BHRT AND HEALTH | Priti Nanda Sibal | Mahesh Jayaraman

Hello everybody and thanks for joining. And I think you all know that today's YouTube Live is slightly different than all the others I generally do. And why am I saying this is different? Because today in this YouTube Live, we are going to talk about how doctors and health coaches can improve their practice, how doctors and health coaches can help their patients better. And in today's times of lot of toxins and stress in our lives, what is that one game changer that some of us have implemented but others are still deciding whether to use it or not? And for this very, very special episode, I invite Mahesh Jayaraman because I think he is the, the expert on this topic. And he has worked so much and he has gone so, so, so very deep that when you hear to his stories, you really start thinking, wow, can this one change can make such a big difference? Welcome, Mahesh.

Thank you so much, Dr. Preeti.

I'm very happy to be here. I will say, and then the floor is yours, Mahesh. He is an IAFF certified functional hormone specialist and co-founder of Sipalika Fertility and Hormonal Clinic. He has helped thousands of women overcome variety of hormonal health issues. He has worked with PCOD, infertility, menopausal health, and lot of autoimmune conditions where he is going to share with us where the patient got stuck and how he got the patient out with simple but very, very, very effective bioidentical hormone therapy.

Absolutely. Thanks so much, Dr. Preeti. As always, to the point. We've got a maximum of 20 minutes like we decided, so everybody can get the clear idea and not at all get bored. So I'll dive straight into a case, right? And this is something that's very close to my heart because it's typically shows with the power of BHRT. Okay, this lady was 39 years old. She came to Cephalica Fertility after 13 years of trying. She had been through 9 rounds of IVF across 3 large chains. I won't take any names, but across cities. Husband was a shippee, literally had to take shore leave to try and somehow manage all the fertility treatments they were going through, right? So he took shore posting, and this was the state in which she came. And of course, as functional medicine practitioners, we looked at everything, put on the detective cap, looked with a very close lens, looked at everything, optimized all the things that all of us would do. So diet, lifestyle, stress management, all the standard D3, B12, all of that. But what everybody else seemed to have missed was that primarily nobody had checked for autoimmunity. Having checked for autoimmunity and found only mild autoimmunity, which means anti-TPO, anti-G positive, but mildly so, no great symptoms other than infertility. FT3 also borderline, nothing that's clearly going to tell you, hey, this is a case of hypothyroidism, but these were there. So we took the patient into confidence, worked with Dr. Vivek Kadambi, who's also one of our senior colleagues and literally the torchbearer of BHRT, uh, for many of us in India, runs Bella Sante Clinic out of Bangalore. So shout out to him. and together we decided that this would be a perfect case for T3 therapy. And once the T3 therapy was initiated, magic happened. The lady conceived. We couldn't believe. We ourselves kept it under wraps for 3 months, you know, much like family members often do in India. Once the pregnancy was steady, established, progesterone was going up but not as well. Again, here's BHRT steps in. After such a long history of infertility, it's very likely suboptimal progesterone levels can happen. Again, with Dr. Kadambi's cooperation and our team strategy that we built, we decided we would supplement progesterone throughout the pregnancy. The lady finally delivered a very healthy baby boy at 40 full weeks of gestation, 3 kg plus baby. And, you know, she had been through enough of L-Troxine, Thyronorm, etc., in fits and starts the way people do in India. But here's a clear illustration of what BHRT can do. It's, you know, it's pretty phenomenal, the power that such a small molecule holds.

Wow. So Mahesh, you've exactly reminded me of a similar patient I had post-pregnancy, and it is known that post-pregnancy autoimmune thyroid or Hashimoto's incidence increases. We see a lot of people post-pregnancy getting into this situation. So when they were planning for a second baby, the lady was just not ready because she said last time this happened. And she said, unless I find somebody who can reverse my Hashimoto's, I am not going to get into this game again. And I think worthwhile, because you need to think of yourself also. And we started working. She had been to many doctors. As you said, everybody comes to us as the last mile you know, try that last thing. Let's try this also. And I told her, let's do that. And the phenomenal change happened only when I corrected her DR and put her on bioidentical thyroid and then did the gut health. So for the first 3 months, I kept doing everything other than BHRT for her, but that became a game changer. And exactly 9 months later Her antibodies were normal. She was off 75 mcg of Thyronorm she had come to me with, and 2 months later she conceived. And just last month she sent me a message, ma'am, I'm almost due now and I'm eagerly waiting to meet you again after my delivery.

So I think all of us in BHRT have such instances, Dr. Preeti, and you know, uh, it's pretty phenomenal that all of us want to keep it as the last step but sometimes it could be the first step as well, right? So it's not that everything has to happen serially and, you know, unless you do the absolute basics completely and only then the patient will begin to see results. This is not how we see it in clinical practice. All this looks good in the books.

Sometimes this gives confidence to the patient that we are in the right track and 15 days later Patient will do everything what we tell them to do just because now the patient is feeling so much better. And it's not only for women, it's also for men, right? So Dr. Mahesh, if it is so powerful, right, why are some doctors and even health coaches not promoting it, doing it, uh, collaborating with other people and giving this benefit to their patients?

Again, Dr. Preeti, I think this is a combination of various things including the history of HRT. Hormone replacement therapy has a bad name, we all know that, and this comes from the time of the using of obviously hormones like Premarin, which is pregnant urine, pregnant mare's urine, which is how the name came. And using such synthetic compounds which are not bioidentical, meaning they're not exactly what the body makes can have powerful effects and side effects, and therefore there is some bad name that is associated with it. This is one. As far as the patients are concerned, hormone is a bad word, right? So everybody takes thyroid medicine, nobody takes hormone medicine, right? So everybody is taking— is what they will say. They will not call it a hormone. You tell them there is something called T3, as long as it's a different thyroid, it's okay. The minute you call it a hormone, it becomes a bad word, without realizing that we are now in the fifth generation of bioidentical hormones. They are extremely safe, identical to what is created in the body. Several of the steroid hormones, the sex hormones that we replace, are actually made from wild yam. So it's a natural source. You are able to actually make these molecules exactly what the body identifies and uses. So these are things that many practitioners are not aware of. And because of this collective fear, both from society, patients, and doctors, I think we are missing a very powerful tool in the collective toolbox of anybody who is practicing medicine.

Great. Dr. Mahesh, quickly, can you tell me 3, 4, 5 scenarios in which you realize that if you would not have been doing BHRT, sure, you wouldn't have been able to heal your patients, because I see this day in and day out, especially, uh, you know, people I get these days, they are stuck with their adrenals. And unless and until I support their adrenals, I'm not able to actually get inroads into their gut health.

Very much so. Yeah, absolutely, Dr. Preeti. And I think you are one of the few. So can you actually give us a little bit about the use of DHEA and cortisone? I know that you've used it when, uh, it's judicious, where you felt that it was stuck, right?

So for me, DHEA has been a game changer in a lot of menopausal women, but more importantly, a lot of autoimmune conditions. And there is a lot of data to support now that low DHEA is one of the reasons that the body can become a target of any autoimmune condition. Now the question is, is DR safe? Extremely safe. But can you give it to everybody? Just an hour back I had a consultation and the lady said her DR is 17, 1-7, and she's a rheumatoid arthritis patient, Hashimoto's patient, right? I know until I support DR, this is not going to change. EBV positive, CMV positive, all of that. The moment I started DR, right, she started having a lot of hair fall and she got scared and she said, no, no, I'm not going to take it, right? So I had to explain exactly, draw the diagram and explain to her how DR should be, you know, converted into estrogen, but it's getting converted into testosterone and a PCOD-like image is being formed. And how can we work so that that gets the right conversion And that right conversion can actually not only help you heal your autoimmunity but help you look younger.

Absolutely. I mean, in the United States, DI is primarily sold over the counter. In this country, of course, it falls under Schedule X. So all health coaches out there practicing with a licensed medical practitioner, especially an allopath who's allowed to prescribe things under Schedule H and Schedule X, is critical. But you can bring the knowledge to the table, right? So like Dr. Preeti just said, we've used DHEA as well. DHEA is a standard supplement, Dr. Preeti, used in lots of declining fertility cases that it happens. However, you must be ready to manage how— what can happen with DHEA. Some women will go into excess estrogen production. It will lead to endometrial hyperplasia. And if you don't know how to use it you will end up being stuck, right? So a lot of people think that it's just about protocols. You get some protocol online, but this is all Abhimanyu work. Once you go inside the chakra view and you don't know how to come out— so stuff happens when you are actually in the, you know, if you're trained by clinical practitioners, then we've been through 100 battles and you know what can go wrong, and that can make all the difference.

So, Mahesh, exactly to this, I had a menopausal woman where we started— I started DR, right? And after 2 cycles, she had some spotting.

Oh, the gynecologist must have screamed, right?

And she said, I had some spotting. And I smiled. She said, were you expecting it? I said yes. And the moment I said yes, you know, she was sitting like this, as a very annoyed with me, very scared. She relaxed and said, Okay, Dr. Preeti, then you know what it is. Explain to me why did this happen and how do I manage it? I don't want to leave the— why? I said, why? She says, I stopped fighting in my family, I have more energy, right? I don't get irritated with my spouse. Yeah, so it is like everything changed for her, everything. And I think my relationship changed for her, and we then reversed her diabetes. She was on insulin. We reversed her Hashimoto's. We helped her lose weight, and, you know, of course, moods and sleep and everything. But the trust which was built there, I think, helped me run with her for 1.5 years and help her achieve health slowly and, you know, gradually. But if I would not have known what to do there, then I would not only have lost an opportunity to help one patient, but have also would have lost the opportunity to heal so many more who are just stuck at there. So that's their health tent which has fallen. You do one right step and the tent comes up like this. Absolutely.

Yeah, yeah. And you know, I mean, again, to speak of another hormone where I have seen this kind of result happen progesterone, especially in cases of endometriosis, right? So the patient comes to you, they're already on some kind of BCP or the other, they're in extreme pain, the BCP is the only thing that helps them. Or conventional gynecologists might use progestins, so a Lupron Depot or something to just totally shut off the hormones so that there will be literally no endogenous hormones that are produced. The lady goes through this The minute you withdraw it, it's back to dolo ultraset. It's back to the craziest amount of pain that the lady can have, usually 15 days or longer. All it takes is a single pump of progesterone, usually progesterone cream on the forearm, 100 mg. This kind of dosage, what a difference night and day it can make for a patient.

So Mahesh, when you are saying about dosage of progesterone, a lot of warning, right? I know why you are smiling. I, I, at American Academy of Anti-Aging Medicine, from where I did my functional medicine and hormone certification also, they taught me that for a person like me, 7 years, 8 years back, progesterone 50 milligrams should be the dose. I started with that, and a month later, in the second cycle, I was so bloated that I could not stay in the same clothes which I had come worn in the morning. That much bloating I had. And so lethargic and everything. And then when I went inside deeper, because they had only taught me superficially, I realized that it was actually opening up my estrogen pores. And then I realized that my estrogen dominance was because of this reason, and I could never lose weight on my lower half because of this reason, right? And therefore I could never shop for Western clothes. No, this is not a matter to laugh at, man. This is serious for women, you know. This is serious. And the moment I realized that I don't have to stop progesterone but up my progesterone to 200, I started coming back in shape. Now I go and I can buy from the market. I don't have to get my western stitched or customized, right? And that simple molecule changed, but I could have left it.

Yeah, and this is, you know, you're in elite company, Dr. Preeti. This is exactly what happened with Dr. Lee, one of the absolute pioneers of BHRT who coined the term estrogen dominance. When he started progesterone for his patients, he found that it was waking up their estrogen receptors, and unless you take away the xenoestrogens from their life, all of the estrogens which are problematic, right? So the lipsticks and the cosmetics, if you don't do that, progesterone therapy alone will wake everybody in the house. So the good guys, bad guys, everybody wakes up. So again, very powerful molecules if used right can give you such amazing results in the clinic. Yeah, perfectly done legally, perfectly done ethically. You're not taking away the body's ability to make these. This is another myth that, you know, if you give exogenous hormones in, in the right doses, the, the medium to micro doses in which it should ideally be used, that somehow the body will lose its ability to make hormones forever. Not true. That's not what we have found in the clinic.

Great. So Mahesh, I've got some questions, and before I come to my next question, let me take these. So Garima is asking, can commercials be limiting factor, meaning what is the average cost of BHRT per month?

Well, it really depends. For— if you're looking at, for example, replacing T4 with T3, while the base price of T4 itself is so low that even if you get compounded T3 at 3x or 4x, you're still talking about ₹10 per day, ₹12 per day, that kind of an outflow, right? Because again, it depends on what you're doing. If you want growth hormone because you want to be an athlete or you want to look in your 30s, it is going to cost you a packet. Everything else falls somewhere in between. But it is again, see, once a patient sees the results You will be surprised. You may think they don't have the budget, but they will come and tell you, I have the budget, you don't stop what you're doing.

Oh yes, exactly. This was my point. It is value versus price. If you consider these two, then I think BHRT is the easiest, most economical form of staying healthy, young, and of doing anti-aging for our patients.

Yeah, right, I would completely agree.

Yeah, thank you. So Sharda wants to know, can you get women off BHRT at some point, especially in menopause? It depends.

So depending upon what you want, right? So progesterone is not going to be made exogenously in your body after menopause. That's because you're not ovulating anymore. If you want the benefits of progesterone to continue, you will certainly need to use progesterone the way you use your thyroid medication, for example. But in acute cases of endometriosis, we have certainly gotten people off progesterone. So it's not one size fits all or one answer, but yes, it is depending upon what you want as an outcome. It's possible to go in either direction.

So I think a very good discussion me and Mahesh were happy having, and I want to share it without taking Mahesh's approval. It is, it is a very daring job, but I want to do that for all menopause menopausal woman here. So I, I think, had menopause 1.5 years back, and just because of BHRT, the way I was doing it, it was the best period of my life in terms of all this. Because one day the period stopped and they never came back again. No symptoms, no hot flushes, nothing at all. No disturbance in sleep, touch wood. Thank you. But I was looking at my progesterone levels, and for some time I had stopped it Because I, you know, it happens sometimes you think I'm traveling so much, you don't want to do it. And I was having some symptoms, so I told Mahesh, I am debating whether I need to start BHRT now in menopause because it needs to continue for long. He said, Dr. Preeti, this is not the question. The question should be, do you want to have your hormones the way they were when you were 30, 40, or you want to have menopausal levels, right? So, Sharda, I would want to say It's our choice. So now I have my hormones here right at the table. I reach the clinic, use it, pray first, pray, then use it, and then start my work, right? So putting with your one small question, I think that you asked changed the whole thing about me. I was taking my health lightly. Which most of us do at different points of our life. Okay, because I think— not kidding. And I've realized if I'm eating healthy, right, there is no demand from my mouth that you should brush because there's no bad odor, nothing, you know, on your teeth. But if I have not eaten good food, then of course body only tells you, your mouth tells you, go and brush your teeth. I am like that type of a person. But that one question actually made me think. I sat and decided what do I want and then wrote my BHRT protocol, full prescription, and started everything whatever I want to do, right?

Yeah, absolutely. You know, so I think, see, a lot of us want to live the active life for longer. A lot of women are making a decision to start families later. A lot of people want to be fully active into not just their 50s but their 60s. That's when you're excelling in your career, you're getting board positions in corporate life, you know, you, you want to travel the world, whatever it was till your kids got to college which you couldn't do, you want to do all of that. If that's the life that you want to lead, here is an option. And again, like I said, we are not in the first generation of HRT, this is BHRT. So, you know, one should keep preconceptions aside and take a real look at what's on offer and weigh it against all the pros and cons for sure.

So, Mahesh, when you said that, you know, I asked my— I didn't ask myself how I want to live. I asked myself what type of grandmom I want to become. Do I want to look like a grandmom of, you know, 2 ages back, or do I want to actually become a grandmom who motivates and inspires others that, oh, This is the way I look, want to look when I become a dadi, right? So I think that made me very, very, very regular with my thing and made me write prescription. Great. So Sharda, I hope we have answered your question. It's all about what you want to achieve, and that's how the protocol and prescription needs to be written. Dia is adrenals, and it's again a hormone. Ragini wants to know, would BHRT help a woman who reached menopause 10 years ago and now has widely fluctuating hyperthyroidism?

Hypo or hyper? Hyper. Okay, yeah, so again, of course it can, and there are many ways to skin a cat, right? As you know, Ragini, so I would certainly do the foundations as well. And again, this is important, right? We're not going to pretend that BHRT is the one answer to everything. Guys, that's not what this is. This is a very powerful tool in the toolkit. It's still a functional medicine approach. We look at why the hyperthyroidism is there. Certainly I've seen multiple cases where with T3 usage and done in the correct time, not done during the hyper phase— you need to watch out for the timing and how you do it— but you can get remission in antibodies and symptoms with the use of T3. So there you go. BHRT for sure on that. And if there are— if the hyper is looking like temperature fluctuations, certainly even DHEA, progesterone, many things which can really help.

So I think I will simplify this, Rajni, and give my version on this. My thing is that anytime a menopausal woman will come to me, I will want to know her hormones and consider BHRT. So if I talk about BHRT separately, that's my take on it. The earlier we start, the better it is, of course. But there is no time where I would think that, no, this woman has come to me 30 years after menopause, I don't want to consider BHRT for her. I want to, but after informing her that the benefits would not be as much as they would have been if she started it 30 years back. Second, Hyperthyroidism— when you say fluctuating hyperthyroidism, if the autoimmunity, as Mahesh said, the basic work can be done properly, hyperthyroidism gets converted to hypothyroidism, and then, you know, it can be managed. And nowadays, what I'm seeing in my practice— and I'm actually presenting in the longevity conference on this Saturday in Mumbai on the same topic— I'm seeing that a lot of Hashimoto's patients We are able to get them off their Thyronorm of 75 mcg, even 150 mcg, when we work on their gut health and on their BHRT, on their hormones and their toxins. So, and I, as Mahesh rightly said, BHRT is serious stuff. That is the reason that only doctors can prescribe it, and it is not for everybody and There is no one time when you can do BHRT. Thank you, Maneesh, for bringing that up. And that is the reason this is one topic which you need to study in detail. Have handholding with somebody who's been doing it. For example, I've been doing BHRT now for 6-7 years. Maneesh has been doing it for many, many more years. So you need to have somebody like this to be handholding you because this is serious stuff. Right, so how everything else is aligned in the body, and we need to do, do that. The 2-3 quick questions, um, which are: Is adolescent idiopathic scoliosis related to hormone imbalance, and would hormone replacement be helpful in that case?

Absolutely. I mean, the term idiopathic itself says that we don't know the cause. So now if there is scoliosis, we need to look into whether there is an estrogen deficiency or even a testosterone deficiency at times, due to which the bones are losing their integrity. So it needs a more detailed workup, but hormones can be one of the powerful tools to be considered even in such cases.

Great. Now, very, very interesting and nice question, Haji Nafi, right? What's your take on a menopausal woman not feeling better even after on BHRT? And Mahesh, I will take a lead on this first and then come to you. You have already told me, Haji, that it's prescription which is being prescribed. You need to look how the body is handling those hormones. Simple thing like food. I always say 20% is what you eat, 80% is what your body makes of it. And I hope Mahesh agrees with this, right? Similarly, 20% is what BHRAT you've been prescribed or what you are taking. 80% is how and where your body is taking it, using it, and making of it. Mahesh is smiling, so I have passed.

Everything that we do as medical practitioners We are only starting the process in the body. We are triggering it with something. What the body does with it is so crucial. We have had cases where women say, after putting progesterone cream, I'm feeling so sleepy. Now, that can just be the GABA receptors which are getting activated more in this lady because the pathway in her body is beta-pregnadiol, not alpha-pregnadiol. So without getting into too much geek speak, the simple thing is same progesterone in two people, right? You give it to person A, they're doing fine. Their moods get better, their sleep gets deeper. Second person feeling drowsy all day is getting oily skin. It's what's happening inside their body, and therefore what other hormone, what other pathway you need to use to balance it out.

I think one word is coming to my mind, and of course, if anybody who knows me knows, I'm a very extempore person. If I prepare anything, I don't say that. So it's really come to my mind and it's saying power comes with responsibility. So BHRT is power on your pen, in your hands, but it comes with huge responsibility. But that is the responsibility we have already decided as doctors and health coaches to take for our patients, right? So let's take it, let's take this power in our hands responsibly. And on that, Mahesh, I want to say thanks to Rajni and Abhira for motivating us. But there is a question and I would want you to answer that. How to learn advanced BHRT in India? Well, first, Shashank has asked this and you need to tell me what they can do.

See, I mean, Dr. Preeti and I have cut our teeth on this by attending obviously multiple courses, working with multiple practitioners and my advice would be to get the basics right first. So make sure that what you're calling advanced isn't actually basic, right? To me, a lot of the stuff that people think is advanced, like when you're giving T4 and switching them to T3 and things go wrong, this is not advanced. All it means is the basics aren't strong enough. So get your basics right. Once the basics are in place, certainly Dr. Preeti would be a good place. We are thinking of an advanced module as well, and of course That is open to everybody who has already understood the basics.

So thank you, Mahesh, and for everybody who is here, and please share this video and spread this because me and Mahesh have collaborated and we are going to share all our knowledge with you guys. So we have launched our first program which is Foundations of BHRT, which starts on the 6th of April. We have a 2-day offline course where for 18 hours we will be talking about adrenals, thyroid and sex hormones, 18 hours of that together in one room, and then post that for 3 months. Once a month we will have a 3-hour online session where we will discuss your cases, give you prescriptions, help you understand what is happening of the hormone you are giving. Downside, we have also created a full logistic chain around it, from where to order, which ones are good, what doses to give. Because as I said, power comes with responsibility, and we want to help you be responsible, help you to know all those little, little integrities which at least I didn't know after even I have done my course from American Academy of Anti-Aging Medicine. But last 8 years using it on myself and a lot of my patients, I think I don't have a single prescription without a hormone on it. I don't have it. And I love the way it helps my clients become better. And I think I always keep telling people the USP of my practice, I think even more than gut health, is BHRT. Because I start with BHRT and then come to gut health. I have not been able to help my patients in a quick way without making a combo of this. If you want to add something, please.

No, no, Doc, you summed it up beautifully. So BHRT is very powerful. Uh, please get the basics right. And like Doc said, the joy in this is to get together an ecosystem of people who want to give results to their patients, who want to get out of that unstuck place. Use it responsibly, see the results, see your practice grow. And, you know, feed into each other the knowledge and keep it going beyond just the 2-day course. So that's the way we have designed it.

Thank you very much. Thanks, Mahesh, for being here. Thanks everybody for joining. When you join, we feel more motivated to come with the next topic. And I am going to share the link of the WhatsApp group which we have created for people who are interested in knowing about BHRT. There is a discount running right now till 15th of February for the course fee. And as I said, as BHRT is, value will be definitely, definitely 5x more than what you will be investing in terms of your time in learning this new science. All the best. I hope to look a lot— find a lot of you in that program. And me and Mahesh are extremely excited And we are working many, many hours almost every day for the last 3 months now to be creating this program. You know, we make something and then next time we discuss and we decide, no, this is not what is going to help people in their practice. This is all theoretical. They can see it on PubMed, right, Mahesh?

Absolutely, absolutely.

And similarly, Mahesh comes and says, no, no, no, Dr. Preeti, this will not give results. So a lot of time, effort, and of course our experience is being invested into creating this program. And, um, we are looking forward to have as many of you as possible in Delhi on the 6th and 7th of April on Golf Course Road, Sector 55, to sit, learn, and brainstorm for 18 hours at a stretch. What is BHRT? How it is different? What is it that you can do with it and how you can benefit yourself and your patients when you use BHRT for them. Thank you very much, and thank you Somali, Haji, Preeti, Abira, um, everybody who joined us. Garima and Abira wants to know, can we have the privilege to mail or connect to panelists to place queries later, please? Um, in this WhatsApp group, please join and share your queries. I think that's a good way. Mahesh would be very good at responding on emails. I am not, sorry. So I think that WhatsApp group, we will make sure that you get all the answers you have. All the best and have a great time. And again, we are waiting to see you on the 6th and 7th. Thank you, Mahesh, for your time. I know you are in Kolkata, back from Nepal, and a lot of travel, right? And I do this only on Wednesdays. Because I think my audience are a little free on Wednesdays at 3 PM. So thank you for joining from that yoga studio of your friend, which is very beautiful. Say my hello to her and all the best for all the good work she's doing.

Thank you, thank you. Bye everybody, hope to see you soon. Bye-bye.