Myths, Risks & Benefits of Hormone Replacement | Mike Brookins on THE DR. JOY KONG PODCAST

I know hormone replacement is a huge part of what you do. And so maybe you can give the audience an idea of why hormone replacement is important.

I found a 40% decrease in all mortality. Women release hormones. They found, you know, there's a ton of cardiac benefits. There's thousands of hormone receptors in the heart, cardiac less hip fractures, memory, critical thinking. Most of these women in this country die from heart disease. It's, it's over 50% leading cause of mortality. You have a 400% more risk of added to that if you're sedentary, have high blood sugar. So important things to look at the benefits of it. But there's a lot of demonization on hormones and estrogen does not increase the risk of cancer. That's just not what the data shows.

Hello. Welcome back, Everybody. This is Dr. Joy Kong Podcast. I am so excited today because we're covering a very important subject, hormone replacement and of course, everything anti aging. But as you know, I bring some of the top experts in the field of anti aging, regenerative medicine, or just, you know, wellness, and even the science of happiness. So I, my goal is to elevate the happiness factor in the world, and it brings together physical, psychological, and spiritual health. So we cover it all. And today I have the great pleasure of having Michael Brookins with me. Michael. So here.

Thanks for having me, Joy.

Yeah. So Mike is amazing. You know, we've actually been friends. I've learned a lot from him, so I'm really excited for him to share his expertise. He's owner of the Age Management Institute, where they focus on longevity, hormone replacement and regenerative medicine. So just a, you know, a little bit summary of his background. His medical background is in nuclear medicine, specializing in interventional endocrinology. And he brings more than just medical perspective to his field. At a young age, he began his career as a competitive athlete that would end up taking him on an incredible journey over the next 13 years of his life. Throughout his athletic journey, he constantly worked to find the ideal balance of fitness, proper nutrition, and hormone optimization in order to maximize his performance. And he utilizes background combined with his medical knowledge, he brings together a unique, comprehensive and successful combination that serves to benefit his staff and those around him. Well, you benefit a lot of patients. So I know you have this amazing clinic in Santa Barbara and you treat a lot of celebrity patients, so you must have done something right, otherwise, you know, all these people wouldn't keep coming back. So, yeah, I'm excited. I've learned a lot from you and thank you. Yeah, maybe you can start by telling us a little about, a bit about your story, your athletic career and how that ended up, ended you on this journey of.

Sure, sure. I mean, I was like, I was a competitive pole vaulter all through college and went to Olympic trials and you know, it was always, I always find that athletes are really in tune with their body. Like, we have a higher inkling of we know we're sick, we know we're not well. We have a little bit better just foundational functional awareness of, of how we are when we're well, how we are when we're not well. So with that background and then going into nuclear medicine, I was doing a lot of thyroid ablations with radioactive iodine on patients who had hyperthyroidism or thyroid cancer. And eight years of doing that, you kind of look at yourself in the mirror and say, there's a much better way to treat people with functional medicine and integrative medicine. And as an athlete, you just kind of know nutrition, stress management, movement, sleep. Like there's just better tools out there. So I quit my job and I found a 4M, which is the American Academy of Anti Aging Regenerative Medicine, which Joy and I are both proud to be board certified in that. And I jumped the pond and got into more functional integrative medicine. Now, I'm not a doctor. I don't really treat, practice, or diagnose and prescribe, but I, I found my calling with building anti aging regenerative medicine clinics, functional medicine clinics. I hire more talented, smarter people than me, and I train and teach physicians on proper bioidentical hormone replacement therapy. And our big clinic in Santa Barbara is Eternity Health Partners. And I own the management service organization, which is just as the management, the training and everything. So I'm kind of like the wizard of Oz. I'm the, I'm behind the scenes, you know, pulling levers and, and making sure everything is, is proper and, and people get great optimization.

Yeah. And it's fantastic from radiology to functional medicine. And I know, and so I know hormone replacement is a huge part of what you do. And a lot of doctors, well, even functional medicine doctors, I mean, some are familiar, but of course, most doctors have no idea about hormone replacement. And I, it's surprising to me. I think even naturopathic schools, they don't talk a whole lot about hormone replacement. So this is a very niche area. But people have so many questions and, and are super curious. So I think there, there's a huge wave of awareness. Right?

There's there, there is when, when, you know, you and I started at a 4m, there was, which is, you know, the, the, basically the, the college that teaches functional integrative biodemic hormone is definitely their standard, gold standard, you know, Cornerstone. There were 300 people in those auditoriums. Now there's like 6,000, 8,000. I, I love it that there's a lot of traditional doctors that feel the same way. And they don't feel like they're really helping patients 100%, just throwing Xanax and Prozac at women when it's really a hormone issue. And they're, they're also kind of looking to expand their career and do things the right way. So. Yeah.

Yeah. So maybe you can give the audience an idea of why hormone replacement is important.

Happy to. So I can start with just women's bioidentical hormones. This is a clinic that my providers, this is a question that my providers see all the time. And it's, you know, women, there's a lot of demonization on hormones. And this, this all started with a, a study in 2002 and you know, that said estrogen increases the risk of cancer. And then, you know, that was, Gosh, that was 22 years ago. And then a study came out 10 years after saying, you know, with all the new bioidenticals and things that people were doing that it does not women's bioidentical hormones. There's a lot of just fear porn out there that it causes cancer. And there's just some old data that seem to stick with the rhetoric with traditional doctors. And the data just doesn't say that estrogen does not increase the risk of cancer. That's just not what the data shows. It's fear porn. Like I said, it's old data from flawed studies that are looking and you know, looking at women who are doing synthetic estrogen and progesterone, which is not what we do. We do bioidentical. So, you know, there's so much more.

The moment you start messing with nature because they can't patent the identical hormones.

Right. Bingo.

You want to make money.

Yeah. You get into the pharmaceutical and the regulatory agencies, which I won't mention, but they're very political and very money driven. So, you know, there's so much data now with bioidentical, not synthetic hormones reducing all these comorbidity risk and even improving osteoporosis, bone density, mood, risk of dementia, metabolic disease. I mean, the list just goes on and on.

Yeah, so, so the, the fear in 2002 that the study was mostly talking about estrogen. Or were they?

Yeah. So what happened is what really, I'll kind of lay it out here. In the, in the 90s we had so many women on synthetic hormones that you would, that, that they would get. And I mean still today, ob, GYN and family practice doctors are giving birth control. You know, they're still giving these synthetics and they get recommended for some absurd reason that I just don't understand. But I mean, here's the truth. I'm going to all die. I'll dissect this pretty good. So that was in the 90s. In 2002, a British study came out and it was called the Women's Health Care Initiative and it said estrogen increases breast cancer. It was 22 years ago. It was a study based on synthetic hormones only it looked at Premarin and progestin, which was the estrogen and the progesterone. Synthetic. Made out of horse urine. Yeah, don't take that obviously. But anyway, it's been so ingrained and indoctrinated in the minds of traditional healthcare and our pharmaceutical industry trying to push their big pharmaceutical medications. But again, yeah, these medications were synthetic. It was chemically man made. And it turns out in the results of the study, it showed a 26% increase in risk of breast cancer, which, well, anybody who heard that saw 26% of these patients got cancer. That just wasn't true. Only 1 out of 10,000 did. So overnight hormone prescriptions went from 15 million to 2 million across the country. Wow. Yeah, it got demonized again. All these hormones they used back there were synthetics, not orals, which, I mean there were synthetics and orals. So when you take a synthetic hormone, it goes through the first pass, it goes to the liver. Your body has to cleave off carbon chains to make it bioidentical. These carbon chains go out into the body, create free radicals, oxidative stress, your body doesn't like it. So these had certain side effects, you know, but there were actually some good things found in the article. You know, they found like a 40% decrease in all mortality women. These hormones they found, you know, there's a ton of cardiac benefits, there's thousands of hormones receptors in the heart. They, they found, you know, 20% had, you know, decreases all course mortality of death. And you know, there was just, there was a ton of benefits really outweighing the risk. Cardiac, less hip fractures, memory, critical thinking. You know, most of these women in this, in this country die from heart disease. It's, it's over 50% leading cause of mortality. You have a 400% more risk of. Added to that, if you're sedentary, you have high blood sugar. So there's more important things to look at the benefits of it. But. So that was the study that came out in 2002. There was a study that came out in 20. I think it was, I think it was 2019 North American study from the Menopause Association. I believe it actually retracted this 2002 Women's Healthcare Initiative study. And there's so many studies being published today, which again, benefits greatly outweighing the risk, largely due to women having accessibility to bioidentical hormones.

But isn't it amazing that most doctors are still stuck in 22,002 study? Right. It's just like that fear mongering and then they refuse to let go of that fear even though it's been proven otherwise. But they're not keeping up with it.

Yeah. And. And you get it. Where do doctors learn medicine from? Pharmaceutical industries and pharma industries are pushing birth control, which birth control is just synthetic progesterone. They're like, oh, you don't want to do hormones. Let me give you some birth control to kind of make things homeostate status. And I'm like, that's just a massive dose of synthetic hormone. Like you're doing it further. I just don't get it. You know, it drives, it drives all my providers kind of, kind of crazy. Once you, once you see the results with patients, once you see their DEXA scan improving, when you see their critical thinking, verbal memory go up, you see their A1C blood sugar go down, their body composition changes, their life just gets better.

Mm, yeah. Yeah. So. So that's estrogen. And there's also some estrogen and progesterone.

Yeah.

Okay. So progesterone was thrown in there as well. People are afraid of progesterone as well.

Yep, yep, yep.

Okay. And testosterone. There's also fear about testosterone.

Yeah, yeah. So today we have the BHRT topicals and bioidentical hormones are largely made in custom compounding pharmacies. You can get them. There are, there are now, of course, some, some things you can get at CVS and Walgreens that are bioidenticals. But the difference between bioidenticals and synthetics is they don't go through the liver. And they're identical to your own hormones. So, you know, they are made from yams and sweet potatoes or soy. They are recumbent into hormones that are bioidentical to your own hormones. Your body can't tell the difference. And yeah, it's just they're, they're, they're safe. So.

Yeah, so the big pharma, I mean, Androgel is actually bioidentical. Right. So they all.

Testosterone. All testosterone is bioidentical.

So the testosterone sipionate. So there are a few different forms. They're all considered identical to the body.

Yeah, they're all identical to the body. You know, you have to find things that are. That say bioidentical, but they're, they're bioidentical to the body. And the three big hormones for women are going to be progesterone, testosterone and estrogen.

So that's what men is, testosterone, testosterone.

And then there's other analogs you can take to keep fertility going, keep testicle atrophy down, including hcg, Things like that will work really well.

Yeah. So are there any risks of doing hormone replacement?

So there's risk with any medication? You know, I like an old. I think it was Socrates or play doh that said the only difference between a poison and a medication is the dose. You know, there's risk with it, with anything, but they're mitigated with a trained, functional, integrated doctor that uses blood work, knows certain levels that get out, you know, a little wonky, but it comes with dose. You know, we always say start low, go slow, hormones, and, you know, start on the lowest dose and then in eight weeks pull another set of blood work and then you can titrate the labs up there. But we got it down to a pretty good art form now. And women just don't have terrible side effects. There's little things like if you give too much estrogen, breast tenderness, if you're not getting too much enough estrogen, Night flashes don't vanish, but you largely go by the symptoms of the patient versus the blood work. When we train doctors, we say, don't treat the labs, treat the patient, use the labs as a guide only, you.

Know, so, yeah, so I, I know there's. Yeah, it's pretty complex. The hormones can get pretty complex, different metabolites and, and, yeah, feedback loops and etc.

So like, for instance, when we first, when we see a woman in the office, we, we. Let's say, you know, women generally are low in progesterone about eight to 10 years before the big change of 51. So late 30s, early 40s, when you first go into perimenopause, you first want to use progesterone. On women.

What are the symptoms? When.

Yeah, they're very critical, they're very anxious. All the Karens you see out there, they need progesterone. I always like to use that and because people understand that. So, so that can be a good one to use first. You know, generally early, early, early 40s, late 30s, women need a little micronized bioidentical progesterone pill. You take it for bed, it makes you calm, good sleeps, gets rid of the needing night sweats. You're not going to bite your husband's head off, you're not yelling at your kids, things like that.

Well, first of all, why do you think the hormone levels decline? And do you think for some, maybe some individuals they don't?

That's, that's a really good question. And I think what we're kind of seeing in the US is microplastics in the environment. Petrochemicals. If you look back at the data, I'm a data nerd. And you look back into the 30s and 40s and 50s, women and men had awesome hormone levels. And you look at pictures of them on the beach. Everybody's lean, everybody smoked, drank whiskey, ate steaks. I mean, think about it. You look at like old photos of like Santa Monica Pier in, in the 40s and 50s, people were lean and they looked, you know, robust. And then we had an introduction of glyphosates and petrochemicals and microplastics and things. So I think there's a lot of endocrine disruptors in our environment and then also just sedentary lifestyle foods rich with sugar and high fructose corn syrup. Obese obesity will just crush your hormones. You know, you take a, you take a teenager, they get them overweight, they're going to have half the hormones of their peers at normal body.

Okay. So I know once in a while we will encounter somebody in their 60s, 70s who has fantastic testosterone level, right? Once in a while.

Yeah, we see it too. I mean my, my Italians, my people from, from France overseas, I'll see old Italian guys that I'm like, how's the libido? They're like awesome. 85 year old, you know, still, still goodness, still out there getting it 900. So I'll see it with my, with my blue zoners, you know, my people from Sardinia and Okinawa and places like that outside the US But I do get a handful of Americans, you know, that maintain a healthy lifestyle.

Do you see the same thing in female hormones with females from those regions?

I do, I do. And then you can't beat mother Nature and menopause thing too. But we will notice women that just kind of have cruised right through menopause didn't notice a big change. They might come see us at 60, 65 and say, you know, I was wondering if hormones could still help me. I know I'm past the menopause, but I heard I'm not supposed to start hormones later. You can absolutely start hormones later without potential risk when you do it the right way, use bioidentical under a trained, trained physician and reap the benefits, you know.

So are there studies done on older women getting a hormone replacement and seeing how that impacted their health?

There. There are. I can recommend some links to you if you want to kind of post at the end where they can read Deborah Matthews, who's incredible. She's written some really good books summarizing, you know, this really dense studies and made it kind of in layman's terms.

And how would it help them if they get.

Look at women in their 70s and 80s, hip fractures, osteoporosis. You get a hip fracture at 80, that's it. So women using a little bit of bioidentical testosterone cream, you know, really helps with bone density. Women need to keep their estrogen above 60. It's just amazing for osteoporosis. So we'll look at blood work and say, I think it's 60 picograms per milliliter. But, you know, my providers will look and make sure estrogen's above that but very, very osteo strong with. With that.

So, yeah. So what are some of the myths that are persisting? I think you covered one of them, which is estrogen causing cancer.

That's the big myth.

And also testosterone. People are afraid of prostate cancer.

Afraid of prostate cancer. And Abraham Morgenthaler, thank God for him, he's done an incredible job. He's the head professor of urology at Harvard. Very Western traditional guy, you know, going to bat for the boys in functional medicine and girls. But he is. He's the only one that's done the 20 year. Just study. And he said, look, he wrote a great book for you guys there at home, men and women, it's called Testosterone for Life. But he's done a wonderful job of proving that testosterone doesn't cause prostate cancer. It doesn't cause, you know, just mortality. It's not cardiotoxic, things like that. And what he found was, yeah, when testosterone, when it goes into the body, it converts to DHT and estrogen so, you know, actually the, the number of men who are doing testosterone with doctors, who are watching estrogen, watching hematocrit, watching dht, which can make PSA go up. The amount of men. Well, the rate of prostate cancer with men is one in seven men are going to get it. The amount of men who are getting prostate cancer now who are on testosterone under the watchful eye of a doctor, it's less than 1%. Explain that to me. So because estrogen is controlled, it's watched, the DHT is watched. We run PSA on patients. If it goes up a little bit, send them to the urologist for digital rectal exam. Like you just, it's preventative medicine. You stay on top of it.

Wow. Yeah, so. And of course there are many, you know. Yeah. So I tell people because, I mean, people are scared. People who had prostate cancer and their doctors are telling them, no, you absolutely don't need. I had a person who was doing fantastic and then, you know, he got a little bit, some kind of, you know, you know, low grade prostate cancer. But so he got, went through some therapy and the doctor was insisting that he had to get off hormone replacement and he was so miserable. He was just knocked flat, you know, on his face and you know, and he was, she was scared to get back on it, even though it made him feel amazing, you know, gave him the quality of life. He was so scared because doctor said no.

Yeah, and, and there's, there's this old, old rhetoric of it. And I found doctors will say no to things they don't know. Instead of our, our providers, I learned, we learned so much from patients. Then we do our own independent study, but if we don't know something, we go, I don't know, but I'm going to go find out. But I think there's a lot of traditional doctors I want to, I don't want to put anybody in a box, but if they don't know something, the answer is no. Right off the get go. Doctors are not trained in this family practice. Internists, they're not trained in bioidentical hormone replacement theory. OB GYNs and endocrinologists alike are not trained in this. Yeah, Endos do thyroid adrenal insufficiencies and diabetes obgyns, a little bit of birth control and pelvic exam, things like that. But I've trained OBGYNs and they're like, oh, I can give testosterone. Yeah, and you should.

Yeah, you're so right. You know, mo, so many traditional doctors, they will say no if they don't know. So, for example, stem cells, you know, a lot of people are scared to tell their primary care doctor because they probably will say no. And some have said no, or some specialist just said, well, there's no evidence it works. And my question is always, have you ever looked for the evidence? Because I can send you evidence if you're interested. And no one is interested.

They got a good thing going right now and they're gonna stick with it, but that's fine. It's just opportunity for patients to find us and for us to give good back in the world and help people.

Yes.

Why we were put here.

So, and any other myths about hormone replacement that comes your way?

Yeah, same thing with like, I think, yeah, breast cancer, prostate cancer. Oh, it's going to be bad for my heart. I heard people about having heart attacks. Again, it's about dosage and, you know, when men do testosterone, hematocrit, hemoglobin can go up. And that's not a bad thing. It sends oxygen throughout the body, things like that. But if hematocrit, hemoglobin go too high up, sure, it can make the blood more viscous. You run the risk of blood clot, dvt, heart attack. But again, we watch this, you know, I, I like it to bump up over. Our providers like it to bump up a little bit. Patients have more energy. They're, they're crushing their workouts. If it goes, if hematocrit goes to 55% or hemoglobin go to 19, patient gives blood, give a pint of blood once a year, go to the Red Cross, give back to the little people and give blood and it drops 8%. So that's.

Well, there's actually health benefits for, well, bloodletting really. That's bloodletting. And some people think that even for women, every month having a menstrual cycle, that's actually really good way of triggering this regenerative response in the body.

Absolutely, absolutely. So it's not everybody. We have to do a bloodletting or phlebotomy is what we, what we call it. But again, it's, if you manage them rightly, you give the right amount, you get the, you know, the lowest dose possible to achieve the greatest result, and you lose low dosages more frequently throughout the, throughout the week. That's a great little secret with bhrt. I don't see estrogen go up. I don't see DHT go up. I don't see hematocrit, hemoglobin go up. Patients feel awesome and all the preventative, you know, imaging and stuff, you see things get better and better.

And there's another concern that some people voice, they say, well, you know, if I take a replacement of hormones then I'm stuck with it for the rest of my life. It's going to shut down my own hormone production. Then I, I would never be able to get off it. So what's your response to that?

That's not true at all. I have, I've had so many men come off testosterone and, and they were like, oh, I want to have a child. I want to, I want to have kids. I heard I can't have kids again. No, the, the, the body has these negative feedback loops and yeah, when you start testosterone, your LH FSH in your brain goes down the signal to your serotoni cells of the testicles to make more spermogenesis that dips a little bit. We always give our providers give a enclomiphene or HCG for free along with the testosterone. It keeps your body like mother nature keeps all these negative feedback loops going. You're still producing spermogenesis, things like that. They're still able to conceive while on testosterone. And if they ever want to stop testosterone, great, they stop, run a little enclomophene or HCG afterwards, the body reboots. If all your plumbing works before you started TRT or testosterone and you could conceive, you can conceive after. I, we've never had an issue. I've had every single one. I can't think of one that has, I'm not going to say 100% but majority of the patients who come through us who, they're able to conceive just fine on testosterone treatment. Your body reboots afterwards. And I have a lot of men too who, who've been on TRT testosterone replacement therapy and just don't want to run it anymore. And they're like, do I have to do this for life? I'm like, no, stop doing it. Let's just run in clomiphene which is a natural testosterone booster. It raises the signal in the brain to make more testosterone things. And I got a 70 year old guy with a testosterone of a thousand. It's his testosterone, he takes a little capsule bioidentical enclomipine twice a week. Works, works very well.

Interesting. Okay. And then I want to, you know, ask you about different forms of hormone replacement because that's a big question that confuses, uses a lot of people and a lot of doctors and there's diverging opinions about what's the best form. There are creams or injectables, gels, pellets, and of course there's oral form. So what's, how do you navigate this?

There's, there's, the first thing is sustainability with patients. You want to ask them, can you give yourself an injection twice a week? If they're like, I don't know, I know they're not going to be a patient of ours for very long. So it's like, okay, would you be more comfortable with like a cream you put on every morning, like your deodorant? Yeah, that sounds like a little bit more doable for me. So there's creams for hormones, all three hormones. There's injectable testosterone, there's oral progesterone, there's pellets. Those are probably the four routes of administration that I see with our, our providers personally really like creams. And it kind of makes sense when you're staging to bioidentical. A bias cream, which is 80% estroil, 20% estradiol, not what your OB GYN is going to give you, which is pure estrogen or estradiol. Estroyal greatly softens some of the harsh feelings estradiol can give you. So it's 80% estroil, 20 estradiol. You start with a low 510 milligram. One click on a little deodorant stick, apply it directly to the clitoris or the, you know, intra labial. That's where the receptor is. So the body is going to pick it up better, it's going to be a little bit more bioavailable. You could do inner thighs and forearms too, but intravaginally it seems to, from what our providers have noticed, it works a lot better. And then just an oral progesterone pill at night, same thing with the testosterone cream for women, just directly to the hoo ha and like 10, 10 milligrams and then one click.

Not inside the vaginal canal, but it's right on the.

Yeah, you kind of, you just. Yeah, right, right to the clitoris, actually. Blood works shown improvement, I think a little bit more readily. And then for men, they have the choice of mono therapy with enclomiphene, a little pill or testosterone cream applied to the scrotum or testosterone injections.

You know, like the scrotum is the best place for the testosterone closest to the receptor.

Yeah.

What about for women?

Yeah, women, obviously not to the scrotum, but to the far as to the Is the best there is. There's a phenomenon that our providers have seen over the years called transdermal fatigue. And when men, especially when they use Androgel, I see it more with that product than anything else. Not so much the bioidentical grains from custom compounding pharmacies, but if they're applying to the arms for six months a year, it stops working. We stop seeing the labs improving, and it kind of makes sense. I think the. The anomaly is your epidermis is your best defense. It's. And it's a part of your immune system. Right. And it kind of figures out, okay, this is. This is foreign. I'm going to. I'm going to block this out. So sometimes the creams just stop working, and then the men need to either switch to enclomipene capsule to just naturally raise their own testosterone or do injectable testosterone.

Well, if they rotate the spots, would that solve the problem?

Yes, they can rotate spots, thighs, scrotum, forearms. I see it a lot less with scrotum. Testosterone cramp.

Okay. Because I was told you're supposed to rotate on different sides on different days. Is that. Yeah.

Yeah. If women are just going, you know, clitoris intralabial and men are just going scrotum, I rarely see it issuing. Do that every morning. I also like creams because if you look at the diurnal production of hormones we make a lot during rem, sleep is produced, it's released, it goes up during the day, and then it comes right back down at night. So this. It. It just kind of does this throughout the day.

And when's the best time to you to put a hormone.

Morning. For estrogen and testosterone progesterone. At night.

Okay.

Yeah, that's, that's. And that's just. This is just what we do. Majority women, there's. There's going to be some advanced techniques and protocols that you. You do for other women just based on lifestyle and what you see, but generally that's what my docs like to do. But with that diurnal rhythm, using creams every day, which do the same thing, it's closer to mother nature. It's closer to those diurnal circadian rhythms of our hormones. And I think the body just likes that. You don't feel like you're on a roller coaster.

Yeah, it's just.

Just more naturopathic.

What do you think of some doctors? Well, I think it's rare. Some rare doctors who actually imitate the. The cycle of changes of the hormones along with your menstrual cycle. So you, you take amounts every day. Is that, is that you think is necessary?

We have some women that want to do that to maintain their menstrual cycle and things like that. But when we talk to a woman in their 40s and stuff and say, hey, you're gonna, gonna take progesterone every single day, your, your menstruation is not going to be as bad, your painful menstruation or it's not going to be as heavy of a bleed. Is that okay? They're like, yeah, I'm going to take it every day. Some women like to take it, cycle it throughout their pregnancy or pregnancy. They like to cycle it during the month for ovulation and just they're saying menstruation, but.

Oh, so you, that, that's not something you regularly do. I thought progesterone. I remember I was, you know, supposed to be 15 to 25, you know, that's when you do progesterone.

Yeah, our, our docs for the majority, they, they just give it every day. You know, the women in their 30s, 50mg, women in their 40s, perimenopausal, 100mg, women in menopause, 200mg. That's a great starting protocol for a lot of women with progesterone. And I'm speaking on behalf of all of this for my providers and they just give it every day.

Interesting.

They start slicing and dicing the protocol too much and you just don't have to make it that complicated. Think about the sustainability for the patient too. Our doctors are trained not to be kitchen sink providers. We don't throw a whole lot at our patients at the very get go. We make it very easy. Couple supplements, maybe couple peptides, a few stem cell treatments a year. Make it very simple to do this.

Yeah, yeah. There are a few questions. So, you know, first of all, if you're doing it every day, are you still going to, you know, people in their 30s, 40s, 50s, if you're doing progesterone daily, are you going to have menstrual cycle?

Normally you will. Yeah. Some women will not as, not as much or they'll stop. But for the most part, women still menstruate, they can still get, they can still have pregnancy, things like that. It might be not as a shorter period, not as heavy as a bleed, but yeah, so it might not, maybe not as regular as they are. What we've noticed though with women in their 40s is iron and ferritin being low and then feeling very tired after their period, I'd be like, hey, you got heavy periods still. Your ferritin's really low. How about we shorten this a little bit, Keep the, the bleed not as bad. And your ferritin iron are going to go up, energy is going to go up, your insomnia is going to go away. Just with progesterone improving the ferritin. So just little caveats, sort of like that.

Yeah. Okay. So even so, same level of estrogen throughout the menstrual cycle and same level of progesterone, and people are doing pretty well and having a normal menstrual cycle.

Yeah, yeah.

Yeah. Because. Well, at a 4am at least some, some doctors were teaching. Withdrawing all hormones by about like five days before menstruation, like before you're supposed to menstruate. And what do you think of that?

There's a lot of different. They call it a practice for a reason. I think doctors practice on patients to figure out their own little art. And, you know, it's, it just kind of depends on how you've been indoctrinated and what you like to do. I know some of our providers will do that, you know, based on what they hear from the patient. But you can just. For the most part, I think our providers, they just keep patients on their line, just easy, easier, and no reason to cycle on and off and get on your calendar.

Well, the bottom line is that when you do that for your patients, they actually are doing very well. Right.

So the, the proof is very, very well. 90% just stay on. Yeah, yeah.

So there's another thing about. I think I've seen some doctors been really concerned about people with heart disease and giving them testosterone.

Yeah.

And then so what, what are your thoughts? Because if somebody has a congestive heart failure or just, you know, cardiomyopathy, are you afraid to give them testosterone?

So for. It would be contraindicated for somebody with atrial fibrillation if that were left atrium. Yeah. If you had the atrial fib, afib, and you're running the risk of blood clotting pooling in that part of the heart, left ventricle, going up with an irregular heartbeat. Because if you're on test and we do this for the patient, but it's also to protect, I mean, just straight up, to protect my physicians from a lawsuit, we have to think about that too. But with afib and certain cardiac disorders, like I talked about before, if you're running testosterone, hematocrit, hemoglobin can go up, making the blood more viscous so that blood pooling, clotting would increase a little bit. So it would be contraindicated for somebody with unstable angina, really bad cardiomyopathy, really severe, you know, coronary artery disease. On the other side of the coin, thousands of testosterone receptors in the heart. We see greater heart output, greater left ventricle ejection fraction. We see great things with preventative for heart men and women. There's so many articles out with reducing risk of cardiovascular events, but if you're far gone with heart disease, probably not the best patient. I just encourage doctors to use discretion with that. Yeah, we, we do, but.

Yeah, right. The correlation between testosterone level and coronary artery disease is, has been very strong risks. Yeah.

And that got skewed with patients having heart attack because they were taking way too much testosterone. Their hematocrit got to 80, like double, and they threw a blood clot. It's never happened on our watch. Abraham Morgenthaler says there's never been a case that he's aware of that this is happening too. But what we tell our physicians is we've never seen it, but you're not going to be our first. So we're going to watch hematocrit, hemoglobin, and if it goes up, we're going to have you donate a pint of blood once a year. But again, these are mitigated with the superior sort of advanced protocols. Like, I just don't see it go up when you do the right amount, low dose, more frequently throughout the week. But it's something that we, we do use surveillance on.

I see. And what about pellets? Because I, I know I have some friends who swear by by it and love it.

Yeah, yeah. Women love pellets. They, they love, they do love the testosterone pellets. It's a big business for a lot of these doctors. You can make a lot of money doing it for the physician. Here's why we don't do it. Every single patient that my providers have seen come in who've been on patient testosterone's through the roof. Women feel amazing. They're climbing the walls with their libido. They feel strong. But all that excess testosterone has to go somewhere. Thinking about risk factors. Okay. It's converting to dht. Women will get thinning hair. They'll, they'll get, you know, others, other side effects with it. So just remember all that excess testosterone in the body gets converted into other things. And, you know, you can, you can have some Viralization. I always say, you know, our biggest concern with testosterone, or one of the. One of the things we try to do is I want to keep your femininity intact. I don't want you to go from a tenor to a baritone. And. And I want to. I want to keep you from virilization. I don't want. I mean, your voice can drop down and you can get little, you know, black hairs where you don't want them. Get a little bit, you know, more. More, Karen, with. With your, you know, with. With just your temperament being a little bit short. So pellets are hard to manage because once those pellets are in, they're in. If a week later it's too high, what do you do? It's a little incision. They put the pellet in. It's. It's a micro surgery. They're there. So I don't like them. Creams are a little bit more diurnally sound and more naturopathic and easily managed. You can adjust it at any time. Breast tenderness, go down a clip. Tomorrow, in 24 hours, the testosterone you did today is going to be out of your system. I could change. We can change their protocol in a day. And for men, testosterone pellets, they have to have a lot more pellets to get to a man's optimization level. 12, 13 pellets. When they're doing yoga or they're rolling around, you're going to feel 13 pellets in your rear end. And it could be. It can be uncomfortable for a lot of men. And same thing. Testosterone goes through the roof. How do you control that? You go back and get them, get another surgery and take them out or. I know it's mostly outpatient.

Yeah.

I had.

I remember seeing some patients who are, you know, their testosterone level 1400 and they're, you know, they feel like they're flying. Of course, actually this is actually the same person. I mean, that they got prostate issues. So I think if that is related, like too high of a testosterone.

Yeah. And I think doctors are a little more inclined to give more because the patients are like, oh, I feel amazing. But again, dht, estrogen, PSA is going to go up, hematocrit is going to go up. Women are not going to be women for very long. You might feel good, but all that excess testosterone is going to go somewhere and it's usually in the form of a side effect.

Yeah. So for men who have too much testosterone, what do you see?

What, Rage, hemoglobin going up? Well, I like to Say, this is what we say, you know, the, the roid rage is really more of a myth. It's, it's from testosterone. Here's, here's the thing with that. If testosterone goes really, really high, it converts to estrogen. If estrogen goes up, what happens? Same thing it does with the women. With a woman during menstruation, little pmse, you know. And I think with men, emotionally that can turn into anger. I know, I know men that have come into, come into our doctor's office and gone, I'm watching these Hallmark commercials of puppy dogs and I'm just sobbing and it's like, oh, yep, your estrogen's through the roof. So again, it's just control of the testosterone to make sure you're not converting to a bunch of, of estrogen.

And then that can also cause the gynecomastia.

So if estrogen goes sky high, you can get development of breast tissue just like a woman. So you just, you watch it and if a guy's symptomatic you of high elevated estrogen, come down on their testosterone dose a little bit or you can run a, I hate doing, we hate doing it. But a 5 alpha reductase inhibitor called anastrozole. But those can be little nasty drugs. But if we have a really obese patient where they're going to convert a lot of that testosterone over to estrogen, the aromatized enzyme lives in adipose tissue. So heavier men, they even smell testosterone, they're just going to convert it to estrogen. So smaller dosages more frequently with them. Sometimes in rare instances we have to use a anti estrogen pill. But generally you can control it by using low dose more frequently testosterone. And then yeah, higher, higher estrogens, again, bad, your PSA will go up. But the roid rage things, temperament, not really going to happen. I always like to say, look, sometimes if you take too much testosterone, if you're an before you take testosterone, you're going to be a bigger, you know, it's if, if you're not doing this right. So listen to our doctors, take the prescribed dose. More is not better. And, and you're going to be, you're going to be good to go.

What about women who may be really sensitive to testosterone because you know, some of them may break out. Right. With acne, how do you deal with that?

Again, start low, go slow with women. I know some providers who've scared patients away, starting them on a relatively Low protocol and 10 milligrams per milliliter a little tube and they start them on one click. Start even lower than that. You know, if a woman has zero testosterone in her body and you started, you know, on a dose that was, you know, you would start people on but they don't have any and then you just give them a big bolus of testosterone, they can have little acne flare ups, things like that. So just start low, go slow. With testosterone, you run blood work in eight to 10 weeks once you start somebody and then you can kind of go, okay, yeah, we're not where we want to be. More importantly, how do you feel? I don't really feel much of anything. Okay, let's take a half step up. A couple weeks later they're like, oh yeah, this feels great. Hot flash is gone, night sweat's gone. I'm crushing my workouts. I'm recovering like crazy. I used to walk into a room for you go, where are my car keys now?

You know, testosterone, the testosterone can help. Yeah, the hot flashes.

Well, sorry, that's, that would be all hormones, mostly progesterone, estrogen. Okay, progesterone, night sweats, estrogen, definitely. With like in a couple days. Generally women are going to see, they should see results within 30 days. We usually see it in about a week.

Combination how important it is for females to boost our testosterone levels.

I mean it's, it's not just take one hormone and you're better. It's a balance of all three. It's a delicate dance and ratio of all three, which this is where if you're slicing and dicing the labs it gets complicated. So don't do that. Just after time of working with patients, you just kind of know talking to them where they need to be. But it's testosterone. Balance of testosterone, estrogen and progesterone. But testosterone is paramount for robust women. Bone density, brain, thousands of testosterone receptors on the brain as well as the heart, as I said. But critical thinking, verbal memory, I like to say estrogens for, you know, just like bone density, things like that. Progesterone can be for the brain and the feel good hormone testosterone's for your motivation and it gets you up. If you're a procrastinator, it'll get you motivated to do things. You'll start doing the things you used to love to do. Your workouts are great. You know, you're, you get a nice little sort of dopamine push after, after, like a great workout. It kind of carries on throughout the day. Yeah, you put on lean body mass which it's so beneficial to osteoporosis and sexual health, like testosterone and sexual health go hand in hand. So does estrogen, progesterone. But for libido, even thinking interest in sex, like, it's so important for women to do testosterone for their relationships with. With their husband or boyfriend or whatever. And this is why we like to treat couples at the same time. If one couple's. If one person's feeling really good and the other one's not, you're gonna have to like, hey, y' all come in together. Trust me on this. Our doctors have been doing this too long. And healthy relationships.

Yeah, yeah. Do people have to be in California to see you guys?

No, we require, you know, a face to face visit once a year, but we treat patients all over. If you come see us, we do a physical exam. Our doctors put our hands on you. We have custom compounding pharmacies that have the permission through regulatory agencies to ship to all 50 states. So I'd say probably 95% of our patients are local. And then we do have a few that have homes in different places as well as Santa Barbara. But yeah, as long as they come in and we do a physical exam.

Okay. Amazing. So how do people find you and receive the royal treatments?

Yeah. So again, our clinic is called Eternity health partners. It's am I santabarbara.com and yeah, we're in Santa Barbara. We do everything functional, integrative medicine, bioidentical hormones, peptides, a lot of gut, GI microbiome, remodeling, heavy metals, mold, regenerative medicine. I'm a proud vendor of Joy's for child biologics. I think it's a far superior product. Joy and I are like, calling each other. Oh, man, I saw this patient. You're not gonna believe what's happening with this. She's like, oh, send me a study. Let's do a study. So Joy and I nerd out and have a lot of fun, but we do a lot of.

That's part of medicine is when you see people recover from really tough conditions. Yeah, that's. That gives. That gives us a high. I know that.

Exactly. So we're. We're on the phone probably once a week, nerding out and selling, celebrating. So do a lot of joint PRP and regen medicine for, you know, and then we do a lot of longevity medicine. We run a biological age testing to see, you know, a chronological age and a biological age. Let's see how. How old you are cellularly. And then we use senolytics to, you know, create apoptosis of bad zombie cells and just optimization on how to do that. And I feel like a lot of people also want to know what's, what's the best diagnostic tools out there. So we use things like the Clearly Gallery cancer test, which looks at 50 different types of cancers from a tube of blood. Early, early DNA genetic signals will be given off with certain presence of cancers. We run that. We run a Clearly calcium score test. Way better than your calcium score you're going to get at your radiology clinic which just looks at hard, hard plaque. Clearly is going to run a test that uses AI and looks at hard and soft plaque in the heart. So a lot, A lot better and then, yeah, just really good.

This is imaging. You're talking about imaging.

These are things that we do at the clinic. But yeah, that's about it.

You have a machine that can measure.

We, we don't. But we refer out to. You could go to clearly.com and, and they have stations all over that I see will do this, this new type of calcium score. So, yeah, patients want to know what's the latest and greatest with diagnostic tools for, you know, morbidity. So we, we have to always stay on the cutting edge of this stuff. So.

But yeah, yeah, that's beautiful. Yeah. I'm, I'm so proud of your accomplishments and how many people you're helping. So I, I hope more people are, you know, are recognizing just the amazing work that you're doing and, and cut and get some help from you. So. So again, I want to thank you for being here. I think it's a super informative session. Thank you. And you've given so many pearls to, you know, to the audience and answered lots of, you know, sometimes, you know, nitty gritty questions. But I think they are all important. All these are things that people are wondering about and they don't have an expert to go to to really get the answer right. Sometimes it's so confusing with all the information that's out there.

Oh, there's, there's so much. And I think if you're, you know, if you don't have access to us or can't come see us, go to a4m.com or ifm.org and there's a list of providers who are functional, integrative or find a naturopathic doctor. Find an osteopathy do doctor they come out of school for the most part knowing this stuff and are going to look at the whole system. They're going to look at sleep, stress, movement, the gut. Are you able to detox, they're going to look at the whole system as one instead of, oh, you're sad, here's some Prozac and Xanax.

That's how we were trained.

So.

Which is why I'm not doing that anymore. Yeah. Okay. So yeah, we are all reformed. I'm in a reformed MD and I'm catching up to you guys. Yeah. So, yep, the medicine is moving forward and that's why we go to a 4am because new things are coming out all the time and. And there are people who are looking for the escape velocity. Right. For reaching that pretty soon where yeah. The rate of anti aging can catch up with the rate of aging. So we can stay, you know, stay put forever. That's.

The world fastest growing specialty, they said.

Yeah.

Doctors are kind of fed up and.

Dissatisfied and it's a lot of fun to stay at the, you know, the head of the spear. So yeah. Again, congratulations to your great work. So okay, everybody, we're gonna end here and thank you for listening.

Thank you, Joy.