Hormone Optimizing Warrior M.D.

Today we're talking about the value of estrogen, and this episode may introduce you to a whole new perspective on the value of it in your life and body. I recently met a patient who kept herself in good physical health. However, she started to notice signs of aging that felt incongruent with her self-image. She was also struggling to desire intimacy with her husband of many years.

Until she listened to some podcasts that specifically focused on hormone replacement therapy, she never connected the dots between her symptoms and the loss of estrogen she was experiencing. I'm highlighting this because it isn't just her story; it's the story of so many women who have experienced a significant loss of estrogen.

After meeting her, I reflected on a situation I went through which had some similarities to hers; a health issue that I waited to address. Thankfully, I didn't wait too long, and I had a dental issue taken care of before it caused more damage. However, this patient I saw waited a long time and went through so much before seeking support.

Many women choose to wait until they experience the loss of something dear to them, like the loss of intimacy with their partner, before they do something about it. Why? Because they don't yet understand what they are facing. Women don't yet know the value of what they lose during menopause, which is why this needs to be talked about.

A woman's body changes irreversibly without estrogen. While I don't consider myself a hormone specialist, I am very well-versed in hormone therapy and have taken a lot of advanced training on this subject. I use this knowledge to help my patients, like the one I've discussed here, feel more like themselves again.

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Most women don't really understand how hormones like estrogen fluctuate during their cycle. If you were to test a woman's estrogen, the level you would get would vary greatly depending on which part of her cycle she was in. Ovulation marks the peak of estrogen levels during the entire cycle.

At the same time, the level of estrogen at ovulation is dependent on the quality of egg that is released during her cycle. Further to this, normal levels of estrogen don't always reflect the optimal levels. This highlights the importance of data interpretation when your levels are being tested, especially if you don't feel well.

The lower your estrogen is, the higher your FSH (follicle-stimulating hormone) will be. Put plainly, FSH is stimulated by the brain and helps your ovaries make estrogen. If FSH is low, this indicates normal ovarian function. FSH and estrogen should always be tested together because it gives you and your health provider a more panoramic view of overall hormone levels.

After the age of 50, FSH can be used as a reliable menopause indicator. When you're taking estrogen therapy during menopause, symptoms like hot flashes and fatigue can be drastically reduced. But other issues, like vaginal dryness and urinary tract infections, may persist at those moments when your estrogen is low.

Pellet administration of estrogen therapy offers a more consistent release of estrogen, which helps you avoid other symptoms. Even in this case, your FSH levels should still be tested alongside your estrogen levels. Gathering this information will allow you and your doctor to figure out your optimal estrogen exposure.

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Why don't we know more about optimal testosterone levels, especially since it can be so beneficial for women? Part of the problem is that research into women's health is significantly underfunded. Testosterone is an estrogen antagonist, so it could help with estrogen-dominant conditions like endometriosis. Yet, it isn't put forth as a possible treatment.

Many women have excellent tolerance levels for the right amount of testosterone so long as their health professionals consider their physiology and reason for treatment. Menopause is another hormone-related issue many women struggle with, yet we put very little resources towards researching how hormone replacement therapy can help.

No study has been aimed at figuring out the optimal dose of testosterone for women and how those levels can improve bone mass, but this would be a critical health issue to explore. Due to the drug dose gender gap, women also experience a higher degree of side effects due to the fact that women are dosed medications based on research done on male bodies.

Women would have happier lives, marriages, and families if their testosterone levels were tested before they were sent off to therapy or given medications for depression. Testosterone isn't just important for motivation and energy, but it's also a mood stabilizer.

So, what is the optimal testosterone level for women, especially considering their specific goals and conditions? There isn't enough data yet to know. Our sex hormones aren't just about continuing the human race—we should call them anabolic youth hormones because that better describes what they actually do.

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In today's episode we're continuing our conversation about testosterone therapy, including its benefits and the importance of monitoring testosterone levels. Understanding the testosterone levels you should strive for and measuring your physiological responses is key to using it beneficially.

Testosterone is the main anabolic hormone in the body. It repairs, restores, and regrows damaged tissue. The problem is that the normal range established by labs—a guide most doctors will use to identify if your testosterone is low—is not always the best baseline to use.

In an ideal world, people would have their testosterone levels measured in their early twenties and every year after. When using hormone replacement therapy, an optimal level of testosterone would be the amount that allows you to see improvements in stamina, endurance, motivation, and athletic performance.

At the right amount, you would also notice a better mood, an increase in sexual desire, and a higher metabolic rate. That said, there's no perfect amount for testosterone replacement for women; only the amount that works for them as an individual. There are different options for testosterone administration, including injections and creams. Injectable testosterone is administered about once a week.

Testosterone creams are usually applied daily, and this method usually increases testosterone levels right after administration (usually in the morning) with the levels tapering down throughout the day. Creams are the easiest to administer, so they are also a popular choice among women. If you're wondering if testosterone could improve your health, reach out to a medical professional trained in this type of therapy.

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This episode is for all the women who have left the doctor disappointed—turned away and told their hormone levels were fine even when they didn't feel right. Hormone level testing isn't given much thought by the majority of medical professionals, yet it's crucial to providing adequate patient health.

Right now, there is a complete lack of standardization in this area. A part of this is due to the fact that hormones impact men and women differently, and we don't know how introductions of hormones will impact any specific individual. There is also a difference between testing for normal levels of hormones and optimal levels.

Ranges for hormones like progesterone and estrogen can also vary in women depending on their age. The time of the day in which hormones are tested can also change the interpretation of the results.

How much testosterone should a woman have, regardless of age? The normal range is considered 2 units above zero. While this is considered "normal," in reality this is quite low. It's important for energy and mood, and no other hormone has the capacity to stimulate muscle formation and muscle repair. Given how it impacts women's health, it's clear to see how accepting low levels as normal in testing can impact a woman's health greatly.

I believe that the key to helping patients maintain optimal hormone levels is to establish a baseline early on. Man or woman, the patient should be tested when they are at their peak health level. No one goes to the doctor when they feel great, and therefore they aren't getting tested when they're feeling their best, but you may want to advocate for this if you're looking forward to how you'll feel down the road.

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We're welcoming Meghan Morrissette, my aesthetics nurse, again today to bring our conversation about Botox and other types of neurotoxin treatments to a close. We'll be addressing more common questions in this episode. When is the best time to get Botox? Is there a better age to start?

Patients in their 20s typically seek neurotoxin treatment for facial balancing, as they haven't largely experienced the signs of aging. By relaxing some of the facial muscles, you can also reduce the appearance of static wrinkles later in life, which are caused by repetitive muscle movements.

Social media has played a significant role in attracting younger people towards neurotoxin treatment and other preventative aging measures. This is, in part, due to the fact that Gen Z is much more aware of their appearance. If you're in your 20s, simply wearing sunscreen is one of the best things you can do for your skin.

For patients who are more advanced in age, it's important to be clear and transparent when discussing expectations for results. For example, Botox can't lift sagging skin. This should be made clear to clients who come in with sagging skin as their primary concern.

No matter what stage of life you're in, your aesthetics nurse should always conduct an individual assessment so they can customize a treatment plan for you based on your skin type, face shape, and outcome desires. You should also know the potential side effects, which can include bruising, headaches, or more serious side effects like the spreading of the toxin itself.

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We are continuing our conversation about Botox with Meghan, my aesthetics nurse. Is all Botox the same? Actually, they can vary in some ways. If you don't feel ecstatic about the results a few weeks later, you can experiment with different types of neuromodulators. For example, instead of the Botox brand name you can try Dysport, Daxxify, Xeomin, and more.

If your treatment is going well and you're happy with it, you don't need to change anything. Typically, injectors don't carry all the different brands. The dosing discussion can be challenging for patients and injectors, so it's important to take into account the person's response and their risk for sensitivity.

Younger women and men are seeking Botox, and it's important to note the frequency of their treatments. Patients who are injected more often (usually with smaller doses) are more likely to build up antibodies to the treatment. Those who want to use Botox with longevity should focus on getting treatments less often at the dose required to see results.

All patients should be educated on what overtreating with Botox looks like. The goal is not for you to feel or look frozen; it's to smooth wrinkles and add lift and balance. You always want to preserve some facial expression.

If you're looking to address static wrinkles, that's where lasers and peels come in. Resurfacing layers can help smooth wrinkles that appear at rest. Botox doesn't address pigmentation, pore size, or hydration—but these are all things layers and/or peels can help with.

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This week's episode is all about Botox as we welcome my aesthetics nurse Meghan Morrissette. As a holistically-minded person, the idea of injecting myself with a toxic chemical just to look better did not appeal to me for many years. However, now that I have a deeper understanding about what Botox can really do, I think it's worth exploring, which I recently did myself.

I had a great experience trying Botox for the first time with Meghan. She has a soft, delicate touch, and the needles are tiny, so I felt no pain at all. She's passionate about giving natural results and long-lasting outcomes. Meghan sees the art in what she does, while also understanding the science behind it.

Neurotoxins like Botox are substances that impact the nervous system. They block the signal between the nerves and muscles, leading to smoother looking skin. It can address existing wrinkles and ones that haven't formed yet. Interestingly, Botox was actually developed for medical use, specifically to help with chronic migraines, excessive sweating, an overactive bladder, and eye spasms.

It takes a certain set of skills to be a great injector. For example, it's crucial to have an eye for anatomy, especially for natural-looking results. It's also important to understand how the neurotoxin works to properly customize the dose and the placement. The personal anatomy and goals of the patient should be taken into account too.

If you have concerns about trying Botox, there are a few things you should know. First, Botox should not freeze your face. Botox is intended to relax specific areas and overall bring greater balance to your face. It's perfectly safe and very effective.

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Today we're concluding our conversation about being independently healthy. This time, we're focusing on preventative care and maintaining your health. Most patients believe their health insurance plan is there to keep them healthy, but this is not true. The medical insurance industry is designed only to cover catastrophically high expenses in serious health situations.

It's important to remember that your health insurance does not guarantee you access to a wide array of services with your medical care provider. If you want services outside of what's covered by your insurance, you may have to start budgeting and saving for those services. As you advance in age, this becomes even more important.

If you require pellet hormone therapy, IV vitamin therapy, hyperbaric oxygen, or vitamins on a regular basis, you'll need to consider these costs in advance. Access to weight loss support can also be expensive. Plan in advance for these times so that if anything happens to you or someone you love, you're prepared.

Some of the best doctors are going with a concierge service, and this is a good thing. It means they can take time to get to know you and truly care for your needs, while also taking your insurance as well. Doctors are not paid their true worth by medical insurance plans, which can also make a concierge fee necessary.

The support staff in your doctor's office need to be paid, and medical insurance doesn't cover that. There are so many things your insurance plan doesn't cover, and doctors are adding a fee to support the administrative work and staff to provide you with better experience in their care.

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In this episode we're continuing our conversation about being independently healthy, focusing on covered medical expenses. Medical insurance premiums have skyrocketed—they are extremely expensive, and therefore unaffordable for many people.

If possible, it's important to prioritize having your deductible on hand in case you ever need it. You may also need a contingency plan for specific medical expenses which are not covered. If it's a therapy focused on maintaining wellness, balancing hormones, or anti-aging, it will likely not be a covered expense.

The medical insurance business is indeed a business, so they want to make a profit. But remember, this has nothing to do with your doctor making profit. Your doctor simply made the decision to allow access to more people by accepting insurance plans. If any issues come up with your medical insurance, you will need to handle it with the insurance company directly.

Here's the truth about private practice: your doctor gets paid last. He or she pays everyone else before they pay themselves, and they would actually make more if they worked for an entity that paid them annually (plus for billing). That's corporate medicine, and it helps doctors avoid dealing with customer service, managing teams, billing, and more.

For doctors, independence comes at a cost. Most doctors today have to implement fees to support their admin, and this is often wrapped up in a concierge fee. When it comes to affordability as a patient, there's also a lot to consider, like where you're at in life and who you're providing for. Perhaps you can't afford to not invest in proactive, maintenance-focused care.

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