74 | The Truth About Hormones: What Every Midlife Woman Needs to Know with Dr. Salome Masghati

In this powerful episode of Rich, Fit & Happy, host Crystal O’Connor welcomes women’s hormone expert Dr. Salome for a deep dive into the evolving world of hormone therapy for midlife women. From outdated guidelines to the latest functional medicine strategies, Dr. Salome breaks down the truth behind hormone replacement therapy (HRT), bioidentical options, and the real risks and benefits every woman should understand.

💥 Highlights:

• Why old menopause guidelines are being challenged
• The shift from conventional to functional medicine in hormone care
• Understanding estriol, estradiol, and the role of progesterone
• What you need to know about hormone creams, orals, and pellets
• How to advocate for personalized hormone support

If you're tired of conflicting advice and ready to take control of your hormonal health, this episode is a must-listen.

🔗 Connect with Crystal: https://agelessambition.com/
 🔗 Connect with Dr. Salome: https://www.drsalomemasghati.com/

Crystal's Instagram: https://www.instagram.com/thecrystaloconnor

Dr Salome Masghati's Instagram: https://www.instagram.com/drsalomemasghatimd/

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Transcript

[00:00:30] Hello, ladies and gentlemen, mostly ladies. It's Crystal here with Rich Fit and Happy. And I have a guest that I have wanted on for a while now because she is she is an expert in the very thing that I have been obsessed about for the last two years because of how it changed my life. So she was Dr.

[00:00:55] Mati. Hello, by the way. Hello. She was [00:01:00] she's been in surgery, right? She's an ob, GYN. She's been in surgery now. She focuses on perimenopause, menopause, helping balance hormones, and it is so needed. We need, society needs to be completely reeducated and you are our girl, and I'm telling you like I worship.

[00:01:19] Some of your videos. So find her on Instagram. Go in the show notes after or even during this this call because you're gonna wanna follow her and learn from her and learn the, get the right information instead of the con the confusing information. One of the things I love about her is that she explains that she thinks she takes complicated to simple and she explains things in such a way that we can digest it and understand it.

[00:01:44] Start to understand what's going on with our bodies. Dr. Mati, welcome and then thank you. I so you were trained and educated by my doctor that I found that was such a blessing. And you call him, you [00:02:00] refer to him as a unicorn, which makes you a student of a unicorn, right? Yes. He, so can you just start out by telling us how you are different and how you approach balancing hormones than most doctors?

[00:02:14] Sure. In my training and in my practice, I've gone through different types of training. So I have been exposed to different ways of addressing hormone balancing. It first started off very conventional with what the Menopause Society says and what ACOG says with, lowers the amount of hormones for the shortest duration of time.

[00:02:35] Now since then, NAMS has come out with a statement last year saying that. That is no longer true and people can continue if indicated for, vasomotor symptoms and protection of the bones. But this is really the only two indications they use for older women. And then in terms of the dosing, NAMS is still very conservative from then.

[00:02:57] I also moved on to doing some functional [00:03:00] medicine and being exposed to courses that we're teaching using. Est, which is a combination cream between estradiol and estriol and using that as a cream and often in combination with progesterone and as a cream or oral. And so I did a little bit of that and then I also got some training in pellets.

[00:03:21] Pellets are little implants that are being in inserted into the subcutaneous fat tissue under the skin. It can be done. In the flank or in the buttocks. And they release hormones in a sustained form. And often there are you can't do progesterone so much as a palate. There are progesterone palates, but the conventional palates don't use progesterone palates.

[00:03:47] They use estrogen and testosterone. And a progesterone is a capsule. I underwent the training. I inserted many pallets. Didn't completely feel right to me for different reasons, and I can get into the details. [00:04:00] And from then I moved on to using estradiol cream and progesterone orally. And then I was introduced to the woman's hormone network through someone called Kristen Johnson, and she's.

[00:04:13] A lawyer, but also a nutritionist, functional nutritionist. And she has together with her business partner, Maria k Claps, they have a coaching program, health coaching program, and I found them on Instagram and I love their posts. And even though they were not doctors, I found that they had something very interesting to say about hormones.

[00:04:32] I contacted her, she got me in touch with Women's Hormone Network. I did their classes and through Kristen, I also met Dr. Nigel, Dr. James Nigel, who is that unicorn we were talking about? He's a unicorn because among all the trainings I've done and all the different people I've shadowed and observed, and he's probably the most courageous and innovative towards.

[00:04:53] Estrogen treatment and the doses that he uses, he's definitely a unicorn with that. So now I feel that I've been [00:05:00] exposed to such a variety of trainings that I can come at it more in an unbiased form, and I do not have any financial incentive in any of that. So it's not that I make money off. This organization or this form of hormones.

[00:05:16] I don't own any of these companies. I don't, a lot of these organizations are, nonprofit organizations, so there's no financial incentive for me to push one or the other. What I can tell you is in my approach, I address hormones in a multitude of ways, and I am very flexible because I individualize it based on and tailor it to the patient.

[00:05:40] Okay, one of the things you mentioned before we jumped on here in fact, what was the other day you had said, let's use your lab results as an example. So this idea of blood level of estradiol or estrogen being so differing and so varying and the confusion has [00:06:00] me having conversations with women that it is, it's.

[00:06:06] Complicated. It gets complicated because, for instance, why sometimes my blood level 680 and a friend's 30, and then another friend's zero. And why are we all arguing about it? Like it's controversial. Uhhuh. Tell me more about that. Because I can address it if I understand what is the controversy about it?

[00:06:28] Why they are differing levels or, okay. So yes, the fact that it's even controversial at all, Uhhuh, it is confusing and complicated. But I think it comes from the idea that it's somehow linked to cancer or something like that, or that it's dangerous. Can we address the, that it's not dangerous, please.

[00:06:51] Yes. So I. The fear about estrogen comes from primarily, this is the one that I'm the most familiar with. [00:07:00] Where the fear started was in 2002 when the Women's health initiative was done. This was the largest randomized trial. Randomized means you took, you take two groups of people and you expose him to different treatments.

[00:07:13] And you look at the outcome over time, it's probably the highest quality of studies because you're not looking back. You can't control. For some factors, you look forward and then you control two different groups with different exposures. They had multiple groups, but that is just the basic explanation of what, what randomized means.

[00:07:31] And then it was double blind. In order for it to be doubleblind, meaning neither the doctor nor the patients would know if they are falling into this group of, okay. We are getting HRT or not, they had to choose women that wouldn't be so symptomatic for it, right? Because let's say you go into a study and you have hot flashes and I give you either a placebo or the right thing, [00:08:00] right?

[00:08:00] The the hormone. You are gonna have a specifically significant more change with your symptoms being resolved with the hormones, right? So that's no longer gonna be double blind because you're gonna know you're gonna have hormones 'cause you're feeling better. So in that study, in order to make it double blind, and we haven't had a double blinded study since then like that, I mean it was a very large study, really great that they could get so many people on board.

[00:08:28] Their outcome was to look at cardiovascular outcomes, not even at breast cancer. And in order for it to be double-blinded, they had to choose women that didn't really have that many symptoms anymore. So they were older. That alone made the study flawed because it was older women. And we know that actually, that's so strange that they did that.

[00:08:48] Yeah, but they had to because they wanted, they had to like, they wanted it to be double blind, so it was one of the, CHO choices they had to make. Yep. The problem is when you're older, you have had more time [00:09:00] to accumulate senescent cells, dead zombie cells that you haven't cleared up.

[00:09:06] 'cause we know as we go old, get older whether we have hormones or not. And just generally part of aging is that we accumulate more dead cells that are not useful to our body. The process that gets rid of that senescent zombie cells that clears that cells that are not useful is called autophagy. We can induce autophagy by fasting, for example, right?

[00:09:32] Intermittent fasting. It allows the body to recycle old cells. Why am I bringing that up? Because getting rid of old self. Your risk of cancer, the older you get, the more you accumulate that zombie cells, the higher risk for cancer you have. You also have just overall more lifetime exposure to toxins.

[00:09:52] That can weaken your immune system. Can, have burden on your cellular health, your mitochondria. You [00:10:00] can accumulate more heavy metals and endocrine disruptors. And if I'm using words that don't make sense, please let me explain them. But having metals, for example, there is association between cadmium accumulation in fat tissue of the breast and breast cancer.

[00:10:15] Has anybody scared women off eating out of, aluminum can aluminum cans or being exposed to heavy metals or being working in certain industries or using certain makeups. Not quite as much as hormones, right? If you think about it. But there are contributors to cancers and us being less capable of getting rid of senescent cells outside of hormones.

[00:10:38] In fact, hormones promote us getting rid of zombie cells. Ah, okay. So just aging is a risk factor. Obesity. Being overweight is a risk factor. Being a smoker is a risk factor. Having insulin resistance is a risk factor. Having impaired liver function is a risk factor because all of that contributes to [00:11:00] increasing inflammation and being less good at reading.

[00:11:04] Reading, getting rid of bad cells in the body. Guess who was selected in that study? Older women, over half of them were metabolically unhealthy. The word smokers in that study, women with high blood pressure, women with higher bmi. There were a lot of contributing factors to potential cancer risk, right?

[00:11:25] I didn't select for those metabolic health risk factors that much. And that's hard because when you do large population, when you larger population studies, you have to include a lot of different types of people in order to get the numbers that you need. I can't, yeah. We have to address also the strengths of the study.

[00:11:42] They got a large number of people in, people got. Hormones. Now, a lot of that data from that trial was also polluted by one more thing, the type of hormones they used. They used oral conjugated, equine, [00:12:00] estrogen. What does that mean, Ms. Crystal? It means instead of giving you just estradiol one form of estrogen, it was a group of different types of estrogen, including metabolites of estrogen.

[00:12:16] Collected are synthetically made from pregnant horse urine. So that's one problem. It was polluted by the type of estrogen it was used. And that estrogen was oral, right? So now we have a few issues with that. One issue is it wasn't bioidentical one strain, estradiol. It was a different, like a group of hormones, group of estrogens with some bad metabolites in it.

[00:12:44] Because it was containing, estro and there is some concern that estro could be more pro-inflammatory or some estrogen metabolites are more pro-inflammatory. They could maybe change the DNA. We have some animal studies and some cell culture studies on that. We don't have a lot of human studies in that.

[00:12:59] [00:13:00] But it's a hypothesis that maybe what the body gets rid of is not what you should put back in the body. Maybe, right? Like I don't drink my urine, I don't eat my stool, and I'm so sorry to be graphic. I'm just saying what the body excretes, I don't want back in my body. Okay. The body had a reason to get rid of it.

[00:13:18] Okay. We wanted to maintain a balance. So why did we give women. Oral conjugated estrogen, which is from pregnant horse urine. The second thing is it's oral. And oral. Anything oral has to go through the liver first, right? We call it first pa first pass effect like liver metabolism through the first pass effect for the liver.

[00:13:37] And then that puts a lot of burden on the liver, right? So it, it distracts from the liver from maybe eliminating toxins towards, oh, I gotta work on this one primarily now, right? So that's one thing. And an oral estrogen has been associated with potentially increasing an inflammation marker called CRP in the body, and [00:14:00] including increasing clotting factors.

[00:14:04] And so when you have more clotting factors, you are more prone to probably, possibly micro clots and those could be potentially contributing to increasing your risk of heart attacks or stroke, which was what, in that study they found women on hormone therapy. They said, oh my goodness, higher risk of heart attack and stroke.

[00:14:27] And they scared everyone off. Folks, we really appreciate the effort you put into this study. We appreciate all the, work that you did, but you chose the wrong type of hormones. You gave it in the wrong form. It sounds like the worst study. The worst study with the biggest effect. On honestly, generation of people.

[00:14:48] I wouldn't bash it so much if it hadn't caused so much harm. Yeah. Yes. I do think that the intentions possibly were good and people wanted to help. I don't wanna assume the worst in people that put so much effort and work [00:15:00] into something. I think it's just that now we know better. Yes. And it would be great to have something similar, randomized and double blind again, but my God, make it happen.

[00:15:10] It's so hard. It takes so many resources and. And then we have to understand studies in that extent are have to be sponsored by someone. And it has to be either like university setting and university hospitals are often very much sponsored by, industry, and so there has to be a product that they want to look into.

[00:15:33] But if we use bioidentical hormones and often also compounded hormones through compound pharmacies, but even bioidentical for a regular CVS, those products already exist. There's not a ton more money to be made with them. I'm not sure there's gonna be a lot of sponsorship behind that. Does that make sense?

[00:15:50] Just people like me and you. Yeah. That truly care about the trajectory of health because women's health, because [00:16:00] it really does. Studies are now showing and data is coming out about hormones or H-R-B-H-R-T, helping with chronic disease, basically eliminating, okay, not eliminating, but reducing the risk of heart disease.

[00:16:14] As you say, lung, the brain health, it's just fascinating and so I can't stop talking about it. I have a friend that laughs because she says your answer to everything is estrogen. Yeah. It's because I felt I had so many symptoms for about 10 years and they just can, just started compounding and getting, at the age of 53 getting worse very fast and within 40 minutes. And by the way listeners, I take an injection and if you wanna touch on that's something that I don't know anyone else besides Dr. Nigel's patients. And I don't know any of yours personally, but I don't know if you.

[00:16:48] Prescribe it. But I take an injection at home and people act like I am, an I am an alien by doing such a thing, but it's really easy. And I saw re or felt results within 40 minutes. [00:17:00] One of the things that I was having is not just hot flashes, but horrible heart palpitations all day. Now interestingly enough, I actually had these.

[00:17:09] When I was a teenager too, it was like it came back. And through my investigating and learning, I've learned that it was probably very much, and you can probably expand on this, it was probably because I was taking a birth control pill, which I didn't even need to be taking is because I was a teenager and they give them out.

[00:17:33] Like it's can you touch on that? Because those same heart palpitations came back and I feel like if I would've continued down that road of just tolerating them, I would've been just inviting chronic disease or heart disease into my life if I hadn't done something. I actually wanted to continue a little bit of my thought process, and then I will address this.

[00:17:55] Sure. I spoke so slowly. I'm sorry I didn't even get to everything you asked me for the [00:18:00] first question. Okay. I wanted to explain. So one problem with that WHI study was the patient selection and that a lot of them were metabolically unhealthy. Okay. And it was the selection of the type of hormones, which were not the best form of hormones, because not only was the oral estrogen that they used, conjugated and not the best, they also used synthetic progestins, methoxy, progesterone, Provera, and that seems to be also.

[00:18:28] Polluting the data a little bit because it's synthetic progestins, they dock a little bit differently on their different receptors and they're not microtized bioidentical progesterone. So I wanted to finish that. And then I wanted to address the cancer question. So in that study, they also found that breast cancer risk was increased and.

[00:18:51] By about 20%. Now, when we say 20%, that's a relative risk. An absolute risk. It's much lower because the incidence of breast cancer is [00:19:00] not that high Among the general population. It is there, but if you take it in absolute numbers, it adds up being, fewer numbers than if you just say 20%, but 20% relative risk.

[00:19:11] If you looked at the follow-up study from that, they used the same cohorts, but then they looked at the estrogen alone group. And that was because there was a fraction of women who had a hysterectomy and they only gave them estrogen. They found a lower risk of breast cancer. So from that, people have now have assumed that possibly.

[00:19:35] The problem with the synthetic progestins, not the estrogen in that. So when you look at it this way, and I really wanna point this out, when we are scared of estrogen and cancer, we should understand in the largest, randomized, double blind study to date that we have, even with a very poor form of estrogen, which is an oral conjugated, including [00:20:00] metabolites that we don't really want.

[00:20:02] Even with that form, there was less breast cancer risk. The breast cancer risk was lowered, so maybe just, maybe estrogen is not the culprit for breast cancer. Then you are gonna hear the counterargument. But when someone has breast cancer and they biopsy it and they look at estrogen receptor positivity, and it is positive.

[00:20:31] They're gonna give something like Tamoxifen, which is a serum selective estrogen receptor modulator or aromatase inhibitor, like Arimidex or there's others. So you think, okay, why are they blocking estrogen receptors either in the breast directly or peripherally? Why are they blocking estrogen? Why are we lowering total estrogen? Good question levels. So that we have to address that, right? So even [00:21:00] though the WHI study said no increased risk of breast cancer with estrogen alone. So maybe it was the synthetic progestins. Why are we addressing it this way? Because there's multiple things that people have to say about it.

[00:21:13] If you talk to a regular oncologist, they'll say, no estrogen when you have breast cancer, no estrogen. And sometimes they will even tell the patient that their estrogen therapy caused their breast cancer. That's a problem because here is how I would look at it. You have soil, you have a seed, and you have fertilizer.

[00:21:38] The soil is the terrain of this woman. Is she metabolically healthy? Does she have insulin resistance? Is she morbidly obese? Is she's smoker. And the fertilizer is the estrogen. So if you have already cancer cells in your body [00:22:00] and estrogen comes in, it's a growth factor. It proliferates nature wanted it to be that, because in the first half of our cycle as estrogen increases, when we are still cycling naturally, estrogen stimulates growth factors and stem cells.

[00:22:18] It not only builds the lining in the uterus, it builds tissue everywhere in the bones. Growth tissue in the so how do you In the breast tissue, sorry, just let me finish this. So Sure. Because it has to do that, and you already have breast cancer cells, if you already have dose, you are gonna be prone to stimulating that if that's an estrogen receptor positive cancer.

[00:22:44] So the differentiation is. Estrogen doesn't cause breast cancer. The oncologists are wrong when they say it caused it, but if you already had breast cancer cells in your body or cancer cells that are estrogen sensitive, [00:23:00] you could potentially stimulate the growth. Having said that, also, this is important, right?

[00:23:05] So that's it is. Having said that, we have to also differentiate between growth and. Possibly making things metastasize, and there is studies showing that while maybe estrogen stimulates the growth of cells, of abnormal cells, it actually, there's some studies showing that estrogen increases the cohesiveness of cancer cells, so there are less likely to want to metastasize.

[00:23:37] They grow faster, so you could diagnose them faster. There's some studies showing that. If someone is diagnosed with breast cancer while they're on hormones, they actually have better outcomes because it made itself reveal itself. And often the estrogen receptor cancers are easier to treat than the estrogen receptor negative ones.

[00:23:57] So the outcome on survival [00:24:00] seems to be actually positive. If someone has cancer and they were on HRT, outside of that, there could be some positive effects from being on HRT because of it protecting your bone and your brain and. Your just overall mood and wellbeing may and being you helping with insulin resistance and lipid markers like cholesterol.

[00:24:19] So maybe overall these breast cancer patients, if they were on HRT, they're just healthier metabolically maybe, right? And but these are just assumptions I'm making. I'm looking at studies, right? So we have some studies looking at women having breast cancer and being on HRT, better outcomes for mortality.

[00:24:36] There's even a study showing that if you had breast cancer and then you get HRT later on, no higher risk of recurrence. We did a lot more studies down on this, but I wanna take women's fear away that estrogen causes their breast cancer. Having said that, it's good to have a baseline mammogram and imaging to make sure you're not starting off with already cancer in your breasts when you start [00:25:00] HRT.

[00:25:01] Very good. Okay. I was gonna ask you that next. If had women have a a breast exam before they start HRT or is age, does age have something to do with it? 50 starting out in fifties, sixties? Or what do you do in that situation? Or do you ask them if they've had breast cancer in their family?

[00:25:22] Is that even relevant anymore? So if they had breast cancer. Even though it doesn't preclude them from HRT, they might need different screening tests and imaging studies. So it does, it's very relevant to know the family history. Okay. Some women like choose to undergo genetic testing to figure out what exactly that family history relates to with genetic mutations that might predispose them to higher risk for certain cancers.

[00:25:48] And then it might have to get screened differently. But it doesn't disqualify them then at all. Not necessarily. Not at all. No. No. I think as long as you have your screening going and you [00:26:00] get your breast exams and you're being, educated correctly, and you just know what's going on with your body and then you also work on your metabolic health, I think this everything, every information, every additional testing and information that you have just makes you more informed towards the step that you have to take.

[00:26:16] Some people feel motivated just by knowing that, hey, it looks like I have a higher risk for. Breast cancer. So I gotta make sure that I optimize my quality of life in every way if possible. Yeah. And my lifestyle. Yeah. And so the interesting thing that was mentioned, and I know, is that if somebody is, and I heard this just recently, if somebody is diagnosed after having a mammogram at a zero breast cancer, but at a zero, which I didn't even know there was.

[00:26:43] Stage zero out there. I've heard of stage one and stage zero just recently. Are they gonna give them tamoxifen to and then how do you feel? Yeah. In some cases they do. Women can opt out because it, these medications come with a lot of side effects. Yeah. Because [00:27:00] they do block estrogen in other organ tissues or, like Tamoxifen can, block it in the breast, but also have side effects because it blocks it in other areas. So some women opt out and then they just opt to get it cut out of them or have a lumpectomy or something. There's a lot of conversation to be held about this, especially Stage one Zero, because there's some people that question whether those would develop full on.

[00:27:24] But then I would say it's difficult because anecdotally I have had some people that are dear to me. Be told it's a stage zero, then they opt for a surgery, and then the final pathology is a different one, and then they found additional cancer that was maybe different in a cellular level. So that's, it's not gonna be an easy answer.

[00:27:47] I'm not gonna be able to answer this on an individual level. All you, because everyone is gonna have different case scenarios. For some women, maybe the stage zero never becomes cancer full on. Stage, advanced stage cancer. For some women [00:28:00] it might, I cannot make that decision for them. You can only advise people and say, okay, when cancer becomes involved, I want you in the hands of an informed oncologist and get your treatment completed.

[00:28:14] Make the decisions based on what they counsel you on once your treatment is over, and it was, let's say it was just a stage zero, right? Or it was. Stage one, but all the breast tissue is gone now or the cancer is completely treated. Some doctors will have the conversation about HRT again because I. What is, and then you have to look at what are the benefits from it.

[00:28:39] You are also helping their bones, their heart, their, yes. The number two cause of mortality for breast cancer patients is not the cancer itself, but it's heart health. Heart disease. So you do have to have. To take that into consideration. Some women say, listen, I understand I had cancer.

[00:28:56] I've done my treatment. This cannot determine my whole [00:29:00] life and my quality of life. I'm gonna make an informed decision to restart hormones again, that just has to be done on an individualized basis and and understand it once you had cancer. It never really a hundred percent goes away. It's just a matter of whe whether will it recur, when will it recur?

[00:29:16] So we want you to feel comfortable with your decision that you're on HRT, because you don't wanna blame yourself for HRT if it recurs, because whether you're on HRT or not, cancer can recur. Absolutely. Okay. Okay. So for in regards to HRT preventing dis chronic diseases in all major organs, especially well brain.

[00:29:39] I said, especially, I didn't mean especially, but just for me, cognitive brain is important and heart. Those two things and the risk I have read. And weighed it. You can weigh in as well with your opinion, but I feel like the risk of not doing it is it's riskier to not do it for your brain [00:30:00] and your heart and your bones.

[00:30:02] What do you think? I think that's a decision that the woman has to make herself. I have patients that are very scared of hormones despite everything I tell them, and I can't take away that. Maybe they were traumatized by seeing their mom pass away from cancer. And so I'm not gonna force anyone.

[00:30:18] I'm just gonna inform them and say, yeah, listen. That would be the benefits of HRT. And, but there's also other things you can do non hormonally if you don't wanna do hormones. But yes, there are just some biological functions to hormones that is hard to replace with a lot of things, but I'm not gonna force you to do them if you feel uncomfortable.

[00:30:38] In regards to some of these other things that you can do to bring the symptoms down, what are and are those from your experience in the functional medicine world. 'cause you did have some experience you said with that. Yeah. Yeah. I think there's a lot of, yeah. I think one of the things I would say to women that are at higher [00:31:00] risk for breast cancer based on family history or they have some other, like they have lumps in their breast and they have in, so I would say, let's focus on lowering your insulin resistance, because that's one of the biggest predictors of just how metabolically healthy you are.

[00:31:14] Let's. If you're diabetic, let's bring you out of that. Let's make you non-diabetic. Let's, we can reverse this. Absolutely. If you have fatty liver, let's work on that. Let's work on your triglycerides. Let's work on your body weight. Like just your weight alone is such a big predictor for cancer and that not only breast cancer and the uterine cancer and other things, right?

[00:31:35] Colon cancer. Let's work on your gut health, because if your gut works well, you're gonna metabolize that estrogen better. You're not gonna retain the bad metabolites and bring it back into circulation, into your blood flow. What about women that don't have any estrogen at all? So for instance, my blood level was zero before I started taking replacing it.

[00:31:56] Yeah. Yeah so what would you have said to me? If I chose [00:32:00] not to do HRT, would you have, I would still say work on your body weight, work on your insulin resistance. It felt impossible though. It felt impossible. It wasn't going anywhere. Yeah. Yeah. I, you are asking me a question. There is no a hundred percent easy answer on this, right?

[00:32:16] I am just acknowledging that there are women out there that despite everything glorious about estrogen, that I tell them about. Will not want it. Am I gonna stop taking care of them? Absolutely not. They need to have someone on their side. So I will tell them, let's work on it. Reducing your insulin resistance.

[00:32:34] And there is ways to do it is harder when you don't have energy and you don't sleep and all that. So you're gonna address it in a multifactorial way. Okay. You can absolutely work on things like making sure you reset your circadian rhythm. There is data that. When you are a shift worker, night shift worker, like nurses, you are going to have high risk of breast cancer.

[00:32:57] Not like just the exposure to blue [00:33:00] light and not sleeping at night is an increased risk for breast cancer. That is absolutely something we can modify. It's hard 'cause they might take a pay cut or when they change to day shift or it might ch mean some career changes and lifestyle changes. But it's feasible.

[00:33:18] We can work on diet, we can work on gut health. And then I explained to women some of the overlooked things about hormones is that when you do them in a physiologic way, if you get appropriate estrogen peak in your treatment, you are mimicking what was happening when you were still naturally cycling.

[00:33:46] From data that we have about that is that when estrogen peaks about a certain level, so it's not always every day the same, but it actually peaks, it stimulates cell [00:34:00] arrests in the cell cycle, cell renewal cycle, and that means that while estrogen, as it goes up, stimulates proliferation and growth, when it peaks, it stimulates cell rest.

[00:34:15] And apoptosis, meaning programmed cell death. And that's a safety mechanism that nature put in place. And the primary goal was we stimulate a follicle to grow and then stop the one follicle that we chose so that all the other one, we stop all the other ones from growing because we have the one dominant follicle.

[00:34:38] That applies to every tissue system in the body. Estrogen grows things, and then it stimulates cell arrest. That's beautiful because that means in the brain that stimulates getting rid of the zombie cells in the breast tissue. It stimulates getting rid of the zombie cells in the bone. It gets rid of the zombie cells, so it helps the cell turnover and [00:35:00] it helps get rid of bad cells.

[00:35:02] So there is some data. That in the fifties or sixties there was, they were using high dose estrogen injections for breast cancer patients to reduce metastasizing to other organs because it could induce that cell arrest. We just have moved on from that because then we pat the pharma came up with Tamoxifen and patented that, and then all the tension went towards the serums and estrogen was no longer used in a high dose form.

[00:35:35] And the type of estrogen that they used was DES, and it was an endocrine disruptor. It wasn't the best form of estrogen, and it had other downside effects. Okay. Downstream effects so just saying that there is some data on that, and then we have data. Progesterone given cyclically. Not every day the same when it peaks, also stimulates getting rid of senescent [00:36:00] zombie cells and stimulates tumor suppressor gene P 53.

[00:36:04] So it downregulates cancer. So I brought it all back to if someone is open to HRT and they are concerned about cancer, I can explain to them. We have to address all your factors, metabolic factors, your inflammation, all your other risk factors. If you're a night shift worker, you're exposed to heavy metals.

[00:36:24] If you're a smoker, if you're obese, if you have insulin resistance, that needs to be addressed. And then hormones can be done in a way that are more beneficial towards your body in getting rid of that zombie cells. And so if you do that in an adequate amount of hormones and in a rhythmic way, maybe. That is better for you.

[00:36:48] Now, we are now extrapolating the data from physiologic data about premenopausal women. I would love to see more studies on that in menopausal women. Even though I'm [00:37:00] applying it in a lot of my menopausal women, we don't have a ton of data on that to objectively measure how that rhythmic dosing and not keeping the same levels all the time is better for the women.

[00:37:12] We do have some data. That cyclical progesterone is better than daily progesterone. We have data on bones and even one study with brain that cyclical progesterone might be beneficial, more beneficial than daily progesterone. And that's what I do. So it one thing that I feel like there was a learning curve, like the first month, two months.

[00:37:35] Yeah. But once I got it down, it was it's very easy, but it can be perceived as, oh, this is complicated because I'm doing three different things. The testosterone cream, the progesterone in a pill form, and then a a shot. And it just sounds wow, that's a lot. But it's so worth it. And it's really quite easy.

[00:37:54] But do you wanna address, and I know you've only got a few more minutes here, if that do you wanna [00:38:00] address. Choosing, why would a doctor choose a higher dose, like what I am on with Dr. Nagel as opposed to a smaller dose that just addresses symptoms? You wanna address that? Yes. From the studies that we know for bone health and possibly brain health as well, we know that.

[00:38:25] Getting estradiol levels. So in menopause, if you don't have any estrogen on board, estrodiol on board, and your ovaries have stopped working, your estradiol is gonna fall below 35. It's gonna be less than 30. You. If you are more overweight or you have more fat tissue, maybe you make a little bit more peripheral conversion from your androgens to estro, and some of the estro can be converted into estradiol.

[00:38:52] It's very small amounts. But a lot of those women, maybe they will be at 35 or 40 at [00:39:00] most, right? They're not gonna reach the levels, which is an 80 or a hundred picograms, to protect their bones very well. Or to protect their brain very well. So that's one, one argument. The other argument is there's gonna be women that even if you get them to a hundred, which is great for the bone, great for the brain, they're still not feeling great or their metabolic markers haven't completely optimized or their mood like they feel their brain fog, they're still fatigued because everybody has individual thresholds even in, with regards to their neurotransmitters and everything.

[00:39:38] They're gonna be moody below a level of 200. I have patients like that. So you gotta individualize it for people. In addition to that, once you understand that possibly if you extrapolate the data of the curves that we have in a premenopausal women, where I talked about getting those peaks and the TROs are important for cellular signaling [00:40:00] and genetic transcription of messengers, and proteins and enzymes.

[00:40:05] That is an additional factor that can be beneficial in terms of optimizing their health outcome because you're treating them like they were treated in perimenopause, where all these organ systems were responding to the ups and downs that you get. So those peaks, often people like Dr. Nagel, who is my mentor and your physician.

[00:40:32] Like to get them higher. So they like to give people anywhere a peak between 300 and 500. Right? And that's because they're imitating it how it was before this menopause. And so I think what he's seeing anecdotally, and in his experience and his practice, and he is done this over 10 years, is that women tolerate this very well.

[00:40:53] And in fact they feel better on this. On a static low dose, and hence why it's doing it. [00:41:00] What I would love to do is stimulate and push towards more research with exactly that approach, because then it becomes more mainstream accepted. Right now, it's gonna be hard to convince the mainstream doctors that approach makes sense and that women often have to accept that this approach includes.

[00:41:24] Cycling and menstruating again. Yeah. And that's something that you will have to, explain to women to why. Yeah. I find that when you work with a health coaching program and they do a lot of that educational process, it's wonderful because patients are very prepared and very understanding. Yes.

[00:41:47] And as a doctor, I think the more education I can give them. The more they can just be, feel empowered that this is the right approach for them. But I do think we will need more studies to be a hundred percent [00:42:00] honest. I see it anecdotally with Dr. NIGOs practice working amazing amazingly, and there's other doctors using creams to reach those levels.

[00:42:09] I. They have amazing results, I think. Really? Yes. Okay. We just have to get the data together so we can make this more mainstream. I, until you said that, I didn't know that the cream actually could do, that. Could bring the blood levels up to what, 500 or whatever he says that makes it, it can give you those peaks.

[00:42:28] And it can be titrated easily, but it's sometimes you have to change the concentration up. You have to go higher concentration than the starting dose. You titrate it based on the woman's absorption. Having said that, creams can be a little bit more of a struggle because you have to do it twice a day.

[00:42:48] And there could be some concern about, I don't wanna rub it my child, or my pet, or my husband. You just gotta keep it covered. Keep the skin areas covered, protected. Okay. [00:43:00] So interesting. Injections can be a little bit easier for some women if they don't have needle phobia because it's once a week or twice a week.

[00:43:08] Interesting that you said that because I thought for sure that I wasn't gonna be able to do it. 'cause I do have a needle phobia and I got over it real quick. I feel nothing. Wow. I feel nothing when I insert it. But with I have noticed that with strength training, the more Yeah. Muscle that I do feel it's a little bit, but it's it's significant, with regard to what I get out of it, it's.

[00:43:27] I feel mind blowingly different. In fact, too many ways to count. And I can now even realize that I probably suffered most of my life with low estrogen. 'cause I I had trouble. I. Attaining pregnancy. I did end up, but it took a lot of change. I worked with a midwife, worked with my foods used progesterone cream and that type of thing to achieve it.

[00:43:52] So I think that I struggled for many years unnecessarily, like I mentioned, with the heart palpitations as a teenager [00:44:00] and that, doctors wanna put the heart the what are those called? That, that the heart monitor on you for 24 hours? Yeah, the Holter monitors. Yeah. Okay. And they make you think you have some kind of a heart condition when you really don't, you just haven't balanced.

[00:44:12] So I thought we could address that, but maybe another time. 'cause I know you have to get going. Thank you so much for being here and trying to help makes sense. Out of, a really complicated issue. But it's life changing. And that's what I like to share and spread is that it is, it's literally life changing.

[00:44:31] It's changed my relationships with my kids even. It's helped. Really. Yeah. It's helped me become more patient and it's just it's just mind blowing that hormones affect us that much. It's in a good way. But I'm going to put, and Ms. Crystal, let me ask you something. When you initially started with the higher doses, did you have some of the side, and I have answers to this, but I wanna know your experience, the water retention, the weight gain, the bloating.

[00:44:58] Did you have some things? Yeah. [00:45:00] Yes. I had and I actually think Dr. Nagel said it was more the testosterone, but I did have, like teenage acne at first. And so I went through that and then definitely gained about 10 pounds. And I remember something that one of his coaches told me that I will never forget because I couldn't wrap my head around it at first.

[00:45:21] And she, I, she said, you will, you might gain a few pounds, but you won't care. And I thought that's an interesting thing to say. What do you mean I won't care? And she was right. To the right places. Yeah. To the right places. But it also makes you feel so much better that you're not so obsessed. Yeah.

[00:45:38] Women are obsessed with thinking weight is the issue when really you don't feel well. And I don't know if we've been programmed, I don't know what it is to make us all think that if we just get skinny, everything will get better and will feel better. Not necessarily you. You might feel a little better.

[00:45:55] Interesting. Very interesting. Yeah. So I am carrying around like. [00:46:00] 10 pounds more than when I started and I, and she was right. And I never thought in a million years, I'd say those words that I don't care now. Can I lose it? Yes. What I have noticed is that that I will strength when I strength train the right way I will shrink.

[00:46:18] The scale won't move, but I'm in a different size. So that is really interesting. And it could be also the testosterone is helping me build muscle. I could not build muscle before I started taking HRT, it didn't feel like I could. And so I would also be just exhausted after a workout to the point where it wasn't giving me energy, it was stealing energy, and I'd need to go sleep for four hours after a workout.

[00:46:42] Love that. Yep. All of that. You're not the only one telling me all of this. It makes a lot of sense. Yeah. Yeah. I think that this is working wonderfully for you and you are in a good Dr. Nicholas. This call it sweet spot for you. It works well. You always wanna [00:47:00] maintain a review of your metabolic markers annually or biannually, where you look at your insulin hemoglobin, A1C CRP lipid panel.

[00:47:12] You wanna maybe, check at a bone density scan and you can look at the body composition scan. Make sure you don't have too much visceral fat. You can, you wanna obviously monitor your breast health and get your annual exams. I. I'll tell you, the cycling can be challenging for women who have uterine issues where they have fibroids or adenomyosis where the bleeding is always gonna be a little bit heavier for them or they can potentially grow.

[00:47:42] So those are some limitations to that. And one of that, can I just say this real quick? Dr. Ngel I noticed a couple of different times with regard to that. He said to increase it a little bit more of estrogen. Yes. Dr. Nagel. He is a pioneer in his thought process in a way where [00:48:00] he's believing, understanding the physiology, and then saying, okay, we know that in healthy women, the more there is a peak, the more the lining is controlled so that you don't get too heavy periods, right?

[00:48:13] Yeah. And even higher estrogen during the period maintains the period. Heaviness. In fact, when I was in residency, if someone came with heavy periods or abnormal bleeding, we would give them IV estrogen. Wow. Okay. So he's right about that. But what I'm talking about is this would be like if it was dysfunctional bleeding from the lining I'm talking about, and then you wanna balance it with progesterone.

[00:48:39] I'm talking about they have a fibroid or they have structural changes in the uterus. That's gonna be challenging because that's going to respond to the hormones. Estrogen is a growth factor, so it's gonna grow, fibroids so not everyone. Can tolerate a certain dose because it's gonna grow their fabric.

[00:48:54] But then Dr. Nigel says something that I love too. He is you can't make the fibroids dictate what your brain [00:49:00] needs. You have to make a decision about those thyroids. Yeah, they can always be addressed, maybe potentially in a surgical way, but I'm just telling you this, Ms. Crystal, this works for you and you're happy, and it made all sense to you.

[00:49:12] I have a lot of women who might not understand it the same way, or might not come to the same conclusions for them. And as a physician, I'm gonna be welcoming to all different kinds of women, sure. I'm gonna, I'm gonna meet them where they are. And one thing. Yeah. And I, when I hear or read and research the protective components to this, yes.

[00:49:36] It's hard for me to not share it with people that I care about. I love that. Yeah. I love that. I think what you're doing is very important and how passionate you are about it. I think it's important to take people's fears away and just say, okay, we're not talking about being scared enough. We just wanna understand the risks.

[00:49:53] And have it informed consent together. Yeah. And so I had a friend say, why would you [00:50:00] wanna get, take your, get your take levels so high that you get your period back? And I said I would rather put up with a monthly period. And avoid possible dementia or Alzheimer's or any of those. That's where my thinking is.

[00:50:17] So it's not about being right or wrong. It's about that's where I am. That's where I'm I've decided that's where I wanna be. 'cause I see it as a safety net. Or insurance against something like that. And until they do the research and get themselves to understand it more, which I hope that you're doing, and just by, sharing this podcast, I hope that we're doing so that, because there are those that have it in there, in their genes.

[00:50:42] Okay. I have a cousin that her. Her mom is not my biological aunt, but she is 70. She had full on dementia at age 67. Sad to watch this, and it breaks my heart every day. I almost feel like crying, thinking about it. [00:51:00] And so I want to tell, so her mom, and then they both got it about the same time.

[00:51:05] So if my cousin can avoid that, by me giving her this information it's life changing for her children as well. So if someone asks you why would you want periods? If you're like, if you have to be, then you have to explain. You say if you want the benefits of growing your stem cells and growth factors in the tissues that you want, like in your bone and in your brain, and you want things to be stimulated in a healthy way.

[00:51:35] And then you also want to get rid of your dead zombie senescent cells. You have to reach a certain level because a period means every month you are shedding that cells. That's such a great way to say it. So it confirms exactly what I said earlier about what the purpose of those hormones are. So if things are I balance and you actually getting rid of your [00:52:00] zombie cells and senescent cells and you're shedding that, the period is the biggest.

[00:52:05] Marker of that. So don't tell her I want a period and that's why I'm No, it's because I want That's not about all the benefits. Exactly. I want all the benefits that it means that you are now having a period. Yeah, that was beautiful. Way to end this. Great. I'm so excited that we got to talk.

[00:52:25] Thank you. You, I'm gonna send, I'm gonna send you some clips so that you can put this on your social media and I wanna, I would love that you could grow and your following grow for the simple fact that it's changing lives. Absolutely. I appreciate you so much. Have a wonderful day. Thank you. Bye-bye. Bye.