Menopause Q&A with Dr. Mary Claire Haver

It's Dr. Mary Cla Haver and it is time for your Q&A. I submitted a video for questions and I have several hundred to choose from and I'm going to be

answering. All right, let's go. First

answering. All right, let's go. First

one, I am on HRT, weightlifting, eating high protein, tracking macros, but still gaining weight. Is there something else

gaining weight. Is there something else that could be happening? Help. First of

all, you need a body composition scan.

You need to know how much of your weight is water, how much of your weight is fat, how much of that fat is visceral or intraabdominal fat, and how much of it is muscle. We have been brainwashed into

is muscle. We have been brainwashed into thinking that the scale like your relationship with gravity is the beall end all of your health. Not true. So, if

you don't know how much muscle you have, how much fat you have, if the fat is visceral, how much water you're carrying that day, the scale is not helpful. Not

all weight gain is fat gain, especially if you're eating protein and lifting weights. I would bet that some of this

weights. I would bet that some of this is muscle and muscle is the organ of longevity. So, how do you get a body

longevity. So, how do you get a body composition scan?

You can get a DEXA scan and they will give you the body composition. Not all

DEXAs will do it. You have to ask the radiologist or go to like a DEXA fit center. That's the most expensive way.

center. That's the most expensive way.

You can do electrical impedance scan.

That's what I do in my office. I have

like the highest level inbody scanner for my patients. I also have a home inbody scanner. So these are are they

inbody scanner. So these are are they perfect? No. But they give you an idea

perfect? No. But they give you an idea of trend and I'm really really loving them for my patients. My patients are loving doing their own body composition.

If you have no money to buy a scale, you can do a waist hip ratio. the waist hip ratio or simply the abdominal circumference is a much better indicator

of your risk of chronic disease than your weight or your BMI. So, if you have a body scanner, drop the drop a note in the comments, let everyone know what

you're using. If you go to the link in

you're using. If you go to the link in our bio and you go to our website and type in favorites, we have a link to the home body scanner. Now, they're pricey,

you know, full disclosure. Um, and then you can go and look up waist hip ratio and body composition. We have a full blog on our website. Um, okay.

Okay. Brit Breijit Breg asks, "I'm on bio identical hormones for over two years now and I'm still gaining weight while training every day and being super vigilant with food, high protein. You

feel you're doing all the things, no change." Again, you could have the same

change." Again, you could have the same weight the whole way through and you gaining muscle and losing fat. So, body

composition is really, really, really the way to go. If you can't afford it, do the use the waist tip ratio to give you an idea of what your visceral fat is. I have a full blog on body

is. I have a full blog on body composition and how to measure it.

Measure it at home in the link in our bio. If you go to blogs, they're all

bio. If you go to blogs, they're all there. Okay. Um,

there. Okay. Um,

thank you for all you do. Question, hair

loss. I get this every day. I see so many things on Insta to help hair grow back from permenopausal hair loss. Is

there a right step or product used to regrow hair? That is a great question.

regrow hair? That is a great question.

Hair loss is complex. There's hormonal

hair loss, genetic hair loss, nutritional hair loss, there's hair loss from post-traumatic stress, from post infection, from postcoid, it really depends on why you are losing hair. But

if it is purely due to aging or something to do with menopause, I'm on. So I started with topical

I'm on. So I started with topical minoxidil. Then I got the men's extra

minoxidil. Then I got the men's extra strength 5%. I did that for years and it

strength 5%. I did that for years and it really did seem to help. I was

struggling with the topical application to remember to do it on a regular basis and it got a little messy and I do color my own hair. I cover my grays. So just

the timing of everything was a problem.

My derm friends were like my dermatologist friends were like just take oral minoxidil. So I was able to get a prescription of the lowest dose oral minoxidil which is 5 milligrams.

That was a little strong for me. I ended

up breaking it uh in half and I do 2.5 a night and it literally cost me $5 a month and it is super super um helpful.

Um what hormone therapy are you on?

Okay, let me know if you want to see what my hormone therapy is on. Well,

let's go back here to get it. Hang on.

Um I'll show you exactly what I'm taking. I've made some changes.

taking. I've made some changes.

um as of late and it's a very complicated regimen, but I am a complicated girl.

So, let me grab all my prescriptions.

These are the ones I take at night, so they're on my bedside. Let me just pop into the bathroom here so I can have everything. Okay, so strictly for

everything. Okay, so strictly for hormone replacement. I just put my patch

hormone replacement. I just put my patch on this morning. So, this is the package. So for my systemic estradiol

package. So for my systemic estradiol replacement, so this is going in my brain, my bone, my heart, all over my body, I started

with an estradiol patch. I my hot flashes didn't go away until I got up to the point one patch. Now, we were taught if you're going to give hormone therapy

to titrate to hot flashes only, right?

But I got curious reading some of the literature around how much estrogen do we need or do we know protects bones?

Like at what estradiol level naturally?

Do women have no um osteoporosis or do they you know so there's a level at which you stop chewing up bone right stop losing bone and you stabilize and there's actually a higher level at which

you can grow bone.

My estradile levels were not even close.

So it was enough to stop my hot flashes but not enough I felt to protect my bones. So rather than adding a second

bones. So rather than adding a second patch and then there were other studies that showed that because of the first patch now I have no risk of clotting outside of baseline. I have no family

history. I've had multiple family

history. I've had multiple family members with cancers and multiple surgeries. No one's had a clot. My niece

surgeries. No one's had a clot. My niece

did clot but she ended up having factor 2. Turns out it come and no one in my

2. Turns out it come and no one in my family had it. Like we tested myself and my daughters. No one had it. So I'm

my daughters. No one had it. So I'm

clear. I have no compunction taking this. And the risk of clots over

this. And the risk of clots over baseline is seven out of 10,000. So, I

was willing to take it. So, instead of doing two patches, you know, and fighting with the insurance company, I added a half a milligram of oral estradiol at night. Now, I take it at

night cuz I take my other meds at night.

It's just easier for me to remember. And

that got me into the level. And it also dropped my cholesterol another 25 points and dropped my LDL another 15. So I'm

happy. This is what's working for me.

Again, this is very different. This is

personalized medicine, right? So what

I'm able to, you know, public health is very different. Like making blanket

very different. Like making blanket recommendations for the population is different than individual recommendations per patient. These are

the discussions we have with our patients in clinic. How can we individualize their care? So, what's

best for them? Okay. So, for estrogen, systemic half a milligram estradile oil at night and then I do this estradile patch that we change twice a week. Okay. And I feel

like I'm hitting all my bases with that that I need to hit. I've got a nice systemic level where I'm believe that my bones are best protected. Um, I started in the window of opportunity for

cardiovascular disease and I was able to modify my LDL and AOBV back into normal levels and I couldn't be [ __ ] happier. Sorry for the f bomb. So, no,

happier. Sorry for the f bomb. So, no,

I'm not sorry. All right, so topical estrogen. Yes, I use that, too. Y'all

estrogen. Yes, I use that, too. Y'all

seen me use this before. This is for my skin. I don't have any makeup on. This

skin. I don't have any makeup on. This

is my alloy. Alloy makes it. So it is a uh tele medicine product company and I use a little bit of topical estradile

estriol for my face. Good studies.

Efficacy is very very safe. They did

safety and efficacy studies. Um it helps with elasticity and collagen production.

Okay. Um and then I'm digging because I don't use it every day. Also vaginal

estrogen. Okay. This goes all in my labia minora around my urethra and in the vagina.

This is oh 0.01%. This is a micro dose.

Remember completely safe. Anyone can use it with clots, with breast cancer, with any kind of cancer. You can use vaginal estrogen. And this tube is $15. Okay?

estrogen. And this tube is $15. Okay?

You should not pay more than $15. All

right? So

progesterone uh there are about 10 or 15% of you who will not tolerate this progesterone. That's okay. We have other

progesterone. That's okay. We have other options. But for the rest of you, this

options. But for the rest of you, this is great. This is oral micronized

is great. This is oral micronized progesterone. 10 bucks a month. Okay. So

progesterone. 10 bucks a month. Okay. So

beautiful for my sleep. And I wear my little stupid sleep tracker. So I know my sleep architecture. And when I don't have this, I do not sleep as deeply as well with enough deep sleep. This

really, really helps me. Okay. And then

uh what other hormones do I have? Oh,

and I also have my minoxidil.

I thought I grabbed it.

Yeah. So, this is minoxidil. This is

actually the 2.5 milligrams. And I take a half of one of these a day. So, it's

1.25. I misspoke earlier. Um so, this is what I do for my hair. And I just colored it so you can see how um thin my

part is and how thick my hair is. So,

I'm super super happy with it. Um,

okay. How much are my prescriptions? So,

I shop around. I'm a do even though I'm a doctor and I have access to all the fancy stuff, I shop around. So, I use HRT Club. Oh, of course, my

HRT Club. Oh, of course, my testosterone. Okay, this is Androgel.

testosterone. Okay, this is Androgel.

So, I use a P-siz amount every day. Are

you ready?

Like literally that much. Okay,

that is about 5 milligrams per day. And

I rub it like this till it dries. The

end. This bottle from HRT Club is about $50 and this lasts me 5 months cuz you don't barely use it all. Okay.

$10. Now this is this is um Express Scrips. I hear Mark Cuban pharmacy $10,

Scrips. I hear Mark Cuban pharmacy $10, $15. Um, minoxidils are free. And then

$15. Um, minoxidils are free. And then

this oral estradiol is super cheap is um oral estradiol is oh god $5 a month and then the patch is um about this is the

most expensive one and it's about $35 a month. Okay, so now those of you I get

month. Okay, so now those of you I get this question all the time. What if you have an absolute contraindication to

taking um to taking hormone therapy? I got you.

Okay. You all of you can take vaginal estrogen 100%. No increased risk of

estrogen 100%. No increased risk of recurrence for any kind of cancer. No

increased risk. I mean this is clear. We

went to the FD we my friends went to the FDA to fight fight fight for you for this. Um, and you just, you know, the

this. Um, and you just, you know, the big thing is where do you find a provider who's going to prescribe all this for you, right? So, my menopause empowerment guide has links to menopause

society certified practitioners as well as to practitioners that my followers did testimonials on. Um, so all of that is there. It's free. It's all in the

is there. It's free. It's all in the link in bio um for you. I'm coming out.

All right. I'm going to go back and read some more questions. Um, so but for hair loss, so besides the minoxidil, there's, you know, biotin. I wouldn't start with

the $90 vitamins. Don't start there. Um,

probably you don't have that serious of a vitamin deficiency to cause hair loss.

Um, though vitamin deficiencies can do it. Vitamin D deficiency is one of the

it. Vitamin D deficiency is one of the biggest um causes of hair not growing the way you want it to. Go get your vitamin D level checked, okay?

Supplement if you need to. Um,

okay. And then

uh list what we use. Okay. Um,

HRT Club is an actual pharmacy and they do um they they it's like they contract for lower rates for hormone therapy. And

so for Androgel, it's so cheap. You can

get Estrogel there. You can get the vaginal estrogen. You can get multiple

vaginal estrogen. You can get multiple forms of hormone therapy. your doctor

just has to send it to the pharmacy related to HRT club um to do it. We do

that in our clinic all the time for our patients. We help them shop around.

patients. We help them shop around.

Okay, I'm going to pull out all the things. Hang on. Um

things. Hang on. Um

okay, full disclosure, look, you can take everything I say with a grain of salt. Um I started in the nutrition space. Anybody here from

nutrition space. Anybody here from Galvaton diet days? So I started talking about nutrition. I went back to school

about nutrition. I went back to school and got certified in something called culinary medicine and used everything I'd learned to develop a you know anti-inflammatory eating program for my patients and my friends and my

girlfriends and started talking about it online. The whole thing exploded. We

online. The whole thing exploded. We

turned it into like an online program um called Galvisson diet. We've morphed

that program into the pause nutrition.

Um, but I was recommending fiber and vitamin D and things all the time for my patients, but patients were coming in with buckets, buckets of this crap with all these additives. I didn't know where this stuff was coming from. And, you

know, some of my physician entrepreneur friends were like, you you know, you could create your own supplement line and put exactly what you want in it.

Third party tested. So, my husband and I, small family business, invested our savings into starting, we started with fiber and we started with a vitamin D product first. So we knew they were high

product first. So we knew they were high quality thirdparty tested and we just were marketing to our you know people who were subscribing to the Galvisson diet at the time which is now come to

pause nutrition. So listen if you don't

pause nutrition. So listen if you don't buy from me I don't care okay I love you all this information is free but please make sure you're getting adequate fiber in your diet. And if you can get it from

food that's great. Food is always first then measure then supplement. Food

first. Food is always superior to any supplement out there. Okay? And if you don't choose to support me in my small business, that's okay. I still give you all the information for free. That's

okay. If you choose to support me, yay.

Hallelujah. You're paying for my kids medical school right now. Thank you. Um,

okay. So, fiber. Okay. Women are getting 10 to 12 grams of fiber on average in their diet per day. We need minimum 25.

Like the benefits for cardiovascular disease, gastrointestinal disease, all of that begins at 25. We max out somewhere around 40, okay, for for heart disease. So, we need lots and lots of

disease. So, we need lots and lots of fiber in our diet. And God, if you can get it through food, you go, girl, you do you. But if you can't, here's a

do you. But if you can't, here's a helper, okay? One scoop of this is seven

helper, okay? One scoop of this is seven to eight, seven and a halfish grams of fiber. And it's mixed. It's not just

fiber. And it's mixed. It's not just psyllium husk. We put amar, we put ke,

psyllium husk. We put amar, we put ke, you know, am we put uh hold, I'll read it all to you. Oh, please. We got a bunch of I wanted a mixed source of

fiber. um citrus pectin powder,

fiber. um citrus pectin powder, buckwheat millet quinoa amar chia seed powder, apple fiber powder. So we

have soluble and non-soluble forms of fiber in here as well as psyllium husk which is the main ingredient. Okay, so

that's Metamucil. Um

and this is a 30-day supply. If you

don't buy it from me, get it. Get it

from food. Get it from somewhere. Okay.

And then um we also have creatine. So

creatine, this is one of our newer products. This is creatine monohydrate.

products. This is creatine monohydrate.

Okay. There's nothing in it. It's just

creatine monohydrate and it's it's um four to five. So it's not gritty. It's

super um ground up. What do you call it?

It's micronized, whatever that means. So

um so it's five grams per scoop. You

want to start like half a scoop because it can cause some bloating and you're going to retain more water. Your muscles

are going to be holding on to water.

You're going to be super hydrated when you start using this. So it doesn't cause weight gain. It does not cause expansion of your fat cells. It may

cause you to hold on to a little more water. And that usually okay so why we

water. And that usually okay so why we don't store just like melatonin we don't store creatine as much as we age and it is super important for mitochondria

processes especially in muscle strength.

So studies are actually done Abby Smith Ryan read her stuff. She is from I think University of North Carolina. Abby if I get that wrong please forgive me. I've

read all of her work. She studies

menopausal women and exercise physiology and creatine and supple. I mean she's incredible. She's so freaking smart and

incredible. She's so freaking smart and she cares about us and she is a huge fan of creatine. Anybody in this space in

of creatine. Anybody in this space in women's health and longevity, creatine is your best friend. So, I put it in my water or my shake every day. Um, we also

have our vitamin D product here. Okay,

so this is vitamin D. It has K for absorption. We threw in omega-3 fatty

absorption. We threw in omega-3 fatty acids. Why? Because it all comes from

acids. Why? Because it all comes from fish oil and it's easy to put together.

So there, if you have a hard time swallowing, they're not tiny. So this is one. See how big? So this is one of the

one. See how big? So this is one of the pills, okay? But one serving has 4,000

pills, okay? But one serving has 4,000 IUs international units of vitamin D a day. That is the maximum you can take

day. That is the maximum you can take without worries of toxicity. You don't

have to check levels if you're taking 4,000 a day. Um, and about 80% of my patients are deficient in vitamin D.

Again, if you don't buy it from me, get it from somewhere or get it from your diet. But you have to eat a whole lot of

diet. But you have to eat a whole lot of salmon and mushrooms to get enough. Um,

okay. And then I also take a probiotic.

The days I don't have yogurt, like today, I didn't have my shake. We went

to brunch uh for our anniversary.

I take a probiotic. And again, uh, my friend Alloy studied this one. It's

called Symbiotic. Again, I don't, you know, yay. They are also one of the tele

know, yay. They are also one of the tele medicine companies that, um, does online menopause care. It's pretty awesome. Um,

menopause care. It's pretty awesome. Um,

okay. So, let me keep going through the uh questions. I don't want this whole

uh questions. I don't want this whole thing to be about supplements. People

get mad at me. Um,

oh, happy anniversary. Thank you. 29

years today. Um, I will save this. All

right. I'm going to keep reading through the questions. Um,

the questions. Um, okay. Uh,

okay. Uh, okay. Brain fog. Um, I'm dying to know

okay. Brain fog. Um, I'm dying to know and I can't find the answer out there.

For Dr. behavior in the ladies who are post-menopausal. Does the brain fog in

post-menopausal. Does the brain fog in particular improve? I've seen data that suggest

improve? I've seen data that suggest things might improve. For example,

there's a Okay. Um, brain fog, it does get better. It's like horrible in

get better. It's like horrible in pmenopause because that's when we're in the zone of chaos, uh, when our hormones are fluctuating so wildly and the brain hates that. And then as things

hates that. And then as things stabilize, the brain fog tends to stabilize. You never kind of get back to

stabilize. You never kind of get back to the exact cognition that you had premenopausal for most women, but you will will see a stabilization at least of the cognitive issues unless you're

one of the unfortunate women who is on the path to early dementia. So, um

let's see. How many weeks does it take for testosterone cream to start taking effect? Um so, we start our patients at

effect? Um so, we start our patients at about five um five per day, five milligrams per day. And um and then we

check their levels in 3 months. And so I you know most of the studies show or when I talk to Rachel Rubin and Kelly Caspersonson if it if they're therapeutic and it is not helping their

libido in 3 months most likely testosterone supplementation is not going to be helpful. So I give my patients 3 months, tell them to, you know, keep their expectations reasonable and then we check levels at 3

months, especially if they are not feeling like it's making a difference in their sexual wellness. Um,

should all women from pmenopause to postmenopause be using vaginal estrogen?

Oh, this is very controversial and I'll tell you what I think. [ __ ] yes. All

vaginas are healthier with estrogen. Let

me repeat that. All vaginas, yours, your vagina is healthier with estrogen on board. If you can make enough naturally,

board. If you can make enough naturally, great. If you don't, why would you wait

great. If you don't, why would you wait until you break before you fix it? Why

would you wait till you had horrific a atrophy, recurrent UTI, vaginal pain, don't want to have sex anymore because it's so [ __ ] painful before you got to treatment? Absolutely. I recommend

to treatment? Absolutely. I recommend

prophylactic vaginal estrogen for all of my patients.

It is safe. It is basically risk-free.

There is no other than it might be messy, you know, but vaginal estrogen can absolutely change your life. And I

don't believe in waiting till there's a problem. Like why would you wait until

problem. Like why would you wait until you had osteoporosis before you started taking care of your bones? Why are we doing that? Why are we letting, you

doing that? Why are we letting, you know, not teaching women to be proactive about the health of their bodies, of their bones, of their brains, of their vaginas and bladders and general urinary

system. So, um,

system. So, um, okay. Uh, I'm reading reading reading

okay. Uh, I'm reading reading reading questions. Hold on. Um,

questions. Hold on. Um,

best Oh, I I answered that. Best tips

for navigating emptiness. Well, I'm

still working on it. Um, how long should a woman stay on HRT? I've been on for a year but not sure if I could for the rest of my life. Okay. So, you have to think of what are your what are your

goals, right? What are your goals? So,

goals, right? What are your goals? So,

your body functions best with its natural estrogen with its naturally occurring estrogen. And fortunately, we

occurring estrogen. And fortunately, we can give that back to you in the form of estradiol. Okay? We cannot assume that

estradiol. Okay? We cannot assume that ethanol estradiol or estriol or estrone, you know, things not made in the ovaries work the same. Do not make that

assumption. So we are we know beyond the

assumption. So we are we know beyond the shadow of a doubt that your brain, your bones, your genital urinary system, your muscles and your heart health, those

vessels that are feeding your heart muscles are healthier with your natural occurring estradiol

on board. Now, can you get the exact

on board. Now, can you get the exact same result by giving yourself exogenous systemic estradiol? No, we haven't

systemic estradiol? No, we haven't figured that out yet. we, you know, we'd have to figure out how to extend the shelf life of the ovary naturally. And

actually, people are working on that.

Um, and again, that's controversial, but you are healthier across multiple ways of measurement with your naturally occurring estrogen on board. The end.

Um, let's see. Uh,

let's see. Uh, how do you know if you need a stronger estrogen patch? Certainly, if you are

estrogen patch? Certainly, if you are still symptomatic, if you are taking estrogen in whatever form and you're still having the symptoms that brought you to the doctor, then I would increase

I would talk to your doctor about potentially increasing your dose. Um,

progesterone is progesterone required in post-menopause when a uterus is not present? No, it is optional. So, if you

present? No, it is optional. So, if you have a uterus, we must protect it. And

we're giving you estrogen. We must

protect the lining of that uterus with something. Now, that could be oral

something. Now, that could be oral micronized progesterone. That could be a

micronized progesterone. That could be a synthetic progesterine. Okay? That could

synthetic progesterine. Okay? That could

be an IUD that contains progesterone. Or

there's one other thing. There could be something um called basodoxifene, which is a serum selective estrogen re-uptake modulator,

a receptor modulator, not reuptake, receptor modulator. So basadoxifene is

receptor modulator. So basadoxifene is similar to tmoxifene. They're cousins

basically in that it binds and blocks the estrogen receptors in the breast and uterine tissue. So it is being studied

uterine tissue. So it is being studied right now vasodoxifine combined with primmerin in the form of duov. It is

being studied in patients with DCIS and they are seeing lower blood protein levels associated with breast cancer than women who are not taking it. So it

looks like it may inhibit rec you know recurrence or progression of that disease state in in those patients in DCIS. Again this is very early

DCIS. Again this is very early preliminary data but it is very exciting and there's some hope of you know if you you know would that be something that

someone who was a breast cancer survivor would would we be able to make this so I don't we don't know that yet but it is definitely worth exploring. So I believe there's some studies starting to go on about that. So, who do I use basodoxine

about that. So, who do I use basodoxine in? Anyone who's so freaked out about a

in? Anyone who's so freaked out about a family history, right? Who has not been recommended to remove their ovaries because of some genetic component. Um,

definitely if you have persistent vaginal bleeding on hormone therapy, basodoxifine is a wonderful option because they don't bleed. They don't

bleed at all at all. Okay. Um,

I have an entire blog on if you don't tolerate oral progesterone. I have a whole blog about this. a whole blog. So

all the options, all the recommendations, what to do, what not to do, everything from doing the vaginally to, you know, other oral forms, transnormal forms, whatever, it is all

in our blogs. If you just go to the search bar and type in progesterone, that blog will come up. Okay. Um,

is HRT therapy say like actually safe?

For the vast majority of patients, the benefits outweigh the risks. So do you know you have to think of it you know I don't know why we have infantilized

women and their medical care and not allowed them to make healthcare decisions for themsel how how do why do you think that is in this country that you know we have totally left women out of the conversation about their own

healthcare and do you know the thing that will kill you aspirin will kill you dead as a doorork knob I've seen it happen okay on on aspirin you're dead

Okay. Uh, oodod on Tylenol, you won't

Okay. Uh, oodod on Tylenol, you won't die right away, but you will die from liver failure. Okay. You will, you know,

liver failure. Okay. You will, you know, it will cause fulminate hepatitis and you will lose your liver and you cannot have, you know, without a liver, you won't survive. And so that is why

won't survive. And so that is why Tylenol in the UK is not is by prescription only. It's not over the

prescription only. It's not over the counter because in the UK they have socialized medicine. Not everybody gets

socialized medicine. Not everybody gets a liver transplant. So, if you accidentally or on purpose take a lot of Tylenol and then all of a sudden you're in liver failure, nothing fixes that but a liver transplant. And they're not

going to give it to you because they don't have enough resources for everyone in that country, right? And so,

these are real life things. Um,

let's see.

Thankful there are doctors like you. I'm

trying to take it seriously. Um, if a woman's had a hyerectomy, what signs are there that she's in menopause? Right?

How do you how do I gauge? Certainly.

So, you can go to our website and take the menopause quiz, which is a real scoring system based on the green scale that is actually published in medicine

that will tell you if you, you know, the likelihood that you're, you know, what your score is of your menopause symptom score. And so if you're not sure, you

score. And so if you're not sure, you have an IUD, you've had a hyerectomy, you've had an ablation, you don't have a period to help guide you, right, go take the menopause quiz. If you even are permenopausal and having a, you know,

regular periods, go take the menopause quiz. It will give you a ton of

quiz. It will give you a ton of information. It's print out with your

information. It's print out with your results you can take to the doctor with all of the resources you can show your doctor on the like 2022 menopause society guidelines on hormone therapy.

Sometimes you are going to have to educate your clinician and this is one way to do it. I try, you know, I can't be everyone's doctor, but I try to provide the resources for you to have

the best chance at a good outcome. Um,

let's see. Uh, I'm happy for you and your supplement products. Would like to use them, but they're a bit pricey for me to replace each month. Do you have a beginner bundle? Okay, so real quick, I

beginner bundle? Okay, so real quick, I my hope is nobody needs a supplement.

Put me out of business. you know, eat all the right things all the time. I

can't I don't even do that. I can't do that. So, you know, so here I'm like,

that. So, you know, so here I'm like, eat healthy for two weeks. Track what

you eat. Download a nutrition tracker like um for example, download um chronometer. C R O N O M E T E R.

chronometer. C R O N O M E T E R.

Somebody put it in the comments down below. Okay. Um and then see where your

below. Okay. Um and then see where your gaps are and then fight to to get those nutritional gaps filled with food. Okay.

Then supplement. Okay. Check your

vitamin D level. Creatine, you probably should supplement. It's super cheap. Our

should supplement. It's super cheap. Our

bag, I think, what is it like? 30 bucks,

$35. How much is creatine?

And that lasts two months. I mean, it, you know, so $20 a month. Creatine is

very, very affordable. Big bang for your buck there. Um,

buck there. Um, and so, you know, vitamin D, just just remember, you know, high quality, third party tested is what you're looking for

for a um supplement. And um let's see, I am continuing to read the questions. Uh

how do you know if you need testosterone? Certainly if you have

testosterone? Certainly if you have hypoactive sexual desire disorder. So we

routinely check testosterone level on all of our patients. Um these are conversations we have um with all the patients and certainly if she had a hypoactive sexual desire disorder or

what you might call low libido um then um I that's one of the products that I recommend. There's also two FDA approved

recommend. There's also two FDA approved products Atti addi and Vissi. We also

discuss those with our patients as well.

And yes I will save this live. Um

curious about birth control versus hormone therapy and permenopause. Great

question. Okay, hang on for this. Are

you ready? Okay. Um,

birth control pills were developed to inhibit ovulation so you don't get pregnant. They're their only job. That's

pregnant. They're their only job. That's

the only thing birth control pills are FDA approved for. Every other use for a birth control pill is off label for cramps, for acne, all the things we use

them for. Okay? So, it does not contain

them for. Okay? So, it does not contain naturally occurring estrogen. It

contains a synthetic estrogen called ethanol estradiol that binds the estrogen receptor with 300 times the affinity than regular estradiol does.

Okay, which is why it works so well and why it's so tiny compared to like you know um because there's it just takes this much.

It also has a synthetic progesterine and that's what makes most birth control pills different is there's probably 25 progesterines synthetic progesterines on the market that are in all these different birth control pills. Not

trying to demonize birth control pills at all. They're great for contraception.

at all. They're great for contraception.

Okay. Menopause hormone therapy is your naturally occurring estradiol if you're in my clinic and your naturally occurring progesterone. Okay. We're

occurring progesterone. Okay. We're

giving you back what your ovaries used to make. However, those levels are not

to make. However, those levels are not high enough to inhibit a pregnancy. So,

the big differences between birth control pills and hormone contraception is dose. Birth control pills are much

is dose. Birth control pills are much much more effective at binding the estrogen receptors and kind of holding on to them and you know and in the brain

that inhibits the signal. Remember, the

brain is where we start ovulating and it sends a signal down to the ovary. It

blocks the brain's ability to send that signal. Okay? Which is why it works. Um,

signal. Okay? Which is why it works. Um,

I was on a birth control pill through most of my permenopause, I was treating polycystic ovarian syndrome and I did well with it. Okay,

I would do it differently. I would have my husband get a basectomy and because I did not want to be pregnant, though it was very unlikely. I had fertility issues, but I would have had him, he was happy to do it. I would have had him get a basectomy and I would have gone on

menopause hormone therapy knowing what I know now. That wasn't an option. I

know now. That wasn't an option. I

didn't understand menopause or per pmenopause. Nothing. Menopause I just

pmenopause. Nothing. Menopause I just thought was an old lady disease and you just tough it out and you only take hormones if you're dying and that's all that was what I was taught. Um I mean I

knew it would be helpful for my bones but I didn't realize how helpful it would be for my heart, my brain and all the other things. Um

let's see. Uh I'm reading questions.

Hang on one second.

Uh can you discuss joint pain and hormone therapy? Does it usually help

hormone therapy? Does it usually help reduce pain? This has been my worst

reduce pain? This has been my worst symptom. Okay. So, for about 20% of you,

symptom. Okay. So, for about 20% of you, your muscularkeeletal pain is going to be your worst symptom of menopause.

As far as I understand the data, women on hormone therapy on menopause hormone therapy, meaning you know birth control is hormone therapy. So women who are on

naturally occurring estrogen and progesterone and mostly because of the estrogen it seems like will have lower incidences of joint pain, lower frozen

shoulder, lower hip pain, lower back pain. Once those inflammatory processes

pain. Once those inflammatory processes start, we need more studies to say is starting hormone therapy going to quickly reduce those levels. Now

anecdotally from my patient population and when I talk to my my colleagues in the menopausi they say yes it is definitely they're seeing a um

decrease you know patients are saying that their hip and joint pain is much better or disappearing completely when they start hormone therapy. Um let's see

let's see uh how do you know if you need Oh we talked about that. Um

if you're taking magnesium glycinate every day make you headachy, feel lightheaded, how do we know the supplements we really need? So again um

food first measure then supplement. So

now there are things like creatine, things like melatonin in small doses that will help build up stores of things. There are supplements that have

things. There are supplements that have anti-inflammatory properties like the turmeric supplements. Um, so it really

turmeric supplements. Um, so it really depends. This is a very individual

depends. This is a very individual decision based on your needs, your life, your diet, your symptoms. I cannot say go buy all four of my supplements and you're going to be perfect. That that

would be unethical, right? And so I chose, you know, fiber and vitamin D in my armamentarium to offer my patients because that is the thing that they're most likely going to be deficient in and

I wanted to make sure they had a high quality third-party tested supplement for them. I added in turmeric because

for them. I added in turmeric because the studies on arthritis and joint pain and lowering inflammation, it actually they saw a slight decrease in in belly

fat. So um and I have a I think it's out

fat. So um and I have a I think it's out there's a full new blog on turmeric with all the studies and um to address you know the case reports there are now any

supplement you need to talk to a doctor okay um especially turmeric especially you know magnesium are you really deficient like what are your levels

because you know there are people who will like Tylenol like aspirin you overdose on things go outside of the limits you know these cas case reports.

So, there's been a handful of case reports of people having liver injuries.

So, you know, hepatitis, liver inflammatory processes from taking either too much turmeric or they did not tolerate it. So, especially for tumeric,

tolerate it. So, especially for tumeric, we're getting labs, you know, on our patients. We know every single one of my

patients. We know every single one of my patients who walks in the door gets a liver function test. So, BA for baseline and then if they start tumeric, we're going to recommend checking that after as well to make sure that they're

tolerating it, okay? And this is a good dose for them. Um, but it's very rare.

It is very rare. There's multiple safety studies done on oral turmeric. So, um

let's see. Uh

his hang on, still reading questions, guys. And you can keep dropping them in

guys. And you can keep dropping them in the comments. Oh, there's 1600 of you

the comments. Oh, there's 1600 of you live. Um we did that one. Oh, HRT

live. Um we did that one. Oh, HRT

combined with GOP ones. My favorite

topic. Highly recommend it. Highly

recommend it. If you're doing everything right, if you are doing everything right and your cholesterol is elevated, you have excessive visceral fat, your inflammatory markers are elevated, I'm

telling you in my patient population, it is miraculous. So before GLP1s came, we

is miraculous. So before GLP1s came, we were going all in. Nutrition, diet,

exercise, all of it. And we still are.

It's still important. Remember, we have the pillars of health. I just a study came out today. Was it today or yesterday? showing um God it was

yesterday? showing um God it was decrease in dementia on people with GOP like they are lowering systemic inflammatory levels. They are lowering

inflammatory levels. They are lowering the amounts of visceral fat when patients have done everything in their human power in their lives to do everything right and this seems to be

turning the needle for them. Does

everyone need it? No. Would I recommend it to a normal weight person with normal labs? No, I wouldn't. It comes with side

labs? No, I wouldn't. It comes with side effects. Nothing is perfect. But for my

effects. Nothing is perfect. But for my patients who you know HRT is is one tool in the toolkit but you know thank God we are you know as a as a clinician who

treats patients as individuals. I have a armamentarium of tools that I can pick and choose from to build a program for her not just to put out the fires of

menopause but to help her set a course.

I can change the trajectory of her health for the next 30 years where she's not going to end up with a fracture at 80. Okay, with a broken hip at 80. where

80. Okay, with a broken hip at 80. where

she's like her mother did where she's not going to end up in a nursing home with dementia, you know, or we can decrease those risks. I can't say never, of course not. But like because that's that's my future if I don't change

everything my mother and grandmother did. Both of them dementia and broken

did. Both of them dementia and broken hips and multiple broken bones. My

grandmother broke her rib, broke, you know, kept falling. So, and then ended up the last 10 years immobile in a bed with three brain cells holding

themselves together, you know, and the sweetest, kindest woman and watching her suffer so needlessly in that bed and now watching my mom do it in her 80s, you know. I want a better last decade. I

know. I want a better last decade. I

want I want to kick ass. I don't expect to live forever, but I want a better health span. And that's what my patients

health span. And that's what my patients want. And that is what we try to build.

want. And that is what we try to build.

And that is what I want for you. I don't

want our daughters, your daughters, your nieces, the loved ones in your family, this next generation to go through any of the gaslighting, any of the denial, any of the confusion that they're going

to embrace their menopause. This is this is like the gateway to the best third of your life. Like I love my life. It is

your life. Like I love my life. It is

amazing. Um,

let's see. Uh, can anxiety meds like Adavan I think the benzoazipene I'll have to double check but I'm pretty sure I've read studies where long-term use of benzoazipines like Adavan do have an

increased risk of dementia. Um, remember

ambient has it too and ambient is a form of benzoazipene. So um, thoughts on

of benzoazipene. So um, thoughts on cycling progesterone? I probably I have

cycling progesterone? I probably I have patients we cycle progesterone on especially in early pmenopause when they're still cycling normally. Adding

in that progesterone in the last half of their cycle really does seem to help with the sleep, the nighttime anxiety, you know. So, we really listen to the

you know. So, we really listen to the patient. When is she symptomatic? What's

patient. When is she symptomatic? What's

going on? So, cycling progesterone can be really helpful. But in a for a post-menopausal patient, I never do it.

I don't there's no there's no reason.

There's no studies to support it. My

patients love having that progesterone kick every night to help them sleep. Um

uh so saying the GLP1 can decrease the effect of progesterone put in a marina coil. There is no data to support that.

coil. There is no data to support that.

That is the old ivory tower academics who don't actually treat or talk to patients. So we are not throwing in

patients. So we are not throwing in marina coils. You become more ovulatory

marina coils. You become more ovulatory when you lose weight. If you have poly, you know, if you are affected by polycystic ovarian syndrome or which is very similar in perry menopause and so

if you really don't want to be pregnant, a morano coil is your best friend. You,

you know, that is the best thing to keep you from getting pregnant, but people are losing weight and becoming more fertile because of the weight loss on the GLP1. It's not counteracting the

the GLP1. It's not counteracting the effect of progesterone. Um, let's see.

Oh, can you do HRT if you have large uterine fibroids? Yes, absolutely you

uterine fibroids? Yes, absolutely you can. So, when we're giving patients um

can. So, when we're giving patients um and and Dr. Sharon Malone, you know, and I had a long discussion about this and this comes from her and this is kind of like thinking because no one's actually

studied this. Um I have fibroids.

studied this. Um I have fibroids.

They're still like my uterus is still 78 centimeters big and um I've had no problems. Thank God. I did

early on and it took some dose adjustment, but now I'm fine. They're

not growing. they're fine. Um,

we give something called Lupron, which is a G&RH agonist, and it blocks the it blocks all hormones coming from the brain that talk to the ovaries.

basically just shut you down, put you in menopause, okay, to shrink fibroids um pre-surgery and like pre IVF implantation, you know, we do it occasionally in the gynecology world,

but we always give the patients back menopause hormone therapy because they're going to have horrible hot flashes and we're worried about their bones and it doesn't make the fibroids

grow. So that is u that is the the

grow. So that is u that is the the evidence for that. Um that is theoretical and that is fear-based. So

saying that if you have fibroids or endometriosis, it's a more nuanced conversation and you know for endo we always recommend progesterone even if you don't have a uterus and you know you

can have like Karen Tang is probably the best on this subject if you want to follow her. Uh the hormone this is not a

follow her. Uh the hormone this is not a hormone ring. This is aura. This is an

hormone ring. This is aura. This is an aura ring. Um if you're curious about it

aura ring. Um if you're curious about it I have some more if you go to my favorites. If you go to our website and

favorites. If you go to our website and you just type in favorites, it's on there with an explanation of what it is.

I'm We are Okay, top secret. I am

working with Dr. Andrea Matsimura and she is a sleep medicine specialist. She

is sleep goddess MD on Instagram and I love her. I've known her for well over

love her. I've known her for well over 10 years. Everything I know about sleep

10 years. Everything I know about sleep and menopause, I learned from her because nobody taught me anything in medical school and residency. And um so we are looking at studies showing kind

of what in menopause, what in women helps with sleep as far as sleep supplements go. And we're we're trying

supplements go. And we're we're trying to put something together that would be specific for women. So we're studying our sleep architecture uh with meaning how much deep sleep, how

much, you know, are we able to kind of affect the length of sleep and the sleep architecture um with a sleep supplement

and and see if it helps. So um

so how long can you remain on HRT? As

long as for you you right here you hi the benefits outweigh the risks you can stay on hormone therapy and that might be for

the rest of your life. Okay so let me say that again. As long as for you this is individualized medicine. I'm not

making public health decisions here.

This is what I tell my patients in clinic. As long as for you the benefits

clinic. As long as for you the benefits outweigh the risks and that could be for the rest of your life, you should stay on hormone therapy. The end. Um,

let's see.

Uh, cream versus pellets for testosterone. So, if you follow me, you

testosterone. So, if you follow me, you know that pellet therapy, I don't like to demonize one form of, you know, distribution. So, you can put hormones

distribution. So, you can put hormones in your body lots of ways. If you were with me earlier, you saw I have a patch, I have pills, I have vaginal cream, I have topical cream, I have all kind of

stuff, right? So, for testosterone, you

stuff, right? So, for testosterone, you don't want to do oral in the United States. If you have been given oral

States. If you have been given oral testosterone, fire your please find a new provider. That is not your in your

new provider. That is not your in your best interest. There is one safe oral

best interest. There is one safe oral product called testosterone unde. It's

not available in the US. I think they have it in Australia. So, skip that one.

Okay. So now how do we do a non-oral way to get testosterone in your body? You

can do a trans dder dermal through the skin. Okay, we have creams, we have

skin. Okay, we have creams, we have gels, we have subcutaneous like the pellets. So they can put the

pellets. So they can put the testosterone in a pellet and put it under the skin. Okay. Uh there are troi so compounder can make a troi and it goes under your tongue and you basically absorb it through the bloodstream there.

You don't swallow the troy. Okay. It's

like a lozenge. Um what am I missing?

Oh, injections. So you can do testosterone injections. I don't know

testosterone injections. I don't know how to do those. I've never done those.

I I do androgel and or tumm gel. So um

and I have thoughts about DHEA and I'll share that with you in a minute if you want. Um

want. Um so uh pellets the pellets are compounded. So they're

not regulated by any government agency.

No one goes in to check to see is this what they have. They are not subject to the same regulations that something that is approved from the FDA like the gel and the creams and the patches that are

available from Walgreens, okay, or from HRT Club. Um, they're making bold claims

HRT Club. Um, they're making bold claims about pellets being superior. Not true.

Okay, I have dug into the research and the data and it is so sketchy. Like

there's I've never seen a a a decay curve, meaning here's your pellet and now we're going to track your levels over the next three months. Never been

published ever. Ever, ever, ever, ever, ever. Okay. No safety data. I went to go

ever. Okay. No safety data. I went to go dig for the safety data. Here's their

safety data. No one died. Okay. Um, I

think you can do better. And in my clinic and everyone in my world who does not use pellets, when we do post pellet levels on our patients, so patients will go get a pellet because that's all they

can find. They'll come back to our

can find. They'll come back to our office and they are like I'm like, do you know that your level is 400, 500?

Okay. So female levels, healthy female levels, you at your randiest, woo, your level was no higher than 70. Okay, that

is female physiologic range. 40 to 70, you know, I can snake it up to 100 and feel okay that I'm not hurting the patient, but over 100, I'm like there's no reason for this. Men low level is

260, okay? And then it goes up to like a

260, okay? And then it goes up to like a thousand or something. I don't treat men, so it's like somewhere around a thousand. Okay, fine. Um, these women

thousand. Okay, fine. Um, these women are coming in in male ranges, okay? And

they're like, "I feel amazing." And I'm like, "Oh my god." So, you don't need that high of a testosterone level. They

never made a pellet for women appropriate for women. They didn't do it. So, I don't I just feel like the

it. So, I don't I just feel like the company's not ethical and I don't use them. I don't recommend them. And I

them. I don't recommend them. And I

think you can do better. Also, if your clinician is only offering pellets, that's a red flag. That means you've become a money machine for them. You

have to go back every three months. You

know, now if your doctor says um hey, here's all of your options. We got

pills, we got patches, we got gels, we got cream, we got and oh, and we have these pellets. and

you make an informed choice that you want to try this pellet and you don't mind if your levels are low male ranges um and you're willing to pay $500 every 3 months or whatever the cost is you do

you boo I just want to make sure you're making an informed decision and you know that you have other options and that my androgel cost me $50 $10 a month for FDA

approved high quality very stable dose testosterone so and that's what most you know, my friends use. Um,

friends use. Um, let's see. Okay.

let's see. Okay.

Um, keep coming with the questions.

Um, will testosterone make acne worse?

Potentially. Yeah. So,

uh, potentially. Sleep doc name Andrea

potentially. Sleep doc name Andrea Matsumura. It's sleep goddess MD on

Matsumura. It's sleep goddess MD on Instagram.

Uh, does GLP-1 cause bone loss? Not

directly there. You know, I haven't seen issues with that, but you know, your nutrition and your diet is, you know, your bones are very sensitive to your

diet. And if you're not getting enough

diet. And if you're not getting enough vitamin D and calcium protein to keep your muscles strong, it's because you're undereating from from unsupervised GLP-1 and you never got all the counseling and

you're not able to get enough calories in to maintain like nutritional homeostasis, you probably are going to accelerate your bone loss. So, it's not

it's an indirect cause if it is one. And

so when we have our patients on GLP1s, we do extensive nutritional counseling for them so that we can limit the muscle and bone loss that potentially could

occur, but it doesn't occur like 100% on its own. Um,

its own. Um, let's see.

Uh, you took testosterone and you're okay.

Um, insurance covers Andro gel, but your doctor won't give it because she doesn't know how to dose it or prescribe it. I

am so sorry. Okay, so here's an option.

Go to Ishwish, the International Society. Um,

Society. Um, let's see. International

let's see. International Hang on, hang on, hang on.

Okay. International Society for the Study of Women's Sexual Health. Okay.

International Society for the Study Isswish and they have guidelines on how to prescribe testosterone and you can print those out and take them to your doctor

and ask pretty pretty please. Would you

please and here's what you say. Hi,

I have hypoactive sexual desire disorder and testosterone is clinically indicated. Would you please prescribe me

indicated. Would you please prescribe me this for three months? here's how to do it and I will come back and let you know how I'm doing.

You take all the work out of their hands. Okay? And now they have the

hands. Okay? And now they have the guidelines and they can learn and so for the next patient they'll feel more comfortable prescribing it and you're helping kind of perpetuate the positive

stuff um all the positive things about uh teaching your doctor because she didn't learn. It's not her fault. So no one

learn. It's not her fault. So no one taught her. I didn't learn anything. Do

taught her. I didn't learn anything. Do

I do tele medicine? I do not. Some of my practitioners in my clinic do, but only in the state of Texas. Um,

yeah, high CRP, GLP1, decreased weight, you've lost 70 pounds, inflammation still remains high. Okay. So, I would I would do a deeper dive on the inflammation markers, which ones are

elevated, and then start looking at your nutrition. So, you've lost the weight,

nutrition. So, you've lost the weight, but now we need to make sure you're eating a very anti-inflammatory diet and remove any pro-inflammatory nutrients um from that and like a is it

autoimmune disease? Like, why are your

autoimmune disease? Like, why are your inflammation markers still up? So, you

need a workup for that. That's what we would do in our clinic. Um

let's see.

Um if you have lupus, can you take a GLP-1?

I would ask uh Ros ro Rosio Salis Whan I think the answer is yes she is that you know um so she is Dr. Salisin, I think,

um, on Instagram. She wrote the book Weightless. And, um, there's also

Weightless. And, um, there's also a book about Oz, the Ozmpic Revolution or something. They'll probably have that

or something. They'll probably have that in there. Um,

in there. Um, let's see.

Burning mouth syndrome is one of the common symptoms commonish. about 20% of women will have burning mouth or tongue in menopause. So, there is a relation.

in menopause. So, there is a relation.

Um, okay. So, I'm going to wrap this up,

okay. So, I'm going to wrap this up, guys. Thank you so much. Um, if you do

guys. Thank you so much. Um, if you do me a favor, go to the link in our bio and go check out all the free resources that we have. We have links to our

blogs, to our challenges, to the belly fat challenge. Um, and uh, yeah, Dr.

fat challenge. Um, and uh, yeah, Dr. Salis whalen and I do use alloy

products. I use their um estriol M4 face

products. I use their um estriol M4 face cream and I use the um probiotic that

they have. So uh hey Kathy Kathy

they have. So uh hey Kathy Kathy Shampine is on here. Oh DHEA. Okay, I'll

talk about that. So,

vaginal DHEA in the form of prosterone or MEXI um is amazing and it converts in the vagina to estradile and

testosterone. And so, we do have

testosterone. And so, we do have testosterone receptors in our vagina and vulva as well. And so, the sexual medicine, the urologists love it, love it, love it. It's just kind of

expensive. Um oral DHEA I'm not a fan

expensive. Um oral DHEA I'm not a fan of. Haven't seen enough data to support

of. Haven't seen enough data to support recommending it. I would make it, right?

recommending it. I would make it, right?

I have a supplement company. I would

make DHEA if I felt like there was enough studies because our factories are broken. So, DHEA is a precursor. Like we

broken. So, DHEA is a precursor. Like we

take cholesterol and we keep cleaving molecules off in this like conveyor belt and then you end up with alop pregnnenolone aloprenalone um, and dione and we go through this process where we end up with estrogen,

progesterone, and testosterone at the end all from like this DHEA precursor, right? So they're like, "Oh, we'll just

right? So they're like, "Oh, we'll just give you more DHEA and you'll make more, you know, hormones down the line." Your

factory is broken in menopause. The

ovaries don't work. So giving you DHEA is just not going to make the ovaries be more efficient, you know, and so you make plenty of DHEA. We don't have a DHA

deficiency in humans. And so giving it to you orally hasn't been shown to increase estradile, progesterone, or testosterone levels. I just give you the

testosterone levels. I just give you the estradile, the progesterone, and the testosterone because I just treat menopause, you know.

Okay. Um All right, guys. So, that's my two cents. We will chat again soon. Go

two cents. We will chat again soon. Go

check out the link in bio. And I had so much fun with you today.