Rich, Fit and Happy Show

67 | Unleashing Hormonal Harmony: Exploring Endocrinology with Dr. Cassie Smith

• Crystal O'Connor • Season 2 • Episode 67

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Can you imagine being a renowned endocrinologist who diagnoses and treats autoimmune conditions daily, then one day you find yourself on the other side of the table, grappling with PCOS, Hashimoto's, and Graves's Disease? That was the reality for Dr. Cassie Smith, our special guest on this episode. 

Today I spoke with Dr. Cassie Smith, a dual board-certified Endocrinologist, nationally respected speaker, researcher, and locally sought-after endocrinologist who focuses on industry leading hormone therapy and a holistic approach to treat patients struggling with overwhelm and make lifestyle changes to rebalance and align their health.

She did her undergraduate and medical school at the University of Missouri Kansas City, which is one of three colleges in the country with a combined undergraduate and medical degree program completed in six years. During her fellowship, she worked on a dozen major clinical trials centered around diabetes care at the Harold Hamm Diabetes Center in Oklahoma City. After fellowship, her insights in research and forward thinking made her a nationally sought-after public speaker for numerous international pharmaceutical companies for which she has presented hundreds of talks locally and nationally. She has also become a thought leader and expert in the field of bioidentical hormone replacement therapy. Dr. Smith serves on the Medical Advisory Board for BioTe, a national industry-leading company with an emphasis on bioidentical hormone replacement therapy. In this role, she educates physicians and practitioners nationally on how to diagnose, administer, and treat patients with hormone deficiencies. She continues to focus on industry leading hormone therapy and a holistic approach to treating patients with autoimmune diseases.

Find more about Dr. Cassie Smith at:

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Hello, hello. Welcome to Rich, Fit and Happy. I brought on a guest today that is going to touch on some really important topics in regards to our health. Okay, so Dr. Cassie Smith is a dual board certified endocrinologist, nationally recognized speaker, researcher, locally sought after in endocrinologist who focuses on industry leading hormone therapy and a holistic approach to treat patients struggling with overwhelm, and she helps them make lifestyle changes to rebalance and align their health. She did her undergraduate medical school at the University of Kansas City, Missouri.--By the way, I'm from Iowa. I'm in Florida right now though.-- Which is one of the three colleges in the country with a combined undergraduate and medical degree program completed in six years. She then transitioned to working on a dozen major clinical trials centered around diabetes care and fellowship at the Harold Ham Diabetes Center in Oklahoma City. And after fellowship, her insights and research and forward thinking made her a nationally sought after public speaker for numerous international pharmaceutical companies, for which she has presented hundreds of talks locally and nationally. Dr. Smith went into private practice in March of 2020 after practicing for a large health system for several years following Fellowship. This particular practice change was inspired by her desire to treat patients with comprehensive care and preventative medicine. She's had her own personal struggle with PCOS, infertility, Graves and Hashimoto's, and after years of dealing with her own medical issues, she was frustrated to learn most medical doctors could not offer treatment or preventative options for the conditions she was struggling with. And over the past few years, she's made it her purpose to learn how to treat and put into remission, autoimmune conditions. She has also personally learned how creating a healthy lifestyle leads to overall wellness. And during her journey, Dr. Smith has become a thought leader and an expert in the field of bioidentical hormone replacement therapy. And in 2022, she began serving on the medical advisory board for Biote-- so she's gonna explain what that is-- a national industry leading company that with emphasis on bioidentical hormone replacement therapy. And in this role, she educates physicians and practitioners nationally on how to diagnose, administer, and treat patients with hormone and vitamin deficiencies. In November of 22, Dr. Smith decided to expand her practice and modern Endocrine was born. She plans to continue using this holistic approach to treating patients with industry leading hormone therapy, comprehensive laboratory testing, preventative care, lifestyle modifications and restorative medicine practices to personalize patient care and treatment plans for autoimmune and chronic diseases. And as an expert endocrinologist, her goal is to help patients struggling with overwhelm, make lifestyle changes to rebalance hormones and align their health. Welcome. That was a long intro. Welcome, Dr. Smith. Okay. We have got some issues here in, particularly in this country. I think, you know, worldwide, but particularly in this country with our health and how we feel. Let's just dive right in. And it sounds like you've been through some of it yourself, and we don't get to hear that every day. How, you know, not all doctors share their own struggles. So, can we just start there? Because you had PCOS and a few other issues and you were even frustrated yourself. Yeah. Yeah. So I mean, I think that's important too. A lot of times, doctors in general, I mean, we don't take very good care of ourselves. And so I was that person in med school, right? So I was in med school and I wasn't sleeping very well. I wasn't eating very well. Doing all the wrong things. And so I developed Grave's Disease in medical school, which is where it's a form of hyperthyroidism. And so whenever I developed this, there's a medication that you can take that they give you to kind of put you in remission and make you not feel awful. And because when you have Graves, you're really hot and a lot of times you, you know, are hungry a lot, you lose weight, you can't sleep. And so there's a medication they give you. I was put on the Methimazole, and what they tell you is, you know, you're gonna take this medicine and if things don't get better in a few months, then we can just give you some radioactive iodine and kill your thyroid. I said, "What? That's it? That's my option?""Yeah. That's your option," you know? And so they don't really talk to you. At least they didn't it when I had this, this was in, you know, 2010. They don't really talk to you about the ramifications of killing your thyroid. Right? Like, what is that gonna do to you? But the, you know, the thought of radioactive iodine was like,' eh, I dunno, maybe I should read more about this.' Right? And so I was in, you know, I was in medical school struggling with this, trying to take the medicine, feel better. And so started kind of doing some of my own research and realized I didn't wanna do the radioactive iodine. Luckily went into remission with the medication. And so then kind of, to be honest with you, let it go because I was busy, right? So I'm trying to finish medical school and get into residency and so, just kind of went back to my old ways of not sleeping a lot, not eating a lot, just living, you know, trying to survive. And so then whenever I was in residency, I had some issues again with my thyroid. Ultimately developed Hashimoto's, had insulin resistance, had some PCOS, irregular menstrual cycles, you know, struggled with that, but just made it through residency and then went into fellowship and didn't really worry about it at the time cause I wasn't thinking about having kids, you know? I was just, again, doing what we'd all do, which is just survive, get by. Right? Then when I got into my thirties though, married my husband, we started thinking about having kids. Then it kind of started to all come together, so, you know, was having issues with just irregular menstrual cycles and fertility and realized I still had insulin resistance and I had Hashimoto's. So a lot of autoimmune issues. And when you talk to people it was just like, 'Oh, well, you know, everyone has that. It's not a big deal. You can take drugs to get pregnant or you know, you can take drugs to fix that." But it wasn't like, you can do things to prevent this. You can do things to get this to go away. So it was just very frustrating for me because I dunno. I just wanted an answer. Like, why? Why is this happening? How can I make it better? Why do I feel bad? My whole life, like a lot of women, you know, I blamed my, I'm tired, I don't feel good, whatever. I'm just, we work a lot, right? We work a lot. I've been in school. There was always an excuse. But it was never like, maybe there's something, you know, medically wrong until I started learning about hormones and I actually was in endocrinology fellowship, right? So I'm in a fellowship where they teach you about hormones and they teach you about endocrinology. And still nobody's telling me in fellowship like, Hey, there's other options besides medications for Hashimoto's or worse. A lot of people don't even get treated for their Hashimoto's, right? They just say, oh, we'll just wait until your thyroid burns itself out and then we'll deal with it. That sounds terrible too, right? So it doesn't matter that you're tired and it doesn't matter that you feel like you're gaining weight, and it doesn't matter that your periods are irregular. The standard is we're just gonna watch you and monitor you. And so I didn't like those answers, especially like that was my field that was giving me those answers. And so that's kind of what started all this was, I was like, there's gotta be something else out there, right, to help these people. The struggle that I'm going through, and I didn't even really realize it was a struggle until I started reading and started doing things to change my life. And honestly, I probably didn't feel well until the last year and a half, maybe two years of my life. So I spent the first 36 years of my life... Just within the last year and a half, recently? Yeah. Wow. Just so the last year and a half. You know, I knew I had all these issues, but it was just like, well, you're fine or you don't need medicine, or, you know, take this medicine. So I was on thyroid medicine, I was on a lot of things. And then when I started with my private practice right around Covid and I started seeing all these people, especially after Covid with all these autoimmune issues and I started researching and looking into hormones and, you know, there's so much stuff out there and there's so much literature. But I was like, okay, I'm gonna try some of this, right? I'm gonna actually sleep eight hours a night and I'm gonna take the vitamins that I need and I'm gonna look at all my labs and see all the things that are wrong, and I'm gonna figure out how do I fix those with nutrition and with supplements and, you know, with stress reduction. And so I just, that's kind of how I got started. And there's so much information, there's so many people out there. And then as I started making changes, I started feeling better. I started, you know, working on my hormones, my insulin levels, and so I'm actually off all my medicine now, so I don't take any thyroid medicine anymore. I take supplements. What did you do? How did it happen? So I think it's just, again, over time what I did was I found this great doctor through Biote, through the company that I work with. So I found a guy, his name's Cory Rice. He's outta Dallas and he does kind of a functional medicine approach. And so I saw him and he did a bunch of blood work on me, which I had done on myself, but he did more. I did a stool study, did this huge comprehensive test, and I met with him and he said, I'm gonna tell you all the things that you probably already know and tell people and you just don't wanna hear. You know, you need to get rid of gluten. You need to get rid of dairy. I can tell by your stool study that it's not processing well. Your hormones are outta whack. You know? I mean, he just told me all the things that I tell patients, but I didn't wanna hear or believe myself, and so I started working on those things. Right? You know, he is like, you've gotta sleep. You've gotta sleep eight hours a night. You've gotta do things for stress reduction. I kinda hate that because even though it's true, how do you do it? Right. Did it tell you how to do it or did it just start coming naturally when you changed your diet and lifestyle? Yeah, I mean, so I think one of the things I struggle with this too, right? I own a business. My husband owns a business. I think the most important thing is when you do start to do it, like I would do it on the weekends, right? And then I would do it a couple days during the week. And I think with me, what really hits home is like when I do it, I feel really good. When I don't, I don't. Right? Well, when you say when you do it, do you mean when you get that deep sleep? And is it go to bed early? Like what specifically are you doing? Yeah, with, with me it's just, I mean, you know, you have to figure out what works for you. So I'm an early morning person. I have to be.

So I'm a 5:

00 AM person. Cause I also exercise every day or do some sort of movement every day. I think that's very important. So then you just have to-- I just have to prioritize. Like, I'm going to be in bed by nine o'clock. You know? And thankfully, once I got all my inflammatory markers down and my hormones regulated, when I am in bed by nine o'clock, I'm usually asleep by 9 till 5, which is nice. I had problems sleeping my whole life until recently, and now I sleep wonderful. So I think it's just, yeah, it's figuring out what do I need to change so that I have that dedicated eight hours of sleep, right? And we all make choices, and so you just have to figure out how to put that into your lifestyle. So how did you get your hormones regulated? What did you do specifically with that? Yeah, so that's a good question. So I have PCOS and a lot of people, you know? I knew I had PCOS for a while. A lot of doctors said, well, you can't have PCOS cuz you're thin, you know? Well there are a lot of people who are thin that have PCOS. So there are criteria you have to meet. And I met actually all three of the criteria for those. Ooh, what are those? So you have to have irregular menstrual cycles. So that means typically less than nine of them over a 12 month period. But irregular menstrual cycles is one. If you have an ultrasound that shows you have cysts on your ovaries, and there's a certain amount that you have to have on each ovary. And then if you have insulin resistance, which I had documented by blood work or hyper androgenic symptoms, so like acne, if you have a lot of excessive hair growth, if you have elevated testosterone. So if you have two outta three of those, then technically you meet the criteria for PCOS. Oh, okay. So I had PCOS, even though I'm thin, you can have PCOS. And so I knew that. And so a lot of what people don't realize with PCOS, a lot of the ways you can treat that, one of them is if you are overweight, losing weight is really important because the other thing we forget is fat and adipose tissue are actually an endocrine organ, right? So we all talk about like our cardiovascular system and we talk about our lungs and we talk about our brain, right? Our nervous system. But nobody ever really talks about our adipose tissue or our endocrine fat system. And so our fat filter I mean, they do a lot of things for our body. One of them that they do though is when you have excessive fat or adipose, you make more insulin. And that's a problem because insulin is very inflammatory. Insulin causes blood sugar levels to rise and over time can cause diabetes. And so a lot of people with PCOS struggle with elevated insulin levels like I did. And so getting those insulin levels to go down changes a lot of things. And when your insulin levels are high, it causes a lot of inflammation. And that inflammation a lot of times kind of tells your body like, oh wait, something is not right here. And so a lot of those women will struggle with hormone issues. So when you start to get insulin levels to go down and you weigh, you know, if you're overweight and you get your weight to a healthy level, a lot of times that will fix. And then sleep. Sleep is important. And thyroid as well, right? So I wasn't sleeping enough. My thyroid was still outta whack. My thyroid antibody level was high. My Hashimoto's antibody level was high, which is another indicator that I was inflamed and I wasn't taking good care of myself. So when I started working on fixing that, fixing that thyroid antibody level and fixing, you know, my insulin level and sleeping, a lot of that will start to fix itself. I did do hormone replacement. I currently do some hormone replacement because my hormone levels are still a little off. But once I started fixing all those things, then your thyroid, I think a lot of times when you have Hashimoto's, when those inflammatory markers go down, then your Hashimoto's-- like my Hashimoto's antibody, my inflammatory marker went down. Well, when that goes down, then you don't have all this inflammation in your thyroid. Well, then my thyroid was able to start functioning again and actually do what it was supposed to do. I was giving it back all the things it needed. I was taking my vitamin D and I was making sure my iron levels were good and my B12, and so my thyroid had everything it needed to actually function, and so I slowly got to take myself off my thyroid medicine which was awesome. So it all, I mean, it all plays together, right? So that's what Dr. Rice told me when I saw him. He's like, you know, you have all these things that are not working. You know this, right? Like your thyroid's not working and your insulin is high, and your vitamins are outta whack and you're not sleeping and your cortisol's high, but you've gotta start making them all work together. I mean, I think what happens in medicine, what's frustrating is sometimes doctors know just enough to be a little dangerous, right? Like they pick at something like,'Hey, I know your thyroid's off. We've gotta fix it.' Right? But we're not thinking about the seven other things that affect our thyroid, right? Well, even though your thyroid gets fixed, if your B12 levels aren't right, or your D levels aren't right, or your ferritin levels aren't right, or your hormones aren't right, you're still not gonna feel well, right? Yeah. And so I was lucky enough to find someone who said, 'Cassie, here's your 1, 2, 3, 4, 5, 6, 7, 8, 9 things that are wrong with you. Now let's figure out how to fix all of them.' Right? Yeah. And so I kinda started attacking that and I started feeling better and better. And I think a lot of people unfortunately get really frustrated cuz they spend years like telling someone, 'I don't feel well, I don't feel well'. And these doctors pick one or two things to work on. And they maybe get that perfect, but they still got this other slew of things that aren't right. And so they still don't feel well. And then they get frustrated. Right? It's like this circle. Yeah. And they feel like they're not being heard. And so that's where I started learning about all this and it was very fascinating. Yeah. Yeah. So a couple of things I wanna mention. So do you feel like, cuz it sounds like the hormone replacement therapy is actually what really helped you the most in getting-- cause I know estrogen, the lack of estrogen or not the right amount of estrogen or even just low estrogen can contribute to microbiome being off and dysbiosis. I know that estrogen can actually help balancing the microbes in the stomach. So that could also have helped, don't you think? Yeah. So estrogen or testosterone. Both. And so I actually didn't need estrogen replacement, thankfully. Just testosterone. But I think definitely yes, hormones can definitely help rebalance your microbiome. Testosterone helps as well. The other thing though is your diet, right? So I tell people this, you're thyroid and like your thyroid markers, so one of them, your TPO antibody, which is an inflammatory. TPO is a antibody that attacks your thyroid when you have Hashimoto's. So if your TPO antibody is high, that tells us you have inflammation in your body that's kinda attacking your thyroid. When that's high, I tell people that's kind of a representation of your systemic overall health. So like if you have gut issues, I mean, and you can look at this, people with like Crohn's, diabetes, other autoimmune conditions, they typically will have high TPO antibodies. So you can have maybe not a whole lot going on with your thyroid, but other things going on in your body, it still affects your thyroid because your TPO antibodies is high. So I feel like what really kind of made me like wake up was like, okay. You have all these things that are showing, you have all this inflammation and so we really need to start fixing it. And Dr. Rice taught me, you know, a lot of it starts with your gut. A lot of functional medicine doctors will tell you that. Every single time you put something in your mouth, you're making a choice of what you're gonna let you know be inside your body and affect your microbiome and affect all the nutrients that your entire body and cells are gonna have. And so, you know when he put it to me like that, he is like, I know people eat for pleasure, but you should really be eating to kind of fuel your body and give your body what it needs, right? So when he said that to me and I started thinking about that when I eat and, and picking things that help fuel my body, I mean, I think that a lot. I mean, the food that you, that you consume helps a lot. But once I started getting all those markers to go down, everything just kind of, it works together. I don't know that there's one thing in particular, you know? I guess if you had to pick one thing, I would say your diet, but I think when you put it all together, right, you're eating the right things, you're sleeping, you're doing all the things you're supposed to, you're fixing your hormone levels. That's when it all kind of comes together. And it's not overnight, you know? It takes a while. So how long have you been speaking? Well, in what realm? So like, I've been speaking for pharmaceutical companies since about 2018. And what were you speaking about? Yeah, so I started out speaking mostly about diabetes drugs. So whenever I was in fellowship I did a lot of research with diabetes drugs. And so all these drugs right now that everyone are throwing a fed about the weight loss drug, so like ozempic, Mounjaro, things like that. There was a drug prior to, called Victoza that you took daily that I kind of did some research on in fellowship. And so I was speaking a lot, mostly about diabetes medicine. Some about thyroid medicine. So how do you feel then about it? I mean, if you were speaking for them then, what do you think about it being disruptive, like Ozempic, Mounjaro being disruptive to the endocrine system? Do you feel like that it is? No. So I feel like in the right people, these drugs are very beneficial. I use them in my practice, and I think for the right people, they're great because they really help people with these high insulin levels. You know, people with PCOS, people with insulin resistance, they help people with diabetes too. That's what they remain to do. But a lot of these people that just have extremely high insulin levels that do have insulin resistance, that are definitely gonna become diabetic if they don't change something, it really helps change their physiology and help bring those insulin levels down. And when that happens, once your insulin levels start to come down, you can actually lose weight and you actually feel better. And those inflammatory markers go down. And when that goes down, you know, lots of good things start happening, right? Your thyroid can work better, you feel better, you wanna exercise, your body makes more hormones. So I absolutely think that they, you know, they're not the end all, be all. I tell people like, this is not going to, you know, cure you. You can't take these... Cause they kinda have to take it forever because when they stop taking it, all of the symptoms come back. And then what I've been hearing, I don't know what, how you feel about it or know about it, but I've been hearing that they gained the weight back and, and what they lost was a lot of muscle. And if you look at a woman aging-- so if a lot of these women are in their forties and fifties and they're struggling and they don't have hormone replacement yet and they don't have the right estrogen, well that's probably why they're getting some of the symptoms. And then they go and they reach for ozempic or Mounjaro, and it's only just to suppress their appetite, and maybe help. But then their hormone issue didn't get addressed. So I just know that the Women's Health initiative that took place in what, '91? More like in 2001, whenever it was published, I think. Yeah. And so I feel like because of that and the research that was, I don't know, a little iffy. When I say the research, I mean the outcomes of that were a little iffy, kind of pointed to people being afraid of HRT. But now it's being debunked and it's basically the answer to heart disease and a lot of other issues. So I just feel like it's not being shared out there. Like HRT was the answer. And who's to benefit, right now, from not taking HRT? I don't think it's the women. I think it's somebody else. I don't know who it is. But I think you can kind of guess where I'm going with that. If lack of estrogen and lack of hormones leads to disease in so

many areas:

heart disease, which is number one killer of women right now, and mental illness. And so I feel like leading women to believe that HRT or estrogen causes breast cancer, increases sales in pharmaceutical antidepressants and a few other areas. How do you feel about that? Yeah, so I completely agree. You have a lot of good information. So if you look at the WHI, the only thing that caused cancer was progestin. So it was the progestin arm, which we don't-- I mean, most people-- I don't prescribe progestin. You can do micronized progesterone, but progestins are what caused the increased risk of breast cancer. And that's because progestins bind to testosterone receptors in women and down-regulate the testosterone receptor. Testosterone is very preventative of breast cancer in women. We know that. So is bioidentical estrogen. So I agree with you. I feel like that that's, whenever that was published, they did a huge disservice to women. Yes. And there's been a lot of meta-analysis since then. There's been over 40 of them from Mayo Clinic. One of the ladies who actually was one of the main publishers of WHI wrote a paper in 2018 where she actually went back and said, you know, maybe that what we published wasn't, you know, looking at long-term data wasn't the best thing to do for women. And so I completely agree. They blew... I don't mean interrupt, but the women that they did were mostly 60 to 70 year olds. Whereas our estrogen drops and we enter menopause around 50. So there was a large part of, you know, women, it is just, it's kind of disgusting. Yeah, it was a huge disservice for women. Like you said, women, one out of three women premenopausal die of heart disease. About two out of three women post-menopausal die of heart disease. And yes, I mean, we're not doing a service to women at all by taking them off hormones in that study. The only people that did worse were the people on the progestins. Estrogen did not increase your risk and neither did testosterone. And you are correct, so estrogen is so protective of your bones and your heart. When we go through menopause, no matter what age you go through menopause, within the first three to four years, you're losing about 25% of your bone mass, which is crazy. And then also your heart. And I see this all the time in women, clinically. You know, I saw a woman today who I hadn't seen in a year, and she had all these symptoms of menopause. I know she's in menopause. And so I'm like, okay, let's look at your labs. Right? Last year, her cholesterol was fine. Her blood pressure was fine. She was kind of perimenopausal. So it's been a year. Her cholesterol's terrible. Her blood pressure is high, and she's in menopause. I mean, it didn't even take a year. I mean, your cholesterol goes up, and so yes, we know. I mean, the time to talk about menopause and estrogen is at menopause. Like when you're having the symptoms. Maybe even before. Because yes, estrogen-- if you do bioidentical estrogen, what we know is that bioidentical estrogen does not increase your risk of breast cancer at all. And testosterone actually lowers your risk of breast cancer because testosterone activates something in your breast cells. You have two breast cells, you have estrogen alpha cells and estrogen beta cells. Okay? Beta cells are protective to your breasts and alpha cells are not. Alphas are awful. Testosterone actually upregulates the beta cells in your breast, and downregulates the alpha cells. And so testosterone is actually protective when it comes to breast cancer and it's also protective when it comes to dementia. So it lowers your risk of dementia... Yes....eight times. Yeah. And then muscle mass, like you brought up. That's huge. So sarcopenia is like a huge issue as we get older. And the more muscle mass that you lose, you know, you have falls, you have fractures, and then unfortunately, after you fracture things and you're older, a lot of times you end up with infections and ultimately end up dying. I mean, to be frank with you. And so estrogen and testosterone, both are great. As long as you do the, you know, the right forms of them. There are lots of different forms. Bioidentical is the best way, the best route to go, and there's lots of avenues to do it bioidentical. So the only contraindication, just so you know, to estrogen, so there's one true contraindication to estrogen and it's epilepsy. So if you've had, if you have seizures, like true epilepsy, you can't take estrogen because it lowers seizure threshold. And I say that you could potentially take estrogen if you were being followed by a neurologist, and your seizures were controlled in a patch form because you could take the patch off, right? But you wouldn't wanna inject yourself with estrogen. You wouldn't wanna do a pellet. You wouldn't wanna do something that you couldn't take back. But that's really the only true contraindication of estrogen, the only one. So yes, I mean-- and then if you've had or you are positive breast cancer, a lot of people will say, you can't take estrogen. Although we could talk about this for five hours. There's lots of studies now that actually show if you're on hormones when you get breast cancer, and you come off those hormones and you go back on hormones after you're treated for breast cancer, you're not any worse. You know, and what you don't have are the side effects that a lot of people have after they have breast cancer. You know, so you take a woman, she has breast cancer, you take all her estrogen away, she has hot flashes, she can't sleep, she loses bone mass. You know, her heart goes bad, her cholesterol's bad. I mean, there's even some data out there now that shows you can put these women back on estrogen because the recurrent risk of breast cancer it is about two to 6%, depending on what you look at over your lifetime. So the question is, as a woman that's had breast cancer, do you want to take that two to 6% chance of recurrence, but but not have any symptoms, right? Be able to sleep through the night, not be hot, have good bone mass, make sure your heart's good, not have issues with, you know, vaginal atrophy or vaginal dryness. Or do you wanna not? And so there's been some literature published in cancer journals that show that actually women don't usually do worse if they go backwards. So I agree with you and you have, you know, you have good knowledge on this, that I think that that study was a huge disservice to women, unfortunately. And I think that we're seeing all those unfortunate events over the last 20 years when we ripped all these people off of estrogen and said the least amount for the shortest amount of time. So yeah. I kind of watched it in my family. I have a 67 year old aunt that, she's not biological aunt, but she's got pretty much well blown dementia. And I can't help but think that that could have been prevented if she had, you know, taken HRT. I had an aunt also that died last year, and she was only 72, and she had all kinds of symptoms. All kinds of symptoms, and lived a life that was kind of depressing because of all the symptoms. And, you know, one thing that's not mentioned is you know, depression and suicide. You know, we need to talk about that maybe, too. Maybe not right now, but it's all linked to the low estrogen and imbalance hormones. So it sounds like you used the patch, is that right? And then you used pellets as a testosterone therapy? No, so I actually didn't. I've never used a patch. I never needed estrogen. I just did testosterone. I've never really taken estrogen. You know, I was on birth control when I was younger. But estrogen... But for your own patients, you will? Yes, for patients, I do a combination. I mean, you can do patches, you can do estrogen patches, you can do estrogen pills. Some people do estrogen injections. You can do estrogen pellets. Same thing with testosterone. Oh, you can do creams. You can do testosterone creams. You can do injections. You can do pellets. And then progesterone you take my mouth, typically. I mean, I don't typically do a lot of progesterone creams or any other ways of giving progesterone because progesterone is the hormone that makes you sleepy. And so you don't wanna put it in some sort of form like a cream where you don't know when it's absorbing because you don't wanna be sitting there during the day falling asleep. So most people take progesterone at night and that's because it helps you sleep. But there are a lot of forms of... You know, one of the things that was mentioned, and I hadn't even thought about it, was that the progesterone cream could actually get on others. So if you are holding a baby, you know, that can actually get on the baby. And it's, that's probably not a good thing, especially consistently. And testosterone is another thing I've warn women about. Like, you know, I tell 'em if they do creams, a lot of times we have 'em put it in their inner thigh after they shower. Because you have to wash your hands really good because yes, if you touch a child or you touch your animal or you know, you pick up somebody and put 'em in your lap and that's not covered up, then yes you can technically transfer it. Interesting. So you are feeling much better now? Yes. Feel much, much better. Which is crazy cause my husband and I talk about this. I'm probably the busiest I've ever been in my life, which is good. Right? And I feel really good. Like, I don't know, two years ago I probably couldn't have done things that I do now. What do you do? I mean, I know what it's like to be really busy, but then also neglect working out. Do you get your heart rate up? And what kind of workout do you'd like to do? Yeah, that's a good question. So I was the girl until a year ago that was like, you must do cardio, right? Like you must do cardio. All the cardio. I used to do like an hour of cardio. I don't do any cardio anymore. There's a lot of research that shows that you need to lift heavy weights, right? And so as you get older, what it shows is that you wanna make sure, like you said, that you keep lean muscle mass. And so I do very little cardio. If I ever do cardio, it's 10 minutes or less. But I lift pretty heavy weights. And in doing that... Oh yeah, that'll get your heart rate up. Yeah. So I have a tonal. I don't know if you've heard of tonal. I love my tonal. Love it. So I do that a few days a week at home. Five o'clock in the morning. It's easy, you can pick what you want, the coaches are great. It really holds you accountable too, cuz it's resistant training. I do hot yoga. I love hot yoga. Oh yeah. That does feel good. Yeah. What is tonal? I don't know what tonal is. So Tonal is this, it's like a workout mirror, I guess, for lack of a better-- so it's on a wall. It's plugged in on a wall and it has a screen and it has handles that move up and down and different devices that you attach to it. And you have a coach on there. You pick what you wanna do like this. This morning, I'm doing like a summer shred, right? And it's like lower body shred. And so you just pick a workout and it will give you exercises to do. you do sets depending on what muscle group you're working on. Some coach walks you through it. But the cool thing about it is like, you know, you're holding handles and squatting or whatnot. It senses how you're moving and it will give you feedback like, Hey, you're not squatting as much on the right as the left. Or... Oh, that's so cool. Yeah. And as you squat, it has ways of changing the weight. So like when you go down, it's heavier. When you come up, it's lighter. It can sense if you're struggling. And so if you're struggling, it will naturally lower the weight. But it keeps track of all this for you. So like when I did it today, it went up on the weight of something that I was doing because I had done it last week and it says like, you're strong enough to go up. So it's a really cool, just device that you can have in your house and it's, you can do anything on it. There's yoga, there's stretching, and so I used to go to the gym and I still do sometimes, but it's

hard to get there at 5:

30 in the morning and still get to work. Like this morning I had to be there at seven. So I do tonal at my house probably like four days a week. And it's just heavy lifting. But then I do yoga with it as well. You can do stretching, yoga, Pilates. I go to a hot yoga class once a week on Saturday, though. That's like my, it's my favorite thing. So I have Saturday mornings I go and it's like my time to, you know, just to... Is it a big class with others? Yeah. Yeah. There's probably 20 people there, but it's good. So I do yoga. So I mostly do heavy weight lifting and yoga. Very little cardio. If I do cardio, it's about once a week and it's usually a stair climber for about 10 minutes and I'm done. Yeah. But then I also, I think it's really important to walk, and it's really important to see the sun come up and go down if you can. Because when the sun comes up and goes down, there's different rays of light in the sun. I dunno if you know this, that red light when it comes up, blue light when it goes down. And that really helps with your melatonin and your circadian rhythm. And so I try to walk every morning when the sun comes up as well after I work out. And then I try to take my dog for a walk as the sun's going down. I actually did hear a doctor give a talk. It was a Ted Talk. And the reason I clicked on it was because it said it was banned. And I'm like, why does it say that? So, of course, you know, that made me wanna listen to it. And so, he was talking about what you just said about the light and the eyes and us looking at, I guess our phones give out a blue light and that's not a good idea. That disrupts the sleep, which disrupts the hormones. Oh, wow. Yeah. It's just like everything is connected. Yeah. Getting to the root of it. Okay. So I want, I know that I'm taking up a lot of your time here, so we'll wrap this up, but, one more thing. So you'd mentioned that you noticed a particular patient's numbers went down or her cholesterol went up or something like heart rate... Yeah. blood pressure actually, is what I meant to say. And so you knew that just in a short amount of time there was this drop. What estrogen levels do you feel like you want to replace for that woman when she's lost? I mean, do you ever see them at zero? And then what levels do you like to see them at? Blood levels. Yeah. So I see a lot of estrogen levels that technically the lab isn't gonna tell you zero. It usually will read depth to 25. So it'll say less than 25. I see a ton of less than 25. And so that's not good. You wanna have estrogen. But the other thing you wanna look at is FSH. So FSH is follicle stimulating hormone. It's made in your pituitary gland. So that's important because that's kind of like, telling us whether your body is happy with the hormones that it's sensing in the brain. So all your estrogen testosterone will flow back to your brain and will give your brain a signal of there's enough, there's not enough, there's too much. When there's not enough, when your brain is like, oh my gosh, I need estrogen, I need testosterone. It increases FSH, and so anytime your FSH is over 23, that means you're in menopause. And so that's what you're looking at is that FSH in combination with estrogen. Because the caveat is there are times in a woman's menstrual cycle, very short windows of time, where your FSH might be really high for a second cause you're getting ready to ovulate and your estrogen might be lower. But it's usually not undetectable. So you kind of need to look at them together. But like in this lady, I knew her FSH was I think 69, so that's very high. And her estrogen was less than 25. And last year when I saw her, her FSH was six and her estrogen was like 90 something. So obviously it's a big change. Right? And the other thing is, I mean, I can kind of tell, right? So she said, I'm not sleeping as well. My husband said I'm moody. I get hot all the time. I'm just like fanning myself. I feel like I'm getting kind of puffy around my midsection. I feel like I'm just getting, you know, a lot of women just say, I just feel very puffy. My clothes don't fit the same, I'm not sleeping as well. You know, and then I saw her blood pressure, it was going up. I mean, I knew. She's like, okay. And she, you know, she was like, I'm still having some bleeding. Like I'll have bleeding and then I won't bleed for four months. Or I'll, you know, that's not... So you probably take labs after about 30, 60 days of being on it. And what number do you like to see? And when do they feel their best with estrogen levels? The blood work? I mean the blood level. You wanna have some estrogen? I like to see levels of at least 40, closer to a hundred. But the main thing is that FSH level. You want that to decrease by half. So wherever it starts, some people it's 110. Some people it's, you know-- ideally we get it to less than 23, but you don't have to. You want that FSH level to decrease by half. You want their estrogen to become detectable. I like it, you know, around a hundred. And then you want them to feel better. It's also symptoms, right? So you want 'em to not be having hot flashes. And if they are, then you need to give them more. So you kind of use that as a clinical indicator? Yes. How they're feeling. For sure. Well, if they still say I am still-- cuz I've heard that it stops working if you keep it too low. So I've heard ideally, now this is, I know that y'all have different opinions. Yes, yes. I've heard that between 350 and 500 is where most women feel their best. And most doctors won't do that. Well, that's probably, I think that's an accurate statement that most doctors would be like, whoa, that's a lot of estrogen. I don't... But why? Why? Why do they say that? Why do they think that, that it's too high? Well, it's a pretty high level, but I agree with you. When we're cycling, when we're, you know, when we're not in menopause, we have estrogen levels. I mean, my estrogen levels have been, I've seen 360 in myself. I've seen 400. When you do have high estrogen levels, I think again, you're right, a lot of doctors are going back to the smallest amount for the shortest amount of time. If you give a woman enough estrogen, you're gonna make her FSH come down. I like to see FSH levels below 23, but I know that your brain is happy and you're getting a systemic good hormone replacement, right? So your heart is getting hormone replacement. Your brain is getting the hormones, and so I like to see the FSH less than 23. But you know, some women, when they take a lot of estrogen, they get puffy. That's one of the side effects is they feel like they're kind of bloated, puffy. And so you really have to, I think hormones is kind of like cooking. I mean, there's not a recipe for everyone. There's really not. You know, I have thousands of people who take to take hormones. It's more about making sure at least their numbers get to a level where, you know, systemically they're getting the hormones they need, and then it's about how they feel. And that's a really good point. Unfortunately, in med school and in residency, nobody tells us as doctors, It matters what your patients feel like, right? What they teach you in school is like, oh, that number's normal, so they're fine. And that's what I reply, you know. And then you get out into the world and you realize that that's not very conducive to practicing and it doesn't make for good medicine and it doesn't make you feel like a good doctor. Like I want patients to come in and, I mean, the first question I ask every patient when I walk in the door is, how are you feeling? Like that's what I wanna know, right? Because if you say, I feel like crap and your numbers look great, and we still have work. And so it's, you know, I look at the numbers, but I look at the symptoms as well. So I kind of do a combination. But you definitely prefer their FSH to come down by half from where it started, and ideally less than 23. And I would like to see an estrogen level of at least 40, but I like it closer to a hundred. Yeah. Are you going to the four M conference in December in Vegas? I haven't decided yet. I may. My husband runs Vegas, so he would love for me to go. Yeah, I'm going to a biohacking event in Orlando, this week, actually, thursday, and just kind of like to learn more and I just like to learn to see what's going on and kind of-- I wanna feel my best. My kids lost their father, almost two years ago. And I feel like I'm now the matriarch of the family that really, I would like to stick around as long as possible. So I had one grandmother that lived in 99 and a half and another that died at 57. So it's like I look at them and I go, Hmm. And I think that the one that died at 57, yeah, she made some bad choices. She was a smoker, for instance, but, you know, what else? I think she was nutrient deficient most of her life. It became more and more obvious with the stories and with what I was seeing. And it was just overlooked, you know, and ignored, and so then that was why she was most likely reaching for the cigarette. So when you have the imbalance hormones, it makes you wanna choose bad because you are frazzled, you feel wired and tired and frazzled. Am I right? Yeah, and testosterone plays a huge role in, like you were talking about mental health. And so when you're testosterone as low as a woman or a man, that can affect a lot of your neurotransmitters, your dopamine, serotonin, a lot of the things that help you feel happy. And so I do agree with that. I mean, mental health is not, unfortunately, we do not do a good job of mental health in this country. And a lot of things, I mean, are very simply overlooked. Thyroid issues, vitamin deficiency. So methylated B vitamins help a lot with when you're having anxiety, depression. vitamin D and then hormones. I completely agree. Thank you so much for joining me here today. And audience, I want you to go in the show notes and find out more about her. Where would you like to send them? Is there a book or something that you would like them to go to? Yeah, so I don't have a book. I think there are a lot of great ones out there. I thought I sent something in your bio. So I have a website that just has some general information. It's just modernendocrine.com. But what I've really been trying to do-- so I love that you have this podcast. Thank you for doing that. I know it's a lot of work, but it's great resource for people. I've wanted to do one, I just haven't. But I do try to put some good information on Instagram, so I try to do some good videos. So my Instagram is just @ modernendocrine_. I have a Facebook page, TikTok, YouTube. It's all modern endocrine, but, maybe I'll write a book someday. I feel like I maybe should, but... Maybe you will. Okay. Thank you. Thank you. And, everyone have a great evening or day, whatever time it is. And get your hormones checked!

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Crystal O'Connor

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