How HRT Protects You Against Heart Disease and Dementia, with Dr. Prudence Hall

Hello and welcome to the Feel Freaking Amazing podcast. I'm Wendie Trubow. My host is Ed Levitan, my co-host, and today we have Dr. Prudence Hall. I'm super excited to talk to her. She started as a traditional gynecological surgeon and then transitioned her career to focus on regenerative and integrative medicine. She's the founder of the Hall Center in Santa Monica, California, and her practice is exclusively focused on regenerative medicine. She looks into the root causes of conditions and diseases associated with aging. So, Prudence, welcome. Thank you for being here.

Guilty as said.

How'd you get into this medicine?

Well, I knew at a slightly later age that I wanted to be a gynecologist and serve women. And I come from a family of girls. We're 4 girls all in a row. And When I started my gynecology residency, I wasn't taught anything about hormones or anything about growing older or what happens. Why are you tired? Why are we depressed? Why do we have no sex drive? Nothing really. And I went to a great gynecology residency. It was, it was a surgical residency, subsurgical. So a lot of it was based on surgery and deliveries and a lot of, a lot of stuff like that, but nothing that really was related to women's other half, which is kind of why am I the way I am and how can we change that?

Where'd you go to residency? Because I got no training in hormones either in residency. So I'm just curious.

Yeah, Keck School of Medicine, USC.

Okay. All right. I was out on the other coast.

Yeah, my patients were very poor. So we did hundreds and hundreds of hysterectomies and myomectomies and all of this stuff. Thousands. Thousands of deliveries, we had, you know, very sweet but, you know, poor patients.

Yeah. So, so we're gonna, we're gonna talk about hormones today. And I think probably the biggest thing that I'm always talking to my patients is educating, like, how, how do you know you have a hormonal issue versus an adrenal issue versus a gut issue? So what are the, when in, in your practice, what are the main signs and symptoms that someone might have a hormonal imbalance? Let's start there. What are the things you're looking for?

So just to kind of put this in an age group, perimenopause starts in our 30s, usually our late 30s, and that indicates that there's been a decline in the estrogen that that woman has. So a woman at that, in that age category, usually tells me, gee, I've gained 10 pounds, Prudence, and, you know, I'm feeling a little bit more down. I have, rather than a day or two of PMS, I'm having 7. I just feel more tired. So these are very typical symptoms. And I— and sleep is a little bit you know, a little less deep. And then as we go into menopause, which has really decreased, Wendie, for the last, I would say, 4 decades that I've been in this field— it used to be sort of 47 to 53, now it's 44 to 48. So we aren't expecting menopause. Yeah, stress.

Have you noticed that too? I've noticed tremendous decrease. It used to be 50s And now I'm like, oh, you're in your 40s and you are done. Like, I've noticed a tremendous, a noticeable change in their age, which was surprising.

And I think that's due to high sugars, you know, high sugar, stress, uh, toxins, toxins, lack of sleep.

Did you say toxins?

I said toxins. So, okay, so there's the vague stuff starting before they really technically are in, you know, that's the, the vague mentions of why they— what could be going on, right? And then as they process more into full-on perimenopause, approaching menopause, what are the things women should look out for?

So those would be very similar but more pronounced. So hot flashes are typical. Not everyone has hot flashes, and we can talk about later why they don't. But hot flashes, quite depression, quite, quite anxious, quite severe or moderate anxiety. 20 or 30 pounds of weight gain, sleeplessness. Prudence, I can't sleep. I'm awake at 3 o'clock. And also things like more obsessive behavior. That was actually one of my symptoms in perimenopause. I thought charts had germs on them. I was a little nuts over there a couple of months there. And other behaviors such as a little paranoia, more fear, feeling less confident. Low sexuality. Women tell me all the time in menopause, what sexuality? Zero sexuality. Yeah, my partner is going to divorce me. So it's more dramatic symptoms. But I love— and I cannot say this enough— I love seeing patients in perimenopause, you know, right when the symptoms begin, because that's the time to correct hormones back to youthful levels.

I'm waiting. 'Cause one of my things, so we've been doing bioidenticals for a long time and menopause is easy and, well, not easy, but we've been doing this for a while. But the, what I've been really, I haven't been comfortable starting like estrogen in perimenopause, but I noticed that a lot of more people are starting, started doing it. Yeah. I, I noticed a lot of people start, I think I started also just 'cause it's a trend I think. But Um, even regular gynecologists have started giving the patch to perimenopausal women.

But it's interesting. So there's a lot to unpack here. I think what I always say to women is perimenopausal hormone replacement is not a set it and forget it the way it could potentially be once you get to your ideal levels, right? But in perimenopause, you're ovulating, you're not ovulating. Maybe you need more estradiol this month than you do next month or last month. And you'll, you, you'll probably know if you're overtreated cuz you'll be, super horny and raging bitch, basically all wrapped up into one. You know, that, that would be like the broad brushstroke that I would say, but there's a lot of nuance to it. It really is like this month you need this and next month you don't need that.

Yeah, a little bit. I, I, I do that over, over time. That is absolutely true, Wendy, that over time you, you take a patient, let's say at 35 or 36, and you look at her estradiol level, and on day 2, that estradiol level is 20. Or 15. That's a very low estradiol. We can also check it again day 21, see what her progesterone is like. And it's either, you know, a small amount of cream during PMS time, bioidentical, or a 0.025 patch during her PMS time, you know, that week before her period. And very frequently, that's a big, big concern. I'm out of control. I just— I'm eating like crazy. I'm screaming, yelling, you know. So that might be a very good time to start hormones with. I strongly support gynecologists, you know, family doctors, naturopathic doctors, to begin hormones when there is evidence not only in symptoms but also in all the labs. And it's not just estrogen and progesterone. Testosterone usually will decline a little bit later, but not always if women have had tremendous stress, just like men. You know, men will have tremendously low testosterone levels when they're circling the globe every 3 months. So it's also thyroid, adrenal hormones. We have to look at the metabolic status of that perimenopausal patient. So their hemoglobin A1c is how much damage do I have to my body and my cells over the last 4 months? And, you know, looking at all the different levels of how is the lack of estrogen or decreased estrogen affecting your LDL cholesterol and then the subparticles, ApoB, Lp(a), and I see those parameters parameters of aging, more rapid aging, really starting to arise during that, that perimenopausal phase. So yeah, give them some hormones and some DHEA and some thyroid if needed.

You know, I'm always struck by women who show up and sit down in the chair and they go, my hormones are off. And I'm like, well, they probably are, but are we talking adrenal, thyroid, or female? Like, let's pick a category because so many women are sandwiched in between aging parents and teenagers. Who, I might add, are cruel and unusual punishment. Having— I have currently two— well, we currently have three kids who are teenagers. Not as about— our second daughter is about to not be a teenager, and then we have two full-on teenagers. They are cruel and unusual punishment. That's how I feel. And they're an adrenal stressor all to themselves. But, but, you know, when women are saying to me, oh, I'm waking between 2 and 4 in the morning, it must be my hormones, I'm like, it is, but it's your adrenal hormones at this point we need to really dial in on. And support you because you're in fight, flight, or freeze, and it's inappropriately secreting at 2 to 4 in the morning.

That's right.

Okay.

And low estrogen, high cortisol. So low estrogen, high inflammation, low estrogen, high stress, basically high cortisol, and then that'll burn us out. So, yeah, everything is tied together. Everything comes back to some core central principles in terms of the aging female body. And it has to be addressed on many different levels in terms of your hormones. People who don't measure hormones, I cannot begin to understand how that is. Like at the University of San Diego, they don't measure any hormones. They don't really measure hormones. Maybe an FSH. I mean, I had many discussions with, you know, the head of the menopause program.

I don't even— I don't understand, like, how do you not measure hormones?

Well, you know, you can use a symptom questionnaire and that can be helpful. But still, I mean, what's causing depression in menopause or perimenopause? Is it low thyroid, especially the low free T3? Is it, is it lower adrenals and kind of a burnout? You know, that kind of fatigue that we have. Is it, is it lower testosterone? I had an experience with coming off the testosterone recently and oh my God, I was exhausted and, and feeling down. I'd given all my testosterone away because it wasn't approved by, uh, the testosterone I make. It wasn't approved by the FDA. And Abe Morgentaler was saying, ah, witch hunt, witch hunt. He's the big father of, um, testosterone therapy for men out of Harvard, as you know.

Yeah, he actually was local until he moved.

Yeah, I know, but he's listening to my patients.

He was local till he wasn't.

Until he was in Florida.

Yeah, he's in Florida. Yeah, I love living it up.

Can you talk to the listeners about how bioidentical hormones work differently than conventional hormone replacement therapy?

Great question, Wendie. Great question. So knock, knock, knock at the door. Who's there? It's a robber coming to steal your, your goods. Or knock, knock, knock, you know, someone is delivering flowers. So it really is that different in terms of how they act in the body. So I was trained on Premarin, uh, back in, you know, 1982, uh, and Premarin is pregnant mares, or in Premarin And that happens to have about 35 different hormones. One of them is estradiol, which is the same hormone that we have, but it caused a lot of inflammation in the body. And that's why the Women's Health Initiative in 2001 said, oh, there's a decreased dementia. Well, dementia has some of its basis in inflammation, and that's why it also increased heart disease. Well, you know, heart disease and inflammation is certainly a key component of that, one of them. And bioidentical hormones are not pregnant horses' urine. And the whole spinoff of all the people who created generic pregnant horses' urine. Bioidentical hormones are exactly the same as our hormones, Wendie, yours and mine and my sisters and all my patients. And so when that comes into the body, it is seen as your own hormones. So the body doesn't know, am I making it or taking it? So it's exactly identical in every single way with what the body is making. And we don't want to give our body things unless it's really necessary that are man-made and, and a different chemical nature. So it's, it's night and day. So bioidentical hormones, as I mentioned, it decreases stress and inflammation and, and cholesterol, and it decreases Dementia. Dale Bredesen has personally told me, listen, keep giving those women estradiol. It decreases dementia, Alzheimer's disease. Big modulating force with that. I've seen ApoBs fall like crazy. Now, the ApoB is the, you know, the subparticle of the LDL. Very, very important to follow. So those just plummet. And even the Lp(a)s. This is the inherited subparticle of LDL. And so cardiologists are saying, well, we, we don't have anything to treat that with. We don't have anything to lower that with. And at this point in time, it's true. There's no medicinal for that. No pharmaceutical for that. Hopefully they'll come up with one, but estradiol helps tremendously. Niacin also helps, but estradiol really lowers those, all of those subparticles. So there's decreased heart disease, decreased dementia, decreased diabetes, decreased autoimmunity, decreased inflammatory diseases. I mean, you name it and it's going to be less. And thank God that the FDA removed the black box warnings. I mean, I've been saying this for 30 years almost, Wendy, you know, and vilified for it. No, it just helps with— it helps with bone density and symptoms. It's like, yeah, and when did you last look at the data? But anyway, it's off. People are, people are happier now.

So where do you stand on, um, starting women at like 10, 20, 30 years after menopause?

I see patients all the way up to 85, 90. I saw a 92-year-old patient that, uh, whose children started on hormones. Yeah, yeah, that 92-year-old. So It might be true, and I think it's probably true, that the effects of estrogen on the brain will be less as if you start hormones later. That's why I like to start in perimenopause, you know, never experience that decreased, you know, terrible reduction in estradiol and the rest of the hormones. But I would say almost every patient tells me, regardless of when I start them, that, oh, my brain's better. Because women are coming in really quite forgetful and worried about it. And so it just helps at any age. And, you know, some of that data says, well, you're not going to get the same results. That's probably true. And maybe does it increase in— I wouldn't dispute that it increases dementia. I think that estradiol at any age is going to be helpful. But, you know, there's some data that we still need. And I would say that that would be one big study. Have you, have you seen a study with that? Because I haven't. No. No. No. Yeah.

And I know in the functional medicine world, there's a lot of thoughts about how to measure your home when you're on bioidenticals, how to measure, are you doing blood? Are you doing saliva? You're doing urine? Where, where in the, where, which fluid?

Which camp? What camp are you in?

I use 'em all. I use them all. I start by looking at all the hormones. So for thyroid, I look at free T3, free T4, TSH, thyroid antibodies, and reverse T3. So I look at that for the thyroid. And then for the ovarian hormones, I look at estradiol, testosterone, progesterone. I use the 24-hour meridian valley. I like that very much.

I don't know that test. Was it blood or is it urine?

Urine.

Yeah.

24-hour urine test that Jonathan Wright came up with. Jonathan Wright is great. Oh, yeah. I was in a meeting with him in Creole once, and it was just like, wow. So this is Jonathan. He's just amazing. So I've used that probably for 30 years. Yeah, probably about years whenever he started it. So that's good. And then ZRT does some pretty darn good saliva tests. And so I'm in a little discussion with some people about, oh, you just have to measure that free estradiol. It's like, yeah, you do. But I, I start with quite an extensive panel of, of blood before I see the, the patient for the first time.

When you put women on bioidenticals, are you giving them anything to help them support processing their estradiol on the other end?

I make a product that I created called Estro Protect, and it has calcium D-glucarate, DIM, B12, folate, some ashwagandha in it. So I think This is why the 24 hours is so important, because estradiol breaks down into 2 hydroxyestrone and 16 hydroxyestrone, those guys. And you want the 2, you don't want the 16. And then that'll break down even further into the 4 hydroxies. And so I measure those with Jonathan's Meridian Valley, and then I'm much more aware of what's happening after going through the liver. And yes, I, I do modify this as much as I possibly can. So I measure B12 and folate levels, homocysteine, CRPs. These are inflammatory markers and what's happening at the level of the liver. So, you know, we're all one organism. It's happening like a big symphony within.

What are the lifestyle things that you're recommending women take on, especially starting in perimenopause, but proceeding through to when they're formally menopausal that help?

I would say that the most singular important thing that anyone can do for their health— of course, balancing your hormones is number one in my book, being a hormone, you know, person here— but measure your hemoglobin A1C and pound that down to 4.9 or 5. So I personally struggled with this one. I was a vegetarian for 20 years when I was raising my kids, and oh my God, my hemoglobin A1C— how much damage did I have in my body over the last 4 months? That's what the hemoglobin A1C measures. It was 5.8, and it's just like, oh my God, I'm killing myself. And I knew functional medicine at that point, uh, and I— it's, it's lower the carbs. Lower the carbs. And the carbs would be, of course, bread, pasta, crackers, anything with sugar in it, rice, potatoes. So that's very important. And that should be measured on every patient. It takes 4 months to lower it, but it should be looked at for every patient. So that's absolutely number 1 lifestyle is eating and diet. So when you talk, you know, when I first learned about Jeff Bland, I went up to Giggs Harbor. And we were, I think, about maybe 40 people in the class. And Jeff taught a lot of the class. It was just incredible. I had to do it twice. As a gynecologist, I didn't have the internal medicine kind of understanding. It's like, oh my God. Oh my God. So I took it twice. And the second time I took it, I think there were 2,000 people or something in the class. Well, many, many, many, many people in the class. So diet alone is what they do. When back then when I was doing, they were saying we have 50% decrease in symptoms, if not more, simply from an anti-inflammatory or a low inflammation diet. And that's what they start with, again, with functional medicine. So diet is important enough. Protein, and I think that varies how much protein to have. Um, John Sinclair was just saying, yes, 1 gram of protein per ideal pounds in terms of what you weigh. So if you're 150, you want to be 130, you'd have 130 grams of protein today. Stanford came out with saying no, 0.8 grams per kilogram. So I go a little bit more than that. I would say maybe 0.8 grams per pound is still, you know, protein causes kidney disease if it's too high or Let's say— I'm not sure it causes it, but if you have any kidney deficiencies or problems, you know, first thing that nephrologists will do is put you on a low protein diet. But protein is important, and good fat, omega-3, 2,000 milligrams of EPA a day. Some— it'll break down into DHA. And keep it refrigerated, it oxidizes very easily. Exercise. Before coming on this podcast, I was at Gold's Gym, you know, lifting weights, which I do about 4 times a week. And and, you know, running, walking, you know, intervals. I do HIIT, high-intensity interval training. So I think that that's very good. Even if you have 10 minutes, 15 minutes a day, you can alternate, you know, maximal intensity with relaxed intensity. You have to be in shape. You don't want to just do that if you're obese and haven't seen a cardiologist.

But that's the one thing you, you haven't talked about is with the testosterone. When you do add women, when you do add testosterone to women or men, of course, the increase in muscle mass.

Yes.

As long as they're exercising, super important.

Yeah.

For longevity and making sure that long healthy life.

So I have to say building muscles in menopause is like pushing rocks uphill. That's how I've felt about, about building muscle in menopause and it's taken, I've been menopausal for, I think, almost 5 years, and it has taken me almost 3 to really dial in how to build muscle. And it has been, it has been so challenging. And I mean, he's witnessed it because I bitch about it all the time. But, you know, take a week off, lose muscle. It's, it's really, it does require 4 times a week plus cardio.

Absolutely. Yeah. Now, one thing that I'm doing, and I've been doing this now for about the past 4 or 5 years, is rather than giving women cream, testosterone cream, which I would say 90% of my patients are on it— I hope the FDA doesn't hear that— but really, it's such an important critical hormone for women. So what I'm doing now is— Abe Morgenthaler taught me how to do testosterone therapy. So I have a lot of men that I take care of, and I've generally used testosterone cypionate with them. You know, an injection once a week. So I started doing that, Wendie, with women. And what I found, myself included, is that building muscle is so much easier. It just— it cuts the time in 10s. Are you on testosterone, Siphiene? Are you on the injectable?

No, no, I've been really leery to do injectables. And in fact, I had a patient ask me yesterday, and I was like, well, You're, you're undertreated. So let's just raise the level and see if that gets you where we need to. I was, I was pretty reluctant even yesterday to, to do it because I just haven't had training.

So what kind of dosing do you do?

Yeah.

Yeah. That's, that's great. Thank you for asking. So it's 0.1 mLs. That's one line on this, on a 1 mL syringe, uh, weekly. And then I measure it just like I do with men at the end of the 7 days. And I see, well, where are you? Now here's the thing, Wendie, that that is so encouraging to me having done this for so many years like you have. It's that the DHT, so testosterone breaks down into estradiol and dihydrotestosterone, and that DHT, just like in men when their DHT is too high, can cause hair loss and hair thinning. So when I get the testosterone up to a physiologic youthful level, 50 to 100, then I start seeing these higher DHTs. Sometimes even when a testosterone is at— I'm looking at the free testosterone, which is more important than the total. But let's just say for a total testosterone of even 25, some women will have their DHT at 20, and that's going to most likely cause hair loss and acne and facial hair. So it's 0.1. And what you— what I did, and, you know, it might be helpful to you, I'm not sure, is you start with a patient that, that, that has a high DHT. And you say, look, let's try 0.1 mL of testosterone. They need 100 milligrams, not 200. Okay, it's 100 milligrams per mL weekly. And usually I say, hey, how about a Friday? That way they can have their blood drawn either on a Thursday or on a Friday before they inject. I am so happy to say that those dihydrotestosterones just fall. Hair replacement doctors also use that for their patients. If their patients are on testosterone cream, the men or women, they'll put them on testosterone injections. And then you can, you know, I don't use the reference ranges from labs because, as we all know, those are skewed very much towards sick and elderly individuals. I mean, how many sick people per super well athletic youthful person is going to get their blood drawn like that? So, you know, I like to get those testosterone up, you know, when, when the farm— when the lab says, yeah, 2 to 25 or 40, depending on the lab, is a normal level. It's like, yeah, if you're 75 and have no muscle mass, that's going to probably be about accurate. But youthful, youthful, vital, individualized levels for women, right? Everybody needs their own dose, their own method of delivery. I have 5 methods for delivering almost every hormone. So it's, uh, do you, out of curiosity, do you do the pellets? Um, I, I did a lot of pellets in my residency at USC, and that was 1978 to 1982. So that— I did a lot of pellets. And then when I came out in practice, I didn't do pellets. I was going back and forth between France and here and bringing bioidentical hormones in. And I didn't— I sort of thought, huh, pellets. Then I started doing pellets again with men. And, you know, pellets will last maybe 6 months for men, or 6 months for women. They were lasting a month and a half. And they have little things on their buttocks, little, little scars and everything. And testosterone, for example, is a very small molecule and it easily absorbs through the skin. You know, it, it absorbs easily and estrogen absorbs easily. The patch, troches, drops, these are all preferred for me over the, uh, the pellets.

I always felt too I was too commitment-phobic to try the pellets. Like, I just didn't want to, you know, if you don't like it, you get it in and you don't like it, it's too high or too low, you're kind of stuck, right? You've got to wait for it.

Exactly, Wendie. Exactly. And you have to, you know, come— women really have to come back every 3 months. So you're tied to the doctor's office and doctors tend to charge quite a bit for that. Whereas the patch is covered by insurance. It's bioidentical, covered by insurance. You know, the compounded hormones are reasonably priced, and, you know, there's different methods for each person.

I was just reading this morning— I've been, I've been complaining that the patches have been really hard to get and backorder. And, uh, apparently Sandoz, which is one of the major makers that I refer to because I don't like Mylan because it's this big and bright white, and I had an allergic reaction to it, so now I'm mad at them, but The Sandoz said that within the month they should be out of, out of low stock and backorder. So hopefully it's coming. Relief is coming soon, but I'd rather get it paid for by insurance than not if I can.

Exactly. Exactly. And the patch works great. But here's the thing that I'm doing. So I'll, I'll start because a lot of times I'm changing them from creams to the patch or, you know, changing from different methods. So I start a little bit lower. So in perimenopause, 0.025, and then I raise them to 0.0375. Menopausal women, I'll start usually at 0.05 to 0.075, depending on how bad they, they feel, because you kind of want to introduce a little slowly. But then when I get up to 0.1, I'm using a patch and a half, I'm using a patch and a fourth, I'm using a patch and three-quarters, and, and, or even two patches twice weekly. So, and then measuring the levels again to see, well, what do you follow? The FSH, because that's very helpful. That FSH brain hormone, that is the mark. It's like the TSH. And this thing about inhibiting the FSH from falling and from coming back into a normal range, I have never seen it. I have never seen that. I find the FSH extremely accurate in terms of knowing how women are responding to hormones, along with the estrogen. Estradiol and, you know, the rest of the hormones. So let's say that I use FSH.

Actually, I've never heard of that.

It comes down, right?

Yes, it does. So the FSH is a follicle stimulating hormone that manages and releases estradiol from the ovary. So you would think the brain is smart enough to know that when there's been ovarian removal, oophorectomies, or when women are at 60, the brain would know that there's no ovary to respond. That's not true. The FSH keeps on going up and up and up and up, desperate for the brain to get estradiol. So I follow that. Now, there's a little thing that can happen as women really start to age, is their pituitary gland can age also. So I'm always looking at how, how accurate is that pituitary gland. And what's their TSH? Is that— does that seem accurate? The TSH, by the way, is about 40% not diagnostic in terms of thyroid disease. That's why I look at the free T3 and, you know, all these other markers for thyroid. But I would say that that FSH is very important. So if I start somebody on 0.075, then I'll look at the FSH. Let's say it's 86. In response to your question, 3 to 5 is the FSH when we're younger, all the way up to perimenopause. Perimenopause when it starts going up to 6, maybe 7, depending on when you're measuring it in the menstrual cycle. Boy, that's perimenopause in my book, coupled with symptoms. You know, women have these symptoms and a slight rise in their FSH on day 2 of their cycle. I mean, that's perimenopause. And then of course their hormones show me that they're perimenopause, you know, the blood work. And then I say, okay, they were 86 for that FSH, and I put them on the 0.07 5, they're still having some symptoms like sleeplessness, and they're still having, um, they're still down, depressed a little bit. Their sex drive is not back, uh, and estradiol runs the sex drive as well as testosterone and DHEA and also thyroid. But really, estradiol is very important in sex drive. So, um, then I'll see, let's say that their FSH is now at 70. I'll say, okay, let's go to 0.1 and try that twice a week, or sometimes 3 times a week, because I measured at different times. Okay, let's measure the day that you're changing your patch, like Monday morning, Thursday evening. That's another thing. I want 3.5 days per patch, not Monday morning, Thursday morning. Monday morning, Thursday evening. So that'll be more accurate because the patch really doesn't last 4 days. In some women, it lasts 2 and a half days to 2 days.

Are you— where do you fall on alcohol? Do you tell your patients to get rid of it? They can have it. Where do you fall?

So I want to start by saying my brother, James Hall, is an award-winning— he had the 22nd wine in the world this year. He just called us a few weeks ago and told his sisters.

So are there any other brothers? So there's 4 girls and one youngest brother.

The youngest. Yeah, he's our youngest one. And I also was partly raised in France. I was married to a Frenchman, have a French passport. So, you know, alcohol is just a part of life. But I do not drink any alcohol now because it's a carcinogen. And as we started moving away from— yeah, this is resveratrol and it's so good in the red wine— to Oh my God, it's a carcinogen increasing many diseases, especially brain stuff. I just— so I'm very gentle with this, Wendie. Everybody has their patterns, and I just say, yeah, just keep in mind that it's a carcinogen and a toxin and full of pesticides and stressing your adrenals.

You know, yeah, I have a politically hard question.

It's okay.

Breast cancer.

Breast cancer. Okay.

And hormones.

That's not hard. So first of all, I take care of lots of patients with breast cancer and I have them on bioidentical hormones. However, I am not an oncologist. So who do I refer to? Several oncologists who are very skilled with this. And they look at the HER2s and all the markers and all the OncoScores, and they look at everything, and then they give a report that they think that estrogen is fine to take and blah, blah, blah. Testosterone, you know, a lot of times patients look online and they say, oh my God, testosterone raises estrogen, therefore I can't be on that either. And it's like, yeah, it's not going to raise much estrogen. Unfortunately, it's going to break down into DHT much more than estradiol. So when I get the approval from a Western, you know, really good oncologist and they say it's okay, I discuss it with the patient. I said, this is right now. We know. And Abe Morgenthaler, you know, he was on the Harvard campus. He was stopped and people were saying, you scumbag, basically, just to be a little bit vile. I mean, how can you do this? You know, you're, you're disgracing our profession to put men on testosterone, increase testicular cancer, prostate cancer, not testicular, prostate cancer. And so we aren't exactly there in terms of women and estradiol, but really important studies have to be done. Dr. Grumley at St. John's in Los Angeles is doing a big study. She's the head of the breast oncology at St. John's Providence, big hospital here. So she's looking very carefully at that. And she— if one of my patients develops breast cancer and I send them there, she does not say, well, you can't take estrogen. She's not telling patients that. She said this is the edge of hormones. She likes hormones. This is the edge of hormones where we don't really know or don't have enough data. Which is scandalous. We should have to. Estrogen Matters is a great book. Avram Bluming at USC, he's now retired, but wrote a beautiful book, Estrogen Matters. And, you know, he discusses breast cancer quite extensively and does not think that breast— that it increases breast cancer.

Well, it's theoretically protective. In theory, estradiol is protective. But the challenge that I have is if you have an estrogen receptor positive tumor, I don't know that I want to feed it with estradiol. In fact, I know I don't want to feed it. That's my concern. Here's the thing.

If you biopsy a normal breast, what are you going to get? Estrogen and progesterone positive receptor. If you biopsy the brain, estrogen receptors, the muscles, the tendons, the, you know, everything, uh, estrogen receptors, bladder, you know, it's extensively estrogen receptors are in many, many, many, many, many cells in the body. So I look at it like this. So this is more normal tissue. Now you have to look at the OncoScore of the cancer, but this is more normal tissue than a wild kind of thing where there's no estrogen and progesterone receptors. You know, that's not a good breast cancer to have. So if somebody does have estrogen and progesterone, that tends to have a much better outcome because it's less of a wild type of breast cancer. And You know, the oncologist will tell me, and they do extra tests. They send tests off to Greece and various places to kind of see other parameters for breast cancer. And I, um, you know, have a discussion with women because traditional oncologists really don't understand the difference between Premarin and, you know, the bioidentical hormones. Right. Yeah.

I don't think Boston has any oncologists that will be okay with any hormones after breast cancer.

I have yet to meet one.

Yeah. Yeah. Yeah. Well, my incidence of breast cancer is about 1 in 60 in terms of patients. Last time we looked at it and, you know, it's not 1 in 7. It's not 1 in 10. It's not 1 in 20. So it's, but that subset of women who have breast cancer That is, that is right where the field is at. Do those patients get treated or do they get denied? So if they're put on the anti-estrogens, you know, Arimidex and things like that, I mean, there are definite risks with that. I mean, risk of dementia. You take a 65-year-old woman and you're going to get rid of every single bit of estrogen she has. That's putting her at higher risk for dementia and higher risk for heart disease. You know, what's the most common cause of death in women? A heart attack. So it's, it's, it's a clinical decision to be made with the patient and the oncologist. And that's where I leave it. And patients are very grateful to be offered estrogen if it's appropriate. You know, it's not just estrogen, you know, testosterone, DHEA, all the hormones that might be deficient.

Right.

Prudence, this has been fascinating. Thank you. Is there anything we, um, can, can you tell us how can people find you? We'll put all of this in the show notes, but how can people find you?

Well, you can go to the Hall Center and my book is there for free. I wrote it with Suzanne Summers. She, she strong-armed me to write this book. So I wrote Radiant Again and Forever. It's for free. You can download it on, on my website. Um, I also have a website, Dr. Prudence Hall. And they're going to see this podcast, aren't they? And all the rest of the ones I've done. I'm so happy you invited me.

Yes, this is wonderful. So we'll thank you for being on the podcast, really. And anyone who wants to contact you, all the information will be in the show notes.

Okay. That's great. Thank you so much.

Thank you.

Humanity. Thank you so much.

Bye-bye.