16: Balancing Hormones for a Healthier You – The Power of HRT with Dr. Amy Killen

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness, and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. So, Dr. Killen, I am so excited to have you here today. I have known you for such a long time and just absolutely love watching all of your content empower and inform men and women about the journey of aging and hormones and all of these things. So thank you so much for taking the time to come and talk with us today.

Well, thank you. I'm excited to be here. Yeah, it's fun to hang out with friends again.

I know. It sure is. It sure is. Well, I want to break down today's conversation into two main categories. The first is hormones, and the second is longevity, because really, you're an expert in both of those things, and I feel like just a wealth of knowledge for our listeners in those topics. So let's dig in. I kind of want to open up and talk about women's hormonal journeys as we age because so many women think about this process as well. I don't need to do anything or consider anything until I'm menopausal.

Right.

I really think there's so much more to the conversation than that. So I would love for you to give us a little bit of insight into what kind of age are you seeing women beginning to consider some form or fashion of HRT and, like, what are some signs or symptoms that they should be watching out for that maybe prompt them to consider it?

Yeah, I mean, I think that, you know, checking general hormones, including thyroid as, you know, and some of those other hormones, you know, makes sense for anyone, any woman of any age. But probably about age 35 is where we generally start seeing, like, perimenopausal symptoms. It could be 35, could be 40. But we start seeing difficulties with sleep, for instance, like insomnia, especially in the two weeks before your period. We start seeing more anxiety and mood changes and brain fog. Oftentimes weight gain is a part of that as well, kind of moodiness. And then also difficulty forming muscle becomes a problem as we get older as well. And that's, you know, most of that starts at around 35. Sometimes it's closer to 40. But those are all symptoms of potential hormone problems.

Right. And what sort of hormones do you see decline earlier than others? Like, in the thyroid population, I definitely see patterns. But I'm curious for you because this is your area of Expertise. Do you see patterns where hormone deficiencies show up before others?

Yeah, I mean, for sure, progesterone starts to go down in early perimenopause and just continues. But in early perimenopause, progesterone goes down relative to estrogen. So we have usually in that period, more high estrogen symptoms and then more of the low progesterone symptoms in the early part of perimenopause. And that's. So that's where you're, like, difficulty with sleeping, with anxiety, you know, kind of mood changes. All of that can be because of low progesterone. We also start to see more thyroid symptoms, as, you know, in. In that kind of population as we get older, that our thyroid becomes a little sluggish, doesn't want to do its job. And that could, you know, that can happen at any age, but especially in the women who are perimenopausal going into menopause. So thyroid is always important to check as well. And then as perimenopause goes along, then estrogen's also going down. And we can then start to see low estrogen symptoms even before you're in full menopause. And, you know, full menopause is 12 months without a period. But, you know, certainly before that time, you can have low estrogen symptoms, too, which is classically hot flashes and night sweats and, you know, weight, more weight gain and things like that.

Yeah. Vaginal dryness. And especially, like, women, I notice, will have that leading up to their period. Right. As they get farther and farther into the perimenopause journey. And so much of the time, women are just suffering through it. And I know especially like you mentioned, the low progesterone symptoms, those are absolutely debilitating for a lot of women. Like, it ruins their relationships. Like, it impacts so many aspects of their lives. It's such a fixable problem. Tell me kind of your favorite way to address low progesterone.

My favorite way is just to give you progesterone. Progesterone is inexpensive, it's very easy to use, and it is very safe. And so, you know, starting in perimenopause or even in premenopause, if you have someone who has a lot of PMS symptoms, you know, or polycystic ovarian syndrome or anything where you have irregular periods, progesterone can be really helpful to help regulate periods and also to protect you from the. From estrogen. From too much estrogen. So we, you know, we can give progesterone in the two weeks before your period, even if you're not perimenopausal, even if you are just have normal periods but you have a lot of PMF symptoms because that means you probably aren't making as much progesterone as you need. And then during perimenopause, I'm usually doing a cyclical progesterone, same kind of thing. So giving it either one or two weeks before your period every night. Usually we do capsules, usually every night before bed, helps with sleep. It's fantastic. And then as you get closer to menopause, then we will add an estrogen too.

Yeah, I want to back up too because I see so many women who come to my practice and I'm sure you're the exact same where they have all those symptoms of, you know, irregular periods, anxiety, agitation, heavy periods, crampy periods, and they go to see their gyn and really the only offering is birth control. Right. And so what I'm hearing you say is there is other alternatives to that, that more don't override, ride your hormonal process, but more support them. Correct?

Correct. Yeah. I mean, certainly progesterone, you know, it's a natural, it's a natural progesterone, the same identical structure as what your body makes. It's not going to give you birth control. So if you need protection from sperm, that is not going to be your choice. However, if you don't need birth control, then progesterone is fantastic. And I think we should probably start it earlier in some women and not wait necessarily until perimenopause to think about it.

Absolutely. I mean, especially in the thyroid community. I feel like progesterone declines so early on in terms of age. So many women need that support. And it's honestly, strangely, I didn't know this years ago, but it's one of the most life changing things I've ever seen in medicine because that shift in their mood and their anxiety and their agitation happens so quickly, like almost overnight that people are almost like caught off guard.

Yeah. And even like people who get migraines, you know, you get migraines before your period and a couple of weeks beforehand, oftentimes just putting, adding a little progesterone before you go to bed, you know, all of a sudden your migraines aren't happening. Your anxiety, your panic attacks, your anxiety, those kinds of things as well are not happening. And then, you know, in the, also in the polycystic ovarian syndrome community, which is, you know, it makes up 10% of women have PCOS, but 70% of them do not know it. So it's underdiagnosed. And one of the symptoms or signs of that is that you have irregular periods. And part of sometimes not everyone does, by the way. Some people don't have irregular periods, but. And one of the problems with that is you're not making progesterone because you're not ovulating. And you have to be ovulating to make the corpus ludium, which then that makes progesterone in the second half of your period. So for wi, any woman who's not regular with her cycles needs to be checked out, unless she's on birth control or is pregnant or breastfeeding. Get checked out and you know, get your thyroid checked because that can certainly cause it. Get your hormones checked because you don't want to miss that. You don't want to, you know, not take the proper precautions because it actually those, they can cause long term problems if you don't have those hormones on board.

Yeah, absolutely. Tell me your thoughts on wild yam cream, because this is like all the rage on TikTok, right. And I have my feelings about it, but I would love for you to speak to your experience and thoughts on it.

On yam cream. Yeah, yeah. I'm not a fan. And the reason is because we know that the diogenin, which is what the. It's a component of yam cream that can be made into progesterone in a laboratory. Your body cannot convert diosteron into progesterone. So, you know, people take it and say, oh, well, it has this, you know, it has this progesterone in it. But unless that has been modified in a lab to actually be progesterone, then the yam cream cannot be made into progesterone in your body. And so, you know, if you like it, it makes you feel good, it's fine. But we do have studies, several of them, that it does not change your progesterone or estrogen levels. It does not improve symptoms relative to placebo. It does not do anything. It just, I call it the yam cream scam.

Yeah. And also I think too, like in the same way that I wouldn't give someone necessarily or 99% of the time progesterone cream that needs to be alternated according to their cycle because it's going to accumulate more slowly in your system than an oral form that's going to fluctuate rhythmically on a daily basis. And we can also alternate that according to Your cycle. There's just nuances to this that I don't feel like wild yam cream can quite handle.

Yeah. And the other problem with, you know, any supplements that are hormonal in nature, we don't know what exact dosing it's not. You know, you can't just. The dosing is so insensitive that we don't know how much you're getting. And so even if wild yam cream did make progesterone in your body, which it doesn't, even if it did, we still don't have a way to say we're putting on a little bit too much or too little. It's all, you know, supplements are not regulated that way. You know, I think I do with progesterone creams. I don't use them generally unless I not. It's fine to use them in perimenopause if they help, that's great. But I definitely don't use them in menopause if the person needs uterine protection from estrogen. Because we know that the creams do not reliably protect your uterus the same way that, you know, either oral progesterone or even vaginal progesterone does. So I generally just don't use them. But there are some people who cannot tolerate oral progesterone. It just makes them too drowsy, makes them feel weird, it makes them depressed. In those populations I'd prefer to do like a vaginal progesterone, but occasionally I'll do a cream as long as it's just perimenopause does same.

The other hormone that I see decline, especially in the thyroid community pretty early on is testosterone. So and women, when I bring this up in practice, they get really sort of afraid. It's, it's like triggering, they think growing a beard and getting really hostile. Right. So I would love for you to take us through some of the symptoms of low testosterone and the importance of having that on board and your thoughts on it in general.

Yeah, I'm a big fan of testosterone replacement when needed. You know, testosterone is a little different than the other hormones. Starting at about age 25 in both men and women, you get this kind of slow, downward, you know, fall off. It's not like progesterone and estrogen at menopause where it just goes like, it goes right up a cliff. Right. But it's, it is very common in like that, you know, same kind of 35 to 40 year old woman to begin noticing low testosterone symptoms. And that's Things like low libido, low motivation, like, I don't want to get off the couch and go to the gym. I'm too tired. That doesn't sound fun. You know, difficulty with forming muscle, difficulty with gaining too much fat, especially belly fat is very common in that as well. And then mood changes, like, you know, a lot of depression, a lot of like just feeling kind of blah is because of low testosterone. And that is something, you know, so easy to replace it. We, the dosing is about a tenth of a dosing that we give to men. So it's not, we're not going to have you be growing beards and, and aggressive and, you know, that kind of thing though certainly if you have symptoms, you should let your doctor know and then they can back off in the dosing. But it's, it's a much smaller dosing for women than it is for men.

Absolutely. And I mean, I view testosterone so much of the time as like this low slash, no risk scenario. If it's done appropriately. Right. Obviously it can be taken to extremes and cause a lot of disruption and symptoms and side effects that are lasting. But if it's done properly, it can be so, so beneficial. Tell me your thoughts. So the most common way that's becoming the norm in medicine for testosterone replacement specifically for women is pellets. Tell me your thoughts on pellets. Give me your honest opinion.

You know, I have a mixed feelings on pellets. I did pellets myself for patients for years and women especially loved pellets, you know, versus creams or other forms. And I have women who would come in out of the state to get their pellets every three months or four months. They loved it. The problem with pellets is once they're in your body, you cannot take them back out again. So if you start having side effects, acne or increased facial hair loss or hair loss, then those are going to continue for at least three months because the pellets are usually three to five months. Women, the hustle, how long they'll last. And so that's what the problem is. You know, you get these super physiologic levels of testosterone that goes really high and they kind of stay up there and then they drop down versus getting a little bit like more of a cyclical arrangement with a cream or even injection oftentimes do, you know, injections with a little insulin needle of testosterone in women just once or twice a week. And that works great also if you don't like creams or gels. So I Don't choose pellets with patients unless they ask for them after they've been on there before and they work for them. Great. And they know the dose. I tend to try to choose something else for testosterone if I can.

Yeah. And you know, I think too, part of the inherent sort of flaw in the pellet system for a lot of people is they're using systems where clinicians, physicians aren't deciding the dose. It's calculated by, you know, the wizard of Oz behind the computer screen on the other end. And we don't have as much control. And I feel like that's never really a positive way to do things. I would love nuanced control over my patient's hormones.

Right.

Because it's definitely my approach that they're there to see. And I'm also holding out hope that maybe Kaiser Tracks will come out with like an oral testosterone for women. We'll see.

Well, I don't know. They say I talked to them recently and of course they're not fda. Of course there's no FDA approved testosterone for women.

Right.

Not anywhere, because. Which is crazy. But they are, they do have some women using at the lowest dose their oral testosterone on decanoate. And. Yeah. And they were saying that they were going to try to get another like a 50 milligram dose, which would be, you know, approved for men because we don't get it approved, but that probably the perfect dose for women.

Right. And how sad that, like medicine is perfectly okay with us being completely out of testosterone. Like, in fact, our testosterone normal levels go to zero. They just don't want it too high, but it's perfectly fine if it's zero and we're just walking around suffering. But I guess it's similar when men's level goes to 200 before they need replacement, which is also so sad.

So, yeah, it's sad. And I also think that a lot of women who are on birth control pills don't realize what that's doing to their testosterone. That's something that's also, I'm sure you see it a lot. It's very common because of the oral birth control pills are increasing your shbg, which is serum hormone binding globulin. That hormone then is binding up more of your free testosterone, your available testosterone. And so, you know, even if you're fairly young, you can see low testosterone symptoms because you don't have a lot of free testosterone. And I also see in women who are on birth control, maybe they're fine for the first five years or whatever. But then as they're. Their overall testosterone is going down and they're. It's all getting bound up. At some point, they reach a threshold where they can feel the testosterone is low. And that is just, you know, one of the potential side effects of birth control pills.

Yeah, I want to put a pin in sort of the libido conversation because I want to come back to it. I'm excited to pick your brain on it and we'll move on to estrogen. So estrogen obviously is like, it's the most demonized, it's the most controversial. There's so much misinformation out there about estrogen replacement. So I would love for you to share a little bit about your viewpoint on estrogen replacement and perimenopause, also menopause and just. We'll dig in from there.

Yeah, I think that, you know, women are afraid of estrogen. And this is discourse goes back to the Women's health initiative in 2002, which came out and said, you know, estrogen therapy causes breast cancer, heart attacks, strokes, dementia, and blood clots. And women heard that and their doctors heard that, and they, they just got all the, you know, they all stopped taking estrogen. We went down, you know, usage got. Went down by. By 88% just from that study. And the thing is, it hasn't rebounded. You know, we, even today we've. Less than 5% of women who are over the age of 50 are taking HRT, including estrogen. Like, they're just not doing it because they're still scared. And I think it's, you know, unfortunately, that message has gotten out. And despite the fact that we have multiple studies including, you know, very good randomized control trials, including the WHI that eventually came out and said that when you use estra estrogen only without the synthetic progestin, that was the kind of the problem child. When you use estrogen only, it actually decreases your risk of breast cancer by 29%. And that's in a randomized.

Can you repeat that?

Yeah. When you use estrogen only by itself, without progestins, it decreases your breast cancer risk by 29%. And that's pretty big news. And yet no, women are still. They still think that estrogen therapy causes breast cancer. And of course it doesn't. So we have a number of studies now that are all randomized controlled trials. There's a recent meta analysis last year with 10 studies, randomized control trials, and the overall finding was that estrogen therapy decreases breast cancer risk by 23%. So at this point, I think that we need to keep telling people this is, you know, the breast cancer thing is not real. And I could give you the same information about the heart attacks and strokes. That was really the type of estrogen they were using and the timing of the estrogen they were using. They were waiting. These women were 13 to 15 years out from menopause onset, and then they gave them a synthetic estrogen, which is known to destabilize plaque. So they had all these years to build up plaque in their arteries because they didn't have estrogen, because estrogen is anti plaque. They had plaque building up for 10 or 15 years, and then they gave them Premarin, which is synthetic estrogen, and that caused some of that plaque to destabilize, break off, and go to the heart or the brain to cause heart attacks and strokes. And so we know that we don't do it that way anymore. We don't give Premarin, most of us, and we do give the hormones early in perimenopause so that you don't have that problem.

Right. And now, didn't a recent study come out, I think, in spring of this year, that really showed it could, if you start estrogen replacement therapy early, that it could reduce your risk of cardiac events?

Yeah. I mean, we have dozens of studies at this point, randomized controlled trials and observational studies that have shown us that if you start HRT within about six years of menopause onset, you will see a 30 to 50% reduced risk of.

Cardiovascular disease, which is the number one killer of men. And women the number one killer.

One in three women will die of heart disease. Women aren't afraid enough of heart disease, and they're a little bit too afraid of other things like breast cancer. In my opinion, heart disease is what's killing us. And, you know, there is not a single drug out there that will reduce your risk of heart disease the same way that estrogen will. There's not one single drug. And that includes your statins, that includes your aspirin, that even includes your, you know, like, all kinds of things. Any drugs that are out there are not reducing your risk the same way estrogen does. And yet even the cardiologists don't think about or use estrogen, which they should totally.

And I mean, just to reframe what you already said, heart disease kills more people, more women and men, every year than all cancers combined. Like, we should be afraid of heart disease. And so getting that protection while simultaneously getting some protection against breast cancer, cognitive decline, osteoporosis osteopenia, These are such valuable things for women as we age. And I think it is a shame that so much of the medical community still is demonizing estrogen. I mean, I get patients in my office every day. I'm sure you do, too. That's like, my OB GYN thought I was crazy for taking estrogen replacement, and she told me that I will get breast cancer. You know, I actually hear that. And I'm like, wow.

Yeah, it's very sad. And even, you know, oncologists are still telling women that they shouldn't take estrogen because they're going to get breast cancer. You know, cardiologists, you shouldn't take estrogen because you're gonna. It's gonna be bad for your heart. It's gonna cause heart attacks and strokes. I mean, it's all just. It's all completely wrong. But because doctors were not taught about these hormones in, you know, residency or medical school, and then they heard this bad news back in 2002, many of them have not gone back to review the literature. It's been 22 years since, you know, since whi come back came out. But the doctors are just not. They're just not interested. They're just like, ah, that sounds dangerous. I'll just stick with these other things.

Right. They're not updating their views either, you know, which is. It's a shame. And I know there has been a lot of movement in the world of hormones because the American Menopause association is now sort of advocating for hormone replacement for women, which I think is great. I think, you know, one differentiating thing I'd like your opinion on is much of the time they advocate for, hey, we're going to start you on this. And we actually never need to test your hormones again just based off of symptoms. And I would love your take on that because I feel like that's an important piece of information for listeners to leave with.

My thoughts have kind of changed over the years. I think that it is actually totally fine to start if you're menopausal. We know you're menopausal. You know, I think that there you're. The blood tests are not going to help us tell you that you're menopausal. We already know that. And so it's totally fine to start hormones in that case without doing. Without checking estrogen and progesterone. But I would still like to check other things like testosterone, like thyroid hormones, like, you know, all of those insulin, some of the other Things that are going to be associated with that. But you can skip the estrogen progesterone test. However, once I get you on the hormones, I do have kind of threshold levels that I want you to be at, because we know that certain levels caught, you know, are going to help your bones, certain levels help your heart, you know, and so I have certain levels that I want things to be at for both estrogen and progesterone. So I do like to check those hormones and make sure those levels are good, and then you can go a little further, you know, six months or so, without having to check again.

I agree. And, you know, I think you want to ensure they have enough. But also, I wouldn't want women walking around with an insane high estrogen or progesterone level.

Right.

Like, too much of anything isn't always great. So I think it's smart and intuitive to track things on both ends, for sure. What would you say ballpark would be the starting age where women might need to really dig deep and assess their low estrogen symptoms? Obviously menopausal.

Sure.

But, I mean, I really want the women in perimenopause out there to tune in and be like, you know what? I really need to pay attention to these symptoms, and maybe this needs to cue me to get my labs drawn to check estrogen.

Yeah. You know, the hard thing about checking estrogen and progesterone in perimenopause is that that your level, you know, there's so many surges and crashes, and the levels are. It isn't. It's not this beautiful curve like it was in pre menopause, where we could say, okay, you're at day 21 of your cycle. We can check these hormones. This will be high, this will be low. Like, in pre menopause, checking hormones makes sense if there's like an ovulatory problem, whatever. In perimenopause there, the cycles are not really cycles anymore. I mean, they can be, but they can also just be crazy. You can get the erratic ups and downs. And so even if you know what day you want to check them on, their body may not be cooperating with you. And so you still may get levels that are super high or super low. And it's hard to know what to do with that because it's changing from day to day, even from hour to hour in some cases. But I think that low estrogen symptoms are, you know, pretty common towards the end of perimenopause. And that, you know, that can be age 40 or it could be age 45, could be age 50, like somewhere, you know, it depends on the person and when everything started. But it's in the beginning of perimenopause, you actually have higher estrogen levels than you did before by about 30%. So, you know, surges and crashes, and it can cause all kinds of problems. And overall, your levels are pretty high. At the end of perimenopause, your ovaries are kind of petering out. They're not making estrogen or progesterone, and those levels are low. So, you know, it really depends on when everything starts for you. But probably 40 to 45 is a good time to start thinking about estrogen.

I love it. Thanks. Thanks for that. I want to circle back to the libido conversation before we move on to touch on longevity. Libido for my patients is one of the most resistant things to treat, and obviously hormones play a role in that. So, of course, I'd love for you to speak to that. But I'd also love to know if you have any other tips and tricks in the libido department for listeners.

Yeah, I think you're totally right. Libido is so difficult because even if you're. You get your hormones where we want them, your testosterone is great, your estrogen, progesterone, like everything else, is good. Libido doesn't always respond like we want it to. And I think it's because there are so many things that are going, you know, kind of playing into libido. I mean, it could be that you've been married for 30 years and you're just kind of bored. It could be that you have some kind of other chronic medical problem that's making you, you know, you're giving you joint pain or some, you know, body pain or things like that that don't want. You're not in the mood. Could be that you're overworked or overstressed, and that's causing you to, you know, fixate on your to do lists and you can't kind of relax. Certainly hormones play a big role as testosterone and estrogen as well, but this, it isn't the only thing that's part of that puzzle. So I think you have to kind of look at the whole person like, what all is going on? What are all the contributors to it? And then think about what are some specific therapies outside of hormones. Yeah, once you've gotten those where you want them, they could be helpful. For instance, there are. There's some peptides out there now that are in factors and FDA approved. It's called Valise. It's based on a peptide called PT141. So PT141 we've had for years. And it works at the level of your brain. It increases what's called the melanocortin pathway and essentially increases desire and arous for starting at your brain. It works great for about 50% of people take it. Not everyone, but 50% will have improvement in desire and arousal. So improvement in blood flow to the area, you know, sensation, all of that. It works in men and women. But now we have an FDA approved drug called Valisi that is the same peptide approved only for women. So it's an option. I mean, it's not going to necessarily fix everyone, but that's a good option. You know, other peptides or other kinds of hormones that can increase growth hormone can sometimes be effective in helping with libido. You know, oftentimes that lack of growth hormone is contributing to lack of motivation and lack of building muscle and all these things. So there are medications and peptides that can help with that. There are some devices that I like. There's like, there's an intravaginal red light therapy device that I like. It's called, it's from Joy Lux, it's called V Fit Plus. That is just red light therapy. But it goes inside and kind of vibrates a little bit and it's warm, it feels lovely. And that is. Yeah, that can help get the blood flow going and help kind of of improve the, the kind of the, the state of the vaginal, you know, cells. That's a nice technology too. That is just over the counter. You can just buy that on wherever, Amazon or whatever. And it's a nice little tool as well. And then I also sometimes will do regenerative injections, you know, stem cell injections into the area as well to try to help with sensation and blood flow and all those things.

I love it. And then one thing I talk too with my patients about is like, I almost feel like when we haven't had a libido for 15 years, that part of our brain almost goes dormant. I'm like, listen, you almost need to reactivate that part of your brain, put it into practice. It's like a muscle. You have to sort of rebuild that function once it's gone for so long. So I love that you look at it from such a multifaceted approach because it truly is like our libido as women is a complicated thing. It's not as simple. Put them on testosterone Testosterone fix?

Yes, absolutely. And I totally agree with you. I think, you know, it sounds silly, but, you know, put it on your schedule, like make time and, you know, it could just be time to hang out with your partner, time to, you know, hold hands, time that you don't have to necessarily have sex, but just make time in your week to be with that person and, or by yourself, just to be with yourself, whatever it is, but make time so that you actually are thinking about that and getting your body kind of used to thinking about. About that.

Agreed, 100%. Well, I want to briefly touch on longevity. Tell me how hormones can contribute to longevity.

Well, we know with estrogen specifically, again, if started within six or so years of menopause onset, then the. Your mortality rates are reduced by about 30 to 40% in women. So that's longevity. Like I tell people, you know, I go to all these conferences, all these longevity conferences, and I speak at different events, and they're all talking about these various technologies and various drugs and this and that and things that are difficult to find, but maybe they help. But nobody's talking about hormones. And yet, you know, HRT can reduce mortality rates by 30 to 40%. And we know this from multiple studies. And it's just. So it's weird to me that we are talking about all these other drugs and all these other therapies and, you know, technologies and going out of the country to get various things done, and yet we have this thing already available to us that we're not using, losing.

Totally, absolutely. And even testosterone, right? Like, as we age, we lose testosterone, we lose muscle mass. It's harder to rebuild that muscle mass. That is also associated with poor lifespan, poor longevity, all of those things. So hormones are so powerful. I couldn't agree more. They are not to be underestimated and just tossed aside for the latest and greatest tech invention. Tell me me, is there ways that we can know how we're doing from a longevity standpoint?

That is still debatable. There are certainly tests out there like epigenetic tests, like the true age test, true diagnostics, various other kind of clocks that they. You can get tested to try to find your biological age. And, you know, I think that those are fun to do. We as a community have not really decided on one test or one way of doing it. And most of those tests kind of can be gamed a little bit and the results aren't necessarily reliable from one time to the next. So I think if it's motivating to you to get that one of Those tests and it says that you're, you know, that your biological age is older than your chronological age and you're like oh my gosh, that motivates me. That's fantastic. But I don't think we really have a single go to marker or test or anything that we're, we can use to evaluate how you're doing that way.

Yeah. And I know you're invested in the longevity sector with Hotbox and all of these things. Tell me some of your favorite longevity tips and tricks. Tricks.

You know, I think that there are some. Yeah. Hawkbox is my, is my women's longevity. It's like a supplement company for women's longevity. And I chose a bunch of ingredients that I think particularly helpful for women to you know, it's to just improve their health span, to decrease chronic diseases, to improve symptoms of hormonal challenges. Things that are, but, but you know, unfortunately we don't have enough knowledge about supplements to say this one is going to make you increase your life lifespan. It may increase your health span, but we can't say lifespan. But I think that's a good point. There are also some drugs out there that are re being refurbished if you will. They're already FDA approved drugs but that are being used by doctors like me who are trying to improve various things related to longevity. So I'm talking about things like the GLP1s which is of course OIC and WeGovy that actually probably has some longevity benefits if we use the right dose medications called the SGLT2S which are inhibitors of SGLT, also diabetes medications medications but have system wide benefits and really very interesting drugs.

And then what are some examples of those?

So canagliflozin or empagliflozin, they're all the flozins. They all end inflows in and they're again they, you know, they're approved for diabetes but they're all. We've also seen it helps with heart disease, it helps with kidney disease, it helps with, you know like basically I was just a presentation and it's like every single organ system is being helped by these drugs. Drugs. And so you know it's. But they are still, they're very expensive still. You have to have insurance to buy them for most people. So it's not something that we could all do. But I think that it's great that we can look at drugs we already have that have already gone through the FDA approval process and see if there are ways to use them. You know, different dosing, different whatever kind of off label for longevity. I think we can.

Yeah. Rapamycin. How do you rap that one? Yep.

Rapamycin as well as metformin. Those are kind of the four big groups of drugs that I see right now that are out that we are, you know, thinking about using using in these patients.

I love that last question and then I will check my social because I did have some questions from people there. But tell me one of your favorite or a couple tips and tricks for longevity that you put into practice yourself.

You know, my biggest one that I that has helped the most over the last 10 years is becoming a good sleeper and prioritizing sleep. You know, I was an ER doctor for 10 years before I switched over in 2013 to this kind of medicine. And so I hadn't slept in, you know, at least a decade. Well and my crazy, you know, my circadian rhythms were all off. And so when I finally like learned to, you know, prioritize getting to bed by nine, 30 or 10, turning off anything that could interrupt me making my room super dark and cold, like all the things that you can do to help with sleep. When I started doing that, it changed everything for me. Like all of a sudden I lost weight more easily. I wouldn't get outside. I was happier, I was nicer to my kids. And it also makes it a lot easier to make good choices during the day if you're rested, you know, you're not as likely to choose the piece of cake that you probably shouldn't eat because you have more willpower. And so we know this from various studies. So sleeping is a big one for me. Another big one is just getting outside in nature. I live in Utah and so it's easy, but I feel like it does wonders for my mood and for my health just to try to get outside, go for a walk or a hike as many days as I can unless the work weather is very awful while I'm here in Utah.

Right. Then you can escape to Austin because you've got a practice down here. You can come and visit.

Yeah.

So some rapid fire questions that I thought were really Great from followers FDA approved HRT vs compounded what's your fave and why?

My fave is either one as long as they're bioidentical. I don't care where it comes from. I think that most compounding pharmacies are very good and I think the FDA approved versions are also very good.

Love it. Estrogen for face to help with wrinkles. Etc. Give me your thoughts.

I am pro estrogen and yet you want to use a very low dose. So it's. It's like a 0.1% estradiol or about a 0.3% estrel and apply it just to your face. It does not have systemic effects, but we do have some good studies that show improvement in wrinkles and hydration and things like that.

Love it. Progesterone. Mine is low. How can I increase it to prevent miscarriage if I get pregnant?

So, you know, the way to increase it is different if you are premenopausal or if you have polycystic ovarian syndrome, because in those cases, you may be able to increase your own progesterone. You know, there are. You could take things like inositol and help you regulate your progesterone or some other herbs, or you can take progesterone. But if you take it and you get pregnant, pregnant, you want to stay on the progesterone through your first trimester because your body still needs it before you stop it. So I have seen women who were on progesterone. It got them pregnant, and then they stopped it because their doctor didn't understand it, you know, when they were pregnant and they miscarried because of that. So if you get pregnant on progesterone, stay on it at least through the first trimester, totally.

Progesterone is what helps prevent miscarriage in early pregnancy. It's what keeps our uterine lining intact. Super, super important how. What is the best way to, to support and increase dhea?

You know, you can take dhea. I think that's the easiest way. There's, you know, it's over the counter. I find DHEA to be sort of helpful. I don't find it to be as helpful as other hormones. You know, DHEA is a precursor hormone. It can go. It can be made into estrogen or to testosterone. And I just don't find that unless you have a chronic disease or autoimmune disease or things like that where you have very low DHEA levels, I don't tend to find it as helpful as just giving estrogen or testosterone.

Testosterone, 100% agree. And it often, I find, makes people agitated. Yeah, right.

Agitated as well as. Yeah, you can have the. And the androgen effects as well. You can get hair loss. You can get, you know, acne, facial hair growth. And because we don't have a way to tell your body how much, you know, to use that to turn it into testosterone versus estrogen, like, we don't really know what your body's going to do with it. So that's why I think it's always better just to go straight to the hormone that you want, which is testosterone and estrogen, because we can very finely tune that dosage.

Seen. Agreed. It's all about predictability and control with hormones. We don't need to throw any variables in that we can't control. And I always think too, fixing someone's adrenals to help them naturally produce better levels of DHEA is better than supplementing with dhea, right?

Yeah, absolutely. Totally agree with that.

Well, thank you so much. This has been insightful. It's been a conversation I've been looking forward to having. I appreciate your time. Is there tell everyone where we can find you your favorite place on social, anything fun that you have coming up that we should stay tuned for.

Yeah. Thank you. So I'm at Dr. Amyb Killen on Instagram and Facebook and all the socials. I'm very active on Instagram, so come check me out there. And then I have a couple of websites, my Dr. Amy killen.com as well as hopbox, hbox life for supplements. And then I also have a clinic in Austin that we just launched. It's called humanot Health. And there's a. You can go to that. Check out that as well.

I love that. So all my Austin listeners, be sure to check that out. We're excited to have you in the neighborhood.

Thank you. Yeah, I'll just stop by and hang.

Out with you for sure. Well, it was lovely. Thanks for this conversation and I'm so excited to share it.

All right, thank you.

Bye.

Bye.