The Impact of Hormones on Breast Cancer and Menopause with Dr. Deb Matthew

Welcome back to another episode of Keeping Abreast. I AM your host, Dr. Jen Simmons, and I am delighted to have a super, super lady with us today. I had interviewed her for my summit in 2022, and the information that she shared with that day rocked my world. She is a, she's known as the happy hormones doctor. She's a best selling author and international speaker, an educator, a wife and a mom of four boys. God bless you. I have two. And let's just say that it's so much easier to go to work than she'll work for them. So, Dr. Deb Mathew, welcome.

Hey, it's so nice to talk to you.

Yeah. So we had this fascinating, fascinating discussion about hormones. And I do want to get into all of that, but you're a classically trained doctor. You come out of the conventional medical world and yet that's not what you really ascribe to anymore. So can you just give us a little background on how you started and how you shifted?

Sure. Well, as you said, I was a regular doctor, but I didn't feel good. I was tired all the time. I took a sweater everywhere with me, even in July in North Carolina, because I was always shivering. The movie theater, the air conditioned restaurants, I was always just shivering. It was so uncomfortable. But I'd felt that way for such a long time that I just assumed that I was a cold natured person who needed more sleep than everybody else. But I also started to get irritable. I was screaming at my kids for no apparent reason. I remember one day, one of the boys was kicking a soccer ball in the living room. He's bouncing it off the living room wall and my head started spinning around and flames are shooting out of my ears. And I just screamed at him, get the ball out of my house now. And honestly, like, that exorcist voice made the kid move. But I felt so guilty because it's not the kind of mom that I wanted to be. And I was waking up in the middle of the night with panic attacks for no apparent reason. You know, nothing was going on that I needed to be worried about. And finally my husband started to say things like, how come you're never happy anymore? And I knew that how I was feeling wasn't me. I knew that it wasn't normal. But there was nothing in my medical training to help me understand what was happening to me. And finally one day, my husband found a book that was written by Suzanne Summers. Remember Chrissy Snow from Three's Company, Right, The Thigh Master on the back cover of this book. It had all this stuff about, you know, being irritable and tired all the time, like, all the things that I had. And the book was called the Sexy Years. If that book had been called Women's Hormone Problems, I'm sure he wouldn't have touched it with the ten foot pole. But in any case, he found this book and he brought it home and he suggested I might want to read it. So we got to give him a little us for being brave, right? Suggesting.

Absolutely. Well, the alternative was living with the exorcist version of you. Which exorcist version of me? I can only imagine. It's intolerable at best. Yeah.

You know, he used to call me from the car on the way home from work because he could tell by the tone of my voice on the phone whether it was a good day or whether he should stop and suit up with his suit of armor before he walked in the door for his own protection. But so I did read the book. And you got to, like, you know, right? Medical doctors do not want to get our medical information from celebrities. Like, I just. I didn't want to read the book. I'm going to be honest with you.

You mean they don't. They don't take well to you bringing in books of famous people written, talking about things that they don't know.

I had known that Suzanne Summers had been reading, writing health books. I know that she'd had, like, diet books out. And I had been one of those medical doctors who was pooh, poohing everything that she said, because how does she know? Who is she? But I got to tell you, she's interviewed all these other doctors, and I'm reading this book and she's telling all these stories about women and how they used to feel when their hormones were out of whack and how they feel now when they've got their hormones balanced. And, like, my brain exploded and all of a sudden all these things that I was feeling made total sense because I was in my late 30s. And so, like, when you're in your 30s, who's thinking about menopause, right? But my female hormones were shifting, and so I was irritable and I wasn't sleeping well, and I was getting anxiety when I hadn't had anxiety before, and I was hypothyroid. I knew that I'd already been on thyroid medication for 10 years at this point. Took 10 years of symptoms before I got diagnosed. But that's a whole other story. But. But I'm on my thyroid medication My tsh.

Out of curiosity there, did that delay in diagnosis happen because you just weren't taking care of yourself, or did that delay in diagnosis happen because your TSH was normal?

Yes. I felt exhausted and crappy, but I had decent lifestyle habits. Even twice in medical school, the doctors that I was training with looked at my throat and said, your thyroid is enlarged. You should go get it checked. And I went and got it checked, and I had every single symptom on the list, but my TSH was normal. So they told me I was totally normal and I went back home and had a nap.

Yeah. But. So let's talk about. For people that don't know what language we're using right now, because doctor. Doctors tend to talk about things like everyone understands what they mean. So what is TSH and why do people use it? And why is it not an accurate approach to working up the person who you suspect has thyroid disease? Okay.

TSH is called thyroid stimulating hormone. It comes from our brain and it tells our thyroid gland when it needs to make more thyroid hormones. And that's the screening test the doctors use to decide if your thyroid is normal or not. And it goes backwards, which is super confusing. If your thyroid is under functioning, the TSH goes high, and if your thyroid is over functioning, your TSH goes low, which is confusing. But in any case, what we are taught at medical school is if your TSH is within the normal range, which is this big.

Yeah. And it's only. It's only getting bigger. Right. We're only allowing for larger and larger standard deviations from optimal.

Yeah. So if. If your TSH lands somewhere within those goal posts that the lab says is the normal range, then you have to be normal. And if you have all the symptoms, if you're exhausted all the time, you can't, you know, you're struggling with your weight, you're gaining weight, you can't lose, no matter how hard you try. If you can't remember things and you've got dry skin and your hair is falling out and you're cold all the time, like, these are all mood changes. All of these can be symptoms of low thyroid. But if your TSH is normal, your doctor is going to insist either that you're normal, like nothing is wrong with you, even when you know perfectly well like this is messed up.

Yeah.

Or you're. When you're.

When you're anything but normal. Right. Yeah.

They'll say that you need to go exercise more, which is what every exhausted person wants to hear. Right. Or they'll Offer you an antidepressant or sleeping pills or something, because that's what we're trained to do. And to be honest, when I finally got the diagnosis, so I'd been on birth control pills for years, and now I'm married. I'm ready to start my family. I went off birth control pills, and I never had a period. And so I went to the gynecologist about my fertility issues. But interestingly enough, I never had periods before I went on birth control pills either. But I went on birth control pills, which made me normal all those years. And then shocker of shockers when I want to off them. Why would I assume that something was fixed? You know, it's the birth control pills don't fix anything.

That is what is routinely happening. That if people go to their doctor with a cycle abnormality, what do they do?

Birth control pills.

Put them on birth control pills. Right. Fix the fix. You know, like, make that. Make the outside look really pretty. The inside is a hot mess, but let's just make sure the outside looks really pretty.

Yeah. And so when I went off these birth control pills, didn't have a period. They finally. By this point now, we're like 10 years into my symptoms now my TSH is out of range. And so that was the problem with my periods all along. When your hypothyroid, it messes up your menstrual cycle. So anyway, once I got started on the thyroid hormone, I felt no better. Like, all the. All these years of being on the thyroid medication, my TSH was in the normal range now. So the medicine made my lab test look normal. And all those years I was told that I was normal, even though I still had all the same symptoms. But that's what I was taught, so I just believed that. So all those years, I just. I had to have a nap. When I started having my kids, I had to hire a babysitter. It's not like it was an option. I could not function unless I had a nap every day. So I hired a babysitter to come and have naps whenever I could. And it wasn't until I read that book that I realized that there was more to the story. And honestly, if I had not read that book, I would not be here talking to you. I wouldn't have changed the way I practice medicine. I wouldn't have opened my office. I wouldn't have written my books. I would have done none of it. I would still be on the couch, staring at the pile of laundry, waiting for it to fold itself Because I was too exhausted to do anything.

Yeah. So where did you go from there? Like, how did you get from doing that to being. I forget what you are the president.

Of the society, the North Carolina Integrative Medical Society. I'm the past president.

Okay.

So when I read the book, in the back of the book, there were all these resources for where doctors could go to get trained. And when I started going to these conferences, like, I realized there's real science to this. This is not medicine. You know, this is. This is real science, and we've got research behind it. And I remember sitting in that lecture hall when there was a doctor who had a list of all the symptoms of low thyroid and what these. And I'm sitting there going, mentally, you know, check, check, check. I got all these symptoms at that point. And he said, if your patient still has all these symptoms, even if their TSH is normal and you've put them on some kind of thyroid pill, if they still have all those symptoms, you haven't fixed your patient. And for anybody that didn't go to medical school, that seems kind of obvious, right? If you, if your patient still has all the same symptoms, you haven't done the job. But to me, it was like this. Oh, my God, like, it was this mind blowing thing. And so because of what I learned, I was able to find practitioners who could help me. I got my thyroid balance, I got my progesterone balance. Another thing that I had going for me is I went through medical school, residency, had four babies in less than six years. My adrenal glands were tanked. And when cortisol is off, it impacts how your thyroid hormones work and how progesterone works. It's all tied together.

Yeah, it's a symphony, right? It's a symphony.

And so once I understood the problem, then I can find, you know, I understood what the solutions were, and I got my energy back and my kids got their mom back, and my husband got his wife back, and I got my life back. But I couldn't go back to just writing prescriptions all day long because that way of practicing medicine just didn't make sense anymore. And so I retired from my own. My old practice. I actually started my career as a pediatrician. And I retired from my old practice and I spent. I completely retrained. I went through a fellowship program at the American Academy of Anti Aging Medicine, and I went to the Institute of Functional Medicine. All these places where doctors can go to learn. And I had to reprogram my brain. I changed everything about How I practice. And I opened my practice in 2007. So I've been doing this now for 17 years. I've been doing this longer than I practice, sort of as a conventional doctor. And it's so rewarding. And every day I get to work with people who, you know, they walk in. The number one thing I hear women say when they walk in is, I just don't feel like myself. Like, this isn't me. This isn't normal. One of my patients, I think she said. I think she hit the nail exactly on the head. She said, I just want Lori back.

I think there are so many people that feel that way. And it's essentially an exercise in frustration to go to your doctor. Because what your doctor does, it's. It's one of two things. My friend Wendy Trubo, you know Wendy, she. She tells me that either you go in and you get put on the line of thought, right? They order some, like, rudimentary labs that don't do any. That don't do anything, or tell them.

You'Re not looking at the right things.

Yeah, right, right. Like, if you're not looking for the right thing, you're certainly not going to find it.

Right?

And so. And your labs are normal, and you get put on this line of fine, even though, you know you're anything but. So I think that's part of it. And the other part of it is that physicians feel really uncomfortable when they don't know. Like, I don't know are three words that they never want to say. And so when they get into that discomfort place, all they're going to do is reflect it back onto you. Right? It's not me, it's you. So it must be in your head or you must be imagining it, or they'll normalize it. Like, what do you expect? I have people call me all the time, and they're like, well, you know, I am 38. And I'm like, are you. Are you kidding me? Someone said that to you. You are 38. You should expect to be tired and have no libido and no energy and be sad or anxious or not sleep. Like, are you kidding me? 38? But this is happening all day, every day.

So common, isn't it? I. I just talked to somebody today who, when she came in, so she's new to me. She. We haven't started working together, but she came in and she was feeling so hopeless, you know, because she'd already been. What she felt like is she'd already been to all the other doctors. She'd already had all the other tests. Like, you know, she had testing done, but all the tests obviously hadn't been done. But she felt so hopeless. And she's explaining how she's feeling to her doctor. She's tired, she's bl. Bloated. She can't lose weight. She can't remember where the heck she put anything. There's not enough sticky notes to keep track of things. You know, like, she's depressed. She doesn't. She's not motivated. She wants to know, have healthy lifestyle habits, but she's just so unmotivated to get up and do anything that she's supposed to do. And so when she went in to complain about all this and they did their little standard tests, they told her that she was perfectly healthy, which is so frustrating. It's disempowering. Right. Like, she felt like she wasn't heard and she wasn't respected.

It's rude.

Yeah. And when she pushed back just a little bit, you know, she was sort of told, well, like, what do you expect? You're getting older. And, you know, she's in her 40s. Like, she's not 93. I mean. But the. The line that I like exactly what you were saying about how doctors don't like to not know things. Their doctors tend to be down on what they're not up on. And so if they're not familiar with it, we tend to kind of poo poo it away. And I got to admit, like, that was me in the old days. If somebody came in and they asked me about something that I never really heard of and I didn't really know, like, I would sort of assume that if it really mattered and it was really important, they would have taught it to me in medical school. But the reality is, I think that we should ask for a partial refund because there's a whole bunch of stuff they left out at medical school.

I couldn't agree with you more. I couldn't agree with you more. It's funny as you say that I still am haunted by an experience with a patient where she, you know, I'm. I'm. As we, like, we follow a checklist, right? We get. We get a history. And as part of the history, she tells me that she has chronic Lyme. And I can't. I can't remember exactly when this is, but let's call it like 2012. I had never heard of chronic Lyme. I thought you got Lyme disease, you got treated, end of story. And I. Here I am, like, Writing in my notes like, woman is crazy. Tells me she has chronic Lyme. No such thing. And this is what's happening all day, every day in doctor's offices. Who they train and what they learn. At the time of training, they assume that is all there is to learn and that what they're learning is correct. Right. And then they go through the rest of their career with these blinders on, unless they have an experience like what you had that opens their eyes to something more. Because once you become a patient and you experience the frustration and just the, like, overall ineptitude of our system, when you experience it as a patient, it's an entirely different thing.

Yeah, right. It's very humbling, isn't it? Like, all of a sudden you realize like a. You don't know everything. And, like, there's so much out there that, that, I mean, there's so much out there. I still don't know, but it's very humbling. And, and what I really feel like it did for me is it gave me this huge attitude adjustment because now if somebody comes in and they tell me about something new that I've never heard of before, I have a totally much like, much more open mind to saying, okay, well, just. Just because I never heard of it doesn't mean it doesn't work. I mean, I don't know how our computers are working right now. Lord knows, I don't know how my phone works. But just because I don't understand how it works doesn't mean that it doesn't work.

Yeah, of course. Of course. And I'm. I'm the same way in that, you know, my, my answer now is, I don't know, but I'm going to find out.

Yeah, exactly.

Right. Like, for sure, I'm looking into this because maybe that way is better than the way that I'm doing it now. And I am. I think being committed to being a lifelong learner means that you have to go through life with open eyes and being open to the opportunities and being open to the fact that there is more. There's always more. Yeah, right.

For doctors, like, in fairness, I think that generally doctors are good people that want to help people. And we're trained in a certain way, and we are trained that we have to have, you know, lots of science to back things up, which is good, because we don't want to be doing things, you know, that aren't safe and aren't appropriate. But we're also trained that we have to do it the right way. The standard of care the way that everybody else says it has to be done. And we're trained that way to the point that we're not willing to be open to any new ideas. And so the flip side of this is whenever there is new data that comes in, it's so hard to change doctors minds and beliefs. Like we're so unwilling to be open to new ideas because of how we are trained. So I think the good thing is once, once we move over to this more functional medicine approach, more holistic approach, one of the things that happens to us is we become more open to new ideas. But that's something that's been really, really hard, is that it's very difficult for doctors to change their ideas. And therefore, whenever any new things come into medicine, it can take 15 years before new ideas really take hold in mainstream medicine, which is one of the problems with hormone therapy. Yeah.

And it's not, I don't think it's solely in the arena of the doctors because I think there are other forces at play in that. The pharmaceutical industry doesn't love functional medicine.

No.

Big Ag doesn't love functional medicine. Big Food doesn't love functional medicine. And so. And they wield a lot of power. Right. And they, they, are they together? Big pharma, Big Ag, Big food, They're controlling a lot of the narrative. So. And they have really loud voices. Yeah.

And hospital systems and insurance company. Right. They, they are the ones that have the power here and they control the information the doctors get to a large degree.

Yeah. Although insurance companies really should be on our side.

I know, but they're not. They don't benefit when you're healthy. It's crazy.

Well, but insurance companies really should benefit when you're healthy because it would mean that they would have to pay out less. I still really struggle with why they haven't come online yet. And I'm hoping that they will because I think a lot of people think of us as practicing elitist medicine. And really what I'm saying is that what you should just be doing is redistributing. Right. Insurance should be for emergencies and it should be for unforeseen catastrophes, but it should not be for health maintenance. But that's what we've made it for. So if you want your doctor to pay for your health maintenance, I mean your insurance to pay for your health maintenance, of course it's going to be very, very expensive. Especially because no one's maintaining their health. Right. And if it were for those catastrophic situations, you have an appendicitis and you need a surgery or you break your leg or if that's what insurance was truly for. And we were spending our money on our food, on our water, on our environment, on self care, our health would be vastly different. But that's not what's happening. Let's talk about hormones. Let's talk about. Why do people think that estrogen causes breast cancer?

When I graduated medical school in the 90s, we were taught that all women should go on hormone therapy when they went through menopause for their own good, because it was going to help their heart, their brain and their bones. It was very paternalistic attitude. You must do this for your. Like.

Basically, women of a certain age were handed a prescription, right?

Yeah, everybody got the same thing. And if you were 45 and older, you got hormone therapy. If you're 45 and under, you got birth control pills. And if you complained loud enough, you got a side of antidepressants. But in, in 2002, this giant study came out, the Women's Health Initiative study, and all of a sudden, stop the presses. They found that these pills that we're recommending for every single menopausal women were increasing the risk for breast cancer. And it made the media, it terrified women, scared the pants off their doctors because we don't want to be doing something that's going to be harming people. We were like horrified to think we were doing something wrong. And so hormones cause breast cancer and specifically estrogen is what, like everybody knows that this is true. The reality though is, and this was 20 years ago, right? So we've had 20 years to really evaluate this is there were two different arms in the study. One of the arms women had had a hysterectomy, so they were given just estrogen. The other arm of the study were women who had their uterus still and they got a combo pill, estrogen with progesterone. So those are the two hormones that go up and down over your menstrual cycle, but they go down after menopause. But they weren't given bioidentical hormones, which are the natural form of the hormones in our body. They were given estrogen. It's called conjugated equine estrogen or cee, which is from horse urine. So it's from nature, but it's not natural to humans. And then they were given a synthetic progesterone. So it's a drug that's a man made chemical never found in a woman's body. But it was mimicking progesterone because we didn't have a ready made progesterone, progesterone option at the time that this was invented. So it was, you know, it was better than nothing. But that was the standard thing that everybody got this combo pill. So in the women who had the combo pill, there was a very slight increase in the risk for breast cancer. And because we were recommending it to every woman in America because we're trying to prevent them from having a heart attack, now all of a sudden we're thinking, ooh, well, maybe that's not the right thing to do. The other group of women just got estrogen. Not only did they not have an increase in the risk for breast cancer, they had a decrease in the risk for breast cancer. It's not estrogen that was the problem. It was this drug form of progesterone. The drug form of progesterone was only causing a very tiny increase in the risk for breast cancer. But that's not what the news said. The news made it sound like women are dropping like flies from cancer. Even the women who got breast cancer, they weren't more likely to die. So women who were on hormone replacement therapy had a 40% less risk for death from any cause, whether it was heart attacks or whatever. So even with this combo one that did have a very tiny increase in the risk for breast cancer, you were still less likely to die.

But I do want to say they had a tiny increase in risk of breast cancer as compared to the control group. But the control group had a decrease rate of breast cancer than we see in the general population.

Right. So there's all sorts of stuff here. We were saying that estrogen therapy across many studies, not just this one study. If you look at all the different studies, it's very consistent. Estrogen actually reduces the risk for breast cancer. When these women were recruited to be in this study, many of them had already been on estrogen before, so they were older. The average women in the studies were already in their 60s. They were already, you know, 10 or more years out from menopause. And so some of them had already been on estrogen, which would lower their risk for breast cancer. But they didn't screen for that. You know, they, when they design studies, they do their very best to try to account for anything that might skew the results. But it's hard to be perfect and account for everything, but. So in the control group, there were actually less incidents of breast cancer than what we see in the normal population. And so when you compare the women on the estrogen and the Synthetic progestin to the average population, there actually wasn't an increase in the risk for breast cancer. But compared to that control group, very tiny increase in the risk compared to the control group.

The most important thing to take away from that is estrogen does not cause breast cancer. And in fact, it's probably protective. Probably protective, Right.

And the problem is the hormones got painted with the same brush. Right. Like all hormones are the same estrogen. Like, nobody distinguished. It was just hormones.

Yeah. So now let's talk to the person who probably wasn't on hormone replacement. Because for decades we did not change our practice pattern. Right. And. And generations of women suffered as a result breast cancer. Because breast cancer is an environmental disease. And quite like our environment sucks, we are really destroying our environment. We are surrounding ourselves. We're swimming in chemical soup. We're just steeping in chemical soup. And we're working too hard. We're not moving our bodies enough. We're not prioritizing sleep. We're eating crappy food. And not everyone's doing that. So I'm not trying to say that we're all going to hell in a handbasket and living irresponsibly. Of course that's not true. But our environment does, in fact, suck. We are not being protected. And there are chemicals all around us that are so unnecessary but ever present. Women still got breast cancer, and then they run their tumors for estrogen and progesterone receptors. And in fact, they're there in the majority of breast cancers. And the doctor said your hormones cause this. And it's very easy for them to believe. Right. It seems like a really easy puzzle to put together. And so what do they do? They completely starve these women of hormones from then on. Right. They either give them an aromatase inhibitor, which shuts down estrogen production, or they take their ovaries out, or they give them a medicine like Lupron which shuts their ovaries down. And these women are really suffering because what estrogen is doing, as you were talking about is it's protecting your heart and protecting your brain and protecting your bones. And so all of a sudden, you throw these women into menopause, or even if they're in menopause, you get rid of any remaining estrogen for them, and they're really suffering. They're really suffering. I mean, the data is out there that women who have been treated for breast cancer are dying of heart disease at two and three times the rate of women who aren't.

Yeah. We know from all these studies that Women who are on hormone replacement therapy have a 40% reduction in heart disease deaths and a 40% reduction in deaths, death from any cause. But it's hard because when you, when you are diagnosed with breast cancer, right, you kind of have to be treated, right, like this. You can't fudge around with cancer, right? I get it. After though, once you've finished your treatment, etcetera, there's sort of another story. But can we talk about those receptors, the estrogen receptors and what that means? Because it's just something that just. I can take a deep breath before we talk about it. So breast cells are supposed to have estrogen receptors on them. That's normal. They have estrogen receptors and progesterone receptors and testosterone receptors. That's normal. When cancer starts, the cells are different. So that's the whole point is a cancer cell has had some kind of a mutation and now it just grows and grows and grows and grows and grows, even when it's not supposed to. And that's why becomes a tumor and causes a problem. And estrogen is one of the signals for cells to grow. So a breast cancer cell that has estrogen receptors on it, estrogen can make that tumor grow. So that's why the logic behind all of this, it's not illogical, but it's not that estrogen caused the cancer, and that's what women are led to believe. The other thing that can happen is these cells can get more severe mutation. So now the cell doesn't look very normal anymore and it loses its estrogen receptors. So if it has lost the estrogen receptors, it still doesn't mean the estrogen caused or didn't cause the cancer. But now estrogen is not going to make that cancer cell grow anymore because it doesn't have any estrogen receptors, which.

Is actually a bad thing because it is no longer behaving like a normal cell. So you know, when people say like I have an estrogen and progesterone receptor positive breast cancer, I'm like, great. Because that is more like a normal breast cell. And it's when we start to get into the tumors that are progesterone, estrogen positive but progesterone negative, that has a worse prognosis than when they're both positive. And then, er, PR negative tumors, they have an even worse prognosis. And it's because these cancers, as they continue to mutate, become more and more aggressive. So you want your cancer to look like a normal cell. It means it hasn't progressed along that, that spectrum so much.

Yeah. And I don't feel like women are being told that. They feel like if they have an estrogen receptor positive tumor, they feel like estrogen caused their cancer and they need to stay far away from estrogen forever because otherwise terrible things are going to happen to them. And that's just not what we actually see in real life. So if a woman has.

Why do you think they're not being told that? Do you think the doctors also believe that that is the. That is the problem and that is the cascade of events, like too much estrogen caused the breast cancer and. And you think.

I believe that doctors to this day believe that estrogen increases your chances of getting breast cancer and, like, estrogen replacement therapy causes breast cancer. I believe that to this day because I hear women coming in all the time. I went to my doctor, I told them that I don't feel good. I have hot flashes and vaginal dryness and sex hurts and I can't think straight and my skin is aging right before my eyes. I look in the mirror and I see my grandma. Like, they explain how they're feeling, and their doctor either, you know, tells them, like, either you're too young. We don't measure hormones, whatever excuse they get, but they're warned away from hormones. Like, this is, you know, it's just natural. You need to deal with it, just get through it, put up with it, because hormones are dangerous and they're going to increase your risk for breast cancer. Especially like if some. If a woman's mother had breast cancer or her grandmother had breast cancer, they're told you're not a candidate for hormone therapy because estrogen might cause you to have breast cancer. So I believe the doctors still have this misguided information and the doctors themselves are scared of hormones. I work with doctors and help mentor them as they're like, opening their practices to help women in this more natural way. And there are so many doctors out there that I talk to who are learning how to help women with nutrition and more natural things. But they are so scared of working with hormones because they're afraid they're going to cause women to get breast cancer. And, you know, it's so ingrained in our psyche. Terrible.

So I know that you're not just putting people on hormones. Right. Because there's more to the picture. So can you talk to us about how you approach someone who comes in and, you know, I always go back to that Avram Blooming explanation where if you told a man that, well, I know that you don't have the energy that you expect to have and you're not sleeping and your mood's not great, and sex is painful, unenjoyable, and you have no desire for sex at all. And you know this will only hurt for 10 years or maybe more, maybe for the rest of your life, but just get through it because, you know, this is the way it has to be done. And if you were to say that to a man, he would knock your block off, right? Like, are you crazy? I'm not going through the rest of my life like this. But this is what we said to women all the time. Like, just deal with it. White knuckle your way through.

Yeah. And. And still to this day, I hear that all the time. But the reality is that women, that hormone therapy has profound benefits. For the vast majority of women, the benefits far outweigh the risks. And there are good options available. So we used to only use the synthetic pills. We've got lots of options now. So, you know, topical estrogen, for example, has less risk for blood clots than the pill that we used to use. We've got lots of options. But still, I actually thought that the.

Topical estrogen didn't increase risk for blood clots. Am I wrong?

No. The oral. Oral Premarin is the one that. And birth control pills, any kind of synthetic oral estrogen increases the risk for.

Because it does not. Because of what's happening as it passes through the GI tract.

Yeah, it goes through our liver. And the whole day's dose smacks your liver all at the same time. And your liver increases blood clotting proteins. And so if you get a blood clot in your heart, that would be a heart attack, a blood clot in your brain, that would be a stroke. So a lot of doctors have women on birth control pills and they just have them stay on birth control pills as they're going through menopause. But birth control pills are just higher doses of synthetic hormones than hormone replacement therapy. And yet doctors are so fine with birth control pills, and they're so freaked out over hormone replacement therapy. Lower dose.

That's another conundrum, right?

Yes, but so. So if women are going to be on any kind of hormone therapy, we want to put the hormones that in the healthiest body possible because we want the benefits of the hormones, we don't want the risks and the side effects. And so it's not so much like estrogen causing side effects, et cetera, it's more how your body uses the hormones. And so if women are inflamed if we don't have enough antioxidants, if we don't have enough of the right nutrients, then our body may not use the estrogen in an ideal way we can, as we're metabolizing or processing it, we can end up processing it into more harmful forms of estrogen instead of the healthier forms of estrogen. So when somebody comes to me, the way that we approach it is, first of all, we always look at the whole person. Because whether you're having memory problems or hot flashes or whatever it is, there's so many factors that go into it. It's not only hormones. So we want to always, always we want to look in a holistic way. And one of the problems that we've got in medicine right now is we're so separated out. You've got one doctor for your female parts and different doctor for your acne and a different doctor for your migraines. And they only look at their little tiny piece of you, but they're all interconnected. So we look at four pillars of health. When people come in, we look at hormones, but we also look at digestion and nutrition. We look at toxins in the environment, and we look at lifestyle factors, because what goes on in your gut is really important with your hormones, how will you digest and absorb your nutrients, for example? Example. And the toxins in the environment are everything to do with hormones. A lot of the chemicals that we're exposed to in our cosmetics and plastics and pesticide residues in our food, a lot of these chemicals are hormone disruptors, like you were saying, and so they cause cancer in the first place. Those are the main problems. But they also make it so that our hormones don't work properly. So then we just have more menopausal symptoms and we feel worse. And clearing the toxins out of our system can help us feel better. But also, if we're putting hormones in our body, our liver needs to flush out yesterday's hormones in order to make way for today's so that they don't accumulate and cause side effects. So we want to make sure that our. Our natural detox pathways are working well. And this is something that is 100% not thought about in traditional medicine. In fact, doctors don't even know what we're talking about. Like, like regular, conventionally trained doctors. If you talk about detox pathways, they just don't even know what to do with that information because they're taught in medical school. They are starting to understand more because there are now gene tests where they can learn how different drugs will be metabolized by the liver. And depending on a person's liver genetics, certain drugs might be processed too quickly so they won't work well, or they might be processed too slowly, so they build up and they cause side effects. So that's true for drugs, but it's true for hormones and toxins and lots of other things too.

But tamoxifen is a great example there where women who had a hormone positive premenopausal breast cancer were automatically put on tamoxifen without giving any thought. And tamoxifen is a synthetic estrogen. For anyone who is doesn't know that. And without giving any thought to. Tamoxifen is actually a prodrug. Right. It's not in its active form. It needs to be activated in the liver. And it's activated in the liver through an enzyme called CYP2D6. No, 3A4. 3A4, a little bit of 2D6, but mostly 3A4. And there is a very large percentage of women whose 3A4 enzyme does not work well. It doesn't work efficiently. So these women are taking tamoxifen in its pro form. It's not getting converted to endoxifen, so they're not getting the benefit of the drug and they're getting all side effect. And we know that the side effects of tamoxifen are not insignificant. Right, because it's an oral, it's an orally taken drug. So you have the side effect of oral estrogen, so you have the possibility of blood clots. And we do see increased blood clots. And the other thing we see with tamoxifen is a buildup of the endometrial lining because we are giving people unopposed estrogen.

I didn't know that it was converted by 3A4, so. And, but that's something that can be measured.

Like it's a simple blood test, but it never is. It never is. In fact, most of the time, when I say to people who are on tamoxifen, like, did anyone measure your 3A4? And they're like, what are you talking about?

Yeah, yeah. It's not routinely done. It's not something that they, you know, your doctor can just slap on your, you know, Blue Cross insurance to pay for it, but the tests are out there that it can be done.

Yeah, yeah. So Tamoxifen is mostly 3A4, a little bit of 2D6.

Yeah, yeah.

And, and these are things that I, I think it's reasonable that patients start bringing up with their Doctors. Because the only way the doctors are going to start learning about this is, you know, for lack of a better word, like they're going to be embarrassed that the patients know more than they do. Yeah, Right. And it's only through this grassroots kind of conversation that we're going to educate the public, and the public is going to take it back and say, like, I want more. Yeah, I. I want. I want information. I want to be informed, and I want to do the right thing for me.

Yeah.

Is that like.

Can I tell you a story about something I just read yesterday, which it doesn't have to do with breast health, although thyroid health is important for breast health, and women who have thyroid problems have higher incidence of breast cancer. So there is somebody on one of the online medical newspapers, he used to be the president of the American Thyroid association, and he was talking about a certain kind of thyroid, natural desiccated thyroid, which is not the standard, but more women prefer that. And so he was talking about how the research shows that this natural form doesn't have any greater risks than the other one, according to all the studies. But the things that they measure, like your heart rate and your temperature and things like that, it doesn't show that the natural stuff is. Works better, but it doesn't show that it has any extra harms. And when they just asked women, which one did you feel better on? Because, you know, they gave them one pill for the first part of the study, switched them over to the other pill for the second part of the study, the doctors couldn't tell any difference. But when they asked the women, which one do you like better? More women liked the natural one than the other one. And yet the doctors were saying, no, you can't have the natural one. You have to go with our synthetic one, because that's what we were taught at medical school. But anyway, what this guy is now saying is, well, after all these years of listening to all these women come in and feel so much better on the natural one that he thinks that we should respect what our patients are saying, and if there's no extra harm, we should give them the one that they are requesting. And I just thought, wow, what a radical idea to respect what our patients are saying. Listen to the patient.

Yeah, Imagine. Imagine that. It's interesting why we're talking about that, because when I. When I trained, I was taught that the natural thyroid, the desiccated thyroid, was associated with autoimmune disease, and that that's the reason that you didn't give it, because there was more A higher incidence of autoimmune disease associated with using that.

There's no research to say that. So I don't know where that came from.

I don't know. Did you hear that?

I have heard people say. I still, I still hear people say that, but there's no research to show that.

Yeah. I remember having a breast cancer patient and wanting to switch her from Synthroid, which is what everyone gets put on, which is synthetic T4, and it doesn't.

Work for everybody, and it didn't work for me, and that's what I was on for 10 years. Yeah.

Well, you know, the thing that you have to know that most doctors who are putting people on synthetic T4 is that you need to convert that to T3 in your gut. And if you don't have a healthy gut, that's not happening. And most people who, you know, it's a little bit of the chicken and the egg, like most people who are suffering from hypothyroidism also don't have a healthy gut. Then we give them something that is supposed to manage their symptoms, but they can't access it for the same reason that they're having the symptoms. While we're on that topic, if you Google a connection between thyroid disease and breast cancer, you will find a bunch of articles saying that people with hypothyroidism have a decreased incidence of. Of breast cancer.

Oh, really?

I can tell you that I've been in practice for 20 years and probably 90% of my patients come to me with pre existing hypothyroidism.

Wow.

So. And it makes sense in that if you don't have thyroid health, you don't have metabolic health because it is the master gland of our metabolism. Cancer, breast cancer, but many other cancers, it's a metabolic disease. It only makes sense that they go hand in hand. Yet the fact that we are not talking to people with thyroid dysfunction about this is your warning sign. Right. This is your red flag. And instead we're just putting them on thyroid replacement and sending them their merry way so that 10 years later they can have the breast cancer diagnosis. And it's just, it's astounding to me. And yet that is the standard of care.

Yeah.

So can you just share a little bit about what that workup is when you have people coming in? So I know that you are. You're talking to them about hormones, digestion, nutrition, toxins, the environment, lifestyle. What is the workup that you're doing with them before you're. You're putting them on hormones Because I know you're not just talking to them and then saying, here's your script, right?

So one of the things we want to do is we want to actually look at hormone levels. And many doctors just won't measure their hormones because hormones, when you're premenopausal, hormones fluctuate over your menstrual cycle. So when you're on your period, they're low. When you ovulate, they're high. Like they've changed. So it has to be done at the right time in your cycle. And so the random Thursday afternoon that your doctor's appointment is, we're going to get all different numbers depending on where you are. So a lot of doctors just when you're pre menopausal, they just won't even do it. But there's lots of different ways we can measure hormones. There's urine testing, saliva testing, blood testing. If you're menopausal so you've already been through menopause, probably your hormone levels are going to be low. I even just start with a blood test for a lot of women. But there's, there's pros and cons of different kind of testing. And what I typically tell people is they all have validity. So whatever, whatever test your doctor is the most familiar with that just let them do their version of the test, it's fine. But we want to look at estrogen and progesterone and testosterone. And the estrogen we typically look at is estradiol, which is the estrogen that used to come from your ovaries and goes down with menopause. And we also look at fsh, which is follicle stimulating hormone. And it reflects whether your ovaries are still doing their job or not. And this is most confusing if you are perimenopausal, meaning like, kind of like puberty in reverse. It's leading up to menopause. Technically, menopause is 12 months since your last period. But you know, there's years when your periods kind of sputter. And so in that time frame, sometimes it's. It's difficult to know exactly when to test if your periods are irregular. So there is a little bit of finesse that has to go into interpreting the test results. And so sometimes women feel like it's a little bit like paint by numbers. We do your test and then based on the numbers on the test, we know exactly what hormone dose to give you. And it's not that it's not paint by numbers. The doctor needs to understand how to interpret the Tests in order to know the right treatment. And this is where a lot of doctors don't feel comfortable. And that's why your doctor doesn't want to measure your hormones, because they don't really know what to do with the results when they get them back.

Exactly. And that's true of a lot of functional testing for.

There's a lot of things they're not familiar with. Yeah, but. But so we look at those basic. Those are the hormones that come from your ovaries. Estrogen, progesterone, testosterone. And then LH or fsh, which comes from your pituitary gland. That reflects if your ovary is working. The other thing that I always look at is cortisol, because cortisol is your stress hormone, but it's also a regulating hormone. And when cortisol is off, it can be too high. It can be too. It can just have the wrong. It's supposed to have a circadian rhythm, and that circadian rhythm can be off. But if cortisol is not right, it impacts all of your other hormones. And so we can give you hormone therapy, but you won't have all the best results. And I got in all these Facebook groups. I totally regret it, but I got in all these Facebook groups where women are trying to help each other with menopausal advice. And so many women are in these groups saying, I started on hormone replacement therapy and I thought I was going to lose weight and feel better and get my sex drive back, but said, I don't feel good or I'm puffy or I'm bloated or breast tenderness or whatever. And then they're asking each other, like, what the heck am I supposed to do?

But if the blind leading the blind.

Yeah, but, you know, we're all very different, so everybody's unique. We all need something different. We all process hormones differently. So there's no one right dose for everybody. But one of the really common things that I see is if cortisol is not right, we can give you your hormone therapy, but you don't get the best results. So I feel like we also need to address what's going on with cortisol. And there's no drug for that. And most women don't need cortisol replacement therapy. We have herbs, there's lifestyle things. There's lots of stress management strategies that you can do. We want to figure out what's driving your cortisol out of whack. Any kind of chronic physiologic stresses. But that's an important and it also.

Depends at what point you're seeing people, because early on in chronic stress states, you'll see high cortisol. But later on, when people have been under chronic stress for months, years, you're going to see really depressed cortisol. Yeah.

And this is a really important one for us to talk about, too, for women who have a history of breast cancer, because when cortisol is out of whack, that is a risk factor for breast cancer. First of all, cortisol is supposed to be high in the morning, low at night. But if it's flipped around backwards, if it's too low in the morning and too high at night, no, you can't drag yourself out of bed in the morning. You're super tired in the morning, and you're tired through the day, and then at night, you get the second wind, and now you're awake and you can't sleep. Good. Super common. But that's a risk factor. And then, so you get diagnosed with breast cancer, your whole world changes. You go through surgery and maybe chemotherapy, like all these things that are humongous stressors on your body. Okay, so now you're out the other end, but your poor cortisol function may be completely. Even if your cortisol had been okay beforehand, it probably is not okay coming out the other end. And this is so important because cortisol has lots of jobs, but one of its jobs is it regulates your immune system. And of course, your immune system is your first defense against cancer. And so if there are stray cancer cells in your body, you want your immune system to find them and get rid of them before they can grow. And if your cortisol is off, your immune system won't be as strong as it should be. So that's something that I think is really important for all of us, but especially for women who've had a history of breast cancer.

Yeah, for sure. So you're checking estrogen, progesterone, testosterone, fsh, cortisol. What else are you looking at?

Full thyroid panel. So I checked TSH, which is the screening test, a free T3, free T4. Those are two of the thyroid hormones. Reverse T3, which is a blocking thyroid hormone, so you don't really want that one. And then thyroid antibodies like TPO or thyroid peroxidase antibodies. I'm also looking at a whole bunch of other things. I want to look at fasting blood sugar, but also fasting insulin. Insulin is the hormone that's supposed to be regulating your blood sugar, but for a lot of us, our Insulin doesn't work that great. So your body makes more and more in order to regulate your blood sugar. But insulin is a growth hormone. It feeds cancer cells, it's very inflammatory, it's the fat storing hormone. It makes us gain weight. And a lot of women are walking around with higher than, higher insulin levels than they should have, which is very metabolically unhealthy. And cortisol problems cause insulin problems when you go through menopause causes more insulin problems. So it's all tied together. So those are the hormones that we look at, but we're also looking at gut microbiome tests to look for what kinds of bacteria or yeast like candida are growing in your gut. Gut we look for hidden food sensitivities because a lot of women are eating foods that are perfectly healthy for everybody else, but it's causing an immune reaction for them. And whether it's the gut microbiome, the bacteria in the gut, or the hidden food sensitivities, it causes lots of gut symptoms like bloating and indigestion and constipation. And a lot of women have already been to their gastroenterologist and they had the colonoscopy and everything looked fine, or maybe they just found a little bit of inflammation and they're just given an anti acid like. But there's so much that we can do to make digestion better. And if you've got some of these digestive problems, you may not be properly digesting and absorbing the vitamins and minerals in your food. And if you can't get them in your cells where you need them, then you can't make your hormones and your brain can't be sharp and your metabolism's not strong and your immune system isn't strong. So those are the tests. We look at vitamin and mineral levels, we look at inflammation markers, we can even look at markers for detox pathways. Glutathione levels. Glutathione is a really important antioxidant and it's a very important one for healthy hormone metabolization and getting toxins out of your system.

Yeah, because it's one of the ways that we detoxify our hormones. Right? Yeah.

So there's, we do a really comprehensive lab assessment, a lot more than what people get from their regular doctor's office. And we do that because we just want to know, like, there's lots of things that you can do without those tests. There's lots of things you can do to reduce your stress and clean up your diet and move your body and you know, but we like to know, we want to know vitamin D levels. If your vitamin D is less than 20, there's like an 80% greater risk for breast cancer or something like that. Like, it's tremendous.

Yeah, tremendous. And yet that is not being routinely measured.

Right. But I, I measure vitamin D on all patients that are considering. Just on all patients, period. But if any woman is considering hormone therapy, I measure their vitamin D. And partly it's in self defense because I know that if that woman get breast, gets breast cancer, my hormones that I gave her are going to be blamed. Even though the studies show that hormone therapy does not increase the risk for breast cancer. But if they have low vitamin D, that just increases their risk. I want to take that one right off the table. And I just realized too, we didn't talk about natural progesterone. Can I just mention that the difference, please, because that's an important point is in this study where there was the small increase in breast cancer, they used a drug form of progesterone. What we use now is the natural form of progesterone, the exact same thing that's in your body or that used to be in your body. And the natural form of progesterone has not been shown to increase the risk for breast cancer. So, so there is no need for anybody to be on those synthetic pills that had that tiny little increase in the risk for breast cancer. But I just had somebody come in last week and their doctor gave them that and they felt crappy and they stopped taking it, but they brought their box. So I don't understand in 2023 why anybody would choose to use that.

But nonetheless, I just think it's a lack of education. But the other thing is these hormone replacements, these bioidentical forms, these are readily available from the same pharmacy that you're getting any other prescriptive medicine from. So it doesn't mean. Just because it's a prescriptive medicine doesn't mean that we can't give you bioidentical. You don't have to go to a compounding pharmacy, you don't have to go anything outside. Estrogen patches are readily available, and that is topical estrogen and micronized progesterone is readily available. And so, you know, there should not be a reason why you don't have access to these things. That quite frankly. I was talking to Tabitha Barber today, who is a mutual friend of ours, and she made an excellent point, which is that, you know, a hundred years ago, the average life span was like, like 53 years. People, women, when they hit menopause, they died. Right now, the average lifespan is 83. We have a very long time to live on the other side of menopause, and we've been told that we're not entitled to live it. Well, that really sucks.

Yeah. You know, in the uk, they recognize that women are just a lot healthier when they're on hormone therapy. So in, in England, you, your doctor will give you bioidentical hormones because they recognize that they, you know, work better. I think they call them. They don't call it bioidentical. It's either bio similar or it's like some other word that's almost the same thing. But also it's 100 covered. It is free. And if you were in England, they will happily give you bioidentical hormones for free because it is saving the government a whole ton of money because it is keeping women healthier. They're not getting dementia. They're not falling down and breaking their hip. They're not dropping from heart attacks. They're not having to have, you know, all the stents and everything. They know that it makes people better.

Yeah.

Hasn't hit mainstream here.

So I, I did hear something today that I just want your opinion on. So, you know, when the Women's Health Initiative study set out to look at hormone replacement, I was told that they were set out to prove that hormone replacement was bad and wrong and dangerous.

So I don't know. What I do know is the goal, the stated goal of the study was they were going to prove once and for all that hormone therapy was going to reduce the risk for heart attacks. And we thought that hormones were safe. So it wasn't really the question. Now, the people who were doing the study, like the study researchers, I don't know what their personal beliefs, their sub agenda was or whatever.

Right.

What their agenda was. But in the study, the combo pill, which is the one with a small increase in the risk for breast cancer, it was causing more blood clots and it was even causing coronary arteries, like the arteries that feed heart to your blood, it was causing them to squeeze, which was just making heart attacks worse. So they were. The whole point of the study was supposed to be it was going to reduce heart attacks, and they found that, in fact, it wasn't in reducing heart attacks. So then why would we give a pill to every single woman in America to reduce heart attacks if it doesn't work and has a tiny increase in the risk for breast cancer? That was their thinking, but it's because they used the wrong pill, they used the wrong women. They, these were women in their 60s. They waited too long before starting hormone therapy. We now know that if you give hormones to women right around the time of menopause and going forwards, there's a significant reduction in the risk for heart disease. Up to 40% reduce up to 50% in some studies. And we're going to die of heart disease. Women are, many, many more of us are going to die from heart disease than breast cancer. But for whatever reasons, we lie awake at night being worried about breast cancer in a way that we just really don't worry about heart disease. So I don't know whether this was set up to fail, the study was set up to fail.

But it sure seems that way. I mean, it sure seems like there was a sub agenda that was looking to do something. And I guess this is just the cynical part of me that if we're not giving women hormone replacement, we have the opportunity to give them other jobs. Drugs like bisphosphonates and statins and antidepressants and very expensive Alzheimer's drugs. And so I think that industry had to have had a hand in it somehow. I can't prove it, I will never prove it. But I really hope that people heard your message today. Estrogen does not cause breast cancer. Quite the contrary. It is protective. And we've seen that demonstrated time and time and time, many, many studies.

And the mainstream, mainstream groups, American Gynecologic, you know, acog, American College of Obstetrics and Gynecology, all the major groups agree, like this isn't controversial. It's just that the average doctor on the corner hasn't, hasn't registered it.

Yeah, well, because there's just, there's 20 years of unlearning to do and it's just not happening. But it will happen. And I think it'll happen at the hands of the public who will demand it. Because women shouldn't have to suffer. Right. Our friend Anna Kabeka said that menopause is mandatory, but suffering is optional. My last question is on the heels of they picked the wrong group to study. Right. What are you doing with that 60 something year old who comes to you and wants hormones? Because the major, the major benefit is in those first 10 years, but then you keep them on hormones indefinitely, right?

You can. Yes. So the North American Menopause Society says there is no study to say, no research to say that women have to stop hormones at a certain time. You know, if they're if you're on the synthetic combo pill that increases your risk for breast cancer, then I guess you want to get off that as soon as possible. But if you're on the other ones that don't increase your risk for breast cancer, you don't have to stop it because of a certain age. Doctors will tell you you need to stop it because of your certain age, but they're not basing that on any science or research that's just become ingrained in our psyche. Right, right. But what the study did, what the Women's Health Initiative study did show on these, you know, non bioidentical hormone pills is that as we gave them to older and older women, they were starting to have more blood clots and they were starting to have. A blood clot in your heart is a heart attack, a blood clot in your brain is your stroke. So it was slightly increasing death. So if you're over 70 and you start on the synthetic combo kind of pills or even the estrogen pills, there was a slight increase in risks and potentially death. And so the standard treatment or standard thinking came to be that you had to start the hormones within 10 years of menopause, otherwise it wasn't safe. Well, we're giving women hormones through their skin, like we're doing it in a way that doesn't increase the risk for blood clots. So my opinion is, no matter how old you are, hormones are still helpful to keep your bones strong. You know, it can still help with the vaginal dryness, the painful sex, the leaking urine. So what I do for women who are a little bit older, who haven't been on hormones, but now they're hearing more about it and thinking, well, maybe I'd like to try something, is I typically give it to them topically applied to the labia, so like the outer part of the vagina. Because when we, when we put the hormones there, that works really nicely for all the pelvic floor stuff, the dryness, the urinary leakage and that kind of stuff. And it can still have benefits, but it doesn't bend the other practitioners, you know, other doctors out of shape. Shape, because not all doctors, but all the groups that advise doctors will say that even for women who've had breast cancer, even for women who are quite elderly, it is okay to give vaginal hormones because it can do a lot for vaginal health. And so it doesn't really matter how old you are or whether you've had breast cancer, you can still have that. Yeah.

And I think the tagline is that you're not going to get systemic levels and so it's not going to impact your breast cancer rate risk. I actually think that that's probably not true. I think that you in fact do get systemic levels because the vagina is highly, highly absorptive and once you absorb it, it does go into your bloodstream. But I'm just happy that they encourage the use of vaginal estrogen because there's really nothing else. And I still have practitioners reach out to me all the time saying, hey, I have a patient and she had a hormone positive breast cancer. Do you think it's okay if I give her vaginal estrogen? And my response is, if you're working with her and you're cleaning up her diet and you're making sure that she's prioritizing sleep and sometimes people need progesterone to do that and you are cleaning up her environment and making sure she's not drinking out of plastics and she's filtering her water and she doesn't have nine stick pans and she's not using perfume and not using traditional cleaners and you know, just cleaning out the garbage and, and you know, you're helping her to manage her stress. Then there is no reason to worry about hormones because breast cancer does not come from estrogen. Just doesn't. Dr. Deb Matthew, thank you so much. This was such I could talk to you forever. I literally like, I love the way you speak and I love to listen to you and you're so brilliant. Where can people find you?

My office website is signaturewellness.org I'm in Charlotte, North Carolina and if women want to know more about this, about whether their hormones could be due to or their symptoms could be due to hormone issues. I actually wrote a book to help women sort of figure out for themselves and if their symptoms can be hormonal. So it's got like a bunch of checklists, like if you're low in estrogen, what would the symptoms be? If you're low in testosterone or whatever the book is called. This is not a busy woman's guide to symptoms of hormone imbalance. And you can download a free copy@isityourhormones.com.

Is it yourhormones.com we are going to make sure that that is in the show notes and that your book this is Not Normal is available to everyone who wants to, wants to dig deeper, feel better and you know, not put on that line of fine when they know they're not. It was great to see you today. Thank you so much.

Thank you.

It's Dr. Jen. Bye for now.