Why 50% of Women on HRT Are Undertreated (And How to Fix It)

Foreign. So what we're going to go through Today are the 10 questions and the 10 things you should know about hormone replacement and where you need to go and ask questions and what you need to do if your practitioner isn't really aware of how to take care of you in a highly personalized way. Number one, bioidentical is not a buzzword. It is biology and biochemistry. Most women never learn that bioidentical hormones are molecules that are identical to your molecules that you make. That bioidentical hormone is a key. And just like a key for a lock, there is one key made for one lock. So when you go to put that key in the lock, the receptor, the lock hole, actually recognizes that hormone. Exactly. When you have a chemical that is different and not biologically the same, you actually have a chemical that jimmies the lock and may get it to turn, but doesn't work really well. So your body's detox pathways, recognize them and your body will respond predictably. Right. You already had estrogen as a hormone for the majority of your life at physiological levels. Same thing with progesterone, same thing with testosterone. Your body knows exactly how to handle those hormones in a predictable, predictable way. Number two, your symptoms that you are experiencing anywhere from about your mid-30s on through your 50s are not random. They are metabolic signals. Things like belly fat, weight gain, sleep interruptions, anxiety, depression, heart palpitations, joint pain, irritability, hot flashes, night sweats, brain fog, fatigue. They are all metabolic signals. They're signals that there is a hormone shift going, going on. Oh, they're signals. Right. So when we have these symptoms that could be signs that your progesterone is declining, loss of muscle mass, muscle fatigue and poor recovery could be signs of testosterone, declining estrogens, crazy bungee cord experience. And then fall is going to result in a lot of those other symptoms, like hot flashes, night sweats, insomnia, mood regulation, all of those things. And those are all signs. And if your doctors are not paying attention to that, you might be in a situation where you're not being completely looked at and completely cared for. And you should demand to have those things tested and evaluated. And if your doctors say no, that's time to fire them. Right? This is your body, your life, your choice. All right, so number three, the whi, otherwise known as the Women's Health Initiative Stage Study, the scare about that was about synthetic hormones and pregnant horse mare urine. So hormone replacement therapy was standard of care, given out like candy all the time, without reservation, until the 2002 Women's Health Initiative. But here's the thing that you don't know is the, the Women's Health Initiative and basically all the subsequent research that includes Women's Health Initiative data actually was about Premarin, which is made from pregnant horse mare urine. And premarin contains 13 different estrogens. Right now, humans, we make three. We make estradiol, estriol and estrone. So Premarin had been used without reservation, again with no indication of increased risk for breast cancer or breast cancer mortality. No increased risk. However, there is some increased risk based on studies looking at much older women know, 15, 20 years postmenopausal using Premarin orally because of what we call first pass liver metabolism. Some of those estrogens that our body doesn't naturally make go through the liver and produce byproducts. Right. Number four, your gut and estrogen are in constant conversation and are intimately connected with each other. So we have microbes in our gut. Think of that as a jungle. And our jungle has lots of animals. The more animals we have, the better off our gut is, especially when we have a lot of each one. Right now, the microbiome goes through some shifts when we enter into menopause. And one of them is the change to a group called the estrobolome. The estrobolome are microbes that actually make an enzyme called beta glucuronidase. So beta glucuronidase, as an enzyme made in the gut, is primarily made by our microbes. Here's where it becomes important. So beta glucuronidase alters, particularly the gut microbiome, levels of available estrogen that can get recirculated from the toxins being slated to be excreted out through the stool. It allows it to get unwrapped and thrown back into what they call hepatic recirculation. So liver recirculation going back into your bloodstream. Now, when we go through menopause, this actually increases your gut health defines your health. You cannot be really healthy with a really jacked up gut because your body can only make things like proteins, enzymes, and other structures in the body based on the nutrients it can take in, digest, and then assimilate. Number five, testosterone is a woman's friend. After 40, here's the reality is testosterone levels slowly decline in women from our peak in our early 20s, and it declines pretty steadily. So by the time we get much older, we, we are at a much lower level. So what does testosterone really help with? So testosterone helps with energy Motivation. It is as much a brain hormone as it is a body wide hormone. That's why it improves libido. It also improves muscle structure, muscle building and bone density. By design, it improves cognition, mental sharpness and mental acuity. And it's highly utilized for. Okay, number six, hormone replacement therapy, whether it's bioidentical or not. Now of course you know that I'm a bioidentical fan is not a one size fits all plan. We don't know how much hormone you produce naturally when you were 20, 25, 30. We don't know exactly how much you need to dose of whatever delivery mechanism, whether it's cream, oil, pellet patch for you to achieve ideal dose. It depends on your personalized absorption, your metabolism, your microbiome, your gut. And so precision is required here. And how do we understand precision? Number one, we test, we don't guess. We use blood labs to identify if we're at a therapeutic range. It's also really important to understand that your hormones like estrogen, progesterone, testosterone, interact with your brain chemistry like dopamine, norepinephrine, epinephrine, serotonin. And that there's receptor activity that is similar, there's metabolism activity in your detox pathways that are similar, there's action in your gut that are similar. And if we're not getting the right outcome, there may be other areas that are being overlooked. All right, number seven, timing matters. Your hormone timing, when you start hormone replacement has its most possible best outcome that the earlier you start in that therapeutic window. So basically we have good research showing that starting hormone replacement early, and in some cases this often means long before your periods stop. It was commonly thought that if you had hormones and a period, right? So if you were having a period and mine at the time was coming every 21 days, that you have plenty of estrogen, right? In many cases you were estrogen dominant. And what we're starting to understand from observational data is that we may be replacing estrogen too late and that might be better to start low doses earlier on. Now that usually still means after progesterone has been started and it may mean after testosterone has started. But the timing matters, right? The timing matters because we want to do is make sure we're intervening early in protecting the brain, protecting the heart and protecting the bones. What we've seen in research is that bone loss accelerates in the couple years prior to the last time you have your period. Number nine is BHRT works best when you address the big five. So what are the big five? Number one is insulin and leptin sensitivity. And it sets hunger and it sets fat storage. Very, very important. Now, leptin is sensitive in a very healthy, metabolically healthy person, meaning as your hunger levels climb, your leptin levels climb with it, and as you feed, they go down. What we found was that leptin in a human made by your fat cells that talk to the hypothalamus, becomes dysregulated. And when it does, you get leptin resistance, which means the brain no longer understands hunger and satiety and gets the message to store fat first. As we go through menopause, we become more insulin resistant and therefore often a little more leptin resistan. And so really working on the sleep, the exercise, and dialing in blood sugar control by eating a high fiber, adequate protein and low processed food diet, along with adequate exercise, particularly after meals, to help burn off glucose, will help. All right, so the last number 10. So when you're looking at hormone replacement and you're looking for your perimenopause to menopause and beyond, journey number 10 is the goal isn't to feel younger, it's to feel more like you. The women that really thrive in this time period don't want to be 25 anymore. What they want to be is the best version of themselves today.