Don't Get Hormone Replacement Therapy Until You Watch This | Dr. Sara Amirmehrabi

How does a person know whether or not they need hormone replacement?

So all of a sudden, she's busy. She's working. She's on top of her professional game, and she wakes up one morning and it's like, I don't know if I can do my job. I can't think. She's also not sleeping. She's waking up maybe 2 or 3am in the morning. She's gaining weight. No matter what she does, she's on prolon. So then she starts to starve herself more and more and more. We all know that that's terrible for your neurotransmitters, for your serotonin and your dopamine, and you're going to end up getting more weight. She's also going to maybe start fighting with her hus and she doesn't know why or her libido's down. She's maybe having vaginal dryness or frequent UTIs. So she's a mess, poor thing. And she finds me or somebody else who does hormone replacement therapy, and we just look and just say, oh, honey, come here, let's help you out.

Welcome to the Dr. Joy Kong podcast. Today, I'm so excited to have Dr. Sara Amir Mehrabi with us. She is a super hormone specialist. She's a naturopathic physician and has been working with patients for over a decade on supercharging their health. She utilizes a variety of modalities, including hormone replacement, peptide therapy. She does a lot of weight loss medicine. She utilizes energy medicine. And I'm really excited to have her as part of our chara health clinic because she brings in such unique perspective and expertise. So today we're going to dive deep into the female hormone replacement arena. Well, welcome to the show, Dr. Sarah.

Thank you.

Well, let me give your full name, Dr. Sarah Amir Morabi. Sometimes you go by Dr. Amir, but I'm so thrilled to have you here to enlighten us on hormone replacement. So I know you are an expert in this arena. You've taught lots of doctors. You've supervised dozens of clinics around the country. So I'm really, really excited to have you here and also to have your expertise at our clinic as well to. To borrow that last knowledge. So here I wanted to share it with a broader audience. So welcome.

Thank you so much, Dr. Kang. I'm so excited to be here. And it's. It's a really momentous occasion in time right now where there's so much attention for hormone replacement thera, especially in regards to women and our health and, you know, all of these beautiful things that are starting to unfold.

I know. So when did hormone replacement actually kind of come to the forefront? Like, when did people realize this is something really important?

So initially, I mean, in the 80s, this was huge. This was huge. In the 80s, everyone was on estrogen. It was in the 90s, early 90s with, or I would say 1991 with the women's Health Initiative study. And this was a billion dollar study that was a really a devastating blow to women's health. So it was at that point where all the rage of get on your estrogen. It's good for you, it makes you sexy, it makes you beautiful, it's powerful. All of a sudden, that went away with that study because that study found that women had greater increased risk of cardiovascular disease, stroke. That study actually was a blow to women's health in general. And every provider, every doc that was giving h hormones to women, I remember.

All of a sutton, so be careful. Hormone replacement. And then I, I think the scare lasted, what was it, 10 years or so, until new studies were following up on those.

Yeah, I want to say 10 plus. So maybe even anywhere from 10 to 20. I think it was recently, these past two or three years where women have just become so sick of it. You know, they had all these issues that they were being dismissed when they would go into their doctor's office or with their loved ones and told that it in their head or that they're making it up or, or that, you know, it was something else. And so now we're finding, especially these past two and a half years, that the floodgates have really opened and women are just wanting this.

And it's. But also studies have disproven.

Studies have.

The earlier study that was damning. And then they, they realize what they were studying, the, the replacement agent that they were using were the culprits.

Yes, it was. So it was a difference really between synthetic hormone replacement therapy. So in that 1991 Women's Health Initiative study, they were using conjugated equine estrogen, which is Premarin, and they were using progestins, which are also synthetic. So you know what we found that not only was the synthetic product less safe, but the women were had also associated comorbidities like diabetes, high cholesterol, you know, alcohol intake was high in some of these, these women. And so what we found was a 26.1% increased risk of breast cancer in that study. But it was flawed. The true data showed 1 women in 1000 over 4 years so when you look at statistically 4 women in 4000 over 4 years, that's, that's not statistically significant.

But also because they were using unnatural form of, that's not, is not endogenous to the human body, right?

No.

Why do you think they were using equine estrogen and then progestin instead of just good old progesterone, which is natural to the body?

Honestly, that's a great question. I find what, what we've been seeing in, in the space is that there's just not a lot of studies done on women's health. We have been left behind. Unfortunately, now we're starting to catch up. And the data that we have extrapolated has been from male population, which also doesn't make any sense because a woman's body is different physiologically. You know, I mean, I don't know.

I.

Most men that I see, they can really go, they can live off of three to four hours of sleep. Women, not so much. You know, cold plunges are a new thing that was recently brought up where, you know, that was like. Because it's not good for women.

Me. Oh, thank you. Thank you.

No, we're not supposed to go into freezing ice water. It actually increases our cortisol response. So we need to go to the cool water.

Yeah, that I'm okay with.

Yeah. I, I had always just felt wrong intuitively when I tried to do a cooled plunge, I could, I could sense maybe my cortisol going up. I was tired afterwards. It wasn't refreshing. I mean, I guess if you're a high end athlete, that's a whole nother story. But you've got a whole other team of doctors doing all these other things for you as an elite athlete that might make it work. But women anyway, are we not supposed to do that?

Yeah. So going back to the, the estrogen and progesterone they were using, it was really because they were using these synthetic forms or, you know, animal derivatives of the hormones that were, were causing these untoward effects in humans.

Absolutely. And what we're finding with the bioidentical is a, these bioidentical hormones, they fit into our own hormone receptors perfectly. So they mimic our own body's natural release and acceptance into these receptors. So they work better. Essentially. It's almost like a shoe that doesn't. The synthetics are a shoe that doesn't quite fit. Yo, it looks cute. You want to wear it to dinner, it matches your outfit. But you come home in pain and it could give you bunions. So we don't want to do that. We want bioidentical. And that's the studies that have shown now when we're using bioidentical.

And of course, big Pharma can't make much money from bioidentical, right? No, they can't patent it.

They can't patent it. And that's where, you know, and then we have this whole controversy of compounding pharmacies with the bioidentical. And that also is another kind of controversy that, oh, you know, is it safe to come from a compounding pharmacy? I know whoever is in the space and you know, most specialists, they will vet their compounding pharmacies. So it is a very safe option. It's something I and several other doctors use all the time. I actually prefer sometimes the compounding pharmacy route because I can individualize based on what I, what my patient is bringing in, what I hear and see and, and how I interpret the lab. So it's not.

Well, these compounding pharmacies are under strict regulations. Remember, they, they go through FDA inspections.

Yes.

Not like they can just be, you know, unsanitary or, or cheat. I mean, it's, I mean, I assume there are businesses that can cheat in anywhere, in any place. But yeah, generally, if they want to stay in business and they're decent people.

Yeah, they've got to follow these, these guidelines and regulations. And you're right, it's not easy. I wouldn't want to have one. I wouldn't want to be, I wouldn't want to own a company. It's a lot. And you know, think, thankfully there are combating pharmacies that really deliver high quality, you know, and precision medicine and they will help you as well. You know, providers can get help from these pharmacies in terms of, you know, what's best or what's.

Yeah.

And you can work with them and kind of individualize what.

Yeah. So I want to focus on female hormone replacement today and I would love to bring you back. So we can talk about males. They're equally important, but both are vast subjects. So. But females, you have mentioned are a little bit more complex and a little bit more ignored than the male side. Can you talk a little bit about that?

Yeah, we'll stick with the sex hormones. You know, there are other hormones, cortisol, insulin, you know, all of those things. But we'll stick with the, you know, the estrogen, progesterone, testosterone, kind of that main class for now. But with women we have the combination of three and then you add in the brain, hormones, the signals from the brain, the FSH and lh. Now you've got five you're worried about. With men, it's literally two. What's your testosterone doing? What's the estrogen kind of doing? And, oh, forgot about the prostate. Got to look at the men's prostate. But that's not necessarily the hormone. It's just a biomarker. So it's five versus two.

Yeah, yeah.

And what we found is through working with women not only in their menopause, pre menopausal years. So these are reproductive age women, but the perimenopausal year. So that's anywhere from 35 to 45, maybe longer for some women, but as early as 35, it can start. And hormones are shifting around that time. And there's no specific data out there that we can pinpoint of. Okay. These are the levels that your hormones are supposed to be in perimenopause because the hormones are shifting and cycling and going all over the place. It's called a zone of chaos. Oh, really? Fun place to be.

I'm sure lots of women don't want to be there. No.

So it's this zone of chaos, and we start to see these ups and downs and, you know, associated moods with it. We're not crazy. It's just our hormones that are fluctuating with us.

It's the hormones that are crazy.

It's the hormones that are crazy. Yeah. And we start to notice that it's more during that perimenopause time or that time before, you know, we were incomplete or the ovaries are not responding. I don't want to say ovarian failure because I want to be nice to my ovaries. They're not failing. It's just a process of aging. Right. And we find that it's initially progesterone that starts to tank first. So that's often something I tell women, you know, in the perimenopause years, you know, let's take a look at your progesterone. And the other reason being we have a lot of stress we're going through. And so it's called a pregnenolone steal with stress. So we need pregnenolone in order to make the rest of our hormones, you know, estrogen, testosterone, progesterone. But cortisol on the hierarchy of hormones trumps the rest. It trumps estrogen, progesterone, testosterone, because we need it to survive more than we need our sex hormones. We need the cortisol to regulate Our blood pressure, our blood sugar, our, you know, capacity to think, our capacity to metabolize, our carbs, immuno, you know, support with our cortisol. So much more important than the rest.

Don't get sick.

Yeah, don't get sick. Right. So it will steal the pregneolone for itself to make more cortisol to help you survive.

Yeah.

And so what we find is that women in their perimenopausal years, not only are they sleeping less, but they're feeling worse, they're experiencing anxiety, they've got all this stress going on because maybe they've got family, maybe they've got a husband, maybe they've got high pressure, high career jobs, or combination of all of it. So all of that's on their shoulders. And now, you know, their progesterone's taint because they're trying to survive. And so that's why I always say, let's look at your progesterone. And that's the earliest marker. Testosterone is usually later. I see the testosterone could drop with the progesterone, depending on stress as well. So that's something we really need to look into. How much is stress and cortisol affecting the rest of the hormones? And that's what I like to look at pre. Menopausally. So in women who are 15 to 32 or 35.

Yeah, that reminds me. Yeah, 15. So, I mean, even young women can have hormone imbalances. Right. And people don't seem to think about it or talk about it. You know, people are, you do have your period, Is it regular? And that's sort of the extent of their concern.

That's it. And then, you know, the next part of the algorithm is, oh, here's some birth control, but it's a band aid.

So do you think that women can start hormone replacement? That's young. If there.

There is imbalance, I think as young as 35. Yeah. Especially in the women who. Let's say it's surgically induced menopause. So let's say they had fibroid cyst to the point where they were hemorrhaging blood every month. And it was there, it wasn't good for them. They couldn't survive, and they had to go through some surgical intervention. So early menopause, surgically induced. Absolutely. Start as soon as possible. If you've gotten a total hysterectomy, which means both of the ovaries removed and the uterus, that woman needs to get on hormones asap, just for preventative. And it doesn't even have to be high dose. We're just doing physiologic repletion. That's it. And they think a lot of the worry and concern comes from dosing. I think for, for women in general. Yeah, we can start with the, with the teens. It's, it's less about adding more, it's, it's more about, okay, let's, let's pinpoint what's happening in your body from a functional and integrative approach. Right? Like, let's look at this systematically. What's happening in your external circumstance. Family, school, friends, boyfriend, you know, social media. How is that impacting when a kid.

Is, you know, having a lot of mood issues and. Well, I was a psychiatrist and we never checked, so even in adults, we never checked. And that's what, one reason I left psychiatry. I was like, you're barking up the wrong tree. You're not looking at the whole body at all. So the hormone imbalance, the only hormone we checked, and we proudly say that we check a hormone, which is the thyroid. Right. And they only check tsh, which is notoriously, you know, not very sensitive to real thyroid changes.

Right, right.

So, so once the TSH is in a decent level, that's when we start to throw drugs at people saying that, oh, thyroid is fine. So it's really sad and I hope the psychiatry as a profession is progressing, is changing. It's, you know, embracing more of the integrative, you know, therapies and actually seeing that how the brain is connected to the rest of the body. So bet, I bet you a lot of people have come to you with mental health problems, right?

Oh, yeah.

And they probably don't want to take medications, psychiatric medications. Yeah, yeah. And what, what is your approach when you see people complaining?

Well, it's funny, the first thing I ask is, so what medication were you prescribed?

Okay.

And then they'll tell me and then the next thing I'll hear is, you know, my doctor didn't even say why they recommended this. And it's usually like a combination. It's either an antidepressant or an anti anxiety med or a combination of both. And nobody explains to these women why it's being given to them. It's just given to them and they.

Receptors. If they ask all about receptors, neurotransmitters, Receptors. We only know about neurotransmitters and receptors, which is good.

I mean, we need that. Right. And I actually like to work with psychiatrists and psychologists closely. We, I mean, I have treated patients, have had Referrals from psychiatrists and psychologists. Because thankfully that subset of doctors were like you, integrative, holistic. Knowing that there was something deeper that, you know, keeping dopamine in your synapse, in that area of your brain wasn't going to help. It had to be something more for the concentration. And so for those women, I always say, and those are the women that have brain fog, mood swings, those are the neurological symptoms of menopause. And this is something that people don't really talk about all the time.

Can you talk about the range of symptoms? Yeah.

So with, with menopause and again, the earliest usually symptom, especially in perimenopause, is brain fog. Difficulty with recall. So you walk into a room, you're like, what am I doing here? Or you're looking for your keys. You're like, I swear I just saw my keys. It's not more, it's. It's less of a. Of a what? Name recall can be something. But that's one of the neurologic symptoms, the brain fog. Difficulty with memory recall. The other symptoms, you know, the more expressed symptoms that we've, we've heard, the hot flashes, low libido, vaginal dryness, anxiety, and also aggression can be something. Oh as well.

Oh, my mom, the very irritable. And I was like, mom, but you've been in menopause. Because she used that as an excuse. I was like, you've been in menopause for 20 years.

It's a long, drawn out upwards of 2, 10 years. Women can suffer, maybe more.

Wow.

Yeah. And so what we're finding now though, this is, this is really exciting. This is really. This is new research. Well, new ish. June of 2024, there's a neuroscientist, her name is Lisa Moscone. She's over at Cornell Weill Cornell. And she's leading the charge on actually finding out what is happening in the br women who are going through estrogen withdrawal, AKA menopause, perimenopause or menopause. So she's comparing a pre menopausal brain under functional MRI versus menopausal has gone through the estrogen withdrawal. And what she's found in this groundbreaking study she did in June of 2024 was that estrogen receptors up regulate in the brain. So it's. What that means is that the brain is actually hungry for estrogen and it's independent of blood levels. So let's say you're on HRT or let's say you're not on hormone Replacement therapy or HRT anymore, Or you haven't started it yet, even though you have low levels, or maybe you have high levels. Maybe you're just not even in that perimenopausal state yet. But what we do know, according to this study, is that the brain now starts to make more receptors for estrogen. It's.

It's.

What it's doing basically, is. Is the study is what it's extrapolating in. What I think is that it's telling us that the brain is hungry for this. It's a battery for our brain. We need it.

You think whether or not hormone replacement was in place?

Yeah. So it's independent of blood levels of estrogen.

So replacing it with loss of estrogen is not calming that down?

Well, no, it calms it down. It calms it down. But what this study is telling us is that the brain is hardwired to soak in estrogen. And so the implications of this are really cool, actually, if we think about long term. So this woman has basically created a marker that didn't even exist. So she spent. Lisa Moscone spent five of five years of her life a developing a marker that can be traced because we didn't have it in women's health and in medicine. Then she spent five years kind of making sure all confounding variables were out of the picture. Right. Because we need data. And then what she was able to show was that this upregulation, so all of these little estrogen receptors in the brain just lit up because it's thirsty for it, because the brain knows that the body has a low supply of estrogen. And so now we can quantify. Maybe. Maybe we can quantify later on. Okay. Or not. Let's not say quantify. But what this means is we could potentially extend that window of opportunity, which is often heard or said in the hormone replacement therapy space, where, okay, that window of opportunity is, you know, don't give treatment for 10. For women 10 years post menopause, or you can only do it for maybe 10 years total or not over the age of 65. So nothing more than 10 years post menopause or stop treatment in women over the age of 65. That's that window of opportunity. And so what we're seeing now is, well, wait a second. What if we test the brains of women who are 70 or 75 to.

See if they're still hungry for it?

To see if they're still hungry for it, because that can then change. Change. Okay, this window of opportunity.

I see so.

Because why do we have to stop giving hormone replacement therapy to women? Imagine you're feeling great. You just got through five years of just the worst years of your life. Like, you couldn't sleep, you're sweating. I mean, you're on a date maybe. Right. Or if you're married, you're with your husband or whoever. You're. You're. You're in public, and all of a sudden you have beads of sweat.

Just.

It's not comfortable. And so you go through that period of random hot flashing. You go through that period of poor sleep. You go through that rage for no reason, where you're looking at your pet or your loved one and you're like, God, what are you doing here?

Like.

Or even worse, you know, so we go through these, and nobody wants to go back to that. So why would I ever stop? And so that's what this study is really giving me hope for.

Very interesting.

Yeah.

Does it ever stop, that hunger?

The hunger? That's what. That's what I think she's this. This neuroscientist, Lisa Moscone. I think that's what she's trying to uncover.

Yeah.

And a big body of her work really is just, you know, women's hormones, health and, you know, how we need estrogen and why we need estrogen to prevent Alzheimer's.

Yeah.

So it's. It's kind of all in that brain health. You know, how do hormones improve and impact brain health?

Yeah. I feel a lot of women are not really embracing the. The feminine biology aspect because they seem to loathe the fact that they have menstruation every month. That is something that they hate.

I hate it.

I don't want it. But it's supposed to be rejuvenative. It is that losing your blood every month has a really beneficial effect on your health.

And I see. Yeah. And I. I like to let the body's natural processes do what it needs to do. And sometimes it can be very detoxifying to the body.

Well, like men, when they actually relieve their blood. And that helps with the rejuvenation.

Yeah. Therapeutic phlebotomy. Exactly. Yeah. It's necessary. It's a good detox. I think what's happening in the world is. I don't think our. The current life and world around us is conducive to letting a woman just rest a little bit if she needs to at that time. I know the Native Americans, they have their own. What's called the red tet. And so where the women would. Would gather together in the, in the tent during that time of the month. And they would do like ancient rituals and ceremonies and you know, we don't have that in the United States here. And I think that's part of, that's maybe why, you know, some of that tradition that's been lost in terms of, of that, that ancient wisdom of, and the sacredness of, of the uterus just being expelled. Right. Because this, this is a thing that gives life. And so when we shed that lining, it's nothing to, to scoff at. It's a beautiful thing. And it's really just, just mother nature's way, in my opinion. Releasing, of releasing.

Waiting for the next time and waiting.

For the next cycle. Right? Yeah. And so hopefully, you know, maybe in the, in the work week or in, in this country, there will be, you know, a couple of days where a woman can be like, okay, just go home.

Okay.

We'll never get there. I don't think.

Well, there's going to be even more hesitance. Exactly. Hesitancy in hiring women. She's like, besides pregnancy, you want what.

You want a day or two out of the month. No, I get it. I, that these are just, you know, reaching for the stars kind of thing.

Right, right. Perfectly.

In the perfect world, friendly world.

Yeah. So what are some of the surprising benefits of hormone replacement that you've seen in people?

Okay, so gaining and maintaining muscle mass. Estrogen, estrogen in women and testosterone in women are so important for that. Without. It will basically deflate. And you know, we all know, you know, and you've spoken about this and many other, you know, experts in the field have, have described muscle as a currency to longevity. It's also great for our bone density. Women need estrogen and men. But today we're focusing on women, but we need it for our bone density. So what we found, according to the data and studies is that a woman who falls later on in life, so 65 and over, if she falls, she breaks the hip, there's a one year mortality rate. And I've actually heard this in a patient tell me that her mom fell and died a year later. Yeah. So it's so important just, just for mortality reasons and, and you know, keeping us out of a nursing home, we need to be able to get up, get out of a car, put things on high shelves, bring things down. Like you're in your kitchen, you got to grab things down and you got to put them up. You need muscle for that. You need muscle to get up out of your chair. Right. And that's why squats are important. Deadlifts or, you know, military press is important when you're working shoulders. Helps with muscle mass. B, preserve bone density. Mental health prevents Alzheimer's and dementia. Protective of our microvasculature. This is something cool I came across not too long ago. So when estrogen is low, we find the microvasculature. So the little tiny vessels, especially in our heart, but they're also in our liver. They're also in other areas of our body. What we're seeing is that women often who present with chest pain, but they go to their cardiologist, you know, their heart is fine, it's great. They've done, you know, the angiogram. The big arteries are clear, but they still have this chest pain. And so what we're finding is that the estrogen helps deliver oxygen to these micro vessels. Wow. So, you know, in terms of heart health on a microscopic level, that's really cool in terms of some of the benefits, you know, improving mood, reducing the hot flashes, improving vaginal dryness and pain with intercourse and just the giving you the will to show up every day to go to work and be with your family. Motivation, motivation, ambition, drive. So basically restoring oneself to who they were. The way I think about it is with hormone replacement therapy, you know, we've done everything right. We're at a certain age where we've had the experiences, We've now built this life and we want to enjoy it. So with physiologic repletion, we can restore, you know, the youth and vigor and vitality that we once had, but with the wisdom we've now gained as we're older. So it's like the perfect world.

Right? Well, that's the whole premise of anti aging. Right. Yeah. I always say I love having birthdays. It's fantastic. So. But my model is accumulating years on earth without biological degradation. So it's all about keeping you in a beautiful state.

Yeah.

For a very, very long time.

Yeah.

So, yeah, hormone replacement definitely is one of the, the, the key cornerstones in anti aging medicine. I mean, that's, I think that's how they started the hormones is where they, they first entered. And so, you know, I'm board certified with American Academy of Anti Aging and Regenerative Medicine. So that the hormone rep. That's a huge part. But it's a very complex subject.

It is complex, but, you know, when you have a specialist that, you know, understands how to work with not only the patient, but with the types of delivery methods out there, because there's Several. You know, there's creams, there's. Nobody should ever give oral estrogen. It leads to clots. We see this in birth control. But typically transdermal is what we find is safe and utilized very well. Progesterone. Any woman with a uterus needs to be on oral progesterone, 100 milligrams, not a cream, nothing else. But if she has a uterus to protect against endometrial cancer, needs that oral progesterone.

So this is a. Do you do it on a pulsatile fashion or you're saying that they should just take it as a baseline?

Yeah, in perimenopause, I'll do, you know, cyclical progesterone or pulsatile. In menopause, most women don't want to bleed. I know some women do. Yeah, some women do just for the, you know, maintaining the natural processes. In that case, I'll individualize and we can have the woman bleed. Need it just needs to be on that cyclical progesterone, just like a perimenopausal woman. But other women in menopause, they don't want it, they're fine with it. And we'll go continuous. What I do find is once we're at a good stable dose, we can take off, you know, five days of the month with the estrogen. Most women don't. They just don't want their estrogen ever taken away from them. They're a little reluctant because they feel so much better and happier and their skin is glowing and they're losing weight.

Weight, yeah.

Because with lack of estrogen now we have an accumulation of belly fat as well. Nobody wants that. And these are women that are eating well, they're working out, they're doing. They're on peptides, they're on, you know, GnRH, you know.

Yeah, people get scared when it comes to estrogen. Right. They can do all these other things, especially if they're older. So that's, that's another question I have is when a woman is in their maybe 60 and they've never really been on hormone replacement, maybe they got on it and they got scared and so they stopped for a long time. They get very, they get scared about restarting. Like, what are your thoughts on that?

I think if there is a past or current history of breast, uterine or ovarian cancer, by all means have your reservations because the last thing I want to do is give a woman estrogen who's already gone through an estrogen sensitive cancer. I'VE seen it done. I've treated patients who have been on it. They are with their oncologist. There is no recurrence of cancer based. And that actually aligns with the studies that we have now.

You mean no recurrence after hormone.

After hormone replacement theory. So they have been diagnosed. It is a myth. Yeah.

So even if estrogen sensitive, still there's no evidence the estrogen actually promotes.

There is. Hasn't been refuted. That's the problem in women's health. So there's, there's, you know, maybe a couple. There's studies that have said, you know, oh, this is an estrogen, you know, estrogen sensitive, estrogen receptor sensitive cancer. No way should you ever get, get estrogen, you know. And so again, we have these studies.

More need to come out for me to believe that. Because if it's a physiological hormone that's so crucial for the survival of the humans, and if you're replacing it to a level that's normal for that human to thrive.

Right.

It's very hard for me to believe that that's, you know, you have to starve your body of a physiological, like a vital part of, of life in order to not have cancer. It just, it doesn't, it doesn't make sense.

Yeah, I agree. It doesn't make sense to me either. And the data has now come out saying that, okay, women, you are safe, you can be on estrogen, it will not contribute to breast cancer. So that much is clear, which we were all excited about.

Breast cancer.

With breast cancer? Yeah, with breast cancer, specifically. And that's the biggest scare, because no woman wants breast cancer. Breast cancer. And even if a woman, let's say you're, you know, her mother or her aunt or her grandmother, just because she has relatives that did have breast cancer does not mean she is. And what's more fascinating is nobody talks about how alcohol and obesity increase the risk of breast cancer by 27.1%. This was higher than the percentage found in that 1991 Women's Health Initiative study, which was at 26.1%.

I see.

Yeah. And nobody talks about that.

That isn't that crazy?

It's crazy. So. And we're also now seeing that, you know, with cancer there's, you know, a spiritual and emotional component that, you know, I don't know if you've ever seen that documentary Heal on Netflix, where, you know, there's people with like, stage four cancer and then they go to this rainforest and then they do all of the spiritual healing and they do psychedelic Mushrooms, for example, and then they get to that root of their trauma and all of a sudden their stage four cancer is clear. So how much of that also has to do with, with generational trauma that women carry from our mothers, our grandmothers, great grandmothers, et cetera. So how much of that is contributing? And again, you know, we are at this point where studies, I think, are going to be coming out more and more and more and more funding has been given to women's health studies. We've kind of just unfortunately been left in the dust. But there is hope, there is hope that we're going to get great data. Rebecca Glazier, actually, she is an obgyn. She was an ob GYN and then she became a surgeon and she's doing some amazing work on testosterone pellets, surrounding lesions in women with breast cancer. And watching this breast cancer, the cancer in the breast shrink. I know. So there's really cool stuff on the horizon for women to just be aware of.

Wow, what a pioneer. Yeah, very interesting. So going back to older women, you said, said if they have history of cancer, especially estrogen sensitive cancer, you would, you know, well, the breast cancer, you, you, you probably are comfortable giving it to them. Right.

If they're working with an oncologist and we're working as, and they give you proper consent and they give me proper consent because I've been doing it for so long, I am comfortable with it.

Yeah.

Now if I had just, you know, I've been doing this for 10 years and I've seen a lot of women, especially in the past two and a half years during this, you know, explosion of women's health, where people are just so sick of, of living lives that they know that they can live a better one. And so I've heard a lot of horror stories like, you know, I think you mentioned earlier that, you know, psychiatrists wouldn't even test for labs. Well, it's not just psychiatrists, by the way. No one, no primary care provider is really testing, even in a woman just because she's 50 and over. They'll, they'll tell the woman, well, what's the point of testing? We already know it's going to be low. Maybe true, but you need a baseline to compare after treatment. So these poor women can't even get the labs they need from the majority of providers that. And, you know, I get it, maybe they don't have experience with it because hormones, although they are tiny, they are mighty. And you can really mess somebody up if you don't know what you're doing. And so I understand why some docs don't want to touch it. And, and kudos to them. Know your limits. It's just for women out there, there find that person that can help you and there are a lot of us that can do it.

Right. And are there other concerns about starting hormone replacement in, in an older woman? She's experiencing all these symptoms. Right. She's not doing great. So what, what did you say?

There was up until a study in I think April of 2024, which basically let the world know that women over the age of 65 can do hormone replacement therapy. It just needs to be low dose transdermal. I'll still give woman progesterone orally if she's having issues sleeping if she's not. I'll stick with the cream. But I liked, I would like to pair both. But yeah, it can be done. That's the point. I'm trying to say it can be done.

And what have you seen in these women when you give them low dose?

Oh my gosh, they, they're losing weight. They're. Especially when I combine that with like.

I don't love that.

Yeah, especially when I combine that with like a tirzepatide or a semaglutide or you know, the tirzepatite is mounjaro or Zepbound and then the semaglutide is Ozempica Wegovy now we have triple agonists that are coming out that retachuride. But anyway, when we pair that hormone replacement therapy in women with a GLP1, the weight starts to come down. It really helps move the needle. I think there was a study that came out in I think March of 2023 or maybe last year that also said women hormone replacement therapy users who were also on semaglutide, this was just for this particular GLP1 lost 16 of their body weight versus 12%. Now it might seem like not a whole lot, but when we're looking at somebody who's 50, 60 pounds overweight and then at the end of their course of their treatment, they've lost, you know, that 16 versus 12, that 10 pounds, like adds up, that 10 to 15 pounds adds up at the end. End. So it's a little bit, but it makes a big difference for a lot of women who are wanting that. What we also find is that their memory improves, their relationships improve, their work performance improves, their sleep improves, they're able to gain muscle, they're happy, they're out with their friends. They're socializing. Their whole life turns around. It's really a beautiful thing to see.

Wow.

Yeah.

And it's wonderful.

It's amazing.

Yeah, I can see that part of your passion comes from just seeing the transformation you're seeing.

Oh my gosh. 100. And you know, it's, it's interesting to lay this foundation down, especially now, you know, now that regenerative medicine is so big and, you know, or getting bigger and stem cell medicine is, you know, what you do, especially in your expertise. You know, when I, when I lay that foundation down, I honestly feel like for the future it could really give, give patients even more benefit once they enter into the regenerative and stem cell world, because we've now planted and seeded that terrain for it to really blossom.

Yeah. Oh, I'll be a miss. Not to mention that animal study that was very exciting, which was giving stem cells to perimenopausal rats. So these rats are, you know, declining their fertility. Right. They're going the older age route. And when they gave them stem cells and what they found was that the ovaries of these rats actually became bigger and heavier with more follicles and their estrogen progesterone level went up, the FSH and LH went down, which is the direction of the youthfulness. And there are more pregnancies. So this is what I love to.

Hear because I'm hoping that they can extrapolate these types of studies to, to us actual women. And, and that's why I actually love the regenerative space right now. Because in my mind I'm thinking, okay, well, yes, we have this avenue to replete entry, but what if, what if we can, you know, hold off on that until later? What if our stem cell and regenerative therapies can do the same thing that they did in the rats for us?

I mean, we have already seen it regenerating various organs.

Yeah.

From the muscles, the brain. Now we know the ovaries. So it just, it's just a matter of time. As far as the anti aging, the rejuvenative benefits, it's becoming more studied. So we've seen a lot more studies on diseases. Right. But diseases are just dysregulations and things go awry. And before things go obviously awry, there were micro awry. So. So the hormone imbalances are, are the pre prequel. You know, things are just not going quite right. But you don't have overt disease. Right. No one is saying, oh, your hormones not balanced and your doctor is not going to diagnose you with a disease. That's why you, you know, when they're not even checking. But it's really, it doesn't quite qualify people as having these traditional conventional diseases.

Right.

However, if you can treat the diseases, you can imagine how it's reversing the process, process of decline. So the, the regeneration is really just, you know, it's, it's a, it's common sense that. Right. If you can reverse disease and you can reverse aging decline. Yeah, it's really very similar. You know, the aging is just, you know, the smoke before the fire.

It is. And that's why we end up with hormone replacement therapy, because our ovaries are just as a natural part of aging. They're declining functions, function. So yeah, I think it's a good partnership, you know, to establish a good hormonal baseline with any other regenerative therapies that are out there.

Well, let's say for a woman walking around, you know, having a nice job, you know, busy with social life and working, how does a person know whether or not they need hormone replacement?

Oh, okay, great question. So all of a sudden she's busy, she's working, she's on top of her professional game and she wakes up, up one morning and is like, I don't know if I can do my job. I can't think. I can't finish this project today. That is, my deadline is tonight or tomorrow. So she's thinking she's not smart enough or, or not she's not smart enough. But she's. Her cognitive performance starts to, to decline. She's taking more time to do a task that would have taken her two minutes before. Now it's 10. She's also not sleeping. She's waking up maybe 2 or 3am in the morning every night, night. And she can't go back to sleep. She's gaining weight. No matter what she does, she's on Prolon. You know, she's, she's really doing herself a metabolic disservice by starving herself because she's thinking whatever she can do, it's not working. So then she starts to starve herself more and more and more. We all know that that's terrible for your neurotransmitters, for your serotonin and your dopamine, and you're losing muscle. So you're going to get, you know, you're going to gain fatty tissue over lean muscle and you're going to end up getting more weight in that metabolic deficit. She's also going to maybe start Fighting with her husband a lot or her boyfriend, and look at him and just be like, ah, what are you doing here? Get out of the room. For no reason. And she doesn't know why and. Or her libido's down. She doesn't even want to become intimate, even though she maybe was two or three months ago ago. She's maybe having vaginal dryness or frequent UTIs.

Yeah.

So she's a mess, poor thing. And this is out of nowhere. She's not sick. She has never had an illness. This is just something that she's noticed over time. And here we are 12 weeks after she's tried to tell our doctor, hey, something's wrong. And she finds me or somebody else who does hormone replacement therapy, and we just look and just say, oh, honey, come here, let's help you out.

Yeah, I didn't know the. There's a relationship between low estrogen or low hormones and uti.

Oh, yeah. Estrogen. Without estrogen, now we have. So estrogen is needed to prevent what's called genitourinary syndrome of menopause. This is an actual thing.

Okay.

The vaginal tissue becomes thin, becomes dry, becomes itchy. The. I think the urethra actually moves location when estrogen drops, which is very interesting. So. So the little tube that we urinate out of, that actually moves location and makes it more prone to urinary tract infections. So the fact that we're physiologically seeing a shift in where our urethra is is pretty insane, in my opinion, for how powerful estrogen is.

Wow. Yeah. Very interesting. Yeah.

And, you know, sorry, just one last thing with this one. Some of that also has to do with the gut microbiome too, because we have what's called an estrobolome. So this is how estrogen directly impacts our gut microbiome biome, which directly impacts our brain, our, you know, vaginal microflora. So how much some of that has to do with that? A little bit as well. So what's happening in our gut?

And is that a metabolite of estrogen?

It's just what they call it, like the estrobulum. So that's how estrogen impacts the microbiome.

Oh, I see. Okay.

Yeah. So, I mean, that's a more intricate topic we can get into at another time, but it does impact gut health. Yeah.

Wow.

It's a lot.

Lot. Yeah. So I'm sure you've encountered a lot of misconceptions about hormone replacement. What are some of the most common ones?

It's going to give you, breast cancer. It's not. With testosterone enrollment, it's going to make you really bulky and grow hair. I mean, no woman, unless you're in the gym three hours a day eating for that muscle growth and dosing super physiologic, like two to three times higher, you're not going to be, you know, Miss Universe, Miss Fitness, you know, because if we were, I mean, I kill myself in the gym, I wish that I could end up, like, just a little bit more tone. But you will not. Women will not get bulky like that with testosterone. It's just going to make you sexy and lean. It's going to help you stay calm, stay focused.

I remember you talking about the testosterone helping with calmness.

Oh, my God.

I don't think people really talk about. About that.

They don't because it's often. There's. It's often been mislabeled as, you know, an aggressive type of hormone, which quite frankly, what I find in men that are aggressive with testosterone, it was there from the start. It's just amplifying it. It's actually just who they are. In fact, it's estrogen that when that's too high, testosterone is the calming chill hormone. Like, okay, everything's good, I got this. But estrogen, when it's too high, can often cause aggression. Now, we don't have studies that I'm waiting for a study to come out to test men who are maybe super physiologic, dosing their testosterone. What's their estrogen look like? Yeah, you know, is it above 50? You know, what's that? So we don't have the study yet.

I see.

But typically, I've seen in men who, who are aggressive, the testosterone just brings that natural part of them out. It's not all of a sudden a magic wand here. Be aggressive. Aggressive you are on testosterone. It's not like that.

Okay, that's good to know. Any other misconceptions?

Other misconceptions? I think that's more about. Yeah, I think that's it. Breast cancer. Yeah.

Okay, great. And then how quickly do people usually notice a difference when they start?

Great question. Some people, some women, immediately, the next day, they're like, I haven't slept like that in 10 years. Some women, maybe takes three. I usually let women know, give it 12, 12 weeks, because we always dose a little bit slow and low, and then we ramp up. Because with hormones, you never want to go too high too soon because it's hard to take away. So you get the body's the woman's body adjusted to it. And then we can always add more and more and more, but up to 12 weeks.

Yeah. Okay. So do you think a very personalized approach is important? I think there are clinics who do hormone replacement in a not very personalized fashion. Correct, Correct.

Yeah. I think the tailored, individualized approach is key. Every. Every woman is different, and this goes for men, too, but every woman is different. So that unique, individualized approach is. Is absolutely necessary. Some women need less, some women need more. I've had women run their levels, you know, higher than I typically would, but they felt great on it. So I go based off labs, how they're feeling and what I'm giving. So it's a combination of all of that. And we monitor every three months. Months, just to make sure we're doing well and we're doing this safely. And we do labs every three months. So it's monitored. We don't just give a woman hormones. Yeah, I see you in a year.

It's pretty labor intensive. Yeah. So it takes a lot of patience. It does. And it takes a lot of knowledge as well, especially for women. It's very complex.

Yeah.

There's just so many things going on. And so can patients monitor their response themselves? What can they do?

Yeah, a lot of it is subjective for them in terms of, okay, well, I'm not sleeping. Well, are you now sleeping or, hey, I'm in the gym. I haven't seen any changes. Now their trainers are saying, oh, we've measured. They've had more lean muscle, less body fat. They're able to complete projects at work and do their mental tasks that they need to, and they're able to. To rekindle relationships. What I will say, and this is very, very, very important for anyone on hormone replacement therapy or about to get on it, and they have a partner, like a romantic partner, that other person should get on it. Oh. Because all of a sudden, one person in the relationship is going to start feeling really good and their libido is going to go up and they're going to want to play. And let's say, you know, if the. This is, you know, male, particular male who's maybe gotten on testosterone and now he's feeling better, now he's dropped weight, now his, you know, confidence has gone up. Now his libido has gone up. Now his erectile quality is performing the way it used to when he was 20 or 25. Well, he's going to knock on his wife's door at night and if she's tired.

Yeah.

If she's tired. She has vaginal dryness. It feels like sandpaper. And she's bleeding during intercourse. Like she's got dyspareunia. Right. Pain with intercourse. Course she's not going to want that. And so it's going to create conflict.

Yeah.

So if one person's going to do it, for the love of God, the other person do it.

So what is you want to. Can you share one story of transformation that, that's, you know, that really stuck in your mind?

I remember a particular patient who. And this is more of a common theme, but there is a particular patient about a year ago who was just so excited and was like, doc. And she was very forthright with it. She's like, I don't even know if I can say this on air.

Yes.

But she's like, I feel the best I felt in years. My husband and I are like rabbits. I'm doing so well with work. I can sleep. My skin is rejuvenated, it's glowing. Everything I'm doing with my trainer is working. I'm losing weight. I feel sexy. I look hot, I can sleep. Thank you so much. And that's the majority of all of what I hear. But I think her enthusiasm and zeal and just rekindling her makes you smile every time you think about every time. She. She literally told me this is the best thing that has ever happened to her life. And she was so grateful that her and I met and I was able to help her. And that just lit me up inside.

Yeah, yeah, yeah. Wonderful.

Yeah.

So many people have primary care doctors, of course, and they, they built a relationship so they trust a doctor. They think the doctor knows, you know, almost everything. So they want to clear with the doctor, hey, I want to do hormone replacement. What do you think? I think there's probably a lot of dismissals going on.

Yeah.

You know, the whole integrated medicine space because it's like a divergent tract from the traditional medical education. So now we've gone outside of the. The box, then a lot of doctors would dismiss it. You know, they dismiss about stem cells, you know, dismiss, you know, peptides. This is everything else. So how would you advise a patient on how they can approach the situation?

That's a great question. So I always tell my women, okay, when you talk to your doctor, tell them these symptoms that you have. Literally list each and every one. Vaginal adrenalis pain within a quarter course, difficulty focus and concentration. Abdominal weight gain that won't come off. And forgetfulness and libido. And so I'll literally have them say all of these things and just say, I'm not interested in mood stabilizers. I know something is wrong. Is there anything we can do here today? And if there's not, then we move on to a new doc until we find somebody who really understands how to treat a menopausal or a perimenopausal woman. Yeah. Because it's really just a surge. Because some docs will hear it. Like I think I mentioned earlier, some docs will hear it, but they don't know. Every person who goes into medicine wants to help. And if they don't, it's not that they're being cruel. It's just not in their tool set.

Right.

And so I often let the. My patients know, if it's not in their tool set, please don't feel gaslit. We will help you find. Find somebody that has that tool set. And they can go to, you know, certain websites like the North American Menopause Society website. If they go to a 4M, like American Academy for Anti Aging, they have, you know, docs that they can look into there or just, you know, hormone replacement therapy specialists in their area. So I'll generally help guide them.

Yeah, yeah.

But I also want to make sure they don't feel left out or gaslit. That explanation of doctors want to help, but they just, yeah, me, like, I'm not. I'm not a kidney specialist or a liver specialist. Don't come to me for that. Right. But it's not that I don't want to help. It's just, I don't have the toolbox.

Yeah. So if a patient comes to you and they have all these symptoms, do you still see some people are hesitant about hormone replacement?

Yes, a little bit. And I think, how do you approach that situation? So with that, I just give them the studies. Like, hey, this is the study that is making you feel this way. Look into the benefits of it. Now this, you know, that Women's Health Initiative study has been refuted. You do not need to worry about breast cancer. I had that conversation probably five to six times a day in the past year and a half.

Wow.

Yeah.

So that's exhausting.

But, you know, they say there's something about repetition. I now firmly believe this as well. You're reading the data and just hearing it over and over and over. So I think that's the main concern is the breast cancer. And then I also let them know, you know, do you want to keep yourself out of a nursing home? Because in the end, that's what it is with estrogen replacement therapy and progesterone and testosterone, you know, keeping yourself out of nursing home means can you drive and get groceries without getting lost? Right. Because patients with dementia and Alzheimer's, all of a sudden, when they get to that point, you have to take their driver's license away. You know, they can't even leave their. Their house and go for a walk in the neighborhood because they'll get lost. Poor things get scared. So do you want to stay out of a nurse? A nursing home is what I tell every woman that I can.

Yeah.

Yeah.

Right now the tools are here. So before hormone replacement, this whole, you know, this wave, then people didn't understand.

Right.

They just knew they were aging, and they didn't realize all these factors could be addressed. And hormones, a huge area that if you can just bring the hormones level back to the younger stage, all of a sudden all your organs are waking up, up, functioning as if they're in the younger state, because the signals are back when they were younger. Right. What they got. So, yeah, it's an incredible tool for people to stay, you know, ahead of the game in this. In this accumulation of years on earth.

I agree 100%.

Yeah.

It lays that foundation down.

Yeah.

And it really primes, you know, it will prime the body to become more and more youthful, more and more optimized with any other type of regenerative, generative, you know, therapy, you add on to that.

Yeah, yeah, yeah. What a great discussion. Thank you so much, Dr. Sarah. This is such a wealth of information. I feel so lucky to have you at our clinic, Chara Health here in la, and so many people, you know, previously, you know, do not get the kind of expert help as far as hormone replacement. Now we have you. And not only you're helping our patients, you're helping everybody in the clinic. Right. We got a mostly female team, so we. We're all benefiting from your expertise. So. And you've been so generous and. Yeah. And your passion and your, you know, your drive for knowledge is. It's. It's really admirable. So I'm so happy you're here.

Oh, thank you, Dr. Kong. I mean, what you do and. And the movement you've created, it's really just so inspiring. I think I tell you every other day how. How just an incredible human being you are and the things that you are doing and the fact that I get to share this, you know, kind of experience and journey here at Chara, especially given the work that you do. And now that I can blend this kind of foundation and make sure our patients get the best possible outcome possible.

Yeah. We amplify each other. Right. So when we do stem cells on patients, we can amplify the results of other each hormone replacement. And your hormone replacement can make the stem cells work even better. So it's a wonderful, wonderful coming together. Yes. So thank you so much. Thank you so much, Doctor. Such a pleasure.

Likewise.

Thank you.