478: The Truth About Hormone Replacement Therapy: Why the Middle Ground Matters Most with Dr. Anna Cabeca

Menopause is natural and mandatory, and suffering is optional. And it takes more than hormones to fix our hormones.

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Oh my gosh, always fun to talk with you. And also again, really dig deep on these topics that aren't talked about enough in a healthy way.

So I've had Dr. Anna on many times before and I'm going to repeat a little of the information, but there's really another area I want to dive into today that I was discussing with Anna before we hit record. So Anna, what I see lately is this, it's kind of like this black and white. Either or there's a team HRT for everyone and there's no outside of that. And if you're not doing it, you're missing the boat and you, you're missing out. And everything that we've been told about hormone therapy being dangerous is debunked and wrong. There's that camp. Then there's a camp of I'm going to just do it natural and I don't need to. And my doctor said no. And I'm maybe I'm estrogen positive breast cancer, whatever it is, and I'm an extreme no. What I don't see talked about enough is this middle ground of maybe it's not for everyone, truly. Or maybe if it is for you, it's not at the levels you think you should be doing. There's this, there's this middle ground and there's this whole other area of our own nervous system. So it's like our DNA and how that's expressed, how we've been living toxic life or detoxing correctly, how that's working in our bodies but then also our nervous system and what that has to do with it. So those are the areas I really want to dive into with you today if you're down with it.

I am. I am. Again, they're not talked about enough. There's a healthy way and unhealthy way and each of us is different and unique and understanding that doing what's right for us and feeling empowered and healthy in our body is key.

So let's start with you've Been doing hormone replacement for a long time before it was trendy. You saw it come and then go and then come again. What are your overarching thoughts about it? Like, give us a, like a general, like, what's your general thought process around hormone replacement therapy?

Yeah, there's a right way and wrong way to do hormones and each individual. So for example, just thinking of my clinic this last week, I had two women coming in in their 50s, mid-50s, same issues, the, you know, menopausal symptom, mood swings, irritability, brain fog, hot flashes, weight gain, without doing anything different. But both of them left with two different treatment plans. Right. So it's really important to customize the treatment and intervention based on the, the individuality of the patient. What's her detox pathways, what's her toxic exposure, what's her stress level, what's her diet and nutrition plan look like, how's her lifestyle and relationships, you know, what else is going on? Because if you think about, like if I, when I think, I don't ever look at one aspect because if you think of this like a bicycle wheel and all the spokes on the wheel are different things. There could be medical issues, psychological issues, environmental issues, relational and list toxins, environmental toxins, etc. Different things. Nutrition, diet, supplements, all of those are different spikes on the spokes on the wheel. So you want to look at what's going on with their health, with their nervous system, with their cardiovascular system and with their endocrine system as well. These are different perspectives to take into account and customize. And women also, you know, right time, right place. Therapy is an intervention is so important. But like I like to say, you know, menopause is natural and mandatory and suffering is optional and it takes more than hormones to fix our hormones.

When someone says that, I'm start with some bold questions here because these are just what I see on social media and what comes up when I anytime I post about HRT or anything that has to do with it, I'll have someone in the comments say my friend or I or my mom or my sister, was totally healthy, did hormone replacement and got cancer. And I don't want to say that that's not true because I'm sure they did get cancer. What is your feelings about that? Is it the hormones that caus it? What. What's your thought there?

Yeah, this is a really important thing to understand is when we have a diagnosis of cancer, what are the underlying causes of that cancer? What's related to toxic burden, toxins, molds, like all the hormone disruptors, inflamma, and the same big part, inflammation in our body contributes to cancer. What's causing that inflammation? What's the underlying reason for that inflammation? What blood sugar control, hyperglycemia or diabetes, insulin resistance increases your risk of cancer, stress increases your risk of cancer. All of these issues have to be addressed. And Natalie, it's such an important question because typically we say that cancers are growing 10 to 15 years before diagnosis. Well, what have we been doing, you know, prior to, even prior to those 10 to 15 years to increase our susceptibility to that cancer? Has it been long term birth control pills, you know, it. What's in our environment, all these aspects and stress as a trigger is huge. How is our body detoxifying estrogen and these hormones? I had early on in my practice, I had a beautiful 47 year old woman who came in to see me and she'd had seven years prior a diagnosis. So in her 40s, early 40s, she had a diagnosis of stage one breast cancer. And, and when she came to see me seven years later, she had, you know, all the menopausal symptoms, brain fog, mood swings, vaginal dryness, tore when she tried to have sex with her husband. And you know, she was like, I have to do something, I can't live this way. So the first thing we have to ask is what caused your breast cancer to begin with? What did your doctor say? I asked her. He never addressed any kind of cause. And so went through her history and you know, she worked in a pulp mill which had high, you know, formaldehyde and she lived on a farm which was heavily sprayed with glyphosate. And you know, she had diarrhea, irritable bowel syndrome for a year. Her vitamin D level, so blonde hair, very pale skin. Her vitamin D levels after her breast cancer diagnosis, and this was seven years later, no one ever checked them. The vitamin D level was 17, so well below the 50 that we think, as you know, the beginning of optimal. And so there were these issues that we had to. And then I did a genetic panel on her as well to look at markers for methylation, for sulfation, for glutathione. I wanted to look at these markers because I want to do something healthy for her and I want to empower her body. But if I don't address the underlying reason she got the cancer to begin with, I, in my years of practice, you know, haven't seen using bioidentical hormones cause cancer. There's always an underlying cause but we have to address those detox. When we're prescribing and using hormones, we have to make sure our body's detoxifying them in a healthy way. The gut has to be healthy, the liver has to be healthy, glucose metabolism has to be healthy. I mean, all of those aspects are really important. So once we got through that initial phase of detox and addressing these issues, optimizing vitamin D, we used hormonal therapy. So that was early. That was early on. So she's now 70.

Oh, wow.

So. Or six. Yeah, 65.

So I have a hypothesis and maybe I'm onto something here. Maybe you're like, many people have said this. Or maybe you're like, no, Natalie, you're completely off the mark. But I'm going to share it because this is just what's coming to my brain. So we're all genetically different. And when you do genetic testing, which I'm a fan of and so is Dr. Anna, and you have. You show that you don't have amazing detox pathways for estradiol, for example, what happens is before menopause, you have a period every month. You have a. You menstruate, so your body's producing hormones. You have a period, it cleans out all the guck. So use estrogen, everything comes back out. So then you're. So your body's producing it, it's cleaning it out. So then what happens is perimenopause, that slows down. So then, now menopause, you're not cycling anymore and you are adding back in hormones. Like. Like I am estrad. Your body no longer has menstruation every month. So what happens with those used estrogens if your body doesn't have good detox pathways? So my theory is again, based on nothing but Natalie's opinion here. And I'm not a doctor, so that's why I'm asking you. In my. In my brain, I'm thinking, Detective.

And yeah, because I'm a.

If I'm. If you're taking hormones and you're not menstruating and you don't have great detox pathways unless you really pay attention to how will I get my body to eliminate this Things like broccoli sprouts or calcium deglutarate or even maybe dim in some cases, then that could build up and create a cancer or a problem. Am I like completely whack here or is this make sense?

Well, no, it absolutely makes sense. You have to have those detox pathways open. And this is what we know from the science. But first I want to go back to that monthly menstruation, which I didn't think about this until you said that. Monthly menstruation, right. We're cleaning out the uterus bleeding, but it also gives us, we have to re, you know, we're going to rebuild that blood supply over that month. So we're increasing our own stem cell production. So that's got to help us.

Right, so now Harvard needs me to speak clearly. Yes, I'm just kidding. Well, but it's making sense to me that if you're not bleeding every month, where is that going? So and if you are already, if you're going into hormone replacement, not metabolically optimized, or you've got other things going on, maybe you were exposed to mold, maybe you've got excess wheat, whatever it is, you, you list the thing, high cortisol, like you mentioned, now we're adding hormone replacement and your body doesn't have a cycle. We have to think about where is that getting stored. And it's going to get stored in fatty areas which like could be your breast and that could be breast cancer. So I feel like saying that hormones, hormones don't link to cancer is not true. Like it can depending on your own the way your body is maybe.

Well, according to the research, when we look at that. So if we think of the science and go Back to the 2002 Women's Health Initiative study, it was looking at oral premarin, which is conjugated equine estrogen. So that's pregnant mare's urine. So premarin and there's over 30 estrogen and estrone prominent. So it's more of a toxic estrogen to ourselves. So we had that study and even in the oral progesterone only arm that did not have a significant increased risk of breast cancer. So even that 20 in the 20 year follow up study that was published last year or year before, it showed that, yes, that estrogen only arm did not have an increased risk of breast cancer. What was significant with the increase of breast cancer cancer was the progestins, the synthetic progestins, and that was Provera Medroxyprogesterone, which is a pregnant derivative of a progesterone. So it's a more toxic form. And in 2008, Dr. Fournier published his EPIC trial looking at estrogen and progesterone, really looking at progesterone in the, in the, in the men in perimenopausal menopausal women and looked at different forms of progesterone, oral micronized progesterone, which is bioidentical, and then the Provera. So pregnane and nor pregnane, like nor thindrone, different types of progestins which are not progesterone. But the literature has been really confused about that. And what they saw was an odds ratio increase with the pregnane derivative, so like Provera, of three times the risk. So we saw three times risk, but with progesterone we saw no increased risk, a one to one ratio. So we can look at that and say, hmm, all right, even in the non ideal detox clean population. But these are Europeans, so they don't have the levels of toxic burden that we have here. So if you look at that and you can say, okay, well the oral progestin should be just a straight no. Well they're in birth control pills, right? Women, I've been on them for decades at this point. And that is toxic to, I mean that is, we know it's a toxin. It also depletes different nutrients, B vitamins, magnesium. It burdens our detoxification pathways. But then we also had last year published the 10 million woman study which looked at a Medicare patient, so that's your Medicare, typically age 62 or 65 and above, who are on different forms of hormones. And then looking at these different forms of hormones found that the bioidentical hormones did not increase morbidity and mortality.

And this was everything they looked at. Estradiol test, like all the, all the different ones.

All the different ones.

Interesting.

Yeah, yeah. And so we can look at that and say, okay, but is estrogen like if we're using hormones on a, with high toxic burden, inflammation, diabetes, cardiovascular disease, autoimmune issues, and we are not addressing any of these underlying issues, could we potentiate something? I think that that leaves us to keep that as an open question.

Then I have another hypothesis based on nothing that I'm going to share because I go down rabbit holes here. I believe personally for me, and where I feel safest is doing levels that are enough to get you out of symptoms and be somewhat preventative, but not trying to replace to levels of 10 years ago, 20 years ago at these high levels. And it concerns me when I see some protocols out there like the very known Wiley protocol, where it gives you very, very, very high levels of things like estrogen at certain times of the month, trying to mimic a cycle. So where just to give you all numbers, if you've done blood testing and hormone replacement Post menopause, you could range all different areas. My personal like estradiol was like 15. It was super crazy low. And by me doing a patch, topical patch, I get it to about 60 or 70, which is conservative. It's definitely not on the height. It's just, it's just enough to get you get my hot flashes out of. And there's some studies that it'll help protect brain and bone and things like.

That and bring your FSH down.

Bring my. Which my FSH is not perfect. It's still kind of up there, but it's, but it's. I want to talk about FSH in a minute, but I have friends that will do estradiol cream, for example, or inject or oral to get it up to 500, 600, these really high levels. And then they'll do that for half the month and bring it back down. And to me that feels risky because we're not truly cycling and that's, that's very high levels. Trying to biohack something from years ago. So I wanted to get your opinion on that. And if you think that's dangerous to play with that.

I definitely do. You know, I've seen high doses of estrogen and estrogen pellets users and high doses of testosterone early in my practice, the 90s and, and early 2000. And you know, when you have a client with those issues with those high levels, I mean they're, I mean that's high toxic burden. You're also, you think about our entire nervous system. It has to function properly. It's suppressing, you know, those high levels are going to suppress the HPA axis just like what birth control pills do. They, your ovaries shrink. We know that high testosterone replacement in men at high doses shrinks their testicles. Right? They, you know, they shrink and that's can do things to prevent that shrinkage, but that's a consequence because when you stop, for whatever reason, you have to stop finances change, you move, your doctor moves, or something else happens in your life where you're like, I can't get these prescriptions anymore. Now you have your high risk. What happens? Clinically and scientific research has shown high incidence of depression and suicide. So what have we done to that HPA axis? I always want to enhance the body's natural product processes versus suppress them. So I think that's really important, you know, and, and when we're on hormones again, that hormone detox is just needs to be part of it, part of the plan, part of the program. And I never want to do anything at such high levels that I'm suppressing your body's own natural function. Again, there's no, there's no research long term on these high levels.

Do, does the ideal level vary for every one of your patients or do you like to see like a specific number? And I'm talking post menopause right now. Like, do you like to see a certain number, like, range that you like?

Yeah, for estradiol, it really depends. But like, you know, 50 to 80, 60 to 80 range.

So like what I said I was. Wasanna is my doctor, so that makes sense. So 50 to 80 is like, that's what you like to see because it gets them out of symptoms and it feels good. So do you when you see somebody with much higher levels, is that when you start questioning detox to make sure that's all happening?

Question detox, question how much they're using and you know, and how they're taking it. When did they get their blood work after they took, say if they're on an oral estrogen, they took their oral estrogen and then did a blood work that morning. Well, that would explain why it's high. So you still always have to, you know, treat the patient, not the labs. But you have to figure out when we're testing. And that's been a question we had. Okay, when did you put a patch on? How many days after before you change to the next patch? Let's look at, you know, try to do that reproducibly and see what's going on. Yeah, so I think that that would also. I'd also question. I always look at, you know, if someone I'm managing on hormones, I want to do it safely. So I'm going to look at the estrogen detox pathways and the estrogen metabolites, the two methoxy and hydroxy estrogen, and 4 and 16 hydroxy estrogen pathways. Because that gives me an indicator how their epigenetics are working together.

By the way, this is really an important thing you just said. Now, I have two doctors that I work with personally. They both are friends. I'm not going to mention the other one's name right now. But they differ on this, however. So my one doctor, she's like, nope, we just do blood for hormones. That's all we need. And I like Anna's approach. So I do my hormones through Anna because she doesn't just look at blood serum, she looks at urine because that's the only way to know how it's detoxing. So if we just go off of blood serum levels at any given time. First of all, they can vary, but we have no idea how that is going, how that's changing in your body over the day. Did I say that right?

Yeah, absolutely, yeah. And, and there's different ways to look at hormone. Like our body fluid tells us something. I mean, for heaven's sakes, it was a 50 billion dollar industry by G pregnant mare's urine, right? That became we were because there's so many hormones in it. So why won't we look at what that is? What is our body doing? Right? What is it? Maybe the support around that's I think a key part. Our saliva tells us something different. You know, I, I don't use salivary hormone testing if someone's already on hormones. But on rare occasion I will, you know, I want to make sure the gut's healthy and I, and looking at their blood markers, we also gives us another picture because you can have certain levels in the blood but very different presentation in the urine. And so that helps me understand what your body's doing with these hormones. Are they using it? Are your receptors receiving this hormones or do we need to do more to clean up the hormone receptors? So use this hormone versus, you know, just giving you more hormones. More hormones. More hormones.

Before I ask you about progesterone and testosterone, which I'm going to in a minute, I want to ask you about estradiol versus like bias and also the forms like I'm again confusing for people. I've heard that the oral or the injection goes through your liver where topical, like a patch or cream is safer. And then I've also heard from people that bias, including me, bias did not work at all. Can you help us understand that? Like, what's the difference between all of this?

Yeah, yeah. So different modes of delivery. And then of course there's estrogen pellets as well. So oral estrogens do get metabolized by the liver first pass metabolism is through the liver. And that's where we really need to make sure, you know, our detox pathways are working optimally. But it also increases inflammatory markers. And oral estrogen has been shown to increase your risk of strokes. That was shown in the Women's Health Initiative study, that was shown in the hers trial in the 90s, that we know oral estrogen does that. So we never want to use oral, you know, oral estrogen and someone at, you know, at risk or without checking their cardio, you know, their cardiometabolic status. So what was the other Part of.

The question about bias versus estradiol, what is bias?

And like, biased is E2, E3. You may have heard, like, triest is E1, E2, E3. Biased is E2 and E3.

What does that mean?

So estradiol and estriol, these are other hormones that our body produce with different types of estrogens. And. And so estriol is the weakest form. It's really predominant in pregnancy. It has some immune supportive effects, like estriol has been studied in people with multiple sclerosis to reduce plaque plaque formation and improve cognition. So estriol at high doses, like, at 8 milligrams, there were studies back in the early 2000 that looked at that. So it has a beneficial effect. Now, you know, how much does that help with hot flashes? So, you know, very little. It can help support skin. It can help with vaginal.

That's what we use for face or for vaginal. Correct.

Estriol and estradiol is our, you know, is a potent estradiol. And you can get that in patches, vaginal rings, sprays, gel compounded, compounded. The. The combination with estradiol and estriol. Some people have a hard time absorbing the creams. The topical creams don't absorb them as well. And the patch has a good delivery system. It's straight estradiol, but it has a good delivery system, and it gets well absorbed. We can see those numbers in the blood.

So if we're using estradiol patches, which a lot of people are, including me, do we. Should we be adding estriol for those other benefits? It seems relatively harmless.

Well, we spend a lot of money on skin care. I know. We both do. Right. It can be expensive, so we can see how that works for us. But then the estriol for hormonal support, I don't know that typically. You know, I think it's something to consider for topical benefits and for if, you know, additional immune support.

Okay.

There are indications to. There's benefits to use it. I personally use a combination of E2, E3, so I do. I do well with it.

Do you do a patch and then a cream? What do you do?

I do a troche.

A troche. So is that. Does that considered oral, then?

It's considered submucosal or buccal. But you are swallowing a little by.

Watch, going through your liver still.

It's a portion of it's going through the liver, but you're also getting lymphatic absorption, salivary absorption.

Okay. So when. Oh, by the way, on the patch. Anna. Dr. Anna and I figured this out kind of by accident, but because I'm a patient of hers, I'm on the patch. I've been on the patch for probably a year and they were working great until a few months ago. And I was like, why all of a sudden are my patches not working? Like, I've had to replace them a lot more. I've doubled up on them. Like I get hot flashes and finally figured out that I was on the name brand. And then when I switched to cvs, they switch it to a generic. So I'm not knocking the generic, but what I learned after we figured this out is that the name brand is. There's a variant, so it can be a lot less. So if you are like, have been thinking your patch doesn't work, definitely try switching brands.

So.

And you're. We also learned this. Like, like mine goes through cvs. We learned that she. We had. You have to have your doctor physician, literally. Right. Do not replace and do it with the name brand.

Yeah. Do not substitute or substitution not permitted.

Yeah. As like I'm recording this. I still have two of the other kind on because it's like literally it takes two every few days in order to get that. So can't wait.

That was good detective work to figure that out because we were blaming it on surgery, everything.

No, it was literally this. It's. I. Who would have thought? I didn't. It didn't even occur to me. And now that makes sense. So, okay, so if you are on estradiol, your or estrogen replacement according to Dr. Anna. And again, you want to talk with your doctor, but the recommendation sounds like you ideally want to work with your body, considering. But between 50 and 80 postmenopausal is a great number. It's a safe number there studies support that. Est, serum levels, serum levels, serum levels. But it's important to also be testing the urine. So that could be a Dutch test. There's other methods, but the urine test, which tests how your body is detoxing it and then bias kind of up in the air whether it's. It definitely was not effective for me, so. But again, up in the air for you. But the estradiol is what is actually going to help with the hot flashes and the mood and all of those things when it comes to testosterone. I've got some questions here. Now, my first question, before I even talk about testosterone in general, what the frick does it mean when they say it's aromatizing to estrogen?

What does that Mean, so the way you know it, pathway pathways that will go, it will either. Testosterone will either convert. So it just means conversion.

Okay.

Convert to dihydrotestosterone, a potent form, and that's a different enzyme. 5 Alpha reductase pathway versus testosterone will convert aromatize to estrogen and both men and women. So if you've ever seen guys with boobs, right, male boobs, they're making too much estrogen. They're converting testosterone to estrogen.

So is that a good thing for women post menopause? We want that.

Well, it depends on your genetics, right? It depends on your genetics and whether you do it and you'll naturally do it. Testosterone converts estrogen. That's how we make our estrogen. But in times of stress, we're going to activate that 5 alpha reductase and then we'll get to the dihydrotestosterone and get male pattern baldness, acne, weird hair growth in weird places. I don't know. But so it's important to know what your body's doing and that you can't figure that out in a blood test. You really need to look at that with the urinary pathways.

Okay. If it does aromatize to estrogen, which is.

Yeah.

Is that usable estrogen? Is that.

Yes. Yes. That's how it. Yeah.

So it can actually help your estrogen levels if it's doing that.

So we basically circulating in our blood, we have a lot more testosterone than estrogen because testosterone converts to estrogen. It also converts to dht. But that's how we get our, you know, we get estrogen through this testosterone conversion.

Okay, so, okay, now testosterone in general. Let's talk about that for a minute. I like, I feel like mine's not working currently, but I'm not talking about me. I want to talk about everyone listening what we talked about numbers for estradiol. What do you feel is ideal or safe for women, aside from they're all being warned about the hair and the male pattern partners. But a lot of women, including me, wanted it for sex drive. We want it for that focus and energy and we want it to help building muscle, retaining muscle. Like, what's the right number? And is there any besides the male pattern baldness, which is obviously a big thing, and the acne and the hair loss, clearly that's from a lot. Is there like an ideal number you like to see people at? Do you recommend all women explore this or do not all women need to do this?

So. Yes. I mean, testosterone is important hormone as Looking at thyroid hormone, even more important than looking at estrogen, because, again, testosterone converts to estrogen. Estrogen. So we want to look at this, and it is important in a holistic, you know, for a holistic approach. And not just. Again, if the testosterone is low, we can assume if we're 60, that it's going to be low. But we still have to ask why? Because we have people in their 20s, 30s, 40s that have low testosterone. We have to ask why? What's going on? Is it, you know, the toxins, hormone disruptors, blue lights, smartphones, EMFs? I mean, there, there are scientific studies showing these things absolutely affect your testosterone level and fertility and virility. And so testosterone, again, because we have more testosterone than estrogen. I don't know. We. I don't know how estrogen got all this press, honestly, but it's. It is important. But testosterone's like, big one.

Well, how. I guess it's confusing. Okay, so, like, I'm gonna, I'll just, I'm gonna just pull up numbers. Like, a lot of people, like me included, we have total testosterone goes higher, but our free testosterone is too low still.

So what is that, hormone binding? Yeah. Because when you're really insulin sensitive, your sex hormone binding globulin is high. And again, this is why I always check sex hormone binding globulin. Okay, so SHBG for short, sex hormone binding globulin. So you can have a great amount. Like if we say, you know, conservatively 40 to 80 on testosterone, on total testosterone or on total testosterone levels, if we're using pellets, it could be in the hundreds to two hundreds. I don't like to see it above 300. There are people that love it there.

Yep.

But. But typically, I think you'd be helping everything at 300.

That would be a crazy sex drive.

Yeah. Well, and it. And it really depends on how. Like, when I say that level, I say if you're not on hormones, you want to see it there. Optimally, if you're on creams, we're not going to see it as much in the blood. We will see it more so in the urine. If you're on vaginal, we'll see it in the BL and urine. If you're on pellets or injections or trochees, we'll see it in the blood and urine. So. But cream, sometimes, like, you can be on a cream, you're like, I'm not seeing a bump, but I feel better, I'm doing better. And that's where it gets dangerous. The doctors will keep going higher and higher and higher, or you'll be taking more and more testosterone. Then all of a sudden it stops working. Yeah. All the things that you felt like, oh, I no longer have the libido, I no longer have the drive. My numbers are good, but I'm not feeling it. I think that has to do with the HPA suppression. We really need more study in this area. But, you know, that's one of the consequences. And so when your sex hormone binding globulin is high, your free percent free testosterone percentage goes low is gonna, you know, you're still not, it's bound, it's not bioavailable.

So you're basically taking it kind of for nothing. It's not really doing anything.

I think it's still doing something, but you're not getting as much benefit. And we need to. That's when we'll have to work on increasing, you know, naturally, trying to get your sex hormone binding glob being a little bit lower. Or you may need more testosterone in these situations. But a free percentage of 4 to 6% is good. Okay, so I have to go to 10.

This is another Natalie ism, being a detective here. So again, Natalie with a mic. Not doctor's advice, but Anna knows probably what I'm going to say here. So this was, I was on injectable testosterone, very low dose. I think it was like 5 milligrams, the right amount.

That I.

Am I saying that right? I don't know. It was a very low dose of injectable. And what was happening when I first started doing it, I'm like, I love this stuff. It was amazing. And then what I realized is I was refrigerating it. You're not supposed to. So usually it comes with, it's in MCT oil or something else. So whatever I was doing, I think the, my theory is the oil was not coming into my syringe and I was probably getting very high straight testosterone, which explains why, I mean, I'm sure my husband was very happy. My sex drive was like, what is going on?

So when I learned receptors were prime because you had been low, and then all of a sudden give it to you and you're like, woo, yes.

So then when I figured out you're not supposed to refrigerate it and you're supposed to do the right amount, it's not working quite the same. So I'm still figuring that out too. But so note to you all, you can't refrigerate it. Like, I know we refrigerate other peptides like BPC137, whatever. You cannot refrigerate your testosterone any. Some people do injections like once a week, some say twice a week. Do. Any preference on that or on how they're doing that? And what are your thoughts on pellets in general?

Yeah, it depends. It. Well, for injectables, I do like testosterone injectable, you know, but it's a pain in the ass, right?

Like, I don't think it's a pain other than it gives you a big fat needle because it wants to go in your muscle.

Yeah, Well, I mean, it just one thing. You just have to remember it. But once a week is nice.

Okay.

So. Okay. So with testosterone injection, it really depends on the individual because when you're getting. Getting that, say 5 milligram, 10 milligram dose, you're gonna. You have a peak in three days and then it's down to your next dose. And some people, for some clients, it is better. For men, we do usually twice a week injections, but for women, typically one time a week is good, but it depends on your metabolism. If you're a rapid metabolizer, twice a week gives you more stability. And again, a little bit goes a long way. That's what I do with testosterone pellets. I used and trained physicians and testosterone pellets. And I dug deep into the research again in the early 2000s and. And one of the things that I noticed, I mean, and I used palette like, this is the perfect person. When I put a pal. When I had a pellet put in me, I mean, I was the perfect person to do because I was crazy. I was like, I was single mom, kids are in schools, three different schools, running a business, running a med spot. I couldn't remember to take a vitamin, let alone anything else. Pellets. I'm good four to six months. That's good. And then I also, I studied the work of and had known and lectured with Dr. Rebecca Glaser out of Michigan, who was a breast cancer surgeon who uses pellets sometimes with an astronaut, an astrozole. Did I say that correctly?

Astronaut first. That was kind of funny.

Astronaut.

That's going to be the clip. I pulled something.

And you know, with. Yeah, so with aromatase inhibitor in patients with breast cancer, but would use these higher doses and found testosterone to be very safe in these situations.

Aromatase inhibitor mean it forces it not to convert to estrogen.

Right. In patients with breast cancer, it's got it. Yeah. So she Was she was using it as a treatment. Androgen therapy for treatment. So we know, like, testosterone therapy is safe. You got to know where it's going to make sure those issues. But again, the functional medicine approach is to look at all the aspects. The gut, the inflammatory, you know, liver, the kidneys, the bowel movements. You have to. And whatever you're doing, if you're on hormones, you have to be having daily bowel movements at least once a day, ideally twice a day. Oh, yeah, you've got to keep those details. I mean, that's part of the elimination. That's basically no hrt.

That's the sign. Okay. My other doctor, who we're friends with, who. I won't mention her name right now, but I'll have detectives to figure it out, who I absolutely love. She's brilliant when it comes to stem cells and everything else. I asked her, I'm like, should I switch to the cream instead of the injection? I feel like I don't feel it because she prescribes the testosterone. And she said, if you want to grow hair on your arms. I was like, wait, what is that a thing? Do we grow hair where we put.

This is funny because one of the lectures that I heard recently was talking about testosterone. And she says, you know, she rubs it on her inner leg. So what if she's like, what if I get hair there? No big deal. But you could see a patch of hair on her.

Oh, that's funny.

I was like, oh, yeah. I was like, you know, for my clients, I'm like, vulvar vaginal area. So you make an increase in hair in the vulvar tissue, but it's perfectly safe for the vulva and the clitoris. You get great. You know, you get. There's no hair growth on the clitoris. Right. But you get that great. It's a pleasure zone. So you get that increase in sensitivity and pleasure without the consequence of hair growth. So vulvar vaginal areas, where I recommend using testosterone, you can rotate it on other areas because it's also good for the skin. Yeah. We'll reduce fine lines and wrinkles, but yeah. Okay. If you're using it on your chin or, you know, on.

I wouldn't be doing that. I would put it on my.

Like, it's a waste. It's a waste to put it there. Put it on the. You know, put it on your clitoris now.

Okay. Okay. All right, I'm going have to get some cream. Okay, talk to me about progesterone and do we have to cycle It. I. Okay. And I know what she's going to tell me, but I just for the record, I was not a good patient here, and I refused to cycle it because I can't sleep if I cycle it. So that's not what Anna's going to tell us. But talk to us about progesterone and why and if should we all be taking it? If we're doing estrogen replacement and do we have to be doing estrogen with it? And how important is cycling?

So, okay, so let me tell you a story. So one of the things that I learned about progesterone, because as a, you know, as I trained at Emory University in Atlanta, and we were taught that if a woman does not have a uterus, she doesn't need progesterone. Because the research on Premarin had, when women were just given Premarin, take that purple pill advertising anywhere, everywhere, do you want a happy wife? Make sure she takes her Premarin? I mean, the advertisements were truly obnoxious. And so every, every woman was getting Premarin. They felt better. It's great. It was a good estrogen and, you know, combination of estrogens until they started getting endometrial cancer. And then they're like, okay, Wyeth errors actually did research in the drug metabolism department at Wyeth Errors before medical school. So, so why there's the makers of Premarin at the time, they've been bought out, but they said, okay, well, let's come up with another drug. So they came up with Provera, the progestin. Okay, couldn't patent progesterone. And when we did get prom, which is bioidentical progesterone, they didn't patent the progesterone, they patent the delivery system. So that's why we had this form of bioidentical progesterone we could use. But anyway, Wyethairs comes out with Provera. And then we, you know, then what we saw was later an increased risk of breast cancer and heart disease. But that's why they said because of the negative cardiovascular effects of Provera, if you have a uterus, you know, first of all, if you don't have a uterus, you don't need progestins. That was, that is what clinics, you know, that's what we were taught. That was in our textbooks. And that's still maybe something you hear from a physician. But I had dug into progesterone research early on, and when I started using it for patients who'd had a hysterectomy and they come back and say, Dr. Anna, like I feel like so much better the word. The world went from shades of gray to multicolor again. Like it is like, yeah, I feel like my old self. I feel like the cloud has lifted. I heard that over and over again. So I started studying the neurochemistry of both progesterone and pregnenolone, these two mother hormones derived from cholesterol and it is a neuroprotective hormone. It can metabolize into allopregnanolone and derivatives and that increases gaba, the nerve. Every hormone, progesterone, testosterone, estrogen, have like a sister neurotransmitter for progesterone. It's gaba, testosterone, dopamine, estrogen, serotonin. So you can't separate the brain and the body in this, right? So, so that GABA helps you get a good night's sleep and is restorative. It's a neuroprotective. It helps with mood, helps with bone health. So why would we limit that benefit to women with only a uterus? And why would we limit, why would we not offer it to women in general for preventive maintenance?

Okay, why do I have to stop doing it and cycle it?

So there's some insist on that because it is one of the mother hormones, right? Because you know, we go from pregnenolone or progesterone to dhea, testosterone and estrogen. Like this is in a cascade. So with progesterone and pregnenolone. So these are higher up hormones and they're hugely. They're the most abundant from our sex hormones. They're the most abundant hormones in our body. They have neurologic nervous system, cardiovascular, orthopedic benefits, right? Have all these benefits and skin and hair. Figure that stuff in there. And so we have these, you know, we have these mother hormones and it can like if you're doing the often we like 200 milligrams, 400 milligrams oral versus transdermal. And so when you're on these doses, you can potentially suppress like birth control pills, the progestin, suppress the hpa. You get a. You could have. So theoretically you can become more resistant to the benefits of it. Again, filling the, you know, tank to overflowing versus allowing receptor sites to have a break and be continually be responsive to these hormones. So there are some people say, nope, absolutely do them every day, no problem. Should not make a difference yet. I think there's in more research that needs to be done regarding that I.

Like to say, do you have more stubborn patients like me that refuse to not take it every day?

I absolutely do.

Okay.

I absolutely do because you can't do. But eventually you'll be able to. Yeah, right now, no. But eventually you'll be able to. Like in, in general, when I did my 92 hour dark retreat in the dark, I detox from everything. No hormones, no whatever, no thyroid, no hormones. And you know, just like I'm just cleaning out everything. What can my body make make for me? And so it's not a bad idea to do periodically. But again, there are seasons for a reason. If we mimic mother nature, there's always a winner. Yet in science, we need more research on this, we need more support. I have found that when I do, when my clients do take eventually in the perimenopause, early menopause may not be able to because that night's sleep is so, so important. If you're not able to get a good night, night's sleep that you're not gonna, you're definitely not gonna like me or like taking a break in that progesterone. So it's okay for now, but you know, it's a good. I, I think we, we need to see what happens. I know that in clients that long term have been on hormones, it's just like a three day detox at the end of each month talking and oh.

What we skipped right there. And I'm gonna get into how doctors are medicating people through because I want to talk about that and I still wanna talk about nervous system. But what I skipped was what is supplementation wise? I mentioned three that I like for detoxing estrogen is. Does mighty maca include all that like to help me help us understand like so like I personally, I know broccoli sprouts. Like just eating broccoli sprouts or even getting freeze dried or powdered, which is what I actually use because I can just take a spoonful, is one of the safest, easiest ways I know to help detox estrogen. But I don't understand why can you help with. Why does it, why does broccoli sprouts do that? And talk to us about dim and calcium deglutarate and also mighty Maca.

So these are so like the broccoli sprouts are rich in sulforaphanes. Sulforaphanes help with detoxification. So we think of the pathways to detox phase 1 and phase 2. Phase 1 is the hydroxylation pathway, phase 2 is methylation glucuronidation and sulfation. So when we're looking at, depending on what your genetics are, right. If you have impaired genes, like say for example, a GSTM1 heterozygous or homozygous gene, and you're not, you're not making glutathione, you're not detoxing, you can make more four hydroxy estrone, which we do associate with higher risks of immune issues, breast cancer, et cetera. So we want broccoli seed extract or broccoli seed these. Can these sulforaphanes help support that pathway?

Does it help, aside from estrogen detox, does it help with detoxing other things by taking.

Oh, yeah.

Okay. So it's just a good thing to take.

Helps with.

Yeah, it's a good thing.

It's a good thing to take. It's a good thing to include like broccoli sprouts in your diet.

Definitely. Which I do. I do broccoli sprouts every single day. It's like harmless. Now, calcium deglutarate and dim. If I did that every day and a lot of people, you would basically counter your estrogen. So you're actually going to start getting hot flashes again. But what's the proper way to use those? And do you even like those two things?

Well, yeah, definitely. Again, it like, this is where, looking at your hormones closely and also your symptomatology, do you have estrogen dominance? And this is where dim can be very beneficial in calcium D glucarate in clients with estrogen dominant symptoms. And you can take it for perimenopause, you know, and PMS symptoms. You can just take it two weeks, a month, for instance, and it is helping the methylation pathway. And then calcium deglucarate is helping the glucuronidation pathways. So the three cover all three, but what? Exactly. And that's why many hormone detox supplements have all three in them, because we're covering it all.

What I personally do, I do broccoli sprouts every day, even when I travel. I do the powder. I do calcium deglutarate once a week, and I do dim once a week. And then in my head, that's how I'm detoxing with those.

Well, and then we're gonna retest. But the key thing was you noticed that doing it daily, you had hot flashes. Again, we haven't changed your hormones. What else are you doing? What's going on here? And that's where you have to be your own detective work.

Now, does Mighty Maca have any of that in there?

Mighty Maca has milk thistle. It has. It has a lot of crucifers in here. Maca itself is a cruciferous vessel.

So that's going to still help with that first part of the detox. And then I would imagine, what was the first, the how, what does milk thistle? And milk thistle helps your liver. Correct. So it's going to help with your liver detox.

Yes, got it. Milk thistle helps with liver. There's vitamin C in here, the acerola cherry, and it does have the brassica. So it has the broccoli stem and floret. Like, essentially it's flour. It's the leafy part of the broccoli too. So it has both.

So you're going to get detox from taking Mighty Vodka.

It does support detox. We definitely see improvement in liver enzymes. We see an improvement in inflammatory markers. So we do see an improvement with that. But for someone with estrogen dominant symptoms that persist, like, that's why for me, it's foundational. Mighty Maca is part of my foundation. How do you do with it? I know I'm helping your adrenals, I'm helping with detox pathways, I'm helping with glucose stabilization. But then what else do we need on top of that?

Yeah, and by the way, could you speak into this real quick because you just brought it up. Estrogen dominance. You can be low estrogen and estrogen dominant.

It absolutely. I really look at estrogen dominance as progesterone insufficiency. And the other reason for estrogen dominance is the hormone disruptors and toxic, you know, and, you know, estrogen mimickers that are in our skin care products like parabens for interest, for instance, that's a hormone disruptor.

And it is so important to learn ourselves all this information because otherwise you like, I'll tell you, when my estradiol was a 20 on my labs, a 20 and I was having massive hot flashes, my previous doctor, before Dr. Anna told me I was estrogen dominant, put me on dim. Do you know what a disaster that was? Like, talk about, I had hot flashes like five an hour. So because in her mind, estrogen did not. I'm like, but I have no estrogen. So that's why we have to learn these things.

You needed progesterone first. And typically my order of supplementation for patients, like in doing this holistically, I do detox, support your adrenals. I start them on Mighty Maca, support your adrenals. For me it's my keto green method, intermittent fasting, because we want to manage insulin, increase our insulin sensitivity, and then it's progesterone and pregnenolone and then DHEA and then testosterone and estrogen, usually in that order. Sometimes estrogen then testosterone depends on, you know, really depends on what you need.

What about the doctors that just medicate? They just say it's menopause or it's perimenopause. This is normal. Here is an antidepressant and birth control pills, right?

And that is still widely used today. And this is a disservice to the human body. It really is just a disservice to the human body. And as I mentioned, every hormone has a sister neurotransmitter. And so is it, you know, is anxiety, depression, is it bipolar or is it your hormones? And usually you fix your hormones, support your detox pathways, get some good night's sleep, add the right micronutrients and nutrients and supplements. And I honestly haven't written a antidepressant in years for patients because they feel better. And you again, part of my platform though, of course, Natalie, you know this. It's always to do things to increase your oxytocin level and to manage stress. So we increase oxytocin and it makes all the difference in your body and that's. We make it within our body. So being able to incorporate these things makes a big difference. I'll share with you on this because we talk about nervous system and these issues. I had a client in my office several months ago. I had her follow up yesterday. But when she first 51 years old and, and menopausal, when she first came to my office, she could barely sit in the chair. She was anxious, she was jittery, she was nervous. I'm like, okay, what are you taking? How much caffeine have you had? You like, nothing. She's not like, she was totally anxious and like really friable, right? And okay, we had a first we got to work on vagal tone, get you into your body. She's like, well, I want to adjust hormones. I'm like, we will get there. Let's let. We'll definitely cover your hormones, but this is not your hormones. Like, this goes beyond your hormones. And then as you know, follow up. I really talked with her about oxytocin. And for her, I did prescribe some oxytocin nasal spray exogenously just to use to get that feeling. She's feeling like she's going over the edge. Let's just add this here. Keep working on detox pathway, hormones, nutrition. And I saw her yesterday and she was just like, oh, she's like sitting relax, telling me about the boundaries she's drawn with her husband. Stood up for herself and you know, is enjoying her life and you know, and it's just enjoy, you know, really tapping into her spirituality and friendship and I mean like all the oxytocin increasing activities and that, that just to see her that way because like, you know, at first I saw her, I'm like, I may have to admit her. Right. That's how I felt.

What about. So let's talk. I want to talk about that nervous system a little bit more because I think especially the women that are very vocal right now about perimenopause, menopause, post menopause. A lot of us grew up. We're generation X. Right? We are. Sorry, Gen Z. No, Gen X. What am I? I have my letters backwards.

I'm Gen X. Gen X.

We are Gen X. So we grew up with kind of tough it out and you know, don't talk about your pain or your symptoms or all these things. And I think we all, a lot of us have higher cortisol nervous poor nervous system regulation because of that. Plus in our years of perimenopause many of us, we started getting hit with social media and cell phones and blue. All this stuff is at one time, right. Starts coming at us. So we already had this different way of managing our cortisol and stress and toughen up. I mean therapy was like not our generation. That was next. Right. That. So we didn't. We just tough it up. So now we've got these compiled nervous systems and then we add the blue light that we didn't have before and cell phones and social and all this stuff and our nervous systems are a freaking mess. And I think that's also contributing to a lot of problems.

Absolutely. And I would just add in the 80s we had the noise. No the low fat, no fat movement.

Oh gosh. That's right.

Right. That no fan hormones are derived from fat. You know, like we have to pay attention to that. I mean like that's, that's so important to have good, healthy balanced fat. Avoid seed oils and you know, you know, the bad fats, all that good stuff. But you know, we need healthy fats and but we had a generation. I mean I was in that low fat movement and I kept of course gained a lot of weight.

Oh yeah. I used to get like a bile. A big bottle, a big bag of gummy bears, fat fruit. But they're fat free.

Remember that we eat popcorn. Yeah.

If everything is fat free, it's okay.

Right. So we really, I think that did a lot of damage to our hormones that increased. You know, mainly you think about fibroids and endometriosis and PMS and those symptoms. But you know, it take we derive our hormones from cholesterol. So.

So Dr. Ann and I, we've done this before. We're doing it again. We're doing it one night on 9 18. So Thursday, 9 18, mark your calendar. We are going to do a class where we're going to deep dive more around this. So if this is resonating and you're like but you didn't answer my question or I've got more concerns here and what about how I'm wired and what I should be doing and what are the things that I need to be doing to be setting myself up to win with hormone replacement? Like if you're going to do that or what if I choose not to do hrt? What do I else do I need to know? We are going to do a free class now. She does a series of these but I want you to come on the one with me because we're going to continue on this conversation here. So if you go to midlifeconversations.com forward slash magic so midlifeconversations.Com forward slash magic there'll be a page you can register. You have it is free but you do have to save your spot and then show up so we can help you. I will kick it off. I will introduce Dr. Anna. She is going to teach and lead and then we stay on as late as we need to to answer all of your questions so we don't leave anybody with unanswered questions. So it is a great time to come on and get your answers around this and get support here. So I will put all of this in the show notes. If you're watching this on YouTube it's in the link below. If you're listening to it on podcast app it's on the show notes. You can hit on that exact link. You can also go to my social media and depending on when you're listening to this I'll probably have a link under a video with Dr. Anna and my and myself so you can find that there. But midlifeconversations.com forward slash magic and then can't wait to see you on there. Anna, why do you want why should they come to class? I don't even know what you're going to be adding in special this class. Is there something like you're like, you have to come because of this or tell what do you want them to know?

I definitely think this conversation about our mental health, health, brain health, really, I really see that that is a bigger need now than ever. So the effects of stress, the effects of hormone disruptors, but how we empower physiology because it takes more than hormones to fix our hormones. Certainly it can dive deep into hormones at any time and that's part of the conversation. But it's really how do we empower our body so that we are living our best life? So what do we need to do to really fix our hormones? So I'm going to hit on some really key areas and especially how it relates to how we show up in the world. How are we making decisions? How are we thinking? Are we happy? Are we having fun? I'm sure to include that.

So good. Thank you so much Dr. Anna. Thank you. Thanks for tuning in to Midlife Conversations today. If you enjoyed this episode, please share it and tag me Natalie, Jill Fitz and our guests on social media. The best way to support the show is by leaving a review. Send a screenshot of your review to supportataliejillfitness.com for a free digital DSR journal download. And just a friendly reminder, I'm here with a microphone, not a medical degree. Half the time I'm sharing things that I read on the Internet or learned just as you were learning it while I'm interviewing the guest. I'm not an MD or your therapist or your mom, though I do give excellent mom style pep talks. This podcast is purely for entertainment, curiosity and educational purposes. When in doubt, please ask your own doctor. For advertising inquiries, contact salesadminategory3ca and this podcast is not intended to be a substitute for professional medical advice. Always seek advice from your physician. Some episodes of midlife Conversation may be sponsored by products or services and I may receive compensation for advertisement of your purchases through affiliate links.