40: Unlocking Estrogen's Secrets: A Guide to Hormonal Harmony with Dr. Felice Gersh

Hello and welcome to the Keeping It.

Breast podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turns functional medicine physician, I'm on a mission to empower women to live their breasts and need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment and holistic approaches to support overall well being. You know what I say, Breast health is health. So no matter who you are, a breast cancer survivor, newly diagnosed in treatment, living with metastatic disease, or you're simply seeking to improve your breast health, this podcast is for you. Join us on this transformative path towards better breast health and a thriving life. And now, let's get to today's episode.

Hi, it's Dr. Jen and welcome back to another episode of the Keeping a Breath podcast. Today we have a lady who has really dedicated her life to making health better for women. She is a trailblazer. What she has done, her contributions are way too many to name and I am so privileged to have her as a colleague, but more importantly to call her my friend. And we have plans to collaborate in the future, but until that happens, I wanted to bring you her today. So she is a multi award winning physician, she's dual board certified in OB GYN and integrative medicine and she is really one of those people who have been out there doing medicine right. For a really long time and is the example, the standard by which we should all be practicing. So Dr. Felice Gersh, welcome. I'm so happy to have you here.

Well, I'm thrilled to be here. And we were chatting just before coming on about how much we have to talk about. It's so exciting to try to really get this information out.

It is, and it's important to get this information out. And it astounds me that the things that we talk about are not further out there and something so simple as a menstrual cycle that when there are abnormalities in the menstrual cycle, be it, you know, coming at uneven intervals or heavy bleeding or having a lot of pain and dysmenorrhea, you know, other symptoms around menstrual cycles or missed menstrual cycles, and the medical establishment is still just giving, giving pills, giving birth control pills, putting that band aid on, and women are just, the can is kicked down the road and women are suffering and, you know, they end up in my office. So why do menstrual cycles matter?

Well, they matter a lot. Now, the first thing to understand is that fertility, and you sort of touched on this. Fertility and the menstrual cycles are a vital sign of health. In fact, the American College of OBGYN has finally acknowledged, you'd think they would have figured this out a while back, that the menstrual cycle is a vital sign. So what that means is that you take someone's blood pressure, their pulse, pulse, their weight, those are considered vital signs because they're very clear indicators of if things are at least basically right or wrong. And that's the truth about fertility and the menstrual cycle. So anytime a woman is having infertility and, or menstrual cycle dysfunction, which is all those things you mentioned, it could be irregular cycles, no cycles. It could be very heavy, very painful or emotional changes like PMS associated and so on. And all of these are signs that there's an underlying problem that's occurring in that woman and they need to be addressed. You wouldn't just want to give, like, ibuprofen to someone who has a perpetually high fever. You'd want to say, I wonder why this person has this really high fever. And this is like such ridiculous medical care to just take birth control pills. And they're told, I mean, I hear this over and over. I was put on birth control pills by my doctor to regulate my cycles. You're not regulating anything. You're shutting down ovarian function. You're literally taking the ovaries offline. They are no longer making any or minimal amounts of that vital life hormone estradiol, the type of estrogen the ovaries make, and progesterone, real progesterone. So instead you're replacing them with endocrine disruptors. I know that seems like so hard to hear that it's not really particularly different than if you took a glass made out of, you know, a drinking cup, I should call it, made out of plastic, ground that into powder, put it in a capsule and said, here's your estrogen pill. Because they're xenoestrogens, they're chemicals that can affect estrogen functioning in a whole slew of ways. It could affect how they are manufactured in the body, how they're distributed, how they bind to receptors, how they're degradated, how they're eliminated, all these different functions. And it's not just with estrogen that they're interfering. It's other Vital hormones as well, they often are blocking proper function of other hormones. And so it's really what they are, are endocrine disruptors. And remember, they were designed originally birth control pills to prevent pregnancy by stopping ovulation. Now if you talk about what's going on in the menstrual cycle that is really key to protecting women from developing cancer. There are genes that can be turned on or off depending on the rhythm and the levels of these vital hormones. So our hormones were not given to us in our bodies. We did not evolve to use them to create disease states in our bodies. Like we didn't have hormones to give us blood clots or to make us demented or to give us cancer. It doesn't work that way. However, endocrine disruptors can do all those bad things to us by dysregulating our immune systems in very massive ways. So if you just take the menstrual cycle just in two little ways, when you have high levels of estradiol, it actually is very anti inflammatory and the estradiol level spikes up at the time that is preceding ovulation. And during that time, big spike, you actually turn on tumor suppressor genes. These are genes that are designed to help protect us from developing cancer. When you have the peak of progesterone in the luteal phase, you actually also turn on these tumor suppressor genes. And when you purge the lining of the uterus, you're actually not just purging the lining during the period, but there's actually been limited studies because nobody cares that much, but where they've actually taken biopsies of breast tissue during that time and found that the breast tissue that involves cells that are what we call senescent cells or like old yucky cells, sometimes people call them zombie cells, they actually kill themselves. We call that appropriate apoptosis or programmed self suicide. So you're actually creating this dynamic of having your body eliminate the crappy, potentially cancer causing cells of the body. Nature created this purge of bad cells, cleaning out the yuck. And you know, it's a beautiful dynamic which is completely lost if you are a woman who naturally in an abnormal way is having missing or irregular cycles. Or if you're using these chemical compounds known as hormonal contraceptives to either stop you from ovulating or adding in additional chemicals that are doing even more interference. And you're not obviously going to have any of this dynamic occurring in the body. And this is not talked about and this is real science. It's like, no.

You Know, I was talking to my friend Tabitha Barber, and she brought up a really interesting point that is so demonstrated by this, and it's that we think of gynecologists as hormone experts, but you know that your hormonal knowledge and training did not come when you trained to be an ob gyn. And that the, the real hormonal knowledge you gained, that you have today, that mastery that you have today came because you decided that it was important to learn that, and you did. Because it's really not taught.

It's not taught by. Into any specialty. Many women think, well, if the gynecologists are not being taught about hormones, which they are not, okay, they don't even know what birth control pills are. They really don't. They don't. And they don't know what the menstrual cycle is doing in the woman other than giving them periods. They don't get it, you know, what's going on on a cellular level. And the endocrinologists don't know either. In fact, I agree. I have worked very closely with endocrinologists and they have reasonably great, and, you know, variable per doctor, but they have expertise in dealing with thyroid, you know, somewhat, you know, and things in. I mean, we, in functional medicine, we don't always agree with them either. But, you know, in terms of. But what they project themselves to the public as dealing with would be diabetes big time with the. That's an epidemic. And thyroid. Thyroid issues, and not just hypo, but also, you know, Graves disease and other, you know, involvement in, say, with parathyroid hormone or adrenal dysfunction, Cushing's disease and so on. But not. They don't know anything. They're not even taught in their, in their residencies or fellowships anything about the ovaries. They don't know about ovarian function at all. Most of them don't know about androgens. They're. That's not what they're taught about either. They don't really understand, but they're really taught nothing about the menstrual cycle. It's like a desert out there of knowledge, really. And it is. You're 100% right. I had to go and read the scientific literature, which is quite abundant. I really feel so sorry for these amazing researchers. Most of them are PhDs who research all of these hormonal functions in the body, publish amazing papers, and they're not.

No one reads them.

Exactly. You know, it's really. It's so upsetting. But the data is there. Not so Much a lot of data involving clinical studies because you don't have anyone caring enough to do like real big clinical studies. No one wants to know the long term effects that can be subtle and not even always so subtle involving putting endocrine disruptors into the body. And you know, we've touched on pharmaceuticals that are actually sold and they're endocrine disruptors. But then of course, our environment is just loaded, you know, we live in toxic soup, you know, and it's every day I read the environmental news and it's, it's very discouraging with the forever chemicals in everything, you know, and all of these are interfering with our hormones. They're all. It's like everything interferes with our hormones in some form or fashion. And of course it is contributing to, to a multitude of cancers, immune related cancers like Hodgkin's and non Hodgkin's lymphomas and leukemia. So many things like lung cancer, which is happening in so many non smoking women and of course that ever feared and realistically so unfortunately breast cancer threat to every single woman and now at every single age. It's like you know, surreal the number of young women who are developing breast cancer and also the colon cancer epidemic among young people. And what is not even really talked about very much is that the real beautiful hormones of the menstrual cycle, for example, estradiol, is very protective of the colon. In fact, even that ridiculous study, the Women's Health Initiative showed a reduction in colon cancer in the women who were on those sort of crazy hormones.

Yeah. Even with synthetic hormone.

Yes, protective. And we know the gut microbiome, which links to everything now. Right. And that's like the center of the body's universe and is linked when you have an abnormal one to many things, including breast cancer, birth control, pill, hormones will change the microbiome of many of the different structures of the body. The vagina, the endometrial cavity, the skin, and of course the entire gut. And the gut microbiome is the biggest collection of these microbial life forms. And when you have dysbiosis, these abnormal collections, it increases many diseases including it's been associated with increased risk of breast cancer. And of course, when women go through menopause, they have the change of their gut microbiome. Chemicals in our food of course change it. There's so many things that affect it, but so these hormonal contraceptives affect it. And all of these are just like big red flags that we need to like recognize. So we Step in and don't just say, oh my gosh, colon cancer is increasing in young people. That's really terrible. We should probably start doing colonoscopies on 20 year olds. I mean, it's like, it's there. We want to detect. Absolutely. And that's why, you know, I love what you're doing. We want to have early detection, but we also need to be proactive in prevention. And that's my, what, what my goal is, is to educate and to try to help women when I see them at very young ages, you know, and educate them that I, I am like the ultimate feminist. I was a feminist in the 1970s. I was like, yay, go Gloria Steinem and everything. But, you know, I was like, equal rights for women. And I don't want women to become pregnant when they don't want to be pregnant. I just don't want to poison them in terms, you know, with slow poisons to prevent pregnancies. I want to have better modalities. That's what I'm saying. I want.

And it's about giving people a choice. Right? Because when, when we give them birth control pills, we are actually taking their choice away because we're going to cause infertility. And so while they may not want to be pregnant in their, you know, teens and twenties, I, and I don't want to get into a philosophical conversation about abstinence or anything like that. But the bottom line is it's one thing to prevent pregnancy when you don't want to be pregnant, but if that prevents pregnancy permanently, this is a huge problem.

Well, there's so many things that can come from this. Most people don't know, including doctors, that the bone building primary years of life in a woman are in her teens, in her teens and in the first half of her 20s, that's when the majority, like 80, 90% of her bone is built. Those are the years that the vast majority of women now starting as young as one year after the first period. That's what is considered acceptable. And periods are coming earlier and earlier because of obesity, dietary things, chemical endocrine disruptors and too much light and so on. You know, there's a whole slew of reasons why girls are getting their periods younger only one year after their first period. It's considered okay in the medical societies to go on birth control pills indefinitely. So you have girls, 12, 13, 14 going on birth control pills and they're on them until they're into their 30s. Often when now they decide their, you know, their careers are going to be established enough. They're 34 now. They want to have a kid. And they've been on 20 years on birth control pills and things. They didn't build their bone. They were on. They lost. They built some bone, but they did not build optimal bone at all. And bone is a very complex structure. It's not just about keeping you from being a little, you know, heap on the floor. You know, it's not just structural there. It's actually endocrine. So we know that it's an endocrine organ. Like so many things, it actually makes hormones that are very involved in cognition and in glucose regulation and, and muscle as well, is really critical as a. Not just for movement, but it burns glucose. It also creates also signaling agents that are involved in a whole host of things and they're involved in immune function. And these hormones of life that I call them now, they are also regulating your immune system and the immune system in the brain. So there's an increase in de. Depression and anxiety in a lot of these women. So there's so many young women now. They're on all kinds of mood altering drugs. It's.

It's a huge, huge issue. And, and I see the end result of that, right? So when, when we are at these various stages, it just goes unrecognized, unrecognized, unrecognized. And then it's this constant kick the can down the road. And, you know, it's interesting that you brought up bone because we know that every year the same number of women that die of breast cancer die of a complication of a fracture, and yet we are not doing the right thing to protect bone health. We are not talking about the importance of maintaining muscle mass because that is kind of the key to our metabolism. And we are losing our health and we're getting further and further away from it. And it starts really early. It's not just alarming that we're seeing younger and younger women with cancer. It's alarming that we're seeing a lesser quality of life at every stage. At every stage.

And it's like our beautiful endogenous hormones are not embraced and respected for what they are. And they're equated with these, you know, awful, really, in terms of health, these endocrine disruptors. And another, like, really important point about having our own natural hormones is that having vibrant, adequate amounts of estradiol has been shown to increase the. The expression of the genes that are involved in what is called cohesiveness. So when you look at cancer, when you know, cancer is developing, say, in someone. Cancer will not kill if it doesn't metastasize. In terms of breast cancer, there are very few cancers, except maybe in the brain, where it has no place where.

You die of the primary.

Right. Even if it doesn't metastasize, the brain has nowhere to go. But in terms of breast cancer, it's the metastatic component of breast cancer that will kill. And if you have cells that are cohesive, they don't break off and then distribute through the body in the lymphatics or in the vascular system, they're not going to kill. And it turns out that estradiol sort of activates, turns on the genes that maintain that cohesiveness. And so that's really, like a really critical thing, that estradiol is so protective. Instead of its acknowledgment that it turns on these tumor suppressor genes, it keeps the cells cohesive so they don't break apart and metastasize, and of course, create that mortality risk. That. And instead you put these endocrine disruptors that react totally differently than our endogenous estradiol in terms of the effects on genes, the effects on receptors, and so on. And so it's so important not to equate them and not to think that they're regulating your hormones, because I keep saying, and so many, even highly educated women think that you're having some kind of a cycle when you're on birth control pills and you have this predictable bleeding, that that somehow is a cycle. It's smoke and mirrors. There's no cycle. It's just that you grow the uterine lining with the estradiol. I mean, rather the ethanol estradiol that's put into the pill. And so it grows the uterine lining. It can do that, but then you take it away for a little bit. That's. If you stop the pill for a few days, and then it just makes the lining unstable and it comes out. But it's not. It's not a cycle. It's just not a cycle bleeding. It's real blood, but there's no real cycle. And it's. It's smoke and mirrors, but it's.

And quite frankly, even worse are the ones that don't bleed like all these women. But it was such a blessing, right, to be on birth control continuously. And yay, I'm not bleeding. And it's like, oh, my God, we're meant to bleed. Like, we need to do this.

Well, it's so fascinating when you have a normal Menstrual cycle, it's like a reboot to the receptor. So, you know, you need everything. Like the Chinese got it right so many thousands of years ago. The yin, the yang, you know, you have like, and the Ayurvedic medicine, you know, there's hot and cold and wet and dry and all of these, you know, these opposite forces. And that goes into play with turning on and off receptors, rebooting, you know, clearing out so you have a time. That's why when it comes to eating now, it's so big. You know, everyone talks about intermittent fasting, which is a big player in how our metabolism, our immune system is working because everything in our body is on a timer. You know, like 90% of all the genes in our body are either clock genes or related to clock genes. So we know that we should, you know, eat at certain times and sometimes fast at certain times. And it's the same thing with our hormones. Sometimes they should be high, sometimes they should be low, Sometimes we should have like a reboot and then we should stop making like progesterone and it should be a rhythm. These rhythms are really critical to how our bodies are functioning. And we have done a lot in our society to disrupt our rhythms, which of course now we understand is related to immune function and to cancer risk. So that's right. Women, for example, who travel incessantly across time zones, you know, and like flight attendants and other people who work night shifts, they have a higher risk of breast cancer, they have a higher risk of diabetes, obesity, depression, and all of these problems, it's all interconnected chronic disease. So, and it's so important to realize they're all interconnected with creating immune dysregulation and this unrelenting, inappropriate inflammation which then disrupts how cellular function is occurring. And so, you know, understanding that rhythms matter in everything. When we eat, when we sleep, you know, even when we exercise has a different effect. And in terms of if we'll grow muscle, if we'll lose weight, and, you know, men have higher testosterone production around 10 o' clock in the morning. Everything is on this beautiful rhythm. And that is lost when we don't have menstrual cycles. And it's lost when we do everything wrong in our lives, you know, in terms of when we do go to sleep and incessant light and so on, which is really disrupting. So we have so many challenges and we need to just be aware of them so we can do what we can there. I mean, we can't always change the air we breathe, we can get air purifiers and so on, but you go outside, it is what it is.

Yeah.

So we have to do what we can to control the food we eat, when we, when we go to sleep, when we do eat, and the toxic stress that we live with to try to control that as well. And you know, understanding what we put in our bodies, our choices in terms of personal care products. I know this is of such a big thing, you know, like please don't put poison on your body. Like on, in terms of cosmetics and beams and all of that, you know, they get absorbed and we know that a lot of sun blocks were and were in the news not too long ago because of the toxic chemicals that get absorbed into the skin. And of course looking at the GMO foods and the glyphosate and what that means and the, the plastics that are, you know, ubiquitous and with the phthalates and the bisphenyls, you know, and if it says a plastic and it has BPA free and it's plastic, then it means it's BPS or BPF full. You know, there's no plastic. It's like don't, don't pay attention when.

It says don't believe the hype.

Right.

It may not have BPA but it's replaced with something or more toxic chemical. Like plastic is plastic. Okay. So don't do it. Don't do it. Yeah, absolutely. No. Say no. Because all of these things are interfering with having normal menstrual cycles. You know, you may think how is drinking out of plastic affecting my fertility and my menstrual cycles because they're endocrine disruptors. It's like amazing what is what. But we can make choices, you know, in terms of like if you go to an airport and you buy a drink, a hot drink, don't have the lid on that, that the lid is really toxic and the, yeah, heat of the, the hot drink will actually dissolve and absorb the chemicals in that lid into your drink as you're drinking through it. Just take the lid off. And if you can have room in your carry on luggage to bring your own, you know, stainless steel, you know.

Just bring your own, just bring your.

Own and tell them to fill your own container. I know it's not.

I.

You and I travel a ton and I just, I always bring my own container with me. And honestly I'm at the point now where even if I'm desperate, I won't drink out of a, of a plastic bottle. Like I'll just Try to figure out how I can, how I can wait, you know, how.

There's been so much in the news now about microplastics. Yeah. In our fish and then into us and everyone is now filled with microplastics and it's getting in our arteries. This is not good for any part of us. Right. So drinking water out of plastic bottles is really toxic for us now. You know, we had. We can't like be dehydrated on 100 degree temperature day when we're out, you know, doing. But, you know, bringing your own is really the best way to go. 100.

I mean, you know, there were, there were days when I was in Israel and I like, absolutely didn't have a choice. Had to drink out of a plastic bottle. That was all that was available. And, you know, I had already drank what, what I had, filled my bottle in the morning and drank it. And, you know, so of course there are going to be times, but for the most part we can make a better choice. I want to go back to something that I don't think we've touched on enough. We have villainized estrogen. And everyone is.

You.

You're talking about the benefits of estradiol and how protective it is and that it is in. Involved in turning on our tumor suppressor and it is involved in so many protective processes, and yet everyone thinks that estrogen is our villain, that estrogen causes breast cancer and that we should get rid of all of our estrogen.

It's pretty shocking, isn't it? Like, no one is really even talking in the medical world of so what would be the mechanism of our biological endogenously produced estradiol harming us? What would be the mechanism? When you really look at how estradiol works in the body, it actually activates the on and the off switch for inflammation appropriately because it has different effects on receptors that involve every aspect of immune function or every single immune cell in the body has estrogen receptors. But it's not to harm us. It's to keep us optimally healthy and it's to manipulate our immune system so that we don't kill off the fetus. Of course, because everything ultimately is about reproductive systems, reproduction. It is. And our immune systems are so dynamic that we can actually have this alien growing in us and we don't kill it. So our immune systems are designed for survival, not for death. And so that's really. And our immune systems are controlled by these vital life hormones like estradiol and progesterone are incredibly involved in immune function. For the proper function of the body not to harm us. And estradiol does turn on inflammation when you need it, because without inflammation, if pathogens like bacteria and viruses try to get into you, they will kill us. If we don't activate our immune system, if we have an injury and we have like burn, a big burn on our skin, we want to activate our immune system because we have broken skin. We don't want the pathogens to get in. Plus our immune system has these incredible capabilities of dissolving dead and damaged tissue, gobbling them up. And then we have to create the post inflammation resolution phase, which involves the creation of growth factors which grow new tissue and angiogenesis, creating new blood vessels to take care of and feed the new tissues that are develop. All of this is under the control of estradiol. And if you have a laceration, we don't want anyone to bleed to death, Right? So then you have the inflammatory process triggered, and that involves constriction of the arteries to maintain your blood pressure so you don't hopefully go into hypovolemic shock. And you also activate your platelets to aggregate or accumulate and then create clotting so that you don't bleed to death. But all of this is finally regulated by estradiol. But if you have ethanol estradiol, or conjugated equine estrogens, that is what they.

Use are the synthetic ones that are used in birth control pills. And. And right, so the birth hormone replacement.

Right, so we have the birth control pill hormones which are ethanol, estradiol. And then we have what was in the Women's Health Initiative, which came from horse urine, which was then powderized and made into a tablet and given orally. Those work primarily on one receptor in the body, which basically turns on inflammation. That's why they're pro inflammatory and pro clotting. That is not what the balanced effect of estradiol has. So the way I really look at it is there's this sort of evil twin. They're not even identical twins. It's like, you know, fraternal twins, but they're the same gender. So you have this evil twin, and all the harm that that evil twin can do is now reflected inappropriately on the good twin. So estradiol has no mechanism to create cancer. It's the exact opposite. It prevents inappropriate inflammation, which is what underlies cancer development. Because when you have pervasive inflammation, you end up with DNA instability and damage, and you're not optimizing all the mechanisms for causing the cells that are Yucky. The zombie cells to kill themselves all. None of that is properly in play, which is all controlled like estradiol is. What triggers, what are the benefits like in terms of fasting? Like everyone, it's like we love fasting and you know, the, that multi day fasting or fasting mimicking diets. And I do too. But the enzyme system called the sirtuins, they're called histone seedylases, they work in conjunction with estradiol to create all the benefits that involve what is called autophagy, intracellular rejuvenation and programmed self suicide where you kill the zombie cells. All of that is triggered by this fasting mimicking diet and multi day fasting up to like, you know, three, four days, not like, like weeks of fasting, you know, short term fasting. And these amazing mechanisms that are looked at as the key to healthy longevity, all of that, they're triggered in conjunction with estradiol, all of these factors. And it's not appreciated that estradiol is the master of metabolic homeostasis because it's once again it's all about fertility, success, reproduction. And in order for someone to live, to raise their children to be successful, you need to have all these mechanisms. So the body evolved that estradiol would be the key player. In fact, estradiol receptors, estrogen receptors have been found to be the earliest of all the steroid hormone receptors, going back millions and millions of years. In like prehistoric creatures that did not reproduce like humans at all. Like things that were like clam, like the prehistoric clams and such, they actually had estrogen in them and it was all about their metabolic functioning and maintaining immune function and all of that. So the primary initiator of what estradiol did in the body was to maintain life itself. And then it became part of our reproductive system. And it's really almost like, you know, like looking at it retrospectively, it really is about life itself, not just about making periods, it's about maintaining every organ system and the body. And it's so sad that estrogen, that is not even a hormone, estrogen is a family of hormones and they're including in that family, which is so bizarre, endocrine disruptors, you know, so they're including things that don't. It's like you have this strange person who's not part of your family, who is a trespasser, comes to live in your house, doesn't even belong there and is trashing your house. And you say you're part of my family. No, this is a trespasser. Who is disrupting your family. Get this person out of your house. This person doesn't belong there. They're actually like saying that endocrine disruptors are estrogens. They should call them xenoestrogens, not estrogens. The estrogens of the human body are three types. And people don't, even doctors don't know this. There's E1, E2, E3, and E1 is Estrone. It reacts to, it binds to the alpha receptor E2. That's the estradiol that's made by the ovaries. It binds in a balanced way to all the receptors. And there's E3, estriol, which is the dominant estrogen made by the placenta. And it binds primarily to the beta receptor, which is why pregnancy is a very unique state where you have a lot of Estriol. And there's a whole like, complex story backstory to that about why that is essential for modulating the immune system, changing the gut microbiome to make a little bit of inflammation. That's why women who are pregnant are always on the edge of having gestational diabetes because they're a little insulin resistant to give them more insulin to grow more fat, to make more blood sugar, elevation to feed the baby. It's a whole like, dynamic of pregnancy. It's like super fascinating, but that's not what we want. Except when you're pregnant, because that's a state. And so. And then there's another estrogen that's called E4 Escital, which is a fetal estrogen, which interestingly enough, is now in a birth control pill. And that is because they can manufacture it. Somebody figured out how to create bioidentical fetal estrogen. So what the heck will just put it in a birth control pill? It's like the weirdest thing ever that would never exist in an adult human. It's a fetal hormone. It's like, where is this thinking coming from? It's like, if you can do it, you just will do it. It's like the strangest thing ever.

Yeah.

So understanding that estrogen is not a hormone and that they're putting in xenoestrogens, you know, endocrine disruptors in the same basket. And then you can understand why they're not all the same. They're differences. It would be like they're, you know, like once again, like one bad family member and is, you know, doing bad things and the good family members get all the blame. It's like, this is not fair. Estradiol is not to blame. It is there to maintain our equilibrium in all our metabolic processes, our immune processes. And when they say it causes breast cancer, it is so bizarre. And it's like a whole completely different scenario. In fact, it's really fascinating what breast cancer can do. When you get breast cancer in a breast, it is so inflammatory that the inflammation will turn on high mode, like turn up the production and function of an enzyme called aromatase that converts androgens. Those are like male type hormones, most of which come from the adrenal gland like dheas. Dhea. And it converts them into estrogens. And the one that it's mostly converted into is estrone, the one that works on the alpha receptor. Breast cancer, when it has estrogen receptor positivity, is virtually always alpha receptor positive. So the breast cancer is its own unique creation, which is an aberration, of course, due to chronic inflammation that's in breast inflammation from all these different multitude of causes. But when you have that high inflammation that's actually generated by the cancer itself in the surrounding tissue of the breast, the surrounding breast. Breast tissue actually upregulates the enzyme aromatase and starts producing locally right adjacent to and surrounding the breast cancer, high amounts of estrone. And this breast cancer generated estrogen in the form of estrone, then can create growth factors that can grow and promote the growth of that breast cancer itself and create new blood vessels. That has nothing to do with this initiation of the breast cancer, nor does it have anything to do with estradiol, because if you have the beautiful rhythms and appropriate amounts of estradiol, it will lower, not eliminate. There's never. You can. In our world, you can never eliminate risk, but it's going to actually reduce the risk of that chronic inflammatory state in the breast that will precede the development of the DNA changes that leads to the breast cancer. But once breast cancer is there, once it's already there, it does its own thing, which is completely unrelated. And, and it's, it's, it's not the problem, it's not the cause, you know, Right. Related to the estradiol. So it's really important to understand these mechanisms because that's what functional medicine is all about, is not just memorizing rote things with no particular purpose and not any understanding. If you understand what's happening on a genetic and cellular level and how it interplays with the immune system, suddenly it all makes sense. And that estradiol is protective, progesterone is protective, and breast cancer does its own thing in creating its own Growth mechanisms. But that is a consequence of inflammation and loss of proper hormonal balance and the ubiquitous chemicals and endocrine disruptors and nutritional deficiencies and chronic stress and light. All these other things, sedentary lifestyle, all the things that create the precursor environment that can lead to the cancer development. And by understanding this, we won't be afraid of, of our own beautiful hormones and understand that they're protective and that, you know, it's just, it's not even like rocket science. It's like that's what's so bizarre. I keep thinking. But doesn't everybody know this stuff? But the answer is, but they don't. They don't.

And, and they, and they stop thinking about it. I mean, what ends up happening is, you know, someone gets a biopsy and they have a cancer diagnosis and they look for estrogen receptors. And the estrogen receptor is upregulated because all breast cells, normal breast cells, have estrogen receptors. So we shouldn't be dismayed in any way about your tumor being hormone positive. And your tumor being hormone positive does not mean that it was caused by the estrogen in your body. Like, people need to get rid of this false association because it's simply not true. And it's mostly there for the con of the pharmaceutical companies because they came up with drugs to interfere either with the reception receptor or to interfere with aromatase. Right? So, and I get it that when you're talking about an intact tumor, there may be some benefit to inhibiting aromatase. Right? But once the tumor is gone, which is true for the vast majority of women, those who present with local disease and don't have metastatic disease. Right. Those who present with local disease, there is not a role for tamoxifen or an aromatase inhibitor after that primary tumor has been removed. And when we are giving women these medicines, we are changing their lives for the worse. We are really interfering with the quality of the rest of their life. Tamoxifen itself is a known carcinogen. It's a known carcinogen. We are giving someone who has already said, I can't handle the toxins in my body, and we're giving them another one. It's crazy to me.

I 100% agree. And there was one interesting study that nobody paid attention to as well, where they gave women, I think it was anastrozole, one of the aromatase inhibitors which would block the local production of estrogen in the form of estrone, predominantly by the breast cancer. But then what did they do? They gave them bioidentical hormone replacement therapy so that all the other organ systems of the body would get the proper hormones. And, and those women did great. I mean, I don't know that you even needed to do what they did, but in. But what they did was recognize that what you need to do is block the production of estrone generated by the breast cancer in the breast. But then they said, but what about your brain? What about your bones? What about your arteries? What about every other organ system?

Because it's a legitimate concern, and it.

Is such a legitimate concern. Women like you mentioned, in terms of fractures, 80% percent of osteoporotic, osteoporotic fractures are by. In women. And over 50% of women will have an osteoporotic fracture, many of which lead to death and all of which lead to some morbidity, like decreased quality of life. And then women make up the majority. They make up more than half of all the joint replacements due to osteoarthritis. Two and a half times compared to men, the incidence of Alzheimer's disease. You know, women have high rates of every kind of cancer now that they used to not even experience it. Used to be that's a male cancer, like bladder cancer. Not anymore. You know, women are getting equal opportunity, you know, for all these different types of, of sense.

Since the Women's Health Initiative. Since the Women's Health.

Yeah, it's incredible. And, you know, so definitely, you know, we need to be defending our, our hormones and understanding that shutting them down for like years and years. Like, what are they doing now, seven years often with these, you know, aromatase inhibitors.

I mean, sometimes people are up to 10 and 10. We're seeing these staggering statistics where women who are treated for breast cancer are two to three times more likely to die of heart disease than women who aren't.

And the radiation, you know, and you're more expert at this than I am, but I'm seeing women still undergoing really high, significantly dosed radiation therapy for what is really local disease. I mean, and they're, they're, they're saying that this will lower your breast cancer recurrence in the breast, which is not about a life and death issue either. And it's really small. It's like a small statistic. I don't even know how real it is, but they're, they're putting this radiation not just into that one spot of the breast, which, you know, is a carcinogen. I always, like, think this is weird, you know, but you're irradiating, even if it's on the other side from where the heart is. It turns out that you're really doing significant radiation damage to the heart. And it's the muscle of the heart and the vascular, the coronary arteries. And I've talked to cardiologists who have done looking at angiograms and such in women who now have heart disease related to the radiation. And they say their arteries are like brittle, terrible little structures. They're not normal. You can see the radiation damage to the coronary arteries and of course, lungs. You're irradiating the lungs. So, you know, you have to. Everything in medicine is about risk. With every drug, every procedure, it's risk benefit ratio. So is the risk below the damage below the benefit. And I think that's lost a lot in terms of breast cancer therapies and that they're not really looking at the global harm that's being done rather just. Well, does this lower the risk of something related to breast cancer by 3%, 5%? You know, some, but. And they're always talking in percents. When you look at real numbers, often like you're talking like per thousand people, you're saying like two one. I mean, like, is this making sense? You don't, you don't want to remember like when they talk about statistics, if the ratio or we'll say the incidence drops from 2 in 10,000 to 1 in 10,000, then you have, oh my gosh, a 50% reduction. Yeah, 50% reduction, of course. But it's one person out of 10,000. How much harm. They always talk in statistics, not in real numbers. Which skews it in such a way that it's. It's almost impossible for the average person to really get a handle or doctors like the doc like I always read these studies, I want to know, but what are the numbers? I don't care about the percents. I want to know.

You want the absolute numbers?

I want the absolute numbers because, you know, when I see a drug, you know, there's been like the. In the news, you know, with like wegovy, you know, and the incident. Now it's approved for heart disease prevention and the incidence of heart events or stroke and heart attacks was in the treated group was something like six something six and something percent and a little over 8% in the untreated. So we have like less than a 2% difference there. But it makes statistical significance. I don't know how I never took enough statistics to understand how everything meets statistical significance in these studies. But if I want to know what's the absolute numbers. Because once again, if it's like a reduction of a few percent, but in actual numbers, we're talking about one person out of a thousand and they're all on this drug, you know, and that's the reason for the use of the drug, then maybe at a thousand something dollars a month, maybe that's not the best utilization of our funds. And there are better ways like exercise, you know, that will do better, something like that, you know, so, you know, and the same with breast cancer reduction. You know, a lot they do use drugs for breast cancer reduction. But why don't you just like eat a better diet, work on endocrine disruptors, work on fitness and sleep and you'll lower your risk. The biggest risk to postmenopausal breast cancer development is obesity, weight gain in menopause. And of course that creates that inflammation, you know, the visceral fat and the inflammation. And we know how to lower. I mean, this is by getting women in early during perimenopause. I'm totally pro treating women who are in the early stages of hormonal change, which is perimenopause, getting them on hormones early. And I call that supplementation. We just need to treat menopause for what it is, a hormone insufficiency and then deficiency state. If you have low thyroid, nobody says, ah, who cares? Or let's wait until you have zero thyroid hormone, then we'll for a year.

That is happening though that unfortunately is happening in the thyroid world is they are, they are waiting for those people to fail.

And not in my office. Right?

Not in your office.

That's true. Not in your office under treatment of thyroid. That is true. Or not treating to optimization. But yeah, but the bottom. So I have to look for a better analogy. But the bottom line is that it makes no sense. If you're even going to consider hormone therapy for women to say, well, you can have hormones for a few years, but it has to be after you haven't had a period for 12 months. That makes no sense at all.

It makes no sense.

No sense.

And the further you get away from that hormone optimization, the more damage is being done. That damage really an accelerated fashion.

Oh my gosh. We know that in the years preceding that last period, there's seriously high rates of loss of collagen, which collagen is involved in everything in the body and not just bones and joints and skin and, and vascular structures and all. And you have plaque already forming in your arteries, you have changes in your brain structure and women have Word finding that they can't remember names, they can only remember adjectives, you know, so it's like really a real thing. That's the thing. And we need to get on this early and recognize that these hormones have vital functions. The fact that it's natural and universal to lose these vital life hormones doesn't make it good. Remember menopause and living in menopause is really not something that has, has really been common throughout humanity, through the history of mankind. I went back and looked at ancient Egypt and in ancient Egypt if a woman, and this is, you know, three to 5,000 years ago and that's our first recorded history. So I'm sure it wasn't better before that, you know. And humans have been on planet Earth for a long time. So if a woman survived childhood and she became an adult, her longevity, if she made it to 35, that was good. So yeah, she didn't make it to menopause. Menopause wasn't a thing. And if you go back to the year 1200, if you live to 50, if you survive childhood, that was good, you know, so you got to the age of menopause and it's only recently that women literally can live half their lives as menopausal women. That's not a, that's not been part of humanity's history. That is a new thing. And we have medical whack a molecule. Whereas every problem that's related to so called aging comes up. You have a drug and a procedure, one or the other or both. And my thing and your thing is prevention, you know. And so you have to get on this understanding that aging is not about number of years, it's about number of deficiencies. And it starts with hormonal deficiencies and then it leads into immune deficiencies, nutrient deficiencies and so on. But if you can maintain these structures and these hormones to be and cells to be optimally functioning at every age, then you can actually delay these so called diseases of aging. And that's what we call super aging, right? And that's what we want everyone, if we're going to live long, let's live cheaply in terms of the society cost for our health care and also so with high quality. So my definition of being a superager is that at 95 and beyond, you can do pretty much maybe not perfectly everything you could do when you were 40. And why not? You know why not? Because every cell in your body is a different age. There's very few cells in our bodies that are there from the day we're born and we, that's why we have stem cells and we want to maintain our stem cell pool and to keep it healthy. So when a cell is born in your body, like we know bone cells typically have a seven year lifespan. So when a new bone cell is born, it doesn't know how old the person is that it's just born in. It doesn't say, you're 70. So I'm going to act yucky. No, it's going to, it's a, it has all the same genes that you would have when you were made a bone cell at age 20. And if you give it what it needs, the micro macronutrients and the directions to do with them, what it should do, which is the hormones, they will still do it at any age. Now, that doesn't mean we can prevent aging, but we can really slow down the progressive deterioration associated with aging by maintaining proper nutrition and avoiding poisons and maintaining our hormones. And that's my goal for me. And that's why I feel like I have, I'm sort of at the forefront of being an older person in this world, you know, in this, this functional medicine world. So I, you know, I feel I have to be the role model for super healthy aging. Right. So, you know, and you are, and.

You are, you are the steroid.

So, you know, I say, you know, like, I'm hormones for life. And that's my other thing. This craziness of if you do go on hormones, they become even more dangerous. They're always dangerous, but they become even more dangerous if you reach 60. Like, where the heck is that coming from? Stupidity from the Women's Health Initiative. Like, let's get over that. Hormones don't change how they work in your body at 59 versus 61. This is like nuttiness. It's hormones for life.

Yeah. So I know that you, you understand all of this. Most medical practitioners, probably because of the Women's Health Initiative, know very little or anything about proper hormonal balance, proper hormone cycling. And so I think that this movement is going to be solved by women because I think that they're going to demand it. They are going to demand it.

It's definitely from the bottom up. It's not from the top down, 100%. I am trying so hard. I am writing articles and getting them published in like the most prestigious medical journals. And every time the editor of the journal says, this article is fantastic, it's going to get so much readership. And then, I mean, it's like, I'm not giving up. But every time it's supposed to be, this is going to go, you know, viral, this article. And it's like, no, it didn't. I just had another one published like about maybe six weeks ago. And it's like, this is going to go viral. It didn't go viral. You know, it's like so hard to change, change the minds of doctors. It's like, why are you so stuck? Why are you so stuck? You know, why are you not curious? Why are you not open minded? But it's not happening. I am trying from the top down. I'm not giving up. But it's really from the, it's going to be from the bottom.

It's going to be from the bottom.

Up and women are going to demand it. They're going to demand it and demand like, I want my hormones, I want my hormones and I want them and I don't want to stop them because I have patients calling my office all the time. I turn 60 and now my doctor refuses to give me hormones. It's like, we'll come over here, you know, it's like, yeah, I'll give it to you. Like, unless you have some obvious contraindication, which is really uncommon, you know. Yeah. Why would I stop them? Just because you hit a birthday. That's ridiculous.

Yeah, ridiculous. So I would love to spend the rest of our time just mapping out for women, when should they start to test, when should they start to replace? How, how do they know that it's time? Because we know that it's at least a 10 year process from when your ovaries start to shut down and you need to supplement to when they are, you know, completely done and you need to replace.

Well, first, just if you're younger, reproductive age and you have irregular cycles, you need to try to do everything in your power to find someone who will work with you to try to get them right. So, you know, you want to start early and don't cover up the problem with masking endocrine disruptors. Now when you reach the, the average age for menopause, which is defined arbitrarily as 12 consecutive months without any bleeding, is 45 to 55. That's a whole decade right there. So if a woman is going to actually stop having periods at 45, her perimenopause would be like at 35. And then there's early menopause, which is from 40 up to 45. And then they would be starting to change, you know, when they're already like 30. So find out what happened with your mom? Assuming she didn't like have a hysterectomy.

Right.

Because there is, is some genetic linkage there. And if your mom had a very early onset of menopause, then we should probably think of you as potentially another early person. And so I would start figuring that if you're going to be in the average range though, that by age, certainly by around age 40ish, that's when you should start thinking of perimenopause. Now if you have symptoms that is like a clear cut thing, like night sweats, hot flashes, but of course those are like the most obvious. But you can have subtle things like your sleep is now changing, your mood is changing, you're having palpitations, you know, you just feel weaker. So you can have like these more subtle, you're starting to have acid reflux. These are some of them in joint pain, more of like sort of inflammation. These are the more subtle signs that your hormones are changing. Maybe you're having brain fog, you know, you just feel differently, you're losing your sex drive. And that is related to estrogen, not just testosterone. That's like another whole subject. But so if you have signs that things are really changing in your body, listen to them. That's probably that your hormones are changing because hormones are about everything. So at that point it would be reasonable. And this is obviously assuming that you're not on something that's blocking your hormones. Like, you know, you're on birth control pills, because then, right, it's whatever, it's not your own natural hormones, it's something else. It's, you know, the effect of the birth control pills or other things. But assuming you're having your own natural cycles, if you have changes in your cycle, the most common being in the early stages, perimenopause, is that the cycles get shorter. They're getting shorter because the ludal phase, the, the point from ovulation to the period which is when you make progesterone, it's getting shorter because you're not making progesterone as well. And so the luteal phase gets shorter. So maybe you had a 30 day cycle, now it's 26 or 27. Like it's just a few days different, it's shorter. That's a sign things are changing. So I like to do menstrual mapping where you can collect urine samples throughout a cycle multiple times. And then it's like mapped out on a graph and it's just so instructive. I have like a whole collection of These showing how also it links to symptoms, how your, your hormones are really linked to the feelings that you have and you're not crazy. Like 25% of women are started on antidepressants in their 40s. Like, duh. It's your hormones that are changing your brain. And you don't need an antidepressant. You need hormones. This is like nuttiness. So starting early, looking at menstrual mapping, looking at your own symptoms, looking at your mom's history. Now, in someone who is very borderline, say, I may not even start them on actual hormones. I may use phytoestrogens and like herbals because they have effects on the hormone receptors themselves. But once I'm sure that the progesterone is not adequate, I'll supplement with progesterone. When the estrogen is not adequate, I'll supplement with bioidentical estradiol. There is no danger, there's no risk to this. It's ridiculous not to do it. And basically it's giving you a safety net. When you give bioidentical hormones like this, it's not changing how your ovaries are producing the hormones. It's not shutting them down. It's not like a birth control. It's not giving contraceptive benefit either, you know, so you can get pregnant on them. It wouldn't hurt you if you got pregnant on them. They're bioidentical hormones. But it's not contraception and it's not shutting down your ovaries. It's giving you like a little layer on top so that you have, have a better amount. So I call it hormone supplementation. Now, once the ovaries cease to make the hormones, which of course will always happen, then I call it hormone replacement therapy. So it's supplementation, then replacement. There is no absolute roadmap for this. Every woman has to be very uniquely looked at and what her needs are, what her goals are, what she's willing to do, and so on. When we give hormone supplementation in a woman who's still having cycles, then we, we give it to blend with her cycle. When we give it to women who aren't having any hormones, we can just create our own cycles because she has none. So we don't have to like, blend it. The most challenging women are the perimenopausal women because they are like, you know, like, like, you know, loose cannons because they're, they're in flux, their hormones are changing. And I'm not changing how their ovaries are going to work. I'm just making sure that they don't fall too low, low. So they're a moving target. They're interesting group because sometimes in perimenopause there's overshoot. That's why it's a group that has more twins, because they still have the capability of ovulating, but their brains are like, struggling to try to get them to make the hormones in a proper amount. Sometimes the brain through the pituitary will put out too much stimulating hormone and they'll double ovulate that month. And then they get twins. And then they will sometimes make way too much estradiol. That's when you can actually have too much. It's very brief time of life that you can have the ovaries make too much estradiol due to this overshoot. So sometimes you have too much and that's. And then it goes down. And that's why the perimenopausal years can be, you know, aligned with things like sudden onset or worsening of migraines and breast tenderness and crazy mood swings because you have fluctuations in hormones. And when I give hormones, I'm trying to get the brain to say, you know what? But the hormones are okay, you know, so you don't get those huge wild fluctuations. And sometimes it really does work because if the brain receptors say there's enough estradiol because you don't get those big dips and then the ups and then downs, then you won't have those giant ups and downs. So the way it kind of works is the tendency is always down, but along the way down, you can get these spikes up. So I want to keep the spikes up and down, those big spikes from happening because they can be really like a roller coaster for women. And we don't want to have that. So we try to give some baseline estradiol so the brain sensors will say, okay, we're good. We don't have to do the overshooting and the undershooting and the overshooting. So it's it. It can really help to level things. You're still going to go down, but, you know, I'm trying to prop you up so you don't also have those giant ups and downs. And it can make the roller coaster of perimenopause much easier. Much, much easier and much healthier because nobody wants to go through these. And it's not good for the body, you know, these gigantic crazy swings either.

Yeah, yeah, absolutely. So lastly, I do. I do want to touch on the topic of testosterone. A Little bit. Because I feel like a lot of women, they think they need it, they want it, they're not sure about it, they're afraid of it. So can you talk a little bit about testosterone supplementation?

Sure. So in a female, a reproductive age, normal female, 25% of the testosterone in the body circulating in the blood is made by the ovaries, just 25%. The other 75% comes directly or indirectly from predominantly the adrenal gland. So the adrenal makes 25% of the testosterone that's circulated, but it also makes a large amount of androgens that can be converted primarily in fat tissue, but other tissues as well, through the different enzymes, into testosterone. So most testosterone, the body, is actually derived from the adrenal gland. Now, the ability of the ovaries to make testosterone is lifelong. It does not require a single egg. So you could say the skill set of the ovaries to make testosterone is completely separate from the skill set to make estradiol and progesterone. Totally different skill set. And during the perimenopause, when the brain has sensors and says, not enough estrogen, it will trigger more production of testosterone. So the way that it works in the ovary, testosterone is produced in a group of cells, the theca cells. And then testosterone moves to a different part of the ovary, the granulosa cells. And in that part of the ovary, under the action of the enzyme aromatase, the conversion occurs that testosterone is converted into estradiol. 100% of estradiol in the body is derived from testosterone. 100% of estrogens in the body are derived from androgens. And testosterone is a specific androgen. So when the brain says, oh, not enough, enough estradiol, because I have sensors and it's not enough, it triggers the ovaries to make more testosterone. And the ovaries are good at making testosterone. No problem there. Different skill set. So you can have, in the perimenopausal years, an overproduction of testosterone, because it's like an assembly line. So you have a little glitch here. You don't make as much estradiol, but you make lots of testosterone. So you have too much testosterone and then not enough estradiol. So some women, it's not uncommon in the perimenopause in early menopause, will say, what is happening? Am I going through puberty again? What is this? They're getting acne, they're getting. Some hairs are growing, their hair is thinning. Androgenic alopecia. The last thing they need or want is more testosterone. And so many doctors just automatically say you're in menopause or perimenopause, you need testosterone. Where the heck is that coming from? That is not science. That is ridiculous. You can make testosterone without, you know, being able to make estrogen. You always make testosterone now and most of it is coming from the adrenal. Now as it happens, the adrenal gland, the section that makes androgens, is called the zona reticularis. And like many things in the body with aging it becomes less functional. So the zona reticularis will actually somewhat shrink, shrink as people age. And so there tends to be a decline in androgen production with age. That's why some people think of DHEA as, you know, like an anti aging hormone because it's anabolic, it helps produce muscle and bone. And there's actually data showing that it can help prevent osteoporosis. And it. So the adrenal gland will make in, you know, statistically, but there's no exact time in life. It's not related to the menopause will make less androgens over time. So there are women that will benefit from supplemental testosterone or DHEA with aging, but it's separate from the menopause. It's really important to know that women, some women will have a deficiency of androgens even when they're like 40, you know, and they may benefit long before menopause, like a decade before menopause from having some additional androgens. There's even data, published data that giving supplemental DHEA can prolong the function and lifespan of ovaries that it's part of like women who are sort of heading into the around 40 and they want to have kids and their ovaries are aging. And that's one of the treatments to try to prolong ovarian function is to give DHEA because the adrenal may be declining. And that's not a good thing because some women will have too early of a decline of their androgens from their adrenal gland. And it's interaction of everything, but it's separate from menopause. So, so you want to look at these hormones. And the other thing that's sort of tricky about testosterone is that a lot of the action of testosterone is in tissues, not through the bloodstream. So we can't measure levels of testosterone in the tissues. And testosterone can be produced from the adrenal androgens in the tissues themselves. So just looking at serum levels of testosterone isn't really telling you the whole picture of what's going on in the tissues. Plus, a lot of the action of testosterone occurs by the conversion to its more potent form, DHT dihydrotestosterone through the action of 5 alpha reductase, which in some women is like overactive genetically or due to inflammation. So the last thing a woman wants is if she has overactive 5 alpha reductases to get more testosterone because it'll be converted to the potent form and then she may have more hair loss. So this is like a whole gigantic subject that is misplayed by a lot of doctors, I hate to say, because they don't understand androgens in the female at all. And they just think you're in menopause, you need testosterone. That's not the way it goes. They may or may not need it. It's a very individual thing. It has nothing specific to do with menopause except that some women, women as they transition, have too much testosterone coming out. And then those are the women that would be very angry if you gave them more because they're going to have more acne, facial hair and hair thinning. So you've got to be aware of this. And also as estrogen goes down, so too does sex hormone binding globulin, the binding protein made by the liver. And Even like only 1% of testosterone is typically unbounding. So you will have even a little bit of extra unbound testosterone. You can have a lot of excessive androgen effects, you know, the acne, the facial hair and the hair thinning. So you really have to know what you're doing. This is not for the amateur really to get into testosterone. And just as one side note, these crazy things that are going on with high dose testosterone pellets in women, like, no, that is insane. I'm a simple thinker, but it's happening, all it is and it's insane. Women should have physiologic hormones. The goal is to replicate the hormonal environment of a healthy woman in her 20s, not to create some alternative universe for women. That's not how genes are going to work properly. That's not how cellular function is going to be optimized. We want to, to remember, like I said, every cell in the body is a different age. They're genetically programmed to do what they're genetically programmed to do when they were, if they were born when you were in your twenties. So give them what you gave them when you were the healthiest, hopefully like in your 20s and they will behave more like they did in your 20s. Don't create an alternative universe of hormones. That is insane. Stop it. Don't do it. Doctors out there, there, stop experimenting with weird stuff like that on your patients.

Yeah, I, I couldn't agree more. We mentioned supplements a little bit and their use in the perimenopausal woman. I heard something really interesting yesterday, that ginsig specifically is an adaptogen that makes your hormone receptors more sensitive. So that you can. In the, in the perimenopausal woman, you can get some significant relief of menopausal symptoms. And in the menopausal woman who is on bioidentical hormone replacement, you can actually use less because your receptors are more sensitive. Are you using or recommending ginseng?

A little bit, yes. But I recommend all the phytoestrogens. That's the miracle of life. And many of the super foods like pomegranates and red grapes. These superfoods, what makes them super is that they have phytoestrogens like ginseng. So quercetin, which is so potent as a mast cell stabilizer, it's a phytoestrogen. Resveratrol is a phytoestrogen. Urolithins are phytoestrogens. The isoflavones are phytoestrogens. So there isn't a phytoestrogen, which includes ginseng, that I don't love. And they all have limited data, but some data that they will activate the receptors which makes them more functional. So you can get these through eating foods that are phytoestrogens, basically a high plant based diet. And that's not just vegetables. It's fruits and nuts and seeds like flax seeds, which have gotten a lot of favorable press and for good reason. They have a lot of lignans. Lignans are also a phytoestrogen. But all seeds will have phytoestrogens. Flaxseeds just may have some more. But so eating across all the food groups of plants will really help with your estrogen receptors. And then you can take what I call green medicine, which would be like, like, like all of the phytoestrogens that are put into a concentrated form and then you take it as green medicine to help promote the functionality and activation of the estrogen receptors. And so I'm totally for that. And every woman is unique. So you can experiment with some of these as, you know, they're over the counter. And you can try some of these and see what Works best for you. And we wish we had more data because there's usually one study that has like 30 people, you know, because who's funding these? But they're all amazing. So totally fine. Try a little bit of this, try a little bit of that. There's, you know, and at the end.

Of the day, it's food and there's no, you know, unlike a drug, it. There's not. There's not a negative side effect here.

Well, and with the green medicine, which is the, you know, the concentrates of the phytoestrogens. Yeah. All the side effects are additional benefits. That's correct.

Yeah, yeah, yeah.

That's.

That's essentially what we're talking about. So I want to be respectful of your time. We didn't even get to talk about breast imaging, so I'm going to have to bring you back because that is something that probably needs a whole hour in itself. And. But if I can just review what you have spoken about today, which is of the utmost importance to my population, is that we do not need to fear our estrogen. Our estrogen.

The.

The stuff that is made by our ovaries. E1, E2, even E3. We do not need to fear our estrogen. It is not causing breast cancer. And that it actually has a number of protective mechanisms. It is an immune modulator. We know that breast cancer is a failure of the immune system. When we override our systems with things like birth control pills with synthetic estrogens, we are overriding our detoxification process. And this is part and parcel the reason why we are seeing breast cancers younger and younger, more and more aggressive, because it's only. It's only adding to our toxicity and stopping our natural detoxification processes. And I love the study that you quoted about women who were put on an aromatase inhibitor to stop that, that. That local production of estrogen, but that they were also placed on bioidentical hormone replacement because that is their protective mechanisms. That is how the disease does not perpetuate. And that if you are someone who is having menstrual dysfunction, because we know how important our menstrual cycle is, if you're someone who's having menstrual dysfunction, you should find someone to help you with that then. Because if you continue to kick the can down the road, you wind up in my office, and that's not what I want for anyone. And if you already have a breast cancer diagnosis, this is equally as important for you.

You.

Because you want to identify your source of inflammation, you want to eliminate that. But that hormone replacement is important for you too. Because we know that the body was meant to function in the presence of estrogen. It's simply too important those, that family of estrogens, it's simply too important to your immune system, to your cardiovascular system, to your brain, to your digestive system. There really isn't anything that estrogen isn't influencing. And we want to make sure that women live their whole life in good health. And this is the way to ensure that that happens. What did I miss?

Well, that was fantastic summary. I think, you know, it's just that. Exactly what you said, that our own naturally produced hormones, hormones are there to optimize our health, not to hurt us. And that we have to stop mixing these up and thinking that they're the same and they're not. And that's really such a huge takeaway that is not really not pervasive in our knowledge base as a society, including the doctors. So we need to just keep repeating that over and over. Our own hormones are good for us. We didn't evolve as creatures to self destruct by our hormones. That isn't how it works.

I mean it, it really comes down to. If you believe that estrogen is the villain and causes breast cancer, that means that we were women were put on this earth for the sole purpose of developing breast cancer.

Exactly.

It's a ridiculous, ridiculous notion.

There is no mechanism, there's no mechanism that estradiol can cause breast cancer. This, I mean that's the insanity of it. There is no way that it can do that. You know, so it's just, we're just setting the, setting the, the everything straight here. Yeah.

Sending the story straight.

Exactly. Yes.

Dr. Gersh, where can people find you?

Well, I'm currently in my office in Irvine, California where I see patients every day. My practice is called the Integrate Medical Group of Irvine. And I'm here to, to do what patients need like get their hormones, get their periods right and, and at, at every age and stage of life. In addition, I have my Instagram Live which I'm trying to actually do every week. Now another interesting hopefully segment and I have a YouTube channel where lots and lots of information is posted. So I'm trying to educate, I have three books and hopefully writing more. So I'm out there, I'm a full time working doc.

Amazing, amazing. And what you do is so amazing and I'm so grateful for you and for your work and for providing a service that is so desperately needed. For being a truth seeker, for Being brave because it's hard to butt up against a system that is really trying to go in another direction. And so thank you so much for doing what you do. I actually think that you need to start a provider training course because I think providers inherently want to do the right thing. They just don't know what the right thing is and it's not being taught in the confines of our medical system. And they would benefit. The world, would benefit so much if you would share that wisdom and knowledge so that there can be many, many, many more providers like you.

You.

Well, that is a definite goal and I will make it happen.

Good.

With people supporting me and pushing me. It will happen. Good.

Well, know that I am there right, right behind you.

I'm.

I. I want to be the wind beneath your wings.

All right. Thank you so much. This was really wonderful and lots of fun.

Yeah. So I'm going to say goodbye for now. If you enjoyed this podcast, please share it with a friend. Share it with someone who needs to hear it. You know, your. Your s. Friend, your mother. We are all going through this together. This journey through life is one that we're. We're taking with one another. And the more that we can do to help to educate each other and to make this experience a wonderful experience, we need to do that. We need to do that. So please share this and I will see you right here next week. It's Dr. Jen. Bye for now.

Now.

Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Jen. 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 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 to breast health. You can find me on on Facebook, Instagram and YouTube. Dr. Jenn Simmons. And remember, my Jen 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.