1 00:00:00,375 --> 00:00:02,583 Welcome to the VP Life Podcast, the show 2 00:00:02,583 --> 00:00:04,041 where we bring you actionable health 3 00:00:04,041 --> 00:00:05,333 advice from leading minds. 4 00:00:06,208 --> 00:00:07,166 I'm your host, Rob. 5 00:00:07,791 --> 00:00:10,083 My guest today is Sarah Ball, a medical 6 00:00:10,083 --> 00:00:12,708 doctor specializing in menopause, HRT, 7 00:00:13,083 --> 00:00:13,666 and personalized 8 00:00:13,666 --> 00:00:15,333 female hormone optimization. 9 00:00:16,708 --> 00:00:19,500 Expect to learn what menopause rarely is 10 00:00:19,833 --> 00:00:21,625 and how it differs from perimone emples 11 00:00:22,041 --> 00:00:23,416 and why the symptoms vary 12 00:00:23,416 --> 00:00:24,875 so widely between women. 13 00:00:25,958 --> 00:00:28,291 Why hormone replacement therapy became so 14 00:00:28,291 --> 00:00:30,041 controversial after the Women's Health 15 00:00:30,041 --> 00:00:32,208 Initiative and what the evidence rarely 16 00:00:32,208 --> 00:00:36,458 says, and how personalized HRT can be 17 00:00:36,458 --> 00:00:39,416 safely implemented using genetics and 18 00:00:39,416 --> 00:00:40,875 metabolic testing to see 19 00:00:40,875 --> 00:00:42,125 the best possible results. 20 00:00:42,833 --> 00:00:44,958 Now, on to the conversation with Dr. 21 00:00:45,333 --> 00:00:45,708 Sarah Ball. 22 00:00:46,041 --> 00:00:46,958 Good afternoon, Dr. 23 00:00:46,958 --> 00:00:47,541 Ball, and thank you for 24 00:00:47,541 --> 00:00:48,666 joining us for the podcast today. 25 00:00:49,916 --> 00:00:50,291 This is a 26 00:00:50,291 --> 00:00:51,750 conversation I'm excited to have. 27 00:00:52,416 --> 00:00:54,291 As I know, there's just a lot of 28 00:00:54,291 --> 00:00:57,125 confusion about menopause, everything 29 00:00:57,125 --> 00:01:00,166 from what it actually is to where the 30 00:01:00,166 --> 00:01:00,875 hormone replacement 31 00:01:00,875 --> 00:01:03,166 therapy is safe and effective. 32 00:01:04,500 --> 00:01:05,166 We've got a lot to 33 00:01:05,166 --> 00:01:06,208 cover for that's for sure. 34 00:01:06,875 --> 00:01:08,416 Before we dive in though, would you mind 35 00:01:08,416 --> 00:01:09,708 just running us through your background, 36 00:01:10,333 --> 00:01:12,208 your origin story as it were, and how you 37 00:01:12,208 --> 00:01:14,458 got into this space to begin with? 38 00:01:14,791 --> 00:01:16,291 Yeah, sure, and thank you, Rob. 39 00:01:16,291 --> 00:01:17,500 Thank you for inviting me. 40 00:01:18,708 --> 00:01:20,500 So I'm Dr. 41 00:01:20,500 --> 00:01:22,708 Sarah Ball, and I am a medical doctor. 42 00:01:23,000 --> 00:01:25,000 So I trained at medical school and became 43 00:01:25,000 --> 00:01:26,625 a GP as quick as I could. 44 00:01:27,500 --> 00:01:29,000 I always wanted to do kind of general 45 00:01:29,000 --> 00:01:33,125 stuff, but I always length towards the 46 00:01:33,125 --> 00:01:36,208 female side of medicine and women's 47 00:01:36,208 --> 00:01:37,500 health and contraception and things. 48 00:01:38,916 --> 00:01:43,000 And I qualified as a GP in 2002, the 49 00:01:43,000 --> 00:01:45,541 summer of 2002, which was literally, it 50 00:01:45,541 --> 00:01:48,708 was three days before this big trial that 51 00:01:48,708 --> 00:01:50,458 I'm sure we're going to talk about was 52 00:01:50,458 --> 00:01:53,791 suddenly broadcast to the world about how 53 00:01:53,791 --> 00:01:56,625 unsafe HRT was having previously been 54 00:01:56,625 --> 00:01:57,500 thought to be the best 55 00:01:57,500 --> 00:01:58,500 thing since sliced bread. 56 00:01:59,500 --> 00:02:01,833 So it's literally, as my career started, 57 00:02:02,583 --> 00:02:03,541 menopause kind of 58 00:02:03,541 --> 00:02:05,916 became something that people 59 00:02:07,041 --> 00:02:09,000 stopped talking about and were scared of 60 00:02:09,291 --> 00:02:10,625 and were confused about. 61 00:02:12,083 --> 00:02:14,250 So really just through my career as a, I 62 00:02:14,250 --> 00:02:15,416 carried on being a GP, so I 63 00:02:15,416 --> 00:02:17,291 was a GP for 20 something years. 64 00:02:17,833 --> 00:02:24,666 And just found myself feeling, although I 65 00:02:24,666 --> 00:02:26,791 was keeping as up to date as it was 66 00:02:26,791 --> 00:02:28,833 possible to be with women's health, 67 00:02:28,833 --> 00:02:31,333 including menopause, it almost felt like 68 00:02:31,333 --> 00:02:32,666 we were living in the dark ages. 69 00:02:33,708 --> 00:02:34,875 You know, we could manage all other 70 00:02:34,875 --> 00:02:36,666 conditions really well with all this 71 00:02:36,666 --> 00:02:39,500 evidence and trials going on and great 72 00:02:39,500 --> 00:02:41,250 big conferences and all sorts of things, 73 00:02:41,250 --> 00:02:43,500 but it felt like we were quite behind. 74 00:02:44,833 --> 00:02:47,791 And then the NICE, the National Institute 75 00:02:47,791 --> 00:02:50,083 of Clinical Excellence Guidance came out 76 00:02:50,083 --> 00:02:53,333 in 2015 and kind of slightly started to 77 00:02:53,333 --> 00:02:56,041 turn the corner a bit in terms of, oh, 78 00:02:56,041 --> 00:03:00,000 actually, you know, there is a chink of 79 00:03:00,000 --> 00:03:01,500 light that we could maybe 80 00:03:02,791 --> 00:03:05,083 start to improve menopause care with. 81 00:03:05,291 --> 00:03:11,250 And so in 2018, then I started to also do 82 00:03:11,250 --> 00:03:12,500 private menopause work. 83 00:03:13,500 --> 00:03:15,250 And I trained with the British Menopause 84 00:03:15,250 --> 00:03:16,250 Society, so I'm an 85 00:03:16,250 --> 00:03:17,875 advanced menopause specialist. 86 00:03:19,833 --> 00:03:22,750 And so now, well, the demand for that 87 00:03:22,750 --> 00:03:23,916 private menopause work 88 00:03:24,083 --> 00:03:26,958 just absolutely skyrocketed. 89 00:03:26,958 --> 00:03:29,208 I mean, Exponential doesn't even begin to 90 00:03:29,208 --> 00:03:30,875 cover the demand for it. 91 00:03:31,375 --> 00:03:34,416 And so for the last six years now, I've 92 00:03:34,416 --> 00:03:36,958 done purely private menopause work. 93 00:03:38,416 --> 00:03:42,166 And so you really get a chance then to 94 00:03:42,166 --> 00:03:46,750 dive into it in a much more deep way and 95 00:03:46,750 --> 00:03:51,791 to really focus on the extraordinary 96 00:03:51,791 --> 00:03:53,708 extent that it has been neglected. 97 00:03:53,708 --> 00:03:56,375 We've sort of had 20 years of neglect and 98 00:03:56,375 --> 00:04:00,208 it's trying to bring everything more into 99 00:04:00,208 --> 00:04:02,750 the 21st century and actually support the 100 00:04:02,750 --> 00:04:04,958 half of the population that are going to 101 00:04:04,958 --> 00:04:07,416 be directly affected and the other half 102 00:04:07,416 --> 00:04:09,000 of the population who are going to be 103 00:04:09,000 --> 00:04:10,166 indirectly affected also. 104 00:04:11,541 --> 00:04:13,708 So yeah, so I now work at a clinic called 105 00:04:13,708 --> 00:04:14,708 Health in Menopause. 106 00:04:16,125 --> 00:04:18,250 And yeah, it's the most wonderfully 107 00:04:18,250 --> 00:04:21,041 rewarding job because it feels like 108 00:04:21,041 --> 00:04:25,125 finally after a drought, there is help 109 00:04:25,125 --> 00:04:28,666 that we're allowed to give and that the 110 00:04:28,666 --> 00:04:31,375 public are now more receptive to thanks 111 00:04:31,375 --> 00:04:33,916 to lots of conversations now 112 00:04:33,916 --> 00:04:35,416 happening in the public arena. 113 00:04:36,583 --> 00:04:37,125 So that's me. 114 00:04:37,958 --> 00:04:39,166 That's perfect, thank you for that. 115 00:04:39,166 --> 00:04:41,458 I'm glad you mentioned these guidelines. 116 00:04:42,041 --> 00:04:43,291 I'm sure we'll get to them later. 117 00:04:45,208 --> 00:04:47,541 Yeah, so I reckon we might as well dive 118 00:04:47,541 --> 00:04:49,166 straight and thank you 119 00:04:49,166 --> 00:04:49,916 for that introduction. 120 00:04:50,083 --> 00:04:52,458 It really sort of covered a lot of bases. 121 00:04:53,583 --> 00:04:55,708 And I'll ask you this question, which I 122 00:04:55,708 --> 00:04:58,708 suppose, what fundamentally is menopause 123 00:04:58,708 --> 00:05:00,166 and how does that differ from sort of 124 00:05:00,166 --> 00:05:01,916 period and post-menopause? 125 00:05:02,333 --> 00:05:04,458 I know many clinicians will sort of refer 126 00:05:04,458 --> 00:05:06,291 to menopause as a single day. 127 00:05:07,166 --> 00:05:08,750 But yeah, could you break down what these 128 00:05:08,750 --> 00:05:10,958 terms mean and then walk us through maybe 129 00:05:10,958 --> 00:05:13,916 some of the common symptoms that one 130 00:05:13,916 --> 00:05:16,291 would sort of associate with, we should 131 00:05:16,291 --> 00:05:18,250 associate with menopause that are 132 00:05:18,250 --> 00:05:21,625 oftentimes put down to maybe other life 133 00:05:21,625 --> 00:05:25,166 circumstances that women and especially 134 00:05:25,166 --> 00:05:26,416 men will often miss. 135 00:05:26,833 --> 00:05:27,541 Yeah, absolutely. 136 00:05:28,083 --> 00:05:31,458 And you're right, it's trying to pin down 137 00:05:31,583 --> 00:05:34,416 the definitions of the words can be 138 00:05:34,416 --> 00:05:35,541 confusing and tricky. 139 00:05:35,958 --> 00:05:38,958 And I would still say that menopause is 140 00:05:38,958 --> 00:05:41,291 one day in a person's life, 141 00:05:41,291 --> 00:05:43,208 a person that has had ovaries 142 00:05:44,625 --> 00:05:46,125 or still has ovaries but they've stopped 143 00:05:46,125 --> 00:05:47,500 working or they've been removed. 144 00:05:48,375 --> 00:05:50,750 So it's that one day if you're having a 145 00:05:50,750 --> 00:05:53,000 natural, a naturally occurring menopause 146 00:05:53,000 --> 00:05:56,166 where your follicles, the parts of the 147 00:05:56,166 --> 00:05:58,208 ovaries that can produce eggs have 148 00:05:58,208 --> 00:06:01,166 stopped working and you've gone a whole 149 00:06:01,166 --> 00:06:02,750 year without a menstrual period. 150 00:06:04,125 --> 00:06:08,375 So yes, it's that one day, but unless you 151 00:06:08,375 --> 00:06:12,041 have a surgical menopause or a menopause 152 00:06:12,041 --> 00:06:14,083 that's induced by some kind of medical 153 00:06:14,083 --> 00:06:16,375 procedure, which can be quite sudden, 154 00:06:16,750 --> 00:06:18,583 most people's naturally occurring 155 00:06:18,583 --> 00:06:21,291 menopause doesn't just happen, it takes 156 00:06:21,291 --> 00:06:24,250 anywhere between two and maybe 12 years 157 00:06:24,250 --> 00:06:27,083 for the buildup or the decline in the 158 00:06:27,083 --> 00:06:28,875 ovaries to actually then 159 00:06:28,875 --> 00:06:30,750 become them not working anymore. 160 00:06:30,791 --> 00:06:35,625 So the average age of menopause is 51. 161 00:06:36,625 --> 00:06:38,875 So that means a woman could be starting 162 00:06:38,875 --> 00:06:39,833 to experience some 163 00:06:39,833 --> 00:06:41,666 issues with changing hormones 164 00:06:43,375 --> 00:06:44,916 while her periods are still going on and 165 00:06:44,916 --> 00:06:47,000 she may be just in her late forties, but 166 00:06:47,000 --> 00:06:49,291 she might actually be in her late 30s. 167 00:06:49,625 --> 00:06:52,291 And so we have this usually decade, which 168 00:06:52,291 --> 00:06:55,916 for most of us is in our 40s where there 169 00:06:55,916 --> 00:06:58,875 could be all sorts of shenanigans going 170 00:06:58,875 --> 00:07:00,916 on with symptoms and health complaints 171 00:07:01,083 --> 00:07:03,416 and life happenings. 172 00:07:04,208 --> 00:07:09,166 And previously we didn't, my sixth sense 173 00:07:09,166 --> 00:07:11,000 and another clinician sixth sense was, 174 00:07:11,541 --> 00:07:12,500 there's gotta be some hormonal 175 00:07:12,500 --> 00:07:15,041 involvement, but there wasn't a kind of 176 00:07:15,041 --> 00:07:17,250 permission to call it something and to 177 00:07:17,250 --> 00:07:19,500 actually then be able to 178 00:07:20,583 --> 00:07:23,708 give it a label and therefore be able to 179 00:07:25,541 --> 00:07:28,833 start to help to manage that. 180 00:07:30,416 --> 00:07:33,000 So yeah, so we have this perimen pause, 181 00:07:33,000 --> 00:07:35,500 which previously was really poorly 182 00:07:35,500 --> 00:07:37,875 understood really, and it's probably what 183 00:07:37,875 --> 00:07:42,208 I would say is the biggest change or the 184 00:07:42,208 --> 00:07:45,208 biggest sort of light bulb moment where 185 00:07:45,208 --> 00:07:46,458 you go, oh, right, okay, 186 00:07:46,458 --> 00:07:47,333 yeah, that really helps. 187 00:07:47,541 --> 00:07:48,791 If all medical doctors knew 188 00:07:48,791 --> 00:07:49,666 that, that would be helpful. 189 00:07:50,916 --> 00:07:52,208 And then you have this one day 190 00:07:53,541 --> 00:07:56,208 which is your menopause, and then forever 191 00:07:56,208 --> 00:07:58,541 after, you are postmenopausal. 192 00:07:59,125 --> 00:08:01,875 So you could have your 193 00:08:01,875 --> 00:08:03,500 menopause at the average age of 51. 194 00:08:03,791 --> 00:08:05,625 And then if you live to 100, well, 195 00:08:05,625 --> 00:08:07,541 actually for the next, for 49 years, you 196 00:08:07,541 --> 00:08:10,125 are postmenopausal and there can still be 197 00:08:10,125 --> 00:08:11,625 issues arising because of that. 198 00:08:11,791 --> 00:08:16,208 So it's, I think, conventional or history 199 00:08:16,208 --> 00:08:18,583 has sort of taught that menopause is, you 200 00:08:18,583 --> 00:08:20,333 know, a couple of years, maybe have a few 201 00:08:20,333 --> 00:08:21,500 symptoms done and dusted, 202 00:08:22,333 --> 00:08:22,916 and then you can move on. 203 00:08:23,833 --> 00:08:25,750 But of course it really, really isn't 204 00:08:25,750 --> 00:08:29,000 because for, you know, the average age of 205 00:08:29,000 --> 00:08:31,375 women in this country, anyway, at the 206 00:08:31,375 --> 00:08:33,833 moment, if life span goes to sort of 83 207 00:08:34,250 --> 00:08:36,375 to 84 years, then actually you're gonna 208 00:08:36,375 --> 00:08:39,250 spend about 50% of that, yeah, 209 00:08:40,416 --> 00:08:41,750 but more, you know, if you start from the 210 00:08:41,750 --> 00:08:43,625 beginning of perimenopause, which from 211 00:08:43,625 --> 00:08:45,541 maybe average is sort of early to 212 00:08:45,541 --> 00:08:49,208 mid-40s, then, you know, that's a hell of 213 00:08:49,208 --> 00:08:52,125 a long time to not understand what's 214 00:08:52,125 --> 00:08:54,375 going on with your own body and to risk 215 00:08:54,375 --> 00:08:55,791 that your health professional also 216 00:08:55,791 --> 00:08:56,750 doesn't understand what's 217 00:08:56,750 --> 00:08:57,750 going on with your body. 218 00:08:59,291 --> 00:09:01,875 So yeah, symptom-wise, I think this is 219 00:09:01,875 --> 00:09:04,208 where another big area of confusion is 220 00:09:04,208 --> 00:09:07,750 that there's so many symptoms and they 221 00:09:07,750 --> 00:09:09,708 can start all at different times for 222 00:09:09,708 --> 00:09:11,666 different people and you might have 223 00:09:11,666 --> 00:09:13,833 completely different symptoms to your 224 00:09:13,833 --> 00:09:15,500 sister or your mother or 225 00:09:15,500 --> 00:09:16,666 your friend or your neighbour. 226 00:09:17,958 --> 00:09:21,291 And so it's trying to, it's constantly 227 00:09:21,291 --> 00:09:22,375 trying to join the dots. 228 00:09:24,250 --> 00:09:26,500 So there's this, maybe the slightly 229 00:09:26,500 --> 00:09:28,666 better known symptoms or the more kind of 230 00:09:28,666 --> 00:09:31,000 physical symptoms, the symptoms that 231 00:09:31,000 --> 00:09:32,583 people find a bit more easier to talk 232 00:09:32,583 --> 00:09:33,791 about, which would be 233 00:09:33,791 --> 00:09:35,541 things like hot sweats, flushes, 234 00:09:37,250 --> 00:09:37,833 fatigue, 235 00:09:39,541 --> 00:09:40,916 maybe headaches, migraine, 236 00:09:42,000 --> 00:09:42,583 joint pains. 237 00:09:42,833 --> 00:09:44,166 Actually joint pain is actually, 238 00:09:44,166 --> 00:09:46,083 worldwide, is the commonest symptom of 239 00:09:46,083 --> 00:09:48,750 menopause, but again, not a lot. 240 00:09:48,791 --> 00:09:50,000 Everyone thinks it's hot sweats and 241 00:09:50,000 --> 00:09:51,583 flushes, but actually only three quarters 242 00:09:51,583 --> 00:09:52,875 of people will ever have 243 00:09:52,875 --> 00:09:53,833 a hot sweat or a flush. 244 00:09:54,708 --> 00:09:56,000 A quarter will never have one. 245 00:09:56,500 --> 00:09:57,333 Yeah, it doesn't mean, 246 00:09:58,791 --> 00:09:59,791 yeah, it doesn't mean they're not 247 00:09:59,791 --> 00:10:00,666 suffering in other ways. 248 00:10:03,041 --> 00:10:04,250 So yeah, so there's another sort of 249 00:10:04,250 --> 00:10:05,416 physical, you know, poor sleep. 250 00:10:07,250 --> 00:10:08,500 So yeah, sort of physical symptoms, but 251 00:10:08,500 --> 00:10:10,333 then there's the genital urinary 252 00:10:10,333 --> 00:10:14,291 symptoms, which people struggle to talk 253 00:10:14,291 --> 00:10:15,250 about often because it can 254 00:10:15,250 --> 00:10:16,416 be slightly more embarrassing. 255 00:10:17,750 --> 00:10:19,750 So-- Fertional dryness, things like that. 256 00:10:19,958 --> 00:10:21,916 Dryness, the vulva dryness, the bladder 257 00:10:21,916 --> 00:10:23,708 issues, the lack of libido. 258 00:10:24,875 --> 00:10:26,916 So that's kind of a tricky thing to talk 259 00:10:26,916 --> 00:10:28,250 about, especially if you're still in your 260 00:10:28,250 --> 00:10:30,750 40s and you think, you know, things are 261 00:10:30,750 --> 00:10:33,125 going a bit wrong down there, it can be a 262 00:10:33,125 --> 00:10:34,125 difficult thing to talk about. 263 00:10:34,500 --> 00:10:36,166 And then there's the emotional symptoms. 264 00:10:36,166 --> 00:10:37,541 And actually, of all of the symptoms, I 265 00:10:37,541 --> 00:10:38,875 would say it's the psychological 266 00:10:38,875 --> 00:10:42,000 symptoms, which are the most troublesome 267 00:10:42,000 --> 00:10:45,416 to women that would come and seek help. 268 00:10:45,416 --> 00:10:48,416 And it's the unexplained anxiety that 269 00:10:48,416 --> 00:10:50,958 comes in midlife for no apparent reason, 270 00:10:50,958 --> 00:10:54,375 or the feeling overwhelmed with life when 271 00:10:54,375 --> 00:10:56,666 previously you were able to kind 272 00:10:56,666 --> 00:10:58,250 of-- That massive drop off and gather. 273 00:10:58,625 --> 00:11:00,958 Yeah, absolutely, yeah, the paranoia, the 274 00:11:00,958 --> 00:11:04,791 rage, you know, and that's 275 00:11:04,791 --> 00:11:06,458 real and scary for some women. 276 00:11:06,458 --> 00:11:08,208 It's the lack of, or the losing 277 00:11:08,208 --> 00:11:09,791 self-confidence and self-esteem. 278 00:11:11,125 --> 00:11:13,083 It's delightful being female, isn't it? 279 00:11:13,875 --> 00:11:14,666 Delute, yes, an 280 00:11:14,666 --> 00:11:16,166 absolute challenge to navigate. 281 00:11:16,666 --> 00:11:18,166 I mean, there's some, I often think, 282 00:11:18,166 --> 00:11:19,166 well, you know, we have this, 283 00:11:20,375 --> 00:11:22,500 for many of us, luckily, this amazing 284 00:11:22,500 --> 00:11:24,041 ability to reproduce, 285 00:11:25,166 --> 00:11:26,500 but there's a hell of a lot of 286 00:11:26,500 --> 00:11:28,875 complicated biology going 287 00:11:28,875 --> 00:11:30,958 into allowing that to happen. 288 00:11:30,958 --> 00:11:33,208 And then of course, when it, even if it 289 00:11:33,208 --> 00:11:35,916 starts to not work in the 290 00:11:35,916 --> 00:11:37,583 proper way, that's challenging. 291 00:11:37,583 --> 00:11:38,291 And then, you know, 292 00:11:38,291 --> 00:11:39,416 there's extremes of that. 293 00:11:39,416 --> 00:11:42,291 So there are some women who sail through 294 00:11:42,291 --> 00:11:44,416 the menopause, and that's wonderful, but 295 00:11:44,416 --> 00:11:47,083 there are literally some women who, it is 296 00:11:47,083 --> 00:11:50,791 the start of the end in terms of, you 297 00:11:50,791 --> 00:11:52,291 know, physical symptoms could just be 298 00:11:52,291 --> 00:11:54,166 completely overwhelming, or it could be 299 00:11:54,166 --> 00:11:55,875 the start of the decline of their future 300 00:11:55,875 --> 00:11:57,625 health, because menopause not only 301 00:11:57,625 --> 00:11:59,375 affects you in the day-to-day sense, but 302 00:11:59,375 --> 00:12:00,458 it affects your 303 00:12:00,458 --> 00:12:02,666 future health and wellness. 304 00:12:04,208 --> 00:12:06,041 And, you know, it changes people's lives. 305 00:12:06,250 --> 00:12:08,708 It takes one in 10 women out of their 306 00:12:08,708 --> 00:12:10,541 job, because they can't cope anymore. 307 00:12:10,916 --> 00:12:13,333 It, you know, the highest divorce rate is 308 00:12:13,333 --> 00:12:15,708 in females in their 40s, because the, you 309 00:12:15,708 --> 00:12:16,416 know, relationships 310 00:12:16,416 --> 00:12:17,500 become more challenging. 311 00:12:19,125 --> 00:12:21,250 You know, people literally, you see some 312 00:12:21,250 --> 00:12:23,208 people, not everyone, some people fall 313 00:12:23,208 --> 00:12:25,375 off their perch completely at menopause, 314 00:12:25,375 --> 00:12:28,000 someone that was very capable, very, you 315 00:12:28,000 --> 00:12:29,750 know, managing life, 316 00:12:29,750 --> 00:12:31,041 multitasking, you know, 317 00:12:32,041 --> 00:12:34,708 absolutely confident and fine, and just 318 00:12:34,708 --> 00:12:38,583 becomes a different person, and no one 319 00:12:38,583 --> 00:12:41,416 previously really understood, you know, 320 00:12:41,416 --> 00:12:42,291 they were usually just 321 00:12:42,291 --> 00:12:44,166 treated as being depressed, 322 00:12:45,166 --> 00:12:45,875 or their individual 323 00:12:45,875 --> 00:12:47,291 symptoms were treated. 324 00:12:47,291 --> 00:12:48,708 They might be sent to a cardiologist, 325 00:12:48,708 --> 00:12:50,166 because they had palpitations, or they 326 00:12:50,166 --> 00:12:51,541 might be sent to a neurologist, because 327 00:12:51,541 --> 00:12:54,083 they had migraine, or sent to a 328 00:12:54,083 --> 00:12:56,083 gastroenterologist, because their bowel 329 00:12:56,083 --> 00:12:59,250 habit changed, or whatever, and what we 330 00:12:59,250 --> 00:13:01,416 have to get so much better at doing, and 331 00:13:01,416 --> 00:13:02,875 medical person is joining the dots, 332 00:13:02,875 --> 00:13:05,416 going, actually, have we thought about 333 00:13:05,541 --> 00:13:06,958 whether there could be a common cause 334 00:13:06,958 --> 00:13:08,500 that's linking all these problems, rather 335 00:13:08,500 --> 00:13:09,458 than seeing them all as 336 00:13:09,458 --> 00:13:10,666 the individual issues. 337 00:13:11,750 --> 00:13:13,916 Yeah, I mean, you touched on a lot there. 338 00:13:14,083 --> 00:13:16,250 I'd love to come back to what you 339 00:13:16,250 --> 00:13:17,958 mentioned earlier about someone with a 340 00:13:17,958 --> 00:13:19,333 woman sailing through menopause. 341 00:13:20,291 --> 00:13:22,291 In my experience, well, not that I have 342 00:13:22,291 --> 00:13:24,916 much experience in this respect, but I 343 00:13:24,916 --> 00:13:27,500 find that women who do transition sort of 344 00:13:27,500 --> 00:13:29,166 more easily through this period in life 345 00:13:29,625 --> 00:13:31,083 are generally healthier to begin with, 346 00:13:31,083 --> 00:13:32,625 and I'm sure we can discuss some of the 347 00:13:32,625 --> 00:13:33,791 lifestyle factors later. 348 00:13:34,500 --> 00:13:37,125 Do you find that A to be the case, and 349 00:13:37,125 --> 00:13:40,500 then sort of on a similar note, what do 350 00:13:40,500 --> 00:13:42,000 you make of this notion that women are 351 00:13:42,000 --> 00:13:43,583 sort of entering menopause sort of at an 352 00:13:43,583 --> 00:13:44,708 earlier and earlier age? 353 00:13:44,958 --> 00:13:46,250 I mean, that's a whole 354 00:13:46,250 --> 00:13:47,208 rabbit hole in itself. 355 00:13:47,541 --> 00:13:48,958 Obviously, we could have a whole podcast 356 00:13:48,958 --> 00:13:50,875 in that, but do you think that there are 357 00:13:50,875 --> 00:13:52,791 any sort of environmental factors that 358 00:13:52,791 --> 00:13:55,875 might be, if it is indeed the case, sort 359 00:13:55,875 --> 00:13:58,625 of speeding up the sort of transition 360 00:13:58,958 --> 00:14:00,333 into menopause for some woman? 361 00:14:00,708 --> 00:14:02,583 I mean, we know that, for example, 362 00:14:02,666 --> 00:14:05,750 smoking tends to bring on menopause on 363 00:14:05,750 --> 00:14:06,958 average three years before 364 00:14:06,958 --> 00:14:08,291 it would otherwise happen. 365 00:14:10,458 --> 00:14:14,208 When we are not looking after ourselves 366 00:14:14,208 --> 00:14:16,000 properly, and of course, in this modern 367 00:14:16,000 --> 00:14:17,166 world, that's very difficult. 368 00:14:17,500 --> 00:14:18,458 So, yes, 369 00:14:19,708 --> 00:14:21,041 on the face of it, we're talking about 370 00:14:21,041 --> 00:14:22,916 getting a good night's sleep, doing 371 00:14:22,916 --> 00:14:26,791 regular exercise, eating healthy foods 372 00:14:26,791 --> 00:14:27,625 that are nourishing, 373 00:14:28,958 --> 00:14:31,875 but we know it's increasingly harder to 374 00:14:31,875 --> 00:14:34,333 do those things these days with all the 375 00:14:34,333 --> 00:14:36,666 financial strains on people and people 376 00:14:36,666 --> 00:14:37,541 trying to be a million 377 00:14:37,541 --> 00:14:41,500 people and have a million roles. 378 00:14:42,583 --> 00:14:44,708 So, and I think we've never, 379 00:14:46,583 --> 00:14:48,541 we've always underestimated the role of 380 00:14:48,541 --> 00:14:50,875 stress in all conditions, haven't we? 381 00:14:51,666 --> 00:14:54,583 And the cortisol and how that's gonna 382 00:14:54,583 --> 00:14:56,166 affect how we make our 383 00:14:56,166 --> 00:14:57,500 hormones in the first place. 384 00:14:57,541 --> 00:14:58,833 And things like that. 385 00:14:59,041 --> 00:15:00,666 And there's so many things we don't 386 00:15:00,666 --> 00:15:02,000 understand and how other 387 00:15:02,000 --> 00:15:03,708 medications that we might give. 388 00:15:04,291 --> 00:15:07,250 So, contentious issue, but we give out 389 00:15:07,250 --> 00:15:09,833 statins now like Smarties, but actually, 390 00:15:10,708 --> 00:15:12,875 is there an argument that if you give out 391 00:15:12,875 --> 00:15:14,791 statins and you decrease cholesterol, 392 00:15:14,791 --> 00:15:16,083 that therefore you're gonna make less 393 00:15:16,083 --> 00:15:17,041 reproductive hormones? 394 00:15:18,333 --> 00:15:19,500 And so sometimes we're 395 00:15:19,500 --> 00:15:21,083 robbing Peter to pay Paul. 396 00:15:23,166 --> 00:15:25,000 So, yeah, and I think we have a lot more, 397 00:15:25,333 --> 00:15:27,875 in a way there's a positivity in that we 398 00:15:27,875 --> 00:15:31,416 have, with childhood and teenage cancers, 399 00:15:31,416 --> 00:15:34,083 for example, the treatments for them and 400 00:15:34,083 --> 00:15:37,000 survival rates are now much better, but 401 00:15:37,000 --> 00:15:39,166 for the females that are suffering those 402 00:15:39,166 --> 00:15:42,375 cancers, they will go into often a risk 403 00:15:42,375 --> 00:15:44,041 of going into an early menopause. 404 00:15:45,208 --> 00:15:47,125 So, we have a lot more, we used to always 405 00:15:47,125 --> 00:15:49,708 quote, I always used to say, a one in 100 406 00:15:49,708 --> 00:15:51,458 women under the age of 40 will be a 407 00:15:51,458 --> 00:15:54,375 menopause and there's unexplained reasons 408 00:15:54,375 --> 00:15:55,958 for that, but for some reasons, there is 409 00:15:55,958 --> 00:15:58,125 an obvious medical treatments for other 410 00:15:58,125 --> 00:16:00,083 conditions has caused that, but actually 411 00:16:00,083 --> 00:16:02,041 now we've redone the figures, it's 412 00:16:02,041 --> 00:16:03,083 actually four in 100. 413 00:16:04,500 --> 00:16:07,083 So, one in 25 women will be in menopause 414 00:16:07,083 --> 00:16:08,291 before the age of 25, 415 00:16:08,916 --> 00:16:10,333 before the age of 40, sorry. 416 00:16:11,500 --> 00:16:13,291 So, again, it's not a 417 00:16:13,291 --> 00:16:15,166 really uncommon problem. 418 00:16:15,500 --> 00:16:18,000 This is everybody. 419 00:16:21,000 --> 00:16:23,500 So, it's really trying to shine a 420 00:16:23,500 --> 00:16:26,625 spotlight on it and not only for women 421 00:16:26,625 --> 00:16:29,416 themselves, although that is the most 422 00:16:29,416 --> 00:16:31,500 important thing, but actually for society 423 00:16:31,500 --> 00:16:34,916 in general and for economics, social 424 00:16:34,916 --> 00:16:38,208 economics, if women become less 425 00:16:38,208 --> 00:16:40,166 productive because they are suffering 426 00:16:40,166 --> 00:16:42,250 around their perimenopause and beyond, 427 00:16:42,625 --> 00:16:44,833 then that has a real knock on effect on 428 00:16:44,833 --> 00:16:47,250 their work and their employers and the 429 00:16:47,250 --> 00:16:51,541 GDP and all of that, this is a much 430 00:16:51,541 --> 00:16:53,166 bigger thing than just medicine. 431 00:16:54,708 --> 00:16:55,666 I love you did, you 432 00:16:55,666 --> 00:16:56,625 sort of brought up stress. 433 00:16:56,833 --> 00:16:59,041 I mean, I sort of, as we 434 00:16:59,041 --> 00:17:00,250 all talk about or fair, 435 00:17:01,416 --> 00:17:02,875 this sort of this functional medicine 436 00:17:02,875 --> 00:17:04,875 approach and even within that sort of 437 00:17:04,875 --> 00:17:06,833 paradigm where you sort of take a very 438 00:17:06,833 --> 00:17:08,375 sort of individualistic approach to 439 00:17:08,375 --> 00:17:09,500 treating these sorts of issues, 440 00:17:10,541 --> 00:17:12,875 I think a lot of practitioners will sort 441 00:17:12,875 --> 00:17:14,375 of overlook the stress component. 442 00:17:14,916 --> 00:17:19,333 And when you sort of start to look at how 443 00:17:19,333 --> 00:17:23,125 stress affects biology and how it starts 444 00:17:23,125 --> 00:17:25,875 to create high levels of inflammation 445 00:17:26,041 --> 00:17:28,041 that then sort of force cells into these 446 00:17:28,041 --> 00:17:30,041 states of sort of 447 00:17:30,041 --> 00:17:31,333 being inert essentially. 448 00:17:32,583 --> 00:17:34,500 It's not surprising that we're sort of 449 00:17:34,500 --> 00:17:35,833 seeing that these sort of generally, 450 00:17:35,833 --> 00:17:37,291 broadly speaking, these endocrine 451 00:17:37,291 --> 00:17:40,833 problems in general, I mean, the same 452 00:17:40,833 --> 00:17:42,750 thing obviously applies to men too. 453 00:17:43,791 --> 00:17:45,791 I think, well, I know that, 454 00:17:47,583 --> 00:17:49,291 what's the easiest way to put this? 455 00:17:49,416 --> 00:17:50,916 If you want to put someone through hell, 456 00:17:51,750 --> 00:17:52,583 completely mess up 457 00:17:52,583 --> 00:17:53,666 their endocrine system. 458 00:17:54,041 --> 00:17:56,541 And one of the fastest ways to do that 459 00:17:56,541 --> 00:17:59,333 short of sort of chugging plastic-laden 460 00:17:59,333 --> 00:18:02,583 water is to just be under this constantly 461 00:18:02,583 --> 00:18:06,833 high stressed state where your body is 462 00:18:06,833 --> 00:18:10,833 fundamentally put into a state where it 463 00:18:10,833 --> 00:18:13,416 can no longer, is no longer worried about 464 00:18:13,416 --> 00:18:14,916 reproduction and where it is no longer 465 00:18:14,916 --> 00:18:15,708 worried about these hormones. 466 00:18:16,041 --> 00:18:17,500 And it's just worrying about getting 467 00:18:17,500 --> 00:18:20,416 through each day as it comes. 468 00:18:21,166 --> 00:18:24,375 And yeah, as you've alluded to already, 469 00:18:25,500 --> 00:18:27,833 I suppose it's actually nature's sort of 470 00:18:27,833 --> 00:18:31,166 cruel irony ultimately, the moment a 471 00:18:31,166 --> 00:18:32,875 woman has sort of transitioned through 472 00:18:32,875 --> 00:18:34,291 her child-bearing edges, she 473 00:18:34,291 --> 00:18:37,500 evolutionarily quote unquote, has no 474 00:18:37,500 --> 00:18:40,291 purpose, said very delicately. 475 00:18:40,958 --> 00:18:43,416 And all of a sudden, as an individual, 476 00:18:43,958 --> 00:18:47,125 you are just sort of left in this state 477 00:18:47,250 --> 00:18:49,041 where life is untenable 478 00:18:49,041 --> 00:18:51,208 and can be unbearable. 479 00:18:52,708 --> 00:18:55,416 And I think, which is why I'm sort of 480 00:18:55,416 --> 00:18:57,041 excited about the initiatives that are 481 00:18:57,041 --> 00:18:59,333 starting to come out with regards to 482 00:18:59,333 --> 00:19:01,958 endocrine health in general, specifically 483 00:19:01,958 --> 00:19:04,583 for women, because for years, I think 484 00:19:04,583 --> 00:19:07,208 it's been far more acceptable as a man to 485 00:19:07,208 --> 00:19:10,458 go to your doctor if you have low 486 00:19:10,458 --> 00:19:12,333 testosterone and they'll say, well, stick 487 00:19:12,333 --> 00:19:14,333 a needle in your ass once 488 00:19:14,333 --> 00:19:15,458 a week and problem solved. 489 00:19:16,333 --> 00:19:19,041 But for women, it's been, yeah. 490 00:19:20,250 --> 00:19:22,583 I don't know why, but the 491 00:19:22,583 --> 00:19:24,041 uptake has just been much slower. 492 00:19:24,041 --> 00:19:26,125 And maybe that has something to do with 493 00:19:26,125 --> 00:19:28,666 the women's health initiative, which 494 00:19:28,666 --> 00:19:29,666 we'll discuss in a moment. 495 00:19:30,458 --> 00:19:31,875 But anyway, 496 00:19:33,375 --> 00:19:33,708 Dr. 497 00:19:33,708 --> 00:19:35,500 Boyle, I'd like to pivot into talking 498 00:19:35,708 --> 00:19:37,791 about how you treat patients in a bit, 499 00:19:38,041 --> 00:19:41,000 both in terms of HRT and whether you 500 00:19:41,000 --> 00:19:42,500 think there's space for some of these 501 00:19:42,500 --> 00:19:44,458 natural remedies as well, things like 502 00:19:44,458 --> 00:19:46,833 black cohosh and red 503 00:19:46,833 --> 00:19:48,458 clover extract, et cetera. 504 00:19:48,666 --> 00:19:51,708 My feeling is that these molecules, these 505 00:19:51,708 --> 00:19:53,500 supplements, they can help maybe manage 506 00:19:53,500 --> 00:19:55,125 the symptoms, but because they're not 507 00:19:55,125 --> 00:19:59,500 really replacing anything, they're not 508 00:19:59,500 --> 00:20:01,666 gonna support an individual from a sort 509 00:20:01,666 --> 00:20:03,583 of a longevity or health ban perspective. 510 00:20:05,541 --> 00:20:06,916 Before we jump into all of that though, 511 00:20:07,375 --> 00:20:09,166 I'd like to talk about what I've just 512 00:20:09,166 --> 00:20:10,916 mentioned, which is the 513 00:20:10,916 --> 00:20:12,166 women's health initiative. 514 00:20:13,583 --> 00:20:16,291 As I think it really set back sort of the 515 00:20:16,291 --> 00:20:20,708 HRT space, specifically within menopause 516 00:20:20,708 --> 00:20:24,041 by a good 20 years or so, if not longer. 517 00:20:24,083 --> 00:20:25,000 Different, longer, yeah. 518 00:20:25,416 --> 00:20:28,000 Yeah, so, but yeah, I'll hand it over to 519 00:20:28,000 --> 00:20:29,250 you because I'm not well-written the 520 00:20:29,250 --> 00:20:32,583 space, but I have a feeling you are. 521 00:20:32,583 --> 00:20:34,333 So maybe you could break down what the 522 00:20:34,333 --> 00:20:37,791 WHI is, what it was about, and then maybe 523 00:20:37,791 --> 00:20:39,375 why it was an issue. 524 00:20:39,750 --> 00:20:40,500 Yeah, sure, yeah. 525 00:20:41,791 --> 00:20:44,708 So essentially, so HRT was started to 526 00:20:44,708 --> 00:20:45,916 become available in 527 00:20:45,916 --> 00:20:47,416 the world in about 1960. 528 00:20:49,041 --> 00:20:54,375 And so for sort of 30, 40 years, women 529 00:20:54,375 --> 00:20:57,250 who were usually about 50-ish and were 530 00:20:57,250 --> 00:20:59,041 going through the natural menopause 531 00:20:59,041 --> 00:21:01,333 started to, if they started to have some 532 00:21:01,333 --> 00:21:03,125 hot sweats and flushes, they were usually 533 00:21:03,125 --> 00:21:05,750 offered some HRT, and they usually took 534 00:21:05,750 --> 00:21:07,083 it for a couple of years. 535 00:21:07,708 --> 00:21:09,250 And- This being oral 536 00:21:09,250 --> 00:21:10,291 HRT, is that correct? 537 00:21:11,041 --> 00:21:13,291 Yeah, so yeah, we used to have, most HRT 538 00:21:13,291 --> 00:21:15,750 used to be what we call combined oral, so 539 00:21:15,750 --> 00:21:18,000 a synthetic estrogen with a synthetic 540 00:21:18,000 --> 00:21:20,125 progestogen, all in one easy capsule. 541 00:21:21,125 --> 00:21:23,583 But these women, it was sort of noticed 542 00:21:23,583 --> 00:21:25,583 in the 90s, particularly, well, these 543 00:21:25,583 --> 00:21:28,416 women that take HRT, they seem really, 544 00:21:28,708 --> 00:21:31,208 you know, really healthy and lots of 545 00:21:31,208 --> 00:21:33,625 vigor, and they look great, and they're 546 00:21:33,625 --> 00:21:34,541 often the ones that are 547 00:21:34,541 --> 00:21:36,416 still being physically active. 548 00:21:37,000 --> 00:21:38,500 And, you know, HRT 549 00:21:38,500 --> 00:21:40,166 was, you know, popular. 550 00:21:40,625 --> 00:21:42,666 Women, you know, wanted to get some of 551 00:21:42,666 --> 00:21:44,000 this if they felt they 552 00:21:44,000 --> 00:21:44,708 were having symptoms. 553 00:21:45,291 --> 00:21:48,000 And then, sort of medical trials started 554 00:21:48,000 --> 00:21:49,541 to notice actually, that women that used 555 00:21:49,541 --> 00:21:51,625 HRT actually seem to have 556 00:21:51,625 --> 00:21:52,833 much less heart disease. 557 00:21:54,250 --> 00:21:56,041 They seem to break less bones. 558 00:21:57,375 --> 00:21:59,166 And there was also starting to be some 559 00:21:59,166 --> 00:22:00,125 consideration that they 560 00:22:00,125 --> 00:22:01,583 also seem to get less dementia. 561 00:22:01,625 --> 00:22:02,333 They just seem to be 562 00:22:02,333 --> 00:22:04,666 generally healthier for longer. 563 00:22:05,208 --> 00:22:06,500 So essentially, and again, I'm very 564 00:22:06,500 --> 00:22:07,541 simplistic about this, but 565 00:22:07,541 --> 00:22:08,500 that's how my brain works. 566 00:22:10,000 --> 00:22:13,250 The American National Institute for 567 00:22:13,250 --> 00:22:15,500 Health, you know, quite, you can 568 00:22:15,500 --> 00:22:16,750 understand why they thought it, thought, 569 00:22:16,750 --> 00:22:18,000 well, okay, well, this is great. 570 00:22:18,250 --> 00:22:20,000 So actually, if there's this relatively 571 00:22:20,000 --> 00:22:22,666 cheap drug that we could give to women 572 00:22:23,875 --> 00:22:25,250 and it reduced their risk of heart 573 00:22:25,250 --> 00:22:27,250 disease, well, wouldn't that be amazing? 574 00:22:27,583 --> 00:22:29,083 You know, we'd save, you 575 00:22:29,083 --> 00:22:30,666 know, gazillions of dollars, yeah. 576 00:22:32,291 --> 00:22:34,541 So yeah, you know, that kind of stands to 577 00:22:34,541 --> 00:22:35,083 reason that they would 578 00:22:35,083 --> 00:22:35,875 want to look at that. 579 00:22:36,125 --> 00:22:37,625 But that's where things slightly started 580 00:22:37,625 --> 00:22:40,125 to go wrong because what actually then 581 00:22:40,125 --> 00:22:42,916 happened was that women were recruited in 582 00:22:42,916 --> 00:22:45,500 America to this trial, but they weren't 583 00:22:45,500 --> 00:22:46,916 around the time of menopause. 584 00:22:47,541 --> 00:22:48,708 They were actually much older. 585 00:22:48,708 --> 00:22:50,000 So the average age of a woman in that 586 00:22:50,000 --> 00:22:52,083 study was between 63 and 64. 587 00:22:52,583 --> 00:22:53,833 So they were usually at least 588 00:22:53,833 --> 00:22:55,166 10 years past the menopause. 589 00:22:55,625 --> 00:22:57,666 And then they were given the old 590 00:22:57,666 --> 00:23:00,333 fashioned HRT that was popular at the 591 00:23:00,333 --> 00:23:03,000 time, but it was quite high dose as well. 592 00:23:04,625 --> 00:23:08,083 And there was one big arm of the study 593 00:23:08,083 --> 00:23:10,541 was women that had still got their womb 594 00:23:10,541 --> 00:23:11,708 and therefore they were having the 595 00:23:11,708 --> 00:23:13,208 combined HRT, so the 596 00:23:13,208 --> 00:23:14,583 oestrogen and the progestrogen. 597 00:23:15,041 --> 00:23:16,458 And then there was another arm of the 598 00:23:16,458 --> 00:23:17,333 trial, which was women 599 00:23:17,333 --> 00:23:18,416 that had had a hysterectomy. 600 00:23:18,666 --> 00:23:19,291 So they were just 601 00:23:19,291 --> 00:23:20,500 given the oestrogen part. 602 00:23:21,166 --> 00:23:22,791 And so they started to watch 603 00:23:22,791 --> 00:23:24,000 these women and what happened. 604 00:23:25,000 --> 00:23:26,625 And then, I mean, you 605 00:23:26,625 --> 00:23:28,041 can't even make this up. 606 00:23:28,583 --> 00:23:29,916 I'm sure there'll be a film about this 607 00:23:29,916 --> 00:23:31,041 one day because it's just 608 00:23:31,041 --> 00:23:33,500 so, such a travesty to women. 609 00:23:34,541 --> 00:23:36,833 They started to notice some figures that 610 00:23:36,833 --> 00:23:38,166 didn't look quite 611 00:23:38,166 --> 00:23:39,250 what they were expecting. 612 00:23:39,250 --> 00:23:40,833 Obviously they were hoping to find that 613 00:23:40,833 --> 00:23:42,750 women had loads less heart disease, but 614 00:23:42,750 --> 00:23:43,916 they weren't seeing that. 615 00:23:43,916 --> 00:23:45,791 It was sort of, ooh, actually, was there 616 00:23:45,791 --> 00:23:46,833 a bit of extra heart 617 00:23:46,833 --> 00:23:47,791 disease in this woman? 618 00:23:48,000 --> 00:23:49,541 Wasn't quite sure. 619 00:23:50,083 --> 00:23:51,625 And then, ooh, actually there's been a 620 00:23:51,625 --> 00:23:53,458 few more blood clots in these women in 621 00:23:53,458 --> 00:23:54,625 their lungs and in their legs. 622 00:23:55,208 --> 00:23:57,333 And ooh, was there a couple more strokes? 623 00:23:58,583 --> 00:24:00,833 And then, was there a bit more breast 624 00:24:00,833 --> 00:24:02,541 cancer in these women? 625 00:24:02,875 --> 00:24:05,125 And then, so what actually happened 626 00:24:05,125 --> 00:24:06,708 behind the scenes was that some 627 00:24:06,708 --> 00:24:08,666 investigators, so quite junior 628 00:24:08,666 --> 00:24:10,125 investigators, were looking at the 629 00:24:10,125 --> 00:24:11,833 numbers, did some statistical number 630 00:24:11,833 --> 00:24:13,791 crunching, but made some mistakes, 631 00:24:15,208 --> 00:24:17,375 didn't go to the senior investigators to 632 00:24:17,375 --> 00:24:19,166 talk to them first to come up with a 633 00:24:19,166 --> 00:24:21,375 plan, but essentially went straight to 634 00:24:21,375 --> 00:24:22,458 the media and the press. 635 00:24:23,041 --> 00:24:28,791 And so in 9th of July, 2002, suddenly it 636 00:24:28,791 --> 00:24:31,666 was announced on the news that HRT was 637 00:24:31,666 --> 00:24:33,291 associated with a higher risk of heart 638 00:24:33,291 --> 00:24:34,208 attack, strokes, blood 639 00:24:34,208 --> 00:24:35,333 clots, and breast cancer. 640 00:24:35,750 --> 00:24:36,500 And it was advisable 641 00:24:36,500 --> 00:24:38,166 for women to come off HRT. 642 00:24:38,500 --> 00:24:41,125 And literally overnight, about half of 643 00:24:41,125 --> 00:24:43,041 women came off for HRT, and then over the 644 00:24:43,041 --> 00:24:45,208 next five years or so, a load more did. 645 00:24:45,958 --> 00:24:49,083 So it literally, it just kind of tumbled. 646 00:24:49,375 --> 00:24:51,000 But the problem was 647 00:24:51,000 --> 00:24:52,250 the statistics was wrong. 648 00:24:52,916 --> 00:24:54,833 The conclusions were wrong. 649 00:24:54,875 --> 00:24:57,583 So yes, so when you actually look back at 650 00:24:57,583 --> 00:24:59,500 the data, and I'm not a statistician, I'm 651 00:24:59,500 --> 00:25:03,083 not, but I've studied the WHO, I used to 652 00:25:03,083 --> 00:25:05,041 study for donkey's years, and I kind of 653 00:25:05,041 --> 00:25:06,666 feel like I know it inside out, that 654 00:25:06,666 --> 00:25:08,125 actually when you look back at the data, 655 00:25:10,291 --> 00:25:12,916 if you look at the very few women that 656 00:25:12,916 --> 00:25:14,833 were around men of Paul's age when they 657 00:25:14,833 --> 00:25:16,583 started their HRT in this trial, they 658 00:25:16,583 --> 00:25:17,916 actually did really, really well, and 659 00:25:17,916 --> 00:25:18,541 actually everything 660 00:25:18,541 --> 00:25:19,916 was protected and good. 661 00:25:20,666 --> 00:25:22,625 And the women, the average women in 662 00:25:22,625 --> 00:25:24,875 there, 90% of women that were much older, 663 00:25:25,583 --> 00:25:26,583 there wasn't actually an 664 00:25:26,583 --> 00:25:27,791 increase in heart disease. 665 00:25:27,791 --> 00:25:30,250 It was a neutral, it was neutral, but 666 00:25:30,250 --> 00:25:33,291 they got the P values wrong for the areas 667 00:25:33,291 --> 00:25:34,625 of statistical significance. 668 00:25:36,125 --> 00:25:37,916 So what it did tell us was yes, there is 669 00:25:37,916 --> 00:25:38,833 a higher risk of blood 670 00:25:38,833 --> 00:25:42,208 clots with oral estrogen HRT. 671 00:25:42,958 --> 00:25:45,000 And we can now get around that by having 672 00:25:45,000 --> 00:25:46,750 different ways of having estrogen. 673 00:25:46,750 --> 00:25:48,083 So it did help to show that. 674 00:25:48,750 --> 00:25:49,958 But then the breast cancer, that was 675 00:25:49,958 --> 00:25:51,875 always the one, that's the most emotive 676 00:25:51,875 --> 00:25:53,958 issue around HRT still is. 677 00:25:55,208 --> 00:25:58,000 And this gets really complicated, but 678 00:25:58,000 --> 00:26:02,583 essentially HRT wasn't causing an 679 00:26:02,583 --> 00:26:04,916 increase in breast cancer in these women. 680 00:26:05,291 --> 00:26:08,083 It was actually, and this is kind of hard 681 00:26:08,083 --> 00:26:09,666 to explain, but it was actually women, 682 00:26:09,666 --> 00:26:11,833 when you broke down the numbers even 683 00:26:11,833 --> 00:26:14,000 more, it was women that had been 684 00:26:14,000 --> 00:26:15,708 recruited into the trial that had 685 00:26:15,708 --> 00:26:17,458 previously used HRT. 686 00:26:17,958 --> 00:26:18,583 They were actually 687 00:26:18,583 --> 00:26:20,375 protected from breast cancer. 688 00:26:20,875 --> 00:26:24,500 So it made it look like the people taking 689 00:26:24,500 --> 00:26:26,375 HRT from scratch were at 690 00:26:26,375 --> 00:26:27,875 risk, but in fact, they weren't. 691 00:26:27,875 --> 00:26:29,583 It was the other group 692 00:26:29,583 --> 00:26:32,041 were relatively protected. 693 00:26:32,708 --> 00:26:33,625 So there were conflating 694 00:26:33,625 --> 00:26:34,958 variables irrespective. 695 00:26:36,000 --> 00:26:36,166 Okay. 696 00:26:36,375 --> 00:26:39,125 So big, big, like huge mess. 697 00:26:39,125 --> 00:26:42,833 And actually that fear has stuck solid in 698 00:26:42,833 --> 00:26:43,875 most people's minds. 699 00:26:44,291 --> 00:26:46,375 I mean, I'm one of the lucky ones that 700 00:26:46,375 --> 00:26:49,291 has been able to really look into it. 701 00:26:49,291 --> 00:26:53,208 And I know that it's not true, but it's 702 00:26:53,208 --> 00:26:54,875 so difficult to take that fear away from 703 00:26:54,875 --> 00:26:56,750 people from the health clinicians 704 00:26:56,750 --> 00:26:59,583 themselves, but also from patients. 705 00:26:59,875 --> 00:27:01,333 So we have got a generation out there. 706 00:27:01,333 --> 00:27:04,541 So my mum's generation all believe HRT is 707 00:27:04,541 --> 00:27:05,625 associated with breast cancer. 708 00:27:06,125 --> 00:27:08,166 And if they were on HRT, they came off it 709 00:27:08,166 --> 00:27:09,833 and probably never restarted it. 710 00:27:10,166 --> 00:27:11,916 And they probably told their daughters 711 00:27:11,916 --> 00:27:13,458 like me not to go on HRT. 712 00:27:13,916 --> 00:27:15,500 And most daughters would just listen to 713 00:27:15,500 --> 00:27:16,291 their mums because they 714 00:27:16,291 --> 00:27:17,166 wouldn't know any better. 715 00:27:17,416 --> 00:27:19,958 So we still are trying to reassure women 716 00:27:21,375 --> 00:27:24,916 that the association between HRT and 717 00:27:24,916 --> 00:27:26,791 breast cancer is still 718 00:27:26,791 --> 00:27:28,791 not 100% eye and doubt. 719 00:27:29,750 --> 00:27:33,041 But if there is a risk at all, we are 720 00:27:33,041 --> 00:27:35,875 talking about a tiny risk. 721 00:27:37,000 --> 00:27:38,958 So around about, so this 722 00:27:38,958 --> 00:27:40,250 is with old fashioned HRT. 723 00:27:40,500 --> 00:27:43,333 So I'd have to give a thousand women in 724 00:27:43,333 --> 00:27:45,666 their fifties old fashioned HRT for five 725 00:27:45,666 --> 00:27:48,833 years for one extra woman per year to get 726 00:27:48,833 --> 00:27:49,791 breast cancer who 727 00:27:49,791 --> 00:27:51,500 wouldn't have already done so. 728 00:27:52,500 --> 00:27:54,958 But we now tend to use more modern sorts 729 00:27:54,958 --> 00:27:57,291 of HRT where the risk has been proven to 730 00:27:57,291 --> 00:27:59,541 be even lower and may 731 00:27:59,541 --> 00:28:01,833 well be very close to zero. 732 00:28:04,166 --> 00:28:06,375 And so essentially the risks 733 00:28:06,375 --> 00:28:07,500 of getting breast cancer with 734 00:28:08,541 --> 00:28:10,083 or without HRT are the same. 735 00:28:11,250 --> 00:28:12,583 And actually it's 736 00:28:12,583 --> 00:28:13,958 lifestyle we should be looking at. 737 00:28:14,083 --> 00:28:15,875 And if we can actually get a woman 738 00:28:15,875 --> 00:28:18,750 exercising, not drinking too much alcohol 739 00:28:18,750 --> 00:28:21,375 and being a healthy weight, that has a 740 00:28:21,375 --> 00:28:22,666 big statistical impact 741 00:28:22,666 --> 00:28:23,875 on her breast cancer risk. 742 00:28:24,375 --> 00:28:28,291 HRT has virtually zero effect. 743 00:28:32,041 --> 00:28:36,291 So it's trying to condense that into a 744 00:28:36,291 --> 00:28:40,958 way that a woman can understand and feel 745 00:28:40,958 --> 00:28:42,166 reassured is tricky. 746 00:28:44,291 --> 00:28:44,916 That's fascinating. 747 00:28:45,125 --> 00:28:47,291 I always was under the assumption and it 748 00:28:47,291 --> 00:28:49,041 speaks to my ignorance on the matter that 749 00:28:49,041 --> 00:28:51,583 there was far more of an issue with the 750 00:28:51,583 --> 00:28:54,041 oral progesterins and the oral estrogen. 751 00:28:55,375 --> 00:28:56,208 Yeah, and that was the 752 00:28:56,208 --> 00:28:57,875 other complete tragedy. 753 00:28:57,875 --> 00:28:58,708 Thank you for reminding me. 754 00:28:59,166 --> 00:29:01,208 So all women came off HRT because nobody 755 00:29:01,208 --> 00:29:02,625 told them there was a difference in the 756 00:29:02,625 --> 00:29:04,583 results between the combined group and 757 00:29:04,583 --> 00:29:06,083 the oestrogen only group. 758 00:29:06,833 --> 00:29:08,375 So, and the oestrogen only group, they 759 00:29:08,375 --> 00:29:09,125 were doing brilliantly. 760 00:29:09,375 --> 00:29:10,291 They had far less heart 761 00:29:10,291 --> 00:29:12,625 disease and far less dementia. 762 00:29:12,916 --> 00:29:15,333 And actually even their risk of breast 763 00:29:15,333 --> 00:29:18,166 cancer was reduced, but they all came off 764 00:29:18,166 --> 00:29:20,458 it because no one kind of broke down the 765 00:29:20,458 --> 00:29:21,291 difference in statistics 766 00:29:21,291 --> 00:29:22,875 for another couple of years. 767 00:29:24,375 --> 00:29:26,541 So yeah, complete travesty. 768 00:29:26,875 --> 00:29:28,791 There have been apologies since from the 769 00:29:28,791 --> 00:29:31,000 investigators, but no one ever publishes 770 00:29:31,000 --> 00:29:34,208 good news or it's just bad news. 771 00:29:35,416 --> 00:29:37,041 A list of knowledge is a dangerous thing. 772 00:29:37,083 --> 00:29:38,750 And there was so much positives in that. 773 00:29:38,750 --> 00:29:39,916 I mean, actually, if you look at the 774 00:29:39,916 --> 00:29:40,916 data, I mean, the reduction 775 00:29:40,916 --> 00:29:42,291 in fractures was impressive. 776 00:29:42,791 --> 00:29:44,916 The reduction in diabetes was impressive. 777 00:29:45,458 --> 00:29:46,500 All cause mortality. 778 00:29:46,791 --> 00:29:48,208 So in other words, your analysis 779 00:29:48,208 --> 00:29:50,000 oversimplification, but your risk of 780 00:29:50,000 --> 00:29:52,333 dying from anything went down in the WHO 781 00:29:52,333 --> 00:29:53,958 trial, no matter who you were. 782 00:29:54,291 --> 00:29:58,125 But it just, you know, that never got any 783 00:29:58,125 --> 00:29:59,375 wind behind it at all. 784 00:29:59,375 --> 00:30:00,416 Yeah, never got published. 785 00:30:01,791 --> 00:30:03,333 It's like you said, 786 00:30:04,000 --> 00:30:05,791 nothing sells like bad news. 787 00:30:05,791 --> 00:30:08,708 So trying to sort of refute that is going 788 00:30:08,708 --> 00:30:09,500 to be an uphill battle. 789 00:30:11,000 --> 00:30:11,500 Dr. 790 00:30:11,500 --> 00:30:14,458 Bow, you mentioned this specifically, 791 00:30:14,500 --> 00:30:18,750 this idea of women sort of in this, sort 792 00:30:18,750 --> 00:30:19,916 of maybe earlier to mid 793 00:30:19,916 --> 00:30:21,916 60s getting on to HRT. 794 00:30:22,500 --> 00:30:24,375 Now, this was going to be a question I 795 00:30:24,375 --> 00:30:25,458 was going to ask later, but I'm going to 796 00:30:25,458 --> 00:30:26,750 ask you all to talk about it now. 797 00:30:27,125 --> 00:30:30,375 Is there a point at which a woman who has 798 00:30:30,375 --> 00:30:33,166 sort of transitioned into menopause or is 799 00:30:33,166 --> 00:30:34,500 now perimenopausal should 800 00:30:34,500 --> 00:30:36,666 not begin an HRT regimen? 801 00:30:37,041 --> 00:30:37,583 Yeah, good question. 802 00:30:38,250 --> 00:30:40,166 So we have a concept now called the 803 00:30:40,166 --> 00:30:42,875 window of opportunity, which essentially 804 00:30:42,875 --> 00:30:46,916 means that the best time to start HRT is 805 00:30:46,916 --> 00:30:49,083 either during the perimenopause, if 806 00:30:49,083 --> 00:30:51,166 you're having any problematic symptoms, 807 00:30:51,875 --> 00:30:55,583 or within 10 years of your last period, 808 00:30:56,500 --> 00:30:58,416 or before the age of 60, 809 00:31:01,625 --> 00:31:03,250 whichever comes first. 810 00:31:03,875 --> 00:31:06,750 So you could go through your menopause at 811 00:31:06,750 --> 00:31:09,666 the age of 56, for example, and actually 812 00:31:09,666 --> 00:31:10,500 your window of opportunity 813 00:31:10,750 --> 00:31:12,375 then extends to being 66. 814 00:31:13,166 --> 00:31:15,083 But unfortunately, sort of myth and 815 00:31:15,083 --> 00:31:18,083 Chinese whisper and simplicity means that 816 00:31:18,083 --> 00:31:20,166 most doctors and healthcare professionals 817 00:31:20,166 --> 00:31:21,666 get very wobbly about 818 00:31:21,666 --> 00:31:23,416 anybody starting at over 60. 819 00:31:23,833 --> 00:31:26,041 But there are many people who just there, 820 00:31:26,583 --> 00:31:28,000 menopause was sufficiently late that 821 00:31:28,000 --> 00:31:29,500 they're still, their window of 822 00:31:29,500 --> 00:31:30,625 opportunity is still open. 823 00:31:31,541 --> 00:31:33,708 But what, if we were to use the old 824 00:31:33,708 --> 00:31:35,541 fashioned HRT, what we would think was, 825 00:31:35,625 --> 00:31:36,875 well, within that window of opportunity, 826 00:31:37,083 --> 00:31:38,375 the benefits outweigh the risks. 827 00:31:39,000 --> 00:31:40,666 If you're beyond that window of 828 00:31:40,666 --> 00:31:42,625 opportunity and maybe trying to start old 829 00:31:42,625 --> 00:31:45,833 fashioned HRT in a say a 68 year old who 830 00:31:45,833 --> 00:31:49,750 whose menopause was at 50, then the risks 831 00:31:49,750 --> 00:31:52,791 potentially outweigh the benefits. 832 00:31:53,708 --> 00:31:56,083 But actually now that we've got newer 833 00:31:56,083 --> 00:31:59,000 types of HRT, the more modern types, to 834 00:31:59,000 --> 00:32:02,416 be fair, the risks never really start to 835 00:32:02,416 --> 00:32:03,416 show up on a radar no 836 00:32:03,416 --> 00:32:04,583 matter what age you get to. 837 00:32:05,000 --> 00:32:07,625 So the benefits for almost everyone 838 00:32:08,000 --> 00:32:09,500 continue to outweigh the risks. 839 00:32:09,500 --> 00:32:10,833 They're just not, there's just not a 840 00:32:10,833 --> 00:32:13,166 bigger, a difference between the risks, 841 00:32:13,166 --> 00:32:14,750 the benefits and the risks when you're 842 00:32:14,750 --> 00:32:16,208 still within your window of opportunity. 843 00:32:17,041 --> 00:32:19,666 So even if you're much older when you 844 00:32:19,666 --> 00:32:20,791 start HRT, you will still 845 00:32:20,791 --> 00:32:22,416 get benefits to your bones. 846 00:32:22,416 --> 00:32:23,375 We know that for definite. 847 00:32:24,333 --> 00:32:26,291 And many, many women will still get 848 00:32:26,291 --> 00:32:28,000 improvements in their day to day 849 00:32:28,000 --> 00:32:31,166 symptoms, which that can then lead onto a 850 00:32:31,166 --> 00:32:33,416 much healthier lifestyle and then much 851 00:32:33,416 --> 00:32:35,791 greater future health 852 00:32:36,000 --> 00:32:37,250 via indirect mechanisms. 853 00:32:37,500 --> 00:32:39,500 So, you know, if I've had quite a lot of 854 00:32:39,500 --> 00:32:41,583 women who may be in their late sixties or 855 00:32:41,583 --> 00:32:44,833 early seventies, who are perhaps caring 856 00:32:44,833 --> 00:32:48,416 for a poorly spouse and they are 857 00:32:48,416 --> 00:32:49,791 struggling with hot sweats and flushes 858 00:32:50,000 --> 00:32:51,208 themselves, because they've just had 859 00:32:51,208 --> 00:32:53,000 that, you know, it's possible for hot 860 00:32:53,000 --> 00:32:54,791 sweats and flushes to go on for 10, 20 861 00:32:54,791 --> 00:32:56,791 years, even longer after your menopause. 862 00:32:57,416 --> 00:32:58,250 And so they're up and 863 00:32:58,250 --> 00:32:59,375 down every hour at night. 864 00:32:59,666 --> 00:33:01,083 And then they're weighing a lot because 865 00:33:01,083 --> 00:33:03,000 their genital urinary syndrome of 866 00:33:03,000 --> 00:33:04,583 menopause hasn't been dealt with. 867 00:33:04,875 --> 00:33:05,958 And so actually they're exhausted. 868 00:33:06,166 --> 00:33:08,500 They're fundamentally fit and healthy, 869 00:33:09,000 --> 00:33:10,166 but they're exhausted because they're 870 00:33:10,166 --> 00:33:11,000 getting no sleep and 871 00:33:11,000 --> 00:33:11,666 they can't stop weighing. 872 00:33:12,083 --> 00:33:13,000 And the stress of their 873 00:33:13,000 --> 00:33:15,458 caring role is all accumulating. 874 00:33:16,250 --> 00:33:17,083 But I give her a little 875 00:33:17,083 --> 00:33:18,791 bit of the best type of HRT. 876 00:33:18,791 --> 00:33:19,666 The hot sweats, flushes 877 00:33:19,666 --> 00:33:21,000 go away, she sleeps better. 878 00:33:21,708 --> 00:33:22,916 Her bladder calms down. 879 00:33:23,458 --> 00:33:25,750 Suddenly she's completely able to do her 880 00:33:25,750 --> 00:33:26,958 caring role and actually 881 00:33:26,958 --> 00:33:28,500 feels like she's, you know. 882 00:33:28,541 --> 00:33:28,750 Human. 883 00:33:29,750 --> 00:33:29,958 Human. 884 00:33:31,375 --> 00:33:33,541 And I know that she's much less likely to 885 00:33:33,541 --> 00:33:35,708 trip over and break a hip if she stumbles 886 00:33:35,708 --> 00:33:36,916 against the toilet as well. 887 00:33:36,916 --> 00:33:39,000 So we've got another win in there. 888 00:33:40,291 --> 00:33:43,041 Yeah, I think I'm trying to remember the 889 00:33:43,041 --> 00:33:45,375 stat particularly, but I think that 890 00:33:45,375 --> 00:33:49,833 fractures in people over 60 or 70 is one 891 00:33:49,833 --> 00:33:53,000 of the highest leading causes of early 892 00:33:53,000 --> 00:33:53,875 death, just because 893 00:33:53,875 --> 00:33:55,250 you're going to, well, 894 00:33:56,625 --> 00:33:58,083 you're going to get into the sarcopenic 895 00:33:58,083 --> 00:34:00,750 state, you lose a lot of muscle mass and 896 00:34:00,750 --> 00:34:02,375 you're then going to have this massive 897 00:34:02,375 --> 00:34:03,416 sort of metabolic 898 00:34:03,416 --> 00:34:05,208 derangement that then follows. 899 00:34:05,583 --> 00:34:09,958 And then as we know now, health is almost 900 00:34:09,958 --> 00:34:12,250 all completely metabolic in nature. 901 00:34:12,250 --> 00:34:14,541 So if you sort of lose that glucose sync 902 00:34:14,541 --> 00:34:16,625 of all that muscle, then all of a sudden 903 00:34:16,625 --> 00:34:19,541 you are in a pretty precarious situation. 904 00:34:20,791 --> 00:34:22,291 I think that's difficult as well. 905 00:34:22,291 --> 00:34:24,041 So if you're in your mid-40s and you're 906 00:34:24,041 --> 00:34:25,250 starting to think about your hormones, 907 00:34:27,041 --> 00:34:28,791 the last thing most people at that stage 908 00:34:28,791 --> 00:34:30,750 are thinking of is what happens if I fall 909 00:34:30,750 --> 00:34:33,958 over and break my hip and I'm 75 and I'm, 910 00:34:34,166 --> 00:34:36,083 I don't know, maybe I don't have 911 00:34:36,083 --> 00:34:37,583 dependence around who 912 00:34:37,583 --> 00:34:38,625 are going to care for me. 913 00:34:38,625 --> 00:34:39,875 People aren't on that wavelength. 914 00:34:40,291 --> 00:34:42,791 But actually, if you start the process of 915 00:34:42,791 --> 00:34:44,208 protecting your bones and your muscles 916 00:34:44,750 --> 00:34:46,083 and your metabolism way 917 00:34:46,083 --> 00:34:47,333 back in your perimenopause, 918 00:34:48,375 --> 00:34:50,791 you've shifted the dial so much to a 919 00:34:50,791 --> 00:34:54,625 healthier life when you're much older. 920 00:34:55,541 --> 00:34:56,791 So it's again, trying to 921 00:34:56,791 --> 00:34:59,500 focus medicine on thinking ahead. 922 00:34:59,958 --> 00:35:02,000 And that's what's been one of another big 923 00:35:02,000 --> 00:35:04,000 frustration of trying to get more 924 00:35:04,000 --> 00:35:06,291 awareness about menopause in the public 925 00:35:06,291 --> 00:35:09,541 arena is that, you know, the NHS, for 926 00:35:09,541 --> 00:35:11,375 example, they will worry about their 927 00:35:11,375 --> 00:35:12,916 budget for the next 12 months. 928 00:35:13,625 --> 00:35:15,583 So they're not willing to spend it on 929 00:35:15,583 --> 00:35:17,833 something that could make a massive 930 00:35:17,833 --> 00:35:19,625 difference in 20 or 30 years time, 931 00:35:20,083 --> 00:35:21,666 because it's just not, that's not how 932 00:35:21,666 --> 00:35:24,916 finances kind of work, but it's a massive 933 00:35:24,916 --> 00:35:27,250 public health option. 934 00:35:27,250 --> 00:35:29,000 You know, if you think about all the 935 00:35:29,000 --> 00:35:31,750 older people in care homes and 936 00:35:31,750 --> 00:35:33,666 residential homes and all the social care 937 00:35:33,666 --> 00:35:36,375 that takes up and all the heart disease, 938 00:35:36,375 --> 00:35:37,875 all the strokes, all the things which 939 00:35:37,875 --> 00:35:41,458 could, you know, if you have a fracture 940 00:35:41,458 --> 00:35:45,541 as an older woman of your hip, 941 00:35:46,750 --> 00:35:48,833 you've got a very high risk of being dead 942 00:35:48,833 --> 00:35:51,625 within 12 months, more so than most 943 00:35:51,625 --> 00:35:52,708 diagnoses of cancer. 944 00:35:53,333 --> 00:35:55,125 And yet we don't tend to think of it as 945 00:35:55,125 --> 00:35:55,625 something that's 946 00:35:55,625 --> 00:35:57,500 important to try and prevent. 947 00:35:58,250 --> 00:36:00,041 I think that's the term prevent. 948 00:36:00,500 --> 00:36:01,958 There's no money to 949 00:36:01,958 --> 00:36:02,750 be made in prevention. 950 00:36:03,291 --> 00:36:04,458 You can't sell a drug 951 00:36:04,458 --> 00:36:05,375 based on prevention. 952 00:36:06,291 --> 00:36:08,083 So yeah, it's going to be 953 00:36:08,083 --> 00:36:09,458 a complete uphill battle. 954 00:36:10,791 --> 00:36:11,000 Dr. 955 00:36:11,000 --> 00:36:12,625 Boyle, I think we've covered the basics 956 00:36:12,916 --> 00:36:14,166 and some of the sort of the underlying 957 00:36:14,166 --> 00:36:16,416 physiology sort of really nicely. 958 00:36:17,541 --> 00:36:18,500 I'd like to talk about 959 00:36:18,500 --> 00:36:20,333 how you work with patients. 960 00:36:20,625 --> 00:36:22,208 Now, for context, as you've probably 961 00:36:22,208 --> 00:36:25,000 gathered, I'm very pro-HRT and whenever I 962 00:36:25,000 --> 00:36:28,333 do again, council a woman in that 963 00:36:28,333 --> 00:36:30,333 respect, it's sort of just providing 964 00:36:30,333 --> 00:36:34,083 guidance as to what they maybe should 965 00:36:34,083 --> 00:36:35,791 start thinking about before, sort of 966 00:36:35,791 --> 00:36:37,750 sending them on to someone like yourself. 967 00:36:38,958 --> 00:36:43,375 I always make sure to point out that HRT 968 00:36:43,375 --> 00:36:46,166 isn't, as we've just discussed about 969 00:36:46,166 --> 00:36:48,458 symptom relief, it's about health, band 970 00:36:48,458 --> 00:36:50,333 longevity, and that these hormones are, 971 00:36:50,583 --> 00:36:51,791 as you've alluded to again, 972 00:36:51,833 --> 00:36:53,291 are cardio neuroprotective. 973 00:36:53,916 --> 00:36:56,208 And we always have the discussion around 974 00:36:56,208 --> 00:36:58,458 lifestyle again, making sure, from that 975 00:36:58,458 --> 00:37:00,916 preventative standpoint, and it's always 976 00:37:00,916 --> 00:37:03,250 very much grounded in this sort of 977 00:37:03,250 --> 00:37:06,458 understanding of getting your metabolic 978 00:37:06,458 --> 00:37:11,458 health as good as you can get it. 979 00:37:11,458 --> 00:37:13,291 Now, of course, that's 980 00:37:13,291 --> 00:37:16,666 difficult for a number of reasons. 981 00:37:17,125 --> 00:37:20,333 And I suppose I tend to emphasize the 982 00:37:20,333 --> 00:37:21,833 lifestyle and nutrition 983 00:37:21,833 --> 00:37:22,958 side of things because, 984 00:37:24,125 --> 00:37:25,583 as a chemist and biochemist, 985 00:37:25,833 --> 00:37:27,375 that's sort of my wheelhouse. 986 00:37:29,083 --> 00:37:32,083 So, with regards to that, I'll often 987 00:37:32,083 --> 00:37:35,708 point to things like making sure that 988 00:37:35,708 --> 00:37:36,541 your detoxification 989 00:37:36,541 --> 00:37:38,291 systems are working effectively. 990 00:37:38,833 --> 00:37:40,500 Because if you are going to think about 991 00:37:40,500 --> 00:37:43,208 getting onto HRT, you want to make sure 992 00:37:43,208 --> 00:37:45,375 that your body can metabolize the extra 993 00:37:45,375 --> 00:37:47,208 levels of these hormones effectively. 994 00:37:47,541 --> 00:37:51,083 So, if there's impaired sort of phase one 995 00:37:51,083 --> 00:37:53,375 or phase two detoxification, you've got 996 00:37:53,375 --> 00:37:55,125 an issue with glucuronidation or 997 00:37:55,125 --> 00:37:56,458 something like that, 998 00:37:58,333 --> 00:38:01,250 maybe taking in using HRT at that point 999 00:38:01,250 --> 00:38:04,875 in time is maybe not the best strategy 1000 00:38:05,000 --> 00:38:07,083 relative to sort of improving your health 1001 00:38:07,083 --> 00:38:10,000 and then considering getting onto HRT 1002 00:38:10,000 --> 00:38:11,250 when you've got those 1003 00:38:11,250 --> 00:38:12,916 basics sort of taken care of. 1004 00:38:15,291 --> 00:38:16,500 Now, I have a bunch more questions 1005 00:38:16,750 --> 00:38:19,958 relating to testing and of course, I'm no 1006 00:38:19,958 --> 00:38:22,416 expert here, but what do you think of 1007 00:38:22,416 --> 00:38:24,458 that sort of as a model? 1008 00:38:24,458 --> 00:38:28,458 Do you think that we should, I suppose, 1009 00:38:28,458 --> 00:38:31,208 as a community, be educating women on 1010 00:38:31,208 --> 00:38:33,375 their health in 1011 00:38:33,375 --> 00:38:35,291 general before starting HRT? 1012 00:38:35,708 --> 00:38:39,541 Or do you find that it's best just to get 1013 00:38:39,541 --> 00:38:43,083 someone who is struggling onto a protocol 1014 00:38:43,083 --> 00:38:44,916 and then sort of maybe dealing with these 1015 00:38:44,916 --> 00:38:48,375 other sort of this one you show off to 1016 00:38:48,375 --> 00:38:50,000 the fact, does that make sense? 1017 00:38:50,000 --> 00:38:51,125 Yeah, absolutely makes sense. 1018 00:38:52,291 --> 00:38:54,666 And again, I think that is maybe a 1019 00:38:54,666 --> 00:38:57,208 journey that we're going on with the more 1020 00:38:57,208 --> 00:38:59,791 public conversations now about menopause 1021 00:38:59,791 --> 00:39:01,583 is that traditionally, 1022 00:39:02,958 --> 00:39:06,291 we've had women make their first call to 1023 00:39:06,291 --> 00:39:09,041 someone like me because they're in a real 1024 00:39:09,041 --> 00:39:13,208 pickle in the throes of perimenopausal or 1025 00:39:13,208 --> 00:39:14,125 menopausal symptoms. 1026 00:39:14,625 --> 00:39:17,000 And they are maybe 1027 00:39:17,000 --> 00:39:20,666 sweating every hour, can't sleep, 1028 00:39:21,875 --> 00:39:23,541 anxious relationships are falling apart. 1029 00:39:24,375 --> 00:39:25,958 They're so achy that they can't, the 1030 00:39:25,958 --> 00:39:27,500 thought of going to the gym is 1031 00:39:27,500 --> 00:39:29,125 completely not on their radar. 1032 00:39:30,041 --> 00:39:33,500 They are depressed, they are rock bottom. 1033 00:39:35,083 --> 00:39:38,000 And we chat to them and we go 1034 00:39:38,000 --> 00:39:40,500 through all lifestyle issues. 1035 00:39:40,833 --> 00:39:42,041 I wanna know about 1036 00:39:42,041 --> 00:39:43,416 what is their sleep like? 1037 00:39:44,000 --> 00:39:44,833 Do they snore? 1038 00:39:46,083 --> 00:39:47,125 What is their diet like? 1039 00:39:47,125 --> 00:39:48,166 What is their bowel habit like? 1040 00:39:48,791 --> 00:39:49,750 What is their movement? 1041 00:39:50,166 --> 00:39:51,125 Do they have any movement 1042 00:39:51,125 --> 00:39:52,166 in their life at the moment? 1043 00:39:52,666 --> 00:39:53,875 What are their stress levels? 1044 00:39:53,875 --> 00:39:56,166 I wanna know, past trauma, I wanna know 1045 00:39:56,166 --> 00:39:59,125 all that stuff, but for each women, I 1046 00:39:59,125 --> 00:40:00,875 will treat her completely differently. 1047 00:40:00,875 --> 00:40:04,166 So there's some that I just need to put a 1048 00:40:04,166 --> 00:40:06,833 bit of, or invite her to put a bit of 1049 00:40:06,833 --> 00:40:09,583 estrogen in the system just to kind of, 1050 00:40:09,833 --> 00:40:11,416 if we could just get rid of the sweats to 1051 00:40:11,416 --> 00:40:13,791 start with so that she can sleep, and we 1052 00:40:13,791 --> 00:40:15,083 all know how dreadful it 1053 00:40:15,083 --> 00:40:16,083 is to be sleep deprived. 1054 00:40:16,333 --> 00:40:17,750 It's a form of torture, isn't it? 1055 00:40:18,125 --> 00:40:20,208 And then, sometimes just a couple of 1056 00:40:20,208 --> 00:40:22,541 weeks later, it's almost like they're 1057 00:40:22,541 --> 00:40:27,000 coming out of a fog, and then we can then 1058 00:40:27,000 --> 00:40:30,916 plan a more strategic way forward, which 1059 00:40:30,916 --> 00:40:32,375 is about the bigger jigsaw. 1060 00:40:32,583 --> 00:40:33,875 So I always, whenever I'm seeing anyone 1061 00:40:33,875 --> 00:40:36,000 not thinking about a jigsaw, yes, I have 1062 00:40:36,000 --> 00:40:38,125 the ability to put the HRT in place. 1063 00:40:38,666 --> 00:40:39,583 And for some people, that's 1064 00:40:39,583 --> 00:40:40,708 the big part of the jigsaw. 1065 00:40:40,708 --> 00:40:42,416 For some people, it's a very small part. 1066 00:40:42,500 --> 00:40:43,500 For some people, actually, it doesn't 1067 00:40:43,500 --> 00:40:44,541 need to be a part at all. 1068 00:40:45,625 --> 00:40:45,833 So, 1069 00:40:46,833 --> 00:40:49,833 there are some people where, and again, I 1070 00:40:49,833 --> 00:40:51,625 am so just to be absolutely, I'm a 1071 00:40:51,625 --> 00:40:53,333 medical doctor, conventional medical 1072 00:40:53,333 --> 00:40:55,666 doctor, but I have done quite a lot of 1073 00:40:55,666 --> 00:40:58,750 extra learning of my own volition about 1074 00:40:58,750 --> 00:41:02,875 diet, nutrition, functional medicine, 1075 00:41:03,125 --> 00:41:04,333 genetics, particularly 1076 00:41:04,333 --> 00:41:06,000 I'm looking at people's DNA. 1077 00:41:07,666 --> 00:41:10,166 And you just realize that I could see 1078 00:41:10,166 --> 00:41:12,375 someone and they'll come maybe and 1079 00:41:12,375 --> 00:41:14,166 they'll say, oh, you know, just really 1080 00:41:14,166 --> 00:41:16,375 depressed and achy and 1081 00:41:16,375 --> 00:41:19,083 maybe a bit overweight. 1082 00:41:19,458 --> 00:41:21,125 Maybe there's a bit of thyroid issues in 1083 00:41:21,125 --> 00:41:23,500 the family, for example, and then I'll 1084 00:41:23,500 --> 00:41:25,000 say, okay, do you take, you 1085 00:41:25,000 --> 00:41:25,833 know, what's your diet like? 1086 00:41:25,833 --> 00:41:26,708 And do you take any supplements? 1087 00:41:26,916 --> 00:41:28,666 And they'll say, you know, got a bit of a 1088 00:41:28,666 --> 00:41:30,083 rubbishy diet because at the moment 1089 00:41:30,083 --> 00:41:31,791 they've got no energy or 1090 00:41:31,791 --> 00:41:33,708 creativity to cook from scratch. 1091 00:41:33,708 --> 00:41:36,333 So they're having takeouts or whatever, 1092 00:41:36,875 --> 00:41:37,958 and they're not using any supplements 1093 00:41:38,416 --> 00:41:40,000 because, you know, they're a waste of 1094 00:41:40,000 --> 00:41:41,666 money, in quote, unquote. 1095 00:41:42,416 --> 00:41:43,833 And- Some of them are. 1096 00:41:44,125 --> 00:41:46,458 Yeah, and then, and they go, okay, do you 1097 00:41:46,458 --> 00:41:47,750 take any vitamin D at all? 1098 00:41:48,291 --> 00:41:49,708 No, and they work in full 1099 00:41:49,708 --> 00:41:50,875 time in an office or whatever. 1100 00:41:51,458 --> 00:41:52,166 And sometimes I just 1101 00:41:52,166 --> 00:41:53,291 give them some vitamin D 1102 00:41:54,541 --> 00:41:55,833 and then they come back a few weeks later 1103 00:41:55,833 --> 00:41:57,250 and go, oh, that was miraculous. 1104 00:41:57,791 --> 00:41:59,625 And then sometimes I don't actually need, 1105 00:42:00,041 --> 00:42:01,833 they don't actually need HRT for a while 1106 00:42:01,833 --> 00:42:03,750 longer because actually it wasn't, it was 1107 00:42:03,750 --> 00:42:05,291 they were lacking in vitamin D, but 1108 00:42:05,291 --> 00:42:07,041 again, the NHS doesn't really deal with 1109 00:42:07,041 --> 00:42:08,791 that particularly brilliantly either. 1110 00:42:10,375 --> 00:42:11,875 Or, you know, sometimes their thyroid's 1111 00:42:11,916 --> 00:42:13,625 completely up the spout. 1112 00:42:13,958 --> 00:42:15,958 I was going to ask about that because 1113 00:42:15,958 --> 00:42:19,416 obviously I have a better understanding 1114 00:42:19,541 --> 00:42:22,291 of male physiology when it comes to sort 1115 00:42:22,291 --> 00:42:23,833 of the thyroid testes access. 1116 00:42:24,583 --> 00:42:27,000 But oftentimes if you've got that 1117 00:42:27,000 --> 00:42:30,000 down-regulated thyroid activity, the 1118 00:42:30,000 --> 00:42:32,500 pituitary is not going to, in any way, 1119 00:42:32,500 --> 00:42:35,708 shape or form, send out sort of LH or FSA 1120 00:42:35,708 --> 00:42:38,500 signaling to the testes to then start 1121 00:42:38,500 --> 00:42:39,291 producing testosterone. 1122 00:42:39,541 --> 00:42:40,958 But the moment you flip the switch on the 1123 00:42:40,958 --> 00:42:43,208 thyroid side of things and you get that 1124 00:42:43,208 --> 00:42:44,416 thyroid signaling back, 1125 00:42:45,500 --> 00:42:47,750 not only does the HPTA start working 1126 00:42:47,750 --> 00:42:50,833 properly, but then at the mitochondrial 1127 00:42:50,833 --> 00:42:52,875 level, you're able to start producing 1128 00:42:52,875 --> 00:42:54,666 these hormones more effectively within 1129 00:42:54,666 --> 00:42:56,291 the testes, within the leg cells, and 1130 00:42:56,291 --> 00:42:57,291 then the totally cells. 1131 00:42:58,291 --> 00:43:00,416 I assume the same logic sort of carries 1132 00:43:00,416 --> 00:43:02,875 over to women as well. 1133 00:43:03,083 --> 00:43:05,000 If you can correct a thyroid issue, can 1134 00:43:05,000 --> 00:43:10,000 you sometimes maybe just offset the need 1135 00:43:10,166 --> 00:43:11,333 for other forms of HRT? 1136 00:43:11,666 --> 00:43:13,208 Absolutely, and we do sometimes see this 1137 00:43:13,208 --> 00:43:14,791 where people all come to me and they've 1138 00:43:14,791 --> 00:43:16,541 been on HRT for a few years and they've 1139 00:43:16,541 --> 00:43:19,291 just never really had that much 1140 00:43:19,291 --> 00:43:20,666 improvements from it. 1141 00:43:21,625 --> 00:43:23,250 And, you know, you're trying to, it's 1142 00:43:23,250 --> 00:43:24,541 like being a detective the whole time, 1143 00:43:24,541 --> 00:43:26,541 you're trying to work out where can we 1144 00:43:26,541 --> 00:43:28,125 change things for this person? 1145 00:43:28,125 --> 00:43:29,250 And then you'll look and you'll go, oh, 1146 00:43:29,250 --> 00:43:32,375 actually, well, there's a family history 1147 00:43:32,541 --> 00:43:35,208 of thyroid issues and actually, you're 1148 00:43:35,208 --> 00:43:36,916 maybe a bit overweight, maybe there's 1149 00:43:36,916 --> 00:43:38,791 been no vitamin D in the equation. 1150 00:43:39,583 --> 00:43:41,583 And I'm thinking, I don't think the 1151 00:43:41,583 --> 00:43:42,916 thyroid's working brilliantly and they 1152 00:43:42,916 --> 00:43:44,666 have, they usually, they will sometimes 1153 00:43:44,666 --> 00:43:46,625 bring to me their NHS blood results. 1154 00:43:47,000 --> 00:43:48,500 And you'll see that actually their TSH, 1155 00:43:48,500 --> 00:43:50,541 it's within the normal range, but it's 1156 00:43:50,541 --> 00:43:52,458 most certainly not a TSH that I'd want. 1157 00:43:52,833 --> 00:43:52,916 Yeah. 1158 00:43:52,958 --> 00:43:53,958 Nine, two. 1159 00:43:54,291 --> 00:43:55,708 Yeah, or even like four. 1160 00:43:55,708 --> 00:43:56,833 And I'm thinking, well, okay, technically 1161 00:43:56,833 --> 00:43:58,125 it's normal, but I'd much 1162 00:43:58,125 --> 00:43:59,208 rather it was a lot lower. 1163 00:44:00,250 --> 00:44:01,375 And then you maybe check their 1164 00:44:01,375 --> 00:44:02,833 autoantibodies or whatever. 1165 00:44:03,375 --> 00:44:06,541 And so, you know, if, I think that's 1166 00:44:06,541 --> 00:44:10,083 maybe why being a GP is quite helpful in 1167 00:44:10,083 --> 00:44:11,625 this job, because you can see that, you 1168 00:44:11,625 --> 00:44:15,000 know, I'm no, you know, I'm not brilliant 1169 00:44:15,000 --> 00:44:17,541 at thyroid, but I know when to call 1170 00:44:17,541 --> 00:44:18,416 someone in that is, 1171 00:44:18,416 --> 00:44:19,166 if you see what I mean. 1172 00:44:19,541 --> 00:44:21,458 So I'll say, you know, with this, your 1173 00:44:21,458 --> 00:44:25,041 history and your symptoms and your blood 1174 00:44:25,041 --> 00:44:27,291 results, I think we actually might need 1175 00:44:27,291 --> 00:44:29,166 to treat you as if you have an 1176 00:44:29,166 --> 00:44:30,125 underactive thyroid. 1177 00:44:31,791 --> 00:44:34,500 And, you know, I might, I stay in my lane 1178 00:44:34,500 --> 00:44:36,791 and I do the hormones, but I will make 1179 00:44:36,791 --> 00:44:38,458 sure I send them to someone that I 1180 00:44:38,458 --> 00:44:40,416 trusted to look after that bit of them. 1181 00:44:42,000 --> 00:44:45,250 And equally I've having learned a bit 1182 00:44:45,333 --> 00:44:46,583 about the nutrigenomics. 1183 00:44:47,125 --> 00:44:49,000 I mean, that's a complete game changer in 1184 00:44:49,000 --> 00:44:51,416 terms of, you know, even just being able 1185 00:44:51,416 --> 00:44:53,291 to show a woman to say, 1186 00:44:53,291 --> 00:44:55,125 look, this is cholesterol here. 1187 00:44:55,375 --> 00:44:56,958 And it comes down this pathway and it 1188 00:44:56,958 --> 00:44:58,000 makes some progesterone. 1189 00:44:58,166 --> 00:44:59,916 And then it comes down this pathway and 1190 00:44:59,916 --> 00:45:01,333 makes some estrogen. 1191 00:45:01,750 --> 00:45:02,750 And look what happens 1192 00:45:02,750 --> 00:45:04,041 if your stress goes up. 1193 00:45:04,041 --> 00:45:06,666 It basically steals it from that 1194 00:45:06,666 --> 00:45:08,500 progesterone and your progesterone is 1195 00:45:08,500 --> 00:45:09,750 getting to your GABA receptors and giving 1196 00:45:09,750 --> 00:45:10,750 you this relaxation. 1197 00:45:11,375 --> 00:45:14,500 So you can really start to, you know, not 1198 00:45:14,500 --> 00:45:16,125 all women need that, not for women. 1199 00:45:16,125 --> 00:45:16,916 It's saying they do. 1200 00:45:17,375 --> 00:45:20,958 It's a lovely thing to have if, you know, 1201 00:45:20,958 --> 00:45:22,833 if people are in that situation that they 1202 00:45:22,833 --> 00:45:27,250 can access it, but it can really answer a 1203 00:45:27,250 --> 00:45:29,916 lot of questions and really help women. 1204 00:45:29,916 --> 00:45:32,208 You know, we have a lot of, you know, new 1205 00:45:32,208 --> 00:45:34,583 diagnosis of ADHD and things at this time 1206 00:45:34,583 --> 00:45:35,875 of life, because, you know, once the 1207 00:45:35,875 --> 00:45:37,625 estrogen drops, the poor old nervous 1208 00:45:37,625 --> 00:45:39,916 system then wobbles like never before. 1209 00:45:40,666 --> 00:45:42,875 And, you know, women just, you know, 1210 00:45:42,875 --> 00:45:44,041 don't know what to do with themselves. 1211 00:45:44,041 --> 00:45:47,166 And then when you can help to explain how 1212 00:45:47,875 --> 00:45:50,500 this is all a series of complicated cogs 1213 00:45:50,500 --> 00:45:52,750 and, you know, once, you know, if your 1214 00:45:52,750 --> 00:45:55,083 big methylation cog at the center of 1215 00:45:55,083 --> 00:45:56,875 everything starts to slow, which it will 1216 00:45:56,875 --> 00:45:58,208 with age and then a bit more with 1217 00:45:58,208 --> 00:46:00,333 menopause, then something else is going 1218 00:46:00,333 --> 00:46:02,750 to reach a critical, you know, drop below 1219 00:46:02,750 --> 00:46:04,458 a critical threshold for working, whether 1220 00:46:04,458 --> 00:46:06,625 that's your neurotransmitters or your 1221 00:46:06,625 --> 00:46:07,708 fire rod or whatever. 1222 00:46:07,708 --> 00:46:09,333 And then we get all the women with the 1223 00:46:09,333 --> 00:46:11,500 histamine issues who come and they've 1224 00:46:11,500 --> 00:46:12,791 always been fine and they get to the 1225 00:46:12,791 --> 00:46:14,375 forties and suddenly they can't control 1226 00:46:14,375 --> 00:46:16,166 their hay fever and they've got hives. 1227 00:46:16,166 --> 00:46:18,208 And if they have a one drink of wine at a 1228 00:46:18,208 --> 00:46:19,416 wedding, they like flush 1229 00:46:19,416 --> 00:46:20,583 and faint and fall over. 1230 00:46:21,833 --> 00:46:23,041 Yeah, 1231 00:46:23,458 --> 00:46:25,916 and so just, you know, and I am no expert 1232 00:46:25,916 --> 00:46:28,000 in it whatsoever, but I have a absolutely 1233 00:46:28,000 --> 00:46:29,791 fabulous colleague 1234 00:46:29,791 --> 00:46:31,125 that I send them off to. 1235 00:46:32,000 --> 00:46:35,000 And it's, I mean, the, they just say, my 1236 00:46:35,000 --> 00:46:35,958 God, this is so empowering. 1237 00:46:36,166 --> 00:46:38,708 This is, you know, to actually be able to 1238 00:46:38,708 --> 00:46:41,666 explain to a woman why she's always felt 1239 00:46:41,666 --> 00:46:43,375 like she has or why things have got much 1240 00:46:43,375 --> 00:46:45,083 worse recently or whatever is, you know, 1241 00:46:45,083 --> 00:46:47,041 it's a complete game changer for some of 1242 00:46:47,041 --> 00:46:48,916 these women, whether it's their thyroid 1243 00:46:48,916 --> 00:46:51,125 we uncover is the issue or their nervous 1244 00:46:51,125 --> 00:46:52,916 system or, you know, they've got 1245 00:46:52,916 --> 00:46:54,916 adrenaline receptors, which are like, you 1246 00:46:54,916 --> 00:46:57,208 know, on high alert or, you know, or they 1247 00:46:57,208 --> 00:46:59,750 caught us all, biochemistry 1248 00:46:59,750 --> 00:47:01,916 is all, you know, very messy. 1249 00:47:02,583 --> 00:47:02,791 Yeah. 1250 00:47:03,125 --> 00:47:05,500 And then, you know, it's amazing. 1251 00:47:05,500 --> 00:47:09,291 So it's made my job so much more 1252 00:47:09,291 --> 00:47:12,833 rewarding because you can start to, you 1253 00:47:12,833 --> 00:47:14,500 know, I've had a lot of, I send a lot of 1254 00:47:14,500 --> 00:47:16,291 women also to a lovely colleague of mine 1255 00:47:16,291 --> 00:47:17,958 who is a breathing practitioner. 1256 00:47:18,750 --> 00:47:21,083 And, you know, we, we either to stop them 1257 00:47:21,083 --> 00:47:24,125 snoring or we send their partner if 1258 00:47:24,125 --> 00:47:25,583 that's, you know, cause it's almost as 1259 00:47:25,583 --> 00:47:28,125 bad sleeping with a snorer as it is to be 1260 00:47:28,125 --> 00:47:30,166 a snorer in terms of your health. 1261 00:47:32,000 --> 00:47:33,583 So yeah, it's just, it's lovely to be 1262 00:47:33,583 --> 00:47:35,916 able to try and work out, you know, so 1263 00:47:35,916 --> 00:47:36,625 I've never got the same 1264 00:47:36,625 --> 00:47:38,166 formula for any two patients. 1265 00:47:38,166 --> 00:47:38,833 It's always a 1266 00:47:38,833 --> 00:47:40,375 different, a different journey. 1267 00:47:40,916 --> 00:47:42,583 I was, I was going to skip over this, but 1268 00:47:42,583 --> 00:47:43,708 then you mentioned genetics. 1269 00:47:43,708 --> 00:47:44,875 So I'm sorry, you shot yourself in the 1270 00:47:44,875 --> 00:47:47,291 foot a little bit there, but, but 1271 00:47:47,291 --> 00:47:50,583 testing, I assume going into, well, 1272 00:47:50,583 --> 00:47:51,791 actually this is a good question. 1273 00:47:52,166 --> 00:47:53,333 Are you doing a sort of a 1274 00:47:53,333 --> 00:47:54,583 lot of testing off the bat? 1275 00:47:54,583 --> 00:47:57,875 Would you just sort of go off symptoms? 1276 00:47:57,875 --> 00:47:59,500 Because I assume if somebody's coming in 1277 00:47:59,500 --> 00:48:01,916 with these perimenopausal symptoms, you 1278 00:48:01,916 --> 00:48:03,833 can be sure that things like FSH are 1279 00:48:03,833 --> 00:48:05,583 going to be through the roof and AMH is 1280 00:48:05,583 --> 00:48:06,791 going to be all over the place. 1281 00:48:07,208 --> 00:48:08,125 Do you sort of worry about 1282 00:48:08,125 --> 00:48:09,416 that straight off the bat? 1283 00:48:09,916 --> 00:48:10,708 Or are you? 1284 00:48:11,000 --> 00:48:12,000 Really, really individual. 1285 00:48:12,458 --> 00:48:15,291 So usually, again, I'm generalizing 1286 00:48:15,291 --> 00:48:17,333 somewhat that a lot of women come to me 1287 00:48:17,333 --> 00:48:19,291 for the first time if they're not already 1288 00:48:19,291 --> 00:48:22,041 being treated for their menopause are in 1289 00:48:22,041 --> 00:48:23,541 quite a state or they 1290 00:48:23,541 --> 00:48:24,541 can be in quite a state. 1291 00:48:24,541 --> 00:48:25,875 They might not be able to retain any 1292 00:48:25,875 --> 00:48:27,833 information because their brain deserted 1293 00:48:27,833 --> 00:48:29,208 them long ago with brain fog. 1294 00:48:30,416 --> 00:48:31,583 You know, they might be, they're usually 1295 00:48:31,583 --> 00:48:33,583 really anxious to actually have the, you 1296 00:48:33,583 --> 00:48:34,416 know, they're tearful. 1297 00:48:34,750 --> 00:48:37,625 They're, they're, they feel like they're, 1298 00:48:37,708 --> 00:48:38,666 that, you know, that 1299 00:48:38,666 --> 00:48:40,375 they're completely losing it. 1300 00:48:40,375 --> 00:48:42,458 And it must be that there's, there's a 1301 00:48:42,458 --> 00:48:43,625 massive problem with them. 1302 00:48:44,083 --> 00:48:45,458 And then I can listen to them and expect 1303 00:48:45,458 --> 00:48:47,625 that you are, you know, this is 1304 00:48:47,625 --> 00:48:49,166 absolutely classical of 1305 00:48:49,166 --> 00:48:50,166 your changing hormones. 1306 00:48:50,166 --> 00:48:51,625 And I can explain why 1307 00:48:51,625 --> 00:48:52,791 that's all happening. 1308 00:48:54,750 --> 00:48:57,208 But then if I, 1309 00:48:58,250 --> 00:48:58,958 you know, there'll often 1310 00:48:58,958 --> 00:49:00,083 be things they throw in. 1311 00:49:00,083 --> 00:49:01,791 And I think, oh, it's almost like you, 1312 00:49:01,791 --> 00:49:03,166 you can sort of see their 1313 00:49:03,166 --> 00:49:04,583 genes beneath their skin. 1314 00:49:04,583 --> 00:49:05,125 It's like, oh, I bet 1315 00:49:05,125 --> 00:49:05,875 you've got that gene. 1316 00:49:07,875 --> 00:49:09,916 But I usually, not all the time, but 1317 00:49:09,916 --> 00:49:11,708 usually won't throw that into a first 1318 00:49:11,708 --> 00:49:13,083 consultation because it's 1319 00:49:13,083 --> 00:49:14,750 like too much information. 1320 00:49:15,333 --> 00:49:16,666 But there's some where actually they've 1321 00:49:16,666 --> 00:49:17,625 already been to a 1322 00:49:17,625 --> 00:49:19,250 million different providers. 1323 00:49:19,791 --> 00:49:21,166 They've already researched their own 1324 00:49:21,166 --> 00:49:22,583 condition, you know, 1325 00:49:23,083 --> 00:49:24,500 upside down and inside out. 1326 00:49:25,083 --> 00:49:27,666 And I do feel that they've got the 1327 00:49:27,666 --> 00:49:30,166 capacity on that day to talk about it. 1328 00:49:30,166 --> 00:49:32,000 And so I will say, look, there is this 1329 00:49:32,000 --> 00:49:34,000 other test that I could send you for, 1330 00:49:35,625 --> 00:49:36,291 you know, and I have to 1331 00:49:36,291 --> 00:49:37,208 say, you know, it's private. 1332 00:49:37,750 --> 00:49:38,916 It's not cheap. 1333 00:49:38,916 --> 00:49:39,791 It's not cheap at all. 1334 00:49:40,125 --> 00:49:42,458 But you know, if money were no object, 1335 00:49:43,000 --> 00:49:44,791 then wouldn't it be great if we all had 1336 00:49:44,791 --> 00:49:46,666 our DNA mapped out the day we were born 1337 00:49:46,666 --> 00:49:47,625 so that we knew what 1338 00:49:47,625 --> 00:49:48,500 our vulnerability was? 1339 00:49:48,500 --> 00:49:49,416 Of course, the full 1340 00:49:49,416 --> 00:49:51,541 genome sequencing was amazing. 1341 00:49:51,625 --> 00:49:52,375 Wouldn't that be amazing? 1342 00:49:52,375 --> 00:49:53,916 But I know most people aren't in that 1343 00:49:53,916 --> 00:49:57,541 privileged position, but there's lots of 1344 00:49:57,541 --> 00:49:59,500 people that I might not even need to 1345 00:49:59,500 --> 00:50:01,333 think about it for, you know, a couple of 1346 00:50:01,333 --> 00:50:02,625 years where we've got 1347 00:50:02,625 --> 00:50:04,083 this right and that right. 1348 00:50:04,083 --> 00:50:06,333 I've had a woman recently who starting 1349 00:50:06,333 --> 00:50:07,625 HRT was quite helpful. 1350 00:50:08,875 --> 00:50:10,708 We then she became a lot more healthier, 1351 00:50:10,875 --> 00:50:12,166 was brilliant with exercise 1352 00:50:12,166 --> 00:50:13,583 that all got a lot better. 1353 00:50:14,541 --> 00:50:16,541 We just that we could not, despite she 1354 00:50:16,541 --> 00:50:19,208 brought her BMI down to normal, she was 1355 00:50:19,208 --> 00:50:20,958 generally doing really well, but we could 1356 00:50:20,958 --> 00:50:24,958 not get her HPA1C under control and no 1357 00:50:24,958 --> 00:50:28,041 family, I couldn't work out why it was, 1358 00:50:28,041 --> 00:50:29,916 but so eventually we got a genetics done 1359 00:50:29,916 --> 00:50:31,500 and she has got all the 1360 00:50:31,500 --> 00:50:34,125 dodgy glucose processing genes. 1361 00:50:34,125 --> 00:50:36,583 And so now she's on rather than the more 1362 00:50:36,583 --> 00:50:38,333 generic supplements that I 1363 00:50:38,333 --> 00:50:39,833 might talk about with them. 1364 00:50:39,833 --> 00:50:41,125 She's now on a very much more 1365 00:50:41,125 --> 00:50:42,958 individualized regime. 1366 00:50:44,250 --> 00:50:46,083 Did you reduce her carbohydrate intake 1367 00:50:46,250 --> 00:50:47,291 alongside that at all? 1368 00:50:47,666 --> 00:50:51,500 Oh yeah, she's so on it with, yeah. 1369 00:50:52,500 --> 00:50:53,208 What genes are you 1370 00:50:53,208 --> 00:50:54,000 looking at specifically? 1371 00:50:54,291 --> 00:50:55,000 And are you doing 1372 00:50:55,000 --> 00:50:57,166 things like a Dutch test? 1373 00:50:57,166 --> 00:50:58,666 Are you doing more of 1374 00:50:58,666 --> 00:51:00,958 a generalized DNA test? 1375 00:51:01,458 --> 00:51:02,166 Yeah, I don't. 1376 00:51:02,166 --> 00:51:04,458 So again, I send, I don't, we don't do 1377 00:51:04,458 --> 00:51:05,916 them within health and menopause, but we 1378 00:51:05,916 --> 00:51:09,791 send them to somebody that we've worked 1379 00:51:09,791 --> 00:51:11,208 with for a long time and that is a 1380 00:51:11,208 --> 00:51:12,791 menopause specialist themselves and 1381 00:51:12,791 --> 00:51:14,666 therefore understands the intricacies of 1382 00:51:14,666 --> 00:51:16,041 what we're trying to achieve. 1383 00:51:17,333 --> 00:51:19,666 And so we really individual, so we might 1384 00:51:19,666 --> 00:51:23,541 do nutrient core and methylation are 1385 00:51:23,541 --> 00:51:25,875 often really helpful, but a lot of our 1386 00:51:25,875 --> 00:51:28,625 patients, we do their hormone, the 1387 00:51:28,625 --> 00:51:30,125 estrogen pathways as well. 1388 00:51:31,375 --> 00:51:33,541 They might want their metabolic doing, 1389 00:51:33,833 --> 00:51:36,166 especially if weight is an issue or 1390 00:51:36,166 --> 00:51:38,708 cholesterol issues or we think there is 1391 00:51:38,708 --> 00:51:40,125 sugar processing issues. 1392 00:51:41,000 --> 00:51:44,333 Histamine, although often you do find 1393 00:51:44,333 --> 00:51:47,541 that the histamine is only the tip of the 1394 00:51:47,541 --> 00:51:49,083 iceberg and it's usually a methylation 1395 00:51:49,083 --> 00:51:50,375 issue at the heart of 1396 00:51:50,375 --> 00:51:52,083 the problem as for my, 1397 00:51:54,125 --> 00:51:55,500 unexpert, my-- 1398 00:51:56,458 --> 00:51:57,708 No, you're right on the money. 1399 00:51:58,208 --> 00:52:00,500 When you've got impaired histamine 1400 00:52:01,000 --> 00:52:04,041 processing throughout the body, it's 1401 00:52:04,041 --> 00:52:06,833 quite often the case that that individual 1402 00:52:07,041 --> 00:52:09,125 is potentially estrogen dominant and that 1403 00:52:09,125 --> 00:52:09,750 individual is 1404 00:52:09,750 --> 00:52:10,916 potentially estrogen dominant. 1405 00:52:10,916 --> 00:52:13,333 You've got to start looking at, well, why 1406 00:52:13,333 --> 00:52:14,041 aren't they clearing 1407 00:52:14,041 --> 00:52:15,083 estrogen effectively? 1408 00:52:15,083 --> 00:52:16,708 Which is why I think these tests are so 1409 00:52:16,708 --> 00:52:19,083 interesting because they can also then 1410 00:52:19,083 --> 00:52:21,750 govern, I think, the way that you 1411 00:52:21,750 --> 00:52:23,666 potentially would treat somebody with an 1412 00:52:23,666 --> 00:52:25,541 estrogen, because if they aren't 1413 00:52:25,541 --> 00:52:28,625 effectively very effective at clearing 1414 00:52:28,625 --> 00:52:31,000 estrogen from their system, then maybe 1415 00:52:31,000 --> 00:52:34,541 you won't sort of bias and the therapy 1416 00:52:34,541 --> 00:52:35,916 towards being 1417 00:52:35,916 --> 00:52:37,458 completely estrogen dominant. 1418 00:52:37,458 --> 00:52:39,041 Yeah, let's shift 1419 00:52:39,041 --> 00:52:40,250 your constipation first. 1420 00:52:40,250 --> 00:52:41,250 There's absolutely no point putting a 1421 00:52:41,250 --> 00:52:42,750 load of estrogen in the top if it can't 1422 00:52:42,750 --> 00:52:43,541 get at the bottom because 1423 00:52:43,541 --> 00:52:44,500 that's going to be toxic. 1424 00:52:45,333 --> 00:52:45,833 Yeah, definitely. 1425 00:52:45,875 --> 00:52:47,708 That's my very simplistic look at it. 1426 00:52:47,708 --> 00:52:50,083 And it's helpful, we also at Health and 1427 00:52:50,083 --> 00:52:52,208 Mentals, we actually also specialize in 1428 00:52:52,208 --> 00:52:54,458 helping women that have a history of 1429 00:52:54,458 --> 00:52:56,375 cancer, any type, but 1430 00:52:56,375 --> 00:52:57,458 particularly breast cancer. 1431 00:52:57,833 --> 00:53:01,541 And so, again, sometimes if you can look 1432 00:53:01,541 --> 00:53:04,416 at how someone is clearing their estrogen 1433 00:53:04,416 --> 00:53:07,125 through, you know, their four hydroxy 1434 00:53:07,125 --> 00:53:09,208 pathway or whatever, it just gives you a 1435 00:53:09,208 --> 00:53:12,000 little bit more information to be able to 1436 00:53:12,000 --> 00:53:15,916 more accurately direct an individual 1437 00:53:16,000 --> 00:53:17,625 rather than a population of 1438 00:53:17,625 --> 00:53:18,750 women, if you see what I mean. 1439 00:53:19,125 --> 00:53:20,916 It's very much an individual level. 1440 00:53:21,625 --> 00:53:21,833 Dr. 1441 00:53:21,833 --> 00:53:24,833 Baugh, I'd love to talk about the history 1442 00:53:24,833 --> 00:53:26,333 of management all day, but for the sake 1443 00:53:26,333 --> 00:53:28,625 of time, I'd like to talk about the 1444 00:53:28,625 --> 00:53:30,625 elephant in the room and that being the 1445 00:53:30,625 --> 00:53:32,541 use of testosterone in HRT. 1446 00:53:33,250 --> 00:53:35,000 Now, I don't know of any medical 1447 00:53:35,000 --> 00:53:38,041 governing body in the UK or abroad that 1448 00:53:38,041 --> 00:53:40,166 advocates for the use of testosterone 1449 00:53:40,666 --> 00:53:42,416 replacement therapy in women or TRT, 1450 00:53:42,750 --> 00:53:44,250 which I think is a little absurd because 1451 00:53:44,250 --> 00:53:46,208 it's a hormone that is, well, naturally 1452 00:53:46,208 --> 00:53:48,166 produced, woman number one, and B is 1453 00:53:48,166 --> 00:53:50,333 crucial to well, life. 1454 00:53:51,291 --> 00:53:53,375 Just being sort of happy, functional, I 1455 00:53:53,375 --> 00:53:56,166 mean, if you look at the sort of the 1456 00:53:56,166 --> 00:53:59,041 Adams questionnaire for men for low 1457 00:53:59,041 --> 00:54:01,500 testosterone, I mean, the same things 1458 00:54:01,500 --> 00:54:03,500 apply to women as well, 1459 00:54:03,500 --> 00:54:05,083 sort of low libido, low mood. 1460 00:54:07,375 --> 00:54:10,333 Yeah, dysregulated insulin sensitivity, 1461 00:54:11,541 --> 00:54:13,208 poor metabolic health and inability to 1462 00:54:13,208 --> 00:54:15,041 maintain and hold them to muscle, et 1463 00:54:15,041 --> 00:54:16,708 cetera, et cetera, et cetera. 1464 00:54:17,458 --> 00:54:19,125 Now, as I mentioned, there are of course 1465 00:54:19,250 --> 00:54:22,708 no governing bodies approving this, so 1466 00:54:22,708 --> 00:54:25,416 there are no guidelines on the use of 1467 00:54:25,416 --> 00:54:27,333 testosterone in women's HRT, 1468 00:54:27,500 --> 00:54:29,000 which again, I think is daft. 1469 00:54:29,833 --> 00:54:31,208 I'd love to get your take on this though. 1470 00:54:31,541 --> 00:54:33,625 What do you see in clinical practice when 1471 00:54:33,625 --> 00:54:35,875 a woman gets onto testosterone or some 1472 00:54:35,875 --> 00:54:37,791 sort of TRT therapy as 1473 00:54:37,791 --> 00:54:39,541 part of a world sign protocol? 1474 00:54:39,750 --> 00:54:41,541 Is it generally a needle mover, maybe 1475 00:54:41,541 --> 00:54:43,416 when they haven't had that much success 1476 00:54:43,416 --> 00:54:46,000 with just manipulating estrogen and 1477 00:54:46,000 --> 00:54:48,416 progesterone levels, or is it just 1478 00:54:48,416 --> 00:54:49,333 another cognitive machine? 1479 00:54:49,666 --> 00:54:50,500 Yeah, it can be a 1480 00:54:50,500 --> 00:54:52,375 complete and utter game changer. 1481 00:54:52,375 --> 00:54:53,583 I mean, it's literally like flipping a 1482 00:54:53,583 --> 00:54:54,791 switch between night and day. 1483 00:54:56,333 --> 00:54:58,833 For some people, for some people it's, 1484 00:54:58,833 --> 00:55:00,916 yeah, definitely have some benefits. 1485 00:55:00,916 --> 00:55:02,666 You know, it's not a game changer, but 1486 00:55:02,666 --> 00:55:03,500 it's definitely been helpful. 1487 00:55:03,916 --> 00:55:06,958 Some people doesn't actually help much at 1488 00:55:06,958 --> 00:55:08,750 all, and very occasionally, some people 1489 00:55:08,750 --> 00:55:10,208 find they feel worse with it. 1490 00:55:11,375 --> 00:55:15,375 But in general, the positives are so much 1491 00:55:15,375 --> 00:55:17,083 more numerous than any negatives. 1492 00:55:18,791 --> 00:55:21,791 And so the nice guidance says that if a 1493 00:55:21,791 --> 00:55:23,875 woman is, well, they're supposed to be 1494 00:55:23,875 --> 00:55:26,750 postmenopausal, if a postmenopausal woman 1495 00:55:26,750 --> 00:55:29,333 is settled on HRT and the HRT is 1496 00:55:29,333 --> 00:55:31,166 essentially sorting out all of her 1497 00:55:31,166 --> 00:55:33,750 menopausal symptoms, except that she 1498 00:55:33,750 --> 00:55:36,166 still has a low libido, which she finds 1499 00:55:36,166 --> 00:55:38,833 distressing, and for which there is no 1500 00:55:38,833 --> 00:55:41,625 other obvious cause, then we're allowed 1501 00:55:41,625 --> 00:55:43,833 to consider a trial of testosterone 1502 00:55:44,125 --> 00:55:45,750 transdermally, so through the skin. 1503 00:55:47,250 --> 00:55:48,416 But only for low libido. 1504 00:55:48,708 --> 00:55:49,875 Yeah, only for low libido. 1505 00:55:50,541 --> 00:55:53,250 The joke about that is that you go, oh, 1506 00:55:53,250 --> 00:55:54,833 okay, well, this woman actually fits all 1507 00:55:54,833 --> 00:55:56,916 those criteria, so let's go, and they go, 1508 00:55:56,916 --> 00:55:57,875 well, what are we gonna use? 1509 00:55:58,416 --> 00:56:00,166 Oh, we don't have a licensed female 1510 00:56:00,166 --> 00:56:02,375 product in the UK for this. 1511 00:56:02,583 --> 00:56:03,625 Oh, well, so what are 1512 00:56:03,625 --> 00:56:04,333 we supposed to do then? 1513 00:56:05,166 --> 00:56:07,166 So then the woman then either has to go 1514 00:56:07,166 --> 00:56:08,875 privately to be able to access, 1515 00:56:11,041 --> 00:56:15,375 yeah, so we have Androfem, which is a 1516 00:56:15,375 --> 00:56:16,625 testosterone cream that 1517 00:56:16,625 --> 00:56:17,791 comes from Perth, Australia. 1518 00:56:18,291 --> 00:56:22,458 So we've been using that in the UK under 1519 00:56:22,458 --> 00:56:24,625 MHRA guidance because we're allowed to 1520 00:56:24,625 --> 00:56:26,166 import it because we didn't have our own 1521 00:56:26,166 --> 00:56:29,250 product for, I don't know, probably a 1522 00:56:29,250 --> 00:56:31,500 good, maybe up to nearly 10 years now. 1523 00:56:31,500 --> 00:56:33,500 Now, it actually got its license a week 1524 00:56:33,500 --> 00:56:35,666 ago, which is brilliant, amazing. 1525 00:56:36,875 --> 00:56:38,458 Although, of course, in practice, all 1526 00:56:38,458 --> 00:56:42,125 that means is that now NICE will maybe 1527 00:56:42,125 --> 00:56:43,958 look at it as a possibility, but of 1528 00:56:43,958 --> 00:56:46,125 course, it's really expensive, so I'm 1529 00:56:46,125 --> 00:56:48,166 afraid I'm not holding my breath thinking 1530 00:56:48,166 --> 00:56:49,833 that it's actually gonna be available on 1531 00:56:49,833 --> 00:56:51,416 the NHS anytime soon. 1532 00:56:53,000 --> 00:56:57,375 Maybe a couple of years, but the other 1533 00:56:57,375 --> 00:57:00,500 option that women have is to have one of 1534 00:57:00,500 --> 00:57:03,125 the male testosterone products, but it 1535 00:57:03,125 --> 00:57:05,833 needs to be prescribed at a female dose, 1536 00:57:05,833 --> 00:57:06,250 which is 1537 00:57:06,250 --> 00:57:08,666 approximately 10% of a male dose. 1538 00:57:09,291 --> 00:57:11,000 Now, of course, I can do it in my sleep 1539 00:57:11,000 --> 00:57:12,791 because that's all I do day after day, 1540 00:57:12,791 --> 00:57:15,291 but most healthcare professionals aren't 1541 00:57:15,291 --> 00:57:17,041 used to doing it, and that's when we see 1542 00:57:17,041 --> 00:57:18,375 mistakes happening in women 1543 00:57:18,375 --> 00:57:19,708 being given the wrong doses. 1544 00:57:19,791 --> 00:57:20,458 Enginealized. 1545 00:57:21,375 --> 00:57:22,500 Yeah, but it is, 1546 00:57:24,541 --> 00:57:26,666 when you explain to women and say, look, 1547 00:57:26,666 --> 00:57:28,541 when you're in your 20s, your late 1548 00:57:28,541 --> 00:57:30,583 adolescence in your 20s and early 30s, 1549 00:57:30,583 --> 00:57:32,416 you had loads of testosterone, far more 1550 00:57:32,416 --> 00:57:33,208 testosterone actually 1551 00:57:33,208 --> 00:57:34,000 than you had estrogen, 1552 00:57:35,333 --> 00:57:36,916 and then from your kind of mid, 1553 00:57:38,333 --> 00:57:40,291 early to mid 30s onwards, it just 1554 00:57:40,291 --> 00:57:41,958 gradually started to decline, and it was 1555 00:57:41,958 --> 00:57:45,250 nothing, it was maybe one, 2% a year, not 1556 00:57:45,250 --> 00:57:47,583 that much, so maybe by the end of your 1557 00:57:47,583 --> 00:57:49,750 30s, you're thinking, well, okay, my 1558 00:57:49,750 --> 00:57:52,041 libido's not as good as it was, but maybe 1559 00:57:52,041 --> 00:57:54,291 I've been with my partner for 10, 15 1560 00:57:54,291 --> 00:57:55,833 years, we're not swinging from the 1561 00:57:55,833 --> 00:57:57,625 chandeliers anymore, we've now got kids 1562 00:57:57,625 --> 00:57:59,791 and jobs and stress, and people, we're 1563 00:57:59,791 --> 00:58:01,208 more worried about who's emptying the 1564 00:58:01,208 --> 00:58:04,541 dishwasher than what sexual position 1565 00:58:04,541 --> 00:58:05,375 we're gonna do tonight, 1566 00:58:06,541 --> 00:58:09,750 and so it's subtle, and most people don't 1567 00:58:09,750 --> 00:58:12,000 notice, but I also think there are some 1568 00:58:12,000 --> 00:58:13,708 women out there where when you really 1569 00:58:13,708 --> 00:58:15,916 carefully go into their history, their 1570 00:58:15,916 --> 00:58:18,000 chronic fatigue syndrome, or their 1571 00:58:18,000 --> 00:58:20,750 fibromyalgia, or their depression that 1572 00:58:20,750 --> 00:58:22,541 seemed to come out of nowhere has come 1573 00:58:22,541 --> 00:58:25,125 about around that time, and we've tried 1574 00:58:25,125 --> 00:58:30,375 all other ways of treating it, and 1575 00:58:30,375 --> 00:58:31,625 actually then you add the testosterone, 1576 00:58:31,875 --> 00:58:34,416 and it's like, bingo, that was what the 1577 00:58:34,416 --> 00:58:35,458 problem was, there was no 1578 00:58:35,458 --> 00:58:36,500 testosterone in the system. 1579 00:58:37,625 --> 00:58:39,833 So testosterone is not, for most women, 1580 00:58:39,833 --> 00:58:41,458 it's not actually about the menopause, it 1581 00:58:41,458 --> 00:58:45,125 started before the menopause started to 1582 00:58:45,125 --> 00:58:48,250 happen, it's just that by the time you 1583 00:58:48,250 --> 00:58:50,708 get to your menopause and your estrogen 1584 00:58:50,708 --> 00:58:52,791 and progesterone have also gone right 1585 00:58:52,791 --> 00:58:54,958 down, I think it's more exposed that your 1586 00:58:54,958 --> 00:58:57,000 testosterone's low, but then of course we 1587 00:58:57,000 --> 00:58:59,250 have got the women, the younger women 1588 00:58:59,250 --> 00:59:02,083 that have the premature menopause, they 1589 00:59:02,083 --> 00:59:04,291 often really do well with testosterone 1590 00:59:04,625 --> 00:59:07,583 because they're still much younger, and 1591 00:59:07,583 --> 00:59:10,083 that kind of need that extra energy and 1592 00:59:10,083 --> 00:59:12,041 stamina, and then the women that have a 1593 00:59:12,041 --> 00:59:13,625 surgical menopause where their ovaries 1594 00:59:13,625 --> 00:59:16,583 are removed overnight, they lose 50% of 1595 00:59:16,583 --> 00:59:18,541 their testosterone in a bucket overnight 1596 00:59:18,541 --> 00:59:21,083 in the surgery, so they 1597 00:59:21,083 --> 00:59:22,791 often do really well with it. 1598 00:59:23,333 --> 00:59:24,625 And when you actually explain to women 1599 00:59:24,625 --> 00:59:27,125 and say, "Look, all I'm doing is giving 1600 00:59:27,125 --> 00:59:29,250 you back a hormone that you've had in 1601 00:59:29,250 --> 00:59:31,250 your body since puberty, 1602 00:59:32,958 --> 00:59:34,625 and I'm only giving you back a tiny, I'm 1603 00:59:34,625 --> 00:59:36,583 giving you 10% before I give to a man, 1604 00:59:37,125 --> 00:59:39,125 and we will actually measure it in your 1605 00:59:39,125 --> 00:59:40,500 blood just to prove to you 1606 00:59:40,500 --> 00:59:42,583 that you're still female." 1607 00:59:44,125 --> 00:59:47,000 And the worst thing that could happen is 1608 00:59:47,000 --> 00:59:48,791 you'll get a bit of acne back if you were 1609 00:59:48,791 --> 00:59:51,041 prone to acne in the past or a few darker 1610 00:59:51,041 --> 00:59:52,500 hairs, and then it's reversible. 1611 00:59:53,250 --> 00:59:55,041 You stop the medication, it comes back. 1612 00:59:55,541 --> 00:59:57,458 So it's amazing, and actually, the 1613 00:59:57,458 --> 01:00:00,583 problem with testosterone is that we 1614 01:00:00,583 --> 01:00:03,833 don't have enough evidence in terms of 1615 01:00:03,833 --> 01:00:06,250 worldwide, big enough randomized 1616 01:00:06,250 --> 01:00:09,125 controlled trials to prove that it's 1617 01:00:09,125 --> 01:00:10,500 effective for anything 1618 01:00:10,583 --> 01:00:12,208 apart from low libido. 1619 01:00:14,000 --> 01:00:16,916 From a day-to-day point of view, we see 1620 01:00:16,916 --> 01:00:18,166 it all the time, people's mood gets 1621 01:00:18,166 --> 01:00:19,916 better, their stamina gets 1622 01:00:19,916 --> 01:00:21,333 better, they can work out. 1623 01:00:22,000 --> 01:00:23,375 I mean, I definitely, when I started 1624 01:00:23,375 --> 01:00:26,250 testosterone, I mean, I was training a 1625 01:00:26,250 --> 01:00:27,875 lot anyway physically, but when you're 1626 01:00:27,875 --> 01:00:29,666 measuring everything on a Garmin, every 1627 01:00:29,666 --> 01:00:32,000 spin pass and every run, and it clearly 1628 01:00:32,000 --> 01:00:33,333 jumps up a massive knot 1629 01:00:34,625 --> 01:00:36,833 from using physiological levels of 1630 01:00:36,833 --> 01:00:39,750 testosterone, you go, "Well, why would 1631 01:00:39,750 --> 01:00:42,416 anyone not want to try this?" 1632 01:00:44,666 --> 01:00:47,416 But we don't have, there is no data out 1633 01:00:47,416 --> 01:00:48,083 there because no one 1634 01:00:48,083 --> 01:00:49,041 will fund the studies. 1635 01:00:49,291 --> 01:00:51,166 The British Menopause Society, just a 1636 01:00:51,166 --> 01:00:54,375 couple of years ago, put in a bid to say, 1637 01:00:54,375 --> 01:00:56,500 "Look, we wanna see, "does this help bone 1638 01:00:56,500 --> 01:00:58,125 density and muscle strength and mood?" 1639 01:00:58,750 --> 01:00:59,958 No one will fund it. 1640 01:01:00,791 --> 01:01:02,250 Now, quite, I'm not gonna get on my 1641 01:01:02,250 --> 01:01:03,291 political high horse 1642 01:01:04,083 --> 01:01:05,833 about what sort of 1643 01:01:05,833 --> 01:01:07,958 misogynistic political, 1644 01:01:09,166 --> 01:01:11,541 people say, "What would the world look 1645 01:01:11,541 --> 01:01:15,625 like "if women had the same rights as men 1646 01:01:15,708 --> 01:01:18,750 "to having their own physiological setup 1647 01:01:18,916 --> 01:01:20,833 "restored to them at this time?" 1648 01:01:22,666 --> 01:01:24,416 There's some stupid quote, isn't there, 1649 01:01:24,416 --> 01:01:28,333 about there's more CEOs in the UK called 1650 01:01:28,333 --> 01:01:31,458 John than there are female CEOs in total. 1651 01:01:31,791 --> 01:01:33,541 It's that sort of stupid, it's like, 1652 01:01:33,541 --> 01:01:34,250 "Well, why is that?" 1653 01:01:34,250 --> 01:01:36,916 It's because we all are far perched. 1654 01:01:37,375 --> 01:01:39,416 And you started the podcast by talking 1655 01:01:39,416 --> 01:01:41,291 about what is our use after menopause. 1656 01:01:41,625 --> 01:01:43,791 I'm a big fan of the grandma hypothesis. 1657 01:01:44,625 --> 01:01:47,666 So, that families, and they found this 1658 01:01:47,666 --> 01:01:48,791 in, I think it was, was 1659 01:01:48,791 --> 01:01:49,958 it dolphins or whales? 1660 01:01:49,958 --> 01:01:50,416 I think it was whales. 1661 01:01:51,083 --> 01:01:54,416 The families with a grandmother in them 1662 01:01:55,000 --> 01:01:56,541 had far better survival rates. 1663 01:01:56,541 --> 01:01:58,208 So the children did better, the 1664 01:01:58,208 --> 01:01:59,958 grandchildren did better with a grandma 1665 01:02:00,500 --> 01:02:01,708 because they're there. 1666 01:02:02,083 --> 01:02:03,958 And to make a grandma a grandma, you need 1667 01:02:03,958 --> 01:02:06,208 to make her unproductive. 1668 01:02:06,916 --> 01:02:08,125 Yeah, so you've got to stop her 1669 01:02:08,125 --> 01:02:09,416 reproduction so that she can just 1670 01:02:09,416 --> 01:02:10,833 concentrate on looking after and 1671 01:02:10,833 --> 01:02:12,125 nurturing and baking cakes 1672 01:02:12,291 --> 01:02:13,916 and cleaning up and things. 1673 01:02:15,000 --> 01:02:17,166 So that's my kind of slightly nicer take 1674 01:02:17,166 --> 01:02:18,791 on why we have the menopause. 1675 01:02:18,791 --> 01:02:21,583 But actually, now we live in a society 1676 01:02:21,833 --> 01:02:23,041 where women have to keep working. 1677 01:02:23,250 --> 01:02:25,333 We can't just not work at all or stop 1678 01:02:25,333 --> 01:02:26,541 work when we get to 45. 1679 01:02:28,125 --> 01:02:29,916 And so, yeah, testosterone 1680 01:02:29,916 --> 01:02:32,333 can be a massive benefit. 1681 01:02:32,333 --> 01:02:34,750 But then equally with some of my ladies 1682 01:02:34,750 --> 01:02:36,708 that have had genetic testing doing, you 1683 01:02:36,708 --> 01:02:40,333 actually see that if they have the genes, 1684 01:02:40,333 --> 01:02:41,916 which mean that you turn your 1685 01:02:41,916 --> 01:02:44,666 testosterone a bit too readily into 1686 01:02:44,666 --> 01:02:46,541 estrogen, and they're already a bit 1687 01:02:46,541 --> 01:02:48,041 estrogen dominant, you'll find that they 1688 01:02:48,041 --> 01:02:49,000 don't feel any better. 1689 01:02:49,000 --> 01:02:49,916 In fact, you wobble their 1690 01:02:49,916 --> 01:02:51,208 nervous system a little bit more. 1691 01:02:51,791 --> 01:02:53,541 Would you not maybe blunt that with some 1692 01:02:53,541 --> 01:02:55,750 sort of compound like aromatase 1693 01:02:55,750 --> 01:02:58,166 inhibitors or aromatics to sort of... 1694 01:02:58,625 --> 01:02:59,833 I think that I have 1695 01:02:59,833 --> 01:03:01,000 certainly heard of that. 1696 01:03:01,333 --> 01:03:03,416 That's way beyond certainly my scope. 1697 01:03:03,416 --> 01:03:08,583 And maybe I think that's maybe more in 1698 01:03:08,583 --> 01:03:10,833 male kind of medicine, but it's certainly 1699 01:03:10,833 --> 01:03:12,166 not something we're doing. 1700 01:03:12,250 --> 01:03:14,750 Okay, you're not trying to actively 1701 01:03:14,958 --> 01:03:16,333 manipulate aromatase activity? 1702 01:03:17,000 --> 01:03:18,250 Not usually, no. 1703 01:03:18,250 --> 01:03:19,625 I mean, obviously some of our breast 1704 01:03:19,625 --> 01:03:21,458 cancer patients may be on an aromatase 1705 01:03:21,458 --> 01:03:23,500 inhibitor, but no, we wouldn't normally. 1706 01:03:23,541 --> 01:03:25,416 We'd be looking more at the kind of 1707 01:03:25,416 --> 01:03:27,166 dietary ways of doing that or some... 1708 01:03:27,750 --> 01:03:29,416 Dim and all of that sort of stuff. 1709 01:03:29,458 --> 01:03:30,375 Yeah, but of course I'm a 1710 01:03:30,375 --> 01:03:31,750 big fan of just don't... 1711 01:03:31,750 --> 01:03:33,500 I get them sprouting their own broccoli. 1712 01:03:33,958 --> 01:03:34,625 Fair enough, yeah. 1713 01:03:34,875 --> 01:03:36,583 That's a starting point, yeah. 1714 01:03:37,166 --> 01:03:38,083 Yeah, perfect. 1715 01:03:38,458 --> 01:03:39,000 And it also brings... 1716 01:03:39,250 --> 01:03:40,750 Sorry, do you mind me just mention it? 1717 01:03:40,750 --> 01:03:42,625 It just also made me think something you 1718 01:03:42,625 --> 01:03:45,500 said earlier was that convention says 1719 01:03:45,500 --> 01:03:46,958 that HRT is about 1720 01:03:46,958 --> 01:03:48,500 estrogen and progesterone, 1721 01:03:49,500 --> 01:03:52,708 but actually now that the pendulum has 1722 01:03:52,708 --> 01:03:54,125 sort of swung with menopause and it's 1723 01:03:54,125 --> 01:03:55,666 more of a common conversation. 1724 01:03:56,375 --> 01:03:58,333 I do get women coming earlier and earlier 1725 01:03:58,333 --> 01:04:00,083 now, so they might be in their early 40s 1726 01:04:00,083 --> 01:04:02,708 and then they might not be in too bad of 1727 01:04:02,708 --> 01:04:05,291 a place, but they're coming in a 1728 01:04:05,291 --> 01:04:06,500 proactive, preventative 1729 01:04:06,500 --> 01:04:07,291 way, which is brilliant. 1730 01:04:07,833 --> 01:04:09,000 And sometimes when you talk to these 1731 01:04:09,000 --> 01:04:10,583 women, they're just getting the symptoms 1732 01:04:10,583 --> 01:04:12,041 of low progesterone at that point. 1733 01:04:12,375 --> 01:04:14,291 So their sleep's gone a bit, their 1734 01:04:14,291 --> 01:04:15,916 menstrual cycles changed a little bit and 1735 01:04:15,916 --> 01:04:17,416 they're getting anxious, but actually 1736 01:04:17,416 --> 01:04:18,791 they haven't got the hot sweats and 1737 01:04:18,791 --> 01:04:20,291 flushes, their joints are still okay, 1738 01:04:20,291 --> 01:04:21,000 they haven't got the 1739 01:04:21,000 --> 01:04:22,208 genitourinary symptoms. 1740 01:04:22,750 --> 01:04:24,250 And so for some of them, you can just 1741 01:04:24,250 --> 01:04:25,750 give them some natural progesterone. 1742 01:04:26,416 --> 01:04:27,250 Bob's your uncle, they feel 1743 01:04:27,250 --> 01:04:28,250 great for another few years. 1744 01:04:28,583 --> 01:04:29,958 And then you just, as long as I say to 1745 01:04:29,958 --> 01:04:31,500 them, at some point you may well need 1746 01:04:31,500 --> 01:04:33,833 some estrogen, but we can do this in a 1747 01:04:33,833 --> 01:04:35,166 very gradual journey. 1748 01:04:35,750 --> 01:04:36,875 I think progesterone has been 1749 01:04:36,875 --> 01:04:38,541 completely overlooked as well. 1750 01:04:38,541 --> 01:04:40,666 Testosterone has been overlooked and 1751 01:04:40,666 --> 01:04:42,083 progesterone has also been, we've 1752 01:04:42,083 --> 01:04:44,291 concentrated a bit too much on estrogen, 1753 01:04:44,291 --> 01:04:46,791 although it is a brilliant hormone. 1754 01:04:47,750 --> 01:04:50,333 Yeah, again, it's so much easier being 1755 01:04:50,333 --> 01:04:52,000 male, all you've got to fundamentally do 1756 01:04:52,000 --> 01:04:53,666 is just, right, so what do you need? 1757 01:04:53,875 --> 01:04:54,875 Testosterone, what's gonna happen? 1758 01:04:55,083 --> 01:04:55,833 Worst case scenario, 1759 01:04:55,833 --> 01:04:57,000 you're gonna over-romatize it. 1760 01:04:57,000 --> 01:04:58,291 Okay, we'll give you a drug for that. 1761 01:04:59,375 --> 01:05:01,041 And then you can just sort of tweak one 1762 01:05:01,041 --> 01:05:02,666 or two variables until you get it right. 1763 01:05:02,666 --> 01:05:04,291 Yeah, maybe you've got to look at the 1764 01:05:04,291 --> 01:05:05,416 thyroid as well, but 1765 01:05:05,416 --> 01:05:07,916 it's definitely simpler. 1766 01:05:09,583 --> 01:05:09,833 Dr. 1767 01:05:09,833 --> 01:05:11,625 Bo, I'd love to sort of maybe touch on 1768 01:05:11,625 --> 01:05:14,125 some of the DHT stuff in a second, but 1769 01:05:14,125 --> 01:05:17,208 first, what are your thoughts on DHEA? 1770 01:05:17,208 --> 01:05:19,291 Now, I mean, obviously women produce 1771 01:05:19,291 --> 01:05:21,083 testosterone as you alluded to earlier, 1772 01:05:21,791 --> 01:05:23,458 either in the sort of ovaries or the 1773 01:05:23,458 --> 01:05:26,458 adrenal glands, and some women are going 1774 01:05:26,458 --> 01:05:29,666 to naturally be biased towards or 1775 01:05:29,666 --> 01:05:33,208 inclined to produce more testosterone in, 1776 01:05:34,041 --> 01:05:34,833 yeah, the adrenal 1777 01:05:34,833 --> 01:05:36,208 glands versus the ovaries, 1778 01:05:37,708 --> 01:05:40,083 as, yeah, just based on the genetics. 1779 01:05:40,833 --> 01:05:45,041 Now, one would assume that if a woman is 1780 01:05:45,041 --> 01:05:48,750 predominantly a sort of a producer of 1781 01:05:48,750 --> 01:05:51,208 testosterone from the ovarian standpoint, 1782 01:05:51,208 --> 01:05:51,833 that when they get to 1783 01:05:51,833 --> 01:05:54,666 menopause, that's going to go away. 1784 01:05:54,666 --> 01:05:56,791 But for a woman who maybe has more of a 1785 01:05:56,791 --> 01:05:59,958 bias towards producing a testosterone 1786 01:05:59,958 --> 01:06:02,916 from the adrenal glands, would a compound 1787 01:06:02,916 --> 01:06:06,916 like DHEA, is it a compound like DHEA 1788 01:06:06,916 --> 01:06:08,875 that is fundamentally a hormone precursor 1789 01:06:10,166 --> 01:06:12,708 be an effective option in these sorts of 1790 01:06:12,708 --> 01:06:14,500 women, or is it a bit hit in this? 1791 01:06:14,833 --> 01:06:19,833 Yeah, so I only prescribe what I call 1792 01:06:19,833 --> 01:06:24,500 body identical HRT, and by that I mean 1793 01:06:24,500 --> 01:06:27,666 it's bioidentical as in it's molecularly 1794 01:06:27,666 --> 01:06:28,666 identical to our own 1795 01:06:28,666 --> 01:06:30,375 hormones, but it is regulated. 1796 01:06:31,083 --> 01:06:34,375 So it's all via the MRHA, so it's the 1797 01:06:34,375 --> 01:06:36,500 standard kind of things 1798 01:06:36,500 --> 01:06:37,333 that can be prescribed. 1799 01:06:38,291 --> 01:06:40,666 Some private clinics do what we call 1800 01:06:41,208 --> 01:06:43,250 compounded bioidentical hormones where 1801 01:06:43,250 --> 01:06:45,666 it's kind of sort of made to 1802 01:06:45,666 --> 01:06:47,000 measure, but it's not regulated. 1803 01:06:47,375 --> 01:06:51,333 So I see the role of it and why it's 1804 01:06:51,333 --> 01:06:52,958 cropped up, but I don't support that 1805 01:06:52,958 --> 01:06:56,541 because the safety data isn't there, 1806 01:06:56,541 --> 01:06:58,000 because it isn't regulated. 1807 01:06:58,750 --> 01:07:00,666 Okay, so prohormans are 1808 01:07:00,666 --> 01:07:01,500 to think for you then? 1809 01:07:02,125 --> 01:07:06,125 No, no, but I do understand why they're 1810 01:07:06,125 --> 01:07:12,666 there, but from my training and my who I- 1811 01:07:12,875 --> 01:07:13,666 The way you practice. 1812 01:07:13,666 --> 01:07:16,041 The way I practice is that it's the 1813 01:07:16,041 --> 01:07:19,458 regulated stuff, but we do have DHEA in a 1814 01:07:19,458 --> 01:07:21,875 regulated vaginal pessary, 1815 01:07:23,083 --> 01:07:24,875 which can be highly effective if just 1816 01:07:24,875 --> 01:07:26,541 using estrogen in the 1817 01:07:26,541 --> 01:07:27,958 vaginal vulva isn't helpful. 1818 01:07:29,333 --> 01:07:32,416 So yeah, the pessary, again, you know 1819 01:07:32,416 --> 01:07:34,625 this, but the simplicity of it is that it 1820 01:07:34,625 --> 01:07:36,208 essentially turns into estrogen and 1821 01:07:36,208 --> 01:07:37,500 testosterone in the cell, therefore 1822 01:07:37,500 --> 01:07:39,500 you're sort of getting, well, I always 1823 01:07:39,500 --> 01:07:40,625 want to say you're getting two hormones 1824 01:07:40,625 --> 01:07:42,041 for the price of one, but in fact, 1825 01:07:42,125 --> 01:07:43,375 probably you're getting two hormones for 1826 01:07:43,375 --> 01:07:46,791 the price of two hormones privately, but 1827 01:07:46,791 --> 01:07:50,291 yeah, so that can be helpful, but I do 1828 01:07:50,291 --> 01:07:53,250 have patients coming to me from IO 1829 01:07:53,250 --> 01:07:55,208 identical clinics who want to change the 1830 01:07:55,208 --> 01:07:56,916 regulated stuff, and often they are on 1831 01:07:56,916 --> 01:08:03,041 DHEA, but I don't prescribe that, so I do 1832 01:08:03,041 --> 01:08:04,541 see that there's a role for it because 1833 01:08:04,541 --> 01:08:07,333 everyone is different, but in a world 1834 01:08:07,333 --> 01:08:09,791 where a lot of the guidelines and the 1835 01:08:09,791 --> 01:08:13,125 MRHA deals with, you know, this is the 1836 01:08:13,125 --> 01:08:14,666 guideline and it's got to suit everyone, 1837 01:08:15,666 --> 01:08:17,833 you know, I sort of explain, well, you're 1838 01:08:17,833 --> 01:08:20,041 not losing too much by losing that DHEA 1839 01:08:20,083 --> 01:08:21,666 because we're going to give you the 1840 01:08:21,666 --> 01:08:23,791 estrogen and testosterone, it's just, you 1841 01:08:23,791 --> 01:08:27,791 know, but I recognize there's a much more 1842 01:08:27,791 --> 01:08:29,083 detailed minutiae underneath 1843 01:08:29,083 --> 01:08:31,416 that, but you know, we're-- 1844 01:08:31,625 --> 01:08:33,250 That's how do your scope of practice, and 1845 01:08:33,250 --> 01:08:34,541 that's understandable, fair enough. 1846 01:08:35,458 --> 01:08:39,833 Okay, DHEA, obviously, yeah, I think 1847 01:08:39,833 --> 01:08:42,416 that's what most women are worried about 1848 01:08:42,416 --> 01:08:44,875 when you mention testosterone, and of 1849 01:08:44,875 --> 01:08:46,916 course, just for the audience, what 1850 01:08:46,916 --> 01:08:50,250 testosterone is, it's a hormone, it's a 1851 01:08:50,250 --> 01:08:52,333 male hormone, which I don't like because 1852 01:08:52,333 --> 01:08:55,000 hormones are hormones, I suppose they 1853 01:08:55,000 --> 01:08:57,333 have a secondary sex characteristic 1854 01:08:57,333 --> 01:08:59,541 development attached to them, but a 1855 01:08:59,541 --> 01:09:02,583 hormone fundamentally does the job, but 1856 01:09:02,583 --> 01:09:05,708 what testosterone does is it's converted 1857 01:09:06,125 --> 01:09:08,083 by an enzyme called anagene called 1858 01:09:08,083 --> 01:09:12,333 5-alpha reductase into DHT, and now DHT 1859 01:09:12,333 --> 01:09:14,625 is this very 1860 01:09:14,625 --> 01:09:19,000 adrenergic, I've got that right, 1861 01:09:21,333 --> 01:09:23,083 no, not adrenergic, that's-- Adrogenic. 1862 01:09:23,583 --> 01:09:24,750 Androgenic, thank you. 1863 01:09:24,750 --> 01:09:25,041 Yeah, that's where you 1864 01:09:25,041 --> 01:09:26,000 get the acne in there. 1865 01:09:26,541 --> 01:09:29,666 Yeah, hormone, that then drives a lot of 1866 01:09:29,666 --> 01:09:32,125 these sorts of issues when it's in 1867 01:09:32,125 --> 01:09:34,250 excess, now a certain amount of DHT is 1868 01:09:34,250 --> 01:09:36,500 definitely very healthy and it helps with 1869 01:09:36,500 --> 01:09:39,166 mood and executive function and all of 1870 01:09:39,166 --> 01:09:41,416 that, but excessive amounts can lead to 1871 01:09:41,416 --> 01:09:42,500 hair growth, hair loss, 1872 01:09:43,500 --> 01:09:46,291 sort of the widening of jaw, all sorts of 1873 01:09:46,291 --> 01:09:47,875 things like this, deepening of the voice 1874 01:09:48,250 --> 01:09:49,583 that are definitely not wanted, 1875 01:09:49,583 --> 01:09:50,750 especially among women. 1876 01:09:51,458 --> 01:09:54,625 When you are sort of working with a woman 1877 01:09:54,625 --> 01:09:58,208 on testosterone, are you, I think you did 1878 01:09:58,208 --> 01:09:59,833 mention it, but are you looking at maybe 1879 01:09:59,833 --> 01:10:02,083 any of these genes, are you looking at 1880 01:10:02,083 --> 01:10:05,000 ways to maybe modulate this 5-alpha 1881 01:10:05,000 --> 01:10:07,250 reductase expression so that you can 1882 01:10:07,250 --> 01:10:09,083 control that conversion 1883 01:10:09,083 --> 01:10:11,083 of testosterone to DHT or? 1884 01:10:11,541 --> 01:10:14,291 Yes, if I had a woman come see me who had 1885 01:10:14,291 --> 01:10:17,166 struggled in her life already with quite 1886 01:10:17,166 --> 01:10:20,291 bad acne, then that would-- 1887 01:10:22,875 --> 01:10:36,166 T-c If the skin erupts, you just stop it 1888 01:10:36,500 --> 01:10:38,625 and it will come back out of your system, 1889 01:10:38,625 --> 01:10:39,666 it's not irreversible. 1890 01:10:40,916 --> 01:10:42,958 But then if, again, if they have the 1891 01:10:42,958 --> 01:10:45,375 ability to, we could say, we could look 1892 01:10:45,375 --> 01:10:47,041 at your genes and then we could look at 1893 01:10:47,041 --> 01:10:50,500 more dietary and lifestyle ways of trying 1894 01:10:50,500 --> 01:10:53,166 to manage that gene as best we can. 1895 01:10:53,666 --> 01:10:55,208 But I mean, we also, I always remember 1896 01:10:55,208 --> 01:10:56,791 that lecture when I was doing the 1897 01:10:56,791 --> 01:10:58,166 training about that some of the 1898 01:10:58,166 --> 01:10:59,333 testosterone goes to 1899 01:10:59,333 --> 01:11:01,333 the, goes to, is it Adiol? 1900 01:11:02,333 --> 01:11:03,083 Androstenediol. 1901 01:11:03,916 --> 01:11:06,291 Which for some people is so relaxing. 1902 01:11:06,291 --> 01:11:09,000 So I've had patients that their primary 1903 01:11:09,000 --> 01:11:10,875 issue is anxiety and we've done 1904 01:11:10,875 --> 01:11:12,958 everything else, we've given them 1905 01:11:12,958 --> 01:11:14,375 progesterone, we've given them some 1906 01:11:14,375 --> 01:11:17,000 estrogen, we've looked at counseling, 1907 01:11:17,250 --> 01:11:19,500 we've looked at, we've kind of done 1908 01:11:19,500 --> 01:11:21,125 everything and then you just give them a 1909 01:11:21,125 --> 01:11:22,333 little bit of testosterone and suddenly 1910 01:11:22,333 --> 01:11:24,500 they go, "Oh, why did you not give me 1911 01:11:24,500 --> 01:11:25,416 that eight years ago?" 1912 01:11:25,416 --> 01:11:26,625 And I say it's because you were too 1913 01:11:26,625 --> 01:11:28,208 anxious to have it, remember, we've had 1914 01:11:28,208 --> 01:11:30,000 all these, then again, isn't it? 1915 01:11:30,500 --> 01:11:30,708 It's a special issue. 1916 01:11:30,750 --> 01:11:32,166 There's obviously the link between 1917 01:11:32,166 --> 01:11:33,666 testosterone and dopamine as well. 1918 01:11:33,666 --> 01:11:35,583 And the more dopamine you have, Bob's 1919 01:11:35,583 --> 01:11:38,125 your uncle, you're going to be in a far 1920 01:11:38,125 --> 01:11:38,666 more sort of 1921 01:11:38,708 --> 01:11:41,041 parasympathetic rest and digest state. 1922 01:11:41,291 --> 01:11:43,333 So I'm sure that plays into it as well. 1923 01:11:43,750 --> 01:11:46,416 What about things like, I'm sure I know 1924 01:11:46,416 --> 01:11:48,958 the answer but compounds like salt, 1925 01:11:48,958 --> 01:11:50,500 palmetto, have you ever utilized 1926 01:11:50,500 --> 01:11:51,583 something like that? 1927 01:11:51,625 --> 01:11:55,083 Again, it's one of those where I have 1928 01:11:55,083 --> 01:11:57,541 heard about it in the lectures and I 1929 01:11:57,541 --> 01:11:59,000 understand that it's all to do with the 1930 01:11:59,000 --> 01:12:01,041 testosterone thing, but I leave that to 1931 01:12:01,041 --> 01:12:04,583 the nutritionist who actually, yeah. 1932 01:12:05,000 --> 01:12:06,916 I'll talk about basic supplements with 1933 01:12:06,916 --> 01:12:09,166 them, but then when we're getting that 1934 01:12:09,166 --> 01:12:11,500 individual, then I say, "Look, I'm not 1935 01:12:11,500 --> 01:12:14,166 actually a nutritionist, I'm sort of 1936 01:12:14,166 --> 01:12:15,958 signposting you towards one." 1937 01:12:17,250 --> 01:12:17,583 Fair enough. 1938 01:12:18,416 --> 01:12:18,708 Dr. 1939 01:12:18,708 --> 01:12:20,250 Ball, this has been a fascinating 1940 01:12:20,250 --> 01:12:22,541 conversation and you've 1941 01:12:22,541 --> 01:12:23,666 been an absolute star. 1942 01:12:24,583 --> 01:12:26,416 Before I let you go though, I'd just sort 1943 01:12:26,416 --> 01:12:29,500 of love to run through a few rapid fire 1944 01:12:29,625 --> 01:12:30,708 questions if that's okay. 1945 01:12:31,833 --> 01:12:34,916 And yeah, to start off with, what is the 1946 01:12:34,916 --> 01:12:39,125 one lab test every woman should, on HRT 1947 01:12:39,125 --> 01:12:40,083 should get or consider 1948 01:12:40,083 --> 01:12:41,291 getting in your opinion? 1949 01:12:42,208 --> 01:12:42,416 None. 1950 01:12:43,625 --> 01:12:44,125 Fair enough. 1951 01:12:44,250 --> 01:12:46,208 Apart from if she was on testosterone, we 1952 01:12:46,208 --> 01:12:48,000 would have to monitor that because the 1953 01:12:48,000 --> 01:12:49,583 guidelines say so but the 1954 01:12:49,583 --> 01:12:50,791 rest is all too misleading. 1955 01:12:51,791 --> 01:12:52,125 All right. 1956 01:12:52,666 --> 01:12:54,791 What's your one negotiable lifestyle tip 1957 01:12:54,791 --> 01:12:58,000 for women on HRT or considering the HRT? 1958 01:13:00,208 --> 01:13:01,125 All of them, but 1959 01:13:01,125 --> 01:13:02,833 movement, I suppose is my... 1960 01:13:03,958 --> 01:13:04,625 Go to. 1961 01:13:04,666 --> 01:13:05,500 That's my go to. 1962 01:13:05,791 --> 01:13:06,166 Fair enough. 1963 01:13:06,750 --> 01:13:07,000 Okay. 1964 01:13:08,333 --> 01:13:10,291 The biggest misconception about the use 1965 01:13:10,291 --> 01:13:11,708 of testosterone for women? 1966 01:13:12,125 --> 01:13:12,916 That it will turn you 1967 01:13:12,916 --> 01:13:14,250 into a bearded lady. 1968 01:13:15,541 --> 01:13:15,916 Will not. 1969 01:13:16,125 --> 01:13:17,791 I've never in, I've, I don't know how 1970 01:13:17,791 --> 01:13:19,166 many tens of thousands of prescriptions 1971 01:13:19,166 --> 01:13:20,666 I've done for testosterone for women. 1972 01:13:21,083 --> 01:13:22,000 Never had a problem. 1973 01:13:22,583 --> 01:13:23,541 So you're telling me you're not 1974 01:13:23,541 --> 01:13:25,125 prescribing a hundred milligrams a week? 1975 01:13:25,208 --> 01:13:25,500 No. 1976 01:13:26,458 --> 01:13:27,166 Fair enough. 1977 01:13:28,041 --> 01:13:30,750 And does HRT need to be 1978 01:13:30,750 --> 01:13:32,958 titrated down with age? 1979 01:13:33,875 --> 01:13:34,791 Usually, yeah. 1980 01:13:34,791 --> 01:13:38,083 So in general, you'll need to go up as 1981 01:13:38,083 --> 01:13:41,000 you head towards the menopause, plateau 1982 01:13:41,000 --> 01:13:46,291 for quite a while and then generally tend 1983 01:13:46,291 --> 01:13:48,625 to come down again, but not till, you 1984 01:13:48,625 --> 01:13:50,541 know, on average, I would say if I was 1985 01:13:50,541 --> 01:13:52,916 giving a 50 year old a normal dose, 1986 01:13:53,958 --> 01:13:57,625 I might reduce that by 25% at around 60 1987 01:13:57,875 --> 01:14:00,583 and then another 25% around 70 and then 1988 01:14:00,583 --> 01:14:02,791 another 25% around 80. 1989 01:14:02,791 --> 01:14:05,250 So that they're just on a smidgen at 90, 1990 01:14:05,500 --> 01:14:07,958 but they've made it to 90 and they're 1991 01:14:07,958 --> 01:14:09,458 still banding up the stairs to clinic. 1992 01:14:09,791 --> 01:14:10,000 So. 1993 01:14:12,041 --> 01:14:12,208 Perfect. 1994 01:14:13,166 --> 01:14:13,291 Dr. 1995 01:14:13,291 --> 01:14:14,500 Baugh, you've been a star. 1996 01:14:14,500 --> 01:14:16,000 Thank you so much for your time and 1997 01:14:16,000 --> 01:14:17,416 hopefully we can do this again soon. 1998 01:14:17,916 --> 01:14:18,666 Thank you, Rob.