Hormone Therapy Just Changed in America: Live Expert Breakdown with Dr. Charles Mok

Hi, this is Dr. Charles Moak with Allure Medical and I'm really excited to talk to you tonight. This has been part of my entire career for the last 20 plus years was women's health. And the biggest disservice to women's health in the last hundred years occurred in 2003 when the FDA misrepresented and misinterpreted misunderstood a study that was designed to help women input what's called a black box. Black box is a warning. It's actually a black box on a prescription with white lettering that said that estrogen caused certain diseases, which it did not. Not the study they cited. It was misinterpreted. The study was not even completed or published yet. And this led to an abandonment of hormone replacement therapy and really had a huge cost on humans lifespan at Healthspan and we're gonna talk about that. And then just recently the black box was lifted in November 10, 2025 going reversing their original bad decision and bad advice. So we're not going to talk about that. And thank you for joining us. And in the comments there'll be the ability to click a link to make an appointment with one of our providers. We have offices in Michigan and North and South Carolina or you can book a telehealth as well. We can only do medical advice for the states for people that live in the states that we practice in, which is North Carolina, South Carolina and Michigan. So thank you. So this agenda, we're going to talk about Allure Medical a little bit about us, why we're the experts to be talking about this HRT basics, how it works, who's it for, history and research and key studies and key turning points. And then eventually the 2025 update by the FDA that unlocked women's health so that women could have access to hormones again without restrictions from their doctors, benefits and options, current best practices and recommendations, testosterone, the kind of a maybe the underrepresented hormone in women's health but the most important hormone and a try before you buy program that we have only exclusively at a lower medical and then we'll have questions and answers. Now you can type in questions at any time and I have a moderator here. If there's a question that's important that I need to answer it, she'll bring it out. Otherwise we'll address it at the end. We can't really do any consultations or one on one during this meeting. And thank you for everybody for joining us. So about Allure Medical, we have been in business over 20 years, 20 years and 20 years, 23 years. I'm sorry, 22 years of experience with hormone replacement therapy. We've had over a million patient encounters, about 1.4 million patient encounters over the years. 14 locations and growing. And 100% committed to your safety and your outcome. So HRT basics, who's it for? How's it delivered? So HRT, hormone replacement therapy. Now, there's different forms of hormone replacement therapy. There's drug therapy where we use synthetic derivatives of hormones or non human hormones. There's bioidentical hormones, which means there are hormones that are exactly like a human produces. And these are actually synthesized in the lab, typically from a plant material, but they look exactly like what a human makes and then what people call natural hormones, which is actually just a bioidentical hormone. Now these bioidentical hormones can be both generic or compounded and can be brand named and we'll go over some of those. So what is hormone replacement therapy? So hormones naturally decline with age and for women's health in particular. Most of your hormones for your sex hormones comes from your ovaries and principally the hormone is testosterone, which turns into estrogen. And as you age, your, your overs don't work quite as effectively and these start to decline. But when they're health healthy levels, we have good energy, good mood, good bone density, good heart and good sexual wellness. So hormone replacement therapy is for women in menopause or perimenopause. So menopause is defined as no period for a year or having your ovaries removed. The average age is right around 54, but it's highly variable. And perimenopause is when you're having some menopausal symptoms typically and your periods are no longer as often as they were. So you're still making some estrogen testosterone, but it's less. You still have some active ovaries, but they're kind of petering out. And this is when the, this could occur, one year to five years, maybe ten years before menopause. And there's different delivery methods from pills to creams to pellets. So history of hormone replacement therapy. So in the very early days we use what, what was called desiccated hormone replacement, which is actually taking an animal's ovaries or an animal's tissues. Even in the case of, we still use desiccated pig thyroid glands, what they call armored thyroid today to treat hypothyroidism. But for sex hormones, the early days we're using ground up sheep ovaries and eventually they would synthesize a estrogen out of a, out of basically out of a pregnant horse. And then eventually we started synthesizing actual human based estrogens. Let's look at, we saw in the evidence for using hormone replacement therapy. And this is going to be principally using a horse based estrogen which we still use today, surpr interestingly and a human based estrogen, estradiol. So estradiol we call conjugated quinine estrogens, which is the premarin or horse type estrogen. So 1981 we had very early signals that women on hormone replacements replacement were just less likely to die. Now on these next slides, I mean talking about a lot of percentages and I want to put it in context. So if we say 50% reduction in mortality, we actually have 100% mortality. But this is over a period of time. So let's say you take women that are 60 on average and you follow them for 10 years and you can measure the death rate of one group versus another group. This is a difference in mortality. But obviously if you followed them for a hundred years, all women would eventually be dead. So these are usually studies done between seven and 14 years. The nurses study 50,000 women, 44% reduction in heart attacks, 1991 with a landmark study called the Pepe trial. This had saw a 40% reduction in mortality 96 and 97. There's two different studies showing a 35 to 37% reduction in Alzheimer's disease or neurocognitive decline. This transformed the practice of medicine in the 80s and to 90s where we were prescribing to every woman who was interested and was going into menopause hormone replacement therapy because they had less likelihood to die, had less cardiovascular disease and less cardiovascular mortality, less strokes, less heart attacks and less Alzheimer's in addition to feeling better, less bone demineralization, better energy, less weight gain, less diabetes. And then in 2002, out came this WHI first report Women's Health Initiative trial and the FDA's black box. Not forbidding doctors from prescribing hormones and not even like taking it off the market. They can actually take things off the market. But a black box warning is this one notch above taking it off the market where they put a big black box on all estrogen products saying they potentially cause disease based on a misinterpretation of a study that wasn't even published yet. So what was their black box warning? They declared that estrogen estrogen causes breast cancer, heart attacks, strokes, impossible dementia. Now as we'll talk about this. There's nothing further from the case. This was totally misrepresented based on a lot of media pressure, a lot of political pressure based on the public's misinterpretation of a certain part of a study that was released the year before. We had a big outcry and at the time there's a big concern that women's health was not treated as seriously as men's health in the early 2000s. And breast cancer was almost like a political charge disease. And because it was some signal of a very small subset of women taking a non estrogen hormone taking, actually what's called MPA had increased risk of breast cancer. This led to a whole flurry of activity and a gross overreach by the FDA that really harmed millions of lives. Fortunately, we'll talk about later, they've reversed that. So let's look at the early studies. 1981 Lancet. Lancet is a very famous, it's a very well known, well respected European medical journal. And in this they looked at hormone replacement therapy users. This in general, whether they were using estradiol or Premarin, those are the two most common things at the time. And they saw a 57% reduction in death. They were more likely to be alive. Now this was a study done over 10 years. So they didn't follow people forever. Obviously everybody dies eventually, but in the shorter term, if you take hormone replacement therapy, you're more likely to be live than if you took nothing.

We've got a question from the audience. As you're addressing women, you only mentioned perimenopause and menopausal. We have a guest who is 54 and is wondering does she act like a.

So the question is that we're talking about perimenopause and menopause and a woman's asking about at 54 years old, is it applicable? So at 54 years old, if you're having no periods for a year, you're in menopause. And if you're still having periods and you have menopause symptoms, you are in perimenopause. We basically treat them both the same. Next study, 1976 to 1991 was called the Nurses Health Study. Massive study. 50,000 women filed for 10 years and they saw a 44% reduction in heart attacks. So 50, this is average age, about 55 when they started. So 55 to 65, 44% reduction and heart attacks, massive reduction. And this led to again change of behavior where doctors started prescribing hormone Replacement therapy for women entering menopause. Just like the questioner had asked. Another landmark study is called a PEPE trial. Perimenopausal, I'm sorry postmenopausal estrogen and progesterone intervention. And this study was the first one to use synthetic drugs. So instead of using bioidentical estrogen with or without progesterone, they use bioidentical progesterone with a horse based estrogen. And they also had another arm that had a synthetic progestin. And what they found was that the women on estrogen had a reduced mortality followed over roughly 7.5 years. If they added in progesterone they had the same reduction in mortality and if they added in a synthetic progestin they had not quite as much of reduction mortality, but almost. And this actually led to the adoptment adoption of using these synthetic progesterones. So let's go over that briefly. Estrogen is your main menopausal hormones and progesterone is necessary to keep estrogen from overgrowing the uterus. So you have to use that for uterine protection. And Y labs had the number one selling drug in the world, Premarin, which was a horse based estrogen for women we knew is safe, effective reduce mortality and cardiovascular diseases. Can they make a non generic form of progesterone? They invented Provera which is a synthetic drug and it worked almost as good as progesterone. So keeping the Mertu selling drug. Go ahead and advance the slide. Stroke Incidence British Medical Journal 1988 that's a famous journal obviously in Britain. And they looked at the incidence of strokes in hormone replacement therapy users versus non users. And interestingly in this, this age, this group, the average age was 78 years old. Now currently in the, in the current healthcare there's a big bias against treating older women with hormone replacement therapy. But the reality is that there's no age where you want to have more strokes. But they saw a 47% reduction in strokes in women who were 78 years old on average taking hormones versus no hormones. Another study looking al Alzheimer's risk reduction Alzheimer's 68 years at baseline followed 14 years. So 68 to 82 years old they saw a 37% reduction. And Alzheimer's disease. Another study around the same time published in Menopause Journal, 35% similar reduction, 35% reduction in Alzheimer's disease. These are women 74 followed for 14 years, so up to 88 and they saw a reduction in Alzheimer's and all these Things led to an understanding by doctors that, okay, we have lower cardiovascular disease, lower strokes, lower all cause mortality, lower Alzheimer's, improved symptoms, improved bone health, less colorectal cancer. We should put all women on hrt. In fact, we. We did. Now, this study is the only one I'm putting in that was in 2000. Did more recent 2012, because it's interesting to fit in here. All the other studies were before they did the FDA's black box, but it's estimated that women on HRT for 15 years get an additional 2 years of lifespan. And even if they're only on it for 10 years, you get additional year lifespan. Now, what's lifespan versus health span? Lifespan, how many years you're on the planet, and health span is how many years you do not have disease. And health span goes up to about three and a half years on HRT. And even if we add in testosterone, about 4.75 years. But if we look at the number of women who were not put on HRT because of a misbranding by the fda, two years per person. This is very, very big disservice the government did to women's health. So in 2003, the FDA declares risks. They say estrogen causes breast cancer, heart attacks, strokes, and possible dementia. So let's dig into this. Estrogen causes breast cancer, heart attacks, strokes, and dementia. And if you go talk to your family doctor, a good chance they'll parrot that same thing because it's written right on the prescription. So estrogen use in the 90s was 40%. So all women were offered it. Only about 40% women took it. And after the black box warning, estrogen use ceased. And it's down to about 1.8% now, up to 5%. And what have we done? We've treated menopause like a mental illness in the past 20 years. So instead of using hormone replacement, we use SSRIs and antidepressants and other drugs, multiple drugs for bone health. Many. There's actually been billions of dollars of big Pharma money being made by the fda, basically essentially banning the use of estrogen. So what's the turning point? The Women's Health Initiative trial was published in 2004, but there was an initial arm published in 2002, and it was halted early because a certain subgroup of women had signals of some increased risk. And the FDA looked at that signal of increased risk in a certain subgroup of women and completely misrepresented the entire study itself, which had not been published as of yet. This was picked up by the media picked up in Congress and people were calling the FDA to stop treating women with estrogen. The media misrepresented what drug was associated with some risk in which women had the risk. And this led to the biggest disservice for women's health in the past 100 years. So let's look what happened. So there's a, a subgroup of women who were 65 years at randomization that had never been on hormone before and they were given estrogen, but also a synthetic medroxyprogesterone, which is actually a synthetic drug that had been recently invented by the manufacturer and it's not progesterone at all. It was only in these women that they saw a slight increased risk. Now the increase of risk was 8/100 of 1% absolute risk. So very, very little and no increased deaths, just increased blood clots, higher cancer rates, slight possible cardiovascular risk and possible link to dementia. And this was using a synthetic estrogen oral and a synthetic progestin started 15 years into menopause. Now what happened later on when we looked in this a little bit deeper again the, the FDA claimed, well, estrogen causes diseases, that, that estrogen causes diseases, that HRT was shown to reduce heart disease and breast cancer and dementia contradicted the positive Women's Health Initiative trial signals. It resulted in widespread fear of HRT use. And we really overlooked the risk benefit profile for most women. Any advanced slide. So let's look at what happened when we look at women put on menopause drugs at or near menopause. Within 10 years we saw a 37% reduction in colon cancer, 12 to 21% reduction in diabetes, 30% fewer fractures and fracture mortality, 30% reduction in all cause mortality. And estrogen only was associated with 22% lower breast cancer risk. Now again, these were synthetic non human drugs designed to resemble human hormones. Now since that time we've had millions and millions of women year study looking at the benefit of human hormones over say horse hormones or synthetic hormones. But even using those drugs reduce mortality, reduce colon cancer risk. The Women's Health Initiative trial ended in 2004. What they saw Additionally, 50% lower incidence of heart attacks, 64% decrease in cognitive decline, significantly lower all cause mortality and no increased cancer mortality of any, any kind. And these findings really weren't known at the time that the FDA put the black box on estrogen. In fact, the side effects of the drug was associated with the MPA drug medroxyprogesterone and not seen at all in the estrogen Group of women. There was none. Well, November 2010. I'm sorry, November 2025. November 10, 2025, the FDA, which is unusual, they're a very arrogant organization. They corrected themselves, they acknowledged they had made a mistake. They misinterpreted the data, didn't even base this reversal of the black box on newer information. They based it on the information that had been available all the time. It was largely reinforced by more contemporaneous information, far more so. Dr. McCrary of the FDA is a new chairman. The fear machine has dominated the few of hrt and the FDA has officially removed the black box warning from estrogen products. There was black box warnings of every estrogen product, including vaginal estrogen, saying it caused potentially dementia. I mean, it was absurd. When estrogen was showed to reduce all diseases. They looked at breast cancer. Instance women on estrogen only therapy had a 22% reduction in breast cancer and 40% reduction breast cancer mortality. Yet the FDA claimed estrogen caused breast cancer. And if you ask your doctor, they remember it. And this was on the news, this is in the USA Today. This was everywhere when the FDA announced it, even though the study contradicted it. Cardiovascular deaths reduced 50%. These are claims from the FDA. Now they're saying that FDA says breast cancer is reduced with estrogen only. Cardiovascular deaths is reduced with estrogen and Alzheimer's risk is reduced with estrogen, improved survival, less mortality and less disease. FDA made some key points. Number one, they deemed the black box was no longer appropriate for estrogen products. And this allows doctors to prescribe it with impunity. Now in the past, doctors could prescribe it, but they had a fear. So even though a drug reduces the chance of say cancer or heart disease or Alzheimer's, you can still get it, doesn't make you immortal. And they were afraid that if they put somebody in estrogen and they wound up being the one that still has a heart attack, they would be sued and they were rightly to be concerned about it. Now, I think in the early days that was a bigger risk. Since that time, there's, there's never been any evidence that estrogen causes disease. But this was a fear Dr. Had, Dr. Had. So they use other drugs. According by multiple societies, including the North American Menopause Society, the American College of Ob gyns, the Endocrine Society has been pressuring the FDA to remove this ridiculous black box for years. And they really put the pressure on the last two years. And finally the FDA decided that they had to admit the truth. They were Wrong. They made an official notification on November 10, 2025 to manufacturers to remove warning labels on estrogen containing products. The backbox warning had been in place since 2003, in spite of the research that they based it on, contradicting all of their claims. That change makes a significant shift in women's healthcare policy that occurred for the past 20 years. Now, we've been using hormone replacement therapy in our practice for years because I read the studies, I've written, I'm an author in several books on hormone replacement therapy and other health related issues. But quite frankly, most doctors are going to follow. The FDA and even several organizations back then supported what the FDA was saying, even though it was not based on any science. So let's look at benefits and best options in 2025. And this is a guide for today. So it's, you know, for some people, they've already passed that time and they've passed away already. But people are still healthy, they have options. So silica estrogen reduces all menopause symptoms. Hot flashes, night sweats, mood swings, vaginal dryness, sleep dis. These are what we call vasomotor symptoms. Helps with weight management. Women on estrogen will gain less weight than women on nothing. Oral estrogen, slight benefit. Topical or pellet estrogen. Even better. Low risk of diabetes. 12 to 21% reduction. Type 2 diabetes with the synthetic drugs. Even more reduction in the actual hormones. Fewer heart attacks and strokes. No increase in breast cancer possible. Decreased and reduced Alzheimer's risk. Now, there's different kinds of estrogen. Now estradiol, there's really three main estrogens in women. One's called, we call it E1 estrone, it's a weak estrogen, probably a little harmful. We don't have much of it in our bodies as women or men. Estradiol, also called E2, this is your main estrogen. This is what makes you a woman. An estriol, which is more of a skin estrogen. And really you pump out a lot of it when you're pregnant. This will give you the glow of pregnancy. And some people use both estradiol and estriol. There's no purpose. You use estrone, but usually we're using Estradiol E2. And this could be a pellet, a patch or a cream or a pill. Now, one of the downsides to a pill is you got to take about 20 times higher dose than a topical because your body has what's called first pass effect by the liver. And when the liver sees that you've eaten a Hormone, it makes all kinds of inflammatory factors to try to bind it up. So we prefer not to use oral hormones anymore. But a lot of studies are based on oral hormones. It's still beneficial. So estradiol Patriot pellet is our preferred natural human hormones. Identical what your body makes. And it's a standard throughout the world. Not so much in America. We've been using horse hormones for the past, well kind of. We stopped in 2002. We've been using mostly a horse based hormone because in America we favor drug companies over generics. I mean this is in nature the, I mean quite frankly I worked in doctor's offices. They bring donuts to your offices and with the new drugs and that's what's prescribed. But hormones have been available for years. There's not really newly patentable unless a new delivery system is made. And then a common alternative again America, Premarin. This is, you see the horse there conjugated to quinine estrogen. Premarin stands for pregnant mare urine. So a five year old pregnant horse makes a lot of estrogen and they originally synthesized Premarin out of horse urine. Now they actually just make it from a soybean product. But this, it still works. It's better than nothing, but it is not the most optimal. Now about progesterone. I identified that MPA was a culprit in the WHI trial. So progesterone is a natural hormone. We commonly call it micronized progesterone, meaning it's like it's pulverized really small. The brand name is called Prometrium. That's a bioidentical progesterone. But usually people are getting micronized Progesterone, the generic term, it's the exact same thing. And this is the global standard, maybe not so much in America. Safest option, lowest breast cancer. I mean the best breast cancer in cardiovascular protection builds bone along with estrogen and better quality of life, better sleep. Progestins. The, the classic one is called MPA or Medroxyprogesterone also known as Probera. This is actually lab created drug. It does not exist in nature. It's mostly used in the U.S. you know, the rest of the world doesn't use this. It did have a slight link to breast cancer in older women starting it. And it does not have a positive effect on your bones and no positive effect on moods. These are just brand names of synthetic progestins. Now progesterone is generic, it can't be repatented. So companies keep coming up with new synthetic progestins to get a patent for 20 years and make a little money on them. I just stay away from these testosterone woman. This is the overlooked hormone. Now this to give you a little bit of, say, biology. If you had no testosterone as a woman, you'd have no estrogen. So your ovaries make testosterone and this gets aromatized or converted into estrogen at about one to 10. So for each one unit of testosterone. I'm sorry, for each one unit of estrogen you had, you had to have about 10 units of testosterone to make it. And you have about 10 to 20 times more testosterone than estrogen. And we just picked horse estrogen back in the 90s, but we could have picked testosterone. It was actually approved for women back in the 50s. So testosterone is a dominant sex hormone in a healthy premenopausal woman. It helps with cognitive function, cardiovascular health, muscle maintenance, bone strength, mood and libido. And woman has 10 times more testosterone than estrogen, but we have both of them now. Men have 10 times more testosterone than women and 10 times less estrogen than women. So we can have a convoluted crosshatch there. So testosterone effect on moon energy and co cognition. Supports brain reward pathways. Improves mood regulation, improves motivation, boosts physical energy. Improves mental awareness such as focus, concentration, mental energy throughout the day increases drive such as initiative, assertiveness and competitive edge and supports memory and processing speed. Improves cognitive performance, verbal and information processing sexual function. Increased desire, more spontaneous thought and heightened interest in intimacy. Enhanced genital blood flow. You can imagine what that does for sensitivity and increase orgasm, sensitivity and sensation on the body and metabolic health. Testosterone aids in muscle protein synthesis. People are trying to get enough protein to to simulate muscle protein synthesis, but without testosterone, there's not much activity going on. It also prevents sarcopenia, which is the opposite of building muscle. That's where your bones and muscles waste. Increases bone density and strength. Reduces insulin resistance, which is a precursor to diabetes. Supports weight management and healthy body composition unless visceral fat accumulates. Now, visceral fat is the stuff we don't want. That's like the beer gut. And women do not like having a beer belly, obviously. And this is the fat that's associated with inflammation and insulin resistance. It improves vascular tone. Now, testosterone was the first approved for women in the 1950s for breast cancer. In fact, tamoxifen, the breast cancer drug, was based on trying to copy testosterone, which was first approved for bre metastatic and resistant breast cancer. It's a dominant female hormone. Testosterone Levels are high when your 20s and 30s and then starts to drop off and it actually drops off earlier in per premenopause. So a lot of times women are pre menopause we to start with testosterone and again de. Decreased testosterone leads to decreased estrogen product production because the majority of your testosterone is from. I'm sorry majority of your estrogen comes from testosterone. And when women lose testosterone they start to get more weight gain around their belly. Now if we look at breast cancer risk, this has been a. This was really a big Buzz back in 2003 because the government claimed that estrin caused breast cancer which it. Testosterone reduces breast cancer by 40 to 70%. These are on longitudinal studies retrospective looking at over 16,000 women years. And this is using a testosterone as a pellet. We don't know that cream would work quite as good for breast cancer protection. But marked reduction in breast cancer risk with testosterone or added estrogen. Now we found in the early days when there was a big political fear of estrogen that we could use this testosterone as a standalone hormone for women as a pellet. And it did work for all symptoms of menopause, but not quite as good as testosterone plus estrogen. It didn't help your skin as much in terms of like getting more radiant skin didn't help your bones quite as much and not as much cardiovascular protection. So we use both of them now. Testosterone and estrogen we have for. For years. So what's the best practice? Testosterone and estrogen pellets. That's our preferred because you cannot get testosterone effective level through other methods. But there's also topical delivery options and then oral micronized progesterone. Progesterone is the natural hormone not optimal. Any synthetic progesterone often called progestins, horse estrogen or oral estrogen. Now I'm not going to get into this at length but the large study called The Danish study 2.2 million women years showed that substantially the topical or dermal or pellet form of estrogen is more protected to the cardiovascular system over time than oral. And women can start hormone replacement therapy at any age and gain the benefit of hormone replacement therapy on cardiovascular risk unless they use oral. Then when you're older you should stay away from oral particularly we have a try before you buy a program. So at Allure this is exclusive to our company, we have a membership and you can get a pellet put into your skin. You just give you a little shot, the pellet goes in estrogen, testosterone, you got to get progesterone on your own and you can see if you benefit from it. And if you do, you can continue with the membership and continue to get a pellet every three months. Typically we're doing this about every three months. Someone sooner or later and then oral progesterone. Taking one pill at night, which helps with sleep. Can you advance it so you can choose your path? Zero financial risk. So let's go over the complete picture. Estrogen. Let's think of that as the foundation. It's a. It's the builder and protector. Protects your brain and your cognitive function, bone density and maintenance, cardiovascular protection, skin elasticity and hydration, tissue integrity and health. Progesterone sweeps improves your sleep quality. In fact, when you take progesterone at night, it activates a receptor called GABA which makes you want to go to sleep, which is nice. Mood stabilization, tissue protection, regulation, cardiovascular support. Intestine is the energizer, drives your energy and vitality. Better muscle strength, better energy motivation, better libido and sexual function, better metabolic health and fat distribution and cognitive focus and drive. This is my book. You can get a copy if you just go. Just Google Allure medical books or do alluremedical.combooks. you can get two free copy, download copy. You can also buy it on Amazon and give me a good review. This is called Strong enough for a Man but made for a Woman. And this is why I want to go on to questions now. Again in the chat you can book a consultation with one of our providers either by telehealth or in office. We prefer an office. You can call us or go to our website and I can certainly take questions.

Okay, so I have a question here. Does the removal from the FDA apply to all forms of hrt? Pills, patches.

So the question is, does the removal by the FDA apply to all forms of hrt? Yes. Everything.

Okay? Another question from the audience. Can women who have had a hysterectomy safely use hrt?

So when we've had hysterectomy, now there's two. The answer is yes. But there's two types of hysterectomy. Ones where they remove the uterus and leave your ovaries intact, which you might not need it yet because you might not be in chemical menopause. But if they've removed your ovaries, your risk of dying goes up without hormone replacement therapy. So I'd say that would be something that again, in the 80s and 90s there was no question they would put you immediately on HRT. In the last 20 years, it was less likely to. And this really caused a lot of shortened lifespan in women, more heart attacks, strokes and Alzheimer's. But this would be a clear indication for hormone replacement therapy.

Is it ever too late to start hrt?

So the ever too late to start this is a great question and the FDA did not specifically address it, even though they removed a black box warning, there's still a legacy belief based on this Women's Health Initiative trial in this subgroup of women over 65. So the largest study on this I refer to as a Danish study and a Finnish study where they looked at women who were over 60 years old, had never been on HRT. And when started on HRT, as long as it was not a pill, as long as it was a topical, they still had cardiovascular protection and less mortality. Then we look at the dementia studies. These were women that were women that were averaging. They started at 78 and they were followed till 88 and they had a 35% reduction in Alzheimer's disease. So this is contrary to the past 20 years thinking, but the way we would practice this, this in a way that the science has clearly revealed us, is hormone replacement therapy in a woman who's in menopause is beneficial for your health and your quality of life at any age.

How much do the pellets cost? Does insurance cover this for how much.

Of the pellets cost the insurance cover? It is out of pocket. It is out of pocket right now. There's no insurance coverage for pellets. There is in some cases for men. The pellets cost $121 a month as a membership. Again, the first two months, there's no charge. It's basically free. So you can come in and try it before you buy it and then decide if you want to move with it or you want to use some other method. But the pellets have, you know, roughly $121 a month. That's what it is currently. Great question.

How quickly do patients typically feel results from hrt?

So how quickly do patients feel results? It's pretty fast, like two weeks the soonest. But typically, what happens when you're getting your second pellet? At three months, your first one's still in you and the second one's added to it. So your best results occur at about three, three to seven months. But typically about two weeks, you start feeling something. A month, you feel better. We actually have a. When you get your pellet for the first time, the nurse calls you at 30 days, kind of reassure you things are maybe 50% better that we're, we're in good shape. Be better next time. 60 days, get better 90 days time for your second pellet and you're, you're, you're better but you're still not at your peak. That occurs about month six.

Is there a way to know what symptoms tend to improve first?

Is your way to know which symptoms tend to improve first? Well, I'll tell you this, the most common complaint I hear from women, I'm gaining weight and it's sticking on me like cement. This is. But that weight doesn't just fall off so you still have to do other things. Now hormone replacement there does, does favor weight maintenance and ability to lose weight. But the first thing that happens typically is you get less hot flashes, less night sweats, less mental fogginess, more vaginal moisture, better sleep. That's what occurs first. Things like bone health and overall health take a little bit longer and it's actually a cumulative sexuality two to six weeks. That's for the testosterone is the main mainstay of the estrogen is a little sooner, quicker onset.

There's a question, what is the best resource for self pay patients to obtain blood work to test for hormone levels?

So what's the best resource for. You said self paid for self pay patients. These tests are very inexpensive. I, I would give you a word of caution. The blood tests are usually useless. So if I took a woman who was in perimenopause or menopause and measured her estrogen 10 times over 10 weeks, I'm going to get a different result every time because they fluctuate. So there's not a whole lot of utility. People try using urine tests and saliva tests, they're just not that helpful. So if you're in menopause that means that you are no longer having functionally ovaries and your estrogen's gonna be, you know, low. But it's not, there's not a threshold that you know you're in menopause. Menopause is a clinical definition, it is not a laboratory definition. And pretty much all major medical societies state that the lab work is not germane or useful for determining menopause or perimenopause. Now people still do we have a love affair test. So if you're self pay, I'd say save your money, go based on symptoms. There's also not a level of blood that tells you you're therapeutic. When you're taking a pellet or pill or a cream, you base it on how you're feeling. I'll Give you an example. If you had high blood pressure and your doctor prescribed you a drug called an ACE inhibitor and they want to see if the blood pressure medicine was working, they're not going to measure the blood to see if you have enough ACE in your body. They're going to measure your blood pressure. Same thing for hormone replacement therapy. Can't sleep, night sweats, hot flashes, you don't have enough. If you feel great, you're spot on. If you have too much, you're going to have pan swelling, breast tenderness. So we do base it on clinical symptoms because the labs, again, people have a love affair with labs. And I know a lot of clinics do a lot of laboratory testing. I think that's really a financial reason. There's no medical reason to justify all this lab work.

Are there any negative side effects?

Are there any negative. There's for anything. But let's talk about pellets in particular. We have some people that can't tolerate them because they get irritation to their skin. I'd say that's maybe one out of 200 women. And there's sometimes bruises or occasionally people will actually. It kind of sounds gross, but they sort of spit them out where the. There's a little inflammation, the pellet comes out. That's pretty rare. So that's one thing that happens, just local reactions. Now, side effects for the hormones particularly are related to two things. Number one, too much hormone. So if you get too much testosterone, you're gonna feel like you're buzzed on coffee, a little bit edgy, and you gotta cut it back. There might even be some hair issues, such as, you know, hirstutism or acne or oiliness. Now, we don't see that at the levels we're using, but this is always possible. Another thing to keep in mind is hair growth. Does occ menopause. Too little, too, too much estrogen? Is breast tenderness, hand swelling, too little hormones, you'll feel, you know, low energy, low sexuality, low, low energy. And I want to talk about hair a little bit because I hear that a lot of times women, when we look at studies with scalp hair, women on testosterone replacement, 67 of them, 67% get thicker scalp hair. If you were on hormone replacement and you experience any thinning of your hair, which is very rare, you have a little bit too much, you just back it off. But in terms of medical side effects with these drugs, we do not see them with hormone replacement therapy in women.

Got a question? Do you also prescribe the progesterone?

Do you also prescribe Progesterone. Yeah. So even if you don't have a uterus, I use progesterone because it does help with your mood, your bones, your. Your joints, your brain. But progesterone is. We use micronized progesterone. What's interesting is you can get it on Amazon. Amazon actually got a pharmacy and it's like 15 bucks for a month supply and Mark Cuban's cost plus is 23 bucks and at the drugstore is probably 50. So. But yeah, we give you a prescription for the progesterone, very inexpensive. And be clear, the membership includes the pellet of estrogen and testosterone, so you don't have to buy that.

Are there lifestyle changes that improve results while on hrt? Hamari.

Are there lifestyle changes that improve results while you're on hrt? And that's, that's an. Absolutely. So if we look at, you know, I'm really thinking about this from longevity and the mission of our company is at 250,000, 250,000 years of health span, lifespan, healthy years to our community by 2028. And we're on track there. And in addition to hormone replacement therapy, you know, we might want to check how's your sleep, how's your weight, how's your activity, how's your energy, Are you working out, are you eating healthy? So all these things that reduce, if we look at lifestyle interventions, everything that I mentioned, that estrogen does, decrease diabetes, decrease colorectal cancer, decreased a better bone health, decrease obesity, decrease diabetes, decrease cardiovascular disease, decrease strokes, decrease Alzheimer's, these are also associated with improved lifestyle. Gives maybe not the same scale or magnitude of benefit, but they all reduce those same exact diseases. And we see as we, you know, when you're 20 and 30, you can get away with a bad lifestyle, but as we get older, we're much more intolerant eating too much food, not having good sleep, having some bad habits. So any lifestyle interaction that is positive for your wellness is gonna give you more better results. And the hormones by themselves go along with, you know, if you're trying to lose weight, you might go on semaglutide and other drugs, you might use hormone replacement therapy, but you still gotta cut it down on the food. So those are all. That's a great question. These are all synergistically positive. When I think about lifespan and health span, I'm more focused on health span, which is how many years you're healthy and lifestyle improves that and hormones do as well.

Does progesterone cause weight gain?

Does progesterone now, progesterone does not. The synthetic ones do. So if anybody's been on these Provera injections, you do gain weight with that. But the actual hormone progesterone does not cause weight gain. It's actually not going to cause weight loss either, but it just is neutron weight. Whereas the synthetic ones tend to lead to weight gain and loss of bone density.

We've got some people asking just to clarify what is being offered as far as pellets and what is in them. Maybe they tuned in a little later.

Yeah, great question. So we're using pellet therapy because it's been shown to be the most superior for protection of breast cancer. Reduced breast cancer 47%. 40 to 70%. Reduced risk of cardiovascular disease such as stroke and heart attacks, roughly 50% and reduce Alzheimer's disease roughly 35%. Very convenient. You get a nice steady level. And the pellet, it's about the size of a piece of rice and sometimes there's more than one pellet. It might be a piece of rice and like a 18th of a piece of rice. And the testosterone is basically weight based. It's 1 milligram per pound approximately, rounded off the nearest 25. And then typically testosterone aromatizes into estrogen. So we don't have to give you very much estrogen. We give you about 6 milligrams typically. So it's a very small amount of estrogen and it gives you a nice steady state. And I'll tell you, weight based dosing hits it nail on 95% of the time. And sometimes we have to make an adjustment based on it didn't work well enough.

How does the change affect women who were previously told not to take hrt?

Yeah, that tells it what happens when you're told not to take hrt. So I'll tell you, this is pretty much everybody and even patients that we've had for a long time, they're on hrt, they're doing great, losing weight, feeling better, and their doctor tells me, get off because it causes breast cancer. This quite frankly just never happened. It's a myth perpetuated by the fda and doctors believed it because they were told by the government this causes these diseases. So it's not like your doctor tomorrow is going to say, well, now I changed my mind because the FDA changed their mind. They've been telling people this for 20 years. They can't really go. It's actually amazing the FDA went back on it. Now if we didn't have a change of administration, it never would have happened. I mean, that, you know, could have happened to any administration change. But the. There was a lot of medical societies demanding that the FDA takes action on this and they never did. They don't go back on their preconceived notions and they finally made the change. But it's going to take a few years for doctors to get wind of this and then not be afraid because they were conditioned and brainwashed into thinking that estrogen causes breast cancer, which the study they cited showed a reduction of breast cancer 22%, reduction in breast cancer mortality 40%. So we can't get over that hump. So I'd say, you know, if your doctor's told you that, go back and talk to them again and if they're still adamant about it and you make a decision, you want to move forward, just find another physician to take care of your hormone replacement and stick with your doctor for your other stuff.

What happens when the person stops treatment? Do you have to be deed off or can you just stop treatments? If I decide to stop for me, yes.

The question is, can you go cold turkey or wean? You can just go cold turkey. Now, if you're into menopause and you have severe symptoms of menopause and you go on hormone replacement therapy, you're generally going to feel great. And if you stop them a year later, you're going to be back to where you were. But if you would did them for like five or ten years and you stopped, you're pretty much going to just feel like a normal postmenopausal women at that same age and you will start having, you know, increased cardiovascular disease, increased breast cancer risk, increased stroke risk, increased Alzheimer's risk, but you really will feel okay. Now we find that women who are older, that don't have the vasomotor symptoms, hot flashes, night sweats that go on hormone replacement therapy the first time, they're mostly feeling subtle but noticeable improvements of their vitality, their mental sharpness, their coordination. They're less likely to fall or trip, they have more energy, they're losing a little bit fat, they're gaining a little bit of muscle, a little bit more sexual energy, a little bit more self confidence. But the woman that's having more significant symptoms has a more dramatic improvement because their symptoms were worse to begin with. But you do not have to wean off of them. There's no risk or rebound effect from stopping hormone replacement therapy. That was a great question.

So are there still any risks patients should be aware of with hrt?

So are there any risks that patients should be aware with hrt. So there's a certain subset. Let's. Let's say a woman has breast cancer. We're probably not going to use estrogen replacement therapy because they're actually doing things that block your estrogen. And in that case, we use testosterone alone or with what's called a aromatase inhibitor. There's a large study by Dr. Ruth Ann Glaser in Dayton, Ohio. Well, she's a breast cancer doctor and she's been following this for probably about 20 years. And she has a case series of several, I believe, thousands of patients. He actually published case here on thousands of women, but women specifically with breast cancer. And she found that women with breast cancer are treated with testosterone. Testosterone alone plus a estrogen blocker have much lower recurrence of breast cancer. So in that subset of women that have active breast cancer, they're not in remission. This would be a consideration. Talk to your doctor about using testosterone on. And again, there's such a deep rooted fear of hormones, they might still not be kind of interested in it. But this is the way we would practice because I'm an expert in this. In that case, we might use the estrogen blocker because you're on an estrogen blocker. So we wouldn't add estrogen. It wouldn't be necessary. And then when you're in remission, you can add an estrogen for cardiovascular protection. Because if you get through your breast cancer, you're not going to probably die of breast cancer, you're going to die of a heart attack and you want to protect against that. Great question.

I've got one here if you can clarify what the black box warning actually meant for patients before it was removed.

Okay, yeah, I love that question. And I think, you know, we're going to be hearing about this and probably Facebook's listening right now. You'll be seeing all kinds of people talking about this. But the black box warning is actually a black box that they put in what's called the physician desk reference. So we doctors, we use something called the pdr. It used to be a real book and they'd have a. It says estrogen. Any estrogen product could have actually a big black label with white lettering on it warning, this drug is known to cause X, Y, Z, Z, Z. And they put that there in 2002 because a study was misinterpreted by the FDA. And because of great media pressure, they put this black box warning to scare doctors off of prescribing it, which led to an Abandonment of hormone replacement therapy, which was the number one therapy in the world for women in menopause, was hormone replacement therapy. 40% of women were on it. And that went down to almost nothing. So that was removed. So it was basically a misunderstanding of the data, overreaction to public sentiment and media sentiment. And they finally took action, admitted their mistake, and corrected it.

And how does time release work for the pellets? Can they run out before three months?

So how does it work for pellets? Can they run out before three months? They can, but they're. It's actually a hormone bound together by something called steric acid. It's like a little glue. And it slowly eludes over three months. And even at three months, it's not actually out. Probably about a third of it left. Then you put the second one in. It kind of piggybacks on the first one. Then you get to a steady state. So we look at, say, a pill. You swallow a hormone, you take a dose 20 times higher than you need. It goes through your liver. Your liver makes all kinds of clotting factors to break it up. And you have a peak in a valley in the morning and a peak in a valley at night. Then you go on a patch that lasts three to seven days. And you get a peak in valley every week. And then with a pellet, you get a peak in a valley about every three or four months. Much more steady release of the hormone. Now, we do see that some women burn them off a little bit faster. In fact, during COVID during the pandemic's height, we saw that, I think because of stress, women were coming in about every two and a half months. Cause they noticed their palates were worn out faster. But that just kind of went away when that stress went away. But some women are two and a half months, some are three and a half months. But it's usually about three months. It's kind of like clockwork.

Where and how are the palates placed?

So the pellets can be placed anywhere. But typically, we're having you lay in your stomach and picking a butt cheek. And we clean your skin off and we numb you up with what's called a tumescent anesthetic. You barely feel it. It's the tiniest needle in the world. And we'll let it set for a couple minutes, soak in. And it's got a little lidocaine and adrenaline in it so you don't bleed or get bruised. Then they make a little tiny nick in your skin. I usually try to put it inside of the bikini line. And then the pellet goes in with a little device. It's like a little, like, let's say a ballpoint pen. It's much smaller than that, but it slides in the little hole. The pellet gets pushed through it and the device gets pulled out. And we don't even stitch it up, we just tape it closed. But I've had people that have had, say, a C section scar or a tummy tuck scar, and I used to use that scar on their stomach to put it in. You can put them anywhere, but typically we're putting them in the buttocks. To help with psoriasis. Autoimmune, there's no reason to believe it would help with either of those conditions. Great question. So autoimmune conditions have a strong link to the gut health. And in my book Testosterone Strong enough for man and Made for Women, I actually talked about autoimmune diseases, how our guts can have an effect on it. Because we do see women when they hit their 50s, the rates of autoimmune diseases go up. But we haven't yet had any observational studies that suggest that hormone replacement therapy is a therapy for autoimmune disease. But there does seem to be a link to autoimmune diseases and menopause. But there's strong link to autoimmune disease and gut health. Great question.

What should somebody ask their provider before starting hrt?

Anything that they what should they ask the provider before starting hrt? I would just say, excuse me, what's your opinion? Estrogen replacement. And if they say it causes breast cancer, you have to go somewhere else. And if they say, I've been reading the literature, I'm very familiar with it, you're in the right place. So I think we're done. And thank you. If you want to visit one of our offices, you know, it's no obligation consultation. There's no fee for it. And if you want to try pellet out, we have a try it before you buy it program. Doesn't cost you anything. We're so confident that you'll love this. In addition, it aligns with our mission, our company's mission of adding 250,000 years of healthy lifespan to our community by 2028. August 31st of 2028. So that's my mission, is get the word out. And I'll tell you, this has been my mission for a long time. But this FDA black box removal was like a gift that I never expected. And I wrote a book about this. I kind of bashed the FDA on it. I've written blogs on it, done podcasts on it, trying to explain to women the FDA got it wrong. And it's just hard to believe that, like, why would the FDA get it wrong and finally come out and said, you know, we got it wrong, we misread the study, we overreacted, and we harmed millions of women. So I think this is a new chapter in women's health. So thank you very much.