Full Transcript Why Estradiol Dose Increases Aren't Always the Answer 0:01 The woman really 0:01 The woman really gets it. The levels 0:02 gets it. The levels 0:02 gets it. The levels are rising and she 0:03 are rising and she 0:03 are rising and she feels as if 0:04 feels as if 0:04 feels as if the estradiol is too 0:05 the estradiol is too 0:05 the estradiol is too high and needs 0:07 high and needs 0:07 high and needs more estradiol? What 0:08 more estradiol? What 0:08 more estradiol? What you should know before 0:10 you should know before 0:10 you should know before increasing your dose. 0:11 increasing your dose. 0:11 increasing your dose. Hi, I'm Dr. 0:12 Hi, I'm Dr. 0:12 Hi, I'm Dr. Valerie Davidson from the 0:13 Valerie Davidson from the 0:13 Valerie Davidson from the Progressive Health Podcast. 0:14 Progressive Health Podcast. 0:14 Progressive Health Podcast. I'm Dr. Mackie from the 0:15 I'm Dr. Mackie from the 0:15 I'm Dr. Mackie from the Progressive Health podcast. And 0:18 Progressive Health podcast. And 0:18 Progressive Health podcast. And now we're pretty sure that 0:20 now we're pretty sure that 0:20 now we're pretty sure that many women don't 0:20 many women don't 0:20 many women don't get 0:21 get 0:21 get enough 0:22 enough 0:22 enough estrogen, right? 0:23 estrogen, right? 0:27 However, there is another side to the 0:27 However, there is another side to the coin. When you
Finding the Right HRT Delivery Method 0:30 coin. When you 0:30 coin. When you use a certain 0:31 use a certain 0:31 use a certain static dose, you 0:32 static dose, you 0:32 static dose, you can only increase it 0:33 can only increase it 0:33 can only increase it to a certain level 0:34 to a certain level . This is a very arbitrary 0:35 . This is a very arbitrary 0:36 . This is a very arbitrary number that depends 0:37 number that depends 0:37 number that depends on the woman herself. You don't 0:38 on the woman herself. You don't 0:38 on the woman herself. You don't know where that line is 0:39 know where that line is 0:39 know where that line is until you start 0:40 until you start 0:40 until you start spotting 0:41 spotting 0:41 spotting . 0:41 . 0:42 . Oh, definitely. So 0:43 Oh, definitely. So 0:43 Oh, definitely. So when you think about the 0:44 when you think about the 0:44 when you think about the patch, I have 0:45 patch, I have 0:45 patch, I have a lot of women who are 0:46 a lot of women who are 0:46 a lot of women who are on 0:47 on 0:47 on the highest dose of 0.1 mg and 0:48 the highest dose of 0.1 mg and 0:48 the highest dose of 0.1 mg and they feel like 0:49 they feel like 0:49 they feel like it's not enough 0:51 it's not enough 0:51 it's not enough but they don't know what to 0:52 but they don't know what to 0:52 but they don't know what to do next. Have 0:53 do next. Have 0:53 do next. Have they reached the ceiling? And 0:54 they reached the ceiling? And 0:54 they reached the ceiling? And then there are other women who 0:55 then there are other women who 0:55 then there are other women who may 0:56 may 0:56 may be using 0:57 be using 0:57 be using estradiol gel 0:58 estradiol gel 0:58 estradiol gel or creams and 0:59 or creams and 0:59 or creams and feel that the dose is 1:00 feel that the dose is 1:00 feel that the dose is too low. 1:01 too low. 1:01 too low. Should they just take it 1:02 Should they just take it 1:02 Should they just take it and make it bigger? There are 1:04 and make it bigger? There are 1:04 and make it bigger? There are a few more nuances here. 1:05 a few more nuances here. 1:07 For example, I had 1:07 For example, I had a patient who
When Creams, Patches, and Absorption Become the Issue 1:09 a patient who 1:09 a patient who was using 1:09 was using 1:10 was using estradiol cream 1:11 estradiol cream , and I had to 1:12 , and I had to 1:12 , and I had to switch her to a 1:13 switch her to a 1:13 switch her to a patch because she was 1:14 patch because she was 1:14 patch because she was constantly smearing 1:15 constantly smearing 1:15 constantly smearing it on things and other 1:16 it on things and other 1:16 it on things and other people. I tell 1:19 people. I tell 1:19 people. I tell patients to apply the 1:20 patients to apply the 1:20 patients to apply the cream to their inner 1:21 cream to their inner 1:21 cream to their inner thighs, but 1:22 thighs, but 1:22 thighs, but if they do that 1:24 if they do that 1:24 if they do that and walk around in shorts, the 1:25 and walk around in shorts, the 1:25 and walk around in shorts, the cream can get 1:26 cream can get 1:26 cream can get on pets, 1:27 on pets, 1:27 on pets, children, or everywhere else 1:28 children, or everywhere else 1:28 children, or everywhere else . I'm saying this won't work for 1:31 . I'm saying this won't work for 1:31 . I'm saying this won't work for you. So, it's 1:33 you. So, it's 1:33 you. So, it's not necessarily 1:34 not necessarily 1:34 not necessarily about increasing the dose. 1:35 about increasing the dose. 1:36 about increasing the dose. More important was 1:37 More important was 1:37 More important was changing the way 1:38 changing the way 1:38 changing the way 1:39 hormone replacement 1:39 hormone replacement therapy was delivered. I think some 1:41 therapy was delivered. I think some 1:41 therapy was delivered. I think some people think 1:42 people think 1:42 people think there is only one 1:43 there is only one 1:43 there is only one way to do 1:44 way to do 1:44 way to do HRT, but there are actually 1:45 HRT, but there are actually 1:45 HRT, but there are actually many more. 1:46 many more. 1:49 Sometimes if we 1:49 Sometimes if we feel the dose is 1:50 feel the dose is 1:50 feel the dose is not high enough, 1:51 not high enough, 1:51 not high enough, like with the patch, or 1:52 like with the patch, or 1:52 like with the patch, or if they are on a 1:53 if they are on a 1:53 if they are on a static dose of gel and 1:54 static dose of gel and 1:54 static dose of gel and start 1:55 start 1:55 start bleeding but 1:56 bleeding but 1:56 bleeding but have symptoms of 1:57 have symptoms of 1:57 have symptoms of low 1:58 low 1:58 low estradiol, we can 1:59 estradiol, we can 1:59 estradiol, we can switch them to 2:00 switch them to 2:00 switch them to rhythmic dosing 2:01 rhythmic dosing 2:01 rhythmic dosing or cyclical 2:02 or cyclical 2:02 or cyclical hormone use. 2:03 hormone use. 2:06 So, there are many 2:06 So, there are many different ways. So 2:07 different ways. So , before we just 2:08 , before we just 2:08 , before we just say, "let's 2:09 say, "let's 2:09 say, "let's increase the dose," which 2:10 increase the dose," which 2:10 increase the dose," which can cause 2:11 can cause 2:11 can cause side effects, it's worth 2:13 side effects, it's worth 2:13 side effects, it's worth considering other 2:14 considering other 2:14 considering other dosing strategies 2:15 dosing strategies 2:15 dosing strategies we could
Why Dose Changes Can Create New Problems 2:16 we could 2:16 we could employ. 2:17 employ. 2:19 Yeah, you know, ultimately it 2:19 Yeah, you know, ultimately it all comes down to the 2:20 all comes down to the 2:20 all comes down to the bleeding issue. 2:22 bleeding issue. 2:23 bleeding issue. If you 2:23 If you 2:23 If you use 2:24 use any of the usual 2:25 any of the usual 2:25 any of the usual options, at some 2:27 options, at some 2:27 options, at some point, if the dose 2:28 point, if the dose 2:28 point, if the dose continues to increase, 2:29 continues to increase, 2:29 continues to increase, you will reach a certain 2:30 you will reach a certain 2:30 you will reach a certain limit. Again, as 2:31 limit. Again, as 2:31 limit. Again, as I said, this is an 2:32 I said, this is an 2:32 I said, this is an arbitrary 2:33 arbitrary 2:33 arbitrary dosage amount. For some 2:35 dosage amount. For some 2:35 dosage amount. For some women, this is a relatively 2:36 women, this is a relatively 2:36 women, this is a relatively low threshold. For 2:37 low threshold. For 2:37 low threshold. For other women, this is a very 2:38 other women, this is a very 2:38 other women, this is a very high threshold. You know 2:40 high threshold. You know , when the threshold is low, 2:42 , when the threshold is low, 2:42 , when the threshold is low, for long-term 2:43 for long-term 2:43 for long-term security you need to 2:44 security you need to 2:44 security you need to find another option. 2:45 find another option. 2:47 And what 2:47 And what option would that be? Usually, as 2:49 option would that be? Usually, as 2:49 option would that be? Usually, as you said, it 2:50 you said, it 2:50 you said, it needs to 2:51 needs to 2:51 needs to be changed somehow. Also, 2:53 be changed somehow. Also, 2:53 be changed somehow. Also, you know, children, 2:55 you know, children, 2:55 you know, children, pets, and partners. 2:56 pets, and partners. 2:56 pets, and partners. That's a big problem with 2:57 That's a big problem with 2:57 That's a big problem with men, isn't it? 2:59 men, isn't it? 2:59 men, isn't it? Because they 2:59 Because they 2:59 Because they use 3:00 use 3:00 use a lot of testosterone 3:00 a lot of testosterone 3:00 a lot of testosterone if they use a 3:01 if they use a 3:01 if they use a transdermal cream 3:02 transdermal cream . 3:02 . 3:02 . You mean 3:03 You mean 3:03 You mean men who 3:04 men who 3:04 men who use 3:05 use 3:05 use testosterone cream, which 3:05 testosterone cream, which 3:06 testosterone cream, which can get into 3:06 can get into 3:06 can get into their family. Yes, 3:07 their family. Yes, 3:07 their family. Yes, definitely. This is another 3:09 definitely. This is another 3:09 definitely. This is another factor I was 3:10 factor I was 3:10 factor I was talking about with women: 3:11 talking about with women: 3:11 talking about with women: if they apply 3:12 if they apply 3:12 if they apply hormone cream, 3:13 hormone cream, 3:13 hormone cream, touch things, or 3:15 touch things, or 3:15 touch things, or hug people. And I 3:16 hug people. And I 3:16 hug people. And I know that some women 3:17 know that some women 3:17 know that some women just can't do
Rhythmic Dosing and Cyclical Hormone Therapy 3:18 just can't do 3:18 just can't do anything about it. 3:19 anything about it. 3:19 anything about it. This is normal. This is where 3:20 This is normal. This is where 3:20 This is normal. This is where we think: maybe 3:21 we think: maybe 3:21 we think: maybe we should choose a different 3:22 we should choose a different 3:23 we should choose a different strategy. Or I have 3:24 strategy. Or I have 3:24 strategy. Or I have a lot of women who 3:25 a lot of women who 3:25 a lot of women who like to swim, so 3:26 like to swim, so 3:26 like to swim, so they can put on a 3:27 they can put on a 3:27 they can put on a hormone cream and 3:28 hormone cream and 3:28 hormone cream and not want to wait a couple of 3:29 not want to wait a couple of 3:29 not want to wait a couple of hours before 3:30 hours before 3:30 hours before swimming, and it 3:31 swimming, and it 3:31 swimming, and it just washes off. 3:32 just washes off. 3:32 just washes off. Of course. Yes. With our 3:36 Of course. Yes. With our 3:36 Of course. Yes. With our lifestyle and 3:37 lifestyle and 3:37 lifestyle and different circumstances, there 3:39 different circumstances, there 3:39 different circumstances, there are always nuances that 3:40 are always nuances that 3:40 are always nuances that should be considered 3:41 should be considered 3:41 should be considered to find the right 3:42 to find the right 3:42 to find the right solution. 3:43 solution. 3:47 Or even with creams, 3:47 Or even with creams, they need to be 3:48 they need to be 3:48 they need to be rubbed in very thoroughly. 3:50 rubbed in very thoroughly. 3:50 rubbed in very thoroughly. I had patients 3:51 I had patients 3:51 I had patients who didn't rub the cream in 3:52 who didn't rub the cream in 3:52 who didn't rub the cream in completely or immediately 3:54 completely or immediately 3:54 completely or immediately put on tight 3:54 put on tight 3:55 put on tight leggings, and everything 3:55 leggings, and everything 3:55 leggings, and everything rubbed off. So the 3:56 rubbed off. So the 3:56 rubbed off. So the main thing is to ensure 3:58 main thing is to ensure 3:58 main thing is to ensure proper suction 3:59 proper suction . If they have 4:00 . If they have 4:00 . If they have problems with this, we 4:01 problems with this, we 4:01 problems with this, we switch them to a 4:01 switch them to a 4:01 switch them to a patch, because it 4:02 patch, because it 4:02 patch, because it can be simply 4:03 can be simply 4:03 can be simply stuck on. But then 4:04 stuck on. But then 4:04 stuck on. But then a lot of women say, " 4:05 a lot of women say, " Oh, this patch doesn't 4:06 Oh, this patch doesn't 4:06 Oh, this patch doesn't stick," or 4:06 stick," or 4:07 stick," or some say, "It 4:07 some say, "It 4:07 some say, "It sticks too 4:08 sticks too 4:08 sticks too well, and when I 4:09 well, and when I 4:09 well, and when I take it off, it feels 4:10 take it off, it feels like the skin is 4:11 like the skin is 4:11 like the skin is coming off." So you 4:12 coming off." So you 4:12 coming off." So you really need to 4:13 really need to 4:13 really need to find a balance for 4:14 find a balance for 4:14 find a balance for each person, not 4:15 each person, not 4:15 each person, not just increase 4:16 just increase 4:16 just increase the dose. 4:16 the dose. 4:16 the dose. Yes, that's right. Because over 4:18 Yes, that's right. Because over 4:18 Yes, that's right. Because over time, you know, this will 4:19 time, you know, this will 4:19 time, you know, this will eventually cause 4:20 eventually cause 4:20 eventually cause certain problems. Not 4:22 certain problems. Not 4:22 certain problems. Not always, as I already said 4:23 always, as I already said , 4:25 , 4:25 , women's tolerance threshold for estradiol 4:26 women's tolerance threshold for estradiol 4:26 women's tolerance threshold for estradiol varies greatly. It's 4:28 varies greatly. It's 4:28 varies greatly. It's just incredible how 4:29 just incredible how 4:29 just incredible how one woman can 4:30 one woman can 4:30 one woman can endure very little, 4:32 endure very little, 4:32 endure very little, while another can endure a whole lot. 4:33 while another can endure a whole lot. 4:33 while another can endure a whole lot. Do you know how 4:34 Do you know how 4:34 Do you know how to determine this 4:35 to determine this 4:35 to determine this in advance? 4:35 in advance? 4:38 And even regarding 4:38 And even regarding absorption: two women 4:39 absorption: two women 4:39 absorption: two women can take 4:40 can take 4:40 can take the same dose of, 4:41 the same dose of, 4:41 the same dose of, say, 4:41 say, 4:41 say, estrogen gel, 4:43 estrogen gel, 4:43 estrogen gel, but one woman 4:44 but one woman 4:44 but one woman absorbs it well, the level 4:45 absorbs it well, the level 4:45 absorbs it well, the level in her blood is high, and 4:46 in her blood is high, and 4:46 in her blood is high, and she feels like there's 4:47 she feels like there's 4:50 too much estradiol, while the other woman's 4:50 too much estradiol, while the other woman's levels are low. Do 4:52 levels are low. Do 4:52 levels are low. Do they absorb it? 4:53 they absorb it? 4:53 they absorb it? Why don't they 4:54 Why don't they 4:54 Why don't they learn it? And if 4:56 learn it? And if 4:56 learn it? And if they consistently don't 4:57 they consistently don't 4:57 they consistently don't absorb it, and we can't 4:58 absorb it, and we can't 4:58 absorb it, and we can't fix the 4:59 fix the 4:59 fix the problem—whether it's 5:00 problem—whether it's 5:00 problem—whether it's the way they apply it or their 5:01 the way they apply it or their 5:01 the way they apply it or their skin— 5:02 skin— then it's worth switching 5:04 then it's worth switching 5:04 then it's worth switching them to a different 5:05 them to a different 5:05 them to a different dosing schedule or a different 5:06 dosing schedule or a different 5:06 dosing schedule or a different strategy. As I 5:07 strategy. As I 5:07 strategy. As I said, there are even 5:08 said, there are even 5:09 lozenges. 5:10 lozenges. For some women who can't 5:11 For some women who can't 5:11 For some women who can't tolerate the patch and 5:12 tolerate the patch and 5:12 tolerate the patch and the cream gets 5:13 the cream gets 5:13 the cream gets everywhere, or who don't 5:14 everywhere, or who don't 5:14 everywhere, or who don't want to 5:15 want to 5:15 want to use the cream 5:16 use the cream , I can prescribe a 5:17 , I can prescribe a 5:17 , I can prescribe a sublingual 5:18 sublingual 5:18 sublingual tablet, the main thing is 5:19 tablet, the main thing is 5:19 tablet, the main thing is that they 5:20 that they 5:20 that they dissolve it under 5:21 dissolve it under 5:21 dissolve it under the tongue and not swallow it. 5:22 the tongue and not swallow it. 5:22 the tongue and not swallow it. This is another option 5:23 This is another option 5:23 This is another option that I have also 5:24 that I have also 5:24 that I have also used in 5:25 used in 5:25 used in working with women. 5:26 working with women. 5:26 working with women. Lozenges 5:26 Lozenges 5:26 Lozenges 5:28 are absorbed very 5:28 are absorbed very well, so if 5:29 well, so if 5:29 well, so if someone does not absorb 5:30 someone does not absorb 5:30 someone does not absorb 5:32 transdermals, 5:34 sublingual or 5:34 sublingual or rhythmic dosing may be another option. 5:35 rhythmic dosing may be another option. 5:36 rhythmic dosing may be another option. Because rhythmic 5:36 Because rhythmic 5:36 Because rhythmic dosing 5:37 dosing 5:37 dosing 5:39 is fundamentally different from 5:39 is fundamentally different from static dosing: you 5:40 static dosing: you 5:40 static dosing: you maintain good 5:41 maintain good 5:41 maintain good estradiol levels 5:42 estradiol levels 5:42 estradiol levels by changing them throughout the 5:43 by changing them throughout the 5:43 by changing them throughout the 28-day cycle, and you 5:45 28-day cycle, and you 5:45 28-day cycle, and you can also 5:46 can also 5:46 can also clearly see the level of 5:47 clearly see the level of 5:47 clearly see the level of absorption. 5:48 absorption. 5:50 Yes, and this is where you 5:50 Yes, and this is where you have a little more 5:51 have a little more 5:51 have a little more control over how 5:52 control over how 5:52 control over how 5:56 the dosing is done. So, 5:56 the dosing is done. So, you know, based on 5:57 you know, based on 5:57 you know, based on patient feedback, 5:58 patient feedback, 5:58 patient feedback, you can now 5:59 you can now 5:59 you can now pick a very 6:00 pick a very 6:00 pick a very specific level, 6:01 specific level, 6:01 specific level, which is not possible 6:02 which is not possible 6:02 which is not possible with some of the 6:03 with some of the 6:03 with some of the other 6:04 other 6:04 other dosing methods. Do 6:04 dosing methods. Do 6:04 dosing methods. Do you mean 6:05 you mean 6:06 you mean rhythmic dosing? 6:07 rhythmic dosing? 6:07 rhythmic dosing? Yes, yes, definitely. 6:08 Yes, yes, definitely. 6:08 Yes, yes, definitely. Rhythmic dosing 6:09 Rhythmic dosing is a protocol where 6:10 is a protocol where 6:10 is a protocol where you 6:11 you 6:11 you essentially recreate the 6:12 essentially recreate the 6:12 essentially recreate the ovarian cycle, like 6:13 ovarian cycle, like 6:13 ovarian cycle, like during menstruation, 6:14 during menstruation, 6:14 during menstruation, where 6:14 where 6:14 where estrogen levels start to 6:15 estrogen levels start to 6:15 estrogen levels start to rise from 6:16 rise from 6:16 rise from day one to day twelve, 6:17 day one to day twelve, 6:17 day one to day twelve, peak, and then 6:18 peak, and then 6:18 peak, and then begin to gradually 6:19 begin to gradually 6:19 begin to gradually decline. 6:19 decline. 6:19 decline. Progesterone begins 6:20 Progesterone begins 6:20 Progesterone begins to be produced only on the 6:21 to be produced only on the 14th day, after 6:23 14th day, after 6:23 14th day, after ovulation, so to speak, and 6:23 ovulation, so to speak, and 6:23 ovulation, so to speak, and reaches its peak on the 21st 6:24 reaches its peak on the 21st 6:24 reaches its peak on the 21st day and begins to 6:25 day and begins to 6:25 day and begins to decline. This is something that is 6:26 decline. This is something that is 6:26 decline. This is something that is inherent in 6:27 inherent in 6:27 inherent in nature itself. This is another 6:29 nature itself. This is another 6:29 nature itself. This is another method I 6:29 method I 6:29 method I use for women 6:31 use for women 6:31 use for women to get truly 6:32 to get truly 6:32 to get truly physiological levels of 6:33 physiological levels of 6:33 physiological levels of estradiol and 6:34 estradiol and 6:34 estradiol and progesterone, 6:34 progesterone, 6:34 progesterone, especially when we are 6:35 especially when we are 6:35 especially when we are working with “fog” 6:36 working with “fog” 6:36 working with “fog” in our heads. Because sometimes with 6:40 in our heads. Because sometimes with 6:40 in our heads. Because sometimes with static doses of 6:41 static doses of 6:41 static doses of estradiol there is 6:42 estradiol there is 6:42 estradiol there is a risk of irritation of the 6:43 a risk of irritation of the 6:45 uterine mucosa, if it is present, 6:45 uterine mucosa, if it is present, or women are very 6:46 or women are very 6:46 or women are very sensitive to 6:47 sensitive to 6:47 sensitive to fluid retention from estrogen, 6:49 fluid retention from estrogen, 6:49 fluid retention from estrogen, but still 6:49 but still 6:49 but still feel this " 6:50 feel this " fog." Therefore, I believe 6:54 fog." Therefore, I believe 6:54 fog." Therefore, I believe that rhythmic 6:55 that rhythmic 6:55 that rhythmic dosing is great 6:55 dosing is great 6:56 dosing is great for 6:56 for 6:56 for mental fatigue, 6:57 mental fatigue, 6:57 mental fatigue, libido, and also for 6:58 libido, and also for 7:00 bone density concerns 7:00 bone density concerns if there is a family history of 7:01 if there is a family history of 7:01 if there is a family history of osteoporosis, 7:02 osteoporosis, 7:02 osteoporosis, dementia, or 7:03 dementia, or 7:03 dementia, or brain health issues. These are 7:04 brain health issues. These are 7:04 brain health issues. These are simply ways 7:05 simply ways 7:05 simply ways to maintain the 7:06 to maintain the 7:06 to maintain the necessary 7:06 necessary 7:06 necessary therapeutic level 7:07 therapeutic level . By the way, I 7:08 . By the way, I 7:08 . By the way, I was talking to a woman 7:09 was talking to a woman 7:09 was talking to a woman who was on 7:09 who was on 7:09 who was on rhythmic dosing 7:10 rhythmic dosing , and she asked, " 7:11 , and she asked, " So, technically, I'm 7:12 So, technically, I'm 7:12 So, technically, I'm not in menopause, right?" 7:13 not in menopause, right?" » I replied: “Your 7:14 » I replied: “Your 7:14 » I replied: “Your age is menopausal. 7:15 age is menopausal. 7:15 age is menopausal. Of course. "But yes, your 7:17 Of course. "But yes, your 7:17 Of course. "But yes, your levels are 7:17 levels are 7:17 levels are consistent with those of a 7:18 consistent with those of a 7:18 consistent with those of a person who is having a 7:19 person who is having a 7:19 person who is having a menstrual cycle." 7:20 menstrual cycle." 7:20 menstrual cycle." Yes. This is precisely what is the 7:22 Yes. This is precisely what is the 7:22 Yes. This is precisely what is the subject of controversy. A 7:23 subject of controversy. A 7:24 subject of controversy. A woman who is 55 or 60 7:25 woman who is 55 or 60 7:25 woman who is 55 or 60 years old is 7:27 years old is 7:27 years old is not technically in
Research Limits and Real-World Clinical Experience 7:28 not technically in 7:30 menopause on paper. This 7:30 menopause on paper. This makes this approach 7:31 makes this approach 7:31 makes this approach somewhat controversial. But 7:36 somewhat controversial. But 7:36 somewhat controversial. But as a practitioner, you quickly 7:37 as a practitioner, you quickly 7:37 as a practitioner, you quickly notice when a woman 7:38 notice when a woman 7:38 notice when a woman starts telling you 7:40 starts telling you 7:40 starts telling you how much better she 7:41 how much better she 7:41 how much better she feels with this particular 7:42 feels with this particular 7:42 feels with this particular method. You only need to 7:47 method. You only need to 7:47 method. You only need to see 7:48 see 7:48 see it a few times to 7:49 it a few times to 7:49 it a few times to realize it 7:50 realize it 7:50 realize it objectively, simply 7:51 objectively, simply 7:51 objectively, simply by observation 7:52 by observation . As for research, 7:53 . As for research, 7:53 . As for research, someone in the comments the other 7:54 someone in the comments the other 7:54 someone in the comments the other day asked about the 7:55 day asked about the 7:55 day asked about the scientific basis of 7:56 scientific basis of 7:56 scientific basis of rhythmic dosing 7:57 rhythmic dosing . Unfortunately, there are 7:58 . Unfortunately, there are 7:58 . Unfortunately, there are few such studies. 8:00 few such studies. 8:00 few such studies. Research 8:01 Research 8:01 Research is always conducted for 8:01 is always conducted for 8:02 is always conducted for profit. 8:02 profit. 8:03 profit. And conducting 8:03 And conducting 8:03 And conducting research costs 8:04 research costs 8:04 research costs money. 8:05 money. 8:05 money. Money. So if you can't 8:06 Money. So if you can't 8:06 Money. So if you can't profit 8:07 profit 8:07 profit from this research, 8:08 from this research, 8:08 from this research, it will never be 8:09 it will never be 8:09 it will never be done. Unfortunately, 8:10 done. Unfortunately, 8:10 done. Unfortunately, many pharmaceutical 8:11 many pharmaceutical 8:11 many pharmaceutical drugs of this 8:13 drugs of this 8:13 drugs of this type still have a scientific 8:14 type still have a scientific 8:14 type still have a scientific basis. Behind every 8:17 basis. Behind every 8:17 basis. Behind every therapy are 8:18 therapy are 8:18 therapy are doctors, scientists, and 8:19 doctors, scientists, and 8:19 doctors, scientists, and real research 8:20 real research 8:20 real research that supports it. 8:22 that supports it. 8:24 But, you know, double- 8:24 But, you know, double- blind placebo- 8:25 blind placebo- controlled 8:26 controlled 8:26 controlled studies—that's very 8:27 studies—that's very 8:27 studies—that's very difficult. And, as you 8:28 difficult. And, as you 8:28 difficult. And, as you said, they are very 8:29 said, they are very 8:29 said, they are very expensive. And if someone 8:31 expensive. And if someone 8:31 expensive. And if someone doesn't directly 8:32 doesn't directly 8:32 doesn't directly benefit from these 8:33 benefit from these 8:33 benefit from these expenses, then the 8:33 expenses, then the 8:33 expenses, then the research will never... 8:34 research will never... 8:35 research will never... Where will the 8:36 Where will the 8:36 Where will the money come from? Yes. 8:36 money come from? Yes. 8:36 money come from? Yes. Yes, exactly. 8:37 Yes, exactly. 8:37 Yes, exactly. There are grants and much 8:38 There are grants and much 8:38 There are grants and much more. So I'm 8:39 more. So I'm 8:39 more. So I'm sure many 8:40 sure many 8:40 sure many of you listening are 8:41 of you listening are 8:41 of you listening are probably well-versed in 8:42 probably well-versed in 8:42 probably well-versed in research. So 8:43 research. So 8:43 research. So please leave 8:44 please leave 8:44 please leave us comments. But, 8:45 us comments. But, 8:45 us comments. But, you know, we have been in 8:46 you know, we have been in 8:46 you know, we have been in clinical practice for 8:48 clinical practice for 8:48 clinical practice for over 20 years, since 8:50 over 20 years, since 8:50 over 20 years, since 2003-2004. So we 8:52 2003-2004. So we 8:52 2003-2004. So we see the big 8:53 see the big 8:53 see the big picture and what 8:54 picture and what 8:54 picture and what really works for 8:55 really works for 8:55 really works for women in terms of HRT, 8:57 women in terms of HRT, 8:57 women in terms of HRT, longevity, 8:58 longevity, 8:58 longevity, metabolic 8:59 metabolic 8:59 metabolic health, and even 9:00 health, and even 9:00 health, and even quality of life at the 9:01 quality of life at the 9:01 quality of life at the moment—how 9:02 moment—how 9:02 moment—how important HRT is for 9:03 important HRT is for 9:03 important HRT is for every woman. We 9:05 every woman. We 9:05 every woman. We just want you to 9:07 just want you to 9:07 just want you to know: there are many 9:08 know: there are many 9:08 know: there are many different HRT methods, and 9:09 different HRT methods, and 9:09 different HRT methods, and if you feel like 9:11 if you feel like 9:11 if you feel like your method isn't working, there 9:12 your method isn't working, there 9:12 your method isn't working, there is always an 9:13 is always an 9:13 is always an alternative. 9:13 alternative. 9:14 alternative. Yes. Yes. Ultimately, 9:15 Yes. Yes. Ultimately, 9:15 Yes. Yes. Ultimately, at the end of the day... 9:16 at the end of the day... 9:16 at the end of the day... There is an alternative. 9:17 There is an alternative. 9:17 There is an alternative. Ultimately, at the end of 9:18 Ultimately, at the end of 9:18 Ultimately, at the end of the day, that's the whole point. 9:19 the day, that's the whole point. 9:19 the day, that's the whole point. It's not that 9:20 It's not that 9:20 It's not that one method is better than 9:21 one method is better than 9:21 one method is better than another. It's all about 9:22 another. It's all about 9:22 another. It's all about finding the 9:22 finding the 9:22 finding the right one for a 9:23 right one for a 9:23 right one for a particular woman. And 9:24 particular woman. And 9:24 particular woman. And that's, you know, the main 9:25 that's, you know, the main 9:25 that's, you know, the main goal, because it 9:26 goal, because it 9:26 goal, because it will improve your 9:27 will improve your 9:27 will improve your quality of life. This
Choosing the Best HRT Option for Each Woman 9:29 quality of life. This 9:29 quality of life. This will improve your 9:30 will improve your 9:30 will improve your symptom profile at the 9:31 symptom profile at the 9:31 symptom profile at the moment. This will 9:33 moment. This will 9:33 moment. This will help you in 9:34 help you in 9:34 help you in the future when, 9:35 the future when, 9:35 the future when, you know, 9:36 you know, 9:36 you know, age-related 9:37 age-related 9:37 age-related problems start to appear in most 9:38 problems start to appear in most 9:38 problems start to appear in most people. So, actually, that's why 9:41 people. So, actually, that's why 9:41 people. So, actually, that's why we're doing 9:42 we're doing 9:42 we're doing this podcast—to 9:43 this podcast—to 9:43 this podcast—to talk about other 9:44 talk about other 9:44 talk about other possibilities. 9:45 possibilities. 9:46 possibilities. So, that's why in this 9:46 So, that's why in this 9:46 So, that's why in this podcast we talk 9:48 podcast we talk 9:48 podcast we talk about before you 9:49 about before you 9:49 about before you increase your dose, 9:49 increase your dose, 9:49 increase your dose, figure out why you 9:50 figure out why you 9:50 figure out why you might need 9:51 might need 9:51 might need more. Have 9:53 more. Have 9:53 more. Have your symptoms worsened? Do 9:54 your symptoms worsened? Do 9:54 your symptoms worsened? Do you feel pain in your 9:55 you feel pain in your 9:55 you feel pain in your joints? Do 9:55 joints? Do 9:55 joints? Do you feel "foggy 9:57 you feel "foggy " in your head? What about 9:58 " in your head? What about 9:58 " in your head? What about libido? Are 9:59 libido? Are 9:59 libido? Are you gaining weight? Also 10:01 you gaining weight? Also 10:01 you gaining weight? Also , find out if 10:02 , find out if 10:03 the drug is not 10:03 the drug is not being absorbed, because 10:05 being absorbed, because 10:05 being absorbed, because we have several 10:05 we have several 10:05 we have several podcasts about 10:06 podcasts about 10:06 podcasts about tricks that 10:07 tricks that 10:07 tricks that will help an 10:08 will help an 10:08 will help an estradiol 10:09 estradiol 10:09 estradiol patch or cream with 10:10 patch or cream with 10:10 patch or cream with estriol or 10:11 estriol or 10:11 estriol or estradiol 10:11 estradiol 10:11 estradiol work better. 10:12 work better. 10:15 Maybe it's just a 10:15 Maybe it's just a simple trick, like in the 10:16 simple trick, like in the 10:16 simple trick, like in the case of a patient I 10:17 case of a patient I 10:17 case of a patient I saw the other day 10:18 saw the other day —I noticed that she had 10:19 —I noticed that she had 10:19 —I noticed that she had very dry skin. I 10:21 very dry skin. I 10:21 very dry skin. I said, "You really 10:22 said, "You really 10:22 said, "You really should maybe 10:23 should maybe 10:23 should maybe use a loofah 10:24 use a loofah 10:24 use a loofah or, you know, get 10:25 or, you know, get 10:25 or, you know, get that dry skin off." 10:26 that dry skin off." 10:27 that dry skin off." Otherwise, you know, a 10:28 Otherwise, you know, a 10:28 Otherwise, you know, a layer forms that 10:29 layer forms that 10:29 layer forms that your cream 10:30 your cream 10:30 your cream or patch cannot 10:31 or patch cannot 10:31 or patch cannot penetrate. I know 10:33 penetrate. I know 10:33 penetrate. I know other women who 10:33 other women who 10:33 other women who like to 10:34 like to 10:34 like to use soap 10:35 use soap 10:35 use soap with added 10:36 with added 10:36 with added moisturizing 10:36 moisturizing 10:36 moisturizing ingredients. I kind of 10:37 ingredients. I kind of 10:39 like that too. But if 10:39 like that too. But if you have moisturizer on your skin 10:40 you have moisturizer on your skin 10:42 and you put a 10:42 and you put a patch on or apply 10:43 patch on or apply 10:43 patch on or apply cream, it won't penetrate 10:44 cream, it won't penetrate 10:45 properly. 10:45 properly. Yes, exactly. 10:46 Yes, exactly. 10:46 Yes, exactly. Little tips and 10:47 Little tips and 10:47 Little tips and tricks, so we 10:47 tricks, so we 10:47 tricks, so we wanted to let you know that 10:48 wanted to let you know that 10:48 wanted to let you know that we have options before we 10:49 we have options before we 10:49 we have options before we just say, " 10:50 just say, " Oh, let me 10:51 Oh, let me 10:51 Oh, let me increase the dose." 10:52 increase the dose." 10:52 increase the dose." Yes, exactly. Of course, because 10:53 Yes, exactly. Of course, because 10:54 Yes, exactly. Of course, because you can only do this a 10:54 you can only do this a 10:55 you can only do this a limited number of 10:55 limited number of 10:55 limited number of times before it 10:56 times before it 10:56 times before it turns into 10:57 turns into 10:57 turns into another separate problem. 10:58 another separate problem. 10:58 another separate problem. The doctor doesn't want 10:59 The doctor doesn't want 10:59 The doctor doesn't want to increase the dose. I've had a 11:00 to increase the dose. I've had a 11:02 lot of people contact me, and I know you have too, who 11:03 too, who 11:03 too, who said their 11:03 said their 11:03 said their doctor doesn't want to 11:04 doctor doesn't want to 11:04 doctor doesn't want to increase the dose. 11:05 increase the dose. 11:05 increase the dose. Additionally, increasing the 11:06 Additionally, increasing the 11:06 Additionally, increasing the dose may be 11:06 dose may be 11:06 dose may be more expensive. So, you know, 11:08 more expensive. So, you know, 11:08 more expensive. So, you know, there are a lot of different 11:09 there are a lot of different 11:09 there are a lot of different options. 11:09 options. 11:09 options. Yes. Yes. So 11:11 Yes. Yes. So 11:11 Yes. Yes. So please leave us 11:11 please leave us 11:11 please leave us your feedback in the 11:13 your feedback in the 11:13 your feedback in the comments section below. We are 11:14 comments section below. We are 11:14 comments section below. We are getting a lot of 11:15 getting a lot of 11:15 getting a lot of feedback and 11:15 feedback and 11:15 feedback and activity. This is very 11:17 activity. This is very 11:17 activity. This is very nice to see. 11:18 nice to see. 11:18 nice to see. It's clear that people, 11:19 It's clear that people, 11:19 It's clear that people, especially women, 11:20 especially women, 11:20 especially women, like the videos 11:21 like the videos 11:21 like the videos we create. It's a 11:23 we create. It's a 11:23 we create. It's a nice feeling that 11:24 nice feeling that 11:24 nice feeling that we are doing something 11:25 we are doing something 11:25 we are doing something important. Sometimes 11:28 important. Sometimes , when you work in a 11:29 , when you work in a 11:29 , when you work in a clinic with your own 11:30 clinic with your own 11:30 clinic with your own small circle of 11:31 small circle of 11:31 small circle of patients, you don't always 11:32 patients, you don't always 11:32 patients, you don't always understand how people 11:33 understand how people 11:33 understand how people perceive or 11:34 perceive or 11:34 perceive or interpret your 11:35 interpret your 11:35 interpret your information, but so far so 11:36 information, but so far so 11:36 information, but so far so good. We are 11:39 good. We are 11:39 good. We are grateful to everyone who 11:40 grateful to everyone who 11:40 grateful to everyone who takes the time to 11:41 takes the time to 11:41 takes the time to watch our videos. 11:42 watch our videos. 11:43 watch our videos. Do you want to add anything else 11:45 Do you want to add anything else ? 11:45 ? 11:45 ? No, everything was great. 11:46 No, everything was great. 11:46 No, everything was great. Thank you. 11:47 Thank you. 11:47 Thank you. Until the next 11:48 Until the next 11:48 Until the next meeting, and 11:48 meeting, and 11:48 meeting, and I apologize, until the 11:49 I apologize, until the 11:49 I apologize, until the next meeting. I am 11:50 next meeting. I am 11:50 next meeting. I am Dr. Mackie. 11:51 Dr. Mackie. 11:51 Dr. Mackie. And I'm Dr. Valerie. 11:52 And I'm Dr. Valerie. 11:52 And I'm Dr. Valerie. Take care of yourself. 11:53 Take care of yourself. 11:53 Take care of yourself. See you later.
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