Estrogen Detox Pathways Explained: The Science Your Doctor Never Learned

Hormone replacement, is it dangerous? Is it not? It's very confusing. Even though I've done many, many episodes and conversations around hormone replacement, the questions still come in about estrogen. To do it or to not do it. What about you specifically? What about detox pathways? This is something I've brought up on many episodes before that all of us process hormones differently. Our genetics tell a story, our urine tells a story, and our blood tells a story, but also our environment and where we're living. So it's very important that you're working with somebody who's actually testing you, working with your uniqueness when you venture into hormone replacement. Today I've got Dr. Betty Murray on, and we're diving deeper into this conversation. And this isn't just one of those basic conversations about to do hormones or not. This is really going to dive into the actual testing and how we process them and detox pathways specifically. So if you want to put on your science hat for today, we're going to go there a little bit. We're going to keep it basic, but we are going to go there and this is. Is important. It's taken me several conversations with Dr. Betty to really get this, so we are going to do our best to break this down for you. Thank you so much for being here.

Thank you for having me. I'm so happy to be here.

So this is one of those complicated and confusing conversations that I think it's so necessary that we do go back to science class and understand it. And if we don't, it's my understanding this is where the problems can start to come in. With hormone replacement.

Yeah, absolutely. You know, it's not just about the hormones that you make or the hormones that you take. It's also about how you package them and prepare them and excrete them. And so for, and I think I want to say this, for the most part, the vast majority of women can go on hormone replacement therapy without complication. However, when you start to see situations where you're not having the outcome that you really are desiring, it's often either in the prescribing and the management of your personalized need or. Or in this pathway.

Okay, let's start with that. And we're going to start a little bit more general and then we're going to get more specific here when we talk about hormone replacement. What is your personal thoughts as a do as You've got your PhD in this. This is your. This is your jam. Your personal thoughts on HRT for perimenopause and Menopause, when someone comes to you and they say, I've heard I should do hrt, what are your, what are your thoughts around that?

Yeah, so I want to give just a few seconds of history just for everybody to know. So. So we have been doing hormone replacement therapy in the form of estrogen therapy and a version of progesterone or synthetic progestin since 1942. So the reality is hormone replacement therapy has been around for a very long time. And I think most of the people in the Gen X and like Baby Boomer, we are unclear about that. And it all comes down to that Women's Health Initiative study and sort of the misrepresentation of the data. And so the reality is every woman, as soon as she starts to feel symptoms that she believes are perimenopausal symptoms, and hot flashes and night sweats are probably the latter part of that game. But insomnia, brain fog, depression, anxiety, irritability, you know, all those kind of symptoms often show up much earlier. As soon as they experience those symptoms, they deserve to explore hormone replacement therapy, even if you might be 38. And on the other side of that coin, if you are 72 and went through menopause at 40, 48, you also deserve the right to examine hormone replacement therapy for you. And there is no reason to not do it, and there is no reason to not explore it. Regardless of where you are on that timeline, you could even be 80.

So many women hear that and they say, I've heard that and I prefer to go natural. I prefer to not do that. Let's speak into that first.

Yeah, so. So natural. So I want to qualify it a little bit. So if we look at the lifespan of women in 1900, our actual lifespan was about 48 years. Now, if you take out dying during childbirth, because that actually claimed a significant amount of women, we lived generally into our mid-50s, early 60s. So the, the act of going through menopause was a fairly short lived experience if you made it that far. So significant number of women never even made it years after menopause. But now we're living a third of our life, if not more, in menopause. And so the choice to go natural absolutely can be done. And I mean, I have patients that I'm like, okay, yeah, that have been seeing our clinicians, whether it's in the telemedicine company or the clinic. And they're like, you know, I feel fine without it. I don't feel like I want to do it. And I think that's totally Fine. But we have to also be aware of the data today shows that if we start, especially in this kind of earlier time period, during the transition or within the first couple years, hormone replacement therapy has a protective effect for osteoporosis, osteopenia, dementia, and Alzheimer's and cardiovascular health. So we have to maybe examine that according to what your relationship with those risks are. Right. You know, what do you have running in your family? What other things. But it is never a situation where a woman, you know, should be shamed for not doing hormones. Right.

And I think many of them are. So for those that hear that and they're saying, I'm tired of being shamed for it, or I'm feeling guilty that I chose not to do it for whatever reason, are there other ways to prevent those things if they choose not to do hrt?

Yeah. So there the reality is, the production of estrogen and progesterone comes from your ovaries. The primary production of particularly estradiol and progesterone. And so when the ovaries run out of eggs, Right? And that's essentially what happens in menopause. We start to run low, and then we run out. We will not have any natural production coming from ovarian levels. We can still make other hormones like estrone from our fat cells, but our. Basically our systemic levels of estrogen are now declined. There is no way to replace those two physiological levels without hormone replacement therapy. Yes, you can do soy phytoestrogens and flax phytoestrogens and herbs to suppress or support some of the symptoms that you may feel, but we can't replace them. I mean, believe me, Natalie, as a. As a nutrition biochemist, believe me, I have played in that arena. Like, can I do this? No, you can't replace what is missing, but you can mitigate some of those symptoms for sure.

Okay, let's talk about the FDA black box warning, because this is all over social media right now about this whole change and how they remove this black box. What does that actually mean?

Yeah. So. So first off, we've been prescribing estrogen therapy since 1942. So when we look at, like, the time period through the 80s and early 90s into the very, very early 2000s, depending on the country that you were in, the women in perimenopause and menopause, anywhere from 30 to 70% of women were given hormone replacement therapy and as standard of care. Right? So this was. I mean, we were prescribing these at levels that were very close to Statin medications. Right. So it was, it was standard of care. Your gp, if you went in and said, I can't sleep, I'm feeling, you know, hot and sweaty, they'd have handed it to you in five minutes, written the script and said, see you later. Now, the Women's Health Initiative, and we can always back up and talk about that because I know you've talked about that for a long, long time. But that single study that perpetuated sort of a massaging of the data to, to make hormone therapy look dangerous when it really was not, and it was one particular part of a drug that actually had all of the risks that we do not use today is what put the black box warning on estrogen products. So essentially when they asserted with the Women's Health Initiative that estrogen caused heart and stroke risk and breast cancer risk, none of which followed through on the data when they followed those same patients and on reexamination, that black box warning was put on all estrogen related products and women were removed from hormone replacement therapy overnight.

Wow.

And so for 22, almost 23 years, we have been fighting that black box warning. So it is enormous. And as a researcher, the thing that is most important to me is we have to remember now that clinical trials involving hormone replacement therapy were basically unfunded at that moment. And we already have, you know, problems with that today, with current administration plans. But the reality is we stopped funding research for hormone replacement therapy for these very important things. So we have a 22 to 23 year gap in women's health research to help women in their 40s, 50s, 60s, 70s and 80s.

Wow. Okay. I want to talk about this whole gray area that's not talked about enough with how individuals process hormones. And this actually created. When I shared about this on social media, I got it created quite a bit of controversy with the pro hormone community sort of slamming me, saying that I was talking negative about hormones, which I was not. And then people that were not for hormones were like, oh, thank goodness someone's talking, speaking up. That's not what I was doing. What I was sharing was that we're all very unique and our DNA is very different and our environments are different and how we individually process hormones is, is different. And it's not that hormone replacement specifically could cause cancer or cause problems. Like it's how our body processes them that could. For example, if you are taking estrogen replacement, whatever form you're taking, and you are taking a higher level than your body basically is processing, and it could be recycling, converting, changing Doing things in your body that could be creating issues that could cause health problems. Did I say that right, Betty?

Okay. Absolutely. Okay. Absolutely.

Okay, so what does that mean? What happens? While you could get a thicker uterine lining, you could get fibroids that start growing out of control, you could get back up in other areas. You also could be taking things like testosterone that are aromatizing or converting to estrogen in your body, creating an estrogen dominance. So I wasn't saying hormone replacement was bad. What I was saying is we have to be very aware of what else is going on in our bodies and how our body is actually processing them. So let's dive in to that. And how do we even know? Let's, I guess let's start with what goes wrong and then let's talk about how do we know.

Yeah. So, you know, the first thing I would say is if you remember, remember back when your cycle started, right? So everybody's, I don't know a single woman who, when they first started their cycles at, you know, 10, 11, 12, 13, whatever age they were, that they were smooth, Right. I remember thinking I was dying and I was like, oh my gosh, if I have to go through this every month for the rest of my life, why? Right. You know, because when your hormones sort of kick into high gear, right? So our hormones kick into high gear when we get enough body fat. So we need about 12 to 13% body fat for our body to actually hit sexual maturation and start ovulation. And that varies according to who we are. So some people start younger, some people start later. Right. But when it starts to get online, it takes a little while for the body to balance out. So most of us had really heavy, kind of uncomfortable periods and then they sort of level out. Some girls level out and their cycles are very comfortable and they don't have any problems at all. Other women, it's like it was a war every day or their cycles were inconsistent. So we have to understand that the woman that was inconsistent, her hormones were never like the woman who was consistently getting a cycle and it never hurt. And it was super easy, right? So you line up 100 women and you look at us, we all look different, right? Some of that is our genetics and our family history and all of that, but the other part is our hormones. And so the idea that you can blanket statement and use a one to many approach is insane. And so when we, when we look at hormones, we have to understand that, that the problems come in when we have kind of abnormal hormone processing, right? If we had it younger in life, that means we're probably going to be slightly more complicated later in life, right? Not necessarily. But, like, if I'm going to give myself as an example, because sometimes the stories make it easier. Like, I had heavy periods, and then I went on the pill because I was afraid to get pregnant. You know, I didn't want to have an uncontrolled pregnancy. I wanted to have control of my fertility. And at about 36, I got off of them. Right. And I had my tubes tied, and everybody said nothing's going to happen. Well, lots of things happened. It actually threw me into kind of an early perimenopause. I, you know, I started losing my hair, I started gaining weight, all this other stuff, and everybody was telling me it was something else. Now, mind you, I was in the functional medicine community at this point. I owned my clinic. I was already there. And then I had an ablation because I had been having crime scene periods when I hit my early 40s, I was having them every three weeks, and they were heavy. I was massively anemic. And so. And so my experience and my need for hormones varied according to that time period. And in that time period, in your 40s, your body is going to have more estrogen generally than progesterone, because that time period is where we start to see some of the infertility changes in hormones, because progesterone is already declining. And so for most women, we have. How do we kind of start out? And what were our periods like in general? Then what happens in that particular season of life, like our 40s, where we start to see pretty big hormone shifts? And then what was my. What would be my optimal amount? Because the last thing we want to do is recreate the symptoms. I was having prior.

Right, right.

Like fibroids, heavy, you know, or uterine lining changes. And so a big part of that is not so much even just giving the hormone. And it varies. So that means that we have to get individualized about how much hormone we give and in what form and for each woman. And we have to look at how those get excreted. Because your gut, your genetics, your diet influence how your body utilizes those hormones, when it's going to kind of package them for the trash to get rid of them. And when we start to see that when it's not working, we do get fibroids. We get uterine lining growth. We might get sore breasts or sore nipples or swelling. Like, women will say, oh, my God, my boobs are getting bigger. Why is that? You know, all the way to hair loss or, you know, chin hair growth and, and mustaches. Those are all signs something is out of balance.

So it's interesting that you just, you said something that nobody else has said. You said, and you were talking about your specific situation. But if you think about in perimenopause, which could be 10 years, some women, me included, had very, very, very heavy periods. We had things that weren't necessarily amazing. And what happens is then in our 50s, we are trying to raise levels to what they were there. And you're like you said, why would you want to repeat exactly that?

Yeah, you know, so, so the reality is like there are, there are practitioners out there that are ascribing to the idea that we should vary our hormones throughout the month, that we should recreate a period in a 70 year old, that we should cycle them. And to be honest, we don't have good data on that. We just don't. Right. So we need clinical trials to see that. But I can pretty much say universally, most women are pretty damn excited to not experience a period the rest of their life. Right. And they're, you know, and, and the reality is, is the period comes from the ovulation activity, the spike of estrogen and luteinizing hormones, and then the sloughing of the interior lining of the uterus. Right. There's no need to perpetuate that. And I think that's the challenge is a lot of like different mindsets in the practitioner world. You know, some come at it and go, let's recreate a 25 year old and get your hormones to the level they were when they were young. Let's get you cycling, keep you cycling, because there's an idea around that. Or, or let's get to you to a physiological level that the research shows the levels will help the brain, the heart, the bones, and reduce your symptoms. But idealize that into a situation where we're getting support but we're not possibly triggering some of those things that may have been occurring years ago.

Okay. What goes wrong when you create this recycling of estrogen or too much and you're not cycling.

Right. So I'm going to give this example. So everything in our body, so every chemical reaction in your body, you make energy, or your body gets a piece of toxin out of your cell, or you come in contact with a toxin. I'm currently drinking some coffee, which is an antioxidant, but there's toxins involved in that too. Those things either get made by the body or come into the body, they get sent to the liver. And the liver's job is to go through kind of a complex wrapping of ingredients around it that is dependent on your nutrition, your protein and amino acid intake, your genetics and everything else. And think of it as kind of the three little bears. I can have porridge that's too hot. I can have porridge that's too cold, or I can have porridge that's just right. Depending on our genetics and how we're wired, we have a couple different steps that could be one of those three directions each time. And so the reality is, is how you're wired will make a difference on how your body sort of prepares estrogen and these other compounds to get excreted. So here's a good way to think about it. If anybody's had, like, let's say. Let's say they hurt themselves and they took a pain medication, right? One of the common ones, they give you hydrocortisone or whatever and. Or, you know, any. And an opioid, heaven forbid. And let's say you had a negative outcome, right? You were like, oh, it made me feel sick. That's a sign that those pathways don't work very well. Maybe a doctor puts you on an antidepressant, an ssri, you had a negative side effect. That's a sign that those pathways don't work very well. Or you went on birth control and you're like, wow, that was terrible. Those are all signs, just ways, kind of monikers that we can say, maybe I don't detoxify or biotransform very well. And I can do kind of a demonstration of that if you'd like.

Yeah, yeah, I want to have you do that. And I also. And I want to ask about. There's a lot of people hear this. They hear we have to make sure we have the right pathways or we have to detox. And I want to talk through what that actually means. But what happens when someone just takes stuff like dim or broccoli sprouts, or they take the. Or binders or whatever it is they're taking to try to get it to detox? Is that. Does that just work or is that a problem?

Yeah. So we have to understand that different nutrients have different effect on those pathways. So think about it this way. I've got the porridge that's too hot, too cold, or just right. I'll use dimming as example. If I happen to be making a just right porridge, dim is going to amplify that. Right. So I'm going down the most healthy pathway for estrogen. I'm getting it ready now. That happens to affect your most potent protective estrogen, which is estradiol. So if I take a truckload of dim, right, Because I heard it was good, so more is always better. What's going to happen is, let's say I'm taking hormone replacement therapy, I'm on estradiol, I take a truckload of dim, which now pushes it down that first step of detox pathway. I'm actually lowering effective levels of estradiol. So you could be undoing what you're doing because you're looking at it as a single pathway or a single gene. Our body doesn't work that way. So here's another example. If I am going to go to the spa today, in order to get there, it's probably not a straight shot. I've got to take some rights, some lefts. I might have to get on a tollway. I need a pathway and those pathways have left turns, right turns, stop signs and toll bridges. And all of those things need to be known and I need to follow the pathways and find the best way. So if there's something blocking the toll bridge, I might need to know if there's other things that I might be able to do, like drive through a parking lot and cut through an alley. I'm a Dallas site. That's how we drive. You know, can I. To get where I need to go. Yeah. And your food and your supplements are like those sort of pattern breaks where you go, okay, I'm going to cut through a parking lot and go through the alley. Sup. Nutrients can do that. And when you willy nilly sort of take those things, it may result in more symptoms rather than fixing the symptoms. Right. And I will say this, Natalie, the reality is too, we have a lot of companies that have come out that are training clinicians and often they sell these products and they sort of try and explain it in this very simplified form and it becomes a blanket statement. Everybody has to have this. And I was like, there's nothing on the planet that everybody has to have totally in a supplemental form other than maybe vitamin D and omega 3s if they're not eating enough fish. Like, there's very few things that I'm like, no, but even vitamin D, it.

Could be problematic if you take too much of it.

So.

So, like, you're right. There's nothing. There's not. Not one thing that everybody should be taking. It's not an everybody conversation.

Right.

Okay. Do you. And to share a screen here. If you do see that little arrow at the bottom?

Yeah.

Press that. That should help you if you want to share. I want, if you're looking on video, what I want to walk through is this is the science portion of the presentation. But I think this is really important here. And she showed this to me a few times. But I want to make sure we understand it because I think a lot of doctors will do like a Dutch test or 24 hour urine and or DNA test and they're talking in code to us and we don't know what it means and we just nod like we do.

Yeah. And there's a bunch of companies. Genova has a test like this. Vibrant has a test like this. There's a bunch of companies and this is actually my favorite diagram by one of those brands. Just because it's what I would say is out of all of them, it's probably one of the easier to read ones. So I'm going to start on the top left just to give some context. LDL cholesterol is what our body uses to synthesize or manufacture hormones, right? So we do need some ldl. That's a whole nother conversation on what's the right amount. And then your body starts to make hormones. So here's my visual. Think of LDL cholesterol making that very first hormone, pregnenolone as the top of a snow capped mountain. I have streams and or rivers that then take it one of two directions, right? So I might have a tiny trickling stream that goes across and makes a 17 hydroxypregninolone and then DHEA. Or I might have a ravaging river that makes a ton of that, right? So your genetics define how big or small that river is. Same thing with progesterone, right? So your hormones get made and they get transformed into different hormones. And the controller of this activity are two parts of the brain. One is the hypothalamus. So think of that as you're watching a show, like a Broadway show. That's the director. It says I want it to feel this way, I want it to look this way. I'm going to communicate to the conductor and tell the conductor exactly what I want. The conductor is your pituitary and the pituitary is what talks to your ovaries, your adrenals, your thyroid. And it starts to tell the body what to do. And to some degree it has directional capacity to sort of shift this balance, right? And so when it does, it either widens that river or makes that river more Small. And then over a period of time, as we get older and we lose, like, eggs, we start to see, like, a reduction in certain hormones, like progesterone production. But we kind of go through these pathways. And I think one of the things that a lot of people don't touch on when they're doing hormone replacement or they're learning about hormone replacement is right here where you see dhea, androstenediol, androstene dio and testosterone. Those are all big words. Those are what we call androgens, right? They're kind of what we call the male hormones. I'm air, you know, air quoting that. They're really recovery hormones. They help you build, right? So they build muscle, they help rebalance from stress, androgens, and especially testosterone. And androstene dione get converted through the aromatase enzyme, and that's controlled by a gene called CYP19. So your body takes testosterone in the ovaries and converts it to estradiol. It takes androstene dione and converts it to estrone, right? So one of the things that I see a lot, for instance, is somebody may be given testosterone, right? And if they're given a lot of testosterone and nobody looks at what this conversion process does, they may also amplify estrogens, both estrone and estradiol heavily. And so. And so we have to understand, these things don't work in isolation. They're in combination with each other. And so your body in the ovaries produces estradiol. So estradiol kind of craps out. It's gone when we run out of eggs, right? If you've had a hysterectomy where they also removed your ovaries, you were pushed into menopause overnight. If you had your hysterectomy but you still had your ovaries, don't believe that that wasn't altered. If there's change in blood supply or nervation because of the surgery, that will alter it as well. If you had your tubes tied, that can alter it. That's what happened to me. So we can get changes in estradiol earlier or at different times, even if it's surgical. Now, here's the thing. Estrone is made by your fat cells, right? So this is the way our body can make extra estrogen and it can interconvert to estradiol. So it can go back and forth here. This is important. Estrone. We see estrone relative to estradiol becomes higher when we're in menopause, right? Because your Ovaries petered out. There's hardly any estradiol, but estrone is higher. Estrone, if it doesn't get packaged for detoxification well, is pro inflammatory. So some of the things that happen to women during perimenopause is we see an increase in fat, weight gain in the abdominal area and in the hips and thighs and buttocks area. Now, not everybody experiences that, but a vast majority of us do. I know I did. And it's because part of it is the body's like, oh, there's not enough estrogen. Well, I'm going to make more. I'm going to make more estrone from the fat cells because that aromatase enzyme can convert androstenedione to estrone in the fat cells. And then in our tissues, like our breast tissues, our ovaries, our uterine lining. Estrone, even coming from the fat, can interconvert to estradiol. Right. So this is something that most clinicians looking at hormone replacement don't even know, don't even look at. They ignore it. Yeah, because we don't have a lot of great data. We have. We have good data that estrone and its byproducts can be problematic. We don't have good data saying, what should that level be for every individual woman? And that's true for all hormones. If we had been doing good clinical studies over the last 23 years, we'd probably be closer to that, but we don't have it.

This is where this is. My red flag. Spidey senses come up. There's too many doctors out there that will say, and I've had them, I've interviewed them that will say serum levels are all that matters. You don't need to look at pathways. You don't need to. And this is where that's problematic. This is hugely problematic.

Hugely problematic. So there's. So we use both. Right. So clinically, we've been doing hormone replacement for 21 years out of my clinic. And then even with Minerva, my telemedicine company, we've been doing hormones using that same framework. And we do both. There's a reason to do blood. Right. And let me. Let me explain the different ways you can test hormones and the advantages and disadvantages. So blood is quick, easy, and probably something you're already getting, because if your doctor is doing a full workup, they should be getting thyroid and insulin and glucose and hemoglobin A1C. Those you have to get in blood. Right. So we check them in blood also. Now, timing matters. So if you're still cycling. The best time to check it, to kind of see the disparity or the difference between especially progesterone and estrogen, is in the second half of the cycle. So if you took the day your period started and you count out about 19 to 21 days, if your cycle is about 26, 27 to about 30. Right. That's a good time to catch it because what you'll see is estrogen and progesterone climbing and. And if there's a huge disparity between them, that's often where we start to see symptoms. You can also check blood levels of FSH and estradiol very early in the cycle, like day five, six, seven, right after your period started, because it's very, very low. If FSH is higher than expected, that's a marker of perimenopause. Right. So there's multiple ways you look at it, but blood, number one, is not a great place to check for efficacy and it cannot tell you how you get rid of them. Hormones have a taxicab, it's called sex hormone binding globulin. That taxicab picks up the hormone from its tissue, like the ovaries, drives it around, throws the door open, ideally, and lets it out in the blood. You cannot distinguish free hormone that got out of the car from what's bound inside the car. So depending on the woman, she might be on hormone replacement therapy and it's all trapped in the car. Right. You got a crazy cab driver in New York and they won't let you out. Right. But blood is where we did studies to look at, is the level of hormone we might be on. Like in osteoporosis and osteopenia. We have research, we know what that estrogen level, particularly estradiol, should be where we start seeing protection to the bone. We've got some data in brain function, right. We have some data elsewhere. So blood, I think is valuable from a. Where do we start and what are the other hormones doing? Because the reality is if you're pre diabetic, you've got really sky high insulin, maybe cortisol, that's going to alter your hormone picture. If you are hypothyroid and untreated properly, that's going to affect your hormone picture. So it's important to look at all of it, not just a minuscule piece of it. So we look at all of it and then when you're looking in urine, urine actually shows this entire diagram. It shows the free levels, so it shows how many got out of the cabin. It also shows how we package it, which I'm going to show you in just a minute, like how that works and how you get rid of it. So it's about the hormones you make, the hormones you take, and how you get rid of it. Yeah.

I've had countless doctors say that urine's a waste of money. But I want you all to hear this because this is, this is, this is where you have to be your own advocate and say, no, I need this and I want somebody that understands it, because if you don't, there's an issue. And I'll give you my per. My personal example is I was getting really bad fibroids and I'm menopause. It shouldn't be having fibroids. Menopause. And even though I was taking all three estrogen, progesterone and testosterone, I was really, really low energy and my testosterone was showing high on my blood work. So it didn't make sense. So actually my doctor at the time kept raising the testosterone. She's like, well, that should. Well, what was happening behind the curtain, which I didn't understand until I learned all of this was it wasn't my estrogen that was creating a problem or the progesterone. My testosterone was not converting to free. So I wasn't. It wasn't usable. I had a high like what you said, the shbg. So my. Even though my testosterone level was very high on blood, my free was under two. It was like not usable. And it was aromatizing based on my DNA. And then we could see this on the urine. It was aromatizing and turning to estrogen. So it was creating an estrogen, extreme dominance that wasn't usable estrogen, that was creating fibroids, a thicker lining, dropping my energy, all of that. So the solution for me was not. I originally I was like, I have to lower my estrogen.

What did it.

What it ended up being is I had to stop the testosterone injections that just was not serving me at all. So it had to completely stop them. And bringing that testosterone way down, like to like 30 on my blood actually increased my free and it stopped aromatizing. So that's not my plan. For everybody else, you might be listening, going, well, I'm totally different. But this is why it's so important to be individualized and look at all these. These areas to know what's going on.

Yeah. And. And this is where having a really strong history and understanding where somebody started can help maybe stave off some of that. So what woman might be in that scenario. If you've been diagnosed with pcos, and even if you haven't, because that is so under diagnosed, because you could be PCOS and still have cycles. Right. The reality is you still have cycles, but PCOS is characterized by an inherited insulin resistance and excess estrogen and androgens relative, so excess testosterone, androstene, dione, relative to your progesterone. So if I have that history, I need to be aware. And so this is where urinary testing would be valuable for somebody because you have a more hair trigger response or you're kind of riding the razor edge of how much, not too much, not too little. Doesn't mean you can't do it, but you can't do what everybody else did. Yeah.

What's the difference between a Dutch test, a 24 hour urine, and there's others too. But what, what does it matter?

Yeah, actually, you know, there's, it's a kind of fine line. And I would say all of these tests still have advances that could be made. So for everybody to understand, this is my research, this is my PhD research. I was immersed in this for well over three and a half, almost four years. And so all of them have their caveats. So historically, 24 hour urine was the kind of gold standard for testing free hormone levels for everything from estrogen, testosterone, progesterone, but even cortisol. Right. So one of the easiest ways to tell if somebody has excessive cortisol is to do a 24 hour urine. Right. And that can go all the way to a diagnosis called Cushing's. So 24 hour urine is probably the gold standard. However, that means you need to have a jug next to you and you pee in that jug.

It's not a big freaking deal. It's so funny. Everyone says, I did it, it was easy, it was not a big deal.

I've done many, I've done many over my lifetime.

Everyone scared me that it was going to be this horrendous. Like, this was easy. I thought it was easier than the Dutch, honestly, because you don't have to dry out those little papers.

Yeah. So here's the thing. So you, so you pick a day, which I also tell people, I'm like, especially for we're looking at cortisol. Don't pick a day that you sent away your, your spouse and kids and everything else. And you're like, I'm laying on the couch having my best day ever. That's not a great day to test hormones because it's not consistent with your lifestyle. But you pick a day when you're doing stuff at home where you have relatively the same amount of experience, right? And if you're still CYC, that 20 day, 19, 20, 21 is the ideal time period for you to do this, right? And so, and so you pee for 24 hours, you shake it up, you take a sample of it, you send it back to the lab. There are several labs that do this. Meridian Valley, there's, there's Rhine labs, you know, there's quite a few that do the 24 hour. And what that gives you is, is a full. How much did you make over a 24 hour period? Because your hormones have a diurnal rhythm, which means that they slightly vary a little bit throughout the course of a day. So for instance, testosterone is a little bit higher in the morning than it is late day. And our testosterone, it doesn't fluctuate as much when we're in menopause, right. So it steadily declines from 20. So we don't see this huge difference between a 50 year old and a 40 year old, but we do see a difference between a 20 year old and a 50 year old. So 24 hours. What I consider the best way to look at this Dutch also is very, very accessible. And where Dutch differs is.

Can you unshare that screen just so I can see you? Oh yeah, sorry, sorry.

Why, sure. Let's see. See, we'll do that. So, so where Dutch is different, right? And there's a couple companies that do this. It's basically a piece of paper that you pee on, right? And you pee on it over the course of a day. So in the, in the example of the Dutch test, you start at 5:00pm, no caffeine for, you know, from basically 11:00 clock on, you do the first one, you pee on it. And what it's doing is taking a snapshot of what your cortisol and hormones were at that time. And then you do another one right before bed. If you wake up in the middle of the night, you do another one because chances are your cortisol got high. And then you do one right when you wake up and then you do one within an hour of waking. And what that's giving you is this diurnal rhythm. So I'm getting kind of what happened at night and then what happened in the middle of the night and then what happened in the early morning. The reason people do this is because it gives you particularly a cortisol rhythm for, you know, did I have enough or too much at any point during those days. And then they use the highest amount from whatever reading they get to get. The estrogen, testosterone, progesterone, hormones are sticky. So sticking on the paper, you have to have very specific paper. The extraction method is very important and these labs have all figured that out. But it may not reflect exactly what your hormones did over 24 hours, particularly if you're on hormones. Right. You know, timing, timing of your. Whether you're taking a cream or whatever may vary that slightly. And so we use both, right? We use both. Depending on what we're looking at. Especially if we think adrenals are playing really heavy, we might use the Dutch test because we're trying to see kind of what your cortisol rhythm is throughout that day. But I have an affinity for the 24 hour because I think we get better overall data for the hormones.

I've done both. And I will tell you, it was super reassuring for me to do the 24 because, like, for example, my. On my blood, my cortisol was always showing because I always do blood first thing in the morning. It would always show 20, like first thing in the morning. And anyone that looks at it freaks out like, oh, your cortisol. But that's not actually high for first thing in the morning. Not at all if it's dropping as it should throughout the day. And then the 24 hour urine basically showed exactly that. I didn't have a high, crazy high cortisol problem. It was just D. So I think there's a. Something to be said. It also confirmed what we were thinking about the testosterone and the estrogen. So it confirms our hypothesis. So I do think it's important. I think that. I think I would prefer personally that the 24 over the Dutch right now based on what I saw, because it was a more consistent. It could tell you what was really going on versus just these markers times.

Yes, exactly. And can I. I'm going to show my screen again really quickly. So I'm going to explain to everybody what we're really looking at when we're looking at these urine tests. So when we're looking at these urine tests, I'm going to go back to what I call the scary drawing. Like, oh, gosh, Betty. So what we're looking at here is kind of the actions at testosterone. And Justine Dione particularly, we see all of this. So urine gives you this entire picture. Nowhere else can you see that saliva doesn't show it, blood does not show it, but urine shows it. And when we're looking at estrogen we're looking at this area right here, right. We have three estrogens. Estrone, predominantly fat cells. Estradiol, predominantly made by your ovaries. Estriol, which is really weak, but we do make it. It's high when we're pregnant. This comes off of your liver detox pathways. Right. And if you're doing vaginal estrogen or a topical facial estrogen like the one I have, or a prescriptive one, it's mostly estriol, if not completely estriol, because it works very locally and protects tissues. Right. So we're looking at this and we. These are your three little bears. Right? So this is, this pathway right here is the, the porridge is just right. It's called the 2 hydroxy estrone, controlled by a gene called CYP1A1. No test after this. You don't have to remember it. Just know that I have a good one. I have one controlled by CYP3A4 gene. That makes 16 alpha hydroxy. That one is kind of the in between. It's a little bit cold. We have older studies that indicate if that's really, really high and you're not getting conversion to estriol, that there may be more, what we call proliferative effect. So if you have a cell that's, that's growing too much like a tumor cell, it can enhance the tumor cell growth. Right. Some other newer studies don't show that. So it's what I would say is, it's what they call equivocal. We have some that go both ways, but still the research today sort of leans. We don't want too much of that. And then the problematic pathway, right. Is CYP1B1 gene, and it makes four hydroxy estrone. That one, if it's too high, causes DNA damage inside cells. Which gene? CYP1B1.

Okay.

And, and so what it does is it may, if it gets stuck here, it gets. It makes a reactive ingredient that damages the DNA over time and can cause, you know, spelling errors in your DNA, which happens in tumors. Tumors predominantly come from replication spelling errors. So when your cell goes, oh my gosh, I'm, I. All our cells have programmed death. You know, they live for a certain period of time and then they make a daughter cell and then they die. When I make a dog. Oh, go ahead.

Sorry. I want to make sure because, because I know a lot of people, especially my listeners, have done DNA testing. Like, doesn't everyone have some, like, everyone has like a CYP1B1, don't they? What does that mean? Like a different variant? Like, because I want to. As you're talking, I just know people are going to go look at theirs and go, wait, I have that.

So essentially when you get made as a human, you get one gene from mom, one gene from dad.

Okay?

Right. You can have what they called wild type, which is the more common and in most cases that confers protection. Right. Based on our research today. So if I have a wild type, which usually is going to show up like as green, Right. So if I get a good wild type from mom, wild type from dad, it's going to probably do the most in that pathway. So it's going to make, it's not going to make a lot of four hydroxy. If I have one bad copy from one parent or one mutated. I don't even say bad mutated copy from one parent and one good one, I'm probably going to get a little bit of mixed bag, right. And then if I have two copies that were mutated from a parent, I'm more likely to go down this pathway.

Okay, yeah, that makes sense. That's where that number plays into when you have one or two.

Okay, totally. Here's this. I have to say this because I hear this all the time. I do a lot of speaking for DNA companies. I've been doing DNA testing personally since 2012. I have used almost every lab out there. I have a lot of experience here. Your DNA is not determinant. It is not, but it can indicate potential, right. How I eat, what I take, what I'm doing will either drive those pathways down a kind of negative pathway. So I call this the Keith Richards effect. Right? So Keith Richards, I don't know if this is true. I know nothing about him, but I just, I marvel at the fact that he's still alive and rocking and rolling because he treated his body like a human trash can. Right. And I'm like, you know, when you think about it, you're like, well, maybe his genetics are such that he's really got like good detoxification because he's admittedly done drugs and alcohol and all that stuff his entire life and smokes still, Right. Not all of us win that lotto, right? So if I have less than favorable genetics and I live a Keith Richards lifestyle, I'm gonna drive things that shouldn't. So you largely have control here. That's the important thing. And so that's the porridge, right? So think of 1B1 making 4 hydroxy. Estrone is the red. I don't wanna Make a lot of that. This one right here making 16 alpha hydroxy is the blue. I don't want to make that a lot. It's okay. And then the two hydroxy is the green, probably the best one. Everybody is going to have some of that in every pathway. There is no way, nor would you want to shut down any one pathway completely. So here's the way to. So here's the way to think about it. I'm going to do some kind of flipping back and forth because this gets so confusing. So the act of biotransformation or detoxification, right. Is not an act of breaking stuff apart, Right. So before I went to school and learned about organic chemistry, I thought that when we detox something, it was like I broke a chair and I was trying to shove it in the trash can and I can't get it in the trash can, so I break the other leg off of it so I can jam it in there. That is not how it works. How it works is it wraps different wrappers around it and passes it through these pathways before it gets it to the trash. So we're going to call this highlighter used up estrogen. It could be estrone, it could be estradiol, but it's used up, it's leaking, right. I don't want it in my body anymore. I need to get rid of it. So I have three choices. I can go down the red pathway, right? So I got red tissue paper. I wrap it, right? It's got to get wrapped in one. There's no way to get around it. So I can either do red, I can do blue, right. Also not great. Or I can do green and I want to do a lot of green. This must occur for it to move to the next position. One of those colors must get wrapped. Now here's where it becomes important. Most of our toxins also go through this pathway. So medications like antidepressants, pain medications go through these pathways. Lipid lowering drugs like statins go through these pathways. So if we also have other stuff that we're taking going through these pathways, I may alter how well these work, right? So those toxins become from fat soluble in this in between state. We're moving them to water soluble so we can excrete them. Fat soluble means your body can store it. So what happens if I get this stuck and I can't get rid of it? I'm gonna store it in a fat cell, right? Some of it gets stored in the liver, some of it's getting stored in the fat Cell, but I can't poop it out or pee it out right here. The next step is going to be where some other genes and some other activities get involved.

So wait, before you go to that part, I just want to make sure I'm understanding this correctly. And so whatever you're, it's all going to get wrapped in something. And depending on what it gets wrapped in, it may or may not store in your fat tissue. And if it stores in your fat tissue and we don't figure out how to get it out of there, that where it can be problematic, AKA cancer cell or something like that.

Right. And the other thing to think about here is it's not so much the action of that gene, it's the downstream. So think about it this way. If I have, think of that mountaintop. So I have a river making hormones, and then we get to this bottom area and I have a river going down one of those three pathways. If I have a beaver that built a dam below the red, the green or the blue, I'm going to have a problem. So what happens downstream? Or like my driving analogy, I'm going to get on the tollway and it's all backed up. If I, if I get downstream and it's backed up, I can't get rid of it. So what happens next is equally as important, if not more so. So. Right.

And what you're saying, if I heard you correctly, so let's just say you're okay here. Like, maybe you're, you are not trapping it, but now you've got higher cholesterol and you're, you've been, you go on an LDL lowering thing, whether it's a zeta bite or whatever it's called, or a statin, or you do P, like a repatha, like, which blocks your PSK9. All three would lower your LDL, hypothetically. And you do that. You are now also, if I'm hearing you correctly, you're not just lowering your ldl, you're also affecting that pathway, which could also potentially another problem. Because now you basically have to start over with how is your body managing the hormone detox? Is that right?

Exactly. So I'll explain this because I, I have, I have some familial cholesterol issues. I don't have great genetics for my, for cardiovascular. When we compared ourselves, I'm like, you're one of my people. So I had, so I had cholesterol that was pretty good until I went into perimenopause and menopause. Then it went up in particularly a particular compound called apob, which is what cause material plaque.

Same thing.

And I went through the process of trying different things. I didn't want to, but you try them. So I did a statin, right? Low, low, low dose statin. Liver enzymes went up, showing liver damage. I tried Ezatembe, which works in the gut and keeps you from absorbing it, not a statin. Liver enzymes went up.

Oh, great.

Because it goes through the same estrogen pathways that my detox pathways don't work. Right. So I'm on Repatha, which doesn't process through the liver at all like that.

Okay.

Which I love.

I was gonna ask you about that. That's another conversation. Okay, so. But the Repatha is known also to lower LDL extensively, like pretty. Because it's an injection that lasts like two weeks. So did that affect anything?

So that doesn't process in the same way. It is a monoclonal antibody. And so it affects an enzyme called PCSK9 and it inhibits. It affects how the liver sort of recycles it. Most of your cholesterol issues are being made not from your diet.

Okay, not to get off on a whole tangent here, but I really want to ask you about this too. We'll have to do a whole other episode about that. But because this is something that a lot of people navigate where they have that PSK9 gene and they've had familia, high apob and cholesterol. And I think the scare. I'll tell you for me specifically the scary thing with Repatha, because I had that same issue with doing a microdose statin, or is it a xetomibite, is that the repathic is one dose, no matter what size you are, it can lower it too dramatically. Is that only for people that don't have that gene expression?

Well, most people don't have. So if you have a mutation on PCSK9, that actually is one of the ones that's actually advantageous. So if you happen to be wild type, you have less capacity to function here. Whereas the mutation is actually advantageous. But most of us don't have it.

Got it.

So drugs are calibrated for an average of £150 or more. So if you are 90 or £100 and depending on how you metabolize things, it may be an overdose or an underdose. I happen to be one of those that I probably. I should do it every month because it lowers it too much by doing every two weeks. And so I.

So can you do you mind sharing, like, what was your LDL and apob and then what did it lower to?

Yeah, so my, my LDL or like my total cholesterol climbed to about 287 on average. It went up as high as 300 at one point. Then my LDL went up to about an average of 155 and my APOB went from like a. Average of like 80 when I was perimenopausal or premenopausal to like 155. APOB, you do not want that high because what it's doing, that's the, that's the carrier that drags it into the muscle tissue of your artery, causing plaquing. So now I just got my labs done. So now my LDL, because I was doing it two weeks and it was like my LDL dropped to 75.

Yeah, I've heard it can drop it very low on some people even.

Yeah. And, and so, and my. But my APOB went down to about 70. Right. So it cut it in more than a half.

Any other side effects from Repatha?

I get. I get no side effects from Repatha at all. My total cholesterol is still good. So my total cholesterol isn't random, you know, rapidly low. But I don't know if I absolutely have to get. So I'm actually.

And I'll report back on this for those of you listening that want to know more about cholesterol. I've had. I've had cardiologists on before. This is something I've been. I have a familiar high, very high. Mine's actually higher than yours, a lot higher. I have had coronary artery scans where I'm fine. I've had. Clearly I'm fine. So I'm not in a high risk yet. But my dad did die of this, so this is like a very important suit. So my cardiologist has wanted me to actually start repatha. And I was scared until you just told me this. So this is actually interesting. And for those of you that are like, wait, what's repath? I'd not heard that. Number one, make sure you actually have that gene expression. Because like she just said, and I know Cash, when I had him on about DNA, said the same thing. Unless you actually have that gene expression, it is not going to be helpful to you. But if you do have it, Rapatha is. It's a. It's a different type of thing. It's not a statin, it's not a zetam and bite. It's a totally different way. It just blocks that gene expression. But it is one dose, it is very strong. And no matter what size you are, and you cannot dose it smaller or anything. So it's in you for two weeks once you do it.

Yeah, but you can extend, extend the dosing timeline. So instead of doing it every two weeks, you could do it. You know, you're. You and your doctor. Obviously I don't prescribe, but you and your doctor can alter how often you do it, you know, because basically you're going to get a peak in a valley. But, you know, your peak valley may not be that dramatic.

Pretty amazing. And it doesn't affect the other protective properties of ldl. That's my other concern.

Yeah, it's. It actually, I would say to me, repather or any PCSK9. There's two of them, prolont is the other one. I think they're game changers because they're actually affecting what the liver is doing at the production or recycling of ldl. It is very, very different than a statin.

Amazing. Okay.

All right.

That's a whole other topic. Sorry, I got a little sidetracked there, but I wanted to. Okay, so. And you mentioned other medications. So, like, what's another example? Like does diabetic met, like talk to like, how somebody is doing a GLP or somebody that's doing metformin, like, how is that going to affect this?

So they don't, they don't process as heavily through this. So GLPs don't really at all. Your metformins and things like that that you might be on for longevity or other things don't. But a lot of your pain medications, statin medications, anticoagulants, all go through here. Right. Okay. Important to know. Yeah. So if you are on polypharmacy, if you happen to be one of those people that your doctor kind of has stacking medications, it's important to be aware of this. A number one, even if you don't do hormones at all, Right. Because it's. Because all of those things, it's kind of like, let's say you had a river going here, right? And now somebody has poured a bunch of things in it and the river is overflowing.

Totally.

Your body was designed to do so much. So the next thing. So like I said, the first step is important. But if you're thinking about like, here's another example. So let's say you're looking at your plumbing, right. And you notice the water backing up in your sink and maybe Your toilet, right? You don't go start futzing with the stink in the toilet. You go all the way out to where it goes out and you open that first. Your detox pathways work the same way, so you have to look all the way downstream. And so I'm going to go back to my diagram and give a picture, right? So maybe I don't make good estrogen, right? I'm making our estrogen byproduct. I make a lot of 4 hydroxy estrone at this point. I have a gene called comt right here and comt right here that methylates it, right? That's not the only way I get rid of it. But methylation is important here. So your compt genes, if you are a slow compt, which a huge percentage people are, meaning they don't express a lot of this. They are slow to get rid of estrogens, they're slow to get rid of dopamine and norepinephrine and epinephrine. That's the warrior warrior gene. And your B12, B6, B2, B9 status will impact this. The type of B12 can impact this. This is the pink wrapper that must wrap around the red, green or blue wrapper, right? You can't jump to pink, you can't jump to pink and skip over those other colors. Right? Now this is where I get mad at all of these labs and it's about how they process the urine. This is not the very last step. But what it does make in the case of the red is it makes 4 methoxy estrone. So if I have 4 methoxy estrone high relative to 4 hydroxy on a urine test, I'm getting it. I'm getting a lot of pink wrapper on there. Or same thing here. Two hydroxy gets made into two methoxy, right? So I'm methylating my estrogen, so that means I'm getting a pink wrapper on it. So here's where I get frustrated. So I'm going to turn this off. This is not the last step. So we either poop out or pee out. At the very last step, estradiol preferentially goes through a process called glucuronidation. And glucuronidation is made from an amino acid, right? And it gets. Think of that as the black wrapper, right? It's going to get wrapped up in the liver, it's going to get bound in the bile, go into the gallbladder, hang out. If you don't have a gallbladder it's just going to go straight from the liver into the intestines, get tied up and all the stuff going out along with fiber. Right. If you're not, you know, pooping, it's going to get stuck in there. It's like leaving a trash bag in your house and letting it sit. Right. And you're going to poop it out. Now your microbiome make an enzyme called beta glucuronidase that can basically wrap that, take that black wrapper off and throw it back into circulation. So here's where it gets interesting. Bacteria that make beta glucuronidase called the estrobolome. We always have them. We should have them increase in numbers as we go through perimenopause and menopause by nature. Again, our body needs these hormones. So it says, hey, make more of you guys so you can get more of whatever estrogen I have out there. Totally cool. Before we were full of industrial chemicals that look like estrogen. Right. Phthalates, pesticides, herbicides, fragrances, plasticizers, all those things are also going through that pathway.

Wow.

So how you poop makes a difference on how you excrete estradiol. Right. So super important. The other pathway, and this is what frustrates me, is nobody has this and it's because of the technique that's used to do these tests in the lab. And I'm not going to go into that because it's kind of a bunch of lab jargon. The majority of your estrone, remember estrone, we don't want a lot of because it can convert into the tissues into estradiol and it's associated when it's high relative to like, like estrogen sensitive cancers. We have association. We have a big, big area of research that needs to happen here. Estrone preferentially gets peed out. Estrone should be on this diagram. It's not. Estrone stops. None of these lab pick up estrone.

Wow.

Sulfate. And it's because when they do the process, the, the or the way in which they sort of pull the hormone away from that hydroxyl group or the hydroxy or the methoxy destroys the sulfate bond so you can't pick it up. I've put together some things, I'm trying to get a couple labs to look at, maybe making my own test so we can see this. So estrone sulfate, we make a ton of that. We should. And it's the orange wrapper. And estrone is going to get peed out. Right? That's the last one. It's got to get wrapped. So if I'm not hydrated, I'm not going to excrete it very well. If I don't do sulfation very well, right? If I don't do that last step very well, I am going to get stuck here, right? And I'm not going to get rid of all of it. So this is where I spent a lot of my research because I kept looking at like, why do I have so many symptoms in my 40s? And I started calling us the canaries, right? I was, it was all these women that would come in and they're like, yeah, I had fibroids, I had crime scene periods, migraines. I get anxiety, IBS and depression when I'm around my period especially. These can all be signs that maybe we're not getting this stuff out, right? We don't sulfate it very well. The donors here is sulfate, right? So women that get into here's, here's sort of my thing. So I have a couple questions that I always ask. If you go to your, go out with your girlfriends to brunch and you get a, let's say a mimosa and you get a runny nose, a headache, maybe you turn red on your neck, right? You get adverse or you're like, I can't do beer, I can't do wine. Obviously beer contains gluten. Maybe not. But if you're like, I chose not to do that stuff forever ago because I don't to want feel good, that's a sign that this may be an issue. Wines, particularly American wines, have a ton of a thing called sulfate in it. Sodium metabisulfite and IT sulfites are known to cause all kinds of allergic responses, hives, itchy, all that stuff. So I have a lot of women that were like, I could do it.

When I was 25, but not now.

40, like everything went to hell in a handbag. And I'm like, huh? Because you have more estrogen going through there in your 40s. So sulfites are toxic. We have a gene called SALT S U T that converts it to sulfate. So often that gene doesn't work. So I don't get the orange wrapper, I'm not making it. And then if I don't do that, I'm going to have a inability to process this. Well, this doesn't just affect estrogen, it affects DHEA sulfate, testosterone sulfate. You know, our neurotransmitters, adrenaline, dopamine go through here too. So it's not exclusive to this and so, you know, if you're a person. Here's another way to think about it. If you're a person that gets into a magnesium Epsom salt bath and you're like, I feel like a damn rock star when I do that. It's not just the magnesium. It's magnesium sulfate. You absorb it through your skin. It's a sulfate donor. So if we use that sort of plumbing analogy, if I'm trying to clear up these pathways, I'm going to start with donating sulfate, and then I'm going to support the conversion of sulfites to sulfates. And the controller to that is a. Is a mineral called molybdenum, right? Then I'm gonna worry about my methylation. Then I'm gonna worry about my other pathways, you know, the porridge pathways. I go in reverse order because if I start fooling around up here and messing with the sink and messing with the toilet and the plumbing is blocked on the way out of the house, I'm not gonna get very far.

Oh, my gosh.

That's what I see all the time. People are like, oh, I'm giving meth related support. And I'm like, do you know if it's getting to the dumpster?

So, okay, bet I might be a little more confused. We're coming on the hour here, here. And I. I actually might be a little bit more confused. And I think other listeners are too. So here's the thing. We're gonna have to do a part two. We're gonna have to do a part two because this is. I want to unpack this more, and I still have a lot more questions. But here's what I want to say for those of you listening, I'm gonna schedule a part two with her. Like, we're. That. That worry that's coming. But here's for those of you that are like, how do I even begin to dive into this? And I feel more confused. I want to share this one. We get to. When you go to your doctor, you have to ask for these things. You have to ask that you want, you want to say, like, I need to understand not just how. What my blood serum is. I want to know how it's processing. If your doctor does not understand urine testing or they don't understand DNA, it. I'm just throwing this out there. It might be time for either you to learn it or you to find a different doctor that does. Because this is important now. If you're like, I feel great. Nothing's. I'm not talking to you like, if you feel like, but if you are on HRT or not on HRT and you're like, something's just not right. I'm getting my blood tested and this isn't right. This is when you have to dig deeper. I will tell you, this is really actually pretty exciting. I have featured other telemedicine companies. I have, I'm in constant search of just trying different ones and figuring out this is really cool. Betty. Dr. Betty here has started one for this reason. And if you go to get hormones now.com forward slash Natalie Jill so you can get extra attention because she knows you came from here. So get hormones now.com forward slash Natalie Jill. She herself yourself has trained other practitioners on all of this, which is really cool. So you can do a telemedicine company and actually get tested with these things and prescribe with the understanding of DNA, with the understanding of urine, all of it. Can you just talk a little bit about that for a second here?

Yeah, yeah. So, you know, we've, like I said, we've been doing this for 20 years in our practice. We've been doing hormone metabolites like the urine test for 20 years. And then when DNA came out, we started adding that additional understanding. So the framework has been there for a really long time. But I found, you know, particularly I, we had all these people flying in from all over the country and I'm like, okay, this is my sign, right? So, so we have, we have clinicians trained in all 50 states and we're actually bringing on a new pharmaceutical partner right now that does hormones and jojoba oil. So it's actually 100% organic. The only brand out there prescribed with organic hormones. And we look at these additional things, we check your, your urine pathways and make sure it works. And the other side of that company, and the thing that I'm really excited about because we're actually finishing our friends and family round is I'm building a technology and a data capture platform. In your spare time, betty. Yeah.

Your PhD and everything. What in your.

Yeah, that's why I went back for my PhD. I literally went back at like 49. Not because I wanted a 300, $300,000 bill, but I wanted to understand complex research models so I could, I could basically collapse under your gap in women's research in less than 5. And that's what Minerva really is being. We, not only will we be personalizing and being able to preventative, proactive and predictive, but we'll be able to then look at the data in aggregate and really larger numbers to go. Why does this woman get menstrual migraines? Why does this woman get PCOS or osteoarthritis? We don't have that data, but we can when we have data.

So I have not personally gone through the process yet, but I'm going to, we already talked about it. I, I've had access to Betty's brain, but I'm going to go through her whole process. So I, I will report back, but we're gonna, we're gonna kind of pause here and we'll do, do a part two coming soon. But thank you so much. And I'll link all this up in the show notes and where to find Dr. Betty. But if you go to get hormones now.com forward slash Natalie, Jill, you can figure out if this is the right telemedicine for you. If you're not doing that and you don't want to, that's okay, too. I'm just going to encourage you. If you're not feeling amazing on what you're doing, you've got to dive into learning this. Whether you learn from what we're sharing on the podcast or you go deeper down Dr. Betty stuff or on your own, it is important that you, you look at pathways, DNA and these urine tests. Thank you so much, Dr. Betty. Thank you, thank you.

Thank you for having me, Natalie.