The Truth About Hormones And Hormone Replacement

Donna White

Oh, thank you. Dr. Greenleaf, I am excited to be here with you and to share some things that hopefully give insight about hormones to your audience.

Betsy Greenleaf, DO, FACOOG (Distinguished)

You know, that’s my big question, is I love people’s backstories. How did you get involved in hormones? And then like people who get involved in hormones all of a sudden open an academy to teach practitioners. So that’s a big job. So how did this all happen for you?

Donna White

Yes, I do have an academy and we train practitioners on how to prescribe Bioidentical hormones. And you just said something funny. You said, how did you quickly just do this? The real truth behind why I started this hormone training academy is because I was a hormone train wreck. 30 years ago I had an awful case of PMS. I wanted to strangle somebody every 28 days. Horrible headaches, heavy periods, acne. I looked like I was in puberty, so I had to learn about hormones. And I figured out all of this chaos going on once a month of my life was related to hormones. So I should be the poster child for bioidentical hormones because I’ve literally been on them for 30 years. Actually, I think over 30 years. I turned 60 last year, so it’s not a career for me. This is a life passion that I have been involved with for more than 30 years. The truth be told, that’s it. Personal.

Betsy Greenleaf, DO, FACOOG (Distinguished)

And in that journey, what made you now decide to like that? You needed to train practitioners on how to do this.

Donna White

That’s a great question because I want other women to get the same kind of relief that I got. And then I realized, and I’m sure you can agree, Dr. Greenleaf, that practitioners there are not trained about hormone balance in medical schools. You didn’t learn that in medical school. You had to go out and step out of your box of conventional training and seek that to learn it. I know you know it well, but that’s how you had to do it. So I wanted a place where practitioners could learn to prescribe and balance hormones and learn it right and learn it well. So that’s what we do at the BHRT Training Academy.

Betsy Greenleaf, DO, FACOOG (Distinguished)

And I have to say, for all the practitioners that are listening to this, this academy is awesome. Like I have actually taught for them and like such a great education source so check that out. But I want to ask you some more. There are a lot of misconceptions, especially about bioidenticals. In fact, so much, I don’t even like to use the word bioidentical much because there’s some people who have this like negative connotation. I always say bioequivalent now because it’s more like what’s in the body just because of that bioidentical getting this bad rep sound.

Donna White

You are so right. And you know what I call it? I call it the hormone confusion. Hormones are very confusing. And you’re right, two bioidentical is kind of a slang term. And what that really means, if we could just get everybody on the same page here real quick, what are these hormones we call bioidentical? Well, they’re biologically equivalent or identical to the hormones we make in our body or indigenously produced hormones. They are similar. They’re exactly the same. So there’s this molecule and then in a plant could come from soy or yam or what have you. It’s converted into the biologically identical or the same molecular shape as the hormones we make in our body. Therefore, they have the same action and the same effect. Our body can’t tell if we made that estrogen or progesterone or rubbed it on as a cream because it’s the same it’s the same hormones we’ve had in higher amounts since puberty. Not anything different. Just exactly the same hormones. So whatever you call them, that’s what they are. And that’s why they were.

Betsy Greenleaf, DO, FACOOG (Distinguished)

And, you know, they’ve gotten this bad rep because I’ve seen it. I’ve seen it in patients. I myself, before I knew any better, was afraid of hormones, too, because there is these hormones are going to cause cancer.

Donna White

Yes. Yes. And I hate that. And that’s one of the reasons why I love to speak and teach at medical conferences and to women is to clear that up, because hormones do not cause breast cancer, not when they’re balanced and done properly. So let me just back that up with just real quick a few pieces of data, because it’s really not what I think or what you think, it’s what the research shows. Because there is research to support the use of bioidentical hormones. They’ve been studied very well since 1976 and have even been used in Europe for what now, 70 years? Well, let’s go back to that breast cancer thing because that’s scary. I mean, to us as women, that’s scary. Why would I want to do something that might increase my risk of breast cancer? Well, what does the data say? Well, just in the past few years, specifically, let’s talk about estrogen. Does estrogen cause breast cancer? So in the past two years, we’ve seen research to come out that has come out that has shown that taking estrogen helps reduce the risk of five different cancers by 33%, including breast cancer. So it reduces the risk of breast cancer by 33%. The longer women have taken estrogen, the lower their risk is and the less risk they have from dying 44% less risk of dying from breast cancer if they get it. 

So estrogen, these needs to come out. And what about these other hormones? What about taking progesterone? What about testosterone? Because, you know, testosterone is important for women, too. Well, progesterone, we knew back in as early as 1981 from a study that came out from Johns Hopkins University Medical School, that half, half, do you hear me? Half of all breast cancer could be prevented by having normal levels of progesterone. Now, since then, there have been many other studies showing us how progesterone protects the breast tissue and protects it from estrogen and in so many different other mechanisms of action. And then now we know that testosterone is breast protective. These hormones are putting us at risk. They could be protecting us from the risk of breast cancer. That’s why I thank you so much for being an avenue to help get this word out so women can rest more. Sure. Now there are other things we need to do to prevent breast cancer as well. But we don’t need to be so afraid of hormones.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah. And then, you know, then there’s a lot of misconception and I just was learning about this because in an earlier session, we were talking with Dr. Felice Gersh in when it comes to replacing these hormones, I think a lot of us practitioners, especially if we’re not educated in how to replace, we’re like, all right, well, let’s just give someone estrogen, let’s give them estrogen progesterone. All right, let’s just give them testosterone. And it was this whole symphony and interaction, especially that works on sex drive.

Donna White

I love that point and I’m a big fan of Dr. Gersh’s as well as I am yours. So, yes, that’s so important. And that’s one of the things that worries is. And so I started BHRT academies because practitioners and women as well really need to understand that all of these hormones, estrogen, progesterone, testosterone, the adrenal stress hormones, if you will, let me call them that DHEA, cortisol, thyroid hormones, insulin, all of these hormones work together. They interfere, and they interact. So a really savvy, well-trained practitioner will look at all of them and test them and not just give out hormones. We are not advocating for that. We are advocating for assessing the hormone levels and getting them back to optimal levels for two reasons for symptom relief and for disease protection. So and then there are times, Dr. Greenleaf, like, as you well know, some women make too much testosterone, like the PCOS patient, or too much estrogen. So it’s about balance, getting hormones into optimal balance and at optimal levels, that’s when you feel good and look good.

Betsy Greenleaf, DO, FACOOG (Distinguished)

You know, I wanted to actually ask you, I’m really curious about this. We were talking about this before we started talking. And you have a questionnaire, a hormone questionnaire. And I was going to like save it to the end. But now that you brought that up, I’m like, I can’t wait. I want to know what this hormonal questionnaire is.

Donna White

Well, I have something that I created a few years ago called the Seven Question Hormone Quiz. And then one of the reasons why I did this is because I’m all about education, and I’m a teacher at heart, is because so many women especially don’t realize that some of their symptoms are correlated with hormone imbalance, but they don’t make that connection. So let’s do that for everybody right now. So hold on. Here’s the here we go. The seven questions can give you some insight. It’s not a real test, but it’s a fun test. So seven questions, hormone quiz. So here’s the first symptom. Now this one, we kind of know any PMS or menstrual problems or menopausal hot flashes, vaginal dryness, low sex drive. I mean, women kind of get that if they’re having any of those symptoms. Usually, they suspect that something may not quite be right with my hormones, but here comes some other ones. 

Number two, fatigue, tired, low energy levels, whether it’s low-grade fatigue all day or maybe just between three and five in the afternoon when you really should be on top of your game, you’d rather be on top of your desk taking a nap. So fatigue is associated with or can be associated with any of those seven hormones we just talked about being out of balance. Then there’s weight gain. Oh, not being able to lose weight or not being able to maintain weight if you’ve generally been able to do that because hormones have a direct impact on metabolism. And so especially that’s so frustrating if you’re doing everything right and you just can’t lose or you lose a few pounds, but I’m right back on. Do you want to know which hormones cause weight gain? High estrogen. Low estrogen. Too much progesterone. Not enough progesterone. Too much testosterone is associated with weight gain or low testosterone or high DHEA, low DHEA, high cortisol, low cortisol, and low thyroid. It’s too easy to gain weight, but you have to get your hormones in balance so your efforts work for you and keep, you know, and most women gain 20 pounds at menopause. It doesn’t have to be like that. Let’s help these women. Dr. Greenleaf.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I was thinking like it’s like Goldilocks. It’s got to be just right.

Donna White

Yes. Yes. Okay, so here’s the fourth symptom. It’s poor sleep, so you can be so tired. Oh, just trying to get everything done, get the dinner cleaned up, kids, whatever you got to do. Oh, I can’t wait to go to bed. And then what happens? Put your head on the pillow and then there goes your brain. Oh, I need to do this. I can’t forget this. I should have done that. How to do this tomorrow? Your brain just kicks in or go to sleep just fine. But what happens at 3 to 5 a.m.? Wake up. Can’t go back to sleep. Think hormone. The next symptom is mood swings, depression, anxiety, crying on commercial, irritability, crying in one minute and then you want to rip somebody’s head off the next minute. Hormones affect mood. I think women should know this or somebody can say Amen, sister to that one. So, yes, hormones directly impact our mood levels. And then number six is foggy thinking. Can’t remember what you went to the pantry for. You’re standing there like I knew it a minute ago. Or just read a paragraph. What did I just read? Got to read it again.I can’t tell you how many. You know, I’ve worked in a number of practices as well, and women will come in and say, I think I’ve got all time or no, you’ve got to have hormones in your brain. The brain even makes some hormones. And if it needs hormones, I need my brain to have them. It’s like the word will be right here, but it won’t go out, you know, it’s like the brain. My tongue is not connected to my brain today. I think hormones and then the last thing is rapidly wrinkling. Did you know that women with low estrogen look seven years older than women with normal levels? Now, I don’t mind being 60, but I don’t want to look, you know, older than I am. I mean, come on. We need hormones to produce collagen, and hyaluronic acid to keep our skin thick and moist. So those are my seven questions or the symptoms of fatigue, mood, sleep, wake, wrinkles in that, you know, think hormones, if you have any of these symptoms and go to a savvy, well-trained practitioner that knows all of the symptoms and knows how well to test your hormones.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Oh, my God, those were really amazing. And you know, I’m thinking because I remember, unfortunately, I had a hysterectomy when I was like 41 and I at the time did not know anything about hormones because I wasn’t trained in them. And I, even as a practitioner, had this misbelief that they cause cancer because I trained I was coming out of training. Right. That women’s initiative study came out and so I was terrified to go on hormones. And I will tell you, I had every single one of those symptoms, including like all of a sudden within a year my skin looked so much older and saggier and I was like, what is going on? And finally, I was like, That’s it. I’m getting out to get hormones.

Donna White

You’re really jaded now, aren’t you?

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, yeah. And thank God! Then actually started looking into it more and finding amazing information out there to actually learn how to do that. So it was yeah. Now that’s the other thing I wanted to ask you. What other misconceptions are there out there about hormones? So that we could all just get over it and just get on her hormones.

Donna White

Yes. Really? Are we tested to see if that’s what your problem is now? We have other kind of problems as well. But yes, other misconceptions I hear quite frequently, you know, out there speaking is that, oh, I’m too young to have hormone problems. Well, let me tell you. No, we see and I’m sure you do in your practice as well. You know, women in their early twenties that have hormone problems like your PCOS-type patients or young women who are stressed out because stress is a major cause of hormone problems. So now my younger daughters, I have two daughters and two sons. My two daughters, they had hormone problems when they were, you know, 19, 20, 21 making too much testosterone, not enough progesterone. So now you are not too young just because you’re not in menopause to have hormone problems. And honestly, some of the worst hormone issues, if you have had them earlier, start about mid-thirties when progesterone levels start dropping. 

And then on the flip side of that, a lot of women think, oh, I’m past menopause. You know, I’m past all that. It’s not my hormones on the contrary, thinking of my mother, who’s 78, who’s been on hormones, you know, since she was 60 something, because, you know, we think that, you know, oh, okay, I don’t have periods anymore. But yes, hormones do drop they’re supposed to drop some time so that we don’t have periods anymore. Nobody wants to do that forever. I love not having a period, but we want our hormones to, you know, the women at 65, 75, 80, they still can have some of these symptoms and not sleep well. And these hormones are protective. They help protect, you know, against cardiovascular disease, cognitive decline, because estrogen revitalizes the hippocampus, you know, so there’s heart disease, bone loss, cognitive function. So many different diseases, inflammation, and immune function. So there are so many reasons why we should support and optimize our hormone levels at any age and then so that people will sometimes bring up, oh, well, okay, so hormones are supposed to drop more. Why? Why on earth what I, what I want to replace them? Well, okay, so our vision changes and we sometimes need reading glasses. That’s normal. But should we just go around? It’s possible to read anything but know. We know too much for that.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I love it too, because, you know, I was thinking about like, nature really doesn’t want us probably living past like 30, 40, you know? And then if you look at like what in modern life, you know, we’re now living in the eighties, nineties, even some places into our hundreds. And so we’re spending more time in life without hormones. If we do the natural process, then we are like in hormones. So why not make that time that we are living easier, and better with able to be able to manipulate our hormones with bioidentical natural hormone yourself?

Donna White

We do. We’ve learned so much. We know, you know, how to eat better. We know supplements, and hormones are just another piece of the puzzle that we can help protect our health and look and feel good. And, you know, we live in a world we live in a dirty planet. There are so many toxins and stress levels are different from how they were, you know, at the turn of the 19th century. So we know more.

Betsy Greenleaf, DO, FACOOG (Distinguished)

When you’re training practitioners, is there a common question that happens with practitioners when they’re first starting this that they’re like, I don’t know that? They’re like, Oh, I’m a little confused about this idea. Do you is there something that you see that gets asked more often than not?

Donna White

I think one, one of the common things that we see at the BHRT Academy is that providers kind of think it’s all about estrogen and progesterone and they’re not considering testosterone for women, they’re not considering the role that the adrenals play and the thyroid and the insulin. Kind of like how we were talking before or because maybe they’ve gone to, you know, a hormone training just to learn how to put in pellets. We have to learn these other hormones because if you just, if you think about it stressed, who’s not stressed these days? Unfortunately, you know, even if you live on an island and, you know, for a few if you’re not working, you don’t have to work and your kids are grown and you’re financially stable. There are toxins. There are all sorts of other factors that are stressing our body. But anyway, stress hormone imbalances or elevations will block the effects of our hormones. And so it’s so important to look at all of the hormones. So that’s where I see a number of providers kind of missing it. And then once they start learning about the other, oh, gosh, that makes sense. That makes sense. And then they start looking at all of the other hormones. 

And then one other thing is that they kind of get in sometimes they come into the academy thinking there’s only one dosing for them, like, oh, it has to be pellets. Pellets are great, but some people don’t want or can’t use pellet creams are good. Some hormones can be used orally, but not estrogen. And our stance is the academy. There’s injections, there’s patches, there’s vaginal. So my recommendation to providers is to learn how to dose all of the heart and use all of the dosing forms. And so that fits what your patient or each patient needs. And learn all of the different ways to test hormones, because there’s more than one way. And sometimes you might want to do a saliva test, sometimes you might want to do a dried urine or Dutch test, and sometimes you might want to do a blood spot or blood serum testing. So learn all of these approaches so that you can best serve your patients and supplement protocols and lifestyle and diet and all that. But practitioners really have to learn supplement protocols as well because it’s critical to learn. You know, the key supplements, I mean, is amazing is I think hormones are there are other things too like the right nutrients to help hormones get into the receptors or you know if you make too much cortisol there isn’t a medication unless Dr. Betsy if you want to write me a prescription to go live on an island for six months, my adrenals might get better. But anyway, me too. Yeah. So, so certain. You know, key nutraceuticals can help balance out the stress hormones. So you have to learn that as well. And it’s not difficult. Maybe I’m making it sound complex. It’s not. Clinicians can catch on to this and women understand that as well. As long as they get the right foundational education.

Betsy Greenleaf, DO, FACOOG (Distinguished)

And I think that’s well, I think that’s so important because I think too often practitioners, because this is how traditional medicine is done in traditional medicine is done one size fits all. Because if we look at all our pharmaceuticals that are in the traditional medicine world that are prescription like let’s take antibiotics, for example, like I’m writing, you know, the recommendations for dosing on antibiotics, it’s the same whether you have a little tiny 100 pounds woman or you have a big, you know, a hefty 300 pounds man and then, like that never made any sense to me. Why are we using the same medication dosing on those people? You know, we don’t do a pediatric medicine. We just the dosing based on people’s age or based on weight. And then all of a sudden, you become an adult, and every medication is dosed exactly the same except for when we get into the bioidentical. And there’s so many little nuances that, you know, back to the Goldilocks, you know, we need to be able to get things just right and to be able to. And I remember even when I first came out of my traditional training, it was, I’ll put everybody this is the starting dose. Put everybody on this. You know, this is the hormone that we’re going to use. Put everybody on that. And you don’t need to test hormone levels because they don’t mean anything. And that was I mean. All right. So I came out of training or God only knows, let’s see. I hate to say how many years ago it was. I can’t even do the math. It was that many years ago. But the point is, that idea has still not changed, except for in the world of functional integrative medicine, where we know better, like.

Donna White

Yes, women are sensitive and you’re so right, especially when it comes to hormones because some women need estrogen, some women dull, some need a little bit of progesterone, and some need a lot. And you, a well-skilled practitioner, are very versed on the symptoms and improvement and they treat the patient, not the lab results patient, not the paper. So that’s so right what you just said.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That’s my favorite thing that you said, too. And that’s something that I love to harp on whenever I’m teaching too is, you know, we’re using the labs to kind of direct us, but like listening because the patients tell you, I mean, and if you’re in, you know, if you’re a woman here, you know, the symptoms you’re having, you know, like, all right, I’m moody, I’m getting hot flashes. I’m, you know, you know, maybe having a low sexual, you know, your symptoms. And as long as you’re, you know, that’s listened to like there’s that directs us to like what needs to be done so.

Donna White

And some women have a higher metabolism and they burn through their hormones quicker. We all have a different biochemistry. Our stress hormones are in effect the rate at which we breathe. So it’s there are many factors to consider. But what you said is so important listening to the patient, this dose made me feel great or I’m still having heavy periods, or whatever. You cannot perfect the lab, but you can certainly get the patient to feel so much better by listening to them. 

Betsy Greenleaf, DO, FACOOG (Distinguished)

You know, another thing, it comes off often. I wanted to ask you about this because the patients will often ask this and I’ve heard practitioners, they’ll go, well, then, when you come off hormones.

Donna White

And more often you may take that out of my hands then, but before then. No, no, no. Okay. I don’t mean to be silly.

Betsy Greenleaf, DO, FACOOG (Distinguished)

No, I love that.

Donna White

So how long do you want the benefits? Do you how long do you want the cognitive protection? How long do you want cardiovascular protection or the skin or the brain function? That’s my answer because once you start, stop taking them like, let’s say, you know, I’ve got, okay, I’m 60. If I went off my hormones today, they would drop back down and then I would be at risk. No, I want to maintain those. You know, like you said, we’re living a lot longer after menopause. I want to maintain those benefits. I want the brain, the bone, the cardiovascular, all the weight management, all those benefits that hormones give for as long as I can possibly get them.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That’s a good point, because, you know, it’s interesting. I had a surgery recently. My surgeon made me come off my hormones. And at the time I’m thinking, well, you know, that’s probably fine because I don’t feel the difference anyway. They’re probably not working, you know, because their doctors were terrible patients, you know. And as soon as I came off them, I was like, Oh my God, they were working. I was like, you know, here I am. I’m like, No joke. I can’t even tell you how many times I’ve locked myself out of the house. I got forgetful, my keys, you know, because I found that the brain fog and the forgetfulness and the sleep and I was like, you know, in the hot flashes, of course. But like, I was like the other things. I was like, I forgot these were back and I was laughing before. When you were, say, crying at commercials, my whole family was like laughing at me. They’re like, What is wrong with you? I’m like, the commercial is so sad. It just made me so emotional. They are like, it was a toilet paper.

Donna White

Yes. It just makes you feel normal. Sometimes we forget what it feels like to be normal. This is all so common. Everybody has this. But yeah.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That I’ve seen that with patients too, where they’re like, well, you know, I’ve reached a certain age, maybe I should stop. And we have that conversation and we’re like, All right, well, if you feel like you should stop based on age a little more, let’s try weaning you down and see how you do. Those same women are going, okay. No, I changed my mind, my background, the hormones.

Donna White

It’s about me.

Betsy Greenleaf, DO, FACOOG (Distinguished)

You know. And that’s the thing too, that I want to also point out because the name of your academy specifically is bioidentical, and bioidentical hormones are not the same as the hormones that were in the Women’s Health Initiative study or some of the synthetic hormones that are out there on the market. So just because you’re on hormones, it’s not necessarily going to have the same effect. And could actually be worsening your health.

Donna White

So you are so right because they don’t they’re not like the human identical hormones and they have side effects and risks. So agree you need to know if you’re taking HRT, are they biologically identical or not?

Betsy Greenleaf, DO, FACOOG (Distinguished)

And that actually, I’m glad you brought that up. How did you explain the bioidentical at the beginning of our talk, because I know sometimes I get hung up when practitioners ask me this question, they’re like, but it’s coming from soy or it’s coming from yams, or it’s being created in a lab. So what makes that bioidentical? And like, I like your explanation, I’m just going to have you tell us that again because I thought that was really good.

Donna White

Yeah. So yes, they are synthesized in a lab from plants, but it’s the end result that has the same molecule or molecular structure as human identical hormones. So here’s an analogy that makes it easy to understand. I think so. Hormones are like a key. So think of your house key or a key. It has its own unique grooves and shape and it only fits in your door lock. And hormones are like that. So estrogen, like the estrogen that we make, has a molecular shape and it only fits and the estrogen receptor progesterone molecules shape fits the progesterone receptor and that’s the same for all the other hormones. Now, if a non-biologically identical hormone. It’s like putting the wrong key into a lock. Have you ever tried to force the wrong key into, like, oh no, this is the right key, but it won’t fit perfectly? And it doesn’t and you can’t. Sometimes it gets stuck in, you can’t get it out. So when somebody takes a nonviolent hormone, whether it’s horse estrogen or a scent, synthetic estrogen or synthetic progestin, it’s like putting the wrong key into the lock. And so those non-biological hormones don’t fit perfectly in there. And the hormone receptors, they get stuck. They don’t dislodge. So they don’t have the same effect. And they also have side effects. Increased risk of breast cancer, increased risk of stroke, and cardiovascular disease. So think about it that way.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That was a really great explanation. I really, that was perfect. I love that. So where can people find out more about you, especially practitioners really want to understand this and do the right thing for their patients or even patients that are like, Hey Doc, maybe you should go check out this academy. So, I mean, I honestly, I have to tell you, some of my best training has come, has been initiated over the years by my patients bringing things up to me and me going, you know, I don’t know anything about that. I’m going to go learn about it. So don’t be afraid to bring this up to your practitioner. And if they’re insulted, they go find another practitioner because that’s not the person you need to be with.

Donna White

So that’s why you’re such a good doctor, Dr. Greenleaf.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah. So where can people find out more?

Donna White

Bhrttrainingacademy.com. After the first of the year, my book for women is coming out The Hormone Makeover. So that’ll help women understand these and how to be able to talk to their patients. So bhrttrainingacademy.com and look for the hormonal makeover.

Betsy Greenleaf, DO, FACOOG (Distinguished)

And you know what? And I’m going to brag for you here a little bit. So in the past year, you guys actually got certified as an official place of Learning.

Donna White

Institute of Higher Education by the Board of Education of the State, where we’re licensed. And so, yes, and we for practitioners, you know, we have CMS, about 55 CMS for our program and we mentor our providers. And it’s a great community if I do say so myself. But it’s so great. It’s so much fun to help equip the providers because when the providers that we really want to learn like you did, you know, years ago, it’s they’re just so unique because they really want to help their patients and they want the best for them. And that’s why my hat’s off to you and the providers that we get the privilege of working with.

Betsy Greenleaf, DO, FACOOG (Distinguished)

So I get it. And I also say for those practitioner, injuries who think, you know, everything more education doesn’t hurt, you know, it always helps. And also learning things from a different way. And things may have changed since the last time you learned it. So I recommend everybody go check it out. Plus, we had fun because like I said, You’ve invited me to some of the office hours and I had a really good time doing that. So thank you.

Donna White

You’re so welcome. Thank you. I appreciate it. And I hope we’ve shared some things to help your listeners today.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Awesome. So everybody go check it out and stick around because we got more great sessions coming up.