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ExcelFemale
HRT in Women
Webinar Video and Transcript: Latest Advances in HRT for Women
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<blockquote data-quote="Nelson Vergel" data-source="post: 36088" data-attributes="member: 3"><p>WEBINAR TRANSCRIPTION- PART 1</p><table class='post-table width: 100%' style='width: 100%'><tr><td ><p>Jay:</p></td><td ><p>Hey guys, it is Jay Campbell and Nelson Vergel with another addition of our The Real Truth Men's Health Webcast. Actually today this episode is going to be more so for the beautiful lovely ladies out there. I'm really excited to be joined of course by Nelson and my lovely wife, Monica Diaz, but our special guest that we have with us today who is Allison Woodworth from the PrimeBody.com clinic network.<br /></p></td></tr><tr><td></td><td></td></tr><tr><td ><p>Jay:</p></td><td ><p>Allison, why don't you tell us a little bit about yourself. The way the show is going to go today is that Monica is going to moderate and Nelson and Allison are going to talk a little bit about women's, well, not a little bit, a lot about women's HRT. With that, the floor is yours Allison. Welcome to the show.<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yea! Well first of all, thank you so much Nelson, Jay and Monica for putting this together. I'm so happy to be here. Just a little bit about me, my background is actually in family medicine. I was trained very traditionally. When I think back about my training I realize hey, the core of it was actually just match the drug to the disease. It was sort of like okay, make your diagnosis and then prescribe medications that are going to almost treat the symptoms of chronic diseases.<br /></p></td></tr><tr><td></td><td ><p>After working in family practice for several years I just saw this pattern. Like wow, we're not really stepping back and addressing the real cause of these chronic illnesses. It's just writing prescriptions to cover the symptoms of chronic disease. I just realized I kind of wanted to shift focus out of that I would say disease-oriented or disease-focused model and move more toward working with patients to develop healthier lifestyles, weight loss, hormonal balance so we could move into the field of preventative medicine, sort of being more proactive preventing these chronic diseases before they start and just helping people live their best and at optimum levels.<br /></p></td></tr><tr><td></td><td ><p>It's something that I've personally become very passionate about over the past six years now. It's just I've dedicated myself to lifelong learning and that's what's really exciting about this field. There's just so much to learn and the more I learn the more I can share with everyone. I'm happy to be here and really excited.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Perfect. That's exciting because now you get to help people be the best version of themselves rather than focusing on the disease, right?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Exactly. Yes.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Yea! Do you mind if we get into all the questions and the layout as to how we're going to work this so that we can get started? Then if anybody has questions ...<br /></p></td></tr><tr><td ><p>Jay:</p></td><td ><p>Yup, I'll introduce.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Jay's going to go ahead and explain that.<br /></p></td></tr><tr><td ><p>Jay:</p></td><td ><p>Sorry about that guys. Nelson, I want to let Nelson jump in here in a second, but if you see over on the right side it looks like we have three or four viewers right now and I'm sure there will be a bunch of people jumping on. You can leave messages, and of course we encourage you to leave messages for both Allison and Nelson in this. It's over on the right side. You should see it. It just says chat. Just go ahead and feel free to leave your questions there. Nelson man, how are you today?<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>Hey. Hi guys. Hey Allison, I'm very excited. I know in this hangout series we've been focusing on men's health, but it is time now to focus on women’s health also. It is time to start expanding into helping women also reach out and get the right information about hormonal balance and aging and menopause and all that. Allison, tell us a little bit more about Prime Body. You are the Clinical Director there, but is that a network? How does that work?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, so Prime Body is actually a network of providers. We're actually national across the United States in over 17 cities now. When I had the opportunity to meet with the owners of Prime Body and they kind of got a feel for my passion for this field and the experience I've had, they actually asked me to help them develop some of their female protocols. I actually work closely with all physicians in the network. I kind of have a unique opportunity to do some teaching and training and educating of all the providers that come onboard with us, as well as working with patients on the clinical level.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Very cool. One thing that I wanted to mention too being a woman and aging, it seems to me like so many women become, and I don't know, fearful about aging because there's so many misconceptions about what can happen to our bodies, our skin, how we look, how we feel. We're already emotional creatures, right? Aging doesn't seem to make it any better. I'm curious, which hormones are important to test and when?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, well that is a great question. I've sort of narrowed it down into four core hormones that we want to focus on when we're talking about women and hormone replacement therapy. Even when I train new providers I say okay, let's break it down. Let's make it simplified. Number one, estrogen. There are multiple different forms of estrogen in the body, but I'm just going to go very simplified, basics. Estrogen, progesterone, testosterone and also thyroid hormone.<br /></p></td></tr><tr><td></td><td ><p>Those are the four core hormones that we want to focus on and test in women. If you want to step back and take a look at the larger picture, the full hormonal cascade, you could also add on DHEA levels, also pregnenolone and even cortisol levels. That would also give a picture into the patient's adrenal functioning as well.<br /></p></td></tr><tr><td></td><td ><p>Very simplified, four core hormones that mainly I'll be talking about with you today would be estrogen, progesterone, testosterone and thyroid. When we check these hormones we're looking at lab work, but I always tell my patients I'm not treating lab work. I'm not treating numbers on a piece of paper. I'm treating you, the person behind these numbers. It's not just look at the labs, prescribe based on that.<br /></p></td></tr><tr><td></td><td ><p>We also have to take into account the patient's medical history. Also I ask very detailed questions about symptoms they're having. As we go into further discussion about the symptoms of hormonal imbalance, a lot of them can be somewhat vague and maybe overlapped, so you really have to look at okay, the combination of symptoms plus the blood work to give you the overall, the full clinical picture and to make the appropriate recommendation for the patient.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Right. When you have somebody, like a woman comes in and she does these tests, she does her lab work, do you go through and explain what each, you're looking at the estrogen, you're looking at all these target points here and do you explain to them what levels are normal and perhaps what's going on with them when you have their lab work? Or is that something that you wait after you get them retested again?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, well in their initial consultation what I do in my clinic is actually have them have blood work drawn before they come to see me and fill out a medical history questionnaire. In that first visit with them I already know all of their symptoms, I see their blood work and I do go through every single lab value and I tell them okay, yeah, here's where your estrogen is at, here's where your progesterone and testosterone is at.<br /></p></td></tr><tr><td></td><td ><p>Some of these symptoms you're having could correlate and make sense with the blood work that I'm seeing. I definitely tie it all together for the patient in the room and definitely break it down and go hormone by hormone as a part of the initial consult.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>A lot of people probably aren't as educated and this is like their first visit with you and you want to make sure that they know what you're talking about. That they understand what they're looking at. I read something also the other day about synthetic hormones. Is that something that is addressed as well? Is that something that's recommended? What do you think about that?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, that is a great question and I hear that one all the time. There is a big difference between a synthetic hormone and a hormone that is considered to be more physiologic. The synthetic hormones, the main ones that we hear of are Premarin and Prempro. Those are both oral synthetic hormones, so taken by mouth. Traditionally these were the hormones that were prescribed to post-menopausal women, so women who were no longer having periods to deal with some of the symptoms of menopause.<br /></p></td></tr><tr><td></td><td ><p>Well, doctors were recommending it for decades and then in 2002 there was a study that was done. The goal was to look at the long term effects of these synthetic hormones in women. Doctors were thinking well, we're going to find oh, it's going to reduce risks of osteoporosis, it's going to reduce risks of cardiovascular disease. These synthetic hormones are great that we've been recommending for years.<br /></p></td></tr><tr><td></td><td ><p>Actually what was found was that women were experiencing increased rates of breast cancer, blood clots, heart attack and stroke. This was being on the oral forms of synthetic hormones Premarin and Prempro. That just sort of shocked the medical community and that's when doctors began telling patients okay, you've got to stop these synthetic hormones. They're going to be harmful to your health so you need to discontinue them and hormones are harmful.<br /></p></td></tr><tr><td></td><td ><p>That's very true about synthetic hormones. That also led to a misconception by physicians and also patients that that's true for all hormones regardless if they're taken by mouth or if they're made in a different way that's not the synthetic version. Oftentimes I see patients even to this day who will go to their doctor and they'll just pretty much tell them, "No, you cannot be on hormones. They are harmful for your health." They don't even want to get into the discussion about different options which would not include taking them orally or in different forms which are not synthetic.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Right. Even the name synthetic hormone to me doesn't sound like it's a good name. I'm like synthetic? Why would I take a synthetic hormone?<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>Let me ask a question real quick if I can.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Sure.<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>A little step back. When you get somebody, a woman to call you or email you guys at Prime Body, what are the usual concerns or symptoms or quality of life issues? What brings a woman to your network? Also, a second part of that question is are these usually women who have gone through menopause or they are younger and the difference between the two populations? That's a multi-loaded question. I'm sorry.<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, wow Nelson. How much time do we have? (laughter)<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>Let's talk about the symptoms and what makes a woman reach out? That's something I see in the field out there. Women are caregivers, they're taking care of people. They're busy. They have kids. They have so many things competing for their own well being because they're usually taking care of people. That's the nature, and thank God for women. We would not be here. It takes them a while to reach out, so when they do reach out, when I guess they hit bottom, they say I can't do this anymore. They may say “I'm too tired to even help my kids or my spouse”…What are the symptoms usually?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, so in my clinic and also at Prime Body we treat women of all ages. I'm going to sort of break down your question maybe like per age group or decade because certain symptoms would relate more to different age groups, different hormonal imbalances. Really any age range can be effected by hormonal deficiencies or imbalances. Women from early 20's all the way through post-menopausal 60's and beyond.<br /></p></td></tr><tr><td></td><td ><p>A woman I would say is in her 20's, you would think oh, her hormones should be perfectly well-balanced. She's too young to even consider hormone therapy. What I see a lot of now are women who are put on synthetic birth control pills, they don't want to get pregnant so they're put on the pill. Now after years of being on the pill they start having symptoms, oftentimes weight gain, they'll be tired, sex drive completely goes down. This is a woman in her 20's and oftentimes early 30's if they're still on oral contraceptive, so birth control pills.<br /></p></td></tr><tr><td></td><td ><p>I think really any age here, but being tired, gaining weight, low sex drive, those are really the big I would say symptoms that drive them to call us. The way that birth control pills do that is they actually decrease the body’s production of testosterone and not to get too technical, but they also raise sex hormone binding globulin, which is a protein that binds up testosterone.<br /></p></td></tr><tr><td></td><td ><p>In two different ways it's decreasing a woman's testosterone levels. Just being on birth control in itself can effect hormonal production. The a woman going into early 30's, mid-30's, we oftentimes see progesterone levels declining and oftentimes also an increase in estrogen levels due to many different factors. Often even environmental exposures. Regardless, that can put a women into a state of what we call estrogen dominance. That is when progesterone is low and estrogen levels are high.<br /></p></td></tr><tr><td></td><td ><p>A women can start having a lot of symptoms, often like the PMS type symptoms that we think of, breast tenderness and swelling, moodiness, irritability, water retention, also just painful periods. In that age group women oftentimes think gosh, when I was in my 20's my periods were so easy, but what changed? That change can start happening as early as your early 30's.<br /></p></td></tr><tr><td></td><td ><p>Then when women hit age 40 they actually have half the level of testosterone that was present in their 20's even if they're on synthetic birth control pills or not. We get calls all the time, any age group, but definitely in their 40's that can have those symptoms of low testosterone. Again, being tired, difficulty building lean muscle mass, low sex drive and sexual functioning. It even can affect memory and cognition.<br /></p></td></tr><tr><td></td><td ><p>That's a I'd say a key time in a woman's life, her early 40's she really can start seeing overlap of these issues. Estrogen dominance and also low testosterone. Then of course the main age that most people I think associate hormone replacement therapy with would be the post-menopausal woman. That would be I would say late 40's to early 50's most women enter that menopausal transition.<br /></p></td></tr><tr><td></td><td ><p>Not only do they have low progesterone and also most likely low testosterone, estrogen levels begin to drop on top of that. Then a woman can start experiencing hot flashes, night sweats, mood fluctuations, vaginal dryness, painful intercourse. You can see it really can affect a woman from her 20's being on synthetic birth control pills all the way through the 30's, 40's and for sure in menopause.<br /></p></td></tr><tr><td></td><td ><p>If it's not effecting a woman at this stage in her life, at some point we can expect to see a hormonal imbalance and eventually deficiency through menopause. Then the one hormone that I didn't mention yet would be thyroid. That also can occur really at any age, especially if the woman has a excuse me, a family history of low thyroid. There's a condition called Hashimoto's Thyroiditis which it can be genetic. Basically that can affect you at any age. Really women from 20 all the way through menopause we deal with.<br /></p></td></tr><tr><td></td><td ><p>I really feel is a woman is experiencing any of these symptoms to just consider getting tested because that's the first step is have your blood work drawn, have it reviewed by a provider who is well trained in hormone therapy. Then go from there.<br /></p></td></tr><tr><td ><p>Jay:</p></td><td ><p>Allison, it's Jay. Real quick let me just ...<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Sure.<br /></p></td></tr><tr><td ><p>Jay:</p></td><td ><p>How are you?<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>It's not Monica. The voice is a little rough.<br /></p></td></tr><tr><td ><p>Jay:</p></td><td ><p>Thanks for coming on the show by the way. You're doing an awesome job. This is amazing information. A lot of people are going to watch this, but just to see from Nelson's question to what you just said and then you brought in thyroid which is a perfect transition spot, I think the majority of women, and I won't speak for you guys, but I think that the majority of women today, their biggest struggle is obviously with their weight, right? Body fat.<br /></p></td></tr><tr><td></td><td ><p>How many women, how would you equate to optimizing a woman's hormones or how important is it to optimize your hormones as a woman who is seeking to reduce body fat, trim up, get more toned, all the different expressions that women use? I feel like, and I'll speak for a man's component as Nelson and I have written eloquently in our books, testosterone is a lipolitic hormone, so there is a thermogenic or an increase in cellular respiration or metabolic, there's a metabolic component to it. Does it stand to reason that when women optimize their hormones it makes it easier for them to "lose body fat" assuming that they do all the other things which is obviously reduce calories and exercise?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, that's a great question, Jay. I'm glad you chimed in there. That's absolutely right. If a woman's hormones are unbalanced, just like a man, if she's especially estrogen dominant, low testosterone it can absolutely be difficult for her to lose fat and build lean muscle mass. I hear that all the time. Women come in, they'll be exercising almost obsessively, seven days a week eating nothing but chicken salads. Doing everything they can to try to optimize their health to lose weight and they're just not seeing the results.<br /></p></td></tr><tr><td></td><td ><p>That becomes so frustrating when you feel like you are working so hard. You're doing everything that you know how to do, but it's almost like your body is working against you because your hormones aren't balanced. Absolutely, I would say giving progesterone to balance out the estrogen dominance, bringing testosterone to an optimal range in women. Women can I would say give them the same benefits that we do see in men.<br /></p></td></tr><tr><td></td><td ><p>Losing fat, building lean muscle mass. Also increasing energy and mood, motivation. If you're exhausted and you're tired, you're not going to want to go to the gym. If you do, if you don't see a benefit you're not going to keep going. You'll just be discouraged and stop, so this is part of it too, the energy, the mood, motivation, confidence, assertiveness. That will get patients in the gym and then also keep them there because they're seeing benefit.<br /></p></td></tr><tr><td ><p>Jay:</p></td><td ><p>Right. Great answer. Great answer. Just one last question to follow up with that then, just for me to statistically understand you guys. Nelson probably knows this of course, but what is the percentage of the female population right now say in North America that are actually on hormonal optimization or I guess what's the percentage of that group? Is it small? I would assume it's microscopic?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Well, I would say in terms of the number of women on hormone therapy in the United States, I don't know an exact figure on that, but I do know in terms of the types of patients that seek hormone replacement therapy, I've heard about 80% of them can be women who end up seeking hormone replacement. That's usually what we see in age management medicine type practices is typically about 80 % women, maybe 20% men. That's just what I see on a clinical level. In terms of national scale I'm not sure the figure. I'm not sure if you know, Nelson.<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>No, we haven't seen numbers on that, but many women like you say are on birth control and that's a hormonal treatment, you know?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Oh, that's a good point.<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>Allison, you keep mentioning obviously estrogen, progesterone and testosterone, we probably should explain each, because I don't think some women may be completely aware of the role of testosterone in women.<br /></p></td></tr><tr><td></td><td ><p>My concern too is there is an epidemic of low thyroid in this country that is not, people are not being diagnosed. Their doctors are using TSH as a main parameter to diagnose hypothyroidism. We know pretty well that TSH is a pretty imperfect variable. A lot of women and men are putting on weight, feeling tired, sluggish, have lower cognitive function due to thyroid issues. Can you explain a little bit before we go into more details on the other hormones on thyroid and the role of testosterone, both of them?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, I'll answer the question about thyroid first because I think this is just such an important hormone. I see patients all the time who come to the clinic and they say you know, I've had blood work done by my primary care doctor and they've told me my thyroid is normal. Oftentimes they'll bring a copy of their labs, I'll look and only the TSH is checked.<br /></p></td></tr><tr><td></td><td ><p>Like you mentioned that is really not I would say a great indication of the actual functioning of a person's thyroid. The TSH is just the signal from your brain to your thyroid to make more thyroid hormone. It's not measuring the actual thyroid hormone levels in the body. In addition to the TSH we also want to be looking at free thyroid hormone levels. The free T4 and also the free T3.<br /></p></td></tr><tr><td></td><td ><p>Now the free T3 to me and to most providers who are in this field is one of the most important tests that we can look at because this is the active form of thyroid hormone in the body. It really doesn't make sense to just look at TSH and tell a patient there's nothing wrong with their thyroid if you haven't really stepped back and looked at the full picture. Well where are their free hormone levels and especially the free T3?<br /></p></td></tr><tr><td></td><td ><p>In my clinic and all Prime Body clinics we do a more detailed panel. Oftentimes I will find that there is an issue with the patient's thyroid. One thing we can add on is we can test for antibody levels, so we can determine does a patient actually have this form of low thyroid that's almost an autoimmune condition? Their antibodies or the bodies attacking the thyroid gland so we can check antibody levels, the free hormone levels and just get a better understanding of how the thyroid is functioning.<br /></p></td></tr><tr><td></td><td ><p>You're absolutely right, just the TSH test is really not giving you the full picture. I would say I encounter patients all the time where a thyroid disorder has been missed for years.<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>Yeah. The role of testosterone? Can you expand on that for women?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Oh yes. Testosterone, it's very important in women. It plays a big role in sexual functioning as well as desire. Also it can impact, as I mentioned before, development of lean muscle mass and also energy levels. There's even newer research showing it plays a role in memory and cognitive functioning. The importance of testosterone in women really can't be overstated.<br /></p></td></tr><tr><td></td><td ><p>I think traditionally we think of okay, testosterone's just a hormone for men and we really don't hear a lot about its role in women. As I just mentioned, it's so important for all of those reasons and again, I'll say when a woman is 40 her level of testosterone is half that when she was 20. With time we really see a decline in levels and that can have a big impact on a woman's sex drive, functioning, all the other areas I mentioned and really impact quality of life. We really do need to look at testosterone as well.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>A question for you with regard to testosterone because men, the way men administer and deal and have testosterone replacement therapy is different than women, right?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yes, absolutely. Women need such low doses of testosterone that typically the way providers replace it is just in very low daily doses, which is very similar to the way the body would naturally produce testosterone. We don't give them a once weekly injection. I definitely don't recommend pellet insertions. I don't know if you've heard of hormonal pellets.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Honestly I had a friend that did that and we were shocked because she was explaining to us what was going on and the pain that she was having from those. We were yeah ... Go ahead. Keep explaining.<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yes. Yeah, I just wanted to mention there are so many different ways to get testosterone, but a pellet in my opinion is not a great way to replace hormones in women. Especially if you think of it, there's a patient that's most likely naïve to hormone replacement therapy. They've never been on testosterone. You don't really know what dose is going to be ideal for them. Why would you surgically implant a hormone into a patient's body where you cannot decrease the dose, you cannot increase it without doing another surgical procedure? You can leave scar tissue at the implantation site.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Infection.<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, risk of infection, risk of scar tissue, fibrosis, even a pellet extruding. The other issues I saw with pellets, because I do have personal experience inserting pellets into patients, I hate to say it, in a former life years ago, when I worked in a family practice years ago they were really pushing pellets. I gave those to my patients. I did it maybe six months to a year and then just did not see very good outcomes because if you give them too much they have side effects. Well, what are you going to do?<br /></p></td></tr><tr><td></td><td ><p>Just hang in there. It will be gone in about three or four months. Just stay strong. The other issue is we see peak levels at one month and patients may have too much and they may have side effects. Then you see basically a decline over the next three months. Then levels are low again before you reinsert. You get this significant peak and drop over time. It's not really balancing a woman's levels in a way that would resemble the way the body naturally produces testosterone.<br /></p></td></tr><tr><td></td><td ><p>The way most prescribers are giving testosterone to women would be in low daily doses in the form of a topical cream is the most common that we're seeing. Basically you just put the cream on, usually once a day and it absorbs into the bloodstream that way. It doesn't involve an injection. The way we're able to do this is because we need such lower doses than men. A topical does work very well for women.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Right. How about the other hormones? How are those typically replaced?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Estrogen, if a woman needs estrogen and that would most likely be the last hormone she needs, but if she needs estrogen, that's also given in topical form. The reason we don't want to give pills of estrogen and testosterone is because that would pass through the GI tract. There is something called the first pass effect in the liver which is where actually the liver has to metabolize these hormones and it can decrease the availability of the hormones in the system and also put a little bit of strain on the liver over time.<br /></p></td></tr><tr><td></td><td ><p>We don't want to give these hormones orally. Also giving estrogen as a pill can increase those risks of blood clot, heart attack and stroke. That's just a risk associated with oral estrogen. It can still be given if the provider really carefully analyzes a patient's risk for cardiovascular disease, but just in general transdermal or topical forms are safer. Estrogen, testosterone are usually always given transdermally through the skin.<br /></p></td></tr><tr><td></td><td ><p>Then thyroid is actually given orally. It's given by mouth usually in the morning on an empty stomach. You have to make sure to separate it from any other supplements, any food, anything by at least 30 minutes to an hour or absorption can be significantly reduced. That's one thing to know about thyroid. It works very well taken orally but you have to be careful not to take it with any other supplements or food or anything.<br /></p></td></tr><tr><td></td><td ><p>Now progesterone can either be given as a topical cream or orally, by mouth. That one is safe to take by mouth. If you use progesterone topically you really don't see the full benefits in terms of help with sleep and stabilizing mood as if you take it orally. Most providers would recommend an oral form of progesterone, especially if there's any underlying issues with sleep disturbance or mood instability.<br /></p></td></tr><tr><td></td><td ><p>You can see there's a lot of different ways of taking the hormones just based on which hormone we're talking about. Unfortunately we can't just put them all in a pill and just take it once a day. That would just be too easy.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>It's always got to be more complicated for the women, right?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah. One thing I do, if a woman needs both testosterone and estrogen, once she's balanced on both hormones I can actually combine them into one cream so she's not having to apply two creams and these different things. You can combine it once they're stabilized on the doses of each one.<br /></p></td></tr><tr><td ><p>Nelson:</p></td><td ><p>I'm sorry. These creams come from where? Are they from my Walgreen's, CVS or made by compounding? Are they special?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yeah, that's a great question. All of the hormones that I've been mentioning, I usually will send those prescriptions to a compounding pharmacy. They're a very important partner for a provider like myself who really specializes in hormone replacement therapy. We can't just use a Walgreen's or a CVS because they have very standardized doses and standard medications that they carry on the shelf. If your patient needs a specific dose or a different amount of application, they're not flexible with their formulas.<br /></p></td></tr><tr><td></td><td ><p>A compounding pharmacy, they can actually make any I would say prescription that a provider needs for their patient in any dose. When I write a prescription for Monica Diaz let's say, basically they are going to make this prescription fresh for her right when they receive the prescription. It's not something that's been sitting on the shelf for a year that every other patient is on.<br /></p></td></tr><tr><td></td><td ><p>It really can be customized to the individual patient and compounding pharmacies are able to do that for us. It's really just a, I'd say a powerful partner that we have to give our patients the individualized care that they need, because everyone's body is different. There's not one standard dose that works for everyone, so a compounding pharmacy is definitely the way to go when you're dealing with hormone therapy.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Yup, VIP service, right?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Yup, exactly.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Exactly. Out of curiosity, in speaking with how these hormones are delivered and how we deal with them, as far as side effects, are there any side effects that people should know about or pay attention to when they're dealing with hormone replacement therapy?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>That's a very good question. That's part of my initial consultation when I make a recommendation to a patient about which particular hormones I'm prescribing. With any medication there are potential side effects. In the case of hormone replacement therapy I would say side effects are usually more dose dependent.<br /></p></td></tr><tr><td></td><td ><p>If a patient is on let's say too high of a dose of a particular hormone, or they're not balanced right, they could see some side effects. I'll just mention a few of the big ones. With testosterone women can notice a little bit of acne, increase in hair growth if they're on too high of a dose. Obviously I like to educate patients about this, so if they have these issues they tell me. We can decrease their dose and the side effects go away.<br /></p></td></tr><tr><td></td><td ><p>Now with thyroid if you're on too high of a dose, this is not very common, but they could have issues with an increase in heart rate, a little bit of heart palpitations. They could have a little tremor, trouble sleeping if they're just on too much thyroid hormone, especially because the type of thyroid that we prescribe typically has T3 which is the active form of thyroid in it. If it's a little too high they may have some of those issues. Decreasing the dose should resolve it.<br /></p></td></tr><tr><td></td><td ><p>Then estrogen, I would say in general we're very careful with the amount of estrogen we give to women. Like I mentioned, typically we would replace progesterone first, testosterone and a portion of testosterone will actually convert over to estradiol or estrogen. We're finding we can use lower doses of estrogen than we have in the past and women are still noticing great results in terms of resolution of their symptoms of low testosterone and also improvement in their symptoms due to low estrogen.<br /></p></td></tr><tr><td></td><td ><p>If a woman is on too much estrogen there would be concerned that she would have over-stimulation of her breast tissue or her uterine lining. That could cause issues with breakthrough bleeding and spotting. A postmenopausal woman, her period's done, we don't necessarily want to bring that back. [inaudible 32:29], so ...<br /></p></td></tr><tr><td></td><td></td></tr><tr><td ><p>Allison :</p></td><td ><p>Right, so those are just some of the potential side effects that I would go through with a patient at their consultation, make sure they're aware of them and again, that they know it's usually dose dependent. It could mean they're on too much. Backing off on the dose they will resolve.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>How about emotionally? Are there any symptoms that someone should pay attention to with respect to their emotions? About what's going on with them? Anything like that? Would they be more sad, more in depressed states? Anything that we should know about in that regard?<br /></p></td></tr><tr><td ><p>Allison :</p></td><td ><p>Well, in terms of emotional changes I would say typically progesterone would stabilize and improve someone's mood, so they may notice that, they just feel a little more calm, a little more mood has been stabilized. It also improves the PMS type symptoms, moodiness, irritability. With thyroid, it can actually improve mood and depression, so you'd see a benefit there.<br /></p></td></tr><tr><td></td><td ><p>With testosterone, if you're on much too high of a dose, just like with men, a woman could feel like she's becoming possibly a little irritable or possible aggressiveness if it's much too high of a dose, but usually she would have those other symptoms first, like a little acne and we'd decrease it. It shouldn't necessarily affect mood. Usually I would say we see more positives in terms of mood changes, which is a real benefit of therapy.<br /></p></td></tr><tr><td ><p>Monica:</p></td><td ><p>Right. Awesome.<br /></p></td></tr><tr><td></td><td></td></tr></table></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 36088, member: 3"] WEBINAR TRANSCRIPTION- PART 1 [TABLE="width: 100%"] [TR] [TD]Jay:[/TD] [TD]Hey guys, it is Jay Campbell and Nelson Vergel with another addition of our The Real Truth Men's Health Webcast. Actually today this episode is going to be more so for the beautiful lovely ladies out there. I'm really excited to be joined of course by Nelson and my lovely wife, Monica Diaz, but our special guest that we have with us today who is Allison Woodworth from the PrimeBody.com clinic network. [/TD] [/TR] [TR] [TD][/TD] [TD][/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]Allison, why don't you tell us a little bit about yourself. The way the show is going to go today is that Monica is going to moderate and Nelson and Allison are going to talk a little bit about women's, well, not a little bit, a lot about women's HRT. With that, the floor is yours Allison. Welcome to the show. [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yea! Well first of all, thank you so much Nelson, Jay and Monica for putting this together. I'm so happy to be here. Just a little bit about me, my background is actually in family medicine. I was trained very traditionally. When I think back about my training I realize hey, the core of it was actually just match the drug to the disease. It was sort of like okay, make your diagnosis and then prescribe medications that are going to almost treat the symptoms of chronic diseases. [/TD] [/TR] [TR] [TD][/TD] [TD]After working in family practice for several years I just saw this pattern. Like wow, we're not really stepping back and addressing the real cause of these chronic illnesses. It's just writing prescriptions to cover the symptoms of chronic disease. I just realized I kind of wanted to shift focus out of that I would say disease-oriented or disease-focused model and move more toward working with patients to develop healthier lifestyles, weight loss, hormonal balance so we could move into the field of preventative medicine, sort of being more proactive preventing these chronic diseases before they start and just helping people live their best and at optimum levels. [/TD] [/TR] [TR] [TD][/TD] [TD]It's something that I've personally become very passionate about over the past six years now. It's just I've dedicated myself to lifelong learning and that's what's really exciting about this field. There's just so much to learn and the more I learn the more I can share with everyone. I'm happy to be here and really excited. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Perfect. That's exciting because now you get to help people be the best version of themselves rather than focusing on the disease, right? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Exactly. Yes. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Yea! Do you mind if we get into all the questions and the layout as to how we're going to work this so that we can get started? Then if anybody has questions ... [/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]Yup, I'll introduce. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Jay's going to go ahead and explain that. [/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]Sorry about that guys. Nelson, I want to let Nelson jump in here in a second, but if you see over on the right side it looks like we have three or four viewers right now and I'm sure there will be a bunch of people jumping on. You can leave messages, and of course we encourage you to leave messages for both Allison and Nelson in this. It's over on the right side. You should see it. It just says chat. Just go ahead and feel free to leave your questions there. Nelson man, how are you today? [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]Hey. Hi guys. Hey Allison, I'm very excited. I know in this hangout series we've been focusing on men's health, but it is time now to focus on women’s health also. It is time to start expanding into helping women also reach out and get the right information about hormonal balance and aging and menopause and all that. Allison, tell us a little bit more about Prime Body. You are the Clinical Director there, but is that a network? How does that work? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, so Prime Body is actually a network of providers. We're actually national across the United States in over 17 cities now. When I had the opportunity to meet with the owners of Prime Body and they kind of got a feel for my passion for this field and the experience I've had, they actually asked me to help them develop some of their female protocols. I actually work closely with all physicians in the network. I kind of have a unique opportunity to do some teaching and training and educating of all the providers that come onboard with us, as well as working with patients on the clinical level. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Very cool. One thing that I wanted to mention too being a woman and aging, it seems to me like so many women become, and I don't know, fearful about aging because there's so many misconceptions about what can happen to our bodies, our skin, how we look, how we feel. We're already emotional creatures, right? Aging doesn't seem to make it any better. I'm curious, which hormones are important to test and when? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, well that is a great question. I've sort of narrowed it down into four core hormones that we want to focus on when we're talking about women and hormone replacement therapy. Even when I train new providers I say okay, let's break it down. Let's make it simplified. Number one, estrogen. There are multiple different forms of estrogen in the body, but I'm just going to go very simplified, basics. Estrogen, progesterone, testosterone and also thyroid hormone. [/TD] [/TR] [TR] [TD][/TD] [TD]Those are the four core hormones that we want to focus on and test in women. If you want to step back and take a look at the larger picture, the full hormonal cascade, you could also add on DHEA levels, also pregnenolone and even cortisol levels. That would also give a picture into the patient's adrenal functioning as well. [/TD] [/TR] [TR] [TD][/TD] [TD]Very simplified, four core hormones that mainly I'll be talking about with you today would be estrogen, progesterone, testosterone and thyroid. When we check these hormones we're looking at lab work, but I always tell my patients I'm not treating lab work. I'm not treating numbers on a piece of paper. I'm treating you, the person behind these numbers. It's not just look at the labs, prescribe based on that. [/TD] [/TR] [TR] [TD][/TD] [TD]We also have to take into account the patient's medical history. Also I ask very detailed questions about symptoms they're having. As we go into further discussion about the symptoms of hormonal imbalance, a lot of them can be somewhat vague and maybe overlapped, so you really have to look at okay, the combination of symptoms plus the blood work to give you the overall, the full clinical picture and to make the appropriate recommendation for the patient. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Right. When you have somebody, like a woman comes in and she does these tests, she does her lab work, do you go through and explain what each, you're looking at the estrogen, you're looking at all these target points here and do you explain to them what levels are normal and perhaps what's going on with them when you have their lab work? Or is that something that you wait after you get them retested again? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, well in their initial consultation what I do in my clinic is actually have them have blood work drawn before they come to see me and fill out a medical history questionnaire. In that first visit with them I already know all of their symptoms, I see their blood work and I do go through every single lab value and I tell them okay, yeah, here's where your estrogen is at, here's where your progesterone and testosterone is at. [/TD] [/TR] [TR] [TD][/TD] [TD]Some of these symptoms you're having could correlate and make sense with the blood work that I'm seeing. I definitely tie it all together for the patient in the room and definitely break it down and go hormone by hormone as a part of the initial consult. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]A lot of people probably aren't as educated and this is like their first visit with you and you want to make sure that they know what you're talking about. That they understand what they're looking at. I read something also the other day about synthetic hormones. Is that something that is addressed as well? Is that something that's recommended? What do you think about that? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, that is a great question and I hear that one all the time. There is a big difference between a synthetic hormone and a hormone that is considered to be more physiologic. The synthetic hormones, the main ones that we hear of are Premarin and Prempro. Those are both oral synthetic hormones, so taken by mouth. Traditionally these were the hormones that were prescribed to post-menopausal women, so women who were no longer having periods to deal with some of the symptoms of menopause. [/TD] [/TR] [TR] [TD][/TD] [TD]Well, doctors were recommending it for decades and then in 2002 there was a study that was done. The goal was to look at the long term effects of these synthetic hormones in women. Doctors were thinking well, we're going to find oh, it's going to reduce risks of osteoporosis, it's going to reduce risks of cardiovascular disease. These synthetic hormones are great that we've been recommending for years. [/TD] [/TR] [TR] [TD][/TD] [TD]Actually what was found was that women were experiencing increased rates of breast cancer, blood clots, heart attack and stroke. This was being on the oral forms of synthetic hormones Premarin and Prempro. That just sort of shocked the medical community and that's when doctors began telling patients okay, you've got to stop these synthetic hormones. They're going to be harmful to your health so you need to discontinue them and hormones are harmful. [/TD] [/TR] [TR] [TD][/TD] [TD]That's very true about synthetic hormones. That also led to a misconception by physicians and also patients that that's true for all hormones regardless if they're taken by mouth or if they're made in a different way that's not the synthetic version. Oftentimes I see patients even to this day who will go to their doctor and they'll just pretty much tell them, "No, you cannot be on hormones. They are harmful for your health." They don't even want to get into the discussion about different options which would not include taking them orally or in different forms which are not synthetic. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Right. Even the name synthetic hormone to me doesn't sound like it's a good name. I'm like synthetic? Why would I take a synthetic hormone? [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]Let me ask a question real quick if I can. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Sure. [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]A little step back. When you get somebody, a woman to call you or email you guys at Prime Body, what are the usual concerns or symptoms or quality of life issues? What brings a woman to your network? Also, a second part of that question is are these usually women who have gone through menopause or they are younger and the difference between the two populations? That's a multi-loaded question. I'm sorry. [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, wow Nelson. How much time do we have? (laughter) [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]Let's talk about the symptoms and what makes a woman reach out? That's something I see in the field out there. Women are caregivers, they're taking care of people. They're busy. They have kids. They have so many things competing for their own well being because they're usually taking care of people. That's the nature, and thank God for women. We would not be here. It takes them a while to reach out, so when they do reach out, when I guess they hit bottom, they say I can't do this anymore. They may say “I'm too tired to even help my kids or my spouse”…What are the symptoms usually? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, so in my clinic and also at Prime Body we treat women of all ages. I'm going to sort of break down your question maybe like per age group or decade because certain symptoms would relate more to different age groups, different hormonal imbalances. Really any age range can be effected by hormonal deficiencies or imbalances. Women from early 20's all the way through post-menopausal 60's and beyond. [/TD] [/TR] [TR] [TD][/TD] [TD]A woman I would say is in her 20's, you would think oh, her hormones should be perfectly well-balanced. She's too young to even consider hormone therapy. What I see a lot of now are women who are put on synthetic birth control pills, they don't want to get pregnant so they're put on the pill. Now after years of being on the pill they start having symptoms, oftentimes weight gain, they'll be tired, sex drive completely goes down. This is a woman in her 20's and oftentimes early 30's if they're still on oral contraceptive, so birth control pills. [/TD] [/TR] [TR] [TD][/TD] [TD]I think really any age here, but being tired, gaining weight, low sex drive, those are really the big I would say symptoms that drive them to call us. The way that birth control pills do that is they actually decrease the body’s production of testosterone and not to get too technical, but they also raise sex hormone binding globulin, which is a protein that binds up testosterone. [/TD] [/TR] [TR] [TD][/TD] [TD]In two different ways it's decreasing a woman's testosterone levels. Just being on birth control in itself can effect hormonal production. The a woman going into early 30's, mid-30's, we oftentimes see progesterone levels declining and oftentimes also an increase in estrogen levels due to many different factors. Often even environmental exposures. Regardless, that can put a women into a state of what we call estrogen dominance. That is when progesterone is low and estrogen levels are high. [/TD] [/TR] [TR] [TD][/TD] [TD]A women can start having a lot of symptoms, often like the PMS type symptoms that we think of, breast tenderness and swelling, moodiness, irritability, water retention, also just painful periods. In that age group women oftentimes think gosh, when I was in my 20's my periods were so easy, but what changed? That change can start happening as early as your early 30's. [/TD] [/TR] [TR] [TD][/TD] [TD]Then when women hit age 40 they actually have half the level of testosterone that was present in their 20's even if they're on synthetic birth control pills or not. We get calls all the time, any age group, but definitely in their 40's that can have those symptoms of low testosterone. Again, being tired, difficulty building lean muscle mass, low sex drive and sexual functioning. It even can affect memory and cognition. [/TD] [/TR] [TR] [TD][/TD] [TD]That's a I'd say a key time in a woman's life, her early 40's she really can start seeing overlap of these issues. Estrogen dominance and also low testosterone. Then of course the main age that most people I think associate hormone replacement therapy with would be the post-menopausal woman. That would be I would say late 40's to early 50's most women enter that menopausal transition. [/TD] [/TR] [TR] [TD][/TD] [TD]Not only do they have low progesterone and also most likely low testosterone, estrogen levels begin to drop on top of that. Then a woman can start experiencing hot flashes, night sweats, mood fluctuations, vaginal dryness, painful intercourse. You can see it really can affect a woman from her 20's being on synthetic birth control pills all the way through the 30's, 40's and for sure in menopause. [/TD] [/TR] [TR] [TD][/TD] [TD]If it's not effecting a woman at this stage in her life, at some point we can expect to see a hormonal imbalance and eventually deficiency through menopause. Then the one hormone that I didn't mention yet would be thyroid. That also can occur really at any age, especially if the woman has a excuse me, a family history of low thyroid. There's a condition called Hashimoto's Thyroiditis which it can be genetic. Basically that can affect you at any age. Really women from 20 all the way through menopause we deal with. [/TD] [/TR] [TR] [TD][/TD] [TD]I really feel is a woman is experiencing any of these symptoms to just consider getting tested because that's the first step is have your blood work drawn, have it reviewed by a provider who is well trained in hormone therapy. Then go from there. [/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]Allison, it's Jay. Real quick let me just ... [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Sure. [/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]How are you? [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]It's not Monica. The voice is a little rough. [/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]Thanks for coming on the show by the way. You're doing an awesome job. This is amazing information. A lot of people are going to watch this, but just to see from Nelson's question to what you just said and then you brought in thyroid which is a perfect transition spot, I think the majority of women, and I won't speak for you guys, but I think that the majority of women today, their biggest struggle is obviously with their weight, right? Body fat. [/TD] [/TR] [TR] [TD][/TD] [TD]How many women, how would you equate to optimizing a woman's hormones or how important is it to optimize your hormones as a woman who is seeking to reduce body fat, trim up, get more toned, all the different expressions that women use? I feel like, and I'll speak for a man's component as Nelson and I have written eloquently in our books, testosterone is a lipolitic hormone, so there is a thermogenic or an increase in cellular respiration or metabolic, there's a metabolic component to it. Does it stand to reason that when women optimize their hormones it makes it easier for them to "lose body fat" assuming that they do all the other things which is obviously reduce calories and exercise? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, that's a great question, Jay. I'm glad you chimed in there. That's absolutely right. If a woman's hormones are unbalanced, just like a man, if she's especially estrogen dominant, low testosterone it can absolutely be difficult for her to lose fat and build lean muscle mass. I hear that all the time. Women come in, they'll be exercising almost obsessively, seven days a week eating nothing but chicken salads. Doing everything they can to try to optimize their health to lose weight and they're just not seeing the results. [/TD] [/TR] [TR] [TD][/TD] [TD]That becomes so frustrating when you feel like you are working so hard. You're doing everything that you know how to do, but it's almost like your body is working against you because your hormones aren't balanced. Absolutely, I would say giving progesterone to balance out the estrogen dominance, bringing testosterone to an optimal range in women. Women can I would say give them the same benefits that we do see in men. [/TD] [/TR] [TR] [TD][/TD] [TD]Losing fat, building lean muscle mass. Also increasing energy and mood, motivation. If you're exhausted and you're tired, you're not going to want to go to the gym. If you do, if you don't see a benefit you're not going to keep going. You'll just be discouraged and stop, so this is part of it too, the energy, the mood, motivation, confidence, assertiveness. That will get patients in the gym and then also keep them there because they're seeing benefit. [/TD] [/TR] [TR] [TD]Jay:[/TD] [TD]Right. Great answer. Great answer. Just one last question to follow up with that then, just for me to statistically understand you guys. Nelson probably knows this of course, but what is the percentage of the female population right now say in North America that are actually on hormonal optimization or I guess what's the percentage of that group? Is it small? I would assume it's microscopic? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Well, I would say in terms of the number of women on hormone therapy in the United States, I don't know an exact figure on that, but I do know in terms of the types of patients that seek hormone replacement therapy, I've heard about 80% of them can be women who end up seeking hormone replacement. That's usually what we see in age management medicine type practices is typically about 80 % women, maybe 20% men. That's just what I see on a clinical level. In terms of national scale I'm not sure the figure. I'm not sure if you know, Nelson. [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]No, we haven't seen numbers on that, but many women like you say are on birth control and that's a hormonal treatment, you know? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Oh, that's a good point. [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]Allison, you keep mentioning obviously estrogen, progesterone and testosterone, we probably should explain each, because I don't think some women may be completely aware of the role of testosterone in women. [/TD] [/TR] [TR] [TD][/TD] [TD]My concern too is there is an epidemic of low thyroid in this country that is not, people are not being diagnosed. Their doctors are using TSH as a main parameter to diagnose hypothyroidism. We know pretty well that TSH is a pretty imperfect variable. A lot of women and men are putting on weight, feeling tired, sluggish, have lower cognitive function due to thyroid issues. Can you explain a little bit before we go into more details on the other hormones on thyroid and the role of testosterone, both of them? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, I'll answer the question about thyroid first because I think this is just such an important hormone. I see patients all the time who come to the clinic and they say you know, I've had blood work done by my primary care doctor and they've told me my thyroid is normal. Oftentimes they'll bring a copy of their labs, I'll look and only the TSH is checked. [/TD] [/TR] [TR] [TD][/TD] [TD]Like you mentioned that is really not I would say a great indication of the actual functioning of a person's thyroid. The TSH is just the signal from your brain to your thyroid to make more thyroid hormone. It's not measuring the actual thyroid hormone levels in the body. In addition to the TSH we also want to be looking at free thyroid hormone levels. The free T4 and also the free T3. [/TD] [/TR] [TR] [TD][/TD] [TD]Now the free T3 to me and to most providers who are in this field is one of the most important tests that we can look at because this is the active form of thyroid hormone in the body. It really doesn't make sense to just look at TSH and tell a patient there's nothing wrong with their thyroid if you haven't really stepped back and looked at the full picture. Well where are their free hormone levels and especially the free T3? [/TD] [/TR] [TR] [TD][/TD] [TD]In my clinic and all Prime Body clinics we do a more detailed panel. Oftentimes I will find that there is an issue with the patient's thyroid. One thing we can add on is we can test for antibody levels, so we can determine does a patient actually have this form of low thyroid that's almost an autoimmune condition? Their antibodies or the bodies attacking the thyroid gland so we can check antibody levels, the free hormone levels and just get a better understanding of how the thyroid is functioning. [/TD] [/TR] [TR] [TD][/TD] [TD]You're absolutely right, just the TSH test is really not giving you the full picture. I would say I encounter patients all the time where a thyroid disorder has been missed for years. [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]Yeah. The role of testosterone? Can you expand on that for women? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Oh yes. Testosterone, it's very important in women. It plays a big role in sexual functioning as well as desire. Also it can impact, as I mentioned before, development of lean muscle mass and also energy levels. There's even newer research showing it plays a role in memory and cognitive functioning. The importance of testosterone in women really can't be overstated. [/TD] [/TR] [TR] [TD][/TD] [TD]I think traditionally we think of okay, testosterone's just a hormone for men and we really don't hear a lot about its role in women. As I just mentioned, it's so important for all of those reasons and again, I'll say when a woman is 40 her level of testosterone is half that when she was 20. With time we really see a decline in levels and that can have a big impact on a woman's sex drive, functioning, all the other areas I mentioned and really impact quality of life. We really do need to look at testosterone as well. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]A question for you with regard to testosterone because men, the way men administer and deal and have testosterone replacement therapy is different than women, right? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yes, absolutely. Women need such low doses of testosterone that typically the way providers replace it is just in very low daily doses, which is very similar to the way the body would naturally produce testosterone. We don't give them a once weekly injection. I definitely don't recommend pellet insertions. I don't know if you've heard of hormonal pellets. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Honestly I had a friend that did that and we were shocked because she was explaining to us what was going on and the pain that she was having from those. We were yeah ... Go ahead. Keep explaining. [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yes. Yeah, I just wanted to mention there are so many different ways to get testosterone, but a pellet in my opinion is not a great way to replace hormones in women. Especially if you think of it, there's a patient that's most likely naïve to hormone replacement therapy. They've never been on testosterone. You don't really know what dose is going to be ideal for them. Why would you surgically implant a hormone into a patient's body where you cannot decrease the dose, you cannot increase it without doing another surgical procedure? You can leave scar tissue at the implantation site. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Infection. [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, risk of infection, risk of scar tissue, fibrosis, even a pellet extruding. The other issues I saw with pellets, because I do have personal experience inserting pellets into patients, I hate to say it, in a former life years ago, when I worked in a family practice years ago they were really pushing pellets. I gave those to my patients. I did it maybe six months to a year and then just did not see very good outcomes because if you give them too much they have side effects. Well, what are you going to do? [/TD] [/TR] [TR] [TD][/TD] [TD]Just hang in there. It will be gone in about three or four months. Just stay strong. The other issue is we see peak levels at one month and patients may have too much and they may have side effects. Then you see basically a decline over the next three months. Then levels are low again before you reinsert. You get this significant peak and drop over time. It's not really balancing a woman's levels in a way that would resemble the way the body naturally produces testosterone. [/TD] [/TR] [TR] [TD][/TD] [TD]The way most prescribers are giving testosterone to women would be in low daily doses in the form of a topical cream is the most common that we're seeing. Basically you just put the cream on, usually once a day and it absorbs into the bloodstream that way. It doesn't involve an injection. The way we're able to do this is because we need such lower doses than men. A topical does work very well for women. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Right. How about the other hormones? How are those typically replaced? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Estrogen, if a woman needs estrogen and that would most likely be the last hormone she needs, but if she needs estrogen, that's also given in topical form. The reason we don't want to give pills of estrogen and testosterone is because that would pass through the GI tract. There is something called the first pass effect in the liver which is where actually the liver has to metabolize these hormones and it can decrease the availability of the hormones in the system and also put a little bit of strain on the liver over time. [/TD] [/TR] [TR] [TD][/TD] [TD]We don't want to give these hormones orally. Also giving estrogen as a pill can increase those risks of blood clot, heart attack and stroke. That's just a risk associated with oral estrogen. It can still be given if the provider really carefully analyzes a patient's risk for cardiovascular disease, but just in general transdermal or topical forms are safer. Estrogen, testosterone are usually always given transdermally through the skin. [/TD] [/TR] [TR] [TD][/TD] [TD]Then thyroid is actually given orally. It's given by mouth usually in the morning on an empty stomach. You have to make sure to separate it from any other supplements, any food, anything by at least 30 minutes to an hour or absorption can be significantly reduced. That's one thing to know about thyroid. It works very well taken orally but you have to be careful not to take it with any other supplements or food or anything. [/TD] [/TR] [TR] [TD][/TD] [TD]Now progesterone can either be given as a topical cream or orally, by mouth. That one is safe to take by mouth. If you use progesterone topically you really don't see the full benefits in terms of help with sleep and stabilizing mood as if you take it orally. Most providers would recommend an oral form of progesterone, especially if there's any underlying issues with sleep disturbance or mood instability. [/TD] [/TR] [TR] [TD][/TD] [TD]You can see there's a lot of different ways of taking the hormones just based on which hormone we're talking about. Unfortunately we can't just put them all in a pill and just take it once a day. That would just be too easy. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]It's always got to be more complicated for the women, right? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah. One thing I do, if a woman needs both testosterone and estrogen, once she's balanced on both hormones I can actually combine them into one cream so she's not having to apply two creams and these different things. You can combine it once they're stabilized on the doses of each one. [/TD] [/TR] [TR] [TD]Nelson:[/TD] [TD]I'm sorry. These creams come from where? Are they from my Walgreen's, CVS or made by compounding? Are they special? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yeah, that's a great question. All of the hormones that I've been mentioning, I usually will send those prescriptions to a compounding pharmacy. They're a very important partner for a provider like myself who really specializes in hormone replacement therapy. We can't just use a Walgreen's or a CVS because they have very standardized doses and standard medications that they carry on the shelf. If your patient needs a specific dose or a different amount of application, they're not flexible with their formulas. [/TD] [/TR] [TR] [TD][/TD] [TD]A compounding pharmacy, they can actually make any I would say prescription that a provider needs for their patient in any dose. When I write a prescription for Monica Diaz let's say, basically they are going to make this prescription fresh for her right when they receive the prescription. It's not something that's been sitting on the shelf for a year that every other patient is on. [/TD] [/TR] [TR] [TD][/TD] [TD]It really can be customized to the individual patient and compounding pharmacies are able to do that for us. It's really just a, I'd say a powerful partner that we have to give our patients the individualized care that they need, because everyone's body is different. There's not one standard dose that works for everyone, so a compounding pharmacy is definitely the way to go when you're dealing with hormone therapy. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Yup, VIP service, right? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Yup, exactly. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Exactly. Out of curiosity, in speaking with how these hormones are delivered and how we deal with them, as far as side effects, are there any side effects that people should know about or pay attention to when they're dealing with hormone replacement therapy? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]That's a very good question. That's part of my initial consultation when I make a recommendation to a patient about which particular hormones I'm prescribing. With any medication there are potential side effects. In the case of hormone replacement therapy I would say side effects are usually more dose dependent. [/TD] [/TR] [TR] [TD][/TD] [TD]If a patient is on let's say too high of a dose of a particular hormone, or they're not balanced right, they could see some side effects. I'll just mention a few of the big ones. With testosterone women can notice a little bit of acne, increase in hair growth if they're on too high of a dose. Obviously I like to educate patients about this, so if they have these issues they tell me. We can decrease their dose and the side effects go away. [/TD] [/TR] [TR] [TD][/TD] [TD]Now with thyroid if you're on too high of a dose, this is not very common, but they could have issues with an increase in heart rate, a little bit of heart palpitations. They could have a little tremor, trouble sleeping if they're just on too much thyroid hormone, especially because the type of thyroid that we prescribe typically has T3 which is the active form of thyroid in it. If it's a little too high they may have some of those issues. Decreasing the dose should resolve it. [/TD] [/TR] [TR] [TD][/TD] [TD]Then estrogen, I would say in general we're very careful with the amount of estrogen we give to women. Like I mentioned, typically we would replace progesterone first, testosterone and a portion of testosterone will actually convert over to estradiol or estrogen. We're finding we can use lower doses of estrogen than we have in the past and women are still noticing great results in terms of resolution of their symptoms of low testosterone and also improvement in their symptoms due to low estrogen. [/TD] [/TR] [TR] [TD][/TD] [TD]If a woman is on too much estrogen there would be concerned that she would have over-stimulation of her breast tissue or her uterine lining. That could cause issues with breakthrough bleeding and spotting. A postmenopausal woman, her period's done, we don't necessarily want to bring that back. [inaudible 32:29], so ... [/TD] [/TR] [TR] [TD][/TD] [TD][/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Right, so those are just some of the potential side effects that I would go through with a patient at their consultation, make sure they're aware of them and again, that they know it's usually dose dependent. It could mean they're on too much. Backing off on the dose they will resolve. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]How about emotionally? Are there any symptoms that someone should pay attention to with respect to their emotions? About what's going on with them? Anything like that? Would they be more sad, more in depressed states? Anything that we should know about in that regard? [/TD] [/TR] [TR] [TD]Allison :[/TD] [TD]Well, in terms of emotional changes I would say typically progesterone would stabilize and improve someone's mood, so they may notice that, they just feel a little more calm, a little more mood has been stabilized. It also improves the PMS type symptoms, moodiness, irritability. With thyroid, it can actually improve mood and depression, so you'd see a benefit there. [/TD] [/TR] [TR] [TD][/TD] [TD]With testosterone, if you're on much too high of a dose, just like with men, a woman could feel like she's becoming possibly a little irritable or possible aggressiveness if it's much too high of a dose, but usually she would have those other symptoms first, like a little acne and we'd decrease it. It shouldn't necessarily affect mood. Usually I would say we see more positives in terms of mood changes, which is a real benefit of therapy. [/TD] [/TR] [TR] [TD]Monica:[/TD] [TD]Right. Awesome. [/TD] [/TR] [TR] [TD][/TD] [TD][/TD] [/TR] [/TABLE] [/QUOTE]
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HRT in Women
Webinar Video and Transcript: Latest Advances in HRT for Women
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