Why You’re Aging Faster Than You Should—And How Hormones Can Fix It!
In this episode of Hormones, Metabolism, and You, Dr. Cassie Smith sits down with Dr. Beth McDougall, a pioneer in integrative and functional medicine, to discuss the profound impact of hormones on brain health, anxiety, depression, and longevity. They dive deep into how bioidentical hormone therapy (HRT) not only supports cognitive function but also reduces all-cause mortality and improves quality of life.
Dr. McDougall shares insights from the latest research on HRT, debunking myths about hormones causing cancer and highlighting their crucial role in aging well. They also discuss practical approaches to hormone balancing, the impact of testosterone and estrogen on muscle mass, and the importance of working with a provider who understands the nuances of hormone therapy.
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Blog/Transcription:
0:03 welcome back to this week’s episode of hormones metabolism and you I’m your host Dr Cassie Smith I am a functional
0:10 medicine endocrinologist this week I am discussing brain health and in
0:18 particularly how hormones affect anxiety and depression in mostly women but also
0:24 men with Dr Beth McDougall in this conversation we had a very interesting
0:31 discussion about hormones and how they are beneficial as you age I asked her
0:37 about our mortality with hormones and she explained how we actually have lower mortality rates when we use bioidentical
0:44 hormones how hormones are actually good for our brain as we age how HRT and
0:50 bioidentical hormone therapy allows you to age better and how hormones actually
0:57 do not cause cancer so we totally like we go through all the data around this
1:02 with hormone replacement therapy and cancer and we end by talking about different ways to supplement hormones so
1:08 there are lots of different ways and we talk about some of the things that you should be monitoring whenever you are
1:14 doing bioidentical hormones how you can monitor these symptoms and their metabolites again the different types of
1:21 HRT that you can use and we talked about again bringing all this back with
1:27 anxiety and depression and we talked about how women in particular have much
1:32 more anxiety depression symptoms like that when they do not have their hormones adequately balanced we also had
1:40 a discussion based around estrogen and testosterone in maintaining muscle mass and menopause so we talked about how
1:47 muscle mass and neurons have the most mitochondria of any cell in your body and how muscle mass is the currency of
1:53 longevity so as we age if we do not keep our muscle mass where it needs to be it will decrease our longevity and our
2:00 lifespan we do this through utilizing hormones correctly so I hope that you
2:07 enjoy this conversation that I had and today we have a special treat I have Dr
2:13 Beth McDougall and she’s going to help me explain to you guys further how
2:19 hormones do affect our mental health and change lots of things which can ultimately have us with have us having
2:27 more symptoms of anxiety depression brain Fog she has been around doing functional medicine kind of since it
2:34 began in 1998 and so she is internationally recognized she’s an integrated physician
2:40 with a specialty in multi-functional degenerative diseases she’s the co-founder and medical director of a
2:47 Cutting Edge bio optimizational facility gyen in mil Valley California she’s an
2:53 early early Pioneer in orthomolecular nutritional medicine and European biological medicine she was among the
3:00 first group of doctors to be trained in functional medicine in 1998 her training in biophysical Diagnostic and
3:07 therapeutic Tech techniques based on Quantum principles and her foundation in Internal Medicine Ern Beth the
3:14 reputation of a medical detective and allows her to creatively and allows her
3:20 to create highly specific personalized and effective treatment protocols for her patients she’s also the chief
3:26 medical officer of Kenobi which is a fund with five Health companies in its portfolio and the companies are around
3:34 energetic Diagnostic and healing Technologies she sets on The Advisory board for Energy Medicine University and
3:42 the scientific Advisory board for Resident uh Science Foundation and so
3:47 thank you so much for joining us on this episode we are excited to have you and
3:53 so I’m excited to talk about hormones with you can you just give everyone a little like brief brief I guess uh
4:01 insight into what you do every day so what is it like to be Dr Beth sure thanks Cassie um yeah well
4:10 I’ve been doing integrative medicine since 1998 and so I see a whole wide
4:16 range of patients but I I came right out of the gate uh after graduating from an
4:21 integrative Medicine Residency into a practice that was
4:27 really focused on bioidentical hormone balance ing so I was kind of immersed in that millu in 1998 and uh so I I got
4:37 many patients in the early days you know that were just mainly interested in bioidentical hormone balancing and so I
4:46 still do a lot of that today and then as it happens for a lot of Integrative doctors the longer I’ve been in practice
4:52 and the more that I’ve learned I’ve been able to handle more difficult things so I do see a lot of kind of multifactorial
4:59 illness and you know like lime and co- infections chronic fatigue syndrome I do
5:05 a lot of neurodegenerative diseases in cognitive decline and uh hormones play a
5:12 tremendous role with with all of those conditions but of course there are other factors as well you know whether it’s
5:18 infectious or toxins that need to be removed um but what I found is no matter
5:24 what I’m approaching be it you know just a menopause of woman or someone with an autoimmune disease or neuroen ative
5:30 process or cognitive decline balancing hormones is is the
5:37 foundation yeah I couldn’t agree more it’s so important and there’s you know a
5:42 lot of stigma around it there’s a lot of people who are still you know scared about hormones from a study from 2001 5:49 which wasn’t even you know published correctly and so I I think the last 25 5:55 years we’ve done women a huge disservice unfortunately and you know it’s people
6:00 like you and people like me who are trying to get this education fixed not
6:06 only for patients but also for providers and so I appreciate that and you’ve been fighting the good fight you know since
6:13 it began basically since before it began right um before 2001 so tell us I have
6:20 lots of questions for you about healthy aging and hormones and and I love that you have this stance but what do
6:26 hormones do for you as you age and how do they lead to longevity and vitality for both men and women and with that can
6:34 you also talk a little bit about like the mental health aspect for both men and women as far as you know hormone
6:41 therapy and anxiety depression things like that yeah absolutely well hormones
6:47 are so important for the brain they’re actually like estrad for example is is
6:53 like a neurotransmitter in the brain so so when the levels begin to decline it’s
7:00 very common for women to have anxiety and depression and also trouble with
7:06 memory and trouble with Clarity and of course trouble with sleep
7:12 as well as hot flashes and night sweats and all of that and then it’s such a
7:17 simple fix really to just kind of supplement Ester dial and you see all of these things kind of getting better but
7:24 unfortunately what often happens is like they’re diagnosed with depression or anxiety and put on SSRI drugs and and
7:32 they never work as well as just replenishing the hormones um for which
7:38 the deficiency was causing the symptoms in the first place so I see that with women I also see with men you know defic
7:46 the andropause which is not as abrupt as with a female but like a more gradual decline in testosterone over time leads
7:53 to a similar set of symptoms for men like they leads to to kind of diminish mental clarity kind of diminished
8:00 processing speed in the brain uh mood changes loss of confidence loss of like
8:06 kind of Mojo and all of that so replenishing testosterone in both men
8:11 and women can be really helpful for mental health as well and then I see both of you know sex steroids in both
8:18 men and women playing such a profound effect on the rate of Aging so for
8:26 example interesting research has come out recently that estrogen is very
8:32 important for women to maintain muscle mass as they age and we know
8:38 testosterone is important for women as well in that regard and very important for men but estrogen the recent research
8:44 on how how replenishing estrogen in menopause can help maintain muscle mass
8:51 is so important because you know it’s been said that muscle mass is the currency of longevity and that’s
8:58 partially because because muscle muscle cells and neurons are two of the cell
9:04 types in the body that have the most mitochondria and the mitochondria are those little intracellular organel as
9:11 you know Cassie that produce energy and as ATP is the currency of the body and
9:19 if we have muscle loss of muscle mass and loss of muscle cell Health as we age
9:27 the our ability to generate energy goes way down and that H that impacts those
9:34 kind of like high energetically demanding cells most of all you know the brain and the muscles so so if you can
9:44 maintain healthy steroid hormone levels as you age you’re going to have better
9:49 brain health better better muscular mass and a better a better mitochondrial Health overall and you know very much we
9:57 age because our MIT Andria become dysfunctional over time our mitochondria
10:02 don’t become dysfunctional because we age it’s more the other way around that we age when our mitochondria become less
10:10 Adept at producing energy or we have fewer mitochondria to do
10:16 that yeah no I completely agree and so we have to be cognitive of that and
10:22 we have to make sure we’re feeding our body fueling our body with the things that they need but also making sure that
10:28 we have hormones so that we don’t age excessively quickly so can you address
10:34 the newest research on hormone use in all cause mortality kind of you know talking about that you know we still
10:41 have this whole generation of patients and doctors who say like you know hormones cause cancer you absolutely
10:47 shouldn’t be on them I know that the research doesn’t say that but do you want to do you want to talk to us about
10:53 that yeah absolutely you know by the way like you you you were saying back in 200 10:59 one yeah that that that that the data that came out of the Women’s Health Initiative study was kind of
11:06 misquoted it was really sensationalized by the the news media and they were
11:11 really focused on uh relative risk as opposed to Absolute risk and I feel like
11:18 doctors and patients alike were you know kind of duped and scared off of hormones
11:23 and because i’ had already been doing a lot of bioidentical hormone balancing for a few years before that I had so
11:29 many patients kind of get off their hormones uh because they were scared by that the news media and then and by
11:37 their other doctors and then they kind of came crawling back in you know to say okay now my life’s ruined what do I do
11:44 and I was like you can still take harmones and you I would always try to explain like the like it the absolute
11:50 risk was like eight divided by 10,000 in terms of an increased risk for breast cancer it wasn’t even 1% increase in
11:57 risk and then I was like and no one’s paying paying attention to the arm of the study where it was estrogen only and
12:03 they actually had a diminished risk of breast cancer compared to the the
12:08 placebo arm of the study so people weren’t paying attention to that at all but anyway so I’ve been helping women
12:15 you know kind of get back on hormones and I would say the only Silver Lining that came from that was that we were
12:20 able to kind of I was able to find that
12:26 I could help women feel just as good with slightly lower levels of hormone
12:33 supplementation as they did before with much higher levels you know so so it was like people were scared so they wanted
12:39 to take as little as possible and then we found like kind of the threshold of like we can usually ameliorate most
12:45 postmenopausal symptoms as well as help people have a really good quality of life with less than we thought we needed
12:51 um so take fast forward to today finally there’s been some really good research
12:57 that’s come out and and I was so impressed by the 10 million women study
13:05 that was um that came out uh by the Journal of the menopause Society in May
13:10 of 2024 did you see that did you see that study yeah so yes they saw they looked at the
13:20 the health data for for 13 years of women that were over age
13:27 65 on estrogen of of various
13:32 types and either natural progesterone or synthetic progestin versus not so 10 13:38 million women follow for 13 years over age
13:43 65 and they found a 19% reduction in all cause mortality in the treated group
13:49 versus not but but then there were some surprising kind of myth shattering
13:56 data they found a they found a 16% reduction in breast cancer
14:01 mortality 133% reduction in lung cancer mortality uh 12% reduction in chaal
14:09 cancer mortality uh 11% reduction in heart
14:15 attacks 2% reduction in cognitive decline and then with progestin they
14:22 found a 45% reduction in endometrial cancer and a 12% reduction no it’s like
14:29 I think it was like 20 21% reduction in in ovarian cancer so this was in the treatment
14:35 group versus not and so it shattered the myth that you know that hormons have a increased
14:43 risk of breast cancer um and it shattered the myth that they were only
14:48 sa to take for five years if at all you know and I’ve been saying that for so
14:54 long I’ve been saying like well why is it safe to take them for
15:00 five years and then not after five years like show me the data that says that
15:05 there’s like this cut off point and uh this finally was like a drop the mic
15:11 moment so that was exciting yeah because what I find in my patients and and maybe
15:17 you do as well is that if you do have these women that you get on really good hormone you know therapy and their
15:24 symptoms are mitigated and they’re living life amazing what what I have
15:30 found recently is you know maybe they get a develop they develop breast cancer you know God forbid they do it wasn’t
15:37 because of the hormones you know they got breast cancer um and then somebody
15:43 Yanks them off of their hormones and they lose their minds you know like they feel awful and so and that’s unfortunate
15:51 and then they’re told like oh you can never go back on hormones or I have you know other patients that are on hormones
15:57 and you know they approach they approach 65 they go to their primary care doctor their primary care doctor says to them
16:03 oh your endocrinologist is trying to kill you you need to come off of those hormones and they’ve seen that primary
16:09 care doctor for 40 years and so they tell me you know I’ve seen him forever so I’m going to stop him and not that I
16:15 don’t believe you it’s just that I believe him and then they stop him and then a year later they’re like their blood pressure is high their cholesterol
16:21 is high they can’t remember anything they’re gaining weight you know they’re miserable and it’s just like but but
16:26 then they go back on the hormones to your point and they feel better and I have a ton of women that have been on
16:33 hormones for you know decades that I’ve you know because of the way that I practice and the way that I preach and
16:40 what I put on social media have found me because other doctors will not give them hormones because they’re 65 70 75 and
16:46 they do amazing you know like I’ve got some of the healthiest yeah some of the healthiest
16:53 age too you can just see this kind of like like departing graph like you watch
16:59 people and because I’ve been practicing long enough now I I’ve watched a lot of people age and those that stay on
17:06 hormones tend to age at a much slower rate their reflex their reflexes are
17:11 faster their their brain is quicker their memory is better their their
17:17 muscle mass is is better their energy is better they’re sleeping better they’re more active they’re they’re kind of living the lives that they’ve been used
17:23 to living whereas those that stop just it’s it’s kind of like a slow slow
17:29 downhill trajectory yeah yeah and so I think that this study that came out you know is is
17:36 wonderful looking at all CA mortality and showing that actually no you have a decreased risk of all CA mortality and I
17:43 think a lot of that I mean you can speak to this I think a lot of that is tied to the fact that when you lose hormones you
17:48 develop a lot of inflammation and when you develop a lot of inflammation you develop insulin resistance to your point
17:54 you stop sleeping you have inflammation in your brain I mean there’s so many things that hormones effect and you know
18:02 when you make sure that somebody has those levels and those levels are replaced it’s just your body works in a
18:08 symphony so much better with those hormones yeah absolutely absolutely and
18:14 you were bring up the point of like people that develop uh cancer while on hormones I think it was about 2008 can’t
18:22 remember the authors of the study but they looked at women who develop breast cancer while on on estrogen versus women
18:30 that develop breast cancer not on estrogen and and it turned out that
18:37 those that were on estrogen the cancer was typically of a lower grade and less likely to have
18:43 metastasized uh than those that develop cancer not on hormones and I think it it kind of speaks to this idea that that
18:50 the the hormones create a kind of a milu
18:55 that that caused the cells to to function a behave a little more normally
19:01 as as opposed to completely disregulated so that was an interesting
19:08 study and it went and I think now combining kind of all of these data together it doesn’t we’re not seeing an
19:14 increased risk in developing a cancer from taking the hormones and potentially if you develop a cancer you’re going to
19:21 have an easier time getting rid of it because it’ll be of a lower grade yeah there’s actually been studies
19:28 too that that have shown that if you take women who have had breast cancer and then you follow them after breast
19:34 cancer treatment and you look at women who don’t go back on hormones versus women who actually do go back on hormones all cause mortality is lower
19:42 and recurrent risk of cancer was actually lower in women that go back on hormones after breast cancer
19:48 so that’s pretty interesting too and it makes sense right because if your brain is working and you don’t have insulin
19:54 resistance and you’re not obese like what are the two like this is what fires me up about cancer the two most common
20:02 uh risk factors for developing cancer age and weight not hormones right so if
20:08 you’re old and you’re obese you’re probably going to get cancer you know even if you’re not old if you’re just
20:13 morbidly obese your risk of cancer is so large and like how do you keep people
20:18 from becoming obese well you fix their mood their insulin resistance their muscle mass you make them want to move
20:23 you know I mean hormones like that’s how you fix this and so it’s just it’s crazy to me that people still still say that
20:30 and still believe that how tell me how hormones affect your brain
20:37 Su because that’s you know I say this I say this all the time and people kind of laugh at me but like heart disease is
20:43 the number one killer right breast cancer kills tons of people colon cancer but none of this matters people if your
20:50 brain doesn’t work like if you develop dementia it doesn’t matter you know it doesn’t matter that you don’t have
20:56 breast cancer it doesn’t matter that you don’t have heart disease or that you do like your brain is very important so
21:01 this is very near dear to my heart as well so as you age what happens with your brain and how does hormones affect
21:07 that oh my well again uh just going off my history it’s been so rewarding to
21:14 treat people with hormones because women will come in like petrified like for
21:20 example that they are developing Alzheimers or something because they’re forgetting things they can’t remember
21:25 friends names they can’t remember movies they’ve watched who starred in the movies they can’t even sometimes
21:31 remember names of places they’ve been or they’re starting to call things the
21:37 wrong thing like for example someone would be like I’m going to go and and pull the milk out of the washing machine
21:43 or I’m G to go yeah you know put something in the you know in the
21:48 refrigerator and they but they say dry or whatever um and their family’s making
21:53 fun of them and it’s just you know but they’re truly scared and you put them on hormones and literally within like days
21:59 like their memory comes back they stop doing the word substitutions they stop having trouble with name recall and word
22:06 finding and and it’s it’s so gratifying you know to to over thousands and
22:12 thousands of women that I’ve done that for and then it’s been so cool to see recently um some really good published
22:18 studies like I thought Lisa muscone study that was published in nature this year was kind of like a another landmark
22:27 study where she was looking at estrogen receptor density in the brain um and and
22:36 studying women that were premenopausal par menopausal and menopausal and found
22:41 that that as estrogen levels in the body were declining estrogen receptor
22:48 expression in different brain tissue was going up and the density of estrogen
22:54 receptors were increasing in different brain structures and the the higher the density of receptors the lower they were
23:01 scoring on memory tests and so it was almost like as the estrogen levels were
23:07 declining the brain was like trying to suck up every last little molecule of estrogen by like because they you know
23:14 it was so critical and vital for the functionality of these neurons and uh
23:19 and then another cool thing from that study was that you know previously we thought
23:25 like after you’ve kind of allowed your estrogen to decline and you’ve waited a while before going
23:31 on hormones let’s say you’re 5 years postmenopause then it’s kind of too late you know they were like there’s really
23:37 nothing you can do that was kind of another myth that was shattered this year when when it was shown that you go
23:42 on estrogen and you will start to remodel the brain tissue you know you will start to reduce those kind of
23:49 receptor density and the various tissues and cuz like it’s the brain is finally getting fed what it needs um the other
23:56 cool thing couple studies like some dating back to 2023 um were looking at gray matter
24:04 volume changes in women uh with reduction in estrogen with time and they
24:11 kind of compared like women that went into menopause while on hormone therapy
24:18 versus women that chose not to do hormone therapy and they looked at like volumetric changes in the brain and
24:25 found like diminished brain structure uh you know the volume of brain structures in the untreated
24:32 women so yeah and I think a lot of that has to do with like blood flow you know
24:38 so a lot of these hormones help with blood flow to the brain so it makes sense I mean blood flow to all organs
24:43 but definitely to the brain and I see this a lot with with patients as well it’s really sad you know the women who
24:50 I’m not going to take hormones because my mom had breast cancer and you see them when you take care of them you know
24:55 I’ve been doing this for almost eight years now like you can just see the cognitive decline and it’s it is it’s
25:01 really sad because when you get people on these hormones it comes back so quickly and I think it’s because of that
25:07 you know vasod dilation that you get um and so yeah it is it’s and and when you
25:14 have blood flow to the brain it also helps with your mood right obviously like it’s going to help with your mood
25:21 it’s going to help with your sleep it’s going to help with your memory so that brain fog that people talk about I mean
25:27 it is a real thing thing but it somewhat is reversible as well which is nice
25:32 right that is the cool thing yeah it’s almost never too late yeah for sure so
25:38 what hormones do you pay attention to when you’re balancing hormones and what does like what do you use why do you use
25:46 it so what are you looking for well I play attention to all the hormones that’s that’s I think why I’ve
25:53 had a good good success over the years and what I have found especially in in
26:00 Western medicine that a lot of times doctors will overs supplement one hormone to the exclusion of others and
26:07 so you have to be more heavy-handed uh you know with one hormone if you’re kind of ignoring
26:12 deficiencies in other areas and then you end up with creating just greater imbalances so what I like to do we’ll
26:19 start with females is that I’ll I’ll look at their adrenal cortical steroids
26:26 as well as their ovarian steroids so like cortisol DHEA pregnenolone and
26:33 testosterone and then also estrad and progesterone and I will look at the
26:39 thyroid carefully as well because there is there’s all of these kind of
26:44 counterbalancing relationships between all these hormones so what I found is
26:49 that uh you know if you’re supporting for example some of the adrenal hormones
26:55 that are hormones in their own right but also precursor to the production of
27:00 estradi and testosterone then you can often facilitate some natural production
27:06 of those and you won’t have to supplement as much of the those end
27:12 hormones so for example it’s common for me to put someone on DHE pregnant alone
27:18 and see how well that converts into testosterone for example sometimes it converts very well they don’t need
27:23 supplemental testosterone by itself other times they have poor conver and they need also to be on testosterone and
27:31 and then you see like how does that convert into estrad um you know perhaps
27:38 there’s a little conversion so then you can get by with a much lower dose of estradi and then complement that with
27:44 some natural progesterone and then then the thyroid plays a huge role like I found that their thyroid and estradi are
27:51 kind of on a teeter totter like if you’ve got mild um thyroid deficiency
27:59 you won’t metabolize estrogen as well you know so like the the the more
28:04 thyroid you have the more estrogen you need and then vice versa the less thyroid you have the less estrogen you
28:09 need so so it’s like almost like a deficiency in one can kind of like you
28:15 know be be made worse so to speak if you over supplement the other so you want to
28:20 try to kind of get everything in good balance and then for
28:25 men again if you focus Fus on the balance of everything you’re going to have much better results and possibly
28:31 have to supplement less uh testosterone so so oftentimes I’ll even start off
28:38 with a guy um if he has got like a mild testosterone deficiency I’ll start off
28:43 with some of the adrenal cortical steroids that are precursors to testosterone and also hormones in their
28:48 own right so DHEA pregnant alone I’ll see how well they convert into testosterone and then either also
28:56 supplement testosterone or not um depending on what the needs are and then also pay attention to how that
29:03 testosterone’s being metabolized so looking at like the conversion of testosterone to dihydro testosterone the
29:10 aromatization of testosterone to estrad and trying to work on you know kind of
29:17 blocking the those the production of those kind of metabolites if necessary
29:23 and then again paying attention to the thyroid as well yeah for sure and how do
29:29 you feel about progesterone in minid do you yeah I mean
29:35 I haven’t done much with progesterone in men I know some people do it just feels
29:40 to me not physiological men have a little progesterone but not a lot you
29:46 know so it’s like supplementing it you’re G to have you’re going to end up with more than they would have naturally
29:53 yeah and I I’m a big proponent of pregn alone and you can give that to men as well and so that’s kind of where I tend
29:59 to start with sleep obviously fixing testosterone helps their sleep as well but okay so tell me yeah and then
30:08 obviously balancing hormones making sure you get that balance right is important because I think that’s why hormones get
30:14 a bad name right because some people you know there are certain clinics or certain providers that everyone gets the
30:20 same dose of every hormone no matter what and then obviously you’re going to get side effects with that in some
30:25 people and then I think you know that’s where fortunately hormones get a bad name when everyone is is getting the
30:31 same amount of things and you end up with with bad reaction so you know I tell people the right type of hormone
30:38 and the right uh dosage and the right delivery mechanism is very important for
30:45 each person yeah I so agree yeah it’s certainly not one siiz fits all it’s a very delicate Nuance system and so um
30:53 for example one type of administration that I don’t like because I spend a lot of my time undoing
31:00 the damage that I see that other providers kind of inflict is is the is
31:07 the pellet therapy uh a lot of people are treated with hormone pellets and
31:12 their levels go way too high so for example a lot of men are on testosterone
31:19 pellets and no one is paying attention to how they’re being metabolized and
31:24 they have you know let’s say total testosterone levels in the 15 1800s
31:29 1800s they come into me um I’m not the one to put the pellets in but they come
31:35 in and I’ll find that their estral is incredibly High you know maybe like up at like 58 60 should be you know 30 or
31:43 less I’ll find their dihydro testosterone is high I’ll find their PSA going up I’ll find their hematocrite you
31:50 know and red blood cell counts going up and so we have to just kind of do undo all this damage and then they have to
31:57 just kind of you know we’re compensating for this and compensating for that and compensating for this while we’re
32:02 waiting for that super high level of testosterone to kind of like you know Fade Out of the the system which can
32:08 take months and so I much prefer a type of
32:13 administration that you can adjust you know very readily so whether for men it
32:19 is using a transdermal testosterone cream or a a weekly or two time weekly
32:28 injection of testosterone cinate or something like that where you know you can you can quickly change the dose if
32:35 it if you’re not if your metabolites are too high or you can kind of begin to
32:41 course correct sooner and you have the power to do that like with pellet insertion once they’re in they’re in you
32:47 really can’t go in there and dig them out you know um so so that’s that’s what
32:53 I favor for men and then for women I think that there’s there’s a quite a few
32:58 different ways you can go about it so for for women um most of my patients and
33:04 myself we we kind of favor the bioidentical estradi patch um because it
33:10 of the kind of steady delivery of the hormones it’s like you know this is a bioidentical patch that you apply to
33:17 your skin and the hormones are metered into the bloodstream in a very steady manner throughout the life of the patch
33:23 the patch lasts uh half of a week and if someone’s good about rep replacing the
33:29 patch on time you will have a fairly steady state of hormones there’ll be a tiny bit of a drop off at the you know
33:35 end of the patch life but it’s not too abrupt usually so that’s that’s one way
33:40 for estradi supplementation and then I do like uh hormone creams so we can
33:46 compound up hormone creams either with estrad by itself or a bi estrogen type cream that has estriol and estradi in it
33:54 and usually if that’s supplemented twice the levels are fair consistent if you have a super thin woman you you do get a
34:01 little bit of a roller coaster kind of like an up and then a down and then again apply later an up and a down so so
34:08 it just depends on how sensitive someone is to the fluctuation in the estrogen level um but but usually you can kind of
34:16 you can keep it pretty steady and smooth with an estrogen cream and then there’s
34:21 trokies that you can create that are kind of under the tongue um with bi
34:26 estrogen or just EST there’s of course vaginal types of preparations that you can make and then
34:33 for uh progesterone again you can do transdermal or oral um you know there’s
34:39 better data on oral progesterone and uh there’s some benefits from oral progesterone such as uh when taken at
34:46 night there’s a metabolite of progesterone called Alo pregnanolone that’s very good for sleep and uh so
34:53 some people love that because insomnia and difficulty with sleep and propensity
34:59 to anxiety is higher you know in menopause so this tends to be very calming and sedating and some of the
35:08 downsides is that occasionally PE there’s a lot of biochemical individuality from woman to women in
35:14 terms of how much they make of that metabolite Alo pregnant loone how
35:19 readily they can clear it out of the system um and so for some women oral
35:26 progesterone given at night leaves them feeling a little sedated and Dopey in the morning and for other women it can
35:32 even compound you know day upon day and then eventually you know the level kind
35:37 of kind of has carryover all day long and they can feel kind of out of it so
35:43 in those cases you know there’s a ways around it of like not taking it every single day doing it more cyclically or
35:50 lowering the dose a little bit or um just switching to a transdermal
35:56 supplementation and for testosterone you can do um either oral or transdermal and
36:03 I know some people are moving to injectable for women that’s a little tough because the injectable
36:08 preparations are really strong and the amount you inject would be very very small um but it is something that some
36:15 women really like um but normally I use oral or transdermal for
36:21 testosterone and there’s some advantages of the transdermal for women like sometimes women when they move into
36:27 menopause menopause their libbido goes down and the there The Sensation that
36:34 they have with orgasm goes down so their orgasms become kind of uneventful and
36:39 like a little blip and they just kind of lose their intensity and so you can use a trans dermal preparation without
36:45 alcohol in it that you can apply directly to the clitoris and labia area and that can both you know enhance like
36:52 your libido but also kind of enhance blood supply and and revive iiz nerve
36:58 endings and and make the orgasm a little bit more uh dramatic
37:04 again yeah so however you decide to use hormones though you need to have a
37:10 provider that is comfortable prescribing this comfortable
37:15 understanding dosage Etc and and also making sure that they understand all the different
37:21 hormones that are at play and that need to be I guess replaced right that’s
37:26 right so so that we’re not overdoing one thing and underdoing something else so that’s right okay and then can you give
37:34 an example or a couple examples of people who come to you with imbalanced hormones and what you’ve done to improve
37:42 their health like what should you expect if you’re somebody listening to this and you think man maybe I need my hormones
37:49 balanced what should they expect from balancing their hormones and in doing so
37:54 let’s talk also about like anxiety depression brain fog as
37:59 well gosh okay so let’s talk Men first
38:05 so um like I said I spent a lot of my day kind of undoing these these cases
38:10 where men are overs supplementing testosterone um either from pellet
38:15 insertion or even just injectable so common case I’ll see will be a man
38:20 that’s that’s in one way or another overs supplementing testosterone and
38:26 let’s say that you know there the the the optimal zone of testosterone is
38:31 going to be somewhere between 600 650 to 12200 let’s say you know some some guy
38:38 may come in and his testosterone is 15,800 and then the higher it goes the
38:46 more it drives aromatization and kind of conversion into dihydro testosterone and
38:53 then let’s say they have high levels of estrad high levels of DHT um now we’re
39:00 starting to see some PSA elevation so it looks like it’s bothering their prostate we’re seeing some high like hemoglobin
39:07 hematocrite red blood cell so now they have to go have a therapeutic photomy to
39:12 pull some of the blood out of their system and you have to put them on kind
39:17 of romaas inhibitor like whether it’s natural like something like chry or um
39:22 or a pharmaceutical um like like PR
39:27 or um uh the the one for minox uh the one for um hair prop Propecia excuse me
39:37 um or you have to kind of do things to augment like the clearance of estrogen
39:43 out of the system like calcium de glucarate or something like that um but but a lot of times what we can do to fix
39:50 that is to is to you know reduce either wait for the pellet to to clear out of
39:56 the system or reduce their injectable to a much smaller level and then when you
40:03 reduce the conversion of the testosterone to the to the metabolites estrad and DHT that simultaneously will
40:11 lower those metabolites and raise testosterone at the same time so you can often get by with with less and end up
40:19 with a better result particularly if you’re also supplementing some of those kind of adrenal uh steroid precursors
40:26 like like we were talking about earlier DHEA and Pregnant alone so that would be like an example of of a guy that comes
40:33 in you know and he’s and he his hormones are imbalanced and what we have to do to fix that unfortunately I’ll see
40:40 sometimes that you know someone’s had imbalanced hormones for a long enough that now he actually does have prostate
40:46 cancer you know and then then that’s a whole different discussion of like how to handle it going forward um for
40:54 women and you want me to kind of tie this back to the brain uh you know so
40:59 sometimes women will come in and they you know either are not on enough estrad
41:05 and so that’s not enough to improve their their anxiety their depression um
41:11 improve their sleep uh so a good fix there would be to kind of bump up the
41:16 estrad and maybe work with some if they can tolerate oral progesterone because
41:23 then you’re going to get a calming of anxiety you’re going to get an improvement of sleep which will ultimately have a brightening effect on
41:30 the mood everyone knows you you’re going to have a better mood if you sleep better um so that’s that’s one thing but
41:35 like what I would say a lot of times is that again there’s like overly heavy-handed supplementation of hormones
41:43 and that’s kind of exacerbating uh women’s metabolisms so
41:49 for example I don’t I have seen many times that women come in and they’re on way
41:56 too much progesterone and progesterone is a precursor to cortisol and then cortisol raises your blood sugar which
42:04 then causes your body to make more insulin to bring it down and so if you’re constantly in that state of like
42:10 higher cortisol higher blood sugar higher insulin you’re going to develop worsening insulin resistance and so I
42:18 have seen that people have not only you know kind of that sedated feeling in the day but they have like um you know belly
42:26 fat accumulation and uh uh fluid retention and they’re they have large breast enlargement and
42:33 they just feel like they are wearing a like a fat suit and one way to to kind
42:39 of turn that around is to to reduce the amount of progesterone they’re taking in
42:45 do it more in a cyclical manner like the you know Mother Nature did where you’re only making progesterone half of the
42:51 time you know from ovulation and menstration not all month long and so
42:56 you give the system a break every month so that you can clear out those metabolites and clear out the
43:02 progesterone and it’s not going to like kind of accumulate in the system and a lot of times you can write the
43:08 metabolism that way so are you saying to do that even
43:13 when women are you’re replacing estrogen like in a postmenopausal period you’re not worrying about bleeding if you’re
43:19 doing that with progesterone like cyclic yep yep and there’s so many there’s no one right way to do it like it’s not
43:25 that you have to go two weeks on two weeks off two weeks on two weeks off because then it is possible that you
43:30 could have a little bit of a a withdrawal bleed um but you can even do
43:36 you can get creative you can be like I do it uh five days a week and I take the
43:41 two days off you know so that like over the month period of time you know you’re collecting a number of days off so that
43:48 you can you can clear out the metabolites like I think it’s been shown
43:54 and I don’t appreciate this I don’t love this approach but I think the data shows that you need to take progesterone 12 44:01 days out of every quarter in order to protect the endometrium and so days out of how often
44:08 out of every three months three but my fallback in my whole career has been
44:14 like what does Mother Nature do you know like literally we’re designed a certain way and like I think
44:22 after you know what do we say millions of years of evolution there’s probably a reason for it right and and so like you
44:31 know at least half the time I think we should be using progesterone because
44:37 it’s not just about protecting the inometrics
44:42 actions in the brain in in the breast tissue you know in the muscles in the
44:48 bones ex like everywhere so so so to me
44:53 you probably need more than 12 Days a quarter but but I think that um that you
44:59 do need breaks and so I’ll you know I’ll have patients that take take their
45:04 progesterone 20 days out of the month and 10 days off or 25 you know so but or
45:10 five days a week and two days off or four days a week and three days off so you can do it in various ways and
45:15 usually prevent any sort of building a buildup of the lining and a
45:22 bleed okay so I think this was very informative for people kind of some takeaway points you know from what I
45:29 heard you say is that you know hormones are very beneficial as you age if you
45:35 are doing hormone replacement therapy you’re going to age more gracefully or or better and that it actually lowers
45:41 your mortality uh and it is good for your brain and that there are different ways
45:46 that you can you know supplement hormone therapy depending on what the patient’s comfortable with but hormones do not
45:52 cause cancer there’s plenty of studies recently that show that they are safe and very effective with helping us age gracefully
46:00 and decrease mortality is there anything else you want to add to that you got it
46:06 I mean that you basically summarized it perfectly yeah that’s exactly my my stance on it okay
46:13 so tell everyone listening I guess where they can find you are you know do you
46:19 still see patients um that sort of thing yeah so
46:26 um people can find me at gyen which is a bio optimization Center that I helped
46:31 found here in the Bay Area and uh I do still accept patients but I not very
46:37 often but myself and all the other doctors that gyen are well skilled in
46:43 bioidentical hormone balancing and have been doing it for years and um yeah uh
46:50 you can also find me on Instagram Beth McDougall MD and uh my book uh your
46:57 pristine blueprint your pristine blueprint okay and we’ll put all that in the show notes
47:03 obviously but I just want to say thank you for everything that you do you’ve made a career out of making people feel
47:10 better and not going with mainstream but going with actual science and literature
47:16 and and listening to people so I appreciate that and thanks for coming on
47:21 and for your time today oh thanks Cassie I really appreciate it it’s been fun
47:28 I hope that you enjoyed that episode as much as I enjoyed recording it after listening to that I hope that you now
47:35 feel that hormones are beneficial as you age that you’re confident that they actually lower your mortality you
47:42 understand that they are good for your brain and that you will age better if
47:47 you are on bioidentical hormone replacement therapy with a provider that understands how to utilize this I hope
47:53 that you also Now understand hormones do not cause cancer and that there are
47:58 different ways to supplement them to monitor them and to monitor their metabolites if you enjoyed this episode
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49:42 for your time the information presented including any materials discussed referenced or
49:49 linked within this podcast are for General educational purposes only not
49:54 the practice of medicine no doctor patient relationship is formed from you listening to this podcast or utilizing
50:01 any of the information provided I am a doctor but I am not talking to you as your doctor the information provided is
50:08 not intended to diagnose or treat health problems or take the place of the professional medical care provided by
50:15 your doctor if you are experiencing any health problems including problems you believe have been touched upon in any
50:22 respect within this podcast you should consult your doctor about the problems with without delay you may ask your
50:28 doctor whether he or she believes the information I have provided would be helpful to you but you should still
50:34 consult your doctor immediately and follow his or her medical advice as your treating physician I’m just here to
50:40 provide you basic knowledge about the issues we discuss so you are more aware of them and can better discuss them with
50:47 your doctor that’s why we call it back to the basics join me on the next episode as we continue our journey
50:57 oh
Disclaimer:
The information presented including any materials discussed, referenced, or linked within this podcast are for general educational purposes only, not the practice of medicine.
No doctor-patient relationship is formed from you listening to this podcast or utilizing any of the information provided.
I am a doctor, but I am not talking to you as your doctor. The information provided is not intended to diagnose or treat health problems or take the place of the professional medical care provided by your doctor.
If you are experiencing any health problems, including problems you believe have been touched upon in any respect within this podcast, you should consult your doctor about the problems without delay. You may ask your doctor whether he or she believes the information I have provided would be helpful to you, but you should still consult your doctor immediately and follow his or her medical advice as your treating physician.
I’m just here to provide you with basic knowledge about the issues we discuss so you are more aware of them and can better discuss them with your doctor.
That’s why we call it Back to the Basics. Join me on the next episode as we continue our journey.