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Or maybe missing key nutrients?

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I've been tracking my cycle since before kids, so we are talking over thirteen years now, since my early thirties.

I'm now forty six years old.

So I've got this little app in my phone, It's called pe Tracker, and I literally have over a decade of my cycle and I am a pretty textbook normal kind of girl when it comes to my periods.

I've been a twenty eight day girl, and then up until a couple of years ago, I was twenty eight days.

Now i've shifted back into about twenty six days, and I know when I'm ovulating, I know when my period's due, and I've also noticed some changes more recently.

Interestingly, not only has my period shortened a little bit, but I've noticed that around ovulation I get kind of frisky.

I know it's happening because I often will get these quite raunchy dreams, and then I find myself wanting to watch shows like Outlander.

A bit more of Jamie in my life would be good.

And then as we get closer to my period, that's when I start to feel some of these really big mood changes.

The mummy rage can step in.

I also notice ability to focus and things like that are starting to get worse.

The other thing that started as well is the night sweats, and I'm starting to get starts with about five days out a little bit clammy, and then last month was just a nightmare.

I had to change my pajamas most nights up until probably about day two or day three of my period, but then a few months earlier they were totally fine, So it just kind of ebbs and flows.

Anyway, all of this got me thinking, when is the right time to start considering HRT.

I don't take any medication, you know, I try really hard to kind of do everything I can naturally, but I do recognize there are so many benefits with HRT, and I am forty six and getting to that point, But how do I know when the time is right?

This is healthy her with Amelia Phillips menopause or pery menopause is finally getting the attention it deserves, which is equal parts exciting as well as it is infuriating considering every woman on the planet goes through this.

Oh hello, why did we need to fight so hard?

And hormone replacement therapy is also finally back on our radar as a real solution to help manage the sometimes debilitating symptoms and knock on effects as we go through pery and menopause or what I like to call reverse puberty.

But of course, without all the support and the help of our parents and our lovely mothers, and the headstrokes and the lunch is packed and the home cooked meals and the laundry done for us and the hot water bottles.

I could do with some of that at the moment.

But after some very poor pr thanks to the Women's Health Initiative, which wrongly stated that HRT increases risks like breast cancer and heart disease, millions of women were scared away from treatment that could have potentially transformed their quality of life.

So thankfully, new research has set the records straight and we now know that for most women, HRT can not only be safe, but also hugely beneficial when prescribed appropriately.

So today we're going to dive into what HRT really is, whether it might be right for you, and when is a good time to consider it.

So to help unpack all of this in a fascinating conversation, I'm so excited to be joined by the Queen of Menopause, an absolute pioneer who has been working tirelessly to set the records straight, Doctor Luise Newson.

Now Doctor Luise is a gp A menopause specialist and the founder of the Nusan Health Menopause and Wellbeing Center in the UK.

She's also the creator of the Balance app.

I highly recommend you download this one stop shop for all things menopause.

She's the author of best selling books on menopause.

I've got her book, The Definitive Guide to the Perimenopause and Menopause, an absolute must read for all of us ladies going through it, and her mission is simple but powerful, is to make sure that no woman feels dismissed or left in the dark when it comes to their hormones and their health.

Doctor Luise, thank you so much for joining us here on Healthy Her Well.

Thanks for advising me to come.

Ah, I feel so honored.

Now we met in person a little over probably eighteen months ago now, when you came to Sydney and all the way up to the Northern Beaches to Whale Beach and you held captive a full room of very grateful women.

It was a great event, wasn't it.

Ah?

It was great.

Everyone was so friendly and actually in Australia people really look after each other.

It's something that in the UK we're not quite good at.

So that great sense of community you could really feel at the event.

It was brilliant.

That's lovely to hear you say that.

Well, kicking off, can you talk us through the main symptoms that HRT might be able.

To help us with so HRT just dons for hormone replacement therapy.

I don't actually like those letters because it doesn't tell you what it is, because there are hundreds of different hormones, so what are we giving what we're doing, So I much prefer to talk about the individual hormones progesterone, estrodil, and testosterone.

But it will help with any symptom that's related to changing or low hormone levels.

So one of the things that you've alluded to already is it's quite difficult to know how many of your symptoms, if any, or if all of them, are related to your changing hormones.

So if you get the dose and type of hormone right, then it will improve those symptoms.

So it can improve any symptoms if the symptoms are caused by the low hormones.

And that's such an important factor to realize straight from the start because for a lot of women, and they think, oh, well, unless I'm getting the hot flushes, I mean I am getting the night sweats.

But you know, historically they're the two that are really well understood.

But then for a lot of women it's actually more around the mood changes and the brain fog and the low mood and teariness that can really debilitate us.

Yeah, for sure.

And this is a problem, isn't it, because women have been denigrated to just their wombs and thinking about periods and fertility and then about like you say, flushes and sweats, which actually are not the most common symptom of hormonal changes.

We know from you know, literally looking at hundreds of thousands of symptoms on balance app that the commonest symptoms are ones that you say affecting our brains.

So low mood, anxiety, memory problems, fatigue, poor concentration, feeling very flat, very joyless.

You know, it's very hard to measure that in a scientific experiment, and that's why it's been neglected.

But the role of these hormones is crucially important.

One of the problems and the concerns that I have is that people are either dismissing or ignoring their symptoms because they feel they're not bad enough for treatment.

They don't deserve treatment.

They need to wait till they've got a certain number or certain severity of a symptom before they can even ask for help.

And then there's quite a lot of people who start to take hormones and they're still having symptoms and then are being told, oh, well you're still depressed or you've got something else going on, and actually they're just not on the right dose or type of hormone treatment.

Yeah.

Well, that's what I really want to kind of unpack a little bit with you today.

But before we dive into that, I want to ask you what the average age of menopause is and therefore what age should really we start to be thinking about HRT and when that comes on our radar.

So firstly, no woman is average, and I think we need to be thinking about ourselves as individuals.

You know, when you look globally, every country is different, but you know, on average in the UK and Australia the average age of menopause is around fifty one.

But and this is a big butt, we have to remember that about three in one hundred women under the age of forty will have menopause, So that's young women in their twenties and thirties will be menopausal.

But you've spoken about perimenopause, when hormone evels start changing, and that can occur for ten years or so before periods stop.

So if you think that's three and one hundred women under the age of forty are menopausal, there'll be a lot more who will be perimenopausal.

So most women in their forties will either be perimenopausal or menopausal.

Are either we have hormone or changes.

But if you think about the hormone testosterone, then testosterone actually starts declining around the ages of sort of late twenties, early thirties, So there are a lot of people who are testosterone deficient but still having regular periods.

And that's why it's really important to think about the hormones separately.

And tell me, is asking female relatives your mom, your sister, your aunties?

Can that be helpful as well to giving you some insights into whether you are close to that average age if you know for them they're a lot younger, is it more inclined that it will be you or the other way around?

I mean it can be if people have a history of POI premature of air and insufficiency.

So if they have family members who have menopause at an early age, then they're more likely to.

There's been loads of studies looking at you know, does smoking, do's drinking?

Does having so many children, affect age.

Or even early menstrual cycles.

I've heard people say, well, if you start at nine or ten years old with your period, are you going to hit menopause younger?

But the thing is, you know, we don't work out textbooks as women.

We're all different.

So I think the problem is is that people spend a lot of time trying to almost ignore their symptoms or to think that it's not related.

And then a lot of women think that menopause is a sign of aging, so they don't want to be thinking about it.

And because also some of the definitions of menopause are related to loss of fertility, there's a lot of women in certain cultures where it's very stigmatizing to think that they're infertile, so then they're not coming for help.

Whereas actually young women who have an earlier menopause, if they're treated with hormones, they're more likely to become fertile.

And this is why I just think the whole terminology of menopause needs to be changed, and even perimenopause.

You know, we just need to be thinking about ourselves as individuals and do we have symptoms that could be related to changing hormones at any time of our cycle, so then we're not even thinking about menopause or perimenopause.

Let's think about the ninety five percent of women that have PMS pre menstal syndrome, or about one in twenty women who have PMDD pre mental dysphoric disorder, which is a more severe form.

These women are struggling with hormonal imbalances, yet people aren't really thinking about them because they're saying, oh, no, you have to be menopausal before you can start hormone treatment.

So changing the terminology, changing the way we think about how we're labeled as women, I think is really important because I see so many women in my clinic who say, oh, I thought I had to wait until my periods stopped before I could get help.

In the last twenty years have been horrendous.

You know, life's really hard anyway, Like the last thing we want as women is to have a change in hormones affecting us.

So am I right then in saying even if you're in your late thirties or early forties and you're starting to get what you feel like is perimenopausal changes, you absolutely can be considering HRT and that path.

Absolutely.

But even if you're in your twenties, you know, you don't have to be a certain age.

That's what I'm trying to highlight.

Really.

You know, the youngest patient I've seen became menopausal as a teenager because her hormones didn't actually get secreted from her ovaries because their ovaries never developed properly.

And there are a lot of women who have hormonal changes.

A lot of adolescents are having really difficult time with their periods.

Yet they're put unconscious, which just block their own hormones working, which obviously means they're not getting ups and downs, but they're not getting any hormones.

So you know, we need to be thinking in a bigger picture rather than that's why just thinking about hormones.

Yeah, or just menopause.

Yeah, yeah, it's just missing out on too many people.

Yeah, I can totally see where you're coming from with that.

What about on the other side of menopause?

So what about postmenopause?

And I'm imagining you're going to have a similar approach on this side of the fence as well.

But is there an age where you're too far postmenopause to consider it?

So what you have to think about is what menopause is.

So menopause is when our hormone levels are low, and two things can happen.

It can cause symptoms, but more importantly for me as a physician, it can cause increased risk of diseases.

So it can increase inflammation in our body, increase risk of very common diseases like heart disease or stereoporosis, diabetes, dementia, Parkinson's disease, cancers, and an earlier death actually as well when you look at the studies, so menopause last forever.

It's not something you get through the day.

It ends as the day we die, I mate to tell you.

So whether people have symptoms or not, they still have health risks.

And this is where you know, messaging is really confusing because people think they're through their menopause.

I mean, if you look at the definition of menopause that was made by a gynocologist many years ago, it's a year since women's last period.

But it's really weird.

Is that is that a second?

Is it a minute?

Is it a year?

Is it a day?

Is it?

Like what?

It doesn't mean anything and.

We don't know that date until that year has passed as well.

So but that's why we need to think about, you know, what are we doing with our menopause, how are we making decisions as individuals, because you know, for most women, the commonest cause of death for women is heart disease and dementia.

And we're living longer as women, far longer than we did one hundred years ago.

But many women in their last ten years or so of their lives is in poor health, so they're not having a great time until the day they die.

They're having a pretty crap time, to be honest.

Often in nursing homes, residential homes co homes one and two will have our stereoporosis one and three will have an ourster product hip fracture with a twenty percent one year mortality.

So we need to be looking after these women now so that they don't age in the way that they have been.

And one of the problems is the lack of hormones because they're biologically active.

When you say hormones to people, people immediately think about hrtwo.

They immediately think about cancer.

But actually, if you just unpick what hormones are is they're just chemical messengers, but they're really important.

They help ourselves to function that's just a fact.

That's not my opinion.

That's just a fact.

We've known that for many, many, many years, and it's just been ignored.

And that's where people, as individuals can make decisions.

So, you know, we know as fact that if you don't exercise, you have an increased of diseases.

That's fact.

It doesn't mean you're going to get a disease by not exercising, but your risk increases.

So as an individual, you decide whether to exercise or not.

And that's exactly the same with hormones.

You know, there will be people that will say, well, I've never taken hormones, Look at me, I feel great, wonderful that if you look at what's killing women and what's increasing to their morbidity as well as their mortality is chronic diseases that increase the longer we are without our hormones.

So is it safe to say that there could be a world where some women, if it works for them, may stay on some form of HRT all the way into their golden years as well.

Yeah, most women take it forever.

Yeah, because it's safe.

You know, the concern before was about limiting it because of this risk of breast cancer and risk of cloth and heart attack.

But that is with synthetic hormones.

I don't prescribe synthetic hormones.

Why would I prescribe an unnatural chemical into somebody's body.

So when you're replacing light for life, it makes sense to continue it.

You know, if I stop taking my hormones, I might or might not have symptoms, but I have increased bone tone over increase risk of osteoporosis without hormones, because I'm menopausal and I'm very scared.

This is me personally of developing osteoporosis.

So I take HRT mainly to reduce my risk of osteoporosis.

I also take it because my symptoms were very bad and affecting my ability to function.

But you know, that's where we need to be thinking about.

We're not just taking it for a few hot flushes.

Yeah, and you've spoken about the kind of umbrella term for hr T therapies.

You know, estrogen, progesterone, in some cases testosterone as well.

But there are several different approaches to prescribing these, depending on symptoms, health history, stage of life.

For those of my beautiful listeners who are thinking about it, can you talk us through the most common approach for someone like me, you know, using my example, who has a uterus, who is starting to experience some of those common symptoms I spoke about at the top, the symptoms of perimenopause, such as night sweats.

What is a common treatment or approach with HRT.

Yeah, to say, for example, you we're my patient, and I'm being very general here, then I would obviously take a full history, make sure there's no nothing else that suggests that there are other causes for the symptoms, because you know, you could have a thyroid disorder, you could have low iron, you could have something else that's causing the flush it.

And that's where hormonal changes should be really assessed, I think by someone who's a general physician, not a gynocologist.

You know, I've had a lot of training in general medicine, So I would talk to you, take a full history, obviously, and often I do a blood test really to exclude other causes.

You know, see what your vitamin D, your iron is, your thyroid, your cholesterol, your blood count, your liver, kidney function, so forth, because that's useful.

And then if I thought that you're symptoms or some of your symptoms were related to your changing hormone levels, then I would talk to you about trying some hormones.

And then we usually start with ester die and progesterone, and they're both very important hormones, regardless of whether you have a womb or not.

And I give them in a natural way so that their chemical structure is exactly the same as the hormones that we make when we're younger as women.

And the easter dine is usually given through the skin because then it goes through the skin into the bloodstream as a patch or a gel.

And then the progesterone usually is given as a oral capsules.

Sometimes we give it as a peasary because it just gets absorbsightly differently.

And then I'll often measure testosterone levels, and if testostery level is low and a woman is having symptoms suggestive of testosterone deficiency, I'll talk.

To them, which are testosterone deficiency?

What are some of those symptoms?

Yeah, so everyone knows about libido problems, but it's more than that.

It's usually the brain symptoms, so the memory problems, the fatigue, the poor concentration, the brain flog, the poor sleep, muscle and joint pains.

Urinary symptoms can recur with testosterone deficiency, and then I will talk to the person about whether they want to try testosterone.

You know, the most important thing in my consultation is talking and listening and not gas lighting a woman and not believing her symptoms.

But also if she thinks it's related to hormones and she wants to have hormones, then you know, all the guidelines and all the evidence are very clear that first line treatment for the majority of women is hormones.

So we do it a lot.

In medicine, we try a treatment and see if it works.

If it doesn't, we try something else.

It's the same with hormones.

I will review the woman after three to four months.

If some of her symptoms are improving great.

I usually then monitor and do an EASTERDAR level to see whether they're absorbing the patch or gels through the skin.

It's distinc useful guide do the testosterone again if they're on testosterone for similar reasons, and then assess how they're doing.

And then once people start to feel better, it's the most magical time.

I love my consultations.

But then I talk a lot more about nutrition and exercise, whether any supplements are useful, but that's thinking about their future health.

That's not to treat them perimenopause or menopause.

Why is it so hard to get real answers about your health?

If you've been told that everything looks fine, but you know that something is off, you're not imagining it.

That's why I created Vitality three point sixty to help you better understand what's going on inside your body so that you can take the targeted action needed.

With a functional health approach plus testing, we go beyond the guesswork to uncover the root causes of your symptoms.

I've teamed up with doctor Esmina, an incredible integrative GP and together we will help you decode your body's signals and answer questions like why am I always exhausted?

What's really causing my stubborn weight?

Am I inflamed?

Insulin resistant?

Or maybe missing key nutrients?

Because when you understand your body better, you can transform your health.

Visit v three to sixty dot health or check out the show notes for more and tell me that second consultation like how quickly do you expect to see some changes in their symptoms and how they're feeling?

Yeah?

So it really varies.

I usually review people after three or four months.

You have to be quite patient.

But some people literally can feel better within minutes, days, weeks.

Other people say nothing really made much difference, and then suddenly I've started to feel better.

Yeah, so it really really varies because the cells in our body have got to learn how to use these hormones.

They help with the immediate cell processes, but they all so effect genetic changes as well, and that can take a bit longer to have an effect in the body.

You mentioned earlier, you and your risk of osteoporosis, and one of the reasons why you took it For a listener who maybe isn't suffering symptoms, but she has some family history there, for example, she might be a higher risk of osteoporosis, whether there's a family history history of eating disorders, low body weight, nutrient deficiencies.

Is it something that she could consider to take as a preventative, even if she's not experiencing any perimenopausal symptoms.

Yeah, for sure.

It's actually licensed as a treatment for the prevention of osteoporosis.

Yet most people don't realize that, and a lot of people don't think they have symptoms.

Yet when they start hormones, they say, gosh, I sleep better, I feel more motivated, it's easier to exercise.

I just feel happier.

So a lot of these insidious symptoms you don't know that they're related to hormones.

But the other thing for people to be reassured is that, certainly the hormones I prescribe, they only last the same day that you have them, so that if, for example, someone just said, oh, do you know what, they're not working or I don't feel great, you just stop taking them.

I remember you saying this in that amazing workshop that you ran that I came to.

It's so obvious, yet everyone takes it so seriously because it is it is something that you can literally just stop taking.

Yeah.

Sure, and you're in control, you know.

I don't use implants, so I'm not holding people down and injecting them with anything.

And even SSRIs and certain other medications where you really have to you can't just stop taking them.

You've got to win off them slowly.

When you put it in that context, it's a little bit like, well, why don't you give it a go?

What have you got to lose?

Sometimes I sort of spin out on its head and think, well, what are the risks of not taking hormones?

So you know, if you weren't taking hormones, then overseas symptoms can occur, and they can change within days or sometimes longer.

But you don't need to wait until you are on the floor or given up your job or arguing with your partner every night.

That's just like self sabotage really.

But also we know that the earlier people start hormones are better for their future health.

So people aren't taking hormones, they've got these increased risk of diseases.

What about those that start taking it and either they're not feeling much of a difference or maybe potentially even feeling worse.

Can you talk me through that period where you know it's a dance between your doctor and your symptoms and what that looks like and how we can best manage if it's not going the way we were hoping it would.

Yeah, so obviously things really vary.

And about half of the women we see in our clinic are already taking HRT.

So they're not coming to the clinic because they want to come and see us, they're coming because they're getting symptoms.

And so The important thing is firstly, as a doctor, I want to make sure that those symptoms are related to their hormone or changes, that I'm not missing something else.

And obviously that's why it's very important just to not take symptoms in isolation.

But that's where looking at the dose and type of hormona is important, because we're giving the estrogen through the skin.

Now, the skin is a barrier.

There's very few drugs that we can give through the skin because they just don't get absorbed.

So we know that easter diel penetrates the skin in different ways, and also different types of skin, different temperatures of skin, different thicknesses of skin.

So sometimes I might see a lady who tells me she's not feeling much better, and then I look at her patches and they're all crinkly, they're not sticking well.

Her skin is very inflamed and red underneath the patches, but she wouldn't be absorbing it very well.

So I can give her twenty eight million patches, but they're not going to penetrate the skin because the easter dial is in the glue.

So then I might change her to a gel that she rubs on and then that gets absorbed very quickly.

Or conversely, I might speak to someone and they're using the gem and I say, well, does it get absorved quite quickly?

And they go, oh gosh no.

It literally slides off my skin.

It drips on the floor.

I'm dancing around the bedroom trying to get it to dry before I get dressed.

It's like, Okay, that's not absorbing for you, So it's important.

And then doing a blood test can be useful because then if their estodar blood test is low and I don't think it's absorbing, then I'm like, okay, do I need to change the preparation or do I need to change the dose?

And some people need higher doses than others to just get the same amount through the skin.

And the same with progesterone.

Some people might say, oh, it doesn't suit me.

I don't feel so great on it, And then I might give them a progesterone pesesany instead and that gets absorbed as pure progesterone into the bloodstream and they feel wonderful on it.

Or they might have low testosterone and they need to start testosterone.

So the other thing is if people start hormones when they're perimen a puzzle.

Their hormones will be really fluctuating, so trying to get the right doses can be like trying to chase a moving target.

It can be quite difficult, and some symptoms take longer to improve.

Sometimes mental health symptoms can take soveral months, and it can be very difficult for people to be patient, you know, because they're living with themselves twenty four seven and you know, just to have that reassurance and support that things will improve.

And sometimes we do find tune the hormones depending on the situation.

So I feel really sad when women are just given a single dose of hormones and then told well, it can't be related to your hormones because you're on HRT, but they're on just like a low dose of estradel, maybe not on progesterone, maybe not on testosterone.

And you know, everyone's different and responds differently.

I mean, hearing you say all of this, what really springs to mind is how important the partnership with our doctor is.

And you know, it really does require this key working partnership with our doctor and trust as well.

How can we determine if our doctor is experienced and trained in HRT?

I mean, I think it would be great for everyone to come and see you, but obviously you can't clone yourself.

Are there certifications to look out for?

Are they key questions we ask?

I think I would be really careful about certifications because you know, there are various courses.

There are various sort of menopause societies, but a lot of people out there have some conflicts just for complete transfort.

So I do no paid work with any pharmaceutical company at all, but a lot of menopause societies especialists do, and then that is going to change what they're doing.

You know, a lot of educational courses are funded by Farmer.

Even though they've got no editorial content, there is still some you know, subliminal conflict going on.

If we're open to HRT and we're going to be you know, taking HRT, is it really a big deal or is it more okay?

Well, you know, because this is the pessary company, so they're going to push pessories on us or.

So there are pharmaceutical companies that make non hormonal medication as well.

Non hormonal medication for menopause.

Yeah, so's there's some for flushes and sweats that are non hormonal So they also fund some of these societies, so they've got their own agenda too, So you have to be really careful.

I give the right do some type of hormone for that individual, not because a peasanty company or a patch company have been funding my trip to a conference, for example.

So it's just about being really transparent.

But also you can do a course, but it doesn't mean you see patients.

And you know, medicine is a science and an art.

You know, I'm very well read.

I read a lot of their literature and a lot of the scientific evidence and also all the guidelines.

But I also have a huge wealth of clinical experience and knowledge, and that's where the art of medicine comes in to individualized care.

So I think if you're seeing someone, I would ask them what their experience is, like how many patients do they see?

Because there are some people who academically look amazing, but I know, for well, they see about two patients a week, and they don't work in a big team.

You know, I work in a very big team of clinicians and we're constantly learning from each other, and we have regular meetings and we have a team's chat going all the time, and it's like, huh, guys, I've seen this patient.

What do you think Beau?

The says, oh, you could try this, let us know how you get on.

We're presenting cases.

We're just learning all the time, and that's really important in medicine that people don't work in isolation, especially because we're learning so much more about prmments as well.

So I think it's looking at that person's experience and knowledge and just ask around.

Actually I've never advertised my clinic.

When I was working on my own ten years ago, someone said to me, all, Louise, watch your marketing plan.

I was like, I'm a doctor.

You don't market anything as a doctor.

But you know, women talk, and if women like who they see and feel confident and get the results they want, they'll talk to others.

So you know, doing a sort of Google review is actually not that useful because it's usually the people that are not happy who start pasting reviews.

Oh but look, you know when you have transform someone's health and happiness, usually they love to talk about it.

So I think you know the power of our beautiful community.

I know certainly where I live in Sydney, I can already name about five amazing menopause doctors that I would be happy to recommend, but it does get harder as people live in rural areas and that's where telehealth can really come in.

And the great news is, I think with metopause is it can also be delivered over telehealth as well.

You don't physically need to touch your patient necessarily.

I don't know if you would agree with me or yeah.

I mean, we do a lot of video consultations as well as face to face, and you know, it's good to have the option of both.

I worry when a company is pure telly medicine because you do need to examine patients and see them, and some people, you know, they much prefer it.

You know.

Some of the questions we ask, especially when we're talking about sexual health and libido, are very intimate and it's quite weird on a screen to be talking you know that way.

So it's good to have both, definitely in medicine.

I love seeing patients in real life as well.

I want to circle back to testosterone for a moment, and I have heard that exogenous testosterone or external testosterone can reduce the body's own endogenous testone production through a bit of a feedback loop called the hPG axis.

So in men, this suppression can lead to quite big symptoms such as testicular shrinkage, low sperm count, maybe a dependence on this external testosterone.

Are there similar risks for women?

And is that something we should be wary of?

So I think we have to be really careful using the word testosterone what we're meaning.

So it's a bit like using the word estrogen.

What are we meaning?

Are we meaning the natural body identical form or are we meaning the synthetic form.

So for example, I'll come back to testosterone.

But if I just explain for estrogen, because I think people will understand better.

If I'm having pure estodyne into my body, my body recognize it as the natural estodyl and uses it in the right way in all the cells in my body.

If I give myself ethanaleesterdyl, which is a synthetic form of estrogen that's in every contraceptive pretty much, then it will switch off my yesterdyl working in my body.

Because it's a chemical, it blocks the receptors.

It stops the natural esterdyl working, so then it will cause infertility.

That's why it's a contraception.

Well, yeah, that's its job.

So let's think about testosterone.

If I'm giving myself natural testosterone, it's just topping up what my body can't produce because my ovary is aren't working as well as they did twenty years ago.

If I'm giving myself a synthetic testosterone, which could be an injection, it will be a chemical ester it will be a different chemical structure testosterone.

Then it's going to block my testosterone working in my body.

So if I was a man, it's going to cause like fertility problems.

It might shrink my testes or whatever.

And this is where it's very difficult to tease out because of a lot of the literature of the research in men is with the synthetic testosterones, and so of course it's going to have an effect on fertility if you give the synthetic, if you give the natural testosterone, there's not been research where you only isolate the natural testosterone, but certainly in women, all we're doing is topping up what's missing.

So we're only giving very low doses of testosterone.

And we know actually that testosterone in women can improve fertility.

It's like twenty four percent increase in ovulation in women who use testosterone.

We know that it's safe to use if women are having IVF or trying to conceive, and we know that testosterone increases during pregnancy, so it's an important harm way that That's why we have to be really careful when we talk about testosterone, because when people write about testosterone, and sometimes doctors as well, they talk about the risks of heart disease, they talk about, you know, risks with testosterone of the weird muscle changes and it being an anabolic steroid.

They're talking about synthetic chemical form of testosterone, not the natural testestosterone.

And that's where the language is really important.

So that's why I always use estradile rather than estrogen, because estrogen also informs, you know, they also describes the synthetic estrogens, and progesterone should only be used for the natural progesterone, otherwise we should be using progestogens, which is a synthetic form of progesterone.

Okay.

And then just the other point on testosterone is around low levels and then clearance rate.

And you know, I'm not an expert in any way, shape or form, and I find it quite confusing when I hear some experts talking about.

You can have low levels of testosterone, but your ability to clear it and utilize it and use it is quite efficient.

So therefore you may not need testosterone therapy because the small amount you do have you're actually utilizing it really well.

Have you heard I'm explaining it very badly.

Sorry, No, there's a few things that Firstly, we do hormone blood test as a guide.

Any blood test we do in medicine is a guide.

We don't take it literally.

And hormone levels can really fluctuate.

So I actually did my own testosterone level eight times in a day a year or so ago, just out of interest.

I've been on the same dose of testosterone for ten years, so I use it in the morning and then throughout the day.

My level really changed, and at one time of the day my level was really low, And if I had been a patient, my doctor would have said, all your levels low, you maybe could increase another time of the day.

My level was actually slightly above the normal range for women.

So if I'd seen my doctor, then the doctor might have said, oh, you need to reduce your dose.

The fact is I felt fine the whole day, so it just shows you it's a guide.

Now, what we do is we don't treat women on a number.

We treat them according to their symptoms.

So if I've got a patient in front of me, for example, who's got polycystic oarian syndrome, whose testosterone level is normal, but she's in her forties, she's got low mood, she's got reduced energy, she's got poor concentration, she's really struggling to remember things at work, she's got no libido at all, then I'll say, well, I can try testosterone and see, let's review you in three months.

A lot of people with peace Lewists often need slightly higher testosterone levels.

I just feel it really sad.

I get DMS all the time from women saying I've been told my testosterone level isn't low enough to try testosterone.

Yet the level is zero point nothing.

It's really low.

But actually, again it's a guide, like I don't measure someone's serotonin level if they're going to be on antidepressants, I look and take a history.

So some people seem and I hear them on social media as well, get very very fixated about how dreadful testosterine could be for women.

Let's just face up to the fact that literally in most countries it's less than one percent of perimenopause and menopause women are taking testosterone, and most of us that take it will be telling others that it's literally transformed the way that they think and work, and we've got good evidence to support that.

Even in the nineteen eighties, there's evidence that people who are given testosterone with estrogen following their ovaries being removed have better well being.

They think clearer, they're happier.

So even if that's all it does, I don't understand if that's a bad thing.

Yeah, look, I totally agree with you, and some pioneering research in testosterone is actually coming out of Australia and with some Australian researchers, which I'm really excited to see where this leads because they really just has not been enough research done in pre menopausal women as well.

Well.

I sort of agree and disagree because there has been research since the nineteen forties women were involved in studies using testosterone.

But also we have to use common sense here because testosterone is a physiological hormone.

So if you understand how testosterone works naturally in our bodies, you don't need big studies you don't need randomized controlled studies to look at a natural hormone working, you know.

So I think sometimes people use that almost as an excuse or we haven't got the evidence, therefore we can't give it.

Let's look at the evidence we use for ssriyes, or for antipsychotics, or for thyroxin, or you know other treatments in medicine.

You know a lot of antibiotics we prescribe.

They've never been a randomized controlled study, yet we know that they work by observational studies.

So and we also know how they work in the body.

So we have to not be sidelined thinking about the evidence, the evidence, the evidence.

We've got common sense as well, and we do have evidence, it's just been ignored because it's about women.

And the other thing about the evidence is that we've got a plethora of evidence about testosterone and men for their health benefits.

Yet we're being told, well, we can't look at that research because it's only about men.

Now, most research that we use to write guidelines on other medications like statins is based on male research because women often not used in studies.

For me, as an individual, if I've got someone in my consulting room.

He's really struggling with their mood, and I think it's related to sustering.

What do I do?

Do?

I say, hang on, there's a study coming out in three years time.

Come back in three years and then I'll give you something that I know is just a natural hormone.

Or let's try it and see how you feel in three months.

And yeah, besides, yeah, well look, doctor Luis, we have covered so much in our conversation and I'd love to wrap up by asking you finally for a woman who is listening, who does not feel like herself, who's you know, at that perimenopausal age bracket, although that could be a very broad age bracket as we've discussed, but who maybe is feeling a bit nervous to go down the HRT path.

What would some parting piece of advice be that you would have for her?

So I would take a bit of time finding out information that's right for you.

So you know, download Balance.

It's a free app, lots of information.

We constantly add more articles on there.

Go to my website.

I love it.

Yeah, Dr Louise News and Dear louisnewsm dot co dot uk because I do weekly youtubes.

I do a weekly podcast.

There's lots and lots of information there and articles we're constantly put to the websites as well.

They're all evidence based, and you know, have a read and make the choices that are right for you, not for other people, and then go and talk to someone who's experienced and just know before what you want.

And if you want to try hormones, then you should be able to get them.

Maybe go with a friend or a relative or a partner to the consultation so you've got an extra pair of ears and support.

But it's important because many of us hopefully will be menopausal for decades, so we want to get the decision right.

It's not just a quick fix that we're looking for.

Doctor Louise News and thank you so much for your time today.

Oh thanks for inviting me.

It's been great.

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