AGE-Backwards Hormone as the key driver

Yeah, how many of you think hormonal health is only for women in the chat box, or you think it's for men also? So very interestingly, you know, when we talk about hormones, it is that myth that it's only for women, because hormonal health about women is talked about much, much, much more. We all know what menopause is, but very few people are aware that there is andropause also. But now when we are becoming— yes, Vanna. So what is happening is— and also women talk about it more. I think men don't talk about it, but it is equally important for both men and women. Yes, more importantly, beyond fertility, I think for quality of life, hormones are very, very important. Beyond fertility also, for example, if you need to make muscles, you will see every day that You are going to the gym and doing the same exercise, and your friend is also going to the gym and doing the same exercise, but both of you are not making the same amount of muscle mass, right? Reason is very simple. Maybe your hormones are not where they have to be. Your high cortisol or low cortisol will put your body into muscle-breaking mode. Your low testosterone will not enable your body to make muscle, and therefore you might keep exercising, but your muscle mass will not build at the same level as it would for another person for whom, you know, all the hormones are balanced. So I thought, let's talk about this beautiful topic today. I am going to share my screen. Okay, I think all of you can hear me. Can all of you hear me? Give me a yes in the chat box if you all can hear me. Okay, so anybody who's attended my session before, you know that I believe in interactive sessions. I don't believe that I am the only one who can teach you. I am a strong believer of the fact that your questions help me learn more, and it is all right even if I don't know, you know, the answers. So please keep asking questions, please be alert. And please engage in the chat box. The more you will engage, the more, uh, you will learn and you will take back. Let's look at this. Anybody here who does not understand Hindi? So let's look at hormone metabolism. Cholesterol to active hormones, how are they made? Now, why have I put this first slide? Anybody who has joined today, taken out time to be with me on Sunday morning, right? If this one slide you take back, I will be extremely happy. You know why? In today's world, what I see is the moment our cholesterol raises a little, we are put on statins. Yes or no? Yes, we are put on statins saying if you have high cholesterol, chances that you will have heart attack are much higher. How many of you agree with that? And the— if the cholesterol is low, I have seen reports coming to me wherein I've seen that cholesterol is 95 or 102 and the doctor has given a smiley there saying, oh, very good job. How many of you actually think that if your cholesterol decreases so low, it is very good job? Please, in the chat box, guys, you have to give me something in the chat box. I need energy from you. Cholesterol is the precursor to all major hormones. See here, right? Which means cholesterol is converted by CYP11A1 to pregnenolone. This gets converted to active pregnenolone, to DHEA, which is a hormone for energy, immunity, and vitality. If your DR is low, there are proper studies to show that this can be your reason for having autoimmune condition. So whenever a patient of autoimmunity comes to me, what is it that I will do? I will first check DR. I will first check cholesterol. Because these are two— these are upstream hormones. If they are not good, nothing else will be made. On the other side, progesterone is made, which is responsible for sleep, mood, and uterine protection. So anybody here who thinks that they have depressed moods or anxiety or they have insomnia, right, one very important thing they must know about themselves is What are their progesterone values? If you are not sleeping well and if you don't know your progesterone values and you are on sleeping pills or something like that, or you are not sleeping well— you know, there are studies to show that one night of irregular sleep increases chances of that you will have insulin resistance by 32 or 34%. That's huge, isn't it? Isn't it huge, guys? Yeah, so therefore this becomes very important. Then comes downstream of progesterone is cortisol. Cortisol is our stress hormone. It is produced by our adrenals, right? And it is It suppresses sex hormones, right? If people have less progesterone, or if you are more stressed, and then you will have less progesterone because this side is about stress. Aldosterone is another very important hormone. Water imbalance, sodium retention— if this starts happening, if you have swelling in your legs You must know what are your aldosterone levels, or you can do a questionnaire to check how is your aldosterone working, right? Similarly, the second line has— hello, Dr. Aman, give me yes in the chat box if you can hear me. Dr. Aman? Okay, Dr. Aman, if you can hear me, give me a yes in the chat box. And happy to have you here. Now, similarly— yes, yes, ma'am, yes, ma'am— if you have low cholesterol, you will have low testosterone. Which is so important, but we are not aware of it. We just think, you know, statin is among the top 3 most sold supplements or medicines in the market today, and that is extremely bad. And then we have dihydrotestosterone, which is responsible for prostate, BPH, and all. When you lose hair, or if men have acne or even if women have acne, DHT can be irregular, not be in balance. And that's the reason all cases of prostate, hair loss, acne risk, we definitely check DHT for them. So more than, you know, more than what these hormones do, which I will talk about in the later slides also, one takeaway from this slide is Make sure that your cholesterol is, you know, between 170. I don't mind if it is 220. People come in, they're very worried. 220 cholesterol, oh, I am at high risk of heart attack. Guys, there are so many other parameters in your reports which are putting you at high risk. Simply having high hs-CRP, simply having high homocysteine, right, are more important parameters than 220 cholesterol. Imagine the second thing I want to address here is make sure that you have good cholesterol before going on statins. You have to be very, very particular. Another thing about statins is it actually depletes you of these and CoQ10, and it can help you become a diabetic 5 years earlier than what you would have become otherwise. Right, so I am not saying you don't have to take statins. Statins are good medicines, but for only maybe 10%, right? So be sure and learn to read your reports. I'm sure all of you know how to check the balance in your bank account. Anybody here who does not know how to check balance in the bank account, give me a hello. Hello Pinky, good, happy to see you here. Anybody who does not know how to check their bank account balance, give me a yes or give me I don't know. Guys, this is more important than your blood, you know, bank account balance, because it can deplete your bank account balance like this. All right, so you must know how to read your reports. Imagine $4.93 billion market is of bioidentical hormone therapy and nobody actually, or very few people, are talking about it despite that. And it is expected to grow to be around $11.8 billion market by 2034. HRT last year, 2022-23, It has grown by 47% in the UK market. Imagine, everybody worked to make sure that women don't enjoy happy, good, decent lives. And you know, the irony is BHRT doesn't mean that you don't have good life in menopause. BHRT means you don't have good life when you start puberty. Right, so I'll tell you a story in a while and you will understand what I'm trying to tell you. After Women Health Initiative study in 2002, just because those reports were misinterpreted, or maybe, you know, there is no big money in this market when it comes to BHRT or hormones. So it was subdued. I don't know what was the reason, but 5% of women only could take hormones. Otherwise, people were scared of breast cancer. 2022, now this has increased to 27% overall, 47% in UK, and it's going to increase much, much, much more. Now there are studies which have shown that WHO results were not interpreted properly, right? And there have been more studies which have been done which say— show that BHRT actually can save you from breast cancer rather than causing breast cancer. Very interesting, bigger fact is India, South Asia, they are the first fastest growing BHRT awareness in Delhi, Mumbai, Bangalore. USA, 1.4 million plus women on BHRT. Compounding pharmacies growing by 15%. UK, 2015 and 2023 NICE guidelines both recommend HRT actively. 10.3% growth in Asia Pacific, highest in the world. There has to be reason for that because we are the ones who are depleting maximum on our hormones. Post— in 2002, usage dropped significantly, but now it's in the recovery phase because we've realized that we are not living properly. Now, having said this, I have a questionnaire on the screen. Please read and tick what applies to you. I'll give you 5 minutes. Think through. For every tick, give yourself number 1. And write your score in the chat box, guys. Recording will not be shared. I like people being present, but I will definitely do more of these. Yes, please. Persistent fatigue despite sleeping properly 6 to 8 hours. Unexplained weight gain, especially belly fat. Poor sleep or waking up at 2 or 3 AM. Hair thinning or loss. Hot flashes or night sweats. Suddenly you feel very hot, or at night, you know, you're throwing away your quilt or sheet because you are sweating badly. Brain fog, poor concentration at work, low libido or no interest in intimacy. Mood swings, joint aches without injury, decreased gym performance and recovery takes so much longer than what it usually used to take. All of us go to gym, lot of us are not able to go to because of the last point. Please share your score in the chat box. We are 29 people here. And, um, yes, thank you, Naresh. Very good, Sanj. So anybody with more than 3 score here, they should look— very good, Bridge— they should or must look at their hormone profile? Mood swings, irritability, anxiety. Great. Now the question is, why do we have to look at hormone profile? One, our life expectancy has increased, right? Second, Because of the environment we live in. Yeah, now this 30s is actually 20s. Hormone decline by decade, 10 to 15% decline is happening by 20s. I see so many young boys and girls with low testosterone, low progesterone at the age of 18, 20, 25, which is shocking. And of course, lot more can be done before BHRT. But yes, this is an area where we have to be aware of. Just a minute, I think I have been— I am not able to— B, I think you've disallowed sharing for this meeting. Can you allow sharing multiple participants? Just a minute. Anybody has any questions till now, please write in the chat box. Hello? Hello? Sorry, I think some glitch has happened. Meanwhile, you can unmute and ask questions, or if you have any questions or queries till now, you can ask. Or if you have learned anything new till now, please share in the chat box. Anything new you have learned till now? Yes, I think, uh, we learned that cholesterol is one thing I am starting with. It's not necessarily always bad. Yes, very important, Arvind, because cholesterol, when we grow old, and, um Second important thing which I wanted to tell about cholesterol is our brain uses fat as energy. Low cholesterol actually impacts your neuro— neurohealth also.

Sure.

So it's extremely important that we keep it on track and don't fall in trap of people, right? So just— can I log in, log out, and log in? Sorry. Sorry, Bridge, can you see the slide?

No, not yet. Yes, yes, now I can.

Now you can. Thank you very much. Yes. No, I have changed the— no, no. Can you see the slide now? Yes, but I have to just mute it. Okay. Yes, the slide is visible. Yes, sorry for the confusion. Yes, so what I was saying is stress plus late nights, they have started hampering the hormone profile big time. 25 to 30% decline is happening in 40s, and perimenopause, but andropause signals are also coming big time. 50s is where the major drop takes place, which is 50 to 60% of the decline. And 60s plus, all major hormones are significantly low. So what I'm trying to say, or what this data is trying to tell us, is that today not understanding our hormones is, is not doable only. What are the things which are impacting hormones? Of course, high stress, corporate life, Cortisol spikes suppress sex hormones and creates imbalance. Sleep deprivation— less than 6 hours of good sleep, you will have low testosterone. You will— your growth hormone will drop overnight. Ultra-processed food will impact your insulin and leptin balance. Air pollution— now this is very, very, very sorry state. Air pollution leads to a lot of xenoestrogens from particulate matter, and we think that estrogen is only important for women, but estrogen is very important for men also. I had a very young 15-year-old boy who visited me and said, I am having big boobs, what can we do about it? And of course Oestrogen was high in his case. Blue light and sedentary work is impacting melatonin and cortisol rhythm. Now, this have integrated so much in our lifestyle only that we really have to be careful about this. WHO Women Health Initiative 2022 study versus now the modern evidence, what has changed? 2002, Women Health Initiative was halted because they thought that HRT or BHRT was giving them high risk of breast cancer. 2007, reanalysis was done. 2017, JAMA re-reviewed. 2022, a 21-year reappraisal was done. And 2024, ACOG and NAMS— these are bodies who give you health guidelines— they gave new guidelines which said in WHO 2022 we had used synthetic estrogen with medroxyprogesterone acetate, but modern evidence, which is bioidentical hormone therapy, shows that if you use bioidentical E2 and E3 combination plus micronized progesterone. The results are very different. This can actually save you from lot of cancers. Patient age, 63.2 years was the average, 12 years post-menopause. New data is saying that within 10 years of menopause, if we start BHRT, the results are the best. Now, does that mean if a 75-year-old lady will come to me and say I am having symptoms, please put me on BHRT. I will not put her on BHRT. I will put her on BHRT, but what will I tell her? I will tell her very clearly that the benefits which you could have gotten if you started BHRT within 10 years of menopause— the earlier you start, the better it gets— you will not get those benefits. But But your quality of life will be much better than what it is now. Breast cancer— WHO says risk overstated. Synthetic progestins were blamed. Micronized progesterone is likely breast neutral. No chances, almost no chances that it can, you know, lead to breast cancer. Heart disease WHI showed that there was increased heart disease incidence. That's the reason black box warning was given. Now studies are showing that early initiators between 50 to 59 years of age, they have shown reduced cardiovascular risk. And we always knew that estrogen protects heart health, bone health, mental health. But WHO actually stopped BHRT completely. Blood clots, oral route raised DVT. That's the reason in BHRT we use transdermal route. No clot risk increase. Now the verdict is usage fell by 70% after WHO. Risks outweigh benefits. Now the new verdict is benefits outweigh risk for correct, correct candidates. BHRT with bioidentical hormones started early is a fundamentally different therapy from WHO synthetic HRT, judged unfairly by the same brush. Which means allopathy is now saying that, allopathy journals are now saying that, allopathy groups who make guidelines are saying that. So this is scientific, guys, and we must know this. Now, what is the difference now between BHRT versus synthetic HRT? BHRT, the molecular structure is different. Molecular structure is identical to body's own structure, whereas synthetic HRT is patentable and hence it is modified. One molecule in the structure, if it's changed, you can patent it and you can earn a lot of money from it. But your body sees it as an outside thing, and that's the reason when it sees it as an outside thing the benefits go significantly down. What are the sources? Source of BHRT is plant-derived. It is majorly yam or soy, whereas for synthetic, it is synthetic animal-derived. Custom dose per blood work can be done in BHRT. Synthetic HRT, only standard doses are there. Receptor fit— perfect. Natural key and lock mechanism. Whereas synthetic HRT approximate fit or misfit. Side effect profile is very low, less in BHRT. Body recognizes it. Why I'm saying less? Because, you know, when we give progesterone to our women, what happens is progesterone also activates some of the estrogen receptors. So symptoms can come like bloating, like feeling unrest. Now those cases are such, when we have tested, we know that we are on the right track. We have to increase the dose of progesterone rather than decreasing it, and the symptoms settle. But synthetic HRT, because it's a foreign molecule, they have lot of side effects. Monitoring, of course, is very important in BHRT. Patients where I give BHRT, I test them every 3 months. I also test them from how their metabolism— estrogen is getting metabolized. I also do genetic testing in some cases where we know that there are high risks of cancer in the family. For example, in my family, my nanny had cancer, my two aunts have cancer, so I know that me and my sister are high-risk people. So to stay away from it, you know, the genetic testing, the metabolism testing, and a new test Dr. Dang Labs have just launched in India— I think it should be available by the end of this month where, um, you know, you can get to know much in advance whether you have chances of cancer, and BHRT can be adjusted accordingly. Synthetic HRT, very less frequent adjustments, and therefore what happens is you will not be able to give it in studies, say, not more than 5 years, even if patient has lots and lots of symptoms. You know, interestingly, if I can tell you a story of a girl named Mia— can I tell you a story of girl named Mia? Give me in the chat box, please. Hello? Hello? Hello, can you hear me? Can somebody unmute and tell me that you can hear me?

Yes, we can hear you. Yes, we can.

Thank you, thank you. Um, yes, so can I tell you the story of Mia? So this is a 14-year-old, uh, girl who had to take off on days when she started menstruating, day 1 and 2, from her school because she had severe intense pain. She was put on oral contraceptives. Life went on, and At 28, when she wanted to conceive, she was not able to conceive. She did 3 rounds of IVF and finally conceived and had lot of gut symptoms after that. And then life continued, and at 48 she had menopause, and she started waking up at least 4 days every week because of hot flashes and all. But she is scared to take BHRT. From 14 years till now, she has lived what type of life? Perfect life, okay, okay life, or unhealthy life? Anybody? What could have changed things for her? Simple hormone assessment and balancing those hormones. So what are the hormones which we commonly replace? You know, some people come to me and initially they tell me no hormones for me, and they are on Thyronorm for last 20 years. What do you think, is thyroid a hormone or a supplement or a medicine? What is thyroid? A hormone? A supplement? A medicine?

Ma'am, it's a hormone.

Yes, but when we take thyroid, do we ask our doctor, must hormone? Right, so all these are replaceable and they can be done safely. Estrogen for women: bone density, mood, hot flashes, relief, skin health. Hot flashes, dry skin, brain fog— this can be— this is an indication that your estrogen is low. Progesterone: if you have insomnia, anxiety, very heavy periods, You know that you are low on progesterone. You must get BHRT or progesterone for sleep, anxiety, uterine protection, and mood balance. Testosterone for men and women both. Remember, testosterone is not only for men. Women make a lot of testosterone, a lot of testosterone. Women who have no libido, no sex drive, testosterone is missing, right? So for libido, for muscle health, for energy, for mental clarity, if you are low, if you have low sex drive, if you are gaining weight especially on the belly, if you are fatigued and you have tried everything, you must check your free testosterone, total testosterone. DHEA— I love this molecule because it supports the adrenals, it supports immunity. I told you in the beginning, autoimmunity, and it keeps you, you know, increases your vitality. So if you are low, burnout, adrenal fatigue, low immunity, you are aging faster than what you think you should, you must check your DHEA, right? Because this can be a game changer. At least this has been a game changer in my case. I can't live without DHEA. My body tells me when I've not taken DHEA. My ability to make decisions, my ability to handle stress, my ability to stay active, my ability to have a clear mind— everything shifts. And I think this is one hormone which has been a game changer in all my patients, autoimmune patients. Also. Yes, it has to be done properly. We have to test every 3 months, but when done right, it is very, very, very important. Thyroid metabolism— weight, energy, mood. If you are gaining weight, if you feel cold, and even if your TSH is all right— guys, almost 40% of my patients have good TSH, but they feel cold off and on, they are fatigued, they are constipated. They are losing hair, their hair are becoming frizzy. All of these, what does this mean? This means that, uh, your thyroid is not optimal. And in 40% of cases, we see that blood tests are not reliable. So I in my clinic do a very specialized thyroid test called Thyroflex. Anyone here can come and get it done. Which is, you know, with an old technology we use the reflex mechanism, and that actually tells us whether your thyroid needs support or not. Beautiful test, amazing test, tells you whether you are autoimmune or not. And, um, so anybody who feels cold intolerance in winters, if their feet never get warm, you need to have an extra pair of socks. Remember, your blood reports could be lying. Right, your thyroid is not all right, ma'am.

What is the name of the test?

Thyroflex. Yeah, now those were the simple ones, but beyond sex hormones, are there any other hormones in our body which we should be careful about? Yes. And what are these hormones? These are the hormones which every diabetic should be careful about. So like, Bridge is a health coach and he makes sure that diabetics get off their medicines. So Bridge, in all your patients, these 6 hormones is something we must know and we must try and optimize if we actually want to reverse diabetes properly for them. Insulin— blood sugar regulation, energy storage, cell uptake. If you have hyperglycemia, you are fatigued, you are losing weight, then means it's low. If high, then means you have insulin resistance, belly fat, PCOS, prediabetes. Low-carb diet, strength training, metformin, or berberine can help in this. But before you put them on low-carb diet, you must know their cortisol and thyroid levels. Keto diet is very, very good if you want to get insulin resistance corrected, but Don't do it till for 6 weeks you've balanced their cortisol and their thyroid. Then comes cortisol. I love this. Adrenal fatigue, low blood pressure, exhaustion, salt cravings— all are low cortisol. Anybody here who has salt cravings? You know, I never knew that salt cravings is a sign of low cortisol. I never knew that. I had forgotten it. Of course, I had read it in my medicine. Medical school, but I had forgotten it. But then, 6-7 years back, I was working with a doctor who especially came up with this. He said, Dr. Preeti, I have a lot of cravings of salt, not sugar. Went back to my medical school books and realized it's low cortisol. And he lost 18 kgs in 3 months. 18 kgs in 3 months without any manjaro or zumpik or anything, right? If it is low, you will have poor recovery. After exercise, you will have low muscle mass and you will have cognitive decline. Melatonin, you all know it puts you to sleep, but it's a very very big anti inflammatory marker. High melatonin If you have muscle loss, if you have central obesity, if you have low energy, if you have poor skin, this means you have low growth hormone. Check it. High is extremely rare. IGF-1, this is very important. You must optimize growth hormone protein intake in resistance training. If IGF-1 is high, cancer risk association is there. If it is low, you will have poor recovery after exercise, you will have low muscle mass, and you will have cognitive decline. Melatonin, you all know it puts you to sleep, but it's a very, very big anti-inflammatory marker. High melatonin will keep you groggy, which is usually not pathological. Leptin. Leptin is a hormone responsible for hunger suppression. For metabolism, for fat mass signaling. Somebody is unmuted, please mute yourself. When your leptin is high, like we have insulin resistance, we have leptin resistance, we have cortisol resistance. Brain ignores satiety signals, you do a lot of overeating. You do anti-inflammatory diet, reduce fructose in your diet, means get off fruits and, and fructose syrup, and do quality sleep, your leptin resistance will improve. Optimizing all these hormones together, not just sex hormones, actually is what separates good BHRT from a truly comprehensive hormone health program. So guys, don't do only BHRT, do comprehensive hormone health program. It is much beyond the sex hormones which we keep talking about. Now, a very important part which without which my BHRT talk cannot be complete is your gut and environment are silent hormone disruptors. Fixing BHRT without addressing these is like pouring water into a leaking gut. Gut microbiome, the estrabolum connection, it's very, very important. There are a set of gut bacteria which control how estrogen is metabolized, and we need to make sure that estrogen gets metabolized properly. Women who have pear-shaped body, means who, you know, have weight on their hips and, and narrow waist, they generally have to correct their estradiol. This balance is in the gut. We do a GI map test where we get to know this beta-glucuronidase levels. Please mute yourself. Please mute yourself. Now, if beta-glucuronidase is high, which means more estrogen is recirculating and leading to estrogen dominance, so we have to set that right. Leaky gut triggers cortisol spikes, which suppresses sex hormones. Low fiber diet starves financial beneficial bacteria, and estrogen clearance is reduced. We must check this, and 30 grams per day of fiber is very, very important for good estrogen metabolism. BPAs and xenoestrogens— I told you this high AQI air is leading to lot of xenoestrogens. BPAs from plastic bottles, pesticides, phthalates, parabens, air pollution— all of these are leading to problem. And you know, for BPAs and xenoestrogens, one very simple solution for people living in Delhi, Gurgaon, Mumbai, Bangalore, and all is one or two sauna, far infrared sauna sessions every week. Very, very, very important, right? And, um, yes, cosmetics. Second, we must be very careful about the soap we are using, the oil we are using, the creams we are using, because they are lowering our testosterone, disrupting our thyroid. And leading to, you know, and shampoos are leading to cumulative hormonal load, and that is leading to a lot of problem at a very young age. And then finally, heavy metals, especially your lead, mercury, arsenic, and cadmium. Arsenic, it mimics estrogen receptors and it impairs insulin sensitivity, and it is found to be behind cancer, breast cancer. Cadmium, again, it activates estrogen receptors without estrogen. So if you have cadmium in your body, high levels, and even if you are not on BHRT, you are at high risk of breast cancer. Lead, it reduces testosterone, disrupts thyroid, competes with calcium in bone metabolism, and that's the reason it impacts your immunity, it impacts your heart health. Mercury, it blocks selenium, so immunity, thyroid suppresses adrenal function, and very important, it is neurotoxic. I tell people who come with high mercury levels, a lot of autistic children, a lot of ADHD children, ADD, they have high mercury. I tell all of them that do something about it. Even if you don't have symptoms, do it, because this can lead to Alzheimer's, Parkinson's. And when you know in advance, why not do it? If you have any of these, there are some advanced tests which are recommended, like urine toxic metal test, or I do an oligoscan at my clinic. I like that test, it's non-invasive, simple to do. Comprehensive stool test, oxidative stress panel, that is OAT. And, uh, they are all done by, you know, you can do it on your own. Now, how can BHRT be delivered? I generally use creams and I use injections for testosterone, but pellets can be given, patches can be given, troches can be given. I don't use these three because I feel my control on the dosage change becomes less. I like the injections and the creams and gels, and I get good results with them. Now, you can take a photo of this This is my panel, and along with this I will do LFT, liver function test. In medical history, I will review cardiovascular disease, I will review blood clotting disorders, any family cancer history, current medications. Never take BHRT from a non-MBBS doctor, only MBBS MD doctors are entitled to prescribe BHRT, and this is, this is your health, guys. Don't do it unless you know that somebody is trained in BHRT. But take this test if you want, get them done if you want. My team can help you book this panel at a very, very decent price. Have your baseline with you, right? SHBG— I tested to check insulin resistance very important hormone marker. Now, how does your BHRT protocol work if, you know, you want to do it? We first check levels, assess symptom improvement, and then adjust dose. We repeat checks after 3 months. We do annual health checkup every 6 months, and we do full health audit annually. This is needed to be safe when we are on BHRT. If you have unusual bleeding, if you have breast lumps, if you have severe headaches, chest pain, bad guts, tell your doctor immediately. Now, very interesting, there are a lot of females who have very lumpy breasts. They need BHRT, and we see a lot of times that 6 months or a year of BHRT helps them get rid of those lumps. So very important. Now this is what I want to give all of you back: 5 exercises which can boost your hormones or balance your hormones. Squats and lunges, please do it 3 times, 12 reps, 3 times per week, 3 sets to increase your testosterone and growth hormone. Glute bridge, estrogen balance and cortisol. High-intensity interval training for insulin sensitivity and testosterone, 20 minutes only twice a week. Legs up the wall helps bring cortisol down and improves cortisol. So 10 to 15 minutes before bed daily if you can do it, it activates parasympathetic. Very simple to do. Nadi shodhana decreases cortisol and increases DHA. So in the morning, if you can do 5 minutes of Nadi Shodhana, this should be your exercise protocol. Your BHRT journey can start today. You have to find a BHRT specialist, discuss your symptoms accordingly, do your test. She— he or she will give you a BHRT prescription. Begin with the chosen method, and if you think you need it, do it yesterday, not tomorrow. This is your simple Monday, Tuesday, Wednesday, Thursday, Friday, Saturday exercise thing. 3 liters of water every day, morning sun 10 minutes, anti-inflammatory diet, no screens 1 hour pre-bed, 5 minutes breathwork, and And we can achieve a lot. There are few myths I want to bust before I say bye-bye. You know, BHRT causes breast cancer? No. BHRT is only for menopausal women? No. I see people from 15 years to till the time they are alive, they are candidates for BHRT. And remember, I don't mean to say that I'll put these young children on bioidentical hormones. But there are a lot of things once we know which hormone is not proper, we can actually do with diet and exercise. So at least get yourself checked. You will be on it forever? Not necessarily. Yes, post-menopause you should be on it forever, but otherwise not necessarily. BHRT is unregulated and unsafe? Not at all. When prescribed and monitored by a trained physician, safety data is strong. Natural means no risk at all? Not at all. You have to be in touch with your doctor. Which are the patients who need to avoid BHRT? Hormone-sensitive cancer patients have to completely avoid BHRT. Clotting disorders, recent cardiovascular event, you must take 3 to 6 months before you can look at BHRT. Pregnancy, absolutely contraindicated. Unexplained vaginal bleeding should be investigated. Uncontrolled liver disease. Oral hormones should not be given. Topical can still be considered. Now these are the studies. You can take a, you know, photo of this. ECOG Guidelines 2023 talks about hormone therapy for menopause. Menopause Journal 2023, BHRT demonstrated safe Menopausal hormone therapy, JAMA 2022. WHI analysis reversing earlier alarmist conclusions. Testosterone therapy in women benefits beyond libido— improved energy, cognitive performance, muscle mass, quality of life. These are some of the channels you can, you can also, you know, uh, subscribe to my channel. It is Gut Glucose Revolution by Dr. Preeti Nanda Sibal. I do a lot of videos and classes on hormones, but otherwise these are some of the names: Huberman Lab, British Menopause Society, Dr. Mary Claire Hever, Dr. Joe Callahan. They talk about this and you can trust them. My thing is, ma'am, your channel please. Gut Glucose Revolution by Dr. Priti Nanda Sibal. P-R-I-T-I. Yes, yes. What did you learn? Anything you learned, share in the chat box please, or if you have any questions. And thank you. I see nobody left in between. Any questions you have? Anything you want to ask?

Yes, ma'am. I have a question.

Yes.

What would be the approximate average cost of the session of this therapy?

And duration, when that depends on the purpose. If it is menopausal, then you know it has to be long-term, right? But if it is PCOD, then it is maximum at most 3 months. I had a patient who was in OCs for last 18 years, and in 3 months we worked on her gut, on her heavy metals, and on her BHRT, and she's off OCs.

Ma'am, it is a very new topic and new horizon. Very less information in the market is available on it. It's a wonder. It was a wonderful session. Uh, I want to know the— I think many women of every age group, right, from 16 to 70, till 70 years of age, is in need of this nowadays.

Exactly. So when the pricing now comes second, first step is you first test your hormones. Second is you book a consultation. My consultation is ₹5,000. Okay, ma'am. Now in that consultation, we need to decide diet, exercise, or supplements. It would cost you about ₹3,000 every month. For example, I'll tell you, I used to go to the market and buy clothes for myself. Now, whenever I have money or I'm feeling a little low, I check out which peptide I want to take, which hormone assessment I want to do, because I know I want to be at my best. And the space I'm sitting in, I should do everything Right, because advanced therapies, but changing, the same money but being spent in different places. Shopping is like Otherwise, I will say, yeah. And whatever you do now, ma'am, I am a cancer survivor, breast cancer survivor, and now right now I'm working as a life coach, but I'm very afraid of hormone therapy because I think, yes, so maybe you don't need hormone therapy, but you must check them and understand what are the diet or the supplement changes you need to do. You must work on your gut microbiome. You must work on your liver. What I'm seeing is, I can be very confident that you can have fatty liver. As a breast cancer survivor, living with fatty liver is not done. It is not done, Vandana, right?

I'm afraid of hormone therapies, even for my clients also. Because we associate it with the cancer of risk, uh, cancer risk.

Because I said all hormone-sensitive cancers, I will not do BHRT.

Do you give offline consult— online consultation?

Yes, yes, I do online consultation.

My sister is in Punjab. You are from Amritsar, I know. And your clinic is in Gurgaon. I know you, I have attended many of your sessions, very informative and very knowledgeable. My sister is in Punjab and she has undergone recently hysterectomy. She's suffering very much from these hormones.

She must get into it and, you know, the aim should be— yes, ma'am, symptoms, we help them taper off.

Online consult, I will definitely ask her to take it from you.

And for you, looking at you, I'm telling you, work on your gut microbiome, estrogen detox, and, uh, that you should work on, and you should work on majorly with diet, with exercise, and with very bare minimum supplements.

Any supplements you can suggest for all these? What, whatever you have suggested?

Fatty liver? I'm already working on all these—

gut issues, fatty liver, exercise, estrogen.

Okay, maybe some tweaking is needed. Yes, ma'am.

I'll come in person to meet you, but for my sister, I will take the online consultation.

Definitely, I will love to meet you. Okay, thank you. Any other questions? Any other questions, guys? Great, thank you.