The Dutch Test for Hormones: How Women Over 40 Get BHRT Right

Everyone who's live, welcome. Uh we're going to be going live twice, once or twice a week now with the providers here at MedMatrix, talking about different uh topics, everything health and functional medicine related that uh we get from patients every single day. So today we're going to be talking about a couple things. We're going to start talking about female hormone replacement therapy and menopause um and some of the biioidentical hormone replacement treatments that we have available at Men Matrix. And uh disclosure, everything anything we talk about today is not medical advice. Um but with that said, we are joined by the lovely Dr. Rose. Dr. Rose, thank you so much for joining after a long day of work. Yeah. How many patients you see today? I saw 13. Nice. That's a busy day. Normally it's like seven, right? Or eight. Depends. Yeah, it was. It felt definitely felt full. Yeah. Was it a lot of more follow-ups? More follow-ups. Only a couple new. That's awesome. Cool. How did that go? When do you before we get right into stuff, how when do you normally start seeing improvements in patients? Is how often are patients seeing improvements in uh three months versus, you know, taking six months to a year to like really notice different changes in their health or is it just really that different for everyone? Are we talking specifically people who start on bioididentical HRT or No, no, we're just broad. broader than that. Um, oh, it doesn't usually take it usually within three months we can start to see if we're going in the right direction. Um, yeah. I mean, the way that I usually talk to people is like in general this is a slower medicine because we're supporting the body's own healing own metabolic pathways. We're not really like suppressing anything. But um I can usually tell by 3 months if we're going, you know, if we're if we're headed in the right direction, if we're on the right track. Okay, cool. Well, we'll probably do another episode on the timeline and expectations of functional medicine, but we got to stay on track and my squirrel brain will get us totally off track. So, let's go back to hormone replacement therapy. So, uh yeah, give can you give a little context just on your expertise with uh hormone replacement therapy specifically for females and bioidentical hormone replacement therapy? Yeah. Um, I mean it's probably I would say 80 75 or 80% of what I do every day involves um like evaluating kind of a woman's baseline hormonal status and that is that includes um lab results which I'm sure we'll talk about more um and her current symptoms just her history and discussing whether some form of bio identical HRT makes sense for her. So it's um yeah and I've done a fair amount of continuing education over the years. I try to stay current um as our viewers may know. I mean things are things are changing I think for the better in the kind of main terms of mainstream awareness. Um, so just kind of keeping up with that and um, both in terms of safety, efficacy, what you know, what forms of hormone replacement make the most sense, meaning like topical versus oral. Um, yeah. Gotcha. Okay, cool. So, let's start with got a bunch of questions here that are pretty common. So, what So, is because people go to their primary care provider, conventional doctor, and very often they'll ask for, you know, things like their sex hormones tested. We hear this all the time from patients and um either they're just told flatout no or sometimes I'm sure they say yes. But also a lot of times say blood hormone testing with through blood doesn't actually matter. How much of that is true? How much of that is um not true. Um [sighs and gasps] so we like to get baseline blood work um on women for a couple reasons. Every individual is different. So, um, uh, whether or not we're going to start kind of treating somebody with hormone replacement therapy, it's always just good to get kind of a bene to get benefit. Um, sorry, to get a baseline and um then we can decide, you know, is there something really kind of abnormal that we need to investigate further? Are things appropriate given um her age? Does it do what what we see on blood work does that match what she's telling us in terms of her menstrual cycle um when she's permenopausal menopausal like what is what are we can we match her clinical presentation to what we're seeing on blood work and so um I find it as a clinician extremely beneficial to um just kind of have that data and then have a very kind of informed discussion with her of what are her options? Is it safe for her? If so, what makes sense? Um rather than um just relying on what she's told me. So, I really value having the lab results. Okay. Gotcha. So, when Okay, so like in 30 seconds or less, like when is blood hormone testing good for sex hormones and when is blood hormone testing bad and misleading for sex hormones? Um, I don't think it's ever bad for Okay. Yeah, I don't think it's ever bad. I think it's always valuable. Um, I think there are some instances when it's not absolutely necessary, but it's never bad. Okay. So, when is it necessary to do something like a Dutch test that's like, you know, I know saliva testing or, you know, over a period of time. When when do you need more in-depth sex hormone testing more than just blood? So, so just to let people know, a Dutch test is usually urine and sometimes saliva. Um, and it what it does is it tests um what are called sex hormone metabolites. So rather than just getting kind of a blood level or a serum level of a hormone, we actually see kind of the metabolites which are breakdown products and it is kind of the gold standard in terms of um especially managing hormone replacement therapy. So ideally somebody comes in, we have baseline blood work and then say 6 weeks at least 6 weeks into treatment is when we would do a Dutch panel and that would kind of show us um how well she's responding and it what it shows us is what's happening at the level of the tissue or where the receptors are, the estrogen receptors, the progesterone, the testosterone receptors. And so that's like just more specific, more a little bit a little bit more accurate than the serum or blood levels. Um it's not always necessary. It's not always convenient. Um but it's great for certain people at certain times during that um treatment. [laughter] Okay. Gotcha. That was a great explanation. Thank you. So all right, switching topics a little bit with testosterone in female health because I know like we get this all the time. and females asking, "Hey, do we offer, you know, do we look into testosterone for female health?" Yes, we do. Why, like, why is testosterone so important in female's health? Because you hear it all the time in like men's health, testosterone very rarely around female health. And I know that's something that, you know, sometimes gets brushed over. So, yeah, why is testosterone so important in female health? Yeah, it's um again, I'm kind of excited because I think there's now a conversation around this and up until I think quite recently, it's kind of been a it's been taboo. It's been a no no in terms of giving women testosterone. And I think there's more research and more um conversation around the benefits of women having adequate levels of testosterone. What does it do? Yes, libido. Yes, like sex drive. But overall overall drive, overall interest um and like motivation um mental mental clarity. So women also talk about a lot about brain fog in those permenopausal and menopausal years. We see benefit yes from progesterone supplementation but also testosterone as well with that kind of mental clarity. Um and then on the physical end of things like muscular strength, muscle tone, um just that lean muscle mass that um you definitely get a benefit from taking testosterone. Gotcha. Pretty important. Yeah. Yeah. And I think that, you know, it's when dosed appropriately, like at the right concentration, at the right dose, it is extremely safe. And I think that's kind of where the misconception has been. So are like, so what about to all the ladies out there who are like afraid they're gonna like grow a mustache or like I have never seen that happen with all the women that we prescribe to whom we prescribe testosterone. Um you know maybe if you took way too much but um you know I don't know dosed appropriately I'm not seeing it. And you have to look at it in the big picture. You have to make sure that estrogen levels are adequate too. you could the estrogen and testosterone are sort of competing and so you don't want somebody to be so what we call androgenic like the testosterone level is so high that that like overpowers estrogen and in a post-menopausal woman her estrogen is low. So you most of the time you're wanting to boost that estrogen as well so that you don't get that um you don't get unwanted body hair. So, if you're post-menopause, like 99.9% of the time your testosterone is low. Um, yeah. So, there's there's I mean, I don't know if you want to get into it, but there's the there's the normal versus optimal, right? And so, there's like the labs have the reference ranges of what's considered normal. Um, and that a woman could fall a woman's testosterone levels could fall within normal. Um, but our definition is different, right? Like we might see we would see that we we have like an optimal level that's safe yet higher than what some other conventional medical providers might consider to be normal. And I'm always bringing in her lived experience, her clinical presentation to match that. We're not just we're not just treating her serum levels of testosterone. Sure. Yeah. Fair enough. All right. So let's talk a little bit about the difference between bioididentical hormone replacement therapy and synthetic hormone replacement therapy. So yeah um synthetic is um similar to our own um endogenous hormones. So like the chemical makeup of our own hormones. synthetic is similar whereas bioididentical is actually identical. Um bioididentical hormones are usually sourced from wild yam sometimes from soy and the um because the chemical makeup is identical the safety profile is better than synthetic. That's the short answer. Okay. So why does like is there ever a time that like synthetic makes more sense than bio identical or is it just like like why would conventional medicine even use synthetic hormones? Um maybe cheaper maybe approved by insurance companies. Um just kind of there's no clinical answer though. There's no clinical reason. No. Have you ever used synthetic hormones or are you always using bioidentical hormones with patients? I have never used synthetic. Okay, gotcha. I have women coming. I have had women come who are prescribed by somebody else and we have that conversation and maybe we switch to bio identical, but I don't think I've ever been the prescriber. Okay. How how often are patients coming in who are already on hormone replacement therapy who are coming from like a conventional medicine doctor um on synthetic hormones versus Yeah. Um it's not that often. Not that often. Um yeah, I think um well I mean I have women coming who are on um oral birth control and that's synthetic. that's synthetic hormone replacement um or an IUD uh a hormonal IUD that is synthetic. So if I include that then yes. But in terms of kind of what we think of as hormone replacement therapy you know usually for women who are you know 40 and over um these days most people have not they've maybe tried they've asked primary care they've asked gynecology and for whatever reason have been told no. So they're usually not on anything. So for women who come to Med Matrix who like um you know have night sweats like they're having all the menopause symptoms [clears throat] um they're tired, they're putting on weight, they're not sleeping, they're anxious, they have no sex drive. Like we hear this all the time where doctors are putting them on birth control. Like what do you think of that as like a solution? Like is birth control a good solution for menopause symptoms? I would say no. Um so one it's synthetic and we just you know I just finished saying how the safety profile of bioididentical is better than synthetic. Um we cannot adjust. The other thing is that um part of that is also the the route of transmission um in terms Yeah. So, in general, especially when we're talking about estrogen, specifically estrogen, you want to do transermal or topical, not oral. Um, so there and that's just a safety safety thing in terms of reducing your risk of blood clots. So, um, so the other thing with um, oral birth control is that we cannot tweak the dose, right? Like once a woman's on that dose, we can't adjust it. Um, and with versus with bioididentical hormone replacement, we can get super specific in how much oral progesterone and how much topical or transdermal estrogen. There's several different types of estrogen. So, I can adjust estriol versus estradiol. One's stronger than the other. can get very specific in the dosing um and really match that woman's individual needs and we just can't do that with oral birth control. Um and and so if a woman really the reason to do oral birth control is if a woman needs it for contraceptive purposes otherwise I don't see why I don't know why one would I right now I can't think of a reason why I would pick that over bioididentical HRT. Gotcha. Um all right so see I got a list of questions here. Um, at what age do would you recommend a lady or I guess either at what age or what things should someone be experiencing to, you know, consider coming to a place like MedMatrix for help with their hormones? I mean, yeah, I mean, it can if a woman has polycystic ovarian syndrome or PCOS, I mean, it could be she could be in her 20s or 30s and we would, you know, start working with her on the appropriate um HRT. Um, in terms of kind of the the perimenopausal transition, like that can start as early as 35. um we really see women experiencing some of these symptoms 10 to 15 years before their menes actually stop and they're considered menopausal. Um I would like to point one thing out which is that we're not necessarily going to see dramatic changes in the blood work at that time. Like people, women can be si are often usually symptomatic for that 10 to 15 years before we look at the blood work and we're like, "Oh yeah, you're menopausal." So what am I looking for blood work-wise with a when a woman's perimenopausal? It's any real red flags, anything that looks super off. Um, but mostly again, it's just that baseline. And really what I'm prescribing on is is she fatigued, has she gained weight, is she having trouble sleeping, is she irritable, has she lost her libido, and is she having hot flashes, night sweats? And again, based on that, deciding what combination of um bio identical HRT makes sense for her. So I don't I think that answered your question. I mean, it could start depending on the on what the woman is coming in for. Or maybe it's regulating cycles, you know. Um, that could be a woman in her 20s. Okay, gotcha. That's Thanks for sharing. All right. Um, why is menopause and weight gain linked? Like how? Because we hear all the time where you know men men but specifically for this talk women you know they get older weight becomes harder to lose. What what role do hormones play in that? It's usually that drop in estrogen. Um and so we see um Oh really? So the estrogen is the one that's linked to the weight loss weight. Yeah. Um it's usually and it's like really that kind of midsection u men belly as they call it. um is often it's often where that's the most common part of of a woman's body where she's going to notice the weight gain. But overall um yeah, it's super I mean I can't tell you how many I'm sure you've heard it when people call. I hear it every day. It's like I haven't changed anything. I I eat really well. I haven't changed how I eat. I work out however many days a week. I haven't changed anything. And yet I just can't lose the weight. And um you know I look at her age and it's kind of you know I mean there's I I don't want to simplify it. Things like excessive stress, things like not sleeping which may be hormonal um also are going to exac it's going to make it harder to lose weight. Um but it's usually the way that it's described is like you kind of know it's got that hormonal flavor. Okay. Sure. So, for like realistic patient expectations, um how often do women come in with weight and um you know, you fix their estrogen and then all of a sudden things start working like they used to? Yeah. So, and it might it might be estrogen and again building putting in a little bit of testosterone can also help um depending on the woman. But um um I would say that it like overall body composition can definitely improve. We can start to see a little bit more of that kind of lean muscle, a little bit of fat metabolism, a little bit of less weight. Um, if a woman comes in and she needs to lose 25 pounds or more, I'm not going to promise her that that's going to just come off in a couple months with without adding anything else in. Um, I mean, I think it's really about again the body composition kind of like feeling better in your clothes, losing I'm going to say, you know, somewhere in that like 5 to 15 pound range can can maybe be realistic. She still has to do the work. She has to move her body regularly. She has to eat well. That's a whole conversation. Um, but um, yeah, I I think it's that kind of weight. It's not somebody that comes in and has to lose 100 pounds. If your sex hormones are super screwed up, is it like impossible to lose weight without without balancing your hormones? Yeah. Um, if your sex hormones are super messed up, is it impossible to lose weight? Is that the question? I guess let me ask a better question to preface that. Um how like because obviously there's varying degrees right of everything. So with menopause like um like could you give like a distribution of like what percent of women like you know their hormones like really messed up and like they really because I you know I've used to talk to a lot of patients who would come in the door and some of them it's like menopause like you know it's all right some of them are like this changed my whole life like this ruined my life like what's what's that distribution look like? Generally, we're talking about women who are menopausal or postmenopausal. Is that right? Um okay. Um I would say that um the majority I'm going to say 70% of women it well let's see it's just such a it's such a gradient right I mean there's women who um became depressed gained a lot of weight you know can't sleep more than three hours at a time like everything like everything's just off right like really really severe intense hot flashes night sweats like you name it. That's going to be the minority when it's that bad. Um, and then there's the handful who are like, "It just stopped and I didn't notice anything and nothing changed and you know, um, and that's also a very small so small percentage, right?" So, um, the majority are there somewhere in the middle where it's like I can't sleep anymore and I'm tired and I have brain fog. [clears throat] um those are the biggest and then I would say a smaller percentage they have all of that and they're dealing with night sweats and hot flashes. Um so I think that answers your question. I mean, it's it's such a range and it and it's like everyone's affected differently and and and it's multiffactorial. Like there's there's other hormones are a a big piece of the puzzle, but there's other pieces in terms of lifestyle, diet, stress level, all of the above. Other other coexisting conditions. Gotcha. Yeah. So, I know in the past you've talked about the link between your adrenals, your thyroid, and your sex hormones. Can you talk about how because when you go through menopause, your sex hormones change, but that also affects your thyroid, affects your adrenals, which affects other things. Can you talk can you talk about like the cascading effect of menopause? Yeah, I think of it as a triangle. So, I think of it as the thyroid gland, the adrenal glands, and the ovaries when we're talking about a woman. It does apply to men also um with testes, but we're talking about women in this in this podcast. So it's a triangular relationship which means it's not linear. So um and these are all hormones, right? This is all within the endocrine system. I think we or in conventional medicine there's this idea that you know somehow the thyroid is off on an island, the adrenal glands are off by themselves and then you've got the ovaries and somehow they're separate. All of these hormones are in the blood together. Um, and these glands in particular, these organs have kind of a relatively complex relationship or with each other influence each other. So, if there's been chronic stress, if there's been um trauma in this person's life, either early childhood trauma, continue, you know, later in life trauma, years of chronic stress, you name it, super common. um that is going to not only impact cortisol levels um but also thyroid and sex hormones. Um likewise, if a woman has um you know kind of estrogen dominance or some kind of more sex hormone imbalance that's probably going to show up in the thyroid. Like it's just all together. And that's I think kind of where we specialize or where we shine is like kind of having the tools and the skills and the testing to figure that out and kind of get to the root of it. Um it's not like there's going to be it's not like the the the the goal is to say, "Oh, it's actually your adrenals." Like it's probably a little bit of both, but let's figure out where are the imbalances, where do we what needs the support, where do we start? And um that's a little bit of that like stepping back and looking at the whole person and not not just throwing even if it's a natural supplement, not just throwing a natural supplement at somebody, but like really figuring out where this specific woman's um overall hormonal imbalances and and how do we Yeah, sure. support her. Yeah, totally. I mean, that's uh [clears throat] I think that's what patients are looking for is a more holistic approach. So, what um what are your thoughts on like I know there's services out there like where you can get women can actually get hormone replace bio identical hormones online things like one main one I've heard of is called Winona. Um what do you think of that where women are just ordering like hormones online getting it shipped. It's obviously some cookie cutter dose. Um there's no testing involved. What do you think that's a good solution? Um no. uh [laughter] not not if there's the option of something like what we do. Um you know I fully understand because women have are trying they're trying to go through again primary care sometimes gyne you know their gynecologist and if they're just keep they they really kind of feel and they know that um something is off hormonally and they're just not getting the answers that they need. They're not nobody's really stepping up to the plate. I fully appreciate going online and or, you know, and ordering, but whoever, you know, if there's a provider on the other end of that, that person is really just kind of checking off a box. Like, there's no, it's not individualized. They don't know this woman's individual chemistry, metabolism, hormonal makeup. There's probably no testing. Um, I don't know if they're looking at medications and supplements that she's already on. like we spend an hour with somebody um and that's after having the blood work done just going through and you know again it's a customized medicine. It's so individualized and that's what every woman deserves. Um and yeah I just wish more women knew that that was that we're here that and there's places you know places like this. So, no, I don't think I don't think that that a male order thing is ideal. Um, if a woman's lucky, taking whatever that whatever is given to her will make her [snorts] feel good, but um and feel better, but you know, there's there's more than that. Yeah. How often So, how often do these things need ongoing care and adjustment? Like, how often are you like I'm sure you don't get it right the first time every time. I know a lot of this is based off of symptoms and the way they feel, right? Everyone feels different at different levels. It's very personalized. It's why we do what we do. Um, but how often is it like, okay, a year goes by, all right, then we tweak it, and another year goes by, it's tweaked more. Or is it like once you get it, you got it? No, I like seeing after that, after woman starts on, um, bioididentical HRT, we like to do labs 10 weeks later. Um, if she's doing, you know, whether that's blood work or a Dutch panel, um, and then I like to see her, um, basically two weeks after that. So, so I see her and then 12 weeks later I see her again. Um, yes, I'm reviewing lab results and I'm I'm asking how is your sleep? Um, how is your mood? How is your libido? All the above. Um, you know, have things changed physically? All of that. Uh, we, you know, it's a really I think that timing works really well. It gives the medicine long enough to kind of do its job and for us to really get a sense of if we need to tweak it in what way. So, um, unless there's something kind of unusual, she needs um that touch point a little more frequently, it's on kind of an a quarterly or every 3 month uh basis. Okay. Very interesting. Um, how often do you see peptides play a like or as far as peptides or any other tools um play a pretty, you know, big role in uh moving the needle with women's hormonal health? Yeah. So, um, again, I'm not sure if viewers know what peptides are. I'll I'll give my little quick explanation. Um, peptides are basically, um, short proteins. So, it's a a peptide is a sequence of amino acids and depending on the sequence, we can target different parts of the body, different tissues. So um I would say in terms of a woman again in those parmenopausal menopausal years kind of dealing with hormonal uh fluctuations there are some spec we have a lot of peptides safe peptides to choose from. Um if a woman is here's an example dealing with kind of joint pain you know we're probably going to want to make sure the thyroid is in balance. We're going to want to make sure that her estrogen levels are adequate and that that's, you know, make sure that those are once those are balanced. Has the joint pain improved? Um, yes, there's other things like weight and other things like that. But if we then can want to tweak it further, she's like, I'm better, but I'm not as good as I want to be. We have peptides that target connective tissue. They target the joints and they're anti-inflammatory and it's completely safe um to take along with bioididentical HRT. Here's another example. Um a woman has been dealing with um poor sleep and anxiety. We're working on figuring out the right bio identical HRT combination for her. We're working on the progesterone, etc. Same thing. Better could, you know, could be even better. um we are adjusting the doses the doses there's a peptide that um has a neurotransmitter modulating effect right so it basically helps put a put put somebody a woman into that relaxation mode into that what we call parasympathetic mode that um that can help lower anxiety help with sleep again completely safe it's not an SSRI there's no dependency there's no weight gain uh completely safe to do along with really any other medications including hormone replacement. Okay, gotcha. Um what are some of like the symptoms of something like menopause that um because obviously there's the classic ones, right? Like the weight gain, anxiety, lower energy. Are there any others that um are less common or less known? Um well I would say in some ways maybe like the joint pain one you know I think how so how is menopause linked to joint pain I think it's the low estrogen I think it's the low estrogen and you know and maybe a little bit of the low testosterone as well I think that um well you know we know that estrogen kind of has like a lubricating effect and so just like we see dry skin dry hair dry nails like vaginal dryness with a drop in estrogen that's going to affect the joints too. Um and so I think sometimes that is overlooked. That's you know it's that yeah I don't think that's like the most common symptom um that's people would when they're listing out menopausal symptoms. Gotcha. Okay cool. All right. So that is it for the um menopause female sex hormones and biioidentical hormone replacement therapy. Now we're going to transition into the second uh talk which is going to be about anxiety, depression and functional medicine. talking about that mind body connection.