Cleared Hot - Powered By BRCC - The Zone of Chaos | Casey Stumpf | Ep. 466

Episode Date: August 26, 2026

Casey Stumpf is a nurse practitioner and my sister. Years in emergency medicine and hospice, a stretch inside military medicine at Camp Pendleton, and now her own practice in Montana treating hormones full time — perimenopause, menopause, testosterone for men and women. She is one of roughly 4,100 providers in the country holding the MSCP certification. There are 75 million American women in some phase of menopause. The math does not work. She is back to answer listener questions and to explain why estrogen patches are disappearing. The FDA says there is no shortage. Pharmacists say otherwise. Best estimate on a fix is two to three years. She lays out what the 2002 Women's Health Initiative did to an entire generation of women, and why the black box warning finally came off. Testosterone for women, prescribed off-label because no FDA-approved formulation exists. GLP-1s and what they pull out of you besides fat. Hormone therapy after breast cancer. Vaginal estrogen, UTIs, and hip fractures. The suicide risk in perimenopause that standard screening misses. Contact Casey Here: https://theradiantwelltality.com/ Today's Sponsors:  Ethos:  Get your free quote at https://www.ethos.com/clearedhot Cash App:  Download Cash App Today:  https://cash.app/ Terms apply. Bitcoin services by Block, Inc. See the Bitcoin disclosures at cash.app/legal/podcast.

Okay, got the red smoke. West of the smoke, I'm looking at danger close now. I'm all winning, baby. Give it to me. I made it. You're clear it hot. I can hear the hangover in your voice. Give us a quick walkthrough of your evening.

Listen to you. You sound older and wiser. Yes, I am older and wiser. Are you still shit-faced? No. No. You sure? I'm positive.

Performance will be the determined factor. How big did you go? That was pretty big. It was one of my good. buddies. So it was a wedding. Do you guys go beer or did you go harder? Harder. Yeah, they had open bar with whatever you what'd you go with. Ticula Sprite. There's a name for, isn't that a Paloma? Something along those lines? Maybe. I'm not sure. Okay. It was good though. It was a good time. How many did you have? You know, I'm not quite sure. Yeah. That's a good question. Good answer.

Okay. These are the easiest episodes for me ever because I'm just. just can ask questions and honestly struggle to even comprehend what you're saying as the answer. You said you had some things you wanted to start with though. Yes, props. Not necessarily props. I'm thinking you said things like, oh yeah, yeah. The problem is though I can't, Michael, Jude. Oh, dude, those are sick.

The problem is these are readers. I know. I was trying to pop the lenses out. I couldn't get the lenses. I have my hot pink ones, but I only need those if I can see. Man, okay. I have a. These are dangerous to.

aware. Why? I mean, I could probably see something right here, but beyond that. No, no, no. That's just for reading. All right. If I could have popped the lenses out of these, I would have worn these the entire episode. And then I have my champagne prop. Yep. We'll put that there. Oh, fuck. Do you know what it is? I think so, yeah. Okay. Well, that's Michael, do you know what this is? It looks like a wishbone. It does. Yes, it is. Now, you guys have like a theme in here, a very dark manly. I brought this nice silver one. I don't know where we'll place it in the, you know, but it goes with the theme. Oh, does that? We'll give that to Michael as a party gift because he's quitting. Yeah. Yeah. So we'll put that. That's your parting gift. Thank you. Because Michael,

you are a pussy. Really, truly, well and truly, yes. I thought for like a holiday, you could do, like, paint this section red glitter. Oh, God. It could be a Christmas tree ornament. Yeah. Well, I'll share at the end, Michael, what that is. Okay. I'm excited. Have you figured it out yet as your mind? I have some ideas. I have some theories.

Hmm. Yeah. I bet you do. Patches. Why is there a patch shortage? Oh, goodness gracious. And this is a nightmare. Absolutely nightmare.

Estrogen patches. Okay. And it's multifactorial why it's a problem. So before the women's health initiative, like 25% of women, we're using hormones. What is the women's health initiative and when did that kick off? That study started in 1991, but they published the results in 2002. That's when they come out and said, oh, estrogen's going to kill you. You're going to get breast cancer and you're going to get heart disease from it.

These were the black box wings or black labels. Right. They got removed. Right. So this hormone that we have had in super high levels in pregnancy and puberty, they're like, this is going to kill you. So all of a sudden, they just stopped. prescribing. So we had 5% of women may be on patches or hormones in general. Then we have in July 2025, FDA is like, this could be life saving. Yeah, no shit. Like we're not dying from estrogen. So November, they removed black box warning. Prescriptions doubled in that time frame. Okay. So you have patches. For hormone replacement, patches make up about 44%. So women, can get their estrogen in a patch, in a gel, a pill, a ring.

There's lots of ways you can get it. But patches just set it and forget it. Easiest to do. Okay. Especially if you have a condition. If you're a female who's got a clotting disorder, you can't take estrogen by mouth. If there's other risk factors, you can't take it orally. So all of a sudden, you've got a manufacturing supply chain set up for 5% of people using patches, right?

And then you and I talked about, well, we need the FDA. Why isn't the FDA saying there's a shortage? There's a pharmacist group. They're the ASCP. And they are kind of got their finger on the pulse. They're seeing what pharmacies are short on. They're seeing what's coming out. Hospitals.

They have a real time, like, accuracy of where our shortage is. And they're like, yes, we have a problem. The FDA just recently, a huge advocate that I love is Kelly Casperson. She's great for women's testosterone and reach out. to FDA, they said, oh, not to worry. We have a supply. There's not a shortage. Total gas lighting. I will say. Why would they say that when people are struggling to fill their prescriptions? I don't know if they're just not tracking it, the metrics. So I spend, you know, I get text messages from my patients throughout the day. Half of them will be, I can't find a patch. I can't find a patch.

So what do they do? So we, I don't have time to call pharmacies. They're like, well, do you know what pharmacy. I don't have time to call pharmacies. And by the time you get to this pharmacy, it could be out. So Amazon used to be pretty good source. When I heard Amazon was running out, I'm like, oh, we're in trouble. We're in trouble if Amazon's running out. Mark Cuban's got cost plus drugs. His generics are great prices, but when those run out, the patches were costing like $200 a month. What was normal before $200 a month? Like you cash price, maybe 30 bucks. Insurance, some people can get it cheaper, 10, 15.

So I was digging into this after you and I had the conversation. If the FDA said, yes, this is a true shortage, we could pull in compounding pharmacies. That's the trigger for them to be able to compound and help out. Yeah, but that's such a dirty world because we were talking about that when it comes to peptides and how they're trying. Was it the GOP3 read a true tide? They're trying to make it a label. as a biologic so it can be pulled out of the compounding world? There's too much of a gnarly economic fight going on there.

100%. It's a band-aid, but if you have women who are finally feeling better or want help and now they can't get their hormones, then that's a problem. So if the FDA said, yes, there's a shortage. Then the compounding pharmacies could at least try to pitch in. That happened with OZempic and Terseptide. They had that mass upkick. Compounding pharmacies got to start making it.

Then they caught up with supply and they had to stop, as we know, there's still pharmacies compounding it. But that would be huge for the FDA to trigger it. Now, the problem, the scary thing is that they think it's going to be two to three years until this shortage is fixed. So there's tons of orders, back orders. They're generic meds. There's a low profit margin. There is no monetary incentive to kick up supply to make. like warehouses for supply would take years.

So we're in a pickle. This episode is brought to you by ethos. A question for the audience. How often have you thought about life insurance? The fragility of life and the difficult decisions that can come at the end of life, whether it is unexpected or even if you know that it's coming. For myself as a person, when I was in the military, there was life insurance associated with that.

I gave it almost no thought because it was part of it. of the sign-up process. After leaving the military, I had a gap in even thinking about life insurance again, because, you know, life goes on, no pun intended. It just wasn't something that came up or that I thought about often, even though I had three young children. And it probably wasn't until they started getting a little bit older, purchased a few houses along the way and got to a place in life where you realize, man, this is complicated enough while I'm here. I don't want it to be even more complicated when I'm not or leave my family without the tools that they need in the unlikely or untimely event that that happens. This brings us right back to Ethos. They make getting life

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brand. Okay, we can get you this brand. But if it's a generic, the generics only have to have 80 to 125% of the active, right? So there's a bell curve of what they can produce. What's the non-generics? What do they have to have? That's supposed to be 100% guarantee. You're getting this. Right. You're getting this guaranteed. So now if I move someone to a generic, what I'm seeing often is like Casey, my symptoms are back. I don't, I'm having hot flashes again. Just put another one on. That's what my guy for medicine. I'll tell them that.

Cut one in half. I mean, I've got women looking like pin the tail in the donkey sometimes just to get where we need to be. So that's the patch option. Okay. So we're hunting patches. But it's going to be yours probably to fix it. So what do women do? So you can do estrogen gel, which you can put on your skin.

It's an every day, which I like because the brain likes steady state. I mean, the patch would, I guess, be every day too, but it's just attached to your skin, so you're not doing anything every day. So there's a patch that's either wear it once for the whole week. Yeah. There's a dual-acting patch twice a week. So you wear one three days, take it off for the next. So either one week or twice a week. The gel I like, though, because it's steady state problem.

It's usually non-formulary. It's more expensive. I don't know what that means. It means that insurance is denying it for a lot of women. So I can't get my patch. So we go to a gel. They're saying, nope, that's non-formulary. We're not covering it.

It's definitely pricier, right? So they're denying it. So then we end up with another problem. There's a ring, vaginal ring, you know, kind of like my bracelet. You put it inside, wear that for three months. That's about $300. Okay. So the options, and then there's the ore astrodial.

It's cheap. It works. It's good. You and I talked about this, though, for if you work with a provider who doesn't understand what happens when you take that by mouth, goes to the liver, the sex hormone binding globulent increases. That's the protein sucks up the testosterone, free testosterone. So say I have your testosterone optimized. You're on an estrogen patch. We have to switch to oral.

I'm going to drop this free testosterone so the brain fog can come back. The depressed, mood, everything, just like, what happened? Yeah, it's like a stereo. One thing, again, you specialize in this. I don't, but even in my own journey, it's not hit a button and everything is fixed. If you improve your sleep, you might have to adjust what you have going on. If you mess with your diet, you might have to adjust what you're going on. It's a stereo equalizer. And it seems as if you move one, you should expect that there's going to be moving at all times. Yeah. And especially route matters. How you take your hormones matters. So those are the big. I think more people are going to have to oral estrogen can be like nine bucks for a month. That doesn't sound bad. It doesn't sound bad. But if you have like a clotting risk factor, so it technically can increase your risk of clots because it goes through the liver

and activates the clot. Okay. So general public and a thousand women, one to two are going to get blood clots. You're just going to. That's just the statistics. Take oral estrogen that goes to about two to four. but that risk goes up if you're older, if you're obese, if you're smoking, have the clotting disorder. So there are some people who can't take it.

All right. Were there any other, I know there was some baseline issues you wanted to cover was the estrogen patch, the only one? Well, I'm curious, your take with your background to this screening of testosterone. What do you mean? The military background? Yeah. In the military. I wish I had a baseline. I mean, I wish I could at least know. I didn't have a baseline until I finally went years ago and got tested for what my levels were at the time. But I don't know what they were in my late teens, 20s, 30s. Well, I'm assuming just how they had you guys operating and not good sleep. It would have been low.

I mean, maybe, but that's a hypothesis. We don't know. Some people tolerate it better than others. And some people, as you know, have higher levels of testosterone to start with. Some have lower. So I don't know where I have no idea where I was. I don't think, first off, correct me if I'm wrong. It's just another box you check on what you're going to test anyway.

And they're drawing your blood as it is in the military, probably annually, if not by annually. Why would you not just check that box? And at least you have an ability for a pathway forward. This is where you are now. And twice a year, once a year, you get that. And then when you leave and you're later in life, at least you can look backwards and say, this is where I was and this is the difference. Well, I think it's great. I mean, we know like the same for men.

If you're like, hey, we're going to cut your balls off. and hold on who's saying that that's menopause for women right okay cut your balls off women don't have balls i'm saying for men i'm giving you equivalent like this is what i feel like balls are gone you're you know you're not sleeping you're obese you're depressed you have no muscle mass that's what happens to you like it's just men go like this i think they should be screened where my problem is is it's not clear in the pentagon's response has been like it was written for service members So, but they're not saying what they're going to do for women. And they're not going to say if they're going to help women.

Oh, that's just because they don't know. Don't worry. The lack of guidance just means they haven't thought their way through it or their answer is. Right. So I think that that's where I'm curious to see. Well, here's the thing, though, too. It made headlines. Right.

I would love to see what it looks like. Right. In execution. When are they going to start this? How are they going to roll it out even for the guys? What's their threshold going to be for the introduction of hormones? What's the – Right.

Well, and that's the thing. Okay, what number are they going to use? When I did some research, they think maybe 300. Okay. Because the endocrine society says if you're below 300 for men, right, we have a good standard for women for them to use. But then what will they do. At this point, I think that the headline was exactly what it was, the headline. Yeah.

That's a PR victory. And I'm not saying it's – I would like to see that done, at least from a screening perspective, the headline is easier than the mechanics of getting something implemented inside of the military. The reason you're not able to find the guidance, my guess is... Oh, it's not there yet. They don't have it yet. No, no, no. I was just curious your thoughts on it.

I don't see how testing and getting as many metrics as possible, as early as possible in your career has any downside. Other than the military... Here's an example. When we were doing parachute testing on the tandem systems, They brought out G meter, like the gravitational forward force load indicators. Okay. And I forget the exact G load that a pilot takes on an ejection seat ride. But I think if you get two of those, you're done flying to ejection seat rides, which honestly, if you have to eject twice, I'm going to say there might be something.

You know what I mean? Like you have the worst luck ever or maybe piloting wasn't your thing. I don't know. We were routinely breaking those devices. And so instead of finding devices that could accurately measure, the G-load, they just said, we're good. Because if you identify a problem, who's responsible for dealing with the long-term consequence of that? So would the military own that replacement then the rest of their life? They identified it during active duty? I don't know. Or if they identify

an active duty, if this is where you start and you do 10 years, this is what you could likely expect, or 20, it's like how long they fought the Agent Orange. This is a horrible analogy, but how long do the military fight, paying people for the things that happened because of Agent Orange and exposure. Decades. Why? Because it's expensive. And they also would have to admit culpability and liability. Yeah. So what if you start doing all this robust testing and it is determined, oh shit, regardless of who you are where you come into this at, this is what you can expect and this job actually destroys your endocrine system and you might have TBI type issues and you might be dealing with post-traumatic stress. Do you have to disclose that up front? Does that become the new recruiting poster? Or do you just realize that every

person that does that, you know what I mean? It's this, it turns something from being very opaque to a little bit more clear. And in my experience, sometimes the military doesn't like it being that clear. Well, maybe it'll go nowhere. Perhaps. Again, the headline is easier than the implementation. Yeah, maybe it goes nowhere. So we'll see. Were you surprised by the response from me coming on in March? No. What would I have been surprised? Well, I think, you know, most of the people you interview are probably mostly male, mostly not topics. Or men reach out than women do. Mostly not topics of hormones.

Yeah, because we don't know anything about them. I have to say the response, and we've talked about this, was just amazing. You know. It didn't show. Well, here's why it didn't surprise me. Before we had talked, you explained to me the number of providers that there were versus the number of people who are likely going through this. Yes. So when you explained the math, no, there was no surprise at all.

Because again, just in the messages that we got, which I mean, I can just start reading through these things. But the theme is, I'm in the forest by myself. I don't have a machete or a compass. I'm stumbling around. Sometimes I hear some whispering advice from over here, but then it conflicts with this advice over here. I'm hiding in a closet. No, that's the men. My feed is full.

It's hilarious. There's this Australian dude. Oh, no, I know who he is. Yeah. He's like, he'd be like, I kid. I'm not even going to try the Australian accent, but he'll do the sniff test where he'll set up the camera and his wife's over there. And he'll just, usually he gets to three.

And she loses her shit. Yeah. It's hilarious. Yeah, my feed is about 50% probably because I'm watching these things and laughing my ass off. But yeah, guys hiding in closets, making videos. This other guy, he's like, guys, I really screwed up yesterday. I need to do better. I went upstairs.

I can't believe. Yeah. And I don't blame the women for, we'll go over that in a second. But I think the surprising thing was these women were calling and be like, my husband sent me. My husband were like, I don't know if you can see the metrics. You haven't figured this out yet. It's probably not best if the husband pitches this conversation to the woman. Like, hey, you're acting real fucking weird.

Maybe you should go talk to somebody. That doesn't go well. No, but it was my husband sent me the podcast, you know, and that was just. just the engagement of men helping women in their health arena was. I think you mean the engagement of men helping themselves navigate life in life with women. I always tell my girls, like, listen, my job is to keep you out of jail. I know when it's going to happen. We talked about, you know, crazy murder stories last night.

I'm like, it happens in this phase of your cycle. I know this is when women go to jail. That's what I got out of your slide straight presentation. The zone of chaos. This is when you kill right here. right here. I mean, yeah. So no, it didn't surprise me to all.

The same thing will happen with this. It's shocking. The math just, it doesn't work well. Well, I was looking at the numbers this morning, too, just to see. So 75 million women, either impairing menopause, menopause, postmenopause, so the three phases. And I'm like, well, how the license or the certificate I have is the MSCP, which is my certification, the board test I took.

estimate currently right now 4,100 of us. Yeah, the math doesn't work on that. Yeah. I mean, of course there's other providers who are doing this. You don't have to have that title that just shows that I,

my commitment in sitting for the exam. Yeah. Do you want to dive straight into questions? Are there any other blanket? I think, I think another surprising thing too that came up since you and I talked like the military thing was surprising to me

but just the funding for women's health, like we have the issue with the patch shortage, right? We know that's a problem. Our funding's getting cut dramatically. So I just, we have all these women. What do you mean your fun? Women's health. Okay. Funding. Like, for example, Alzheimer's cases, two-thirds of them are female. Really? Yep. Why is that? Well, we don't know exactly why. And it's not just that we live longer. We think it's something due with the estrogen. There's a big study going on right now. Because you end up killing your partners. Yeah.

Yeah. So if two thirds of cases of Alzheimer's cases are women, the funding for women in that is only 12% of Alzheimer's research. So these. It doesn't. And it's this way across the board for women's health, for research for funding for menopause is 1% of all funding. Who's making these cuts? Where does the money? Well, the NIH.

NIH is only does like 6% of the research. searchers other funding besides the NIH, but we are disproportionately and then we're getting cut. And so we've got all this going on now. We've got more buzz more people talking about it. Celebrities of, you know, things are moving now. But the funding's cutting. So there's one person who is donated more for women's health.

She just put another $215 million in. Melinda Gates. She's contributed $600 million for female, for midlife health for women. When you say that, where does the money go? Who does she, who does she cut a check to? Well, I don't know exactly who, like, so I'm part of the Menopause Society, and I was at their convention last year, and they said, oh, we got $10 million. Is that a cool logo? The Menopause Society?

Yeah. Michael, look up Menopause Society logo. Let's get some branding. It's not. It's not. They need some flair. It's a misbranding opportunity. Yeah.

So they announced that we got $10 million. So a lot, big thing for her, too, is education. See, look. Week? I know. It's not. I would have like a dagger with a Ghostbuster symbol on it and a guy running away. Big thing that she's putting money into is education, which is what we need.

We have to have it taught in medical schools. We have to have, we cannot do unless we start getting teachers and providers helping. We're still in this problem. That makes sense. So yeah, I'm so grateful for her. But she has outfunded the whole government system for women. It sucks that they're going in the wrong way. Yeah.

I don't want to steal the NIH's ability, though, to fund gain of function research on back coronaviruses, though. Okay. You know, because that worked out pretty well for us the last time. All right. Should we go right into it? Yeah. Hold on. I had a couple people.

Okay. My wife is 43. It was on HRT and feeling good. Then got diagnosed with breast cancer and has gone through treatment, including chemo and upcoming mastectomy and then some radiation. It sounds like HRT, her HRT provider, won't work with women post-cancer treatment. I was wondering who Casey has any insight on HRT, which is a term I'm sure we'll use hormonal replacement therapy after cancer. Specifically for this person's wife, her cancer is a non-hormone reactive form. Her oncologist recommended she stop the HRT during treatment, which she has.

He also stated there's a good chance the chemo will put her in menopause anyway. Is H.R.T. post-cancer treatment possible and still beneficial or detrimental? There's a lot there. Yeah. And actually, you know, I think, unfortunately, you and I saw Mom die of cancer. You watched Mom die with cancer. I came back about 10 days before she died. But we saw her quality of life up until. And so you have these breast cancer survivors who go through hell to live, right? They go through treatment.

it. And then sometimes their quality of life can be hell on the other end. Now, breast cancer is tricky in the fact that there's so many types. Is it estrogen receptor positive? Is it there's so many different kinds? Is it DCIS? And they can tell levels of definity in that? Yeah, yeah. It's all on pathology. You can see these. So on my, because I actually had special training for treating breast cancer patients. You know, I have a passion for helping women who are told no, no, no, no, especially like breast cancer. They're told, nope, you're done. And just go, just go like, live your best life, but you feel miserable. You know, you survive treatment, but now this is going to look cruddy.

Yeah, that sucks. Now, there are some cancers if it is ER positive. That means there's a receptor on the breast tumor that responds to estrogen. And I'm going to be really clear, estrogen does not cause breast cancer. We know that. There's not one study because you'll hear that. Oh, my mom had breast cancer. I can't take it.

No. If you have this ER positive breast cancer receptor, you give it estrogen, it can feed it. It's not going to cause it, but it'll make it grow. So there are some cancers. It's a no. You can do other things. But a hormone negative receptor has a lot more options. Non-hormone reactive.

Exactly. So it wasn't fueled by estrogen, wasn't fueled by progesterone. So they should be able to, down there on they can. Vaginal estrogen for everyone across. the board. We've talked about that, right? So saving that area. But then there's a medication called Duave, which is someone like this you could do. So it, especially your DCIS patients, there's studies on this actually using du of A for part of helping with lowering the tumor burden. So it's estrogen, but then it has a serum on it. So it protects the breast tissue and it protects

the uterus. So there's a, you just have, she's got to find a provider. No is not the answer. You got to keep searching. God, that's rough when you're going to the provider, hoping that they have the answers. That's why you're going in the first place. Well, and the oncologists, they think in this lane, right? They're here to try to keep you alive. But I mean, also I saw with mom, too, she's like, she was a shell of herself. And they're like, here, you want to do another round of chemo? And I'm looking at her going, she's like using a walker or holding on to me to walk in here. And you want to. Also, what kind of bullshit false choice was that? Basically, what they said was, do you want the cancer to kill you or the chemo to kill you? She would not have survived

another round of chemo. No, no, no, no, no, I know, but they offered it. Why? Well, that's kind of, you know, working in hospice and oncologists, they have a great role, right? They have a role. But sometimes I see them just looking at the disease and not seeing the whole person. Like, where is the quality? And breast cancer patients get a short end of the stick sometimes with hormones. So you've got a, I want to highlight for breast cancer survivors, Dr. Corinne Men. She's the biggest advocate for women. How do you spell the last name? M-E-N-N.

Okay. So they should start following her. She had breast cancer herself. She's a OB-G-Y-N. She's a huge advocate looks into all the, that's who I studied with for breast cancer post-treatment. So she'd be a great one for them to follow. What's the best HRT regimen for peri-menopausal woman that still has her uterus? and any differences in someone that has had a hysterectomy.

And this is where I think we have to change the story. So people will be told the gaslighting and health care is horrific. Do you think they're intentionally doing it or they're repeating the last thing that they were taught and not continuing education? Well, I think there's two things. They're so busy seeing patients. They don't have time to be curious. The reason I ask is I think intent matters. I don't think there's a whole fleet of McAvellian doctors out there trying to gaslight women.

Well, I think... I had one patient who went in and told her male provider, hey, you know, my sex drive is gone and he said, you should pray about it. Listen, we're talking about a community that is comprised of individuals. There's a bell curve, as we all know in life. And even on the highest performing team,

there's a bottom 10%. I think, though, that most doctors are there doing their best to help each other, but even I have seen this in the doctors that I know, especially if they specialize in one thing, you take a step outside of that and their knowledge becomes very general. You take a step outside of that.

It becomes very hypothetical. You take a step outside of that. And they're like, I have no idea. I don't think they're, I mean, gasoline, I understand the term now based off of previous business partners. But I mean, I don't think the doctors are being dicks. I think, like you said, they're time compressed. They don't know, but they remember the last thing that they were probably taught.

And that might have been 30 years ago. Or taught at all. Yeah. And that's not to remove the burden from them. Obviously, they're still their job to do the best that they can. But I also don't want to make this, hey, all male doctor. doctors are out there trying to screw over women patients. I'm not, this could be male or female.

Yeah. But the common things, because, you know, I just shared about this, it often will take women four to five providers to get to me, right? And they're told, you're too young. Oh, you're still having periods. You don't have hot flashes. You're too old. X, Y, and Z, why you don't qualify.

Well, we just talked about the math. There's a reason why it takes them. I don't think intentionally people are trying to do harm or, but what it feels like to a female, if you go in and you're, you're. in tears and you need help and you're told you're fine when you're you're telling them I'm not fine I'm falling apart. Yeah. So what was the question?

It was best HRT regimen for paramedopause woman. It still has her uterus and any difference in someone that has had a hysterectomy. So perimenopause is where we got to start. We're not, I don't want women waiting like me that did the crash and burn. I want to see women starting hormone therapy early. We know that that's better for bone, brain, heart. That could be age 35. You know, I don't like to put a label on it.

If you're not feeling yourself, which usually starts looking like I'm not sleeping well or my mood is off, right? My husband, what was it, the sniff test? Like the sniff test, the Aussie guy. If he's, oh yeah, you sniff three times and eventually his wife goes, what the fuck is wrong with you? Right. If this is starting to rear its head.

She's going to lose her shit. Not your typical presentation. If you're 33, 34, okay, we can help that. So perimenopause. is going to be all things, estrogen, progesterone, and testosterone, all three. But it's finding the recipe for everyone.

Everyone's got their own recipe. There's some great telehealth companies, but they're kind of time constraint. And then perimenopause is this dance. So you have to find a provider who knows how to move with it. So we'll find their sweet spot, and then the hormones move again. And then we're shifting.

Okay, now we've got to shift again. So you've got to find someone knows how to dance with you through it. I also feel like you have to be, for my own, I think I've been on TRT now for, I don't know, just under two, I don't even know. But if you're not also intimately involved in your own journey, and like I just asked you like, hey, can you get my blood work ready to go? If you're not somebody who is going to actively have your hands on the stereo equalizer as well, it's not going to go. Well, I think the other person has to be intimately interested and involved in the process as well. No, I agree. And I think this came up on a lot of the questions was, well, what blood test do I need?

Yeah. Hold on first, though, is there treatment difference between uterus and post-historectomy when it comes to best HRT regimen for perimenopausal woman? So post-hysterectomy, they would say technically you don't have to have progesterone. You have to have progesterone if you have a uterus to protect the endometrial lining. Estrogen can make that lining build, which could cause cancer. Progestrum protects that. So, like I was told, I don't have a uterus. They said, oh, you don't need progesterone.

bullshit. What we know now on progesterone, I will take it the rest of my life. So progesterone helps with mood, sleep, bone density. So for me, there's no difference. You get all three. What path were you going to go? The testing. The lab testing. And I think this is women want help. And they're just like, fine. Just give me a lab test. Give me a lab test. I don't feel right. I feel crazy. Something's not right. Give me my labs. They'll go get their labs. They'll see a provider who maybe doesn't understand this arena. and they'll be like, you're fine. You're fine. Everything's fine. Just sleep more, exercise more. Meanwhile, they're dragging on the couch. They're not sleeping. So I think that they can really run

into some trouble hanging their hat on, I just need labs. I think specifically, though, what labs should they be looking for so they can get the right pieces of information to take it to a provider? Is there a generalized lab you can request? No, there is no lab test for paring menopause. And that is why I need an hour. My initial intake with people is an hour. And I'm listening. I'm listening. And I'm like, okay, in my head, coming up with a plan, insurance model isn't set up for that. Because estrogen and progesterone and pari menopause is that zone of chaos, that up down, up down. So I could check you four times in one day. It's going to look different. And they're going to fall within range. So you see a

provider and be like, this is fine. It's more how the fluctuations, that chaos is creating the symptoms. Where does testosterone treatment for women specifically play a role in which product does she prefer? So testosterone is a test you could get. You could get that test. Again, though, you have these arbitrary normal ranges, right? As you're answering this, I'm going to go to the IG page because there was a question. Somebody specifically asked about a level that they wanted your input on. So go ahead.

Well, I'll speak to what I feel best at. So they can't, you know, back in the 90s, they tested 500 women and said, this is the range. or the lab will give a range. So that range on some labs, I've seen a normal range, the bottom number be a two, two as normal. Nine is normal. That is crawling, you're dragging.

You are just not feeling yourself. So in testosterone, men and women, just tick, tick, tick, tick, it just goes down. It just decreases. So I, myself personally, I feel best between 120, 130. That's my range. So this is going to go right into your question here.

My hormone doctor likes me at 60 for TRT. I feel that is low. Also, what are your thoughts about GLP1? I work out and eat healthy, but I have a hard time losing weight. I'm 52 years old and have weight training since last year has been hard on my body. Do women have more tendon tear during pre or during premenipause? So yeah, so 60 at TRT for you, you're saying that would be low. I wouldn't feel good at that.

And there's a few caveats on that. It's, okay, here's a lab test, but how does the person look in front of me? Do you have brain fog still? Are you still irritable? Do you feel, is your mood not the best? Do you not feel like yourself? Are you having more problems gaining muscle mass? Right.

If you're still saying, I've got all these things in your 60, let's bring this up. Let's try a little higher. What if she's on oral estrogen and what's circulating in the blood is really low? So, you know, this is one, treat the person. Use the lab just as a, you know, a reference. pairing the HRT, I'll use the broader term, and GLP1. There's a lot of misconceptions about GLP1s. I know.

I had somebody asking me the other day, I think it might have been on the show as well. No, it was on the show, asking essentially what my thoughts on it and if it's cheating or I think it was just my thoughts in general. And my answer was, I mean, it's a tool that can be abused like anything else. It's also not you, new. It's been around for a long time. 20 plus years now. Yeah. And if, you know, I think the comment came from the super heroin chic idea that some people see,

which I think those people are probably not weight training and doing all the other things that you're supposed to be doing. No. Yeah, which I would say, that probably doesn't work great. But I think, again, in an HRT model for somebody who is 52, what would your general thoughts be on a GLP1? They work beautiful together. So say you just, we'll use terse appetite. Say you use terse appetite on its own. Is that a one?

Two. A two? A two? And then red is a three? Three and some on glutate's one. So if you use terzapotide on its own, you have some improvement. If you add in the hormones even better because midlife insulin resistance goes up, the menopause muffin top shows up. So if you combine the hormones, beautiful.

And why I love testosterone even more for this, because those GLPs are going to pull muscle. You've got to be actively involved. It's going to pull fat, but it's going to pull muscle. So my patients, they have to eat the protein. They've got to do the weight. But what is here? Bring in testosterone. It's going to help build muscle.

So those two together, great sweet spot. Can you talk about the difference, too, in how you use the GLP ones? And this is, again, my broad understanding, a microdose versus some of what I'll consider to be the macro doses for pure weight loss? Well, and that's like a trigger word these days. What is? On microdosing. Some people are getting really upset with people using microdosing.

So let's say tersepidivis. A starting standard dose terseptopatite for weight loss is 2.5 milligrams. And then if you're using their pens, it goes 2.5. 5. You know I can't do these conversions. We're using terseptitide. But say it's starting dose for weight loss is 2.5. I like to start depending if it's male or female, females 1.5 to 2.

Some men will start at 2 and a half because we just, we need to get things moving. but I may only take them up to three, which wouldn't be microdosing. A true microdose would be, you know, less than a milligram. Per week. Correct. Which you can do. You can, now your rings are coming off, right?

Your clothes aren't in tight. The puffiness people get. Yeah. So, and the health benefits, there was just this huge study that just came out on over 100,000 women, and they had 30% decreased risk of breast cancer on them. There is some fascinating.

I think you and I've talked about this for maybe the first time you were on, the long term when it comes to the cognition protects against neuroprotective. And again, this isn't it some macro dose, but the smaller doses that you're talking about. Because it's lowering the blood sugar in the brain. It's lowering inflammation. When we don't have great trials on that, we're just looking at observation. But I think it'll lead that way. The question two was on the testosterone formulations. There's no FDA approved testosterone from women.

There's eight for men, but none for women. Do you need a specific testosterone for women? Or can one of those eight satisfy? Well, so what we have to do is go off label, which a lot of medications we use off label, you know. To include the GLP ones we were just talking about. GLPs too, I like for pain management. So what we do is we have to take a male formulation. So you can get test them gel in these little packs.

And you're supposed to make that last like seven to ten days. well it's alcohol based so it can dry up the effectiveness change and now a lot of pharmacists are saying nope this is for men we're not giving it to women you can't write it like that so we've got a barrier there okay so then it's then there's other pumps that you can use but what of one pump is different there's too much variation and i want you to use a pea size or an adamami maybe you're atamami it looks different than mine right there's too much variation so i prefer compounding because I can control each click that comes out of the cream. I can control the dose on that.

And what if I want to fine tune it? What if I want to bring someone up maybe 10, 20 percent? I can dose that in a compounding cream being, oh, a P and a half. Use a P and half. But again, the pharmacist, too, a lot of them are saying, no, they won't give it to women. I'm 54 and still having my period regularly. I just want to be done. However, everyone says how great it is for my skin.

What's going on? I've been in perimenopause for over 10 years. She's probably talking about that she still makes her own estrogen. I don't know. Yes. So low estrogen, dry skin, crepey skin, itchy skin. That's why you'll see. I actually just came up with the pharmacist I work with with a E3.

So we took estriol, copper, NAD. I haven't released this yet. But when I get home next week, we're going to put it out there. We came up with it. So it's like a lower dose estrogen for the face with copper and NAD on it. Yeah, but for this person's question, she's been on this ride for 10 years. Sounds like she wants it over. I don't feel like there's an eject button.

No. Any advice, though? For her. She's loving her skin. Wasn't she loving her skin? She doesn't say she's loving her skin. She says, however, everyone else says how great it is for my skin. So everybody else is complimenting her on her skin.

She's probably to be close. So the median age women go through menopause is about 50 what? She's got to be close. But is the reality you're on the roller coaster until the roller coaster comes back to the right end or the get on, get off one? Like four to 10 years. More on vertigo and menopause.

I don't remember us talking about this. Yeah. So I'll see this one often. Like women will go, I had this. And I didn't even realize it because, you know, not having a uterus. I didn't. We went on a Disney cruise.

and for two months I came back and I was like, oh, just spinning, spinning. Well, I didn't know. You had none of those issues before the cruise? No. Do you think it was some of the movement? 100% it was, but I think it was exacerbated by the fact

I was impairing menopause and didn't know it. So the fluid in the inner ear, you have these crystals and think of like seaweed. They move together. They should do this and match, right? And the brain moves they should match. So sometimes they can be like this cause vertigo. We got to have enough fluid in here

to make it move smoothly. That makes sense. So the inner ear is definitely, if you have low estrogen, it affects the inner ear and the fluid. I had one patient who debilitating vertigo couldn't get out of bed, went and saw E&T,

doing all the uply maneuvers, doing meds, nothing more. Get her on some estrogen. She's working again. She still has some vertigo, but now she's actually like getting out of bed and working.

Damn. So, E&T will miss that, that it's hormone-related. Should me or my doctor run labs or my minerals to see what I might be deficient in before prescriptions, secondly, specifically for progesterone. And when does progesterone knock me out? I'm so sleepy in the AM when I take it. And in parentheses, 100 milligrams of bioidentical. Okay.

So I would never say like vitamins, trump what hormones will do. Now we've got to look at the big picture because I think people miss that. Vitamin D would be a must. You're taking that, yes? Yes, D3K2. Yeah. Vitamin D is going to be a must because everyone's low. Even in California, right?

Everyone's like, oh, I'm in the sun. They're notoriously low. You've been up here in the wintertime? Oh, I know. Sun comes out from 9 a.m. to 10.30 a.m. on days that aren't overcast. Vitamin D is a hormone. Misclassified is a vitamin

during the ricketts time, but it's actually axo-hormone. So super important for mood and energy. So vitamin D is a must. B-12 when that's low, brain fog, sluggish, low energy. You see how these overlap. Yeah.

So you have to, it's not just hormones. It's looking at the big picture. So it'd be vitamin D, you can look at your zinc, your magnesium, your folate, your B12. You could look at those. The second part, why does progesterone knock me out? I'm so sleepy in the A.M. When I take it 100 milligrams of bioidentical.

So progesterone, I would say for people, 50% of my population of women love it. 25%, 30% say, I don't notice much, but I have a uterus. I have to take it. And the other 10, 15, are like, I hate this. So we call that progesterone. intolerance. So when you take progesterone by mouth, it goes to the liver. And one of the byproducts of the metabolites is it ends up raising the gabba in the brain. So think of Mother Nature Xanax. Hence, 50% love it. They're sleeping better. Their anxiety has come down. But you've got 10 to 15%

where it can be more anxiety, too sleepy, headaches, reflux. You have to think outside a box how to protect the uterus if they have that. Someone like that, I would move the dose up earlier. Like, what if you took it at dinner time and see if that comes off? Oh, sleep through it, you mean? Right. So move it up and see then if you're not as groggy in the morning. Yeah.

Sounds like they're taking it in the morning. No, you would take progestion at night. It's meant to be taken at night because the side effect of it is it makes you sleepy. Oh, well, there you go. She tells you what I know. If I start taking TRT slash HRT, can I ever get off of this? therapy or am I stuck taking it for the rest of my life? This is a very common question. So the old saying was you should only take it for five to ten years. That's what they said,

right? When you're supposed to fear the hormones your body made. And then what you hit 60, got to stop. 60 were done. Just crash and burn. That was, that was what it was. That was like a great carnival ride. That was what it was. At 60, you needed to come off. Again, this is an individual journey and you have to find a provider who can raise, weigh the risk and benefit for each person. If you're doing well, have no side effects. I mean, I'm going to die with that testosterone in my hand, be it an injection of cream. I know how awful I am off of it.

Why would I stop? I mean, what's dad? He's going to be 80 now and he's still clicking away. We don't have time to dedicate an entire episode to the current... Status. Circus. That is... I was...

I just did a speech in Scottsdale. And the man who ran the organization, as a touch older than dad, still day-to-day operations, crushing it, not showing up at the house with no shoes on. That was yesterday, Michael. He just, he rolled in with, he rolled in with linen pants. Linen pants. Linen pants. No shoes, left his phone at the house, came back.

I mean, you get to interface with him. Yeah. Yeah. So I think it's an individual journey. Do you have to take it the rest of your life? No. But do you know how you feel on it? Most people feel 60, 70% better.

We know when you stop taking it, the bone, heart, brain protection goes away. How much do you think, I mean, let's say we're halfway around the lap of life on our track? How much do you think there will be an innovation or how much have you seen? in evolution in the delivery mechanisms of these things. Like even since I've started paying attention to it, I remember the first time I ever heard the term GLP1. And then it's like, GLP 2, GLP3. And getting this news from Instagram, but, you know, people, the newest GLP 5.

So obviously they're continuing to push forward with all that stuff. Testosterone just seems to be testosterone. Same with estrogen progester. Do you think they'll get any more sophisticated and complicated in a good way with the treatment and delivery mechanisms? Or is that just it is what a. is. Like if you're on testosterone, you're going to have a cream or an injection or an oral. That's just going to be. I mean, it's working. Yeah. I mean, but the horse and buggy was working for a while too.

I mean, that goes back to like the theory of like people say the pellets are better, right? To me, that seems like a pretty high level of commitment because once those suckers are in there. Now, I told you about that. I don't know their name. So I'm not going to say it here, but there's a medical place here in Calispell, mismanaging women completely on pellets. how so like the women i'm taking over what what does the mismanagement look like um that they are dosing them so high that like one girl she was five months post injection and still had a testosterone of 400 which is a male range yeah so tell me what you think it was five months ago and that makes it really makes it really hard for me because these women are used to living this high but you also what can you really do you have to wait for that to wait it out roller coaster to

come back around. Holy cow. Yeah. Okay. So you might be on it for the rest of your life is the answer to this. I think it's a personal choice. If you have no contradications to it, yes, you could. I mean, this is an area of medicine. Actually, I'm going to look into is using hormones for like hospice patients end of life. That's my next journey. Okay. Here's a question I completely don't understand. will using wild yam cream to support progesterone grow a uterine fibroid or help balance hormones to prevent its growth? Yeah. And I saw this.

You understand that? I do understand it. And I looked into it. And so with AI these days, there's some great things where there's apps I can use that pull data, right? It pulls all the data from trials. Yeah, it's what AI is best at is. Trials that ever are done. So I put this in there because.

What's your preferred tool? I open GPT or do you clawed open evidence. Oh. It's the medical. It pulls the databases of the research who's been done. You know, I don't know everything. So I said, all right. I don't know.

Let's see if I eat 10 pounds of yams. What's going to happen? So I looked. The yams do not have. This is cream. Oh. This is wild yam. No.

So no. So I'm saying, I understand these words, but I'm this sentence to me is. Well, I'm telling you, women are desperate. Women are desperate. They can't get help. So they are seeing things on the internet. They are, oh, this influencer said that. They are going for, I get it.

You feel awful. You want help. No. So yams are not going to trigger estrogen or progesterone. There's been no clinical studies that show any link to fibroids. So I actually dug into that one because I found that interesting. Is dim, D-I-M necessary to combat the side effects of testosterone supplementation, especially for those of us on higher dosages?

I don't even know what dim is. That's a male, correct? Who asked? This is Skitch 1974. Let me click on that profile. I'm going to think it's a picture of somebody's eyeball. I haven't, the first name, though, is Heather. So I'm going to say that's a,

Huh, okay. In the modern era, I'm not going to say what it is. I don't know how they're living their life. So dim is made up of like cruciferous vegetables, your kale, your broccoli. Yams? Dim, cruciferous. Oh, are those yams? No. Okay. So it is, there's not good strong data or evidence on this, but it is thought to help with some of the conversion of testosterone to estrogen.

Because there's this fear. I see it in my men. Oh, Casey, I've got to be on aromatase inhibitor. I'm like, why? You need estrogen just like I do. So if you block estrogen, it's going to affect your bone, brain, and heart. You need it. You do not need to be on aromatase inhibitors.

Is your estrogen going to go up if I give you testosterone? Yes. And maybe it goes red and goes to high. You're not wearing a B-cut bra these days. Just the egg cut. Sure. Right? So you're watching for that.

You're watching for men who do. develop breast tissue. Titties, middies, if you will. Yes. You're watching for, I'm just crying at every, like a hallmark commercial. I'm falling apart. Some of those commercials are tear jerkers. Sure. But it's like, throw puppies in there? What are you supposed to do? Just like, so there's this fear of bumping up estrogen. It's rare that you're going to see it be in a range that you need to do anything about it. That's really. So for women, you don't even move the needle. So say, like, I have breast cancer survivors that were estrogen sensitive, so their receptor was positive, right? If I give them testosterone, there's a fear of how much of this

am I going to move to estrogen? Am I going to trigger potentially down the road? I tell them the risks. If they're miserable and want to try it, they can send their life away. That's your journey. But I track their estrogen. I'm not seeing it move. And women get a tenth of the dose as a male. So if a male, if I bump their, say their estrogen up, say even 10 points, that would be one point for a woman. You're not going to see it. Do I think that supplements necessary? No. And the data's not great.

All right. But check out the EMs. Yeah, the EMS. What does she, meaning you recommend as top resources for women to learn more about navigating parmenopause? It's hard. I think so many women are experiencing issues related. related to hormone changes, but they don't know where to start. Or maybe a checklist or tracker of things to do that you, this is a homework project for you,

this person is saying maybe you could make a checklist. Actually, that would be a good product for you to sell. Well, where is it? On my computer. Oh, it's doing a great job helping your people on the internet you're trying to reach. Unfucking believable. You can only do so much, you know. Resources for women.

Where do you start your journey of information? Clearly, Instagram influencers. Yes. I mean, I'm happy to share my tracker. The problem is even if they track it, if they go see a provider who doesn't know the serena, then what, right? Well, that's the second part of the journey. I think this question speaks to where a lot of people are at. But I'm saying this as somebody who hasn't gone through this journey, they don't know where to start.

Right. So the provider might actually be the second step. This is legitimately, where would you push people for education or point them to it, not push? Right. The tracker could help. What you do with the tracker is, It gives you some agency over what's going on. Well, 100%.

And my patients who come see me, they get a copy of my tracker. And I highlight on this because I teach them how to navigate the hormones. Like, you're going to go up on estrogen here. Send me these trackers so I can gauge how you're doing on them. So we look at about 25 symptoms on the tracker I use. Now, for education, Heather Hirsch has the perimenopause survival guide. Dr. Mary Claire Haver has the new perimenopause. Kelly Casperson, the menopause movement.

All these are providers who I train with. And I'm lucky enough how with Internet now, that once a month we do ground rounds. So I get access to these people and we run hard cases together. Do you have any books that you would recommend? All three of those. People I just mentioned.

Yeah, those are all three books I named. Any good podcasts specific about this stuff? All three of those. Okay, they'll have the, okay, so there's a variety of mediums. All right, that's a good starting point right there. Ask my wife if she has As questions about paramedipause, her response was, when does this shit stop?

Remember, four to 10 years? But here's the thing, it doesn't have to be awful. Because when I, and I think for me, this has been the most rewarding medicine. I'll have women come in, they look like a shell themselves. You've seen, there was a few comments on there from people of just how life changing this can be, who have seen me. And it doesn't have to look like this. It actually can look very high functioning and like yourself again.

So it doesn't have to I'm going to Michael any more thought on this I'm just taking it off to rehydrate here I do it I think Did you have you been doing research behind the scenes back now

where we're talking? I actually have it I feel like it's something that goes into the vagina Oh goes into it Yeah So it's like you could buy

You could buy You could buy one of these at the, you're still going to play rugby when you go to Missoula or no. Yeah. So he can travel with this and educate. Is that what, did that get it right? So you think you buy this. You think that's a toy?

Like a sexual tool. No, no, no, no. Like something, like an actually, that's too big. Because I was thinking like an IUD or something. Okay. He thinks like a birth control. Yeah. Okay.

This is, this is, no, I appreciate your honesty because this is, Most people can't name what this is, and we'll talk about it at the end. Yeah, that's what I was thinking, and then I thought about how small an IUD is. And I was like, yeah. First of, that's your next ear piercing is, Michael. Okay, please talk about how this kind of therapy can help women who have had hysterectomies. I know so many women who have had one, but there's no push to have them seat treatment for the horrific hormone issues they'll have because of this surgery. Please cover this, exclamation, exclamation.

Okay. So you have to say, is it a total hysterectomy, which they take the ovaries and the uterus out, or is it a partial? Like, I had. So this doesn't clarify. Well, I can speak to both. Okay. So a partial is what I had. They left my ovaries, took the uterus out. If you have it. Why do they decide to do one over the other? Maybe they had a concern for like braca, right, genetic risk of ovarian cancer, something like that. Okay. What's the benefit to a partial versus a complete? So like myself, I left my ovaries. Okay. So if you do a total come out of the operating room, full menopause. You're in it. Yeah. And a lot of women aren't replaced. Now, if I was a surgeon and I was doing a total hysterectomy, I'd have an estrogen patch on prior to surgery. So they're getting hormones and they leave. Now, if you're like myself, they left the ovaries. I still want of my hormones. No uterus. That. That. The problem is a lot of women don't know is this group here goes into menopause about four years early. The blood flow isn't going to that region as much anymore. You don't have a uterus, so the ovaries die sooner. Which is why when I was 47, when I started figuring things out, I was like, there's no way.

I'm too young. No one had explained to me. So totally different. If you have a total hysterectomy, everything's taken out. Everything should be replaced post-surgery. If you have a partial, like myself, you've got to track those hormones. But again, that's where parimenopause comes in. And I want people starting hormones early.

So the answer to that is you got to start hormones early. Okay. Any suggestions for women who have PCOS? My wife suffers from it and has all the usual symptoms. I don't claim to understand PCOS or women. But some suggestions would be helpful. Thank you. So on PCOS got rebranded this year.

What is PCOS? Well, PCOS stands for polycystic ovarian syndrome. It had kind of a narrow, like how you were diagnosed it. An ultrasound, you had to have 20 follicles. A ring of pearls was the standard classification. And missing periods, irregular periods, it affects fertility. They renamed it just two months ago to PMOS. So the polycystic ovarian syndrome is no longer a thing.

What did they rebrand it as? They rebranded as PMOS, which is more of what it actually is. It's more metabolic. So polyendocrine metabolic ovarian syndrome. Okay. Yes, it involves the ovaries, but it's also you see a ton of insulin resistance. So you could be my size and still have it. Because most of the time, a lot of people think, oh, insulin resistance, that they're really overweight.

But you could still have insulin resistance be smaller, having irregular periods. These people tend to have more acne on their jaw, more facial hair. They can have hyperpigmentation of their neck and armpits and groin, which is interesting. This hyperpigmentation is a sign of insulin resistance. So this, like, I would ask women, I'd be like, is your armpits darker? and they would be yes, and I'm like, hey, you have insulin resistance without a lab test. So. Odd expression of that.

Well, it's the hyperpigmentation that comes with it. So what someone like, if they have that known diagnosis, one of the biggest things I've seen help is the GLPs. Interesting. Yeah. So the GLPs bring down the insulin resistance, bring down the inflammation with it, can actually help cycles become more regular. So that has been for my PMOS girls, one of the biggest things. And progesterone. So in PMOS, they tend to have more androgen.

So their testosterone levels normally run higher. It's the pathology of what's going on in the ovary that they kick out more testosterone. This is another one. I think a lot of people on your side of the table, meaning women, will probably resonate with. Most insurances won't cover testosterone treatments for women because it's not approved by the FDA. At least that's what I have been told by our insurance. Is there a press to get FDA approval? We are in Southern California.

This is actually somebody who could probably work directly with you and are out of pocket for my wife's treatment. Have you seen any progress on this? Is there, it's just a hard block? Depending on your provider, it sounds like. This is an insurance question. Remember I said, men have eight FDA approved. Well, that's kind of where I was curious, too, with the military, where it pulled in, like, all service members. I'm like, hey, what are you going to do for women who we don't have an FDA approved?

Military 10 does, in medicine, tends not to work off book. They don't, they have a pretty narrow lane. You have to stay in for medicine in military medicine. They do. Maybe your experiences are slightly different than mine. Did you see him going off book? Maybe. Well, maybe in your arena that they would.

When you're isolating. and well away from the rest of the large machine in the military and they're just like, here's a dish of whatever you want. Treat your symptoms. Sure, very different. But like, say, Camp Pendleton was like, nope. Oh, you should talk about your experience. I mean, so you're saying this because somebody who worked as a practitioner at the Camp Pendleton.

I was going to say Marine Corps Hospital, but I feel like it was a naval hospital. You have, you got to fall in these lanes. You could prescribe, you know what I mean? It was very rigid of what you could do there. Does this basically leave it to being out of pocket? If you find a provider, they make a prescription, but boom, your insurance isn't going to cover it. Is there other avenues that you have heard of that have been successful? For insurance, no.

Writing a check. It's rare that you're going to find. Insurance cover it. There is, it's indicated for hypoactive sexual disorder for women. H-S-D-D-D, hypoactive sexual dysfunction. Is that too much or too little? It's saying that you have a low sex drive for at least. Hypo is low.

Low sex drive for at least. six months and it's distressing. Okay. That is the only indication for testosterone for women right now. Repeat that exact verbiage so maybe somebody could say that in front of their doctor. What was it? H S-D-D. Yeah.

That is- And what are they supposed to say how they're feeling? I have had no desire for sex in the last six months and it's causing me a lot of distress. Okay. That is- Not saying what you should do with those terms, but- That's the only clinical indication. Now we know it helps with brain fog, with mood, depression.

And I'll ask you that in a second. Muscle mass, feeling like yourself again. Had you noticed, or if you can remember, any change in mood on your testosterone journey? I struggle with this one because I'm pretty flatline. I don't have high highs and I generally don't have low lows. And it's not me trying to be like that. I just don't know if I naturally have high highs and low lows.

I, when this, you know, are you open to sharing where you were prior to us starting? What do you mean? Your levels. Do you remember what they were? Right at 300. Okay. So that's where with the military saying, oh, if it's 300 and less, we can go. Six.

Something like that. Six. Yeah. 306. Mm-hmm. 306. Yeah. Which is to me for a man crawling.

barely. I don't know if I would describe, I mean, I have no problems talking about my own. One of the first things I did actually was talk about it on the show because I just want to be transparent. Yeah. And also, I don't want people think that there's this, just magic button that you can hit. I don't think I've ever suffered from depression. And I have to say that, though, based off of how horrendous I've heard some other people describe their experiences. And what I can say is, I don't.

think I've ever felt that. But again, if I have lower highs and shallower lows, that would be a relative term for me. I'd certainly have my good days and my bad days. But for me, the biggest difference that I have noticed is my ability to feel like I am rested versus constantly, you know, the gas state, hey, 50 miles still empty light is on in your vehicle. Yeah. But it also hasn't been drastic. And we're still, you know, two years into this. The last time I had my blood check, I was like, whoopsies, that's a bit too. And I was feeling it too.

I'm like, I don't like the way, and I've been honest about that too. Yeah. So this will be the first check after lowering that dosage down. Well, lowering it, but the frequency is different. No, it was always Monday, Wednesday, Friday. Oh, yeah. I don't think I've ever deviated from that. Oh, no, I did because there was the creed.

Well, at some point, you were doing twice a week. Oh, yeah, I think I did play around with that a little bit. But, I mean, that's the thing. I'm trying to figure out what works best for me. Some people inject every day. I just don't think I would enjoy that. Some people, it'd just be like if you're a diabetic. Okay, here's my little shot.

Yeah, but I'm not diabetic. So I don't think I would enjoy that. Okay. Well, I ask about the move because, you know, Jason working for the fire department, I take care of a lot of firefighters. And the penis gets them in usually. Oh, something's wrong with the penis. That's usually why they'll come in.

And then I'll ask them, how are you feeling? And they're like, oh, Casey, I feel great. My mood is better. So it's so good for mood is testosterone. And it's downplayed, I think. That's why I was asking if you noticed it. I personally noticed a big difference. In Jason?

No, for myself. I won't speak for him for myself. Well, you could speak for what your perspective was as a spouse. I'd have to ask Leah, to be honest. I mean, I mean, objectively, how good are we at rating our own? mental health. Well, I can feel it. Oh, the resilient. I mean, because I was in the shits before I fixed this. So I know. I'm crazy for the vast majority of your life. Now I'm not, but now it's a fun crazy. Is it though? Yeah. Yeah. But I do want to speak to that. The optic on where you're

viewing it from probably depends. But I do want to speak to that though because I think, and you've seen this in your arena and it's really unfortunate is suicide. Yes. But however, comma. It's way more convoluted than this person served in the military and killed themselves. I am the more I talk with people, the more I dig into, and this isn't true of everybody, but I will say that there is a growing cohort that seems to fit with this. There is this conversation of this person was in the military and killed themselves, therefore it is because of their military service. The number of people that I know of now who had the epitome of traumatic,

upbringings before going into the military. And it absolutely makes sense to me why they would pursue that job. If you were bullied and you want to smash bullies, guess what's a great place conceptually to be able to do that. But if you don't deal with that before going in and then you have a job that gives you another full bag of stuff going out and I have heard that the culture and the community is changing and the drinking aspect and culture of that is way down. Spectacular. That was not the case when I was in. And that is not to put a finger on the military and lay blame or anything like that. But it is there. Shit, you were around. It is a drinking culture. We worked hard. We partied hard. And it can be managed, but not as well by everybody. So you layer

on, though, some years of that. Exposure to blast. Exposure to trauma. You get out and then most people will go home where they were from. So isolation from the community. Then they'll isolate from everybody. Dive deep. And again, these are broad general statements that don't apply to everybody, dive deeply back into whatever coping mechanism that they were using before and end up making decisions that are horrible. Is that from your military service? I'll say corollary, not causal. No. But there's this 22 a day, which is a horrible number. And I'm not saying that it's not tied, but I have just, and now the conversations I've had with people, it's such a deeper, more nuanced issue. My guess is their testosterone was also low. There's probably that as well too, because, again,

if you look at concussive blast exposure, all of those things. Like that's all very real in what it does to the brain. 100%. Well, and I was just saying too, you unfortunately had lost too many friends from death by suicide. But I think this can be a very scary arena. And I think women need to be validated that it is documented. It's biologic. It is not their fault.

It is not from too much stress. That that zone of chaos is what causes it. but the suicide rates go up by seven times for women in pari menopause. And mental health diets go up, seven, you know, huge increase risk of suicide in pari menopause. And the screening guidelines as a provider, there's two screenings we use, one for anxiety and one for depression. It's just across the board.

Any provider would use these. It's a PHQ9 and a gad seven. They're kind of missing the mark of what can happen in pari menopause. So I see this all the time. Leah and I were talking about it of how many women she knows, here's an antidepressant, here's an antipresent, right? Where you're missing the root cause is the hormones of this chaos. So maybe they're going to feel a little better, but then they can feel flat and just

and the sexual side effects that are already stressing them out. So I think for perimenopause women really have to advocate for themselves with mental health of looking at the hormones for, supplementing, replacing those for mental health. So here's a question that goes right into that. My wife's doctor does not deal with testosterone at all. The other two meds have done wonders for all her symptoms so far. Why are some providers hesitant to deal with testosterone?

And I'm going to add to that, what do you do if your provider doesn't deal with testosterone? Do you have to go find aid another? Michael, can you pull up the Ishwish organization? So the Menompas Society, he pulled up. That's great for hormones. But just because you do, you're an MSCP doesn't mean you know testosterone. So Kelly Casperson is who I trained with. It's...

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Bitcoin services are by Block Inc. See the Bitcoin Disclosures at cash. Dot app slash legal slash podcast. Back to the show. It's nuanced in a sense. You've got to understand how the hormones work and the testing and that. This right here is a great organization. They're for sexual health for women.

And they have a list of providers on here. Most of the providers on this list will prescribe testosterone. So this organization is very, forward thinking and advocates for um will they do it telehealth it did yeah they'll do telehealth but some of the like i have to have a DEA license to prescribe testosterone it's a controlled substance i have to pay eight hundred dollars whatever but you know there's an extra barrier you have to have a DEA so there's some other loopholes you have to go through but i think there's also this fear of when i'm giving testosterone they're going to overdose or women are not titrating or treating to a beard.

No female wants a beard, you know, well, I can be careful. Not my wording on that. But most women aren't titrating to a beard. You know what I mean? Like we just want to feel better. Yeah. So it's not here, we're not here abusing it. Okay, here's a super long one.

And again, I'm lost in some of the verbiature. I am perimenopausal and initially started HRT with subcutaneous testosterone and progesterone. so needles. My libido and clitoral sensitivity improved dramatically. But my mood. This feeds into our accessory. I know. I was going to see if Michael put the pieces together,

but honestly, he's not good at puzzles. But my mood anxiety and irritability were still significant because I wasn't taking estrogen. Next paragraph. I switched to a women's hormonal clinic and started oral estradol. 0.5 milligrams daily instead of a patch due to supply issues

and because my family history of colon cancer, my mood is so much better in capital SO. So emphasis. But within weeks, my clitoral sensitivity decreased by 75%. My provider feels the estradiol dose is too low to be the cause. And increasing my testosterone hasn't helped after a month. So here's the question. Can even a low dose of oral estradiol,

is it estradile meaningfully increase SHBG, the sex hormone binding gobulin, right? Is that correct? Yep. Yep. Or otherwise reduce free testosterone enough to affect libido and clitorial sensitivity. If so, is switching to transdermal estrogen a reasonable strategy and how would you approach that conversation with a provider

who doesn't think the oral estrogen is responsible? That is a lot. I hope you got that. No, and we talked about that. We talked about that. Remember, like if you're feeling good on this testosterone dose and then all these women who are probably going to have to switch over to oral because we don't have patches.

Yep. And that raises the sex hormone binding glabuline and sucks up what's circulating free in the blood. Yeah. And you can't, I don't think as a provider, you can't be like, well, this dose doesn't, you can't feel like that. You know, this is. So what is, so this person is trying to find a happy medium essentially? Right. She's being told that her feelings are not.

No, they can't be from that. That's not true. This is the thing. You got to listen to the woman in front of you. If you're feeling it, you're feeling it. So switch, get off the oral estrogen and go to a patch. If you can't find a patch, though. Then there's that estradial gel that you can use.

Or if you have to use oral, you've got to bump up that testosterone. This is what can really freak out providers. Like say a woman's total testosterone, say it's 190, right? That's going to be red, red, red in the labs. going to die. But her free testosterone is barely in the upper limit. We're looking here.

This is what's doing the work. Yeah, the total's high, but it's bound up. It's not doing anything. So you either have to raise this or go to a patch. And having a family history of colon cancer, estrogen in itself will lower,

taking that will lower at colon cancer risk by 40%. The route how you take it doesn't matter. So she needs to either increase her testosterone or go to a patch or transdermal. What? As men. How can we best work to prepare for this, especially if our wives are nearing perimenopause? So I'm going to say 35 or plus I would start tracking it. And you can get a period tracker on your phone. You're saying men should get a period tracker? 100%. Oh, this is so we know when to play hide and seek. Yeah, 100%. You get a period tracker.

Yep. And you put it on your phone. Michael, that one slide that had the dips and things, remember? And I'll teach the men how to. So. This is how, this is survival 101 for men. You get a period tracker. Okay.

And you start tracking it. So you've got day 14, day 12 to 14. If men think they're going to have sex, highlight that with stars. That's going to be your go days. 12 to 14? That's going to be it. After the end of the period? No, day one is when the period starts.

So day one, usually on the apps, it has like a, usually has like a drop of blood or something. And day one. Day seven is where it would end, usually? Usually. Some women shorter or longer. Okay, look at 12 to 14. See the heart? That blue line is estrogen.

That estrogen helps with sex drive. This is when women feel their best. What's LH? Lutinizing hormones, the brain. brain horns. Okay. So that's the thing's peaked at like the midpoint between 13 and 14. If you think you're going to have a chance at all, it's going to be day 12 to like 14. That's it.

You're screwed. The rest of the month. Michael, are you taking notes here? Okay. So estrogen is that blue. It spikes and ovulation. It comes down. Okay.

The pink in the back, you'll see like day. Deludial phase is the back half. You'll see the progesterone climbs, climbs, climbs, climbs, climbs, climbs, Estrogen is also climbing. It looks purple because it's overlaid. Okay, day 21, there's no pregnancy. It crashes. That dump is the hiding.

That is you've got your MREs in the closet. At day 22? 21. You got your MRIs, you got your snacks, you got your, you're not breathing. No sniffing. No sniffing. No chewing. That was one of the other ones too.

He goes, guys, I... No chewing. I messed up again. I chewed my food. suggestions? No. So basically what you're saying is from day 21 through day seven. Day 21 to 28. It resets at day one. So J 21 to if it's a 30. Everything is still looking low over on the up to day. Yeah, but we're at the back end here at the cycle. So you can track when the hormones will dip. But this is honestly, if a female has a provider who's working with them in perimenopause, my goal is they don't feel that dip. I bring women's hormones up, progesterone and estrogen up. And dip so they don't feel that so that crash isn't happening so that that is where I come into play now if you have a partner who isn't this is when you're camping in the car you know right here

it's really sad though if you think look at that you get women get maybe two to three days out of the month where they have energy feel their best on managed HRT what do you think you could increase that to as opposed to two to three days and managed you think you could gain a couple more days? Like, what are we looking at? Weeks. I can get, oh, the women I work with, it's night and day. It's weeks. Like, yeah, sure, you have a few days that aren't your best. But right, even there, women with headaches and migraines that dip right there in the ludial phase. The brain is super sensitive to the dip. So I can get, I can control headaches and migraines. Most of my mind, I can get most of them under control with hormones. Here's a good question. When does parameda

start and how can you tell it's starting and do you find a provider when you start to notice symptoms or should you find one before what's a good strategy for this so the most two common things that women complain of paramedopause not being able to sleep you can relate to that and change in mood the irritability right the just not feeling like myself so they say could be 35 but to be honest if you feel, start feeling those, I don't care what age you are. Like, I have patients who are 83. You know, I was talking to her when we were up here, my 83 year old cute patient. Like, it doesn't matter to me your age. Just get help. But for pariomenopause, if you're just not feeling like yourself, I would get help. Would you start researching it before you feel like you're getting

to that area? So you know where you to go? You have a plan? Sure. I mean, you could go. The hard part is like, where do you go? Right. 4,100 of us who have the certification. Um, So on the Menopause Society, you can search by your location. It'll pull up. And then Dr. Mary Claire Haver, who I recommended, she is probably the, she has the largest platform for women's health right now. She also in her books has a list of providers, too. A couple people have referenced manopause. What is that?

Yes, manopause. Well, the technical term is andropause, but that's boring. Okay. So I like manopause. Well, same like thing that you will see. Like for men go through it, their hormones dip. They tank. They lose.

They don't have energy. The brain fog, the mood, lack of muscle, getting that adiposity, they start gaining weight. So I find when I work with men and women, if I only bring up one, you get this disbalance. So it's best if you can bring up two. Okay. Any advice for hormone replacement and treatment for adjutement. Addison's patients, which I don't even know what Addison's is. So Addisons has to do with your adrenal glands.

Adrenal glands look like a little kidney bean that sits on top of your kidneys. Okay. And it produces, it's important for like cortisol. So for Addisons, you have to take cortisone or a steroid the rest of your life. You just sort of affects sleep, mood, energy. So you have to deal with the Addisons in addition to this. Yeah, but it doesn't like preclude. You can do anything.

with that. So just because you have Addisons, you can still do all of the other hormones. Since menopause, my hair is extremely dry and brittle. This is a hard one. What is the most effective way to improve the health and moisture of my hair? This is a hard one. Is it? Mm-hmm. Okay.

This is a huge complaint. And a lot of women I will see will blame it on testosterone or GLPs, which can be a thing. You'll see women lose a lot of hair on GLPs. Really? Mm-hmm. but here's why I think's happening. If you're not eating, if you're not getting your protein, your body sees it as a stressor.

So it dumps the hair. Now it's not immediate. It's three to four months usually after you start it. But if you look at women, you probably have done this. Elder women tend to have like hair thinning in the temples or the part here gets whiter. And we just lose a lot of hair. It's just across the board.

So it's super frustrating. and I think of hair for women. This is our crown. And it just starts to thin as we age regardless. So estrogen can help testosterone. Some women are really sensitive to DHT. So when you, especially by skin, if you put testosterone on your skin,

increases the DHT, which can make hair fall out. So one way around that is you can do injections. There's plus or minus info on using some, Palpametto, pumpkin seed oil, Nutriful. I know if you've ever heard of them. They're a popular company that does hair supplements. About yam cream? No, no yams.

Andy's rubbing yams in his hair. I'm just trying to find. You genetically have good hair. Dad's is out of control. What do you mean? It's a real force. He still has some. Which is impressive at his age.

It's impressive that it's all over the place at all times, but I mean, yeah. So for optimizing estrogen is huge. If you're on GLPs, you have to eat, right? How many people do you see that'll just, they just don't eat? They just rely on the shot. Do you think some people are taking GLPs because they don't want to eat as much? I mean, it is an appetite suppressant.

Oh, no, I think it's, and for alcohol abuse, there's studies come, nicotine. Like there's a lot of addiction. There's a lot of great things for them. but if they're dose too high or body image issues could play a role in here. And if they just stop eating, you're going to dump your hair. Oh, that makes sense. Yeah. Slight divergence here.

What's the best supplement for prostate health? So there was this, the traverse study came out. There was for men saying that testosterone was going to cause prostate cancer. So kind of like, okay, estrogen causes breast cancer, right? That was the big concern. We know that that is not true. there's this concern oh does testosterone cause prostate cancer and the traversed trial showed that the data doesn't support that so taking testosterone yes it can bump your PSA number your prostate number we trend that your provider should be following that if you're on the metrics or the little things in the reports yeah if you live long enough for a man you're going to get prostate cancer it just it grows so there are some things like saw palmetto again not great data on it but to help protect prostate health.

Pumpkin seed oil. But there are actually some people who are using, even after prostate cancer, they're giving back testosterone and not showing recurrence. Michael, this one's for you, totally off topic. Hey, Andy, has anyone ever mentioned to you that Michael looks like Mark Zuckerberg? Just saying, there you go.

Just wanted you to feel included, Michael. People are thinking about you. Thank you. Let's see what else here. Covered that one. we've actually made quite a dent in these. A couple of questions about over-the-counter testing for paramedipause, but like you said, I don't feel like that's effective.

Yeah. Kind of answered that one. It's going to, if you took it four times in a day, it'll give you different answers. So it seems like you treat the symptom a lot more than manopause, yep. There's a yam cream one again. What was your friend's question that came through last night? Oh, I think we answered some of them, but I'll go back over there. Let me see if there's any more in there.

What is best an older woman who hasn't been treated but is now having frequent recurrent UTIs? Do you know the answer to this? Cranberry juice. No. It's the vaginal estrogen. Oh. What? I know the answer to that.

We did it last time. Oh. So Jason, you know, he on his medical aids, especially where he works, a lot of older people. and it's a lot of elderly women who fall. And I ask them, where did you find them in the bathroom? And the reason why for elderly females don't have to be elderly, that UTIs and women as you get older make you confused. It's not the young girl who's got to sit on the toilet,

who's peeing all the time have pain. They get confused. What happens, an older female gets up, she's confused, goes to the bathroom, she falls, she breaks a hip. So vaginal estrogen will save life. I tried to get Jason to tell people at the calls that CPR for the vagina was vaginal estrogen. He said that was too much. I don't think that the San Diego Fire Department is going to sign off on that level of...

No, but he has been really good at telling, like, she needs vaginal estrogen because it will decrease the risk of UTIs, which decreases hip fractures, which decreases death. Okay. So vaginal estrogen, everyone can be on that. Even active breast cancer patients can be on vaginal estrogen. How does stress, everyday stress in parentheses, and also the big life events affect our female hormones, divorce, family, trauma, life, death? Is there a big difference for men versus women? And this is a very different question. How do women who have had no sexual experience get doctors to hear us to get our hormones checked, our bodies properly checked, and to hear our concerns?

Yeah, I think I actually responded to that person. Well, guess he was calling? Should we answer? No. We should not. If he was in here. Hi, Dad. Oh, let me talk about my testosterone and what's going on now.

He studied for days to be able to say it correctly because I had mocked him so incessantly. My tetosterone. I'm on my tetosterone. Dad. Oh, are the fans wanting, do the fans have questions for me? I don't think sexual activity in any way should dictate if a woman gets help, right? Like I actually I don't and maybe this is my reading it wrong no how do women who have had no sexual experience get talked are they saying earlier in life or someone later in life who just was not interested in sex I'm trying to understand where this lands maybe they've never had sex okay right I don't think your sexual history should be an indicator if you feel good the rest of your life no I think they're completely independent yeah yeah and so I to be honest if you saw a provider and that's a And that was their question and that was their hard stop.

Next provider. Trauma, trauma is actually really, so trauma rears its head and paramedopause. And so I do what's called and women. Because they're traumatized. Yes. The men are. Yes. From the.

You need to focus on paramedopause from a men's perspective. We're the ones who are suffering here. Oh, I don't doubt it. Yeah. I mean, I've been very open that Jason and I almost got divorced during this time. I mean, I is pretty fun. I don't doubt it. But so I do what's called trauma-informed care.

So in my intake questionnaire, actually have... For the men. Yep. It's on the men's page, too. I'm joking. It's on the men's beach, too. But for the women, I actually have a trauma history. And it unfortunately seems to rear its head in pari menopause.

Is that bumping the suicide risk also, potentially? But trauma that a lot of women have stuffed and buried rears its head in pari menopause. Men and women, I mean, I think just for me, be for mammals, not dealing with your traumas. It's not a great strategy. You can either deal with it or it's going to come deal with you at some time, probably your lowest points. And then what are your, I think we covered all the questions, which is good.

What are your thoughts? I'm going to shift a little bit to peptides. And I ask this because depending on what you, how your algorithm for people out there listening is what you're looking at, it's a wild ecosystem out there. do you think that and I've I can't say I have deeply dove into this but have read some stuff where a lot of these peptides especially from large online influencer platforms being sourced from China which and I have seen some people who are the opposite spectrum of the influencers who are buying some of these and testing them and holy cow oh yeah and they're not scrubbed well and some of them contain way too much some of them can not not of them can not have Nothing. Yeah, nothing. Everything in between.

I know your stance on peptides, you're pro-peptide, as I am myself, but again, it's a tool. But you also, you have to be so careful where you're getting your information from. And then also the product itself. So do you think that this ecosystem of really large platforms, really promoting this, is this net positive or net negative or yet to be determined? Because if you're like jabbing stuff, you don't even know. Well, they're making money. These influencers with no medical.

The people background are making money off of this, right? And I go, oh, look at some of these going, you don't even know what you're talking about. And what if someone just goes to a pet tide and we're actually missing the root cause, right? And I get it. People are desperate. And if you're scrolling on Instagram, oh, for $50, that's a red flag. Well, you can make it worse. And this is where I understand organizations like the FDA wanting to say we need to regulate this,

but also at the same time, I don't like how their arms reach from Big Pharma who's trying to regulate. as well because they see how massive it is and try to cut compounding pharmacies out. But also, what's the lesser of two evils? Having some level of quality control and yeah, it might go under the realm of big farm, which I'm not advocating for, or you're ordering something from overseas and you don't know what's in it and you're just hoping for the best. You know, live your life however you want to. Right.

But maybe not everything you see on Instagram is the best idea. I've had, since I've been practicing three, four patients now become peptide distributors. Like, they're selling peptides. Interesting. Where are they sourcing them from? That's the thing. Like, where are your sterility reports?

Where is the purity reports? Where are you getting them from? Because there are compounding facilities in the U.S. There are. And so that thing, you know, you're friends with Brigham and he's a big advocate of this. And the FDA, I think it was six that they just said, we'll go in front of the panel.

They did not get approved. They said, okay, we'll put these in front of the panel to see it. The next step is to see if the FDA will approve them for compounding. The only one I recognized in that was the BPC-157 TB-TB-5,000 combo. That one was in there. There were some other ones, but I didn't recognize the other ones. Yeah, I don't know them all off the top of my head. I knew which ones they were, but I don't know them off the top of my head.

But it's very concerning because then what happens, you start having adverse effects, too, right, from these people. And then other organizations can be like, see, they're bad. They're bad. One triggers the other one. So you're choosing between, I don't want big pharma involved in control of peptides, which are naturally occurring. And I think big pharma has shown they've done some amazing things. And then also they operate off of bottom line.

I get it. I'm not, I understand what that is and I don't want to interface with it as much as possible. In my personal choices, I choose not to do that. I do like what Brigham's got going on. I do like the idea that there are ways outside of just Big Farm where you can go through providers. And the cool thing about Brigham is he's vertically integrated. We're talking about the founder of Ways to Wells. But he knows where it's coming from.

The issue is it's Shop Now button. And yeah, it'll show up. But I mean, what is it? Well, saying you can buy the GLP's online, you know, through the influencers too. You don't know what you're getting. So I think that that's where we're going to run into a problem. I don't know. I don't know.

I don't know. I don't be more effective at regulating that or throttling that if it would be the platforms itself or it would be neither of those are great options because then you're talking about censorship as well too. I mean, peptides have a role. Insulin's a peptide. Basot tracing you put on your skin is a peptide. People are using peptides and they don't realize they're using them. They've been around for insulin was like 1920, a long time. It's the, like you said, the wild west of people going crazy with it.

I know one thing that we didn't cover. that came up by selling a couple of questions is thyroid. There was thyroid questions on there. So thyroid, it's a little butterfly, sits in front of your neck, and it regulates the speed of your body, your metabolism, your sleep, your energy. So if it gets sluggish, it looks like perimenopause. So it would be good if someone, you can get a thyroid panel. That's not just a TSA.

That's what people are superficial scratched the surface. You want to know your storage form in the tank. what's free circulating. Is this for men and women? Yeah. Do you have that in my blood work? Yeah. Okay.

So I was... All I know is that when I'm getting my blood drawn, I just, they keep going and I say, please leave me some for the drive home. Also, where's the nearest orange juice dispenser? But, well, I think it's because of the lab company, which is crazy. The same panel that you get drawn, I draw in my clinic, it's three tubes. So their explanation was because we ship this one here and we ship this here. their processing is not in one place.

I feel like if my, what is it, hematocrat, hemacrit, if it was high after my, no, no, you're good. You're good. I was going to say, I feel like my biannual blood work is doing my job. But that's why, because they ship out. I draw the same in clinic and in three tubes. Man, they just keep going. They lay it all out before. I'm just like, I don't know how much of the hydraulic food we have in here, but save me some.

Yeah. So thyroid's a big thing. And people will, oh, my thyroid's low. It can feel the same. perimenopause and hypothyroidism, low, looks the same and feels the same. But you've got to do a deep dive in your thyroid labs too, because they can overlap. And if someone's on thyroid medication and does oral estrogen, you have to increase your thyroid medicine. This is where it really, you've got to find someone who knows this dance, right?

Even if you dial all this stuff in, but your lifestyle metrics are just trash, are you basically pissing into the wind? And that's huge for me. I have, what are the, I always pronounce this wrong, what dad makes, the rocks? Oh, the, what are those called? Karen. Karen. Karen. See, I always say it wrong, Karen.

So I use that. Rock Karen. So I have one in my office and I use it to teach. And the bottom rock is sleep. And the next rock is exercise. And the next is nutrition. And I tell my patients, if you cannot get these stable, I can't even build on top. You know?

Because so many people, I get it. They just make me feel bad. I'll just inject, right? I understand why they are feeling that way and why they want it to be the light switch, but that just isn't the reality. No, but I teach to that. We have to focus on sleep. We know for Alzheimer's, if you don't sleep, your risk goes up.

Heart disease, everything. Sleep is key, which is really hard for a lot of people. So that was a question. I'd also have people do deep dive on lipids, not just your standard cholesterol, triglyceride. do the lipoprotein A, you know, it will be. So doing all those would be on there. How close do you think dad is to getting it at home? Michael's like, do I get an opinion on this?

Yes, Michael, you can, you're welcome. You're part of the family. Well, I don't think that he'll listen to this because he can't figure out how to listen to your podcast. Did you know that? What? Yeah. I said, oh, did you listen? There's some podcasts you had done.

And I said, oh, did you listen? Well, how do I do that? How do I? Did you know, Michael, the Chinese hacked him too? He's been hacked by the Chinese. They did it. A real thing that he said. No, what's a real thing is?

He really said that. He was hacked by the Chinese. No, he really said that. What's a real thing is Jason born of electronic devices, aka my dad, somehow went into his settings and changed the language to Chinese, which I'm going to assume is actually a bitch to undo, especially if you go back to the home screen. Yeah, you'll know where this, if you can't read Mandarin,

It's pretty tough. So he convinced himself that because of his intelligence value to near peer adversaries, that China had hacked his phone. Yeah. So where would you go if you thought your phone had been hacked or you needed help with your Apple device? Where would you seek help for that? I mean, probably. I don't even know, actually, the internet, first of all.

So he went. That's a no-go. He can't get online. So instead, he went to his cell phone provider, Verizon, and demanded that the person that he encountered fix his phone. So they factory reset his phone because they're not tech people. They're there to sell you a plan. He has no contacts save in his phone.

Yeah, they did a factory reset. That sucks. He's got one, but it's not anybody in his family. Yeah. And so he'll just, he has convinced himself, well, I know the numbers that are important to me. He doesn't even have me saved as a contact. No, we are doing, we are being very responsible children. And we did his advanced care life directives, which everyone should have, right?

I'm a huge advocate for. Actually, talked about what you were going through with him so people can think about this. A huge advocate, like working, like, working, like, What I saw in the ER, what I have to deal with with people not having their wishes working in hospice and people not having it spelled out, right? So I don't care. Even you should have it. Like we should have it. Oh, they used to have us update our wills. Yeah, well, you were in a different situation. There's not really an advanced care directive. But like in everyone should have it where do you want CPR or not? It's the pulse form. Do you want CPR? Yes or no. What kind of care do you want? Do you want full care? Yes. I want to be intubated. I want a ventilator. Give me everything. All that stuff's good, but if somebody, if a nine, like say you stroke out at a restaurant, somebody calls 911, how are they going to know that?

If you don't, yeah, if you don't have it, right? Most of the time people will put this on the fridge. Fire goes in and they're looking on the fridge. No, I get that, but I mean, you're at a restaurant. Right. So then what happens is you hope you've had a conversation or you're with someone and they'll be like, call the person who is their health care proxy. That's why you and I have to each have a copy of this. as the 9-1-1 responding personnel, they're calling you to say...

No, they're doing full code. That's what I'm saying. So they're going to be doing a lot of the things that you might have asked not to. And that's... But say you and I are there with them, then you can be like, no, you know. But otherwise, yes, what they have to do is they have to run a full code until they get to somewhere where it says otherwise to stop. You just can't do that. Did I ever tell you I had to do the Heimlich on dad one time?

I was there. Yeah. And you said, Kesey, Kesey. My dad. And I'm like, you're bigger than me. dinner roll in his mouth and didn't want to say anything. I was sitting across the table looking at him. He's over there.

Yeah, and Andy's looking at me. Andy's looking at me. I'm like, I'm like, I'm like, the nurse. Handle your shit. Look at me. I'm like, I'm not going to be able to do anything to this large man. Full on. Had to go, God.

I looked him three times. It came out just like in the movies too. And it came out at a fucking dinner table. He ate that roll by the way. He cut it in after. Yeah. That was it a Thanksgiving. Thanksgiving dinner.

That's awesome. Yeah. How long ago was that? Years. Yeah. Well over a decade ago. Yeah. Yeah.

The journey never ends with that one. Yeah. So. So healthcare proxy is directed. Proxy for everyone. Yeah. But then, yeah, if 911 one gets called, they're probably going to violate those things. And that's all right.

You just, you have to, like, if I'm in that shoes, I don't know your wishes. I'm going to do my best to save you. Right. And you just do that. And then when they go to the. You got a better medical kit first if you're going to save people. Oh, I know it's pathetic. Have you shared your story of?

No, I'm not going to talk about that. Okay. Yeah. That's, that, yeah, irrelevant. Okay. All I'll say is this. If you actually want to be useful and helpful, you need tools and knowledge and understanding how to use them.

Yeah. I have tools, just not as good of tools as yours. And don't go Co-Black. Co-Black helps no one. I don't know what that means. It means you're fucking, you're physically present but not mentally aware of what's going on. You're overwhelmed by the circumstances you're dealing with. Oh, I don't run into that situation.

Well, if you're ever out in town, and people are not used to seeing relatively traumatic things. They'll be standing there. Oh, yeah, no, no. And you can look at them. They have the apple squirrel wheel of death. That's code black. You're code black.

Physically present, mentally checked out. I mean, call me weird, but I love those situations. You know, I love to be able. I mean, the craziest one was working on the damn airline with Carter when we were flying to Brazil for eight hours working on that guy. Yeah. That was the most expensive. What would they have gone if you hadn't been on board, do you think? Land of the plane.

plane. They wanted to land the plane. And I was like, I've got a tour to go on. I'm on vacation. I have a con I have got to get to Brazil. Did you have part of their handing you medical devices and providing bedside care? No, Carter said I was like, Carter's like, mom, I've seen you do this so many times. I'm just going to play my video games. You know, and I'm working, you know, a cheap airline we're on. A guy who speaks. Stop budget shopping airlines. I know. Your poverty mindset is disgusting. Korean guy speaks no English. He had passed out diaphoretic. They haul him on to the four-seater, you know, seat, haul him there.

His other friends are Korean, hand him all these pills. I'm like, don't take these pills. I don't know there. How is he even going to take them if he was? He takes a handful of pills in front of me. Hell yeah. He just had stents place. I'm like, great.

We've got a heart situation. They bring me this bag of like, you know, for fluid. There's 250 bags. Right? 250. So tiny. I'm used to leader bags. Oh, yeah. The 250 bags are. There's turbulence. I'm like, Carter. This is how Carter assisted me. I'm like, Carter, get me my readers because I can't see to start an IV. What gauge needle did you have? I didn't need. I'm working in another country. I'm just like, let me see. I think I started with a 20. Oh, that's not bad. No. But we used to have us practice with 14s. Fuck that. Yeah. So yeah. Let's do IV training. We're at. out of 18s and 20s. Here's some soda straw 14 gauge needles.

Well, you guys, your A.C. Would be able to. Oh, does it make it feel any better when a soda straw is puncturing your vein? No, it does not. So, yeah, here we are. And we're right over Panama. And they're like, we need to land the plane. I was like, give me 30 minutes.

I'm like, I've got to get on this little tugboat with Carter in the Amazon. What did you learn from this experience? Oh, it was great. We had a great time. Life was saved. the whole, there's like 500 people on the plane. I get him stabilized. Did he eventually come back to it?

Yeah, he was stabilized. And then I said, do not pull your line out because all I had was 250 bags. I had to keep just changing him out. We land and he's so mad, rips the IV out, is bleeding everywhere. So the paramedics show, oh, it was a hot mess. But Carter goes, Mom, I just gave you an air clap because I've seen this before. Perfect. I love it.

That was like. Yeah. Yeah. Well, yeah, there you go. Have advanced medical directives. And, you know, don't take a fistful of pills on planes. Maybe that's... After a stent and you've passed face, like face plant in the aisle.

Yeah. Yeah, they had nothing. They didn't have, I got a blood pressure cuff. Yeah. Passed up. It was like, where am I? Third World. People are passing up the medical tools they had in their own carry-on to help me.

Someone passed me up a blood o2. sat had. Someone passed up their blood pressure cuff. It was crazy. Well, at least you were there. It was crazy. Yeah. Well, how can people get in touch with you? Oh, well, and I have to say, too, the reach of this, and I talked about this, of that lady in South Africa, right? Of you opening up this platform to potentially a way to help another country who doesn't have help. in this arena. Once I hit upload, I have no control. It's fascinating to see how the internet works like that. Right. But even like me getting the opportunity to speak with her and in real time seeing what South Africa had and her excitement. And if that leads her excitement to teaching other

women, right, that's what we need. It's going to be a grassroots effort. It's going to take too long for my age to catch up, right? So it's going to be women teaching women. And so I thought that was amazing to work with her. So currently I'm licensed in California, Montana, but what I saw happen is, you know, people crying miserable throughout all the United States. And I'm like, do you have a desire? I mean, not that it could happen overnight, but do you have any desire to increase the number of states that you are, would you say registered in? Licensed. You have to have a license. So, and then there's just me, right? I'm solo provider. And, and, and, you know, And I love helping.

We've talked about that. That's a scaling problem. Right. Well, and that was the thing. You know, I'm very fortunate. I'm very fortunate in the growth that I've had. I'm very fortunate in how people trust me. I am very different personality than they're used to.

And they either like it or not, right? But I think my results speak for itself and people can relate to me. But what happened was is just myself. So I have decided to train other providers to work under me. so I can help more people. And then in the rest of the United States, I'm doing coaching. Are you going to increase the states your license in or keep it? I don't know.

I mean, honestly, I've had patients to be like, I'll pay for your license. I will pay for this. Is it mostly paperwork? It's paperwork and money. That's all it is. Those are softened, though. Oh, yeah. And I have.

You could hire somebody to just do license, licensure. Yeah. Licensing. Yeah. And I have patience. They'll say, I'll pay whatever, Casey. So you can see me here. Are you looking at that?

or so that's still a little bit too far as you scale? I mean, it's always a potential. But what I can do now is coaching. And so a lot of providers don't have time to learn this medicine. And I have found providers in other states or even you could go like, hey, I found a menopause or peri monopause specialist. Would you work with her? And what I do is I do my initial intake.

I write it exactly their plan. They can then give that to their provider who doesn't know this medicine and can prescribe it. I still can help with the follow-up with recommendations. I'm just not doing the prescribing and management. So the coaching is what I've been able to do all in the U.S. Okay. So California and Montana are my two. So Best Way is on the website.

How's the phone number? Give people your email. It's fun. My personal cell phone. Yeah, those are fun. Instagram people can reach out to me, but scheduling will have to go through the office. What's your Instagram handle or username, whatever it's calling? KC.stumpf.f.f.fnp.

What do you want to close that with? I think just gratitude of being here. Us being able to... Here is in like the studio? Yeah. Us being able to do this. Being able to get to share my passion here. That's huge. Not a lot of people give me the opportunity to speak like this.

Which is wild, considering half the Earth's population is women. Yeah. But I think just gratitude that I get to even do this, that people trust me. Okay. Michael. Oh, yes, we have to close out with the show and tell. Still haven't figured it out. I'll be honest.

You what? Still haven't figured it out. Okay. La la la la la. Copy of adult sex ed. Will you go to that one? This one here. No.

Are you going to copy of adult? Okay. You're going to have to scroll down like probably 20 slides, probably. you may see some things that'll scar your eyes. They really will. He's sensitive. Keep going. Do do, do, do, do, do, do, do, do, do, do.

Okay, stop. Go back. All right. Now what do you think it is? A representation of that was on the screen. So I find this super interesting. And adult sex ed is a really big thing I love to talk about because there's not many providers who do this. But in utero, we look the same.

like 10 weeks and then we differentiate. So a male's erectile tissue you can see, right? Hello. Saluting and women have the same tissue. It's just tucked beneath. So this is a full representation of what hides, yeah, of female erectile tissue. Which is why you're going to get one so you can study and practice. Yeah.

Take home homework, if you will. It's your parting gift from the show since you're quitting. Wow. Thank you. Yeah. So that is in utero. We have the exact same anatomy, male and female, is just 90% for women is tucked.

We all have dongs. That's what you should get from this. Wow, that's beautiful. Hobby has a dong too. He does. You get the silver one. Oh, hell yeah. That's awesome.

Take it on tour with you in rugby. I will. Actually, honestly, Michael, it's the best parting gift from the show ever. I feel like your life, you are ready to now go on the road. and teach others what you have learned. Yes. Very knowledgeable about it. Oh, look and teach on the rugby tour a yoni massage.

It's spelled Y-O-N-I. Before we get completely off the rails, we're going to go like to wrap this up. It's not off the rails. No one talks about this for women. What is it? What's a yoni massage? A yoni massage involves massage of all the tissue. Stop.

You can have a conference with Michael afterwards. Yeah, I just looked it up. Yeah, look it up. Listen, I'm here to educate both men and women. That's great. Spectacular. So. All right.

We have to get back because I'm sure Carter is already pacing, waiting for Huckleberry Day. Huckleberry Day. Is that what are we doing going to Whitefish? Yeah, it's Huckleberry Day. Have you ever heard of this, Michael? Huckleberry Day? Is this like a fair or a...

It's a festival in Whitefish. I think I'm going to let you guys explore that on your own. I have limited, if not any interest at all, in Huckleberry days. We'll see if dad shows up in his linens. Dude, no shoes. Shows up at the house, no shoes. Powerful. Like, just barefoot.

Just a fucking hot mess. Mm-hmm. Yeah. Tucked in shirt. His shirt was tucked in the zipper was up. Yeah. I'll give a credit. I'll give a credit that the zipper was up.

Yeah. And one of the pant legs wasn't soaked in urine, so that's a positive plus. All right.