Is HRT Safe for Women Now? The 2002 Study, Bioidentical Hormones, and What Changed

Here we go. Here we go. Stream is live. Yay. Can I hear you? >> Yeah, I'm here. >> Yeah, I can hear you. Great. Yay. Yay. >> I can hear you. >> Yay. We'll give it a few minutes for people to to pile in or a few seconds. How are you? How was your day today? >> Um, it was a good day. It was um Yeah, I ended up having a longer lunch, which was welcome, but >> busy. Busy other than >> I had that yesterday. I had that yesterday. >> You did? Nice. It's nice when you don't even especially when it's not expected. like a little gift. >> Yeah. Yeah, it is really nice. Um, so yeah, we're just giving people a few seconds to to pile in. Um, we're talking about hormones today. I'm very excited. Not something new we've talked about on the podcast before. We've talked about >> just a few times. >> Just a few times. But I think this is going to be exciting because we're going to dive into some of the specifics of hormone replacement. Not necessarily the treatment. And I mean we'll cover that too, but some of the other like background of hormones and like how they came to be and all of that. So >> if you're just joining us, u welcome. Let's we're going to get started. So what if everything you think you know about hormone replacement therapy is based on an outdated version of the conversation. For years, hormones have been surrounded by fear, confusion, and extremes. Some patients are told to avoid them completely while others are sold hormone therapy like it is the answer to aging, energy, libido, weight, and longevity. In this episode of the Ben Matrix Method podcast, we're breaking down the truth about hormone replacement therapy. Uh what changed early uh after the early 2000s, what did not change and what patients need to understand now. We'll talk about the history of hormone replacement therapy, which will be really fun, and how that history still affects women and men today. the difference between hormone replacement and hormone optimization and why a functional medicine approach looks at symptoms, labs, risks, um risk factors, metabolism, sleep, stress, body composition, and long-term health before deciding whether hormones make sense. So, as I said, we're doing hormones today. Welcome to the MedMatrix Method podcast. If you are just joining us, we are um talking all about hormones today, all about bio identical HRT and we're going to talk about everything functional medicine. Today's episode is called the truth about hormone replacement therapy. What changed, what didn't, and what now. And we've been looking forward to talking about this because we see this all the time, right, Dr. Rose? We do this a lot. um patients who are confused by conflicting information, afraid of hormone therapies because of what they've heard in the past or being offered hormone therapy without a full understanding of whether it's actually right for them. So, um today this is going to be a provider discussion. I'm Colin Bernard. I'm one of the lead uh functional medicine clinicians here at MedMatrix and I'm joined by my very esteemed colleague, Dr. Sasha Rose. And together we're going to break down what patients should actually understand about hormone replacement therapy and how the conversation has changed over time. uh why men and women both need individualized hormone care and how functional medicine helps personalize the decision instead of treating hormones like a one-sizefits-all solution. So, [clears throat] just a little bit of a background um how this episode today is going to work is we're going to start with our discussion. Dr. Rose and I are going to talk for a while and as we go for those listening live, if you're on YouTube or Instagram, uh make sure to drop a question in the comment. You can also let us know where you're listening from. If you're in Maine or New Hampshire, New England or around the world, whatever. We'd love to hear from where you're from. Um so drop us a question if you have a question. Uh after the discussion we'll walk through um we might have a little game to play. We're going to talk about some specifics of the history of hormone replacement therapy and then um we are going to answer all your questions live in a live Q&A. So drop your questions if you're on Instagram or YouTube. And just a reminder before we get started for those listening, this episode and all of our episodes of the MedMatrix Method podcast are for educational purposes only. This is not meant to be personal medical advice and it should not replace care from your own medical provider. If you are interested in receiving personalized medical care from one of our providers at MedMatrix, we'd be happy to help you. Um, you can go to our website medmatrixusa.com and book a discovery call and start the process of becoming a patient. So, let's get started. Uh before we jump in, I want to introduce ourselves uh to those that are maybe listening for the first time or don't know us that well. So I will ladies first. Dr. Rose, tell us who you are. Um and then I can I can uh jump in. >> All right. I'm Dr. Sasha Rose. I'm a naturopathic doctor. I'm a licensed acupuncturist. Um been practicing for gez, we're going on 21 years now. Um >> congrats. Yeah. And I too am one of the lead providers here at MedMatrix. Um I have uh worked with women's health and um hormones and hormone replacement for many years. Um it's a passion. Um and yeah, I feel like we've done this podcast a lot and I could do a lot more. Like I just feel like there's so much to talk about. There's so many layers. There's so many It's so important. Um, so yeah, tell let's let's hear a little bit about you. >> Yeah. Yeah. Um, yeah, I'm like I said before, I'm I'm Colin Bernard. I'm one of the lead clinicians at MedMatrix. Uh, I have a pretty unique background. I have a background in chiropractic medicine, um, in natural medicine. I practice medicine at MedMatrix as a PA. I hold multiple board certifications. Uh, I am fellowship trained in functional medicine and anti-aging. And um I haven't been doing this quite as long as you, but I am over the 10-year hump. So I think that's pretty good. Um and when we talked before, I think I think when we added up all of us as clinicians in the practice, it's over like 50 or 60 years between all of us that have been doing this. So it's it's pretty cool. >> Um so let's get started uh and dive into all things hormone replacement and what has changed and what is why this is important. So, for those that are tuning in and were are like, "What the heck are you guys even talking about?" So, um [laughter] um when when patients hear the word hormone replacement therapy, Dr. Rose, what what is like the usual picture that is painted for them and and what sort of um how does that like broad what kind of is the broader horizon of that? Like what does hormone replacement really mean? And then what does it mean for patients on a larger scale? >> Yeah, it's a great question. I think when patients, people in general hear the term hormone replacement therapy, um they sometimes will only think of menopause and traditionally menopause is associated with hot flashes. Um or maybe they some people might think of estrogen. Um and then in terms of men's health, they might hormone replacement might um bring up uh testosterone clinics for men. Um we know uh that the broader conversation really includes um replacing or supporting hormones when symptoms, labs, history, clinical context kind of indicate that there is an imbalance, that there's a deficiency. and that this hormonal piece of the pie is um affecting or maybe part of what's affecting the individual's health. >> Yeah, I think that's I think that's a great introduction and um you know you mentioned it a little bit between men and women and um you know we we talk about certain hormones for men and women because we operate at different hormonal levels, right? So I think it's important to note um for our conversation for our listeners that >> hormone replacement therapy is very individualized for all of our patients but it is really individualized between the the genders, right? So like for women >> the conversation would not always necessarily just be about estrogen. >> Um >> it's estrogen, progesterone and sometimes and oftentimes testosterone. Women do have testosterone. They do need it. Um and it is really I think underappreciated for women in the conventional medical setting for hormone replacement. It's like oh testosterone my husband's on that or like my brother I don't need that. >> Um for men [clears throat] we pretty much do focus on testosterone. We don't really replace the other hormones for men but we have to monitor and understand them. Um so you know we have to understand how es how testosterone affects um estrogen how it affects thyroid function cortisol metabolic health and you know all these other things. So for obviously both men and women those things are important. >> Yeah. >> So that's a that's an important thing to to distinguish between the the men and women aspect that you mentioned. So, um, one thing I think we need to dive into early on in our discussion because it kind of goes on the why, you know, or what hormone replacement is, why we do it, what's changed. Um, there was a very famous study done in 2002 about hormone replacement and um, sort of about what sort of changed with this. So, >> what are what are a couple things what are the top few things that people misunderstand about this hormone therapy study? Cuz I hear about this a lot with patients like oh yeah that study or >> you know even in in our world like our colleagues like oh yeah it's you know so what what are some things you know about how this study is misunderstood? So my answer to this in terms of like three things that people still misunderstand about the 2002 hormone therapy study also known as the women's health initiative. >> Women's health initiative. Yeah. >> Yeah. So I would say um the risk of heart disease on hormone replacement therapy. um the risk of breast cancer or breast cancer recurrence on hormone um replacement therapy. And the um fact the the the under the thought that um really hormone replacement therapy is only indicated for a small percentage of women and that it really should never be prescribed after the age of 65 or um after 10 years after menopause. >> Yeah. They have made some like hard rules, right? >> Absolutely. [clears throat] Yep. >> So, it's like so we can we can dive into all of those. You know, there's there's so much there and it's, you know, there's still >> some there's still misinformation out there. There's still kind of, you know, some controversy around it. But, >> um, basically it that was kind of a blanket rule. It seemed like that was it. like, you know, women were kind of like taken off hormones um overnight and um there really wasn't discussion. And we now know that those um that information was kind of misinterpreted and really inaccurate on a lot of levels. And it's taken 25 years basically almost 25 years for like kind of the truth to come out and to finally start to be implemented clinically. Uh which honestly is a tragedy in my opinion. >> Yeah. because I say this a lot to my female patients and we talk about this on the podcast is I feel not being a female um but being a clinician who does women's health a lot >> is um that uh women's health especially for women of a certain age we'll say you know menopausal years >> it's just underrecognized in the conventional medical setting where women don't feel good they're gaining weight they're tired they're brain fogged and they just get nothing from their doctor. But well, it's normal. You're 55, you're 60, you're supposed to feel crappy. Oh, okay. Well, thanks. You know, so it's just it's not fair. And um the thing that also I think bothers me about the study, you mentioned this too, is this whole notion of you have to be under 65 or it has to be within 10 years. and um from a cardiovascular disease perspective and the really the honest part about that is we can understand the risks and the benefits and we explain that to the patient. But if we're >> taking care of the patient, right, we're monitoring, we're doing cardiac cardiovascular analysis, right? If the patient does have cardiac markers, you know, do we get a cardiologist involved? Do we do a calcium score? Do we do stress testing? you know, it's it it helps to know this information about heart disease potential, but it doesn't necessarily throw the whole thing out the window. It's like we can still do the work the the the work that needs to be done to assess that female from a proactive and preventative health screening perspective versus just, oh, nope, can't do this, right? We do that at Medatrix, right? We do all these cardiac markers, we do blood sugar, we do cholesterol, we do inflammatory markers. So we can understand a woman's risk. So it, you know, that's really I think the work is about is okay, could there be a risk? Well, if there is, monitor, right? Do the due diligence to really make sure you're taking care of the female from all aspects. It's not just, oh, we don't do this just because. So that's I think what we're doing really well. I know I strive to do that is say regardless if we're doing HRT I'm still understanding risks and cardiovascular disease is one of those. I think it's so important. >> Yeah. And I think that one thing that we now know and really makes all the difference is that there's there's not HRT is not one thing. >> Estrogen replacement is not one thing. So the timing, the dose, the route of um administration as you mentioned the the the specifics of the patient and the spec and the risks for that specific patient, their uh health history make all the difference. So um you know oral synthetic estrogen can increase your risk of a blood clot. When you're over 65, statistically you also have a higher risk of of a blood clot of having some kind of cardiovascular event. They don't want that compounded, but transermal topical estradi or estrogen really doesn't increase your risk of a blood clot. And so if we're still going back on that information from 2002, there's no nuance there at all. And I think as you said quite well, you know, when we're really doing our job, which hopefully we do most of the time here at MedMatrix is nuanced medicine. And um >> yeah, >> so I think it's why these conversations are so important. >> Yeah, it's so so important and it's and it's important for us to talk about them because it's important for patients to educate themselves about how things get misinterpreted in healthcare. This happens across all all um departments of healthcare, right? All disciplines and all types of health care. Um things change, >> uh data changes, ideas change. So, I think it's important we have this discussion. Um for those that are just tuning in, if you're tuning in live, uh if you have a question, if you're on YouTube or Instagram, please drop us a question in the comments section. We will get to it at the end of the uh podcast when we do a Q&A. So really, I think this is important to kind of get to segue us into why does this really matter, right? Why do we care? Um, so from your perspective, Dr. Rose, as a as a HRT clinician, why does the history of HRT, why do why does this matter? Like what? Because I know I know we educate our patients about HRT when they have questions about, oh, I've heard it does this. I've heard it caused cancer. my mother got, you know, whatever. So, why does it matter that we still keep talking about this today? >> Well, I think um it's understandable, but a lot of patients are still making decisions um kind of based on this old information, old headlines um again kind of 25 years old. Um and there and there's partial information and then there's you know what happened in 2002 is that um there was a lot of fear and I think fear was um instilled both in the general population and within the medical community about the dangers and the risks of putting a woman on hormone replacement therapy. And that was I mean it was like it was pretty significant and it really it overnight it changed how women were treated. It prevented a generation of women from getting potentially really therapeutic medications. Um, and you can talk about this a little bit more, but it that I think that also included kind of this fear around testosterone therapy um, for you know, definitely for women, but also for men. Do you have do you have thoughts on that? >> Yeah. Um, I still I mean I battle this I think more with my female patients where it's like, oh, HRT, I heard that causes cancer. Well, it did. You know, a while back when they used all synthetic hormones, they could only I think there was like a six month or three month limit that they put women on when they were really symptomatic and then they took them off of it. It's long time ago, right? We don't do that anymore. We don't use synthetic hormones. We use bio identical. So, the hormones are essentially identical to what your body makes. And we're going to talk about the specifics of that shortly. But uh I think I see I see this a lot with women because of the cancer part. But same thing for men because of you know oh well my my testicles are going to shrink up or my penis is going to just I'm going to lose I'm not going to have one anymore [laughter] or I'm going to get prostate cancer or I'm going to get heart disease. And it's like well when we look at the data right hormones are a longevity molecule. So something like testosterone for a man could prevent something like Alzheimer's and dementia because of what the effects on the brain. It could prevent heart disease. It will keep a man's muscles strong and bones strong. >> Um for women, you know, from a longevity perspective, estrogen is the number one reason or a deficiency in estrogen is the number one reason why women get osteoporosis. So if I had my drutheanss when women had osteoporosis or osteopenia screw the you know the osteoporosis medication that can be really really dangerous put women on estrogen right it rebuilds the bone matrix and but that's just not how health care thinks about things. Um certainly these all these things are have their appropriateness you know in terms of effectiveness and and specifics for a patient but um it's all about what is most appropriate for the patient and and this kind of leads me into I think some of the biggest mistakes people make when the hormone conversation becomes really extreme right it it guides the discussion into kind of the the two extremes is like hormones are really dangerous versus everyone should be on them >> and it misses the point of the conversation being individualized. Um what are the symptoms? What do labs show? What are the risks? What are the benefits? What are our goals? Um what is the dose and what is the route? You talked about oral estrogen, right? I don't really prescribe that because it increases your risk of of blood clots. It also increases cholesterol. It's like that's no. What's the benefit of that? >> So when you take into consideration the different routes of administration and appropriate monitoring, that's where I think we do our best. with hormones, they become very safe. They become very manageable. Um, but you really need to have clinicians that understand all of this and we're taught all of this. And most conventional clinicians just don't have the knowledge. And as you said very eloquently earlier, this has sort of been demonized within the medical community. You go you go to medical school and it's like, don't prescribe hormone replacement. It's bad. Blah blah blah. So then they come out of you come out of school like, okay, not going to do that. >> Um, but you're not following the data. You're not following the change. So, um, we talked a little bit about menopausal symptoms and women. You you kind of mentioned this before. Um, we were talking a little bit about the the danger aspect. So, what are some as a as a woman's health clinician? We both are, but can you name a few top um ways that hormones affect a woman's body besides just like the standard hot flashes and sex drive? when women go through menopause. >> Yeah, there's um there's at least five ways that hormones affect the body, you know, beyond um libido, beyond hot flashes, beyond those kind of like >> those few things that I guess again classically those are the only things kind of linked to um menopause to menopause, excuse me. [clears throat] So, we know that hormones affect sleep, they affect mood, they affect muscle. You and I did a whole episode on that. Um, metabolism, bone health. I did a whole episode on osteoporosis and osteopenia. Um, we've basically done podcast episodes on all of these. Um so we have sleep, mood, muscle, metabolism, bone health, brain function, energy, um recovery, cardiovascular risk, blood sugar, overall body composition. So I mean what part of the body do hormones not impact, right? I mean they really I think when hormones shift, when there's deficiencies, when they're optimized, you're going to kind of usually notice changes across the whole body. you know, >> in my experience, >> does that match your experience? >> Yeah. No, totally. And and that's how I educate patients too when we talk about hormone replacement is it's like, yes, we're trying to improve your symptoms because what you're experiencing from weight gain to fatigue to muscle deficiency or strength deficiency to um brain foggess, all of that is linked to hormone deficiency. But there's also a longevity conversation that we have to have >> um about how these hormones could protect your body as you age like we were talking about earlier with muscle mass and bone health and brain health and >> um essentially testosterone affects every cell of a man's body. It's not that's just it's not just the sex and the muscle hormone. It's part of it but it's a lot more than that. So I think this is a great time for us to talk more about some of the symptoms and the root causes as we're sort of already talking about this. So, um, some of the symptoms, you know, you were talking about about women's health and some of the symptoms that you see. So, I I see a lot of the same things that a woman a woman might consider hormone replacement therapy for. You know, the some of the most common things are the obvious, like the hot flashes, the night sweats, the poor sleep, the mood change. But a lot of a lot of times women don't understand that irritability and brain fog or just like mental cognitive mental mental or cognitive dysfunction can be a huge symptom of of hormone deficiency. Um obviously the the sexual specific symptoms like painful sex or vaginal dryness, low libido. Um one of the most common symptoms I see and I'm sure you do too with women is this steady weight gain. Just kind of goes up a little bit every year. They're not changing their diet, they're not changing their lifestyle. Um, and I actually just today I had a new patient and one of her chief concerns was my muscle mass is just like >> shot. I work out all the time and I just have no muscle mass. Um, and then I mentioned earlier some of the bone density concerns. >> Yeah. >> So, um, you know, it's it's so important. And then we see very similar things in men too. Um, and you know, I I I love your input too, but you know, a lot of the sexual things, low libido, erectile dysfunction, uh, the mood is a big one for men where I hear men say, "I just don't feel like myself. You know, I just don't feel quite like in my own body, my own skin." Um, low motivation is a big one, increased belly fat, not being able to build muscle, sleep issues, um, reduced strength, they don't feel as strong. So there's a lot of overlap between men and women as as you pointed out, but there are some specifics that uh are are are >> t common in in each of the the sexes, but >> it's an overall I think and maybe you have a different take on this, but it's like an overall just decline in physical function and mental function. Is that do you have anything you want to add to that? Well, I think a really important point is um for both women and men uh I'll I'll focus a little bit more on the women that I think one misconception is that this is this happens with some of these things happen with menopause and menopause is actually just like a single day. It's 12 months after there's no bleeding, no period. So really we're and and honestly for a lot of women the years after that the post-menopausal years are not as bad. There's not as many symptoms as the 10 to 15 years before that date. >> And that's pmenopause. And so what this means is that for a lot of women there's hormonal fluctuations. there's a drop in testosterone and progesterone and estrogen and fluctuations in estrogen and that can happen as you know really at 35 or even a little bit younger and still oftenimes even within the medical community and certainly just in general uh mainstream thought people aren't really thinking about that at that age right it's basically like these are things that happen in your 50s and these things that you've that we've been talking about like the fatigue and the irritability and the weight gain um the disrupted sleep like all of that can really start so much earlier than I think what the um mainstream thought is. And so in terms of like when when either a patient or a provider is kind of starting to think about the like are hormones playing a role here. I think that part is missed because of somebody's age. Um, and I think that um really we're looking at kind of all of those things. We're looking at the low libido, the body composition, the loss of muscle, all of that. Um, it really can happen for both. And again for well you've you're the one that you know first taught me this about testosterone dropping in men and women as young as even your late 20s. And so that's going to >> you know that's just something to be cognizant of when we're evaluating uh somebody's health. >> Yeah. Yeah. I think the some of the top to kind of >> sum this up for people listening. I think some of the top things that we see with men and women that experience hormone fluctuation or just hormones aren't functioning well is um there's a really strong fatigue issue, really sleep, really poor sleep, uh brain fog, mood changes, libido is a huge issue, body composition change is a huge issue. And then um the sort of around the physical part of your body, your your muscle mass, your physical stamina, your ability to recover. So those things I think cross over between men and women really all the time. Um let's dive into some root cause issues. So one thing I see a lot is and I educate patients on this a lot because I see it all the time is >> blood sugar and hormone replacement. So I see all the time, especially in men, but women too, almost all of my female patients that are fairly new, if they're menopausal, post-menopausal, permenopausal, >> they're almost like I would say 90% of them are all pre-diabetic. I don't know if you see the same thing. >> You know, the A1C is like 5.7, 5.8. It's like not that high, >> but it's all of them. And then I have so many men that are uncontrolled quote unquote diabetics and they have low testosterone. >> And when we start hormone replacement, whether it's testosterone for men or combination of hormones for women, the blood sugar numbers just drop. >> You know, I'll have A1C's drop like over one whole point, which is awesome in like three months. It's amazing. >> Yeah. Yeah. Um, so there's a huge there's a huge metabolic health influence with est with testosterone, estrogen, metabolism, um, how they all kind of go together. And then, you know, that leads into like cardiovascular risk and, um, you know, weight composition and body mass. So if blood sugar and body mass, in my opinion, if if blood sugar and sort of body composition are ignored, hormone therapy may not address like the whole problem. And I think that's a huge thing to to educate people on because this is not something that I see, >> nor was I taught, you know, in conventional healthc care education. Oh, if a person has insulin resistance, it could be their sex hormones, [laughter] right? And patients get mad when we do all this work and we see these huge improvements in their diabetes marker, their diabetes numbers, their blood sugar markers when we optimize their testosterone or we optimize their their hormones for women and they're pissed. I've had m multiple patients mad, not at me, mad at their doctor like, "Why didn't my endocrinologist tell me this? Why hasn't my my diabetes has been uncontrolled for years? I've been on this medication. Like, it was just my testosterone. Like, what the heck? >> Um, do you have other thoughts on that? I I think this is so fascinating because I see this every day. >> Yeah, I know. Just that I see it as well, and I think I mean, I think it's it's >> it's a it's missed big time, and that's an understatement. Um Yeah. And I so I think that it's really important and you know as you've mentioned to to look at like the entire metabolic health picture um in conject and and it's like you know kind of marriage to hormonal health um and I think in the same way you know there isn't always this connection between like stress and sleep and what's your baseline with that and how does that affect how your you know your hormonal levels and Um, it's, you know, if there's chronic stress, if there's chronic disrupted sleep, that's going to affect testosterone, that's going to affect your cortisol levels, your insulin, um, definitely cravings, um, mood, inflammation, recovery, hot flashes, energy, all of it. And so if you're just if those things are um kind of not part of the bigger picture, then you know, you can't just throw kind of like a band-aid. You just can't throw a ba, you know, band-aid hormones on it without again looking at metabolism, looking at those kind of fundamental lifestyle pieces. Um I mean, you can, but I don't think that's the kind of medicine that we like to practice. So >> no, >> because it's not that successful in the long term. >> Yeah. No. And I think this is why I get the question a lot and patients will ask or just they ask of they've done reading. It's like I think this is mainly the reason why two people with similar hormone levels can be completely different. Exactly what you were saying, right? Symptoms depend more on just a number, right? There's there's total testosterone, there's free testosterone, there's receptor markers, sex hormone binding, globbulin, inflammatory, thyroid, uh blood sugar, stress, you talked about stress and sleep, uh gut health plays a role, and nutritional status is a huge one. And also, uh people don't think about it, but all the medication that people accumulate. You know, if you are of the age of menopause or low testosterone for men, you might very well be 40s, 50s and beyond, it's kind of well known that as we age, we accumulate more medication, right? Oh, more stuff to kind of add. So, that's a big that's a big part of it, too. So, um and just someone's overall health can change how you feel. So, >> yeah, >> no two things are the same, and that's why an individualized approach is so important. Um, I think this is a really good place to shift into sort of the conventional approach so that we can kind of understand that and talk about that. Um, just to remind people that are listening live, if you're on YouTube or our Instagram, if you have a question or a comment about the topic that we're discussing and you'd like to have it asked, I'm sure someone else might have a similar question. So, please drop us a comment or a question. We will answer the questions at a live Q&A towards the end of the episode. So, uh, from your perspective, Dr. Rose, and we talked a little bit about this before earlier, um, but I want to dive into this a little bit more where, and I, this is a huge vice for me. Um, I don't know why. I think because I was, you know, I saw this in my parent in my in my mom. I I actually, I have two moms. Um, I was raised by two moms and >> I saw them go through menopause in the, you know, >> sweating. It's 100 degrees outside and I'm sweating. You know, I saw it. But, you know, where does the conventional hormone conversation fall short for women? Like, why does conventional health care just not prioritize women's health, especially in menopause? >> Yeah, it's a big question. Um because conventional medicine really I would say has not um for the majority of my patients at least and people that I know of even outside of my practice, women, um the the conversation between the patient and the conventional provider really does often fall short. At least it falls short um for that for the patient. um and what they're hoping for and what they're looking for. They are often told just to avoid hormones completely. Um wait until uh symptoms are just really unbearable. Um it's just part of normal pmenopause. Part of part of of menopause is just kind of part of the change. It's just kind of what we go through as women. Um a lot of women are offered um an anti-depressant. um they're if part of the concerns include um you know body composition changes, weight gain, they're often told not bad information, just very limited of well and also a little dismissive of well just eat less and exercise more. Um and they're rare and and even with testing there if a woman asks to have her hormone levels tested, she's often denied. Um the this whole deeper look that we've been talking about in terms of metabolism and sleep and stress and the connection between your thyroid and your sex hormones and inflammation, nutrient status, not part of the conventional conversation at all >> to be to be blunt. >> Yeah. Yeah. It's it's it's really sad because um >> I I I empathize I I I don't think that necessarily the conventional health care system does better. Maybe it does. Maybe you can answer this, but I it I think they I think it does better for men. >> Okay. >> Not tell me more. >> I don't think it does great, but I think it does I think because it's quote unquote easier. M it's easier to to to evaluate a man who's maybe 50 60 has low testosterone on labs and just send them to the urologist and the urologist will start testosterone. I think it's a bit easier. It's not good. It's not good. Um so but I think because women's health is much more complex, you know, there's multiple hormones. There's this whole cancer thing we talked about earlier that the the women's health initiative study from 2002. >> It's just like no, we just don't do that, right? You go through menopause, you got to live with it. So, I just think women get the short end of the stick. Conventional hormone, the conventional hormone conversation falls short for men. Absolutely. Many men get, you know, one testosterone lab, which is does not give a full picture. Um, and they're often told it's quote unquote normal, even if it's in the very low end of of the range. Um, you know, total testosterone alone does not explain the whole picture, right? There's other markers. There's free testosterone, sex hormone binding globbulin, which can effectively make testosterone inefficient. Um, estradiol is not talked about. And then you mentioned too the whole conversation about sleep or nutrition, insulin resistance, which we talked about a few minutes ago. Um, and then people's fertility goals might not be talked about because you mentioned that we've talked about on the podcast where men are just becoming younger and younger with low testosterone. That's a whole another conversation for another day. But >> yeah, >> um, yeah, I just think across the board that men and women are just >> ignored or gas lit. It's not everywhere. It's not everything. I want to make it very clear to our listeners that >> myself and Dr. Rose and the other clinicians and the med matrix philosophy is not anti- medicine. We prescribe medicine every day. We're not anti-conventional healthcare. We just think that there is a lack of a a good approach to longevity health care to people in a certain age group to menopause to low testosterone. you just don't think that it's um it's it's well recognized across the health care system. Of course, it is in certain places, just not across the whole system, which it should be. Um, so you mentioned um earlier when you were talking about the the 2002 study on on hormone replacement therapy about the sort of >> the the older HRT conversation and how even within the medical community, >> they're sort of demonized and taught, oh, HRT is bad. So, how did how did in your opinion, how did fear from the older HRT conversations affect the way providers and patients approach hormones? Now, >> I think that fear from this this kind of outdated HRT research um continues to make some people and some providers just avoid the conversation entirely. Um, and because it was instilled, you know, so well, this fear that there's just this like not even going to go there kind of attitude and not and and it it not willing to kind of, you know, look at the newer research, look at kind of what we do know like in in the world of, I'll say menopause medicine or hormone replacement therapy medicine, like kind of the advances that have um that we now have kind of a a somewhat of a refusal to to look at that. And so what ends up happening is that I think some people are suffering unnecessarily um and not getting that kind of support that they really could use in a safe way. And then others are, you know, a lot of people I think are going kind of outside the traditional system. they're obtaining various forms of hormone therapy from online clinics and um unfortunately I think there's oftentimes not enough of an evaluation in those clinics. Um there may be some very initial blood work. It's just very um it's it's it's not again it's not nuanced. It's like there's a few things that are maybe checked off by, you know, somebody that knows a few things about you that kind of helps them with liability, but they really are not looking at the whole picture and they're not um kind of really customizing the the HRT program to the patient. So, I think those are two extremes um that do unfortunately continue to happen. >> Yeah. And a lot of times with the online companies or these, you know, mailaway pharmacy things, it's all AI now. You answer some questions and an AI kind of comes up with something. Obviously, there's a medical person at this company to rubber stamp the prescription, but >> yeah. Yeah. >> You're not really meeting with someone or it's kind of all very generic. And >> um I I think this is this is really where we see hormone therapy uh kind of go wrong. So like some of the top things I see uh that can go wrong when hormone therapy is not prescribed without a full evaluation is that patients can be overtreated, patients can be undertreated and sort of given the wrong route, the wrong dose, they're not monitored properly or as you mentioned they're treated without some sort of root cause. Um you know we we talk about with all patients when it comes to hormone replacement we talk about cancer history, we talk about clotting risk and cardiovascular disease risk. um you know for men we talk about fertility goals and prostate related health uh we talk about thyroid function and metabolic health for everybody. So if you're not addressing these parameters, like you said, it you're just missing the boat. And I think this is also too why we we've talked about this too on the podcast a lot where this whole your labs are normal thing comes in and it's like well it's not always, you know, enough like in a hormone conversation, you know, it's like >> standard ranges of things are very broad, right? We talk about this when we talked about testosterone and men's health. If you have a testosterone of 320, but the cut off is 300 to be low, it's like, well, that's not normal, right? Your doctor might tell you it's normal, but if you feel like it's not normal because you have the symptoms of it being not normal, then it's not normal. Um, so that's why we look at all the different types of the the markers that we look at. That's why we do the work that we do to evaluate patients on this deep level. So, I think this is a good place to segue into as we come up on the uh last uh 10 or 15 minutes of the podcast is really diving into what we do that's different and how we approach this. So, >> as a functional medicine clinician, Dr. Rose, for 21 years, you said 21 >> um [laughter] what um how does how does the functional medicine approach to hormone replacement therapy really differ? And what is it that we do differently? >> Yeah, I mean, I think we've touched on the way that functional medicine um approaches hormone replacement. Um I'll just kind of say it again. You know, looking at the larger system, looking at symptoms, labs, metabolic health, uh health history, thyroid, blood sugar, sleep, stress, inflammation, even gut health. um and and also that individ what what is the individual looking for in terms of preventive um measures and long-term goals and you know there are I think you know kind of five really important markers that can help us um give a more complete hormone picture and the ones that we use and that I find really valuable um include estradiol which is the strongest of the three estrogens progesterone. Um, as you mentioned, we do kind of a complete testosterone panel. So, that includes a total and a free testosterone. We do a test that's called sex hormone binding globulin, which you know largely impacts how much testosterone is actually available, bioavailable. We include um a couple adrenal hormones. So we [clears throat] do cortisol, we do something called DHEA, full thyroid panel, we do fasting glucose, fasting insulin. All of these are going to give a more complete hormone picture. Um, and I realized that that was more than five. Um but >> [laughter] >> um I think the point is that we do test all of these and in addition to some of the other markers like nutrient levels and liver enzymes and a complete blood count like they really do give us that um real sense of um how how hormones are affecting you know somebody's metabolism and the rest of their body and how the metabolism and these other markers are potentially also impacting hormones. And it goes both ways. >> So it really does, I think, really allow us to um kind of see the whole picture um you know, more than more than um just a single number or a single single marker. >> Yeah. And and I think the other and I you said that really really well. Um, but I think if I would add one thing uh to the conversation that we have that I think is really valuable for patients, I actually just experienced this today where a female patient I had, new patient, she was introduced to the idea of hormone replacement therapy by her her gynecologist, but it was just kind of like thrown at her like, "Oh, try this. Okay, I'll see you in six months." Like, whoa, wait a minute. Try what? >> Yeah. >> What is it? What What do you want? And it was it was it was hormone replacement, but there was no sort of education. And I think >> these are the the other good things that we do and and how we stand out from a functional medicine perspective is we can we can talk about the the safety, you know, we can sort of change that whole conversation about well what are the risks and benefits? What are this what is the safety profile around HRT? We we talk about the route of administration. We talk about the dosing, the timing, how we monitor it, what type of hormone it is, you know, what risk factors are involved, what are the benefits, what are the alternatives. Um, we talk about the cardiovascular health aspect like we mentioned earlier. We talk about your cancer history, clotting risk, >> and we we monitor very carefully. So, at the end of the whole conversation I had with this patient, she was like, "Oh my god, I I totally get this. This is what I needed. I want to do it, but if it when it was thrown at me, it's like, well, I don't know. And you know, it was the conversation we had earlier. Well, >> there's this kind of stigma and and I that's all I know is that stigma and my doctor didn't explain it to me. So, I was very hesitant, but you explained it so well and I and I feel very reassured. So that's I think another piece of the puzzle that the conventional health care system is missing is the time it takes to sit with the patient and talk for 10 15 minutes about okay this is what the expectations are this is what the risks are this is what you should expect for potential outcomes these are things we have to monitor does this all make sense um that's really I think what patients need and that's how you build a good relationship with your health care provider when you do have those uh conversations I think it's important. So, um, from a med matrix perspective, Dr. Rose, since that's where we are, right? >> Yeah. >> Um, a med matrix plan, you know, if someone is looking to come to med matrix, see you or me or one of the other clinicians that is very very uh skilled at hormone replacement and is asking about hormone therapy or they maybe are curious about it or have read about it, where does that process begin for a patient? >> Yeah. Uh so when somebody is first coming to MedMatrix, they're interested about hormone therapy. They are not sure how to start, where to begin. Um the process here really does start with what we call a discovery call. And so we there's a patient success coordinator that takes kind of your health information, you know, what is it that kind of prompted you to reach out um and what you're looking for. And at that point, then you kind of can get on board. And if it seems like you're a good fit, if we're a good fit for you, then we do a full comprehensive lab panel. When you meet with the provider, which happens after that, a full health history is done, symptom review, hormone timeline. And, you know, I had a 70-year-old new patient today, and I was asking her when menopause happened for her. Was it surgical? Was it natural? You know, kind of how did she get to where she is today hormonally? um a medication review, supplement review, family history, lifestyle assessment, sleep and stress evaluation, um nutrient gut health review, risk in, you know, risk assessment in terms of, you know, our hormones and what type of hormones might be right for this individual. Um so that's kind of how it starts. starts with that very initial discovery call. And our patient success coordinators are really good at giving you the outline of kind of really making sure that you're clear on what the steps are, what the process is like, so that you don't feel confused, you don't, you know, don't feel overwhelmed, and that um you do feel support even from that very first phone call all the way through your meeting with the provider. and beyond. >> Yeah. Yeah. And the and the beyond really is where we dive into all the things we've been talking about, right? Yeah. >> Um for women, the plan could include estrogen, progesterone, testosterone, um non hormonal support depending on symptoms or um you know where they are in menopause or past medical history. Um for men it could be testosterone therapy. It could be root cause support depending on symptoms. It could be non-testosterone based tes um non-actual testosterone therapy uh for testosterone support. There are other methods of increasing testosterone that actually using the hormone. Um talking about fertil fertility goals, talking about metabolic health, talking about nutrition, diet, um you know where that all comes into play and how that affects things. So that's really where you know the the story continues with us I think. >> Yes. Um, >> so before we run out of time, let's dive into some questions before we give some final thoughts on what we're talking about. So, we've have a number of questions. >> Um, and I'm going to read them aloud and so people that are listening can can hear them. The first question that's on here is, would HRT help women with osteoporosis in a 74 year old woman? So, we're not giving medical advice, but I think I already answered this earlier is that, you know, uh something like estrogen helps a lot with bone bone mineralization and bone the bone matrix no matter how old you are. Um do you have any other thoughts? >> I do. Yeah. Um the answer is, you know, it's again without giving medical advice. Um every woman is different. Every woman has a different is in a different place in terms of osteopenia or osteoporosis. Um but um we do know that if you if a woman starts hormone replacement therapy, you know, say around the age of 74, 75, there's not a whole lot that necessarily is going to change her cardiovascular risk at that age. However, there still can be gains in terms of bone mineral density with the addition of the appropriately dosed and administered um estrogen or estradiol. Um again, it has to be customized. It has to work for the woman. You know, pros and cons, but um it's not uh it's not too late in terms of bone mineral density. >> Yeah, that's a great great point. Um the next question is are your providers trained to monitor cyclic HRT? So for those that are listening that don't know what that means, um cyclic or also known as sequential hormone replacement therapy is typically we're doing this for it's involving women. It basically involves um timing the hormones. So taking estrogen daily and then adding progesterone for the like 12 to 14 days of the month at the end of a woman's cycle. uh what we would call the ludial phase of the cycle. Um it's basically after the woman ovulates until she has a menstrual bleed. Again, this is when progesterone is supposed to be highest. And one of the most common signs of pmenopause is low progesterone and women start to get premenstrual symptoms like moodiness and anger and irritability and headaches and whatever. So yes, we are trained and we do a lot of cyclic HRT monitoring. Um I'll answer that for all of us at the clinic. We all do that. Um and then um the same person asked the same question. What parameters would you focus on for determining whether cyclic HRT is balanced correctly? This is a really case byase uh basis because it depends on what the woman's symptoms are. It depends on you know what the hormone levels look like. It depends on how permenopausal she might be, right? Are there missed periods for multiple months? Is she still having a regular period, but there's just a lot of premenstrual symptoms? Um, so it really it depends. Do you have anything to add to that? >> No, I think that was that was pretty pretty complete. >> Yeah. Um, is high lipoprotein linked to postmenopause? Um, surgical menopause at 36. I did bio identical hormones for 13 years. Now I'm 62. Lipoprotein is 34.9. So again, we're not giving medical advice here, but hormone replacement can be linked to cholesterol change. >> I don't know how else to I don't know what else to say. That's not geared specifically at this. >> Yeah. I'm not sure if the person's asking about um lipoprotein A, LP little A. Yeah. um you know LP little A is >> um 80 to 90% determined by your genetics um and so that percentage is not going to change whether you're pre or postmenopausal but there is a 10 to 20% you know kind of uh window there where it can be impacted. So um I guess the answer is you know yes and no. >> Yeah. Um, Kim from Boston. Hi Kim. Uh, how often do you monitor estrogen, testosterone, progesterone levels in menopausal women on bioididentical HRT? I'm 63, recently diagnosed with osteoporosis and started HRT at 62. Uh, in our clinic, it depends on where you kind of fall in the treatment like place. I get I don't know how to word that but like for me when I start women on hormone replacement I typically give it about three months before we reassess. Um but if we've kind of done a lot of work after six eight like six to nine months and the woman is really stable and she's feeling really good and the hormone levels haven't really changed on blood work then we can monitor levels like couple times a year two to three times a year depending on the case. But if I'm monitoring other things, we might have to follow up sooner. But once hormones are pretty stable, we monitor a couple times a year. Is that >> Yeah, I would agree. I think that initially um because often times with HRT, um >> it because each individual is different and responds to hormones differently, um it takes tweaking, right? And so we really, you know, the the best of the best uh HRT specialists, you know, will kind of nail it like 50% of the time the first time. And I tell my patients that because it's I think just to have that expectation that it's going to take some adjusting. We might bump up the progesterone. We might need to drop the estradi a little bit. Certainly, you know, testosterone wise might go up, might go down. And that's just part of the process. And as we're adjusting the doses, yes, that makes a lot of sense to kind of do the every 3 months testing once, again, as Colin said really well, as you said, really well, um once both the the symptom picture has stabilized, the you know, blood work has kind of stabilized, we're not adjusting the dose anymore, you don't really need to, um monitor quite as frequently. >> Yeah. Um, another question. We already kind of answered this. If I'm already osteoporic, will HRT help? You answered that really well. Um, >> I'm going to make a plug for my podcast that's if you go, it's it was just on osteoporosis and it was a lot on HRT. [laughter] >> So, you just need to look in like the list of >> look Yeah. Go to our podcast. >> Our podcasts. Yep. >> Um, I had a complete hysterctomy about 13 years ago at age 49. No HRT until now because I did my own research and found a menopause specialist. Can you still make good gains even though it's 10 years? I think we've kind of made that point very clearly. Yes, certainly. Absolutely. Um, being only 49, you still have a lot of life to live. So, 100% you could make a lot of gains. And the same person Janet also said, MHRT P estrogen patch, progesterone, testosterone, blood test monitoring shows normal levels, but what would be considered normal for a surgical postmenopausal woman? That is very hard to answer. It's very patient specific because we're not just monitoring the blood levels, we're also monitoring your subjective outcome and how you feel. Uh, anything you want to add to that? >> No, I think we, you know, we're not giving medical advice here. >> Yeah. Okay. >> Um, Janet also asked another question. We'll get to that in a second. Janet, thank you for your questions. Um, Pam, I just finished all my labs as a new patient with you. Very excited to sit down. Um, have an appointment soon. I'm on estradi oral tabs long progesterone. Should I stop until I see you? Blood clots. Uh, no. You should not stop anything. Um, do as you're doing and we will guide you from there. We don't we don't want you to stop anything. Um, and then Janet's other question, my last question. My husband has low testosterone, but according to the lab, it's within normal range. He asked his doctor about testosterone therapy and was told no. What should his tea level for a 64 year old be? So, again, I'm not giving medical advice. We're not here to give medical advice for people. Um, but there is an optimal range of testosterone and um, if it's within the normal range on the low side of normal, that is probably an issue. Um, but I'm not going to give specific levels because I don't want to give any specific advice for people. Um, I just don't think that's appropriate. Um, anything you want to add, Dr. Rose? >> Nope. I think these are really great questions. >> These are really great questions. Yeah. >> Sorry, guys, that we can't be more specific. We're not here to give medical advice. Um but yes, we we our job is to understand optimal versus normal and we did a whole podcast on that too. So if you're interested, go listen to [laughter] that as well. >> Um okay, we are pretty much out of time. Um Dr. Rose, what is just in a few like 30 seconds, what is your biggest takeaway for someone who is confused about hormone replacement therapy? Um has questions about it? What would you say is your answer? Yeah, if there's one takeaway for someone who is feeling confused about HRT, um I think I would say um hormone therapy is not just about menopause. It's not just a men's testosterone conversation. It's really a personalized kind of nuanced medical decision. And what has changed since 2002 is that we do understand this. we understand more of the nuance. Um, what hasn't changed is that hormones need careful evaluation. And so I feel like everybody deserves kind of a functional medicine approach that is looking at symptoms, labs, root causes, risks, long-term health benefits, um, kind of before deciding what might be right for them. >> Yeah, I think that's great. Um, so if you guys are listening to us live, thank you for your questions. Um, we are here one to two times a week talking all things functional medicine. Um, if you are interested in becoming a patient of either myself or Dr. Rose or some of the other clinicians that you see that broadcast live on our podcast, you can go to our website medmatrixusa.com and you can book a free discovery call. As Dr. Rose mentioned that is sort of the gateway into the process of becoming a patient with us. Um caveat, you must be in Maine or New Hampshire, a resident of Maine or New Hampshire only at this time. That's where we are licensed to provide pre to provide care. Um you can also stream us all of our podcast episodes on Spotify or Apple Podcast. So if you missed today or you want to listen again or send it to a friend, all of our podcasts are there. So, like I said, we are here a couple times a week covering all sorts of health topics. We thank everybody for joining us, for your attention. We thank you for your questions. I hope this was helpful and informative. Thank you, Dr. Rose, for your time today and joining me. This was a great conversation. I know we both love talking about this stuff. So, um, you can tune in next week. We'll be back next week for more episodes of the Men Matrix Method. And again, thanks everybody for tuning in. We'll see you next time. Bye-bye. >> Thank you. Have a good night.