Podcast Episodes
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Episode #
4
In this episode of The Root Cause Medicine Podcast, Dr. Anthony Crifase is joined by Dr. Elizabeth Yurth, Founder and Medical Director of the Boulder Longevity Institute. They discuss the most common root issues linked with hormone imbalances in women, reasons and signs of hormonal imbalances, and the treatment options available for women.
Hosted by
Anthony Crifase
November 4, 2021
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46
 mins

Hormonal Imbalances with Dr. Elizabeth Yurth, Founder and Medical Director of the Boulder Longevity Institute

Transcription

Hey, everybody. Welcome to the root cause medicine podcast. I'm your host, Dr. Anthony  today, we're talking with Dr. Elizabeth URI about women's hormones. Here's a clip from today's show. You're young. If you're 25 and you're somebody who has a family history of breast cancer, very likely you have a metabolism pathway.
That's sending your estrogens down a bad material. And if we know that we can do very simple things to change that metabolism, same. Thing's true. If I put you on hormones, I put you on hormones and you took all that hormone and you metabolize it down a dangerous Catholic then likely I did cause cancer in you.
But if I make sure it's all metabolized in a safe pathway, then like that protected you from cancer. That's just a small taste of the great show we've got. Rupa health is the best way to order track and get results from 20 plus lab companies in a single place.
Welcome to the root cause medicine podcast. My guest today is Dr. Elizabeth URI. Dr.  is the founder of the Boulder longevity Institute where she currently serves as the medical director. Dr.  is a graduate of the university of Southern California medical school, where she finished at the top of her class with honors and is board certified in anti-aging and regenerative medicine from the American academy of anti-aging medicine.
Dr. URI has an extensive background in numerous areas with a primary focus on genomic interpretation and analysis among many other things. So Dr. , it's a pleasure to have you here today. So excited to have you on the podcast. Thank you. I really appreciate being invited here and talking to you. Yeah, of course, it's a pleasure to have you here.
You have an amazing background and have clearly spent a lot of your career helping women and working in the field of hormones. So I want to just dive right in today and really get your feedback on how you manage to help your patients. And people understand this sometimes very complex topic from a really simplified say 10,000 foot view perspective.
Perfect. I love this and it's a great topic. That's going to be the root of everything in terms of health in my mind. So let's get people familiar with this. And so they really aren't scared of hormones. Cause that's the biggest problem we have right now. Absolutely. It's very true. People are scared of their own bodies.
Right? Well, I think that unfortunately the propaganda around hormones and cancer has really just stuck with the general practitioners, right. Who have then propagate that information to their patients. And so trying to dispel some of those myths is been a challenge and really unfortunately at the detriment of women's health.
So we have to get that out of. That's true. I can see how that happens. So when you approach patients with, again, this, this topic of hormones and how people can address it, can you give somebody a, just a very elementary explanation of how you approach the process of looking at their hormones or how they could look at their hormones from, again, just a very basic perspective.
Well, I think that the, probably one of the misconceptions about hormones is you don't really start thinking about hormones until you're 50, right? And you start having issues. And unfortunately your hormones actually are sort of at their optimal, at a very young age, and then they start changing. But even at a young age, we're doing a lot of things that are hormone disruptors.
So we're singing young males with low testosterone. We're seeing females were on birth control pills. So their hormones are very, very messed up even after they stopped the birth control pills. So one of the things we always try to encourage in our clinic is that you need to actually start thinking about hormones at a much younger age.
It's not at 50 when all of a sudden you're mean and bitchy, and can't lose weight. You live to start looking at how they're affecting your impact in your health, even at a young age. And we'll talk about that a little bit more when we talked about how hormones are metabolized, but ultimately I think what oftentimes brings people in is something going wrong, right?
They're either not sleeping or they're gaining weight or they're irritable. Or their energy levels are bad, or they just can't put on muscle. And that can happen in a 30 year old. And it can happen in a six-year-old in times at different times for different people. And so when people come in with those complaints, one of the first things you have to look at is what is going on with their hormone levels.
And remember, we all have, if you're a man or a woman, you have the same hormones, you just have them in different ratios. So we all have estrogen. We all have progesterone and we all have testosterone. Those are main hormones. And then you've got, of course the thyroid hormones, your adrenal hormones, cortisol and DHA.
We'll focus on those sex hormones, the estrogens and progesterones and testosterones. We'll sort of focus on those right now. And so it's not just what are those levels, but it's really the ratio of those levels. That's what makes you a man? I mean, a woman is the ratios of those levels and the imbalances that occur are what create symptomatology.
So we have to start with getting a little baseline, look at everything. And then how are those things working together in symphony and in a perfect. Perfect. Thank you for that explanation. That makes more sense. And for those of you who are listening, if you want to seem smarter to your friends or family, like say when you're sitting at the dinner table around the holidays, just repeat what Dr.
just said, and they're going to all be going to for their health concerns. Thanks for that. Dr. Harris, obviously joking about that, but on a more serious note, we know that there's more involved here with hormonal issues, right? We have women who are in different phases of their life, whether they're menstruating or they're going through menopause, or they're trying to conceive a child.
So situations can become pretty complex, but for all of these different scenarios that women find themselves in throughout their lives. What are the, some of the most common root issues you find with hormone imbalances? So we're talking about women come on, a bounce is actually start pretty young. Men were meant, unfortunately, to really kind of conceive at a very young age, 18, 19, 20.
And that's really even younger than that. If you think about back in the old days, you have babies when you're 16 and then you're pretty much done at 35. So we've pushed that timeline right now. Most of us aren't even thinking about having babies till 30. And so one of the issues is the hormones are designed back to the old days or optimal hormones, or when we're 16, 17.
And then things start changing. And one of the first things that starts happening at a very young age early in your thirties potentially is you start changing in terms of your progesterone levels. So your progesterone levels start dropping and you become what we call estrogen dominant. So, and again, that can be 30, 31.
It's why it's harder to maintain a pregnancy. When you're 33 34 35. Sometimes you have to give women progesterone to help them maintain the pregnancy, but even together. So you have to have this ratio. And really the ratio has to be about a hundred to one, a progesterone to estrogen. But if you look at most women after the age of 30, it's not that.
So people come in and what happens when you're estrogen dominant, which is a that's what, when you start to get peri-menopausal, you become very, very estrogen dominant. Your progesterone levels. Now are almost non-existent. We still have these nice high estrogen levels. So what is that? So thinking about estrogen, I think it's what men think about women as we're a little bit all over the place and little bitchy and big breasts and big belly, all those things that you start to think about what the fertility statue, well, that's all estrogen, right?
So basically if you have no progesterone to balance that out, your brain's not working quite as well. You're you can't settle things. You end up putting on fat, you breast tissue gets bigger. So you need progesterone to balance that out. So it's this progesterone levels start dropping. You'll start seeing that.
And again, that can occur really, really young. I have a lot of 28 year olds, so I have to put on progesterone because they're irritable and mean, and they don't sleep. So progesterone. Think of it as the balance, right? It's what helps you sleep? It settles you down. It balances the uterine lining. So estimates, uterine lining big and thick and grow, and then progesterone balances that.
And so if you don't have progesterone, then women will start having heavy periods. Bill as they start to get into that perimenopause phase, they'll just be bleeding, irregular. Because that's the uterus is just working on estrogen. There's no progesterone to say, okay, keep the years in line. Now, go away.
You just please. So you have to get progesterone on board. So that's, I think one of the first things that almost always brings people in without progesterone, you don't sleep well. And you have a lot of anxiety. Progesterone is a neuro stabilizer to be really good for our brains, relaxes our brains. Think of it as sort of the hormonal Valium in a sense.
So it's sort of settling your brain down. Making you be able to think more clearly. And it's a great antidepressant. One of the things that happens when you have a baby, what causes postpartum depression is to progesterone levels in that third trimester of pregnancy are, are nice and high, but they dropped dramatically once the baby's born.
And I have no progesterone on board and you become very, very depressed. You're not sleeping because of the baby, but also you have. And you start getting very depressed. So it's one of the things that happens postpartum. And instead of putting people on it on anti-depressants, you can put them on a little bit progesterone to really help with that.
So I think that's one of the really key hormones you have to look at. And then when you look at androgens, so testosterone, I think it's the forgotten hormone in women, right? Because we always think about testosterone for our men and we forget it for our women, but testosterone levels also start to drop at a pretty young.
And so women now somebody says, oh, you got to go to the gym and exercise, but they go to the gym and they exercise and they'll put on any muscle. And they're like, well, this is worthless. And so then they stopped doing their exercise because they're not getting any benefits out. They're not losing fat.
They're not putting on muscle. And that's because they have no androgens. If they have no testosterone, you can go zero testosterone. I can send you to the gym all day long and have you lift weights and you're not going to get any stronger. You have to have some engines on board. The estrogens help with muscle building too, but you have to have some testosterone.
And most women, as they start to get into their perimenopause age, don't have testosterone board. But remember that the same thing happens with all your young girls who are on birth control pills. So what did birth control pills do? They are going to actually lower testosterone. So that's going to be a key in young women.
That's so interesting. I love how you use that example of progesterone being the hormone Valium. It makes so much sense and you have to keep all these hormones and proper balance. So if the hormones are some of the bottom root causes of some of these dysfunction that women occur, our experience, as they get older.
Can you discuss a little bit, maybe some of the reasons why those hormones might be off, uh, earlier on in a woman's stage of life and what that means as they become older and actually start getting diagnosed with other conditions and that developing symptoms and signs of hormonal imbalance. I love it.
It's just that our, our men testicular function reduces for women. Ovarian function reduces that's just natural with age. That's just what happens with age we're meant to reproduce young. And then we sort of our bodies. Yeah, you don't need any ovarian function anymore, which would be fine as you died at 30, but we want to live to be 120.
You can't live without hormones. So really it's just this matter of these start getting. Loss of the gonadal function and there's ways some people will, that happens at a much later stage than others because there's certain health factors that will sort of keep that around longer. But some of that's out of our control, some of this genetic pieces, some of it's how many babies you had in your life, things like that.
So, and diets and exercise, all play a role in sort of keeping hormonal function up as well. So basically some of it is just kind of this natural process that occurs so that you're not going to be able to help, but there's other things that happen. For instance, when you're under a lot of stress, your body does what's called progesterone steal.
It actually takes the progesterone to help make cortisol. And so you actually, when you look at women who are under a whole lot of stress, They'll start to exhibit more and more anxiety symptoms. And that's because they've dropped even when their cortisol levels are still doing okay, they've stole the progesterone to make cortisol.
So stress situations can accelerate some of these processes. And so can things that are exterior that interfere with our production. So a lot of Xeno estrogens that are in our environment, plastics and BPH and estrogens that are in waters and, and food. So if you're needing non-organic dairy or nonorganic met, you know, mill, those have a lot of estrogens in them.
So now we're exorbitantly giving both our men and women and estrogenic source, and that's going to also create imbalances. So people who are not eating organic foods or eating a lot of, you know, non-organic dairy, things like that, they're going to be getting estrogen and that's gonna make them even more estrogen dominant.
That's in your younger population and your older population. Okay. Very good to know. So it's clear that root causes can overlap between different conditions. Is that correct? I mean that in fact they usually do, right. There's usually not one. Even if you're living in the perfect environment, there's going to be things your genetics or your environment is dishing out to you.
It's going to influence and make you potentially be aging faster or changing your hormones more rapidly. Okay. So just out of curiosity, doctor, how common or hormone imbalances in women and what are the most common diagnoses that females get with these conditions? So, I mean, universal, I don't think you see any woman.
I mean, certainly I had a war population, right. Because I have, the people were coming here to say, oh my God, I don't feel well, blah, blah, blah. So we're going to get the war population. But even if you randomly just pull every woman out of the population and you check hormones, there are going to be very few potentially, probably over the age of 35.
Who have quote, normal, perfectly balanced hormones. So when you say how many it's going to be almost everybody. And, you know, I'm partly because of the world we live in and the stresses we're under and, and changes in blue light exposure and all those things that change our circadian balance. So there's tons of things that influence that.
But a hundred percent of people come into my office have hormone imbalances, even our 25. So I'm going to come from a warp side, but we know from studies that even if you take somebody who feels great and everything's perfect, that you can find imbalances in their hormones that are indirectly or sort of in the background affecting their overall longevity and well-being and health.
And so that's why I think sometimes the problem with, with everybody, with all of us, if we don't start thinking about our issues until we're sick, until we don't feel. Right. Like if I feel great, I'm I feel great. So should I even do anything? And yes, because ultimately I'm going to live to be 150 and I'm going to be healthy at 150, then I better have everything in order.
And there's a lot of background stuff going on that you don't know about. So I would tell you that almost everybody should know what their hormones are doing, starting at a young age. And we'll talk about how we look at metabolism and how that, how you should know that even at a young age, That that's going to be universal now, you know, what symptoms do people come in with?
So when they walk in that's I would say the number one thing that brings the women into our office is anxiety, irritability, poor sleep, and way to me, weight is always kind of at the forefront. Unfortunately, I would wish people come in saying I need to put on muscle, but they come in saying I'm too fat.
And I would rather women stop focusing on fat and start focusing on muscle. But ultimately that's what brings a lot of people in and hormone imbalances are certainly paramount in helping you lose. It's very true. And we know that muscle is the organ of longevity. So it's very true. The more muscle you have, obviously you're going to impact hormones and other ways, but I think you made a really good point.
And the bottom line is Dr. Girth. As you mentioned, women are just smarter than men. Women often go to the doctor much sooner than men do to find out if something is actually going on. I think most men put things off the side, so at least women know that, Hey, I should probably get something checked out before it becomes a really big problem.
But you talked about a couple of these symptoms as well, that females can start to experience. So such as weight gain and maybe even skin issues or something along those lines as early signs, what would be some tools for early to tell. Well, usually you can start with just simple blood tests, so you can actually look at some simple blood tests and you know, that's looking at your estrogen levels, your progesterone levels, your testosterone.
After, when you look at things like testosterone, you can't just look at total testosterone because some of that testosterone is an inbound form and the testosterone is available for us as women. And you as men is Bri or bioavailable testosterone. So a lot of times doctors just check testosterone, they go, oh, you testosterone.
Well, we have something called sex hormone binding globulin that binds our testosterone is one of the things birth control pills, do birth control pills, res sex, hormone binding globulin. So no woman on birth control pills has adequate free testosterone. None. Their testosterone levels may measure. Okay.
But they have super high levels of sex hormone binding 11. So it's all in a bound not available form. So it's one of the problems that happens with birth control pills. And one of the downsides is once you stop the birth control pills that can go on for years afterwards. So the sex hormone binding lobbing can stay elevated.
So women will come in after being on birth control pills, and they're still feeling like they can't lose weight. They can't put on muscle. And that's because they have these high sex hormone binding globulin levels, that's binding off their available testosterone. So they have no available testosterone.
So you have. Measure free testosterone levels to get an idea of what's going on with androgens and both men and women. And then, you know, one of the things that we do in our younger women and in our women, after we get them going on hormones, because initially when they come in, lots of times, their hormone levels are pretty low.
We'll have to start on them, but younger women who are making a fair amount of hormones, we actually will do a test. That's a urine metabolite test. We use something called the Dutch test stands for dried urine test of complete hormones. It's just a little test that people can do it on the piano piece of paper four times throughout the day.
And that tells us how the hormones are being metabolized because just estrogen has different forms that it can go. So if I give you extra dial or I give you even testosterone is a guy. So testosterone, metabolizes into estrogen, whether it be in you or in me, and then it can go down three different pathways.
So it can go down a really good pathway called two hydroxy estrone. That's going to be really protective to. Or it can go down a four hydroxy pathway, which is not a good pathway. And that pathway actually creates what's called a reactive quinoa damages, DNA leads to cancer and things like that. And then 16 hydroxy extra, which is somewhere in the middle.
So one of my sort of things that I really emphasize, it doesn't get done very adequately in medicine, even in a lot of functional medicine clinics. I don't think, especially if I'm, if you're young, if you're 25, And you're somebody who has a family history of breast cancer. Very likely you have a metabolism pathway.
That's sending your estrogens down a bad metabolite. If we know that we can do very simple things to change that metabolism. Same. Thing's true. If I put you on hormones, I put you on hormones and you took all that hormone and you metabolize it down a dangerous Catholic than likely I did cause cancer in you.
If I make sure it's all metabolized in a safe pathway, then like that protected you from cancer. So I'm really kind of passionate then when you put people on hormones, or if I'm looking at young women who have their own hormones and we know what's happening to the hormones, we really are. We emphasize a lot of following hormones with urine metabolite testing.
And there's a couple of companies that do that. We really liked the Dutch test for it, but there's a couple of companies that do that. Very interesting. That's great news for all the women who are dealing with potential hormones or have family or relatives that have experienced other cancers related to hormonal issues.
So glad to hear that. Now Dr. Gareth, I want to change the direction a little bit here, because you've talked about a couple of these other different body systems. You talked about cortisol a little bit earlier. And you talked about some of neurological conditions, people experience. And so I want to give our audience a little bit of a further, bigger picture of how all of these different body systems work together, even down to the cellular level.
So can you talk about what other organ and body systems are impacted by hormones specifically, obviously female hormones and how they're all on. Sure. So when you look at all of the accesses, so we have this, our gonadal access, that's our testicular function or ovarian function, which is making our estrogen progesterone testosterone.
And then we have our pituitary, which is kind of the master gland in our little brain. Right. And pituitary signals the thyroid. And the adrenal glands and those all play a role. As we talked about, for instance, if I'm stressed my adrenal glands, I can't make enough cortisol. My adrenal glands start taking progesterone to make cortisol.
So they all play back and forth. But what is basically telling your ovaries to work is your pituitary gland. So the pituitary gland produces. Luteinizing hormone follicle-stimulating hormone, thyroid-stimulating hormone. It produces all the things that tell your other organs what to do, because it's kind of that master regulator.
It's also kind of working on the adrenal function as well. So if there's something going wrong with a pituitary like tumors or things like that, that can disrupt things. The adrenal glands are really important, especially for women in terms of our androgens. So where do we get androgens from? We don't have testicles.
So we get our androgens from the adrenal glands, making something called D H E a and the DHA converts down into the androgenic pathways into testosterone, and then ultimately the androsterone, which is our most anabolic hormone. So if the adrenal glands are really tired or you're really stressed, right.
Then the dream plans do two things. Think about them as a, kind of a balance between anabolic, which is getting strong and happy and catabolic, which is stress and breakdown. And we always want to be a little more anabolic and catabolic. We don't want to be always breaking down that's age and death, right?
We're in this kind of downward spiral. So we always want a balance between DHA, our anabolic hormones and cortisol are catabolic, chroma survive without some cortisol, right? You need cortisol because it's helped you manage stress too much. Cortisol. You do two things. Number one, my adrenal glands, since I'm under stress, they put all of their money into cortisol.
So they're going to stop making DHA. So now I've got a problem and blocked all my nice androgens that made me feel better, helped me heal, help me recover. And I'm producing tons of. And that's keeping me alive for a while, but eventually the adrenal glands can't do that anymore. They just go, okay, well now we're really shot our wad.
Now we get gamma game where DGA, I can't make any more cortisol. And now you really feel like complete hell you basically. Now you have no cortisol. So any little stressor that happens to you is the end of the world. So some point you go into this kind of adrenal exhaustion state, and now you're not making androgens.
You're not making cortisol. You feel like you want to just crawl into your desk. So sometimes you have to actually help the adrenal glands to recover, and that can be replacing DHA in cortisol and some people, and it can be using what we call adaptogens to help perk the adrenal gland back up. So using things like ashwagandha and Rhodiola and things that help adrenal function back up to help the adrenal glands to survive.
And then you've got your thyroid. So, and the other thing the pituitary is doing is telling the thyroid, the thyroid adrenal, pituitary and hypothalamic functional, balanced. The thyroid is employees. Think about the fibroid for weight gain, and it's a big player, but here's the way doctors test thyroid.
They basically run a TSH test by words, dummy hormone, which is not a thyroid hormone, right? You put two Atari produces thyroid stimulating hormone when it senses that the body needs more thyroid hormone. So if my thyroid is not working well since I was big land, right. If my thyroid is not working well and it's not producing enough thyroid to keep me healthy and happy, then the pituitary bangles come on, thyroid work harder and it raises TSH.
So docs will look at your TSH and go, oh, TSH is high. Let's give her some thyroid. And the problem is some of those numbers are way by the time your thyroid is not normal on labs. You're feeling pretty darn bad, and you're probably fat and feeling miserable. So what we consider optimal ranges is very different from regular range.
The other problem is. TSH tells the thyroid to produce something called T4 and T4 is helpful. What's the most metabolically active thyroid hormone is the conversion of T4 into T3 and no doc's measure that functional medicine docs do, but your regular documenters at TSH TSH normal, you're fine. In reality, if you don't have adequate estrogens, for instance, instance, T4 doesn't convert into T3.
And so now. Your TSH looks fine because it's responding. It says T4 is normal, but you don't have no T3. So now you're fat and you have no energy and you can't figure out why and your doctor says, Hmm, I was fine. I don't know why. So you have to do things. You have to give a little fibroid, but you also have to fix the estrogen so that T4 can convert back into T3.
So this is all very intricately related and you have to do the right testing. So if I'm looking at thyroid function, I've got to look at. Not just TSH, but a T3, a T4. And then remember we talked about the free testosterone, the same, thing's true about thyroid there's free thyroid and bound thyroid and the free thyroid one that's available to you.
So those all have to be looked at. And that way it may be why you're feeling fat and sluggish and people keep telling you thyroid's okay. It's because nobody actually measured the right thing, which is that free, tight T3 or free thyroid. And that's a huge, huge issue. The number of women I see, and men who have normal TSH, but their T3 is in the dumper is.
That's so true. Your discussion about the different access systems. As you mentioned, we have the hypothalamic pituitary, adrenal, the hypothalamic pituitary gonadal, the hypothalamic pituitary thyroid. It reminds me of that song. Your ankle bone is connected to your knee bone and the bones connect your hip bone.
And it's so true. I always like to use the analogy of a, also a very expensive sports. Which really ties in everything that you can wash and wax the exterior of that sports car all day long to make it all shiny and beautiful. But if you don't change the oil, if you don't rotate the tires, you're not going to have a very overall well-working sports car.
So everything has to be working together and also. Connected all at the same time and that's important to run optimally. So thank you for diving into that. Now you just started talking about some of the testing, which is really, really important for women who are suffering with hormonal conditions. So you talked a little bit about some of the thyroid testing with TSH and, and getting, making sure that they're getting the T4 and the active T3.
Can you dive again a little bit deeper into some of the tests that you like to run for your female hormone patients, as well as how those might differ from say your standard testing that a woman might get at her general practitioners, all. Well, I think number one, the general practitioner never checks for months.
I mean, honestly, they just don't sometimes they will just, if a woman comes in and they're perimenopausal and they're saying all these things, you know, that the docs like, oh, we'll put you on a little hormones and they throw them on some standard hormones. And the problem is that that may not be the right dose.
It may not be the right type. It may not be what you need. So you come into your primary care doc and you're complaining of hot flashes for instance. And they go, okay, well, let's just put you on a little Bible dot, which is estrogen. There's some confusion in the sort of, I think even in the functional medicine doctor, world.
So estrodiol is estrodiol whether it's bio-identical compounded from the pharmacy, we always emphasize you have to be on bio-identical hormones, which is true, but let's say pharmaceutical estradiol is the same thing as competitive. So get that misnomer out there. Now, progesterone is a different story.
Progesterone is not bio identical. So if your doctor puts you on Premarin, for instance, that is not progesterone. That is progestins progestins are completely structurally different from progesterone. They don't have the same mechanism of action and there are indeed Christian. So you have to be on bioidentical progesterone, and you can be on estrodiol we'll have we have a compounded because we like to dose it a certain way, but you can use patches and things like that as well.
So when I would first say that, I think it rarely actually gets tested. So people just put them on a whore. I have no idea what the dosing should be, cause they don't know what the levels are, which is ridiculous, but that's what happens. So you've got to know what the levels are and then you never would put a woman coming in with complaints of hot flashes just on estrogen and not balance that with progesterone.
So the first thing I would emphasize is that you've got to have somebody to do the testing. You know, as I said, we do the dried urine metabolite testing. Once we've had women on hormones or if they're coming in younger and they're making their own hormones, we'll do the metallic testing. But that's the first thing is you've got.
So when we run a panel, we're looking at estradiol levels, estrogen levels, testosterone free, and total level sex, hormone binding globulin. We're looking at progesterone levels. We're looking at TSH free, T3, free T4. We look at cortisol, we look at da, so you can get a balance of all those things. We look at FSH.
So those allow us to put together all of the pieces of the puzzle. So now my treatment, isn't just Willy nilly store. Everybody on the same dose of hormones, it's going to be very dictated to what those values show. I see this all the time it's going to come in. And the guy I'm feeling that my doctor put me on hormones and they put them on a estradiol dial patch and it wasn't the right dose for them and they didn't balance it out with anything else.
So testing is really important. It really is. You just can't make guesses in medicine. You have to have information. So I would say that that's the first thing it says, test, even if it's just simple blood tests. And again, when we follow up using these, you're a metabolite testing as you and I talked about before, which is that Dutch testing that we do.
So that's kind of where you've got to start and get a baseline of what's going on. I love that. It's all about testing. Not guessing, no point in wasting time, spinning your wheels, trying to pretend you have x-ray vision and just get the proper testing done. And as well as not just the proper testing, but enough testing it's as similar.
If somebody breaks their ankle, you don't want to just get one view of an extra. You want to get multiple different views of that ankle. So you know where that fracture might be or how severe that fracture might be. So absolutely test don't do. Dr. Harris. What about the women who are trying to conceive or Sarah going through something like menopause though?
Do the same test apply to that? A Democrat. I'm going to do, I mean, particularly with conception, you have to have that progesterone estrogen ratio at a hundred to one. So you need a lot of progesterone to conceive. So that's a place where you really have to balance that out. And we know that fibroid is absolutely critical and especially that T3 value, we know that that T3 value has to be relatively high for conception.
So if women are even mildly hypo, thyroid conception becomes much, much more. And that gets neglected docs will, will put people in range, some good studies that support that you have to push them to the higher end, the better end of the range in order to really get conceptions that you've got to get that high, that estrogen progestin to estimation a hundred to one, and you have to get thyroid to a really optimal range for conception.
Again, as we said, that's why consumption becomes much more difficult after 30th because progesterone levels almost always drop and women are estrogen dominant. So that is a place where you absolutely have to know those values and you have to optimize them. So we really, we work with a lot of women who are trying to get.
Yeah. And there's lots of things you can do that sort of help. You have to get, you've got to get rid of a lot of inflammatory markers as well. Things like that to get inflammation down, you can't be in an inflamed state and concede, you have to have thyroid optimized. You can't be overly stressed. You know, the body doesn't want to have a baby when you're in a horrible stress state.
So that has to be addressed. And then that perimenopause kind of almost the same thing's happening is that you becoming completely except to a worst. Super estrogen dominant. So again, that's where you're going to get that kind of that belly fat gets put on. It was going to have these kind of bigger breasts and all that estrogen dominance.
And so remember fat cells make estrogen. So there's this kind of piece of, as women start putting on fat because their hormones are not balanced. Now they're even making more estrogen because the fat cells make estrogen in and of themselves. So that's where that ratio becomes really, really important to us.
That's very interesting doctor you're you brought up a really, really good point, which is on the actual ranges. Can you discuss a little bit the difference between say maybe the standard ranges that somebody might get at their again, traditional office and why we need to, or why you might be looking at, say an optimal range for a patient and how those two types of ranges really differ and how it affects and impacts the patient?
Yeah, that's huge. Normal range is in medicine. This bell curve like this, right. And normal ranges are designed for illness. Meaning if you're outside that bell curve, you are sick. So when you look at that, I don't really want to be on this bell curve. So these dots look like, oh, you're fine. Well, what if I'm 0.1 into the normal range?
Is that fine? No, of course not the people who feel best are going to be in what we call optimal ranges. That's the range for feeling really good and building muscle and living forever. And so those values are completely different. For instance, thyroid TSH levels are ridiculous because you can say a TSH is normal from 0.1 to 4.0, this is another lab value that has that discrepancy.
So do you think that people with this 4.0, which means the thyroid is really not working very well, feel the same? No. And in fact, they've done studies to show that the optimal range, you have to have a TSH level below two point. So we know that these lab lives are designed for illness, medicine, not for what we want to do, which is create super healthy human beings.
So you've got to ignore that. And so when you're done all your doc will look at when they look at the labs, is there anything that's marked red, right? Does it, they higher, low, and other than that, they'll have all gone through this, right? They'll hand you your labs and say, And you're like, oh, I don't want, I don't feel well.
And then I'll look at them and go, Jesus, this is not good. And there's a lot of simple little things we can look at, even a basic, complete blood count that will tell me the patient's not doing well because they're not in optimal range. We look at labs in a very, very different fashion. And the remember that a lot of times when hormones are reported, they're reported for age matched controls.
So if you're 60, do you want the hormones of a 60 year old? Yes. You're normal for 60. That's not what you do. You want it to be normal for twenties, right? Because that's where you were super healthy. So if you, as a guy and I measure your testosterone levels and go, yeah, they're great. They're 300, you know, that sort of stuff.
The old guys who come in with testosterone levels that are fine. No, they're not fine. They're five times less than what they were when they were 25, right. When they felt great it's sex drive and directions and all that stuff. And so then the other thing you have to remember is that what is fine for one person might not necessarily be fine for them.
So I have guys who may feel great with, uh, uh, not super high testosterone. And I have guys who I've got to run their testosterone higher, or they're not going to feel good. So even within our own selves, even with that optimal range, what's optimal for one person might not necessarily be optimal for another, a woman, some women who feel horrible with the progesterone running on the higher end, someone that's there in hog heaven, they feel at one.
So I think there's that, that personalized approach to it too. It's not being restrained by lab values. Oh, I'm not going to treat you any further. Cause your lab values are already optimal. Well, are they optimal for you? If you don't feel good then probably not. You have to listen to your patients to and treat with another.
Thank you for your insight there, you brought up a really additionally great point, which is again, that each of us have our own unique, what's called a biochemical individuality that I might respond to a different diet or supplement than 10 other people. And so that means that I might not be best suited for getting that.
Diet or supplement as 10 other people. And those you're saying you really have to work with your patients in not only dialing in to a normal optimal range, but what's optimal for them individually. So it's very, very true. Thanks for talking about. Yeah, that's a huge problem, right? I mean, you guys have all experienced this, where you go into your doctor and you're like, I know you put me on the thyroid, but I still feel horrible.
And maybe there's something else going on, but maybe your thyroid is still not optimal for you. Right. You've got to listen to your patient and you can't discount what they're telling you. So you use the labs as a guide and use what your patient's feeling is. The ultimate treatment. Speaking of treatment plans, Dr.
Yours, let's discuss some of the tree and plans. Once that women get the proper testing done. Can you give us some insight into what treatment options are available for women? And what about things like hormone replacement therapy? Is that an option as well that women can utilize? Or what's your base? So, yes.
I think almost everybody needs hormone replacement is after you get to a certain age. Right. And might that be 30? Yes. It might not be 60. Yes. You don't know. It depends on, on how you're doing. So we put together this course, it was called what to fix first. You guys can find it on our human optimization academy site.
So basically going to be a lie.academy. And this whole course, it was, it was put together exactly for this because when I sat and I listened to people with their complaints and they'd go, I'm going to the gym and I'm eating right in them, all this, doing all this stuff, and I'm not losing any weight and I'm not feeling.
And they really are kind of doing everything right. And so we really in that, what fits for us first course when I came down to it and I sat there and racked my brain on what do you fix first? And people who come in complaining that your hormones really are in that, that bottom run. You've got to get the hormones better.
As I said, I can't tell you to wake up and feel great when you didn't sleep. Cause you have no progesterone. Or if you're a guy, you know, who's that horrible belly fat, I can't say, you know, just drink less beer when you not eat drinking beer. And you know, but you have no testify. You've got to optimize hormones.
And so then there's lots of options. I mean, we, so as I said, we need to use bio identical hormones, but bio identical can still come from a pharmacy. It doesn't all have to be, you know, I think, you know, doctors go bio identical hormones. That's the sort of trashed functional medicine. Cause we're like bio-identical and that's the dial is Esther dial.
Now we like to mix and match with different forums. So we like to have a compounded progesterone. And again, it's a completely different structure, Premarin, which a lot of women are put on is not progesterone. Usually use transdermal for women, transdermal hormones for estrogen, because we know that estrogens are not great for the liver.
So two things happen if you take oral estrogens, like what's in birth control pills or women who are put on, I hate to see it, but they do still get put on oral estrogen pills. Well, when estrogen goes to liver, number one, it's a little liver toxic, so it can cause cystic and fatty changes. Number two, once it goes through the metabolism of the liver, it creates a metabolite that can actually increase blood clots.
So when women say, oh, estrogen causes blood clots, it only does. If it's given orally, that's why birth control pills can cause. Transdermal estrogen has no effect on blood clotting because it's the metabolite. Once it's gone to the liver that creates blood clotting. So you absolutely have to use estrogens.
Transdermally either as a cream that you can have made or as a patch or a gel, but you have to use them. Transdermally not orally. Are you going to increase risk of blood clots and strokes, but transdermally that risk does not exist. And I fight with doctors all the time on this and I put the literature.
Very very clear on that. So the other problem, if you use testosterone orally, and there's actually a new testosterone that's available now, oral, it seems to be safe to deliver, but testosterone cypionate, which is usually what we use also can cause liver changes. So we know that it can cause fibrotic changes to the liver.
It can cause fatty liver changes. It can lead that patio cellular cancer. So we don't like testosterone orally. So we usually use testosterone. Transdermally just like estrogen. And we have these little sort of clicker things. You just do a little clicking and you rub it on forearm. And it's great. You do that once a day and it's really easy.
And then bypass the liver and you get all the good effects and also use testosterone as an injectable. Lot of times we'll do that in our men. They seem to like injectables better in women's. You'd like transdermal is better, but you can use either you can. I have women who I have on subcutaneous injections and it can just be a little, you don't have to do a big iron injection of testosterone just into the little fatty tissue.
It's easy to. So testosterone has to be again transdermally or given as an injection, again, not orally or causes liver changes, and then progesterone can be given orally. In fact, it has better, he crosses the blood-brain barrier a little bit better given orally, so you can get a little more brain effects orally.
Some people get too sedated for it. In which case we can use a trans Durham to still get some of the other benefits of it, which good for joint health. It's good for uterine protection, all the. Fascinating. Thank you for covering some of those different treatment options. I think there's some really good news for women who are obviously dealing with hormonal issues out there, but for that one group of women, as you discussed core, doing all the right things, they're exercising, they're eating.
But they're still dealing with symptoms. Maybe they're having a regular periods. Maybe they still can't lose weight. Maybe they're having hot flashes, night sweats, digestive issues. Can you shine some light on that predicament? A little bit more, that many women out there still expecting. I mean, that's exactly what we're just talking about.
And that's why, why I did this, what to fix first course. I said, you know what? You're not going to get there unless you get the hormones optimized. Because if you're sitting there with no testosterone and you're estrogen dominant, you're going to put on fat and you're not going to build muscle. You're not going to lose weight and you're not going to feel energy and you're not going to sleep well.
If you don't sleep well, everything gets compounded. Right? So those people I really emphasized to you guys, you got to go get it, you know, work with a good. Doc who understands hormones do we'll do appropriate testing. We'll follow it appropriately and get those optimized because clearly until the thyroid is optimized until the testosterone, estrogen, progesterone are optimized, you're not going to make much progress.
You've got to get things back to how they will. You mean, that's why he's in their twenties. You're like, oh, it's easy to lose weight. And I felt good. It's your hormones. We're in a much better level than they are now. And you've got to get the thyroid and then you have to, you may have to work on from the stress management and then if women still aren't losing weight.
So you've gotten all the hormones, optimized thyroid looks great, and there's still like, oh man, it's still in fat. And I still have, you know, the socks I'm still not getting any better. Then you gotta look at other issues and you know, lots of times those are inflammatory. Well, there's a lot of inflammation going on.
Lots of times people have not great glucose control. So we have to, even if they're eating a good diet, I mean, I have somebody who ate a pristine diet, but my glucose just genetically, I struggle with it. And so sometimes you have to use things that will lower insulin levels. And so sometimes we'll work with really monitoring glucose.
We'll have people use a continuous glucose monitor and monitor glucose levels. So we know what's happening. Why, you know, why aren't you losing weight? It's because your glucose is just spiking all over that. And every time your glucose spikes, you release insulin insulin tells your body to store fat. So sometimes you got to glean more information about what's going on metabolically, because even when everything is optimized, you know, sometimes, maybe something you're eating is still grading insulin spike.
So you've got to measure insulin levels in these women. The insulin level are greater than 12. It's very, very hard to lose. And then we have to sometimes, you know, if we, if we can't control that with diet and dietary changes, sometimes we have to use medications to do that. Like we'll use that foreman and people to help lower insulin levels so that we can actually help them lose weight.
We use a new line of drug called GLP one agonist, which are great, and they make your brain. They're great for weight loss, they're game changers in weight loss. And so lots of times you have to go to that next step, but you've always got to start with the basic easy things, which is fixing the hormones.
And then if you're not losing weight, you got to delve into metabolize. Dr. Harris. It was so nice to have you on the podcast. You gave us a ton of great value, really how understanding how these hormones are impacting our health, some of the root causes of it, and really dived in some of the different science approaches and background that I know many practitioners out there listening, or just going to be getting giddy about.
So thank you for that. I have just one last question for you today. What would be one piece of advice that you can give to our listeners who have a wife, a sister, a partner, a daughter, or. Or anybody else that they know who are dealing with hormonal symptoms or conditions such as what we talked about. I think if you can find a practitioner to work with, it's going to be your team member, not somebody who's just telling you what to do, but looking for a practitioner, that's going to sit down with you and be your team member.
I have patients all the time, teach me things. They bring me an article. They go, I think this is what's wrong with me. And maybe some I've never heard of, but I'm going to listen to them and I'm going to read the article and I'm going to say, okay, let's try that. You see you've got fine. I don't think there's.
Doctor patient relationship, you should be working together as a team. My patients often teach me as much as I teach them. And so you really got to look for a practitioner that does that. I mean, and we work with patients all over the world and because of zoom, it's easy now, right? To do that. So, and then if you can't find somebody like that, then you'll start listening to these podcasts or learning.
You can actually order some of your own lab tests, look at them, but you know, if you can find a team to put together somebody who's going to sit there and talk to you and work with you, and that's going to go such a long way for you can team with that person for the rest. And that's going to be how you're going to be 120 in still living well and doing all the things you want to do.
Fantastic advice. Thank you, doctor yours again, for those of you who are listening, Dr. Harris, where can everybody find you and learn more about you? So I'm at Boulder longevity. So if you just Google Boulder longevity.com and look at our website does a lot of information. And then if you guys want to learn, we actually realized that doctors sometimes are hard to find.
So we actually have put a whole education. So, if you go to bli.academy, you can join that academy. And our goal with that academy is actually to teach you guys like doctors should be learning based on scientific data, help you guys to understand the evidence is out there, where I'm passionate about reading really two hours every night.
So we're trying to get you the newest best thing, and then sharing, digesting it, sharing it with you guys. So you understand where medicine is going. Medicine is doing the same thing for 30 years. And you've got to be moving forward faster than that. If you want to really be healthy. So join bli.academy so you guys can learn some stuff on your own, but we welcome, you know, virtual consults.
We'll, we're happy to talk to you. Just go to bottle longevity. You can throw all that information in there and somebody okay. Thanks again, Dr. Harris, it was a pleasure and we will see you next time.
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