Cleared Hot - Powered By BRCC - The Biggest Lie Women Were Told | Casey Stumpf | Ep. 440

Episode Date: April 6, 2026

Casey Stumpf is a nurse practitioner with 18 years of clinical experience spanning emergency medicine, military family health at Camp Pendleton, hospice care, and hormonal optimization. She holds a Menopause Society Certified Provider credential and a bachelor's in dietetics from UC Davis. She now runs a practice in California focused exclusively on perimenopause, menopause, and hormonal health for both men and women. In 2002, a study got published before the researchers finished reviewing it. The media ran with one conclusion: estrogen causes cancer. For the next two decades, women were stripped of hormone therapy and told to white knuckle through the worst years of their lives. That same study actually showed women on estrogen alone had 18% less breast cancer. Nobody reported that part. Casey walks through exactly what happened, why the data was misread, and what six decades of fear have cost 75 million American women — only 5% of whom are on hormones today. We get into the real mechanics of what perimenopause does to the brain and body, why testosterone is her favorite hormone for women, the connection between untreated menopause and Alzheimer's, hip fractures, heart disease, and divorce. She talks about sitting bedside through hundreds of hospice deaths and how that shaped everything she does now. We talk about our mom's end-of-life letter, our dad's refusal to age gracefully, and what it means to build your 80-year-old self in midlife.  https://theradiantwelltality.com/   Today's Sponsors:  Montana Knife Company: https://www.montanaknifecompany.com Brunt:  For a limited time, our listeners get $10 off at BRUNT when you use code "clearedhot" at checkout. Just head to https://www.bruntworkwear.com  

Okay, got to red smoke. Gun runs. North and south. West of the smoke. West up of smoke. Okay, copy, west of the smoke. I'm looking at danger close now. Come on winter, man.

They give it to me. Copy, clear that. Oh, I get to start it? Yeah, we're already going. Okay. I personally think you should start a little bit of your medical history and bring people up to speed on how you got into this. Yeah. What is this field called?

Don't die. Don't die? What do you mean? The opposite of what our father is doing right now, slowly decaying into the oblivion and the abyss through. Well, he also thought he was going to be here. I'm sorry. Yeah.

While we were recording this, he thought he would be here? Yeah, because one of the questions was like, please talk about your dad when he was in the hospital and handed you a ton of cash. Yeah, that's when he got the BWI. And for people who don't know, that that means that's biking while intoxicated, which he didn't tell my mom about.

Which didn't it translate over to a DUI? If he would have been. The judge didn't hold that up. But yes, it could have. And mom opened the letter on that one, right? The summons, if you will. I don't know how it went down. Yeah.

But I said, well, why do you think you're going to be there? Well, we have a lot of stories and I can talk about my menopause. I'm like, what? I'm like. He said, everything you're saying deeply checks out. His menopause? Yeah, I said, now, men go through manopause. The technical term is andropause, but manopause.

to me sounds much better. But he's like, yeah, my menopause and my blood flow issues. I'm like, no one wants to hear about your bedroom blood flow issues. No. No, he described it on the show, though, actually. He said there was morning wood and now he has kindling. Yeah, so he wanted to come on and discuss his experience. Maybe he was going to give a patient feedback.

Yeah, I'll use my phone because the laptop is an odd experience. Yeah, a little bit closer. Whatever. As discussed this morning, he's decided to enter end of life care. He wasn't there for this conversation, but it's time for him to make his transition. Yeah, I think you should start with how you got into this in the first place. What is the field called hormonal optimization? Well, it could be a lot of things.

So I am a menopause certified provider. Menopause certified provider. MCP. MNapause Society certified provider. We got to work on that. Yeah. They just changed too. So 18 years practicing as a nurse practitioner

Started my career in the ER Actually worked at the hospital where a dad had his incidents Yeah, you know Maybe you can tell the portion of the story that you were calling me in Virginia Beach From the back of the fucking cop car It's a little panic hammered Trying to tell the police officer My brother's a Navy SEAL

Yeah you just talked to my brother he's the Navy seal. And the cop, God bless him, takes the phone. And all I said to him was, I am, before he even said hello, I'm like, I am so sorry, please hang up the phone. I don't want any part of this. Take her to jail if you want to. And my dad, too.

I wasn't the one in trouble. I was just in a mild panic. Facilitating dad leaving the hospital without checking out might be you being in trouble a little bit. Oh, no, no, no. They checked us out. The criteria was he had to walk straight. That was it. They were done with us.

What do you think his BAC was if you had to estimate? Well, so some people don't function well with a few drinks. He had a good training, right? So he could live a lot higher than others and be really functional. Yeah. 0.38.0.4. Him and Greg had been at the Ozzy bar. Yeah.

Drinking greyhounds. And I was at the open bar and Greg showed up, we got to go. Covered in blood. I thought something happened to him. He was covered in dad's blood? Yeah, it was Greg shows up. He's covered in blood. We got to go.

And I'm like, and then he's like, it's your dad fell off the bike, you know, that was like, sit back. Handel bars up here. Michael, are you sure you want to travel with us to Australia? This is like, you may well, the fact that he will be 80 by the time we go there is this doesn't change that all of this happened and likely could happen again, just for clarity. Sounds like a good trip. Yeah. Ladies and gentlemen, today's episode is brought to you by Montana Knife Company. You need to head over to their website, montananknife company.com.

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But if you want to go see behind the scenes, actually see the facility, I'm pretty sure they're doing tours. Josh Smith will sign anything you want to from your forehead to other items that you may want him to sign. He's willing to do that. That's what he told me specifically. there's nothing that is out of reach. But for those of you who can't make it, those knives that I was just talking about, those things are unbelievable.

And there's a bunch that are in stock right now. So if you want to support a Montana born and bred organization with lifetime sharpening, an amazing warranty program and an industry, or I should say a business in an industry, bringing jobs back to the U.S., sourcing, creating, building, all right here in Montana. head over to montana knife company dot com so worked in that er did er medicine between nursing and np about nine years

you you know got out of the military and had a huge calling for me to give back to the military and went into the navy not as an active duty but civilian provider up at camp pendleton for nine The new hospital, not the old one. Both. No, I did both. Really? Oh, yeah. Why do they have that hospital like 30 minutes deep into Camp Pendleton?

I don't know what their logistics, but. The new one seems a lot nicer. Oh, 100%. So did that. I got booted out of that because I couldn't work full time. That was a whole, as you've seen with the military, how my HRD did not sign a stinking line on my paperwork from eight years. What's HRD? It's like they're human resources.

I don't have any experience with the GS side of the house. So the way you were working with the military and the way I was working with the military, very different. The command had agreed that I could work part-time, Jason being a firefighter and having, you know, I needed to be home. They agreed I could work part-time. Gets approved, do this for nine years. Then all of a sudden we get a new CO in and says, no, you have to work full-time. So they looked through all my papers. Yep, that's fine.

But one line had not been crossed and, you know, signed off. So I had to leave that. You didn't have five minutes to go into another room and come back with it signed. It was above my pay grade. But I learned a lot when I worked there for the military. Yeah. So there was this one point, you know, they were going to have me work Christmas Eve. No problem.

I wanted to know, though, if that was going to be paid overtime. So I sent it to the people who were saying, okay, this is a paid holiday. And they said, thank you for working. Da, da, da, da, X-O somebody. I'm like hugs and kisses. I'm like, this doesn't seem very appropriate for the military to be saying this. Okay. So active duty sitting next to me, lieutenant at the time.

I'm like, how can they say X-O in the military? Don't you think that's a little bit much to say? Oh, for the love of God. What you're saying just now clicked. All right, yeah, they meant executive officers. That's literally, that's how. This was nine years in and you learned this lesson? No, no.

I was one year in there. I was at the old hospital. My situational awareness was not high at that point. It's not situational awareness. That's familiarity with military acronyms. Yeah. So loved my time with a military. But if you look at, so where I start with ER to military, heavily male dominated.

Oh, especially at Camp Pendleton. Oh, yeah. But did the, so at that hospital did they bring, were families getting service there as well to in treatment? Okay. Well, thing about this. So in the ER, mostly male. They didn't want to deal with women's health. I love women's health.

I was getting all the women's health cases. Was the ER really the place to deal with? with women's health anyway? Oh yeah. Oh yeah. Ectopic pregnancies, vaginal issues. They didn't want to deal of that. So I got it.

You go to the ER for those though? I thought in general you would just go see your provider. Some people will use the ER as primary care. Yeah. I mean, if it's available, I get it. Yeah. So they, you know, any female health, that got shunned to me, especially in the military.

You get all these guys in uniform, the women don't want to, you know, they're not really wanting to see that. So all the women health within that group, I was running most of the women health for family medicine in my little group. And no hospice care yet? Not yet. Okay. So hospice care actually, that was supposed to be my retirement gig. That ended up way faster in my lap. So I went to an end of life conference, because who doesn't want to just spend their Friday date learning about that? Me.

So I go to this conference and one of my old... Why did you go? Because I love it. I wanted to learn more about it. It was so intriguing to me. You loved it or it was intriguing? Those are different things. I- Because you weren't doing hospice care yet.

I know, but I found it so interesting. Like the things you and I talked about just the other day, just to me, it is one of the most special areas of medicine that you can have a pivotal role in. Okay. So I just couldn't get enough. Could not get enough about the education. So San Marcos State, which is right by the house, has a palliative care conference. Sign me up. How often do people die in the ER? Like how often were you guys around death? Because hospice is, I mean, obviously, you're intentionally putting

yourself into that place. But in the ER, I mean, you had to have some level of exposure to. I'm just curious where the fascination or curiosity came from. Well, that's traumatic death, though, right? That is like, okay. And I can remember the acute cases, you know, dying of pulmonary ambulism, heart attacks, very common, strokes. You're around it at least. Oh, all the time. But not in the palliative care sense. All the time.

But ER death is very different than a hospice death. Now, I would see hospice. Patients come into the ER because families would panic. I get it. It's scary. And the families know that they were in hospice? Mm-hmm. Yep.

Isn't that defeating the purpose of hospice? Families get nervous. They get scared. Okay, well, we'll get to it. But then there's a question of that. How do you make sure that that doesn't happen? and so the person who's electing to make that decision doesn't. That would really suck.

You've chosen a path and your family goes, it does. No, we're not ready. It does. So there's a farm, the pulsed farm that everyone should have. So it's life-sustaining orders that you can describe. Have we written dads out for them yet? Yeah, I signed it.

Good. Mm-hmm. Let's make sure those are up to date. Yeah. He's made the choice. So first line, DNR, do not resuscitate. Next line, attempt CPR. Okay, that's first, right?

So most people in hospice or do not resuscitate. Just let this disease take its course, whatever it is. Yep. Next section, do you want full care? Do you want some care at home or do you just want comfort care? Hospice usually just comfort care, everything in house. Third section, do you want to be fed artificially? Yes or no?

No. You're saying no. I agree with you. I think where people need to have this. conversation is, I asked dad this. I said, if you can't feed yourself, do you want me to feed you? Because I will see that a lot. You can keep a body alive on tablespoons of food. What did he say? He said no. Good. So like Nancy, I'm her power of attorney, do you want me to feed you? What'd she say? No. But so many people like, well, yeah, okay, well then you're living probably a bedridden existence for potentially years.

whatever. I mean, that's people's choice to make. Not my gym for sure. Right, but it's a conversation people need to have because they think just, oh, I don't want a feeding tube, right? But you don't think about, okay, to me, in hospice and anything, let the body guide this journey. If you can't feed yourself, I think it's speaking where it needs to go. I would agree. So, okay, so families fill this out. It's supposed to be on the fridge. Firefighters are looking for this, right? They come in, families panic call 911 okay they're looking even though that can say that the family can insist what are the firefighters obligated to do well i don't speak out of term jason be ideal for this when they arrive i feel like the dnr would take precedence it should trump things sometimes though in a panic

you can imagine the chaos that can can happen in families or if or if it's not completed so here you have someone who's dying, actively dying, comes to the ER, all of a sudden, they've got a breathing tube, they're pumping on their chest, the ribs are cracking. It is such a traumatic death. Like, I do not wish this on anyone to go through that. They leave the rib cracking out on TV. Yeah. Yeah, if you've never actually compressed somebody. Yeah. Might want to stand by for the audio experience of that.

Yeah. I'm not strong enough to do it. I don't. I did CPR one. and throughout my back. I don't even really know what to do with that information. I'm still shocked you're drinking champagne at 9.30 in the morning. Oh, I have a reason. Fire away. Let's just take a left-hand turn right now. I am having coffee, everyone.

Michael is, go ahead, Michael, show your cup as well. Hey, yeah. It was explained to me that champagne is a morning beverage. Yeah, I'm surprised you didn't know that. Right, Michael, stay hydrated. at all times. Fire away with the champagne. Okay.

So the other day. It's a real bottle, by the way, people. And it's really in her company. So the other day, I was looking for the deed for our house. Okay. And I'm digging, digging, digging. And I see Mom's Death Certificate. And then behind it, I see this thing that says,

Andy and Casey, things to keep. Yep. So you've seen some of it. You wanted some of her handwriting. Yep. So the list that you read, you thought, I don't know if I can read it. I might let you read it.

You don't have your telescopic readers. Both you and Jason are hilarious. If you don't have them on, it's like you're limited by your ability, the length of your arm. Well, I think you should read it out loud because I think what it did. You're going to fucking ambush me with this one of the last things mom wrote in one of the last things. But I think this to me,

and end of life and how people. All right. Sentence one. The opener is a real, it's got a real hook to it. It looks like I don't get to stay in the game as long as we had planned. But the notebook says.

You know the movie the notebook. Are you serious? What a fascinating woman. Diveraging for this for a second. What was that book, Nancy Drew? Nancy, you see when she came up, brought a application letter, essentially a, it wasn't a resume, but it was an application for a job at the local newspaper in Santa Cruz, right?

And I don't know what kind of job she was applying for, but in there she's a bookkeeper. As a bookkeeper, she's just like, I'm a coward to the core. I've been scared to death. I can't watch scary movies. And the Nancy Drew books, I can't even finish them, which reminded me, she took me to go see the original Michael Keaton Batman movie. Have you seen this, Michael? Actually, yes, I have seen.

this one. Okay. You're not going to remember this, but in the opening sequence, as the movie starts, the camera, you can't tell what it is. It's like moving slowly with cinematic music through this little architectural area. And as it comes out, it's the Batman logo that is on his belt that he wears. I'm there with my mother. And she goes, we have to leave. I was like, what? She goes, it's too scary. And this was in the opening sequence. The job she was playing for was an admin. and assistant time all right so yeah there you go nancy drew terrified my mother and i don't think we watched that movie because we couldn't make it through the opening scene okay but the notebook meaning the movie says i can leave with you the cards held in my hands so i'm granting you my

life share of chocolate but only if you'll root for the giants which is her absolute favorite team i mean she was dying listening on the radio to the giants and all of my vouchers for cups of good coffee in the morning. Son, you can have all the bottles of, let me see you. Oh, good coffee in the morning, son. You can have all the bottles of good wine I've yet to find as well as the cheeses and champagne. Two, double O.

To be opened for both small and grand occasions. God, her handwriting. So how I tied this in, I was like, oh my gosh, Andy has gone into the coffee world. Yeah. And I was like, I don't know, just how the universe sometimes lines up. I'm like, this is you. This is your coffee world. She turned to me off to coffee.

I didn't have my first cup of coffee until I was 27. Because I don't know if you remember what she drank. It was like that red Folgers, like old school. And now that I understand coffee a little bit, I'm not a coffee nerd by any stretch. I think she burnt it for about three days before she drank it. I remember having a sip and it tasted so horrible that I just like, no, I don't want any. So I didn't have coffee until after I had kids. And then a buddy of mine overseas and it was Beckast.

Stan slid me a iced mocha. And I was awake for about two days. Oh, yeah. And then, you know, after your kids age a little bit, then you can just put your face under the espresso machine and drink it. But yeah, she actually ruined me from coffee to begin with. But here we are full circle. Well, that's what I thought.

When I saw this, I was like, little did she know. You would end up in a coffee world and I'll drink champagne the rest of my life. But I feel like you're kind of like really shoehorning things in here just because you like them. But it's whatever, you know. It's your world. For big and small occasions. Like, to me, it's huge to be here. Why?

Well, how long have you been podcasting? Eight years, nine years? Well, yeah, I mean, I, before, you've been doing it before I've been here. So I don't know how many years before that, but that makes two of us. I have no idea. Eight or nine years. But you're not coming on. You're not coming on.

Yeah. So to be here. No, you can come on and talk about medical stuff. We're not going to go do like a chapter and verse of our life because trust me, you don't want to go down that path. Well, that's fine. That's not meant for the Internet anyway. ways. Yeah. But yeah, I mean, again, I'm in a phase of my life where the stuff that you are

talking about is I'm directly impacted by not only my own, you know, I'm on a two and a half year journey at this point to figure out my own endocrine hormonal system. But my wife is, you know, going through it as well. I mean, to tell you that what you don't get briefed on as a man is if you have a significant other, what they're going to be going through at some phase in their alive. Yeah. So. Well, and women aren't told that either. Am I allowed to swear on here? Just the internet. You can do whatever you want. Have you, we've, dad's been on here. What do you think? Oh, that's true. Yeah. So end up in hospice care. So the military phased out. My girlfriend's there. And it was just crazy that I go into this conference and I'm like,

I really need to find someone in this conference who I can talk to about working in it. I was in a marijuana lecture of all things. I don't know how much that's been discussed in our upbringing of our exposure to that with dad's hobbies. A little bit. He forgets that he like lit half of a mountainside on fire and they had to do a, you know, one of those fire retardant drops. And yeah. So my bestest friend from nursing school, I hear my name, I look up and I see her name and Elizabeth Hospice. And I was like, oh my gosh.

She's like, they have an opium. and here's the, here is our hiring manager. He was a medical director. It just like fell in my lap. And I loved it. Absolutely loved it. And so many people, when I say, oh, hospice, they go, oh, that must be hard. That must be hard.

I actually miss it and I feel really guilty that I'm not doing it still. Because I know this gift I have, most people cannot sit in the comfort of doing it. It's a unique place. And if you think about it, most people will very infrequently touch death in their life. I mean, obviously, then everybody, I hate to tell everybody this, but life is a fatal event. Yeah. So at some point, you're going to be there. But yeah, I guess both you and I come from a slightly different world where it's not like I enjoy being in those moments necessarily, but I've been around more than my fair share of people at the end state of their life. Yeah. And unfortunately, yours is I could never sit on that side. I couldn't do that side. You never know? Well, I couldn't do that. When somebody's trying to kill you, you just try to kill them back. I get why you have to do it. I just couldn't do it.

I'd be the one like a mom with that. This is too much. Let me just tell you, none of the stuff we were doing was making it into a Nancy Drew novel. No. So. Fucking Batman opening credits. But I think that is such a unique experience for me that you don't meet many providers who have sat bedside.

of hundreds of deaths, listen to bedside stories of what matters. They're not worrying about, oh, I should have worked more. You know, I should have spent more time at the office. No, it's like I should have traveled more. I spent more time with my kids. This is what I heard repetitively. And so for my mental shift is, I mean, I work to travel. That is what I love to do is to travel.

And that's where my money goes. But also, I took care of a generation of woman who were not on. on hormones and how the quality of life, I'm not dying like that. And the people I take care of both men and women, I'm not gonna let that happen. Yeah, it just seems like you've shifted your focus from the tail end of life to like maybe let's delay

how long somebody has before they get there or you arrive there at a better spot. Well, both. So I had to do it like switch in my brain. So I'm like, okay, I'm doing hospice of the ovaries. Just switch it up. Okay, I'm still doing end of life care. Ovaries are dying and the testicles are a little bit slower.

So end of life care, just different framework. Whatever works for you. That's what works. No idea what you just said, but whatever. As long as it lights your fire. Menopause care. It's hospice of the ovaries. How did women get so lied to, like the, again, and we can go through some of the exact questions,

but one of the resounding themes is hormones cause cancer. which seems to be the biggest lie that was told that how many generations of women when you say got caught up in that five or six, 50 to 60 years ago they made that. It seems to be improper determination because they just removed the, what is it, the black label warning on those things? Yeah. Yeah. Thanks for that for the generation of women that had to, their words not mine, white knuckle it through.

Yeah. That's not pretty. No. But why did that happen in the first place? Well, if you look at like in the 60s, it was common practice to, be on hormones. So about 30% of the population. Men and? Women? I only know women. Okay. Men of, this is where I get a little bit frustrated. Men it's always been like, oh, you're not feeling good. Here's some testosterone. Access to care with hormones for men,

night and day difference. Is that because it was understood better? I don't know if it's that, but like even in. Well, nobody understands women. Well, we aren't even studied. So all the research that's been done, because you're not studiable is on, it's been on men. It's been on men. And they extrapolate that data to make it work for women. Like, um, you guys are crazy at a genetic level. How can we study you? Men are like rock solid, always good to go. But so like blood pressure medicine, sleeping pills, um, cholesterol meds.

Those studies were done in men. And then they're like, oh, okay. Well, we will use this on women. There's been no like data that shows you give a woman, um, but like cholesterol medication and it's going to lower their all cause mortality. It'll lower her cholesterol, but it doesn't necessarily decrease her risk of death. You can't take numbers from what they study in men and put it to women. So we've been underrepresented there.

Well, let's also just be honest. I mean, not too long ago, they were drilling holes in people's head to get rid of headaches. So medicine is slow to evolve. It's always evolving. It's a practice. It's science. So in the 60s, they're using it like 25, 30 percent of the population who can be on it or on it. Right.

Then the WHO study comes out. That's 2002. And that's when I was like, oh, estrogen causes cancer. They ran with it. The people who actually wrote the study, it got published before they did the final review. And it was on mice, right? No, no, no, no. It was women, they studied.

Oh. It was a double-blind random control trial, which is the gold standard, which is what you want. Okay. You have two groups. But wasn't the information recorded inaccurately or reported inactive? How it was interpreted. Yeah. It was inaccurate.

Maybe it's not the gold standard people would want. How they ran the study was appropriate. The reporters, the media published before the people who were working on the study got the final say of what was to come out. Nice. That is where the problem happened. They've been backtracking it ever since. That study actually showed the women who are on estrogen alone, not estrogen and progestion. The estrogen alone actually had 18% less chance of breast cancer alone.

That did not get reported. It was like, nope, this is going to kill you. And so all this fear. happened. So all these women get ripped of hormones. So even right now, this is crazy. So within the US, there's 75 million women, either perimenopause, menopause, postmenopause. Five percent of the women aren't hormones still. Minimal. Yeah. Best of luck. I mean. Well, yeah, because if you have a, what did they call it, a black label warning? Yeah. You, we, there's like, you should fear this hormone in your body, like the litmus test for a lot of this, I'm like, okay, estrogen is

highest for women when they're pregnant. That is like the peak. It's about 3,000, the level can get to 3,000 in the body. That's the highest peak. It's like a stress test for your body. So, okay, we can tolerate it in pregnancy. Why are we fearing it at doses that are like a tenth of that? I don't know. Or a 1% of that, right? It's this women, we're told, fear a hormone that has been so protective. So I don't think I'm speaking out of school with this. Leah was talking to her mom and her mom's sister, which would be her aunt. Verbatim, both of them, you're going to get breast cancer. Yep. I mean, instantaneously. That message is pervasive. It's deep. I know. So if you look, think about it, like breast cancer rises as women get older. Okay. Estrugent's dropping. This doesn't

make any sense. Tell me, tell me how you can make that correlate. one's going up and the other's going down. It doesn't even, doesn't equal up. It should be other way, right? If that's what they're saying, you should be getting a ton of breast cancer when you're pregnant. Yeah. If it's the cause and it goes down when you're older. So.

I don't know. So where do we begin? We had hundreds of questions that were submitted. You said you kind of want to go through, and I think it's smart because I think in your, the way you want to go through this and reference your notes all you want to. I think a lot of the questions will be answered. I'm going to just turn it over. just turn it over to let you explain this and then I can kind of serve through some of the questions that maybe might be on the perimeter of that after you get through it.

Well, do you want me to explain like what this is? Yep. Lay the foundation. Go through what you have because I do think it's going to answer quite a few of the questions and in listening to what you're saying, I'll kind of go through and see if there's anything out there that's on the fringe. Okay. So I think to like coming from that hospice background,

you know, if you are lucky enough, you get to experience menopause. And I think back to like mom's experience. She just wasn't. Say that one more time? If you're lucky enough, you get to experience this. Meaning you're still alive. Correct. Okay.

Right. And I think that mom's procedures she went through probably threw her into this, but she was such a stoic person, did not talk about what she was going through. I heard her yelling at dad a few times. Well, all right. That probably was related to other things. She was fucking him up. What do you mean?

He was just like, so yeah, if you live long enough, you're going to go through this. The problem I see is, okay, in the 1900s, women were living to 50, right? So you would go through menopause. The average age of menopause is 52. Okay, great.

To be going into it or being done with it? when you hit menopause. So menopause is defined as basically one year no periods. So day 366. Okay, where's your badge? Which I realized, I'm like, cleared hot. Could be a menopause podcast. Come in and hot.

Go ahead with that if you'd like. Right? I won't see you for IP. That's fine. But what about the women who don't have uteruses? Like, I'm going to be very transparent on this. And I've always been open with people about the hell I went through. And that is partly why I'm,

doing this, how poorly I was treated. Being a provider, I speak the language, went into my provider, and she's like, oh, gosh, I don't know. Maybe I'll help you for five years. What happens when I'm, at that age I was 47? So I'm like, okay, at 52, you're not going to help me? And they said, I want my testosterone checked. Well, if we check it and there's something wrong, then we'll own it. I'm like, oh, so I speak the language. I know what to say. What's happening to the women who don't? They're just doing what they're told. Right. Or they're being gaslit and being like told, oh, you're just supposed to just have some more wine, exercise more. Do you think that the people who are gaslighting them are doing so or they're just repeating what they were told a long time ago and they're not keeping up with what's evolving?

I don't know that having more wine was ever taught in medical school. I didn't go to medical school so I couldn't tell you. Well, I'll tell you that this, the type of care I provide is not taught a medical school. Yeah. Even your OBGYNs, who a lot of people think this is where you get the care from, they get one hour training in this. Yeah, and you could also apply that wider too. I mean, how many doctors have a solid understanding of nutrition? They don't get taught about that either.

No, 100%. So. So I'm saying, do you think that they mean to, we'll say have subpar information or they're just not keeping up with the times? Well, and I also don't fault them in that also. Like if you look at your OBGYNs, we need them for delivering healthy babies. That is a critical time. Focus on that. I mean, I spend hours a week training and always learning in classes.

They don't have time to do both. So I want to, people need to shift from thinking that their primary care knows about this, their OB. You need to find someone who lives in this arena like myself. And like, you're not going to go see a dermatologist for your skin. You're going to see a batiatrist for your feet. Orthopedist. There's all these specialists. This is another arena.

Find someone that this is all they do. Yeah, that makes sense. Because the OB doesn't have the time. You know, they may want to be able to do the best that they can, but how are you going to stay up on all that? You just can't. It's just too much. I mean, I do this full time. I couldn't start, you know, learning some other path of taking care of babies.

Slightly off topic. Are asshole doctors, like they focus on assholes? Are they weird people? Proctologists? Proctologists. Who in the fuck is like, I know what I want to do. stare at other people's assholes. Well, GI docs do a lot of that, I guess, with the colonoscopies do.

I don't think I met any. I don't think I've met a proctologist in all my time. I don't think I have. I don't know why that thought came to me, but I'm just going to let it out so it doesn't occupy free rent in my head. I mean, even when I worked ER medicine and people accidentally fell on a bottle. Or a life bulb. Got stuck. They just fell. I hate it when that happens, by the way.

You know who I call? Michelle. I just fell. Careful with those nunchakus that you have. I mean, I don't remember, I don't think it was Jason, but I think it was another, like, first responder who somehow, how they fell or a device got stuck and it was still vibrating their whole drive to the hospital. Let's just say there's an entire website and Instagram pages dedicated to this, so go to town people. The accidentally I have a wiffle ball bat up my asshole. Like just, just own your shit.

Also put a lanyard on it. Yeah. So I'm going to backtrack then. So, okay, we before 1900s, we're living to 50. All right. So you're not dealing with us. So current day, we, women lived longer than men. Our average lifespan's about 80.

Men are 72. So. Is that it in the U.S. right now? Yeah. So dad has passed. He's extended his lifespan. Oh, he's out. We should, we should, he's overextended quite a few things.

We should make him aware of that today. Off topic, because we've been joking so much in front of him about putting him in a home, we were doing it. Well, we're not quiet about our discussions. No. And actually, I thought process in front of him. Yeah, I told him yesterday, I can't wait to figure out how much of your money we can spend to put you into a home before we have to pay for it. Verbatim is what I said. Now this morning on a call, he's like, I'm not going to a home.

It's like, don't worry. It's being decided for you. So we are not supposed to outlive our ovaries. So women, I don't know. I think we're just one of the most unique creatures. When you are born, you are born with all the eggs you're ever going to have in your whole life. And what's really cool, if you're pregnant, like say when I'm pregnant with Ella, she's got all her eggs. So you are carrying your grandchildren.

Does that make sense? It does. Yeah. I don't thought about it like that. It is like amazing to me. So women are, they're ovulating, they're releasing all these eggs, releasing all these eggs. By age 30, we've got 10% of our reserve left. Okay.

That's not that old. No. Right? So why it's harder to get pregnant when you're older. The body's working harder, harder, harder to ovulate. And you're not getting the best of quality of eggs, hence why you can see more chromosomal abnormalities at that point. Average age of no more ovulation, no more eggs.

that that is menopause, you stop having periods. You can't get pregnant anymore. Okay. So 52. Okay. So our ovaries are aging twice as fast as our body. Okay. I'm with you so far.

They provide all the hormones that have making our world run and they're done. We get castrate leg this. Wow. Done. Drops off. Men, not like that. You guys, you go through manopause, but it's definitely way more gradual. What did you call it?

Androgen? The real term is andropause. That's kind of boring. Manipause is way better. Manipause is way better. Dad is, I forgot, I called it, what his term was that he came up for himself, why he needed to sit here with his comments. Clinically insane?

Yeah. Yeah. So, okay, so here are women who have outlived their ovaries and it's, you've been castrated and you're supposed to be productive and live this life that you did prior without hormones. And there's only five mammals who do this. The other four live underwater. Okay. So we're just such unique creatures in this way.

So we have a long lifespan, but I want to get people's health span to match a lifespan. Have you heard of that? Yeah. Before. Brigham talks a lot about that waste oil. So, okay, great. You're going to live, you're a female, you live to 80, but you're, that's your lifespan. But say your health span is only 65, 70, where you're not using a walker, where you can get off of a chair, right?

You can still remember people's names or what car keys are for, right? What if that only goes to 70? Then you've got that 10-year gap, right? That is where I'm trying to bring that discrepancy of those two matching together. We call those the pudding years. Yeah, we're seeing it's coming up. He's in him. He doesn't know it, but he's in him.

Yeah. I can just hear him listening to this episode just, oh, really? Let me just, we don't have enough space on the hard drive for me to repeat the number of things I've been forced to listen to. So what do you mean by that? Do you know our father? The number of things I've had to tolerate him saying to other people and sit there and listen to? Oh, I see what you're saying.

Yeah. Yeah. Yeah. So you've got a whole generation of women that I took care of, no hormones. It's a compounding factor. It's not being taught in med school. And you have now a lot of women being educated on this. Thank goodness.

Are interested. It's all over. You see it. Maybe that's not on your Instagram feed, but it's all over mine. Well, yeah, the algorithm is not some person with, you know, twirling their mustache behind the scenes. It feeds you more with what you engage with and you live in this world. So it actually should make sense that your feed is dominated by this. So here you are.

You're a female. You have, you go to your provider and you're like, I don't feel like myself. I can't remember things. I'm tired at two, three o'clock in the afternoon. I just want to go to bed. I'm not sleeping. I'm wired. I'm tired. One to three a.m. My head's repetitive thinking about things. All of a sudden I have a menopause muffin top. I'm exercising. I'm eating the same. My clothes don't fit. Depending on where I am in my cycle, I may want to kill my spouse. Like, don't talk around me.

Don't breathe. Don't chew. It's like not even recognizing yourself. So it's pretty scary. Every month. Every month. Hard pass. But you live it if you have a, you know, a partner. And I, like I said, I have very open book about what I've been through. And I asked Jason about this. I went on a podcast last week. And before I went up, I said, how honest can I be about what we went through?

Right? Because I'd be very, like, respectful of that. And I said, you know, I have my story. And he's like, well, I have a story too. I tell people. So, oh, okay. Well, tell me your story. story. And he's like, well, I tell people if I had to choose between giving you hormones or me,

he said this to me this morning. Right. Right. Because he, women's going to get him first. He's like, I would give it to you because the impact it had on you was way better for us. So I personally, like when I was in the thick of it, I didn't know I was. I don't have a uterus, which means I don't have a way to track anything of what's going on every, every month. And it was 47 at that time was like, there's no way in hell I'm in menopause at 47. Well, what they don't tell you is when you have a hysterectomy, you're more likely to go into menopause four years early. So I didn't know that. So who knows how long it was going on. It's just where it finally hit. So I call, I'm like, I'm leaving Jason. I'm filing for divorce, hire the best divorce attorney

in San Diego, who's now one of my patients and my biggest advocates. And that's whose podcast I on. Jesus Christ. I was on the receiving end of some of those phone calls. Yeah. Yeah. No, 100%. I was done, but I hear it every day in clinic too. I'm done. I'm leaving my husband. I can't do this. And I get it. How can you? If they go down that path, though, it doesn't actually resolve the problem, right? Because there's still the battle you're talking about is within. Well, and I actually, not that these people, you know, maybe they're not a great match for their spouse, but I'm just saying, right. That's, that's probably not the one single factor that's making them feel that way. Oh, but it's when you are in the trenches of that, you can't even think outside of.

Everything is just too much. And I was talking to Amy, the divorce attorney on her podcast. I'm like, how much more effective could you be in these mediations or even divorce proceedings if I got them a few months ahead of time? And I got them stabilized. Maybe they don't even go down that road. Maybe they might not even get that far. Maybe they don't. But say that they do for that just isn't going to work, the mental resilience and just who they could be, I think divorce would look.

so different if I could optimize somebody ahead of time. So. That makes sense. So, yeah, here I am in this chaos, trying to get help from my primary care provider, can't get help. The mental health was really scary. I've had times of depression in my life. When mom died, of course, I've taken antidepressants throughout my life. That was one of them.

I think there's a time and a place for them, for sure. But this was a different kind of like, this was like, Like, not that I was going to hurt myself, but if a bus hit me, that would be okay. It wasn't, nothing I was going to act on, but it was just I couldn't see a light. It's a general malaise, if you will. It was just, and it's scary. And I see women, you know, all the time crying about it and I get it. And I'm so open because I want to validate how they feel and that I have been them and who I am now is very night and day.

That there is hope on the other side. It takes time to get this dance done, especially in Perry, but there is hope for sure. Perry is before. Yeah, and that, so perimenopause can last seven to ten years before menopause. So you think about that? Oh, you think about that from an economic standpoint. So this whole thing we're describing costs the US 26 billion a year.

In lost wages, women stepping out of leadership roles and just getting out of the workforce and healthcare costs. there's a huge economic impact of what's happening here. But if you think about that from a relationship standpoint and you're like, what is going on here? This could be seven to ten years of this chaos. Then you have your one day of menopause and then the rest of your life is post. So you can have seven to ten years of chaos. Yeah, that doesn't sound awesome. No.

Life's hard enough. Well, life's hard enough. but when you are just, your brain cannot even filter or function because of hormones being fluctuating, I mean, I have friends like, I just couldn't go to work today. I just couldn't do it, you know. Or they're like certain times of the month, too. I would like to teach to this on the screen too because I think it will help. On this particular slide?

Help men know when to hide in the closet. I actually wonder if I threw it up there. Sorry, Michael. I don't know if I threw the slide. I want it up there. Okay. Do you remember which number it is? Is this slide correct?

Well, we can start here. We can start here. So this here is a description of what happens to females hormones. So testosterone you can see at 25 just starts on a slow decline. Now, progesterone and estrogen, those decline, but it's a zone of chaos. You see how those flexulate up down, up down, up down. Progesterone is our first one to leave. and estrogen will follow.

So progesterone, how that presents for women is this looks like disrupted sleep. They're not sleeping. Yeah. And they have anxiety. So I think of like a pot on a stove and it's just bubble, bubble, blah, blah, blah, blah, right? So no progesterone, they're just, it's bubbling over. The resilience of mental health just bubbling over. So when we replace progesterone, when we take a, butchesterone, when we take a little bit of, it's bubbling over.

When we take it by mouth, it goes to the liver. One of the metabolites is GABA, and that is the feel-good mother nature Xanax. Gabba is? Gabba is? Is that in any way tied to gabapentin? Because that's what fucked me up. So gabapentin is used off-label for sleep. Okay.

Because they gave it to me off-label for neuropathic pain control, and it jacked me up. You were on a high dose, and my understanding, too, those you were on a lot of other meds at that time. Just like 14. And also washing it down with, what was that? Crown Royal. Yeah. No, no, no. Not that.

I can't remember the name of the alcohol. Crown Royal is alcohol. No, no, no, I know, but it wasn't that that you were drinking. That was it. Yeah. I went through some phases. Yeah. Captain and diet, it's not a big deal.

So, okay, so progesterone is the first one to leave the body. And so disrupted sleep. You may or may have not experienced this in your household. someone who cannot sleep. Well, and again, I'm not talking out of school. Leah has a later shifted schedule as well, too, so it's kind of compounding. I think it's hard to separate one from the other. She teaches an evening jujitsu class.

Sometimes I'll go to it, and then I'm in bed tired and tired. Like you're tired, but your endocrine system is alive. So again, compounding factor. Is it A or is it B or is it C, which is the combination of A and B? Right. Well, it doesn't help when that hormone's leaving. Yeah, for sure. So if you think of this as Mother Nature's Xanax, just bring.

this calm down. So where I think for your population is primarily male. So I want to give some action items for people of how they can help. The first thing for me, what are those things that dad builds? I don't want to say it wrong. The where you stack the rocks Karen, Karen. Oh, rock Karen's. Yeah. So when I teach. Not to be confused by the lady who runs the HOA. That's just a cunt Karen. These are rock Karen's. So in, My office, I actually have a model of this. Okay. Because my foundation is sleep.

If you are not sleeping, you cannot, I cannot build and help anything above this. Let's just also clarify this applies to men as well, too. Like this is anybody who actually wants to try to optimize anything they're doing in the room. 100%. Yeah. But we're going to have a challenge in this situation when a hormone that helps sleep is leaving. For sure. So things that both the men and women can do to help protect the sleep.

Dark environment. So blackout like. right? Keeping it cool. So 65 degrees, putting a fan on, cooling blanket. I have no relationship with this company, but Lee and I got one of those eight sleep things that has the thing you lay on top of and the cover is got the liquid flowing through it. Yes. Yeah. And you can split it down the middle so you can have your own side. I have never slept in one of those, but I hear good things. They're very expensive. That is why I haven't done it then. Okay. Have some more champagne. We'll get your credit card out here in a little bit with the Wi-Fi connection.

We can make it happen. Very, very impactful. Yeah. So, and then another thing, too, is you can listen to white noise or pink noise. My personality is I'm going to listen to pink noise. Pink? What, I don't know what that is. So white noise is like, that static.

That's actually pink noise. Okay. So pink noise is more your nature sounds. The wind going through the trees, the ocean waves. What would you classify, Dad's noises house currently, since he doesn't wear his hearing aids, the smoke detector, beep going off every minute. Well, I haven't been there since this happened.

Did you not hear it? He was on speaker. You could hear it every minute. Oh, I, oh, really? I wasn't paying attention. Don't worry. Neither was he. Is that pink noise?

Oh, I didn't realize it was that bad. The firefighter didn't fix that. I don't think he's been to the house yet. Yeah, he was there yesterday. Did he go inside? Yeah, he said it was. said. No, it's still beaving. I heard it on the phone. So those are kind of some action items protect the sleep. Okay. Things to start with. What do you think about those, uh, the glasses,

the red glasses and stuff that, so if you. For the blue light. Real BS marketing. I don't know the dad on it. Um, magnesium glycinate at night. Love for sleep. Mm-hmm. Just calming. Be careful on your dosage people. I've played this game. With magnesium. Oh yeah. Was it glycine? Right? Or was it sit trait? Shit trait. I don't know what it was, but there were almost accidents. So it was probably sit trait, shit trait. And that's the problem. Be careful on your dosage. Well, that's the problem, right? People are desperate and they're like magnesium. Oh, I'll take that one. Right? And they're like, yeah, I'm doing my colonoscopy prep. I'm not sleeping. Yeah. Right. So first thing, foundation is going to be sleep. So that is the progesterum. Uh, Michael, I don't think I wrote down this, the slide for you on the one I wanted. He can kind of surf through.

I can look for it off screen. Are you able to, you just shared that file I sent right? Yep. Okay. Do you want them to go towards the beginning? To the, yeah, keep going to the right. Yep, keep going here. Uh, yeah, it's number 30.

30, okay. That it? No, 30. Oh, here. Okay. So this is the every month cycle that is supposed to have. that is supposed to happen. Okay.

This is. Are we working for NASA now? Jesus. We're trying to put a fucking satellite into orbit? Well, this is what's happening behind the scenes and women. So, and this is what I love. This is the science of what I get to do every day. So you can see these fluctuations going up and down, up and down.

The brain likes stability. And that is my job is to try to make things more stable. So estrogen is going to be that blue line and progesterone is the pink. So starting day one, that's when period starts, day one. Hormones are really low. Then estrogen peaks right in the beginning, or not in the beginning, excuse me, ovulation. That is mid cycle. And okay, so women get two to three days where they feel good.

They have energy. Maybe they want to have sex then because mother nature wants you get pregnant. This is around that heart. Yep. And for people who are just audio only, there's a right around the middle of the month, there's a little day 14 for a 28 day cycle, mid cycle. mid cycle. So you're probably going to get a day in front day on the other side of that?

Yeah, but you feel good. Okay. This is all we get. Okay. So then the body is looking to see, am I pregnant? That, so progesterone is the hormone of pregnancy, progestation. Okay. That is progestation.

Okay. So progesterone is climbing, climbing, climbing, climbing. I'm getting this environment ready for a pregnancy. It's waiting. It's waiting. Oh, okay. There is no fertilized egg. I'm just going to crash.

So day 21 on, you can see that. progesterone tanks, the estrogen looks kind of purple in this life with the overlay. You see that crash is where divorces happen. That is where men get killed with forks in the eye. This is when they're hiding in the closet. I'm not coming home. Nothing I do is right. It's that crash is where, like for women who have bad PMS or PMDD, perimenopause, this is where it really has a negative outcome. The tail end of the month. Yeah. And this is not a calendar month, I'm assuming this is the, uh, this is a cycle month. Yeah, so it doesn't like, this is an, okay, January 1st. You can't, I don't want men circling the 14th on their calendar

and assuming that this applies to. Casey said we're going to get to have sex in January 14th. Yeah. Okay. Yeah. No. This is a cycle month for women. So right there, that crash after day 21 or could be earlier, depending on a female, is where my job is to soften that blow. So the brain likes this, right? This fluctuation of hormones, it just becomes the zone of chaos. Michael, can you go back to that first slide? I wrote down for you. Actually, sorry, slide 19.

Okay. So, Jesus. So premenopause, you see how it looks nice, cycle, you can follow the pattern. Perimenopause, look at that. It is all over the place. That is the zone of chaos. So there's a sweet dong there, two-thirds the way to the right. You see it, Michael?

Yeah. That's awesome. And then postmenopause, like myself, where you're flatlined. Yeah. So there's just nothing happening. So perimenopause is this zone of chaos. This is where estrogen and progester, and they're just fluctuating so much. So what I will do for women in this, when that dip happens of estrogen,

This is where I'll put on an estrogen patch. Okay. Bring it up. Support that hormone. So people who are, some of the questions were like, oh, migraine with aura or migraines are triggered. Yes, because the brain doesn't like that switch and they can bring on migraines. If we kind of soften that out, I can correct a lot of headaches. Okay.

I will, we're always, I personally always bring up progesterone and I may have women take two pills during that dip to give them extra support. Are they doing that based off just how? they feel. That's how they know it to take two. Okay. So one, like one of your question was, what about labs? And I think labs is where women can really get gaslit. Okay. Like, I have, you're meaning blood draws. Correct. Okay. Well, I want my labs checked. I want to know my hormones. Tell me my hormones. The typical perimenopuzzle woman, they're going to look normal. And then they go in, their providers said these are normal. And you're like, well, I've heard you say this enough times now that the labs are giving you a snapshot of where you're at that day. And if you were

to get them taken the next day or two days later, it might present a completely different picture. So it's a snapshot, not a holistic view. Well, and I could check a perimenopausal woman's labs in four times a day and they'll look different. But they're still probably going to fall in this normal range. But you have got a woman who's not working. She's not sleeping.

She's leaving her husband. She doesn't like how she's showing up as a mom at home, being told in an office saying, oh, these are normal. You're fine. Exercise more. Eat more protein. how's your fiber intake, drink some water, you know, all these things. And they're just like, well, it's me.

It's me. And it's just, it makes me really sad to hear that. So I honestly can sit down and listen to a woman after taking care of so many women and be like, know exactly where I need to navigate these hormones. And I think it just comes with how much I've invested in this. Parymenopause is a dance. And that's why for women, it's not like for myself. In menopause, you know your dose and you're set, right?

But body's really funny. I may get some women and they're like, yes, I'm back. A few months later, I don't feel this. We got shift correct. Well, yeah, because the body responds to if you add something else a variable up front, it might shift some stuff on the tail end, right? Well, the hormones are always decreasing. Yeah.

Always decreasing until you get to menopause. So it's always this dance. And you need to find like a provider who can do this dance with you and this journey and knows how to navigate it. This is not cookie cutter. You don't go, here's your recipe. This doesn't work for everyone. Everyone is so different, how we metabolize.

Some women aren't really good absorbers of patches, and maybe they need oral estrogen. You know, it just depends. We don't use much oral estrogen, but you've got to find someone who knows how to navigate the changes. Okay. All right. Where to you from here?

What slide do we look at? I'm trying to think of what their questions would be. So where do you, so okay, where do you start women when they reach out? What do you mean, where do I start them? Do you, I mean, obviously, lab are going to be important. No. Do you talk, so somebody reached out to you like, Casey, I have an axe in the back of my car.

And when I get home today, I'm going to use it on the door or whatever happens to be on inside of the door. Is it a conversation you listen to their sense? symptoms and you treat to symptom. I'm just like, so somebody who enters into this journey, like what can they expect? And like what kind of timelines are we talking? Yeah. So, and I feel like you almost have to put them in two buckets. You've got your pariomatopause and your post, like your postmenopause people.

So your pari menopause, when I hear that rage, that is not enough estrogen. Throw a patch on. I always tell women, keep it in your purse. Because if you get pulled over it by the cops, don't roll down the window, peel off that patch, show them what you're doing and put it on. So rage to me is a lot. of estrogen deficiency. No, police officers are going to know what that means just so you know. Well, that is what I tell them to do. I would say crack the window and just let him know that

you're traveling and it's your personal conveyance. Now, in the menopause world, we know we have to keep estrogen up to a certain level to be bone, heart, and brain protective. What is crazy is so you make estrogen. You have more estrogen in your body than a menopausal woman does if she's not treated. Okay. So the thinking right now, I know everyone's like, well, how much estrogen do I need? What level do I have to be at? Well, I have really good data on that. So we have to just take what we have. We think we want it at least estrogen higher than 60. My guess is we're going to want to push higher than that and probably get to 80. So I am dosing women, one, to get rid of symptoms, but two, also for their bone brain and heart health. What type of, because I know people will say, I am feeling like

the person with the axe. If I do start this, what are we talking about for any appreciable difference in symptoms? So estrogen can be pretty fast. So say a woman's having a hot flash, you put a patch on her. I got it. Done. Really? Yeah. Oh yeah. I went to work the other day and had forgotten to put a patch on and I had this plether, cute dress on and I'm sweating to death. The girls are freezing because I got the air going on. And I know if I just put my, it would be done. Maybe just don't wear a pleather dress. No, one must dress too. But what is pleather appropriate for? Work for my office.

I don't even know what to do with that. Listen, I wore a white lab coat for 17 years. You have to wear one in your current role because that's how you know the person you're talking to knows what they mean. No, I show up in my sequin boots. Oh, I fucking know, trust me. Dad was marveling. This is off topic too, but he was just like, did you know that Casey rents her clothes? She doesn't buy.

I don't even know that was possible. Yeah. Is this for like you're going out of tire? Because you do. This is a rental. What does that mean? There's this company called Newley. Yeah.

And you get a box that's shipped to your house. And the basic package is you get six items. And so you can wear them for like a month. And then you ship them back. Like I'm leaving for Japan, you know, next week. So I rented a box that was just specifically for stuff. I'm going to travel in Japan. Just kimonos and wooden sandals?

Yes. Yep. Yep. But so it's like a thousand dollars retail what comes in this box. Yeah. I'm not going to wear this probably ever again. Like some events I've done, I'll never wear a $500 dress again. Michael, up until about 30 seconds ago, were you aware of clothing rental?

Uh, no. This is it for guys? Well, I mean, you look like kind of how, is that Viori? What? Your top. Is it a Viori top? What are you talking about? The brand of top you have on.

Oh, I don't know. Fly low. You know, guys, I mean, if they want to, I wish they did, but most men are pretty. What does that noise mean? You kind of have your just routine of what you do. Yeah, it's T-shirts and board shorts in the summer and then T-shirts and pants in winter. But you know what? I did the lab coat for 17 years, and I'm going to let my personality shine when people see me.

You can get a different color lab coat? I'm not everyone's cup of tea because I'm champagne. So what I get from this is you don't mind wearing clothing. that other people have worn. They clean them. How do you know? It says on the... Oh, that's great.

That's great. Yeah, that's nice. Just sharing clothing with serial killers. Okay. They were just paramedopausal women who are pissed off. I worry that people think it's a... They snap their fingers and the problems go away. Oh, it's a journey for sure.

And so... What's a realistic expectation to get to a place? I was open about getting my blood work checked and my testosterone was like... Or what does dad call it? Testosterone. Tetosterone. Fuck. Was, well, and I didn't have any, what sucks is I didn't have a baseline.

And one thing that I would recommend to men is, you know, or probably to women too, like get a baseline when you're younger. Because I don't know what my numbers were at. And I did limited research, but talk to you too. Some people naturally sit in the higher range of normal, which is this normal range. It's like saying a size 10 shoe fits for everybody, which works great if you're near a size 10, but not if you're a 14 or a 7. Well, it's the same thing for women. Yeah. The testosterone is by far my favorite hormone.

Yeah. By far. My point being, it's been over, just over two years and I think I'm finally, like, because I'm working with you on the lab suit, like, titrating to the point where, like, this is exactly where I want to be. That's two plus years. Today's episode is brought to you by Brunt Workwear. Let's talk about the craziest thing about these boots.

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Do me a favor. Tell them it was either me or the show or both. Back to the show. Yeah, I think you worked with some different formulations and. I also intentionally went into it and worked with everybody that I've worked with. I said I wanted to go incredibly slow because it's not like a choice where you're like, okay, I feel great. I don't have to get off of this.

This is much more of a long term journey. Well, I think it's a forever. I would agree. That's what I mean. So why rush and have these masks, in my opinion, or at least for my involvement in they care why have this pendulum that's just like smashing left and right like let's just narrow the ups and downs a little bit to land where we want to be well and the same thing with women and that's where i'll see it like we're women who do pellet therapy have you heard of that uh i've been

pitched that actually by a bunch of male doctors so i know what you're saying i'm assuming it's the same thing oh for you for treatment yeah okay so pellet therapy for people who don't know it looks like a grain of rice yeah right they put it in the fucking turkey baster it looks like it is a surgical procedure and it could extrude, meaning it could pop out, but it's also could, it's in your body for months releasing these hormones. Well, what happens if you have side effects? We can't dig this out. They cannot dig it out? No. You're screwed. You're stuck with it. Why can't they dig it out? It's just like the small. You don't, how much work that would, no, they don't do that. The jeweler's loop. I'm just like, you know. So if think about pellets, you're at sea level,

go to Mount Everest. The body. Yeah. The body does not like that. So, up, and then you titrate down, down, down, and this is not physiologic. Yeah. Nor is that actually a fun ride. No, and people feel great here. Of course you feel great. You feel really good up here, and it comes down, and then you get used to living here at this higher range. The brain likes steady state. So testosterone is my favorite hormone. If I... For women. Yeah. I think that might be surprising for a lot of women. here. Oh, 100%. So the brain fog. Why did I walk into this room? I was giving presentations and having to do, like, present on patients and I couldn't remember medical terminology. I'm like,

oh, gosh. What did you do in that moment? I just looked like an idiot. I was like, oh, no, the move is you make something up. You know, presenting these cases going, oh, my gosh, I know this stuff and I couldn't present on it. Depression, anxiety, testosterone decreases. So it comes down for women, age 20, starts slowly coming down. But when I can get a testosterone optimized in women, I feel like myself again. The fog has been lifted. So we got estrogen and progesterone, but when I get all three together, they're back. What's an average range testosterone for women?

Well, if you look, this is another thing. They took some women in the 90s, about 600 women, and took an average and said, this is your normal range. What is it for men in comparison? So we'll give an average range for women could be, it depends on the lab. Say nine to 45, maybe 60 depends. For a man could be anywhere from like 250, 700. It depends on the lab, 700. So big variance in the numbers.

Again, though, you'll go in and say the average 40-year-old is going to have a testosterone level 19, 20. Falls normal. They get told, you're normal. I'm sitting in about 130 right now. That's where I'll put myself. Right? And the bit... Women are terrified of that, by the way.

The thought of... And again, I'm not speaking for all women, but I think this is a fair statement that applies to a lot. I don't want to look like a dude. I know. And I'm like, tell me, this is not look like a man.

You know, I got up at five and shaved my beard. Yeah. Dad's jeans passed to you. Not me. What can I say? But it is a fear. they think, oh, I'm going to look like a man, right? I have more energy now than I did probably in my 30s or 40s. Okay. Michael, can you do slide 23 for me, please? That is honestly one of

the resounding things I've heard is women's fear of testosterone. And it, it, there is, it's like broad jumping the Grand Canyon. They immediately go, I don't want to look like a dude. Yeah. So I think what's surprising for a lot of people. So estrogen and testosterone in lab are measured in different variables. But if you were to normalize them, the PG's picograms per millilator, women have four times, sometimes 10 times more testosterone in their body than estrogen. This is a human hormone. Yeah. We live off of testosterone. So the ovaries can make some of it, but they also in the peripheral tissues, be it your brain or other organs that need it will aromatize it, which means they can convert testosterone to estrogen. But we actually

have way more testosterone in our bodies than estrogen. But it doesn't reflect that because on labs, it's not measured in the same value. So this slide here is the normalization if you actually were measuring it in the same. What is, for your average patient, we'll have to hypothesize here a bit, the woman you're talking about who goes and gets the labs and is advocating for their care and they have the doctor that says you're normal. Where does that leave them? That leaves them going home saying, I'm the problem. I'm the problem.

Yeah. This, you know. So I think to like for a lot of women will go in with I'm depressed and anxiety, sex drive comes up a ton on testosterone. Or just what you're talking about when optimizing all the hormones? Just in general. They'll go. I don't feel like.

myself, I'm depressed, they check their labs and they're like, you're normal. This is fine. So they go home thinking that this is them. There's something they've done wrong. Or they're given an antidepressant, antidepressants, which I see all the time. What is that due to hormones? Nothing. Okay. So it's, it's not, it may not be the solution, but it's also not going to negatively impact this. It doesn't impact this, but they're missing, they're missing why these women are feeling like this. Yeah. Now, I think a really scary thing, and you, I mean, you see this within the military, that parimenopause, is the highest rate of suicide for women.

That age range, you mean? Yes. Okay. Right. So when estrogen drops, the serotonin drops, your feel good hormone, dopamine drops, noraphanphrine, your energy, everything drops. So we see divorce rates go up and we see suicide go up. Okay.

The VA did a really good study and they saw when they introduced hormones that actually depression anxiety went down. But women go in and they're given an antidepressant. It's totally missing the mark. Yeah. There's a time and a place for antidepressants and I will give them to women. I'm very, you know, I think I've taken them. Do I think that this is the answer, though, for hormones?

It's not. And you talk about like if you're already having sexual dysfunction and you add an antidepressant to that, that's going to compound potentially to this issue. I didn't know that. Well, I didn't tell dad that. Yeah, we don't, I don't ever need to hear about dad's sex life ever. Casey, I need to go on and talk about my blood flow issues. Yeah.

And for those of you who are lucky to catch his Instagram story like Michael, you're welcome. So testosterone by far is my favorite. Even though it is my favorite, it takes its sweet-ass time to show up. This is the hard part. Estrogen, you're having a hot flash, you're irritable, throw a patch on. Okay, much better. This can take three to four months for it to get its full effect. Okay.

So, Casey, this isn't working. This isn't working. Just wait. Just wait. Some women are faster, but I always like to set the stage. This one takes a little bit longer to show up. And so I will start low on my dosing and titrate up. This is where I do follow labs.

You know, I like to live at about 120, 1.30. I don't like to push super physiologic dosed for women. So I keep them in a narrow range. I'm following it. But I do follow testosterone. on. How often do you recommend people get labbed? So for me personally, once I start someone, it's eight weeks after initiation. If I go up on a dose or down, I'm doing another eight weeks. If they're pretty stable, I want at least a couple times a year just to make sure that I don't have any other

changes on that. Quarterly or bi-annually? Be fine on that. Okay. Yeah. Okay. But then you have the pushback of finding providers who will do this. So like I said, I have my MSCP, which the menopause Society certified provider. I said there's 75 million women in the U.S., right, of Perry, menopause, or post. 4,100 providers that have the title I do. It doesn't mean that there aren't other providers who can... That's rough math, though, I see what you're saying.

Yeah. I mean, there are other providers well versed in this like myself, but it's low. So then you want to find someone who is trained in doing testosterone for women. So if they're not seeing myself, a good resource for women is Ishwish. It's I-S-S-W-H. And they will list out a list of providers per state where women can go. These are sexual med providers who are trained in testosterone. But I went to that conference in Long Beach last month.

And you thought 4100 was not many. Talk about sexual med. It's about half of that. So, mm-hmm. really underserved, really underserved area for women. Okay. What else you got in your notes there before we dive into some questions? Anything else you want to cover baseline before we try to hit some specifics?

I would like, because testosterone is my favorite, I would like to talk about some of the pushback that women will get. We don't have the data. We don't have the data. I'm not going to prescribe this to you. We have 80 years of data. We know it's safe. There was a five-year study. done for the FDA. It was a $1 billion study, showed it was safe, but then they're like, oh,

women have breast tissue. We're going to need five more years another billion dollars. The companies were out. Yeah. No, I know. So I'll hear that. It's not safe. We have the data. You're going to, they're going to look like a man. We don't, you know, we don't know long term. Well, we actually have really good data on trans. So if you have a woman transitioning to men, Can we stop right there and just acknowledge that scientifically that's not possible? What? There's never been a successful sex change operation. No man has ever transitioned into being a woman or vice versa.

Having said that, I have complete and total empathy for somebody who feels like they are trapped in the wrong body. But can we be honest about the ability to switch back and forth between the two? I'm not talking about switching back and forth. I'm just saying we have the data of women who take the dose who want to transition to that gender. So your dose of what you take is 10 times more than mine. Okay. Okay. So we can look at 30 years of data of women transitioning to men and show no negative outcomes.

So how can you say it isn't safe when women in a tenth of a dose if it's been fine on this end? Mm-hmm. So. That's interesting. Right? So these are the pushbacks I will hear for women. We don't have the data. It isn't safe.

We actually have a lot of data on it. And then what happened recently with the testosterone shortage? I don't know if this ties into this. No, no, no, it's estrogen. No, but remember specifically the sippinate. Oh, for you. I don't know what happened with that. For women, we can't get patches right now.

That was like pharmacy, many farm, like, almost like nationwide. It was, uh, wasn't the sippunate, wasn't it? It was sypunate. I thought it was the etheneate. Oh, ethinate, yeah. Ethanate, you couldn't find. And in theate. And in,thate, yeah.

Well, actually, you tell me, I don't know. I know it starts with an eight. I had the sippianate. You needed the other one. Yeah. Or I wanted the other one. Yeah. Yeah.

What is that all about? I have no idea. How is there a production hiccup? I mean, you want to talk about auguring in a sex society. Holy shit. Well, yeah. The women right now can't get patches. Why?

I don't really. I have my own really biased, angry opinion on this of why we can't get it. It's like if you can't get an erection, they're going to run to you. your house and give you Viagra and a cup of water. That's actually not how that works at all, but go ahead. Like the access for that is, so when I talk to CVS pharmacy, do you have this? No. Do you know when you're getting patches from my patients? No. Do you have Viagra? Yes. We have no shortage of that. Well, dudes have been trying to get their dicks hard for a long time. So they've been working on that for a while. Do you think that that could be a metric of,

I feel like, and I'm not connected to this world, but I feel, and undercurrent of the social circle. This is like my own anecdotal social circle. There is an undertone of a lot more people paying attention to this. And that doesn't necessarily mean that the production behind it can keep up yet, especially if it's starting to leap forward in demand for. But still that much, five percent? Yeah, but I mean, you know, I don't know, I don't know how much, like,

I don't know what our national estrogen stockpiles are. They're empty. That's what I'm saying. So it could be, it could be that person who's like, whatever, screw the women, let's just take care of the dudes. Or it could be, holy shit, we weren't prepared for this to start catching fire the way that it has. And if the stockpiles were already at zero and you deplete those, it takes a little bit of time for the production to catch up. So for those women who can't find patches, alternatives are a cream.

You can put on your forearm every day. The patches I like, they're set it and forget it. You can just wear, you know, mine's twice a week. But there are alternatives. There are creams that you can do. Okay. Yeah, I think some of this honestly is, well, it's tough. Again, anecdotally, I wasn't also paying attention to any of this for the vast majority of my life.

And it's like the yellow car theory. You never think you see one until somebody says, oh, man, you know, see how many yellow cars are? And then it's all you can see. So maybe there's a little bit of that too. But I just feel like the undercurrent of women saying we've had enough at this point and asking for these things is increasing. I think it might be more of a production issue. Let's hope that that's all it is. I'd hope so.

because the other side of that, like the evil twisting the mustache theory, that's not awesome either. No, it's not. Okay. So. What other obstacles are people going to run into? I'll start getting some questions here. I think testosterone, finding a provider that's well nuanced in that. Yep.

Estrogen supply right now for patches is a problem. I see this every day. Okay. So, I mean, I was going to say, can people stockpile? But then at the end of the day, that might end up screwing over somebody else who wants to get one. But at the same time, maybe you want a stockpile. You really can't, though, because it comes down to a prescription, right? So if your prescription, and this is what's like I may write a person for 90 days of progesterone,

and the insurance will only give them 30. So I will get called. Casey, please give me three months. I'll look back. I've given you three months. Well, that's an insurance reason. That has nothing to do with me. I think the biggest obstacles are just going to be finding providers who understand the same.

type of care. Okay. I think to, for for men who listen to this, you want to be able to enjoy your partner for a lifespan.

And a lot of not treating this leads to osteoporosis, heart disease, or Alzheimer's. And people think of these as like later in life diseases, but really these are mid-life diseases that are forming now.

Yeah. And so I think here's where a hospice comes in again for me is when I tell my patients, I am thinking about your 70, your 80, your 90-year-old self. We are building her now. But people don't really think in that mindset, that we are building her now. Okay. Right. I mean, one of the first questions from a woman who had on the show, Car, the Huntress,

she used to work in the anti-human trafficking world, gaslighting. demanding the tests. Yep. Dan Hart says he hasn't really heard anything on this topic. Which makes sense. Yeah. Check up. You answered that one directly.

I think women in testosterone, you hit that. My wife says she can Google everything that she's going through. Is that true? Is it true? Sure, you can Google it. You got to be careful with Google because you can find anything that you're looking for. You can, but like, I would. was just trying to explain if you're impairing menopause this is this shift that happens you've got to

find someone you trust that knows how to shift with you so with that should we push to have our hormones tested independently and why do doctors say that testing our hormone level is not important or relevant right i think we covered that yeah i've never yelled and hung up on a doctor until two weeks ago in london to the gp which i may assume means general practitioner was trying to tell me that my dizziness in Virgo, which I'm going to throw a tea and an eye in there and assume they meant vertigo because I don't think the doctor cares what month you were born in. We're not related to parameda paus. This is an interesting one. So I have a girl very near and dear to me who if she was just so mistreated and couldn't get out of bed, could not get out of bed because of her vertigo.

And so estrogen, you've got a receptor everywhere on your body for estrogen testosterone. projection everywhere. And when they, you're not feeding these hormones, they, you may have the repercussions of vertigo or dizziness. So if estrogen is low, people who struggle with vertigo, you're going to, you're going to have worsening symptoms. Okay. If you start HRT hormone replacement therapy during perimenopause, is it recommended to take indefinitely or taper off once post menopausal? Or is it more nuanced and dependent upon the individual? Both can be true. So, hormone therapy, you should always have the risk and benefit discussion with your provider. And what you may experience and your health can change.

You may develop breast cancer. You may have other cancers, other health situations that arise. You're always going to have to have these conversations. Does this make sense? I would say for most people, like myself, when I die, probably die before you as I'm older, I want a photo of me with that testosterone in my hand. Like I will take this. What do you want me to do with that photo?

Just put it out there. You take this to end of life. This is, you can do what you want. But for me, I will take this forever. I know how bad it was before. I don't want to ever live like that ever again. And I saw bedside of hundreds of women who weren't on hormones. Yeah.

Who do we need to lobby? pressure do we need to exert in order to get all the forms of B.H.R.T. What is B.H.R.T. I think they're talking about the bioidentical. Yeah. Well, let's assume it's this topic covered by insurance. What should people expect when it comes to the cost of this? Can insurance cover this? Or is this something you're going to have to invest in yourself out of pocket? So I am seeing, this is California where I live. I am seeing people like myself who specialize getting out of the insurance model. If you, like for my initial visit with people, I spend an hour with them, an hour plus. If you're using insurance to pay your bills, you need, you get 15 minutes.

You are pumping people through like cattle. I refuse to do that. Yeah. What is the stats, docs are with you and like, uh, like if you go to just in general, a doctor has like eight minutes with you or something like that. Oh, it's insane. I mean, and I think you, it takes longer than that for someone to trust you. The questions I ask people are very intimate, the things we just say.

can be really challenging. No one ever talks about. Like light bulbs and stuff? Light bulbs. You need more than eight minutes. Okay. That being said, most people's insurance will cover estrogen and progesterone. I can push those through. Let's say they can't. What would be, give me a range.

Obviously, don't, you know, hold, nobody hold Casey to this because providers will be different. But let's say you have to do this completely out of pocket. Give me a range of what you could reasonably expect to pay. Well, I think there's two ways you can approach this. There is this company called the HRT Club. They run it by a membership. So you pay $99 a month. Right now they have not run out of supply.

So I've been leaning heavily on them. So their progesterone for 30 days is $15. Their tube of vaginal estrogen, I believe, is $25. And their estrogen patches are $48 a month. Okay. So that is them. Now, like when I ran out of patches and we went on vacation to Palm Springs, I had to pay cash.

They wanted me to originally pay $120. And it's like, no, no. You can always try to use like a good RX coupon, negotiate a cash price. I was able to- Like a Walgreens or something like that, I mean? And say, no, I want to pay cash. And I got mine down to like $30. Insurance is such a fucking scam.

Well, and testosterone's even harder because to get it for the women, I will have them say. So like the, an alternative, I use compounded, testosterone. Like the, you've seen it. Comes in the applicator. There, you can, some women will take test them, which men use, and they'll use one packet and put it on their chest. You can try to write that for insurance to cover. There's pushback of this is for men. We won't give it. There's a lot of pushback. But with that formulation, you're asking women, put a pea size on. Your piece size could be different than mine or Michaels. I don't like relying on that because that's, that's

where I see variations and levels. Everyone is different. Switching over here to peptides, what peptides are good for post menopause? I think we would need a whole peptide discussion. Give me your top five. Discussion. Yeah.

Which, by the way, I know we are focusing heavily on these hormones, but just to let people know you are deep into the peptide game as well. Love peptides. Yeah. Well, I think where peptides really tie in for this is insulin resistance for women. And men, men will see. see this too in the manopause of all of a sudden your pants don't fit right you you just you feel inflamed you're exercising the same you're eating the same when you're still the scale is just getting

higher and higher so i love the glp medications i love what's coming out the data on them i swear every month there's it's showing to be neuroprotective yeah it's for clear and i think you should clarify too based off just listening to you talk and watching you work with people in this you're not talking GOPs at a weight loss dosage. You're essentially micro dosing. And I just think we need to clarify that because the utilizations are different and the dosages are different. 100%. And for people in my office, I have a shape scale, which is an AI device, which gives me body composition, the muscle mass, the visceral fat. So I'm doing this in a very responsible way. I am not letting people get like to real thing, the ozumpic face or because honestly,

That is not a good 80-year-old self. That's a hip fracture waiting to happen if you lose your muscle. So I love the microdosing of it, bringing down the inflammation, helping with that extra fluff, that food noise that can happen. The neuroprotective aspects, like you said, that keep coming up. Neuroprotective. It's indicated for sleep apnea. They have had studies that if you have a heart attack and you're on these meds,

you have less heart tissue death and less mortality. They did a study for people who had colon cancer for five-year survival rate was higher if you're on these drugs, which makes sense. So cancer, we have it happening all the time, firing off cancer cells. And the body is trying to calm this. But if you're so inflamed, that's where you can see problems happen. Yeah, the systemic general inflammation. Right. HRT and blood clots.

Mm-hmm. So birth control, there's red flags on this of oral estrogen. potentially increasing clotting risk. If you do hormone replacement for estrogen transdermally, be it a patch, a gel, a ring, there is no increased risk in baseline. And I really see this as a problem where other providers will be like,

no, you've had a blood clot, I won't give this to you. No, you have a migraine with aura. So there's really only, I'd say, four reasons you cannot be on HRT, four red flags, active breast cancer, undiagnosed vaginal bleeding, recent, am I, heart attack, stroke, or blood clot?

And when I say recent, six months. But I will treat breast cancer patients with hormones. Everyone is so different. It just depends. It's literally my next question, yeah. Everyone depends on what type of cancer it has and their quality of life. And that is where hospice comes in for me too.

So I have a cute little 83-year-old women coming to see me next week. She has a history of cancer that was estrogen receptive, meaning estrogen did not cause it, but estrogen feeds it for her. It reacts to it, yeah. Right. It makes it grow. She is 83.

She is suffering. I will let her know the risk and benefit, but let's run this out. Do we think that she's going to die from breast cancer? I don't. But for her quality of life and what she has left, that's what's most important for me. Like, she is miserable. So for everyone, I believe that this is your health journey. and I think a medicine, women are told no too often,

but I think everyone deserves the discussion of the risks and benefits. Asking for a family member of the family, are there options for a woman who completed five years of tamoxifen? Is that a cancer med? After a breast cancer diagnosis, doctors to date have said any type of hormone replacement therapy is off the table due to increased risk in the cancer coming back, which, again, touches what you're just saying.

Same kind of thing. But I do think that there's a lot of. a role for testosterone for people here. So even if they have a ER positive, which means estrogen receptor positive, meaning estrogen can fuel a tumor. There's this fear, oh, testosterone like in this, can convert to estrogen. There's this fear, oh, you're going to convert to estrogen. So say I take a man and I get him optimized, say he's at 300, 400, I bring him to 1,000. His estrogen levels may only go up five points in that. That's a tenth of a

female's dose. So you take a tenth of that, we are barely raising estrogen levels up to where they were baseline. So testosterone, I'm much more likely to help give women with history of breast cancer. This goes into what you were saying. I know multiple women who were told hormone treatments

are a waste of time and dangerous and they could have prescription for an SSRI drug instead. So just reinforcing that. You know, you were talking about this, this ties into your question about doing content. If it gets good traction, could you see if your sister could do a live video where people could ask questions in real time? So this is you kicking around that idea of whether you want to have an online presence. Just letting you know it seems as if one data point, right, that people out there would probably consume that here.

Woman here, perimenopause in full swing. Currently 23 days late. I assume that means on her cycle. I've noticed when I'm late. that the night sweats are so much worse. I was hoping to get through the other side without hormone therapy, but now I'm second guessing myself.

Hormone therapy, is it safe? Question mark. I mean, if you've gotten to this far in the episode, I think we've answered some of that. And there is no study that shows increased risk of mortality

with estrogen. None. There is, for people who are really, really do not want hormones. There is called VOSA. It works on the brain in the thermoregulatory system,

to help with hot flashes and night sweats. So for people who, but it's pricey. Yeah. Okay, shifting gears, somebody has a question about end of life. If this topic is appropriate, plus you and Andy feel comfortable talking about it, how to navigate end of life care for a parent and the do's and don'ts, y'all learned along the way. You want to start with that? I was at the tail end of mom's end of life care and was a shell of a human being.

So you may actually want to answer that one. Why are we reapplying lip gloss? How do you know when you're supposed to reapply it? Oh, how's it look? Because my lips are dropped. Okay. More shamps. Well, I think you and I had a private discussion about this the other day.

I've talked openly. I mean, again, I wrote in the book openly about my experiences and what I wish I would have changed. I do understand that mom knew who I was and that the last interaction that we had was, you know, that doesn't define our entire relationship. I just wish I could have been in a different. headspace, which is impossible, given the velocity of the environment that I went from to, and it's not the velocity that I went from. It's the months spent reordering your headspace to make very complex decisions in a binary fashion as fast as possible, oftentimes around life and death choices.

And then all of a sudden, you're back home. And you can't just turn that off. Because the best way I can describe it is you get home from a deployment like that. and the world's just kind of unmute. Like you're in the world, but it, you know, people hit you with something. You're like, whatever. I don't even care. What was it?

What? I'm not even paying attention. Unless it's like, if a decision needs to be made, you're like, boom, got it. Next, next, next. And you're just in this next, next, next, next, next, next. Headspace. And it was months before I got out of that. So that unfortunately just happened to be the headspace I was in with my last interactions with

mom. You, on the other hand. And again, we were talking about this yesterday. I went from seeing her in February of 2010. when I left to August of 2010 when she died. So I didn't have snapshots in between. You and dad and everybody else got to kind of see the decline. So it was a little bit more jarring for me as well too.

Well, the question is, what have you learned? End of life care. Doos and don'ts for a parent. Doos and don'ts. So how to navigate the end of life care for a parent and the doze and don'ts you have learned along the way? I think the biggest thing is have the conversation now.

while they have the ability to make their own decisions. That can weigh really heavy on people when they have to make end-of-life care decisions. So, you know, dad and I have been very open. He is very easy to have very blunt conversations with. He doesn't take us seriously when we say we're putting him into a home. Having those conversations, I think people get hospice involved too late. I understand that when hospice is. called it can be a big reality check for people and that can be a hard call but for people that

i had more time with i know i could improve their quality of life end of life if i have more time i actually this is where my big vision board is where i think i want to go with bringing hospice back in my world stretch goal if you were stretch goal i don't know when it'll happen but introducing hormones with hospice because if you think about end of life and say cancer for people are tired they have brain fog. Testosterone helps with this. People can't sleep. Progesterone helps with this. I somehow want to start teaching providers how we can introduce hormones at end of life to optimize what we have left. I mean, what's the downside? You're going to die? Listen, when I was... That's what I'm saying. There is no downside there.

When I was doing hospice, I had a male medical director and there was things I was doing. He just sit and roll his eyes at me. Oh, yeah. Were my patients happy? Yes. You know, but that is where I can bring both of my loves together. Just a random comment here. Best investment ever if you have a wife, it'll make her a different person entirely. How different are you in Jason's stories when they're told? That was a comment or did he write in?

That was not. Well, it would be a ghost account if he did write that. Well, I mean, we had a very open discussion about it just last week when I was going up to L.A. Yeah. So there's some, let me see here. What are the best ways to help manage hormone changes naturally, especially if you work in a high stress job that can spike cortisol?

Do peptides help with the hormone changes? Or are they independent of each other? Well, nothing's going to replace a hormone. But you're going to see cortisol spike more in perimenopause. So the brain is already up, up down, up down in that slide that I showed. So cortisol is going to rise. It's a stress response to this fluctuation of hormones. So I think if you want to do lifestyle, sleep's got to be number one.

Exercise is going to be number two. Eating healthy is going to be my number three. And this is how I teach in clinic that we build that way. This is more of just a comment, but it reinforces. Thank you for doing this. I'm of the age where I was told estrogen therapy was a death sentence. And I'm finally past the typical menopausal stage 10 years in in parentheses. I am wondering if there's anything I can do at this late time to help with sleep,

nighttime hot flashes or dietary suggestions for overall health and feeling better. So this is somebody that looks like they're past menopause, but still. Right. So in the data that we see, there's like this sweet zone and they want that was studied, 10 years of menopause, you want to initiate hormones within that. So say it's 52. The ideal window would be 62. To start or be already on by that point?

Well, that's a whole thing because I like to start women in pari menopause. and I do want to talk about that. But so say you've got menopause and you're 52 when you go into it, you're 54. Are you too late? No, the window they study was a 10-year window. That was the sweet spot. However, if I see someone who is 70, I will optimize their quality life any age. Yeah.

Where the data is really strong is that 10-year window. Okay. Information on endometriosis, diet and inflammation in perimenopause. It's hard to understand to be supportive. my wife is very proactive. Oh, yeah, proactive with her symptoms. It's a burden I wish I could carry for her. What's the question in that one? The information on endometriosis dius and inflammation and paramedopause is for people who have endometriosis, it seems like something there's not a lot of data about. What are you seeing when it comes to the hormone optimization? Does it have a net positive,

net negative, net unknown impact? Well, the hormone optimization is separate from the endometriosis. So endometriosis is lining of the vaginal tissue, the endometrium outside of the uterus. Some peptide therapy has been promising on this. Again, you're looking at retrospective data. You're not getting these randomized control trials. So anything that's lowering inflammation, like your KPV could help with that. Redetrutides, the big one coming down the pipeline. They're waiting on the FDA approval next year.

But anything that can lower inflammation can help. with those. How does a lady get through menopause without prescription drugs and or hormones? What do you think after what we've shared so far? White knuckling? Yeah. End of life is not pretty. So top three things that end women up in a nursing home, Alzheimer's disease, hip fractures, and neuro sepsis, a bladder infection that travels throughout your whole body. Oh, that sounds horrible. Yeah. I actually have a little prop here. You're like, oh, God. What are you grabbing? Yeah. Like we're talking about a bladder infection that is systemic, but then you're reaching to get something out of your bag. I just don't know where there's going. So if any, your podcast actually

could save lives. Just from this. I'm not sure where things pick up or where there's same things. Estrad. Estradial. This little tube will save women's lives. Okay. Right here. So vaginal estrogen cream for anyone who's over, you know, paramedopause, postmenopause, your mom, your cousin, they need this in their toolkit. This is cheap. So say insurance doesn't cover this, this would be about $15. Okay. Is that like use when you're feeling?

This should be used at least twice a week. Yep. So what happens when you go in menopause, estrogen goes down. Estrogen feeds the good bacteria around the bladder. We replace estrogen. It keeps it healthy. it keeps the vaginal pH low. So bladder infections go up in menopause.

That does not present the same. Like someone in their 40s and be like, I got to pee all the time. It hurts. An elderly female is going to look confused. So if you have like a family member who she's just not making sense, first thing I'm thinking is she's got a bladder infection. This can prevent bladder infections.

Jason went on a call the other day. And he was 83 year old found. down in the bathroom. I said, I bet broker hit probably. I'm like, you could have prevented it with this right here. I mean, I feel like that's potentially a stretch to say that, but I understand. Well, I don't think so at all. If you can calm the bladder with this. Yeah, I mean, long term usage for sure, but I don't know if it would have like one application would have saved. No, this is something you do twice a week. Yeah. But if you can calm the bladder down and you don't have elderly women who maybe have a bladder infection and they're confused. Totally. Right. This,

can prevent that. Insulin resistance in menopause. That's interesting. So that's the menopause muffin top that shows up. So insulin resistance, I can look at a woman's labs and watch her cholesterol trend up and be like, this is where perimenopause started. So when estrogen goes down, the liver becomes less efficient of filtering out cholesterol. It also becomes less efficient of getting insulin, of getting blood sugar into,

the cell. So you have more insulin circulating in the body. So if you think of insulin, insulin's like a key, right? So you've got your cell. Insulin's a key when you're younger, opens a lock just fine. Insulin resistance, that key becomes rusty. Can't get in. Oh, I'm going to make more keys. I'm going to make more keys. So you become, you get more insulin going up and what follows insulin is fat. So we see as the hormones go down, insulin resistance goes up. You can see, increase risk of diabetes. The cholesterol goes up. So what do they do at women?

Here's a statin. Here's some metformin when we're really missing the mark of how to get that done. This kind of reinforces. I want to ask how HRT or other recommendations change for women 70 plus versus paramedopausea. You already talked about that basically treating the symptoms and focusing on the health span. This woman says HRT is a game change. The ability to sleep through the night was one of the best feelings. Like you said, it's the foundation that you're building on top of it.

that. How do you make a hormone? I wonder, I'm assuming that's a question inside of the human body. How do you make a hormone? Well, it's part of the endocrine system. I'm not sure what they. How can I help my wife who's entering perimenopause, not just emotional, but physical support. Could be the most important question I've asked so far. Okay. We talked about the sleep environment, right? Building the sleep environment. But also, I showed you that ludial crash. If I was a man behind the scenes, I would be like, okay, I'm trending when this bus may derail. It's coming. We're going to need more carbs. We're going to need more sugar. She's going to mean more patience, more grace in this time. Now, if she's with a provider who helps support that, that crash is going to be much less.

But if they are not, this is where the brain just isn't functioning as well. You have less resilience. You're not sleeping. So it's going to be a lot more patience during that. time. There's hundreds of questions and it's this is all the comment section is like refreshing itself. So I know. I did that to me. Yeah, I can see some of the same ones. So I'm just kind of catch the wavetop. Oh, I would like to hear about how to get my libido back, especially because my husband does not deserve to feel undesired. It's not him. He is amazing, but it is a general lack of desire. Now you said you have personal and private conversations with women. I'm assuming this topic comes up. Is this something that you actually specifically ask about

before them even bringing it up? Oh, yeah. Yeah. Well, I was like, I thought this would be a good topic if you were ever open to it to Leah sitting in that chair and her and I having a conversation about women's sexual health. I, it's a little odd for you and I to sit here and talk about sexual health. I have to fucking listen to Dad talk about it. So you guys can have that conversation about. you want. I don't know if I'm listening to that episode. If the world wants to hear that, I mean. Well, I will tell you this. Why do men care? This is one of the top reasons men care. For sure. And I get it. It's part of women's whole vitality also. But I will ask women when they come in, we're the top three goals that they want to work on. Decrease sex drive is one of them.

Now, can testosterone help 100%. But I'm not going to hang my hat on that and say, if I get your testosterone this high, but you hate your husband, I can't fix that. That is true. So sex is bio-psychosocial. Bio, meaning I can fix their hormones. Psychological is a time of they may have high intense careers. They're juggling families, all the sports, right? You've got aging parents. There's all these elements that can play into this. There are peptides that I like for this. The PT-141 is a peptide that can help with arousal. There is- What does PT stand for? I have no idea. So that's the peptide name. You can get, it's an injectable that you use 30 minutes prior, and it works in the brain.

So it serotonin is kind of the brakes on that. It increases in norapy, which is kind of the gas. So it works on the neurotransmitters. Testosterosterone works on the hormones. This works on neurotransmitters. 30 minutes prior, I like it with the peptide versus the pharmacological brand because it's a set dose. Peptides, you can titrate to yourself. There is the pink little pill.

Have you heard of that for women? No. It's called Addy. A-D-D-Y? A-D-Y-I. Yep. I have to spell shit like that. So how Viagra took...

Is this women's Viagra? So when... Do they call it Niagara? Just checking. Viagra took six months to approve. Mm-hmm. How long do you think this took to approve? Oh, 26 years?

Yeah, a long time. A long time. So you have to take it every night. Yeah. It shouldn't really be taken with alcohol. So that's one thing that women have to be careful with. Side effect is it can cause drowsiness. Okay, great.

We're not sleeping anyway. So let's try that. It can cause decrease in appetite. Okay. So it found that there was one more sexual encounter per month. Because the sexual encounters were so low, it became statistically significant. Yeah. That's a lot of, you know, the risk versus reward ratio there.

I don't know if it hits that one for a lot of people. It's one per month. It takes about six to eight weeks to be effective. Oh, good God. So that's kind of too where I lean on the peptide, where it's an as needed. Now, here's a problem with that peptide. The arousal can last for hours. So.

Strap in. Say you have. You know what I mean, Michael? Strap on. He's a different demographic. Yeah. I have a lot to learn from them. But say you have young kids in the house.

You've got to be, this might be more of a vacation peptide you take. Okay. Truth about hormone blockers. I don't know. So for like men, aromatase inhibitors. Oh, okay. I didn't know where this was going. I think that is it a man or women?

Christina. Oh. Are there hormone blockers for women? Well, for breast cancer treatment. Oh, okay. It's literally all it says, so there's no context. Okay. generations of women were crushed because they never took women's health seriously.

I don't, well, I think they mean they by the medical community, not the women actually going through that. So I think, oh, here's a good one. How do we get women to think logically? Was that from a man? It's hard to say. I think it can be very hard to have clear and calm thoughts when your hormones are all over the place. I mean. Yeah.

I mean, that what you just said makes sense. With your estrogen dipping, there goes your serotonin, your feel good hormone. You have fluctuations. And I will see this in men. The men I treat, a lot of them come in because the penis isn't working. And then I ask them at fall visits. They're like, oh, I just feel so good. Kesey, I never expected to feel this good.

I'm like, yeah, testosterone works between your ears. It is a mood hormone. How do they describe their penis not working? How do they... It works at like 70%. Well, that's a hard one, right? Because they see me. I'm in my rhinestone boots.

And your plethora, whatever you were describing. Yeah. So how do they try to bring this up without being just on the nose? It's usually, well, I have a questionnaire so they don't have to talk to me directly. They fill it out online. Right. So I bring up the issue. Yeah.

I'm pretty like dad. I'm very blunt about things. How do you bring it up? Is your penis working? Nice. Straightforward. Are you having issues? Like.

Does it sit in back in their chair a little bit? Like, ah. Sometimes they're. You know, but, but what comes out is more, I have more energy and my mood is better. Yeah. This is a longer one, but it ties into Australia, which, by the way, I've talked about on the show, people know you were born there near Melbourne. My question is, how do we get health industry and practitioners all up to date and on the same page?

Now, we'll come back to that. I'll add, I'm in Australia. I have one doc for an annual full medical and anything of a conventional nature that arises, a different doc who is prepared to prescribe my HRT and a clinical nutritionist with whom I am working at the deeper level of nutrition, supplementation, and lifestyle. P.S., each of these practitioners is aware that I'm working with the others. But how do we get everybody on the same page essentially as a question? That's going to have to start with the schools they go to. I went to a functional medicine conference last year in San Diego. That functional med tends to be

pretty forward thinking on things. They've got the eboo machines like you experienced when you went to Texas. They have, you know, very forward thinking on ozone and other things. And I saw, next to this young man. I was like, okay, he doesn't look like he's been out of medical school that long. And he was doing testosterone therapy for men. And I told him I used the same for women. And he looked at me like I had three eyes. He's like, you're kidding me. You use this for women. I was like, you want to make money in New York. You start treating the women. Yeah. But it's got to start with the teaching program. What does it take to change to change that though? Does it do what are they waiting for? 20 years of seeing this before they start implementing it. I mean like,

What does it take to make those changes? You're seeing people like myself who were going out finding our own resources to get educated. Yeah, but that doesn't change the foundation that these people are coming out of medical school with. With nothing. They're coming out with nothing. What would it take for them to make a chance? I mean, neither of us went to medical school. So I guess this is a slightly rhetorical question that neither of us can answer.

But what do you think it would take for them to update what it is that they're teaching? So the guy fresh out of medical school doesn't look at you like you have three eyes. Well, maybe it's going to be the next generation who is going to demand this education. Yeah. Right? Because the new ones coming out already are not being taught this. And no fault to their own. How are you going to practice in an area we're never taught to?

Or maybe it's a divergence. Maybe it's people like yourself who just focus in this. And maybe that would, I don't know, maybe there's a world where if people are going to offload this particular type of treatment from their general health care practitioner, maybe that would let them be better general health care practitioner because they know it a point somewhere else. Well, I think exactly. OBs don't have enough time. Yeah. Right?

You need to find someone like who practices like myself that this is all I do. Yeah, but they also have to have an inherent understanding and belief that what you're doing is effective. And you know what I mean? All the things that would let that point in that direction, which if they're coming out of the school and don't have an understanding of it, you get back into this place. Do they have enough time to educate themselves to be able to point? It's a self-licking ice cream cone a little bit. Yeah. Yeah, I think that's a really hard.

I think the next generation, I'm hoping. I mean, Carter can give a testosterone lecture. He's 12. Well, that's because he's been to a lot of them, though. No, but he, you know, for what he, his vocabulary and what I do is amazing. If you start him young and that they normalize this, this is what we do. You get birth control, you know, when you're young. What about imperium menopause?

You start in hormone replacement therapy. when women are pregnant, they're given this book. What to expect when you're expecting? Have you seen it? I've read it many times. You've read it? Yes. Oh,

it's the number one gift you get when you announce that you're going to be having your first kid. Okay. Like eight copies of it will just immediately converge on your house. Perfect. So when you turn 35, how about some of the perimenopause books that are coming out? Like, we need to start that normalize that. Well, there's already two really good ones out. Oh, okay.

Well, there's only one published author in this room. I'm not published yet. What do you mean? The book doesn't come out until next month. That's what you told Jason at banana grams. That's true. Speaking of Carter's vocabulary, he was pushing back on some of the words. I still took a picture, but I'm actually really proud of my performance.

He was like, you can't. One of my words was Dongs, Michael. That's a real word. The other one was penis. Yeah, and he's just, well, and then Ella also was just like, you can't use those words. But so how normalized is that in the pregnancy world? Yeah. It needs to be this.

Literally, if you announce to the world that you're going to have your first child, you will get, I'm telling you six copies of that book will descend on your address. So when you turn 35, you should be getting like a perimenopause survival guide. What are the two books that you wrote, the two that were written? So who I trained with is Heather Hirsch, and she wrote the perimenopause survival guide. The big name in the menopause world is Dr. Mary Claire Haver. Okay. Her book comes out next month.

and she also wrote a perimenopause book. Okay. So I hope that this is happening. She had such a huge following and also saw, like myself, pari menopause is where we're missing the boat. And I think for your listeners, if you want to impact your end of life, you've got to do something in midlife.

Yes. Knowing nothing about medicine, I completely agree with that. So that is Alzheimer's. Alzheimer's disease, the amyloid plaques. So if you think, about how nerves talk to each other, you're doing telephone game.

Amylate plaques are like this sticky tissue between. They can't talk, right? And there's tau proteins, these tangles and the neurons. So they're mixing up how communication happens. We know that estrogen can help decrease the amount of the formation, but sleep is when we clear these. So sleep happens then. But Alzheimer's is not an end-a-life disease.

It's a midlife disease that shows up. So I think what's really scary is, is when women, so in your 40s, 50s, one in five women will have Alzheimer's, one in 10 will, men will have it. That's what I'm talking about. Huge discrepancy. When women get to 65,

they're twice as likely to die of Alzheimer's than they are breast cancer. But they're fearing breast cancer. What do you think kills women with breast cancer most? I think kills Alzheimer's. Heart disease. That's not what I guessed. No.

Heart disease is the number one killer of women. Okay. So you go through your breast cancer treatment. What we have now for treatment is great. Survival rate is really high. So you're more likely to die of heart disease. So you need estrogen early on. Palpitations is another big thing.

Oprah had palpitations for two years. Oprah has access to all kinds of care, right? Economically, for sure. Right? Two years, cardiologist. I see this all the time. Went to the cardiologist, did the halter monitor. Oh, she just needs some estrogen.

So in the heart, we have a pacemaker called the SA node. It's very sensitive to estrogen. When that is, you're going to get this palpitation. So I hear this all the time. Women tell me, I'm having palpitations. Let's bump the estrogen up. You'll calm it down. So I think more than anything,

what I want people to learn from this is midlife. The time is now. It's not waiting to 60 or 70. You are, we're trying to prevent Alzheimer's disease. Now, Alzheimer's disease is not, I can't find my keys. I'm losing things. It's, I don't know what my keys are for, right? So Alzheimer's falls in this big umbrella of dementia, all kinds of dementia.

You can have Lewy body dementia, vascular dementia. Frontial temporal lobe dementia. We have close. We know how that presents. Hope this gets to the right people. But that being said, estrogen is neuroprotective. It lowers the inflammation in the brain. It helps the glucose utilization in the brain.

So if you don't have estrogen, the communication between the cells is messed up. That looks like memory problem, attention problem. I thought I had ADHD. This is crazy. I speak the language. I was given Vivance a stimulant because I convinced my provider I had this. Couldn't convince them to give me the hormones I needed. But they'll give me a stimulant.

Guess what? It didn't work. That wasn't the problem. The problem was my hormones. You don't need a stimulant. No. But I'm saying they were more likely to give me a stimulant. Or at SSRI, like many of the people said in the comments.

Yeah. But the hormones, no. And then the other thing, too, is hip fractures. Do you know much on that one? Only that if it happens, it's a certain portion of your life, it's like your all-cause mortality, death goes to the roof. Yeah.

So if you're over 65 and you get a hip fracture, 30% will die in the first year, which is insane. Yeah. And another 30% or 30-50% have decreased morbidity. And so they, sorry, decreased motility, a lot of them. Mobility. Mobility.

Yeah. Yeah. So you're using a walker. You've got a cane. You're in constant pain. Let's get dad a walker for a person. Well, he needs one. Whether he needs it or not, I think it would be an emotionally devastating blow. I'll wrap the entire thing and be like, we don't know what it is. Go ahead and unwrap it. And it'll just be sitting there like a walker. You could have a cup holder, a bell, some streamers, tennis balls on the, you know. Yeah. He's coming to live with you. That's all I'm saying.

So bones are hugely important. There's only three indications, FDA approved indications for estrogen. One is hot flashes and night sweats, so vaso motor. Two is for treatment osteoporosis. And the third is for urinary symptoms that vaginal estrogen treats for. Okay. We have to get out of here relatively soon. Oh gosh, it's already 1160.

That's fine. We've got plenty of time. We've been out of it for a couple hours anyway. How can people get a hold of you? So actually, let's talk about where you are licensed to practice because people will hear this all over the world that doesn't necessarily mean you're going to be able to help them. And I think a lot of this information or people reaching out to you

might be in the form of how can you help me find somebody where I live right? Because the law isn't the stuff associated with this. So, and I get this, this is really hard. So I practice in California and just got my Montana license. Unfortunately, my heart wants to help everyone and doesn't always come out cleanly if they're not practicing. They're not living in a state that I practice. It is possible that you could continue to grow and go state by state. Well, and I've had some very interesting offers of people, actually patients be like, I'll pay

whatever it costs just so you can prescribe me in this state. Well, there's also, you never know where your relationships could build and you might end up finding somebody who already has licenses and you're working as a, you know what I mean, underneath their umbrella in many other states as well. I still have to be licensed. Oh. So especially testosterone. Can you tell how much I know about the medical worlds?

What I was just laying out was a turnkey solution to this and you're just crushing my dreams. Well, testosterone is a DEA controlled substance. Okay. Because of the doping that happened in the Olympics in the 90s. Which, by the way, I think should be completely legal. You just have to be honest. Like, I don't give a shit what you're taking, but let me know because maybe I want to take a look at it too. So what happened, though, is.

Depending on what state you are, like in California, that's in the same drug class as Vicodin, your oxy. Sweet. Yeah. It falls in the same drug class. Some states is the same as fentanyl. So I have to have a specific license in my prescribing is you have to be very careful because of that. So Montana and Cali. For me personally.

So say you live out in the U.S. I can speak to. There is that menopause society. You can go on there and you can search by your state and find out. providers. Ishwish, that's going to be more your sexual med. So maybe your primary care is going to give you estrogen progesterone, but they're not giving you testosterone. That's where Ishwish is going to come in. And I'll get these links from you. I'll put them in the showdose to make it easy for people. Dr. Mary Claire Haver, she's the big menopause. She has a provider list. I'm on her provider list. So you can go to her site and she's got providers. So I feel like it's

like this grassroots effort of us women coming together of how we're going to support other women. It's not going to be guys that solved this problem. I can tell you that much. No. When I go to these conferences, there's three or four men. Yeah. So those are they going to be the big. The Metapause Society website, Ishwish, Dr. Mary Claire Haver has her list.

Where can people get a hold to you, though? Well, are you going to link that on here? Yeah. But sometimes people are listening to this versus no looking at the show notes. Go ahead and throw out your Yahoo email address. Fucking psychopath. It's 2026. I don't have a.

Yahoo for work. Oh, I'll just link your personal email then. It's fine. Yeah. What's your website? Jesus. Let me help you market. The website. The radiant weltality.com. Okay. What does the landing page look like? The landing page? Michael, pull this up. The radiant. The radiant. Yeah, the. Radiantwaltality. The he immediately look this up, Michael. I think it's got it's got glitter and sparkles. I'm just trying to guess the picture. Is Is this you, what color outfit are you wearing? Are you in high heels? I'm just trying to guess. Oh, that's not.

Pink sequin top. But here's the thing. Get a lab coat made out of those sequins and then you're right in your sweet spot. That is a coat. That's not a fucking lab coat. I'm not wearing a lab coat ever again. But what if it looked like that but was a lab coat? That would be dope.

You're ready for professional settings and a disco party at exactly the same time. Here's the land. Not as gorgeous as the one you're about to release. I like it, though. That's excellent. It's a starting place. We should talk a little bit too. You just, you have a new vice president of operations. I mean, this is an amazing time. We really need to talk about this is just like improvements in your business are coming. Rampant opportunities inside of Casey Stumpf LLC here. Talk to us about your new vice president of operations. Well, I would also like to highlight on that that besides being a nurse practitioner,

I'm also dietitian. Okay. Right. So in that, some people will throw up, I'm a nutritionist, right? What is, what's a difference between a dietitian and nutritionist? Yeah. I have a bachelor's of science in diet addicts that I got. You know, because we started with your nursing. That's what you were getting that up in Davis, right? You see Davis. Yeah. So then you have to do a year of postgraduate work. I went to Indiana, worked at Ball State Hospital for a year. Known for its mountains. Known for its mountains. Oh, something.

And then you have to take a national exam. And that's how you become a registered dietitian. I do not do the CEs or continuing ed for that anymore. I can use dietitian because I have the education on it, but do I have a California license? I don't, but I have the education. So that's the difference of a nutritionist and dietitian. So my new VP, we are really working on the platform,

for people I work for every month, they get recipes, say nutrition, low inflammatory foods, high protein this month, how to introduce fiber. I mean, we didn't even get to talk about gut health. So my new VP has all the time to do the behind the scenes. My gift is to take care of people. How often do you guys think you'll do performance reviews? And then what template do you think you will use for your new VP? What template?

What do you mean? You're going to start with what he's doing well, maybe open with places for improvement, just general fee. You're going to grade him on a 1 to 10 and A to F scale. He comes from a very male dominant background. Yeah, her new VP, by the way, is her husband, which is. That's why I'm saying, how is this feedback going to go? His level of patience is not like mine with certain topics.

So he's working on that. He's already had a performance review on that. Oh, how'd that go? It was well received. He can come in with an intensity you've seen with the... Yeah, we're about to go get it on. You're going to choke him again. Okay, exactly.

I'm only going to choke him with the thing he told me I'm not allowed to, though. You have seen the intensity he can bring. I love it. Which intensity is really good for certain situations. I need intensity in certain areas and he's like laser focused on some things. When it comes to maybe personal relations with women who may be a little sensitive, that's where we need to. Room for improvement.

This is good. We're going to get him there. Yeah. He's working on it. You received the feedback really well. I have to say, though, this is the in our relationship where I have felt the most supported and a teamwork between the two of us. Like we have a bigger goal of just what we can build to help other people.

It's an interesting pairing because, and I've talked about Jason many times being a San Diego City fire captain. He, I mean, you know, hospice care, you spent a lot of time that. What people probably don't realize is most of the calls, the firemen go on these days are medical, depending on your station. Like, I'm not trying to take anything away from. Remember how he said he was in die in the fire department? Yeah.

And so again, I'm not trying to take anything away from firefighters, but the statistics show that a lot of this medical call. So he has touched a lot of people earlier before they got to you. And you know what I mean? So it makes sense to me that he would be. interested and passionate about this as well because although maybe not considered a health care provider when you call 911 from what I can tell a lot of the times the firefighters get there before the ambulance you know so they're right there at a first line first responder well and he also

not only is my husband but a patient of mine yeah and I look at photos of him when you got you and you and Leah got married and I was like oh he looks sick and where he is now and I take full credit for what I have created yeah like no work on his part whatsoever nothing. This is all mind creation. And I take full credit for the before and afters. But like just his mental health, the muscles, you know, everything that he is now. Like Leah even said yesterday, he is really strong and stable. And that wasn't who he was two years ago.

But he, I've got him optimized. I'm going to keep him run. Just pump that testosterone through him. Keep him running. Okay. Whatever works for you guys. Anything else you want to close it out with? Because we do need to get to the house and then head over.

I'm legitimately only going to choke him via the means he said he's not going to let me. I think my biggest thing is for people to know that there is hope on the other end of this. And I have a box of Kleenex that sits in front of me for a reason. Unfortunately, how many people just feel like there's no other options. But then I get to see them three months later and they're like, I'm back. Some of my patients actually responded onto the post. Right. And I appreciate that they're sharing.

that there are my patients, but end of life of what I've seen, this generation where now it doesn't have to be the same. There's definitely hope. And you can be contacted through your website, I'm assuming. Yes. Okay. That's all I got. You're up here doing, oh, you're up here, not that this will be out in time, but you're up here doing a, like an in-person, I'm sure it's going to be a presentation followed on by Q&A at the coffee shop. My guess is there is going to be between 60 to 80 women that are there. And I think what it's safe to say is that we can plan on doing that again in the future. So. Well, this talk is going to be strictly hormones.

Okay. My next talk is going to be adult sex ed. I will not be attending that. I would like to know where in the coffee shop my supplies are going to be. Are we talking about a shelf of dildos? This is what we're talking. Dad said, well, where in the coffee shop is Andy going to have all these products? There's a difference between the presentation and selling a line of products.

Cleared hot. It is a menopause line. Go ahead. I don't want any part of that. I'm not attending that talk. Michael can go and take notes. I know some of my friends were like, I don't think Montana's ready for what you're bringing for adult sex ed.

But it's an important topic and its whole body health is bringing that. And it's partner related too. Yeah. And there aren't many people who talk like I do to that topic. Well, point being you'll be back up for in person stuff. In the summer. Well, yeah. And the internet being what it is, obviously this will go everywhere.

But anybody in Montana or if, let's do this, though. the next time that you're going to come up and do something, let's get it on the books a little bit farther ahead because it'll be after this episode comes out. I can reference this episode. And if it's in the summer, people can honestly combine it with the most tourist heavy season of the year anywhere because, or any way, because it's a great time to see Montana, but then we can add it. It will be summer. This one was a little harder because we were waiting on the Montana board. I'm just saying it's an additional reason to come visit the big sky state, which I highly recommend for everybody. With sexual tools. sure whatever that's the line dad wanted in the coffee shop I'm not sure if he's allowed in the shop that he was stealing from my office yeah that's

let's just leave it there okay ready Yeah.