Hormone Myths Debunked: Real Talk with Dr. Tabatha Barber

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The energy to play full out at 100. Well, I've been watching all of our downloads and it seems to be that the most popular shows on well beyond 40 deal with hormones. And so I'm always looking for amazing guests to come in and give their insight on hormones and bust some of the crazy myths and misinformation out there. And I have a great guest today doing just that. In fact, what we really focused on today, such practical information. But you know, how do you know when you need estrogen or testosterone, progesterone? What are some of the symptoms? Should you be taking dhea? Which test should you really be looking at? Is testing validation. So we're going to be unpacking all of those questions and those are questions. I get DMed all the time on Instagram. And then what else is important as you're navigating menopause to make this easier on you? So I've got Dr. Tabitha Barber with me today.

I've known her now for a couple of years.

She's a member of my mindshare mastermind group and I have just absolutely fallen in love with this woman. She is an amazing doctor. She was a teenage 17. She had a baby, was a high school dropout and kind of emerged through all of this with a lot of faith and perseverance to become a medical doctor, a gynecologist, a functional gynecologist now and has a thriving medical practice. She has the Gutsy Gynecologist podcast, her Gutsy Gyne supplement line. She has her Fast of Faith book. She has been very busy getting information.

Out into the world again to really.

Kind of break through some of the myths of what's been going on. And bonus points, she went through menopause herself, or I think right now she's actually in perimenopause, which makes it even better because there's nothing like real world experience of your own situation that helps you really understand what's going on because you can hear about it, you can learn about it, you can read about it, you can treat people, but boy, when you go through it, you're like, ah, this is what it feels like. So she has got all of that, having treated, gosh, I think thousands of patients now helping them go through navigate menopause and taking a beautiful approach where she combines her allopathic training, her functional medicine training, all of that to really help you, help you navigate this in the best possible way. So I will be right back with Dr. Tabitha Barber. Also, she is going to be gifting you her guide on how to go through menopause, how to balance your hormones, and so you're going to be able to get that@jjvirgin.com Dr. Tabitha that is D, R, T, A, B, A T, h, a, all A's. All right, I'll be right back with Dr. Tabitha.

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Dr. Tabitha Barber. Welcome to well Beyond 40.

Oh, my gosh. Thank you for having me. This is such an important conversation.

It is. Oh, my. Well, anytime we talk hormones, everyone leans in. And what I'm really excited today to talk about is, first of all, debunk some myths, but also just talk about how to navigate the system, because I feel like so many people are just kind of left out. Left hanging.

Yes.

Yes.

So let's start there, because I recently was listening to a podcast. I was listening to my buddy Jason Wakab over on Mind Body Green, and he was talking to Dr. Lisa Moscone, who wrote the Menopause Brain, and they.

Were talking about the lack of, really.

Doctors trained in menopause therapy and that most gynecologists are actually not even trained to handle menopause. Which I was like, what are you talking about?

What?

Everyone is so surprised. And let me just start out by saying gynecologists are surgeons. We spend four years in a surgical residency learning how to do a hysterectomy four different ways, doing procedures. Procedures. Delivering babies that C sections. We do not sit and study the intricacies of the endocrine system and how hormones are affected by all the other systems in your body. Honestly, my menopause training consisted of a few lectures and conversations about conjugated equine estrogen and synthetic progestins and how to dose them. That really was the gist of it. To manage vasomotor symptoms, you know, your hot flesh.

Wow. Okay. Yeah.

Big problem. Right?

Well, so is that still kind of what a conventional gynecologist knows?

Yeah. So, unfortunately, the medical system is pretty antiquated when it comes to what we're learning. And, you know, how we're being trained. We're still being trained in the same way, generation after generation. A Lot of myths are being passed down. Bad advice, bad standard of care training. But I will say, like I continue to follow the societies that governed my training, American College of OB gyns and North American Menopause Society. And I think because of this big shift we're seeing just in society with women going, hey, what about us? They are finally catching up and shifting their committee opinions. How they say with their practice bulletins, they're finally getting the idea that women want to feel good going into menopause. And so slowly but surely, the tides are turning and it's important that we continue to have these conversations so that they do step up and help us out.

Well, what are some of the miss and bad advice out there? Because I want people to be able to spot it when it's happening.

Yeah. So when I was in medical school and residency, it was standard to give women hormone replacement therapy for menopause. Like, everybody just went on it because we had four decades worth of studies that showed the benefits against heart disease, bone loss, dementia. And so it was standard of care. And then the crazy study, the Women's Health Initiative, came out in 2002, scared the bejesus out of everybody because there was a study story that got ran through media that really was a lie, and it was that estrogen caused breast cancer. Unfortunately, when you put something out there like that, it's hard to take back. It's like a bomb went off and we're still trying to clean up the mess. But what happened was the study was stopped early because of a tiny little increase in breast cancer in the estrogen plus progestin arm of the study. So we were looking at two different populations. One woman, one group was taking estrogen alone because they didn't have a uterus. The other group was taking estrogen plus a synthetic progestin. There was a tiny increase in risk in that group with the progestin. And so they halted the study and they scared everyone. And unfortunately, about 17 years later, the lead investigator, one of them, came out and said, we were going for high impact. We wanted to change the thinking on hrt. We wanted to show it was harmful. And as soon as we saw that tick in the number, we, you know, went with that and the damage is done.

So why did they want to do, like, why. What was their reasoning?

To show that it was harmful.

So it's a big business. And there was, you know, a lot of money being made for hormone replacement therapy at that time. They were standardized prescriptions. And this was really going to shift, shift that and it did. Overnight. The big drug companies lost billions of dollars because over 70% of women went off their hormone replacement therapy overnight. But here's the cool thing. When I came out of residency, I inherited a really amazing practice from an older gentleman just retiring, and his average patient was in menopause. So I inherited this huge practice of older ladies.

And, hey, they're not older.

Right. Wiser and youthful and amazing. But the cool thing was he didn't buy into that fear of that study that came out, and he left all his women on hormone replacement. So I got to inherit a practice full of women on hrt.

Wow.

Mind you, they were mostly on synthetic hormones like conjugated equine estrogen and progestins. But. But they were still happy and young and vibrant and having sex with their partners and playing pickleball. And they just showed me how incredible hormone replacement therapy was. I had women threatening, like, don't you dare take my hormones away from me. I'll hurt you. And so I quickly learned, you know, the benefits. And I'll never forget the one woman, she had gone to a cardiologist for some minor thing seen on an echo, and he made her go off of her estrogen overnight, and she had a stroke the following month. And that really got me thinking, like, what is estrogen and how is it associated with our clotting factors and our cholesterol and all of the changes that happen in our body? And it really just drove me to want to study this more and figure this piece out. And I quickly learned, like, that whi study was full of crap. It really was. And now we have people who have, like, really shown it for what it is. The book Estrogen Matters. If you haven't read it, every woman should read it.

It's who's that by?

Dr. Avron blooming. He rips apart every single study and just tells you the truth of what those studies show and why they don't show what they claim they showed. And it's really helpful information. Like, I love to give this example. We use percentages to scare people. Like, HRT increased the risk of breast cancer by 26%. Well, it turns out it was one extra one person in the group. But think about it. Like, 1 in 10,000 versus 3 women in 10,000 is a 300% increase. So percentage wise, it sounds huge, but it's literally one person versus three people in a group. So you have to be very careful about how things are presented to you, and they're not always at face value.

Wow. That's wild. Well, you brought up something. And I know I've unpacked the Women's Health Initiative and started looking. I go, oh, it was one person. And then they didn't even. Like, they followed them out. Nothing. They were treated and they were fine. So I was like, right.

And it was in the progestin group, not even the estrogen alone group. Yet estrogen got the blame. Poor estrogen.

Well, let's talk about estrogen, because I do feel like estrogen gets the blame.

A lot out there. You know, the estrogen dominance.

And one friend said, well, women are estrogen dominant. That's what being a woman is. I'm like, oh, that's such a good point. What is estrogen's role? Because you said you started to look at it and unpack it. And I'll give you a little insight. That happened with me. I was working in an office, out of an office in Palm Desert, and the doctors were sending me in, people they wanted me to do nutrition consults on. And I literally could tell before I looked at their labs and their health history or just by looking at their labs, without looking at what they were doing, I could tell if they were on hormones or not. I mean, you can see it, like, the minute a woman goes through menopause and is not on hormones, you see it in her hscrp. She see her more inflamed. You see her LDL go up. Like, you just saw all these markers go the wrong direction.

Oh, my gosh, I'm so glad you said that. I literally had a patient this morning who was being threatened with a statin by her doctor because her total cholesterol and LDL jumped up over 40 points in one year. She went into menopause. That's what happens because steroid, or all the steroid hormones, estrogen, testosterone, progesterone, dhea, cortisol, they are made from cholesterol. Cholesterol is actually the backbone ingredient. So if your ovaries stop making these sex hormones because it's gone into menopause, you're not using that cholesterol. It's just continuing to sit in your liver and accumulate, and it takes your body a minute to go, oh, we're not requiring all this cholesterol production anymore. Okay, let's get rid of some of this excess cholesterol now. But I see it every single time. Same thing with blood sugar. It increases when you go into that menopausal transition. You become inflamed. We see increase in autoimmune conditions because our Immune system is actually regulated by estrogen. This is really cool thing. So a lot of people don't realize that or think about the fact that when you are pregnant, you are carrying half foreign DNA in your uterus. Half that baby has foreign DNA that normally your body would attack and kill and destroy because that's what the immune system does to foreign DNA. But because of the innate intelligence in your body, the high, high doses of estrogen downregulate your immune system and it doesn't attack the baby, but what we see is after the pregnancy when the estrogen drops to like really low levels because now you have to breastfeed and make prolactin, we see autoimmune conditions just skyrocket. That's when I was diagnosed with Hashimoto's was after my 17 year old pregnancy and delivery. And it was because I no longer had that protection of estrogen. My immune system was out of control and on fire and I had a horrible gut and it was like a perfect storm for my autoimmune condition to arise. So estrogen is protective.

Wow, how have we gotten this so wrong? What is your process? Because there's so many different schools of thought out there. Everything from, you know, don't test, just give hormones. Don't give hormones. Wait till you get through menopause. So someone starting to notice some differences, you know, maybe their periods are getting longer, heavier, they're starting to get hot flashes, you know, how do you take someone through this process?

Yeah, so I feel like a little unicorn in this space because I have the cool opportunity to use my conventional training and not have it be used against me, but to use it in a way of knowing what a typical doctor is going to say to these women, knowing the way that they approach things, but also being functionally trained. I know that there are alternatives. When I was a surgeon, I would always have you sign your consent before the surgery. Risks, benefits, alternatives. But honestly, I wasn't giving the proper alternatives because I didn't know them. All I knew was birth control pills and surgery. I didn't realize there was this whole world of let's use herbs, let's use food, let's use antioxidants and all of these other things and bioidentical hormones. So it's really important that you know the alternative. So if you bring the two worlds together, you want to take the best of both worlds. And conventional gynecology, we are trained not to test for hormones unless we are dealing with infertility and trying to adjust to create a Baby, like putting you on Clomid, doing ivf, then we're checking hormones. We don't have any standard levels that we base anything off of in conventional gynecology. So we just don't test and we tell people, people it's not necessary. We don't understand how to interpret the results. You don't need it. And that's our way of just kind of turning a blind eye. But in functional medicine, integrative medicine, anti aging medicine, there are decades of studies and I don't even know countless patients that we have tested, and we know the standard levels that are optimal that we are looking for. And so there's these worlds fighting back and forth that you can't test, it doesn't work. And yes you can. Here's the levels. And I love that. I know both sides of that. And I can meet women in the middle and go, okay, if you are having an irregular period, we are going to have to interpret these levels a little bit differently. But we still can. It is worth testing. It's worth seeing how far down this perimenopausal trail you are. And sometimes it's more than one test because we do change our levels every day of the month. We have to start to see some trends. We have to talk about symptoms and we have to put the full picture together. So it's not like a five minute conversation where you do one lab test and here's your diagnosis. That's not how it works. But if you're working with a provider who's trained in these hormones, they know the patterns, they know what's up. I can tell just by talking to women whether they need estrogen or progesterone or testosterone almost every time. It's. It's not very often that I'm surprised. So I do love testing. And the way that we test is a whole nother conversation. Not sure if you want to get into that, but I don't know.

I was like going, okay, I'm making notes right here. And I told you in advance, I'm like, I have a load of questions here. And then I want to see where we go. But you know, what are some of the basic tests that, that you would have someone look at? Like what? Or get tested. What would be the starting point?

Well, as a functionally trained gynecologist, I look at everything. You know, I'm looking at your average blood sugar, your hemoglobin, A1C, your fasting insulin. I am looking at a complete thyroid panel doing all the things. But when it Comes to hormones at minimum. I would love to see estradiol, which we call E2 and Estrone, which we call E1. Progesterone, DHEA, total and free testosterone and sex hormone binding globulin and fsh. It sounds like a lot, but it comes in a panel. You can get. Did you know you can order your own labs now on Ulta lab test dot com. You don't even need a doctor's order. That's how advanced we're becoming. I love this. Let women take back control of their health. So you can get a hormone panel and you can see. I recommend then trying to get it in a time where we're going to catch ovulation to see if you are still making enough progesterone. And that's typically going to be in the second half of your cycle. In the ludal phase. Optimal days if you're having a 28 day cycle is somewhere day 19 to 22, somewhere like day 21. If your periods are super irregular, I guarantee you're not ovulating or you're not making enough progesterone after you ovulate to sustain that luteal phase. So I'm a little less concerned. I know you need progesterone support. I want to see what your estrogen levels are doing. You can do that earlier in the cycle, like days three to ten somewhere in there when it peaks. And if women don't have a period because they had an ablation or they have a hormonal IUD like a Mirena, we get it. Whenever we talk about the symptoms that they're having, when they have those labs drawn and we try to put the pieces of the puzzle together and we usually figure it out and sometimes we recheck to verify, but it's, it's not rocket science. It works, you know, we don't have to guess.

So you said something that was very intriguing. You said, I can talk to someone and pretty much figure out if they need estrogen, testosterone, progesterone. And I'm like, okay, like give us, give us some insight into that.

Oh my gosh. Well, about two years ago, I found myself sitting on the couch and not wanting to do anything. By about the third day of canceling all my patients, I was like, what is wrong with me? I have a tendency to have depression. But this was different. And like an aha moment. I was like, oh my gosh, I think my estrogen dropped. And mind you, my periods were a little bit wonky. I was having some spotting beforehand. They were lasting a little bit longer, but this one was late. And it finally dawned on me. And lo and behold, my estrogen was so low, it was like menopausal levels. And so I put on a tiny little bit of an estrogen patch. And by that next day, I started to feel like myself again. And by about the third day, I was back to me. And that was so eye opening, because I was always trained to that. It's a gradual process that you're slowly going to, like, transition. You're going to start to have hot flashes and night sweats. But this was overnight. Like, this took me out at the knees. I didn't want to be married to my husband. I didn't want to do my job. I didn't want to show up for my kids. And if I would have been a regular old Joe and went to the doctor, they would have gave me Zoloft or Pack. So Prozac or Prozac. Exactly. I would have got an antidepressant. And can I just tell you, that was the worst. I don't know who came up with this and who started studying SSRI for menopause, but holy cow. If you like, I feel like that person must not like women. Because if you're already gaining weight and going through the menopausal transition, feeling down and depressed and weepy, and you get an antidepressant, you're going to gain another five to ten pounds. You're going to completely wipe out any tiny libido you had left and wipe out any drive that you have left. Those are the three most common side effects of antidepressants. So if you want to really destroy yourself, that's the route to go. So if you ever get offered that, please just say thank you. No, thank you.

Well, this is the difference between a conventionally trained gynecologist that doesn't have those tools that you have, and then a functional gynecologist who's going to look and go, what's this? You know, this isn't a. The depression is not a result of having a Prozac deficiency or a serotonin deficiency. It's an estrogen deficiency. I. I will tell you, too, when my estrogen dropped, it wasn't. It wasn't a slow decline.

Yeah, I'm seeing that more and more. It's really not. And I think it's because we are driven, busy women with high stressed lives. And I try to explain to women that your adrenal glands are your backup ovaries. So if you are making a lot of cortisol to manage your day every day, because you're busy from dusk until dawn and you're exercising and you're running a business or you're like trying to please your boss, or you manage all your children or whatever you're doing. All the excess cortisol production is really taxing on the adrenal glands, but the adrenals also make dhea, testosterone and estrogen. And so when your ovaries are done, they're like, nope, we don't ovulate anymore, We've run out of production, we're closing shop. Your body goes, okay, adrenals, it's your turn to kick in and give us our sex hormones for the second half of our life. But if you go into menopause with tanked adrenals and low DHEA and you're screwed, it feels 10 times worse. And now we're seeing more premature menopause and more symptomatic menopause because we don't have healthy adrenals going into that next phase. So for me, that was my problem. I was way overstressed. I just killed my ovaries, you know, that year. And I learned a lot about myself and just women in general that year.

Yeah, well, it makes you a far better doctor, too. Look at this.

I know, right?

So when I think about going into menopause, I always think if I could do it over starting about 35, I would have really leaned into stress. Handling stress better.

Absolutely.

And instead of trying to get that badge of honor for everything I could possibly do and thinking, my thing now is like, I'm not superwoman. I didn't sign up to be superwoman. I'm not superwoman. Super mom. Nope, not it. But I think we all do that. We are doing everything. And when you look at moving into menopause where you have no margin for error, it all comes down to feels like to me, how rocking are your adrenal glands?

Absolutely. And we have so much control over that, like you're saying. So for those of us who are still in the perimenopausal transition, now is prime time. Like, set yourself up for success. And if you have already gone into full blown menopause, meaning you haven't had a period in over a year, you have an elevated FSH level, you still want to resuscitate your adrenals and get them back into balance because they are the driver of health or disease or I just saw another patient who had such a crazy, stressful situation in her marriage that she and her husband both developed cancers within six months of that situation. And I see that a lot. And it's because when we have chronic cortisol production, it tells the rest of our body to make all of these toxic immunoglobulins and things to break down all these inflammatory chemicals. Excuse me, to destroy cells, to not recycle, you know, not to get into autophagy, not to clean house. And so there's so much that you can do to actually prevent disease, and we're just not talking about it. And getting out of that sympathetic fight or flight mode is key. It's key.

So how does someone know that, you know, because I feel like it's kind of a. This thing out there. How would someone be able to take this into practical, everyday life and go, do I have an adrenal issue? How do I know I have an adrenal issue? Okay, I have an adrenal issue. What do I do about it?

So that one is a little more complex because the systems are overlapped when it comes to symptoms. So fatigue could be a thyroid issue, it could be adrenal issue, it could be a low sex hormone issue, it could be a chronic viral issue, that kind of thing. So when it comes to adrenal glands, the most common symptoms are you just don't want to get out of bed in the morning. You're like, you got to hit snooze 10 times. You're talking yourself up of getting out of bed, you're reaching for caffeine in the afternoon, you're taking naps in the afternoon. And then a lot of women get their second wind. They don't want to go to bed at 10 o' clock because they finally have some energy. They're like, ready to do their job and, like get on their emails and everything. And so they have insomnia at night. That is the classic adrenal dysfunction. There's different stages and it's. It's like stage one, you're just making too much cortisol all the time. You're feeling wired and a little tired. Stage two, your pattern starting to flip. You're starting to be tired during the day and awake at night. And then stage three, you're just flatline, you're just tired 24, seven, you can barely function. And I hope no woman gets to that point because that's really a struggle to get back from. But if you talk to a functional provider, like, that's pretty much the first thing we're going to look at because it affects your gut health, chronic Stress causes leaky gut. It destroys your good microbiome. It does so many bad things for you. So it is something to pay attention to. And the cool thing is you can do a 24 hour saliva test and see what your cortisol pattern is. You can see, are you making enough too much? Is your pattern flipped? Like, what the heck is going on? And that is invaluable, I think.

And this is another one that you can order on your own, which for a while I was doing it every six months because I would trash them and repair them and trash. But one of the challenges I saw when I was seeing people one on one is that no one came in during the first phase.

Right.

The first phase.

Power through.

You're like, you're superwoman, man. You're just like. It's like you've got an IV of caffeine all the time. You can get so much stuff done.

Exactly.

But that does not last. And when you're doing this too, I mean, when you are trashing your adrenals, you're also going to be impacting progesterone, correct?

Absolutely. So this is why we're seeing perimenopause at a younger and younger age. When I flow, you know, went through my medical school training, they told me perimenopause was like this one to two year time period before menopause where women might be a little bit uncomfortable, they might have some hot flashes and some mood swings. Really?

What was that, 1900s?

I know.

So, yeah, I don't want to date myself too much, but it was like the early 2000s, and that's what they said perimenopause was. And quickly, you know, over the next five to 10 years and then through the pandemic, we really saw these symptoms were prolonged and they weren't going three years or five years. Now we're seeing women 10 years. So at 35 or 40, complaining of these perimenopausal symptoms, like, what the heck is going on? What is up? And there are a few other reasons that we probably don't need to get into today because it's a whole nother topic, like toxins in our environment cause destruction of our ovaries, and gut issues causing destruction of our ovaries. But it really is this chronic cortisol adrenal dysfunction that is driving it. And think about it. Your body doesn't want to create another human being. If you're in survival mode, you know that your reproduction is going to be the first thing to go, because that's an extra that's a bonus for your body to reproduce. It's not a bonus to live and survive and have thyroid functioning. And so that bonus gets put on the back burner as soon as you get into survival mode. And even I tell my patients this all the time. Even though you can handle it, like mentally, you're like, I'm good, I got this. Me and my friends were all just busy, busy, busy. Your physiology can't handle it. Your physiology still responds in the cave woman way that it was created to respond and it will still be inflamed and shut down your ovaries. That's how the physiology works.

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Perks.

What are some other signs of low progesterone?

Yeah, so I mentioned, you know, that I had to go on an estrogen patch. Well, I was already on progesterone for about a year and a half, two years before that. And I knew I needed progesterone when I could no longer sleep at night even though I was so sleep deprived as an ob gyn, I should have just like been out as soon as I hit the pillow. But I couldn't, like, I couldn't fall asleep or I'd wake up in a panic feeling anxious and I felt anxiety for the first time ever in my life. And it turns out progesterone is our anti anxiety natural hormone. It keeps us calm, it keeps us balanced. And so that is the most common symptom that I hear from women is like, man, I just can't handle things anymore. I just feel overwhelmed. Or I, I'm waking up at night, I can't fall asleep. I'm, I'm feeling my heart racing and panicky in the middle of the night. I give them progesterone orally and like by day three, they're messaging me. I love you. I life back. This is incredible. It's pretty amazing. And I probably, I didn't learn that as an OB gyn. So this is really important for women to understand. And I just combed through ACOG again because I wanted to see what they've updated recently and they're finally getting on board with progesterone because all of the birth control pills, all of the IUDs, the shots, the. The arm inject implant on rod, the next one on rod, like everything, is a synthetic progestin. That is what the drug companies make. There is something called micronized progesterone. It's a bioidentical capsule. It's been around for decades. It's a generic drug, but nobody uses it in the conventional space. We all use progestins. That's what we're trained to use. And there's a huge difference. And this is why these worlds keep fighting as well, because progestins, they do a great job of stopping the lining inside your uterus from overgrowing. So estrogen's a growth hormone. It tells the uterine lining to grow every month, and then progesterone comes in and calms it and keeps it quiet. So these progestins do a great job at that, but they do the opposite in the rest of your body. So progestins typically cause a little weight gain, a little anxiety or depression, a little puffiness, a little inflammation. A lot of women do not feel good on them. Asking someone who's had a depo shot, it's terrible. But progesterone, the capsule, which is the same chemical as our body, makes we feel good on that because it sends the right signal to the rest of our body, not just our uterus. And that is a huge difference. So ACOG finally put in their statement, and I wrote this down because I was so excited that they're finally acknowledging micronized progesterone has a different effect than these synthetic progestins, and it doesn't have the risk of breast cancer that synthetic progestins do. Oh, my gosh. Let me just read it. There is adequate evidence in the medical literature that natural progesterone is not associated with an increased risk of venous thromboembolism like blood clots and stroke. Conversely, there's evidence that, by comparison, synthetic progestins do increase the risk of venous thromboembolism, and the use of estrogen alone has been associated with the increased risk compared to those. So estrogen and progestins cause blood clot, stroke, progestins cause breast cancer, progesterone doesn't cause any of it, and estradiol transdermally has a significantly less risk of blood clot and no risk of breast cancer. So ACOG finally put this out in a committee opinion, like, we have hope. There's hope.

Well, here's the other one that I just find bizarre and weird because I know our biggest hormone, our most abundant hormones, testosterone.

Yes.

And here in Florida, our mutual friend, Dr. Was it Dr. Lisa Coach, telling me this? Anyway, in Florida, it's now a controlled. Testosterone is now a controlled substance. Yes, across the country because they're very concerned about something about the transgender thing going on here in Florida. So, like, you have to be specially trained to be able to, to prescribe it. There's all this stuff around it. And so talk about how someone would know if they were low in testosterone and what, you know, what we should do about that. Because, like, I was like, how could this be hard to, like, why is this so hard to prescribe for. For women if it. It's not hard to prescribe for men.

No, it is not. And that is the frustrating part because that originally became a controlled substance because men were abusing steroids with like, weight training and Olympic athletes and things like that. And so the FDA's answer was to make testosterone a controlled substance. It didn't help at all because you can still get all of those things and there are so many options for men. There's all kinds of injections and creams and different things with many, many doses. For women, there's nothing. There's a lower dose injectable, it's 100 milligrams per milliliter. So you can like give yourself an insulin syringe, little injection of testosterone, or you can use a compounded cream, but they're not FDA approved for women. And the bodies that be ACOG and NAMs still is not on board with it. They continue to give conflicting information. So they're saying we don't recommend testosterone replacement for women. But I just read an art a committee opinion about vaginal therapy and they said testosterone seems to be beneficial. And here's the dose that we recommend it at. So nobody's in agreement with anything. But I will tell you in the functional space, we've been using it for decades and women are so thankful because it can be a game changer. Testosterone is actually a very abundant hormone in our body. Even though it's in smaller doses than men, it's still super important. We have testosterone receptors throughout our body and it gives us not just a sex drive, but a drive for life. It's that feeling of like, I'm going to get up and do something today. And I would say that's probably the most common complaint I hear from women is they're just blah. They don't want to do life anymore. I had a woman who, she was like two months postpartum, stuck on a mini pill right after delivery because she had a bleeding episode or something. And she came into the office and she wanted to divorce her husband. And her husband was so lovely, and they were so in love during the pregnancy, but she was like, I don't want him out. I don't want life. I don't want him to ever touch me or look at me. He disgusts me. He tried to kiss me. And it was because she had no testosterone. Her testosterone production was being suppressed by this progestin only birth control pill.

She.

And it took us a while to figure that out because I was still a conventional doctor at that point, but that was really eye opening for me. So just feeling blah, not wanting to be intimate, no sex drive, not being able to build muscle, not being able to look like JJ and get in the gym and make some gains. Like, you need testosterone. And working out helps you actually make your own testosterone. So it's like this awesome thing where if you can get into the gym and start making gains, you'll probably make more testosterone unless your adrenals are tanked and your ovaries are gone. So there's always that piece. And getting women on some testosterone replacement can really be what they need to get back to feeling like themselves. And the brain clarity. Let's talk about that. Like, that can be a game changer as well. So many of us are struggling. Like, we can't remember things, or we can't complete a thought, or we can't finish a project at work, and it's because our hormones have shifted so so much. These can really give you your life back.

So when you're going through. Because I. What I describe this like, is when you're going through it, it's kind of like you're out paddle boarding. Then all of a sudden the wind kicks up, and all of a sudden you're surfing out there, and then the wind goes down and then you're fine again. You're up and down and up and down. And then all of a sudden you get through all of it and it's calm. And you know exactly which hormones. Like, you can balance your hormones because nothing's changing, right?

Yeah.

But when you're going through it, how does one. Because your estrogen's all over the place. Like, how do you balance hormones in the middle of a storm?

Yeah. So that's why testing is important. And testosterone and progesterone, they typically just decline they're more like of a steady decline, whereas estrogen is that roller coaster. And that can go on for a while. I've seen women do this for like two years where they're. I think of it like when you're squeezing out a rag, try to get those last drops of water out of that rag. The ovaries are like, I'm going to give you a little bit more estrogen. And they keep trying. But, like, once you stop ovulating and producing progesterone, it doesn't usually come back. If you're like menopausal age, same with testosterone. Unless you work really hard to try and resuscitate those adrenal glands and do all of the right things, that typically doesn't come back either. And so, you know, those are probably going to be the first two hormones that you're going to replace. And then estrogen is going to come in later at some point. Unless you've already gotten to that calm period with where everything's just low and staying low at that point. And that you can all see in standard blood work. You really can. And I just want to make a note about testosterone because some conventional doctors will just check a total testosterone and then tell their patient, you're fine, there's nothing wrong with you. Your testosterone is, I don't know, 15 or 20, and it's in the normal range. But there's a lot more to the story. There's a, there's an amount of free testosterone. So total is actually bound up to a carrier protein called sex hormone binding globulin. And it holds on to testosterone until your body's ready to, to use it. And it carries it around the body and drops it off at different locations. So you might have an okay testosterone, total testosterone, or you might be in the, quote, unquote, normal range, but it's really low for you. So you want to see what is your free testosterone, because a lot of times I see less than 0.4, which means the level's so low they can't even qualify it or count it in the lab. It just, it's not there. And so these poor women are being told they're fine and they have no free testosterone. Testosterone. And their sex hormone binding globulin is really high. It's like, oh, my gosh, honey, we can help you.

And what do you do about dhea? Do you have people take it, not take it? What's this?

I love dhea, but there's an idea that if you take it, your testosterone is going to go up. And in practice, I don't really see that. I see that being a separate thing. And dhea, call it your anti aging, keep you young and healthy hormone. It is combating cortisol. It is keeping cortisol, your stress hormone, in check. It's repairing all the stuff from cortisol. And naturally, our DHEA starts to decline as we age. The production does, but it doesn't have to be down in like the 20s, 30s, and 40s. You want to be in triple digits. Like, you need to have those levels be halfway decent. And this is for men and women. It turns out when my dad almost died from a pulmonary embolism a year and a half ago, his DHEA was like 20. And the only reason we knew that is because I made them check it. And it's because DHEA helps you heal and recover from stuff. So you need it more in your second half of your life than ever before. So I do like to replace dhea.

Wow. This was a fabulous masterclass. Now, the good news for everybody who's been probably furiously writing notes is, number one, we have the transcripts, but also you have a guide to hormone balancing naturally. Will you tell us what that is? And we're going to put that@jjvirgin.com Dr. Tabitha D R, T, A, B, A, T, H, A.

Yes. Three A's, No I's. Yeah, the guide. Actually, we didn't talk about what's in the guide very much. So I think it'll be a good little add on to what we talked about today because it turns out the other systems in our body really do affect our sex hormones. And I talk about the adrenals more. I talk about gut health. I talk about the nervous system and the sympathetic and the parasympathetic and all kinds of stuff that can totally affect your sex hormones. Thyroid is another big one that we didn't even touch on. And it's so important to get that evaluated. So that'll be really helpful for anybody listening. You can can start to, like, really see the picture. Once you put all these pieces together, like, oh my gosh, it makes so much more sense.

This is fantastic. Thank you so much. And again, I'm going to put that@jjvin.com Dr. Tabitha and this was fabulous. And you're fabulous. And thank you so much for all the amazing work you're doing out there.

Oh, thank you, jj. Love you.

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