Full Transcript Introduction to HRT Troubleshooting 0:02 So, it really depends on what fits for 0:02 So, it really depends on what fits for you. 0:02 you. 0:02 you. >> And then if you feel worse, obviously, 0:04 >> And then if you feel worse, obviously, 0:04 >> And then if you feel worse, obviously, then a dose needs to change. 0:12 >> Why isn't my HRT working? Seven reasons 0:12 >> Why isn't my HRT working? Seven reasons why you still don't feel better. Hi, I'm 0:14 why you still don't feel better. Hi, I'm 0:14 why you still don't feel better. Hi, I'm Dr. Valarie Davidson from the 0:16 Dr. Valarie Davidson from the 0:16 Dr. Valarie Davidson from the Progressive Health Podcast. 0:17 Progressive Health Podcast. 0:17 Progressive Health Podcast. >> And I'm Dr. Mackey from the Progressive 0:18 >> And I'm Dr. Mackey from the Progressive 0:18 >> And I'm Dr. Mackey from the Progressive Health Podcast. Uh so, these types of uh 0:21 Health Podcast. Uh so, these types of uh 0:21 Health Podcast. Uh so, these types of uh you know uh 0:22 you know uh 0:22 you know uh issues come up all the time. 0:24 issues come up all the time. 0:24 issues come up all the time. >> probably like way more than seven, but 0:25 >> probably like way more than seven, but 0:25 >> probably like way more than seven, but we're going to dial it in to seven. 0:27 we're going to dial it in to seven. 0:27 we're going to dial it in to seven. >> Yeah, just uh kind of a nice condensed 0:29 >> Yeah, just uh kind of a nice condensed 0:30 >> Yeah, just uh kind of a nice condensed list uh and just some things to think 0:32 list uh and just some things to think 0:32 list uh and just some things to think about as you are sort of trying to 0:34 about as you are sort of trying to 0:34 about as you are sort of trying to figure out where your optimal dose 0:36 figure out where your optimal dose 0:36 figure out where your optimal dose should be. 0:36 should be. 0:36 should be. >> So, number one is your estradiol dose is
Estradiol Dose Too Low 0:39 >> So, number one is your estradiol dose is 0:39 >> So, number one is your estradiol dose is too low. Right? 0:41 too low. Right? 0:41 too low. Right? >> Yeah, now um that is we just did an 0:44 >> Yeah, now um that is we just did an 0:44 >> Yeah, now um that is we just did an episode about that um you know exact 0:46 episode about that um you know exact 0:46 episode about that um you know exact thing. It comes It happens all the time. 0:48 thing. It comes It happens all the time. 0:48 thing. It comes It happens all the time. Uh right, so that's the first place to 0:50 Uh right, so that's the first place to 0:50 Uh right, so that's the first place to look because uh estrogen's what makes a 0:52 look because uh estrogen's what makes a 0:52 look because uh estrogen's what makes a woman a woman. 0:53 woman a woman. 0:53 woman a woman. You know, the the the higher her 0:55 You know, the the the higher her 0:55 You know, the the the higher her estradiol level, the better she's 0:57 estradiol level, the better she's 0:57 estradiol level, the better she's typically going to feel. Uh and uh 0:59 typically going to feel. Uh and uh 0:59 typically going to feel. Uh and uh that's always so what we've noticed is a 1:01 that's always so what we've noticed is a 1:01 that's always so what we've noticed is a trend and it's always first place to 1:03 trend and it's always first place to 1:03 trend and it's always first place to start. 1:03 start. 1:03 start. >> And the one thing with estradiol is you 1:05 >> And the one thing with estradiol is you 1:05 >> And the one thing with estradiol is you can start a little lower initially when 1:06 can start a little lower initially when 1:06 can start a little lower initially when you're starting HRT, but work your way 1:08 you're starting HRT, but work your way 1:08 you're starting HRT, but work your way up. Don't just keep it there cuz women 1:10 up. Don't just keep it there cuz women 1:10 up. Don't just keep it there cuz women do feel better, so that would be the 1:12 do feel better, so that would be the 1:12 do feel better, so that would be the first place to start. The second one is
Progesterone Form and Delivery 1:14 first place to start. The second one is 1:14 first place to start. The second one is perhaps the progesterone, which we did 1:16 perhaps the progesterone, which we did 1:16 perhaps the progesterone, which we did another podcast on that, but the form of 1:18 another podcast on that, but the form of 1:18 another podcast on that, but the form of progesterone that you're taking is not 1:20 progesterone that you're taking is not 1:20 progesterone that you're taking is not the right form for you. 1:22 the right form for you. 1:22 the right form for you. >> Yeah, uh now that's uh you know, that's 1:25 >> Yeah, uh now that's uh you know, that's 1:25 >> Yeah, uh now that's uh you know, that's Usually there's always there has If 1:26 Usually there's always there has If 1:26 Usually there's always there has If you're on estrogen, there has to be some 1:28 you're on estrogen, there has to be some 1:28 you're on estrogen, there has to be some form of progesterone that you're taking. 1:31 form of progesterone that you're taking. 1:31 form of progesterone that you're taking. >> Especially if you have a uterus. 1:32 >> Especially if you have a uterus. 1:32 >> Especially if you have a uterus. >> Yeah, yeah. Um if you have a uterus, uh 1:34 >> Yeah, yeah. Um if you have a uterus, uh 1:34 >> Yeah, yeah. Um if you have a uterus, uh so you just got to find the right one 1:36 so you just got to find the right one 1:36 so you just got to find the right one and uh you know, usually nowadays 1:38 and uh you know, usually nowadays 1:38 and uh you know, usually nowadays there's a lot of just talk and 1:40 there's a lot of just talk and 1:40 there's a lot of just talk and discussion that last episode you can go 1:42 discussion that last episode you can go 1:42 discussion that last episode you can go back and look at uh gives you some 1:44 back and look at uh gives you some 1:44 back and look at uh gives you some options of what's possible. Um some 1:47 options of what's possible. Um some 1:47 options of what's possible. Um some women uh you know, it seems obvious that 1:49 women uh you know, it seems obvious that 1:49 women uh you know, it seems obvious that you could just go from a capsule to a 1:51 you could just go from a capsule to a 1:51 you could just go from a capsule to a cream, but that's not as easy as that 1:54 cream, but that's not as easy as that 1:55 cream, but that's not as easy as that for most women for for some women. 1:56 for most women for for some women. 1:56 for most women for for some women. >> And some women do better vaginally, some 1:58 >> And some women do better vaginally, some 1:58 >> And some women do better vaginally, some women do better with a trokey, some 2:00 women do better with a trokey, some 2:00 women do better with a trokey, some women do better with rhythmic dosing or 2:02 women do better with rhythmic dosing or 2:02 women do better with rhythmic dosing or cycling their progesterone. So that's
Estradiol Form and Individual Response 2:04 cycling their progesterone. So that's 2:04 cycling their progesterone. So that's number two, which would lead us to 2:05 number two, which would lead us to 2:05 number two, which would lead us to number three, which would be maybe your 2:08 number three, which would be maybe your 2:08 number three, which would be maybe your estradiol form, the form of estradiol 2:10 estradiol form, the form of estradiol 2:10 estradiol form, the form of estradiol you're taking isn't the right one for 2:12 you're taking isn't the right one for 2:12 you're taking isn't the right one for you. 2:12 you. 2:12 you. >> Yeah. Now that one I think of all of 2:15 >> Yeah. Now that one I think of all of 2:15 >> Yeah. Now that one I think of all of them, either the estradiol 2:17 them, either the estradiol 2:17 them, either the estradiol dose is too low or the form of it isn't 2:20 dose is too low or the form of it isn't 2:20 dose is too low or the form of it isn't right. Okay, there's no way to know 2:22 right. Okay, there's no way to know 2:22 right. Okay, there's no way to know ahead of time before a woman, let's say 2:23 ahead of time before a woman, let's say 2:23 ahead of time before a woman, let's say she's 51, she's going to start HRT, 2:26 she's 51, she's going to start HRT, 2:26 she's 51, she's going to start HRT, there's no way to know ahead of time 2:27 there's no way to know ahead of time 2:27 there's no way to know ahead of time which form of estradiol is going to be 2:29 which form of estradiol is going to be 2:29 which form of estradiol is going to be the best for her. Okay, it does have to 2:31 the best for her. Okay, it does have to 2:31 the best for her. Okay, it does have to be a little bit of a trial by fire 2:34 be a little bit of a trial by fire 2:34 be a little bit of a trial by fire process where you start somewhere 2:37 process where you start somewhere 2:37 process where you start somewhere and evaluate over time to see if you 2:39 and evaluate over time to see if you 2:39 and evaluate over time to see if you feel better or worse. And then if you 2:41 feel better or worse. And then if you 2:41 feel better or worse. And then if you feel worse, obviously then the form or 2:44 feel worse, obviously then the form or 2:44 feel worse, obviously then the form or the dose needs to change. 2:45 the dose needs to change. 2:45 the dose needs to change. >> I do initially take a 2:47 >> I do initially take a 2:47 >> I do initially take a big background on a patient. I'll ask 2:49 big background on a patient. I'll ask 2:50 big background on a patient. I'll ask them what were their periods like when 2:51 them what were their periods like when 2:51 them what were their periods like when they were younger, when did they start 2:53 they were younger, when did they start 2:53 they were younger, when did they start their periods, if they had a pregnancy, 2:55 their periods, if they had a pregnancy, 2:55 their periods, if they had a pregnancy, what was the birth story like, what how 2:57 what was the birth story like, what how 2:57 what was the birth story like, what how did they feel while they were pregnant 2:58 did they feel while they were pregnant 2:58 did they feel while they were pregnant cuz there's so many hormones there, how 3:00 cuz there's so many hormones there, how 3:00 cuz there's so many hormones there, how how heavy were their periods, how 3:02 how heavy were their periods, how 3:02 how heavy were their periods, how infrequent or frequent or on time. So 3:04 infrequent or frequent or on time. So 3:05 infrequent or frequent or on time. So there's a lot you can get as an intake 3:06 there's a lot you can get as an intake 3:06 there's a lot you can get as an intake to decide where you want to start and 3:08 to decide where you want to start and 3:08 to decide where you want to start and what form, but some women love the 3:11 what form, but some women love the 3:11 what form, but some women love the patch, the estradiol patch or like this 3:13 patch, the estradiol patch or like this 3:13 patch, the estradiol patch or like this is it. And some women hate it. Some 3:15 is it. And some women hate it. Some 3:15 is it. And some women hate it. Some women love the transdermal biest with 3:17 women love the transdermal biest with 3:17 women love the transdermal biest with the estradiol and the estriol. And some 3:19 the estradiol and the estriol. And some 3:19 the estradiol and the estriol. And some women just like the estradiol as their 3:22 women just like the estradiol as their 3:22 women just like the estradiol as their as transdermally on their own, you know, 3:24 as transdermally on their own, you know, 3:24 as transdermally on their own, you know, just putting it on the skin. Everybody's
Underdosing Estradiol and Timing 3:26 just putting it on the skin. Everybody's 3:26 just putting it on the skin. Everybody's different. A lot of women love the 3:27 different. A lot of women love the 3:27 different. A lot of women love the rhythmic dosing. I'll say I love the 3:28 rhythmic dosing. I'll say I love the 3:28 rhythmic dosing. I'll say I love the rhythmic dosing. I cycle my estradiol 3:31 rhythmic dosing. I cycle my estradiol 3:31 rhythmic dosing. I cycle my estradiol and my progesterone. So I have a, you 3:34 and my progesterone. So I have a, you 3:34 and my progesterone. So I have a, you know, a protocol there that I follow the 3:36 know, a protocol there that I follow the 3:36 know, a protocol there that I follow the ovarian cycle. But a lot of women don't 3:39 ovarian cycle. But a lot of women don't 3:39 ovarian cycle. But a lot of women don't like it and they'll say I hate this. So 3:41 like it and they'll say I hate this. So 3:41 like it and they'll say I hate this. So it really depends on what fits for you. 3:43 it really depends on what fits for you. 3:43 it really depends on what fits for you. But do know that there are lots of 3:44 But do know that there are lots of 3:44 But do know that there are lots of different forms and deliveries and 3:46 different forms and deliveries and 3:46 different forms and deliveries and routes to be able to do the estradiol. 3:48 routes to be able to do the estradiol. 3:48 routes to be able to do the estradiol. So that's number number three. And then 3:50 So that's number number three. And then 3:50 So that's number number three. And then number four is something that we've run 3:52 number four is something that we've run 3:52 number four is something that we've run across a we run across a lot with 3:54 across a we run across a lot with 3:54 across a we run across a lot with patients new patients coming to us is 3:56 patients new patients coming to us is 3:56 patients new patients coming to us is they're not taking the estradiol often 3:58 they're not taking the estradiol often 3:58 they're not taking the estradiol often enough. 3:59 enough. 3:59 enough. >> Yeah. Yeah, you know you're trying to 4:01 >> Yeah. Yeah, you know you're trying to 4:01 >> Yeah. Yeah, you know you're trying to literally you're trying to build up 4:02 literally you're trying to build up 4:02 literally you're trying to build up somewhat of a blood level especially of 4:04 somewhat of a blood level especially of 4:04 somewhat of a blood level especially of the 4:05 the 4:05 the of the estrogen whatever form it is. 4:08 of the estrogen whatever form it is. 4:08 of the estrogen whatever form it is. So you know again couple of consults 4:11 So you know again couple of consults 4:11 So you know again couple of consults I've had recently women are taking are 4:13 I've had recently women are taking are 4:13 I've had recently women are taking are told to take it once a day. We have 4:15 told to take it once a day. We have 4:15 told to take it once a day. We have always our default 4:17 always our default 4:17 always our default this is not medical advice. This is for 4:19 this is not medical advice. This is for 4:19 this is not medical advice. This is for educational purposes 4:21 educational purposes 4:21 educational purposes our default using biest or some type of 4:24 our default using biest or some type of 4:24 our default using biest or some type of transdermal cream is to dose that 4:28 transdermal cream is to dose that 4:28 transdermal cream is to dose that basically every 12 hours. It doesn't 4:29 basically every 12 hours. It doesn't 4:29 basically every 12 hours. It doesn't have to be exactly every 12 hours but 4:31 have to be exactly every 12 hours but 4:31 have to be exactly every 12 hours but you're going to apply it in the morning 4:32 you're going to apply it in the morning 4:32 you're going to apply it in the morning and you're going to apply it in the 4:33 and you're going to apply it in the 4:33 and you're going to apply it in the evening. A lot of women are told to 4:35 evening. A lot of women are told to 4:35 evening. A lot of women are told to apply it once a day 4:37 apply it once a day 4:37 apply it once a day and now your blood levels are kind of 4:39 and now your blood levels are kind of 4:39 and now your blood levels are kind of starting over every 24 hours. That that 4:41 starting over every 24 hours. That that 4:41 starting over every 24 hours. That that estrogen does not stay in your system 4:43 estrogen does not stay in your system 4:43 estrogen does not stay in your system very long or in your bloodstream very 4:45 very long or in your bloodstream very 4:45 very long or in your bloodstream very long. Your body is soaking up that 4:47 long. Your body is soaking up that 4:47 long. Your body is soaking up that estrogen really quickly. So applying it 4:49 estrogen really quickly. So applying it 4:49 estrogen really quickly. So applying it twice you get a morning dose to get you 4:51 twice you get a morning dose to get you 4:51 twice you get a morning dose to get you through the day and you get an evening 4:52 through the day and you get an evening 4:52 through the day and you get an evening dose to get you through the night. 4:54 dose to get you through the night. 4:54 dose to get you through the night. You know applying it once you're sort of 4:56 You know applying it once you're sort of 4:56 You know applying it once you're sort of leaving a little bit on the table. 4:57 leaving a little bit on the table. 4:57 leaving a little bit on the table. >> Yeah cuz estrogen is telling the body to 4:59 >> Yeah cuz estrogen is telling the body to 4:59 >> Yeah cuz estrogen is telling the body to do stuff. So it can connect into 5:01 do stuff. So it can connect into 5:01 do stuff. So it can connect into receptors and there's a there's a you 5:03 receptors and there's a there's a you 5:03 receptors and there's a there's a you know reaction that happens post post 5:05 know reaction that happens post post 5:05 know reaction that happens post post that and that can happen usually that's 5:08 that and that can happen usually that's 5:08 that and that can happen usually that's where if you take it in the morning it's 5:09 where if you take it in the morning it's 5:09 where if you take it in the morning it's you know having these great signaling 5:11 you know having these great signaling 5:11 you know having these great signaling molecules. It's having the body do all 5:13 molecules. It's having the body do all 5:13 molecules. It's having the body do all this response to the estradiol but then 5:15 this response to the estradiol but then 5:15 this response to the estradiol but then 12 hours later the body's like where's 5:17 12 hours later the body's like where's 5:17 12 hours later the body's like where's that where'd that go? We need it. You 5:18 that where'd that go? We need it. You 5:18 that where'd that go? We need it. You know we need it to you know 5:19 know we need it to you know 5:20 know we need it to you know >> fit into the receptor. So that is 5:21 >> fit into the receptor. So that is 5:21 >> fit into the receptor. So that is definitely one thing is if you're on a 5:23 definitely one thing is if you're on a 5:23 definitely one thing is if you're on a transdermal estradiol or a biest is 5:26 transdermal estradiol or a biest is 5:26 transdermal estradiol or a biest is doing it twice a day. It doesn't have to 5:27 doing it twice a day. It doesn't have to 5:27 doing it twice a day. It doesn't have to be perfectly 12 hours apart but sometime 5:29 be perfectly 12 hours apart but sometime 5:29 be perfectly 12 hours apart but sometime in the morning when you wake up maybe 5:30 in the morning when you wake up maybe 5:30 in the morning when you wake up maybe after your shower or and then sometime 5:33 after your shower or and then sometime 5:33 after your shower or and then sometime before you go to bed. And then number
Other Hormones: Thyroid, Testosterone, and DHEA 5:35 before you go to bed. And then number 5:35 before you go to bed. And then number five is forgetting about other hormones 5:38 five is forgetting about other hormones 5:38 five is forgetting about other hormones like your thyroid like testosterone like 5:40 like your thyroid like testosterone like 5:40 like your thyroid like testosterone like DHEA. 5:41 DHEA. 5:41 DHEA. >> Yeah, certainly thyroid when it comes to 5:44 >> Yeah, certainly thyroid when it comes to 5:44 >> Yeah, certainly thyroid when it comes to women in menopause 5:46 women in menopause 5:46 women in menopause Uh why uh hypothyroidism is 5:48 Uh why uh hypothyroidism is 5:48 Uh why uh hypothyroidism is predominantly a woman's problem, right? 5:50 predominantly a woman's problem, right? 5:50 predominantly a woman's problem, right? Because, you know, there's so much 5:53 Because, you know, there's so much 5:53 Because, you know, there's so much uh hormonal chaos that's going on when a 5:55 uh hormonal chaos that's going on when a 5:55 uh hormonal chaos that's going on when a woman goes, you know, into from 5:57 woman goes, you know, into from 5:57 woman goes, you know, into from perimenopause into menopause, and then 5:59 perimenopause into menopause, and then 5:59 perimenopause into menopause, and then you go from uh having all this chaos to 6:01 you go from uh having all this chaos to 6:01 you go from uh having all this chaos to nothing. All right? You know, your 6:03 nothing. All right? You know, your 6:03 nothing. All right? You know, your estradiol is, you know, bottomed out, 6:05 estradiol is, you know, bottomed out, 6:05 estradiol is, you know, bottomed out, your progesterone's bottomed out, uh and 6:07 your progesterone's bottomed out, uh and 6:07 your progesterone's bottomed out, uh and that pesky little thyroid can be there, 6:09 that pesky little thyroid can be there, 6:09 that pesky little thyroid can be there, you know, causing some problems. Uh and 6:11 you know, causing some problems. Uh and 6:11 you know, causing some problems. Uh and that's going to have a huge impact on 6:13 that's going to have a huge impact on 6:13 that's going to have a huge impact on energy and mood and, you know, uh a few 6:15 energy and mood and, you know, uh a few 6:15 energy and mood and, you know, uh a few different things. So, um we'll do a 6:17 different things. So, um we'll do a 6:17 different things. So, um we'll do a whole separate one on thyroid because 6:20 whole separate one on thyroid because 6:20 whole separate one on thyroid because that's, you know, it sort of deserves 6:22 that's, you know, it sort of deserves 6:22 that's, you know, it sort of deserves that kind of attention, but certainly 6:24 that kind of attention, but certainly 6:24 that kind of attention, but certainly something to look take a look at. And 6:25 something to look take a look at. And 6:25 something to look take a look at. And make sure your practitioner is running 6:27 make sure your practitioner is running 6:27 make sure your practitioner is running your free T3 level, okay? TSH, of 6:30 your free T3 level, okay? TSH, of 6:30 your free T3 level, okay? TSH, of course, uh you know, but that doesn't 6:32 course, uh you know, but that doesn't 6:32 course, uh you know, but that doesn't tell you the whole story. We want to 6:34 tell you the whole story. We want to 6:34 tell you the whole story. We want to optimize that free T3 level. Uh we'll 6:37 optimize that free T3 level. Uh we'll 6:37 optimize that free T3 level. Uh we'll save that one for another episode. 6:38 save that one for another episode. 6:38 save that one for another episode. >> Absolutely. And of course, like I said, 6:40 >> Absolutely. And of course, like I said, 6:40 >> Absolutely. And of course, like I said, the testosterone and the DHEA, cuz even 6:42 the testosterone and the DHEA, cuz even 6:42 the testosterone and the DHEA, cuz even though men make lots of testosterone, us 6:44 though men make lots of testosterone, us 6:44 though men make lots of testosterone, us ladies need a little, too. So, checking 6:46 ladies need a little, too. So, checking 6:46 ladies need a little, too. So, checking on that. So, that which leads us to 6:48 on that. So, that which leads us to 6:48 on that. So, that which leads us to number six, which is stress. Stress and
Stress, Cortisol, and Estradiol Needs 6:51 number six, which is stress. Stress and 6:51 number six, which is stress. Stress and cortisol can have an issue on your HR on 6:55 cortisol can have an issue on your HR on 6:55 cortisol can have an issue on your HR on your HRT. 6:56 your HRT. 6:56 your HRT. >> Yeah. And if you think about it, when a 6:57 >> Yeah. And if you think about it, when a 6:57 >> Yeah. And if you think about it, when a woman goes into menopause, and this 6:59 woman goes into menopause, and this 6:59 woman goes into menopause, and this isn't exactly how it goes, but the 7:01 isn't exactly how it goes, but the 7:01 isn't exactly how it goes, but the female hormones are a buffer while that 7:04 female hormones are a buffer while that 7:04 female hormones are a buffer while that stress and cortisol that we're dealing 7:06 stress and cortisol that we're dealing 7:06 stress and cortisol that we're dealing with in this complicated 21st century. 7:09 with in this complicated 21st century. 7:09 with in this complicated 21st century. Uh and when you go when you're in 7:10 Uh and when you go when you're in 7:10 Uh and when you go when you're in menopause, you don't have that, you 7:12 menopause, you don't have that, you 7:12 menopause, you don't have that, you know, that um buffer anymore. 7:14 know, that um buffer anymore. 7:14 know, that um buffer anymore. Um 7:15 Um 7:15 Um cortisol, you know, too much of a good 7:17 cortisol, you know, too much of a good 7:17 cortisol, you know, too much of a good thing. We need cortisol to be alive, 7:18 thing. We need cortisol to be alive, 7:18 thing. We need cortisol to be alive, right? We need cortisol, it's important. 7:21 right? We need cortisol, it's important. 7:21 right? We need cortisol, it's important. Uh it can be very helpful in some ways, 7:23 Uh it can be very helpful in some ways, 7:23 Uh it can be very helpful in some ways, but too much of a good thing can be 7:25 but too much of a good thing can be 7:25 but too much of a good thing can be become very quickly not a good thing. 7:27 become very quickly not a good thing. 7:27 become very quickly not a good thing. >> And I know we all have stress, that's 7:29 >> And I know we all have stress, that's 7:29 >> And I know we all have stress, that's life, you know, that's the minutia of 7:30 life, you know, that's the minutia of 7:30 life, you know, that's the minutia of life, but some women that have a lot of 7:32 life, but some women that have a lot of 7:32 life, but some women that have a lot of stress on their plate, I find that they 7:34 stress on their plate, I find that they 7:34 stress on their plate, I find that they need more estradiol, cuz that estradiol 7:36 need more estradiol, cuz that estradiol 7:36 need more estradiol, cuz that estradiol helps that bandwidth, that patience, 7:39 helps that bandwidth, that patience, 7:39 helps that bandwidth, that patience, helps them be able to make decisions, to 7:41 helps them be able to make decisions, to 7:41 helps them be able to make decisions, to have that focus, to have that working 7:43 have that focus, to have that working 7:43 have that focus, to have that working memory, to be able to prioritize. So, I 7:45 memory, to be able to prioritize. So, I 7:45 memory, to be able to prioritize. So, I do find that when cortisol levels are 7:47 do find that when cortisol levels are 7:47 do find that when cortisol levels are elevated, they do need more estradiol. 7:49 elevated, they do need more estradiol. 7:49 elevated, they do need more estradiol. So, that's one thing when you're looking 7:51 So, that's one thing when you're looking 7:51 So, that's one thing when you're looking at someone's or a patient, you know, 7:52 at someone's or a patient, you know, 7:53 at someone's or a patient, you know, when I'm looking at a patient, like I 7:54 when I'm looking at a patient, like I 7:54 when I'm looking at a patient, like I said, this is not for medical advice, 7:55 said, this is not for medical advice, 7:55 said, this is not for medical advice, education only, is when I I love to hear 7:58 education only, is when I I love to hear 7:58 education only, is when I I love to hear about their life. I want to get to know 7:59 about their life. I want to get to know 7:59 about their life. I want to get to know them, you know, I'm like, "Tell me, you 8:00 them, you know, I'm like, "Tell me, you 8:00 them, you know, I'm like, "Tell me, you know, tell me about your life so I can 8:02 know, tell me about your life so I can 8:02 know, tell me about your life so I can determine, you know, what's your stress 8:04 determine, you know, what's your stress 8:04 determine, you know, what's your stress level at and what are we going to do 8:05 level at and what are we going to do 8:05 level at and what are we going to do with that estradiol dose?" And then the 8:07 with that estradiol dose?" And then the 8:07 with that estradiol dose?" And then the last one, which is one of Dr. Maki's 8:09 last one, which is one of Dr. Maki's 8:09 last one, which is one of Dr. Maki's very favorite, is insulin. He's the 8:11 very favorite, is insulin. He's the 8:11 very favorite, is insulin. He's the insulin doc. 8:13 insulin doc. 8:13 insulin doc. >> [laughter] 8:13 >> [laughter] 8:13 >> [laughter] >> Uh well, hey, you're teasing me all the 8:14 >> Uh well, hey, you're teasing me all the 8:14 >> Uh well, hey, you're teasing me all the time. 8:15 time. 8:15 time. >> Love the insulin. 8:16 >> Love the insulin. 8:16 >> Love the insulin. >> Yeah, yeah, yeah. Uh sorry to be a 8:17 >> Yeah, yeah, yeah. Uh sorry to be a 8:17 >> Yeah, yeah, yeah. Uh sorry to be a broken record, but uh it has to be on 8:20 broken record, but uh it has to be on 8:20 broken record, but uh it has to be on the list because those two hormones, uh 8:22 the list because those two hormones, uh 8:22 the list because those two hormones, uh cortisol and insulin, are major 8:25 cortisol and insulin, are major 8:25 cortisol and insulin, are major metabolic hormones that they're going to 8:27 metabolic hormones that they're going to 8:27 metabolic hormones that they're going to have a huge impact on how we look and 8:29 have a huge impact on how we look and 8:29 have a huge impact on how we look and feel on a daily basis. Um so, it has to 8:31 feel on a daily basis. Um so, it has to
Insulin Resistance and Weight Gain 8:32 feel on a daily basis. Um so, it has to be part of the conversation. Uh like we 8:34 be part of the conversation. Uh like we 8:34 be part of the conversation. Uh like we talked about a couple of episodes ago uh 8:36 talked about a couple of episodes ago uh 8:36 talked about a couple of episodes ago uh about weight gain, 8:38 about weight gain, 8:38 about weight gain, uh insulin is your main fat-storing 8:40 uh insulin is your main fat-storing 8:40 uh insulin is your main fat-storing hormone. Okay? So, your insulin status, 8:44 hormone. Okay? So, your insulin status, 8:44 hormone. Okay? So, your insulin status, um meaning your fasting insulin, going 8:46 um meaning your fasting insulin, going 8:46 um meaning your fasting insulin, going into menopause is going to have a huge 8:48 into menopause is going to have a huge 8:48 into menopause is going to have a huge impact on how you look and feel once you 8:51 impact on how you look and feel once you 8:51 impact on how you look and feel once you start HRT. 8:52 start HRT. 8:52 start HRT. >> Because estrogen actually helps with 8:54 >> Because estrogen actually helps with 8:54 >> Because estrogen actually helps with insulin sensitivity. So, the cells 8:56 insulin sensitivity. So, the cells 8:56 insulin sensitivity. So, the cells become more sensitive to insulin, so 8:58 become more sensitive to insulin, so 8:58 become more sensitive to insulin, so your pancreas doesn't have to pump out 9:00 your pancreas doesn't have to pump out 9:00 your pancreas doesn't have to pump out so much insulin. So, the less insulin 9:02 so much insulin. So, the less insulin 9:02 so much insulin. So, the less insulin your body your pancreas is pumping out, 9:04 your body your pancreas is pumping out, 9:04 your body your pancreas is pumping out, the less likely you're going to gain 9:06 the less likely you're going to gain 9:06 the less likely you're going to gain weight. So, somebody that has a lot of 9:07 weight. So, somebody that has a lot of 9:08 weight. So, somebody that has a lot of insulin 9:09 insulin 9:09 insulin or they have this huge insulin response, 9:11 or they have this huge insulin response, 9:11 or they have this huge insulin response, then the it's going to be really easy to 9:13 then the it's going to be really easy to 9:13 then the it's going to be really easy to gain weight and really hard to lose it. 9:15 gain weight and really hard to lose it. 9:15 gain weight and really hard to lose it. And that's where that estradiol is so 9:17 And that's where that estradiol is so 9:17 And that's where that estradiol is so really nice at helping curb insulin 9:19 really nice at helping curb insulin 9:19 really nice at helping curb insulin resistance. Or it has, you know, there's 9:20 resistance. Or it has, you know, there's 9:20 resistance. Or it has, you know, there's so many other things, like Dr. Maki 9:22 so many other things, like Dr. Maki 9:22 so many other things, like Dr. Maki could go on and on about how to work on 9:24 could go on and on about how to work on 9:24 could go on and on about how to work on your insulin resistance. 9:25 your insulin resistance. 9:25 your insulin resistance. >> down over there. 9:26 >> down over there. 9:26 >> down over there. >> Estradiol can be part of that piece of 9:28 >> Estradiol can be part of that piece of 9:28 >> Estradiol can be part of that piece of that puzzle, too. 9:29 that puzzle, too. 9:29 that puzzle, too. >> Yeah, yeah. I mean, that's that's why uh 9:31 >> Yeah, yeah. I mean, that's that's why uh 9:31 >> Yeah, yeah. I mean, that's that's why uh HRT, um you know, or we just did the 9:34 HRT, um you know, or we just did the 9:34 HRT, um you know, or we just did the episode about uh estradiol and weight 9:35 episode about uh estradiol and weight 9:36 episode about uh estradiol and weight gain, estradiol is a very much a 9:38 gain, estradiol is a very much a 9:38 gain, estradiol is a very much a slimming hormone, right? That's why you 9:40 slimming hormone, right? That's why you 9:40 slimming hormone, right? That's why you weigh less when you're 25 than you do 9:42 weigh less when you're 25 than you do 9:42 weigh less when you're 25 than you do when you're 55. And it estrogen plays a 9:44 when you're 55. And it estrogen plays a 9:44 when you're 55. And it estrogen plays a pretty good role a role there. Um, but 9:46 pretty good role a role there. Um, but 9:46 pretty good role a role there. Um, but it's the runaway train of insulin and 9:49 it's the runaway train of insulin and 9:49 it's the runaway train of insulin and the cortisol that sort of causes a lot 9:51 the cortisol that sort of causes a lot 9:51 the cortisol that sort of causes a lot of the problems. And the HRT sort of 9:54 of the problems. And the HRT sort of 9:54 of the problems. And the HRT sort of helps again to buffer all that. So, you 9:57 helps again to buffer all that. So, you 9:57 helps again to buffer all that. So, you can tease me all you want, but the 9:58 can tease me all you want, but the 9:58 can tease me all you want, but the insulin is a very significant part of 10:01 insulin is a very significant part of 10:01 insulin is a very significant part of that whole process. 10:02 that whole process. 10:02 that whole process. >> And now we're looking at this sort of 10:03 >> And now we're looking at this sort of 10:03 >> And now we're looking at this sort of collectively. I do have to say a little 10:05 collectively. I do have to say a little 10:05 collectively. I do have to say a little side note, and I know you've seen this, 10:07 side note, and I know you've seen this, 10:07 side note, and I know you've seen this, too, is there are some women that are 10:08 too, is there are some women that are 10:08 too, is there are some women that are really sensitive to estrogen HRT, and 10:11 really sensitive to estrogen HRT, and 10:11 really sensitive to estrogen HRT, and they do start to gain weight. 10:13 they do start to gain weight. 10:13 they do start to gain weight. Uh, you know, when you're looking at the 10:14 Uh, you know, when you're looking at the 10:14 Uh, you know, when you're looking at the pathophysiology of their mechanism 10:16 pathophysiology of their mechanism 10:16 pathophysiology of their mechanism action from that, it's hard to determine 10:18 action from that, it's hard to determine 10:18 action from that, it's hard to determine where that's coming from because 10:20 where that's coming from because 10:20 where that's coming from because estrogen has so many effects on the 10:21 estrogen has so many effects on the 10:21 estrogen has so many effects on the body, and people are so sensitive, and 10:23 body, and people are so sensitive, and 10:23 body, and people are so sensitive, and we're all very unique and individuals. 10:26 we're all very unique and individuals. 10:26 we're all very unique and individuals. So, those of you that are listening 10:27 So, those of you that are listening 10:27 So, those of you that are listening like, "Oh my gosh, you know, estrogen 10:28 like, "Oh my gosh, you know, estrogen 10:28 like, "Oh my gosh, you know, estrogen made me gain 30 lb." I believe you. 10:31 made me gain 30 lb." I believe you. 10:31 made me gain 30 lb." I believe you. >> Oh, yeah. 10:31 >> Oh, yeah. 10:31 >> Oh, yeah. >> Because it can happen. But, 10:33 >> Because it can happen. But, 10:33 >> Because it can happen. But, collectively, we're looking kind of 10:35 collectively, we're looking kind of 10:35 collectively, we're looking kind of everybody's an an individual, so we want 10:36 everybody's an an individual, so we want 10:36 everybody's an an individual, so we want to take that into consideration. 10:38 to take that into consideration. 10:38 to take that into consideration. >> Absolutely. Now, the the benefits that 10:40 >> Absolutely. Now, the the benefits that 10:40 >> Absolutely. Now, the the benefits that you get from estrogen are wonderful as 10:42 you get from estrogen are wonderful as 10:42 you get from estrogen are wonderful as far as, you know, slimming and mood and 10:44 far as, you know, slimming and mood and 10:44 far as, you know, slimming and mood and all those things, but progesterone and 10:46 all those things, but progesterone and 10:46 all those things, but progesterone and estrogen together sort of kind of battle 10:48 estrogen together sort of kind of battle 10:48 estrogen together sort of kind of battle back and forth, and progesterone sort of 10:51 back and forth, and progesterone sort of 10:51 back and forth, and progesterone sort of negates some of the benefit of the 10:53 negates some of the benefit of the 10:53 negates some of the benefit of the estrogen. 10:54 estrogen. 10:54 estrogen. >> Uh, well, particularly, um, you know, 10:57 >> Uh, well, particularly, um, you know, 10:57 >> Uh, well, particularly, um, you know, where you 10:58 where you 10:58 where you where your uh, where your body 11:00 where your uh, where your body 11:00 where your uh, where your body distributes some of that, um, you know, 11:02 distributes some of that, um, you know, 11:02 distributes some of that, um, you know, talked about this in a couple of 11:03 talked about this in a couple of 11:03 talked about this in a couple of episodes ago, so I'm not going to go 11:05 episodes ago, so I'm not going to go 11:05 episodes ago, so I'm not going to go back into it right now. Um, but, um, 11:07 back into it right now. Um, but, um, 11:07 back into it right now. Um, but, um, certainly from a 11:08 certainly from a 11:08 certainly from a cravings, appetite, munchy perspective, 11:11 cravings, appetite, munchy perspective, 11:11 cravings, appetite, munchy perspective, progesterone can create some more of 11:13 progesterone can create some more of 11:13 progesterone can create some more of that type of behavior, and now you're 11:15 that type of behavior, and now you're 11:15 that type of behavior, and now you're sort of negating the positive benefit of 11:17 sort of negating the positive benefit of 11:17 sort of negating the positive benefit of the estrogen. 11:18 the estrogen. 11:18 the estrogen. >> Yeah, so that's where if you do have 11:19 >> Yeah, so that's where if you do have 11:20 >> Yeah, so that's where if you do have that progesterone sensitivity, it's 11:22 that progesterone sensitivity, it's 11:22 that progesterone sensitivity, it's finding, you know, the right form of 11:23 finding, you know, the right form of 11:23 finding, you know, the right form of progesterone for you, the right 11:24 progesterone for you, the right 11:24 progesterone for you, the right estradiol for you, so they can work 11:26 estradiol for you, so they can work 11:26 estradiol for you, so they can work together. 11:27 together. 11:27 together. >> Yeah. Uh, now, uh, it doesn't it, you 11:30 >> Yeah. Uh, now, uh, it doesn't it, you 11:30 >> Yeah. Uh, now, uh, it doesn't it, you know, no, we don't want to turn this one 11:31 know, no, we don't want to turn this one 11:31 know, no, we don't want to turn this one into a strictly weight gain type of 11:34 into a strictly weight gain type of 11:34 into a strictly weight gain type of episode, but that's always the big 11:36 episode, but that's always the big 11:36 episode, but that's always the big concern for everybody is sometimes a 11:39 concern for everybody is sometimes a 11:39 concern for everybody is sometimes a little bit of, let's say, water 11:41 little bit of, let's say, water 11:41 little bit of, let's say, water retention in the beginning might be, 11:44 retention in the beginning might be, 11:44 retention in the beginning might be, you know, sort of normal and expected, 11:46 you know, sort of normal and expected, 11:47 you know, sort of normal and expected, but it's usually not going to stick 11:48 but it's usually not going to stick 11:48 but it's usually not going to stick around. 11:49 around. 11:49 around. And now there's, you know, there's a 11:51 And now there's, you know, there's a 11:51 And now there's, you know, there's a little bit more work to be done on the 11:53 little bit more work to be done on the 11:53 little bit more work to be done on the backside of that. 11:54 backside of that. 11:54 backside of that. >> And as I always say, there's so many 11:56 >> And as I always say, there's so many 11:56 >> And as I always say, there's so many different ways to do HRT with an 11:58 different ways to do HRT with an 11:58 different ways to do HRT with an individual that it you can't It might 12:01 individual that it you can't It might 12:01 individual that it you can't It might take a little time, but you can find the 12:03 take a little time, but you can find the 12:03 take a little time, but you can find the right protocol for that person for their 12:05 right protocol for that person for their 12:05 right protocol for that person for their goals. 12:06 goals. 12:06 goals. >> Yeah. So, let us know what your thoughts 12:09 >> Yeah. So, let us know what your thoughts 12:09 >> Yeah. So, let us know what your thoughts are 12:10 are 12:10 are and what your with your experience with 12:14 and what your with your experience with 12:14 and what your with your experience with HRT. 12:15 HRT. 12:15 HRT. Write them in the comments below. 12:17 Write them in the comments below. 12:17 Write them in the comments below. But until next time, I'm Dr. Mackey. 12:20 But until next time, I'm Dr. Mackey. 12:20 But until next time, I'm Dr. Mackey. >> And I'm Dr. Valerie. 12:20 >> And I'm Dr. Valerie. 12:21 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
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