What Doctors Don't Tell You About Estrogen Dominance

Hormone replacement is all the rage, especially with midlife women. But what if you are someone that cannot metabolize correctly? What if when you're taking them, it's actually converting to something else? What if they're creating more problems than good? How do we know when we actually need them, when we need to make some adjustments or when we can do without them? And is the hype about we all need them or we're going to ruin our brains and our bones and everything else? Is that true or is that hype? We are continuing the conversation. This is part two of a conversation I started with Dr. Betty Murray that you already heard last week. If you missed that episode, I highly suggest start there, pause this one, start there first. This one will not make as much sense because we covered in this first part what pathways meant. Like when you hear about a Dutch test or a 24 hour urine and you hear about how your estrogen is metabolizing. We did a whole science lesson, we showed that, we shared that. But I highly suggest starting with that episode before continuing on with this conversation. In today's conversation we're going to go deeper there, but what I want to talk about is adding in the other hormones. So I want to talk about testosterone and progesterone and what happens with those. Also signs and symptoms as to if we have an imbalance or if we are aromatizing the wrong direction. I want to know that. Can we do anything about that? I want to talk about how to actually intervene with things. How can we course correct, how can we fix this and then also want to get into hormone delivery methods. How do we know if it's best to do a cream, a trochee, a injection? How do you decide? And then even talk a little bit about peptides and how those are signaling things and how it's very different than just doing hormone replacement. Thank you Dr. Betty Murray for being back for part two. We just had too much to chat about last time we had to do a part two.

Thank you for having me back. You know, I could talk about this for, for days on end.

So let's. We're going to continue the conversation now. Hopefully those of you listening have listened to the first one again. If you have not pleased, please go back and listen to it. It'll make a lot more sense first. But where I want to pick up is let's start with signs and symptoms. How do we know if we haven't done a 24 hour urine or a Dutch test? How do we know if something's going down the wrong direction. We're taking estrogen, whatever, and it's not doing the right things for us.

Yeah. So. So let me. I'm gonna back up, and we're gonna stage it in kind of the three stages of the menopause transition. So early. Early perimenopause, perimenopause, like midtime and then kind of menopause. Right. And, you know, and so because. Because different things happen at that time. So early perimenopause is really signaled by the shift in change between estrogen and progesterone. Right. Their relative relationship between them, particularly in the second half of your cycle after you ovulate. You know, progesterone is supposed to skyrocket after ovulation, and between the two of them, they bring blood supply and tissue support to the uterine lining. And then progesterone is supposed to support in case implantation happens. So in early perimenopause, progesterone is declining. So so often what we start to see is we might see heavier periods, fibroids, you know, clumpy periods, that kind of thing. More pain, more pms, sleep issues, irritability, all those kind of period symptoms that we start to see. Some of us may have those all the time, you know, every cycle, but they tend to amplify, you know, at this time. Sometimes your cycles may come more frequently. Like mine started coming every 21 days. That was awesome. Not awesome. And then they were crime scene. So that could be a sign that they're out of balance. Now if you're in the second stage, and that's where progesterone is already declined. So all those symptoms tend to be true. And then we start to have some other variable symptoms. Some people may get hot flashes and night sweats. We might get heart palpitations. We might get more irritable, more moody, more anxious, more depressed. We might feel heart palpitations. We might feel some of all those symptoms that are also kind of often misleading because people think it's, oh, my joint pain or other stuff, when it really is a sign of the hormones kind of going wild. Progesterone's low. Estrogen is doing what I like to call the bungee cord. It's kind of up and down right now you get all those symptoms. Well, if you haven't done any replacement of progesterone and estrogen is bungee cord dropping and going up and down, you are estrogen dominant just by nature, because estrogen dominance means the relative relationship between your estrogen and progesterone, which Whether it's what you make, what you take, or how much you have and how much you can get rid of, which is your metabolism pathways. So what's interesting is you could have estrogen dominance where you're not clearing estrogen very well and have very similar symptoms to the groups I just talked about.

So you can be estrogen dominant without having actually too much estrogen.

100%. Yes, yes. And a lot of it depends on kind of timing, right? You know, like I said, you could be estrogen dominant relative to your progesterone just because you're 39, 40, and your progesterone, you're not ovulating completely every month. So your progesterone production gets low. Right. And it may not be consistent every month because again, estrogen's kind of all over the place. And sometimes you ovulate, sometimes you don't. And so you could be having that experience. But if you don't clear estrogen well, and let's say you're eating a poor diet of, you know, highly sugary foods and you're pounding coffee and you're stress, like all these other things, and, and you don't clear it well, that just makes it worse right? Now, when you get into menopause, where estrogen has now flatlined, progesterone flatlined a long time ago, if you haven't replaced it, you are no longer truly estrogen dominant in the classic sense. Like you are making too much estrogen, right? Like it's too high. It may still be higher than the other two because they may be like literally at zero, which I think we'll probably talk about, right? But you are also probably going to feel the impact of that loss of estrogen more because you have more receptors for it. If you are already dominant, especially if you were wired for it like I am. And if you don't clear it well, you've got pesticides, herbicides, phthalates, plasticizers, you know, fragrances, all these things that are environment that go through those detox pathways. So they could be stimulating those receptors and slowing down those pathways. And we may still have symptoms related to that because it's the dominance or not. And the symptoms or not are based on relationships between the hormones and then total production and total availability.

All right, I've got some questions here. So the first question is if someone is told they're estrogen dominant, but they don't actually have high levels of estrogen, so they're in that latter perimenopause or maybe in menopause, Starting menopause, and they are told they're that and their levels are low. So let's say they do a blood test, for example, they've got low levels of estrogen, but they're told you're estrogen dominant. Or what a lot of naturopath doctors and functional medicine will do is instead of hormone replacement, they'll put people on things like DIM or calcium deglutarate or broccoli sprouts to help them clear. So in theory, I'm assuming what they're doing makes sense. But isn't that just dropping them even lower and creating more problems?

Yeah, I mean, you, you know, whether it's those products or even, you know, extracts from, you know, Russian rhubarb plant, there's a lot of products that can lower estrogen levels mostly through the detox pathways. Right. So they either amplify, slow down or increase it. And so you could possibly lower the symptoms. But if we remember the physiological effect of these hormones, you know, progesterone is going to act in the brain and the rest of the body. Testosterone is going to act in the muscle tissue and in the brain also very heavily. It reacts everywhere. But I'm pointing out the big ones. And then estrogen protects the brain, the heart, the bones. So if I have still more estrogen, again relative to the other two, I could be estrogen dominant. But if I give a bunch of things to lower it, and I'm 55 and I went through menopause five years ago, I am going to have less available for my brains, my heart, my bones. Right? Yeah.

Plus you'll have the other signs of low estrogen, like just how you feel, I would imagine, right?

Oh, yeah, yeah. Weight gain, hair loss, you know, worsening night sweats, worsening hot flashes, all of those things start to get worse. And so, you know, the idea is it's about restoring relative relationships between these hormones and getting them to a physiological level, not super physiological level, and then making sure that you can get rid of them when you're done with them.

This is important because if you go back, anyone listening, and you look at labs, you can start to see this as you get more educated. I know for me, I didn't know anything about hormones five years ago until I was really walking through this. And if I go back and look at my labs from five years ago, I can clearly see I had very declining estrogen. I was not yet on estrogen replacement. And I remember my naturopath prescribing me dim, and I was feeling worse. And I didn't understand. Now I understand what happened there. So it's just important for us to understand and ask those questions, like, what is the dim for? To really understand what you're doing. If you're, if you're not actually adding HRT and you're adding dim, it could be very problematic.

Yeah. The other thing I want to say about this too, if you're in the bungee cord time period, right, when we're younger, if, if you had normal cycles, we'll qualify that, right? So if you're pcos, you know, non congenital adrenal hyperplasia, things that would mess with your natural cycles, you know, when you're naturally cycling, progesterone and estrogen sort of move together in a very, you know, sort of organized way. But when we're in perimenopause, they often can get, particularly as you move through that first phase into the second, and then sort of into menopause, it can become wildly, you know, unpredictable. And that's why a lot of conventional doctors go, you can't test for it because it's wildly unpredictable. And I'm like, but yes, you can. Right? We can time it. So it's the second half of the cycle when it's supposed to, you know, go up, which is, you know, about day 19 to 21, 22, since the first day you had your period. And it's important to look at trend value, right? So trend value means maybe one, let's say estrogen, that's 350 or is not really meaningful because that might have been where it was. It's where it was that day. And it may not be, if you have a 350 every single time, right, that may indicate that you're actually rising at the appropriate level. And on blood level, it's usually going to be about 250 to 450. But if you look at it, 600, okay, I'm estrogen dominant in that moment, so maybe I check it again in a month or two and see did it drop to 40, right. Because then I'm bungee cord jumping, because it's the overall expression. And so, and so the reality is we have to kind of know what we're looking at. And there are things today I have no attachment to this. But there's the MIRA device that you actually pee on every day. That's like a glucose meter, you know, like the old school one. And you can literally watch your hormones move throughout the month. It's great for perimenopause if you're trying to figure this out. But the reality is the trend value is valuable. And so many women myself, I had the same thing. My doctor's like, you're obviously estrogen dominant. And I knew I was right. I knew I was. I've, you know, it's like I explode from every direction. I was very, very curvy and still am. And. But I know now that I probably should have been put on estrogen five years prior. Six years prior. I went through menopause at 48, full menopause. But I probably needed to be on it in my mid-40s. And I wasn't because everybody kept telling me I was so estrogen dominant and I was afraid I was going to gain more weight, I was going to lose more ha there. And, and really the reality is the exact opposite. Yeah.

And it's important, you know, you just gave some number examples and people are going to pull out their labs when you said that, when you said 350 or 650. But you can also be told you're estrogen dominant at 20, just so, you know, at 20 on your blood work. So, so it just, it's all ratio. And it's important to be aware of that because I know too many people in these very low ranges being told they're estrogen dominant. And what it sounds like it should be managed more with HRT versus just let's reduce even further.

Yeah, yeah. Because the reality is estrogen is protective to every single tissue in the body. So when you drop below physiological doses, even if your other hormones are lower and you're higher, you are not getting the protection anymore, period. Full stop. And so, and so we have to look at them relative to each other and then where are they relative to what we know in the research where it starts to provide that protection and then individualize it to that person to make sure that they also feel well. Because there's ranges that we know from the literature that are like, okay, these are ideal ranges.

You mentioned two things earlier that I want to circle back to and close the loop on. The first one was a really simple thing you said, but you said you could be not detoxing well, but you said, like you're eating these bad foods, you're eating a heavily processed diet. But what about the people that are actually eating very clean, they are doing the right things, they are at an ideal body weight, they are not eating the junk. Could they still have a clearance problem?

Totally, yeah, they could have a clearance problem. But for sure, if you're kind of doing the sad standard American diet. You know you're going to make it worse. You're going to absolutely make it worse. And we know that from the literature. Hot flashes and night sweats are worse in people with higher BMIs that eat the standard American diet because those things also impact those pathways.

But you also can have, if I'm hearing correctly, you can have bad genetic pathways or you can have other reasons that that happens. Even if you're. So don't dismiss and say, well, I'm eating perfect, I don't have bad detox pathways.

You still might, yeah, you might just be doing a little bit better than somebody else. But you may not be awesome at it and may need some additional support.

You also mentioned endocrine disruptors or estrogen mimicking things like cleaning products or specific foods or plastics or whatever. What does that actually mean? Because that's confusing too for people. Like if you're. Because you would think if something is estrogen mimicking or it's an endocrine disruptor, why is that not helping our estrogen? Help us understand that.

Yeah. So think of your hormones. So think of estradiol. So estradiol is the protective hormone that your ovaries make. Think of it as a key. So that key has, let's say, five fingers on it. You know, like if you look at key, the little notches in it. And that key has a specific lock that fits perfectly with those five fingers and turns it very easily. When we look at the chemical structure of let's say a pesticide, an herbicide, just so you know, there's a birth control for plants and bugs. Right. Or we look at PCBs and plasticizers, BPC and all DEs, which they used to use, which is actually a plasticizer. They used that for women and they didn't realize that they made their, the babies of those women infertile. Right. And that was pulled off the market way back when. So we've used plasticizers as estrogens, just so you know. Right. Way back in the day. So what it is is that chemical structure. So imagine now if you can't see me on the screen, because you're listening, you know, imagine I'm holding my hand out, five fingers. Now I take two fingers away. It kind of looks like the five finger estrogen, but it's not the same. But I go to click it in the lock and it centers into the lock, but it doesn't turn it completely. So it doesn't have the same physiological effect. But I can jimmy it and sort of halfway Turn it right. So like, let's say you get your key stuck in there right now, birth control, just so everybody has clarity around. That is a synthetic estrogen. It sits itself in the receptor, the key, and then breaks itself off. That's how it controls pregnancy. It irreversibly binds to receptors. Right. Particularly on the ovaries. So these, these, these xenoestrogens sit in the receptor but don't provide any value. Right. They don't do the positive effects. Right. So here's, you know, we don't have a ton of research here because nobody's really funded it. And it's why I created Minerva and why we're doing the technology. So if the average age for diagnosis of breast cancer, United States is 62 years old, that's a good 10 years to 1112 years after menopause. Most of those women do not have hormones. When we stopped treating with hormones, the number of diagnoses went up. Not just because we got better at it, they actually flat out went up. So we don't have our protective estrogen. However, we have a ton of things in our environment that are estrogen. Like, so if I don't have estrogen, estradiol sitting in that receptor, what do you think is. Your plastics, your herbicides, your phthalates, your. All of those things, the stuff that's in your cleaning supplies, your body care products, they have an effect on those receptors. And we don't have enough data here at all.

Interesting. Okay, so we're, they're sitting in the receptors. They're not adding any benefit, but that also is creating, helping us become estrogen dominant and create some of those symptoms.

Potentially, yes.

What about food?

Yeah, we don't have ton of, a ton of good research here to go. You know, what's the, what's the threshold? Which ones? How much? We don't know that. Yeah.

In your opinion, what about foods, things like soy, Are they helpful or hurtful?

You know, here's where it gets really, really interesting. So soy genistein and flax lignans, you know, sweet Mexican yam extract are probably the things that have been looked at the most nutritionally that are what we call phytoestrogens. So plants have phytoestrogens just like we do. So what they are is an extremely weak estrogen. Right. They have a physiological effect in a plant. What's interesting is, and we're going to qualify these by non GMO organic, you know, hopefully heirloom. Right. So when we look at soy genistein and flax Lignin, we have good research showing that they both have mildly estrogenic effect to support things like hot flashes and night sweats. There's some studies looking at flax, lignin and breast cancer, cell tumor inhibition and other things. So they have this effect that can be somewhat positive. So for the woman that may not want to do hormone replacement by choice, but let's say they do get some of those symptoms, they can use these things to support it. There's also an extract from a Russian rhubarb plant that's got clinical trials on it that shows that it actually reduces hot flash. It's a product called Estrovera. You know, so there are natural things that have this sort of slight effect, but they won't improve the heart, the brain, the bones. They're not at that physiological level that you would normally get from a hormone replacement. But they can help. What would.

Why, what's the harm in them? Because there's seems to be a lot of bad speak about soy containing phytoestrogens.

You know, it's. So some of it is the difference between mechanistic action and in vitro, which is in a petri dish and in human clinical trials, right? Most of your natural things do not get trialed heavily because it's expensive, right. And natural products, they're not patentable, right? And so we don't have a ton of these. But for instance, in petri dishes, we know that soy genistein will attach to the estrogen receptor and stimulate estrogen like activity or flax. And again, those, those tend to be cancer protective, right? And so you go, okay, so that's positive, right? So that's a mechanistic action in a petri dish, right? Now when we get into human interventions, a lot of them are feedback related, like observable data. Like women say, my hot flashes are better, my night sweats are better. That means it's got somewhat of a human physiological observable effect. What often happens, and this happens with a bunch of other things, which is a whole nother conversation we can get into, is people will take in vitro studies which are like in a petri dish showing mechanistic action. They will take that and misrepresent it when they're talking about it as if it's physiological action in the human, where we don't have human clinical trials, right. Or it's contrary to what we've seen in human clinical trials. So this can often be this place. And then there was, there was kind of. You got to think about the last 22 years we were told, estrogen kills you. Right. So everybody took that and said, well, any estrogen is dangerous. Right, Right. All of a sudden. The other thing we have to remember is when we started making GMO food here, our primary crop in the United States is soy. Europe and most of the other foreign countries would not take our GMO soy. So we had a glut of soy on the market in the 90s. Like huge. Like huge. This was our biggest export crop. And so what happened in the 90s, you and I both remember, soy became everything. Soy milk, soy ice cream, soy plates. So we had a glut of it on the market. And so the other thing is, is if somebody, you can over consume anything, a little bit of a good thing is good. Too much is too much. And so soy is better given in a fermented model like miso soy sauce and, and tofu and tempeh, rather than tons of it in food. Although I will say soy protein is 100% usable for muscle protein synthesis, unlike other vegetarian forms. So it has its place. But I think we do too much. Like, we. I don't know what it is about human behavior. We find one thing and we go, it's good. Then we're like, okay, truckloads is better.

So soy formula also became very. Baby formula became very big in the 90s and even early 2000s. And a lot of babies that were fed on soy formula ended up menstruating super early, age 10, age 11, getting breast early. Related, I would imagine.

Yes. If we look, if we look at some of the studies, most of them not done here in the United States, and it's been a while since I don't do pediatrics. But if we look at particularly babies fed on soy, because you still have developmental activities going on where you're developing your hormones, your testes are developing, your ovaries are developing. We do have some relationship with early estrogenic effects and especially effects in men. Right. Excess aromatization. We, you know, where it might be reducing available testosterone that may affect development, you know, and so, so the reality is we want to think about it as a food source where we might be using it in addition to a lot of other things. But when it's the only source formula that a child has, that's problematic. I was given soy. I was adopted, so I had no breast milk, not a single bit, you know, And. And I was also allergic to all other forms as a baby. So it was like, oh, okay, there we go.

This. I literally, I'm Guilty of this. With my own daughter, I breastfed initially until my, I was not producing any milk and then she was sensitive to other formulas. And my, I remember my mom telling me, which is before I did anything with nutrition, I or I really understood any of this, oh well, soy will stop that problem. So I definitely fed her soy. And then I saw those, I saw what that created at age 11, you know, so I, you know, and I, so I saw it with my own eyes. So I don't even need to read a study to, to see that how, what that, what happens when you do that. So I'm, I'm in that category of seeing that. So it's wow. But it makes sense if it's the only food. That's why it would be problematic. Just the same as an adult, if you're eating only one food, it's going to be problematic.

Yeah. You know, and I think I, I mean, because I get a lot of women in my age group that have grandchildren and children and now they're looking back, right? Because of course hindsight's 20 20, they look back and they're so upset at the choices they made. I'm like, we are all, regardless of what happens in our world, doing the best we have with the information we had at that time. And you know, malnutrition is worse than giving a soy formula. Totally. Right. Really, Honestly. And so I think, I think we all have to sort of give ourselves a little bit of grace there because we just didn't know. Right.

Yeah.

So, so the take home message is these, these plant based, estrogenic, weak estrogenic things can help some symptoms. They are not something that you can't have if you're on hormone replacement. I would make them, you know, something I eat three times a day, but you can have them in your normal everyday diet.

So just to close the loop here, I want to make sure I'm understanding on xenoestrogens, when you use that term, that's not just food, that's also disruptors. Is that correct or no?

Really, Xenoestrogens and endocrine disruptors are synonymous with each other. So those are more so the chemicals, the man made, things that are in our environment that now interrupt our normal endocrine function. And again, most of those look like estrogen in our body and basically you're.

Filling up the receptors in your body but you're not getting the benefits from it. So we're actually blocking good estrogens, we're blocking good use from it. So now we appear Estrogen dominant have the negative things that we're not getting any of the benefits. Did I say that right? Right, Right.

And we're probably mucking up our detox pathways. Right. We don't have a ton of research looking at individual ingredients, but we, we know those things pass through there. Right. So at the end of the day, if I'm already not great at that genetic activity, then it just going to muck it up more if I have a lot of exposure. Which is why in the functional medicine world we're like, let's try and clean up your environment as it's. You're never going to be perfect, but we're just going to like, try and clean up what we can.

I promise. I'm going to get to how do we intervene? But I want to first, I want to not skip testosterone and progesterone. I want to. I know we've talked a lot about estrogen, especially on the first episode. Can we talk about both of those and where those can be problematic, where they could be helpful? Should they always be on board when you're doing estrogen? Help us with that. Can you do them instead of estrogen?

Yeah. So. So let's start with progesterone because it's again, it's the relative relationship between progesterone and estrogen that really is. Is the balance. Right. And so progesterone, most women make adequate progesterone and it's very low in the first half of your cycle. So the day you start all the way through ovulation, which on average is 14 days, some are 10, some are 18, some are, you know, longer. Right. And that second half of the cycle, right, the luteal phase is when we see a spike in progesterone. And it's because. So how that happens is, is your ovary creates a follicle. So it sw. So the visual I give here is like a sunflower. You know how the sunflower has all those seeds and the seeds are getting ready to pop out, Right. And one of the seed. I don't know if you've ever seen this video, but it blows open, it goes boom. And the egg shoots out like a bat wing fighter, goes down through the fallopian tube. Right. And when that follicle collapses on itself, that collapsing follicle produces the progesterone. So that's why you have to have the egg come out in order for that to happen. So at the end of the day we have that happen. Then our progesterone peaks. And when we get into our late 30s, early 40s. We don't ovulate all the time. We might have. Or if you're polycystic, it never flies open. Right. That's why we get polycysts. So when progesterone is low, we get all those symptoms, usually insomnia, you know, estrogen dominant, related waist gain, because again, our estrogen's too high relative to progesterone. Moodiness, irritability, hot flashes, night sweats, all those things. So progesterone is very active in the brain. It turns on the receptor for gaba, which is your. Think of that as your natural Xanax. Right? So that is what calms you down, helps you stay asleep. And GABA helps control the thermostat a little bit. So it keeps your body, core body temperature cool at night, so it keeps you asleep. So progesterone has its own effect metabolically in the body, particularly in the brain. But the other part of what it does is it protects the uterine lining and keeps the uterine lining from getting overly full. Right, because it'll keep filling up. Because that's what estrogen's job is to do. It's called hyperplasia. Right. So if you're on estrogen, you must, and you have a uterus, you must be on progesterone. And topical creams do not have good data on being adequate enough to protect the uterine lining. Vaginal inserts, oral do. Right. And then. So if we're looking at that, we have to have that. But I would argue every woman benefits from progesterone, even if they've had a hysterectomy, because we want those other effects. What's interesting is, is Nadalie. Some people get a really sedating effect from it, you know, like it knocks them out. They can use it vaginally in that case, like if it's because when you take it orally, gets metabolized into a byproduct, depending on your genetics, that helps do all the brain stuff. And so some people overly do that and it makes them sleepy the next morning and then.

But also I want to point out, because I didn't know this until I figured it out myself, but there's a difference on progesterone between IR and sr. And this is important to understand because so one SR stands for suspended release. IR stands for instant release. When you get progesterone compounded, if you do not request instant release, they will almost always give you suspended release. I didn't realize this. So if you are that person that you're taking progesterone, and you're like, okay, it's helped me fall asleep, but now I can't wake up. You likely are a candidate for instant release. Instant release comes on sooner and it's out of your system halfway through the night.

Quickly. Yeah, exactly. Hormones get utilized at different rates. So it's, it's called half life. So progesterone has a very short half life. So it's. If you do in instant relief, it's here and gone by the. Just within some, a few hours. Testosterone has a longer half life. Right. That's why you can inject it like once a week. It's going to come up and sort of metabolize estrogen, has a faster, you know, it's not quite as fast as progesterone. It's kind of in between. Okay. And that's why even dosing, timing and all those things matter because we're using them at different rates to manage the overall effect.

Effect that we see while we're on progesterone. Two more questions here about this. I want to ask about cycling it, how important that is, and then I also want to ask you about. Well, actually, before I ask you about the cycling, this is another little nuance with progesterone. A lot of people go through their insurance. They'll get it at like a CVS or a Walmart or a Target or whatever. It, they're orange, they have food coloring and they have peanut oil.

A hundred percent.

If you are sensitive, you will feel a difference with that versus compounded. So if you, you're like, I can't do progesterone. I've tried, it doesn't work. Me, not a doctor, not Dr. Betty here would say try compounded because it makes a big difference. I mean, I know with me, I can't do the, the regular generic one, the compounded one feels totally different to me.

Yeah. And it might, you know, and I would say that's true. When we start talking about delivery mechanism, everybody's a little bit different as to which one is their best choice. Right. And so if you try one form, always consider another one before saying, it just doesn't work for me.

Okay.

Right.

When you look at cycling progesterone, some doctors are very adamant you must cycle it, some are not. How do you feel about that? And is it different in menopause versus perimenopause?

Right. So in perimenopause, we generally cycle it because we're still ovulating some of the time. So we often will say day 14 through 28, depending on where you ovulate.

Right?

So that takes a little bit of science, but that's the general just of the cycling. Now when would you not do that? What if somebody's experiencing a lot of sleep interruption and when they go to cycle it, their sleep gets messed up? That would be an indication to not cycle it. Right? So I cycled mine. So I started progesterone very early. It was in my late 30s. I cycled it at first and then it was like, okay, I can't sleep during the month when I'm not cycling it. So I started taking it continuously and I've been taking it continuously ever since because if I forget it for just one day, I'm like, all right, yep, not, not working well. I need to sleep. Right. So there are some proponents, there are people out there speaking about cycling it sort of mimicking the natural it's experience. And some people even recommending cycling and having a period into your 70s. I happen to not be one of them. A number one. There's one thing to look forward to during this time period and it's the loss of that damn period. Right? Dear Lord. Right. The other part is we don't have good data, we don't have human clinical trials using a cyclical method and comparing it directly to continuous use. We do have studies, not huge studies, but we do have studies like the approval studies for Prometrium and other studies looking at just even using progesterone alone for sleep for women, even if they're not on estrogen replacement. Right. And so I am not a proponent of cycling. The other thing I always think about is. And you and I kind of have had these conversations too. I don't. And my practitioners don't ask people to do things that they themselves struggle to do. I'm not going to ask somebody to take some supplement in the middle of the day between meals, four times a day and then take. Because I. You want to know why? I freaking can't do it myself. So I have a complicated enough life that it's going to be hard for me to manage cycling. Right? And here's the thing, the other thing will happen if you're cycling it and you forget, guess what's going to happen if you continue your estrogen, you will have a period. So you can also get breakthrough bleeding that then makes you think, is it real breakthrough bleeding or is it just because I forgot my pill? Right.

So some doctors argue, and one of them in particular is a good friend of both of ours. I'll leave her nameless because she'll probably listen. But. And we love her. But she would say, you, you must take five to seven days off, even if you're in postmenopause, because if you have any buildup you want it to shed, she really insists on it.

What do you.

And I. And it's interesting because I. Then I'm like, well, I don't want to because then I don't sleep well. What's your take on that?

You know, so build up in the uterine lining.

I mean, yeah, like, like she, she's being preventative. And so she's saying that because she works on so many patients, she's like, it's just important to give your body a five to seven day break every month just because if you have any buildup, you want to be able to. To shed it. She. And she said something about, you don't want your own receptor, something with your own receptors to get.

Yeah.

Have you heard that?

I have heard people say that. I would say the, the data and the research is overwhelmingly not pointing that direction. And again, we haven't studied anything in 23 years.

Yeah.

So this is where, this is where a clinical trial would be great. These women cycled, these women didn't. What did we see? So we got to remember, if we get too much estrogen, we're going to get a big buildup of the uterine lining, and then you're going to be at risk for hyperplasia. Right. Which then can become cancerous. And it's not because that's the thick stripe.

That's the stripe when you get the thick stripe. Correct.

Yep. Yeah. Thick stripe in the inside. Right. That really doesn't happen unless you're taking unopposed estrogen or too much estrogen relative to progesterone in general. Right. Now, could you be poor, detoxer, and have a bunch of other things going on and not have it balanced? But generally speaking, now, progesterone's job is to inhibit the uterine lining. So in women that are bleeding heavy, have endometriosis that is being fed by estrogen, especially in perimenopause and cycling, we give high, high doses of progesterone continuously for a period of time to shut it down. So if I'm using progesterone consistently, the uterine lining, like if you go get sonograms and look at it, it's very, very thin in most women. Right. Because even if they have breakthrough bleeding, it's pretty low. If it isn't there's usually an issue with detoxification, the balance between progesterone and estrogen and the delivery mechanism. There's something that needs to be changed, but I don't, I disagree with that because I don't have. And I'm just looking, I don't prescribe, but it's more so that I don't have the data saying that we need to go through that administration to do it. Hey there.

If you're finding value in this episode of Midlife Conversations, I would really appreciate it if you would hit that like button and subscribe. And when that little bell pops up, you want to hit that. That way you are notified of all new episodes so you don't miss a beat. Also, you subscribing and liking helping helps others find this content and this allows me to keep growing, keep getting amazing new guests for you and to keep sharing. Makes sense. Okay, let's talk about testosterone for a minute. Now we're going to switch over to that. Testosterone is a whole nother topic. So if I'm hearing you correctly, you could do progesterone alone. You cannot do estrogen alone. You, if you're doing estrogen, you must encounter with progesterone.

Yep.

Testosterone is a whole nother topic. You could take that alone. You can take that with things. Let's talk about test. Do we actually need it, when do we not need it and what goes wrong with it?

Yeah. So every, so every woman makes testosterone. So let's level set. So all women make testosterone. So at any given time, our testosterone level throughout the course of a month is about three to four times the amount of your estrogen. It looks different on labs because we use a different unit of measure. Right. So it's like looking at cups compared to quartz. So, you know, so the reality is our testosterone levels have a steady decline from our 20s onward. So if you compare a 40 year old woman to a 6 year old woman, you're not going to see this wild difference because it's not changing there. It's just slowly going downhill. Now, some women have a preferred pathway and if you want me to, I can bring up the pathways where they might make a little more of the androgens. Dhea, androstene, dione, testosterone. And so they're going to have more. How do you know that? So number one, you could be a little bit androgen dominant and be less curvy. Right.

So generally you could be manly. I'm just kidding.

Nice.

But if you have more of the, if you have More a of. More of that. Typically, you're more of that, right?

Yeah. Your hips are going to be narrower. You're not going to be super busty, like, I'm gigantic. We.

We like this in the 90s. I loved that look. I was like, we. We chased that look, remember?

Oh, my God. I've chased it my entire life. I was like, why do I have to have a. Dated it right now?

They were not in there. They were not.

That's.

Remember, we used to cover our butts? So anyways, yeah, we got off track.

Sorry. We went a little nuts. We had a little menopausal women moment. Right. So the reality is all of us vary a little bit. But if you had a lot of facial hair, chin hairs, things like that, especially growing up, that's a condition called hirsutism. And hirsutism also follows along with pcos. So if you were diagnosed or you think you might have pcos, it's generally an excess of androgens, which is all of those. And estrogen relative to progesterone.

Okay.

So now testosterone steadily declines. Where would he feel it? Right? Being able to put on muscle, motivation, you know, determination, libido. Libido is a mood, not a hormone. Not a. Not a. Not a side effect of sex hormones. It is a mood. And so testosterone has not been approved by the FDA for women in the United States, except for sexual dysphoric disorders. I don't want to have sex. However, it has indications for being breast cancer protective in human clinical trials. Helps with bone mineral density, muscle building, mood, you know, memory and cognition. I argue that many women, maybe not all of them need it, because we need to know where your testosterone levels are and where they need to go. Because again, you've got receptors. We got to figure out how much you need. And the other thing is, we take testosterone and we make it into estrogen. And genetically, you may be doing that more or less. Less. Right. So when we look at testosterone, testosterone is going to help all of those things, but we have a certain amount. And so generally this is an area where less is better. And to start low and add until you need it. Because if you get it too high, you can experience hair loss, right? Particularly on your head. Male pattern baldness. And it's because testosterone can make a hormone called dht. And DHT is active in your hair follicle. It doesn't have to be high in your blood work to be doing this. This, this is often missed. And so if you start testosterone, you start losing hair, like on the crown of your head, you're ex. Excessively making DHT in the scalp. In the scalp, even if your blood levels are normal.

I have a lot of questions about this because there, when you look at testosterone on blood, there's two different. There's a couple different numbers, the total and free. What's the difference here?

Yeah, so total is the total testosterone in the sample, right? In the viewable sample, free. So they're calculating, you'll see it says calculated. Right. So calculated mean, they're taking it and calculating an estimate of how much is free based on your sex hormone blinding globulin activity, which is the taxicab that drives testosterone around. You need some of it. You don't want too much. Right. And so if you have a relatively decent total testosterone but you're free, that means none of them got out of the taxi cab. Right. They're stuck in a New York taxi cab and they just getting driven around. They can't get out.

So wait, you might have said that. I want to make sure you said that right. You said if you have a total number that's normal or higher, but you're free as low. You mean if your free is low. Give us example numbers just so we.

Have it like, let's say you're. Let's say your total testosterone is, you know, 55, which would be a relatively good one for a woman in midlife. Right. And let's say you're free is 0.1.

Okay.

Which we routinely see. That means, you know, think of it as we have a bunch of taxi cabs that picked up that 55 testosterone and only 0.1 got out at Times Square.

So it's not usable. That's why your number can look normal, but you're not. You're feeling blah.

Right. And here's the challenge, because it's calculated, it's not exact. That's why saliva is better. And I would say urine's even better because it shows you how you metabolize it. It. Those show free amounts, like how many are out and actually active. So you could have a total testosterone that's. That's adequate with very little being free. Right.

And.

And that's genetically driven. There's a lot of things, nutrients can contribute to that too. And we could also be taking a lot of it and making estrogen out of it too. So the vast majority of women would benefit from a little bit of testosterone. Right. Especially in midlife and beyond because it's already declining it. Again, it doesn't wildly change during Menopause. So if you get somebody that's like.

It doesn't go down.

It does, but it started a long time ago. So I want to.

I'm going to use me as an example here to illustrate kind of even how I ended up talking with Betty and how we ended up doing this double conversation here. I'm going to back up a minute, but I think this will be, hopefully it will be helpful to some women listening, especially if you all were following my hormone journey. So I'm on all three hormone replacement and what was happening to me. And I'll tell you my amounts that I was on. I was on a. I was on a 0.1 patch. I was doing small testosterone injections, so I thought. And I was doing 200 milligrams of progesterone. That's what I was doing. And I thought all was good until it wasn't. I started having fibroids. I had an ultrasound. We thought I had a thick uterine stripe, which is dangerous, which she said earlier. And because of that started questioning a lot of things. This is how Dr. Betty and I started talking even more. This is when she ran a 24 hour urine with me. I also worked with my own doctor. I worked with my OB gyn. I was doing all the things to figure out what was going on. One of the first things I did was lower my estrogen patch to see could that have been the issue. Another thing I did right away was I started cycling my progesterone thinking, could I cold stop it? Could I create a lining to shed? But the other thing I did is I totally stopped the testosterone injections. And the reason I totally stopped them, and I'll give you guys exact numbers, you know what we're talking about. I'm totally menopause. My Testosterone total said 175, which sounds high for menopause. My free testosterone wasn't even one. My shbg, my sex hormone binding globulin, which she was talking about, was extremely high. So our theory was that because the way I metabolize, the way that I aromatize, the way you listening might too, my testosterone was aromatizing to estrogen, which is creating an estrogen dominance. And I was not getting any usable testosterone because my free was too low. So because of that dominance, I was, was getting this thicker uterine lining. I was getting the fibroids. Did I explain that right?

Dr. Betty? Yes.

Okay.

Okay, got it.

So what I did is I went the opposite extreme and I said, okay, I'll lower my patch Which I did. I changed my progesterone to instant release instead of extended. I completely stopped the injections. And my most recent test, my testosterone was a 0,00 flat out 0 free 0, total 0. Like 0,0 negligence. Which explained why I had no motivation for last month. So, so restarting. But very, very, very, very low microdose. Like the smallest amount you could possibly do just to get things moving. I feel like a new woman after one day, which is not even supposed to work that fast, but it, but it does. I'm bringing this up because I think this is very overlooked. And that's a prime example of I was converting the wrong way. I didn't know. I'm just basing on lab numbers. And this is why it's dangerous when we're just looking at those numbers. So I. Sorry, I wanted to bring that up as an actual example so we can kind of tear that apart and then speak into what could be going on with a lot of women.

Yeah. So not every woman needs testosterone. Now. The, you know, I would say there's a couple problems here. You know, in the last, you know, 10 to 15 years, testosterone therapy has exploded, even for men. I mean, there's low t. Something. Something centers on every corner. And yes, you know, men lose testosterone also. But then there was a big push for women. And actually like especially the pellet companies, about 80, 85% of their entire patient base race is female. And there was very much this idea of if a little bit is good, a lot is better. And here's what happens. This is. It's a marketing ploy. I'm just gonna be really honest. We. We were one of the first companies to start looking at pellets because we were already doing it. Right. Because we had people that wanted it. And so we started way back before anybody else was really doing it. And we immediately found that like, hey, we have to lower that dose and we don't do. And this is in my physical clinic, the telemedicine company. We obviously can't put a pellet in your butt, but from far away. But very little of it. We do very little of it now because we use the organic oils and it absorbs really well. We don't have to do that. But, but, but the reality is, is if we look at a physiological amount of a healthy woman, it's going to be somewhere between 40 and about 80. Right, right. It's in some women a little bit lower. As if you look at the reference ranges in women in menopause, of course they're going to be marched downwards. And I would say most practitioners, if they're doing sort of longevity, they might push it to 100, maybe 150. When you start getting a lot above that for a lot of women, that's where we start getting the massive chin hair growth, hair loss on your head. You can get a mini peony, you can get clitorial enlargement. That is not cool. Right.

But you could also get none of that and have like, what happened to me? Right. I mean, I'm assuming you could still get.

Exactly. You could still get too much of it converting to estrogen and exacerbating potentially pre existing fibroids. Or you could feel great. There are people, I. I have friends of mine that are like, man, I'm at like 380 and I feel awesome. And I'm like, wow, your sex drive is probably much, much higher than it. You know, because here's, here's the way to think about it. In order of magnitude, a very low for a man is going to be like in their 250s. And most reference ranges for labs are going to be like 9, 950. Some labs will shove them a little bit higher, 1100. So you do the math, right? So if a woman has an incredible sex drive at 250, that is unbelievable. Like, I've had women literally say, I can't do this because it's like I'm chasing my husband around the building.

You get predatory.

Yeah, you get predatory. Seriously. Now imagine what it's like to be a teenage boy at a 950.

Yeah.

You know, because I know, I know. I tried. So, for example, everybody's different on what formula they need to take. But I tried one of the testosterone troches, right? Which means that you put it in your mouth, under the tongue, it absorbs into the mucosal barrier pretty much instantly. Man, my testosterone was so high, it went to like 450. I'm like, you know, because I was pretty much, I looked at my husband, I was like, you get your butt in that bedroom right now. He's like, oh, my God, you're scaring me. It's, you know, breakfast. I'm like, move. You know, and I'm like, I can't do this. Right? You know, you think your husband likes it, but they get scared. And so everybody's different here. And so this is where.

What is the free with that? I don't want to skip that part though, because if you're. Was your free when you say you're. They're high like 152, 53 is the free, like 10, 20, where is that?

Right. So most. So the thing to also know is when we're looking at research, most of the research is just looking at total not free. So you know, a free could easily be, you know, most of the time if you look at the reference ranges, it's going to be like 0.1 again because that's what we see in the population to like a 4.2. Right. And you want to be somewhere in there. We don't need a 15.

So even if your testosterone is 170, 200, whatever, you ideal free would be.

What I would say somewhere between like two and a half and five. Without symptoms. Without symptoms.

Okay. Okay. So your free is not supposed to be 40, it's not supposed to be high. A high number.

That would be problematic. Okay, no.

Okay.

No. You know, and here's, here's the thing is hormones are messengers to all of the body. That's why we have receptors everywhere and we have a lot of variability because we all look different, we have our genetics, we have all these other things. But you know, you wouldn't see a woman in human history with a testosterone of 500 and a free testosterone of 40, you know, or even 10 to 12. That wouldn't happen. Okay, right. It just wouldn't happen. And so I am a firm believer, you know, I very much look at the research and our teams look at the research and we're like, like, you know, more is better is not great. I'll give an example. So back in the 90s, you probably remember this because you probably flew a lot. You remember the ads in the magazines and the airport airplane about like these longevity clinics and had this older dude where he looked like he was, you know, 80 from year up and then he was shredded. Well, that was when growth hormone, not peptides to develop growth hormone, but growth hormone was really popular on the longevity scene. Well, guess what we found when you take large amounts of growth hormone, guess what you die from cancer. Because it stimulates insulin resistance and it stimulates IGF1, which stimulates cancer cell growth. You know, so more isn't better. And I think particularly in testosterone for women, we've gotten a lot of messaging around more is better. And it's highly nuanced. And I think if you have practitioners that are pushing more is better and you're symptomatic, definitely don't do it. But we don't know what the long term effects of having a woman at 400 would really be even without symptoms.

Symptoms. This is wild too. This is something else I just recently learned. When people are striving for these higher numbers of testosterone and what happens is this is not just this what happened with me, this happens with other women. Your body will want to self course correct. So it will raise up your shbg. It will also force the testosterone to convert to estrogen because your body was not meant to have that kind of testosterone, which then you're now thinking, I've got a bad pathway, this isn't good, I need to block the aromatization which could create other issues. Can you speak a little bit about that?

Yeah. So again, your body's smart, right? Our body's very like, I think of it as like a self cleaning oven and it's like it knows how to like correct itself. And so when you get the testosterone, very high sex hbg, which is the cat taxicab, starts to rise and then that's tied to your estrogen. So you create more estrogen out of that testosterone, which then stimulates your uterine lining which then overwhelms the liver detoxification pathways. And then all of a sudden you can't clear it. And so you keep going, oh, I'm now going to block aromatization, I'm going to put stuff in there to block it because I need more testosterone. And it doesn't really help the problem, right? The ultimate problem is the testosterone was too high. We need to bring it down to a physiological level, let the body course correct and then figure out what the low dose is. Testosterone dose research, mostly done in England, shows that the particularly around, you got to remember it was around libido because we've got a patriarchal system that most women benefit from a 5 milligram dose, right? They've looked at 5 and 10 and.

Saw the same or even smaller 2.5.

Or even smaller 2.5. We have a lot of women that are usually somewhere between there. We have a few that are like, no man, I feel better, right? And as long as they're not symptomatic, we're just watching things. But I think, I think that idea of super high physiological dosing, I just look at it and I go, we don't know what's going to happen 20 years from now. It's really crazy high doses because they, they, they can't exist in nature. We can't, we can't do that without human intervention. And I just don't, I just don't think that's what we were meant to do.

We're asking some of the wrong questions. If you look at like, so the typical thing that I see, a woman's testosterone jumps too high, their free is low, and they see a, a sky high S, H, B, G. And they say, how do I lower the H S, H, B, G. Instead of saying, maybe I should lower the testosterone. So there, it's like this, it's this interesting thing we keep going to, like, no, but I want it higher. But let me, let me like trick the body. But I think the other things are the warning sign. The low free and the SHBG are the, are the warning signs. Right, right, right.

And this especially happens in men, right, because practitioners who don't necessarily understand this sort of deeper dive at this level, that's my argument, will give man testosterone and then they'll give them aromatase inhibitor. So they have very low shbg. Well, you got to remember, estradiol in both women and men promote bone growth. Growth, right. Men can get osteoporosis, right? You shut down a man's ability to make estrogen, you're going to affect bone building, right? Not to mention there's other, you know, there's other potential effects that we probably haven't even examined. And I look at that and I go, is it really necessary to get them as high as possible and then try and shut off every pathway? You know, here's the way to think of biochemistry and I can bring up one of my many lovely diagrams for a visual. The more you can go upstream and gently allow the body or support where the deficiency is in a physiological dose, the more the body is going to operate. The body never, ever had the opportunity for super physiological anything in human history until we got industrialization. You couldn't juice spinach in, in 500 years after Christ, right? Like you couldn't. So there's no way to get that much spinach. You know what I mean? Like, we just go crazy as humans, particularly Americans. Like, anything that gets hit, like, and we see it on Instagram, we do crazy crap. It's just crazy.

Oh yeah, okay, I've got to go there then, because this is a, this is a little bit of a different topic. But it goes with this. Peptides. Peptides are kind of all the rage right now. People are throwing around a lot of terms about microdosing. What are peptides? And where do these go in together with hormone replacement?

So peptides are small molecule hormones, right? So like insulin was the first peptide we ever synthesized in a lab, right? So it's a peptide we make hundreds of them. So like glp, gips are incretin hormones or incretin peptides. Our body makes them, right. And they influence the brain and other things. And the reality is all of these things are made at varying degrees and they probably change over time. And so they're signaling molecules. Right. They're small signals that talk to the cells and tell the cells what to do or they transport. And in most cases. And again, your body didn't get super physiological doses of these things naturally. Right. So if we look at the success of GLPs and GIPS at physiological dose for the pharmaceutical.

What's a GIP? I know what GLP is. What's a GIP?

So tirzepatide is a combo of GIP, JLP. Yeah.

So explain what that means. Sorry, I want to make sure. Because a lot of people don't know what that means.

Yes. So there's two. There's two peptides that are what they call incretins. So glucagon type 1 peptide and then. Oh, I'm having a moment. Gip. So they work on different receptors. Right. So for instance, semaglutide is a single glp. So it's a single peptide that works on the brain and gastric emptying and a bunch of other things. Right. Insulin sensitivity. Tirzepatide is basically a GLP plus a gip, which has a very similar mechanism. And so these combinations, actually, I would say one of the most powerful things they do is modulate hypothalamic control, which is your director of your show. If you watch the First Call, I had a conversation about, you have a director of the show, hypothalamus that talks, the pituitary, who's the conductor of the orchestra that makes your hormones. Well, what we now know is that these things, we've known it actually, we isolate these things back in the late 1800s. So we knew that they had an effect on like hunger, satiety, brain mechanisms, cravings. So when you dose them at super physiological dosing, what happens is you lose hunger. Right. Your gastric, your stomach slows and it's digestion, which is why we get a lot of digestive stuff. You may get diarrhea, so you don't eat as much. Right. These medications slow down how much you eat. Right. And they reduce cravings, which I would say is one of the best things that they do. When we talk about weight loss now, they have mechanisms everywhere because they've got receptors everywhere else. So we're seeing that they're Anti inflammatory and they help with cognition and all these other things. A lot of those research studies aren't out yet but you don't have to have physio like crazy high doses to where you have nausea the first two days after you inject and you're in the bathroom for two days to get the effect of them. And in most cases the anti inflammatory and the anti aging and the longevity effects are at these microdoses, the smaller doses that are probably closer to what our body made, which is not what the pharmaceutical brand names have done. They took the dose as high as they could to get the weight loss as fast as they could. Could. Right. I have a lot of.

This is like a whole other topic. We'd have, we could, we'd have hours on this. But I just want to. There's a couple things I want to ask here or point out. Okay. So first my first question as somebody who's been in nutrition and fat loss for many, many years, when you talk about fasting or skipping meals so you prolonged. I always have talked about moderated modified fasting. So like having 12, 13 hour window at night, longer time between meals, even some benefits to fasting. Wouldn't you get those same benefits as what you just said you get from GLPs from doing that?

A little bit. A little bit. You know what's interesting is that not everybody responds to them. So I'm going to give me as an example, right? I have been overweight, so it's not like I'm naturally thin. Right. I have gone through that experience particularly in my 40s, but I don't, I, I'm on the opposite end of the spectrum. I don't have food noise.

Okay.

I don't have like I don't crave things. I don't think about food. I'm actually so far on the opposite end. I'm one of those people that I'll go all damn day if you let me go, you know, to force myself to think about food because I'm busy.

Okay.

Right. And then. And so there's metabolic damage from that too. And so not everybody responds to these really well because they may not have some of those mechanisms that are signs that they're off, you know, so they're not magic. They help. However, could that person benefit from using them in very small doses to get the anti inflammatory. I think we're going to start seeing that, right?

No, but I guess, I guess what I'm saying there, I want to make sure I'm clear on my question. So like like if, if you said one of the benefits is stopping cravings and stopping a food noise, wouldn't fasting also do that too? Like, aren't you. Isn't that doing the same thing if you're not eating?

Maybe, maybe. So if you're not eating and you're prolonging fasting. Right. You. Yes, but it can also trigger the opposite side. So prolonged fasting can also make you crave more, particularly if you're not doing it properly or if you jump into it too quickly and you're fasting for too long. And I would say the person that has maybe disordered eating history is not a good candidate for significant fasting just because it often is somewhat triggering and then the other side is too. If you, if you have other hormone imbalances like insulin resistance, it's particularly like cortisol issues you may get where you're white knuckling it to fast. So my rule has always been, you know, don't fast every day. Don't you don't fast like a man because it doesn't work that way. Our hormones freak out and we get cortisol. But. But if you're white knuckling it to make it to that window, that's the wrong fast at the wrong time.

Makes sense. There's no arguing. I mean, GLPs, I, in my personal opinion, have a huge, tremendous amount of benefit. But I also see that this danger with them, and I just want to just point out that. So I think with the, with the benefit one, if you take the obese. So people that are actually obese, they have struggled their whole life. This is a real thing. I think it's been life changing for them, number one. Number two, I think for the true insulin resistance, the autoimmune, the even. There's even. There's a lot of signs that it can actually reduce coronary artery disease. There's a lot of benefits to small, small doses where I think there's a huge danger right now with GLP is a huge danger. And I don't know if you're even seeing this, Dr. Betty, but this is all over like TikTok and even hitting Instagram now. But it's this extreme eating disorder culture that Skinny is back and let's just not eat and like videos going around of people going, you know, your friend comes over for dinner, but you're on a glp, what do you do? It's like, it's, it's this extreme danger zone and it's. That's scaring me totally.

No I agree. A matter of fact, you can go back into my old episodes of menopause mastery. Like two years ago, Amy Cornerman and I had two conversations about this because I was such a harsh critic. And it's not because of the drug mechanism. We've. We've been using these drugs for a long time. It's the onus of the practitioner and the market abusing people by allowing that to happen. They don't counsel them on how to eat and make sure that they get enough protein that they're eating adequately. They give it inappropriately to people who do not need it. Right. If you're trying to drop five pounds to go to a college reunion, you do not need a GLP at a dose that's high enough to cause all those symptoms. You know, not like that is the, not, not the indication.

I'm not gonna blame the practitioner, though, because people are getting these online. That's the problem. People are finding a way.

Oh, yeah, they go on there and they say they weigh a lot more and then they just change the health history. They're working with a telemedicine company that doesn't do video visits. They don't get any counseling. They just get a prescription, you know, and so. But there, you have to have a practitioner to do that. Right. There are people that are, that are capitalizing on this inappropriately and we're going to see all the damage that comes from starvation culture and starvation in general. Right. From a health standpoint. So they can be used, but they need to be used properly. And in many cases, the, the longevity effort is going to be at a much smaller dose. That's a signaling molecule that mimics what the body should do at an optimal range. Not a crazy high one.

One. Because if you do the, if you're doing this to have extreme weight loss when you don't necessarily need it, or to do that, you're going to have the other health benefits, like health negatives like sarcopenia. You're going to have. You're gonna have all kinds of bone loss, you'll have muscle loss, you'll have hair loss. You'll. It's. It's really wild. I'll see people online, they're like showing chunks of hair falling out, but. But saying it's okay because they're losing weight.

Yeah. I mean, right now, because I own a clinic and I have medical practices, I own a telemedicine company. I'm getting all these ads on Instagram with companies selling skin tightening devices for specifically glpgip. You know, facial fat loss and bodies for loose skin because of rapid and inappropriate weight loss.

What's the solution here? Because there's so many benefits. Like I, there's. Honestly it sounds like it's just this miracle peptide for everybody. Like if you really look at this, the whole data on that, what's, what's the solution here? Do we just make it available to everybody because of the benefits and then it's just the same as before?

You know, it's. Yeah, I mean, I think, you know, we, it has benefits, particularly in the aging. Right. And so I think, I think it has a massive place in that. And I think the hard part is, is especially in a capitalist society, it's very hard to shut down the inappropriate use. Right. Because something else will just sprout up to take care of it. I think it really is at this point a lot of education around like what's the long term impact of that sort of diet experience? And you know, because I see it in Gen X just from previous life of those extreme diets in their bone density. Right. And so I think because we're not gonna, that that cat's out of the bag, it's not going back in and it's valuable. But I think it's, people need to be really educated before they start this medication, you know, and, and usually in this case less is more and you know, if you're not getting counseled on how to eat, how to exercise, how to take care of those other things, it's a disservice and it's inappropriate.

I think this is, is, this is such a big conversation here. But there's more peptides than just GLPS there. Peptides is a big word and it's a big category. How come, I mean it seems like we're all, every time we mention peptides now, people go right to GLPs. But there's also peptides like BPC157, there's KPV, there's all kinds of things for gut health. There's things, yes. Like what are your thoughts? Are peptides kind of going to replace supplements? Like what's happening here?

Yeah, so peptides. So there's a couple things happening here. So you know, the advent of what go, especially the, the weight loss based peptides and allowing people to use that instead of diabetes, because before it was really indicated for diabetes, allowed that sort of cat to get out of the bag and the media to pick up those words. Peptides have been around for a long time. We've been synthesizing peptides. Now the reason why there's a lot on the longevity market is peptides naturally exist and so they can't be patented. Right? And so that means compounding pharmacies and other pharmaceutical companies can manufacture peptides because they naturally exist in the body. So they're basically chemically making something and all we have a bunch of them that allow for like tissue regeneration, collagen regeneration, hair stimulation, even, even tanning. I don't know if you bought that one, but it will actually. Yeah, Melanitan, which will increase the melanin in your skin. It looks really odd if you ask.

Me, but makes your brown spots darker too.

Yeah. Oh yeah, yeah. It makes everything pop out at this age. But so we have a bunch of those, right? And so there is, is there is clinical use of those, right? And especially. But, but what I would say is they, they're super valuable. There are a lot of people like buying these online and kind of becoming their own doctor. And, and again, because there, there's things like that which I'm very nervous about because these messengers, the take home message is these messengers are dosed and sort of pulsatile, right? So they come and go and they come and go. If you give a bunch of these things all the time, you shut off your body's naturally ability to give it a. So especially the other longevity peptides need to be rotated, right? They need to be managed. There's a couple that don't, you know, like the BPCs and things like that don't have as much.

You should even rotate.

You should rotate all of them. All of them. But there are indications of using it at a dose for longer periods of time. So doing it yourself, as scary as I'll get out, especially if you don't know what you're doing, because you probably don't. And then the practitioner needs to really be trained. And here's the other thing. If you're not doing the diet, the lifestyle, the exercise, if you're not dialed in on all these other pieces, you're wasting your money. They are not magical, right? The longevity peptides are not magical. They're not going to March you back 30 years and you're still eating at Chick Fil A. You need to do those things and it's not something you do for a month and see any damn difference. You got to commit, right? You have to go through doing them to really see benefit. You might be able to use BPC on a recovery thing, but to really use it for longevity, it's something that you commit to.

Well, this is a whole. I've gotta. There's so much more I want to ask about Peptides. I'm. I'm just myself scratching the surface on where everything is going with Peptides and the confusion. I unfortunately have lived through the weight loss world way too long. I do not believe people will not abuse it. That's just going to keep going. I also, there's. It's not about. I don't know even know that education matters to people. When, when you look at skinny culture, people will do anything to be, be skinny or to be thin. We've saw this. I've seen this since I was a kid in the 70s with diet tab and this. It's a thing. And even Dexatram and this is just a thing. We had a glimpse, a moment, a brief moment of body positivity making it come, come back. And that's. It's gone now. It's. It's back to shaming. If you're not super skinny.

It's.

It's really crazy. It's one of the big reasons I'm not doing a big. Or didn't do a big January launch because I, I was like, I don't even want to. I don't even want to be in the middle of all that. It's just, just. It's just wild to me.

No, I agree. It is, it's. It's very, it's very troubling and concerning and I agree with you. I don't, I think the, I think that train is like a runaway train and people are either going to choose to be healthy or skinny. Yeah.

And I'm, and I'm literally not against peptides. I think they're amazing for so many reasons. And there's a. We are also feeling eating disorders. So it's like, it's like there's a. There's a small percentage of people using them super responsibly and I think it's incredible for them. And then there's this whole runaway train with skinny is back. And it's worth seeing it led with celebrities. It's. It's a whole big thing. So I don't, I don't even know what to say there. It's just, it's just wild. Okay, back to hormones for a minute. I just want one more question around hormones about delivery. It's very confusing for people to. Whether to do troches or injections or patches. And do you have kind of a rule of thumb there? Is everyone very unique? Like what, what's your thoughts there?

Yeah, so, so we have a couple rules of thumb, right? So the, the rule is, is generally right, and I would say if you're, unless you're a young woman who maybe still cycling and other things, and you're given estrogen because of some, like some medical reason, estrogen should be given topically. Right? So that means a patch, a cream, an oil, right. On the surface of the skin. It can also be injected. Again, it's going on the skin. And the reason why is it gets metabolized first in your body, goes into the bloodstream, goes and does its job, and then a small amount of it goes to the liver and then it goes through your detox pathway ways. Same thing with testosterone. Testosterone topically, right. Now, depending on the base. Right, we'll get into that. But topically, same reason. Progesterone is different because it metabolizes so rapidly, it doesn't go down those liver pathways in the same way. It's generally better orally or vaginally. Right. At a physiological dose. And then estrogen cream. Also if you have UTIs or vaginal atrophy or other conditions that, like urinary incontinence, those kind of things, the method of delivery. And oil, we use oil. So we happen to have the only organic bioidentical hormone in jojoba oil, full stop. That's all it's in there. Right. So our estrogen is either an estradiol biased or a testosterone in an oil. Right. And the reason why we want topical absorption and we don't want endocrine disruptors because the reality is, is the creams have some endocrine disrupting ingredients in it to keep them from separating. And also the cream bases, there's only so many bases that the compounding pharmacies use and they're all different combinations. So one person might be on a, on a, on a cream that doesn't work and they go to a different pharmacy and it does. So it's either the compounder or the base. Right? So if you try a cream and it doesn't work, you can try a different one or a different brand. The patches are absolutely bioidentical. However, they do have adhesives. So if you are allergic to adhesive adhesives, you can't do those. And there is some endocrine disruption activity in there too, but it's relatively clean. And I'll be really honest, I use the oils. But when I travel like to Europe, I'll take a few patches with me. So I'm just Have less bottles of stuff. Yeah, Right. But my preference is always the oils. And then, so we get to. So we get to like which one you choose and how it's very different by woman. We don't have good data to say every woman needs this dose. Right. Louise Newsom did a study out of England looking at her patient population. She's leading up their entire menopause sort of effort in England. And she found because they have a nationalized dose like you, everybody gets this dose in menopause if you use it. And she found that 50% of the women were underdosed at that dose and 25% were overdosed. So the dose, the method, needs to be individualized to the woman. What I will say, and this is the reason why we've. We've chosen to go with the oils is, is it absorbs well. And I will say this over the creams because we've done. We. We ran like labs and clinicals and all this stuff, you know, so we like that. And it's also a great delivery. But some people are like, man, I want to inject my testosterone. It's like, great. I generally recommend not doing any oral testosterone.

Is Troche considered oral too, even though it absorbs that at your time.

So Troche's absorb in the mouth. There's going to be a little bit that you swallow, but not that much. But you want to let them melt and absorb, so they absorb through here, not getting swallowed. I don't want somebody swallowing estrogen or testosterone. No synthetics. Just take that stuff off. No. Medroxyprogesterone. No. If they say progestogens, progestins, those are all synthetic. And then no Premarin conjugated equine estrogen. That's. That's not what humans make. It's not bioidentical. We don't use those anymore.

Gosh, this is so helpful. I think hopefully some of you are seeing why I wanted to have Dr. Betty on and why I took us at least these two episodes to. To get so much of this out and also why she's pretty fed up with what's going on around the country, especially with different providers and telemedicine companies, and that's why she started her own.

And I'm.

I can't wait to go through the process with her to check this out. But if you go to get Hormones now dot com. So get hormones now dot com forward slash Natalie Jill. Get hormones now dot com forward slash Natalie Jill. Make sure you do the forward slash Natalie Jill. So she knows that you came from me and you get special attention, special treatment, because she's going to get slammed. You can actually work with her trained providers on her method and actually even get prescribed hormones. So especially with her delivery with the hobo oil. How do you pronounce it? Jehovah or Jojoba oil.

Yeah.

I can't wait to dive in and try this whole process here. Thank you so much, Dr. Betty. Thank you so much for being here and answering all of my questions.

Oh, thank you for having me. I love talking about this stuff. Obviously, that.