29: Revealing the Truth about Breast Cancer and Hormones with Dr. Elena Zinkov

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Hello and welcome back to another episode of the Keeping Abreast Podcast. I'm your host, Dr. Jen Simmons, and I have a really special lady with me today. Today we have Dr. Elena Zinkoff. She is on a quest to empower women to be their best health advocates. While dispelling myths around hormones and women's wellness, she is an esteemed naturopathic doctor. Her expertise spans endocrinology, longevity, anti aging medicine, nutrition and metabolic health. And actually, you and I are on a very similar mission because. Because women have been lied to.

Oh, my gosh.

And there is so much misinformation and, you know, outright frank lies that we have been selling to people. I am currently on the bandwagon of getting people off the mammograms save lives.

Yeah, right.

Like that is the biggest lie that women are told. And women, as a result, because, you know, it's said enough times so people think it's true. And as a result, people are afraid to get mammograms and afraid to not get mammograms. So they've been completely brainwashed and captured into this space because they think that if they don't get a mammogram, like they're doing something wrong and there's guilt surrounding it. And nowhere does any anyone, like, use their logical brain and think about the fact that mammograms are radiation. Why on earth would they be helpful? And the true statistics are, for every 10,000 women that we screen, we may find one breast cancer, but we're going to cause seven. So this is a huge problem. Right? And you have been on your own personal mission to talk to women about hormones and the safety of hormones. So I want to dive deep into all of that. But first, obviously, I want to welcome you to the podcast. I'm so grateful that you're here.

Thank you so much for having me.

So I'm sure that you have a pain to purpose story. Like, we all have a pain to purpose story. So how is it that you came to be in this space of women's wellness?

Yeah, well, I think like a lot of people, I went through my own journey. I went through my own health journey. And honestly, like a lot of women, I was given birth control for a lot of symptoms that I was experiencing that were due to hormone imbalances. Yeah.

And you talk about that because there, that is happening all the time, right?

Yeah. So a lot of times this is what a typical woman will go through is let's say she's having acne or painful menstrual cycle, or she feels PMS or PMDD like symptoms leading up to her cycle. And because it's a very quick conversation with her primary care physician or her OB gyn, the fix is birth control. So birth control is like this band aid for our skin issues, hormonal issues, et cetera. So a lot of women get put on birth control as well as antibiotics and antifungal meds for the UTIs, followed by yeast infections. And no one in conventional medicine, I shouldn't say no one, but very few physicians in conventional medicine will question if there's a deeper cause for these recurring symptoms. And so, like many women, especially when I was in my teenage years and early twenties, the solution was birth control or antidepressants or anti anxiety medication. I frequently talk about how, for me, it was so frustrating to go through my younger years and not being able to figure out what was the cause of this recurring terrible acne that I was experiencing. And what really changed my perspective on the role that our hormones play was in my early 30s, when I had my son, I had an autoimmune reaction. So I developed rheumatoid arthritis and I was losing hair. I was in this constant fight or flight mode. You know, it's their blessings, but they bring a lot of sleepless nights with them. And I tested my hormones, they were just all over the place. And as a naturopathic physician, I wanted to take the most natural route. I wanted to. I wanted the herbs to fix everything. I wanted stress management to fix everything. I'm an ex athlete, so I knew how to eat, I knew how to work out, I knew what supplements to Take. And it wasn't working. And when I finally even started on bioidentical progesterone, I was like, oh, my God, I'm sleeping better, I'm less anxious, my skin cleared up. Like, I've never had clear skin since I first had my period. And my relationship with my husband improved because I was not this crazy wacko a week or two leading up to my period. So having gone through my own hormone imbalances when I was younger and then postpartum, I was just so, so determined to help myself, but then also spread the message of how important hormone health for women, how important it is in terms of reducing inflammation, improving our quality of life, disease prevention, and that hormones don't cause cancer. Yeah.

So I want to back up a little bit because I think so many conventional medical doctors would say, like, well, birth control pills are perfectly safe. Like, what's wrong with putting people on birth control pills? Well, so why don't you talk about what birth control pills are and your concerns with putting people on birth control pills?

Yeah. So control. There's. I would even call the estrogen, the synthetic estrogens and synthetic progestins that are in birth control. I wouldn't even call them hormones, chemically speaking. And what they do in our body is completely the opposite of what our biological hormones do. So suppresses our ovulation, it prevents pregnancy from happening. And what we know with our biological hormones, they obviously don't do that. Right. They we want to have ovulation, we want to have a period, we want to be fertile. So birth control, effectively, with its chemical structure and the synthetic hormones that it does contain, it effectively suppresses that. And if we look at what synthetic hormones do compared to our own biological hormones, synthetic hormones increase risk of cardiovascular disease, blood clots, inflammation, neurological issues. Whereas our own biological hormones, like the estrogen, the progesterone, and the testosterone, as we know, actually support cardiovascular health, support brain health, support cognitive health, and actually reduce the risk of cancer. Because progesterone, for example, in optimal levels is anti proliferative.

And we do see actually a number of changes associated with taking synthetic birth control pills. For instance, we see profound changes in the microbiome. Right. And the microbiome is a key to hormonal health. So if you don't have a healthy microbiome, you can't process your hormones effectively.

Absolutely.

So that's one part that is literally never discussed within the conventional medical realm.

Nobody ever talks about, like, if you go and someone says, oh, you're having these symptoms let's just put you on birth control. They don't talk about a lot of the side effects, the risk factors, and by the way, how it affects your microbiome. They just don't talk about those things.

Yeah, of course not. And the incidence of depression goes up significantly when you put people on birth control pills or synthetic estrogen and progesterone replacement. And we know that breast cancer increases for people who have been on prolonged birth control pills. And it's a linear relationship because these are synthetic hormones. And there are a multitude of medical problems, not the least of which is infertility.

Absolutely. Which is huge. It's a really big problem nowadays. And one of the things that I love about my practice is I get to see women in all phases of life. I see teenage girls, I see women in their 20s, 30s, 40s and beyond. I see women coming off of birth control trying to conceive, and we take them through that process. I see the frustrations of women being on birth control for over a decade and then not being able to conceive. And I see women who are in their 50s or just coming off of birth control. And it is heartbreaking that women are just not, are not taught about the consequences of being on birth control and what it does to our brain health and what it does to our fertility.

Yeah, yeah.

And it takes quite a bit of unwinding to build trust that our hormones don't work the same way as synthetic estrogens and progesterones that are found in birth control. And it takes time to revive ovaries and those pathways to get them to function properly.

So again, we started this conversation with the fact that I am on a mission to dispel the mammograms, save lives rumor. What is your mission? What are the top five lies that you think women have been told? And how do we start to correct this so that people can have the health that they want and deserve?

Absolutely. So, number one, that we can't test hormones. And I don't know about you, but you know, when you obviously, when you, when you're in medical school, like, you see the graph of hormones going up and going down. What do you mean we can't test hormones? Right. Just the fact that we're all taught to look at that graph, stare at it, learn the different phases of the cycle tells us that hormones do go through certain fluctuations. So it's, it's just a blatant lie, a flat out lie that when a woman goes to her primary or endocrinologist or obgyn. And they say, you know, we can't test your hormones. That's number one. Number two is that what you're feeling is normal, that it's normal to have PMS symptoms, that it's normal to lose hair, that it's normal to gain weight as we age, that a lot of things that women experience that are signs of a hormone imbalance are normal. So just even establishing just the basic. Right.

We have normalized all of that, because as you said before, it's a much faster conversation to say, here, take these birth control pills, than to actually sit down and figure out why someone's having pms, why they're losing hair, why they're gaining weight. Right. These are longer conversations that take thought.

Yeah, absolutely.

And quite frankly, I mean, I was never taught to do any of that in medical school, and it wasn't until I became a patient and did my functional medicine training that I ever began to think about approaching someone from a why standpoint. Why is this happening? Because really, all we're taught to do is to manage symptoms. Right. That's why people prescribe birth control pills, because it suppresses that symptom, albeit temporarily, but it usually does suppress that symptom that people are complaining of. I want to go back to testing hormones because I do find with universal regularity, people get a diagnosis of breast cancer, and never are their hormone levels measured. They look at receptor status on tumors, and if the tumor is hormone positive, then they say, oh, we have to take away all your hormones.

Right, Right. Yeah.

So I think this is an area that really needs conversation around it.

Absolutely.

Because our hormones are not to blame.

No.

Right.

Well, and you say it beautifully. I've listened to you talk so many times. And one, I love your work, and I love your mission, and I love the point that you drill in a lot of your talks and conversations is what is the demographic of women that is at the highest risk for breast cancer? It's not the pregnant women when their hormones are through the roof. It's the postmenopausal women when their hormones are tanked. Yeah. Because hormones regulate our immune system.

Yeah.

Cell division, cell proliferation, inflammation. Right. Hormones. They're not just there to help us develop, whether feminine or masculine features. Hormones have so many different functions. We have receptors in our brain. We have receptors in our heart. We have receptors all over our body, and it's not just in our breast tissue.

And it's only when our hormones start to fail that those other body systems start to fail. Right, Absolutely. So if you look at a premenopausal women woman, they're not getting anywhere near the heart disease that men are getting. But when you then look at them in the postmenopausal state, if they have not been given hormone replacement, then the numbers start to approximate.

Men.

Absolutely, because it's protective. And the reason that we see dementia in postmenopausal women as opposed to premenopausal women, is because that estrogen is protective. It's protecting your heart, it's protecting your brain, it's protecting your bones.

Yes, absolutely.

And so that's why we see all of these disease states in the postmenopausal woman that we don't see in premenopausal women. Now, obviously there are breast cancers in premenopausal women. It's still vastly happening in the postmenopausal state. But there are premenopausal breast cancers without question. Because estrogen can't protect against everything. And, and our environment is increasingly more toxic.

Absolutely. Our environment, our lifestyle, our diet. We can't talk about cancer and cancer prevention and life after cancer without looking not just at the person, but what is the environment that they live in, what is in their household, what is in their work environment, how are they eating, how much are they exercising, are they under exercising, are they over exercising? Right. It's all about checks and balances. But we tend to laser focus on hormones and fail to talk about things like obesity as being one of the biggest risk factors for developing cancer.

The cynical side of me responds with this. We have medicines, pharmaceuticals, to block estrogen, and so we blame estrogen because it's an easy way to oversimplify the problem in a way that seems logical, and then sell a pharmaceutical drug. But you'll notice, like, even though we test hormones for progesterone receptors, because we don't have progesterone blockade, because it would be very, very dangerous because we don't have progesterone blockade. We, we, we, we say, oh, you're, you're tumors hormone positive and we're just going to block the estrogen.

Absolutely. And that's, you know, I actually haven't even thought about it that way before because the focus has been so much on blocking estrogen that even, you know, as you say that, I'm like, I haven't even thought about that, blocking progesterone and just even talk a little bit about, you know, I want to go back to the testing and how important it is even for younger women to establish their hormone baseline, which is something That I wish that I could have done years ago, even in my teenage years. But now that's what I'm preaching, is trying to get younger women to start being more in tune with our bodies, understand their predisposition. Because you could be doing all the right things, but guess what, you could still be estrogen dominant. You could still. Your progesterone could still be taint. You know, you just, you just don't know.

And, and part of that is going to be genetics. So I think that that, that part of the story is important for people to know about themselves. But the other side of it is that there's a lot of power in the knowledge of knowing. Like, if you're estrogen dominant, are you truly estrogen dominant or do you have problems breaking them down? Is it not. Is it a production problem or is it a breakdown problem, or is estrogen not really the problem at all and progesterone is the problem?

Absolutely. And is there a methylation issue? Right. Methylation and phase two detoxification. Or we can talk about the gut. Right, right. And beta glucuronidase activity. There are. It is a lot more. What I think about it, it's simple for me because this is how I operate. When I. When a woman comes to me with potential hormone imbalances and history of breast cancer, I don't just jump at hormones. I look at environmental toxin exposure, diet, lifestyle, exercise, gut health. And to me, it's really easy to wrap my mind around. I know that a lot of our listeners will be like, oh, my gosh, it seems like it is so complex and there's so much. And I just have to say that one, you're not doing this on your own. You're not trying to figure all of this out on your own. You're working with someone who understands how all the systems are interconnected.

Yes.

And this is, this is what I want women to know, too, is that, you know, if I go in and I look at what a computer engineer is doing, I'm going to be so overwhelmed, I won't know where to start. It'll take me years to understand what I'm doing. And same thing when it comes to your health. It's not just you trying to figure out how your body works and you can go down a rabbit hole and never come out. You want to work with someone who has been in this field for a long time to whom it's second nature to look at how your systems are interconnected. And they're not just these individual entities.

Yes, Right. But that is one of the major problems with conventional medical care is that it's become so segmented that the cardiologist isn't thinking about what the endocrinologist is thinking about, who also isn't thinking about what the gastroenterologist is thinking about, who also isn't thinking about the gynecologist is thinking about. And because everyone's like, oh, that's not my. That's not my spot.

Absolutely. Yeah.

And so. And the only person that suffers is the patient.

Yeah. I. I joke sometimes that I'm like an air traffic controller sometimes for my clients because, You know, go here, go there. Even though probably in real life I crashed the planes, but when it comes to the human body, I'm pretty good.

I don't think you're going to crash anything. All right, so we talked about. The fact that you can't test hormones is absolutely untrue. You can test hormones that we have normalized all of these things. It's normal to have pms, it's normal to lose hair, to gain weight. What are the other lies that women are being told?

That you can't start hormones until you're in post menopause or menopause when you're having those symptoms.

And so how do you approach a woman who is, you know, coming to that, to that transitional period of her life? And what do you recommend for people in terms of being proactive?

Absolutely. So if you haven't had your lab done and you're in your 30s and you don't know what your hormone levels are, perimenopause can happen for women in their 30s. Right. So 35 years old, no exception. Some women, it can happen a little bit later. Some women are a little bit younger. But if you're going about your life and all of a sudden you're noticing this shift, like your cycle is getting heavier, you're losing more hair, nothing is changing in your diet and your exercise, but all of a sudden you've put on ten pounds over a course of a year. So if you're starting to notice these shift, and let's say you're in your mid-30s, that could be a sign that you're actually heading into perimenopause. Those could be early signs. So the signs could be very subtle, such as, wow, I keep forgetting where I put my key, where I put my cell phone. And flat out, it could be really big red flags, like, irregular menstrual cycle, significant drop in libido, extreme fatigue in the afternoon, and I have to Say that we're predominantly focused on estrogen and progesterone, but the other hormones, they also start to decline. So a lot of times women will start to notice that thyroid is also starting to decline. And it's. We have to take a look at how all the hormones are working synergistically because it's not just estrogen and progesterone in particular. It starts to decline. And the initial phases, it's usually progesterone that's starting to decline. And estrogen can stay a little bit on the higher end, but all the other hormones can start to tank as well. But what I like to tell women is we want to get a baseline. So whether if you're in your 30s, for sure, if you're in your 40s, we got to get a hormone baseline and we have to see how far along you are. This is something that we could use, for example, fsh, lh, to see if it's elevated or if it's slightly on the higher end. We can see what your current hormone levels are and if they're really archanged or they're just suboptimal. A big part of what I do, especially with my younger women, is the education about what are our options. Are we going to try and stimulate whether it's the ovaries or the thyroid or the adrenal glands, focusing on the pituitary, the hypothalamus, I went from a down up approach instead of up down. But we want to see can we stimulate these glands to potentially produce more hormones on their own? And why are they sub producing? Sort of speak, right. Is it due to nutrient deficiencies because you're not sleeping? Is it because of heavy metal toxicity or gut health? So we want to approach it from a natural perspective first and see if we can get things back on track and prevent.

And of course, you're looking at cortisol because oftentimes it is the stress of life that's kind of detracting from what we think about in terms of sex hormone health.

Absolutely.

Or even thyroid health.

Even thyroid health, yeah. Because cortisol, your body will always sort of prefer cortisol production when you're in a stressed environment.

It's going to choose life, right?

It's going to choose life. Exactly. It's not time to procreate, it's time to survive.

Yeah.

And. And sometimes people will say like, well, stress. Well, stress can be. You could be over exercising and malnourished. You could be working with a boss who is overbearing. Right. And you're constantly. Every time you open up your inbox, you've got a spike of blood. You know, your glucose goes up and your cortisol goes up. You could be in a relationship that's extremely stressful, or you could be. You know, there are things that you don't choose. You could be a mama who has a kiddo that's suffering with a few health conditions, and that is also stressful to navigate. But what we have to do is. We have.

Or you could be a caregiver to a sick parent.

Absolutely, yes. So we have to take a look at, let's say, stress and our. And our. You know, as much as we live in these urban environments, our brain is still pretty primitive in some ways, which is it wants to protect us from getting hurt. And that cortisol response is real. And no matter what situation you're finding yourself in, maybe you're the caregiver. You're. Maybe you're that busy mom or you've got that crazy boss that you're working for. We have to build tools to help us manage that stress, because that's actually one of the things that will throw women into early menopause is stress. And a significant stressful event.

Yep. And that is not even to mention like a loss, a death in the family, a divorce, move. All of these things have profound effects because they are profound stressors. Yeah. And so they're going to have profound effects on your ability to make your hormones and which hormones are being made and which aren't, because, again, your body is always going to choose survival over procreation.

Absolutely. And when we address, let's say, the stressors and try to approach improving hormone levels in younger women in perimenopausal, let's say, say using more natural approach, if we don't get the results that we're going for, let's say the hair loss is still there, the weight gain is still there. It's still a libido. And we're struggling to get the hormone levels up. Then we start having a conversation about bringing on bioidentical hormones. And for women who still have a cycle, usually the culprit is low progesterone. So I frequently see women experiencing low progesterone levels, low thyroid, lower testosterone levels. So we start to bring those hormones on board. And certainly that's usually part of what we do. We still make sure that their nutrient levels are optimized. So we want to give the body the building blocks. Right. So that it continue to make whatever hormones it can on its own and to support the enzyme activity and detoxification of hormones and all those other good things. But if you can't produce hormones on your own and you've tried all natural therapies, you know, it's not going to. Your body's not going to be able to make more on its own. There's certain shelf life for things.

Yeah, of course. I mean, we all get to the point where our ovaries are just not able to keep up. Right. We only have so much potential over our lives for ovarian function.

And.

And when it's done, it's done.

Yeah, absolutely.

There's no diet that can stimulate that back. There's no gentle exercise, there's no meditation. Like when it's done, it's done.

Yeah. And I hear sort of, with all due respect, was with even our colleagues in our, in our field who will say that you can improve hormone levels through certain diets in post menopause. I have not seen that. And I look at lab all day long.

I mean, with all due respect to those people that are saying that it's a ridiculous notion. Right. Like when your ovaries are done, they're done and there's no diet, there's no movement, there's no sleep, there's no meditation, there's no anything that is going to replace ovarian function except replacing ovarian function. So I know that you have heard people say that there are diets and ways that you can eat and things that you can do that make that can balance hormones in a post menopausal woman. What do you think of that?

Well, once the ovaries are done, they're done and there's nothing that will just replace what they do unless we support this with hormone replacement. And I mentioned earlier that it takes time and it takes trust building with women who especially have been fed lies over many years that hormones cause cancer. And I find it easier to lead in with progesterone, for example. So for women who are very hesitant to start a hormone replacement, I like to double down on progesterone because it is anti cancer. It is not. Not anti cancer, but it's anti cell proliferative.

It's anti proliferative, right?

Yes. It prevents excessive cell growth and a lot of women will feel more comfortable with that because this is something that is cancer protective. And that's what it meant. It is cancer protective. And so women feel a lot more comfortable with that. And even when we just start them on progesterone, they feel so much better. Their sleep is better, their hair is better, skin is better. A lot of the, a lot of their symptoms do feel better with progesterone. And I do so much education in my practice that I'll provide the research material on the benefits of estradiol. If it is a woman who's going through menopause and is in men and is now in post menopause, I'll provide the research behind the benefits of estrogen replacement and estradiol. So we always are using bioidentical, we're not never using synthetic hormones, whether it's progestin or synthetic estrogens. And once we build that trust and once we introduce hormones in not super physiological doses like pellets, for example.

Right.

We don't start with that. And once we introduce it in baby formulation, just the minimum amount and they're starting to see the benefits and their labs are not crazy and their, their quality of life continues to improve, then we're on the right track. But it takes a little bit of time and education and undoing a lot of the lies that women have been told over so many years.

Now, one of the major lies that women have been told is that hormones cause breast cancer, especially hormone replacement causes breast cancer. So how do you address that lie and how do you approach the woman who has had breast cancer in the past, hormone positive breast cancer, and is now postmenopausal and is suffering?

Absolutely. So again, I have to, I can't just give him my word. I do show plethora of research studies that now have debunked what the Women's Health Initiative had said previously.

Yeah, that was really the landmark study that created all of the fear around hormone replacement.

Yeah.

And a lot of women still, even when I have a conversation with them, that hormones don't cause cancer. And, and here's a statement essentially retracted what the Women's Health Initiative had done in the first place. There, there is that fear that is underlying in this decision making process. So what the turning point for a lot of women is is what happens next if they don't start a hormone replacement. And that I think has now been even been a bigger fear for women because they don't want to have a heart attack, they don't want to lose their mind and have dementia or Alzheimer's and end up in a nursing home. They don't want to have a major hip fracture. Right. And their lifespan. So it's, and I think it's important.

To note that the same number of women every year die. From a complication of a fracture as do die of breast cancer. These are numbers that are not spoken about enough. As far as the benefits of hormone replacement, we have to remember that that Women's Health Initiative study, at the onset, the goal was initially to look at whether or not hormone replacement was beneficial in terms of being cardio protective. And the secondary goal of one of the primary investigators of the Women's Health Initiative was to get rid of the runaway train of hormone replacement. I mean, those were his exact words. And so when a study investigator sets out with a goal to get rid of hormone replacement, and people often ask me why? And the response is, why give one medicine? Right. Why give hormone replacement when you can give an antidepressant for anxiety and depression, a cholesterol lowering med lipid lowering medicine for hypercholesterolemia, which happens after menopause, a bisphosphonate for bone loss, a beta blocker for tachycardia, and on and on and on it goes.

Yeah, it's fascinating to me how many women will come with arrhythmias, for example, irregular heart rate. And it'll be, let's say a woman who. But some of them have premature ovarian failure and some of them are in post menopause and when we start them on hormone replacement, their arrhythmias go away and their heart rate normalizes. And for whatever reason, if they forgot to fill their prescription, something happens. They'll let their prescription while traveling, when they're off of their hormone replacement, they will have this event of arrhythmias happen again. And it's a direct connection. And, you know, going back to what we were saying about how do you talk, how do I, let's say, talk to women about who've had breast cancer and who've been on tamoxifen and how do we build trust with them and get them on hormone replacement? Honestly, a lot of these women, they're so fed up with how they're feeling. They're so fed up with vaginal dryness, they're so fed up with how their skin is looking, the weight gain, they're concerned about their metabolic health. A lot of people, they've never had an elevated A1C. All of a sudden their A1C is high, they're fasting through the roof. And they are given what, the list of medications that you've just listed?

Yeah, yeah. Which incidentally, don't do anything to improve their health.

No, absolutely not. And so a lot of these women, it's actually, it doesn't take much convincing to say, you know what, let's help you get your health back on track and that.

Do you have any concerns that you are promoting cancer growth when putting women on bioidentical hormone replacement?

Absolutely not. There's no doubt in my mind that we're actually preventing women from getting cancer again. And we know it's not just, again, it's not my word. We have research studies that actually show that hormone replacement reduces the likelihood of cancer showing up again.

And this is something that I just spoke on at a 4m, which is one of the largest integrative practitioner conferences in the world. And the, the data we have to remember, you know, women who go on hormone replacement are going to have recurrences, just like women who are not on hormone replacement are going to have recurrences. So it's going to happen in both groups and the data shows that it happens equally in both groups in combined hormone replacement in estrogen alone. It's happening less.

Absolutely.

It's happening less.

So, but happening more. Right. And I think this is the research that you presented happening more when estrogen is combined with progestin. Yes, again, synthetic. Synthetic.

Right.

And, but, but the interesting part is that even though people are having more recurrences on the combined, although we, we again, we have to approach that data with a lot of trepidation because it was data mined and also the control group had less than expected incidence of breast cancer. But I think it's really interesting that even though there was an increase in the number of breast cancers seen with synthetic hormone replacement, the outcomes were better.

Amazing.

So more cancers, better outcomes. And it's hard to say chicken or the egg in that the women who go on hormone replacement are often more health minded, are in general, in general taking better care of themselves, being more mindful about how they eat, how they sleep, how they move. And so we're probably not comparing exact cohorts, but that there is something to be said for the fact that these people are having better outcomes. And I don't think that we should ignore that. That is really meaningful information.

Absolutely. The problem in medicine and some even research studies is that we're looking at these variables and forgetting that there's so much more that goes into any condition or any issue. And if you take a woman on hormone replacement, but we don't address the gut health, the environmental toxins, the alcohol consumption, the smoking, the vaping, the stress levels, and we take a woman in hormone replacement who is addressing her sleep, is not drinking alcohol Is eating a whole foods diet, is exercising in moderation, is sweating on a regular basis, the outcomes. And if we take a thousand of those women and a thousand of those women, the outcomes are going to be different.

Yeah, yeah, absolutely. Absolutely. So I think it's pretty clear and we talked about the benefits. Well, let's really list them, though. What are the benefits of bioidentical hormone replacement? Because I want to make sure that people understand the scope of what's happening.

Yeah.

So biochemical hormones, they support brain health. And what I mean by that, sharp focus, better memory, better cognition, clarity. So prevents brain fog. It also prevents bioidentical hormones. They prevent neurodegenerative diseases like dementia and Alzheimer's disease, which is huge. And women are more likely than men to develop Alzheimer's disease. Bioidentical hormones also prevent cardiovascular disease. And this has to do with. With a. A few factors. So not only can they help improve lipid metabolism and keep cholesterol at bay, but they can also support proper inflammation.

Right.

Because it's not cardiovascular disease. Even if we think about plaque formation, it's not just glucose, it's not just lipid, it's also an inflammatory process.

Absolutely.

Control that as well. Even the plaque accumulation and, and the rate of plaque accumulation. Bioidentical hormones also can support lean muscle mass. Lean muscle mass, how we build it is not just, yes, we can go to the gym and we can eat tons of protein, but if you don't have hormones like estrogen and testosterone in place, because testosterone is really important for both. Estrogen is really important for strength. Strength, we know, is one of the factors. It's one of the longevity biomarkers.

Yeah, absolutely.

And.

And so grip strength alone. Absolutely. Yes. So bioidentical hormones can support lean muscle mass, can support our metabolism, which in turn, you know, supports overall health, strong bones. And we can't overlook the importance of reproductive health as well as vaginal health, libido, sexual health.

Right.

That's also really important part of being a human being. So there are so many benefits to it, including collagen production, regeneration. So skin health, hair health, male health, urinary tract, urinary tract, as well as, I would say, prevention of autoimmune conditions, including rheumatoid arthritis, other autoimmune, and really regulating inflammation. A lot of women who start on any sort of hormone replacement notice that they get sick less frequently.

Yep. And we also, we. We didn't talk about mood and sleep. And it has very important roles in both of those as well.

Yeah. Absolutely. So progesterone, for example.

Right.

It is. I call it kind of the teddy bear of hormones. It really calms us down. It affects our GABA receptors. It makes our mood more even keel. For women who are still cycling and have a menstrual cycle, they'll notice that the period kind of sneaks up on them. That before it used to be this dark cloud looming over their head and they would get into fights and breakups with their partner. Now all of a sudden, they're just. Their mood is even keel throughout the month. And for women who are in postmenopausal, just notice they're sleeping better, their mood is, you know, they're less anxious. And so hormones are extremely important for that as well. Yeah, Mood, absolutely. And see, if you look at.

I'm curious as to whether or not you cycle women who are postmenopausal or you just steady replace them.

I just steady replace them. Yeah. And I noticed that when I've tried cycling them, I've heard sort of good reasons for trying to cycle women. But a lot of the feedback that I received from my patients is that they just don't feel as good when we're cycling the hormones. And so certainly, you know, we'll do sometimes once a week or something like that, like a hormone holiday. But most women, they don't like to be off of their hormones. And that kind of leads me into the. One of the other lies is that you should stop taking hormones after a certain age.

Yeah, yeah. And it's really a shame because the. These people, like, it's their lifeline. And then believing that you should take that away, it just seems. It seems so cruel.

It really is. And that's the thing that I think is kind of the bottom line with the Women's Health Initiative and pulling women off of hormones and depriving women, normalizing these symptoms. It's cruelty.

Yeah, it is.

How can you make someone suffer so much? And that's what, like, I'm on a mission to just buzz these myths and help women at least have these conversation starters with their providers. Like a patient when they come to see me, they don't need to convince me about hormone replacement or testing hormones or doing functional testing. But not everyone is like you or me. Right. Or the colleagues that we have the pleasure with. And so my recommendation is that women, they have to do their research, like, with anything else. If you don't like your cpa, you fire them. You get a new one. If you don't like your lawyer, you fire them. You get a new one, you have to educate yourself about the topic, about the subject and then you have to be prepared to ask these maybe tough questions with your healthcare provider and see how open they are or they, or is their research and their knowledge 20, 30 years behind of what we know now about hormones and the impact on health.

So I think on that note, it's really important to mention like if your doctor is not talking to you about hormone replacement or is telling you that hormone replacement causes cancer and is under, still under that mindset and that belief that that's someone that you need to walk away from, it's time to get a new doctor. Because that, that information has been completely dispelled. It it, the findings of that study were retracted and if your doctor doesn't know about that, your doctor needs a lot of re education and it's not your job to do it. Yeah, I just want to.

Just bring.

Awareness to the fact that Dr. Mary Claire Haver is compiling a database of doctors who are aware of the data, who are practicing good medicine and giving women opportunities for bioidentical hormone replacement. So if you have a doctor that is doing the right thing for you and is keeping up with the current data and is aware of the benefits of bioidentical hormone replacement, please share that information with Dr. Mary Clairhaver. And if you don't currently have a physician that is doing this for you, you have to find one. You do and have to find one.

You have to put in the work. It's sort of like a relationship.

Right.

If you go on a date with someone, you don't have to marry them.

Yeah.

It can just end right there when it comes to your physician. The trick here is a physician may be open minded and say, okay, I'll test your hormones, but are they educated in knowing what optimal levels are? Because technically it's quote unquote normal for postmenopausal women to have estradiol less than 5.

Right.

Normal. Not optimal. Not optimal.

Exactly. So it's not just about. There's a few sort of things that the physician needs to be aware of. Is like one, they need to be open minded to do this kind of testing, but they also need to be educated.

Right.

In optimizing hormone health and not just looking at the lab range and, and not just looking at breast cancer as you know, from a hormone lens or perspective.

Yeah.

It needs to be a total body approach.

Yeah, absolutely. And what I spoke about at a 4m, which is so important is that even in the breast cancer population if you have healed from your breast cancer, if you are no longer actively cancering, then this is something that should be as thought of as part of survivorship, that you need to prepare for longevity, prepare for the future. And so many of the treatments for breast cancer actually interfere with your health. So surgery is traumatic. And we know that chemotherapy adversely affects the microbiome, the immune system. It is very pro aging, it will accelerate heart disease, accelerate dementia, accelerate neuro degenerative disease. In lowering and getting rid of ovarian function, it actually adversely affects bone health. Radiation has its own long term sequela effects. Bone health affects cardiovascular health, affects lung health, and then all the anti hormonal treatments in the long term have very detrimental effects. So if you are no longer actively cancering and you are ready to work on why the cancer was there in the first place, mitigate that. Then it's important to consider hormone replacement for longevity for all the reasons that you talked about for the brain health, for the clarity, for preventing brain fog, neurodegenerative disease, cardiovascular disease, lipid metabolism, supporting lean muscle mass, supporting bone health, reproductive health, libido, vaginal health, skin health, prevention of autoimmune disease, urinary tract health, regulating inflammation, mood, sleep, and that these benefits far outweigh any risks that may be associated with hormone replacement. I think the evidence is indisputable and this is a conversation that everyone should be having. I think your, your comment about the fact that it's a conversation that we need to be having probably way earlier than we are having it. When you first get these signs of menstrual irregularity or weight gain, hair loss, mood changes, like when you're first seeing these signs, this is the time to really start to think about your hormonal health. Yes. Before you have ovarian failure, you can certainly do things like diet and stress reduction and all of those things to try to mitigate and improve your hormonal health. But ultimately our ovaries have a lifespan and when that lifespan is over, the very best thing that we can do is use bioidentical hormones to replace their function and allow for all of these benefits that you so clearly pointed out.

Yes, absolutely. And I want to say a couple of things. Number one, there may be some women and some listeners who may have active cancer.

Right.

And they could be early diagnosed or are actively seeking treatment. And because I get this question frequently is, you know, can you, can you treat a woman who has active breast cancer? And I say, no, let's get rid of the cancer, let's get you back to baseline where you're cancer free and we'll pick up from there. Sort of when you have a car crash, right, you've got to go to the emergency room or the icu. We got to take care of you, you've got to get back on track. And then we're going to figure out how to prevent that from happening in the first place and all the safety precautions that we'll take from that happening again.

Yeah, absolutely.

For women potentially who have. Or for family members who have someone who's actively, who's been early diagnosed or is in the process of doing cancer treatments, we got to get them out of that state and for sure start looking at all the, at all the factors. Yeah.

And that's why I said it's important that you have healed from your breast cancer, that you have completed treatment, that you no longer have cancer. And what I, what I look at in order to say that this person is no longer actively cancering is their examination is normal, their metabolic markers are normal, their inflammatory markers are normal, their tumor markers are normal, they don't have circulating tumor cells. These are all the things that I'm looking at to say, like, this person does not have active cancer. And I want to mention that I am looking at them and saying, why did this happen?

Absolutely right.

Because unless we, unless we figure out why this happened and help people to mitigate that, that's going to be the same person that turns up with a, with a recurrence. So we have to actively think about, you know, why did this happen? We can't just say, oh, well, you know, your cancer, you're five years out or three years out or whatever you are. We have to figure out the why, because what is to stop it from happening again or getting the next manifestation. So if, if that person is still in that inflammatory situation, you know, my friend Susan, I said, like, how did you, how did you heal from your breast cancer? She said, I had a husband, ectomy. So, you know, like, everyone has to do what they have to do to get rid of why they got the cancer. And for everyone, that's going to be different. And as you said before, I don't think that people should take this on, on their own. I think that that's a very difficult thing to do. I think that we all need help. Every coach needs a coach, every provider needs a provider. And, you know, if you're going to try to figure this out on your own, it's going to be a very long and lonely road so there are lots of people out there who can help you on this journey and help you get to the place where you can be a candidate for bioidentical hormones and you can put your focus on pursuing health rather than chasing disease.

Absolutely. That's beautifully said. And I just want to mention that especially when it comes to treating women or evaluating women in younger ages, our hormones really start to decline in our mid-20s. So it becomes really important to understand that, know that, and support women because they can. The. The speed at which those hormones decline varies individual to individual. Some women can go through the. Through it faster, someone will go through it slower, and the consequences are different as well. And if we take something like Alzheimer's disease, for example, we know that the first symptoms of Alzheimer's start about 20 years before the actual diagnosis. So starting early on is extremely important. And the hormone replacement is always there for women to consider and to talk to their provider about. And I just appreciate the work that you're doing. I know when you and I ran into each other at a conference, I was like, my gosh, where have you been all my life?

God brings everyone together in his time.

Yeah. Yeah, absolutely.

So I love your message that women have been lied to. I love the fact that you tell people that it's not normal to have acne, to have irregular cycles, have pmdd, to have infertility, to have weight gain, to have hair loss. Like, these things aren't normal. And. And if they're happening to you, partner with someone like yourself to figure out your why and to get your body on the right path, because we were not put here to suffer. And it's only this environment that we've been put in that causes the suffering. And we can help people to figure out their why and get them back on the path to health.

100%.

Yeah.

Dr. Zinkoff, it was so great to have you here today. How can people find you?

They can find me on drelinazinkoff.com and I'm also very active on Instagram under Dr. Elena Zinkov. So those are the best ways to connect with me.

Awesome. Awesome. So make sure that you connect with her, and we'll make sure to put all of this in the show notes. It was such a pleasure to have you on today. We talked about so many important things, and I know people are really going to love this podcast. If you love this podcast, make sure you like it, make sure you share it, subscribe, make sure you're here every week, and let give. Let leave us a comment Let us know your thoughts and let us know what else you want to hear about. It's Dr. Jen Bye for now.

Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Chen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jennsimmons and remember, MyGen has two N's so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.