How to Spot Menopause Misinformation: A Doctor Talks

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What do Oprah Winfrey, Halle Berry, and Drew Barrymore have in common? Well, yes, they are all female, and they are all talking about menopause, as are we in this episode with my guest, Dr. Shawn Tissone. Don't miss this, where we're going to dive into what is real science versus published science. Know the distinction. What are opinions of experienced doctors, OB-GYNs, who work specifically with women in midlife? What's the opinion on Ozempic, GLP-1, on intermittent fasting? And who do we trust when anyone can adopt the name association, society, institute. What's a girl to do? Coming up. My guest today is Shawn Tassone, Dr. Shawn Tassone, known as America's holistic gynecologist. He's the first physician in the United States to be double board certified in obstetrics and gynecology and by the American Board of Integrative Medicine. He holds a medical degree in addition to a PhD. He's all the doctors in mind-body medicine. He's practicing OB-GYN in the Austin, Texas. Hormone specialist, author, speaker, highly rated patient advocate, and creator of the world's first integrative hormonal mapping system. And you're going to hear more about this. And I want you to know that if there's a book you should have on your library that isn't there yet, This is going to be at The Hormone Bible. It's published by HarperCollins, I believe, in 2021. We talk a little bit about it in the show. Dr. Tisson has helped over 40,000 women, and he is determined to remove the myths surrounding women's health. As an integrative health practitioner, he believes you should have an active role in your own care. His work includes studies and publications on hormonal imbalances, Spirituality in Medical Care, Whole Foods to Heal the Human Body, and Integrative Medicine. Dr. Tisson is featured in many publications, including the New York Times, CBS News Online, Stanford MedX. And don't forget, the book to put on your shelf next is the Hormone Balance Bible. And we're going to put connections for all those things in the show notes, as well as where to connect with him after the show. Stay with us right now. I'm Debra Atkinson. You're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness in menopause and beyond before you knew to ask them. The goal to help accelerate your results with science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman, and it's not just about you but the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, and an international speaker, to founder of the first and the only exclusively made-for-menopause and beyond fitness membership in the world. Every week I interview experts behind the scenes and the science optimal hormone balancing, fitness, and longevity, and share answers to our community's questions so you can have the vitality and the energy that you want, need, and deserve. Dr. Shawn Tessone, thanks so much for being here.

Of course.

It's been a while, but I'm so glad. And you look like— I feel like I'm talking to Tiger Woods just a little bit. And At least you've got this green background going on, and the Masters is this week as we're recording live.

So it is the Masters, and actually right now he's 2-under. I think having broken both of his legs and all that stuff, I'm impressed.

Yeah, really, right? And I think I just saw him today on something social giving a thank you to mom and dad, tearful.

We all have. We're all works in progress.

We're all on a road.

Yes.

All right. And we're diving into that. I think a work in progress is going on in regard to menopause. You are the go-to guy, and maybe we should do a quick shout out and mention to your most recent book. I know it wasn't brand new, but it certainly, in talking about our— was— is a go-to in a Bible for people. So mention your book, talk about when that was published, the Hormone Balanced Bible. I know I had that poolside for one whole summer.

Yeah, it came out in 2021, and basically it's kind of a culmination of my journey. You know, people will always ask, you know, why as a guy did you go into OB-GYN? And I think sometimes you don't necessarily know why you do what you do. You, you maybe don't find that out until years later. I think it turned out to be serendipitous that I did, because when I was a second-year resident, my mom was diagnosed with ovarian cancer, and that kind of put me on a different path. And I knew a lot about the disease process, a lot about the surgery, but what I found during my mom's journey that eventually took her life 5 years later was that I couldn't help my mom feel better. You know, it was like I could understand that I couldn't fix the cancer, but what I discovered was I just couldn't give her a quality of life. I felt really limited and my own, you know, toolkit. And so that sent me on a journey that took about 5 years where I did an integrative medicine fellowship at the University of Arizona. Then I did this PhD where I learned different ways, you know, traveled South America and learned different ways of healing. So the book for me was a culmination of all of that where I— what I found was I was talking to women all the time about hormone imbalances, whether it was menopause or low testosterone, low, you know, estrogen, progesterone. I wasn't really connecting. If I put the hormone imbalance into a story form, like the nun, the queen, you know, and I gave them titles and storylines, people were just— women were just like connecting. So the book is kind of that culmination of the top 12 hormone imbalances in women and the storylines that connect them. And then when you write a book, as you know, you have to just— you have to find a problem, and then you also have to fix the problem. So I have a 6-step SHINES protocol that brings in a spiritual practice, hormones, energetic aspects of the process, nutrition, exercise, and supplements.

Very cool. Very cool. I highly recommend to everybody. We'll put that in the show notes. You know, in 2024, which is obviously, if you're listening to this in the future, this will have had a moment. I feel like there are two buzzwords going around this year and they are longevity and menopause. So you and I think are in the thick of it. Yeah, you know, it's like maybe we've been here for a while, but it seems like everybody else is making it the popular thing to talk about. And I think there's always a risk, like when first of all nobody's talking about it, then all of a sudden everybody's talking about it. The continuum expands. There's more options, more people. The quality also expands. Like there's a lot less quality, there's a lot more quality, and there's a lot just kind of in the middle.

Yeah.

If something right now were to give you pause for concern where misinformation might be going out, we're just going to dive right to the heart of it. Where would you go? What's being said today that, you know, is probably going to be misinterpreted by a listener?

Well, there's two things. One is, like you said, the popularity is being driven by right now, celebrities, Halle Berry, Gwyneth Paltrow, Drew Barrymore. What happened is they— the— these women are now getting into that age group, so they're at their upper 40s, lower 50s, and they've discovered that menopause sucks, which, you know, we've known for a long time. And what they did though, good and bad, they're bringing a lot of attention to it, but they have discovered this supplement that they— some— they invented on their own that fixes everything. And there, it's a cash grab, but there's a lot of women in menopause that are suffering. And so some of the misinformation is coming from this aspect of what your doctors won't tell you. I discovered this through my own experience, you know, this N of 1. And if you just buy the supplement that I'm endorsing, well, you know, you'll, you'll save yourself. So that's one aspect. The other aspect is coming from the medical community, where we are just not helping women. So when we are still afraid of hormone replacement because of that completely defunct Women's Health Initiative that came out about 13 years ago, and we're still propagating this fear of hormone replacement, and you still have a generation of women that were harmed by the Women's Health Initiative 15 years ago, they're still afraid of it. Like, I mean, I'll prescribe estrogen for a woman and within 2 weeks she's calling me because one of her friends said, oh my God, that causes cancer. Yeah, hopefully in the future that won't be the problem anymore. But so you have both sides of the spectrum. One is, oh, everything under the sun will help with menopause. And the other side, on the doctor side, is menopause is just a normal part of life. You kind of have to suffer through it. We're too busy to talk to you about it, and we're not going to help you fix it. We're just going to tell you to tough it out.

What are your thoughts on the words that are used to describe it? Is it hormonal insufficiency? Is it deficiency? It seems to be— we're almost borderline— it's a disease versus, okay, wait a minute, so you're saying every woman alive ever gets a disease, like, in the middle of her life. What are your thoughts about how we call this, what it is?

It's a good question because the reality is menopause is a natural state, obviously. And so it just sucks, right? So it's like, it's a natural stage of life. I, I kind of believe that the reason we have menopause is 300 years ago, the lifespan was like 42. And so there was no menopause because women didn't live that long. We have extended the lifespan. Women now living into their 80s and 90s quite comfortably, that it happens so fast that evolution hasn't had a chance to catch up yet. So we are now in this gray zone where maybe 100 years from now menopause will be 60 instead of 50 as we come up with new things like stem cells and all that stuff. But the reality is it's not a disease. It's a stage of life. The other word that now in 2024 that's huge is perimenopause. And perimenopause is even worse because it's being used as a disease to sell money, to sell products. But the reality is perimenopause is just a word. It just means around menopause. The reality is menopause is a deal when your hormones basically go to zero. So is it a deficiency? Yeah. Is it normal? Yeah. However, it can be really bad for some women, probably 80 to 90% have some sort of issue with menopause that I say it becomes a problem if it's interfering with the way that you want to live your life. If, you know, like I asked my grandmother one day, she lived till she was 93. I think she was in her 80s and, you know, older Italian lady who was a World War II wife. And, you know, I was like, what did you do when you went through menopause? And she's like, what the hell is menopause? And I was like, you know, hot flashes. She's like, we just, I was working in the factory and, you know, She worked at the electric company at GE, or, and she was like, we just kept going to work and we had families to take care of. It was a different generation where they, women weren't heard, still aren't for the most part, but they were really not heard back then. And they just felt like they had to just deal with it. And even back in her days, there wasn't really estrogen replacement, really. It was Premarin kind of came out in the early '80s. And so. It wasn't available to them back then, really. There was birth control pills and whatnot, but women were just made to suffer, you know. And even, I guess, since the day Eve bit the apple, y'all were supposed to suffer, really, if you think about it.

We have our ways of making y'all suffer too. But let me ask you this. So your grandmother's age and era when she— and she sounds like a unique soul, actually, but you know, suffering through and going through. Could there be any, do you think, degree of truth that maybe they didn't suffer as much because the level of toxicity that they were exposed to versus what we all are exposed to voluntarily? I mean, I think we, we brought it on ourselves with the, you know, processed foods, and, you know, our state of living is not as good as it could be. Any truth to that?

You know, one of the cool things I saw on Instagram the other day was this video camera from, I think it was like the 1930s or 1940s, that they had colorized. And it was a downtown picture of New York City at a newsstand, and all these people were walking by, and it was really interesting. But what I noticed was there was no obesity. Like, none of the people were fat or overweight. Or 60 years ago, people just— there was hardly any, like, not one person that walked around. Now, granted, everyone in New York City walks everywhere anyways. So that's a little bit more. You kind of notice that now, if it's not a tourist, if it's somebody that lives in New York, there is less obesity there. You just see it. And I think it's because they walk around. But if you notice, yeah, like my grandmother, she made her own food. We ate hamburgers, but it was like different meat. And, you know, she made her own buns. I just thought that was normal back then. If you believe in the Blue Zones, you know, they eat carbs and stuff. The carbs they eat are different fruits and vegetables and stuff. Even their flour is— they grind it themselves. I mean, so I do think, yeah, that has a lot to do with that generation. And the food supply was just totally different than it is now.

Okay. So, you know, back to this, like perimenopause and/or menopause, I don't think it matters, but they are like marketing terms right now.

Right?

I mean, because everybody knows we have a heightened awareness. I've seen this for the last decade, you know, as nobody was talking about menopause fitness, how that might change. And now everybody is, you know, and everybody's got a title, which brings me to this next question. I think, you know, like titles and seemingly very official titles like associations, institutes, societies. Titles can be like 30 seconds to acquire. Put that on your profile, boom, you're the president of such and such institute. You know, and that's so dangerous, you know, in terms of, you know, we're not checking credentials and we're not checking, is this really an authority? Is this an influencer or an expert or is it both? Are there things that are being said that are just downright wrong? And doing harm, in addition to, you know, letting lingering research that has been disproven and revoked, you know, go on. What other things bother you for women?

Well, one of the things that I've seen that you just mentioned, as I call it, the death of expertise, is everyone's an expert, right? And I mean, and I joke, I'm— I call myself America's holistic gynecologist. America didn't vote on it, obviously. So if that's a tag for you, that's a tag. Um, yeah, but anybody that's saying guru, you know, blah blah blah, expert, whatever, they probably went to IIN or one of these FDNs, you know. And we're friends with these people, and I'm— I try not to get too upset about it because a good friend of ours, Nat Kringoudis, and we talk all the time, And I have two things. One is I'm a male in a female industry. So I'm a guy and I'm telling women about hormones. So that, that's one thing. And then I'm a physician and there's a lot of animosity towards the medical system. And I always say to Nat, I'm like, how am I supposed to swim upstream all the time? Because I feel like I'm constantly— and she said, you know what you have to do? You just have to keep being you. You have to claim your expertise by just being out there and giving the information. People will find the right person for them, really. I mean, and that's what it comes down to. I used to spend a lot of my emotional energy trying to combat this expertise that's not really there. And what I found was it just made me look more angry. You know, it's like, You can fight it if you want. I kind of have to just ignore it. I tried to befriend a lot of these folks, but it's really hard when they continually bash the medical system because they use the word medicine, whether it's functional medicine, lifestyle medicine, integrative medicine, and then they'll go and bash medicine. And it's like, you can't have it both ways. You can't try to legitimize what you're doing by using the word medicine, but then saying you— and everyone's a doctor, whether it's a chiropractor, a doctor of physical therapy, a doctor of nursing, now a doctor of human bio, whatever it is, everyone's a doctor. So where do you get your information? I don't know. And then it is confusing even between doctors. I mean, I had somebody send me something today on Instagram from another OB-GYN that is somewhat confusing. It's like, because this OB-GYN was saying you only need hormone replacement for which will be a good segue for us, for vaginal dryness and hot flashes, because that's what the North American Menopause Society recommends. And I kind of say we should be talking about insomnia, you know, the mood swings, the weight gain, the, you know, the bone loss, all the things, all the other things that are coming in with menopause. So it's even confusing between OB-GYNs sometimes.

So first of all, difference of opinion or a different slant or angle are good things. I think the hard thing gets to be, okay, where's the science? But yet you and I both know if we had an opinion and we wanted to go find research to defend that, we could, and we could ignore the rest. So it is hard for a consumer to say, am I hearing the whole story? And do I have all that I need to make an informed decision for myself? Hey, this is Debra Atkinson, and there is one thing you can't do in the gym at your age, and that's get all the protein that you need. You've got to do that in the kitchen. To make it easy for myself, not only to get the protein but the fiber, the fruits and vegetables I want daily, I started drinking a smoothie a day 30 years ago. But when I realized all the junk the sugar and the extras that you don't want, that I don't want, hiding in most protein powders. That's when I finally caved in after years of saying I will never ever ever sell supplements. Stop skipping, skimping, and sabotaging yourself in the morning after workouts by always being prepared. Look, yep, I agree, real food first, but it's just not convenient to to carry a turkey sandwich. Sometimes the protein, and don't forget the fiber, they kill cravings and they boost satiety. And you've gotta make it easy to do the right thing. You can use code PODCAST for 10% off your first order at flipping50.com today. The misinformation, is it intentional? Is it ignorance? Is it a desire to appear as authority and maybe only have skimmed the surface on the knowledge and understanding themselves in order to deliver? I mean, do you have any sense? I know I'm asking you to look in a crystal ball.

There are a lot of people out there. The common thread that I see with experts that aren't really experts One, they say, I do a lot of research, or I've read all the research, or I'm a researcher. And what that means is they search on Google, and what they'll do is they'll put in something that they're interested in, and they will find a study, and they'll just quote the study. The problem is, what if the study only had 12 people in it? That's not a good study. What if the study was a retrospective analysis? So what I always say is, doctors know how to read studies. Whether they do it or not, they know, because we learned that. That's something we learn in residencies. These people that have very little background don't know how to read a study. They just pick a study that, like you said, supports what their premise is. They have an end result they're looking for, but they don't tell the reader that it's a crap study. So that's one thing that goes on. Then you've got people like— and I'll name Paul Saladino, who's carnivore guy. Okay. So Paul is a psychiatrist, so he knows how to read a study. But what he tends to do, and Andrew Huberman, exact same thing. Huberman, oh, everybody loves Huberman. Huberman will find a study and he knows better because he's got a PhD that's very weak. It's a very weak study, but it will support whatever he's trying to sell. I just feel like those guys are doing it intentionally because they know better., but they're finding some weak study because they may not have a real study to support what they're saying, and they should just be honest about that. So I think it's some ignorance on the part of the people that don't have the background in how to read a study, and then there might be intentionality on some of the people that do know better, but they're just finding a weak study to support what they want.

For listeners, do you want to talk just for a minute about research? What is a quality study, like a longitudinal? How many subjects ideally do you want to have in a study for it to really be valid, or at least for it to be upfront and somebody say— now granted, this was a small study, so we can't take much from it— what do you feel is a good way to preface, here's some science?

You know, the problem is, is that now you can publish a study on the internet and you don't have to even have it peer-reviewed. So you really want a study, first of all, that comes from a journal that is peer-reviewed, that, that is a legitimate journal A lot of these things online now are just open submissions, so you just submit it and they'll publish it. It doesn't— and it's on— people will say, oh, PubMed. Well, PubMed, it doesn't mean any— it's Google. It's just a Google search engine. So you want it peer-reviewed. Then you want something that's going to be the, the gold standard for a study is a double-blinded, you know, placebo-controlled, meaning the subjects are blinded. They don't know if they're getting the drug or the placebo, and so are the people submitting. So the doctor, say, is also blinded. So nobody knows which is which. The best way to learn this is to look on a supplement website. First of all, they'll use something saying science-backed. What the hell does that even mean? Science-backed means, oh, we've got chromium in our supplement and there's science that says chromium's a thing. Okay. That's science-backed. Another red flag would be FDA regulated or FDA application, you know, meaning they, they submitted paperwork to the FDA, but they're never gonna do a study on it. So they're just using that as a way to sell something. Then you wanna look at the materials and methods. So when you look at a study, there's a section called materials and methods that will give you the number of subjects that were in the study. There isn't a magic number for power in a study because it depends on the way the study itself was designed. A study where they call it retrospective, meaning they went back and looked at data that was already done. Like, we found 900 women who had breast cancer already and we studied this. That's retrospective. Prospective means they just signed up 900 women, they controlled for weight, you know, medical diagnoses and stuff like that, and then they followed them for 7 years to see who developed— you know, they were all smokers, say we wanted to see who developed cancer versus 700 women we followed that didn't smoke. That's a prospective. Prospective is always better because it has less bias in it. Retrospective, you can find the data that you're kind of looking for. And then another piece of a study that's really good is when they give you the strengths and limitations of the study at the end. Like, they'll freely admit one of the limitations of the study was the study size. They'll— some— a good research article will say that right up front. The ones you want to watch out for are the ones that, like I said, if they're not peer-reviewed, you want to look for the number of participants, but then the number can be inflated as well. So let's say the number says there were 200 people in the study, but then later in, on the paragraph, it'll say 100 fell off because they couldn't follow up. And so you'll want to break it all the way down. So at the end, it'll say, so we had 12 in this arm and 12 in that arm. So you really want to look at the numbers that were involved. Then at the very end of the study, a really good study will say what the strengths and limitations were in the study. So a study that will say flat out, one of the limitations of our study was we only had 25 people in the study. They will spell it out for you. If they don't put their limitations in the study, you kind of wonder why. And that usually means it wasn't published in a really good journal because most journals that are respectable won't let you published unless you put the limitations of your study in there.

Got it. Thank you. And thanks for that kind of brief review. But I think you've got a couple of gold nuggets in there. I mean, everybody, I think, is going to PubMed feeling like we're doing a little bit more research, we're going a little bit deeper, not knowing, okay, this is not a peer-reviewed journal. So question for those people who are prove-it-to-me girls. I know there's a lot on our show who actually do want the science. And those peer-reviewed journals, for the most part, can a layperson get their hands on them, or do we have to have a subscription? Are they gated?

You can usually get the abstract for free. You might have to, and really that's the meat of it anyways. I don't usually read the whole study. You'll get a good piece of the materials and methods. You'll get the conclusions. You'll get the study design just from the abstract alone. And so for even for people that want the proof. If you're someone that likes to collect journal articles, you could, you could subscribe. You might be able to find it if you dug a little bit deeper, but for the most part, you can get what you need from the abstract.

Great. Okay, two, two topic areas that I wonder if you have a strong opinion about. The first one is intermittent fasting. Do you have strong feelings one way or the other for a woman, or who shouldn't I think it's good.

I know there was an article that came out recently that kind of bashed it a little bit, but I think that was a little ridiculous. Yeah, but they— there were smokers. I mean, it was like, this is— again, they didn't control for that. They didn't control for diagnoses. Like, were they comparing diabetics to non-diabetics? Were they comparing smokers to non-smokers? That's where the study design comes in, and it's a problem, right?

Okay. And who was it? That was publishing that?

I don't know, I can't remember the journal that it was published in. But what happens is then you have the intermittent fasters going against people that don't fast, and so it was quite controversial. But I personally think that fasting is good if it's not overdone. So especially for women, younger women especially, because also then, you know, you have women that have eating disorders and things like that, and you know, you don't want to necessarily You know, no pun intended, but you don't want to feed that process.

Cute. Very cute.

But I think 3 to 4 days a week of at least a 12:12 fast. 16:8 is great if you can do it, but I don't think you have to be super strict about it either. And I always tell women, hey, if you're hungry and you're trying to fast, eat eggs or something in the morning, you know, eat a protein source or fat. Don't eat a carb. I think that's better than, you know, or if you want to put some MCTs or something in your coffee in the morning to get you through the fast, that's better. But I think whatever you can do, we get into these mindsets where we have to do it a certain way. And it's really whatever works for you is the best. You know, if you can do one day, well, that's better than none. I've done that whole Prolon thing. Maybe you have too, the whole 5-day thing. That's fine. I just kind of like, to me, that stuff is like a cold plunge. It's like, I, I just want to do it.

It's worse than a cold plunge.

But I want to do it so I can just say I did the damn thing. Am I going to do it every day? No, but it's kind of like a mindset thing. I wanted to do the cold plunge because everybody was doing it, but then you got the people that have to do it every day and they think that because they're doing it every day, it's almost like they're better. You know, than you or whatever. And it's like, whatever, you know, I've done Prolon. It's probably, you know, like the research is showing that it might help you live longer and whatnot. But if you can't do it, you can't do it. And I know, don't beat yourself up about it, you know.

Yeah. Well, a couple of things that I love, and I— this is my feeling, you're the doctor, I'm not the doctor, but I like that you said You know, don't do it all the time and don't do it too extreme because I think rotating it actually is some of the— where the most benefit comes from.

You've probably seen, I think, zigzagging calories. I tell patients to do that all the time. Don't, because your body's going to get used to a certain routine, right? So yeah, yeah, confusion, just like when exercising, the whole concept of muscle confusion that I'm sure you've talked about. But it's the same concept. Your body will adapt, right? And so you want to change it up.

Yeah, totally agree. And the other thing, you know, with the, with the ProLon, just so that in case anybody doesn't know, so we'll share something in the show notes, but it's a 5-day fasting mimicking. So you are able to eat. There's something regularly given to you— breakfast, breakfast, lunch, and dinner, and sometimes some days snacks. Some days I really look forward to that, like, where's my damn crackers with that tomatoes, olives, and soup? Dry, dried soup, like astronaut powder soup and olives.

And I never loved an olive so much in my life. You know, I don't even like crackers. I looked forward to those damned olives, I can tell you that.

I had on a CGM one week while doing it, and my blood sugar spiked after all of those. Really? Yeah, that's crazy.

Yeah.

So I mean, just higher in carbohydrate, lower in protein. So it, you know, for that reason it was like, okay, is this working for or against? Yeah, yeah, yeah. So interesting. Okay, the other topic, Ozempic, GLP-1s. Ozempic would go be more common or familiar to our listeners, I'm sure. But the GLP-1s, I mean, what are your thoughts about that? Pro, con, it's good sometimes?

What? I'm of the mind, I'm of the camp that it's good in the sense that it's another tool. Now, I don't think that we should use it as a crutch, but I can tell you because I only see women and I know from my own battles with weight that it works. It should be used, in my opinion, with the exercise, diet, you know, nutritionist type thing. Personal trainer. Even I've been bringing in mindset coaches for patients because the two things that I've noticed with the Ozempic/Mounjaro, one I call Ozempic greed, where the patient will set up like, oh, she might be 180, and I'll say, what weight interests you? Like, we're, you know, I want to get to 150. Okay, so we finally get her to 150, and then she goes, what if I go to 140? Okay, well, where is it going to stop? You know, what are— and what's your concern? Well, if I gain— if I go to 140 and I gain 5 pounds back, well, then I'll still be under my goal. And I'm like, if you think that though, that means you haven't made the mindset shift. You are already gaining the weight back, right? You haven't— that tells me that they're not doing what they should be doing and working on that. The second thing besides the greed is the flat-out fear. When they come off the medication. Some women are very, very afraid of stopping it. And because they're afraid, and if you have that fear, then also that means you're probably not eating good because, you know, you're fearful of getting your appetite back. Your appetite comes back, that's great. But if you make good choices, right? I mean, if you eat what you should be eating. And so I think for me, it's really, it for PCOS, polycystic ovarian syndrome, it's been a godsend for some women. For a lot of menopausal women, because I do think losing weight in menopause is harder because of the hormonal shifts, but I just look at it as another tool. Now, if someone comes in and they're 135 and they want to get to 125 for their wedding, I mean, I don't know. I, it's, I try not to judge and I try to just be helpful in what I do, and I want people to do it safely and effectively. And I try to take the judgment part out of it because, hell, there's enough of that already. But I do find that it's a positive tool.

Any negative side effects? And have you been working with microdosing or mostly with the brand names that come in? And I say that for listeners, not so much for you, but like the Ozempic and the Wegovy come in a like one-size-fits-all. Doesn't matter if you're, you know, 130 or you're, you know, 280. It's the same size, same dose. And microdosing is just a little bit more specific to the individual, maybe to how they metabolize things.

So what's interesting is these are not— semaglutide and tirzepatide are naturally occurring peptides.

Okay.

They occur naturally and they weren't made by some company. So what's fascinating is the Ozempic and the Mounjaro, it's not the compound that's inside of the pen, it's the pen that they patented. So when these compounding pharmacies are making these medications, they're the same things, they're buying it from the same place, but they've patented the device that gives you the medication. So that's one thing. These have been around for a long, long time, 60 years. So we have a lot of data. Side effects, more gastroesophageal reflux cuz it slows the GI tract down. Constipation's probably the number one thing I see. Pancreatitis is probably one of the worst things. I have never seen that in my population, but it can happen. Usually it reverses if you stop the medication. The two things that were kind of blown up were the gastroparesis, which is where your stomach just stops moving altogether. That was reported in about 16 patients. All 16 of them had overt diabetes, which is already a risk factor for gastroparesis. And the other thing was thyroid cancer. And the thyroid cancer was done, and it was only in a rat study. It was never shown in humans. So I think it was blown out of proportion and I think it was more dramatic to do that. But yeah, there's definitely side effects as there are with any medication. And I think if it's used wisely, as far as microdosing, no, I just use the doses that usually are used. It's an interesting concept to think about the doing smaller doses, but right now it's hard to, I, the smallest dose for say Tirzepatide or Mounjaro is 2.5. And I don't think I could find it in a dose smaller than that. Now, you can buy tirzepatide from some websites. I just don't know if it's really tirzepatide or not. Comes in a powdered form, you have to remix it. Is it real or not? And that's part of the issue here is, are you really getting the real thing when you buy it that way? And that's some of the criticism that's out there right now.

And/or with a Groupon. I'm hearing you can get it with a Groupon.

So is it real or not? I don't know. And then if it's not real and you lose weight, is that placebo? Who knows?

Yeah, I'm all about placebo if it works like that for you. I like placebo. Okay, so we've been kind of dishing a little bit, but my question, if you were to look back a decade ago versus today, are we better off or worse off, or are we about the same just for various reasons on education awareness of menopause? What's the state of the union awareness?

We're better off. I would say if we looked back to 10 years ago, for me, I was practicing in, in Tucson, and I was just starting to prescribe bioidentical hormones. And I was a pariah. I was ostracized. I was the crazy ob-gyn that was using these made-up hormones. I had to learn how to prescribe them by the pharmacist because there was no other learning tools. Now there's places everywhere that teach doctors how to do bioidenticals. Now major pharmaceutical companies are producing bioidentical hormones. So that has been good. I think as far as the awareness we're still, as physicians, way behind. That's why people are searching on the Instagram and Facebook and all those places, TikTok. That, I think, is good and bad because there's great information out there and there's bad information out there. The problem— and I have, I actually, I did a reel this morning on why is it so confusing. And so I think what's happened is the as usual, the alternative community tends to go first, right? They will go headlong into some topic, whether it was adrenal fatigue years ago or whatever the newest topic is. They just dive right in and they go headstrong and they put out a bunch of stuff that is probably light years ahead of any research they can find, but they just go out there and do it. Then the medical community is way behind criticizing them. Maybe eventually 10 years later, it will then be part of their true— they'll find it's real. And some of the time it's not. And so we're kind of— I think it's good, but you have to, as a consumer, you have to weed through the information and find what resonates for you.

So it's all back to us.

Okay.

Thank you so much. And you have a plethora of information and very I think consumable, down-to-earth reality, you know, like, this is it, this is my opinion, I'm not apologizing for that opinion. Where can they find you? Where can all listeners go and find you and get more?

If you don't get tired of my voice, you can listen to Confessions of a Male Gynecologist, which is my podcast. Otherwise, I'm on Instagram, SeanTassoneMD, and my website is tassonemd.com.

Thank you so much for being here.

You're welcome. Thanks for having me.

Thank you for listening. To listen to a decade of episodes and to get the show notes, visit flipping50.com where you'll be able to find all the previous episodes. And I made it super easy to make the most of your listening time and get exactly what you want to listen to as top priority by getting the top 10 episodes in the areas you most care about, like how much protein do you need, weight loss, and other 3 ultra important topics we've identified as our community's top 5. There's no more powerful health influencer in the world than you, midlife woman. So go and listen right now. So in this episode, we talked about a lot of things, but I hope your biggest takeaway from this is not really about Ozempic or GLP-1 or Wegovy or intermittent fasting. I really hope one of the biggest things you take away is how to filter through and be an advocate for yourself, how to filter through information. This is a really important piece of solving our own issues and following our guts. But looking at how do I know quality research when someone says we published a study? Anyone can publish a study. So we're talking really about peer-reviewed journals and knowing how many subjects should there have been in over what period of time. We also talked about it being a double-blind. So the best possible is double-blind, meaning both the subjects and the researchers are blind. They know there's a potential that they may get the real thing or they may get the placebo, but the researchers don't know which group is which either. Let's face it, we're not supposed to have favorite children, but a researcher who starts with a study having a pot hypothesis. They want that hypothesis that they had potentially to be true. Now, if you're a researcher who only cares about the science, all you care about is, is this right or isn't this right? So send me down the right path. And that's really where all of us want to be. It's like, I don't want to be right. I want to share with you all the information about intermittent fasting, about whether you fuel or you fast prior to your exercise, for instance. And you know where I lie on that. But you too are a study of one. You're your own researcher, and that's fair, right? So measure. That's the bottom line for you. In order to do your own research, you have to be measuring because any researcher in a lab, respectable one, would be doing that. Measure your before, measure after. No, what it is you want to be measuring. All right, we'll see you next time. Don't forget to visit the show notes for today. Do you have a question for a podcast? A question you'd love to ask, or maybe a story you want to tell? Did you know we have a special group just for podcast question roundups and the answers? My community coaches and I provide answers daily inside of this group, but it's also where I go when I occasionally say, okay, open call for podcast questions, or tell your story, would you like to be a guest? So if you're looking for a community of women who are also interested in optimizing their health, strengthening their mindset, and looking forward to every new year, join the Flipping 50 Insider group that's flipping 5-0. Insiders on Facebook.