, skinny, wiry woman, and, you know, she loses her estrogen, she barely feels it, but she loses her testosterone and it— she falls apart. And so genetically, some of us are more prone to being one or the other, and then we're going to be more sensitive when those hormones start to drop. So And had somebody looked at my levels, they would've been like, "Oh, she's in range." I mean, the range is ridiculous. Like, a woman's estradiol range is like, "Oh, if you're between, you know, 20 and 500, you're totally fine." You know? So, it's really about, okay, if you're not feeling well and you're getting symptoms, then that number is not a good number for you and you're not optimized. So, we really need to listen to women and go, "Okay, how are you feeling?

What's happening?" And then, be able to go, "Okay, it sounds like your testosterone is not high enough or your estrogen is not high enough." So, for testing for something like this, the way that I've seen things positioned in the past has been blood test kind of gives you a snapshot, a salivary test gives you a 24-hour index, and then a urinary test gives you a 24-hour index plus upstream and downstream metabolites of hormones so you can see how they're being metabolized. Do you use a specific testing protocol? Like, the urine one I know is called the Dutch, for example. I've heard good things about that one and have seen good results from it, but I'm curious what you do.

We prefer to do both blood and on the same day do a urine metabolite test. But, the urine metabolite test is expensive. And so a lot of people, they can't afford it. And in which case, we'll just ask that they do their blood work on a very specific day of their cycle, which is day 21 of a 28-day cycle, or 7 days before your period starts, so that we can see— because your estrogen, progesterone, testosterone, we— it fluctuates throughout the month. So we need to have it on a day where there's actually supposed to be a rise in both estrogen and progesterone so that we have something to compare that to. So, cuz if you were to test progesterone in the first half of the cycle, it wouldn't show anything. So we want day 21. And yes, serum is going to test what's called bound hormone levels, and that's bound to sex hormone binding globulin. You can think of that as this little bus that shuttles your hormones all over the system, but it has to get off that bus in order for the cell to be able to, you to, for it to dock onto the cell. And so that can, that can be really misleading because some people, for instance, that are on thyroid medication like myself, it raises sex hormone binding globulins. People that have been on birth control pills, it raises sex hormone binding globulin. Oral testosterone raises sex hormone binding globulin. So, there's all these things that can raise this. And so, you could look like you have great levels, but it's not testing free levels of hormones.

Right. Because the serum test is only showing the bound version. So, your levels could show fine, Now, on the serum test though, wouldn't it also show if you were to test this if sex hormone binding globulin was elevated?

Yes. Well, yes, we like people to test for that too. We always have it on our lab request requisition. And then urine is going to give— it's only testing metabolites, but it gives you a reflection of free levels of hormones. And then plus, it's going to tell you how you break it down.

And just so people know, when you say metabolize, what do you mean by that?

So break it down. So when we need to be able to break down our hormones and get rid of them, and there's 3 phases of elimination. So there's phase 1, phase 2, phase 3. Phase 1, you know, the estrogen has to go down these 3 different pathways, and we want to see which pathway it goes down because one of them can cause more DNA damage than the other 2. So, and then from there, and that's called hydroxylation, and then it goes into methylation. So we want to see kind of where a woman's being held up possibly with her metabolizing of hormones. And then also gives us the androgens as well. So some women are really prone to converting testosterone into dihydrotestosterone, which is a very masculine form of testosterone. And, that will give a woman more masculine features. So, we can see that on a Dutch test. It'll be like, "Okay, you are somebody that really pushes down what's called the 5-alpha reductase pathway," which means if she goes on testosterone replacement therapy, she may run into problems.

She's going to get a handlebar mustache.

She may get a handlebar. She may grow a clitenis as I like to say. So, you got to be very careful. A clitenis.

Penis. I can hazard a guess as to what that means, but is that like an enlarged clitoris?

Yes. It does start to grow for some women. Okay. We've had that happen. All right.

Got it. So, when you're testing all these things, I imagine at some point you're sitting down and designing a repletion protocol using DHRT, but I'm just curious, what's it look like as far as delivery methods? And you mentioned transdermal estrogen earlier, but I'm just curious what the package looks like for a woman.

Yeah. So when we, when we work with women, we are looking at that whole picture because hormones just still don't— they're, they're great, but they're not going to fix a bad diet or fix a bad exercise program or anything like that. And we want to be healthy. We want a healthy gut system. We want to be exercising. We want to be, you know, maintaining our muscle tissue. All the good things, all the lifestyle factors still have to be in there. We want to make sure that that's the foundation. Because then your body's gonna take on these hormones a lot better. And then we'll usually start, like, depending on the woman, of course, let's say she's in menopause or she's far into perimenopause and she's got no progesterone, estrogen, testosterone. So typically we'll do an oral progesterone. You can have oral or transdermal. Um, both of them work great. Oral works really good because it has a lot more anti-anxiety effects to it. So a lot of women really like that. And then the estrogen, we always typically start with a cream or a patch. Those are the two top things with that. And then with testosterone, we prefer injectables because cream can cause hair growth, more hair growth than injection. And so, like, I just heard from a woman today, she said, I've been using cream on my inner thighs and I'm growing lots of dark hair there now. And so she's like, I want to switch to injection because it has less of that conversion to the, to the dihydrotestosterone. And we just see it coming up better Over and over again, we see this where transdermal testosterone for women just doesn't absorb the same and it doesn't get the levels up well enough so that you always end up having to use a higher dose, which then gets more costly. Rather, the injectables, it's a once-a-week injection. You know, you could do sub-q or IM, and it tends to— you don't need to use nearly as much. Like, we're talking 10 milligrams a week compared to 5mg a day if you were to use cream. So it's a big difference. So it's more cost effective. It's easy because you just inject once a week. And so women really like that. We don't do pellets at our clinic. I'm not really one for pellets. I know some women really like them, but we prefer not to use them because once pellets are in— so if your audience doesn't know what that is, they put these little— they look like little rice things. They put the— they implant them in your butt and then you can't get them out for 3 months. And so, it's—

and they—

You mean, you mean like in the skin on the buttocks?

Yes.

Yeah. Underneath the skin.

Okay. Yeah. And it gives you— it's supposed to give you the slow release of testosterone over a 3-month period, but typically we see really, really high levels, up to the hundreds for women, like masculine male levels.

Which would be an issue because then you're going to get conversion of that into DHT, right? Potentially.

Potentially, if you're a high converter, yes. And so, some women are like, "Oh, it's amazing. It's so easy and great." And then, we've had other women that have been like, I gained 20 pounds, I got acne all over my face, started losing my head hair, started, you know, having clitoral enlargement, labia enlargement, chin hairs, voice cracking. And they can't get them out. They have to wait that out. So I always say, if you want to do pellets, first find out how your body's going to respond to testosterone, either through injection or through cream. Once you know that, then you can explore if that's what you choose to do. The pellets, right?

Because once the pellet's in there, it's in there, unless you want to do your own little home-based surgery with, with some tweezers and a kitchen knife, right? Yeah, exactly. Yeah, yeah, don't recommend that. So the, the oral versus the transdermal progesterone. Yes. Why is it that I hear a lot of people recommend, you know, take a little progesterone, put it on the inside of the arm or the inside of the thigh, but it seems like you're recommending oral?

No, I, I prefer cream, actually. Oh, you do? I do. Yeah, yeah, I have my own line of Progesterone cream, I love it. Um, it— the, the oral— so when you swallow progesterone, A, it's not the natural way your body makes it and processes it. It shouldn't— it doesn't go through your first hepatic pass of the liver, it doesn't go through your digestive system. When you're taking it oral, it does. And so what happens is, A, you got to use a much higher dose, so typically anywhere between 100 to 200 milligrams, and 80 to 85, about 80% of it is going to convert to the progesterone metabolites. So it's almost like you get two different drugs out of this. So the metabolites can be— is what is really calming. There's one specific metabolite that acts on the GABA receptors of your brain, which induces calm and helps women to sleep. And you get this big dose of that. And then you're going to get about 20% of actual progesterone. Rather, the cream, it's more natural to put it on the skin as a way to process it. It, it's not gonna convert to the metabolites to that extent that the oral does. So you don't get as many, you still get some, but not as much. And so progesterone cream, you don't need to use as much, you use about half. So usually around 50 milligrams is a good dose. 50 to 75 for women in menopause is great.

Yeah. I don't know if I mentioned this to you, but my wife uses a transdermal progesterone. And, I'd heard that about anxiety and the anxiolytic effects of it. I've tried it a few times on nights where I've been super hyped up to assist with sleep and it actually does have what seems like a pretty potent anxiolytic effect. Do you have guys who are stealing their wives' progesterone or have you heard that before?

Oh, yes. Yeah, for sure. You guys produce progesterone too. You typically aren't deficient in it, but yeah, it'll work the same way. I'll do that if I can't sleep. I wake up in the middle of the night, I have my progesterone on my nightstand. I just take a pump and I just rub it on my chest and it'll take me back to sleep again.

Yeah. Have you seen, have you seen that book? There's a guy who even prescribes it for like kids with ADD or ADHD.

Yeah. Dr. Platt.

People with anxiety. Yeah. Dr. Platt. What do you think about that?

Oh, so I've interviewed him. I actually did the, some of his program for him. Talked with him for a long time. So he uses extremely high doses and he does them. He, he recommends doing it every day, which I disagree with because you can start to suppress estrogen if you do that. And he's, he'll be like, oh, take, you know, to God, to men, to kids, to everybody. It's like, go ahead and take 200 milligrams of cream a day.

500 milligrams.

Yeah.

His book makes it sound like it's just the miracle cure.

Yeah. And you don't want that much progesterone. You can start to run into some problems. And actually it shows in some of the research that it can actually lead to insulin resistance. And he's, he's saying it's going to cure the insulin resistance, or at least help it. And so, we can see the opposite effect of that. And then, he's a doctor that thinks that estrogen's the devil and it's going to cause breast cancer. So, I had to kind of go, "Oh, you're such a nice old man. I love you, but you're wrong." Yeah.

Now, the estrogen piece, you talked about progesterone and testosterone delivery methods, but I've seen two different forms of estrogen. Described before, estradiol, and one called Bi-Est if I'm pronouncing that correctly, B-I-E-S-T. What's the difference between the forms of estrogen repletion and what do you like to use?

Okay. So, I like to use estradiol for most things because estradiol is our most important hormone for women. It's the equivalent to your testosterone. So, estradiol is the one that is shown in research to be brain protective, like incredibly brain protective. I mean, your, your, your risk of Alzheimer's and dementia drastically reduces from estradiol hormone replacement therapy, like between 77 to 79%.

Oh, wow.

Isn't that insane? There was a study done by the University of Arizona in 2020, 400,000 women. And, it showed that women that took estradiol replacement therapy for 6 years or longer in menopause had a 79% reduction in Alzheimer's and 77% reduction in dementia.

Ben Greenfield: Dang. You know, I've even heard similar things about guys who are on aromatase inhibitors or selective estrogen inhibitors that they could experience potential risk for Alzheimer's or dementia by suppressing estrogen, probably for similar reasons.

And same with your bone health and your erections and sex drive. Estrogen is really needed for women's sex drive especially, but you guys too. If yours gets too high, it's a problem. But if yours gets too low, it's a problem too.

Gets annoying during movies when you're crying during all the sad scenes.

Yes. Yeah, exactly. So, we have 3 main estrogens. There's estrone, which is a more inflammatory estrogen. We produce it out of our fat cells. Estradiol and estrone can convert back and forth to each other, and then they both convert down into a really weak form of estrogen called estriol. And estriol, we produce boatloads of when we're pregnant. So, it's considered the pregnancy estrogen. When we're in menopause, a lot of doctors will insist on using Bi-Ess, which is a combination of estradiol and this really weak form of estrogen called estriol. And that's because it's been shown to be really breast protective because it doesn't sit on a receptor that causes proliferation. And it's really great for vagina health and really great for skin. So I tend to— in my— in our practice, we tend to use the estradiol because estradiol needs to get to a certain point in menopause on hormone replacement therapy to give us the bone, brain, and heart protection that it can give. And so, if you're combining it with estriol, and usually, they'll do an 80% estriol with a 20% estradiol, that's too— it's too much of the estriol. You end up using way too much estriol. And so, I just don't agree that we should be trying to mimic pregnancy levels in menopausal women. It's just like, that doesn't make any sense to me. So everything that I've read is all estradiol, estradiol, estradiol. Estradiol is the one that's giving us these incredible benefits. It's giving us our skin, our bones, our brain, like everything. And so, and we have estrogen receptors, estradiol receptors on every organ in our body. It's like we're rich with them in the brain. It's not just about Alzheimer's, it's about how we think. It There was a study done that showed that women that used 2 milligrams of estradiol, uh, their hippocampus part of their brain volumized, it grew. And the women that weren't on it or were on 1 milligram of estradiol didn't have any effect. Their brain did not change. And when the women went off that 2 milligrams, their, the hippocampus gray matter went back to the regular size. So it actually helps your brain to volumize. And so estradiol, I like it for that, but I do have a bias. I love it for vagina because it's really good for lubrication and moisturizing and atrophy of the vagina. Super excellent for a face cream. It's been shown to shrink your pores by 60 to 100% within 6 months. Same with estradiol on the face, builds collagen and even decreases the depth of your wrinkles. So, who doesn't want that?

Wow. I had no clue. And, I'm assuming based on your description of it, this is transdermal, the estradiol?

This is transdermal, yeah. I'll send you and your wife some.

Oh, wow. Fantastic. I'll keep that next to progesterone for times of need when I need that.

Yeah. It's just a little baby amount. Yeah.

Yeah. And, you said for the face. What would be the other benefits for a guy? Just cognition, facial health?

Yeah. You'd have to be careful because men tend to be estrogen dominant right now.

Okay.

Right? Because not you, Ben, but a lot of guys, because they're unhealthy or if they've got weight gain or anything like that, their testosterone's gonna come up. Right.

Synthetic estrogen, synthetic estrogens.

Synthetic estrogens. We're, we're, we're, there's so much of them. But the research shows that if you're using just enough to just moisturize your face, it won't raise levels systemically. So if you were to just use like a little pea size on your face once a day, then it really helps with that. Actually, I taught John that and he ended up putting it in his face cream, in one of his face creams.

Oh, Dr. John Ross. That's interesting. I remember seeing that in the face cream. I was kind of wondering about that. Yeah, that's interesting. So, in terms of these different estradiol, progesterone, testosterone, I assume all this is prescription. There's no OTC options for management of something like this.

No, there is. The only one we can get OTC, of course, is testosterone. So, testosterone is classified as Classified 4 or whatever, Class 4, is that what it is down in there in the States?

Yeah, which I guess would make sense because if we're talking about— I know my wife orders progesterone without prescription. You just offered to send me estradiol and that would be a big no-no if it was a prescription. So, progesterone and estradiol, you can get over-the-counter and then testosterone would be prescription.

Correct, yeah. And I have one of the only estradiol-only over-the-counter creams, cuz most people won't do it because of the fear of estrogen. So mostly you're gonna find Biest over-the-counter. You will never find estradiol unless you go to Karen's website. And it's just a low dose because I do think that you should be monitored with higher doses. You want to be working with a practitioner with hormones as best you can, as everybody should if they can, no matter what, because hormones are so Everybody's so different and how you react is so different that there's, there's so many nuances to it, but a lot of people can't afford it. So I created my own line for people that just, you know, they, they want the help, their doctors aren't giving it to them, and they wanna try progesterone cream for their symptoms. And it's like, now, now it's available.

So, yeah. Now, now what about DHEA? How come you haven't mentioned that yet?

I love DHEA. I do, or I prefer oral DHEA over transdermal in small amounts. So a lot of it, a lot of practitioners will be like, oh yeah, use 50 milligrams. You don't want to do that because like testosterone, DHEA can also convert down into a more androgenic pathway. So, and we have a lot of DHEA receptors in our skin, so it's in a higher dose, a lot of women will get acne and hair growth from DHEA. But DHEA is great, especially for women that have cortisol issues like low adrenal status, which tends to happen later on in perimenopause and menopause. Your DHEA will, will go down with it. And DHEA can— when you bump it up, it's very anabolic. Rather, cortisol is very catabolic, so protects the muscles. Really great for insulin resistance and blood sugar control. And then, it's a prohormone, so it helps us to make testosterone, helps us to make estrogens. And, it's an adrenal hormone, so it has all these different functions. It's at the top of the hierarchy. So, testosterone and DHEA are a woman's most abundant hormones in her fertile years. Not estrogen, not progesterone, testosterone and DHEA. And all of your estradiol is made from testosterone in your ovaries. So your ovaries make testosterone, which then will make estradiol. So I would say it's like kind of man makes woman. Interesting.

Yeah. So with DHEA, are you actually testing to see if cortisol is dysregulated and then saying, okay, we're going to throw DHEA into the mix also?

Yeah. Yeah. And then we do that through the Dutch test. Blood, you cannot test cortisol with blood. It's just giving you the snapshot in time. Cortisol, we need to see what the rhythms do. We need to see is it coming up in the morning and then tapering down as the day goes on and then overall 24-hour cortisol production and then how you're metabolizing it.

Right. And the metabolizing is important because someone might, for example, be making adequate cortisol but showing like really low cortisol metabolites due to hypothyroidism or something like that. That's why the DUTCH Test is very interesting to know upstream and downstream metabolites because often you don't know whether it's a clearance issue or whether it's an actual issue with subpar production.

Yeah. You don't know how many women that I have been able to go, "Do you know you have hypothyroidism?" And, they're like, "What? From my DUTCH Test, you can see that?" I'm like, Yes, like 95% of the time, if your metabolized cortisol is low or under range, you've got hypothyroidism.

Right, right. Now, how about peptides? You hear those talked about a lot now as either alternatives to some type of hormone replacement therapy or an adjunct to them. Are you using peptides at all?

Lots. Yeah, yeah, lots. Yes. So, I have a peptide group that is mostly focused on using weight loss peptides uh, semaglutide and tirzepatide for women in perimenopause and menopause because menopausal weight gain and perimenopausal weight gain is some of the most stubborn fat to get rid of. And I, I, I attract lots of healthy women into my practice, tons and tons that are doing all the things and they can't get the weight off. And they— these women were women that you know, were 115 pounds or 110 pounds their entire life and they hit perimenopause or menopause. And they can be extreme athletes, they can be, you know, eating perfectly, and they pack on 20 pounds and cannot get it off even when they replace and optimize their hormones and doing all the things. And so we wanted to, like, having these peptides has been a huge blessing because women are now getting their physique back so that the hormones are giving them their life back for some of them, and they're their libido back and their skin back and their hair, and they're feeling good and emotionally stable. But then the body wasn't catching up with some of them. And so, and not with every woman. Some women, they take hormones and it's like, boom, they lose all the weight and they're happy. It's great. But a lot of them, they get, they get stuck. And so the peptides really work well with hormone replacement therapy. And so the women can shed that extra weight that they gained, plus they're getting the hormones and they feel great. So it's been great. But we are also using like BPC-157 for women with inflammation.

Yeah, I was gonna ask you like which, which peptides specifically would you use for the hormone support piece?

We do the BPC-157 cuz it's so great for gut health, which then of course is gonna help you to metabolize your hormones. CGC, ipamorelin. So that's the growth hormone. Some women do really well on that. I personally did not. I crash and burn. But a lot of women do well, especially if they're doing the, the weight loss peptides. Those two are great to add into it because the growth hormone can obviously help to protect the muscle if you're not eating enough, right? And then, we all use the Kion Aminos. That's our number one recommended supplement in our group.

Your check's in the mail.

Yeah, it is. No, it's been great. I love Kion. I love Angelo. I just had him on the podcast. I actually met Angelo in person last year.

Yeah, yeah, yeah, yeah, he's great. Yeah, obviously a good friend of mine.

Yeah, obviously. Yeah. So, we do those. Melanotan a little bit. Like, I've just personally tried melanotan. Oh, that made me feel super sick. But, that one can give you your skin color. So, it's protective of the skin. So, it gives you a nice tan. We're exploring a little bit with some people that are looking for an increase of sex drive because that's definitely something that happens in menopause is the lowering of sex drive. So we've had some women try oxytocin, we've had the, you know, PT-141. So we've used it, we've tried a couple of those, the Tadalafil cream that you can get at peptide sites. We've had some women do the NAD. So we're not super focused on peptides, but my, one of my coaches, she is a peptide expert, so she Absolutely helps people in our groups to, you know, figure out which peptides could be good for them.

Yeah. You know, now hopefully this isn't a dumb question, but when it comes to this idea of managing perimenopause and menopause, is the, is the strategy to stave off menopause for as long as possible or to simply ease the transition into it?

I feel like it's, it's to ease the transition. Because a lot of women really look forward to losing their period. I wanted to stay, so I completely reversed mine, and I, I had my period up until last year, and then I went into menopause. But I was able to completely reverse it, and I really wanted to hold on to my cycle for as long as—

when you say reverse it, what do you mean?

So I started to lose my cycle at 42, so I was going into menopause. So menopause is considered one full year without without your period is one day. It's one day. It's the first day after one year without a cycle, then you're considered menopausal. And then after that day is post-menopause, which is really stupid. They just came up with that number. I just think, you know, if you start losing your period, you're going into menopause.

So yeah, why, why wait, why wait a year to officially announce it? Right.

I just think it's so stupid. So I was going there, I had missed my period. Like I said, I was having all the symptoms, my hormones were dropping. So I replaced my hormones to a level that brought the period back. And so a lot of women will continue to do that. We do cycle hormones for women so that they'll continue until as long as they want. We have some women that are in their 60s that still actually get a once a month, just a slight bleed, but that's just because their estrogen's at a high enough dose to give them the protection. For the brain and it causes a little bit of a bleed because they're cycling the hormones. Some women, they choose to do static hormone dosing so that, that means they would do progesterone and estrogen every single day at a steady dose, the same dose, and then they wouldn't get a cycle. And so those women will eventually, you know, they, they would lose their period and then they would continue with the static dosing so that they never got their period again. I personally will probably eventually do the rhythmic dosing because I think it's better for receptor health to do some cycling like our bodies naturally do.

Okay. We talked about peptides and DHEA, but another one I wanted to ask you about that I see recommended a lot for estrogen dominance is DIM, diindolylmethane.

Yeah.

Methane. Methane.

Okay.

So, DIM, you know, cruciferous extracts, cruciferous vegetables, broccoli, broccoli sprouts, et cetera, You see those recommended a lot for estrogen dominance in both men and women. What do you think about DIM?

It's also recom— highly recommended by practitioners for menopausal women too. Pellet clinics, they, it's like automatic. Every single woman is put on diindolomethane, DIM. So diindolomethane will lower estrogen levels. And so, it's great if you truly have too much estrogen, which actually very few women do. So let's just be very clear about that. Every woman thinks she's estrogen dominant, but when you actually look at her levels, they're fine. It's usually that progesterone drops. So in comparison to their progesterone, they're— they have too much estrogen, right?

So, so it's more a ratio issue, not that there's too much estrogen. It's the ratio of estrogen to progesterone.

Yeah. And then the— when we look at the metabolite test, through the Dutch. Remember I was talking about phase 1 hydroxylation? There's a pathway for hydroxylation that is the most toxic of these 3 pathways, and we see that that causes the most DNA damage, that women that do get breast cancer will have a higher level of 4-hydroxylation. And then there's 2-hydroxylation, which is the safest of these 3 pathways. DIM will make it so that your body will push down the 2-hydroxylation and take out of 4-hydroxylation. So, if you did a test and you actually saw, "Wow, my 4-hydroxylation's elevated. I do produce a lot of estrogen." Let's say you've got really high levels of estrone or estradiol or you're at least over what you're— definitely way over what your progesterone is. You could use DIM to push down that path. It works excellent for that. But willy-nillying the DIM is not a good idea because if you have estrogen dominance or you have too much in comparison to your progesterone, A, what if your estrogen's not that high? What if you're close to menopause and your estrogen's dropping and you're gonna go take DIM and it's gonna then deplete your estrogen faster and that's gonna push you into menopause faster, which will give you a lot of symptoms very quickly.

Yeah. And I, I assume based on what you described about estradiol, if it affects that, that it would also potentially cause issues with brain fog.

Everything.

Or things along those lines.

Oh yeah. Terrible. It's terrible. What can we don't, we wanna hold onto that, that estrogen is, or is what makes us feel the best. And that'll cause more, more the, the loss of estradiol will cause more weight gain than an excess of estradiol. Always remember that because estrogen's needed for insulin sensitivity, leptin sensitivity, That's why we gain so much weight is the loss of estradiol. Progesterone a little bit and testosterone will contribute to weight gain, but estrogen loss is number one. So, we don't want to be draining our estradiol, we want to be coveting it. So, you have to be very careful there. And then, the second thing is, is set phase 2 is methylation. So, you may be held up in that phase. So, if you go start taking DIM, you're going to start dumping out this estrogen. But if you're not methylating it out well, it's going to back up into the system and you're going to get higher levels and cause problems.

Ben Greenfield: That makes sense. When I talk to a lot of male hormone specialists, they're also recommending other things like everything from ice baths to red light therapy. I've seen pulsed electromagnetic field therapy recommended, you know, mitigation of EMF the cell phone in the pocket. Are there certain things from a lifestyle or even a biohacking technology standpoint that you're also implementing in your practice or recommending to women that go beyond just having a cell phone?

That will help them to slow down that process?

Beyond the drugs. Yeah, other lifestyle practices or biohacks.

There is. We always start with lifestyle. I mean, we always want that in there. But a lot of the time it's— you can't biohack your way out of it. Like I said before, like, you men have it a little bit easier because there's a lot you guys can do to restore testosterone. But once our ovaries shut down, they shut down. Um, bioregulator peptides, I have seen slow down the transition to menopause in just a couple people because not a lot of people use them, but I have seen it in my practice, like a before and after Dutch test of levels after taking the ovarian bioregulator peptide.

I was gonna say there's like a few dozen different bioregulators, but you're using the ovarian one.

She's using the ovarian one, and I've used it now with women, um, that are having infertility problems. Um, I do use it with them and I want before using hormone replacement therapy because it can help restore the ovaries for them. Um, there are certain herbals that can help nourish things, like supplementation. Stress management is huge. Um, cortisol will block the receptors, and so women can feel like they have no estrogen when they have plenty because their cortisol is really high, is blocking those receptors. And so, you know, lowering stress levels, of course, is going to be huge. Lowering inflammation, making sure your gut's healthy, all of these things can help with the journey in, but a lot of it's genetics, you know, when you're gonna hit menopause and once your ovaries start going, they just start going and there's no bringing them back.

So when it comes to that ovarian bioregulatory peptide, is that, do you know the name of that one? Cuz I've got all sorts of funky names, these bioregulators.

Yeah. And it's not like Ova or something, do you know what I mean?

Like it's, yeah, it's not intuitive.

It's, it's not. And so I can't, no, I don't remember it right now cuz it's something strange.

I'll look it up in the, yeah, I'll, I'll put it in the show notes cuz these bioregulators, every time I go to use it, I have to go look it up. Right. And unlike other peptides, very short amino acid sequences that can target a tissue, an organ, very precisely.

Very precisely. They have incredible research behind them. Our mutual friend, Nad Nedim, she's come on my show lots to talk about bioregulatory peptides and just how you can use them for women's health, for many different things, even thyroid function. Thyroid will go down like the rest of our sex hormones. And there's a really good bioregulator for your thyroid. So taking the thyroid, the ovarian one, even the blood vessel one, because, you know, women, it's our number one killer is, is heart disease. So taking the blood vessel one, she says, really important. There's a bone one. Women will start to develop osteoporosis, especially if they don't replace their estrogen and progesterone and testosterone because it's so important for bone health. So that can be a great addition to it as well. I'm not the expert on bioregulators, so I wouldn't— definitely go check out Nat.

Yeah, yeah. Nat Nidum's podcast. Shout out to Nat. I have a podcast with Phil Micans that I'll link to in the shownotes that I've done on these bioregulator peptides. I wanted to ask you also, Karen, because a lot of women get concerned about weight gain during perimenopause and menopause. Besides the strategies that you've just outlined, is there anything specific that you do for the weight gain piece?

Yeah. Yeah. So number one, you have, you gotta lift weights like across the board. It's like that, that is the number one thing that you need to do is to, to put muscle on and you gotta tamper down on the cardio because the cardio is gonna stress the system out. It's, it's gonna cause more problems than, than, than good.

You, you don't mean walking in the sunshine. You probably mean like training for a triathlon or marathon or something like that.

Yeah. Like the cardio bunnies that are out there going, I'm gonna go, you know, go on my step machine for 2 hours. Straight and then go running, which a lot of women think that that's the only way that they can lose weight and they're very highly addicted to the cardio.

So— Peloton, spin classes, 5Ks, which are— that could be great for VO2 max and metabolic health. Yes. But, you're right, I always see better weight loss effects coming from low-level aerobic cardio compared with weight training and lifestyle modifications.

Yeah. And then, as you've talked about a lot, it's our biggest glucose processor, right? So, because our metabolic health gets really bad. I mean, every woman's blood sugar is gonna go up when she starts losing her hormones. Like, mine went up and I'm like, my perfect blood sugar my entire life, and it went up and I was like, what? And so that's the loss of mostly estrogen that's causing that. Your cholesterol goes up because you're— the loss of estrogen and thyroid, they'll both affect insulin and blood sugar. Cholesterol. So you have to put muscle on to help with that metabolism. Without progesterone coming in, your, your metabolic rate does go down a little bit. Same with thyroid, right? It's going to have an effect on your metabolism. And we know the more muscle, the more thermogenic you're going to be. So it's like, it's just the number one thing. And then it's also going to protect your bones. And so doing that, walking outside in the sunshine, like, really into circadian health, because that has so much effect on our blood sugar, on our leptin, on our sleep, all of those good things. So doing all of that, I think, is like number, number one. And then exercise-wise, I have a Carrow bike now, which has been really handy. Do you have a Carrow bike?

It's right behind me. You can't see it because I have this dumb green screen up, but yes. So that's really great if I've got no time and I'm locked away in my office on a busy writing day.

Exactly.

10, 15-minute What about the weight training? What does that look like for you?

I, I really like weight training. I'm not a cardio person, so I can weight train very easily, like 4 to 5 times a week, no problem.

And what would a typical workout look like, like you're recommending for women for sets and reps and weight?

At least if they can, 3 days a week, at least for 30 minutes, you know, if that's all they can get in, great. And I really like, Like there's this really easy set that we, that I teach them that has like, you know, you go through just super setting, you know, you do squats, you do shoulder press, you do bent-over rows, squats, and you just boom, boom, boom, boom. And you just, you wanna make sure that you can't get to 8. If you can get, if you can get to 8, you're not lifting heavy enough. So we're not talking like, oh, 5 dumbbell weights. No, no. If you're getting to 8, you're not, it's not heavy enough.

Yeah, no Gwyneth Paltrow elastic bands here. Yeah, you're right. I think that 6 to maximum of 10 reps. If you can exceed that, I use a rule of 3. If you can go more than 3 reps over about 10, you probably need to increase the weights or adjust the tempo or adjust the lowering phase or do something to increase stress.

Yeah. One of our coaches, she trains people in heavy lifting contests. And then, we have another woman that we have a whole library of videos for weightlifting for women because it's so key for menopausal women.

Yeah, absolutely. Well, Karen, I'm going to link to all of your stuff. If folks go to bengreenfieldlife.com/martel, you've got your telemedicine, you've got some of these products, I assume, that we were talking about. Anything else that, that people can turn to for as far as wisdom or advice that you have on your website?

Yeah, we can prescribe in every state. In the United States as well as British Columbia and Alberta in Canada. We do do testosterone therapy because that's kind of hard to find for women. And then we also have— so you can do private coaching calls, but then we also have group coaching for— it's a more affordable option. We do, we do lab reads in our group coaching calls, so you can get tons of help with what your labs are saying. And with the whole program on hormones and getting the lifestyle and the diet nailed down with the videos of all the weightlifting. And it's rich with tons and tons of content. And then, we have a weight loss peptide group if that's all you're interested in, it's just the weight loss. And then, my podcast, I have a top 100 iTunes podcast, The Hormone Solution.

Oh, yeah. Forgot about that.

I just interviewed Ben on it, so be on the lookout for that. We did a nice up close and personal with Ben Greenfield. It was great. So, yeah. And then, there's so much on there. I mean, I've interviewed world-renowned hormone experts and there's so much to be had on there.

Yeah, yeah. You're definitely an incredible wealth of knowledge and I'm glad I discovered you and was able to have dinner with you and learn about what you do. So again, the shownotes are going to be at BenGreenfieldLife.com/Martel, Karen's last name, M-A-R-T-E-L. I'll include all the details. All of her information over there. And Karen, thanks so much for coming on the show.

Thanks for having me.

Alright folks, I'm Ben Greenfield along with the great Karen Martel signing out from BenGreenfieldLife.com. Have a fantastic week.

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