Episode #71: The Truth About Our Hormones and Bioidentical Hormone Replacement, with Dr. Stephani...

Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board certified OB, GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain period issues, anxiety, insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist. So welcome. Okay ladies. So do you feel like maybe your hormones are imbalanced? Are you wondering how to get them tested? How to go about checking into that? Why would, what would be causing it? Or maybe you want to do hormone replacement therapy. Maybe you're going through menopause, maybe you're not sure. This is going to be an awesome episode. We are going to talk about all of that today with my guest, Dr. Stephanie Gray. So she's going to talk about the different ways that we can test hormones effectively and interpret them and why they get imbalanced and what we can do about them naturally or with hormone replacement therapy, either bioidentical or otherwise. And we'll talk about the risks and benefits and all of that. So tons of good information today. You're going to really love this.

So.

So Dr. Stephanie Gray is a functional medicine provider who helps men and women build sustainable and optimal health and longevity so that they can focus on what matters most to them. I love that she's been working as a nurse practitioner since 2009. She completed her doctorate focusing on estrogen metabolism from the University of Iowa in 2011. So additionally she has a Master's in Metabolic Nutrition Medicine from the University of South Florida, Florida's med school. Her expertise lies within integrative, anti aging and functional medicine. She's arguably one of the Midwest most credentialed female healthcare providers. Combining many certifications and trainings. She completed an advanced fellowship in anti aging, regenerative and functional medicine. In 2013, she became the first BIOT certified provider in Iowa to administer hormone pellets. Also in 2013, she's appeared on numerous podcasts, summits and TV interviews. She is a contributor to various health publications including Mind bodygreen, which I love. She's the author of FNP Mastery App and an Amazon best selling book, youk Longevity Blueprint, which we're going to talk about today. She is the host of youf Longevity Blueprint Podcast and she's co founder of youf Longevity Blueprint Nutraceuticals with her husband, Eric. They enjoy spending time outdoors with their son, William. He's adorable. If you follow her on Instagram, you will see how cute he is. Together, they founded the Integrative Health and Hormone Clinic in Hiawatha, Iowa. So no doubt she knows what she's talking about. And the best part is she and I agree on everything. So it's a pretty awesome episode. I really love what she's doing, and this is really good information for all women because hormones run our lives, right? And so it's really important to know how they get out of balance, how we can get them back into balance, how we can test them if need be, and what we can do during the perimenopausal, menopausal years to be our best. So this is an awesome episode. Share it with every lady you know, Right? Call your sisters, your moms, your friends, your daughters, everybody, and share this with them. I would love it if you'd hit the subscribe button. If you haven't, give me a review and send me your questions. I want to know what you're thinking. I want to know what you want to hear about. Follow me at drtabithatha. So let's get to it. Well, welcome, Dr. Gray, to the Functional Gynecologist podcast.

Thanks for having me on. Glad to be here.

Yes, we've tried to connect a few times, so I'm glad we finally made it happen.

Likewise. Yes, me too.

I'm really excited for my listeners to hear from you today because you have such important information about hormone therapy, who it's for, who it's not for. What else do we need to be thinking about?

Right.

Tell my listeners just quickly how you got into all this.

Well, we each have a story, and sometimes those stories are really long, so I'll try to make mine. Make my short. But I'm kind of probably like a classic patient, someone who would come to see you. I mean, honestly, I had just so many, so many challenges. I did struggle with infertility. I had stage four endometriosis. And amidst this journey, I was really stressed out and didn't realize it. I mean, so many women come to see me and I'm sure to you and they just don't even realize it. They think, I'm not stressed. I'm fine. I'm fine.

Yep. Yeah. Because everybody's doing it, right?

Yep. We think that's normal. And I was driving hard, starting my practice. I was kind of. I started a functional medicine practice in Iowa as a nurse practitioner. As a female, right. I was kind of doing something that was different. And I had to work hard to kind of to build this practice. So I knew I was going to have to push hard, but I didn't realize how it was going to impact my health. And one day, after what I thought was a great morning, seeing patients sitting at my desk, my heart rate took off, like, really fast to the races. And I was very disoriented. I sitting at my desk, I tried to buzz my husband, who's our office manager, on my phone, but I couldn't even figure out which button to push. I was just disoriented. I was dizzy, lightheaded. You know, I thought, oh, my gosh, I'm having a heart attack. Yeah, what's going on? So since I couldn't get the phone to work, I tried to walk out my door and down the hall, my clinic. And my nurse found me super pale. She's like, oh, my gosh, what's happening? You need to call 911. Long story short, I did go to the emergency room, and I ended up at Mayo Clinic for tachycardia, which is the medical term for fast heart rate. And their solution to me was to take a medication to control my heart rate, which is a band aid approach, right? So regardless of the condition that patients go see their doctor for, many times, that doctor is going to give them a band aid approach, which can be helpful. Sometimes we need the band aid. But I knew that taking that medication or putting on that band aid wasn't going to tell me why that was happening to me. So I needed functional medicine myself. I needed to get to the root cause of my challenges, reduce my stress, right? And optimize my hormones so that I could calm my heart rate down, but also so that I could get pregnant. So that was kind of the. That's the short version. But I found a lot of discoveries along the way. I did test myself for celiac. My blood work was positive. You know, I thought. I remember looking at those results I ordered on my cell phone at my desk. I started crying. I thought, oh, my gosh, I'm one of these people that has to go, has to go gluten free. I had been telling others they needed to go gluten free for years, and I needed to do that myself. And I did. I've been gluten free for, I don't even know, seven to ten years by now. But I had many discoveries along my journey, but that only fueled my passion to continue to help others as I was able you know, working through this kind of blueprint that I created along this journey, I was able to create that and then use that with my patients so that they had some sort of game plan or roadmap for them to regain their health. Yeah.

I think almost everyone I've met who practices functional medicine has their own personal story. Right. It's just that is how you got into it. That is why it's happening. And you had to go through that in order to heal you. And you have so much more empathy and understanding for your patients. So it's amazing.

Absolutely. That's the. What do we call the silver lining? And I needed to be. I hadn't really been in the patient's shoes yet at that age in my life. And so I did learn a lot. And now I can look back and say, I'm glad I went through it, but it wasn't easy.

Yeah, exactly. Wow. You got all this great understanding, this knowledge. You went back, you got a doctorate in estrogen metabolism, and now you specialize in hormones, right?

Yes, absolutely.

So I would love for you to walk through and you talk about in your longevity blueprint book. This is what you need to evaluate and look at to get back into balance and have health and how our sex hormones are only one component of it. Right. So I think we need to make that disclaimer. You know, when you have patients come into your office, what are you usually starting with?

Yeah, it depends. It depends. I will say, as we were discussing before we started recording today, hormones are one piece of the puzzle, but they're an important piece of the puzzle, and they're a piece that can get patients feeling better pretty quickly. So sometimes we do start with that piece of. Yeah, excuse me. Sorry, I had to cough there. When I assess patients, and I'm sure you do the same thing, I take a really comprehensive history. I go through kind of the timeline of events that has led them to why they're here, seeing me today. And then I let them prioritize their complaints. What's most important for them, because I want them leaving that day knowing hopefully I'm going to feel better very soon. But what I do, and I'm sure you do as well, is order a lot of functional medicine tests. So these are tests that conventional doctors don't always offer. And so maybe I should actually back up and kind of share one analogy that I use with many of my patients first. So we need conventional medicine. And you were conventionally, initially a conventionally trained gynecologist. Right. You did surgery. Right. You had two major tools that you talk about a lot, drugs and surgery. And many times those are needed in, at least in my patient practice, I discuss those tools as being part of the fire department. Right. That's the fireman approach. They're here to put out big, bad, ugly fires, and we need them. But I like the carpenter approach a little better. And you've become more of a carpenter over the years, as have I. Right. So carpenters try to repair and rebuild the body, but we have different tools. And so I think one of those tools is the ability to test patients a little more comprehensively. Right. Even with our hormone tests, we do urine testing many times to really see how the body's eliminating estrogen, not just the levels of hormones that we have, but how our body's eliminating estrogen. So through my book, I'm trying to circle back around and answer your question here. I tried to outline in every single chapter what the patient can do for symptoms of each organ system. So chapter one is all about gut health. And so that's chapter one for a reason. So, yes, we do usually start there if we think of the foundation of a home, and that's what I'm comparing in my book, I'm comparing your home to your body. So if we think of the foundation of the home, that has to be strong to support the weight of the entire household or the house is going to crumble. And the same is true with the gut. And in your body, you have to have strong gastrointestinal health upon which to build full body health. So I basically, through my book, I'm walking patients through every organ system in the body and what functional medicine testing tools we have available to help get to the root cause of that problem. And so for many people, we're starting with chapter one and chapter six, which is gut health and hormone health. But then many times, we dive into whatever else we need to maybe explore, talk. Maybe the patient has been exposed to. Exposed to mold. Maybe they have a really poor diet and they have nutritional deficiencies. Maybe we need to look at genetics. So the layers of that onion kind of peel back with additional visits and running additional labs. But I try to start patients with kind of listening to what their chief complaint is and kind of follow my instinct as far as what will get them feeling better most quickly, but then also obviously get the ball rolling with labs.

Yeah, I love that. I think sometimes we need an easy early win to start feeling better so that you feel motivated to keep going and keep. Because it is a lot of work. It's a journey. You know, you have to make new habits, change things up, deal with relationship crap, all that stuff. So getting to the hormones. So where do you begin with that?

So it depends on the age of the patient. So for younger women, and essentially it also depends on where. What their goal is. Right. Are they a younger patient who's trying to conceive, Are they a patient who's going through perimenopause or their patient who's 70, 80 years old who's gone through that? But they're coming to me more for bone, for hormone management, for bone density. I have to gauge what the goal is with that patient and coming to see me. But is your question more, where do I start? With labs? Like what?

Yeah, so I would love for you to talk about, you know, your favorite lab testing. And, you know, traditionally, gynecologists are taught that we don't really check hormones because they change all the time. They're unpredictable. They're hard to really get a good idea of what's going on. And that's because we only look at the basic, free, available labs in our blood. Right. We're not looking at more comprehensive testing. You do and I do.

Yes. I've seen so many. I'm sure you have, too. So many train wrecks where patients come to me many times having been put on estrogen, oral estrogen at that, and their gynecologist has never tested their hormone levels, and in fact, they never needed estrogen in the first place. And now picking estrogen has created more of an estrogen dominance. So labs can really help us know what a patient needs. And so I'll start with a younger patient, so. And a younger patient who is cycling. If they do have cyclical symptoms like headaches with ovulation or premenstrual headaches before bleeding, I may want to do a saliva hormone test because saliva is easy to collect versus getting blood drawn multiple times throughout the month. You can do a saliva or urine test actually every couple days through the full month. Then we can map out that cycle, and we compare symptoms with labs to see at what point in their cycle they're having symptoms. Let's see, do they have low progesterone? Do they have high estrogen? Like, what's going on at those points in the cycle. So mapping out a more comprehensive kind of hormone, we call the hormone. I don't know what you call it, but cyclical hormone map can be very helpful for those younger patients and patients trying to achieve fertility.

Yeah, definitely.

Or. So there is value in saliva testing there for women in midlife, sometimes their cycles are very irregular. So sometimes we're really guessing as far as when the best time is to test labs. But ideally I want to see if patient's progesterone level is still optimal or not. And so that's supposed to peak a week after ovulation, if the patient is ovulating, if they have any symptoms of ovulation, we try to test hormone levels. We could do blood, we could do saliva or even urine levels a week after ovulation. For many patients who have a 28 day cycle, that's around day 21, like 19, 20 or 21, I'm okay. If the patient's on a budget and they want to do blood testing, I'm fine with that. If they want to do saliva testing, we can do. Some patients have read that. Saliva testing and they want to do saliva testing, that's fine. Or even urine testing. The benefit of urine testing, though, is that we get to see, as we mentioned before, more than the hormone levels themselves. We get to see, depending on which company you use, we get to see cortisol levels and we get to see how the liver is eliminating or detoxifying from estrogen, which is kind of your specialty, like looking at estrogen dominance and how that can cause so many problems in patients. And so that's the beauty of the urine testing. It just gives us so much more information than we can gather from blood. But with any of the above, we can still deduct if the patient has high estrogen, low progesterone. Right. We can still deduct those things and look at testosterone and DHEA and whatnot. There's value in all different types of testing, but I think it depends on what the patient's goals are, like what we're trying to achieve with that patient and what's in their budget as far as what testing best suits them.

Yeah, I mean, even the basic blood work testing, I just was thinking of a patient that I had who had breast cancer and she was currently on tamoxifen. So tamoxifen is supposed to suppress your estrogen. Right. And she was having periods again. And her breath. You're not. Not her breast tissue was hurting, but like she was having phantom pain and she was just feeling like pmsc. And she goes, could I be making estrogen despite being on tamoxifen? And I said, let's not guess, let's just. And we did basic blood work that's covered by insurance, and her estrogen level was sky high. And you know, coming from her fat cel, coming from our adrenal glands. And thank goodness we checked that because that's kind of a big deal when you're trying to suppress estrogen and it's just being made into this more toxic form. And her oncologist unfortunately had pooh, poohed her and was like, no, you're fine, you're on the tamoxifen, you're fine. And I just added some liver support, some diindomethane, some milk thistle, and that estrogen came down and those symptoms went away. And I. And hopefully her risk of recurrence went away as well. You know, like, that's huge. That's a big deal. So I'm with you.

That's such a prime example of where labs were that missing piece. I mean, we just don't have that data. Right. If something's wrong with your car, you take it to a mechanic, they run tests and they figure out what's wrong with it. But then with our bodies, many times we're just put on drugs, no tests, we're just prescribed drugs. And sometimes the drugs work and sometimes they're needed. But the lab testing is just so helpful and personalizing care.

Yeah, exactly. So I love the dried urine testing to just get the more comprehensive picture, like, what is your liver doing with those estrogens? How are you handling your testosterone? Are you making more manly testosterone? You know, so much good information. So you get women on this. I want to focus in more on the perimenopausal woman and hormone replacement because I think there's so many confusing statements around hormone replacement. Women are scared. And I want women to be reassured, like, there is a safe way to support your hormones. Right. During this transition.

I always say hormones don't cause cancer. Right. And that's, I guess, the myth and the confusion that lies with hormone replacement therapy because of the Women's Health Initiative study. So that study was done in 17,000 women who were taking oral Horts urine. Right. And so the oral estrogen, premarin, stands for pregnant maragerine. Right. The oral estrogen they were taking did increase various risks, but that was synthetic estrogen and primarily estrone that was used in that trial. And so I try to not replicate that in my patients. And therefore we can't translate the risks that were found from that study to what practitioners like yourself and myself are using with patients. We use bioidentical, natural, plant based hormones. If hormones themselves cause caused cancer, because we all have some level of hormones. Right. We'd See a bunch of 20 year olds walking around with cancer who have high levels of hormones. And then we'd see 90 year old women who have low levels of hormones not getting cancer. And that's not the case. Right. We see less cancer with younger individuals with higher levels of hormones and more cancer with patients with low levels. So we know that the levels themselves and that the hormones aren't what's causing cancer. But back to how the liver handles those hormones, I think is where the, I don't want to say the mystery, but where the more important piece lies. So hormones can be used if you need hormones, if you're symptomatic, as you're going through perimenopause and you're found to have low hormone levels, there are practitioners that can help you replace those appropriately using safe methods. But you have to find someone who's been appropriately drained, which. That can be the challenging part.

Yes, exactly. Because most gynecologists use the synthetic conjugated equine estrogen or the synthetic progestins. Those were the ones that were found to increase breast cancer, blood clot and stroke. Right. I find it interesting also that the average age woman in that study was 64. Can we just let that be known? These women were already menopausal. They were already without hormones for a very long time. And then they were given hormones. Of course they had a reaction. You know, it's not even the same situation, but the media ran with it. You know, our societies got scared.

And then most crazy statements next year was Prozac. Right. Because all these women were left without hormone management and. But they were prescribed Prozac because the doctors didn't know what else to give them. Sadly.

Yeah, it's, it's crazy. So there's a good way to replace hormones in a bad way. So the bad way is synthetic hormones like Premarin, prem pro, Combi, patch, any of that stuff, taking birth control pills in your 50s. Like I see that a lot around here and it just. There's a safer way. So I want you to talk about this safer way.

So there are a lot of different routes of administering the natural bioidentical hormones. So what bioidentical hormones are, are they are biologically identical to what your body's supposed to be making. In my book, in chapter six, I really describe this as the hormone should be fitting into your hormone receptor, like a key fitting in a keyhole. Right. The synthetics I actually have in chapter six, the molecular structure of the hormones you were just mentioning mapped out in the book so patients can see, oh, my gosh, this synthetic progestin, the synthetic estrogen does not look like what I'm supposed to be making. The natural progesterone and the natural estrogen, bioidentical hormones that you can get from a compounding pharmacy usually come from a yam plant based source. Those actually, again, will fit into your receptor appropriately. They look exactly like what your body has been making earlier in life and should still be making. So the options for replacing those hormones are topical gels and creams. There are some patches that exist. Oral progesterone. I don't give oral estrogen, but oral progesterone does exist, which is nice because of the sleep benefit. And we can compound a sustained release version of that for patients who need that to release throughout the night to help them with sleep. Sublingual lozenges, which can be put under the tongue, can be compounded as well. And then hormone pellets are also one of my favorite ways to replace estrogen and testosterone. Not progesterone, but estrogen and testosterone. Oh. And I actually kind of listed those today in order of not severity. What's the word? Kind of potency. So for many patients, a little bit of a topical is all they need. Right. Some patients need something a little stronger. Some patients with really severe symptoms are going to need pellets. So I start patients usually with a more conservative approach, depending how severe their symptoms are, and then kind of work them up to what best suits them.

I love that. I think that's super important. Can you hold on?

My dog's getting crazy. Go, go, go.

All right, Jason, make sure you edit that out, Okay? I just wanted to hit on the point of we don't really like oral estrogens. You know, I think people get confused when I want to give them the oral progesterone but not the oral estrogen. So can you speak to what happens when you take that orally?

Yeah, so. So the benefit of oral progesterone is this metabolite that's created that's so calming. Right. And there are not risks with that. So we're okay, I believe. When I say we, I think I speak for you and myself prescribing oral progesterone. I'm not okay with oral estrogen specifically because anything you take by mouth is going to go through your gut and then your liver. And what we know is those oral estrogens can be more difficult for the body to detoxify. Many of those if they're not estrone Sometimes they will convert to estrone, which is just more difficult estrogen for our body to eliminate. And we think, at least through my training, that's where a lot of the risks in the Women's Health Initiative study came from. And so we want to try to minimize those risks. If you are taking oral estrogen or you are taking birth control, there are things you can do to support the liver. Right. To reduce the risk of taking those. I just prefer to just not have patients on them because we know there are other alternatives.

Yeah, exactly. And you bypass the liver, so you're decreasing your risk of blood clot and stroke as well. Right.

The reason also why I love the pellets. So even for patients who have literally genetic blood clotting disorders, like for pellet replacement, which is estrogen and testosterone, again, we place those pellets under the subcutaneous to the fatty tissue in the lower back, upper bottom area. And those are clear through the kidneys. I mean, those entirely bypass the gut and the liver. So from a safety standpoint, that really is, I think, the best way to go for patients who need that aggressive therapy.

Right, Yeah. I think that's an important point because what I've seen locally is women in their late 40s get hormone pellets and their levels probably weren't low enough to need that aggressive of therapy. And so they come to me because their testosterone is crazy high and they're, you know, angry and irritable. And I'm like, all you can do is wait three months. I can't really help you. You know, you can't take it out once it's in. Right.

That's the downside. That's the downside of the pellets once they're in therein. And so for some people, if I have a patient who's super sensitive to everything, or if I know someone, you mentioned this early in the episode, who's making more of the dangerous testosterone, which we can see on the urine hormone test. If they're more likely, if they have more of this enzyme that converts testosterone to DHT, they use more of this 5 alpha reductase enzyme. I may choose to give them a lesser dose of testosterone because I don't want them to have side effects. But with any form of hormone replacement therapy, you could get some side effects. But hopefully your practitioner is listening to you, the symptoms you have, comparing those with your labs and then finding you that best fit moving forward.

Yeah, exactly. I think that's key. And I don't know about you, but I hear A lot of apprehension from women about progesterone because they have been on progestins, they've had the depo shot or the mini pill or the Mirena iud, and they get the weight gain and depression and the headaches and all of these horrible symptoms. And it's like. Like, you have to understand, this is a completely different compound. Progestins are not what your body wants. It's like the opposite effect. Right.

I absolutely agree. And I hear that all the time. I have patients who come to me. Whoa. Who say, well, my gynecologist has already tried me on, you know, X, Y, and Z, and I'm scared. I don't want to. I don't want to take hormones, or I don't want to take. They say progesterone, but they mean progestins. And then I have to kind of re. Educate them that, okay, even though you had side effects on that, that this should be different. And I would confidently say 90% of the time, women who can't tolerate the synthetic progestins do tolerate natural progesterone. That's what their body is making. Yeah, exactly.

It's completely different. I couldn't tolerate progestins at all. I took out my own IUD because I was, like, suicidal. It was horrible. Yeah, I can't take this. I wanted to jump out of the window of my office. I couldn't. Couldn't stop bleeding. I was getting breakouts. I gained five pounds. And, you know, my colleagues and I kept telling myself. And my colleagues were telling me, just wait it out. It gets better. You know, like we say, that's how we're trained to say to patients, it'll get better. Just be patient. Wait two months. Wait three months. I couldn't take it anymore, and I finally took it out on my own, and I felt better within, like, two days. It was so obvious. And that was one of the things that really started opening my eyes, was me experimenting on myself. I felt horrible on birth control pills. I couldn't handle the progestin IUDs, and I was having the crazy heavy periods. And so none of these band aids were working. I actually went to a gynecologist. I got my consult for an ablation, and she said to me, I don't know. I'm really worried because you've had two C sections. Let's, you know, check the. See the thickness where your uterine scar is before we go in and burn stuff. I'm like, okay, that sounds good. And my lining was Too thin in my scar area. And she's like, well, we'll consent you for laparoscopy and go in your belly if I have a perforation, meaning, like, if the burn goes through that wall, she's going to open my belly up. And. And that was a very defining moment for me. I was like, oh, hell no. I mean, I cut on people all the time, but to think of it being on me, I was like, oh, my gosh. And that is when I really stepped back and I thought, why am I having these heavy periods? Is it really just because I'm 40? Because that seems like a bunch of bullshit.

Why? There's a reason. There's a reason.

And then I started studying functional medicine, and it was like, ding, ding, ding. Oh, my God. Like, so many things affect your estrogen production and your progesterone, and there's a reason this is happening. Ladies, like, listen and do something about it.

Because just getting that ablation or just having that hysterectomy doesn't get to the root cause of the problem as far as why you needed that in the first place. Right. So even though having that ablation had you had, you know, thankfully you didn't proceed. But, you know, I have patients who have had ablations or who have had hysterectomies in their 30s or 40s. Right. And then they come to me and I have to kind of, again, kind of educate them that just because we got rid of the heavy bleeding because you removed your uterus doesn't necessarily get to the root cause as far as why you had to have that removed. Right. So if you were estrogen dominant, then you still are. Now, we still need to look at your hormones. We still need to look at your gut health and your detoxification pathways and whatnot.

Dr. Stephanie, I can't even tell you how many women I've seen who've had ablations and 10 years later have breast cancer. Like, it's really sad how ignoring this estrogen dominance and then, you know, we're putting the band aid. Great. You don't have the heavy bleeding anymore, but you are still pumping out too much estrogen and it's feeding your breast tissue or causing havoc in other ways, destroying your liver, whatever. So I want women to just pay attention to their bodies. Yeah. So hormones can be good and bad. They're so complicated. Don't think they're that easy that estrogen is bad, like you're saying. Right. It's so much more complicated than that. We need it to feel good in certain amounts and certain types.

Estrogen is most like serotonin. It helps you not be depressed. I mean, it does help you feel good. Progesterone is most like gaba, that calming neurotransmitter. Testosterone is most like dopamine. But we need all of the hormones to feel whole, to feel well in our bodies. And as we age, those hormones do start to decline. And so it's my strong belief that if we can keep hormones higher, Right. And in balance. Right, then patients will age much better. They'll keep their memory, they'll have bone protection, they'll have cardiovascular protection, and they'll just feel happier and better in life.

I love how you correlate that, like the estrogen with the antidepressant, the progesterone with the antianxiety. Because so many women, and once they hit their 40s, especially late 40s, all of a sudden they have anxiety that they've never had before. They can even have panic attacks and they're not understanding why. And, you know, so here's your Prozac, here's your Lexapro or whatever. And it's really that declining progesterone level.

Right? All of the hormones, Yes. I mean, they all are important. But I agree the first hormone to go is usually progesterone. These women are anxious, revved up, they can't sleep, they have heavy bleeding, all of which are symptoms of higher estrogen but also lower progesterone. We need to intervene, and I strongly believe that if we do intervene, we can minimize the use of those antidepressant sleeping pills, anti anxiety medications in these patients.

Yeah, exactly. If women go on hormone replacement therapy, is there a time period that you usually tell them they should be on it, or what does that conversation look like?

Yeah, I get that question all the time. So with synthetics, a lot of patients are called, okay, you can only take this five years or only 10 years, or, you know, only I don't. Or some doctors will say, I only want you on this a year or two. And I give my patients the option if they only want to take hormones throughout the time period where they have really severe symptoms. Right. If they're having 20 hot flashes a day and they can't sleep, if they just want to take hormones through that time period, which varies with each person.

Yes.

Could be a few months, could be several years. I've had 90 year olds come see me with hot flashes. I mean, I've seen a lot of long, severe lagging symptoms, but I offer that to patients, if they want to just go on hormones short term, that's an option. But I also have patients who are in their 90s who are still taking hormone replacement therapy because it has greatly improved the things I just mentioned, their memory, their bone density and its cardiovascular protective. And they're on no other medication. So there is. With natural bioidentical hormones, there's no limit. Right. If you start them Even in your 30s or 40s, you can continue them long term. But you should have a provider who is managing your hormone levels. You should have some sort of breast screening. Right. Done. You should have someone watching over you managing those hormones long term. Yeah.

Oh, I completely agree. I have so many women, 80s, 90s. I inherited a practice from an elderly physician and he had so many older women on hormones. And you know, when I started practicing was shortly after that WHI study came out and it was, you know, American College of OB gyns really pushed that we got to get these people off their hormones. Those ladies threatened me. They were like, hell no, you're not taking my estrogen away. I will hurt you. And so I listened to my patients and I learned so much. And what I realized was patients do know best. And there was more to this story. That study was super flawed. And I'm glad that I was open minded enough to look into further research and what the studies were really saying about it because I would have done such a huge disservice to all of those women if I had just, just taken that away. I do clearly remember one woman who came to me and told me this dramatic story. She was probably like 70, where her primary care physician saw she was on hormones and just took them, took her off of them cold turkey. And she stroked out that next week.

Oh my gosh. Yeah, oh my gosh.

And that stuck with me. Like it really does affect your health and change all of your other systems. And so you know, those knee jerk reactions are not helpful to patients. If you feel like you are not getting the answers you need or being heard, you know, reach out to me or Dr. Stephanie or somebody in your area. Like there is help. There are people who understand hormones and aren't afraid of them.

Absolutely. I haven't had that happen to me where a patient literally had a stroke stopping their hormones. But I, I've seen the research and I talk about that often how cardiovascular protective hormones are. Right. Estrogen doesn't just help with vaginal dryness. Right. It helps with the elasticity of our vessels through our whole body. Right. You want Your vessels to not be stiff. You want them to be stretchy and elastic and accommodate whatnot. So, you know, think of. Hopefully the listeners will now think of, gosh, estrogen isn't just important for. For vaginal dritis, but, no, it's important for so much more. And we know that cardiovascular risk, or I'll just say heart disease in general increases postmenopausally. Right. So one in seven women premenopausally have heart disease. One in three women postmenopausally have heart disease.

Why is that? That's the number one killer after menopause.

Right. So what's happening with menopause? Hormone levels are declining. So cardiovascular risk is going up and hormone levels are declining. And I think a case can be made for estrogen, progesterone and testosterone, all three being cardiovascular protective.

Yeah, exactly. And brain protective like it is. There is clear evidence that our brain health declines when that estrogen declines. Right?

Yep. Alzheimer's. I can't ever say that Alzheimer's rates go up as estrogen goes down. Right. So you don't want to have low hormone levels. And like you said, estrogen isn't the devil. Estrogen isn't something to be feared. We just need to make sure you're not. You're not. You don't have too high estrogen levels as compared to your other hormones and that your liver can properly handle and excrete. Right. The rest of the estrogen, some's going to be used, and then the rest we need to be able to get rid of.

Yeah, exactly. So you've mentioned testosterone a few times. That might be surprising to the listeners. You know, we don't talk about test testosterone in women a lot. I had Dr. Deb Matthew on, and she talked about that. But can you just, like, explain why some women might need testosterone?

Yeah, I love Dr. Matthews. She's great. I had her on my podcast as well. She's written several good books, too. So women do make and need testosterone, and it's not just for libido. Yes, testosterone can help libido, but it helps with the mood. I mentioned before, testosterone is most likely the neurotransmitter dopamine. So I have a lot of women whose depression really sets in as their hormone pellets wear off, for instance. So they're getting testosterone hormone pellets. They know, oh, gosh, my mood is tanking. I need to come back in and get picked back up and get those testosterone pellets. So testosterone helps with libido, but it helps with mood Motivation, drive, energy, muscle mass. A lot of women come into my office and say, I'm still working out. I'm still doing the same thing I did two years ago, but I'm flabby. Like, I've lost muscle mass. So testosterone can really, really help there. And I will say the research shows that all hormones are important for bone density, but specifically, testosterone pellets outperform everything with bone density. I talk about this more in depth on my podcast. I brought in Dr. Gary Donovitz, who's the CEO of BIOT, and we talked about just the literature supporting that. I mean, we see patients, bone densities improve. I just had one yesterday. Patient came into. This is so exciting. I love it when this happens. But the patient brought her bone density to the front desk and she said, look, look, look, look. She had seen it before our team had even seen it. My bone density increased 12%. Right.

That's awesome.

That is significant, right? The medications that are available, like the bisphosphonate medications, whatnot, to supposedly help preserve bone density. I mean, when we put patients on those, we're just hoping they don't have a decline. We're hoping their bone density stayed stable throughout. At least through my training, I hadn't seen anything significantly improve bone density other than, you know, hormone replacement therapy, specifically testosterone pellets. I've seen dramatically improved bone density over years. Not overnight, but as the patients are on them year after year after year. Testosterone can dramatically improve bone density, which is important because as you age, if you fall, your rate of dying is going to go up. Right? You so. And then, you know, my mother has osteoporosis. That's something I'm concerned about. I've been, you know, working out since I was young. Such a build bone density, but. But you can't just start working out in your 70s, right? You've already lost that opportunity. You should work out for balance and flexibility and whatnot. But it's difficult to build bone density at that age, and testosterone pellets have shown time and time again to do that. So that's one strong indication for testosterone use in women, not just libido.

Yeah, that's such a huge point because honestly, one of the biggest causes of death is a hip fracture in older women. And if we can prevent that, you know, that is no way to die. To go into the ER with a hip fracture, have surgery, and never come out of the hospital, I mean, it's a horrible scenario. And I saw it way too much when I was practicing in the hospital. So if we can actually prevent that, that's amazing. You know, and I just think women don't realize that they lack that motivation and that energy. They don't want to get up and do their job anymore. You know, I hear this all the time from, from 50 year olds. I just, I'm not feeling it, you know, and it's that testosterone decline. So I love this information.

I agree. Could be testosterone also could be low. Thyroid. We haven't talked much about thyroid, but that's another thing that, you know, needs to be assessed comprehensively with labs by a functional medicine practitioner who can interpret your labs appropriately and then treat you accordingly. Yeah.

Yes. I think Dr. Stephanie and I may be the same person living in different.

States.

Because it's so important to take a comprehensive approach. The thyroid, the adrenals, the ovaries, the pancreas, everything pings off each other. Right. It all affects itself. And so if you're not getting your thyroid functioning, your thyroid will take the brunt of the work. It will work hard and try to support that bad sex hormones, you know, those low hormones. But it gets exhausted over time. It can only do that for so long. Same with your adrenal glands. It will, it will do the work, but only for so long. Right?

Yep. So your body sends you signals like mine did. Really high heart rate, really high heart rate. You're doing too much. Right. They're saying, we're about ready to crash and burn here. So your body will send you signals. And like you said, we want patients to listen to their bodies, to listen to what's happening and listen to those cues so we can figure out what's. What's going on. Yeah.

Unfortunately, our society, the United States, is very hyper focused on being comfortable ignoring symptoms as a warning sign. And you know something? That they're a nuisance. They need to be covered up. They need to go away asap. I don't have time to deal with them. Right. And that is the complete wrong way to look at it.

So from a longevity standpoint, ignoring, ignoring symptoms isn't going to get you real far.

No, it is not. Oh, my goodness. So you love to get their hormones balanced. An easy win upfront. Oftentimes, while you're working on the gut, you're checking their thyroid, their adrenal glands with their cortisol. You mentioned toxins. That's a whole other topic. What else am I missing?

Well, so if we kind of go back to at least the longevity blueprint that I wrote, so this may sound silly, but I strongly Believe even in things like chiropractic care. Right. So chapter one of my book is all about gut health. Chapter two is about spine health. So I know personally I just feel less stressed. I feel more in line. It's beneficial to my nervous system to get routine adjustments. So it's important for my patients to also even think of their spine health. Right. That's the framework of the house. I'm comparing your spine and your musculoskeletal nervous systems in the body to the framework of the house. So that's chapter two. Chapter three is all about genetics, which I'm comparing to the electrical work in the house. Right. Something you want turned on, some things you want turned off. Kind of like you don't just leave all the lights on your house on 24 7. Right. You're going to turn some off at night, whatnot. So I think even just in this functional medicine realm. Well, maybe not even just that. In the conventional medicine realm, we're now more apt to look at genetics. So genetics can even influence one's estrogen metabolism, right?

Yeah.

So a lot of my patients are bringing me their 23andMe or Ancestry.com or, you know, genetic profile, and I'm plugging that into an interpretation site and then kind of looking at all those genetic variants in combination with each other to see, okay, where do you have some room for improvement here? How can we swing odds in your favor? So I think genetics is a really important piece to look at for longevity. Looking at nutritional deficiencies is also super important. Many of us are so stressed out. We have low magnesium. Right. Maybe for bone density. Patients need K2. I mean, there's so many different nutrients and supplements that are available. And so I, with my patients, like to examine their diet to see what I, what I might think they need more of, like if they're vegetarian or if they're on a ketogenic diet or, you know, whatnot. I run a nutritional analysis on them to see what they have need for and then recommend appropriate supplements. Detox is all about chapter or is discussed in chapter five, where I'm comparing the laundry room of the home to your gallbladder and liver and the body. So which we've talked to you a little bit about today. So that's very important that we minimize our toxin exposure, but also actively work to provoke our body to get rid of toxins. Right. Doing liver cleanses, taking supplements like dim, using an infrared sauna, making sure you're not constipated, that you're pooping out your Toxins. So detoxing is very important. Then also along the line of cardiovascular health, Chapter six in my book is all about. I'm sorry, six is hormones, which we've discovered. Seven is all about reducing. I'll just say clogged pipes in the house. You don't want to have too high water pressure. You don't want your pipes bursting. And the same is true with your body. I'm comparing the plumbing in the home to the cardiovascular system in the body. There are advanced cholesterol tests that we can run with conventional medicine. Many patients just have a regular lipid panel run, and they're put on a statin medication when maybe they never needed it. Maybe the statin was the wrong fit. Right. Just having higher numbers with your cholesterol panel doesn't necessarily translate into having higher risk. So I like to run an advanced lipid panel looking at particles and inflammation and genetics as well, to really see what we need to do to reduce cardiovascular risk in patients. And then lastly, I look at the immune system in my patients, so. So could they have chronic infections like yeast overgrowth? Could they have Lyme? Could they have other co infections, parasites? Could they have mold toxicity in their body? There's just so many layers to unravel with health, to rebuild health. Right. And that's where, again, we open the podcast saying, hey, hormones are one important piece of the puzzle. But with functional medicine, there are so many different pieces, and not everybody needs every single piece. Right. Not every patient has Lyme disease or mold toxicity or whatever. Not. But some do. So if we optimize hormones and patients aren't feeling better, well, we know there's another layer to unravel. Right. There's more. More to the story. So that's the short version. But there's. There's just so much that can be offered to patients, and I hope that encourages them. They have some hope that there's someone out there that can help them find the answers that they need.

Yeah. I love how you laid all that out in your book. It's so beautiful and comprehensive. You know, I think it's a great read for anybody just to, like, start to see what are the possible things we need to investigate, you know, and I think everybody should read that even before you go see a functional practitioner, just to have a baseline understanding of what we might get.

Yeah.

What you're getting into, because it is a journey. It's not an overnight fix. This is not a band aid. It's an actual fix. You know, you're actually getting into your body back into balance so that it can do what it needs to do. And that takes time.

I mean, it takes a financial commitment, right, to pay for the labs and office visits and the supplements and the lifestyle, the diet changes. It takes a commitment, but it's worth it.

Yeah, it's such an amazing investment because it completely changed my life. You know, if I hadn't gone down this path, I. I would probably be divorced again, miserable, overweight. You know, I probably would have had my uterus out. I mean, the list goes on and on, and so super important. You got to invest the time and the money.

I'm glad you found your. Your answers.

You as well, you as well. Well, thank you for sharing all this with my listeners. You're awesome. Your link is in the show notes for your book and your website. Where can my listeners follow you? Dr. Stephanie?

Yeah, so I recently interviewed you on my podcast, so I'd encourage listeners to check that out also. So if you go to yourlongevityblueprint.com, you'll see my book. You'll see my blogs and the podcast there as well. My clinic website is the Integrated Felt Hormone Clinic in Iowa. That website's ihhclinic.com back at the Human Longevity Blueprint site, I have a freebie, which is three tips to boost your hormones naturally. And I also outline that whole blueprint that I mentioned throughout this episode, so you can grab that on that site and then follow me at Stephanie Gray CNP on Instagram.

Awesome. Yeah, all those links are in the show notes. They need to check you out and follow you because you're doing awesome things. So thank you so much for this.

Thank you for having me on the show. Like you said, I think we're doing the same thing. So we're with the same mission.

Yes, exactly. All right, talk to you soon.

Thanks.

Well, I really hope you got something out of that. I think it's so important to understand how your body functions as a woman and the significant role hormones play in your body. You know, all of our systems are interconnected, and they all affect each other. They're all working together to keep you in balance. So if your sex hormones are struggling, your thyroid is going to step up and help, or your adrenal glands. You know, if your blood sugar is too high and uncontrolled, if you're having insulin resistance, then another system steps up like it all is trying to keep you in balance. That is how God created our bodies to be. And so we need to remove the impedances that are preventing that from happening. We need to support any nutritional deficiencies that we need to make that happen right and our body can get back into balance. So I hope this episode gives you hope or some idea of where to go to get your issues dealt with. You know I am here for you definitely. I'm licensed in over half the country so please reach out to me at Privamd. Our number is 616-213-0253. You can always come see me and we can do the testing. We can get you back into balance and figure you out. So I hope you got a little golden nugget out of there today that you can take with you and add to what you've been doing. I'm really excited, excited that you're on this journey and that you I feel honored that you let me be your guide. So thanks for staying tuned and I will talk to you next week. Go have a kickass week. Bye, ladies.