That unfortunately is happening in the thyroid world as they are, they are waiting for those people to

fail. And not in my office. Right.

Not in your

office. That's true. Not in your office. There's under treatment of thyroid. That is true or not treating to optimization. But yeah, but the but the bottom so I have to look for a better analogy. But the bottom line is that it makes no sense if you're even going to consider hormone therapy for women to say, well, you can have hormones for a few years, but it has to be after you haven't had a period for 12 months. That makes no sense at all. Makes no sense. No sense.

And the further you get away from that hormone optimization, the more damage is being done. That damage really happens in an accelerated fashion.

Oh my gosh. We know that in the years preceding that last period, there's seriously high rates of loss of collagen, which collagen is involved in everything in the body and not just bones and joints and skin and vascular structures and all. And you have plaque already forming in your arteries. You have changes in your brain structure. Women have word finding that they can't remember names. They can only remember adjectives. You know, so it's like really a real thing. That's the thing. And we need to get on this early and recognize that these hormones have vital functions. The fact that it's natural and universal to lose these vital life hormones doesn't make it good. Remember, menopause and living in menopause is really not something that has really been common throughout humanity through the history of mankind. I went back and looked at ancient Egypt and in ancient Egypt, if a woman, and this is you know, three to 5,000 years ago, and that's our first recorded history. So I'm sure it wasn't better before that, you know, on planet earth for a long time. So if a woman survived childhood and she became an adult, her longevity, if she made it to 35, that was good. So yeah, she didn't make it to menopause. Menopause wasn't a thing. And if you go back to the year 1200, if you lived to 50, if you survived childhood, that was good, you know, so you got to the age of menopause. And it's only recently that women literally can live half their lives as menopausal women. That's not a, that's not been part of humanity's history. That is a new thing. And we have medical whack-a-mole, whereas every problem that's related to so-called aging comes up, you have a drug and a procedure, one or the other or both. And my thing and your thing is prevention, you know? And so you have to get on this understanding that aging is not about number of years. It's about number of deficiencies. And it starts with hormonal deficiencies. And then it leads into immune deficiencies, nutrient deficiencies and so on. But if you can maintain these structures and these hormones to be, and cells to be optimally functioning at every age, then you can actually delay these so-called diseases of aging. And that's what we call super aging, right? And that's what we want everyone. If we're going to live long, let's live cheaply in terms of the society, cause for our healthcare and also with high quality. So my definition of being a super-ager is that at 95 and beyond, you can do pretty much, maybe not perfectly, everything you could do when you were 40. And why not? You know? Why not? Because every cell in your body is a different age. There's very few cells in our bodies that are there from the day we're born. And that's why we have stem cells. And we want to maintain our stem cell pool and to keep it healthy. So when a cell is born in your body, like we know bone cells typically have a seven year lifespan. So when a new bone cell is born, it doesn't know how old the person is that it's just born in. It doesn't say you're 70, so I'm going to act yucky. No, it's going to, it's a, it has all the same genes that you would have when you were made a bone cell at age 20. And if you give it what it needs, the micro-mapronutrients and the directions to do with them, what it should do, which is the hormones, they will still do it at any age. Now that doesn't mean we can prevent aging, but we can really slow down the progressive deterioration associated with aging by maintaining proper nutrition and avoiding poisons and maintaining our hormones. And that's my goal for me. And that's why I feel like I have, I'm sort of at the forefront of being an older person in this world, you know, in this functional medicine world. So, you know, I feel I have to be the role model for super healthy aging, right? So,

you know, and you are, and you are the stirrer.

So, you know, I say, you know, like I'm hormones for life. And that's my other thing. This craziness of if you do go on hormones, they become even more dangerous. They're always dangerous, but they become even more dangerous if you reach 60, like where the heck is that coming from? Stupidity from the women's health initiative. Like, let's get over that. Hormones don't change how they work in your body at 59 versus 61. This is like nuttiness. It's hormones for life.

Yeah. So, I know that you understand all of this. Most medical practitioners, probably because of the women's health initiative, know very little or anything about proper hormonal balance, proper hormone cycling. And so, I think that this movement is going to be solved by women because I think that they're going to demand it. They are going to demand

it. It's definitely from the bottom up. It's not from the top down. A hundred percent. I am trying so hard. I am writing articles and getting them published in the most prestigious medical journals. And every time the editor of the journal says, this article is fantastic. It's going to get so much readership. And then, oh my goodness. It's not. It's not. I mean, it's like, I'm not giving up, but every time it's supposed to be, this is going to go viral. This article. And it's like, no, I just had another one published. Like about maybe six weeks ago. And it's like, this is going to go viral. It didn't go viral. You know, it's like so hard to change the minds of doctors. It's like, why are you so stuck? Why are you so stuck? You know, why are you not curious? Why are you not open minded? But it's not happening. I am trying from the top down. I'm not giving up, but it's really from that it's going to be from the bottom up. It's going to be from the bottom up. And with our question. And we're going to demand it. They're going to demand it and demand. Like, I want my hormones. I want my hormones and I want them. And I don't want to stop them because I have patients calling my office all the time. I turned 60 and now my doctor refuses to give me hormones. It's like, we'll come over here. You know, it's like, yeah, I'll give up to you. Like unless you have some obvious contraindication, which is really uncommon, you know, yeah, why would I stop them just because you hit a birthday? That's ridiculous. Yeah.

Yeah, ridiculous. So I would love to spend the rest of our time just mapping out for women. When should they start to test? When should they start to replace?

How, how do they know that

it's time? Because we know that it's at least a 10 year process from when your ovaries start to shut down and you need to supplement to when they are, you know, completely done and you need to replace.

Well, first, just if you're younger reproductive age and you have irregular cycles, you need to try to do everything in your power to find someone who will work with you to try to get them right. So, you know, you want to start early and don't cover up the problem with masking endocrine disruptors. Now, when you reach the average age for menopause, which is defined arbitrarily as 12 consecutive months without any bleeding, is 45 to 55. That's a whole decade right there. So if a woman is going to actually stop having periods at 45, her perimenopause would be like a 35. And then there's early menopause, which is from 40 up to 45. And then they would be starting to change, you know, when they're already like 30. So find out what happened with your mom, assuming she didn't like have a hysterectomy, right, because there is some genetic linkage there. And if your mom had a very early onset of menopause, then we should probably think of you as potentially another early person. And so I would start figuring that if you're going to be in the average range, though, that by age, certainly by around age 40 ish, that's when you should start thinking of perimenopause. Now, if you have symptoms, that is like a clear cut thing, like night sweats, hot flashes. But of course, those are like the most obvious, but you can have subtle things like your sleep is now changing, your mood is changing, you're having palpitations, you know, you just feel weaker. So you can have like these more subtle, you're starting to have acid reflux. These are some of the enjoint pain, more of like could have inflammation. These are the more subtle signs that your hormones are changing. Maybe you're having brain fog, you know, you just feel differently, you're losing your sex drive. And that is related to estrogen, not just testosterone, that's like another whole subject. But so if you have signs that things are really changing in your body, listen to them, that's probably that your hormones are changing because hormones are about everything. So at that point, it would be reasonable. And this is obviously assuming that you're not on something that's blocking your hormones like, you know, you're on birth control pills, because then it's whatever, it's not your own natural hormones, it's something else. It's, you know, the effect of the birth control pills or other things. But assuming you're having your own natural cycles, if you have changes in your cycle, the most common being in the early stages, perimenopause, is that the cycles get shorter. You're getting shorter because the luteal phase, the point from ovulation to the period, which is when you make progesterone, it's getting shorter because you're not making progesterone as well. And so the luteal phase gets shorter. So maybe you had a 30-day cycle. Now it's 26 or 27. It's just a few days different. It's shorter. That's a sign things are changing. So I like to do menstrual mapping, where you can collect urine samples throughout a cycle multiple times, and then it's like mapped out on a graph. And it's just so instructive. I've got the whole collection of these showing how also it links to symptoms, how your hormones are really linked to the feelings that you have. And you're not crazy. Like 25% of women are started on antidepressants in their 40s. Like duh, it's your hormones that are changing your brain. And you don't need an antidepressant. You need hormones. This is like nuttiness. So starting early looking at menstrual mapping, looking at your own symptoms, looking at your mom's history. Now in someone who is very borderline, say, I may not even start them on actual hormones, I may use phytoestrogens and like herbal because they have effects on the hormone receptors themselves. But once I'm sure that the progesterone is not adequate, I'll supplement with progesterone. And the estrogen is not adequate. I'll supplement with bioidentical estradiol. There is no danger. There's no risk to this. It's like ridiculous not to do it. And basically it's giving you a safety net. When you give bioidentical hormones like this, it's not changing how your ovaries are producing the hormones. It's not shutting them down. It's not like a birth control. It's not giving contraceptive then either, you know, so you can get pregnant. It wouldn't hurt you if you got pregnant on them. They're bioidentical hormones. But it's not contraception and it's not shutting down your ovaries. It's giving you like a little layer on top so that you have a better amount. So I call it hormone supplementation. Now once the ovaries cease to make the hormones, which of course will always happen, then I call it hormone replacement therapy. So it's supplementation then replacement. There is no absolute roadmap for this. Every woman has to be very uniquely looked at and what her needs are, what her goals are, what she's willing to do and so on. When we give hormones supplementation and a woman who's still having cycles, then we give it to blend with her cycle. When we give it to women who aren't having any hormones, we can just create our own cycles because she has none. So we don't have to like blend it. The most challenging women are the perimenopausal women because they are like, you know, like, loose cannons because they're in flux. Their hormones are changing and I'm not changing how their ovaries are going to work. I'm just making sure that they don't fall too low. So they're a moving target. They're an interesting group because sometimes in perimenopause, there's overshoot. That's why it's a group that has more twins because they still have the capability of ovulating, but their brains are like struggling to try to get them to make the hormones in a proper amount. So the brain through the pituitary will put out too much stimulating hormone and they'll double ovulate that month and then they get twins and then they will sometimes make way too much estradiol. That's when you can actually have too much. It's very brief time of life that you can have the ovaries make too much estradiol due to this overshoot. So sometimes you have too much and that's and then it goes down and that's why the perimen opausal years can be, you know, aligned with things like sudden onset or worsening of migraines and breast tenderness and crazy mood swings because you have fluctuations in hormones. And when I give hormones, I'm trying to get the brain to say, you know what, the hormones are okay, you know, so you don't get those huge wild fluctuations. And sometimes it really does work because if the brain receptors say there's enough estradiol, you know, because you don't get those big dips and then the ups and then downs, then you won't have those giant ups and downs. So the way it kind of works is the tendency is always down, but along the way down, you can get these spikes up. So I want to keep the spikes up and down those big spikes from happening because they can be really like a roller coaster for women and we don't want to have that. So we try to give some baseline estradiol. So the brain sensors will say, okay, we're good. We don't have to do the overshooting and the undershooting and the overshooting. So it can really help to level things. You're still going to go down, but, you know, I'm trying to prop you up so you don't also have those giant ups and downs. And it can make the roller coaster of perimenopause much easier, much, much easier and much healthier because nobody wants to go through these and it's not good for the body, you know, these gigantic crazy swings either. Yeah,

yeah, absolutely. So lastly, I do want to touch on the topic of testosterone a little bit because I feel like a lot of women, they think they need it, they want it, they're not sure about it, they're afraid of it. So can you talk a little bit about testosterone supplementation? Sure.

So in a female, a reproductive age, normal female, 25% of the testosterone in the body circulating in the blood is made by the ovaries, just 25%. The other 75% comes directly or indirectly from predominantly the adrenal gland. So the adrenal makes 25% of the testosterone that's circulating, but it also makes a large amount of androgens that can be converted primarily in fat tissue, but other tissues as well through the different enzymes into testosterone. So most testosterone, the body is actually derived from the adrenal gland. Now the ability of the ovaries to make testosterone is lifelong. It does not require a single egg. So you could say the skill set of the ovaries to make testosterone is completely separate from the skill set to make estradiolum progesterone, totally different skill set. And during the perimenopause, when the brain has sensors and says not enough estrogen, it will trigger more production of testosterone. So the way that it works in the ovary, testosterone is produced in a group of cells, the thick of cells, and then testosterone moves to a different part of the ovary, the granulosa cells. And in that part of the ovary, under the action of the enzyme aromatase, the conversion occurs that testosterone is converted into estradiol. 100% of estradiol in the body is derived from testosterone. 100% of estrogens in the body are derived from androgens, and testosterone is a specific androgen. So when the brain says, oh, not enough estradiol, because I have sensors that's not enough, it triggers the ovaries to make more testosterone. And the ovaries are good at making testosterone, no problem there, different skill set. So you can have in the perimenopausal years an overproduction of testosterone, because it's like an assembly line. So you have a little glitch here, you don't make as much estradiol, but you make lots of testosterone. So you have too much testosterone and then not enough estradiol. So some women, it's not uncommon in the perimenopause, in early menopause, will say, what is happening? Am I going through puberty again? What is this? They're getting acne, they're getting sudden hairs are growing, their hair is thinning, androgenic alopecia. The last thing they need or want is more testosterone. And so many doctors just automatically say, you're in menopause or perimenopause, you need testosterone. What the heck is that coming from? That is not science, that is ridiculous. You can make testosterone without being able to make estrogen. You always make testosterone. Now, and most of it is coming from the adrenal. Now, as it happens, the adrenal gland, the section that makes androgens is called the zona reticularis. And like many things in the body, with aging, it becomes less functional. So the zona reticularis will actually somewhat shrink as people age. And so there tends to be a decline in androgen production with age. That's why some people think of DHEA as, you know, like an anti-aging hormone. Because it is anabolic. It helps produce muscle and bone. And there's actually data showing that it can help prevent osteoporosis. And so the adrenal gland will make, you know, statistically, but there's no exact time in life. It's not related to the menopause. Will make less androgens over time. So there are women that will benefit from supplemental testosterone or DHEA with aging. But it's separate from the menopause. It's really important to know that some women will have a deficiency of androgens even when they're like 40, you know, and they may benefit long before menopause, like a decade before menopause from having some additional androgens. There's even data, published data, that giving supplemental DHEA can prolong the function and lifespan of ovaries. That it's part of like women who are sort of heading into the around 40 and they want to have kids and their ovaries are aging. And that's one of the treatments to try to prolong ovarian function is to give DHEA because the adrenal may be declining. And that's not a good thing. You know, because some women will have too early of a decline of their androgens from their adrenal gland. And you know, like there's interaction of everything. So but it's separate from menopause. So you want to look at these hormones. And the other thing that's sort of tricky about testosterone is that a lot of the action of testosterone is in tissues, not through the bloodstream. So we can't measure levels of testosterone in the tissues and testosterone can be produced from the adrenal androgens in the tissues themselves. So just looking at serum levels of testosterone isn't really telling you the whole picture of what's going on in the tissues. Plus a lot of the action of testosterone occurs by the conversion to its more potent form. And then DHT, dihydrotestosterone through the action of five alpha reductase, which in some women is like overactive genetically or due to inflammation. So the last thing a woman wants is if she has overactive five alpha reductase is to get more testosterone because it'll be converted to the potent form and then she may have more hair loss. So this is like a whole gigantic subject that is misplayed by a lot of doctors I hate to say because they don't understand androgens in the female at all. And they just think you're in menopause you need testosterone. That's not the way it goes. They may or may not need it. It's a very individual thing.