Webinar Video and Transcript: Latest Advances in HRT for Women

[Nelson Vergel]

Allison Woodworth, RN, MSN, FNP-C, Clinical Director of PrimeBody.com 's clinic network, has extensive training and experience in the field of Age Management Medicine. Her areas of expertise include bio-identical hormone replacement therapy and medical facial aesthetics.

Some of the talking points:

__Which Hormones are Important to Test in Women
__Why are Synthetic Hormones no Longer Recommended
__At what age do most women need to consider hormonal testing and what are the symptoms of a hormonal imbalance or deficiency?
__How are hormones replaced?
__What changes do women notice after starting hormone replacement therapy?
__Questions about thyroid hormone replacement.
__Women and Testosterone-What are the Latest Understandings and Recommendations

 

[Nelson Vergel]

WEBINAR TRANSCRIPTION- PART 1

Jay:	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.
Jay:	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.
Allison :	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.
	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.
	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.
Monica:	Perfect. That's exciting because now you get to help people be the best version of themselves rather than focusing on the disease, right?
Allison :	Exactly. Yes.
Monica:	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 ...
Jay:	Yup, I'll introduce.
Monica:	Jay's going to go ahead and explain that.
Jay:	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?
Nelson:	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?
Allison :	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.
Monica:	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?
Allison :	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.
	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.
	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.
	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.
Monica:	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?
Allison :	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.
	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.
Monica:	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?
Allison :	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.
	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.
	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.
	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.
Monica:	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?
Nelson:	Let me ask a question real quick if I can.
Monica:	Sure.
Nelson:	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.
Allison :	Yeah, wow Nelson. How much time do we have? (laughter)
Nelson:	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?
Allison :	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.
	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.
	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.
	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.
	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.
	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.
	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.
	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.
	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.
	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.
Jay:	Allison, it's Jay. Real quick let me just ...
Allison :	Sure.
Jay:	How are you?
Monica:	It's not Monica. The voice is a little rough.
Jay:	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.
	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?
Allison :	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.
	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.
	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.
Jay:	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?
Allison :	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.
Nelson:	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?
Allison :	Oh, that's a good point.
Nelson:	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.
	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?
Allison :	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.
	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.
	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?
	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.
	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.
Nelson:	Yeah. The role of testosterone? Can you expand on that for women?
Allison :	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.
	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.
Monica:	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?
Allison :	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.
Monica:	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.
Allison :	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.
Monica:	Infection.
Allison :	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?
	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.
	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.
Monica:	Right. How about the other hormones? How are those typically replaced?
Allison :	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.
	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.
	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.
	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.
	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.
Monica:	It's always got to be more complicated for the women, right?
Allison :	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.
Nelson:	I'm sorry. These creams come from where? Are they from my Walgreen's, CVS or made by compounding? Are they special?
Allison :	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.
	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.
	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.
Monica:	Yup, VIP service, right?
Allison :	Yup, exactly.
Monica:	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?
Allison :	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.
	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.
	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.
	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.
	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 ...
Allison :	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.
Monica:	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?
Allison :	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.
	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.
Monica:	Right. Awesome.

 

[Nelson Vergel]

WEBINAR TRANSCRIPTION: PART 2

Nelson:	Allison, how about the pregnancy category X issue? We were discussing that back a few weeks ago.
Allison :	Yes, so that's a great point to bring up. With testosterone, it is considered to be pregnancy category X. That just means that if a woman, if she's on hormone replacement therapy and were to become pregnant, she would definitely know that there is risk of causing fetal harm. Before a provider would give a woman testosterone they need to be talking about okay, what is your reliable form of birth control? Have you had a tubal ligation or do you have an IUD in place?
	Hopefully it would be a form of birth control that doesn't involve synthetic hormones like oral contraceptives, but that is a discussion that needs to be held between the patient and provider because you would not want to start testosterone if you're a pre-menopausal woman and not on birth control because there would be real concern there.
Monica:	Now one thing I wanted to ask as well which it peaked my interest because Nelson posted an article about how people starting hormone replacement therapy and making changes to their diet and how diet plays an impact on hormone replacement therapy. Can you elaborate a little bit on that? Because sometimes what happens, what I've noticed with women is we have our habits.
	We're accustomed to eating emotionally or whatever this is. When we get hormone replacement therapy sometimes we tend to think oh, well this is going to fix that. I'm not losing weight or whatever it is. What kind of a conversation would you have with a woman with respect to their diet, their lifestyle choices and working together with hormone replacement therapy so we can benefit the most from it?
Allison :	Yeah, that's a great question as well. It's so true, there's not just one magic pill or cream that's going to solve all of our problems. I have a lot of women who come to me and weight is a big concern of theirs. That's oftentimes one of the main reasons they're coming in. Just balancing hormones is one really important step, but the lifestyle absolutely has to go along with that, like you said.
	Regular exercise is very important. The mixture of not just cardio training, but also weight training to build lean muscle mass is important. I think a lot of women have the misconception that more cardio and running is better for you.
Monica:	Cardio queens.
Allison :	What's that?
Monica:	Cardio queens.
Allison :	Yeah, I was the same way when I was younger. All I would do, I would run and run and run and I would run half marathons. That's all I would do. I never lifted a weight. Then I did some reading and I realized oh no, women, we actually should be doing some weight training as well. We want to develop that lean muscle mass.
	When I say lean muscle mass, that's the key point there, you're not going to look bulky and big and huge. You're just going to develop that nice lean muscle mass. It's going to actually increase the amount of calories you burn, your basil metabolic rate just sitting there because you have more muscle as opposed to fat.
	Building lean muscle mass is very important. You can keep that toned look and also build that muscle mass without having to have that concern. A little cardio is good, but then also you want to do some weight training. Then in terms of diet, I would say if I had to mention some just basic recommendations, something along the lines I would say of a Mediterranean type diet would be a good recommendation. That's basically just plant-based diet, fresh fruits and vegetables, legumes, nuts, whole grains, fish, olive oil. Occasionally I would say chicken, eggs. You want to have a good amount of protein but then rarely red meat.
	Following that diet it actually was found that it reduces the risk of heart disease by up to 47% over a 10 year period. That was actually a study published in the American College of Cardiology in 2015. Just saying that, if I'm going to make some basic recommendations, I would say fresh fruits and vegetables, lean meats, like chicken, turkey, fish. Rarely red meat. Then just making those simple changes can actually reduce your risk of heart disease by almost half, which is incredible.
Monica:	Right.
Nelson:	Breakfast is very important and I know women are rushing with their kids and ...
Monica:	Yeah. The other thing that I've heard time and time again from other women is many women believe that after you have children it's very difficult to obtain a great physique or to be in your optimal shape because having kids just ruins your body. Is there anything that you can say with respect to that? Then maybe even with hormone replacement therapy, how putting that altogether ... Honestly what I've noticed is I'm in better shape now than even before I had kids.
	Of course I have excess skin in some areas and some other issues, but I honestly feel better and I feel like I look better than before I had kids. Is there something that you can let people, let other women know about that, about having kids and it not being the end all, be all?
Allison :	Yeah, that's a great point because I think after having children a lot of women sort of shift their focus as you need to. You're a caretaker now. You have a child as your main concern, but you cannot neglect yourself and your own health. Even though yes, you are the caretaker, you're a mother, your children are your top priority, you can't lose sight of your own health and wellness because you have to take care of yourself if you're going to be there for your children.
	That's a good point. Don't just think okay, everything's over. I've had a kid. It's the end of the world. I'm fighting a losing battle here. No. Just know that your health is important. You need to take time to actually exercise. Take the time to make healthier choices. It's not just everything's I would say too late if you've had kids. That's a very important time. I didn't know you before you had children, but you do look amazing. You look great. You're a good example of that. It doesn't have to be over. You're just starting.
Monica:	Exactly, especially if you pay attention. I think the great part about this whole show is that it's more or less the individual knowing their own body and paying attention to what's going on. Many times we'll go through our days and we just react, we just live. We live off of default. Things are happening and then we react. Things are happening and we react.
	If you go to someone like yourself and you're like okay, wait a second. I want to make sure that I know what's going on with my body. Help me be the best that I can possibly be. That's what this is basically about. Hormone replacement therapy is just making sure that we're living optimally, right?
Allison :	Yeah, absolutely. It's just bringing your hormones into upper end of a normal range to an optimal range so your body can just function at its best. That's I think the simplest way I can think to explain it. We're not trying to give you super physiological doses or hormones. We're not trying to turn people into the Incredible Hulk or change their anatomy. It's just we want to give them an optimal level of hormones so the body can just function at its best in conjunction of course with diet and exercise lifestyle changes. People are just at their healthiest and they have a good quality of life.
Monica:	Right. When my mom was alive one thing that I remember her saying time and time again was, and I would love to hear your input on this, and I know a lot of people think this way, is oh no, I want to do this naturally. I don't want to take anything. What would you say to somebody like that who's thinking that they want to stay natural, especially living in the environment that we currently live in?
Allison :	Yeah, and that's difficult because there are a lot of things in even our environment now that can disrupt our hormones. I tell patients even if you try to avoid oh, I was going to say drinking out of plastic water bottles.
Monica:	Hormone disruptors.
Allison :	You try to avoid these endocrine disruptors and the CDC has published reports that there truly are endocrine disruptors in our environment, plastic water bottles, PCAs, especially heating things up in a microwave in plastic containers. There's even ...
Allison :	Yeah, it's true, you want to do everything you can, but we cannot live in a cave. We can't isolate ourselves from the environment. Like I was saying, the CDC has even published reports that there are endocrine disruptors even in our air and in our water. It's not like we can isolate ourselves and avoid hormonal imbalance just living in the society that we live in now.
	I would say you want to do your best to do it naturally, but then also just replacing hormones in a very physiologic way which matches very similarly the way your body naturally produces them and just replacing these hormones that would already be present to levels where they should be if the body was making an optimal amount. It's not like we're doing anything that is I would say not physiologic. It's just restoring these hormone levels to their optimal range so you can do your part avoiding the environmental exposures, living a healthy lifestyle, exercising, diet so it can all work for you.
	Like I mentioned before, if hormones are out of balance, it can be very difficult to maintain an ideal weight, to lose fat, build lean muscle mass. It's almost like you're doing all you can but it's like fighting a losing battle because internally you don't have that hormonal balance to really see the benefit from what you're doing.
Monica:	Right, which is why we have a lot of women, especially as they age, I remember Jay and I having a conversation about this as well, I believe this is as the result of a thyroid, many women as they age the thyroid malfunctions and they'll do all these training, these workout regimens and they don't see any results because their thyroid is not functioning, right?
Allison :	Right. It can be thyroid, yeah. Of course I look at testosterone too. There's a whole lot you can look at but thyroid is a big one, testosterone is a big one. Making sure there's a good balance of estrogen and progesterone, that a woman is not estrogen dominant.
Monica:	Right. Go ahead.
Nelson:	Any suggestions on supplements, Allison for women?
Allison :	Sure. Yeah, so I feel very strongly that if we're going to be recommending supplements we should actually test levels and see what a patient is deficient in. In my personal clinic I do a test called, it's a SpectraCell Micronutrient test. I don't know if you've heard of it, but it's actually testing for intracellular micronutrient deficiencies. It tests over 35 micronutrients. It's looking at vitamins, minerals, aminoacids, fatty acids, antioxidants. It gives you an antioxidant function score, even an immune system score. It's looking at inside of the white blood cells. It's intracellular. It's a lot more accurate than just doing a one time serum test.
	If someone is asking me about supplements, and I've had patients come in, they had a table full of supplements. I'm like okay, how did you know you needed all of those? Number one. It's probably pretty expensive to be buying all of those. Also, have you been tested to make sure that you're absorbing them and that you're on the right doses?
	I would say going into just High Health or GNC and picking up supplements, are they going to be harmful? No. Are they going to be containing active ingredients? Are they tested for purity and potency and are you going to absorb it and is it actually going to translate into absorption and get intracellularly? That would be a different question.
	In a patient like that I would say well, let's just test your SpectraCell Micronutrient test and just see where you're at. Oftentimes they're still deficient in so many areas that they're shocked because they thought that they were taking every supplement to address this. I think with recommending we need to have accurate testing. That's just the one that I use in my clinic which I found to be very helpful. It gives patients a detailed breakdown of are they borderline, are they deficient, are they adequate in each of the nutrients?
	It will even make recommendations on dietary changes that can give them more of those nutrient and even supplement dosing protocols for patients if they're deficient. Then after four to six months you retest and you can see where those levels are to make sure everything is optimal. It's very similar to prescribing hormones. I wouldn't just have a patient come in and say okay, well based on your symptoms here's what I recommend. I would need to see blood work to back up that recommendation. Then that way you can retest and see are you absorbing and what was your actual response to therapy. Of course taking symptoms into account on hormonal side, but supplements, I think testing is just cannot be overstated the importance of that.
Monica:	Right. That's awesome. Now I have a question with respect to your clinic opposed to say somebody's provider. What is the difference and is it something that you would recommend going to someone who specializes more like your clinic versus their primary care physician? Because from my experience the primary care physician that we go to doesn't know anything about hormone replacement therapy. What's your insight on that?
Allison :	Yeah, I would say that every provider is going to be different and just like you, I've found oftentimes a primary care provider just doesn't have a lot of detailed training outside of just traditional western medicine like synthetic hormones and the Women's Health Initiative Study, we shouldn't be on hormones and that's about it.
	They're good with birth control, synthetic hormones. In terms of knowing about how to prescribe more physiologic hormones through compounding pharmacies, that takes a lot of extra training. It's not something that we're even taught in school. Even myself, I'd always been curious about it, but wasn't taught anything about it at all.
	After graduating I realized there's a big need for it so I had to do continuing education just to learn how to work with these hormones. Even an endocrinologist, they are typically thought of as a hormone specialist, but oftentimes even with thyroid they're still just testing TSH total, T4, they're only prescribing synthetic T4 which is Levothyroxine.
	A lot of times patients aren't converting to T3. They don't check it. Every provider is unique, but I would say you really would want to go to someone who has training in the more physiologic forms of hormone replacement and who also has experience working with compounding pharmacies because you can send any dose, any prescription you want to them. They will make it. It can be a little overwhelming for a new provider to get into this field if they don't have the training and experience because it's all on you.
	It's not there's a standard dose at Walgreen's. Go pick it up tomorrow. No, you're the one making the call. It takes time. It takes training and I've been doing it for six years now and I'm still learning all the time. That's the exciting thing about this field is it's sort of a journey. It's a process. The more you learn, like I mentioned before, the more you can help yourself and help others. It's something I'm really passionate about.
	A lot of it actually came from my own mom. I don't know if I've told you guys this, but my mom had low thyroid. She actually struggled with the classic symptoms of low thyroid for like over a decade. I remember this when I was a child. She was tired. She was always sleeping. She was gaining weight. Her hair's falling out. She's constipated. She's even depressed. All the classic symptoms of low thyroid.
	All of her doctors would say, "Your thyroid's normal. You're on Levothyroxine. It's working well. Your TSH and your total T4 are fine. It's not your thyroid." They would just not, they didn't know what other tests to do. They didn't know how to help her. They just said, "We don't want to discuss it. It's not your thyroid. Just don't even ... We're not addressing it."
	This was in the Valley. This was in Arizona. She went to probably 10 different doctors, endocrinologists, specialists, naturopaths. No one was able to help her. Finally she encountered a provider who was trained in hormone replacement therapy. Checked the free T3 level and found she wasn't converting that T4 over to T3. They switched her to a natural desiccated thyroid. It was actual armor thyroid and within I would say the first about month, month and a half, all of her symptoms started resolving. Once her hormones were fully balanced she was fine.
	She had to suffer with these issues for over a decade. I think me just having seen her go through that and her telling me how much she suffered and how she feels it was a life changing difference, it's almost like I was meant to go into this field just because her having gone through that. I don't want patients to have to deal with that. That's why I think it's important just, it's great there are webinars like this. There's so much information on the internet now where patients can almost educate themselves and be more proactive and ask these tough questions to their providers.
	If they're not willing to check free T3 or even consider a natural desiccated thyroid you really oftentimes have to be your own advocate at this point and find someone who has the right training or else you're just going to suffer and not have a good quality of life.
Monica:	No, absolutely. Absolutely. Out of curiosity, what is the cost of going to a clinic like yourself there? What is the usual investment for someone?
Allison :	With Prime Body we actually do an initial consultation for free. It's complimentary. Just so that we can talk with the patient to determine if they're a candidate, can we help them at all. The initial consultation is complimentary. The blood panel, we typically send patients to Lab Corps and the cost of the full hormonal panel for women is around $78.
	It's under $80. Then after that, once we come up with the program it's basically, at least the way our clinic does it, it's a monthly subscription-based fee. Each month it's covering your office visits, any patient management, all the prescription medication, shipping to your home of office. You kind of know each month this is going to be the price that covers everything. You don't have to worry am I going to get charged again for my office visit next month? How much are the prescriptions going to cost next month? You know it's a set price.
	It just ranges based on how many hormones a patient needs. Starting out is around $150 a month. That would be for one hormone then up through around a couple hundred dollars a month just depending on how many hormones a patient needs. That would be whatever dose is appropriate for the patient. You don't have to worry if we're changing the doses over time is the cost going to change. It doesn't.
	At least that's the way our clinic deals with it. That's also because we really don't do any billing of insurance at all. Only because it's considered more preventative, wellness service. I tend to always say we don't really have healthcare or health insurance. We more have sick care, disease care.
Monica:	Exactly.
Allison :	Yeah, if you're sick and you're diseased then you go to the doctor, you can get your prescription, that's covered. If you're doing this to be more preventative and wellness-oriented, typically insurance wouldn't reimburse for it so we don't do any insurance billing. I have some patients using their Flex Spending Accounts or HSA account. That's sort of pre-taxed money that can help with some of the cost.
Monica:	I'm sorry. Is it where people have to go in physically and visit your clinic or is it tele-medicine?
Allison :	We do require an initial face-to-face visit with one of our providers. We're in multiple cities throughout the country, so most likely we'll be in the state that a patient lives in. If not, Prime Body does provide travel reimbursement for that face-to-face visit, but at least a face-to-face visit once a year would be required. The followups could be through tele-medicine. Only because we're dealing with a controlled substance in most cases, testosterone. We just feel that we should establish that face-to-face relationship.
Jay:	You don't have to answer this, but why is testosterone a controlled substance again? Okay, hold on. We actually have a really good question here. I just want to read it to you. It says do you suggest a certain blood test for women such as Nelson's company DiscountedLabs.com the female anti-aging blood test or should you test independently and separately for estrogen, progesterone, testosterone and thyroid?
Allison :	Nelson, if you know what's on your panel I could tell you if that's everything. Or I could just let you know which labs.
Nelson:	It's pretty much that. It's pretty much what you said. Progesterone, estrogen, testosterone, which one am I missing? Free 3T and TSH.
Allison :	Perfect. Yeah, so that's exactly what I would recommend. If you want a little more specifics, like definitely you'd want estradiol would be the dominant form of estrogen you want to check. Progesterone, the test is just called progesterone. Testosterone, I do like to look at free testosterone levels in particular. Most of the time probably on your panel you'll see free and total, but it's almost more important diagnostically to look at the free testosterone because sex hormone binding globulin is actually oftentimes a lot higher in women, especially on oral contraceptive pulls it's very high. It binds up a large portion of that total testosterone.
	Looking at the free gives you a better picture of what's actually available for the body to use. Then thyroid, I do like to look at TSH initially, not that I obsess over that when I'm treating a patient, but a TSH and definitely said free T3 is very important. You can even add on thyroid antibodies. You don't have to do that, but if there's a family history of Hashimoto's or you want to know exactly what's the cause, antibodies can be added on.
	Those would be the main ones. Then like I mentioned in the beginning, if you really want to take a look at the full hormonal cascade and even adrenal functioning you could add on tests like DHEA pregnenolone, cortisol. I know pregnenolone can be pretty expensive, but if you really want that full picture you could include all of those. The basics like Nelson mentioned, estrogen, progesterone, testosterone free and total and then the thyroid including the free T3.
Jay:	Go ahead Nelson. Go ahead.
Nelson:	We have a few minutes. Do you want to expand on cortisol or is that ... Cortisol is so controversial on testing and treatment, Allison. Or is that something ...
Allison :	I would say maybe that's something for another webinar. Even talking about thyroid with all this, that could be a whole webinar by itself, you know?
Nelson:	Yeah.
Jay:	I think it's a great idea, Nelson. By the way, Allison you've been phenomenal on this show. The information that's been coming out, I'm kind of blown away. That actually speak to my question, I know we're coming up on 5:00, so before I ask my question we've got about seven or eight people it looks like coming on and off watching this based on Google. If you guys have any questions please type in the group chat, any other questions for Allison before we end this.
	We're probably going to be on for another five or six minutes. My question is there's so many different hormones, obviously men and women are very similar, but for men it's usually a management of testosterone, estrogen and the process that it entails. Yes, we are looking at other hormones and yes, we are looking at other blood ranges and whatnot, but it seems like for women, and again, correct me if I'm wrong and then allow me to ask a deeper question, it seems like it's a lot harder to balance everything and get a woman dialed in from the perspective of let's say a woman comes to you, she's 40 years old. I'm giving you a hypothetical patient.
	She has never been on hormone replacement before and she wants to lose body fat. She most likely has, she's had two or three kids, she's most likely has a not optimal thyroid level or a dysfunctional thyroid level. How long on average would it take a woman to get "dialed in and balanced out" and have her hormones optimized if they work with say you or Prime Body? Then compare that to an average endocrinologist or general practitioner who's doing hormone optimization with women across let's say North America.
Allison :	Yeah, that's a great question. I always explain to my new patients in their consultation that balancing hormones is really, it's a process that we cannot rush. If I try to rush it and give them excessively high doses or I'm too aggressive because I want to see that end result tomorrow, they're going to end up having side effects, having issues and probably stopping therapy.
	I always just tell them you need to be committed to this, work with me. I'll work with you. We're going to start moderate doses. We're going to increase some based on your response and your lab results. It's definitely a process. I would say average, probably around three months. Some patients up to six months to get them perfectly dialed in. They're going to start seeing initial benefits for sure in the first month, but to get them perfectly dialed in I would tell them give it the full three to six months to get you perfectly balanced.
	Then you asked to compare it to other specialists like family practice or endocrinology. They may never get someone balanced. Looking at a three month process to someone that's never going to get you balanced, that's, you just really can't rush it. You can't be too aggressive with it. Every woman is different. Everyone responds differently.
	You just have to take it slow. You can always increase the dose with time. It's not a race. We're not in a rush. We have time, but most often women start seeing some noticeable benefits within the first oftentimes three to four weeks of starting. That's just encouraging to see some improvement and then just know it's going to keep getting better as we get closer and closer to her perfect balance.
	It changes over time too as a woman who transitions later in life and gets closer to menopause or past menopause, we're changing the doses, so it's not like you're going to be on the same dose for the rest of your life. Maybe if you're post-menopausal yes, but most women it's sort of like re-evaluate and make adjustments based on her body and how she is responding. Definitely cannot rush the process.
Jay:	Awesome, awesome. Great answer. Real quick, we're right up at 5:00. We haven't had any other questions come in. Nelson, if you have some questions that you want to get answered real quick.
Nelson:	Let's talk a little bit about logistics. This video obviously is being uploaded right now to YouTube. It will also be available on ExcelMale.com, PrimeBody.com and FabFitOver40.com
Jay:	Awesome. Yeah, so Allison, that's what I was going to say. Tell us a little bit about how people who will be eventually watching this video, I'll of course link to it, Nelson will link to it, but how can people work with you and Prime Body?
Allison :	Yeah, I would say the best way would be to check out our website. It's really easy to remember. It's PrimeBody.com. Then that will have our phone number and email so patients can get in touch with our administrative team. They'll definitely go through the administrative team and then they'll let them know, okay, where do you live? They'll let them know which provider is closest to them and then get them setup to get blood work done and their initial consult.
	Definitely going to the website would have all of that information on how to get in touch. The email is pretty easy too. It's just [email protected]. That's pretty easy to remember.
Jay:	Awesome. Then for a lot of the ladies that will be watching this too, you know Nelson started an awesome discussion group on ******** for women's hormonal replacement therapy and women's hormonal health. There's not enough women in that group. I don't know why we can't get more women to take advantage of it because there's some really strong thought leaders in there.
	We'll post a link to that. Is there Allison, any other books or resources? Obviously Nelson's site, Excel Male. I know he has some stuff in there about women's stuff, but is there any sites or books or resources that you would recommend that women check out?
Allison :	I'm actually on Nelson's ******** group as well and I try to as often as I can go in there and look at the questions. There's great articles posted there. There are also some videos that I've done about what we just covered and they're posted on Prime Body's website. Definitely going to the website you can see some videos and then Nelson's ******** page is great. I would say definitely start there. There's much more detailed videos about the things that we just covered. There's one all about testosterone in women. There's one about physiologic estrogen, progesterone, synthetic versus natural hormones. Those would be worth checking out as well and they're on the website.
Jay:	Awesome.
Nelson:	My ******** group is called Women's Health and HRT. Women's Health and HRT. You can find it by just typing that on the search box on top of the ******** page.
Monica:	I would encourage every woman out there, woman or man, to take responsibility for your own health. Seriously guys, if you don't take responsibility for it do not put it in the hands of a healthcare system because you'll just be a number. You will definitely, you'll regret it and you will wish that you took your health seriously because until you have sickness, you truly do not appreciate your great health.
	I've seen it firsthand, so please do what you can, do the research, know your body. Ask questions because when you ask questions you truly learn. That's why, you guys, Nelson is an amazing person. He has years of research involving all of this and he has a free ******** page out there to help people that people aren't even participating in. Wake up. Wake up.
Nelson:	I don't promote well, so most women are not aware it exists.
Jay:	No, that's definitely not true.
Monica:	No, I'm just saying people, wake the F up before you have to pay attention. That's it. I'm out.
Jay:	Okay. Listen, Allison, again, we really, really, truly appreciate you coming on this show. We're definitely going to have you back. I think that like you said the thyroid issue is paramount. Way too many women are suffering and not enough people are informed. Obviously you speak at an incredibly high level, so we'll set something up I'd say probably this summer. I'd like to have you back on again and we'll promote the living hell out of this hangout.
	Again, for everybody who's watching, we appreciate you guys watching. This will be live on Google or on YouTube and then we'll also post it on our blog which is FabFitOver40.com. Then Nelson, you have final words, but remember Nelson's site ExcelMale.com. There's tons of information and of course we encourage all the men out there and ladies too to buy both of our books because they're also very awesome resources on TRT and hormonal optimization.
Monica:	Amen.
Nelson:	Thank you Allison. You were great.
Allison :	Thank you.
Nelson:	There's a folder on Excel Male called Excel Female, so it's actually a part of Excel Male. I need to create one specifically for women, a whole website, but there is a section on Excel Male for females because a lot of the guys on my side are over 12,000 are getting on TRT, on testosterone replacement, feeling better and then obviously their women may or may not be interested in their higher sex drive. The conversation starts there.
	It's either one partner bringing the other one into this progressive, preventative field. That's what I see. Either the female, the woman gets it first. She feels better, she's losing weight. Then she talks to her partner and vice versa. That's why I think men and women should know about male and female health because we all obviously have partners that we can help change their lives. Thank you, Allison. Thank you, Monica. Thank you, Jay. Thank you everybody and look for our next hangout maybe in three weeks.
Jay:	Yeah, so we're going to have Shaun Noorian the owner of Empower Pharmacy to talk about the compounding business, the compounding pharmacy industry and upcoming changes. It's going to be a really power packed, information packed event. We're excited to have it, so more marketing on that very soon. Again, thanks everybody for coming out. I'm going to go ahead and stop the broadcast.
Monica:	Real quick, real quick. Nelson. Thank you for all you do. Allison, thank you so much. We appreciate it.
Jay:	Awesome. Okay guys.

 

[Nelson Vergel]

The role of hormone replacement therapy through menopause and beyond