Hi everyone.

My name is Haley and this is Laura and welcome to the body Pod.

Welcome back to the body Pod everyone.

Today I have the honor and privilege of speaking with doctor Louise Newsan, who is a general practitioner and hormone specialist and a leading voice in transforming menopause care worldwide.

As the founder of the News and Clinic and the not for profit News and Education, she is dedicated to improving awareness, education and access to evidence based care through in person events, a comprehensive library of freely available articles, and an education program for healthcare professionals.

She empowers both women and clinicians with the knowledge that they need.

A Sunday Times best selling author and host of the UK's number one medical podcast, doctor Newsan is passionate about driving positive change for women's future health.

Doctor Newsan has been described as the medic who kickstarted the menopause revolution.

She is an award winning educator, podcast and author committed to increasing awareness of hormone health, including perimenopause and menopause.

Her mission is to provide inclusive, accessible and evidence based information in formats that suit all women, helping them make informed choices about their health.

Through her work, she has empowered a generation to take control of their treatment, bodies and minds, ensuring menopause care is recognized as a vital part of women's healthcare.

Today, we dive deep into what each hormone does and the benefits, pros, and cons, as well as common myths that are surrounding hormone therapy.

So enjoy this episode with doctor newsan welcome back to the Body Part everyone.

We have doctor Newsen here with us, who we've already introduced, and Louise, thank you so much for joining us.

We are thrilled to have you.

Oh, thanks for viting mat It's great.

Well, we have a probably five pages of questions, and then of course I put out on my Instagram story.

I was thinking I probably wouldn't, but I love how in your YouTube's in your lives that you always ask questions at the end, and so I was like, I'm going to keep some of these on there if we have time to answer any in the last five minutes.

But this is going to be a hefty conversation in all things hormone therapy.

So we are going to dig right in.

So first of all, when you're called the medical who kickstarted the menopause revolution.

First of all, that's a hefty title.

Yeah, what sparked your passion for transforming this menopausal care?

Yeah, it's interesting because I didn't always have this passion.

Like if i'd met you fifteen years ago, I would have gone, what, No, I'm interested in everything in medicine, and I still am.

But I suppose it was hearing stories when I'm in When I was in my GP practice, I would only see the patients that came to me, and you're limited in how many you can see.

You know, thirty forty patients a day probably ended up about eighty percent of them or menopausa by the time I left.

But I'd hear those stories.

Women would be suffering for a little bit, and then I'd help them, and then they would start to feel better.

And then when I started to do my clinic, I thought it would just be an extension of what it was like in general practice, But it wasn't.

Women would travel for hundreds of miles sometimes and they would tell me how they'd been suffering for years because their doctor had given them antidepressants, told it was all in their head that they needed other drugs, and all the symptoms have started since their ovaries were removed in an operation age thirty, or since their period stopped or whatever, and I was like, what, like, how what's going on out there?

And then I started, wrongly or rightly, to sort of play with social media and people would message me with these stories.

And then over the years, obviously the clinic's busy, My social media is really busy.

People stop me in the street and tell me about how they're not being listened to and believed.

So what drives me now is just in injustice actually of what's happening and how the medical system is letting down so many women without any good reason.

So it's gone from just being interesting to like something that's making me really sad and cross.

Actually, yes, and what do you think do you think that one country has has it a little bit harder than others?

I mean we're in America actually, lauras in Europe right now, so yeah, nice, But does I mean if we look at the U, don't just take the UK and take America?

Are there huge difference?

I mean, I know there's a lot going on in America right now, but.

Yeah, for sure, for lots of reasons.

But you know what every country.

It's bad.

So lots of people say, Louis, it's what you're doing is amazing.

UK is really increasing.

HRC prescribing had been increasing, but the last few months it's plateaued again because there's various people who are trying to scare people away again from hormones.

But let's think about it.

One hundred percent of women will become menopausal.

About five percent of menopausal women globally are prescribed hormone replacement therapy and in the UK it's about fourteen percent.

But every MENSE guideline, whatever you know, you think about the guidelines, they alsay first line treatment for symptomatic menopause for the majority of women is HRT.

So I'm not a mathematician, but five percent and fifteen percent are not the majority.

So even if you just look top line, do you know what I mean, then it's bad.

So I feel sometimes guilty with my work because awareness is improved, knowledge has improved, but access to evidence based treatment generally hasn't really improved.

So let's go to that evidence based treatment.

What does that mean to you?

Because I'm obviously I am in the strength and conditioning world, but I have partnered with a lot of influential experts, and I feel like there's that while menopause has gotten widely more popularized, there are two camps.

Yeah, and the camps are of you know, and sometimes it's loud.

But when you I feel like everyone's throwing around evidence based care, what does that mean to you?

And what are you providing different?

No, it's a great question, and I think women's health in general becomes very polarized.

Something about hormone health becomes really quite toxic in summer.

You need to look at some social media comments and you're like, hang on, what's going on here?

So with obviously, I'm a physician and all my work, whether it's hormonal or not, is based on evidence.

And when I say evidence, that's that's scientific evidence, but clinical evidence as well.

So we have to remember that medicine is a science and an art.

So the science is knowing, you know, the biology, the physiology, the biochemistry, the pharmacology, studies, the trial, the evidence.

But it's also the art is individualizing care, and that's sometimes lost in people who don't have a huge amount of clinical experience.

So then well, if we think about what menopause, perimenopause is it's related to hormonal changes.

Menopause is when the hormones are low because our avaries don't work for various reasons.

So then if we unpick what the hormones are, they're chemical messengers that work in every single cell.

So then when I talk about hormone deficiency, there's already people going, no, it's not a hormone deficiency.

Well what is it?

Then?

Do you know what I'm saying?

It's low hormones.

Therefore it's a low deficiency.

So then you have to think, well, how do does our body work with hormones?

Well, the cells work better, the tissues work better, the organs work better, the organelles in the cells, like our mitochondria work better.

That's just fact.

That's not me telling you something I've made up.

This is just you know, basic physiology.

But then when you think about treatment and individualized treatment, it's about choice, and I often will compare it with things I exercise.

I don't need to tell you that exercising is really good, but there are different types of exercise and there's choices.

Some people don't exercise at all, and that is their choice.

They're not all going to get heart disease.

Because they don't exercise.

But we know that risk of heart disease, for examples, increases if you don't exercise, and it's the same with hormones.

If you don't take hormones, there are risks to your future health.

But you might be absolutely fine.

But you just need to know and accept what's going on in your body.

And knowledge is really important.

And I see some people on social media are going, look at me, I'm amazing, and I've never taken a hormone.

This is all done like naturally.

Well, it's not natural to not have hormones for a start, But do these people want a medal?

You know?

I see women who are suicidal and falling apart.

Do I say to them, oh, do you know what, if you exercise, then you might be fine.

Like I don't say that if someone's got other deficiency, if they've got low iron, I wouldn't be saying, well, exercise and you'll be fine.

I mean exercise, of course you'll improve with other ways, you won't replace that iron.

So I think it's misunderstanding actually about what basic humans do in our body.

And then the HRT conversation is really fragmented because people don't seem to often understand there are different types of hormones.

Like if I wanted if I was ten years younger and wanted contraception, I'd get it really easily.

As a fifty four year old menopausal woman.

If I want HRT, everyone's like, what you can't have that that's terrible.

But if I wanted antidepressants, it would be very easy for me to get them.

So there is this inequality of care that's going on.

And my work is really about empowering people with knowledge so then they make choices.

You know, it's not saying you have to take this stormont or you have to exercise in a certain way.

Just have this knowledge, but the knowledge has been hidden or it's been wrong.

And I just to be really clear to your audience, I don't work with pharmaceutical companies.

I don't work with supplements or brands or you know.

My knowledge comes from reading academic papers and you know, knowing a lot about basic science and then putting that into context for individual patients.

Do you think that it's so we will get to what hormones pros and cons and what each one of them do, because I think those are still with all of this information out there.

I just know from what I'm getting in my DMS and my groups because I always hire a menopausal like a menopause physician to come into my courses to educate because not my lane.

But it's amazing how much of the same questions, yes, homos all of the time.

So what would you say, are the three the top three if you could pick two or three misconceptions about HRT that we're still getting wrong today or most people don't understand.

I think the biggest reason why people don't take homens and don't prescribe them if they're doctors is the risk of breast cancer.

That's the biggest same people are scared about.

Now.

One of the things to think about is the study that everyone scared everyone away from two thousand and two was using synthetic hormones.

So even though it showed the risk wasn't statistically significant, and even though it showed easter and only HRT was associated with a lower risk of breast cancer, you can't compare it with the natural hormones, the body identical hormones we prescribe.

Now, there has never been a study to show that our own hormones cause breast cancer like it wouldn't make sense really, even if you think about it as a basic scientist, how would our own hormones?

Cause cancer just feels a bit weird, doesn't it.

Yes, So that is the biggest myth that scares people away.

The other thing is that people think that they're too old to be considered on hormone And let's face it, we've got twenty years of lost women who have been misguided and denied hormones.

So now a lot of these women who were forties fifties when the study came out and maybe in their seventies.

No one is too old to be considered for hormones.

And then the other myth is all about testosterone, what it is, who can have it, what does it mean, because a lot of people think testosterone is the hormone that people inject to be bodybuilders and have like massive muscles, and what those people are doing are giving themselves something that's like testosterone, but it's not the same.

So it's like, you know, eating steelbery flavored sweets rather than having strawberries.

There's a big difference in the body.

So those are myths and not every hormones the same.

You know, I contraceptives are very different to homones that we prescribe, and most even doctors don't seem to realize that.

Okay, So if I were to come in, so Laura and I are the same age, we're both turning forty eight this year, so it's a good assumption that we're in perimenopause.

And I feel like this is almost the I mean, I would love your your advice, but it feels like perimenopause, where everything is really erratic, is the harder section a at least postmenopause.

But here we have perimenopausal women the majority, as you said, from the statistics at the first of the call, that are either our metopausal or in this peri face, that aren't taking hormones.

And if this is the most dramatic, you know a few years leading up to it.

If I were to come in your office and this is generalized, I know it's super individual, but do you normally more than not prescribe, what do you start with?

Do you go in and just say, oh, progesterone is like the easiest one, although I heard you say it was the most forgotten or maybe the most misunderstood, and I was thinking that that was the testosterone I feel like testosterone now is getting a lot of love.

It's kind of like the darling of the hour.

But they each are so individual.

Where would you just start someone generally?

So it's a great question.

The most important thing actually for me as a clinician is really taking a good history and understanding because you know, things have changed.

When I started my clinic ten years ago, people come in and say I think I'm perimen of but I'll tell you what.

I don't want hormones because they've been so scared away.

Whereas now people will come they've got more information, great and they'll say I'm perimenopausal.

I've used your balance app.

I've listened to your podcards, I would like a gel, I would like the pedesterone and like testosterone dad, And they basically running the consultation.

So the important thing for me is a doctor.

Firstly is is it definitely perimenopausal?

And that's hard because there's no quick test, But also is there anything else that's causing their symptoms?

So not everyone who's tired I can blame low testosterone.

They might have low iron, they might have low vitamin D, there might be something else going on, they might have another condition.

But you know, I've had a lot of good training, very I've done a lot of medicine, and so I can ask those screening questions and do blood tests to try and exclude.

So that's really important, and then it's working out, you know, I think perimenopause and menopause a just labels for women.

What is going on?

Are they gesterone deficient?

Are they esterodyle deficient?

Are they testosterone deficient?

Do they have endometriosis, which is a lot worse when their levels of esterdyle are fluctuating?

Do they have a history where they find that they're more intolerant of progesterone?

Are there periods regular?

Are they heavy?

Do they need contraception?

So all of these things is working out in my mind, which hormones?

What does to start?

Sometimes if someone has really bad PMDD pre mensal dysphoric disorder and they're just feeling terrible for those few days before their periods and the rest of the time they're fine, well, then I might just give them some progesterone for those few days, and then I might consider doing their estodyl and testosterone blood test and reviewing them.

But other women I might give all three hormones together.

It really really depends, and that's where it's very individual.

And then we just review people and it's a review consultation that's actually can be more revealing because then we can see are they responding, what other symptoms do they have, what their blood levels doing, and then that will help us guide whether we need to change the dose or the type, or adding another hormone for example, or think about vaginal hormones as well.

And then in a review, usually when the hormones are balanced, we spend a lot of time thinking really carefully about nutrition and exercise and whether they need supplements or what else is going on in their lives too, So it's not just the transaction that we just do, and it's a journey.

And often in perimenopause you think you've got it.

Patient patients feel really well and then suddenly their own hormones drop and they might need their dose changing.

So it can be a moving target sometimes as well a movie.

You exactly do you think blood tests are useful for perry menopause?

So they have to be done.

This is what I think, in conjunction with a really good consultation, because it's so easy now to get blood tests, isn't it, And people come in with these realms and reams.

A lady came in yesterday.

It was almost like a book of blood tests, but she hadn't even had her testosterone level done, and I'm like, oh, you've had all these other blood tests, so you have to be really careful.

And our hormone levels do fluctuate and change.

So I've seen ladies with really high estradial levels and they're not on any hormones but their own bodies squirting it out.

But then other times of the day when they weren't having their blood tests, they have got loads of symptoms of low estrogen.

But they've been told of your estrogen dominant or they might be at the time that the blood test was taken, but all the other times of the day they're having low estrogen.

So we have to be really careful how we interpret blood tests as well.

I think they're useful.

I mean, when we start to testosterone, we'll usually do a testosterone level just to see but then there are some women who have polycist over in syndrome who might just be, you know, always run with a slightly higher testosterone than others.

So we have to this is where you're tak it in context.

But we often do do blood to exclude other causes, like I say, like looking at their iron level.

They've been d get their kidneys, the liver and all that as well, so you know, but you can the thing in medicine you only do a test if it's going to change your management.

It's very easy now, Like I mean, I've been qualified for many years.

It wasn't so easy to access all the scans and things that you can now.

But I always ask myself, is it going to change my management?

And if it isn't, then I'm not going to just do a blood test for the sake of it.

Is estrogen dominance real?

It's a great question.

Yeah, I don't think really, I think.

I mean, there's lots of labels we give women.

What does it mean that you're Eastern dominant?

Like basically it means that you've got load progesterone and probably low testosterone.

The balance of hormones is really important.

And Professor Mokhiro, who's a urologist I know well in the US, he talks about the triangle of the hormones and I love that because you've got to get those three hormones balanced.

Sometimes I talk about a three legged stool.

You can have the right height of one leg, but if the other two aren't there, you're going to be upsided.

So often it's because people don't have the other hormones balanced.

So also sometimes when people are perimenopausal and their hormones really fluctuate, sometimes if we do give a higher dose of estrogen, which seems a bit paradoxical, but then it stops the ovaries doing this eeyo stuff, you know, and that can be very useful for some women, you know.

So this is where it's all very individualized.

So if we want to take estrogen, let's start with estrogen, yeah, because I feel like that's the one that gets the most love.

Most women are very familiar with estrogen.

So if we're taking that, we have vaginal estrogen and then we have systemic estrogen.

So what are the different types?

Because I was just I was fascinated Lauren and I were talking about this before you jumped on about the transmission of through a patch or through a gel.

I didn't even think about like the skin texture and if the skin is thicker, And now I'm questioning is mine getting I've gone the.

Gem, I'm parting out in the right place.

What it's really interesting today because it's very crude medicine, So we usually use it through the skin so it stays as estradial because there are different types of estrogen, and the estodyl is the anti inflometry, the good estrogen, if you like.

And once we've put something in our mouth, things get metabolized through our liver.

That's just how anything works that we eat or drink.

So if we have esrogen through our mouth, it can get metabolized to different types of estrogen.

We put it on our skin, it goes through the skin into the blood stream and then it stays as easter dial.

But the ways of getting it through the skin are usually a patch or a gel.

But you're absolutely right.

The absorption can really vary between women.

It can vary because of their skin texture, their thickness of their skin, their temperature of their skin.

You can imagine if I put it on my bottom, which has more subcutaneous fat than the small of my back, of course the absorption is going to change.

So and then we've got the way we prescribe drugs.

They're always within license to certain range, but some women even with the highest license dose, they're just not getting it through their skin, and so we sometimes change to a different manufacturer patch or the gel.

But even then you might have seen on my Instagram every soft and I flap mine in the camera and just say, like, they really don't stick very well.

So I use more than one.

But some people use a very small dose and they get loads more through their skin than I do using more than one.

Because we're all different and we've known that for many years, but we have to have the right amount into our body so that it works to not only improve our symptoms but also to improve our future health.

Well, I'm second guessing everything now.

So if you have it, where's the best place you can put it?

On the thigh?

So really there is It's where it sticks.

Really, So I actually put mine on my lower bat because I don't have much subcutaneous tissue.

I can, like you know, I can feel my muscles quite easily through my back and they just stick.

They don't wrinkle.

If I put them on my bottom, my bottom I'm sitting and standing, I'm moving, so they just become a bit more crinkly.

If I put them on my leg, they just come off in my jeans, like they just once the patch is edge start rolling, they flick off.

So so that's just for me personally, but other people find different places.

So the other options like on your head.

Yeah, so I mean they again the way they're license, they say put them below the waist, but you're just using the skin as a vehicle, you know.

I sometimes joke and say to face you should put it on your forehead, like it's just using your skin to get it.

You wouldn't put it on your forehead, of course, but it's just about doing that.

And then the gel again it's license for the arms or the legs, but again it varies on the way that it's absorbed.

It can really change, and that's where the deuce is less important than the penetration and the absorption.

Okay, so the gel, the patch, we have that vaginal astrogen, so that's separate.

I was shocked because I was just hiking with my sister in Europe and she has access to any of my podcasts and I've had a lot of experts on I don't think she's listened to one clearly, but she was like, oh no, you can't take vaginal estrogen if your if you've had breast cancer.

And I'm like, that's not true, and she was arguing with me, and I was just it showed me how much misinformation is still.

I mean, it's my sister.

Yeah.

So vaginal hormones are very very firstly, the very low dose and they only really penetrate the area, so they'll use their help the vagina and the valve, but they'll go into the bladder, the pulpit floor uni tract, so they work for localized symptoms.

And there's we've got vaginal estrogens, and we've also got something called presterone, which is a hormone called DHGA which converts to estrogen and testosterone, which can be a lot more effective actually, And these hormones can be usually very safely used for women who have breast cancer because they don't get absorbed into the body.

They can really make a difference.

But women who take HRT often still have urinary symptoms or vaginal symptoms.

So then we can use the vaginal hormones as well as having systemic hormones.

And you can put it on your face.

Oh yeah, that's the Yeah, sometimes people use the vaginal tread put it on their face.

But you know, what if you have systemic hormones.

So all three hormones estro down, pedestroone, testosterone, they work throughout your whole body, so they work throughout your whole skin.

So they will improve collagen deposition, they'll improve the skin that the blood flow to the skin, they'll reduce wrinkles, they'll change the texture of the skin.

Now most of us, yes, it's the face is what we see.

But there's no point having a young face and then like really old hands and dry flaky skin elsewhere.

So if you know, I don't know, people do it, but then they're not on HRT and I don't really understand.

Why do you know what I mean?

So I think we have to.

Of course it's going to probably help.

It won't penetrate very much.

But it's the skin, is it really?

It's the biggest organ in our body, so we want we want it well perfused because if our skin is healthy, our liver, our lungs, our heart, our kidneys are going to be better as well.

So it's always well having a nice young face, but we need to be thinking about getting those womans into our blood stream and our body.

Yes, we've all seen the eighty year old that has the amazing forty year old face.

But then the rest of the PLOODT I remember.

So if we move on to progesterone and the different ways, so we can have that orally, which I didn't even know.

And I have to tell you, I was training a client and she was just super she'd gotten on progesterone and she was super tired when she would show up in the morning for our training session.

And she came back the next day and she said, oh, well, this is like I take it rectally.

Now I didn't even know that was an option.

So you can take it vaginally, you can take it rectally, and then you can take it obviously oral.

What's the differences?

How would you how would you decide?

So progesterone, and this is really important terminology.

Progesterone is the same stretch as the natural progesterone we produce when we're younger.

When we use the term progestogen or progestin, that's a synthetic, chemically altered progesterone that's in all of contraception, by the way, So progesterone we use as part of HRT.

And historically I was taught people are taught that you only need if you have your womb because it protects the lining of the womb from eastrogen.

But actually it's a really important hormone in our organs and our brain as well.

So many women, including those that have had a hysterectomy, still take progesterone with good effects.

So we can have it orally.

It's quite hard to get absorbed orally, so it's made in a way it's called micronized, so they basically make it very small and suspend it in an oil so it can get absorbed through the body.

But like I've said before, anything that gets absorbed through the mouth gets digestive metabolized through the liver, so it can get broken up into different types of progesterones, and some of those metabolites can cause side effects for some women.

Whereas if we use it as a peasuri so as a vaginal u rect or peasurie, it gets absorbed through the mucous membranes.

It's a bit like you know, putting any anything sort of inside, like through our mouth, the blood supply will take it away.

Progesterone doesn't always get very well and reliably absorbed through the skin, so that's why putting it in the vagina or the rectum will just get absorbed through the through the mucous membranes into the bloodstream as the pure progesterone, so it doesn't get chemically converted, if that makes sense.

So some people who have side effects with the tablet the capsule oral capsule find that they tolerate it really well vaginally, especially women if had PMS or PMDD or postnatal depression.

Having the doses vaginally can be a lot better.

Okay, that's fascinating.

So then if somebody comes in and says they're progesterone intolerant, they.

Might yeah, and that's that's really interesting.

I have done a YouTube about progesterone intolerance because we suit a lot and there's a couple of things there.

One is a lot of women are intolerant of progester gins or progestines, the artificial So they'll go, oh, do you know what I had contraception?

I had a marina coyle and I had to take it out it was so awful.

So they are intolerant of a synthetic chemical hormone, not progesterone.

Most people aren't intolerant of their own hormone, but what they can be intolerance is of changes of those hormones levels.

So women with maybe PMDD who are more sensitive to that drop of progesterone before their periods, if we give them progesterone, sometimes people feel worse.

And I saw a lady in my clinic yesterday who really can't tolerate progesterone, but she's still having regular periods, so she's still producing progesterone herself.

So it's like I'm giving a progesterone and she's producing it herself and it's just not suiting her.

Once she becomes menopausal and her periods stop, her own natural progesterone will decline and she'll probably be okay on a low dose of progesterone.

So it's again individualizing the care and really working out is it progesterone intolerance or not.

And some people, actually it sounds a bit paradoxical need a higher dose of progesterone, especially as a pesari.

So they have a load dose and they feel awful.

You increase the dose, it stimulates the receptors better and then they feel quite different and better.

Wow.

Yeah, So it's options and choices really, but a lot of people are not as intolerant as they think of the proper progesterone, if that makes sense.

So do you recommend cycling it or just taking it daily?

So it really farries again because we're all so different.

If people are still having periods, we often cycle it just because if they had it all the time, they often get breakthrough bleeding.

And it could be no one wants to have break through bleeding.

Really, some people have it all the time and feel great.

They have no bleeding, They feel great, so why would I change it.

Other people find that they feel better after having a few days break maybe every month every three months.

So again, it really really varies.

Which is why it's hard because there's so much trial and error.

Yeah there is, and also there's so much out there on social media.

Some people say you have to have a few days off.

You don't, you do?

And and the thing is you learn by experience.

But this is why everyone is different.

And like what suited me nine years ago, I'm not on the same dose in type of homaones nine years ago than I am now.

So it's evolving all the time.

You know, I started HRT when I was perimenifausal, I'm fifty four, I'm going to be menifausal now.

So things change, don't they.

So that's why it's really important to make sure that you see someone who understands it's not just a one size fits all.

Well, then the level of care for the general physicians, the general practitioners, that's what is probably holding up a lot of this because I mean, women ask at least I don't know, Laura, if you get asked, but all the time, who should I see in Colorado for instance, and everyone asks me, yeah, I mean it just there's not like a long list, or at least I don't I don't know a long list.

That makes it tricky, Yeah, to get it really dialed in if we move on to testosterone.

So again I say it's the darling of the hour because it's getting a lot of love.

But I think that it's the most feared out of all three.

It seems like, well, at least in the United States from my insurance company, personally, it's been a doozy to even get.

But then you go to Australia and you can get it fairly easy.

Well you can and you can't.

It's licensed for women in Australia, but most doctors don't prescribe it.

So it's really ironic, isn't it.

They've got a product we can't prescribe it, or that women can't get it.

And we can prescribe the female testosterone cream that's licensed in Australia over here, but it has to be privately, or we can prescribe the male testosterone like you can over there with you in different doses.

But the thing is it's a female hormone.

It's an important female hormone, yet we can't get it.

Like it's just madness, isn't it that we can't have our own hormone back.

And then you've got people telling us that we'll grow beards and mustaches and it's really dangerous, and you know, our voices will change and we'll lose all our hair.

It's like, well, most people, when you have the right dose and type, actually don't have all that.

I don't shave every day, like you know.

It's but I tell you what my brain works, you know.

But then it's all denigrated to it's all about whether you can have an orgasm or not, whether you're sexually active or not.

You know, one of the doctors that works as me went to see her GP recently to get her hormones just a repeat prescription, and that doctors said, well, I know you've recently had a divorce, so therefore you won't be needing your testosterone.

Stop it.

Yeah, yeah, I know.

This is to a medical doctor to another doctor, and you're like, hang on, it's twenty twenty five.

Do you have to have a husband to have a libido?

You know?

I mean, I love my husband, but you know, I still it's really like, it just feels wrong that we're just talking about women like sexual objects.

And some menopause societies talk about HSDD, which is hyperactive sexual disire disorder, and one other criteria to have this condition is that you have to be severely psychologically distressed with your reduced libido for at least six months, and then you can maybe have testosterone.

And I'm like, hang on, I'm a doctor.

I'm not watching my patients being severely psychologically distressed.

But we know that the hormone works throughout our body and brain, so we know that women.

We've published data.

So if others find that their mental health improves their mood, their memory, their concentration, their muscle strength, just their ability to exercise is better, but then people say, well, it's just perceive it.

Well it's it's not because it's a biologically active hormone and it's just a hormone.

And you know what, if it doesn't work, people don't have to take it.

But most of us that take it are never going to stop it because we've it HAPs this function.

But again, it just comes back to choice, doesn't it.

So how would you determine?

I know this might be going down the rabbit hole again if someone if I come to you and I say, my main symptom right now is brain fuck.

I can be on a podcast and mid sentence, I'm like, what was I saying?

This is concerning this has never happened.

But that's the main symptom, is that there's one hormone combat that more than others or just all the pen on the comedy.

So it does depend.

But you know, if I could only prescribe one hormone to women, it would be testosterone.

If I could tell you the hormone that has transformed the most number of lives and probably save the most number of lives the women I've seen who have had suicidal thoughts, it will be test us to it.

Wow, you know, I see a lot of women who have had really sad stories that you might have listened to the podcast I did with Jay and Haley, the mother and her son who she'd been in a psychiatric hospital for nearly thirty years on and off.

So we see a lot of women who are like Hailey.

They've had awful psychiatric histories.

They've been on antidepressants, antipsychotics, Lithian electro convulsive therapy sessions, they've had sometimes they have ketamine, but no one's thought about their hormones.

That often they or their family have put it together and thought, can I try some hormones?

The HLT can help them, but you give them testosterone and then wait a few months, and these women are often transformed and they I've had low testosterone often for many years.

So we have to be really careful when we think about women not having test us.

To me, and I never thought about testosterone before when I did psycholatry, I never didn't know women even had it in their bodies.

So you know, I'm as guilty as any other doctor by prescribing other drugs.

But if someone's got a load test us, doone they've got symptoms?

Suggestive of test ustone deficiency.

We should be really replacing a natural hormone.

I don't really understand the dangers of it.

So for bone health, because that's another huge one.

And I love that osteoporosis and osteopinia that there we all knew.

I mean, this is something that I remember my grandma couldn't have a hip surgery because her bones were too soft and she wasn't cleared for the surgery.

Do you see again, is there one?

Is it estrogen that helps more?

Is it testosterone or is it a combination of all of them?

So often all three actually, because we've got hormone receptors for all three hormones on our bones, and our bones, as you know, are biologically active.

So we have these cells osteoblasts that build the build the bone, and osteoclass that break it down.

And we've got androgens, testosterone receptors, estradar receptors, and progesterone receptors on these sets.

So if they're stimulated the right way, the osteoblasts, they'll build the bone and keep it strong.

If they're not stimulated, the osteoclass will take over and they'll sort of gobble and make the bone weaker.

So this balance is really important.

So you know, our bones are biologically active, but so are our muscles as well, So both of those are really important.

And it's almost forgotten.

I think people think osteopiosis is an old person's disease, and yeah, it gets more common as we age, or they think, oh, it's just a fracture that will be repaired and then I'll be fine.

But I'm petrified of ostereoporesis.

I'm worry about osteoporosis of my spine because when you see these people that are stooped, you know, with the curvature of the spine and due to osteoporesis, it's very painful because they have lots of little fractors.

The coughing might cause another fracture.

Sneezing, they can't digest food properly, they can't breathe so clearly, but they can't reach for a cupboard in the same way.

You know.

So, and we know obviously exercising weight, bioing, exercise is really important.

But we know that hormones, you know, we've known since nineteen forty one.

There was a professor Albright who said and realized that women's bones were thinner when they were menopausal, and that was because of the lack of hormones.

So it's nearly one hundred years we've known it.

Wow, so every female, I mean, this could benefit the bond for every female.

Yeah, for sure, Yeah taking it.

So look at the counter argument of I guess the women pushing or anyone pushing not not having hormones for whatever reason outside of a female's choice.

So we all know that if female has like we have choice, we can decide whether to take it.

Round.

How many women do you see that come in that maybe aren't aren't taking it, not because they're scared to or they don't have the information, but are choosing not to take it for whatever reason.

So obviously they don't come to the clinic because they come to the clinic easily because they want hormones.

But you know, I sometimes see women who are mothers of my patients, so they may be in their sixties, seventies and saying, do you know what, I've never thought about homones, but now I've seen how well my daughter is or my sister is.

I'm just wondering, you know, I don't think I've got any symptoms, but I'm worried because my mum had us to process or what have you.

And then I'll talk to them and if they want to try it, they will, and then often they come back and go, Wow, my sleep is so much better.

I can spring out of bed in the morning.

I don't have to get up at nighttime for a week.

You know, I feel different.

But I thought that was just because I was older.

I didn't realize that it was due to hormones.

It's very hard to find a menopausal women with no symptoms at all.

They might think they don't have them, but you don't know until you have those hormones back.

Now, what about the muscular skeletal syndrome of menopauds.

I would say that's what people come to me from the strength side, and I can work on strength with them.

But it's the joint you know, arthritis and just I've noticed my fingers just yeah, I'm feeling it there.

Yeah.

So it's really important, crucially important, because all three hormones are anti inflammatory, reduice inflammation in our muscles and joints.

So things like frozen shoulder really really common.

Arthritists both you know, osteoarthritis rheumatoid arthritists.

Syrah negative arthritis a lot more common in women in the late forties.

So those hormones help lubricate the joints as well as reduce inflammation.

They help the cartilage, they help the sinovia, they help the tendons the ligaments as well as the muscles as well, and they help the muscles to work better.

So it just seems madness that these poor women are like the tin man from Wizard of Us, you know, rusty trying to creak and get their joints.

It's you know, of course, exercising will improve and our muscles will make hormones, so if they are stronger, they're going to work better and that will help.

But they're not going to replace the hormones to the level that they were when they were younger, and they over is working well, m and the brain.

I listen to one of your posts about just the effects all three of them have and how important it is too on our brain, and I mean, I don't know how you can't listen to that and not think, Okay, sign me up for all.

Well, you know, I'm a general physician, I'm not a gynecologist, and you know gynecologists.

Most of them think that the womb is the most important organ in the body, whereas I actually, and I think many women would agree, feel that the brain is the most important organ in our bodies.

And I'm very interested in neurophysiology and so how our brains work and function.

And we've got all the brain is the most amazing organ in the body.

And it can sort of the cells can grow, they can change the neuro transmitters, the chemical messengers in our brain.

The levels of those can change all sorts of things we do.

It can alter the function.

But these hormones ESTRODIWM, pedesterone, testosterone are neurosteroids.

They are made in our brain.

Every sell in our brain responds to these hormones.

There's a reason that that happens.

It's not just to give us periods.

It's to help our brain function, help the other neurotransmitters to be at the right level.

So it helps our serotonin, our dopamine, our melotonin, our neu adrenaline, our glutamate, all of those neurotransmitters work better in the presence of our own hormones.

So it goes without saying, really that the commonest symptoms are those affecting our brains, so you know, the low mood, the anxiety, the memory problems, fatigue, and a lot of people have very dark thoughts as well.

But then you can see where they're misdiagnosed as having depression or psychosis or personality disorders or what have you.

But we have to understand how hormones work in our brains, because then when we don't have them, our brains don't work in the same way.

Our brains are not working the same right now, Heyley, I don't.

Think we'll testify to that, So okay, I'm going to cover some of these quick questions before we wrap up here.

Clearly, we know that you can go through a post metapause without any HRT, But this person's asking is it a must?

Obviously outside of choice?

Would you recommend it for anyone that's even asking this question.

It's a good question.

I think you also have to think what are the risks of not having hormones?

So it's an individual choice.

Of course, people can live without hormones, they can live without virroxin hormone, but actually, if you've got symptoms, why would you suffer?

But it's the health risks as well.

We know that the communist cause of death and women globally cardiovascular disease and dementia, So taking natural womens will reduce the risk as well as, as we say, reduce the risk of usityoprosis that affects one in two women and other inflammatory conditions.

So it's a choice, but a lot of people, you know, make the decision to take it or make the decision to not take it.

It's fine, but just know the facts really is really important.

Do you feel like any of these are easy to stop?

That's the next question is if I started test asterone, is it easy to start?

Yeah, sure, but most people don't want to stop, you know, and that's because they're biologically active.

So you know, I take HRT and tossing for two reasons.

One to help me, you know, not have symptoms, because my symptoms were really affecting me.

But secondly, I've already said I'm scared of usteoporosis, so I'll do anything to keep my bone strong, so I do weight baying exercises, I take this d you know, I'm active, But also I take hormones for that one reason, So even if I wasn't getting symptoms, I don't want my bone density to reduce, But that's my choice.

Other people might not be on their way down, they might not mind.

So the hormones we use only last in the body the same day.

So if I don't use my testos to win tomorrow morning tomorrow night, I won't have any in my body.

Doesn't build up in the body.

It's not my antidepressants that it can take weeks or months to come off them.

Oh I felt it.

I only took a certain amount on my nine day mont Blanc hike and I ran out, And yeah, I can tell you.

So how do migraines And this is actually something that a lot of women ask migraines and how they change over the metopause transition and when you're post metopausal, when you're officially in metapazzal do they get Does it get better?

So yeah, for sure.

So again there's information on my youtubes and podcasts about this.

But migrain is a chronic as in long term and it's usually a genetic condition, so people will always be predisposed to migraines if they have them.

But the brain likes homeostasis, It likes things the same, especially in people who have migraine.

So anything that changes in the brain could trigger a migraine, including hormone fluctuations.

Like you say, so, a lot of people find that they have worsting migraines in the perimenopause, and giving hormones back at the right dose and type can really help with migraines.

Sure, they might improve in menopause when the hormone levels are low, but then you've got health risks, you might have other symptoms, so it's not really good enough to say to someone just wait until you're hormone drop and then you might be Okay.

That's not really the way I practice medicine.

But also, you know, I'm a migraine sufferer, and it's looking at everything.

You know, I still get migraines despite taking hormones, So it's looking at what we eat.

I mean, I'm very strict with I don't drink alcohol, I don't don't eat chocolate, I don't have caffeine, I don't eat processed foods because all of those would trigger migraines for me, but other people might be fine.

So it's working out your lifes done.

I mean, I'm very routine.

I eat the same time I get up the same time I go to bed the same time.

If I do too much exercise, it can trigger migraines.

Have to be really careful.

But other people are fine.

So it's looking at what you need in a But hormones have a massive impact, often in a negative way when they're not balanced properly on migraine.

Okay, so you've talked about a little bit about exercise and diet, so that goes into proper mental puzzle prescription.

If you have someone seeing you, you guide them on that.

What are your recommending trends for exercise specifically?

So I think exercise, well, it's very individual, really really individual.

And for some women, exercise might just be walking to the bus stop.

It might be just parking their car a bit further away.

Other people, it might be changing their exercise.

It might be that they can't exercise the same because they're getting symptoms.

But as they improve, they might get stronger.

You know, I was thinking about this last night.

I'm probably stronger now than I was, certainly twenty years ago, even thirty years ago, as a student.

I think I'm stronger now, and that's partly because as a student I was taking contraception, which you know, probably doesn't means my muscles weren't working as well.

But I'm exercising differently, but I'm able to with my hormone.

It's a combination of things.

So I feel sad when people say you're menopausal, you have to do this exercise, so you can't do this exercise.

You know, people are really there's no reason we can't do more and more.

But I think the most important thing I don't need to tell you guys, but it's just doing something that people enjoy and that they can keep it as a routine because it's all very well, isn't it.

Every January people want to start running or start doing whatever.

You know.

I still enjoy yoga and I've been doing it for many years, but you know, other people are different.

I've started using doing some weights and I quite enjoy that.

Still like doing yoga as well, But you know, it's doing what's right and what fits into your schedule.

Like it's although I like cycling, but it's three hours if you're going out on your bike.

I never have three hours to myself, so I've just got to limit and change, you know.

But so it's you know, some people like exercising on their own others like doing it together.

It can be really social.

I'm not that socially, quite happy doing it at home, but it's it's you know, I think looking at it as part of your life, like we have to eat, don't we You have to drink.

You can choose to exercise, but it should really be part of your daily routine.

And I think that's important.

But it's the first thing that often goes.

But I feel sad when people say, if you exercise you won't get symptoms, if you exercise, you don't need hormones, because it's not any either.

Aw I don't think yeah.

So for any parting words on women that feel like they've been dismissed, maybe they don't have How does one go about finding good care?

Do you know what?

I wish I could tell you easily, But I think the most important thing firstly is to get the information that's right for you.

You know, there's a lot of free information on my website on balance app.

I don't work with pharmaceutical companies.

I don't have a hidden agenda.

So work out what's right for you and then try and find the clinician.

And it probably won't be the first clinician that you see but it doesn't matter, like none of us as clinicians loose sleep if someone gets a second, third, fourth opinion, like it really doesn't matter and we need to remember that that it really doesn't matter.

And then take someone with you and I would, you know, have a really open conversation.

No one wants to fall out with their doctors, but if they're really saying no, I would then challenge and say, well, why are you not prescribing evidence based treatment for me?

And ask them if you could try it, you know, And some doctors don't like being challenged.

I really like it when patients ask me things but don't give up, you know.

And I think this is and it's really hard, but I see it over here in the UK and other countries as well, that often doctors are being educated by their patients, you know, as a busy DP when I was working in you know, family medicine.

If you've got many people coming in the same day with the same problem, you've got to learn about it, you know.

If I see some if I don't know about, I don't know headaches, and then every day I'm seeing six ten people with headaches, I've got to really read up and learn about headaches, and this is sort of happening over here and in other countries that doctors.

Some of them are going, wow, this is brilliant.

I've learned so much.

This is great.

So they've done our education program.

They're like, brilliant.

I feel really confident now, And others will go, Louise, you just need to shut up because too many women are coming through the surgery and they're blocking other appointments.

Well, you could argue, and they're good appointments because these women you'll transform their future health and lives.

So I think as patients we need to keep the momentum going and learn from others.

You know, there will be others in your town or area who will know who's good to see.

But I just don't be scared getting another opinion.

I think, do you have a vision for what menopause care could look like or should look like in the next five to ten years ago?

Do you kind of have a dream?

Yeah?

I do, but it's but it's not just menopause.

Actually it's hormone or care for women.

Because I have three daughters and my oldest daughter has PMDD, so she was dipping really badly.

Before her periods in COVID, I really noticed it.

So she has natural body identical hormones and they've really transformed her life.

And I see a lot of her friends, some of them who have been given lithium and a lands a pain, horrible drugs, and no one's thought about hormones.

So I'm transforming their lives.

So when you've got twenty two year olds saying, Louise, is it legal to feel this good every day of the month?

Like this is amazing, Like that's incredible.

So those women or girls, women will never really be menopause because I will adjust their hormones according to what they need.

So the dream is to stop the suffering, to stop the gas lighting, to stop this not believing women and thinking hormones are just something trivial.

So I would be so happy if everybody that wanted hormones could access them on their first consultation, and everybody who needed them knew that they needed them and had started that conversation earlier.

So actually menopause wasn't really a thing, and perimenopause wasn't thinking because people would get going a lot earlier, really, and you know everybody who's on contraception should be thinking about hormones in a different way.

Really wow, well this has been such an incredible conversation.

Most women aren't going to be able to work with you one on one, So how where are women finding you?

I know you have some books, yeah, podcast.

Yeah, So the best way is going to my website Dr Louise Newsen.

But Dr Louise Newson one wad dot co dot uk.

Balance app is free, so people can download that through the app store and Google Play.

A podcast it's called Dr Louise Newssen and then the YouTube as well, So just furtle around and find something that's relevant for you.

Great.

Well, thank you so much for your time.

You were so respected in this industry and we were thrilled if you answered our call.

So honored.

Yank you so much for sharing your time with us.

Oh well, thank you, it's been great.