55: The Truth About Hormone Replacement That Every Woman Needs to Know with Dr. Daved Rosensweet

Hello and welcome to the Kenya breasts 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 turned 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.

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Hello and welcome back to another episode of the Keeping Abreast podcast. I AM your host, Dr. Jen Simmons. And sit down, get your notepad out and get ready for today's guest. Because he is a wealth of information, he is the absolute trailblazer in his field and he has set aside some time for us today so that you can hear about everything that you need to hear about in the world of perimenopause and menopause. So I am sorry, so delighted to have Dr. David Rosensweet with us today. He has specialized in treating women in menopause for the last 30 years. He's written a book on is actually like the bible. It's called Happy Healthy Hormones and everyone needs a copy of this book. It is like an owner's manual for a woman. And he is, he's testified three times for the NASEM committee on the safety and efficacy of Biologic Hormone Replacement Therapy. He's the co chairman of the Coalition to Protect Biologic Hormone Replacement Therapy. He is just an absolute gem, a brilliant man and has made such a contribution to women. And I'm just so delighted to have you here today.

And I am equally as excited to be here because, gosh, we're kindred spirits. We're operating in some of the most important areas to both of us. And I recognized you as a new hero. When I first encountered your work, I went, wow, she's trailblazing in cancer detection and a breast cancer surgeon. Oh my God. This is a thrill for me too, Jen.

Well, thank you. Thank you so much for saying that. I really, I feel the same way. We have like a mutual admiration society going here and you Know, I think it's really interesting because we have very similar backgrounds, we were trained in very similar ways. And I know for my part of it, I am considered a hormone, a women's health expert, let's call it that. And yet none of my training really prepared me to be what I am right now. And I know for your part of it, neither did yours. I mean, you really. I'm sorry to say that, but I just know what our education was. I know what our training was, and I know that it did not prepare us for this. So can you talk to me about how you even got interested in this space and how you. How you trained yourself, how you learned about all of this?

Well, gee, I love medical school. To me, it was like going to a synagogue or church. For me. That's what it was like. It was so sacred. And our training, oh, my goodness, it gave us the ability to begin. That's what it did. And there were. Yes, there was a lot of. Couldn't cover everything. And even in my gynecology rotation, it was so much more about delivering babies and the pathology of gynecology. And no, there was no mention of the female hormone cycle. And this is 1968, and there was no mention of menopause. I didn't hear the word menopause in medical school, but I loved biochemistry. I loved and I went. I started out as a functional medicine doctor in 68. And over the years. Well, a very seminal patient of mine, Deborah, came in in the early 1990s. I knew her very well. She was brilliant. She had retired in her 40s, and she comes into my office without an appointment, walks right up to my desk, slams her fist on the desk and says, you gotta. You gotta.

I can just fix. I can just picture it.

That's right.

You gotta fix me.

She says, you gotta listen to me. You gotta believe me. I'm telling you, I'm going crazy.

And that's very real, though.

Yeah. And she was in her mid-40s, and I knew her so well. I mean, again, this is a brilliant woman. And serendipitously, or, you know, however, the. The magic or spiritual way our lives unfold. Three weeks prior, I had gotten an interest, I don't know where from, about hormones. And I contacted a pioneer, Dr. John Lee, who was really bringing out the information about progesterone. And I gave her some progesterone, and she was still in perimenopause. I gave her some progesterone. Three weeks later, I get a letter from her saying, oh, my God. I can't believe this stuff. I'm totally myself again from insanity. Well, that was very impressive. I mean, how many times in the practice of medicine do you see something work that well? Yes, but I wasn't really controlling my career. She referred a couple women, they had some good results. And before I knew it, I had a primarily a menopause practice, which suited me wonderfully because I love biochemistry. I love figuring things out. And it became really apparent. Yeah, midlife women and men, our hormones drop off so significantly in women, eventually there's not enough estrogen to create a menstrual lining or menstruate that's significant. And these are the most powerful biochemicals in our body. So the interesting thing is there was so little information back then, like you said, so I had to figure it out. So no problem.

How did you do that?

Well, I had the great good fortune of dealing with the most health conscious, motivated, intelligent women as my demographic, my patient demographic. And what I did is I did with Deborah is I started her on a relatively low dose, gradually increased the dose because I had learned how to titrate thyroid with Alan Gaby sometime before, and I saw how beautifully it worked. You start low, you gradually increase. If someone's hypothyroid, it alleviates symptoms of thyroid insufficiency. And if you go too high, you get symptoms of thyroid excess, which are very blatant because these hormones are the most powerful biochemicals. Well, I thought, I'm going to do this with the ovarian hormones and I did it with estrogen. I had a heads up already. I was a friend and colleague of Dr. Jonathan Wright, who had already brought. Well, he had started with tries, but he had already brought biased, a combination of estradiol and estriol into awareness. So I was titrating, I was giving women low dose of bias, gradually increasing it, low dose of progesterone gradually increasing. And I made this mini manual. Ultimately it became that book. I said, women, these are the symptoms of estrogen insufficiency. And we're going to start low and we're going to know we're going to be successful when you start not having hot flashes anymore. And these are the symptoms of progesterone insufficiency. In fact, we eventually put them on a laminated card for women who've kept them for years. And here's the symptoms of testosterone deficiency, and here's the symptoms of too much. So if you're gradually increasing and you feel better, fantastic. And if you increase further and you get symptoms of too much back down. And I tell you, I figured it out patient by patient by patient by patient.

Yeah.

And women were so individual.

Sometimes that's what it takes, right?

Yeah.

So I want to back up a little bit, because you started to talk about something that I don't think is talked about enough. You started to talk about progesterone decline, and in your book, you talk about the fact that that's really what's happening first.

Most often it is, yeah.

And there's so much conversation about estrogen excess and so many people that think that they're estrogen dominant and that it is a function of having too much estrogen. But I don't believe that that's really what's going on there.

Me neither. The way I look at it. Yeah, the way I look at it is men and women, we have our peak output of the ovaries, three major hormones, plus the ATA or men, the testicles, testosterone, at the age of 20, plus or minus two years, and in everyone, those hormones decline. I've never seen an exception. And by the time we're at midlife, they've declined dramatically. But it's interesting, they don't necessarily decline at the same rate. Progesterone can decline earlier and deeper than estrogen. So a woman could be lower in estrogen in her late 30s, for example, but really low in progesterone. They didn't decline together. Really low in progesterone. And there she gets estrogen dominance. She gets a stimulation over stimulation of stuff because she doesn't have the progesterone to balance her. So that estrogen dominance is usually coming from an earlier and quicker and deeper decline in progesterone. And, you know, any woman can figure this out. You know, a woman who's having regular clockwork cycles, there's a high likelihood she's ovulating and she's producing. If she ovulates, and only if she ovulates a robust amount of progesterone, huge, hundred times more than estradiol.

Can you talk about that a little bit? Because I don't know that everyone understands that connection. In order to make progesterone, you have to ovulate. Right.

There's a little bit of baseline progesterone that comes out of the adrenals. But, yeah, in order to produce the natural cycle, which has a robust amount of progesterone, again, 100 times more than the amount of estradiol, it occurs every cycle. If you ovulate, and only if you ovulate, there's the ovum, the egg. It's surrounded by some cells. And if that egg releases, these cells become a progesterone factory. If that egg does not release, you got minimal progesterone. Thus you have no balance to that estrogen. So any young woman, if she is not ovulating, she's going to be progesterone deficient. And how do you know if you're ovulating from almost without exception. And you know this, this is deep into your training, that if she's not clockwork regular, it's high probability she's not ovulating. And these young women, and so many young women, it's occurring more than, I think ever before, although I don't really know, have this anxiety and they call it anxiety, and they think it's anxiety rather than just the standard stresses of life. It's brinked over to where there's some emotional stuff to it that they call it anxiety. And what's its primary cause? That loss of progesterone. The absence of progesterone. Because progesterone is the great relaxer, it's the great calmer. It's a very unusual hormone. Most hormones are activating. They're great for fight or flight, not estrogen. I'm not progesterone. It's the great quieter. And if you lose that great quieting hormone, that peace hormone, you have anxiety. So that's one form of progesterone loss. Excuse me, a rather severe one in young women. There's another form.

I always say, if estrogen is the on button, progesterone is the off button.

Right.

But how many women are being placed on antidepressants and anxiolytics because of progesterone decline? I know, I mean, it's an unimaginable number, right?

It is. And, you know, fortunately, there's a march of awareness squeaking into general consciousness and into medicine.

The other thing, because we have to have conversations like this.

Yeah. And for women, you know, unfortunately, in the world of menopause that got so stunted, it's an unusual field. The world of female hormones is very unusual. When I was growing up in medicine, this phenomenon was occurring called specialization. When I got out of med school, there was not even a family practice residency. But then I watched this rising up of specialization. It's occurring everywhere. Why? Because doctors realized they could no longer get their arms around the whole body of knowledge. All fields couldn't be generalists, so surgeons were specializing into urology, into knee surgeons and internal Medicine people were specializing. And it's great, it's great to specialize because you get really excellent at one lane and you can really help people. It was not happening in menopause. It was so strange that because of the Women's Health Initiative study that I have a feeling we're gonna be able to talk about in 2002. Everyone got afraid of hormones from wrong information being blasted out to the public. Yeah, but everyone got afraid of it, including providers. They thought there's increased risk all of a sudden, out of the blue. And the specialization that was occurring in every other field in medicine was not occurring in menopause or andropause, you know.

So I would love for you, because you have this perspective, talk about the world before the Women's Health Initiative and then talk about the world after the Women's Health Initiative.

Great. If I may, Jen, could I back up a little bit? You can do whatever you want. Progesterone, you know, the star of the.

Show.

The other piece around progesterone is highly significant. You know, the ovaries are putting out these hormones and even in women in ovulating who are ovulating, you think there'd be a perfect balance. Estrogen, progesterone, perfect balance. And in a very healthy state there is. Estrogen stimulates progesterone, calms down, perfect balance. And then as decline takes place over time, because it does, you'd think there'd be a perfect balance in the decline, but there isn't. The progesterone often declines earlier and deeper than the estrogen. And I describe this in the book. And of course your listeners can have a free access to a free PDF copy of that book. And that's rampant. So you've got women in their 30s that they were doing pretty well and then they start getting anxiety. Then there's still clockwork. Regularly menstruating, but they're getting anxiety and a multitude of other symptoms that are possible. So we're seeing earlier than we would hope for an imbalance of estrogen and progesterone. It's called estrogen dominance, but it's really from deeper loss of the progesterone. Moral of the story. If women could identify when they are feeling that progesterone slipping deeper and more early than their estrogen and just started being treated with progesterone, you can even get it over the counter. Really good stuff because the medical doctor found this, really started describing this in the 80s and wrote a book about it and made progesterone available over the counter, you can do some good with that. So if a young woman can identify that slippage of that progesterone and that imbalance, how do you identify it? If you've got breast tenderness and you weren't used to having breast tenderness?

Yeah.

If you're getting uterine cramps and PMS and you weren't used to having. Yeah, there's, there's some period phenomena, but it got exaggerated. Like you started getting cramps and heavier bleeding in your late 20s or your early 30s or so. Uh oh, you no longer got the balance and it's time to deploy progesterone.

Yeah.

So I love that whole topic about progesterone. If women could just learn enough about it, they could start off the hormone balancing process early on. Yeah.

What about I find another piece of it is women who were fine sleepers before and suddenly lost their ability to sleep.

Perfect. Progesterone is the great calmer. Like if we were to inject the proper dose intravenously of progesterone into any of us, including me, we could be put into a sleep so deep surgery could be performed on us. Thus, when a woman's losing her progesterone, what's one of the things you just announced it? Sleep disturbance. I used to sleep great. Then in my mid-30s, I stopped sleeping as well. There's a couple hormonal causes of lack of sleep sleep disturbance when you didn't have it before. And progesterone is numero uno. And estrogen also plays a role in that one.

Yeah.

So.

I think it's really important for us to list the signs of perimenopause and menopause only because when people don't know, because of that whole specialization that you spoke about, people kind of self refer or put that themselves in the silo that they recognize with the symptom. So for me, I can tell you that I had palpitations out of nowhere and had a huge cardiac workup. Right at this point, they tell, they told me that, you know, my heart was strong and I had no cardiac issues. And I said, why am I having palpitations all the time? All the time. So can you start to talk about some of those signs and symptoms? The other thing that I had was dizziness and had a neurologic workup for it. So, you know, it's really amazing that we're kind of not told about these symptoms that are very, very common in the perimenopausal state. Like, everyone knows about hot flashes and then we don't really know anything beyond that. Maybe people talk about weight gain, but beyond hot flashes and weight gain, we're really not talking about it. We're not talking about the cognitive decline. We're not talking about the sleep loss, the palpitations. All of these things that you're gonna shed some light on right now because people need to know.

Yeah. And the more you know, the quicker you're gonna get to the remedies. That's the really crucial thing. Yeah. You know those palpitations out of the blue, you know, and my own sister had the exact same thing. She woke up in the middle of the night. Instead of disturbing me, she went to the emergency room because she was having a racing heart and some chest pain. And they did the full. They did an angiogram on her. Gosh knows how much that cost and what kind of trauma it is to actually have an angiogram, only to find that her coronary arteries were in great shape. Because let me tell you, the source of that palpitation. These hormones are so powerful, coming out of the ovary and coming out of the testicles and the absence thereof has powerful consequences. So when, for example, when your estrogen gets too low, that happens to be very stressful to your body. Your body really thrives on estrogen.

And when it gets too low, Whistling Dixie.

Talk to any man who's got a droppage in his testosterone and oh my God, they scream loudly. But at any rate, it triggers. It's capable of triggering the fight or flight biology. And at the van, it's so stressful to a woman's body to have a droppage in her estrogen that it can trigger what fight or flight consists of biologically. At the vanguard of that biological response is adrenaline. Great stuff. Really helps us run from saber tooth tigers. Yeah. Well, that adrenaline also makes our heart race and can even affect our circulation to the point where the heart's going, I'm in trouble here, and I got a racing heart. And some women even have chest pain. So the remedy is not spending five grand on a cardiac workout. The remedy is replenishing estrogen to reasonable levels. The estrogens drop too low, okay, you still have periods, but you don't have enough to do what your body loves to do with estrogen. It's stressful. You replenish the estrogen to reasonable levels, those palpitations go away, they don't appear anymore.

Yeah. So other than palpitations, what are the other kind of lesser known symptoms of menopause?

Let's break out the various Hormones and look at it. Yeah, declining estrogen again, it's so powerful is a multitude of symptoms. There's the surface stuff and then there's the deeper stuff. The deeper stuff is really significant. But I'll start with the surface stuff.

Yeah, the deeper stuff is bad though.

Yeah, the deeper stuff is really worth looking at to inspire women to get hormone replenishment for their whole life. The surface stuff is when that estrogen drops and you get really low, it does trigger warm rushes or hot flashes. 75% of women going into perimenopause have symptoms, 25% don't. And they're looking around going, what's wrong with everybody? My menopause is easy. Oh no. They're subject to the exact same deep consequences of loss. They're the ones I'm really concerned about. The symptoms of lowering hormones are so profound and they're often life stopping. And that's a blessing because it sets many women off on the trail of. I don't know what I'm doing with my life, but I'm telling you I'm going to pause here and figure out these hot flashes and I can't sleep anymore. So like sleep disturbance. Very, very common. Metabolism isn't working as well for a couple reasons. And one of them is that thyroid hormone isn't working as well. And this is really related to progesterone. So you're not getting the level of energy and you're not metabolizing as well. So you're putting on weight just from low progesterone itself. I'm listing the big ones. Mood. These hormones have receptor sites everywhere. And my God, there are a number of receptor sites in the female brain and the male brain. And you know, because so much of libido, not everything about libido, of course there's these, happens to be these relationship and life issues that are related to libido. But there's a biology to it and you start losing your libido and you want to look for, for what's going on with your hormones. Your skin changes, you start getting dry vagina. And if you're having, if, if you, when a woman trans makes the change from having painless lubricant free intercourse to needing a lubricant, there's already been a very substantial drop in the estrogen. That sign alone, oh, I starting to need lubrication. I never used to need lubrication before. That sign alone tells us it's gotten really significant and that could take women to seeking help. As far as estrogen Decline goes. There's some big ones right there. Mood, libido, sleep. Oh, my God. Energy, weight gain. Yeah, there's reasons for that weight gain. They go beyond ovarian hormones, but they can be related to ovarian hormones and then testosterone. Female libido has got a biology to it, just like male libido does. And we have to think in terms of all the ovarian hormones when we think of libido. But what's at the head of the pack? It's often testosterone for women. And if you start, your libido starts declining and your orgasm is starting to change. If it's not related to your life and your relationship, you really want to think of testosterone. I love to emphasize this one, because as a physician, I see people at all decades of life, and I've seen women and men in their 70s, 80s, and 90s, and I know what happens to them. And what happens to them is 80% of them wind up in assisted living facilities and nursing homes. And 80% of the women and men who wind up in assisted living facilities and nursing homes are there because of loss of ovarian or testicular hormones. And one of the major reason is loss of muscle in a process called sarcopenia. And if you look at elderly folks, you're going to see thinner lower extremities, and you're going to see them making a shift from to canes and walkers to wheelchairs. So this testosterone decline in women is so significant, and I can guarantee every woman that is listening to this podcast, that you're going to have a testosterone decline. And for all of you, three years from your last period, you're going to have very, very low levels of testosterone that are going to affect your life greatly. And what I'm seeing these days, which is different than about 30 years ago, is a lot of women in the perimenopause have already had significant testosterone decline.

Why do you think it's worse recently?

Well, there's those multitude of reasons that you listed in other podcasts. I think, you know, these ovarian hormones are recruited for the biology of stress. So you take a woman Olympic athlete as an extreme example. She's training on a very intense training schedule. Very few of these women are menstruating their wonderful estrogen and testosterone. They're being recruited for the stress response. So they're not going down the female pathway.

Yeah, yeah.

And it's just one extreme example of women who are stressed. They're going to recruit some of their excellent energizing estrogen and Testosterone for that stress and they're going to have menstrual changes. They're going to have.

Yeah, it's not just about the elite athletes anymore because though they are putting themselves in this prolonged stress state, right? Because they're, they're calling on that stress response so frequently, but most of us are unknowingly calling on that stress response. And truthfully we were only meant to be in that state. You know, we are modern beings living on this very old gene code and we're only meant to be in that state like 5% of the time. And yet our lives are a series of saber toothed tigers. Right? We go from one emergency to the next and one, you know, stressful event, whether it's your cell phone, whether it's, you know, whatever it is, job deadline, bad relationship, difficult relationship, you know what, whatever it is, we're so surrounded by these saber two tigers and the truth is that we're always going to prioritize life over procreation and so we're always going to make our stress hormones before we make our sex hormones. And at the expense of making our, our sex hormones. Even though those saber toothed tigers are not real. Right.

And we'll also recruit our sex hormones to participate in, in this biology. The stress response we tend to think of, well, adrenaline and cortisol as far as hormones go and even thyroid, they're at the vanguard of the stress response. But you can also utilize some of the empowering aspects of estrogen and testosterone. So there's that double cause there. Like you said, hey, we're going to prioritize, we're going to develop, we're going to shunt the resources towards cornisol. We're not going to give them to the ovaries. But that's not the only reason. There's the other reason. They also function pretty well in waking us up and energizing us and energizing metabolism. So yeah, I think we're in a time of human history where we're getting a big wake up call to address how we respond to stress and to acquire some information and tools and some practices that help us learn more than ever before about our own emotions and our own emotional pain and our own thought process so that this earth can take a turn towards self responsibility and stop attacking one another. Oh my, that's Pandora's box lid coming.

Off there for sure. For sure. And I agree with you, I think it's that I also think that, you know, we're not living on our grandmother's earth we're not even living on our mother's earth. We're living in a very different chemical environment than we ever lived in before. And I think that that alone is causing a lot of dysfunction.

Thank you so much. I mean, we could almost list that right up there with numero uno. I mean, just to give a gross example of that. We, you know, people think, well, there's toxicity and. Oh, yeah, well, yeah, okay. But I don't feel it. I didn't. It's not like I just swallowed a glass of arsenic or something or hemlock.

Right.

But, you know, I lived in Florida for a while and I became aware of the study that was being done on the alligator population of Florida because the scientists had noticed that they were not reproducing and they were getting hermaphroditic changes. There was widespread smaller penises, smaller sperm counts, and they studied what was going on. And there was a toxic overflow from Lake Okeechobee that drained into the Everglades, was containing all kinds of chemicals, including birth control pills that had been, you know, women who are peeing are peeing out hormones and the fertilizers and the herbicides and pesticides. Of all the things in the world that they could mimic in human beings, they can stimulate estrogen and progesterone and testosterone receptor sites. We call them xenoestrogens. So, yeah, nice theory. I think maybe I should not be using my perfumes and my deodorants and my cleansers and my drier pads and stuff. Yeah. Because we're flooded with this stuff, as you mentioned.

Yeah.

And they are interfering with receptor sites. They are changing. When I was in medical school, the sperm count that was normal for men was five times what they report as the reference range these days. How did that happen?

So it's crazy you brought up the topic of birth control pills, and I do want to go into that a little further, but maybe, maybe. We finished talking about declining estrogen, declining testosterone, we talked about declining progesterone. But I do want to get back to that topic of birth control pills.

Sure.

So with declining testosterone, yes, we are definitely seeing changes in libido and that's causing big problems for people because all the lube in the world doesn't help if you have no libido. And this is causing a problem in relationships. And there's no therapist in the world, no couples therapy in the world that's going to solve this issue. Because at the end of the day, when you're in a long term relationship, that is your connection. And when that is lost, that's a big problem in a relationship, you're saying.

So clearly, I hardly have anything to add to that.

So what else do we see? We see definitely a loss of libido. We see a clear loss in muscle mass. And I think you're pretty famous for saying that one of your goals is to keep people out of adult diapers. What's happening there?

Well, there's two functions there in a woman. And if you go into any assisted living facility, you're going to see that the vast majority of the women in there are in adult diapers.

Which is a horrible existence.

Yeah, I mean, women are strong. They put up with it. They go into the assisted living facility and they don't like it. And I have personal experience with my family members that have made that transition. But there's two elements. One is without sufficient estrogen. And this can occur in your 30s, your 40s, for sure, 50s for sure. Estrogen is so much needed for the health of the vagina. And without it, the vagina starts changing and gets dry and thin. And any gynecologist or anyone who does pelvic exams in women can actually see the change in the vaginal mucosa. And at a certain point of dryness, that's when the lube begins. And then it gets worse. So there's often pain on intercourse. Well, the bladder empties through a tube called the urethra in the vagina. And so at that junction, that dry vagina, and that opening to what's called the urethral meatus, that gets irritated. And women start getting have to pee in the middle of the night more than they ever had to because of the irritation. They start getting bladder infections because there's inflammation there. And eventually that's one of the elements in how women lose control and start getting incontinent and losing their urine and getting coughing. Because many women have already stretched this region from childbirth. Not all women. There's the stretching that's occurred in there that's not holding up the bladder as well. And then there's a major muscle in the pelvis. It's like a sling. It holds up the uterus, the bladder, the rectum. You get sarcopenia, you get loss of that muscle, and everything starts to drop, and you lose bladder control there. So there's a triple whammy going on there. And why, when you go into your local grocery store and you take a look at the shelves devoted to adult diapers and you see how much real estate they Take up. You know, this is happening out there and you don't know it when you're in your 40s. Well, I don't think about that. You know, we don't think about that. But this is where we, as physicians and educators, we can really help the public. We say, look, you feel good now. This is what is probably going to happen. You can prevent this. Just take these measures. And you're not going to be thinking about it when you're 80 either. You're not going to be coughing and losing your urine. You're not going to be transitioning to a cane than a walker. Then a wheelchair.

And a wheelchair. Yeah, yeah. So it's really something to think about and it is really not talked about. And I think that's mostly because most people's education is around birth control pills. Most people who are considered the hormone experts, we're talking about the OB GYNs, and the totality of their education is around birth control pills. So let's back up and talk about the world before the Women's Health Initiative. So the world before 2002, 2003, and the world after 2002 and 2003.

Wow.

Minor topics where we need to go.

Well, you know, you brought us something else. How about let's talk about the world before birth control pills. Is that okay?

Yeah, for sure.

Because I was in my 20s and I'll tell you, we cared about contraception and I was schooled by my own wonderful, beloved father. He took me aside when I was about 14. I was not having intercourse at that time. We didn't dream of that. We didn't dream of opening a woman's blouse. We didn't think of back in those days. But he wanted to let me know I had already explored their bathroom when they weren't at home. And I saw these things called condoms. And I was curious about them. And he said, listen, use these condoms. You're going to be safe and you're going to protect the woman. And that's very important. And then I grew up in the era where there was condoms and diaphragms. And you know what? They weren't perfect, but boy, did they work for so many women and men. And then along comes birth control pills. Oh, totally innocent. Just pop a pill. And I love that they call it low dose. These pills are so strong that they're capable of stopping ovulation in a woman. Do you know how much force it takes to prevent reproduction and stop ovulation in a woman and throw a woman.

Out to stop mother Nature, my goodness.

It takes a tremendous amount of chemical force to do that. So when, you know, it's such a challenging topic to talk about because it's become so commonplace. But I want to tell you, as a physician, I'd like to give you my best shot at all times. Young women think of other things. I mean, I grew up in a. We used condom and diaphragm when I was in my 20s. And, you know, they were wonderful. And we didn't. And anyone who complains I can't feel anything, they got to be out of your mind. I mean, there's so much powerful feelings going on during an act of just caressing somebody when you're in your 20s.

Yeah. The power of touch is so amazing.

It's so huge.

Yeah.

So. So why would I say this?

What's wrong with birth control pills? I mean, quite frankly, there is such a trigger reflex to put these young girls on birth control pills because they have an irregular cycle or because they have headaches or because they have acne. They just keep coming up with more reasons to put these young girls on birth control pills. What's wrong with that?

Well, I would like to defer to your expertise here. Would you please answer that? Because you have more knowledge in this area.

Yeah. I mean, there's so much wrong with that. First, you're kind of taking over a process that is supposed to happen by nature alone. Right. The second thing is that if you are having irregular cycles, if you are having headaches, if you are having acne, it's not because you need a birth control pill. Right. Like, that's never the reason. And there's always a reason why those things are happening. And we have for decades kind of been so permissive in this area. Like, I'm not going to think about it. I'm not going to trouble myself by thinking about what's happening to this person in front of me. That's body. Whose body is dysfunctioning. I'm just going to kind of overrule it with these very, very strong synthetic hormones.

You know, Jen, there is a story I could tell here. And then. Please, I like. Please continue. When I graduated medical school in my internship, I was offered a job by Planned Parenthood. And it was such a relief. Oh, my God. I was seeing young, healthy women. I was not dealing with people who were gravely ill or moderately ill. I could take a breath and. And do something rather simple. And what was Planned Parenthood about in those days? It was about birth control pills. And here I was examining the women and giving them and writing prescriptions for birth control pills. And as a doctor, without having any knowledge whatsoever, I started to get very, very uneasy. And I quit Planned Parenthood. I had a salary. I got a regular check. And after three months, I said, I can't do this. This is too profound to the female body to stop them from ovulating.

So is that what your trigger was?

Well, I was just, you know, we've trained. We've got this in our bones and in our soul. We have a real deep feeling for how the body works. And here I am, I'm stopping ovulation, and I'm going, this is way too consequential. This is way too big of a biological interference. And I quit my job after three. Yeah.

And, you know, it. It got a lot worse because pretty early on in my career was the time when they would just give pills straight through. So women didn't have to have a cycle at all.

Well, that was really. That was really a.

Or they put implants in people's arms so that. And, you know, those are there for, like, four years so that people wouldn't have a cycle. And I. I remember thinking, even though, you know, I was a surgeon and this wasn't really my. My space, right, because we're super specialized, I kept thinking, it seems crazy to me that people are not bleeding, right? Like, I. There has to be a genuine purpose for that. There's a reason why we bleed every month. Why are we stopping women from bleeding? It can't be good.

If anyone. If anyone needs convincing, I want to quote the great authority called Saturday Night Live and tina. Tina Fey Co. Do this skit that every woman should see. It's about stopping ovulation. What happens to a woman with permanent birth control? I forgot the name of it. But talk about birth control and Saturday Night Live. It's weird that I would say that. Can I ask you what happened to this world of breast cancer? I mean, when I was in medical school in the mid-60s, breast cancer was one part of our pathology course. It wasn't given that much emphasis because it wasn't that prevalent. And now what do we have going on and what things relate to it? And my question is, what's the evidence around birth control pills and incidence of breast cancer?

Well, it's definitely more common in women that take birth control pills. And we saw that from the Danish study of 1.8 million women. And, you know, the. It. And it's directly, linearly related to how long you take birth control pills for. I mean, you know, we see we see signs of this dysfunction earlier because these women that took birth control pills in their youth then dealt with infertility when they wanted to have children because they have completely filled, thrown off their ovarian function as a result. You know, if you stop it for long enough, your ovaries are going to say like, okay, I guess, I guess you don't want me, right? And then as we get a little further down the line, although, you know, at this point, not much, we're seeing breast cancer in teenagers and 20 year olds. I mean, this was unheard of when I was, when I was practicing as a surgeon. And granted, I've only, I've only stopped being a surgeon for five years, if you ever really stop being a surgeon. But, you know, the youngest patient that I saw was 23. And now we're, we're seeing, we're seeing teenagers with breast cancer and it's because we live in this crazy toxic environment. You know, those birth control pills aren't only in the Everglades, they're everywhere. Right. And so whether you think you are ingesting these xenoestrogens, these toxic forms of estrogen, whether you think you're ingesting them or not, you're ingesting them whether you intended to or not, you're ingesting them because they're in our water supply.

We pee them out in the. Montreal. Montreal did a study of the city water supply and found high levels than expected, much higher levels of, than expected of estradiol in there.

Yeah.

This is not just a theory.

No, no, no. It's, it's, it's clearly evidenced, you know, anywhere and everywhere we check. So I, I think that that definitely plays a part. I also think that we, we live such artificial lives that we are so inflamed and we are actually changing our chemistry. And when we do that, you know, the breast, the thyroid, these are the canaries in the coal mine. These are the organs that are so very sensitive to even minute changes in the environment. And when these changes occur, these organs are, these cells are just going into survival mode. They just want to survive. So when they're swimming in this toxic soup, they just go into survival mode. What does that mean? Just reproduce, reproduce, reproduce. Don't check out if what you're doing is right. You know, like that movie with Michael Keaton, I think it was called Carbon Copy or something like that. Like, you know, the first, the first one was okay. Second one, okay, not so great, but okay. By the third one, it's like, you know, Bizarre, off the wall. This is what's happening in our body because we're just reproducing without our checkpoints. And then we live these lives that are so stress dominant, that are so sympathetic dominant, that our immune systems are for all intents and purposes shut off. And so it's this combination. You know, you think about it, when you are running away from a saber toothed tiger, you have no need to protect yourself against the common cold. Right? So when you're in that stress survival state, that switch for your immune system just goes to off. Just goes to off. And we see some of this shift happening as a result of our environment, as a result of the way that we live now. This happens naturally as we age, because as our sex hormones decline, so too does our immune system. And you know, we just saw a great living example of that with the, with COVID Because who was the vulnerable population? It was people over 65. Right. Because we know that they have less inherent immunity. Their immune systems are just not as strong. But we're seeing that also in kids now. We're seeing it also in teenagers. In young adults, we just don't have the immune competence that we had. So it's this combination of all of these things. But the birth control pills definitely aren't helping. They're not helping.

And on the flip side of that, there are really good methods, barrier methods are really excellent. And IUDs for many women, if you have a steady partner that you know that there's no transmission of infection proper possible. And I grew up in an era when infections were being transmitted, they had different names. They didn't have the more egregious names of hiv, for example. Yeah, that and hepatitis C that have been transferred. No. But they were still pretty vicious. And so there's something really to say about barrier methods. But if you've got a steady partner that you're totally committed to, so many young women can use IUDs even if you haven't had a baby. And we recommend the IUD that is just. The copper wire doesn't have the progestins in it, doesn't have the chemicals.

Exactly. Yeah, and I'm so glad you brought that up because that's what I suggest all the time for people in committed relationships is just, you know, if you're not looking for a child, you know, now or in the near future, have a copper wire IUD put in, don't use the ones that have the progestins implanted because, you know, that is very similar to Taking these synthetic hormones. But the copper wire IUDs, for someone in a committed relationship, they work very well. And I haven't really seen complications with that. Now, when I was training, we were told you can never put an IUD in someone who hasn't had a child. So where did that shift happen?

Well, because a lot of women was.

That old wives tale.

Well, a lot of young women can tolerate, yes, it is true that some young women, it's hard to get them in or they cramp so much and they don't want to live through the cramping, initial phases of it that they're not going to readily accept an iud. There is some sense to that. But young women, that would be my first recommendation. Like you say, Jen, if you're in a committed relationship, one caveat I'd like to say is an illness like cancer. We don't want to oversimplify it. You've already said it, Jen. There's a multitude of causes. You know, any illness so strong that it could lead to our leaving Earth, it's got a lot of causes to it. What do we like to do in medicine? We like to identify the causes and reduce the living heck out of them.

Yeah.

And really, really, really take the time and energy. Some of these toxins that you've mentioned, they're so avoidable. Like, I started picking up on it when I was in my 30s of the household cleansers and stuff and the soaps and they're all over the place. And I started after I started getting rid of them because I wanted to get rid of them, because I like to be. I love my health. I think it's an amazing thing to have health. And then I started noticing I was spending less money. My whole life got easier.

Yeah. And even if you choose like the organic cleaners and the organic, you know, products, you're using so much less that you do save money. It does make a difference. I completely agree with you. So let's get back to the world before 2002 and the world after 2002, because the women's Health Initiative, I know that the birth control thing has definitely contributed to a significant amount of illness and probably contributed to an increased amount of breast cancer, both in young women and just in women in general, for sure. But the world is very different after 2002 than it was before. And when you look at the breast cancer incidents, because if what they were saying was true, we should have seen a precipitous decline in breast cancer. And in fact, that is not what we saw at all.

I love this topic. And I lived in the world prior to 2002. I'd been a physician for over 35 years by then. And it was pretty simplistic as far as menopause went. Not many people talked about it. And women had doctors, and women would go to their doctors and they would receive some really decent menopause relief. And it was in the form of Premarin or Prempro. And, you know, over the course of many, many years, I met many of these women who were on Premarin and Prempro, and mostly in my practice. It's because they wanted to convert to bioidenticals. But women who had been on Premarin and Prempro for 10, 20 years, they looked better and they felt better. And you could identify a woman in her 60s who was on Premarin or Prempro. And 18 million American women prior to 2002 this date were on Premarin or Prempro. It was the most popular and wouldn't, you know, profitable drug of all times. Up to that time, that was 40% of American women were silently on Premarin and Prempro. They knew about it, their doctors knew about it, and that's what menopause was about. Yeah, it wasn't about that for some physicians, like some pioneers in menopause medicine, Jonathan Wright, bless his heart, and some compounding pharmacists in the 80s, Jonathan said, Wow, I wonder. What I think is going on is I think there's pure estradiol out there, because they're putting pure estradiol, they're combining with something. Yeah, there's not the pure estradiol, but in order to combine it, there must be pure estradiol. And he asked his compounding pharmacist, who is. These compounding pharmacies are beautiful scientists. Very often, they're the ones who love to figure things out. Jonathan asked, is there any. Can you get the purest? They're using it in birth control pills. They change it. But is there any pure stuff out there? And his pharmacist did find it. And so the early 1980s, Jonathan proposed to the functional medicine community that why don't we use the same molecule if we're going to treat women in menopause? Instead of giving them Premarin, which is derived from pregnant horse urine, pregnant mare urine, it's not ridiculous that that's how it came about. I mean, the Chinese, a thousand years ago, they had it figured out. They collected the urine of young women and young, healthy women. They dried it out and Fed the dry powder to the aristocracy. They did the same for the young men. Different urine. Because these hormones come out in the urine.

Yep.

And so thousand years pass, and then the pharmaceutical industry started getting interested in treating menopause. And they started out even trying to collect pregnant women's urine because they're loaded with hormones, but that was impractical. So they turn to a large animal. The horse puts out a lot of urine, especially when pregnant and catheterized. Oh, my God. And at least 50% of the hormones in a horse are equivalent to what's in a female. 50% aren't. They're unique to horses. So it wasn't outrageous that they came up with this and they were able to treat millions of women, 18 million of them, to be specific. But Dr. Wright, and simultaneously Jim Hernzer, a pharmacist in Dallas, he was thinking the same thing. He said, I can get my hands on purestradiol. I'm going to give that to my wife who's going into perimenopause. I'm just going to put it in a gel and put it on Abra, put it on her skin. So there was this other movement going on, and that's what I. When I intersected with menopause, I was very fascinated. I said, gee, horse urine or pure molecule? I'm going for the pure molecule. Why not identical to what's in a woman's ovary, what they're putting out. And so I started out, and that's the only hormones I've ever given is. And they're prepared by compounding pharmacists. Because why? Because the name of the game in hormones, and here's the big one for all of you out there, it's an individual thing. There is so much individual variation, woman to woman, of how much estrogen is optimal for you, how much progesterone, what's your balance between these two? Is throw in testosterone what your balance is? Clinically, it's no issue at all. We do the same thing. We start low and we gradually have women find their way into their optimal dose. Takes two to three months. They get there. But individualization is so critical to get the kind of treatment that anyone who's watching this podcast is going to want. It's not like horse urine didn't. Estrogen didn't do well. It did, but it was the beginning form. It was a primitive form.

It helped a lot of women.

Right.

But yes, it was quite imperfect and quite.

It didn't lead to any possibility to individualize and it had extra, extra stuff in there that I wouldn't want in my body.

Yeah.

So anyway, simultaneously in the world of treating women in menopause, there's the rise of compound and bioidentical hormones. Then along comes an event that I've never seen anything like it in my whole career. There's a study published in 2002 called the Women's Health Initiative. It was very large. My understanding, the motivation behind it was they Knew there was 18 million women on Premarin, but they knew that it had cardiovascular benefits as well. So the purpose of the study was to encourage physicians by proving that there was cardiovascular benefit, to expand the market share from 18 million to. The other 60% of women weren't on it. But the study was. I mean, we had a six month course in the University of Michigan Medical School when I was a senior on the medical literature and on medical studies. And by the time I hit that, and maybe. I don't know if this was your experience too, I had my white coat. I didn't want to sit in any classroom. I didn't want to sit in the library and figure out medical studies. But within weeks, I saw the brilliance of University of Michigan once again and I got way into the medical literature because what they were trying to point out to us is there's garbage science out there and there's great science and it can be very concealed until you know how to understand a medical study, the difference. And the thing about the Women's Health Initiative is this was one of the most poorly designed studies possible. I'm not going to go into the weeds there. There's resources for how you get to see this. And the bottom line is women who are taking Premarin alone, what was discovered is they were at reduced risk for breast cancer. That was in the study, significant 21% reduction in breast cancer incidence for women who are on Premarin alone.

Which is, which is estrogen, right?

Primarily estrogens, yes, it is estrogens.

Yeah.

I say primarily because there's synthetic estrogen, but it's. There's horse estrogens in there as well.

Yeah.

And what they discovered about the Prem Pro, which is a combination of Premarin and an artificial progesterone called a progestin, that there was a statistically insignificant increase in incidence. What we know of breast cancer. Breast cancer, yeah. And what we. Anyone involved with science knows what statistically insignificant means. It means don't draw any conclusions. It does not have significance.

So it could be due to chance. It could be due to any number of things. But you cannot use it as fact and you cannot use it for medical decision making.

Exactly. Statistically insignificant. Well, the press got a hold of some language in the study that said there was increased incidence. They left out the statistically insignificant part and they blasted it out in a way that I've never seen happen before. And it scared women all over the world, like in an explosive way. And it scared healthcare providers all over the world. And it was one of the main reasons that people just didn't get interested in hormonal medicine and menopause medicine because they were afraid that they would be increasing their patients chance of getting breast cancer, as we mentioned earlier. And oh my God, it scared me. I was part of the, you know, my ear was to the railroad tracks and I heard that there was increased incidents. But then I read the study and I was discussing it with colleagues and I went, wait a minute, they say statistically insignificant in there and this study design is outrageously faulted.

Yes.

And it didn't. I didn't. And there's European studies showing the safety and efficacy of bioidentical hormones. So I felt fine about proceeding and I did. I didn't drop a beat.

Yeah, well, most people did. The world dropped a beat overnight that 18 million women that were taking hormone replacement diminished to 3 million women.

Yeah. Less than 3 million. Yes.

Yeah. And the prescribers who had previously been prescribing hormone replacement all stopped.

They did. Now the study committee did continue to follow these women. And by 2006, they saw that the increased, statistically insignificant increase had dropped. It wasn't there anymore. There was no increase. But no one heard about that. And in 2017, the same study committee, the original one, published in the same Journal that after 18 years of follow up, there is no increased incidence of breast cancer, heart attack or stroke. And how many women have heard that and how many health care providers have heard that?

Almost none.

Almost none.

Yeah.

Yeah. So we spend in chapter three of the book of my book, the PDF copy, we cover this in detail and give you references. And then there's a quote bible about this written by an oncologist, a medical doctor who specialized in treating women with breast cancer. That was his. That's his. That's his field of choice. He run the only study that I know about of giving women who had breast cancer hormones after the breast cancer was properly treated. And his book is called Estrogen Matters. It's by Avram Blooming and Carol Tavris. It's work of highest genius. And Any woman who really wants the science read this book.

It is required reading for all of my patients. I talk about it on every single one of my platforms. My Facebook group knows all about it. I talk all about it on this platform, on my Instagram platform. It is. As much as your book is required reading and a bible for every woman, so is estrogen matters.

Can I comment on this too? Because I always love to say my understanding of the science and since this is in my wheelhouse. It's the the bottom line of menopause medicine, just like testosterone treatment and the risk of prostate cancer is the bottom line of treating men in andropause. Here's what I love to say about it. Number one, we're all at risk for all kinds of illness. Every one of us medical doctors knows there's thousands of diagnoses and about 95% of them are not okay and they're not fun. And we're all at risk for hundreds of cancers. We're at risk for hundreds of cancers. And yes, for men, there happens to be a prevalence of prostate cancer. That's really out there. And for women, breast cancer is the most popular, most prevalent cancer amongst women. And there's reasons for this and there's a big difference over the course of time, as we were mentioning. But given that we're all at risk and we're all at risk for women are all at risk for breast cancer. Here's the science. Women who are treated with hormones are at less risk for breast cancer, heart attack and stroke than women who are not receiving hormonal treatment. That's the science. Here's some more science. Women who have had breast cancer and have had that breast cancer properly treated, they happen to be at an increased relative risk for recurrence of that breast cancer than a woman is in developing breast cancer. Brand new. Given she's at an increased relative risk, that relative risk is less for recurrence if she's treated with hormones than if she is not treated. Yeah, that's the science. Hormones reduce the risk of breast cancer.

Yeah. And yet it's so hard to believe. People are so willing to accept the explanation that estrogen causes breast cancer and it is rampant in the physician community and it has trickled down to the patient community and they're really not letting go of that. Why do you think that that is so easy to believe and has stuck so hard?

Well, years and years and years ago, I noticed a 30 year lag time because I was so curious about what good stuff is out there. Who's getting successful in whatever branch of medicine they're in. What's the best information? I noticed that it would hit a certain public, a certain professional public 30 years earlier than it would become popularly known. The classic example was homocysteine. In the 1970s, this Dr. Kilmer McCully came up with a theory that homocysteine mattered to coronary arteries. Well, he got fired from Princeton where he was. He got fired.

He lost, as most of the trailblazers do.

Right, right. And then 30 years later, I'm driving down the highway in Florida and on npr, there's been a brand new discovery about heart relationship to homocysteine by a Dr. Kilmer McCully.

Thirty years later, there are still so many doctors that if you tell that I, I know that I asked my husband's physician to measure CRP C reactive protein and homocysteine and he said why?

Yeah, this was not part of our original training. And you. And there's a jillion great physicians out there and nurse practitioners and there's others who are, they're not paying attention to other fields. And that's. I understand that, but you know the why. It's part of the human experience. Once someone gets scared, we tend to treasure our fears. And this professional public has treasured this fear for reasons that I can't under explain that better not give hormones out there. And even though it's false information, well, it's creeping back in. Even the North American menopause society is starting to creep back in. Okay, you can give hormones. In fact, you can even give them longer than what we used to think you could give them. So it's slowly changing and there's trailblazers out there that are speaking to hospitals, speaking to doctors. Dr. Blooming's traveling all over the country. Here's what happens when he lectures at a hospital in front of a group of doctors. He says every single time some doctor stands up in the audience is furious at me.

Furious.

Calling me a woman killer. They're not listening to the science I'm saying to them.

Yeah.

So, yeah, human consciousness is that.

I know all about that because as you know, I do not advocate for mammograms. And my former colleagues who I worked with side by side and we had this amazing symbiotic relationship because they handled the radiology side of things and I handled the breast cancer side of things. And you know, we were partners. And now they're sending me direct messages about the fact that I'm killing women because I'm telling them not to have their breast crushed and radiated.

Right?

And it's like such a disconnect. And these people really, you know, because we came up with that tag, tagline that mammograms save lives. People have clutched onto that without looking at the data because the data's not there. And we know that converse. Not only do mammograms not save lives, but they actually cost lives. They actually cause lives, and over diagnosis and over treatment. So. But, you know, my colleagues are so. My former colleagues are so quick to tell me that I'm dangerous, that I'm killing people, that I'm harming people. And they really, you know, you said we treasure our fears. People have become so afraid to not get a mammogram, like it's somehow going to help them. And I completely relate to what Avram Blooming is going through in trying to change the tide. But the thing is that we have to be the lamplighters. We have to be the lamplighters, right? And so, you know, I endure the criticism because it's necessary for the greater good and because we have to speed up that timeline. It does take 20 or 30 years to impact change, to change the system, to change patterns, to change ways of thinking. And for the purposes of the people that don't want to live through that agonizingly slow change, we need to do it. We need to be loud voices and.

Lamplighters, and it really speaks to individual women and individual men. We really need to take on our health, and we need to learn enough stuff that we're the source of many of the health decisions, and we turn towards the professionals that we choose based on what information that we've acquired. An example of this is I used to like to work on cars, and I once actually rebuilt my Corvair van engine, and, you know, the thing ran for 7,000 miles until it froze up entirely from that. Then I watched a mechanic overhaul the engine of my Volkswagen van, and I went, oh, my God, this person is doing a zillion steps that I never even thought of. No wonder my thing froze. There's a time to turn to professionals. Oh, yeah. I turned to a urologist once, and I just was on my bended knees. The gratitude of the excellence of this physician and what he did and another surgeon at another time. There is a time to turn to the professionals we do recommend. Always. I'm speaking for you because I just believe you're going to say, this is, you want to do your homework. You want to find out who's the good One in your community. What do your friends say? What friends have had good experiences? What friends find the physician or nurse practitioner, not only knowledgeable and expert, but kind and willing to listen and willing to partner with you. This is the imperative. We have to go out shopping these days. Someday we won't have to go out shopping. It'll be almost universal that almost anybody you choose, just like almost any orthopedic, any orthopedic surgeon you choose these days, you're probably going to do pretty well. If they're decent human beings and they got a nice office, you're probably going to do pretty well.

Yeah. Yeah. But these days I do hope that that is part of, you know, we call the OB GYNs hormone experts, but they're really not. They're really not. They're not getting the training. And what they're, what their four year residency is mostly focused on is them being surgeons. And that's okay because they do have to be surgeons. And speaking as a surgeon, it takes a long time to, to master that. But maybe since we think about them as the hormone experts, maybe that residency becomes a five year residency and they actually learn about female hormones. Because right now they are getting taught to prescribe birth control pills. And that's it. That's it. They're really not getting any menopausal training at all. No perimenopenopausal training. And all of their training in the issues that we brought up before is prescribed. Korma prescribed birth control pills.

God bless them. I mean, over the course of my career, I have had so much benefit from referring to obstetrics when I was delivering baby, referring to obstetricians and referring to gynecologists. They're gifted in surgery. That's why they chose it. They have a love for it, like you say. And there needs to be a new specialization called midlife medicine. Midlife hormonal medicine for women and men. Our group is actively creating standard of care and working towards board certification. Our training is aimed at board certification. Yeah. The time has come for this new specialty so physicians and nurse practitioners and PAs can get training in getting excellent at hormones. They're powerful. There's some complexity to them. There's some individualization needed.

Get great at it and it changes people's lives. As you said, it is improving and prolonging cardiovascular health. And that is the number one threat to everyone's life. You know, we talk about breast cancer and how common breast cancer is, but women and men die exponentially more of heart disease than anything Else exponentially in every single decade of life past the age of 30, they die exponentially more of heart disease. And so we need to do something to intervene here. The amount of dementia and Alzheimer's that's present, that's prevented the cognitive function that is maintained with hormone replacement is a huge issue. I mean, we are going to have an Alzheimer's epidemic that we can't possibly deal with. Right. Alzheimer's is the type 3 diabetes of our, of our generation and we are not going to be able to deal with it. And yet so much cognitive decline is preventable if we intervene on a hormonal basis early enough. And as you said, the, the musculature, the joints, the bones. You know, as many women die every single year as a complication of a fracture as do of breast cancer. Where are the ribbons for that? Right.

You know, you also asked earlier, and I neglected to say this big one that you just mentioned. Of the women that come to me in menopause, what's the number 1, 2, 3 of what is challenging them? Cognitive decline is right up there. Yeah, I'm not remembering things. I had a 55 year old physician colleague who thought she was going to have to stop practicing when she was 55 because she was losing her ability to think. And her mom had dementia and her mom's sister had dementia and she went on hormones. And when I was talking, when I was lunch with her when she was 65, she was sharp as a belt. She was certainly hormones rescuing so many women is so commonplace when they're having cognitive decline. Things that are being called dementia but really respond excellently to hormone replenishment, especially estrogen.

Yeah. So I want to talk a little bit about where. What is the difference between bioidentical hormone replacement and what we just call HRT or MRT or what is the difference there?

The molecules. The human ovary puts out specific molecules like it puts out three estrogens, estradiol, estriol and estrone. It puts out testosterone twice as much, like I was saying, testosterone in a woman than estradiol. It puts out pure molecular progesterone and they have molecular configurations. And it turns out that our friends, our dear colleagues in the plant world, also contain molecules that have hormonal similarity. And what happened many, many years ago is that scientists realized that they could produce the same molecule. If they took the soybean, for example, or the wild yam, extracted a precursor and biochemically changed it, they could change that diastrogen in that plant into pure estradiol. Same molecules as in the ovary. Well, that had a high level of appeal to me or Dr. Wright, in my own inclination was copy nature. When in doubt, don't try and reinvent the human being. It's got a lot of good stuff in it. And the compounding pharmacists gained access to it in the 80s. Where did they get it? They got it from pharmaceutical manufacturers who had bought up soy fields and were extracting this diastrogen and converting it to the pure molecules. Then to take those pure molecules and combine them with something else so they could patent it. You can't patent pure estradiol. You can't patent. There's a law that says you cannot patent something that's already present in the human body. So they would take that estradiol molecule and combine it with an ethanyl chemical, have ethinyl estradiol, they could patent that. And that's where the profits lie. Well, the compounding pharmacists gained access to the pure stuff. And what do they do? They take these pure powders and they mix them up in gels, creams, or if they're using our product, they use organic oils. I love the organic oils. And they can produce a prescription coming from a physician or nurse practitioner. That's highly individualized. And that's another key thing in the world of hormone replenishment is you want to really get it to where the individual woman is balanced and the amount that she has and the sensitivity she has and the absorption that she has. Not hard describe it in my book. It's easy to do. It just takes a little bit of time. But bioidentical is the same molecule.

So in terms of how people should replace, because we hear that there are a number of different modes of delivery. There's oral replacement, there's transdermal replacement. Some people are putting pellets in. I'd love to hear how you think people should be replaced and speak specifically about the different hormones.

This is a very interesting topic.

I brought it up.

The world of treating women in menopause is like the Wild west because there was no standardization, there was no good training, and there was very few specialists. I'm one of the few specialists I actually know who just zeroed in on women and then men. There's all kinds of methods were invented, and some of them had primarily financial origins. Bottom line, there's the safe and best ways to deliver these hormones. For example, estrogen, you want to not take it by mouth, because when you take estrogen by mouth, when you take any steroid hormone by mouth. You have to take a lot more of it because it goes to the liver first. And 80% of it gets metabolized from the liver before it gets to the rest of the body. But more so than that, our livers don't need the extra work, that's for sure. And not the modern day liver, as you were pointing out earlier. But the main thing is that here's what we learned about birth control pills. A certain small percentage of women who were put on the birth control pills had clots form in the veins in their legs. And some of those women had those clots break loose and had a pulmonary embolus and went right to the lungs. And a few of those women died from the oral estrogen. That's what the cause was. And so when I started getting into hormones and I was given the choice of oral estrogen or topical estrogen, which doesn't have that increased risk of clot, I went, gee, I think I'll go for the topical.

Yeah, I think that's a really important point that you bring up. Those clotting risks are only associated with oral estrogen, that they do not exist with topical estrogen.

Yeah. Now there's a little more to consider around estrogen. The natural, like Dr. Wright had this wild idea. He was so outrageous, he said, why don't we copy nature? What we know about young women is they produce very high levels of estriol. Compared they produce four times as much estriol as they do estradiol. And he ran across a study done by an oncologist, a medical doctor at the University of Nebraska who was publishing in their late 1960s, Dr. Henry Lemon was his name. And he was comparing the 24 hour urines of healthy young women and the 24 hour urines of women who had breast cancer. And what he discovered is there was a lot less estriol in the women who had breast cancer than the women who were healthy. There was a lot more estriol. Now, every single cycle, I'm going to dive into the weeds here because I think it's so important that we get this one about estrogens. Every single menstrual cycle. And you interrupt me, Jennifer, this is going too wild here.

No, I love it.

Every single menstrual cycle, a woman goes through a couple phases. She menstruates, and then she starts rebuilding the lining of the uterus as a nice, wonderful, fertile cushion to receive a fertilized egg, should that occur. And in order to do that, she has to proliferate new Cells. She shed all the old cells when she with the menstrual flow. And she prepares brand new every single month, new cells to line the uterus. It's called the proliferative phase of the uterine. And proliferation is also going on elsewhere every single cycle. Go figure. A woman is preparing for the beginnings that ultimately will result in lactation. She is preparing new breast glandular cells. Many women feel this. They feel like their breasts are getting fuller over the course of their cycle. Well, those are new cells that are occurring there. Cells by cell division. And what stimulates this biologically, this proliferative phase? It's estrogen interacting. This is estrogen interacting with an estrogen receptor site called estrogen receptor site alpha. That's the proliferative phase. And the principal stimulant inspirer of estrogen receptor site alpha and proliferation is estradiol. But if a woman does not get pregnant, nature has designed this to get a fresh start every single time. And everything deproliferates. Eventually, the uterine lining sheds. Eventually, the new cells that were formed in the breast, they disappear. I love the name of this. It's called apoptosis. I don't think the cells actually pop, but they disappear. They deproliferate. So the second half of a cycle in which there's been no fertilization is called the deproliferative phase. And that deproliferation is inspired by estrogen interacting with estrogen receptor side beta. And the principal stimulant of ER beta is estriol. Dr. Lemon didn't know this. In the 1960s, these receptor sites were discovered. In the 1990s, bottom line. Dr. Lemon described to us what he thought the balance between estriol and the two most other potent estrogens should be. The two most potent estrogens are estradal and estrone. He said, there should be 1.3 times as much estriol as there is the sum of estradiol and estrone. He even did the math. That's the average. I was funded by a laboratory in the early 2000s. They wanted to develop a 24 hour urine hormone test, which is the gold standard of testing hormone levels in women. And I said, why would you want to do that? There's a good lab out there that's been doing this for years. There's two of them. They really got it down. Why would you want to do this? And they said, and this was a big lab. You know the name, it's now Genova, but it was metametrics at the time. And they said, because we have so many physicians all over the world, they want a one stop shop. We want to become experts at this too. I said, well, I'll do this, but I want to do a study to develop new reference ranges of modern women. I want to inspect the urine of 20 to 29 year olds at the right time of the cycle and see what's normal. Now, Dr. Lemon said there was 1.3 times as much estrogen in 1960s. I want to know what's true now. And what did I get instead of 1.3? I got 1.1. Women have more estriol, the primary inspirer of estrogen receptor site beta deproliferation, than they do the sum of the two most potent estrogens, estrone and estradiol. So Dr. Wright had this outrageous idea. He said, why not copy nature? Why invent a new human being Instead of giving pure estradiol, which is only stimulates proliferation, let's do biased, let's do estriol. In fact, let's put four times as much estriol in a formulation than we have estradiol. Why? Because when you do 24 hour urines and women that you're treating in menopause and you want to get a prevalence of estriol, you need to have, you need to at least start off with four times as much estrogen. So in the world of estrogen, the optimal way to deliver estrogen is through a formulation called biased. Every compounding pharmacist on the planet earth knows this, how to, knows how to prepare it. All you got to do is write the prescription. They're already been doing it. And you want to deliver it topically because we don't want to do it orally.

Right.

And we want to apply it to the skin and it absorbs beautifully in the skin. It's amazing how well it does. How do I know that? Because I've done thousands of 24 hour urine hormones. The woman starting out with zero, close to zero hormones, and we treat her and we see the levels. Now there's something else that goes on. Ten years into treating women in menopause, I had never seen a hormone. I was in Santa Fe and I was writing a prescription to a pharmacist because there weren't very many back in those days who knew about hormones. He was in Albuquerque, he was extremely knowledgeable and I was sending him the prescriptions and he was shipping them to my individual patients. I had never seen a hormone and one day he made an error and he shipped it to my office rather than to the patient.

Oh, wow.

I know. That was my response. It was in a white cosmetic jar. This is in the early 90s white cosmetic jar. And it had a seal on it. And I went, oh my God, it's biased in a jar here. And I cracked the seal, opened up the top, and out comes this very strong odor. And I was concerned about that odor. And I did some investigating. And what I learned is these ovarian hormones, as our testicular hormones, are very poorly soluble. You can't get them into solution unless you use a very strong solvent. And the odor that I was smelling was the strong solvent. And what I learned was over 99% of what was in that jar was the carrier, the solvent, and less than 1% of it was the actual hormone. You needed that much solvent to get it up in a solution to be able to deliver the identical dose. If you use a topic click or a spoon, like they did in those days. Well, my son and I, my son was there and we went, oh my God, I've been a functional medicine. I've been trying to tell people. What Dr. Jen's been telling people is try and eliminate your toxic stuff.

Yeah.

And I looked up what the chemical.

And then you hand them a whole jar of toxins.

I did the math and I was asking the women that I was treating to apply on the average 1 quart of this solvent per year for 5, 10, 15, 20, 30 years. And I went, what's wrong with this picture? So we went on to do a lot of work and we came up with a certified organic oil base. And that's how we decided dispense our hormones is in this certified organic oil. There's no solvent in here. This is not a solution. You have to shake the bottle before use. So this morning when I got out.

Of the realize that hormones are lipophilic in that they are oil. Right. And so they will only dissolve in oil. And we try to put them in these water based solutions and it just doesn't work.

Well, they're putting them in strong solvents, in petroleum based solvents. And what this is, is in order to get it to disperse and become a suspension, you have to shake the bottle. And that's what I did about an hour before I got on this podcast with you as I shook my bottle of testosterone and rubbed it on my skin. So the best way, the state of the art is for estrogens. Oh, and progesterone and testosterone do bioidentical. And if you can get at the organic oils, they're all over the country, we have over 36 pharmacies that are dispensing them. Get it in the organic oil and take these things topically.

So what about oral progesterone though?

Well, here's an interesting thing. A woman has, like I've said, 100 times more progesterone than she has estradiol. That means if a pharmacist is going to prepare a progesterone topically, they have to, they can only make it so strong. For example, we can only make this 200mg per ML progesterone. If you make it any more concentrated, it's too thick, you can't spread it out. 200 milligrams per milliliter. And even compounding pharmacists, the most that they could make it in, the most common carrier, which was co opted by the pharmaceutical industry, was Carbopol. And you could only make it 100 milligrams per milliliter. Because you go higher, it turns to a powder. You get a powder residue do now if you use a stronger solvent like Versa base, you can get it up to 200 milligrams per milliliter. Too much stuff. So what happened is since women's bodies for the most part vary enormously, is how much progesterone they need. A lot of women did really well on small doses of topical over the counter progesterone, which was only 1.6, let's see, was 1.6%. So 16 milligrams per milliliter. So they were getting 16 milligrams a day. And a lot of young women with good absorbing skin, they did fine on it. But menopausal women who needed more, well, the compounding pharmacists realized that they could only get so much in through the skin. Let's see if we can get progesterone orally realized and it works and it's safe. That's the thing. Oral progesterone still goes through that first pass. You still don't get access to but 10% of what you're swallowing. But there's no identified problems with oral progesterone. There's been a tremendous amount of it used. By now the problems would have shown up. We have this new opportunity with the organic oils in the pharmacy we're using. Price was the main prevention of getting enough oral topical progesterone. Well, the pharmacists that we, our national pharmacy that we work with, they didn't care how much they put in the bottle. So we now have an opportunity to experiment with giving a woman 200 milligrams topically or 300 milligrams topically. No problem. Now we're seeing urine levels that really matter. So there's a new era and we're on the frontier of it, and we love it. So I always love topical. But oral is fine. Oral progesterone is fine.

And is oral progesterone available in bioidentical?

Yes, it is. It's universally. The compounding pharmacists have been making it up in capsules for 40, 50 years.

Yeah, yeah.

Now, the pharmaceutical industry saw this happening and they came along finally with this product called prometrium, which is. Well, it's got bioidentical progesterone in the capsules, but it's in peanut oil, it's got some dyes in there, and it's the most popular thing because the insurance companies will pay for it. It only comes in two different doses.

It's problematic for a bunch of people, though.

And it only comes in two dosages, too. 100 milligrams and 200 milligrams. Well, we titrate progesterone even when we do it orally. And I've got women who 50 milligrams is what they can tolerate and 75 milligrams they can't tolerate it. It's an overdose. I've got women at the other end of the spectrum that need 600 milligrams. Probably the averages in my practice is around 100, 150 milligrams. We go to an extent to get it down to a much more accurate milligram to titrate it for the individual woman. Well, the pharmaceutical only allows 100 milligrams and 200 milligrams. So you don't have a lot of choice there.

Yeah, yeah. And then what about testosterone?

It's one of. I've come to realize that all these years I've been treating women, test all these hormones are extremely important. Want to save your brain, get the right amount of estrogen, save your vagina, save your bones, get the right amount of estrogen, but you want to stay out of assisted living facilities and nursing home, get the right amount of testosterone, because without testosterone, you're going to develop what a gerontologist warned our senior medical school class in 1968. They said, you're University of Michigan senior medical students. You know, thousands of diagnoses. Let me tell you what's happening to older people. They're losing their muscles. Process is called sarcopenia. And they can't stand with stability and they fall on their osteoporotic bones and they die. You want to do something for old people, Help them with their muscles, their bones and their brain. Yeah, everyone knows this. Anyone who lives in Florida and watches older people on the beach, and there's not so many as you would think. You see the thin lower extremities. For the ones who are still walking, they've lost muscle. Women lose muscle. They'll come into my office and they say, what happened to my triceps?

Yeah, I'm not embarrassed to be even showing my arms. No, it's real thing. My son, as I pick him up from the train every day after school and he plays with my arms. It's terrible.

Because there's muscle loss. Yeah, well, it's not that compromising of function when you're 50. When you're 60, you may notice that it's harder to get up and down off the floor when you're playing with your kids or your grandkids. And when you're 70, you start having trouble walking. And human beings have been using canes forever and it's because of muscle loss. Your question was, what about testosterone? 100% of the women we treat, we treat with testosterone because we think that's one of the greatest services that we do. Because God bless assisted living facilities in nursing homes. But when you talk to an individual woman who's about to go into a nursing home, it's shocking. She does not want that. It's hard to anticipate when you're 50. Oh, I won't have to think about this. But you're going to become 70, God willing and you're going to become 80. And as my mother did and my mother in law did, they had to go in and they're strong and they did it. But oh my God. My mother, as I was walking her into the assisted living facility, said, is this the old folks home?

I know, it's very real. It's a big deal. It's an awful eventuality for most people, even in the nicer ones. It's terrible. It's a terrible existence. I mean, I know I went through it with my grandmother who had, had. She had terrible osteoporosis and because she never believed in taking hormone replacement and she broke her hip for the first time, I believe she was right around 50. She had a hip replacement, did it again at 70, had an, had a redo hip replacement. And then when that fractured at 80, I remember my aunt Even though I was a big grown up physician by that point. And I said, you know, we have to replace her hip or she's going to spend the rest of her life in a nursing home. And that's an awful existence. And my aunt thought that the surgery was too dangerous and didn't do it. And my grandmother, I mean, God bless her, she lived for 15 years in that nursing home in a wheelchair, in diapers. Depend. I mean, it is for, for a woman who was so alive, so capable, so functional and could have lived those last 15 years with dignity and purpose and instead she rotted in a chair. And it's awful. It's awful and avoidable. I think that that is the main message that we have to put out there to everyone is that these things are avoidable. So let's talk about when you start and when you finish.

Well, boy, you have the questions. I'll tell you, they're the perfect ones. These are the practical ones. I'm a plant, you're a plant, I get it. Women are a lot. 80% of women are going to start getting symptoms of hormonal decline in their 40s or even their late 30s and certainly by their 50s. And it's a great time to start. It's just fabulous. Now some women in their 20s are starting to have symptoms and if you're sharp enough and you're connected enough to people who can counsel you, maybe you could go see the hormone person. It can be a tremendous benefit for young women because like we described that progesterone, they can get anxiety and that can really interfere with their growth and their life. So it can be these days as early as the 20s, but midlife, 40s, 50s, it's a great time to start and 80% of women are going to be inspired to do so because those hormones are life stopping. They really catch your attention and they really want you to, they catch your attention, they want to stop your world, those deficiencies and get you to ask a question, what's going on here? And they don't want, they want the correct answer. They don't want, well, this is a Valium deficiency. They want this. A hormone deficiency.

Yeah.

Now I didn't start treating my mother and my mother in law until they were 80s. They didn't want me to be there. Female related doctor until it got really late down the pike. So I say to any woman, anytime, anytime you think about it, you wonder about it, that's the good time. We had great benefit with my mother in law in treating her when she was in her mid-80s. And we had some benefit in treating my mother. Now, there are special precautions that are important to take. And any physician or nurse practitioner or PA well trained in hormonal medicine knows what kinds of things to look for. And maybe there's an extra trip for a cardiac evaluation. Not the catheterization type, but there's some great cardiac evaluations that are non invasive. And so there's special things to think about when you are embarking upon it when you're older. But my answer to your question is anytime you think about it.

Yeah.

Do it.

And I'm just curious as to what you do for your cardiac evaluation. Do you. Sending women for a calcium score, what are you doing to mitigate that risk?

There's two issues involved and I can go into the science, but I'll start with answering your question directly. And I've talked to cardiologists about this. A stress ultrasound in the hands of a cardiologist who's doing it themselves, I think is my number one preferred.

Okay.

Well, you get on a treadmill, you're hooked up to an ultrasound, and a good cardiologist can tell when there's compromised circulation to that heart that you would suspect.

You see the contractile dis function on the screen.

Exactly.

Yeah.

And that's non invasive enough and yet successful enough that they're going to pick up the problem issues. That doesn't mean you don't do hormones. You just have to do some extra stuff. And I won't go into that. That's the world of cardiologists. It depends on extra stuff you need to do. Then there's coagulation issues that we like to consider, and that relates to heart attack as well. And sometimes we do coagulation evaluations by blood testing. And so that's a whole protocol that we train all our providers on how to do this. And when does this become relevant? If a woman. The magic number. Magic. I don't think it's so magic. The magic number of a woman has 10 years without having a period and without having taken hormones, we're going to zero in on special evaluation of heart and blood coagulability. But we don't hold it that way. In our method, we take several things into account. If a woman is one year out and she had an aunt that died of a stroke and uncle and another aunt that died of a heart attack, and there's some special suggestion that, ooh, this could be some family problems here, some genetic problems, we're going to do the investigations earlier, depending on what that story, that family story is.

Yeah.

She's a woman who had a clot on the birth control pill. And they're out there.

Yeah, for sure.

I know I could name names of patients that I've had. They were so stood out in my mind. We're going to do some coagulation studies early on with them.

Yeah. But I do want to go back and stress what we had talked about earlier, which is that having had a history of breast cancer and having had recovered from breast cancer, that is not a contraindication for you. And in fact, those people are probably the people that you're considering even more.

Well, I've. From another perspective on that exact same topic, over the years, I have been approached by many women who've had breast cancer, had the breast cancer properly treated, were desperate. And yes, I've been treating women with breast cancer for about 30 years.

Yeah.

I'm treating women right now who've had a prior history of breast cancer. They're doing terrific. There's some extra things we like to deploy when working with a woman with breast cancer, but the process is the same, and they're as grateful or more grateful than anybody.

Yeah. Yeah, for sure. And let's address when you finish.

Yes. Well, I can tell you when I, as a man, plan to finish. When I can't take the top. I can't work the oral syringe anymore to pull up my dosage or someone rips it away from my hand for causes unknown. Every day we're on Earth, you don't want to stop these hormones. You talk to a woman who's been on compounded bioidentical hormones and she's 70, and you say, well, that's enough. And you get the response of the woman. They're not taking these hormones away from.

Me like my life no longer matters. Right.

Yeah.

Right.

It matters to me. Yeah.

Yeah. And it's just. It's. It's such a shame because I know that I came out of training in 2003, and when I. And I was trained by a gentleman named Gordon Schwartz. He was an internationally known expert in the area of breast health. Breast disease.

Breast.

Breast cancer. And in 2003, he taught me three things. He taught me hormones cause cancer. He taught me the only people that should be on hormones are the people that absolutely, positively can't live without them. And he taught me if you put someone on hormones, it should be the smallest amount for the least amount of time.

That's the prevailing mantra.

People said.

That was an invention. It was A response to the fright that everyone went through who didn't dive into the science. And it was a. Someone invented that thing in their mind. Well, maybe if we do the smallest amount for the shortest amount of time. There was no science behind that. Even the North American Menopause Society has backed off that science suggestion. And they're now saying, yes, it was.

Part of their recommendations for a while.

It was, but they backed off. They've come to realize that women over 65, they can have great benefit from this stuff. And they. Their protocols now include that. And they don't say, don't exclude these women.

Yeah.

And, you know, you take a woman who's 85 and she's been on hormones since menopause, and you stop all of her hormones, and within five years, she's going to have such severe bone loss, osteoporosis. Not to mention the other things. It's like you stop those hormones, there's a consequence of that. It's not like stopping a blood pressure medicine when there can be immediate consequences, but you're subject to the same things of low hormones, mood, weight gain, sleep disturbance, bone loss, muscle loss. That's the deep stuff we were talking about.

Yeah.

Loss of cognitive function. That's the deep stuff that we mentioned earlier.

And I also think it's important to speak to those women who don't have the hot flashes, who don't necessarily have the weight gain or notice the sleep disturbance. Those women need to know that they still have the cardiovascular decline. They still have the sarcopenia, the muscle loss. They still still have the osteoporosis risk. And those are the people that are actually getting into more trouble because they don't have the symptoms, the signal.

It's beautiful. Like I said earlier, those are the ones I'm most concerned about because they have no motivation. They look around them and they think, I'm not having trouble. I don't need the hormones. But like you said, I'm just saying it to echo it, that they still lose their bones, they still lose their muscle. Many of them still lose their ability to think clearly. They definitely lose their vagina.

Yeah, yeah.

And on and on and on. Skin, hair, all these things, the exact same deep stuff. They don't have the dramatic hot flashes, but the deep stuff marches on.

Yeah, absolutely. So for those women that are out there, that are listening, that say, like, my doctor won't even talk to me. My doctor won't talk to me about this, they're either dealing with or have had a history of breast cancer, and so, you know, their doctors are saying absolutely not. Their medical oncologists are saying absolutely not. And then they hear me and they hear you. And even if they're not dealing with a breast cancer diagnosis, but they just, their doctors won't discuss it with them because they're still, you know, they still hear that that headline that was released in 2003, right? Like they're still living under that headline. Where should these women go? Where are the resources for these women?

Here's the great news. Ever since the 80s, there has been amongst the physician and nurse practitioner and physician's assistant population a certain percentage of us that have had a high level of interest in hormones. And they're everywhere now. And there's training programs everywhere. And that's the main thing I do, is I train and mentor physicians, nurse practitioners and PAs. And so here's some resources. Number one, if you get a download a free PDF copy of my book from, from Jen and contact us and we can give people if, if we know your zip code and we've trained someone in your state, that we'll give you referrals. And here's the great thing about menopause. Telemedicine has changed the whole way of operating. I realized 12 years ago that it was a myth that I needed to see my patients in person. And they were traveling from all over the United States. And I said, okay, pay for an airplane ticket, fly in from Europe, but I don't need to see you in person. It actually works out that the telephone works because back in the day when I started doing remote dolls, I was doing it by telephone, right?

There was no zoom.

This was dispelling a myth for me. I thought the doctor patient in person relationship was sacrosanct. And you know, it absolutely is. For some medical conditions you've got to get an exam by an in person human being and not a robot. But for menopause, medicine and andropause method, so long as a woman has a personal healthcare provider that can do physical exams when they're needed, everything in menopause and everything in andropause can be done beautifully by telemedicine. That means you don't have to find someone in your neighborhood, you just need to find someone in your state. Now, if you don't contact us and you don't have a resource, here's another suggestion I have. Talk to your friends, someone in your circle is quite likely to be on hormones and ask them, do you know anyone who's good that you like that you're satisfied. Okay. The women network. And it's one of the greatest places to get the provider because they know if they don't know. Here's another way to do it. There are 7,500 compounding pharmacies in the USA. There's two in my small town that I live in. In big cities, there's three or four or five. What I suggest is you identify one of those compounding pharmacists that's nearest to you and you actually go into the pharmacy. These are busy people. You don't want to try and get them on the phone. But if you show up in their pharmacy, that pharmacist is going to walk out of their compounding room. And they love to talk to people. And you say to the pharmacist this. You're receiving prescriptions from a lot of hormone providers out there. Who would you choose for your family? Can you give me a list of one or two or three? Because this is the most important question to me, Jen, that we've covered. It's finding that provider.

Yeah.

It takes excellence and it takes licensure to prescribe hormones. So the primary job of any woman in menopause or perimenopause is to go shopping until you find a provider that you like, that you feel comfortable with, and those are the ways to do it. I say that I've given you enough that you should be able to find someone in your. In your. And all you need is someone in your state, no less.

Yeah, yeah. And just find someone who's doing it well. And I think that, that, that, that goes a very, very, very long way. I think that that is excellent advice for everyone, is to go to the source. Right. Because the. Just like when I was a surgeon, you know who the other good surgeons are and you know, who the ones are that are, you know, not so great. Right. Like when you're inside of the circle, you know, you know, and for the providers that are listening, because I do have a lot of providers that are following me. How do they get this education? How can they train to be prescribers and do it well and do it right and understand how to work up these women and how to provide what they need?

Well, I want to give me my best shot and they can contact us because that's what I spend 80, 90% of my professional time doing is training and mentoring physicians and nurse practitioners. We have elaborate training and mentoring. Once they go through our training program, they have access to our weekly grand rounds. That's the big fun of the Week. We all, we all grew up with grand rounds. This is a wonderful forum to present your challenging cases. So you could, you could contact, you could go to iobim.org that's our training company. You could go to Bright B R I T E Live, or you could contact me directly drrm.org there's other training programs out there, but I want to give you my best shot. That's all I've been doing, primarily for the last 30 years.

Yeah.

And so that's given me and doing.

It well and doing it right and making a huge contribution to women, to medicine, to education. I mean, what you're doing is really changing lives. It's saving lives, and it's making a huge, huge impact in this world. So I am so grateful for everything that you do, for your time that you provided us today, for your clear, deep passion about health, longevity. And, you know, this isn't just about living longer, because if you're living longer, but the last 20 years of your life is spent compromised in a wheelchair in a nursing home. That's a terrible existence. You know, we all emulate the blue zones because these are pockets of the world where people have tremendous longevity. But they're not spending their last 20 years in nursing homes. Right. They're spending the last quarter of their life the same way that they spent the first three quarters of their life. They remain active, strong, with purpose. And that's exactly what we want to do. And this is one major, major way in which we're going to do that. So we covered so much today. We covered birth control pills and what the issues with that are. We covered safe protection. We covered the rumor about estrogen and breast cancer. We covered all the symptoms of menopause, from the very early ones to the more advanced ones. And we covered the fact that even if you don't have symptoms, these deep changes are happening within you. And so it's so important to acknowledge them. We talked about how we treasure our fears, and I think that that was probably one of the most profound things that we talked about because it's fear that has stopped us from accepting truth and change and all of that. And then we talked about the different kind of hormones, how to replace them, when to replace them, for how long to replace them. So we really covered a lot of ground and most importantly, how to find a provider that can help you. And pretty much, if you are living past the age of 40, you're going to need that help at some point. And then for those providers that want to learn more, you gave your website iobim.org for them to learn about how to educate themselves, train properly because it's so important if you're going to take care of women, it's so important to know this and to do this. So I thank you so much for being here today. This was an amazing conversation. I know that people are just going to be hanging on to every single word and I'm sure there's going to be lots of questions. So we're going to have you come back, but for now I'm going to just say thank you so much, so much for everything.

Big fun, Jen. Yeah, it sure was wonderful synergy. The first time I ever heard you lecture I went, ooh, this is a tribes woman of mine for sure. We gotta start sharing this work together. So anyway, it's been a real pleasure, absolutely all mine.

And we are truly kindred spirits. So I'm so grateful and lucky and thankful to have you in my life and as a resource and a colleague and a friend and a support. So if you enjoyed this podcast and I can't imagine that you didn't, please like it. Please share it with the people in your life that matter to you because we all need to know it. We all need to hear it. And I will be back next week, same time, same place. 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 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 Facebook, Instagram and YouTube. Dr. Jennsimmons 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.

Sam.