Unlocking the Connection Between Addiction and Hormone Health with Dr. Esra Cavusogluu

So maybe explain to the audience your unique methods of dealing with addiction in your patient population.

We see that their energy level comes back. They're more coherent. They're more willing to get into sobriety. So that's one part of how I try to approach.

So we use different combinations like anesthesia, does specific nerve blocks with ropivacaine, and then we do specific nerve blocks with a combination of basically regular Marcaine and then liposomal. Today I have Dr. Ezra Akavasoglu, uh, who is a doctor in psychology and certified addiction therapist in the state of New York. She formerly held a position on the clinical advisory board of the Yale University School of Medicine, served as an advisor for international development with the Yale Program on Supervision. Dr. Ezra has participated in numerous international medical conferences and events Some of the prominent organizations include serving as moderator at the event organized by the US Office on Drugs and Crime in Vienna, Austria in 2016. Also, also acted as a panelist at the Asia-Pacific Behavioral and Addiction Medicine Conference held in Singapore in 2013. Dr. Azra continues to treat her patients. She is established in the Contemporary Addiction Studies Association, Türk Medikament Growth Addiction Problem Club in Turkey. In her, uh, power, her desire to spread the science of addiction to the field and support institutions who are in need of their residential and outpatient program, as well as creating curriculas. Please welcome Dr. Ezra. All right everyone, I have a special guest today from Turkey, Istanbul, Turkey, Dr. Ezra, and she has a very complicated Turkish last name that I'll let her say and I will not say it again. I'll just refer to as Dr. Ezra. Thank you for hopping on the show this morning, Dr. Ezra.

Thank you, uh, Dr. Robert Yeah, my last name is Chawusholo.

So yeah, so yeah, that's way different than I would have pronounced. I'm gonna say, uh, Dr. Azra and I were talking offline, you know, previously about her work with addiction and biohacking and longevity. And it's funny because I got sent a text message yesterday by someone and, and they said, uh, can you speak about cognitive impairment? And I said, yeah, sure, sure, sure. Yeah, I'm cognitively impaired a lot of times, so yeah, I can talk about it. Um, In terms of it and how we see it in our practice, Dr. Esra, because I take care of patients who are interested in improving their wellness, like you've had your own journey, part of it is dealing with and coping with whatever, you know, trauma or other problems that have led to and possibly contribute to problems with addiction. So maybe explain to the audience your unique methods of dealing with addiction in your patient population.

Sure. First of all, I'm in recovery myself over 18 years. Therefore, it's much easier for me to connect with the patient by sharing my story with them. And how I approach to them is that a colleague of mine over 15 years ago did a study on a male population who are, who've been using alcohol and/or drugs for a long time. Even they're young, their, their testosterone level was very low. So she got interested into it. She was a psychiatrist. And then after that, she started sending these patients to urologists to be able to test their hormone levels, and they refused her. They said, like, this person is young, why would I do it? And then after she got back into school again, she did an A4M certification. She's a board-certified functional medicine doctor. And me working with her, I use her as a, you know, part of my clinical practice as a psychiatrist. Our approach is to not to approach to people who comes to us dealing with their addiction just talking about their problems or their trauma. What we do first, comprehensive blood work. And over there, instead of just giving them an antidepressant or anything else, we see that vitamin D level is very low, their hormone levels are low, their thyroid levels are low most of the time because of heavy use. When we fix these, we see that their energy level comes back. They're more coherent. They're more willing to get into sobriety. So that's one part of my, um, how I try to approach. The second part is that I actually, to be honest with you, convince them with longevity. Because in my own journey, what I did see, since I've been very interested into this longevity biohacking world for, um, over 10 years, um, more and more tests started coming out. And I saw that 13 years of using drugs, um, really affected my system so much that all these biological age test shows that I'm barely now equal to my chronological age. Therefore, I try to convince them because I have high-profile people or their sons or daughters in their 30s to 40s. And, you know, life is very easy for them. They don't need to make money, earn money. They just— everything is very available now in Turkey. But because this biohacking and longevity sounds so sexy and they me in front of them, they're, ah, this woman is cool. She doesn't look like a normal therapist that we go to. So they got interested into it. So I try to convince them from that angle as well.

Well, then let's, let's go tangentially there because you, you first mentioned hormones and I feel like, you know, you probably have to explain it in, in how it is in Turkey, but, and I'll just give, you know, my interpretation of it here in the United States. States, which has a lot of— it's a huge place, obviously, and the complexity of living here depending on where you live and what you'd expose to. Dr. Ezra lived in New York, so she's uniquely aware of the things that challenge you in a city like New York. They're very different, whether it's the, you know, air or water or where you're living, getting exposed to things like mold. All these things can affect your, your hormones, your thyroid function, your sex hormones, and cause what Dr. Ezra is describing as a suppression of those. And then certainly in females, because females have such a low amount of free testosterone, it takes very little disturbance of that to cause a significant suppression. But I commonly see— and maybe you can just give us your thoughts about this— I see a lot of people with thyroid dysfunction. Like, that's the most common thing.

Yeah, we more see not thyroid but the other reproductive hormones, let's say. So the pituitary gland for us is the pituitary gland is not functioning correctly. And I have one patient, she is 35 years old, she got into an early menopause in her early 30s, like 31 years old. She's now over 1 year sober and her periods came back. But it's very difficult, you know, like these new approaches, you follow a very, you know, a regimen that is very comprehensive. You're not just doing operation on people. How I follow life is like that. And it's very difficult. Actually, the most difficult thing is to find a doctor, a regular OB-GYN, and send someone who's 30 years old, 35 years old. They're mostly given synthetic hormones and you're trying to swap them. And I'm sure you're seeing them as well.

Yeah, that is a, a very confusing topic for me because I see a lot of patients who have estrogen toxicity because they have problems with with their period, they're then given synthetic hormone, which actually doesn't help that problem. So it's a very odd way for someone to try to, to treat a problem that is more a function of production of toxic estrogen rather than trying to balance— it's not balancing out anything. It's a very strange concept to me how that has stuck so long with the OB-GYNs and, and why they're so resistant to like looking at genetics and, and maybe looking at more of a specific subset of estrogen metabolites that contribute to PCOS and endometriosis and painful periods and all these things. And, and looking at levels of estrone, which I, I almost uniformly have people come to me and, and I ask them, I go, did they look at your estrone level or any other levels? And they don't know, you know, they were, they had blood drawn and, and they'll pull it up on their phones now because they can, and they'll show it to me. And it may have their estradiol level and that's basically it, which, you know, estradiol, if we want to be like good, bad estrogen, estradiol be the good estrogen. But if you're someone who metabolizes a certain way genetically, you'll have more.

You know, I consider myself very, very educated and perceptive, and I had to go through 4 different doctors until to be able to find the right combination for myself. I mean, you know, the one give this much estrogen, I blew up like a balloon. I said, I don't want to take it, but I had to practice what I'm preaching. So I had to suck it up and start using it until Now I shall say, like, only 4 months ago they realized through Dutch test pathways of the estrogen is not working properly. So they gave me extra detoxifying agents so that I was able to take as much as the doctor wants me to use. But I have a question for you actually about— because you do, you do the operation and patients need some sort of a painkiller, I assume. What we see around the world, especially in the United States, 1 out of 5 or 4 addiction patients coming is hooked on opioids or OxyContin, that type of painkillers. How are you controlling it?

Yeah, it's an interesting question. And every time I have to do continuing medical education or do a renewal of a license, there's a whole opioid educational curriculum. And it's interesting because I've operated— in 2026, it'll be 30 years that I've been operating. And we've always used short-term narcotics as a way to treat, you know, surgical pain. What I do is called an ERAS, so it's early recovery after surgery, and it's a combination of ondastrol for nausea, an anti-inflammatory, and you can sub in different anti-inflammatories. Ones used routinely are celecoxib or naproxen, and you can choose whatever. The other thing you want to do is control for neuropathic symptoms because neuropathic pain is a really difficult problem for patients. And if not appropriately addressed— and we try to do everything upfront. We don't try to respond to it after it's already happened because that's more problematic. So we treat all of our patients upfront with a dose of gabapentin or pregabalin, and then post-op, There is narcotic available if needed, but intra-op, so during the procedure, nerve blocks are done with a combo of short-acting and long-acting local anesthetics. So we use different combinations, like anesthesia does specific nerve blocks with ropivacaine, and then we do specific nerve blocks with a combination of, of basically regular Marcaine and then liposomal. So the, the short answer is I don't do anything as I was taught. I do everything to avoid what you're describing, which is problems with post-op. So it's almost universally unheard of for me to have people ask for more pain medicine. And if they do, then we have to be, uh, alert to like, that's somebody with a metabolism issue. Because it's, it's, it's very rare that I would have somebody, you know, have an addiction-type issue. But you should not have people on, uh, short-acting narcotics, you know, beyond, you know, the first week or so after a surgery that we're doing. So we don't see a lot of that behavior. It's very rare, honestly, because we do so many multimodal things. And then obviously in my clinic we have hyperbaric oxygen, lymphatic massage, and red light therapy. I mean, we do a lot of things that are, you know, from an anti-inflammatory standpoint, very aggressive to promote, uh, recovery.

Because, you know, um, how I help my patients also is I'm probably one of the only— maybe there are like 3 in in the country that are in recovery themselves and also do this as a practice. So I know both sides of the story. Therefore, I really try to educate them. And what we see most of the time, they do not share that they're in recovery with the doctors that they're going. They don't tell you, they don't come to you and say, hey, I'm in recovery. If they're in early recovery and they're still— their mind is still in this tricky stage that, oh, it would be so nice to have a couple of pills so that I can get high and it's going to be prescribed, so I'm allowed to take them. And I will really try to make them share that information from the get-go, from the, from the first time they're meeting. Hey, I cannot take this, this, this type of medications.

Yeah, maybe from a— because that's a complicated mindset, you know. Yeah, the addictive, you know, mindset. High-functioning people, folks have a lot of obsessive-compulsive, you know, type behaviors. And those, those types of personalities, not to generalize, but those people have the ability to become addicted very easily to, you know, alcohol or other, you know, substances. And, and that's not uncommon. Doesn't matter what it is. I've seen like professors be addicted to what you would imagine would be pretty scary, you know, some pathomimetic drugs, because they want to stay awake, they want to work. And, you know, that's how some of those things manifest, right?

Yeah. So, you know, when you said high performance people, there is now a third type— third, I don't want to say third type. It used to be, people used to think like, oh, people want to party, they want to have a good time, then therefore they got addicted. Then there were the second, after that, we did the research started showing that no, actually they're doing self-medication, they have an untreated depression or OCD or attention deficit disorder, whatever. So they're using drugs. Now there's a third approach is the performance Whether sex performance, athletic performance, we start seeing these guys are being hooked on these, you know, steroids, things for their sexual performance. So now, like, the areas keep shifting and you need to adjust yourself accordingly.

Oh yeah. I mean, that's— I often get people, Dr. Jesper, they'll be in front of me and they'll you know, have been put on a, a hormone and they'll say the hormone didn't work. I'm like, well, okay, so you're telling me that all the athletes who use drugs, these hormones, use them because they don't work? So obviously no, right? There's a dose delivery target tissue type phenomenon. Either you're not taking a real drug or you're not taking enough of that drug or it's not reaching the target tissue that it's meant. So obviously, just like you said, hormones, in the athletic world have been abused for decades, you know. That's not— and now in our country, you have this thing about peptides, which I'll probably get, you know, chastised for. But peptides, now all of a sudden peptides are a problem, and they've been used for decades as well without any scrutiny. But now all of a sudden there's scrutiny because whatever, you can—

what, what's like— oh, tell me, I didn't hear that part. I'm using peptides myself, but so they're abusing it, therefore they're getting extra extra feelings, extra outcome, because I don't feel much of anything when I do them. You're— I can't hear you suddenly. I know. Yeah, I think it's coming now. No, it's— yeah, it's good. Yeah, it's gone again. Something happened.

Push the— all right, we had a little internet issue. Uh, Dr. Ezra's in Turkey and I'm in Austin, Texas, so that's— that can happen. Um, so basically what happened with peptides is the FDA sent out a, a they put it on the dangerous list, which is kind of interesting because peptides are simply amino acids. And we, you know, recently had Semaglutide and Wegovy. These are peptides that are used to treat diabetes. And so they're already being used and they're being used by drug companies. So of course, if someone feels like somebody is not getting their cut of the money, so to speak, there's going to be a problem. And BPC-157 has been used for decades as is a tool to help patients, uh, for recovery, uh, after injury or surgery. And I'm just using that one as an example. Of course, there's all sorts of others— ipamorelin, tesamorelin, um, you know, there's TRIPS, there's a whole list of peptides. And of which, like you said, you can use them and not notice anything, um, because they're not meant to, you know, alter states of consciousness. To me, they're not meant to enhance performance in such a way like an anabolic steroid would. So you're not going to take, you know, BPC-157 and then go to the gym and work out like crazy because it's not going to do anything. So it is interesting that all of a sudden those have come under scrutiny. So basically in our clinic, which used to recommend peptide therapy as part of our program, I stopped because I don't— it's not worth the trouble to be in a conflict with what the FDA is putting out in our country.

Okay. So I understand. I thought that you were talking more around the addiction, but actually, you know what, even though it's really good, these GLP-1 agonists, I feel like people who are having eating disorders, that they might be abusing them.

Oh yeah, of course. I mean, yeah. I mean, I've got skinny people in my neighborhood taking GLP-1 agonists. This. Like, why? They're, you know, the, the— once you burn up— for everybody listening to this, once you burn the fat in your face, don't come to Dr. Whitfield trying to figure out how to put it back. That's not happening. So, you know, those, those types of situations like you're describing are— they're not uncommon.

Yeah. Do you see how young your patient populations are? Any age variety?

Oh, I, you know, mostly it's 35 to 55.

I started seeing lately, uh, In the young people population, 25 to 35, Bloomia nervosa and alcoholism going hand in hand, very much so.

Oh, wow. Okay. Yeah, I, you know, I don't see that many younger patients. So the, the kind of demographic like that would not be in my clinic because typically, you know, for patients, you know, traveling from whether it's Turkey or UK or Asia in general, they're going to be the, like, older in general. Um, I have some— I will say I've had some people in their early 30s lately, which was concerning because considering that I, uh, am 55, that's like almost operating on your kid.

Yeah, yeah, me too. I keep saying kids and I'm like, okay, this person is 25, 30 years old.

Yeah.

So do you think that they are having— they're starting to some sort of uh, body dysmorphia and want to start keep changing stuff at an early age, like their breasts, their face.

Yeah, for, for women, I think there's this always this concern about looking and appearing too heavy for, you know, still to, you know, for whatever reason. When you're younger, you probably typically will have like a rounder face. Yeah, so I mean, I I've had, you know, moms and daughters worried about that, and I have some, uh, relatively, uh, we have a non-invasive treatment that if someone has a rounder face who's younger, that with one treatment you can, you can help contour it. I don't ever recommend, uh, removal of tissue in someone young. That is just not— that's going to create scarring, and I, I don't even— you know, surgery is not something you start when you're in your teens or your, your 20s if you can avoid it. Like, if you had accident or there's an emergency or something, then, oh well, that's fine. But, uh, cosmetic things, I, I would try to really lean into what are the non-invasive, uh, or if, if in fact they ran my program, uh, and had inflammation for a reason, then they would actually decrease their inflammation. And for everybody listening, uh, fluid movement is the biggest culprit in looking puffy or bloated or, or, or anything of that nature. And that can really, uh, manifest itself quite Obviously with, you know, like diet issues, like if, if you're somebody who's sensitive to gluten and you eat a bunch of gluten, you're going to get puffy. If you, um, drank too much, you know, if you're out, you know, I'm in Texas, so, you know, margaritas and salt on your margarita is kind of a comment. And if you eat that, have that and a bunch of sugary stuff, I mean, you're gonna wake up looking like a mess the next day with a swollen face and eyes and thing. So, you know, I, I, uh, I always try to get people, you know, checking themselves with their diet and, uh, you know, sleep more than anything.

So what type of, um, non-invasive procedures you do?

Uh, the non-invasives we use, uh, the company is called InMode, and the, the actual devices are Evoke, and they're non-invasive bipolar radio frequency devices, and they stimulate some of the skin contraction and fatty layer can be adjusted. And of course, when you're younger, everything works better. So if you're trying to do those facial changes, like one treatment in someone under the age of 25 would be like standard. In someone under the age of like 35, I would just do, you know, 3 and wait. And it does work when you're older and you have skin laxity or changes that we all get get collagen, you know, goes down. It starts going down in your 20s, actually. So it's going to get harder and harder to get a non-invasive or minimally invasive treatment to give you a result as you age. That's just— those are the facts.

How, how, uh, successful is the Ellacor?

Yeah, so, um, skin removal—

it kind of removes micro skin removals, correct?

Yeah, so that's a micro coring technology. So if I have somebody uh, who wants to come in and have a no-cut facelift, which is my, you know, collection of, uh, or combination of treatments. Microcoring, which Ellacor is the device that is FDA approved for microcoring in the United States, it takes out, uh, slivers of skin that are less than a half millimeter in diameter, so it removes skin. The issue would be like what I just said with a non-invasive it. So as you age, the skin gets looser. So there's, you know, someone in their 6th, 7th, 8th decade of life, that treatment is not going to be a standalone treatment that's going to make some visual change. It just can't. So even though you can take skin out, it's still not going to give people this perception of pulling their face back, which is the universal sign of a facelift, even though your face doesn't age sideways. That's what everybody does. They pull their face back and like, yes, I— yeah, that's the most unnatural appearance change you could actually have because everybody ages vertically, you know. They're not gonna age sideways. So the vector is down towards your feet, it's going south always, you know.

Um, the clientele that I have lately, uh, after I, I announced my sobriety on, uh, on two popular podcasts in Turkey, I started bombarded with families that are trying to hide their names. They don't want, you know, doctors or institutions get to know them. And I, me, I'm kind of one of them as a family, so they feel more comfortable. I see these young people are really suffering from their addiction, young meaning in the, in their 30s. And unfortunately, the shame and the guilt of the parents doesn't allow them to get into recovery. And I see in these young young people not only using drugs, some of them having bulimia, but they have an excessive, excessive aesthetic procedure chasing mindset. One doctor to the other doctor, like one does the hyaluronic acid fillers, the other one does this eyebrow lift. So do you ever receive these people that are in their like 30s? And is there any— is there any time that you said, no, I won't do this to you because—

no. Um, the, the thing with— everybody knows my practice in my area, and so we are traditionally a natural appearance clinic. So, uh, the kind of clientele who wants you know, more toxin and more filler is not our clientele. So they already know not to come here. So that's kind of a self-selection process that we've created and our reputation that we have, because I'm very interested in natural appearance. Um, so many people look so strange already due to filler placement that we don't need to add any more to them. So, uh, that is not something we see. And then in terms of people who want more and more cosmetic surgery, uh, I no longer address other forms of cosmetic surgery. So I don't do facelifts anymore, I don't do tummy tucks anymore, I don't do arm lifts. So we concentrate on our explant, uh, patient population to help them. And then we do have the no-cut facelift, and we have some other, uh, curated things that are minimally invasive. So we I don't see people who want to be continually changing their appearance.

So you told me the other day that you do the jaw contouring. What do you do for the upper face? Because, you know, imagine like someone comes to you in their 50s, you give them a great jawline, but their brow is like not in the place that they should, and their eye area is looking much older than now. Yeah, we have equipments to fix them too.

Yeah, so basically for the eyes, um, I don't do lower lid blepharoplasty anymore. I do do the microcoring close to the eye but not too close, and it works great on foreheads. So instead of doing brow lifting, I would do that to the forehead. I think that's a really, um, underutilized treatment area for microcoring, and it would be off-label. I tell everybody, you know, on-label is like the, you know, cheap. Yeah, off-label is everything else. I just let everybody know, like, this is the technology, it's here to take skin out. So because the, the forehead, to your point, can look aged and the brow can be malpositioned and contribute to what looks to be like saggy eyelids, yeah, it's a nice, uh, treatment option.

So one treatment is enough? No, most of— do you go aggressive on them so that it's enough, or like, how does it work?

Uh, it's a function of aging, you know. It's, it's not a function of how many times I have to do something. Everybody shows up at a different place and space in their life, and their aging is very different. It depends on their ethnicity and weight loss, weight gain. You know, you mentioned semaglutide. I have people showing up who've been taking that drug. So every— everybody's going to be unique and you just have to meet them where they are and figure out what's going to be best for them. So in terms of folks who, um, to wrap this up, the, the, the things— what would be the good take-homes if someone's concerned about addiction, uh, maybe that, or their, their children? What, what advice, you know, can you recommend? And then where would they, uh, go to learn more about what your clinic is doing and what your work is?

You know, obviously I have my YouTube channel that I have a couple of— it's a variety of topics that I cover, but also there is about addiction. But you know what they should pay attention to? We don't— people come to me and they're like, oh, do you think me or so-and-so is addicted to whatever, alcohol or illegal substance? I said, we We don't measure and diagnose based on what they're using or how many times they're using. We're measuring it if their behaviors are changing, their priorities are changing, their feelings, thinking pattern, how they're taking care of their schoolwork or their wife or their children is changing. We're looking into that. And the diagnosis, it lately changed into a substance use disorder. Mild, moderate, severe. In the mild version, you know, everyone can diagnose each other, I think. Moderate and severe— when it comes to severe, unfortunately, it's really dangerous because going back is very difficult at that point. And we see a lot of early dementia, alcohol-driven dementia, in their late 50s, women especially. Therefore, I think that when they see their, they see their loved one is changing, their friends, they're coming home eyes, bloody eyes, and they're, you know, hiding in their room, they're depressed. For the kids, they should start paying attention what's happening. Also, they should stop, the loved ones shall stop enabling them because that's the worst part. You know, they're just like, don't cover up for them. Don't think that they're not having a problem. Don't blame yourself. Maybe you caused it. Try to read scientific literature instead of thinking this is a shame issue. I have a website called longevilab.com. Over there, we're obviously Turkish and English. We have many articles in many subjects as well as addiction. On my YouTube channel, AYKafa, I'm sure you will add to the podcast notes and you're going to be appearing on mine. The English name is Soberhead. Over there, I'm, you know, every couple of episodes I'm inviting very well-known faces in the addiction field from the United States. And I'm in Turkey and, you know, they can reach out to me through my Instagram because I'm checking it out and I'm replying to the messages.

That's awesome. Well, thanks for coming on the show today. I really appreciate having you. Um, this is the first time I've had someone who is both, um, taking care of patients with addiction and doing it in a holistic way that, that helps them, uh, with their longevity as well. So thanks for coming on the show today.

Thank you.