470: Complete Guide to Hormone Replacement Therapy: Separating Facts from Fiction with Dr. Betty Murray

So they were able to trace what was happening with the estrogen receptors. And they showed for the first time, as a woman goes through menopause, the estrogen receptors in the brain increase, not decrease. We always the dogma was that they decreased, which was wrong.

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Welcome to Midlife Conversations. I'm your host, Natalie Jill, and I'm passionate about having amazing conversations that matter to us midlife women. On this podcast, I do what I do best, taking complicated health topics and breaking them down simply so that we can optimize aging together. I share actionable steps to help you thrive in what I believe are our best years to come. Join me as I interview the most inspiring people living their best midlife years and dive into essential topics like hormone changes, health optimization, weight management, blood sugar, emotional well being, relationships, beauty, and so much more. Hormones can be so, so confusing. And every time I release an episode on hormones, I get the most questions, the most shares because they're confusing and we are starting to recognize that they are critical and important in perimenopause and menopause and beyond. But there's a lot of confusion around them, like do they cause cancer and how much is too much? And are we doing it right? And is there a difference between bioidentical and synthetic? And does it matter? And how do we know if they're helping us or hurting us? And what, what about dosing? How much should we be taking and what type Creams, injections, pellets. There's so much confusion, and I'm sure I've contributed to the confusion because I've had so many different guests on. What I love about My guest today, Dr. Betty Murray, is she is a very strategic middle of the road approach with hormones that is not talked about enough. She is very aligned in how we can optimize, but do it healthy and optimized in a way where we can truly thrive in midlife. So I'm so happy to have her here today. We've got a great conversation ahead. Thank you so much for being here today.

Oh, I'm so happy to have this conversation. This is my favorite thing to talk.

About before we jump in because I got a million questions for you and a few stories I want to, I want to dive into here. Can you just let the audience know a little bit about you, like your background, because you know, you have this covered. You are extremely knowledgeable, very experienced. You are obsessive around the studies. Just give us a little background about you.

Yeah. So I think the first thing I have to say is that functional medicine, nutrition, science was actually a second career for me. My first career was actually sales and marketing. And then I got swept in the technology boom. So you and I can both remember the dial up days. Oh, yeah. In the early 90s. I have a very strong sort of scientific engineering mind. And so I got swept up into that boom. And I actually ended up getting a bunch of certifications and ended up being hired to a company to report to. The CTO is the first female hired into that company. All men. And everything you can imagine about the MeToo movement and everything that could go wrong in that world was true. I worked twice as long, twice as hard for half as much money. And while I worked for that company, I thought it was first stress. So I was taking yoga, meditation, all these other things. And I had digestive problems that were episodic at best. That became almost all the time. And I ended up going to a gastroenterologist and getting diagnosed with colitis. And when I talked to him, I asked what I thought was the most legitimate question. Could I change my diet and change the trajectory of my disease? Because he was giving me these immunosuppressive drugs and this overweight man laughs in my face and says, it has nothing to do with diet. So I was like, that's complete bullshit. That doesn't make sense. So I was like, okay, I'm going to go just take some nutrition classes. I had already been into bodybuilding and all of that world. So nutrition is what I did in my free time. So I started taking nutrition classes. And that's where it clicked. I was like, oh my God, this is what I'm supposed be doing. So I went back to get a master's in a cn, you know, open up my, you know, personal practice and start helping people with really autoimmune activities. And I came up with the concept at that time with a partner, a friend of mine, Jenny, about what our clinic became. So I open, I opened the first integrative functional medicine clinic with a multi specialty approach in 2006 in Dallas. And we start working with people. And then, you know, I decide in my mid-30s that I'm going to get my tubes tied because I'm like, I don't, I don't want to be on birth control anymore. It's making me, I feel terrible. I got my tubes tied and within about six months of that, this is hindsight. All of a sudden my hair starts falling out. I, you know, I start, you know, losing the outer part of my eyebrow. But I gain about 35 pounds in a matter of months. And, you know, I go to everybody, I'm like, something's wrong. I'm already in the functional medicine community. Something's wrong. And they're like, no, no, no, no. It's your adrenals, it's your thyroid. It's this, you know, you work too much. Because I just opened and lo and behold, I was in very early perimenopause and I didn't know that when you do a tubal, a lot of times what happens is the blood supply gets altered to the ovaries and they will start to shrivel up.

So even though it's not a hysterectomy, they're not functional anymore.

No, no. And I had always been estrogen dominant. If you look at my genetics, I have crazy estrogen dominance. And I at the time was displaying all the features, the weight gain, the swelling, the blood sugar abnormalities. And so I start this 10 year process of going through my 40s. That was hell. And I wouldn't talk to anybody about weight loss. At that point I was like, oh, hell no. Because obviously I don't know what's going on here. I can't figure it out. Don't talk to me about it. When I got to about 48, I said, this is time to figure out the science. Because if I have access to the best of the best in functional medicine and I'm still not well, I got to Figure this out. So I went back for a PhD, ended up getting a second master's, and the PhD I got was in Integrative and Functional nutrition from Saybrook University. Integrative and Functional Medicine, or Integrative Medicine Program. And there's only a handful of us in the world because it's relatively new, but it was all about systems biology. So I immersed myself in hormones, hormone metabolism, the interaction in the gut. And what I found there helped me lose the 35 pounds, keep it off, without having to, like, avoid every carb on the planet. And I ended up doing research on women's hormone metabolism and the interaction in the gut. And so I'm one of the world's expert in that, particularly around an enzyme called beta glucuronidase. And then the other part of that is we've been doing hormone replacement for 20 years in my clinic. Tens of thousands of women. So I'm uniquely poised as a PhD because I've read almost every bit of the research. Yeah. And then we have 20 years of history, and I've been through it. So it's not me talking about theory. I've been there.

I get. So this is my own personal thing. I know when we're triggered, we got to look within. But I get triggered when I hear males that have not walked through it giving advice on menopause. It's just a thing. It's because I'm like, in. Because I. I think back to the advice I gave 10 years ago. I didn't understand or know. So there is. I just don't see how men that haven't walked through it, especially the ones that are dismissing. And some are on board in there, but there's ones that talk ill about hormone replacement or ill, like, as if their nutrition remedy is going to heal our hot flashes. And I, I don't. I can't stand it. It's my own personal trigger.

Oh, no. Oh, my God, no. So I'm triggered, and I'm going to own that trigger. I don't want to get rid of it. I know about erectile dysfunction. I can totally tell you the science behind it, but I don't know what it feels like. So I'm not going to pretend to tell a man what to do with it. And likewise, you keep out of. You don't have ovaries. Get off. And the reality is, because of that male bias. I'm sorry, there's so much patriarchy bias in medicine because of that patriarchal bias. The biggest thing you have to watch in science is Your own bias. And actually a true scientist actually goes to disprove their theory, not agree with their theory. And that's not really what happens today. And so the reality is, even if I'm looking at something, I look for the opposite. Also, if I'm like, my belief is X, I require myself to go and look at the thing that I don't believe, because otherwise all I'm doing is speaking in a vacuum and, and spreading misinformation. Honestly.

Absolutely. Okay, let's go down. I want to break up some of the these things that you just mentioned. I want to understand and define what mean. And then I want to have a conversation about dosing and I want to have the cancer conversation. I've had this before here, but it's important to bring it up again. But let me start with. I want to start with the idea of estrogen dominance because I think there's a big misunderstanding that people think an estrogen dominance means you have too much estrogen. And what it actually means is you have more estrogen than you do progesterone. Or can you help break that down? Because somebody could be very low on estrogen and still estrogen dominant. So what does this mean?

Totally. And then there's, there's, you know, I'm going to give my theory of also what happens to us when we have no estrogen? Okay, so estrogen dominance is a state that most women will be in for a little bit of their time because of what happens in midlife. Right. And so, you know, we have estrogens, we have three estrogens, we have progesterone, which is the other major hormone. And when we're not ovulating completely. So ovulation is where the follicle kind of grows. The egg pops out like a X wing fighter and then go flying down the fallopian tube. Well, as that follicle compresses on itself and becomes a corpus luteum, that is when progesterone is produced. So if your egg doesn't pop out, right, if you're what they call an ovulatory, for whatever reason, your progesterone levels will not climb that particular cycle. You would be estrogen dominant. It's just some of us are estrogen dominant anyway because of our genetics and other environmental and metabolic things. But when we're in our 40s, what happens is your egg carton is running out. And so we often see progesterone levels declining because we' shooting eggs out all the time. And so estrogen dominance is the relative relationship between your estrogen, particularly in the second half of your cycle, relative to the progesterone levels, and when there's a big disparity from where they should be, that's where we start to get a lot of the symptoms. The sleep and the insomnia and the PMS and the fibroids and the heavy crime scene periods and all of that stuff. But it doesn't mean that you yourself are necessarily always overproducing estrogen. And then if you add how the body gets rid of it, that can also lead to greater likelihood of estrogen dominance. But it's more about the relative relationship of these hormones to each other.

It was important that I brought that up because I know women have experienced what I had experienced. So I think back three years ago, before I really understood hormone replacement and I knew I needed hormone replacement. I thought I did, I knew I did. And the doctor I was going to at the time kept saying, you are estrogen dominant. You need to get rid of it. So she put me on dim. Dim. Now, my estrogen was at level 20 on my blood work. Me going on dim at that time plummeted it. Ridiculous low. So I wanted to point this out because we're going to talk about pathways a little bit more and when you need to work on those, but that just because someone says you're estrogen dominant doesn't mean you have too much estrogen or that you should be removing it out of your body. So that's why I wanted to bring that up. Yeah, this is important.

Oh, yeah. I totally want to say this because I hear this all the time from women. I was estrogen dominant in my 40s and now I'm in menopause. I'm still estrogen dominant. I can't have estrogen. I'm like, girl, your estrogen is lucky to be five. You know, and here's, here's the other thing, right? So one of the most exciting studies that came out in 2020, I want to say it was 2023, was Lisa Moscone and she, she does imaging. And they found for the first time, they were looking at tracers in the brain to see estrogen receptors, because that's the gold standard. Like, we can't see those. We don't have testing for imaging. We can see it. So they were able to trace what was happening with the estrogen receptors. And they showed for the first time, as a woman goes through menopause, the estrogen receptors in the brain increase, not decrease. We always. The dogma was that they decreased, which was wrong. Categorically wrong. So as the estrogen levels drop, the brain is popping out receptors constantly, right. To try and grab what little is there. So my brain goes to logic, because science is logical. You, if that's happening in the brain, where else do you think that's happening? Everywhere, because estrogen loss is a full body effect. So the woman that may have had maybe a little bit more estrogen, because they're wired that way, also has more receptors for it, and they probably feel it more profoundly when it starts to drop. So clearing estrogen more is not going to be helpful for them.

Okay, let's. Before we get into all the other questions I have, I want to talk about the cancer conversation for a minute because we've talked about the Women's Health Initiative and how it's flawed, but if you somebody has not listened to past episodes, can you touch on that? And then when and where do we need to consider hormone replacement in this cancer conversation?

Okay, so the first thing everybody needs to know is hormone replacement therapy has been standard of care since the late 40s, right. In all westernized worlds. And depending on kind of which country you looked at, you know, all the way through the 70s and 60s, 70s and 80s, up to 40 to 70% of women were put on oral Premarin at the time as standard of care. So your most conventional doctor used it with no question. And up until the Women's Health Initiative, no studied showed significant cancer risk with hormone replacement therapy, including Premarin, which is made from horse pee. Right. So the Women's Health Initiative was, was designed to look at cardiovascular death risk in women. And either no hormones or Premarin alone, or Premarin with a synthetic progestin called medroxyprogesterone helped protect women from stroke and heart attack. Well, the challenge in these kind of studies are to look at long term health. Right. Number one, you always want a control group that's healthy. Well, they're not going to die in a short period of time from cardiovascular disease if they're healthy. So they excluded healthy groups already. Poor study design that gets a major thumbs down. The next thing they did is they needed these people to be close to cardiovascular event because this study wasn't going to go on for 30 years. It was only planned for like 10. And so they excluded women that were healthy. And they basically picked women who already had cardiovascular disease. They had high blood pressure, they were smokers, they had metabolic syndrome, diabetes, they were obese. So these women already had disease. And so then they Said, okay, this one group don't do any hormones at all. One group do Premarin alone. The other group do Premarin and Medroxyprogesterone. The group that was on the medoxy. Progestin, Right. Synthetic progestin showed an increased risk of stroke a couple years into the study. So they stopped the study, appropriately so. And then they started digging through the data while it was going through peer review. So peer review is where somebody else looks at your study, your statistical analysis, and confirms that what you did is right. Because it's really easy to do bias and screw up your own math. Right? It's just we didn't have AI back then to do good math for us, right? So while it was in peer review, they started digging for other data. So the other thing that needs to happen with studies is when you ask the hypothesis, you don't go digging for other data because you weren't looking for that. So that skews it. But they were like, let's go dig for some breast cancer risk and let's get some stats out here first. A woman in Midlife has a 4 in 1,000 chance for breast cancer. When we get into our late 80s, it's one in eight, right. Just because things are breaking at that point for most people. But everybody that's probably watching this, 4 in 1000. Now, in this study, it went to 5 in 1000. Was not statistically significant. Could have been absolute to chance. But how they wrote it in the study was, it was a 25% increase going from 4 to 5. And that's what the media ran with because this group wanted to stop the runaway train. I quote of hormone replacement in women. A patriarchal opinion about women. Just need to. What did you call it? Raw dog It.

Yeah, Raw Dogging menopause. I got that from my friend Tina.

Menopause, right? She goes, why?

There's no reward for that.

There's no. Yeah, you're right, you're right. And so all these women were on hormones and it was taken away overnight. Overnight. Now, so that was the start of this cancer argument, right? Here's the reality. The women that were in that study that were on Premarin alone had a 23% reduced risk compared to that group that did nothing.

Wow, that's wild.

Now, probably the most important study that came out last year was a Medicare study. So these were all women over 65, and they were looking at replacement of hormones in 10 million women. So they went back. It's called a retrospective study design. Used all the time to give general recommendations for care and, and come to consensus. And they looked from 2006 to 2023 and looked at all causes of death. So anybody that died, what killed them, and then they separated them into three groups. No hormones at all. Women who took hormones for a short period of time and women who were on them and didn't listen to anybody else and stayed on them. And then they looked at all causes of death. Heart attack, stroke, osteoporosis, fall infection, all of it across the board in every category. The women that were on hormones and stayed on hormones out survived. The women with nothing and outperformed women with nothing. So essentially the truth of that study showed that hormone replacement started and continued reduced all cause mortality. Now the breast cancer risk went down 16%. Lung cancer 13%, colon cancer. I'm going to probably mess this up. Colon cancer was like 11 multi digit percentages. Dementia 34%. And here's the other really cool part of this study because this to me was like, okay, this coffin's closed, we're going to seal it and we're done having this conversation. When they looked at it, it was the first time they had a huge population of women who were using what we would consider standard of care today. Bioidentical hormones that are topical, not premarin, right? Definitely never. So here's the rule. Never ever. Synthetic progestins, they cause stroke risk in everybody, right? Never those. But they had women on bioidentical hormones and topical estrogen. And there is no increased risk in stroke, blood clot or cardiovascular disease when women are on topical versions of estrogen.

Zero. So when people are talking about, when you see the crazy TikTok videos, whatever that is, a synthetic version. And it's oral.

Yeah. And the reality is there's so many studies out there where they pull together either systematic reviews or what they call meta analysis, where they pool in data from other studies, but nobody's extracting the Women's Health Initiative like that data needs to go to bed. We need to quit using it because it's wrong.

And the reality is this finding of the no stroke and heart attack risk, the clotting risk, was so meaningful that it made it into the abstract. An abstract is a 350 word kind of blurb about what your study was about. As somebody who has written one that is so vital, like you don't miss any word, that's how important that was. So the reality is all of the risk stuff that we've heard about hormone replacement and it's Going to cause a woman to have a heart attack if she starts it later can be mitigated by lower doses and doses that are topical. And we have to weigh potential risk factors individually with people against what's the benefit? Right. What's the real benefit? If I have high osteoporosis risk, I may worry much more about my bones than, you know, a risk of a Cardiovascular event at 85.

Yeah, that makes total sense. What about someone's listening, saying, but I had estrogen positive breast cancer, but I had. Or, but I have estrogen positive. What do you say to them? And some of them, they're told absolutely no hormones. Some of them want them anyway. What's your thoughts?

Yeah. So even in conventional care, family. I'm going to get this out of the way because this will come up too. Family history of breast cancer is not an exclusionary to hormone replacement. Right. Brca. If you're a BRCA carrier. Right. If you're a BRCA carrier, just so you know, BRCA has to do with how your DNA cleans up stuff. Like if you have a mutation there, it doesn't clean up errors in the DNA that has nothing to do with your estrogen. So the standard of care would say if somebody is, is currently under treatment for an estrogen receptor positive breast cancer and they're on like a letrozole or one of those drugs while they're on that suppressive drug that suppresses any ab for your body to make estrogen, you, you wouldn't be doing hormones, right? You wouldn't be doing hormones because you're sort of kind of fighting against the drug. However, after that, there are a lot of women that go on hormones. And this is an individual conversation. I'm a PhD, so the beauty of being a PhD is I don't actually prescribe. I can talk about the science. Right. And the reality is, is we have women that have been in our clinic that have been on hormones that have a history of breast cancer, but it was forever ago, completely clear. Right? And the reality is that every woman deserves that conversation and the book every woman must read. If you don't read, listen to it on Audible. That's how I did it. Estrogen Matters by Avram Blooming and Carol Tavris because they go through all the research and here's the thing. So remember I was talking about those estrogen receptors and other things. So a woman's risk for breast cancer exponentially goes up after menopause when you have no ovarian function, meaning your hormones are at its lowest. So I'm a scientist. My question is why, if the hormones were so deadly, we would all die from it in 20s. But if you have more children, you have, you have earlier menses and your cycles are longer, meaning that you go longer before you go through menopause. Those are all protective against breast cancer. It has nothing to do with our own estrogen, right? It's like, are estrogens good? And then at 50, something magical happens and now it's bad. Like, that's not logical. Here's my theory. My theory, because I spent so much time in the literature looking at how we package it to get rid of it. When we lose our estrogen, we have two receptors in the body. We have one called estrogen receptor A and estrogen receptor B. B is cancer protective. Estradiol sits on that, estriol sits on that, which is a weaker estrogen, so that it hits it more preferentially. Well, when you get rid of your estradiol and your estriol because your ovaries aren't making it, what do you think is hitting that receptor? And estrogen receptors A is cancer proliferative, right? So that one will drive more cancer. What do you think's hitting it? Your plasticizers, your herbicides, your pesticides, your phthalates, all the crap in our environment that is estrogen, like, has a free rein to hit that receptor. Wow.

So when we say estrogen disruptors, that's what that's meaning. It's like it's. It's the wrong type hitting that.

Right. And it preferentially binds to that estrogen receptor A, which is cancer proliferative. Right? So here's another thing this boggles people's mind. Tamoxifen. Did you know tamoxifen is a synthetic estrogen?

No, I didn't.

It binds to receptor B. Binds to receptor B preferentially. So my logical mind goes, well, what happens if a woman has adequate, not crazy levels, but adequate levels of estradiol replaced because we weren't supp to live 30 years past menopause and we put that in there. Now you have something that taps and sits on that estrogen receptor B, turning on the protective effects and it's blocking that receptor from the other things in our environment that are cancer cancer proliferative. That's what the research is leaning towards. That's why how we get rid of these hormones of the liver are so important. That's why I dug in there. Because we're lying to women and telling them that their hormones are Totally safe. And some radical crap happens at 50 and now they're going to kill you. That doesn't make sense. It just doesn't. And it's making women pay with a crappy lifespan and a crappier health span than men. They die earlier than us, but they're actually healthier during that time.

Wow.

So you don't buy into. I just want to make sure I'm hearing the right thing. And everyone's taking away that just because you have estrogen dominant cancer in your family, in your past does not equate. You should not be doing hormone replacement. That's what I heard you say. No. And all the reasons you just claim. Yeah, yeah. So, so if a doctor is telling somebody that, what do they do? Because this is common. You have it, you go to your GYN for your regular checkup and you ask about it and they shut it down like that.

Yeah. And you know, a lot of that comes from, you know, we don't. Here's the thing is that in the science we don't have clear data here, which is part of the reason why I do what I do. I'm trying to contrib to the science so we can start giving clear recommendations. Because it's all, it's all dogma at this point. It's all crap. People are pulling out and sort of spouting or we don't have enough to really give clear indication. And I think Avram Blooming does a great job in that book talking about it that, that it doesn't necessarily mean that that's going to come back in that way. Especially if a woman's 10 years out. Right. So our first hallmark in breast cancer or any kind of cancer is that five year survival rate. I hate those terms. And then 10 year. Right. And, and I think at that point you're really looking at, it's a quality of life question, you know, so if you're, if you've got bone density issues and you're losing your cognitive skills and your, you know, your libido is gone and it's like a Sahara desert down there and you got a thousand other things showing up, is the quality of life such that you're willing to continue with that when the risk of a cancer reoccurrence is relatively low? If you're 10 years out, I think a lot of women would say no. Yeah. Right. And here's the other thing. So even in conventional treatment, so, and I'm not necessarily a lovely fan of every conventional treatment, conventional treatment of breast cancer caught early like stage one. 95% cure rate. Now I don't love the conventional treatment but that's the reality. Yeah, right. And so I think every woman deserves to, to have somebody sit down and have an intelligent conversation with them about that so they can choose for themselves.

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Yeah. So.

You know, it's, it's one of those things where we start looking at hormones. So it's a privilege to live in. After our 50s. Right. The average lifespan of a woman in 1900 was around, you know, somewhere around 57. Right. In the United States. So you're old, I'm two years away.

I know we are old.

I know I'm two years away from biting the dust. Yeah. You know, so, so the reality is, is, is us living three, you know, an average of three decades after menopause is unprecedented. Right. So you know, if we flash forward a couple hundred thousand years from now, we might go through menopause at 75. Right. Kind of scary.

Yeah.

But you know what I mean, we haven't adapted to our, our longevity. So with that being said, can you.

Imagine having a teenager at age 90? No. Sorry, I thought that's what just went to my head.

I have a friend right now that's, that's, that's trying to get pregnant that's knocking on 50 store and I'm like, could you borrow a baby for a week or something?

Yeah, I don't want to do teenage thing at age 90. No.

Nope. Oh God no. Yeah, it gives me highs thinking about it. But the reality is, so we haven't usually lived this long. Right. So estrogen and progesterone and testosterone are primary sex hormones are vital to the body's recovery. They're anti inflammatory, they help keep everything vital. Now most of the research, almost all of the research is looking at therapeutic levels that take us to where we start to see physiological changes. Meaning that, that you know, for instance in your bones the bone reabsorption. So that's like the demolition crew and the bone building crew are in equal measure. Like you're cleaning up old stuff and getting rid of it. But the other guys are building at equal pace. Right. Or that we see cardiovascular remodeling of the arteries. So protection of the arteries, estrogen does that, that we see that we don't see. Our women have relatively Low cardiovascular risk until we hit menopause. And as soon as we go through menopause, we accelerate rapidly. So artery reconstruction, and then the brain side of menopause that we really see, which is the shrinking of the brain, rerouting of the sort of highways to the critical thinking part of the brain, sort of remap when we go through menopause. Dr. Moscone's group out of the Weil center of Cornell has done an amazing job of identifying that we're protected against that activity. But when we go through menopause, that accelerates. So our brain shrinks and then remaps from smart centers. That's why you can't remember anything. Yeah, Right. So then the question becomes, okay, so those things are all protected. What is the dose necessary to create protection? Right. And to create physiological function? So the body will continue to operate like it did before. Right. That, to me, number one, is our goal. Right. Because we got to remember that the rest of the body is somewhat aging. Right. The detoxification pathways, the telomeres. Yes. We can do a lot to fight telomere lengths, which are the ends of your DNA that can tell you whether you're biologically aging or not. But the reality is, is we're fighting this war against aging, right? Aging in itself qualified as a disease because it causes all mortality. Right. But we don't look about it that way. So the aging process is still accelerating. Now. If we take hormones away, it accelerates. Like, it's, like, going downhill now, like a snowball. But the rest of the body is aging that way. So the research shows that we can get to therapeutic levels in women and sustain all those positive effects without having to get really, really high. And what I would say is the biggest challenge is we don't know where you were individually when you were in your prime, because you could line up 100 women. And we all look different. Like, you know, the women who are estrogen dominant because we got, like, badonkadonk, but, you know, like, we just exploded in all directions, Right. Like, if you're a curvy girl, you probably had quite a bit of estrogen. Right. Because that's what drives it. But the reality is, is your level of estrogen relative to my level of estrogen at 25? We have no earthly idea what it was.

That's right.

So we have to. We have to do our best case scenario to guess. Right? And so proponents of the. The. The alternating dosing, or what's called the Wiley protocol, is the most commonly known one, say hey, we're going to go ahead and mimic a cycling woman in her 30s by giving you variable levels of estrogen based on the lunar calendar. And we're going to go low in the first couple days of your period. And then as you get closer to when you would normally ovulate at about day 14, we're going to spike it, and then we're going to go back up. So it takes a lot of variable dosing, but it mimics what you're doing as you were at 20. And the goal is to also then do the same thing with progesterone.

So the challenge then becomes, is it's not all about the hormones you take. It's about how you process those hormones to leave. And if somebody wanted to do rhythmic dosing like that, which I am not a proponent of, you better be testing it all the time because, again, your body's ability to get rid of it is aging at the same rate as if you didn't do hormones.

Wow.

Right. The reality is your liver isn't going to get better at that. Yeah, Right. And you got to think about the toxin load we already have.

And so I'm not a proponent of that. The idea that we need to mimic what we did when we were cycling doesn't show. We have no research to say it protects your brains more, it protects your bones more, or protects your heart more. And the reality is, if we're not controlling and getting that progesterone to estrogen ratio appropriate, what will happen is you'll get growth of tissue in the uterus called uterine hyperplasia that can become uterine cancer. Because progesterone's job must be matched to that estrogen at the right level to keep it from doing that. And that means you have to test it because you don't know, because there's no way to tell from symptoms.

So this is very. This is a very close to home topic of mine because I have some personal friends that had gotten cancer that were on that type of protocol. And just to put in perspective, you all, when I look at, like, the patch that I wear, so I wear a 0.1 patch and I take. I counter that with progesterone. That's what I do. And I'm very aware of how I'm detoxifying my estrogen. So taking broccoli sprouts and some of the stuff that you mentioned, the. To, like the beta. To counter the beta glucuronidase, like, I'm very aware of that. One of my friends, for Example, she was taking 20 times the dose I had on my patch. 20 times. So I just want to be. That is an excessive amount in my mind for what you're talking about with then growing tissue. And I, and I, this is my own personal opinion. Not, not judging my friends and all. They're very knowledgeable. I don't think that, that they even really fully connected the dots here on pathways before. But when you think about when you are working on growing something or creating an environment that you were when you were younger, like, like you're also growing other things. So that's to me personally why I won't touch things like a growth hormone, like, like, like some Orlin or something like that. Even though lots of studies, lots of people taking it to, in my head, we're growing other things then. So I think when any of you listening, my advice would be when you are asking questions and looking at regimens for you, you want to literally listen to what's coming up in your own own head or your own questions. Like if it doesn't pass the common sense to you or it doesn't feel right to you, then it's probably a clear no. Now that doesn't mean there's somebody listening that might love that protocol and they're very in tune with their body. They know it's working, they're testing more power to you. But I think all too well, people hear something and they go, I should just do that. And they're not really getting in touch with what does this mean for me. That's how I best explain it. Because I can't say it's a black and white, that it wouldn't work for anybody. Somebody, it might, they might thrive with it. I just think there's too much unknown there.

I, I agree. You know, unless. Oh, sorry, go ahead.

No, and also I think what's the goal of the hormone replacement? Like, for me, I'm, I'm not personally trying to biohack. I'm trying to enjoy my life. I'm trying to feel focused. I want to not have the hot flashes, I don't want night sweats. Like I wanna preserve. Like I'm thinking that way. I'm not thinking, how do I make myself 35 again? So it's just a different conversation to me.

Yeah. Yeah. And I mean for me for sure. I'm like, I want to maintain my absolute best health. And I also call it the assisted living, you know, avoidance program, because my mom happens to be in assisted living and I never want to end up there. And so I look at it from both those. From both those terms. So let's talk about what is the therapeutic dose that most of the research shows. Right, Please. Because the other thing that people think is that they're getting, going to be given these really high doses of hormones for menopause, which is. Is so far from the truth. So here's the reality, right? So when you. Recycling. I'm going to go back to the average woman cycling in their 20s, right? Your estrogen production during ovulation can go as high as 500 on a blood draw. So from 0 to 500 and then it drops back down and then in the second half of that cycle called the luteal phase, that's usually where your PMS and stuff shows up. It'll go to between 250 and 400. Right. So. So every month of your life for the entire time you're cycling, it's doing that. Now, some women are going to fall below that, some women might go above that. But on average, in order to get therapeutic levels, where we're protecting the brain, the heart, the bones, most of the studies indicate that we probably need to get to 50 to 80 on an estrogen, on a blood draw, on estradiol to show that we're probably in the ballpark range. And then we always look at that relative to symptoms. Right. If you're still hot flashing, maybe you're somebody need more because we don't know where you were when you were younger. And so we. It may fluctuate a little bit, but we're not going to take somebody to 400. No.

That's what people. So, like, I think about the 0.1 patch is the highest number patch you can have. And I cannot get mine past 75 or 80. Like, at the max, it's usually between 60 and like, that's the highest I've ever gotten it. And that's like, if I kind of trick the patches and put two on, you know, whatever. If I, before I take the last one off, put it on.

Like.

So when people hear this is dangerous, like, that is such a still low level. If you think, you know, 50 to 80, it's like, that's a smidge. It's nothing.

10% of what you made at ovulation and less than 25% of what you made ever, you know, on average.

But to get you out of hot flashes and night sweats, it's freaking amazing. Like, why wouldn't we do that?

Protect your risk for dementia by 27 to 37, depending on which Study you look at, that is the thing that terrorizes most people, right? I, I, if I have a heart attack, cool. I probably won't know, you know what I mean? Like, take me out. But I do not want to lose my mind and still have a physical body. Right. That scares people. And three to one, right. If you look at Alzheimer's and dementia risk, we by far exceed men on that. It's not just because we live longer, it's because of loss of estrogen. And so when we're talking about therapeutic doses, we don't need a lot, but we also need to match progesterone with it to help balance it out. So it protects the uterus. But progesterone has its own impact on sleep and anxiety, and it's its own hormone and it's very, very valuable. And to be honest, there are studies using progesterone at much higher levels, particularly around mood like PMDD and other things where it's very, very safe, even in postmenopausal women, for sleep alone with no estrogen. Right. So it's a very, very safe hormone.

Okay. So when every time I interview the wise and, well, girls, which I love, I love them, and they, they're, they have a little bit of a different opinion about numbers on estrogen, and that's what works for them and their community and all the things. But they always convince me that I've got to be cycling progesterone. They're like, if you're not cy are basically drugging yourself, so. And I'm like, that's fine. I'm dragging myself every night. I don't care. I take it every night how I feel best. What's your opinion on progesterone and cycling it or not cycling it. Can you take it every night if you're postmenopause?

Yeah. Yeah. So a lot of the research shows that, so I'm going to give some qualifiers. So, particularly women. So for osteoporosis, estrogen replacement therapy was actually approved as treatment in 1988. And what it showed was that if you cycled progesterone with it, they saw a slight improvement in bone mineral density over a period of time. Why? Because estrogen stimulates bone growth. Right. So there's probably a little bit of play. So there could be reasons to cycle it, but.

Truly, honestly, the impact of it with GABA and the brain, because of how it metabolizes through the liver, it makes a ingredient called allopregninolol that actually helps the GABA receptor. So it's like your natural Xanax. There's enough research showing there's no need to cycle it for that impact. I take it every day because if I don't take it, I can't sleep.

That's how I am. I'm waking up all night.

Yeah, yeah. If I forget it, okay, so there's my day, my receptor date.

That's how I do it. That's literally how I.

Here's the thing to know too. It has to be micronized in order to be absorbed. And it should be taken orally, never topically. Nothing in the research shows that that can protect the uterus. And you can use it vaginally for those that get like way too sleepy on it, which is super rare. Rare. But the reality is it has about a three to four hour half life. Like it is in and out quickly. That's why even some women on progesterone may not help them stay asleep the whole night because it is literally metabolized rapidly. So the reality is it's very innocuous. Very innocuous. And I think it's fine to take it every day.

What about testosterone? I feel that this one's also misunderstood. Sometimes I think it's too highly prescribed. People do these crazy doses because you do feel great on it initially. But we're estrogen's the queen. Like, I feel like we need to be looking at that. Why do some doctors first start with testosterone and why such high doses?

Okay, I'm going to blame this on the pellet industry. So I live in Dallas. All three pellet companies started here. And they were actually all the three same guys that were the Southwest distributor for a company called Sotopelli.

Wow.

They created Biot. They had a lot of ego. You can imagine all narcissists. I'm going to go ahead and say that I don't care. And they got in a fight and they broke up. And so Biot won.

And they stayed. The other two companies had a two year injunction, couldn't do it. And then avexapel was born as soon as that was up. And then another company and so very male bias. And so they prescribed and recommended and even had calculators that would dose very, very high. And I think it was, I think number one, that was sort of the mindset that go in a little testosterone is good, a lot is better. And here's the reality. Our testosterone is at its highest by about 20 and it's on a steady dec line. So by the time you hit your 40s, it's already like nosedive. But the reality is you take a woman who maybe never got above 40 and you get their testosterone to a 150, 200, 300, which is often what you see with pellets. Because I've been in the industry, we started, we used pellets. We were one of the early adopters. And then we started looking at the labs. I'm like, whoa, okay. And we do them in our clinic, in my physical clinic, but we dose way down. But the reality is, a woman getting that much feels what it's like to be a low level man. Yeah. And the reality is, is your libido rocks. You're highly motivated and you're ready to kick ass and take names. And so once you feel that buzz, you'll ask. Women that are on pellets, they never feel the same after the first dose because they're constantly chasing it.

You're chasing that, right?

It's like your crack it. You know, it's your testosterone crack hit. But there's a lot of side effects that come from that. Hair loss, you know, a hair growth, a mini peni. Clitorial enlargement that will not go away when you stop. Wow.

That's right.

So voice changes and other things. So we, we do make three to four times the amount of testosterone in our body than we do estrogen at any given time. We use different measures on labs so it looks different. We do need it. My telemedicine team and my clinical team that prescribe in my companies, you. We do use testosterone, but use it judiciously and we put it back to the levels it should be, not some crazy level that's going to make you feel like a dude. I've had it that I've used every pellet. Okay. Like, I'm gonna put it in my butt and I'm gonna show you. And I. One time I got it, my hair. I was like, my hair is starting to fall out. I had gotten to 400 and I was just like, this is what a dude feels like. I can't imagine. Because a man is easily like, you get predatory. I can't imagine.

You get predatory. Oh, my God.

Yeah. Oh, yeah, yeah. I'm like, hey, babe, what are you doing? My husband's like, trying to cook dinner. I'm like, what's up? You know? And he's. Yeah, it scared him. He was like, you need to chill out. And it was like three months of that.

So it's interesting how everyone metabolizes. So, so, like with the injections with testosterone which can also get you a little too. Too much too. But can you explain the difference between free testosterone and total testosterone? I know that, and I'll use me as an example. I've. The highest I've ever gone unintentionally was about 120 on my 120 on my blood. But my free testosterone still said 2. So I don't under. Didn't understand that at the time. And I feel like a lot of people don't understand that. Where others will say they've gotten theirs too high, but their free was 40. So what does that mean? And help us understand the difference?

Okay, so every hormone in your body, let's start with the sex hormones have a taxicab, right? So a taxi cab is a protein that they stick to, that they ride around on, and then the taxicab is supposed to let them out. So the cab that drives around testosterone and estrogen is one called sex hormone binding globulin. And on a test, it's called shbg. When you give testosterone to both men and women, what will often happen is SHBG will climb with it right in relationship to it for different reasons. Some of it's genetic, some of it's tied to how much is getting made into estrogen, because there's an enzyme that takes testosterone and makes it into estrogen. Sometimes even boron deficiency or other mineral deficiencies can contribute to it. But often, if your total testosterone comes up, but free testosterone is not up, it's still bound to the taxi cab, right? It's still bound to the taxi cab. That's like a crazy New York cab driver that won't let it out.

Yep.

Right. So the other thing is, is in blood work that is calculated, that is not an exact measure. So we don't have a way in blood to see how many of your sex hormones get out and get free. Which is why urinary hormone is very, very good. And why some people use saliva. And saliva has its own challenges too. But that shows you free because they're free when they're picked up. Two mediums in blood, we have to guess free.

When it says something, it doesn't necessarily mean that's fully accurate. Because what you're saying is we need to see how it's actually getting used. That makes sense.

Right.

So that brings me to that next question about testing. Because there are some doctors that are only about blood tests. Some say that the Dutch test is a waste of money. Others want a saliva test. What are your thoughts around that?

Yeah, so, so, so we from a paradigm and also from the research standpoint. The research has been mostly done in blood. Right. When you look at menopausal women and looking at, particularly at estrogen levels, blood is easy because you're probably doing blood work for other things. And we can check things like thyroid and metabolic hormones. So blood, to me is what I call quick and dirty. Right. Are we in ballpark range? Because if it's radically high, there's probably a problem. And if it's radically low, there's probably a problem. I love urinary hormone metabolite testing, like Dutch Humac, Map Hormone Zoomer. They all have major caveats in them because of the way the technology is done. And I'm trying really hard. I have a friend that opened a lab and I just sent her all this research, like, can you build this test for me?

Because there's missing pieces. But those tests, whether it's Dutch Humap, Hormone Zoomer, all competitors, are the closest thing we have to tell you. A number one, how much is out in free and then how much is moving through those liver pathways and potentially getting detoxified. And that's really important because it's not just about the hormones you have or the hormones you're taking. It's how you package them to get rid of them. And even more importantly, even if you're not doing hormones, because again, your risk for breast cancer is actually higher because you have all these other toxins that also go through this pathway. You also have medications like statins and pain medications and SSRIs that go through these pathways. Pathways. So these tests can kind of tell you are you pretty good at most of them. It doesn't tell you all of them, which is a huge caveat, which is probably a whole nother podcast. But, but, but they're helpful because blood tells us generally, are you okay? The urine tests are not accurate if you have almost no hormones. It even says it on the test. It says if your hormones are incredibly low, you cannot trust these results. I don't ever recommend hormone metabolite testing like a Dutch test in a woman who's two years most postmenopausal until she starts hormones because it's a waste of money, because it's not accurate. And we are our team, so that's part of our paradigm. We check blood work multiple times a year. But we also will test a urinary metabolite test and we will do 24 hour also, which is actually the gold standard. But it sucks because you have to pee in a jug for 24 hours. But we will check that.

That.

But it's once we feel like a. The blood work shows it's at that those levels that are therapeutic and we have symptom resolution. Right. Then we go, cool, let's make sure you're packaging it and getting rid of it because that's where we add the beta or the calcium deglucarate in the dim or the citrus bioflavonoids, hops, all these things that help you move those pathways. And I think it's important, but I think it's about timing. And when you and I were talking earlier, it was about the order in which you do things. Things. There's an order to it. The gut needs to be working, you need to be hydrated, you need to be peeing this out. We need to be eating the right foods. Then we add the supplements on top of it to make it work. And it's the order of things. So that is added, but it's added later.

Makes total sense. Makes total sense. What about.

Where people can go get hormones? Because what happens is what I notice is people will say, okay, I'm hearing this, I want to do this. My doctor's not on board. What do you advise them? Is this an automatic let's go find a new doctor. Do you advise telehealth? And I'm going to get into like even why you created yours there but for general that are they don't want to switch their doctor. They don't want to what. What do you tell a woman? Because this is very. This very commonly comes up. In fact, I'll hear a lot of gaslighting and dismissing like they cause cancer or you're too young or you're too past. Whatever. We hear that a lot.

Yeah, yeah. You should just handle it right. It's all in your head. Or they give you an SSRI for your in a sleep medication. So first and foremost we have to understand even gynecologists less than 20% have any training, not even an hour of menopause. Gynecology is a surgical surgical specialty, not a hormone specialty. Endocrinology is barely a hormone specialty. They usually manage brittle diabetics, maybe a few people with osteoporosis poorly and maybe some really bad thyroid people, but they don't generally do that well. I'm sorry, I've yet to find one that's really awesome. But the reality is this is a new frontier because we've ignored women's health for well over all the time, but particularly the last 20 years. They're like, oh, once fertility is over, forget it, man, you're done. We don't need to talk about women anymore. So the physicians and nurse practitioners and PAs, they have to go out and get additional education. Now there's a menopause society that at least is helping a little bit, but they're decades behind the research, quite literally. Sorry, but that's the reality. But at least they're helping women get access. So that's a route. But the reality is if you have a doctor you here, it doesn't matter what your concern is. Medicine is a community service and a customer service business. And doctors hate it when I say it. But sorry, that's the reality. That means they work for you. And if they're, pardon me a prick, you know, dismissive, gaslighting or rude to you, fire them. They don't deserve your money or your business and find somebody who will. And sometimes that means that they may not be in your area because we are, we have the a women's health crisis because we don't have enough providers for women's health anyway. And it might mean that you need to work with somebody on a virtual platform or a community of professionals to help you. Which is all of this is why I, you know, I started my clinic and why I've started the Minerva project because I was just so frustrated by my own experience and then just I had hundreds of women coming to our, my clinic in Dallas going, help me. And I'm like, you're in Canada or you're in North Dakota or you're in California. And so I was just like, okay, we got to do something about this. And instead of thinking about retirement, I went back and got a PhD and said, let's kick ass and take names on this problem.

I love that. So you all, first of all, I think we all deserve to have really good guidance around this and we all deserve to have great education. So I'm going to say, if you're listening, make sure you educate yourself. Like, it's not just listening to this interview, it's listening to lots of conversations. And you will know what resonates with you. Not everyone will resonate with you, but to learn all the different sides, I know when I don't agree with something or I don't, I will try to hear the other side too, because I just want to understand. So I, I think it's important for us to own Deep dive our health. I also feel if you're going to any doctor that you feel dismissed or gaslighted by like, just listen to your gut and leave and find a new one, because that we all deserve to feel seen, heard, and understood by our doctor. So your symptoms are your symptoms. So, so don't let somebody dismiss you. That's really, really important. What I got really excited about, and I had no idea until we started this interview today or right before when we were prepping for it, that she has a doctor Betty Murray has a telemedicine company, you all. So I'm going to link it up. If you go to midlife conversations.com forward slash, get hormones. So midlifeconversations.com forward slash get hormones. I will also make sure to link this in show notes. Whether you're watching this on YouTube or you're. You're listening to it on, wherever you're listening to it, check the show notes. I'll have it there. But it's worth exploring. If you have been like, I want to do this, but I don't know who can help me. This could be an option for you. And she did mention, you mentioned that you not. It's not just the sex hormones. You also help with thyroid. Is that correct? And you could eventually. You said some peptide stuff maybe. Am I missing anything else there?

That's part of the kind of future, future plans. We do some peptides like GLP1s Gipsy. But the reality is, is if you're managing sex hormones, we. We have actually a thyroid problem that happens in perimenopause and menopause.

Yeah.

Yeah. Most people are low. The hormones are a symphony. So when one's completely flatlining, the other ones try to adjust, to manage it. And so we, we don't want to leave that to chance. So we look at all of it and we, we do. If somebody's got like high A1C or their insulin's higher than it should be, we also address the metabolic situation. Right. Because at the end of the day, I'm sorry, people market it. And I see people, particularly telemedicine companies marketing this online. Get estrogen, lose weight. I'm like, dude, that's not how it works at all. Estrogen helps your efforts of weight loss.

But it cannot be the candidate. Yes. Not. Nope. Whole package.

Yeah. And so. And so that's really important. And so we look at all of it. And so, and so the Minerva project really came out of the framework that we built over 20 years in my clinic. And it really is. We've been treating bioidentical hormones in women. Like, I literally saw a woman that we have been seeing for 20 years. She's 82 years old. She came in and she's like, cold, dead hands. You're not taking them from me. All my friends are dying. Breaking hips, you know, stroking out and having dementia. And she's like, I'm still playing tennis with women half my age. She's like, I'm not. I'm not leaving. She was 82. I love her. I love her. I love her.

Wow.

I saw her not too long ago, and I was just like, oh, my gosh. You're a poster child. Right. And she takes good care of herself. She's doing all the right things.

Yeah.

You know, so. So we had 20 years and tens of thousands of patients to create this framework. And so I said, gosh, we need to do this. So we have licensed providers in all states, and so we can do all the contingent United States, and they are trained to do hormone replacement. And we individualize it. Like, some women do well with injectable testosterone. Other people do better on a different method. Some people do better on a patch. It depends on you, and we personalize it to you. And then even more importantly, we're testing along the way, and we're looking at the hormone metabolism. Once your doses are good and we know your symptoms are better, to make sure you're getting rid of it okay. And so, to me, it's like, the right answer. And then we stay in that, and we continue to take care of you. And we always look at the hormone. Like, to me, you've got to look at the hormone metabolism pathways at least once a year to sort of make sure it's okay. And that's what we do. And we start with a conversation just about where you're at, what you're looking for, and whether we're the right person to help you. And then from there, we start with a test and get you started. And you talk to a provider that talks about all the kind of functional sides and then also the prescriber, and then that we get started. And so I think, you know, I was super excited to not only do what I do in a clinic, but to be able to expand it. And we're expanding it, and we're eventually going to build an entire technology platform that'll basically allow us to get the data that's missing in women's health, because I can't handle it. Like, I'm just. I'm like, somebody's got to fix this. And I was like, quit pointing fingers at you. That's why I went, literally, that's Why I went back for a quarter of a million dollars worth of data debt and to do research. Like I needed the research chops to build what I'm building.

So good.

Because it's, it's not just, oh, this is what so and so says at menopause society or whatever. And this is what we're going to do. I was like, I need real credible science because once we have this built, we'll be able to predict Natalie, like you're having this and this and this, this symptoms. Hey, you know what? You probably should do these two things based on the data we have in hundreds of thousands of women or your own personal data data. But until we get the data, we can't do.

No, it's so brilliant.

We can't identify all the other problems women have that we have no answers for because nobody will study women.

So brilliant.

Well, gosh.

Well, thank you so much. I'm gonna. I'm sure I'll have to have you back on for parts two and later because this was so much and we only scratched the surface on things, but thank you so much. I will link everything up in the show, notes you all, where you can find her, where you can go with her telemedicine if you want to try that out. Thank you so much for being here today. Thank you.

Gosh, thank you for having me. This is great.

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