Welcome to anti aging unraveled with Dr. Lori Gerber. The body is one of the most complicated systems in the universe. Dr. Gerber and her guests explore integrative medicine and cosmetic dermatology, combining traditional medicine, alternative health practices, new innovations and technology which work together to help you look and feel natural and age gracefully. Now, here’s your host, Dr. Lori Gerber.
Good evening, everybody. It is another rainy evening in the East Coast. And welcome to anti aging unraveled. And I’m gonna give you a little story today. And I hope to one do it justice and to make it make sense to everybody. And those of you tuning in. I really encourage questions tonight. So though there’s a lot of them. And it’s a topic that is pretty relevant to everybody. I’m going to talk about hormones and the hormones what I call the hormones story. And really, I’m going to break down what changes in the body, what happens, what are the the pitfalls that start to happen, and I’m going to give you a couple of sample patients and break that down for you. So if you want to send me a Facebook question, you can go to Dr. Lori Gerber. Or you can go onto Instagram and go to Dr. Lori Gerber as well. Or just send us an email to info email@example.com. And I can check that on there as well. So I’ll be kind of flipping back and forth and see if I hold the questions the answers to the end. And I’ll try to pop the answers into what we’re talking about. So without kind of boring you guys, I want to try to make this a little bit interesting. So I’m going to give a couple of cases of patients and we’ll touch base on why these patients are different as we move along. So I think if any of them trigger in your brain, oh
my gosh, that’s me how many times that happened, where I’m listening to something like wow, maybe I need that or that seems like it suits me or that all those describe me, then again, you can do an intake on my website, there is a link for under wellness, for a wellness intake or wellness questionnaire, you can fill that out. And then we can start kind of doing your workup. So if any of this rings true for you. And by the same token, I take emails all the time directing people in the right direction. And if they don’t know if this is where they should end up, then we can help you, you know, maybe end up with us or maybe send you somewhere different. So the first thing I want to talk about is the young mother, small kids and her mid to late 30s. Really, you know, we think oh, and there shouldn’t be anything wrong with you. And you just had kids, you’re running your life day to day activities. And she complains of anxiety, fatigue, weight loss issues. And honestly, after talking to her a bit more, we end up realizing that she has a decreased libido and decreased orgasm and and that is what I would say my my peri peri ladies, my ladies that are maybe super early, they don’t really are they’re not in menopause. They might have some mild hormone changes, which we’re going to talk about. And, you know, I think that that is really important to understand that early on in life, you can have hormone imbalances that can create these issues. And what we’re going to talk about is the what I call the estrogen and progesterone seesaw. And that seesaw is essentially a balancing act, right. So all your whole life, we’re just trying to balance these two hormones and testosterone as well. And the highest percentage of progesterone receptors are actually in the brain. So when we start talking about early, early changes, progesterone and testosterone are to the hormones that go down the earliest. Okay, so let’s talk a little bit about what happens when, you know, progesterone goes down and this early, or a young mother, she just had a baby, her progesterone was really high, and then it starts to decline over time. And as that declines are really even right after pregnancy, maybe contributing to some postpartum depression. The brain receptors aren’t saturated with progesterone anymore. And progesterone is a kind of feel good well being hormone, it makes you feel better, right? It’s that calming hormone. Without that hormone and with decreasing levels of that hormone. You may not feel great. It can also create some, you know, brain issues and anxiety is a big complaint. Everyone attributes it to new family, new babies, all these things, but in reality, I’m decreasing progesterone slightly, especially after pregnancy and decreasing testosterone, which I think we’ll talk about a little bit is the first hormone to go down. You know, babies aren’t the sole reason of decreased libido just because they’re not sleeping, or we’re not getting our privacy, there’s really a physiologic change in your mid late 30s, maybe even some early 30s with testosterone going down. So we’ll get back to that in a few minutes. And so let’s talk a little bit about estrogen and the progesterone balance, and then we’ll kind of move on to as the hormones decline with the next patient would present with So, um, progesterone, like I said, is responsible for staying asleep, brain fog, if you don’t have enough anxiety, mood swings,
even, you know, balancing out estrogen and estrogen can cause lots of issues with anxiety. I call it emotional, you know, we feel kind of like you can’t keep your emotions in check. And it can cause belly fat trouble losing weight with extra estrogen. So again, it’s that seesaw effect, right, we want to say what’s high and what’s low. When that progesterone starts to decline, it gives us this, this vision or this feeling of extra estrogen. And we call that estrogen dominance. And estrogen dominance over long periods of time, can create what we call this belly fat or even a higher cancer risk factor. So what does estrogen do? Well, it actually makes your lining of your uterus thicker, so we can get heavier bleeding, we can get some uterine enlargement. And it actually is responsible for stimulating the sympathetic nervous system, which can help with keeping you alert. But in general, when it doesn’t have enough progesterone can actually cause anxiety as well. So you know, too much estrogen and not enough progesterone, both can cause anxiety. So I like to think of them on the seesaw, because they’re really not isolated in in one way or another. Alright, so why is progesterone so important to the brain, while there’s GABA receptors on the brain that are what we call parasympathetic response stimulators, and they just chill you out. I mean, it really is the calming agent for the brain, and natural progesterone. And we’re going to talk about some differences between synthetic and natural, but natural progesterone will actually stimulate that gamma receptor, and counteract some of your estrogen, which we said is sympathetic, which kind of revs you up with this parasympathetic calming response. So if you have these two in in unison, or in synergy, then you should feel pretty even if you can’t fall asleep, you can’t stay asleep, you have the brain fog, the anxiety, the mood swings, maybe even some OCD tendencies, that kind of thing, then we’re talking about some imbalances. And I think people tend to think about estrogen as being the primary culprit of these changes, and really, most of it early on is testosterone, which all kind of bring up at the end, or progesterone. So I call progesterone, the brain hormone, it really is the kind of calming agent for the brain. So let’s talk about the next female who is maybe a little bit more in a middle aged, their kids are in high school or college, can’t lose weight, exhausted, no libido, wants it back and wants her husband to come in as well, because now we’re talking about both of them. And the biggest, what’s the biggest difference is 10 to 15 years ago, um, she was fine with those symptoms, but now she can’t sleep at all. And her brain is shot, she has, you know, brain fog, like crazy. So again, that brain fog is that progesterone continuing to decline. So not only do you have some mood disturbance, maybe that anxiety that we talked about, but now the the brain is what I call twitchy, and maybe a little cloudy, and all those receptors are not saturated with progesterone anymore. So you have all this extra estrogen because estrogen doesn’t fall until you really start, you know, losing periods or getting later periods, which is a little bit later. And that progesterone continues to go down on that downward slope. And progesterone is again the I call it like the be all and end all hormone but it
really, we’re going to talk about cancer risks and all those things. It really does not have any cancer risk. Very, we have a lot of talk out there about progestin, which is synthetic progesterone, and birth control or medroxyprogesterone. Again, we’ll kind of get back to that because I just got a question on that as well.
We’ll talk a little bit about cancer risk, but progesterone and we’re gonna talk bioidentical meaning the same as your body’s molecule does not create an extra cancer risk in that regard. So bioidentical means that it’s made from your body, or sorry, it’s made from your made to look like your body’s molecule so it’s not extracted in a laboratory. So it literally we Make it to be identical to your body’s molecule as opposed to a synthetic, which is manufactured and has n groups and all kinds of things that are different than our bodies molecule. So for all you Penn State fans out there, I know we have a lot of them, it was actually discovered in the 1930s. So this has been around quite a long time by Penn State Professor Russell marker, who actually transformed a chemical from wild yams into natural progesterone. And, you know, the interesting thing about that is doctors have been using bioidentical compounds for a very, very long time. And finally, we’re getting the data and the, I guess, the backing to be able to move this forward into into kind of more mainstream medicine. I think it’s been missed for a lot of years. The bioidentical progesterone we use is made from yam. It used to be made from soybeans, but it’s made from yam. And that Yeah, bioidentical progesterone is usually taken as a capsule. It can be done as a cream, we’ll talk about the benefits and stuff risks of that. But unlike natural progesterone, when we make it synthetically, it’s not identical to our bodies molecule. So what’s the downsides? Well, synthetic progestin was made for contraception, right, it was made to stop your ovaries from ovulating because the half life, which is the duration of how long something lasts in your body of natural progesterone is very short. So they can’t use that birth control. So they needed a very potent progestin that could actually stop the ovaries from oscillating. And birth control pills have synthetic progestin, and synthetic estrogen. And these progestins are very, very strong. And that little bit of chemical structure actually makes them one, be able to be by pharmaceutical companies so that it’s actually profitable, we can’t make things that are bio identical or natural and make money off of it from a pharma company. That’s a whole separate lecture a story. But the synthetic compound of progestin itself, if you think about what it does, it actually cannot stimulate the brain receptor the same way that progesterone does, it doesn’t actually fit. So it has no brain calming effect, and it actually doesn’t bounce out your cancer risk. From a same perspective as progesterone does. By the same token, progesterone actually will decrease swelling, it’ll actually decrease water retention. Well, the progestin unfortunately does not do that. So what happens is, you’re going to get all these other side effect profiles, including some water retention with a lot of the synthetic, so we’ll kind of get
back into that and bring it back in. But a lot of the negative results of progestin, or birth control are because it hits different different receptors or doesn’t hit them at all. It creates swelling, where progesterone will reduce swelling. And last but not least, it actually will shut off your natural progesterone production. So that kind of brings me to my next patient. You know, when you give someone a synthetic hormone, like a birth control pill, it’s going to give you a little bit of more estrogen and actually will, it’s very simple, similar to your body’s estrogen, so it won’t shut off your estrogen, but it will regulate it. But it does really shut down your progesterone with and replaces it with progestin. And again, that brain receptor thing, and a lot of the cancer protection just isn’t there when we replace it. So it actually increases your cancer risk to go on this synthetics, even birth control and that data will come out. I’m thinking pretty shortly. There’s a lot of studies going on on that right now. But that, to me is one of the biggest things to take out of this whole podcast. So let’s kind of bring that into this next patient. So I have a female that hasn’t had a period in nine months, her brain fog is horrific. She can’t sleep hasn’t slept enough in probably a year or two because her progesterone has been going down for so long. And she gets a little bit of hot flashes and night sweats here and there. Sorry, this one, let’s actually she gets a lot of hot flashes and night sweats and she can’t control them. Her ob gyn put them on birth, her put her on birth control. And it helped her hot flashes. But her mood swings are even worse and she’s gaining weight. So this is a really common one. And actually it’s very common with a younger patient base to that go on birth control. So let’s let’s address a little bit of that. So a lot of it is the same as the first patient and second patient. But now she’s getting hot flashes as well. Hot flashes are again, the big difference between estrogen and progesterone. So the bigger the difference, the more you get hot flashing if you’re actually estrogen is still high, you’re still going to get hot flashes. If I can bring your progesterone up to match a little bit better, then you’re going to they’re going to go away. If I can bring your estrogen down, they’re going to get better. So when you go on birth control, it’s going to give her a more steady dose of estrogen. And it’s going to shut off her progesterone and replace it with a synthetic progestin. Okay, so we’ve helped her hot flashes a little bit. But now we’ve any little bit of progesterone that her body was already making, we’ve taken that away. And we’ve replaced that with this synthetic hormone that is not hitting those GABA brain receptors the same way. So it doesn’t have the calming effect. It doesn’t have the mood evening effect, and it shuts off any little bit of that that she had left. So maybe 10 years ago, she was able to tolerate birth control, no problem. I hear this all the time. And now when she’s in her 40s, and you know, she’s maybe almost menopausal. She went back on birth control, and she can’t tolerate it. Or after you have babies, you go back on birth control and you can’t tolerate it. Your moods are all over the place. You can’t sleep and you’re gaining weight. So we address the moods, we address the brain. Why is she gaining weight? Well,
I just got a question on this as well, you’re gaining weight because of two reasons. One, we talked about progesterone being that diuretic it’s a it’s an anti water hormone, it’s going to actually help to reduce the water retention, and extra estrogen and last progesterone, progestin does not do the same thing, you’re going to have a lot of water retention, and I call the squishy, mushy effect. To it actually decrease or increase is what we call binding globulin. And that actually will hold on to testosterone for dear life. So it makes it not usable. testosterone is great for helping with weight loss. So we’ve cut off your progesterone and we’ve decreased your testosterone. Oh, and by the way, she said she had no libido, who knows it was probably there before she went on the pill. And now it’s even worse. So doctors are kind of famous for saying that birth control pills don’t affect libido. And in theory, I understand where they’re coming from, it’s only estrogen and progesterone, which shouldn’t, although it does estrogen and progesterone do slightly affected and lubrication. But testosterone is changed when you get binding globulin, which is actually increased when you go on a pill birth control pill. So by like a secondary byproduct, you decrease the free testosterone that’s available. And that is why you get a lower libido when you go on birth control. Some people are much more susceptible at different ages in their life than others because their hormones are already declining, or lower genetically. Okay. So, in this time of your life, what is extra estrogen doing? Well, it’s probably leading to an irregular or heavier period. It’s, you’re nervous, your progesterone levels are low. So you’re, you know, you’re not having good brain function. So it’s just getting worse. And at that time in your life, when your progesterone is dropping and your estrogen is high, you’re actually you’re starting your highest cancer risk, okay. Why? Because it’s basically this unopposed estrogen. When estrogen goes on a post, it becomes what we call proliferative and it just makes cells divide and divide and divide. Whereas progesterone stops the division. It’s actually the anti proliferative hormone. So women that actually have a lot of extra estrogen over periods of time, for a lot of reasons. Let’s just say they went into menopause early, or they started their period early, okay. And they had longer life’s lifetime of extra estrogen, or maybe their progesterone was very low for their whole life. Those are all higher risk for estrogen sensitive cancers. So breast, ovarian, uterine colon. Okay. So, you know, if you put that into perspective, and then you put the birth control pill out there, the longer you’re on the pill and suppress your progesterone, if you already have a high estrogen level, then it definitely is increasing your risk long term, because we’re shutting off your progesterone. It’s increasing your risk of estrogen sensitive cancers long term. Okay. And so you’re taking away your balance to that seesaw. And I think that seesaw is so important to understand. And so let’s kind of go to this last female and then we’ll summarize this story a little bit. So the last female hasn’t had a period in three years. Okay. So at a year you’re done menopause. Well, technically speaking, is you need 12 months of no period. still has some mild hot flashes, night sweats, but not that
bad. She wouldn’t have come in for those ordinarily, she cannot lose weight. She has a middle pooch on her belly that she never had before. And now what really brought her in, is she sees her skin aging, her face aging, and she’s dry everywhere, okay and visually included. So this is kind of what I like to say is your menopausal or postmenopausal female who has really lost her testosterone early on normal, but earlier on, then lost her progesterone. And now after about two years of going through these menopausal changes, she’s finally lost her estrogen. And when estrogen finally declines, it tends to get a little easier to lose weight, actually. So that pooch should start to get easier to go to get rid of. But that pooch came on because it is
your metabolism slows down, when you have all this extra estrogen and you actually tend to store fat a little bit more. So progesterone kind of has a pro metabolism effect. Without it you don’t have as you don’t have that effect. So as that estrogen finally disappears, you’re going to get a lot better results with weight loss. Um, that being said, When estrogen is gone, you see the signs of aging. So you have skin aging, texture of the skin, osteopenia, which is bone loss, you have osteoporosis, which is when it actually starts to you know, break down more. And you have a lot of the cardiovascular effects. So we know that estrogen is very anti inflammatory at low doses. And it’s actually estrogen and testosterone are great for maintaining bone density. So you see some cardiovascular changes from inflammatory and lipid panels. You can actually see some disorders like Alzheimer’s, dementia, other kind of inflammatory disorders, and you will start to see other autoimmune and inflammatory conditions as well. So you know, this, this lady that comes to me and her estrogen is now down, we’re obviously we’re looking at some more longer term fixes so that we can keep her her health maintenance goals intact. And progesterone is gone too, right. So she has basically a higher risk of breast cancer as long as her estrogen was high and now it’s down, but ovarian cysts, endometriosis. endometrial hyperplasia is when you have low progesterone for long periods of time, and the estrogen is still high. And then obviously increased miscarriage and delivery. So this female, the second female might say to me, man, I needed in fertility drugs to get pregnant. And I tell her Oh, well, it makes sense that, you know, now you’re having trouble sleeping, or even after your babies, you’re having trouble sleeping, and you have anxiety, because you had no progesterone to start with. And now it’s declining, and you still have a lot of estrogen. But your progesterone is not there to give you that protection, that brain protection. So, you know, estrogen is great. When it’s balanced. I think that’s the key. And to understand, too, that not all estrogens are created equal. And I think this is a story that is a little under discussed, especially, you know, with with risk, HRT and replacement therapy. It was we did HRT wrong for years, and we created cancer and that and that is it’s there’s no doubt to that. But no one has ever really talking about what we used and how we used it. And
there’s there’s many types of estrogen. And when we replace with bioidentical estrogen, we replace it with something called a biest – means two types of estrogen, estradiol and estriol and they’re in what we call an 80 to 20 mix. So let’s break this down. Estrone, it ends an O-N-E. I always say it’s one because it’s -one- is the strongest estrogen. It actually is the strongest in menopause becomes very dominant, it’s 10 times more potent than regular estradiol, so it can drive a lot of those hot flashes during menopause. But as estradiol declines, and it’s just a stroke, we’re gonna talk about that, then it’s really not as bad an estrogen is actually made in the fat. So it’s kind of it’s kind of a catch 22. The more fat you have, the more estrogen you’re going to make. It’s not a great cascade. estradiol or “die” is two, is a mid potency, estrogen. And it’s really strong mid in middle life and early on life and when you go through menopause, it actually declines. But it is responsible for that vaginal lubrication and some libido, oscillation and all that cardiac protection that I was talking about earlier. So when we repair this, we don’t replace with estrone anymore. It decades ago we did we use a lot of estrogen, very dominant, very potent estrogen, and we created proliferation and never gave progesterone as a balancing act Okay, even even as a synthetic hormone so I like to put that out there because we you know, estrogen itself may have done it because it was synthetic, but it was also not balanced out with any progesterone. Okay. estriol-“triol”, which is triad, which is three is a very weak estrogen it has the ability to actually convert into E2, so it’s a great
so it’s really good to use because it’s very weak, it can convert into some of that E too on its own in the body and it helps with dryness, so it’s great for vaginal dryness, eyes bladder, which actually helps with UTI as well and urinary tract infections and bladder and uterine infections, because it actually helps to thicken the lining. So I call it the humidifier. So when you think about these three hormones, we give 80% estriol the weak one, we hope some of that converts into estradiol and we give 20% estradiol, so we’re really not giving any estrone anymore. And we’re giving these in bioidentical formulations that are not synthetic at all. So I think that’s a really important point. Um, when we talk about replacement, and I, I did get that question earlier about cancer risk and the data does not suggest that at 20% estradiol or even estradiol pellets with progesterone, they do not increase or that we’ve not seen an increase in cancer risk. So I think that’s really important to understand. So let’s talk really quickly about Depo provera, because I think I missed this point, and Depo provera is a progestin birth control that’s been popular over the years. And it’s gotten a little bit of a bad rap because it actually gives progesterone a bad rap because it’s only progesterone as an injectable. And it’s been linked to blood clots, fluid retention, acne, weight gain, depression, you name it. But we’re giving a synthetic high dose progestin shutting off natural progesterone, and basically giving the body this what we would call like estrogen
dominant, and I like to call it a pro clot state, right we’re making you’re actually making your body very estrogenic, and much more prone to clotting. So to me, most of your reaction is by shutting down you’re progestin and actually having this just extra estrogen low that’s already there. Which is why the majority we call it medroxyprogesterone acetate, or Depo provera has been linked to all these issues. Again, it’s not the same as bioidentical progesterone, okay, which is much weaker, but cannot be used for birth control. So, alright, so I spent the for about the first half hour talking about estrogen, progesterone, and females, literally ranging from 30 to probably 60. So the question that I get a lot is, is this for life? Are we on this for life? And I would say the health benefits of bioidentical progesterone are huge. And I would say you’re on something probably for life. Although when it does decline as you get older, so your needs get lower, you have a much smaller metabolic requirement, right. So while the answer is yes, I think the answer is also for how long you want to maintain your quality of lifestyle is how long you stay on it. And we change that as you age. So that question just came in, I wanted to make sure I got that one answered because it fit in there. Alright, so let’s talk about men for a minute. And then we’ll go back Actually, let’s talk about testosterone. And testosterone. I always say testosterone is funny. It’s the it’s like a bad word in our in our world and and nobody ever talked about it. And men and women both need testosterone, guys, it’s not an isolated thing that men need testosterone, and why it has been such a stigma. And no one has checked testosterone levels in females. For all these years, I do not know. But I can tell you that women don’t like to talk about testosterone, but men love it. And it’s just like talking about sex or talking about libido or orgasm. It’s the same to me. It’s the same. You know, what
dichotomy or it’s the same misconception men think they can talk about it, women think they can’t. And, you know, we all need it. It’s the Mojo hormone. It’s the hormone that makes you kind of get up and go, it’s what you it’s gives you that ability to work out it helps you put on muscle mass. It’s Really important. So men make about eight to 10 milligrams of testosterone a day. Women make about one to two milligrams of testosterone a day. So let’s just say one in 10. So women have about 1/10 the amount of testosterone that men, but it does not mean that it’s not significant. So when we talk about testosterone, we can go back to that very first patient that was complaining. And she was a young mother with small kids. And a lot of the time, their progesterone might just be starting to decline. But the biggest problem is usually low testosterone, that testosterone goes down pretty quickly in females, and it’s much goes down much more quickly in females than it does in men. And there’s there’s lots a little bit of theory behind that. But the biggest reason why is that testosterone is produced one quarter and the
adrenal glands, one quarter in the ovaries and one quarter in what we call peripheral tissues, such as fat, and some women just don’t metabolize testosterone very well via their adrenal pathway. So they get low levels that are lower earlier in life. So I tend to find these to be women that are what we were talking about last week, which is adrenal insufficiency. Cortisol is being low, high stress athletes. I see this a lot that athletes have burned out their adrenal, their adrenal contribution. So now you’re stuck with your basically your peripheral and your and your testicular and ovarian replacement. So when that happens, the testosterone goes down young and it’s dismissed, right? Most people say, Oh, you’re tired because you have babies? Or Oh, it’s family life. Or, you know, this is normal aging process. Well, yes, it is. But I don’t see a reason why we shouldn’t treat it. And when we talk about bioidentical testosterone, it is the same molecules, your body, it’s made from yams and it is replaced really easily. So with what does it do for a woman to not have testosterone, like in that first patient, low libido, maybe a little bit difficulty with orgasm. I joke that it’s not just because you have children, um, muscle weakness, I have a lot of athletes that come to me that say, my I’m lifting and all of a sudden I can’t make gains, or my muscle fatigue and soreness is extending out way longer than it should like three to four days. A lot of that is testosterone lows, right? Because you’re not able to get the water drawn into the muscle and have the testosterone to actually build muscle mass. That is common in my athletes that have burned it out. Like I talked about my endurance athletes, or maybe my adrenal fatigue, my athletes that are so burnt out that they really don’t have anything left because guess where you make your testosterone from guys, it’s cholesterol and cortisol. Cholesterol makes cortisol and then cortisol makes her sex hormones. So if you are not right in that whole axis, then it’s really tough to make your hormones regularly. So sometimes you have to go back to basics and start fixing that access fixing the cortisol levels and the adrenal levels and sleep and sugar response and all those things. So um, muscle weakness, let’s talk about lubrication. arousal, we talked about orgasm, energy levels, and brain clarity are big ones. So difficulty losing weight because you can’t put on muscle mass, inability to put on sorry, inability to put on muscle mass difficulty losing weight and night sweats. That’s what I missed. night sweats is a huge one. Men tend to complain about it more than women. But when you have night sweats, it’s almost always especially if it’s consistent. It’s almost always low tea or low testosterone. mental clarity to me regester and and testosterone compete on this level, because testosterone is a great I, like I said the Mojo that kind of I’m going to get up and get things done hormone. So it tends to help with clarity a lot. I find that testosterone in myself helps mental mental clarity, a ton. And I’m not on progesterone. So it does, it does wonders for me. So I encourage you to think about these things when you’re kind of aging or even when you’re just going about your day. So
let’s talk about men for a second. Let’s talk about a man that comes in complaining of fatigue, joint pains, and exercise intolerance, doesn’t complain about erectile dysfunction doesn’t complain about low libido just says that he doesn’t feel right. He feels like he’s getting old. Okay. This is probably where we should catch most men. Unfortunately, we don’t catch them until they come in complaining of fatigue, joint pains, exercise intolerance. And they don’t want to do the things they used to do that they used to like to do they have a low libido, maybe some erectile dysfunction. And oh yeah, my doctor put me out of medicine for high cholesterol about three months ago. And I just feel terrible and needed to come, my wife finally convinced me to come see it, maybe it’s the lady from one of our previous examples, right. So I feel like men are hesitant to talk about it when it becomes a libido issue. The libido issue is very late in low tea, doesn’t really happen till testosterones, below about 300. So testosterone for men should be 800 to 1100, approximately, women, since there’s no normals, it’s about let’s see, 60 to 80, or 80 to 200, depending on how we’re treating you. So if a man is complaining, and his levels are 700, or even 600, generally speaking, it’s joint pains, can’t get out of bed, they’re tired and exercise and tolerance, and they start having metabolic changes, meaning maybe their insulin isn’t working really well, maybe their thyroid isn’t working as good as it used to maybe they’re putting on weight. That or sometimes even night sweats. But the key is when you start to decline with testosterone, specifically in men, you start having metabolic changes in your insulin, your thyroid, we call, you know, metabolic syndrome, which is, you know, trunk obesity, or obesity in the belly. And they usually will complain of some joint pains and inflammation. So that can be fixed pretty easily. At that point, usually, we can do a trophy or a loss injure some guys like the pellets early on, but they
are all ways to get that level back up into about 800 to 1100. So they don’t feel terrible. When they come in at 400 or 300. It’s a pretty late sign, and that tells me their body’s not making much anymore, they can’t usually the trophy is not sufficient to get them up to where they need to be every once in a while, I’ll get someone that is okay with sitting around 600. And that’s about how high we can get with the trophy. But we will get their libido better, we will get all of their stuff better with a little bit of testosterone replacement, we just got to get them to talk about it. So I think that’s that’s the key is men don’t want to talk about it. Then late in the late stages, women are willing to talk about it after we we tell them it’s important. But men are usually only willing to talk about it early on. So that’s generally why why we bring their men in after they’re already in menopause. And their men are finally having issues with libido. They don’t think about it earlier on with the fatigue and joint pains. joint pains are a big one, do not underestimate the power of testosterone as an anti inflammatory. It’s a steroid guys and steroid hormones in general, are great and inflammatory. So not to say you’re taking testosterone to kind of like bulk up and get beefy and maybe take all the inflammation out of your body. But if you’re getting multiple joint complaints, multiple injuries, you know, this knee hurts and that knee hurts or both knees and both hips, a lot of the time it’s hormonal, and that can go for men
or women. So, you know, to me finding it in the earlier stages is more important than finding it in the later stages. Because we can, we can alleviate a lot of the inflammatory damage that might be caused and the metabolic damage that might be caused by prolonged low testosterone. So let’s talk about his cholesterol medicine briefly. So I actually find this to be I was a family practitioner initially, right? So when I first came out, you know, you had a cholesterol that was over the 200 you’re you’re on cholesterol medicine, and it didn’t matter. Kind of how old you were, what your status, you know, wasn’t live, except if you were a female of childbearing age. So
what I look at it now from a very different perspective, and I look at the what I call the spiderweb of hormones. Cholesterol is the precursor to all of your hormones. So when we decrease cholesterol in a guy who may be at a testosterone of let’s just say he was at 600 or 500. And on all the lab tests, if you’re not, if I’m not analyzing it, it’s gonna say that’s normal, by the way, okay? Their threshold is actually 400. But let’s just say he was normal, quote, unquote, and then you put them on cholesterol medicine. Well, now we’ve decreased his cholesterol. Let’s just say we’ve decreased it by 40 points. Okay. What happens when we decrease the cholesterol in the sex hormone pathway we’ve now Taken away the the bowl of cholesterol that he’s supposed to make his sex hormones from. And if he’s let’s just say he’s type A, and he is an executive, and he is a CEO, and he’s going, going going, or maybe he’s a shift worker, well, now you have no cholesterol and no cortisol, and really no way to make your hormones. So I actually pick guys don’t think about this, because it takes a while for it to happen, and they don’t attribute it to cholesterol medications. But and this is, I mean, people are gonna controversy me all over the place, they’re gonna not love this comment. But if you go on a cholesterol medicine, and we lower the amount of cholesterol in your body, the downstream effect is hormone changes. Even if we’re not talking about sex hormones, if we’re talking about, I’m not talking about sex hormones, if we’re talking about cortisol levels, it can definitely change those as well. So I think that we need to address the way we handle cholesterol and cortisol levels and make sure that they’re, I’m not saying they don’t necessarily have to be on cholesterol medicine. But if we get critically low testosterone levels, and the guy only has a cholesterol that slightly above 200, putting him on testosterone and getting the weight loss, and the eating habits better are far gonna outweigh anything that that cholesterol medicine is going to do for him long term. So, you know, and actually testosterone does lower LDL, which is the bad cholesterol, it will actually lower a little bit of the good cholesterol as well, the HDL. But again, when we talk about risk to benefit ratio, if you can get that belly fat gone, if you can have the energy to work out, if the inflammation is taken down, then the benefit is huge. And we know that testosterone helps with decreasing inflammation, but we also know that it decreases cardiac risk
factors. So again, we’re talking about kind of taking down the greater inflammatory effect. And I just got a question here. I was trying to read someone to bring I’m going to pop it in here. So it’s does testosterone replacement cause testicular cancer or cancer in general? So let’s talk about testosterone in cancer for a second. We’ve talked about estrogen and progesterone. Let’s talk about testosterone. We have about, I don’t know, 12 minutes or so. So let’s let’s bring that up. So testosterone studies are all done on synthetic testosterone, okay, injectable, high dose synthetic testosterone. So you’re giving like 200 milligrams, 100 milligrams, all at once, and you’re letting it sit in the muscle. So you’re getting conversion. And we talked about those accessory tissues, they love to convert, so they take testosterone, and actually they can make it into estrogen. Okay, especially fat. So the more fat you have, the more testosterone you convert to estrogen. Now, you give a high dose of testosterone that your body has no to do with that will convert back to estrogen as well. So again, we’re talking about this large bolus dose, it’s synthetic, and it has the chance of conversion back to estrogen. So that is one way that synthetic testosterone injections can create what we would call hormonal cancers, okay, too. When you give testosterone of any kind, it will actually increase what’s called DHT, which is a precursor hormone. It’s really
it’s responsible for prostate stimulation and hair loss DHT receptors on the prostate when you haven’t had testosterone for a long time, mostly for guys who were under like 400 or 300. When you give that testosterone back, and they get a little bit of extra DHT, it will stimulate the DHT receptors. So you can get some prostate enlargement, which is very common with testosterone replacement. However, if there was an aggressive prostate cancer already there, okay, meaning the cells were pre existing, and it was sitting there, it will stimulate those cells that would have grown anyway, to grow. Okay, so when we replace testosterone in a male that’s lower than 400. In the first six to eight weeks, we recheck a PSA and testosterone levels to make sure we’re not getting this crazy excessive stimulation and that PSA isn’t jumping up and we’re not finding a prostate cancer that was there. Okay. The cancer was there. All you did was make it show itself, okay. And it’s unlike the slow growing prostate cancers that would have just sat there until probably the person passed away right there. There. There’s a myriad of types of prostate cancer and aggressive and non aggressive it’s it’s really important to distinguish between the two. The aggressive one was just found earlier, okay, and actually might even do the patient service to be honest, because you found it and you’re able Gotta find it, you didn’t create it. Okay. And I think that’s a really important point, um, testosterone will increase some water retention in males and females, it’s not a ton in females in males, it can bump your blood pressure a little bit. So cardiovascularly, you will have some cardiologists that, you know, want to make sure that you’re not bumping your pressures too much, especially if you
have problems with your ejection fraction, getting the heart to squeeze, or having blood pressure issues a little bit of what we call systolic or diastolic hypertension. And for the most part, if it’s kept, the levels are kept reasonable and you’re not taking it. Like our like steroid abusers would, then you’re going to be okay. And we can talk about that if that’s something that interests you. But I think testosterone in general gets a bad rap. It’s one of those hormones that is it’s a it’s a great hormone. And men and women both need it. So. And we talked about symptoms of deficiency, but I just got another question. So we’re going to reiterate that a little bit, low testosterone, decreased libido, decreased arousal, muscle weakness, maybe not making gains in the gym with for active patients, or not being able to put on muscle mass lubrication, that generally arousal response, energy levels, it definitely helps with energy levels, so decreased energy levels, and night sweats if you don’t have it, and mental clarity if you don’t have enough of it. So those are the big ones. And I know they overlap a lot of the other hormones. So my, my key point is, when we are looking at these, we have to talk about timeline of symptoms, how did it progress, which is why I think those patients in the beginning really make sense, right? At first, you’re just a little tired, maybe you have a little bit of brain fog, you don’t feel so great. And like I said, After talking, you know, you might not have a libido, but that had to be drawn out of you, then you can’t sleep insomnia, you know, and you want your libido back and your brain is getting mushy, and then all of a sudden, you’re getting these massive hot flashes, maybe the night sweats start, and the mood is just, you know, can’t be controlled. After a long period of time we get the dryness, that’s kind of the later sign. And by the same token men, the later signs that they get is that libido and erectile dysfunction decrease, I think the first sign for guys that they’re not doing well with testosterone is, you know, I don’t really want to go to the gym today, I don’t want to go out the guys and go golfing. I don’t want to go work on the car, if that’s your thing, because they their testosterone is linked directly to their pleasure center. Whereas it’s not the same for females necessarily. So when they stopped wanting to do the things that they liked to do, that’s an early sign of testosterone decrease, and you know, falling asleep on the couch. You know, we all know that one, right? You know that that fatigue early, early in the night or early in the late afternoon. That’s a sign as well. So I think if we start catching this stuff earlier, we’re really going to be better off long term. And we talked about inflammation. And I just got a question about inflammation. And it is would fixing hormones decrease inflammation? The answer is no, not by itself. And yes, it can help. But I like to look at these in the bigger picture, right, the picture of how much
what other things are going on? Right? Are they having gut issues? Are we having adrenal issues? Are you having vitamin deficiencies? Is your stomach not working correctly?
Because all of the did you go on cholesterol medicine, all of these things are linked to how you’re going to respond to hormone therapy, right? It’s just not an isolated treatment therapy. And I used to early on, I used to treat hormones isolated, right, we would just oh, you have a hormone deficiency, we’re going to we’re going to treat that. And I think what I’ve realized over time is those pyramids that I love to talk about are so important because the gut, immune brain, well, your immune system in your brain can do the same thing. You know that that link can do the same thing as progesterone, and extra estrogen. So where do we draw the line? And then if you’re not absorbing your nutrients, are we making enough hormone? So there’s all different ways to kind of treat you but I think mixing them looking at all the triangles is the most important way to do it. Alright, another question with our last couple minutes. Let’s see. What tests do you do? Well, how do you know if your hormones are off? Well, we kind of talked about this, but we The next question is what tests Do you do and I think we I used to do saliva, and I have nothing there’s nothing wrong with alive I still like it. It’s just expensive. So I tried To use insurance, if we can to do some blood testing, we can do finger sticks as well, which has been really nice with COVID. We send it to your doorstep, you prick your finger, you send it out, we get a great cortisol occur, we got your, we get your hormones, everything. So I love that too. But we go to all your traditional labs if we can, I also have a lab that I work with self pay actually work with all themselves pay, so we can do that as well. So if you don’t have insurance, we can make it work. If you have insurance, we try to use that or we can send it to your house. Okay, so the next question is costs. Okay. So that’s a tricky question, because it depends on what you need, right? hormones are pretty reasonable bioidentical hormones range anywhere from about 60 to $80 a month, give or take per hormone, we can combine hormones after a while. Meaning we can kind of put multiples things in one trophy or lozenger. pellets are about $400 for a pellet, and they go under the skin. And they last about four to six months, depending on what we’re using. And they slow release over time. We have some injectables that you can get as well. And they like testosterone, and they run about, let’s just say about 150 for 10 ML, which lasts about 10 weeks, give or take. So we’re not talking about huge investments in in money. It’s a little bit of investment in time, because it does take some time to kind of get your dosing, right and all that stuff. So I think that what you’re going to find is, it’s not the cost is not prohibitive for most people. And it will, if you give yourself a couple months trial, I think you’ll find that it’s amazing. I actually had a patient tonight, and I’m going to kind of close with her story who had cervical cancer. Oh, gosh, I guess it was about seven, eight, maybe almost 10 years ago now. And no one would treat her with hormones. And she was miserable. Her moods were all over the place. She couldn’t sleep. And she was dry as heck. And she was looking for help. And you know, they, nobody would touch her. So we talked about the risks. We talked with her oncologist and we actually spoke today. And she’s been doing HRT bioidentical HRT for about three years. And she bees between that and getting her got an order, she has been a new person, she can have sex, she has libido, she’s not dry,
she has, you know, her mood swings are stable. And this is a person that has eight children. So you know, if you can have stable moods with eight kids, it’s pretty impressive. So you know, I think that we, we look at people in such isolated packages, that sometimes we just really need to look at quality of life, and she went through heck to get to the space that she is now. And for her to be able to enjoy the quality of life that she wants and be safe about it is really important. And we use the tiniest amount of estradiol, which is that weak estrogen to help her. And it’s it’s been a miracle worker. And we know ash trial does not incite carcinogenic cells. So with the last two minutes that I have, guys, I’m going to kind of say, tell you that what I think you should do is,
if you’re having mood swings, log them, if you’re having symptoms, log them, when you log them, you can look at timelines, and you can actually rank them. So zero to five. And that’s how my intake works. It’s five is the worst, zero is nothing. And we track it over time. And if you’re not getting better on the therapies that we’re using, and it’s not right for you, right, but I will say the majority of people that do this stuff, and that read on it and understand it will realize that traditional medicine misses the mark with hormone therapy, and unfortunately, we did it the wrong way. And we probably basically, you know, cut off our nose to spite our face, right? We shot ourselves in the foot, if you will. So now people don’t really think it’s a reasonable way to to treat themselves. So you can go online, you can go to mydrlori.com. And or email me like I said at firstname.lastname@example.org, and just let’s get your symptoms, let’s figure out what’s going on. Are you not sleeping and let’s just make it let’s make it better. There’s no reason we can’t have a better quality of life, especially living in close quarters during COVID than what we have right now. So again, if you have any questions, I’m here for you. and I apologize that is a change from what was listed. So I’m going to change that on our website as well. And I’m going to post this article that I wrote on these hormones on my website, so you can find it there at mydrlori.com. And thank you very much guys and have a great evening.