The Truth About Women's Hormones| Dr. Jennifer Berman on Women's Hormones, Menopause & HRT

[00:00:00]Educational content only, not medical advice. TRT HRT requires licensed physician evaluation. Consult a provider on the H4M platform.

[00:00:08]>> Welcome to H4M. We're here with a with a special guest. I'm really I'm really honored to have urologist Dr. Jennifer Berman on here um on the show today.

[00:00:21]Thank you very much for for coming. I've seen you on um uh a lot of podcasts, a lot of shows, and uh and I was really excited to to get you get you on um on our show. We we've done some research and um it it turns out that getting right to a point and getting right to the show is what people really want to see. So, we're going to get right to this. The first things I want to highlight is some of the some of the shows that you've been on some or the some of the So, you have done Oprah, right? You've done um Good Morning America, you've done Night Line, you've been on Conan O'Brien, um a lot of evening other evening news. Um so we've seen you everywhere. We have a few clips of you on some of these shows that will play throughout this, but um but it's an Yeah, it's another thing I want to highlight is it's becoming more mainstream uh women's HRT. Um, and and the understanding that a women need testosterone, b that HRT is not dangerous. In fact, it's very protective. And and that we're really starting to understand this, but you were talking about this 10, 15 years ago when it was completely taboo. And you and I were sharing before the show that there was times when people thought you were a charlatan because you wanted to you wanted to use estradile yourself.

[00:01:38]And you have a family history of cancer, right? Okay. And you wanted to use it yourself and people just couldn't believe that an educated doctor would actually want to use hormones on herself, let alone anybody else. Um, so, so you were doing this. You were like, like I know we talked about this before, you were essentially like the first influencer. They didn't call them influencers back then. That wasn't really a term or a word, but >> trailblazer.

[00:02:01]>> Yeah. You were you you were you were a trailblazer in this industry. You you started talking about this when nobody else was. And we kind of briefly talked about how when you came in and started talking about these really shocking things that nobody else was saying, then every everybody wanted a piece of you, right?

[00:02:19]>> I did become um I made a career out of talking about taboo taboo subjects and normalizing taboo subjects. Um and I, you know, been trained to do that. I just did it. Um the thing that um about the the hormone replacement therapy and my willingness to put my neck out like like I did um is because similar to you, I read the data. I understood the mechanisms. I believed the results and I was able to use my medical training, my medical knowledge, my intuition and my bundle of knowledge and to make um to make an informed decision and working in sexual health. I started just sexual health, not necessarily menopause and hormones, just sex ma male urology is how I was trained which you know transitioned into female male and female sexual health. But I based on the career and what I was working in, I had to become confident and familiar with prescribing drugs off label. So from day one, it was like a matter of fact for me. And this is what I'm noticing about regular all the other doctors out in the world that are in private practice, they never had the opportunity to do that.

[00:03:41]They were never challenged or inspired or motivated to do that. and my the fact that that I had to do that for my job and my research and my you know I didn't have a choice. I even got I was thinking back on this I got I was at Boston University which is a very rigid academic teaching center and I got um IRB approval for a multic-enter clinical trial um with Viagra in women. Um, I had those patients on testosterone. I just looked back at the paper. I was like, "How did I do this?" And I got uh I had to um apply to the FDA to get like a 50 some sort of I had to get some sort of license from them to use Viagra in this population, which I ended up getting.

[00:04:32]So, um, so I it was just I was just getting [ __ ] done basically. I >> That's interesting.

[00:04:39]>> Yeah, that's great. I remember when that first came out for females like they they made it a pink pill, right? Wasn't it instead of >> pink pill? So what came out of that study was that Viagra um was didn't Viagra does increase blood flow to the genital area and that increase in blood flow and arousal lubrication does not subjectively transmit. So if I were to take it by her or any other woman which that it did not in a statistically significant way improve sexual satisfaction, orgasm, libido um on on its own. So that what that was important and that that finding that whole process of doing that study is how I learned that hormones were equally if not important than blood flow. See I was looking at sexual health in women in a male oriented way. blood flow. That's all I knew. Measure blood, make more better.

[00:05:35]>> So that's all I knew how to do. Okay, make more and that'll be good. And it was just by reverse engineering that I realized, oh, so it does enhance engorgment, lubrication, sensation, but the woman doesn't, you know, it's not like I can tell, okay, now I'm 30% more lubricated or maybe 20%. You just know that it works and you know, we we can't quantify it as much.

[00:05:56]>> Yeah. So um that was so through although Viagra didn't get to be a drug for women, I did learn about the the the roles that hormones play in female sexual and mental health. And from that from that that was that was in 19 that was like probably around 1999ish.

[00:06:18]>> Yeah.

[00:06:19]>> Wait 98 to 2000. So this when was it?

[00:06:24]This is when I was at Boston University, right? 88 to 92. 92 to 98. So this is 98 to 2000 range is when I figured out that hormones were essential and for women's se sexual health, cognitive function, mood, all of it.

[00:06:43]>> Um and yeah.

[00:06:45]>> Yeah.

[00:06:46]>> So yeah, that's that's great.

[00:06:48]>> Dr. Burman, if if I may briefly, we've done I think a good job of introducing Dr. Dr. Burman, I think already people are probably excited and interested. We forgot to explain what this evening's episode is about.

[00:07:01]The uh for for those of you that are just tuning in and perhaps those of you that are already excited but not quite clear on what we're going to be uh discussing this evening, it is uh centered on females health. And uh the the question that we'd like to pose is look, we have a we have a mostly male audience. We know that uh we do have some females and we're very grateful for you that tune in. But uh the question we will pose to our largely male audience is what if the best years of uh the woman in your life, be it your girlfriend, your wife, etc. could be a daughter or anything, a friend, uh what if her best years are still ahead? We have many many viewers that are patients of H4M and they're live in the chat right now and they'll they'll tell you about uh the many different parts of their life, the different facets that have improved by the use of therapeutic hormones. And we we've already had this gentleman chime in. That's what kind of reminded me. He's excited for this because he wants his wife to feel as he does.

[00:08:04]>> So we we've TRT has come a long way. it's got a long way to go. Uh we like to think we're part of the uh the better end of that.

[00:08:15]Uh and within our little niche, our patients do enjoy very positive results.

[00:08:21]>> However, it's it's not really fair that the the guys have this glow up in the uh middle or latter years of their life and their their wife the other equation side of the equation doesn't get the same treatment. Right? So, our hopes is um for the men, you can either grab some popcorn and have her uh pop a squat next to you or if uh you want to share this after it's done as a live uh perhaps because there's there's a lot of uh big questions and concerns around uh female HRT, which we we've already alluded to a little bit. So, the the moving into uh that that line of conversation, Dr. Bourbon, as you've just said, uh, we we've moved from a a real taboo to now things are starting to become more mainstream for female HRT. What would you say has changed and what's really spurring that?

[00:09:18]Well, um I'd say the only thing that's changed is awareness and the problem, the issues, the treatments, um for the most part have been available and we've known about them. But in terms of mainstream consent awareness and also two two failures, the awareness of the of the patients and also the education and training of our medical community and and and health care um providers.

[00:09:50]There's been at least two decar gap in training of healthcare providers related to me. I'm I'm not I'm not even talking about men. I'm talking about women. Menopause and hormone replacement therapy due to a false narrative and based on fear that hormones are bad.

[00:10:14]Hormones cause cancer. Hormones will give you heart disease and stroke and all that other stuff which was entirely false, misleading and inaccurate. And millions of women suffered a as a result of that. So now fast forward. So what what caused that? In my opinion, it was inevitable with the advances in digital media and digital digital >> digital communication, social media, let's say. Women women were suddenly able to talk to each other in different lady in New Zealand lady and then talking about and then one lady was saying, "Wait, what? You got this?" I remember um the Kardashian, the Ma Kardashian mom, what I forget her name.

[00:11:02]She started talking about her menopause like she her hot flashes and her this and her that and that she was on hormones that blew up. Then Naomi Watts, then Oprah, then you know um who was it?

[00:11:15]There were three or four different um celebrities and >> Berry Berry and your pink pill is going to come up in a sec. So then it became a thing like oh yeah we all have this and we all now in Hollywood we started talking about it. So as awareness grew the the lack of um understanding training and and care that the medical community failed women became increasingly apparent. So now there's this huge scurry and franticism and rush to um to correct a problem that really doesn't need correcting because all of the tools are already there. All we need to do is get testosterone FDA approved for use in women. And the only reason it's not the only reason it's not is because it's generic and it's not patentable right now. But there is somebody that did create is another company that did create a methylated version of the testo. So it's only a matter of time probably within a year that we're going to see testosterone exploding all over the place for women and then it's going to be the answer to everything and then we're gonna like it it's you know the roller coaster ride. It's testosterone is going to be FDA approved. There are patent new versions of it. It's going to be used in women for hormone replacement therapy also in women with breast cancer. There's another version that there's a testosterone pellet that's in development. Another one.

[00:12:46]>> So, um what was needed? I think that social media is what >> Yeah. No, that's fantastic. I we um we actually our my our co-founder um Todd, he is actually friends with Marty McCary, so he has dinner with him. So he was like he he got a lot of inside information on what was going on when Marty McCary was FDA commissioner about about all the things that are happening and Marty McCary is really passionate about women's HRT too because uh mainly because of his mother. He felt his mother really needed it and she was not treated properly. Um so he he takes it personally and and so there was a there's a lot of good that came out of that. one thing. So, what I'd like to discuss really briefly and we'll try to keep it brief because I I stand on this soap box a lot about the just the lack of education and education is the most important thing and and all these people are being all these females are being um undertreated, you know, pretty much due to the lack of educ education of mostly of of the providers, right? That we're just not taught this in medical school.

[00:13:49]Can you can you highlight that for us?

[00:13:51]Like even as a urologist, right? Do you think do you believe that you adequately learned about hormones and and women's menopause and how >> no and worse sexual health even which is where I started that there is a like there's marginalization of women in by the healthcare field especially as it becomes pertains to sexual health reproductive health. We've got that covered. We know how to have babies, all the anatomy for that. But even in our anatomy textbooks, there was a textbook called Netter, which is how we learned the anatomy. And there were diagrams.

[00:14:26]And the diagram of the male pale male pelvis, diagram of female pelvis. Female pelvis was the male pelvis with a penis chopped off. That's literally what it was. And nobody understood like even like and I remember asking my my attendees, my chairman's department, there was nobody that could that could articulate a medical basis for the female sexual functional response. And I was told that these that that's not me that's not part of medicine. Those things are for psychologists and therapists and relationship experts to deal with. We as doctors don't talk about that stuff. And that was when I that was the very beginning that I realized that quality of life issues.

[00:15:18]There were people that were doing public health studying outcomes, but they weren't doing anything about it. That quality of life issues weren't something that we as doctors really dedicated ourselves to improving or treating it was a symptom and this and the symptoms that women were having of fatigue and low libido they were not considered medically relevant and that was horrifying to me and that's where I went that's how I went into female sexual health when I saw this huge disparity and huge gap in how women were treated it was shocking to me and how >> oblivious that all of our doctors were so that was the original pioneering work making female making it recognize that female sexual function response there are is real medical bases there's emotional relations psychological all sorts of other things but there are also medical physical reasons menopause being one of them why women experience sexual issues and there are real medical valid treatments that can alleviate symptoms that was the crux of the work that I did with my sister who was a sex therapist we pioneered that >> and Then from that I go on my way and I'm I'm in my early 30s at this point but I'm learning everything and there then I turn 37 and get hit like with a brick of pmenopolics horribly and I already knew from all the other women that I oh this is what that is now it's happening to me. Oh [ __ ] I need hormones. And at that point, I went out to try and find somebody to treat me.

[00:16:54]And I was permenopausal, not menopausal, which was like >> blasphemy. No, you cannot treat a parmenopausal women ever. So that was considered absolutely wrong and taboo.

[00:17:05]But I knew that I needed hormones. So um yeah, so that's I took matters in my own hands. Had to um prescribe myself basically estrogen, progesterone, and testosterone.

[00:17:17]And um and I became um my first patient basically. And they thought you were a charlatan. charlatsane crazy that like where what like could not wrap my their heads around how I thought this was remotely reasonable possible especially given my strong family history of breast cancer like everyone in my mother's we didn't have the bracka gene but my mother died of it my sister had it all the other so and I knew that I had a higher risk than most women just based on my family history >> I also knew knew that adding estrogen on top of that was going to increase my risk more, but the number wasn't like 90% risk. It was like 36%. I was like, "Yeah, >> what I'm taking it otherwise I have to stop practicing medicine." I was one, then this is based on my genetic biotech. I am one that is extremely sensitive. My brain is extremely sensitive to fluctuations in estrogen, the up, down, up, down. Some women, you know, can tolerate. Some women get like peasy little annoyed. Some women like me become completely unraveled and >> unable to function. So that was >> and um and I knew, you know, I knew that it wasn't an option. So either quit and maybe not get cancer or >> continue doing this and maybe not get cancer. And lo and behold, I was also on testosterone, which they thought that was where the charlatan be like craziness.

[00:18:53]Gonna grow horns and penises and things coming out of my hair and my ears. And >> you're gonna become a man. You're gonna grow.

[00:19:00]>> So, but in reality, the testosterone treatment over the past 25 years is probably what's prevented me from getting breast cancer at all. And I've been tested every year. all of the MRIs and mamograms and B everything is so much testing of these breasts and there's no cancer and I attribute that now in hindsight to testosterone >> DHT is a binds specifically to estrogen receptor beta right which would be anti-prololiferative and and that has been show there's been some studies that have actually been done on things like um and drastenolone and DHT that actually show it's anti anti-prololiferative for cancer right so a high DHT level would be beneficial in that case >> and it prevents progression they've said this prevents progression of of tumor growth of tumor spread y >> um and I my opinion now even just based on the research that we have now I think every woman should be on it for the protective effects and other >> I love that you said that yes every woman at some point should be on all the hormones right specifically testosterone is is just as important as as the other ones. What I want to do really quick, Dr. Berman, is let's go into if if we're talking about how how beneficial these hormones are for females, why isn't everybody using them? Why isn't everybody if everyone should be on them, why isn't everyone on them? So, let's talk very briefly because I stand on the soap box a lot and I don't want to keep boring pe boring people with the with what I already pound into their head a lot, but let's talk very briefly about the WHI and what happened in that study.

[00:20:38]So we had a study that came out and it it very in a very uh manipulative manner indicated that there was increased risk and and one of the major manipulations they used was relative risk versus absolute risk. Right? So what they said is that there's a 26% increase in the risk of cancer. That's specifically what they stated and that's just it sounds scary. It sounds like almost a third of the women are going to now get cancer who are on this treatment. But what that the absolute risk was actually it went from 30 out of 10,000 women in the placebo group to 38 out of 10,000 women in the in the HRT group. That was the difference. And that difference is not statistically significant. So when you use terms like that's a 26% increase in the risk, it's manipulative. It sounds scarier than it actually is. And they did not use the absolute the absolute value which is actually only 08% in real absolute increase in absolute risk which is not statistically significant. So so talk to us about about that I guess about about how that >> okay I want to I want to tell you one other factor and this is all publicly public knowledge. There was something else going on at that time. So the drug that was studied was a drug called Premro. It was a combined oral synthetic oral. We don't use oral anymore for number synthetic oral um prearrin derived from horse urine. That's the one horse and provera which is a synthetic progesterone and that combination of pill and that was um YS pharmaceuticals and they had millions of women taking the taking that medication and they were the ones that was conducting this study at that time. There were there what there were women that were developing breast cancer on that drug and they linked it to the provera that provera which is that is associated with breast cancer >> and what was misleading is is that they lump they just called it hormones they didn't separate the provera from the estrogen that's also what I read I read I saw that in the in the data so I I was like Okay, I'm it's not estrogen, it's that. But they the the narrative didn't explain that to the public or even the doctors. So, it's the provera, but yet they're lumping it into hormones. And so, what happened is as these women were coming forward with breast cancer, they they they initially kept the study going knowing that these women had breast cancer. And then what happened is the media got hold of that announced on headline news that the that this Prem causes breast cancer and all of a sudden then that the study halted immediately.

[00:23:32]all the doctors that were part of those studies were left like what happened and then no explanation came after that and what that did and then like I think it's both it's what caused that misinformation and that misleading was a lawsuit in money so they then fizer bought Wyth and all the patent and all the you know the the the the risk and kept it sort of nebulous low-key quiet for every for 20 years people thinking hormones about hormones about est so fizer also launched another drug called doue which is a combination of estradiol plus a serum and it's not progesterone doesn't but it's a combo weak not great hormone replacement pill but hormone I think it's a patch um and they kept that really quiet that patent is about to expire in 27. So, we're about to see some crazy stuff happening when that patent expires. What's coming next, but that narrative, so all that's happened in the past 20 years is Fizer protected themselves from huge lawsuits by confusing doctors and the public that hormones are bad. And so now, I don't know, fast forward, here we are, you know, 20 years later. Well, and they were saying all along, if you read the stuff, they were saying all along that it's the what the what the reality was, but the narrative that they were giving the public was an entirely different story. And the the the people who I think are most responsible for this issue is not the FDA, not the it's us doctors. How is it possible that we allowed this to happen with the data being there? didn't question it, didn't challenge it. We just took for at face value, okay, this is bad. So now, and hopefully at minimum, what this does is to make is for doctors to think twice, to question, to maybe not just assume, you know, this is this and this is that the onus is on us. We're const we are supposed to be constant learners, thinkers, evolving, growing, expanding and um that you know that that narrative could have been I tried. I'm just one lady you know on a soapbox trying you know I'm trying to do my you know make a difference and hard but you know it's hard to >> it's hard to do. So those two things, the false narrative that you talked about and the mis misinformation, complete misinformation and nebulousness, what drove that was money and politics. Yeah. And um >> it's really interesting that you talk about when Fizer bought was it Wyatt Wyatt right um because I have read conspiracy you know I narratives that that it was all done on purpose kind of for that reason like why it went under like or or I mean they became so their value t so tanked so much after that who ki came out that that fizer was able to buy them and and like you said now patents are going to be up. So like it if you if you really look into it I don't know there's some some theories that that this was all done on purpose by Fizer was orchestrated so that they could get rid of Wyatt and and buy >> Yeah. They wanted to keep it quiet whole lawsuit and they 100%.

[00:27:11]>> Yeah. Um okay so let's let's move on. I I could talk to you about that all day because the the whole almost scop that occurred with that whole thing is just it can go deep and it can be very conspiratorial. But let's I I digress.

[00:27:25]Let's talk about let's actually I don't we I have a guy preparing clips for us.

[00:27:30]Um Chris is doing Chris does a great job, but I didn't give him this clip. I want to play a clip of you talking on Night Line, but I didn't give it to him to prepare. So I'm going to pull it up for us really quick. Um, and then let's actually talk start talking about the benefits of hormones.

[00:27:50]Um, I think it's this one.

[00:27:54]>> So, normal menopause is 45 to 55. And so, if you do the math and back that up, 7 to 10 years.

[00:28:02]>> Sorry, that's not the one. Wait, I have it. It's this one.

[00:28:08]I feel like all women should be on on testosterone for the preventive benefits, not to mention all the other things, the cognitive parts, the impact that it has on bone mineral density, lean muscle mass. There's a lot of health beneficial reasons and also well-being from your libido, energy, and and mood and cognition.

[00:28:33]Okay, that was you on night. So, now we started to go over some of the some of the benefits. So, what I you talked about it in a different one. What I want to talk about is um a different clip of yours. I wish I had that one pulled up, but what I want to talk about is is the benefits and and and especially testosterone, estradile, but I want to talk about the the cognitive benefits. I don't the reason I want to start out there before start out there is because you said something on one of your clips here that I have been saying for a long time and that's that women go in with parmenopause or menopause symptoms and they're immediately just thrown a lot of other drugs that don't make sense especially depression medications and SSRIs and SNRIs and wellbutrin and and and sometimes aderall right they're giving they're giving these crazy concoctions they're getting jacked up those are your exact words they're getting jacked up with all these other medications we I've been saying this for a long time that that testosterone solely controls the intensity of the phasic spikes of dopamine, right? So, so you know the the the our base level of testosterone tells how much of the the spikes in dopamine we have during certain actions when when we um see something exciting when we're anticipating a reward when we um the the phasic spikes give us that excitement the joy the sense of well-being right our baseline testosterone controls that estradile in a similar manner it builds dendritic signs spines for dopamine reception but also estradi solely controls the intensity of the phasic spikes of serotonin together they both build um they both build um I'm sorry oxytocin receptors and estradile specifically increases the production of endorphins. So now we're seeing the four major neurotransmitters that control our mood, emotion, sense of well-being, and pervasively control human behavior are naturally produced and and um and a and a harmonized through these testosterone, estrogen, progesterone as foundational neurological signal molecules. Right? So they so what I've been saying for a long time and and you are I've seen you say say the same thing is that these hormones should be f frontline treatment for all cogn cogni for cognition for depression disorders for you know instead of antiscy psychotics for any sleep disorders they should be the frontline treatment for that let's try that first if that doesn't work then we can move on to some of these other things that that they're doing right what do you think about that concept >> no 100% in my opinion everything starts and stops with hormone balance. Hormones are at the root of all cellular functions neurolog biological hormonal muscular skeletal um mood everything. So at once hormone imbalance sets in then you know everything starts to decline and left untreated which is what we're doing is women were becoming more fatter more tired less interested in their husbands arthritis aching cholesterol rising and on Prozac on aderall maybe then you know it's um this raisin like the It was we were just letting women, you know, phase out. Phase out of the workplace, phase out of living life but in a vital way.

[00:32:05]>> Yeah. And then they just say, "Oh, you're getting older." That's that's what happened.

[00:32:08]>> Part of getting older and getting old means getting rid of fat, not interested in sex, sagging all over and not sleeping and moody and with health risks. So um testosterone when you're talking about there were two thing like my brain mood and cognitive function were were the biggest impact for me and testosterone is essential um estrogen for memory short-term memory focus recall things along those lines but without testosterone and many do many providers now are okay we'll do hormones but not testosterone I'll do just this the patch and project. I'm okay with that and but I'm scared of testosterone and that's better than nothing. But testosterone, I want everybody to hear this. Testosterone is from the standpoint of just the cognitive function. Nothing else. No muscle, no sex, but just cognitive fun.

[00:33:03]Testosterone is your creativity, your inspiration, your motivation. Motivation to do the things you love doing either.

[00:33:12]um and definitely motivation to do things you don't want to do yet that you avoid become um way easier to avoid without testosterone. So testosterone in my opinion is that vitality the um the devivve the energy the physical energy your strength and endurance your emotional energy yay let's go to par your sexual motivation energy I want the wanting um and the intelligence like when my tesa when my pellets went out my tesa people around me notice my staff notice my kids notice that I'm spacey I'm like what that my that my I'm not firing on all cylinders. So again, I'm more sensitive to fluctuations than others, but it it it just highlights the point that every woman respond, every man, not all men, every human is different and we can't treat them all the same and throw everyone a primro and and expect to get the same results.

[00:34:10]That's also what's become glaringly apparent through this process is that how um the the nuances of um optimizing hormone balance and maybe through the bad there this was definitely damage damage is done but from this maybe we can start fresh and be better because the primro situation wasn't cutting it and what we have now a patch and a cream and unapproved testosterone isn't cutting So setting the standard of care which is what you can do by collecting this data and the data is power. So once you have the your your patients your patients getting labs and then you can start um to to measure and set protocols understand you know where where people fall and the different nuances and then >> create >> yeah let's talk about that really quick.

[00:35:02]So, what I always say and and Brandon, if you want to really quick and I want to talk about getting the labs really quick, but then I also and I want to talk about what we'll do is we'll show how how we can get um labs uh how we can provide people with labs, how easy we make it, and then we'll talk about some of the labs that you that you've talked about using as well.

[00:35:24]Brandon, do you want to really go over if if anybody's watching tonight and you're the female themselves or somebody one of the men who's watching their wives, they kind of want to figure out what happened. The first thing I always say is let's get labs and then and then and then let's talk about it. That's the first step. If you're questioning, if you have if you're questioning, you have concerns, let's get labs and then let's talk about it and then, you know, just get a hold of me and I'll give you a free a free consultation after you have the labs. So Brandon, do you want to really briefly touch on how we do that?

[00:35:55]How we make that easy?

[00:35:56]>> Yeah, sure. Uh, so while I ceue up my screen, uh, Dr. Burman, would you mind highlighting maybe a couple of the uh, more typical symptoms that we would expect to hear from a female that is in in this state that they're they're suffering from possibly low hormones.

[00:36:14]So whether you're pmenopause or menopause, permenopause means you're still having a period but experiencing symptoms related to menopause mild moderate severe but still have a period.

[00:36:27]So that >> what I want to highlight here and I apologize doc but but this is important just because you have a period doesn't mean that you don't need hormones right and and a lot of a lot of practitioners will will say oh no we don't we don't give you hormones until you haven't had your period for a year. I've heard that.

[00:36:42]I've heard people call I'm like >> that's the permenopause thing. That's why they thought no.

[00:36:46]>> Yeah. So just because you you're still having your period does not mean your hormones are okay. Okay. So continue please. I just want >> So you're still a candidate for hormone replacement therapy. This is the one of the main areas where our doctors aren't trained. So don't be alarmed if they say your levels are normal. You don't need that's the other thing to talk about at some point on this one or another one is what is considered normal ranges by the lab because those are um like statistical averages populationbased norms not norm for you for your testosterone levels. you really can't um you really have to uh use it as a reference range, not as this is this is my >> there's no science done in those reference ranges. So what I like and I I'm sorry because I I talk about this all the time, right? The just like you said the ranges come from just one or a few studies. Um they they take an average of a very average population and they use statistical equations, not science. No science to show yes inside this range is where all the biochemical reactions are happening properly and anything outside the range is dangerous.

[00:37:53]That's not where they come from. It's a statistical equation that finds standard deviations and percentiles outside of that population average or that one study average. And then and again it's statistics no science. So like >> 18 to 80 like all ages all issues. So it's not even your demographic.

[00:38:12]>> Yeah. Yeah. Yeah. And then so what we find is like and and you know you were talking about this as well. Did I do that?

[00:38:23]>> No, that's me. Uh >> oh, sorry.

[00:38:25]>> Sorry.

[00:38:25]>> Yeah, go ahead.

[00:38:28]>> Sorry. Okay. Sorry. Um um what was I just thinking?

[00:38:32]>> About the ranges.

[00:38:33]>> Yeah, about the ranges. So like what we find is that that women tend to actually feel their best at two times the top of the two to five times the top of the range. And it's different for everybody.

[00:38:43]uh different for everybody. Everybody's, you know, very vastly vastly different.

[00:38:47]Everybody's bio different >> talking about.

[00:38:49]>> Yeah, I'm sorry. I'm talking about testosterone. Yeah, >> that's true.

[00:38:52]>> So, I'll I'll hop into the labs. If you go to our website, which is gohm.com, and you navigate to Pathfinder Labs, there are three states that are restricted. That's just local jurisdiction. They don't allow for these kinds of labs. You would have to go directly through a provider for that.

[00:39:09]But everywhere else it's as simple as if you're a female scrolling down to female essential. This is what we'd consider uh you know the bare minimum for treatment.

[00:39:20]And then we do offer more comprehensive labs for uh females that usually they have some pre-existing health concerns.

[00:39:28]So they already know what these markers mean and what they're looking for. So we're just trying to make it a little more accessible. And then we have uh both male and female what we call apex panels which are topof the line. and they they cover an absurd amount of biomarkers. Really, this is just for uh people that are interested in the absolute apex of optimization. For the average patient, Essentials is going to do really well or custom.

[00:39:52]>> So, you you would add that to your cart, proceed to checkout, and then uh you'll receive an email with what's called a requisition form. It's it's a PDF. It's a permission slip. You bring it to a Quest Labs. If somebody's not familiar with Quest Labs, they're like Starbucks.

[00:40:07]They're on every corner of every major uh city or town and uh you just go in, give them your wreck form, they they'll perform the draw. You don't pay them anything. And then you do receive your uh results in uh about 5 to seven days at which point if you want you can click get started and then uh get that consultation that Ryan alluded to.

[00:40:30]>> You're saying that insurance covers it.

[00:40:32]They don't pay anything because it's if they have insurance, it's covered by >> No. No. So they they they've paid for the third party labs through us. So it's already paid for Quest. Quest is just performing the draw. Um at the same time, if you're watching this and you were to you actually have a provider that tested your sex hormones in your annual physical, which >> let's be real, it's kind of rare, but some people have good relationships with their doctors. So they're in a position where they can say, "Hey doc, I'd really appreciate it if we tested my testosterone progesterone." If you are fortunate enough to have one of those situations or you've done labs elsewhere, we'll accept them. We we don't we don't they don't have to come from us. We just need the markers to be able to provide, you know, informed uh conversation around that.

[00:41:18]So for my my work to the the labs or for somebody prior to a patient coming in to see me they make the appointment we set up their labs they go to lab core quest or pri different labs get their labs it take by the time the labs come back then I get all their labs and the patient comes in and then we go over it. So the labs are the frame of reference that we need to make our recommendations and decisions based individually for you >> ti tied into their symptoms of course.

[00:41:45]Uh Dr. Burman, I'd love to get your perspective on uh what what kind of ranges are you looking at for uh suboptimal versus what's like kind of common to see somebody who has these uh the symptoms and then what are you targeting in terms of therapeutic benefit once you >> here's the thing that's really important that you know we're on labs labs labs on the one hand but on the other hand really we treat the patient not the number and I can't tell I can countless times I'll get the patient I'll have the patient's labs and her qu and her questionnaire and her data and I'll look at the labs and I'll be like oh god this lady's definitely you know not good she's going to be bad here we go and I look at her symptoms and talk and this the symptoms don't match the labs other times I've seen labs where you know middle of the range okay maybe we can do a little this and that and the lady's miserable like suicide or whatever. So, the labs don't always match the symptoms and that's really important. That's why you have to take that into account. But generally speaking, the symptoms that women experience related to estrogen and progester and progesterone, the main ones, hot flashes, night sweats, sleep, disruption of sleep, can't fall asleep or difficulty falling back to back asleep if they wake up, racing thoughts.

[00:43:12]um the um moodiness, irritabil, anxiety, irritability, short fuse, weeping and depressed, combination of all of them.

[00:43:22]Um worsening if you're parmenopausal around their period. Women will say I have like a week to 10 good days a month. That's it. the week before I'm miserable, the week after, you know, so that um you know, the the not feeling like yourself where you feel out of sorts where you're super reactive and agitated by your family members and friends and and and which you're not normally that way. That's extremely common. Weight gain is another difficulty losing weight or maintaining the weight that you have. Women will say, "I'm exercising. I'm eating a broccoli spare a day and I can't lose this weight. I'm all fat right here and I'm squishy. I'm going to the gym. I'm lifting weights and I'm not getting any definition. I have a trainer. Why is that happening? Um, and then sexual health. Low libido is probably one of the most common ones. Also, um, loss of interest in sex, not motivating sex.

[00:44:16]Also, orgasm is testosterone. Difficulty achieving orgasm, change in the intensity of, harder to come by, less cost benefit. It doesn't even pay off sometimes even having sex. That's another one. And um there was uh oh the cognitive the cog memory short-term memory focus concentration difficulty learning new things taking on new information absorbing that information teaching that to somebody else you know could mean you know the seamlessness of what you're able to learn retain master and act upon gets harder with age. Um, and it's, this is also my personal opinion. Every woman needs to be on testosterone. I already said that. But also, everyone, it's impossible for a woman to remain productive and competitive in the workplace, competitive with younger women and men for that matter, not on hormone replacement therapy. It is unreasonable to even expect them to do that. And it's the reason why we're not seeing women, you know, in their 70s and 80s leading Fortune 500 companies because they've all phased out due to men. As soon as you start having hot flashes, night sweats, not sleeping, moodiness and tired and have memory. As soon as you notice that that you're not fire, then that impacts how assertive you are, how aggressive you are, how motive you are, how much you're putting yourself out there to take on new work, and already he and she are better than you. And so once they realize he and she are better you that then you get phased and this isn't me because I never worked in the workforce. I've always been but I'm seeing this with countless patients and they get phased into a different role and some will like retire out with with this change that we're about to initiate a new movement. Um there's going to be, you know, hopefully a change. We're going to see more female leaders of our country, of our corporate, of our finances, Wall Street even.

[00:46:15]>> And um you we're better managers of people. Women are mult multitaskers.

[00:46:21]>> Um empaths can lead with emotional intelligence. So it'll be interesting.

[00:46:27]Um >> I love it. You're And yeah, you're absolutely right. like a a I um the first thing I like that you say is that as soon as you start feeling the symptoms it's time it's time to look into it like as soon as you start getting those symptoms you can feel that things aren't the same right like I know men can and I can see it in females too it talk you know a lot of our females patient it's like the number one regret we get from female and male patients for that matter is that they didn't start 5 to 10 years earlier that's the number one regret that that >> what they do is they attribute the symptoms it's very easy to attribute ute these quality lifes to other things stress my husband lost his job my son didn't get into college I have this huge wedding that I have to do all of that stuff which people experience as stress or burden does impact hormone balance but you're also pmenopausal and coupled with stress so they they write their feeling off to life and things and when when this gets better after this and then all of a sudden two three five years have gone by. Yeah. So yes, and by the time you're experiencing symptoms, by the way, damage is already done. So by the time you're acknowledging and feeling it, that you you might be just having hot flashes and can't sleep.

[00:47:41]Let's say that's how you present. But that's not to say that your brain, your bones, your vagina, your heart, everything else isn't impacted. You're just not feeling it and you're not fat yet. You're just not feeling it yet.

[00:47:53]It's not It doesn't just go to one place. It's your entire body and your glycemic control and your ability to combat inflammation. All of that um is is impacted.

[00:48:05]>> Yeah, that's great. I I I love talking about that. Like I know that you're like me. I can when I go out in public, I can see hormone deficiency everywhere. I see it everywhere. And I see so many women walk, you know, barely able to get out of their car. like if they're sitting down, it's like a struggle to to get up out of a seat. Just get up out of a seat. Um I see it everywhere and all I can think of is if this person just understood hormone replacement therapy, like you would move better. You're it would there's no doubt in my mind that even in and I've said this a lot of times before in nursing homes, if we brought hormone replacement therapy in the nursing homes, it would unequivocally at least have the population of nursing homes and people on walkers would be able to walk normally. people who were bedridden would be able to probably walk on walkers now. There would just be so much such a dramatic shift and a dramatic change.

[00:49:00]>> So, I I'm hearing a lot of potential benefit. I I think it's time to to move into what are a couple of the main um beliefs, myths that are are holding women back. Uh probably the largest is that hormone therapy causes cancer. And then the second is of course testosterone is a male hormone. it's only for men. So, uh, Dr. Burman, I'd love to get your reaction to both of those statements.

[00:49:25]>> So, the first and most important one that every single person that's listening to this needs to understand that estrogen does not cause breast cancer. Estrogen does not cause breast cancer. Estrogen does not cause breast cancer. Estrogen can cause breast glandular tissue to grow. So, it can make your breast more full, more tender, but not does not cause cancer. and the estrogen arm only of the of all the studies are still going. They're even using estrogen giving estrogen to some breast cancer patients that aren't estrogen receptor positive. So estrogen is safe and effective. Progesterone, natural bioididentical progesterone, not the provera, not the synthetic form of pro natural progesterone is um also safe and effective and protective in the breast. Progesterone is necessary if a woman is menopausal, not having a period, and is put on estrogen, is receiving estrogen. She also must be on progesterone because progesterone protects the uterus from thickening, from the lining thickening, which can lead to bleeding and endometrial proliferation and ultimately possibly endometrial cancer. So any menopausal woman on estrogen also needs to be on progesterone. But not just for that reason. Progesterone also has other benefits. Progesterone helps with sleep.

[00:50:44]Progesterine also helps with mood.

[00:50:46]Proessine also helps with metabolism. So progesterone um and sexual health. So that um we we even women that have had a hyctomy that don't have uteruses, I still put on progesterone for the benefit.

[00:51:00]>> I get that a lot too like oh I don't I don't need progesterone because I had a hyctomy. I don't have a uterus. Like no that's not the only thing that progesterone does. That's also a neurological s neurological signal molecule that is that was evolved 500 million. Testosterone, estradile, progesterone evolved 500 million years ago. They are in every vertebrae and in most plants. They are foundational metabolic and neurological signal molecules. So you still need you still need the progesterone even if you don't have a uterus. I'm really glad you brought that up.

[00:51:29]>> And then um the testosterone. So testosterone and the challenge that we have in far as women go is that well testosterone is a male hormone. It is not a male hormone. It is a hormone a human hormone that's equally essential in women as it is in men for similar and also different reasons. Now our le our levels are different than you know the the therapeutic levels in men and women are different but men with low testosterone levels experience similar things that women experience with low hormone levels estrogen progesterone testosterone fatigue weight gain they have men experience andropause fatigue weight gain loss of lean muscle mass difficulty with erections maintaining erections um sustaining erections sleep, even moodiness. Now, the thing about men is that they it happens gradually and subtly over time. They don't have a huge crash at menopause like we do, but um they they still experience um changes with age that we as a community, as a medical community, and for that matter, society don't really fully acknowledge.

[00:52:43]Um the we've looked at um testosterone as an ED kind of segue not and in the weightlifting bodybuilding world in or people with hypogonatal like pituitary disease but in the mainstream regular run-of-the-mill guy like the two of you um they you know they nobody's really thinking about or worrying about testosterone levels and what I'm seeing pandm ically is low levels of hormones in women and men for that matter. Young men with ED, 30 year olds are showing up with ED and low testosterone levels. Why that is probably having to do with the you know >> endocrine disruptors toxins toxins and chemical and it's leading to infertility in women. Young women are infertile men for that too higher incidence of PCOS and all this other stuff. So um with that said um I think that there should also with one of your initiatives should be towards the you know the regular guy is optimizing their hormone balance even they don't get you know pre-andropause >> because um >> I I can't even M this is new like I don't know what this is going to look like what these guys are going to look like 20 years from now because it didn't need to happen this way. So that when I was in my training they and by the way the level that we considered normal back then has shrunken used to be 500 to 700 is where we wanted a guy to be. Now it's like 300 is normal 250 to 300 you can't testosterone if you're like that's ridiculously low.

[00:54:30]>> Thank you. Thank you for saying that because you're right like the the testosterone level the newest testosterone level actually dropped the low end of the range dropped. So all they're doing is normalizing dysfunction.

[00:54:41]>> Dysfunction. Yeah. But have you read that guy there? They did initiate um the ability for the enlisted men to have testosterone level which is huge. That really bothered me because they are under stress, physical stress, emotional stress, mental stress, depleted and then have to go go out. They have a very short time to recover and go back again.

[00:55:04]I cannot imagine the burden that's and they testosterone was illegal. They not only were they not tested, they couldn't take it. So now that has changed. I don't know what led to that complete 180, but that's um >> yeah, >> you know, I think they're worried that it was, you know, because with testosterone in men that, you know, it could cause if it caused aggression, aggro, maybe hypersexuality in the bar like I don't know why they were afraid of it because we're we're creating weapons. The Marines are they're weapons. So we want them to be strong optimized >> but just they can't be that's it.

[00:55:46]>> Yeah it's a it's a step in the right direction. I think it's still got a long way to go. One thing that Hedgeworth did say is that if you if you qualify for replacement therapy and we know that all you know the VA doctors are going to go by the range and I think they're still going to be undertreated but it's a step in the right direction. Right. They're they're acknowledging >> we want to treat we want to test everybody over 30 and I and that's it's a it's a step in the right direction.

[00:56:10]It's beautiful. I'm >> there's still plenty of troops that are going to be >> take it. Before they they were they it would be illegal to take it. You would be screened for that and you know whatever. Now at least if they're on it they're yeah >> allowed to be.

[00:56:25]>> Bringing the uh conversation back to to females. Chris, would you uh play that testimonial uh for Billy Mun? Uh we've got uh a few people that have asked some questions that I think her uh testimony will actually uh kind of answer as well as we'll move into H4M's approach. Uh would love to hear Dr. Burman's uh thoughts, comments, similarities maybe within her own and then uh we'll answer some of those questions.

[00:57:01]I think Chris is queuing the up. Yes.

[00:57:06]>> Audio >> and I feel stronger. I think I heard Ryan on YouTube. I kept listening and I'm like, "Wow, I think they could help me." This is when I found uh hormones for me and was hooked up with Matthew Bucko who is my health maverick who was very intuitive, experienced and uh respectful so that we as a team could figure out what to do for me. It helped me so much because I had celiac disease and I also had a bad back and it helped both of those issues. I'm so thankful I could cry. So the process is so easy and the um hormones come in the mail so quickly and everything is very well done. The people at Hormones for me understand for which I am very grateful.

[00:58:02]>> She was she was great to work with though. She was you know what it stands for H4M. I didn't know that. Hormones >> hormones for me. It was originally hormones for me and then um our audience just started shortening it to H4M. Uh so so we just kind of we just kind of like rebranded a little bit to H4M.

[00:58:23]>> So just to quickly get into our approach, I'm going to go very quick on this because we have some questions stacking up and I I want to make sure we actually get to to all that. So we begin with labs. uh if we haven't been clear with that that that was what we showed you with uh starting with labs the and and this is very true of what uh Dr. Burman said, "The values are important, but they are subjective. Just because one person feels fine at one number doesn't necessarily mean the number is right for them, but we need the number to have something hard to to go off for our providers to start. And then we move into a personalized protocol. So the the protocol is going to vary uh the dosage, the route of administration for what is right for that patient. And then there's ongoing monitoring. It would be entirely irresponsible to begin administering medication to a patient and say, "Okay, see you in six months. Let us know when you need more." That that would be ridiculous. So, there is uh when the medication and the treatment has begun, there's a period of time where the hormones build up in the system and then once they've stabilized, we're going to look for follow-up labs. And again, we have general targets that we've seen work across a broad population, but we're very much looking for that patient's feedback as to how do you actually feel? And the number again is important because it tells us what number corresponds to what level of feeling. So from there, adjustments can be made in a customized manner. Finally, uh you know that I'd say that's that's the lab work uh guiding every decision.

[01:00:02]the maintenance. Once once uh everything has been figured out, it's pretty easy to keep things going. It's uh sometimes people need a little bit of work in the beginning to get them to where they need to be. So, uh Dr. Burman, any similarities, differences from what?

[01:00:18]There are similarities, but I thought of one thing I wanted to bring up that the testimonial lady um highlighted that I haven't talked about is her autoimmune issues, any inflammatory issue or autoimmune issue, any um can is is um alleviated with hormone replacement therapy. And from that standpoint, if you think about yourself is whatever issues you have autoimmune wise, allergy-wise, migraine headaches, ex whatever issue you have will get worse with hormone imbalance, parame flaring. So hormone replacement therapy also alleviates a lot of those autoimmune issues, you know, irritable bowel, um fibromyalgia, even rheumatoid arthritis. Estra, it can cause an acute flare, but ultimately will alleviate joint pain, arthritic pain, frozen shoulder, neck pain, back pain, all of that. um your um interstitial cyitis inflammation inflammation anywhere is mitigated with hormonal place.

[01:01:25]>> They're immunomagulators as well. It's another function of testosterone. So they they um reduce the NFKB pathway. They they get rid of it. They they reduce tumor necrosis factor alpha interlucan 6 interlucan one beta reduce all these inflammatory cytoines and they also um stop the differentiation T- helpper cells. don't differentiate in the T-helper one which is notoriously the attack attack um um the attack formation of the immune immune system where they're going to that's where autoimmune disorders your tail for one is going to just attack your own cells and then your in your cells inflame and then they they become dysfunctional right and then when you have dysfunction if it's in your gut you have gut dispiosis you have bottle syndrome if it's in your joints your joints inflame and then and they just can't be use. So testosterone just suppresses these overactive immune system >> and in the brain inflammation can cause chronic decline ultimately Alzheimer's and things along those lines is neuroprotective also. But in terms of your question, do I do some of the same thing? Yes, we draw lab we draw labs. Um and uh go over the lab like everybody's story is a similar but different what her symptoms are, what her labs are, what her goals are, what issues um she's wanting to address. And every woman is dealt with individually and treatment we we create treatment plans based on each woman's in based on her age, her weight, her symptoms, her risk factors, her DNA, all of her goals. Like some of sometimes women will come in and the I need to lose weight. I thought this is the main thing like you know so and and we take that into account too. So for somebody like that you know we add peptides and things along those lines and how aggressive do they want to be with peptides. So it so by the way we haven't talked about peptides at all but in my opinion peptides are a huge part of this. Yes, >> need to be hormone replacement plus fat diets. We >> we agree we get to to questions here, but I also will you do me a favor.

[01:03:31]>> Will you come on our show again so we can get into peptides and genetics? We didn't talk about genetics either.

[01:03:36]Genetics.

[01:03:36]>> Thank you. Because that that's a that's a long rabbit hole. We'll we'll do a follow-up. We talk about once we get somebody stable, what do we look at for really bringing somebody to the next level, which is for us going to be the genetics as well as the peptides. I think we're all kind of on the same page there. I think that'd be fantastic.

[01:03:53]>> Yeah.

[01:03:54]Followup show and we'll talk about all the things that we we have an outline here and we didn't talk about half of it. So, uh, we'll do another show and and and we'll get to all that. I think it's important some of these questions that we have for you for for you, Dr. Bourbon. Some of our some of our audience is asking questions.

[01:04:11]>> Athanitos asks, "Dr. Burman, what are your thoughts on those that say high estrogen is a cause for cancer?" I think you already answered it.

[01:04:19]>> I already answered that. Estrogen does not cause breast cancer, but moreover, there's no such thing as high in contrast to low. High. What What is high? Um, you know, there there there's a range. And by the way, your estrogen level is never going to stay one number.

[01:04:35]whatever that lab is, that time at that moment in that day that you drew that level, I guarantee you it's not that level now. So, you have to take all of that into account. And some women, like I said earlier, um require higher estrogen levels for metabolic health and symptomatic improvement. So there isn't really a high or low, but they what the medical community is trying to do now is define what is considered low estrogen or too low to require hormone replacement therapy. I don't even like that. Um they're saying it's 40 to 60, I think, but some I I just said earlier some women feel fine at 40. Um so that that doesn't necessarily mean So every woman is different. We know what's considered low. We know what's considered high. But it it it's a reference point. It's not necessarily do this or do that based on that. It helps guide your direction, the medical direction and decision making and keep you feeling safe and that we're monitoring that m the main thing we're trying to do is mitigate side effects and risk. That's it. that that's all this is is how do we optimize balance and keep mitigate side effects. That's the purpose of the lab.

[01:05:54]>> Beautiful.

[01:05:55]>> Well said. Well said.

[01:05:56]>> Uh similar vein uh 1976 asks would love to hear what she considers optimal levels of testosterone for women in her experience.

[01:06:08]>> That is a good point. In my experience and my training and my research, we learned that for women to experience symptomatic improvement with testosterone, we need to push levels up higher, significantly higher than what the standard normal ranges will say on Quest Lab or wherever. So um for women typically um within and I draw labs six week with pellets let's say there's lots of ways to do hormones patches creams pellets after pellets we draw labs six weeks for and that's your peak levels and at that time six weeks post pellet I want testosterone ranges to be within 180 to 250 nanogs per deciliter now 250 I just told you that some men are 250 to 300 see that number or doc like oh my god she's gonna grow balls and what it's not and what is the what is in your bloodstream isn't necessarily getting absorbed into the cell that's the other reason we have to push up so high because it's not all getting absorbed and your vitamin D levels you have to talk about that's also really important for the absorption of hormones from the bloodstream into your cell and we all as a community as a culture are now vitamin D deficient because we're not able to get our nutritional requirements from our food sources anymore and have to um supplement.

[01:07:34]>> Yeah.

[01:07:35]>> Imagine if you have like systemic inflammation too and now and like we just talked about the immune immune modulation immune disorders where your your cells are inflamed and now testosterone it's important that testosterone has to diffuse into the cell so it can bind to the androceptor transllocate to the DNA to have the hormone cascade of effect. If testosterone can't get into the cell because it's inflamed because there's too many necrosis factor alpha and just inflammatory cytoines then your serum level isn't necessarily what's happening intracellularly. Right. So you're absolutely right. Sometimes you have to push those levels to have the effect. I love everything you just said Dr. B.

[01:08:10]Thank you for saying it too.

[01:08:12]>> This is a massive question that we get all the time. Um, for a late menopausal woman, meaning a woman who's been in menopause for 10 years or longer, is taking HRT with all three hormones, testosterone, estral, progesterone, still beneficial? I've been trying to get my mother on board with this inner high. I can relate. I won this battle.

[01:08:34]It took me making a PowerPoint. It took a lot of me citing studies and research, but my mom's been on HRT with hormones for me for a couple years now. I think she's watching and she would pipe on to say that she wishes she started earlier.

[01:08:50]Dr. >> For more context, I put my 70 year old mother on hormones too and she is just having major benefits. But Dr. Burman, let's hear your >> Well, there so in answer to that question, um, yes, women, older women benefit from hormone replacement therapy. The only issue is that and start and to what you both said, I wish they would have started early. Starting early is essential and I didn't mention this earlier. Starting in pmenopause as soon as you're getting symptoms is essential because you will you will not only get the symptomatic benefit you'll not only feel better you will also get the preventative benefits of hormone replacement therapy from age related to cognitive decline from col from all of the hormone related risks and diseases that can develop. Starting early gives you prevention. If you start later you'll get symptomatic benefit but not the preventive benefit. So that's another reason to start early. Now, starting late, the only it that's not just you're definitely going to benefit.

[01:09:52]However, in my experience, there's way more in in older people that have developed medical issues, um are on multiple medications, have high cholesterol levels. So, there's more risk than the clean pmenopause menopause like early. So, in those patients, and I don't get a huge amount of them coming in wanting hormone replacement therapy, but for the the handful of them that do that come like what I'm attracting are usually healthy, active women that are wanting to play tennis more, feeling a little stiff, not wanting to have sex anymore, are widowed and wanting to get back out. So, that's kind of been my my demographic. But even in those women, I um I worry about um the cardiovascular issues only because in somebody that's older over time might have developed plaque in their cardio in their vessels and estrogen although it's doesn't you know doesn't it's not like the oral estrogen that causes clot. Estrogen is thrombolytic. So it can loosen and l make the risk of throwing a clot higher.

[01:11:05]So in women you know o postmenopausal that have risk factors high cholesterol levels APOA which most of them do I um will ask them to get you know to have their primary care doctor or internist appro like approve them for hormone replacement therapy. I mean, if they don't have one, what I do myself is I I'll get a calcium scan. A calcium scan is a really easy test that looks for plaque. And if they don't have one, then good, then we do it.

[01:11:34]But you would say that if if they don't have that if they have a decent calcium score and >> that that the benefits outweigh any outweigh the any potential risks if um you know especially when we're talking about uh osteoporos perosis reduced in bone fracture risk reducing fall risk >> reducing fall risk and getting off the medicine that you have to take for calcium that IV thing was like a pain in the so this um is hormone replacement there is a way easier and more um productive and more better symptomatic wise >> for bone mineral density protection >> then yeah >> that's great >> so similar theme here uh what's the oldest age you would recommend for HRT for women or is there no age limit >> age is just a number so for your mom people that are thinking about their moms moms. Um I would urge you to think back because she if that she went through menopause at some point and maybe you're thinking now like oh that explains it that time when she was like this all and when she was so think about when that happened, how she tolerated that and where she is now. Because eventually once you go through the hot flashes and night sweats, that's the throws of menopause. those symptoms, those two symptoms, hot flashes and night sweats do subside. And so a woman can be post not the hot flash and night sweat are really is what's most disturbing to women getting hot in the middle. You know that that's disruptive to life. So those eventually go away and women were routinely taken off hormone replacement therapy. But here's the thing is that everything else stays the same. So your libido stays the same, your cognitive fun stays the same, your sexual health, your bone mineral density. So getting off of hormones once you're through the hot flashes and ice sweats in my opinion is not indicated.

[01:13:35]Your question is my mother might never have been on hormones or was taken off and now do I put her back on? And the main question isn't just do I put her back on or not. What are her symptoms?

[01:13:46]How is she experiencing life? What is her level of vitality? Is she experiencing arthritis and pain? Is she not motivated and slothy and just like not doing anything anymore with with her inspiration life or anything else? Is she more moody or depressed? So we the hormones would be indicated for her in my opinion symptomatic benefits. I personally I don't know about you guys but I personally have not put a post-menopausal asymptomatic woman with nothing wrong on hormones just for you know benefit at that point. Um I have I I'm not that >> Dr. Burman. If they were asymptomatic, we wouldn't be speaking.

[01:14:27]>> Yeah. Well, no, because you think about prevention too. You might think, well, she's not really but I might be able to prevent her from falling or might be able to prevent her dementia from progressing. In specific cases like that, I think it it could be warranted.

[01:14:45]It's a it's a longer conversation, but something simple as she's menopausal.

[01:14:50]You can confirm with laps her testosterone is cratered. If nothing else, what about sarcopenia >> for a muscle wasting? True.

[01:15:00]>> But um at that point she would need to be ambulatory. Like I guess in my mind like somebody that's in a wheelchair that is you know in diapers and that kind of thing. There's a point where >> we're probably okay I I get where you're going with this. There is probably a point where like if they are wheelchair bound and we can extend the argument to the point of absurdity where >> and I'm envisioning my parents who are really old. I forget that you guys are younger. Your parents are probably what?

[01:15:33]Like what are they?

[01:15:34]>> My mother was 78.

[01:15:36]>> So that's Yeah. So that's my mom's 62.

[01:15:39]She started >> That's my age. She needs to be on it.

[01:15:47]>> I could be your mother. Oh my god.

[01:15:52]>> That that math doesn't math on your side. Although my mom doesn't look her age either. So >> you look absolutely fantastic for your age, Dr. >> B.

[01:15:59]>> Hormones. It's hormones.

[01:16:00]>> It's hormones.

[01:16:02]>> But yeah, I think that very well answers that person's question. Thank you very much for it. Uh this one now I think this is probably part of our part two.

[01:16:11]Uh but is there a better route for women to receive HRT injections or compounded creams?

[01:16:17]>> Good question. I'm going to tell you in my opinion >> right now based on what's available commercially available to us in the United States right now as far as testosterone is concerned for women. In my opinion, the best way to deliver testosterone in terms of precision.

[01:16:32]Precision with calculating the dose.

[01:16:34]What does she need versus her need based on your age, your weight, your symptoms, your height, your what dose do you need dosing wise? And how is it metabolized?

[01:16:46]So the in my opinion the pellets offer the best options for precision with dosing. I can calculate the dose this woman needs based on data based on her data and I know that once I once she I put the the pellets in that they are going to release hormone over time over a period of three and a half to four months based on her not mine or not the la her or the drugs halflife her individual metabolism blood flow and cardiac output. So the that will optimize her beneficial effects, minimize potential side effects, and it also offers in my personal opinion because I I've tried every single mination of testosterone that exists on earth. I have tried for men, for women, for whatever animal I have tried and the most physiologic optimal perception of well-being from testosterone in my experience and then based on thousands of patients that I've done is with the testosterone pellet.

[01:17:47]Now, that's not to say that it's going to remain that way as more options become available. The challenge with the creams is the precision. Like, if I let's I want to give her three milligrams, I want to give two, well, she might need 2.5. And what I think I'm giving isn't necessarily absorbed. So, if I want to deliver three, I don't know if three is getting in there. And what's absorbed, what's put on there isn't absorbed. And there's variation person to person, batch to batch, dose to dose that you can't and there's way it's way more cookbook, way more like, you know, little salt, little pepper, and um it it's less precise in my opinion.

[01:18:28]However, I was doing that. That was the I was on that stuff. So the only So it wasn't until it's been with been with the last six to eight years that I had pellets have been around for decades, 20, 30 years. It's only been with the last eight years or so that I've adopted it. And the only reason I adopted it after really wanting nothing to do with them because I saw all the complications I most everybody was getting overdosed.

[01:18:54]Everyone was getting overdosed with pellets and it was frightening and I was having to deal with all the side, all the bleeding, all the acne, all the hair loss, all the music that I was having to treat all that stuff. So I wanted nothing to do with pellets. And it wasn't until this company came forward biot which had at that point that they they he the reps were stalking me. They were coming to the office and I'd tell the staff, "Get them out. I'm not doing no.

[01:19:19]I don't want their lunch. I don't want it. No, no." like literally hiding from them. And then one day it was the end of the day and I was cleaning up the front.

[01:19:27]I was the only one in the office and I looked up and the guy the rep from sitting there Luke in my office and I was like, "Okay, fine. What?" And he came and he showed me at that point that they had pelleted probably six million people at that point of all ages, races, social, and they had the data like you're going to have. They had the data and based on that data they were able to develop ranges for dosing of women which did not exist. men we knew, but women dosing of women was not existent and they created a very simple to use calculator that plugandplay and I was like what this is crazy and then they offered to train me. So I was flown no I was in Orange County. So I go down to and they have a um a whole staff of these these g transformed gynecal obgyns that were delivering babies miserable like and life and then they discover >> I'm now a peptide factory and so they become the these this group of like frustrated angry o smart frustrated angry busy sav businesssavvy smart quasi academic gyns were the original few, you know, they were the infantry that brought everybody in and I got to experience them and their knowledge and all their experience and lots of data in there that I hadn't that I knew kind of through my own trial and error like you.

[01:20:58]But the seeing it written like that was re reassuring, reaffirming sort of like what you're experiencing right now with me saying it. I got that from the biote thing. And then um then they even offered to come and train me. So I had the ma my main doctor come to my office.

[01:21:16]I scheduled five patients including myself and they proctored me putting the pellets in and then after that they even had they don't offer any of this anymore now that they're trained but then they um also offered to everybody a mentor to run things over because like I said putting the pellets in or prescribing isn't the hard part. The hard part is managing the symptoms side effects and balances that they have afterwards. So, how do I deal with this or what I in this case do this lady had this and I had this woman um doctor down in Torrance that I had that I called from time to time and um you know she so it was just re I knew what to do anyway but it's just reassuring and and support and um and that's how that's how I got into pellets. Now there might be a better way you know in in the near future. Um it is a procedure so you do have to you know it's there's implanted subcutaneously in the glutial region. It's not covered by insurance. That's the other thing.

[01:22:19]Although testosterone is not covered any which way by insurance. So um there's that. But that's my feeling on the benefit of the pellet over the creams.

[01:22:28]The benefit of the pellet over the injection is the injection can get get you therapeutic levels but you get this high spike and that you know it's uh it's that what we want is you know is balance not up down and I've noticed when we've done and I've some women don't want the pellets they want the I whatever you know it's it's a it's a joint decision I don't make people get anything it's based on convenience their budget what they're comfortable with um some no women women will no way do any shot. But so, but what I noticed with the um with the testosterone more definitely more risk of side effects, hands down. And they they need to know that. And also um tolerance. They quickly build up um like a tolerance or resistance to it that um either requires higher dosing or changing a level. So I I feel like it that there is a point where you can super saturate the receptors and downregulate the receptors that you know we have to figure that out a little better and you know and take that into account. Again showing how this is not just you know dumb science that there is a lot of care a lot of knowledge a lot of experience a lot of thought that has to go into um managing each program because >> yeah you Dr. Dr. Burman, you are you are obviously very knowledgeable about how to apply the pellets and and very good what what we've seen from because you you mentioned this right that if you apply the pellets incorrectly or if you don't use the brand and you apply them like a lot of people have problems like we've seen we've seen people who had them applied incorrectly they would like you said their their levels would go really high and then they won't replace them for like six months. So after after just two months their levels are back down again and the person has to deal with symptoms of low testosterone again for >> that's not normal. That's not the way it's supposed to. So they last the challenge is like what was happening before is that it took forever to get the lab. So these women were that were overdosed were bleeding forever.

[01:24:39]forever to get. So the I've never seen levels drop quickly with with the pellets, but the level but there is a range the 180 250 at six weeks and then again if it's early in their course I'll draw again two weeks prior to the prior to their second pellet. So that's a trough peak and trough and that I have a sense are they fast metabolizers slow metabolizers what level and um and the only way and these these companies that are offering um like biot there's another one called Belmar Bella Pelican there's a couple of competitors now um that offer a dosing calculator they've made it for dummies so you you can just plug in plug and play not think I I never give exactly what it says because it underdoses. So they they figured that out and they are down whatever they're recommending is like one dose down from what it should be probably. Um so they're I'm seeing less overdosing probably more underdosing and not not properly um not properly balancing. But where you're seeing people getting overdosed or >> Yeah. or just just having the pellets applied incorrectly like you stated like if they're not done correctly then then there can be a lot of >> are they being implanted incorrectly like those kind of issues >> done incorrectly and like yeah the dosing and then they let them go too long before they >> and it could also be bad pellets that's the other thing that I've realized there's a shortage of patches going on right now and a shortage of pellets most all of these pellet companies are out of stock and biot is like the mob they have a monopoly on an Aniseo which is one of the biggest the biggest pellet manufacturer. I feel like they might even own it and other far other companies can use that but biot gets the bulk of them. They double screen. So the the aniseo screens all the pellets for safety, purity, you know, percentage and all that. And then biot does their own assessment also. And the one the the the pellets that don't meet their criteria and there are some they give back to ano and ano sells those to other people. So biote says everybody else is getting our you know discards and the pellets might be bad and I think that is true because some of the other companies I've used have I question was there even a hormone in that pellet. So the pellet manufacturer also matters. Um, >> so if you if you can't get to Dr. Burman to do the the pellets professionally and very very you know with with a lot of experience then then if you can't get to Dr. Burman then another option would be would be to come to H4M and and we we do use injections. We have a lot of success with it. We have like really nuanced approaches to it. Um and that that that works really well for us. So yeah. No, I I understand that if you use those pellets properly, they're that I've seen if they're done properly, I've seen um women have a lot of success with >> that. That was a fascinating discussion on pellets and very uh broad >> patches and creams are fabulous, too.

[01:27:52]Again, some women prefer um prefer that and it should be a a decision, you know, an individual decision based on your comfort zone, your budget, your convenience. There's some women like I had women that did, you know, didn't want the p. They were single or I don't want the patch and and or it's inconvenient. I want the freedom of just throwing out like so again every there's something for everyone.

[01:28:16]>> Dr. Burman, you've been extraordinarily generous with your time this evening. We we've gone over time in fact and uh we we really appreciate you, you know, taking the time especially to answer the questions of our viewers. I I know it means a lot to them. Uh kind of in closing, I want to speak to our audience briefly and say, you know, to to the guys watching, we we appreciate you coming back or if you are new joining, we appreciate you sticking uh with us through a female episode. And uh I I want to give each of you a lot of credit for uh the courage it takes to take control of your own health. You know, I I've been there myself and uh there's not a lot of great information out there. You had to wade through some bad stuff to get to anything good. And uh hopefully you're you're experiencing the benefits of that. We do ask that you know you you step up for the woman in your life, the the woman that you care about and uh give them the support and information they need to at least open open the door and you know do a little of their own learning so they can at least make an informed decision because right now if they're choosing not to chances are they don't really have much information. They just have fear and myth. Um, and for the women watching, we want to remind you that you don't need permission.

[01:29:35]If if you don't think you feel how you should, uh, it's your life, it's your health. You are fully capable in 2026 of taking control of your own health. Be it with us, be it with somebody like Dr. Burman, who based on this conversation, I I would recommend to anybody without hesitation. And uh you know, working with experienced providers will save you years of guesswork and will get you to where you want to be in the shortest amount of time possible.

[01:30:04]>> And Dr. Burman has a book, too. Uh you can uh get her for women only, a revolutionary guide to reclaiming your sex life. So, she has >> she's got a couple books. She's a multiple time New York Times bestseller.

[01:30:15]I think I saw >> New York New York Times bestseller. So, uh you can you can also get her work get her work there. Um Dr. Bourbon, let's do another show. I'm really excited. We have a lot more to talk about.

[01:30:26]>> Definitely. I'd love to. Um, peptides, genetics, >> genetics.

[01:30:33]>> We We would love that. Thank Thank you so much.

[01:30:35]>> Thanks for coming on. It's been an honor.

[01:30:37]>> Thank you. Thank you everybody for tuning in. Uh, we'll be excited to see you guys next week. And, uh, with that, this was H4M.