An Introduction to BHRT

Welcome to the Balanced Body Podcast, where Sherri Griggs, owner of Balanced Body Health and Wellness in Omaha, talks to us about health, wellness, and balancing hormones. Sherri, hormone expert extraordinaire.

Yes.

Real quick, let's dive in about Hormones 101. Like, what is the concept behind BHRT? Like, why is hormone balance important?

It's very important. And to start out with, John, okay, BHRT, what is that? It's bioidentical hormone replacement therapy, right? And what's important about that is bioidentical hormone replacement therapy is where we are taking a natural substance and we have adjusted it to match our our body as closely as possible. Right. So just like any pharmaceutical, anything from nature, make changes to it. So I want to make that clear because some people argue that bioidentical hormone therapy, people will say, but it's natural. And others will say, no, it's not, because it has been— adjustments have been made to it. So it is made out of a natural plant substance. Generally, a lot of times yams are out there and that does that.

Really?

Uh-huh. For estrogen. Yeah. Yeah. So, so, you know, it is adjusted so that it is, it meets as close as possible to our body's natural hormones.

Okay. That, and that makes sense to me, but like, is it just that over time, wear and tear of life brings our hormones out of balance, or is it just a natural thing for our body to just start removing hormones as we go?

Yeah. Well, here's the thing. It's natural. We were not made to live much past the age of 35 years old.

Oh, my God.

If you think about it, in the, quote, olden days, right, people didn't— they were married and having children at 12, 13, 14 because they didn't live to be a ripe old age. So, what has happened is we weren't made to live for half of our lifetime. without these needed hormones. So, our body starts to— for women, the ovaries start to shut down. There's no need to produce eggs to have children. For men, the testes start to shut down. There's no need to produce sperm for children, right? These organs start to wear out. Women are born with the number of eggs that they'll have for the rest of their life. It isn't something that they reproduce like men do.

Mm-hmm.

Our body, it just, just like every organ, it just starts to, starts to wear out and it doesn't work as efficiently. So as the ovaries start to shut down and they stop giving off estrogen and progesterone, and our adrenals do our testosterone and our DHEA, and for men, the testicles do the testosterone and the adrenals as well. So not everybody will be low on testosterone and DHEA, but the majority of people will be.

Hmm.

Okay.

And it seems like estrogen might be sort of the one that's top of mind for most people when they're thinking about hormone replacement. Am I wrong with that?

Well, it generally is because that seems to be the symptoms that can be the most talked about. But I'll tell you, John, I like to think of our hormones. I always like to use the car analogy.

Okay.

Right. So, let's think about this. If we have 4 tires on a car, we're going to call that estrogen, progesterone, testosterone, and DHEA. Those are the tires on your car. Your car's motor is cortisol. Cortisol is a hormone produced by our adrenals. And the car's transmission is thyroid. And our thyroid gland, it produces the thyroid hormone that we ourselves use for energy. So, let's think about this. I can give you 4 new tires, but if your motor is not running properly, say it's missing, it's skipping a beat, you're not going to go very far or very comfortably or very efficiently if the motor's not running properly, even if you have 4 new tires.

Mm-hmm.

So, let's say we've got a motor that's running great, our cortisol's good, we got new tires, but our thyroid, our transmission, It can't shift out of low gear. We can't go fast. We're going to be dragging. We're going to be tired. We're still not running efficiently. So, that's why I like to talk about that because even though estrogen really is the one that tends to be spoken about the most, we need all of those hormones to be working together.

So, it's like the squeaky wheel. It's the one that takes the most wear and tear for some reason because you always like to turn left.

Yeah, kind of like that, really. I mean, that's great. It is.

Okay.

Estrogen is, you know, if women are low on estrogen, oh my goodness, the, the amount of symptoms that are involved with that. This is when we're talking about the hot flashes, the night sweats, dry skin. You start to see wrinkles and fine wrinkles, dry eyes. They end up at some point with vaginal dryness. And if they don't do something, To treat that or replace the hormones, then they end up with atrophy. Then once things start atrophying in that area, now we're talking about incontinence, we're talking about painful intercourse. Um, it's just, it's miserable. It's terrible. So it's the squeaky wheel. You're right. It's the one that's gonna give you the most discomfort if you don't have enough. Okay.

So that's one of the wheels. So then I guess I know we talked about it because it's the squeaky wheel, and that's my fault, but you would say that progesterone is probably a little bit more of the— I'm not trying to, like, rank who's more important out of the engine versus the wheels versus the transmission here, but, right, it seems like you would want to keep your engine running above everything else because at least it'll drag the rest of the car forward.

Well, you know, that's quite true because here's the issue. If cortisol is high, Let's think about this. If our cortisol level is running high, meaning we're under a lot of stress, we're under a lot of stress for long periods of time, it will sit on our hormone receptors because it is a hormone and it will block those receptors so that the circulating estrogen, progesterone, testosterone that we have in our body can't get to the cells.

Yeah.

That's why you want to make sure that that cortisol is where it needs to be, because it— you're right, man, that motor has to be running.

Absolutely. Sounds like it to me. Yeah, I don't know much about cars, so the car analogy is a little bit lost on me, but I feel like the engine is the most important.

Right. And it really is, because we could— we'll get into that sometime and talk all about cortisol and how much it can do and what can happen. And, you know, that'll be one for the future. Um, that, that little hormone all in itself is, is, is quite huge. And that really doesn't depend— that has nothing to do with how old you are or whether you're low on any of the others. I mean, that really is one of the most important is that engine. So you brought up progesterone. Here's the thing about progesterone. Women start to lose progesterone sooner than they do estrogen. Okay. So some of the first symptoms that women start to find can be as early as 35 years old, is trouble sleeping. They start to have trouble sleeping. They may fall asleep and then they wake up at 3:00 in the morning. That seems to be the witching hour. I hear it all the time, 3:00 in the morning and my mind is racing and I don't know why I'm awake. Sometimes it could be that they had a night sweat and when that response happened, they didn't realize it. It just woke them up. Progesterone is our relaxation hormone. So that's also what helps us relax. It helps with anxiety. It's why women, as they start to age, may find that their periods get heavy, because progesterone is what kept the uterine lining from building up so much. And so, as they start to become estrogen dominant, we call it, they start to have heavier periods, irregular periods, right? The sleep disturbances, the anxiety. And, you know, now the doctor's giving you depression medication. Antidepressants when really all you needed was progesterone.

Man, that's crazy.

Well, it treats the symptoms, not the cause.

Yeah.

Yeah.

And I, and I always think that, you know, not to stop down on what you said, but like, that seems to be an important thing that I hear a lot from the world of hormone replacement is that when you go into the doctors and tell 'em your symptoms, they kind of treat the symptom. They don't necessarily find the cause and fix Fix that issue, right? So it's like if you are feeling I don't know, like something's not going well because and you don't know that you're low on progesterone, but like to you it makes a lot of sense. Let's get your levels back sort of up, and then you'll see a change in a lot of this behavior that you've all of a sudden taken on. But then when you're talking to a doctor, they're not thinking about it that way. They're like you have you know an issue with your mood, so let's fix that. Or you know you're feeling depressed. Let's get you on anti-anxiety meds. Like It's all about fixing the symptom, not necessarily finding where that's stemming from.

Correct. And that's just the way that medicine has been for many, many years is we treat the symptom. This hurts. Let's give you a pain medication, right? Yeah, I'm depressed. We'll give you an antidepressant. I'm having anxiety, an anti-anxiety. It just goes on and on. What we're doing here is we're looking for the root cause. Right. Yeah. Okay. So, so maybe I give you progesterone and you still have the depression. Well, let's check your neurotransmitters. If your neurotransmitters are low, then we do know you have depression. You've been diagnosed with it.

Yeah.

But that type of testing is not testing that most general medical providers are— I don't want to say they're not aware of it, but they're just, they're just not trained. They don't learn about it in medical school. And they don't use it. They, they, you know, insurance companies don't want to pay for it. They say they have all these symptoms. They've answered this, you know, PSQ-9, this depression scale. Oh, boom, they have depression. Put them on a depression medication. Who needs to pay for a test to make sure that's what they really have? Does that kind of sound stupid in a way, though? Why would we want to pay for a test to make sure that's what they really have? Right.

I mean, now we're getting into an issue with the medical system, which there's issues with any kind of system, obviously. And correct. We're not saying not to go to the doctor, but if you do go and then it— and then they hit you with, here's some anti-anxiety meds or antidepressant, you know, depression meds, that could solve your issue because that might be your issue. But if it's not helping, it could be from low hormones, right?

Well, very possibly. And it could very much help that symptom, right? It could help that symptom. They've shown that some of those medications will even help with hot flashes and help those symptoms. But then the other symptoms will still be there, right? So estrogen being your anti-inflammatory hormone. So we've, we've got the antidepressant that's helped with our anxiety. Um, it's helped with some of the hot flashes, but we're still achy. Our joints still ache. We still have the vaginal dryness, the dry eyes, the wrinkly skin, you know. So it can treat some of the symptoms. Like we said, it just doesn't treat the root cause. Now, um, you know, and I do want to piggyback on what you said. We're definitely not saying don't go to your medical provider. I see mine every 3 months religiously. So, um, Right. Definitely not saying that, but— No, of course.

And we didn't, we didn't say that.

Yeah.

I just wanna make sure that it under— underlying all of this.

Yeah.

Is that a lot of times I think just from my own experience, and I think from what I've heard, is that a lot of times when you're in the office for the doctor, I think especially for men, it's a quick, hey, what's wrong? Oh, you've said that this is wrong, so this is what we're gonna treat without really kind of like getting— because they're trying to see as many people as they possibly can through the system. I mean, it's not necessarily bad, but, you know, if you feel like something is off, usually the biggest, you know, engine check light is you knowing your own body, right? Correct.

I'm trying to keep the analogy through.

I'm trying to keep the analogy through.

There you go. Yep. You know your own body because even though, again, the mechanic can put that machine on there, right? Do the test just like we do. Sometimes there are symptoms, there are things that are happening that take place that only happen occasionally. It may not be when he's driving the car. Right? May not be, you know, before we had computers and there weren't codes that they could look at, it just may not happen. So you do, as the patient, know your own body. And that's one of the most important things that people need to understand. And I just said it to another medical provider today when she said, I've checked my patient's estrogen and it's lower, but she feels great. What do I do? Do I give her more estrogen? I said, you treat the patient, not the number. Okay. So even if the number is lower, you still want to treat the patient and their symptoms. Now, there's a little caveat there, because as we're using estrogen to protect against osteoporosis, cardiovascular disease, if it's not high enough for protection, that's another story. But we won't get into those weeds. But yeah, we're going to listen to what your symptoms are. Right.

Yes.

And safely adjust those hormones for your symptoms. For instance, for men and testosterone replacement. Now, men and women both need testosterone. We all know why men need testosterone. They need it for memory. They need it for energy. And quite frequently, it isn't until it is so far in the gutter that they start to have issues with erectile dysfunction. The first issues they generally start to have are fatigue, loss of energy. Um, I had one gentleman that said it was like the humdrums. He felt depressed. He didn't want to do anything. When he got his testosterone back up, he felt like himself again.

Hmm.

For women, it helps with our muscle tone. Muscle tone is important to prevent incontinence in those pelvic muscles, muscle building, and weight. Um, and for both men and women, libido. So it's, it's very, very important for everybody. I was telling somebody yesterday, and he was quite shocked. We were talking about FDA approval of medications and some of the things that are coming out there. And I said, you know, testosterone is not FDA approved for women.

Yeah.

FDA doesn't think women need testosterone. We know they do. We know we do. Right? We had it. We've always had it. If we stop making it, why don't we need it anymore? Why did we need it for 40, 50 years of our life? Why do we all of a sudden not need it anymore? That doesn't make any sense. So, but again, we weren't meant to live this long. So we do need it. It is, you know, we have medical evidence and it is very, very common. We do treat women and replace their testosterone.

Well, and I think of Is you think of testosterone and you think of like a gym person that's—

Yeah.

Sticking themselves with needles everywhere and like getting really swole.

Yeah.

That's not what you're trying to level out to be or whatever.

Yeah.

It's just a natural hormone that helps you to have, like you said, more energy, better libido, keep muscles on and, and keep things a little bit tight. And it seems like testosterone is one of those ones that hits everywhere. Like, it really does.

No, it really does. Um, like I said, muscles, brain strength, and because of the energy, right? Libido. It's— and, and we're— because we're not giving you super doses of it, you are all of a sudden like, you know, look like Mr. and Mrs. Hulk, right?

Yeah.

We give women too much testosterone, they don't like the acne.

Yeah.

Right. The acne is not worth— but you, you know, I don't want to— again, well, we won't go there.

Um, well, when we're talking about testosterone as its own thing, we'll get into it, right? You know, we could call it the bodybuilding episode.

We could. And how you can look at somebody and know, just look at this. Um, and the same way with men, you know, we don't want to give you too much. I mean, there is such a thing as too much of a good thing, you know. Just because this is good doesn't mean that more is better.

Yeah.

Right? We're trying to get you back to a natural level for you so that you can live the remainder of your life. It could be 40 years of your life, not fatigued, not breaking a hip, you know, not with heart disease. That's why so many women over 50, the amount of heart disease The incidence of heart disease is so high because if they don't replace their estrogen, that anti-inflammatory hormone, then they are more prone to heart disease. I'm not saying it prevents heart disease. It just— if you're going to get it, you're going to get it, right? But, but it helps keep your body at a more balanced state the way you're meant to be.

That makes sense. And with how it hits everywhere, I mean, it seems like making sure you're in balance will help you across many different areas from my perspective.

Yeah. And the balance is— balance is such a big word in it, not just because we're Balanced Body here, but because it is balancing, right? We don't want estrogen dominance, having too much estrogen, because that's a problem. Too much estrogen is a problem, right? Too much progesterone is good luck getting out of bed. You're exhausted, you're tired, you're too relaxed, you know, too much testosterone. Women with acne, aggression, men, you know, almost causing anxiety in itself and aggression. So that's why we want these things to be balanced and balanced for your body, not just what the lab test says it should be.

Hmm. Yeah, I tell you, one time I had my, my blood drawn, and I forget what exactly it was for, but it, it pulled, uh, a testosterone number. And when they looked at it, the person almost fell out of their seat. It was like really low. But it was a couple years back, so I was still, you know, in my 20s. So that must— I mean, I don't know what level it was. I can't remember the number. It could be 5,000. I mean, I don't even know what the numbers are.

Yeah.

They were like, you need to be on testosterone. Like, we need to give you something today. And I was like, no, I'm good.

Because maybe it was low that day. And if we measure it in the afternoon, it's going to be lower in the afternoon anyway. So one low measurement doesn't— when it is an unusual time of your life, right? Yeah. And that's a really good, good subject you bring up is somebody in their 20s with a low testosterone, right?

Yeah.

We give you testosterone when you're that young, it will shut down your body's ability to make sperm. And when we take you off that testosterone, that may not come back. So we have— I mean, we've sterilized you. Okay.

Oh my gosh.

So, but there are things, HCG, clomiphene, enclomiphene, things like that, that will help the body naturally make more testosterone and not shut down the sperm, the ability to make sperm. So that is why it's such a specialty. And that person who said to you, oh my God, we got to give you testosterone because they didn't know the specialty. Nothing against them. Yeah, that would be the likely thing if we're low on something, replace it. But that's why it really is a specialty.

Yeah.

And if you want to do it, you need to make sure you're with someone who specializes in it, not just somebody that has added it to their repertoire of 500 other things they have to know.

Here's right, here's what we can do, right?

Yeah, yeah, yeah.

All right, so we've talked about testosterone, estrogen, and progesterone, right?

Yep.

What's next?

DHEA. That's that 4th wheel, 4th tire, right? That, that hormone seems to get ignored a lot. And I'm not sure why. You know, it is a precursor hormone. Women can turn DHEA into testosterone.

Oh.

They don't do it very well. I have tried high-dosing some women on DHEA to see if their body would convert enough, and it didn't. Um, but I didn't high-dose them that much either. Thought we would see. But, um, that's another one that, that Absolutely starts to decrease. But DHEA is also very important for our adrenals, right? And what does our— what do our adrenals make? Cortisol. If our cortisol is off, that's our motor, remember? Yeah, motor's not running right. So DHEA is a very important hormone that quite frequently is ignored. Hmm.

Do you think it's ignored because it doesn't tie directly to a specific set of Issues like we were talking about how low estrogen leads to certain issues, low testosterone leads to certain issues, but as a precursor or something that helps the engine run, maybe it's less important or made less important because it doesn't have a specific end goal, right? Like more DHEA turns into bigger muscles.

So, you know, John, you've hit the nail on the head with that one, really, because You know, I have a chart that says, as I am having my, my ladies do this, not my gentlemen, but as they are changing up their progesterone and their estrogen, and if we're doing a topical testosterone, they actually have a chart that tells them, here's too much estrogen, here's too little. These are your symptoms. Progesterone, testosterone, too much and too little symptoms so they can adjust their dosages. But there isn't one for DHEA, right? There are no specific symptoms that are related to that because it is a precursor hormone. But it's again, it's very important because it works with our adrenals, and many times cortisol and thyroid are left out when people are doing hormone replacement. The practitioner leaves out two of the very most important hormones—that being cortisol and thyroid. They just put new tires on the car, but they never. check the motor. They don't ever check the engine. And, and they, they only check one part of the transmission. They don't check all of it.

Hmm. So tell me a little bit about thyroid. Like, is there— because I know you've talked about it to me in the past and to our group in the past, but like, I just don't get the thyroid and what it does. It seems like it's an imaginary thing. But why do I think that?

Oh, well, you know what? Most people aren't even aware of the thyroid unless they have a problem with it.

Seriously. Okay.

Thyroid gives us energy. Thyroid— so, we have our pituitary gland. And I'll try not to get too technical, but this is important to know. Our pituitary gland, it puts out something called thyroid stimulating hormone, TSH. And that's what most of your medical providers will check, your TSH, making sure that the pituitary is not pushing too much out. It's going to push a bunch of that out if the thyroid's not working right. It's going to keep going, thyroid, work more. more. And that level will get really high. And we'll know something's wrong, that thyroid's not responding. Okay?

Okay.

But not always. Because sometimes the pituitary level, the TSH, is within a normal range. And it's a very, very large range, a very large range. And the thyroid does make what we call T4. Okay? That's the thyroid hormone. T4, the thyroid makes, our body converts, our body changes that thyroid T4 into thyroid T3. Thyroid T3 is what our cells use for energy.

Okay.

Okay? It's a very simplified version of some chemistry there in our body, some biology. But what happens is if we only check that TSH level, that doesn't tell us if we're making T4. And if we are, are we converting it to the usable T3? So we need to check those levels.

Okay.

I've had more than one patient come in with a perfectly normal TSH, a normal T4, and a less than optimal T3. Now, it fell in the range of normal, but it wasn't optimal. And optimal is important because a very, very, very small replacement dose made a world of difference in this person's life. They no longer needed to take a nap at 1 o'clock in the afternoon. They no longer felt exhausted most of the day. It was the tiniest of dose, but just enough to help that extra T3 to give the cells the energy they needed to perform.

Interesting. So they can get into the next gear.

Right, exactly. So you could get into a higher gear. Okay. Move faster, go faster. Now, just like a car, you know, you wanna rev it too high and get too hard, you know, blow that transmission. So we make sure we don't give too much thyroid. That's important too. Yeah.

I'm thinking we need to redline it. Just put all of the attention into the thyroid now and make it go as fast as possible. There's nothing wrong with that, right?

Well, weight loss, palpitations, exophthalmic eyes bulge. Yeah, there's a problem with that. We don't wanna do that. You could have a heart attack.

All right. Yeah, that doesn't sound good.

No, no, no, no, no, no.

So would you, when you're, when you're going through the process, and I think we'll probably address this in future episodes when we're looking at each one.

Yeah.

Where is— I mean, you're, you're checking all of these, right, with your tests, and you're trying to see where each one is so that they do balance to each other.

Yes.

But I mean, what, like, tell me super highline the process and like things that you're thinking about, and then we'll leave a little left for, you know, future episodes when we're looking at each one.

Sure. So the process is, if I am dealing with a gentleman, we are checking your— we're drawing your blood, we're checking your testosterone level, we're checking your PSA, your prostate Prostate specific— can I say it? Prostate specific antigen. So, looking at the prostate to make sure everything is working properly there. And we look at your thyroid too. We're going to look at all your levels of your thyroid and then cortisol. You can't just do a blood draw on cortisol because that's just one moment in time. Cortisol, and we'll get into this further, but it has a graph, it has a range. It should be high in the morning and low at night. And that's what the curve should look like. So we check it 4 times a day, and that's through a saliva test. And so each tube of saliva is tested for the amount of cortisol in it. So that's what that looks like for women if they are postmenopausal. Exact same thing, no PSA though, and we'll throw some estrogen and estradiol test in there. Um, and Cortisol also. If they're still cycling, then we want to check it during the luteal phase, which is days 19 through 21 of their, of their menstrual cycle. And then I'll usually just do it with the cortisol. It can be tested in saliva as well.

Okay.

And when we get into different delivery methods, I think that's our next topic. We'll talk about how we test, the different ways we test for hormones depending on how We are delivering those bioidentical hormones to you.

I think that's a great way to end it. And then we'll talk about delivery methods as well as testing methods and then what to expect, right?

Yeah, I think— yeah, we'll get into that next time.

And it'll be all about how we can get that engine revving the right amount, not redlining it.

That's correct. Absolutely. Running as efficiently as possible.

Hey, that's— we expect that of our mechanics and our cars. Why not of our bodies?

Correct. Exactly. We are, we are the mechanics of the body. Medical providers. That's exactly what we are.

This has been the Balanced Body Medical Podcast with Sherri Griggs, owner of Balanced Body Health and Wellness. If you're looking to find Sherri, go ahead and look For the website, balancedbodymedical.com. If you're looking for the business and you want to find Sherri at her office, you can find her at 10815 Elm Street in Rockbrook Plaza.

Thank you.