The Checkup with Doctor Mike - Is Your Women’s Health “Expert” Lying To You? | Dr. Jen Gunter

Episode Date: November 5, 2025

I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Huge thanks to Dr. Jen Gunter for joining us on this episode!Website: https://drjengunter.com/IG: https://www.instagram.com/drjengunterFacebook: https://www.facebook.com/DrJGunter/Twitter: https://twitter.com/DrJenGunter00:00 Intro01:30 Blaming Reels09:10 Her Journey21:50 Hormone Tests31:22 Taking Advantage Of Women40:10 Women's Health Initiative50:14 Menopausal Hormone Therapy59:50 Testosterone Therapy + Estrogen1:15:57 Birth Control1:26:46 Working With Big Pharma1:42:05 MAHA + RFK1:59:21 Dr. Gundry Battle2:06:00 Starting Her Own Supplement Company2:08:32 Yeast Infections + ProbioticsHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

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19 plus Ontario only. Please play responsibly. Concerned by your gambling or that if someone close, you call 1866-3-3-1-2-60 or visit comixonterio.ca. So do you think the internet scares women away from birth control unnecessarily? I think the internet is both an amazing and a terrible tool, and it depends where you end up. When you Google something, what comes up is on what's the most scientifically valid, what comes up is the most popular. Do you think that not enough women are on hormonal therapy? Welcome back to the Checkup podcast. Lately, social media has been absolutely flooded with wellness gurus and even medical doctors.

making all sorts of claims surrounding women's health. Based on what I've seen, there's been a lot of fear-mongering and shaming regarding women's bodies, usually done to encourage the purchase of some sort of quick-fix supplement or product. This is why I'm so excited to host Dr. Jen Gunther, who's a board-certified OBGYN and pain medicine physician,

a two-time New York Times best-selling author of the Vagina Bible and the menopause manifesto. She also writes the substack newsletter, The Vagenda. She's one of the most prominent critics of wellness pseudoscience and a widely cited voice on women's health from almost every leading news outlet. In our conversation, not only will she tell you the truth about when hormone testing is useless, how hormone therapy is actually supposed to work, the truth about how women are targeted with vaginal products, but she also opens up about her traumatic experience

in navigating the health care system in seeking answers to her children's serious, serious conditions. Please welcome Dr. Jen Gunther to the Checkup podcast. You know, it's better than the one big thing? Two big things. Exactly. The new iPhone 17 Pro on TELUS' five-year rate plan price lock. Yep, it's the most powerful iPhone ever, plus more peace of mind with your bill over five years. This is big.

Get the new iPhone 17 Pro at tellus.com slash iPhone 17 Pro on select plans. Conditions and exclusions apply. I think a good place to start would be the fact that I've been dying to have you on the show. for probably half a decade or mostly because I feel that the women's health space has been contaminated, for lack of a better word, with a lot of misinformation and a lot of look over here while I'll sell you something over here. And I feel like in my world as a primary care physician, I feel like it's led women to potentially make bad choices with their health care, but also perhaps just have a poor understanding of how their own bodies work.

And being a primary care physician, I want to fix it, but I'm not also fully equipped to have every conversation in every bit of detail, especially because in my residency training, I wasn't learning a lot about hormone replacement therapy. It was kind of frowned upon actually when I was doing my training. And I'm excited to learn more about it from someone, more about it, from someone who's actually evidence based in this regard. Well, thank you. I'm really excited to be here and very happy to meet you in person finally. For sure. So do you feel like the situation that I've described is an accurate one, a situation that you've been seeing as a women's health specialist? Yeah, so I would say, you know, I've been active on social

media since 2010 when I first got on Twitter. And I would say that there has been a progression of disinformation online. And I don't have good studies to back this up. But my gestalt is, is this really happened when reels became a thing, when this really short form. fast, kind of inject it right into whatever vulnerable part of your brain it's going into. And, you know, fear is what sells. Fear is what gets our attention. Facts are often super boring, being really definitive cells. And, you know, you and I know that it's really rare to be super definitive.

You know, I can say, yeah, I get the HPV vaccine. That definitively reduces your risk. But we don't have a lot of great data like that. and there's nuances, but nuances don't play out. And so I think what we're seeing is this chorus in many areas of medicine, of this sort of these fast format, you must do this or you must buy this product, or if the real doesn't include that product, every third one might, you know, that it's along for the ride. And we're sort of starting to see, like, I think, an amplification.

You know, once you get, once you tell every single person, that they must be on menopause hormone therapy or something bad, it's going to happen to them. Well, then, okay, when you have all of your followers doing that, then you've got to have the next cell. So then what is it, it's testosterone for everybody, or then it's higher doses of estrogen, or then it's microdosing GLP1s, or then it's wearing a weighted vest. And it sort of, it starts to escalate. And I think it's really difficult for people to sort out the fact from the fiction. Yeah, I've seen that situation that you're describing,

constantly one-uping oneself happen in medical media before even social media. So you'll have medical shows that came on air in the early 2000s that perhaps had some good information, information that people needed to hear. There were campaigns about blood donations and women's heart health being overlooked. So interesting topics that we needed to hear about. And then as ratings drop, because people get bored of hearing eat well, exercise, sleep well, like grandma's advice still holds up. they needed to do something different.

So that's how I feel like you end up with an ABC medical talk show with the title, how your horoscope impacts your heart health. That's like a legitimate series that aired. And I feel like it's due to ratings falling. And on social media, that process happens way quicker. Right. So you could have one viral piece of content and then it feels forever until you get another one unless you have the next potion to sell.

Right. So I would say that's the ozification. of health communication. Okay, that's a good way to put it. You think that? Because I think that's where it started. Yeah. I mean, he had, I'm sure I remember this correctly, he had the Long Island Medium on. Yeah.

You know, he was on Oprah saying that John of God, a psychic surgeon. Well, he couldn't explain those things. So, you know, giving it like this veneer of respectability. So yeah, I think it's, you know, it's the ossification. I think that we should like put a stamp on that and use that term. Yeah, it's disappointing to hear. Do you think that the fact that these reels came in, and I would even venture to say that TikTokification, if we're doing names for topics, TikTok coming in and making the short form content so viral, it ended up impacting perhaps

women disproportionately in this health space because they were so mistreated by our healthcare system. Do you think they were primed for that? Yeah, I mean, whenever gaps are always ripe to be, you know, exploited. And I think wellness has exploited those gaps in many ways, but it was slower in print. But there was, I would say, for example, with like Goop and Gwyneth Paltrow, they really introduced the concept that you could push the aesthetic over the actual message. But that was like in print, and that's slow. And then once you have something like TikTok and you have this fast format, and then you have

to think people are whatever, they're duetting or they're, you know, reacting. There's all this sharing. So we know that propaganda works. And so you have not just this one piece of misinformation, like if you read something in a magazine where you're going to show one friend, maybe you're going to tell four people, but you have a, you know, a TikTok video that maybe gets seen by a million people, maybe gets amplified by another three million comments, this and that, and all of a sudden it becomes this melee. And so when you when you have a group that has been historically understudied, has been historically neglected, when they can't go to their doctor and maybe get the answer that they want, there are obviously people that are exploiting those

gaps, and they're not filling them. I'm not, you know, you're not, you're not filling a gap by, you know, telling women that vaginal steaming is good for their health. However, that probably looks really good on a TikTok. There's actually, you know, streaming is a, it's a unique industry in that what we're doing right now is technically not streaming. We're kind of video on demand or podcast on demand. And then you have the short form that's just served to you without you necessarily clicking on stuff. But streaming is interesting in that a lot of the streamers that have success actually have clippers working for them that take little bite-sized bits from the long-form stream and just flood the zone with it. And based on the success of their clippers, a lot of times

that will decide whether or not their whole content platform is successful. So it goes to show that perhaps the things that you're seeing amplified are not actually viral in the way you think. They're forced viral. And that's really not authentic and not how social media was supposed to be used, at least when we first started with social media. Oh, I completely believe that. And that's really actually the extension of really celebrity culture, right? Like if I write a piece of content and a celebrity writes a piece of content, what's the news going to go for? Right? And, you know, So who's, you know, is People Magazine going to then write about what Dr. Chen Gunter wrote about or are they going to write about what whoever celebrity wrote about it, right? So you see it

just doesn't have that, maybe that same viral capacity. It's slower, right? You don't get on the cover of People Magazine probably for like eight days after, you know, whatever. So yeah, but I completely believe that sounds very valid to me. But you've been incredibly successful despite all of these disadvantages that you've brought up. So how have you been so successful? What has been the journey like for you? Yeah, I am tenacious. So I just have kept at it. I think that one consistency is key with anything, right? Whether it's an exercise program, whether it's diet, whether it's, you know, whatever job, learning your skill. So I, and I also do it because I believe people deserve the facts. And I think about times where, you know, I've been victimized

by misinformation because it did happen to me after my kids were born. They were had incredibly complex medical conditions and, you know, people couldn't answer questions. And this was the very early days of the Internet. And I got sucked down some rabbit holes and made some choices I wished I hadn't made. And so I just started thinking about how that experience, you know, dealing with kids that were born at 26 weeks, with congenital cardiac defect, with cerebral palsy, all these things. And then I started thinking about, okay, well, now how do I try? translate that experience to what my patients are having and why isn't there a good place for them to go? And so very early on I thought, oh, I'm going to fix the internet. Seriously, I was like,

a backpack on my back and I'm going to have a blog and of course people will come and I'm just going to post content. And I just kept at it. And initially, I think the traffic was a little bit slow and then I just thought, well, that I need to be myself. I was reading stuff that I was writing in a far more, like if I was writing for a journal, right? And I just decided. Academic in nature. Yeah, exactly. And that's, you know, that's great for academics. And you have to meet people where they are. And so I just started being more authentic me. And I think it just sort of gradually kind of took off. And I kept at it. So I think that was also part of it. And, you know, along the way, then different news sites would come calling. And, you know, there was a time where, you know, I had had a couple

columns with the New York Times. I've floated in and out of other sort of like, you know, print media, which obviously helps with your, you know, your audience. But I've just kind of stayed true to writing about what interests me. Are you comfortable talking about what was that misinformation land or direction that you got pushed into? Oh, sure. Yeah. I mean, I think that it's, you know, as I would say the old saying is that obstetricians have the worst pregnancy, pregnancies, I'm sure cardiac surgeons feel they have the worst. You know, I mean, we're all like, yeah, exactly, right? So I was pregnant with triplets, and you just heard me say that I have two kids.

And so I delivered extremely prematurely at 22 and a half weeks, and my first son died at birth. We elected not to resuscitate him. And then I managed to stay pregnant for another three and a half weeks, which was, yeah. And so I had an interval delivery at 26 weeks. And to sort of just really point out about how important it is to be honest with patients, You know, there were no, obviously, randomized, double-blinded trials to say what you should do. So my doctors were very honest with me, hey, we called all the experts in the country and asked for a consensus. And do you want to do this consensus?

Do you want to do something else? So that is super honest about, is important to be honest about the quality of the information you have when you're giving it to people versus, you know, we have this great quality data and you should do this. And so I got sepsis at 26 weeks and needed to be delivered. And it was resistant E. coli, too. So that was awesome. And my kids were 1 pound 11 ounces and 1 pound 13 ounces. And they were in the NICU for a long period of time. And I had sepsis, but recovered. And obviously. And on top of it, my son Oliver had a complex cardiac defect. He had a pulmonary valve stenosis and a massive ASD. So you're in this area where you have. of no whether information to go out like, oh, he's the first or maybe the third, like who knows, what are we gonna do? And so you're relying on people's expertise,

but also I was very fortunate that, you know, my children also benefited from the great evidence-based medicine of how we should run a ventilator in the NICU, who gets surfactant, what are the oxygen levels we should run at, right? And so when you'd see, I'd say, oh, are those oxygen levels too low? No, we have good evidence-based medicine to say,

Right, exactly. And so I was very reassured by that. And so one of my sons had terrible, severe gastrosophageal reflex, like vomiting after every meal. And, you know, he was also on oxygen. So he would vomit. It would go in the oxygen tubing. I have to switch. I mean, it was, like, very complex. And I learned a lot about the health care system. Like our oxygen benefits ran out. And it's like, oh, really? There's such thing as oxygen benefits? Yes, there are. And you can exhaust your oxygen benefits. Yeah. What does that term even mean? Yeah, well, it means that fortunately because they had such a low birth weight, they also Medicaid eligible. So we were able to continue to get oxygen under Medicaid, which is why these programs, people forget that very low birthway babies

are automatically eligible for Medicaid at birth. And so how those cuts might also affect, you know, newborns that are very vulnerable is also a concern. So, so yeah, so nobody can figure out was going on. Of course, there wasn't an answer. There wasn't an answer. It was one of those things that he needs to grow out of it. And nobody wants to hear that. You want a pill. You want a surgery. You want this. You want that. And you feel helpless probably in that moment. Yeah. And so, you know, so I ended up switching as, you know, all these formula switches. And of course, it really just needed to be the tincture of time. And I ended up putting them on a soy formula, which now I wish in retrospect I hadn't done. But then I just stuck with it. And, you know,

also I went down the rabbit hole of oh he needed to be on this compounded medicine for reflex when you know it was the fact that his lower esophageal sphincter wasn't working well because of his cerebral palsy like you know and so I but I I would say that I don't use this term lightly but I would say that I got in my head about it in a bad way and was thinking you know should he have you know a procedure to stop this five because I mean you know he's a year and he's like vomiting everywhere and going apnic and I've got to resuscitate. I'm like, it was a big deal. Maybe that was still when he was six months. And I fired off, I pulled every, like, you know, who do I know at this university? So I looked up

who all the experts were. And then I fired off emails to the medical centers of people who I knew. So I could say, hey, this is Dr. Jen Gantor. I'm friends with so and so. You know, and I received this incredibly kind email back from somebody at the University of Michigan who was basically like, sounds like you were doing all the right stuff and she just said it in a way that spoke to me and I know my kid's doctor said that to me but I just didn't hear it she just said in a different way and that's when I thought oh oh why was wait why was it so hard to get this information because it wasn't presented in a way that I needed to hear and that's when I decided I really needed to start to get active online because you can be the best communicator in the office but it can be hard

and people need to follow-up information. And there's so many things sometimes flying around. So I'm very, very empathetic when people are in the office or when they're being led by disinformation. I know what it's like to have to be in a really difficult situation. You know, recently my son had open heart surgery because he needed to have a valve replaced. And again, you know, we were faced with what is the evidence show.

And, you know, with adults with adult survivors with congeal heart disease, we don't have a lot of good information. So again, but his doctors were really great about saying this is the best that we have. This is what we can say. This is my clinical judgment versus, hey, this is what the data shows. Right. And, you know, sometimes people need to hear a message more than once, even though the message might be delivered in quite the similar way. Again, not that it's remotely relatable, but on YouTube, for example, sometimes they have to be shown a thumbnail more than once in order for them to click on a video and switching it prematurely can actually yield worse outcomes. So just showing people who are in different worlds how the human mind sometimes

takes repetitive messaging. So same thing with those who are perhaps vaccine hesitant. Maybe they won't understand what you're saying on the first conversation, but if I can open up that dialogue so that when they are coming in for their second visit, maybe now they're more open to it and taking them through the stages of decision making. And also investing in the follow-up. Right. So if you can't, if you're not going to change them, like if I have somebody in the office, I'm not going to change their mind. I drop it almost immediately. Like you can always tell. Because the best thing is to invest in the relationship that maybe they'll come back and they'll hear it the next time. I mean, I'm a, you know, a subspecialist. I also do fellowship in

infectious diseases. And so I see a lot of people with very complex vaginal health related issues. And I would say about half the time when I'm seeing somebody, their referring doctor was actually right on. But, you know, they probably just, they didn't have like the way, you know, when you see something a lot, it rolls off your tongue in a different way. And so there's a different confidence that comes with it. But it also could be that they'd just been prepped three times by hearing it before. Yeah, exactly. And that it sunk in like the fourth time. And so, you know, I'll send a message back, you know, hey, you were right on right on the money. And, you know, I, you know, I just reinforce what you said. And so, but yeah, repetition. And so you can see how repetition works in a good

way. They can also work in a bad way when we're talking about propaganda. Yeah. I'm curious because I'm so human interested. In the moment where you're learning about the fact that there's perhaps nothing more you can do to help your children and you're still wanting to investigate, you're still wanting to try something because you feel like perhaps if you don't try, you're letting your kids down. What's your mindset like in that moment? What are you trying to achieve and how are you trying to balance it without doing too much? Like what advice would you give to someone who might be in the same position as you? Yeah. So I wish I could claim credit for what I'm going to say and I don't know the doctor. But I believe it was in the New York Times. I could be

wrong. So I'm just believe. Sometimes the best thing a doctor can do is nothing, which is no thing. No thing is also an intervention. And so when I finally sunk into me that this was tincture of time, he had to outgrow this. I needed to accept it because maybe the more anxious I am about it, it's affecting him. And I'm not saying at all that it was, you know, in my head or in his head or anything. I mean, it was like nine months old. But just that, you know, the only thing I could do is control my response to the situation. And if I was doing the best that way it is, I just needed to do no thing. And that's really hard. I think we're all creatures of, first of all, action. But medicines also, like we've taught people that, oh, if you have an ear infection, we can give you an

antibiotic and make it away of appendicitis. We can operate on that or give you antibiotics and make it go away. There are things that we can do. And I think one of the greatest harms that we do when we're talking about health care in general is we conflate acute care and chronic care. And we make everything seem like it should be acute care that you should have a fix in the office today. But there's only if, you know, we have acute care and we have chronic care. And it's not always an easy sort of pill to swallow. Of course, I wanted something to make my son better like that, which parent doesn't. But also following bad advice after bad advice is a lot worse than doing no thing. Yeah. Yeah, I see that even from acute care and chronic care, but also acute diagnosis

versus chronic diagnosis. Sometimes people come in and want a diagnosis in a given moment. And I have to explain that right now, it's not anything, but it could become things. We need to watch its development. And sometimes that's hard to hear. It's like, what do you mean you don't know? I watched influencers on social media, and they always know. So you have to explain the fact that situations evolve, and sometimes we need them to present itself.

Sometimes we need to try interventions and see how your body responds to those interventions before we decide what the best avenue is. What's interesting to me is when you compare a doctor who constantly needs to hedge their bed, who constantly need to say, well, I think it's this, but I'm not 100% sure. I think you should try treatment A, but treatment B could work if.

And then you contrast that with someone who seems to have all the answers all the time. Doesn't it seem like we're always going to be disadvantaged in terms of mass communications? Yeah, I think we are. I think that we love absolutes. We love definitives. And the problem is nuance doesn't play. And so it doesn't get that same attention. And I think that it can be a hard message, but that's, you know, I want the truth.

When we can't be definitive, we should be. When we can't be, we should be honest about that. When the data is a varying quality, we should be honest about that. I always think about the principles of informed consent. And if somebody's told you something's definitive and it's not, and you then make a decision, you haven't had informed consent. You've been misled, right? If I, as a surgeon, if I tell someone, there's a zero percent risk of complications with this surgery.

That's not informed consent. That's not informed consent. If I tell someone there's a zero percent risk of complications with the medication, that's not informed consent. Now, obviously, risks need to be put in perspective, but it's really important that we be accurate. And I think one of the other issues is a lot of people, I think you learn this maybe after you've been in practice for a while. Again, we talk about investing in the follow-up. So when you have a diagnosis, that's not certain, say, well, okay, we're going to do this today, but we're going to check back in in four weeks or six weeks or eight weeks.

And that, I think, is one of the most powerful things a doctor can do, as opposed to someone says, well, I don't know, we need to watch it. And then you're sort of like left out into the ether, right? With no plan. Right. People want plans. I want a plan. Everybody wants a plan.

I think most people do. I shouldn't say everybody. People who don't like plans. There's people who go who get on planes and go places and I'm like going to figure it out. I'm like, well, I need a little bit more. That's impressive. Yeah, I know. You know, so I think that we need to be honest and we need to lead with that.

And I think that also is what is making a lot of doctor's jobs difficult in the office because people come in with this certainty from social media, this absolute certainty. And the doctor's like, well, like, I'd be honest with you. like maybe, but we should talk about it so you can be informed. And then, you know, I've spoken to people who've been, I would believe, misled by people online and you explain it and they still want to do the thing that I don't agree with. And then you have to decide, well, is this, is this a risky proposition or is it, you know, not a risky proposition? And then kind of go from there. You know, what can the literature support, what it can. And then how can I explain to somebody

the risks and benefits, and then, you know, they can, they can take that information, you know, and then use it how they want to. I have that just happened the other day when I was working. I had a young girl come in, early 20s, with back pain, maybe a week so of back pain, no red flag symptoms, really pushing to want to get an MRI. And I explained why early MRIs lead to downstream effects that are actually negative in a scenario like this, especially because we saw improvement happening. and it took like 30 minutes of counseling, printing out research, printing out other people who say

the same thing as me, even though they're saying word for word what I just said. That reassurance helped her come to the right conclusion. That being said, I could have done all of that and she still could say, I want the MRI. And because it's not the riskiest proposition, I probably would have prescribed her the MRI. Would you do something similar in your decision making tree? Well, I think it sort of depends. And I think, again, it depends on the investment in the follow-up. And so there are times when I've absolutely ordered a pelvic ultrasound that I would feel absolutely not indicated.

But there wasn't any other way I was going to reassure that patient. And I think that, you know, what is the goal? It's the goal of reassurance. Now, when I see someone who's had maybe a pelvic ultrasound every six months for reassurance, and it's not indicated based on a genetic screening. You know, then that's a different conversation. And that's what I might say, you know,

because there's there definitely are also, I believe, studies that show that sometimes doing the test then reinforces the test is needed and then when that anxiety comes back again, are you going to do it again? And so I think that you have to look at, you know, the history, you know, so someone coming in whose best friend was just diagnosed with ovarian cancer and you, you aren't able to reassure them in another way, I would say that that test may have benefit that hasn't been measured in studies. Got it. Right? Versus, you know, someone coming in because an initial. influencer said they needed this test or not a test. And then you have to decide. Like, one of the

biggest problems we see are people coming in requesting hormone tests. And I was like, well, those are, unless you have a very specific clinical indication, they're completely meaningless. So hormone tests are completely meaningless. Well, it depends on the indication. Okay. Right. Meaning without an indication. Right. So you come in, you're a healthy person who's having regular menstrual cycles. Hormone tests are going to tell me nothing about your health because you're in regular menstrual cycles. And why are people recommending them? Oh, because they hear about it online.

Yeah, what are those people online saying? Well, I think you needed to be in tune with your body, right? You need to know, you need to know. You need to know. They use words that we would not recognize as medical, that we would recognize as quasi-medical, right? And so they hear these terms, like, well, I need to know it, need to be in tune. And many times these people are also selling supplements to optimize your menstrual cycle, right? So, oh, well, if your estradiol level is in this range, then you should be on this

supplement. If it's in this range, you should be on that supplement. there's almost always a cell that goes along with it. It may not be obvious to see it first, but there almost always is a cell. And it's like, well, okay, but your hormone levels change every day. So, so, you know,

so I just think it's, and it's hard for people to say, well, how come you can do my hormone level when I haven't had a period for four months and it means something, and if I'm having regular periods, it doesn't. And it's because that's in context, because we're looking for an explanation

for the lack of period. You're taking a diagnosis. Exactly. Versus, well, like, what's the diagnosis here? And if it's because you don't feel well, the important conversation is not to dismiss someone because they don't feel well. You absolutely do feel well, but hormone tests aren't the right test to figure out why you don't feel well.

Maybe we need to check your iron level. Maybe we need to do a ferretin because iron deficiency grossly underappreciated in women who menstruate. I think something like, if we look at women under the age of 24, 23, I think it's almost like 40% are iron deficient. So yeah, so there may be tests if you don't feel well, but it's not those tests. Yeah, I could see that happening often because they're trying to give some kind of thing to sell, as you said.

And I like the principle going back to the no thing because I actually will tell patients that, hey, I don't think we should do anything for reasons, X, Y, and Z. And sometimes I feel the skepticism still. Like, oh, this doctor, I came to see them and they're still not giving me anything. I try and explain to them that usually if a doctor is comfortable explaining a plan and saying right now there's nothing necessary to be done, they're taking a lot of liability on and instead you should celebrate those doctors that are not just trying to give you a solution to say, oh, here you go, here's a diagnosis, this is probably what's going on, here's what I

could sell you for it, bye, never see you again. Yeah, no, I think it's harder to not give anything. It's absolutely harder. It's much easier for me, you know, one of my areas of, of, sort of subspecialty is chronic and recurring yeast infections. It's a lot easier for me to just like write a prescription. That's probably not gonna be the right prescription for this patient than to say, wait a minute, your story doesn't quite sound like that.

And I need more information. I need to get sensitivity testing. I need you to have a culture when you have symptoms because I wanna help you. I'm actually really bothered when I can't solve someone's problem. They really bothers me. I'm really like, you know, my office mate will say,

I wish sometimes patients, could see how much time you spend online looking things up for these incredibly rare things that you sometimes see and like the hours you spend like you know scouring the literature or thinking you know if only you were a lawyer yeah i know there'll be billable hours i'm on salary so you know it's it's i'm i'm happy to do it i love i love reading new science i love like oh my god i never saw that article i love that that's you know learning i love learning but yeah belotti's year for me to give people the wrong care but i'm also personally offended by bad methods medical care. And I don't want my kids to get that kind of care. So why should I practice that

kind of, you know, seriously, like I want someone who, and maybe because I have kids that have, you know, all these unique health issues. And fortunately, you know, through modern medicine, they're doing really well. But, you know, I want someone to go that extra mile because people want the extra mile for my kids. Like, that's, that's why we're in it, right? To try to help people live better lives, but also not to make shit up. Well, I think the way that you can communicate that is by investing in that relationship you talked about. Why, if they see that you're committed to this level, they're going to trust you because you're actually trying so hard as opposed to trying to sell them something

to get them out the door, which so many people are, and it's really disappointing. I think doctors are taking advantage of women. When it comes to hormone clinics, when it comes to hormone testing, as you said, do you agree with that? Yeah, I mean, I think that as a broad statement, so I'd say some absolutely are. I think that if you have people who are, you know, selling supplements, selling products, I mean, look, we know that the whole reason they had the registry for pharmaceuticals is even like a drug lunch can affect your ability. So if a bad $22 sandwich could have some effect on me, if you're making $3 million a year or selling supplements, that's not going to have an effect on what you're doing. Or if you're getting ads from, you're getting ad money from whatever clear blue for their menopause test, that's not going to affect your messaging? Like, come on, man. Like, this is a lot of money. I, you know, people forward emails along to me about, you know, what some supplement company offered them

or whatever. And, you know, for 10 hours a month, you could get $20,000. You know, I mean, I couldn't live with myself. My kids would be deeply disappointed. And yeah, I mean, it's completely offensive to me. But yeah, so when people have products to sell, that affects things. And I think it's really easy for people to tell themselves it doesn't. You know, I've been, you know, pharma-free since, I don't know, 20, 2003, 2003. What is pharma-free me? Oh, I don't do anything associated with pharmaceutical companies ever, like ever.

And that's why I often don't get involved with patient advocacy groups because many of them are funded by pharma. So I'm just very, very... That's hard to do these days. Yeah, I know. Just from a practical standpoint, forgetting financials. I mean, I probably trip up now and then, but it's like a real conscious effort to do it. And it's, again, it's hard because you see like, what's the messaging and what people say, oh, I want you to share this real.

I'm like, well, I don't actually know that person. You know, I'm just very careful about those associations. And I'm not saying everybody needs to do that. That's just what I've decided for me is the right thing. And so I just think that when you're telling somebody, When you have doctors online making these statements about, oh, you need to get your hormone testing, or you need to buy my supplement, or they're not saying you need to buy it, but like every fourth video is or, you know, whatever, then you are taking advantage of people. That's what I find. And I think some people are doing it simply for attention. Attention is a currency. I mean, that's why a lot of people are influencers. I mean, some people don't ever sell products. It's just the attention, right? So there's that. I think some people are maybe hoping to, build brands in other ways. Other people are maybe trying to funnel people to clinics and other people have products to sell or books to sell or whatever else. And so I think it's just important to kind of

look at how the messaging, you know, what is that messaging attached with and what is that person getting out of it? What are some of those messages that stand out to you of them saying things that don't seem to have scientific backing? Well, I think, you know, one of the ones that that has been in my mind a lot recently would be the claim that menopause hormone therapy has been definitively shown to reduce the risk of dementia. So no. And we've seen very well regarded experts make claims like that in certain documentaries. Yes. Yeah. What's the truth there? Yeah, no. So we had a fantastic review of this at the 24 Menopause Society meeting led by Dr. Pauline Mackey is a neuroscientist and, you know, leading researcher in the area where she reviewed all the data that we have on

menopause hormone therapy and cognition and what are the gaps. And we don't have, you know, the problem with many sort of these big claims, they come from observational databases. I can pick and choose any observational database. I want. I can pee hack. I can do whatever. And I, you know, we can all, we know, we can all come up with something that we want to suit sort of a preconceived outcome. And so one of the big problems with menopause hormone therapy and databases is the women who tend to take menopause hormone therapy tend to be healthier they tend to be wealthier they tend to live in zip codes with less pollution they tend to exercise more things that may not always be caught up in the database right so you don't have equivalent populations maybe getting a prescription for

menopause hormone therapy is a catalyst that gets somebody to exercise right so without having randomized double-blinded trials you can never be definitive first of all i mean you can't well we have smoking as an example because the association is just so strong okay so I would say yes there's an exception to every rule sometimes the observational data is absolutely just so overwhelming that and doing the clinical trial would be unethical I think that's also there are situations like that where it would be unethical to do the clinical trial so yes but so yeah there are some observational databases that show that taking menopause hormone therapies associated with a lower risk of dementia there's also some that say is a higher risk.

Not significantly high to any way to panic, who's on it. But so we have conflicting data. And the long-term data we have from some randomized trials doesn't show any benefit. So, you know, there's the Keeps trial, which has some long-term follow-up data. There's Wimsy, which was the young, I can't remember. The acronyms, man. Sure, there's a lot of them. So that was an ancillary branch for the Women's Health Initiative that was followed up.

And so we don't have data. We have, there's no data to show that in the short. short term for people who are in menopause, that menopause hormone therapy improves cognition when that's, you know, a primary outcome that's tested. And we don't have data to show that it reduces the risk of dementia. What we're getting more data about is that it seems that women who have more hot flashes may be at higher risk, right? So now we're starting to see a signal. Why is that? Could it be that the hot flash is having a negative effect on the brain? That's a possibility.

Sleep. Yeah. It could be, exactly, could it be the impact on sleep? Could it be that people who have hot flashes and people who get dementia have a shared neurobiology? Maybe they have some type of autonomic instability. Maybe there's a vascular issue. So we're at the point where we're like, hmm, maybe we're kind of drilling down.

And so, you know, there are studies looking at, you know, do we need to use estrogen or there's a, or could we use a non-hormonal? So it depends on. the mechanism. And so right now the best that we have is the data would suggest that the highest risk group may be, and this is a may, people who have more hot flashes. Well, those are the very people we should be treating, right? Like, we don't want people to suffer. So while the data is being sorted out and there's more studies ongoing, we should treat the people who are suffering because, look, good sleep is good for your brain. Not being uncomfortable is good for your

quality of life and and we don't have any significant evidence that that's going to cause harm right for those people so that's a lot of that's a different message than me finger pointing saying every woman we know this prevents neurodementia right they're completely different message and you know patients appreciate that in the office when you you know go into it and discuss it but it's very easy for people to see these clips in from a movie or something that's played over and over and to say well, I'm super scared. I need to go on it. And so while, and I know it's hard. Look, as again, as somebody who had, you know, had to make decisions for their kids. And it's hard to have uncertainties. But based on what we know, we should treat the people who are suffering.

Is there a world where those influencers, medical or otherwise, are making that content trying to oversimplify it to the general population to get more people in the door, to have this conversation, or is that too charitable of thinking? Well, I don't know people's individual motivations. I would say that I feel it's unethical to be definitive about things that we can't be definitive, where there's really, this isn't like an 80-20, this isn't, you know, it's, I don't feel that that's ethical. Would I want my kids to be told, to get a message that something, was definitive. And then they have to come in and hear from me. Now I have to play the bad

bad cop. So that's what that does. That sets up a lot of antagonism, you know, in the office. So I think that that's setting people up to be sort of bad cop, good cop. And I just, I, it doesn't sit right with me. I think that it's just not something that that I would do. There's been a lot of trust lost in our health institutions, our government agencies, over the last decade or so, perhaps the pandemic played a big role here. Do you think that there were times where the health agencies were definitive, where they should have been? They shouldn't have been?

Oh, you know, I have to say I pay less attention to what government agencies say and more with what does my medical society say, because I know politics affects a lot of things. And I also know that, for example, when you have the U.S. Preventative Services Task Force, they're going to be a far more conservative opinion, you know, because they have methodologists, right? Then maybe what I might see from my professional society, and I want to put all of that in context with the patient.

So, you know, I think that one issue is that medicine changes and it evolves. And what we believed we knew 10 years ago might not be what we know now because that's science. And isn't that amazing that we learn something new? And so I think that it's very easy to go back and say, we should have said this 10 years ago, or we should not have said this 10 years ago. But what did we actually really know at the time?

And it's hard to look back with what you know now and try to forget that. For sure. There's been a lot of controversy over the research that was done for hormone replacement therapy. Dr. Marty McCarrey sat right in front of me and was quite critical of the work that was done,

basically said that this is, I don't want to overstate his words, but it's one of the biggest discrepancies in women's research, harming women in his lifetime. Would you agree that that research was as detrimental as he puts it, or where does it land? It was a well-done appropriate clinical trial that did not have any, you know, there weren't concerns about how people were enrolled. There weren't concerns about how the trial was done. So because you don't like the conclusions or because they don't fit with your pre-year-old,

preconceived ideas, that doesn't make a trial bad. And I would say that... Can we give some context about what the trial did and what you're found out? Sure, yeah, about the Women's Health Initiative. So menopause hormone therapy, which actually what we're trying to call it now, menopause hormone therapy is replacement implies that there's a disease. And that would be an appropriate term for somebody under the age of 45 or some of the primary ovarian insufficiency, but for people age 45 and up.

So the Women's Health Initiative is probably, I think, the largest randomized, double-blinded placebo control trial ever. I might be wrong, but it's pretty large. And I think in the, and there were four arms to it looking at Premarin and Medroxyprogesterone acetate, which was the Prempro at the time, the most common, I believe it was the single most common prescription. Then a premarine only arm, people who don't have a uterus. And then there were arms to look at a diet, a low fat diet for risk of breast cancer.

And then calcium and vitamin D for fracture prevention and whatever else they were looking for with that. And so in the two hormone arms, they were about 27,000. people. Pretty big, you know, randomized trial. And the problem is people don't put the trial in context. And somebody like Dr. Marty McCarrie, who doesn't see women as a gynecologist in the office, he's not managing menopause care. I don't know what he was doing in the late 1990s when this came out, but as someone who was seeing patients, what I can tell you is the message that we had received from animal studies and observational studies, and we've talked about the limits of observational studies, was that estrogen may well be cardioprotective. And maybe we should be

giving it to everybody for that. I mean, we had 70-year-olds coming in, and I was like, sure, I would have to go to hormone therapy. It's supposed to be cardioprotective. That's what we believed. And so that's why the average age of the population was 63, because we were saying, you know, for all women who are at relatively low risk, should we be prescribing this? And, The other reason that people were past the age of menopause, where they were really trying to enroll people who didn't have hot flashes or a significant percentage you did because obviously you could unblot, you would know, right?

If you were taking medication, you're like, whoa, like all my hot flashes have gone. You probably would be suspicious that you were given the medication, right? So that's the context. That's often forgotten when you're discussed about, when it's discussed, and you can't blame a trial for not doing what you wanted it to do. And what is the criticism of the age group?

Well, so the age group is, so what happened, the age group is, is that we were starting too old. And that what we found from the study was when menopausal hormone therapy has started later, after the age of 60 to 65, that there's an increased risk of cardiovascular complications, an increased risk of dementia. And when they went back and reanalyze the data and looked at the 50 to 59 group, the, you know, those risks reduced significantly. And so there wasn't a net cardiac benefit, but there wasn't a net. problem so that's great isn't that great data if you want to take hormones to prevent hot flashes and night sweats that you don't have to worry about that oral estrogen is associated with increased risk of blood clots it's still kind of in the rare risk obviously you have to decide and that's just with oral with transdromal we think the risk is lower so people have criticized the w hi for not

using other estrogens well they were using the most common at the time so you can't criticize them for that. They criticized the age group while they were looking at primary prevention for all women and they were trying to get people who wouldn't have hot flashes or a significant percentage. So those aren't valid criticisms. And then, as you know, as you start pouring over the data and they follow. So what happened was the data was presented in such a way that you and I know the press loves to scare people and they love to scare women more than anything else. And what they really like to scare women about are breasts and vaginas and fertility. Those are the things. So this is the only thing that matter to, obviously.

Well, there are hearts. Yeah. No, they don't like they're not so big about that. Far more, far more concerned about, yeah, because, you know, I, it's, that's a whole separate discussion about patriarchy and what sells and what gets page clicks. But that's, and that's my own personal opinion. I don't have any evidence-based either to back that up. But if you're talking about breasts, vaginas, and fertility, those are the things.

Buzz words. Yeah, the buzzwords. Brain and heart probably there, but not as much. And so, you know, there was a news conference. And I think that's probably the biggest criticism that people have is that there was a news conference that, you know, and I wasn't there and I never been able to find a transcript of it. So the takeaway from the news conference was, you know, breast cancer, heart disease, stop. And there were, I think, over 130, you know, major articles and major newspapers dedicated to those scary things. But when you look at the menopause society and, you know, the first statement that they

released after the W.H. We actually read the papers. They don't say women shouldn't be getting it for symptoms. They say women shouldn't be getting it for primary cardio protection. And the other issue that people have is that the study was stopped prematurely. Well, so you and I know that with any clinical trial, you have a preset safety point that you stop the trial at. Now, the preset safety point doesn't mean that you've passed into some awful, terrible, dangerous range. that hey maybe we shouldn't be continuing it because we might get there and if you're looking at a primary prevention trial you can't be causing like more harm than good so they had this composite score of you know stroke death breast cancer if you I think there were nine factors

that went to this composite score because they're kind of looking at like net harm net good and when that composite score you know hit the predetermined threshold they stopped the study And that sounds like really reasonable when you talk about it this way. That doesn't sound like the greatest harm ever done to women. Imagine what would have happened if they hadn't stopped. And then they had kept going and imagine if there had been a further increase in breast cancer that had crossed the predetermined safety threshold. But they said, we don't care.

We don't care. And they kept going. And then when the study results came out that there were a statistically significant increased incidence of breast cancer, cancer, what do you think would have then been the confidence in government-run clinical trials? What do you think would have happened with lawsuits and the government? And so it's very easy for people to play armchair quarterback, but in fact, we know that there were tons of lawsuits about breast cancer, even though, as Marty McCarrie likes to point out, the risk wasn't statistically significant. It was a trend in the first publication. In the later publications,

it was statistically significant. It's very easy to cherry pick. there were all kinds of lawsuits about it so of course i mean i can't say of course because i don't have a crystal ball but you would think that you know if the fears had become true what would have happened with lawsuits right so the context all matters and so and and and people love to cherry pick from the w h i and talk about how oh estrogen alone reduces the risk of breast cancer Well, no, Premarin does. Premarin is a different molecule, pregnant mares urine, and it has, I mean, depending on the marketing you believe, it's got 16 different molecules, 26, I don't know.

But it's got all these different molecules in it, and some are selective estrogen receptor modulators, which we know that there are selective estrogen receptor modulators that can lower the risk of breast cancer. So permarin's a really unique molecule. So you can't say, well, if Premarin does this, then Estradial will do this. you have to study it for estradiol. And it was only the permanent alone arm that did that. So meaning people who didn't get a progestin, which was in the study.

And so people cherry pick. So it's like, well, wait a minute. If you think the WHO is the worst study ever, then why are you choosing some data from it to support your conclusions and then ignoring others? Yeah, that's really complicated. So where do you think that puts an individual who perhaps is in menopause or perimenopause? and they come to see me. Let's run that example. You know, 51-year-old patient comes in, perimenopausal,

and is interested to learn more about hormone therapy. So the best compilation of all of the data, because there's all kinds of observational studies, there's prospective studies, all kinds of things, I think comes from both the Menopause Society and also the Australasian Menopause Society has fantastic stuff on their website. Those are the two that I personally feel

have condensed the information and the australasia menopause society have some actually great patient handouts but they they also have some forms of medications that aren't available here so you can't put that on context but for for many people so i actually keep printouts of the 2022 uh menopause society guidelines for hormone therapy in my office and at the end of each segment there really is kind of a nice summary about about you know there's all the you know this is observational this isn't if you take out the unblinded studies, blah, blah, blah, which is I find really fascinating, but obviously a lot of people don't hear that. It's all clear. It really, they've, they've sifted through the data. They, they have all declared their biases. You know, when you, you and I know getting

a whole bunch of doctors in a room to agree to something, and they also have neuroscientists involved. Like, getting people to agree to something is not easy. People like, well, what about this? And we all have, you know, people have their, you know, their pet projects and all this kind of stuff. And so when you have that kind of consensus, it's a really great launching point. And I think that when people speak against the guidelines, they do a huge disservice to all of the people who have dedicated their lives to studying this. Some of the giants of menopause are, you know, have collected those guidelines and put that together. And one thing that I hear a lot from internet influencers is that all the guidelines are out of date. I'm like, well, what study has been

published since 2022. That's not included in the guidelines, crickets. So, you know, when there's a new study that comes out and is something pretty significant, you know, you get a release, you know, you get a press release from, or not a press release. You get, you get something, an email from your professional society that's saying, hey, you know, this study came out, and this is super important, and we need to put this in context. So when we hear physicians who who are active on social media make claims that hormone therapy decreases all-cause mortality, dying of anything as a woman? Is that not true? I would say maybe the data is not great. And so the problem is that I would say, okay,

well, what dose, what formulation, what method of delivery? Is it oral or transdermal? And you can't drill down on the studies to get that information. And a lot of the data that we have comes from oral estrogen and we don't have that kind of long-term data from transdermal which is the most common that we prescribe so the answer would be maybe maybe could also be maybe not so when you're talking with somebody and you're saying you have hot flashes you have night sweats you want to go on menopause hormone therapy fantastic might you get this additional benefit okay maybe but when you're going to talk about something from a preventative care standpoint where we say everybody should be on it that's a completely different threshold may we don't make guidelines

about everybody being on something based on maybe, you know, we say, well, this is what we know, this is what the evidence says. It's a very, you know, when you put the risks in perspective, it's quite safe. If you're getting benefit from it, fantastic. And I just think there's enough good reasons to be on for people who need it that, that why do we have to go into this maybe category. Do you think, do you think that not enough women are on hormonal therapy? Do you think they're under-treated? I think that many people have their hot flashes and their night sweats under-treated, absolutely.

I think that there are people who are suffering and their doctors either tell them erroneously, well, this is too risky to be on. But also, we also have to acknowledge that we have a lot of people with high cardiovascular risks and that we do know that the greater the cardiovascular risk, the more concern we have about prescribing estrogen and so we have to kind of put that in context so it's always hard to say like well what's the actual patient population so I would say lots of people have their hot flashes and their nights what's undertreated um lots of people have other symptoms that are undertreated we have less good data about the other symptoms and so for example joint pain is a

fairly common symptom of menopause the studies aren't like that great when you look at them there aren't that many that were specifically designed to look at joint pain. There was a study called, I think it was called Wisdom, and there's now a new wisdom trial. So I think the point where we were using. Wisdom V2. Yeah. So this was also looking at permanent pervera like the WHOI,

and I believe it was started during the WHOHI and then halted when the WHOI was halted or when those results came out. But they had a year of data, and they actually, unlike the WHOI, did have younger women enrolled, they also were really following them based on, like, all of their symptoms. And they found that, you know, on estrogen, something like, I don't have the number specific, but we'd say like maybe 52, 53% had joint pain. And the placebo group, it was 63%.

Okay, that was statistically significant. How clinically significant that is. So does it mean it's wrong? Just I know. I'm like, yeah, maybe you're going to, we don't really know. Maybe it's going to help. How much of that is related to sleeping better? We don't really know.

And symptoms are a bit of a soft call. You know, it's not like with a statin or whatever when you say, okay, well, you're at this level. You should be on, right? So it's quality of life. And people have to decide how well they feel on a treatment. And if taking this medication, you're sleeping better, you feel better, great. The concern is, for me, is when people are making sort of false claim. So we hear about, well, it's great for brain fog.

Well, we have at least, you know, four clinical trials that looked at cognition. but this is for people immediately after menopause that show no improvement. We don't have data for people in peri menopause. So if we don't have data, you shouldn't be definitive and say that it's great. The studies don't exist. What we could say is, well, brain fog is kind of a complex thing. We don't even really have a good definition of it. Maybe.

Depends on, you know, if you're having super irregular periods, it's a very, you know, it's a common symptom that's described. There's other causes, too, like an even. and other things. So would it be reasonable to try menopause hormone therapy, especially if you're not sleeping well because not sleeping well? Absolutely sure, it's reasonable to try. But we also shouldn't maybe neglect looking at your thyroid and making sure you don't have diabetes and checking these other things, right? So that, again, there's that difference between the nuances of the discussion and saying it's definitive. And I would say being definitive, you wouldn't, if you said I'm taking menopause hormone therapy to treat brain fog in perimenopause because a influencer

told me it's going to do that, that's not informed consent because we don't have any studies. So you can say, well, you know, you can try it and it might help you. And I'm absolutely not opposed to it. But, you know, let's say, okay, we're going to try it. And if you're not improved in three months, then we're going to say the trial was unsuccessful, you know, decide what's the best dose. And so those are the nuanced conversations that, you know, when you have 30 years of experience talking with patients about the medication.

And I thought it was interesting. You know, whenever I talk like this, I will get people saying, well, you're opposed to menopause hormone therapy. What are you even talking about? No. I just want people to make decisions with all of the information. Yeah, it's so tricky because in a space like this, and this applies to like men's hormone replacement therapy, because it's so subjective or because there's this

heavy layer of subjective feeling, joint aches, brain fog, how well you sleep, how much energy you have, if you come at it with a more definitive promise, even though that's not what the data shows, are you getting people better outcomes through the placebo effect? Well, I would say that you may be harnessing the placebo effect initially, but we know that tends to wear off. And so then what happens? Does that lead to people escalating doses into increasingly unsafe levels. I've definitely seen that for some people who come in on these massive doses. Heavy bleeding, you know, risk of endometrial cancer, other types of things, right? Maybe risk of blood clot. So, so there's that. And we also know that the more people pay for something,

the greater the placebo response. That's actually, there's a fascinating study looking at Parkinson's disease. And I mean, you think, okay, like, you can say, oh, well, my subjective, I feel better. You can see that, but actually motor improvement. And so, you know, the brain is a really interesting tool. So the more people pay, the greater the placebo response as well. And I think that it's ultimately not fair to mislead people. I think people deserve the data. Yeah.

Testosterone is a hormone that's not often mentioned with women. Is that a hormone that we should be talking about more often? Should we be checking it and women should be prescribing it more often? to women. Yeah, so there's this misperception and I would say a lot of disinformation about testosterone therapy on Instagram. And people talk about as a vital hormone essential. Well, sure, yeah, I mean, epinephrine's vital too, but, you know, I'm not like, you know, I'm not selling it to stabbing people that be pent on the street. Right. Exactly. So, you know, so that's, I would say that's a great example about taking something that's true and taking it completely out of context.

We know that testosterone levels actually start to decline in kind of late 20s or early 30s, and they follow kind of an age-related decline. And then around age 70, there's a little bit of a peak again, or late 60s or at least 70s it goes up. So it's not related to menopause at all. Obviously, it's different if people have the ovaries removed. But that's because your adrenal glands produce a good chunk. And so, first of all, it's not a menopause-related phenomenon.

I think it's a really important thing to talk about. There is no indication to check testosterone levels for concern about low levels. If someone comes into your office and they've got a receding airline, if they have acne, if they have signs of, you know, of excess testosterone, absolutely. They need to have their testosterone level checked. Completely different situation. But there's no low level that's considered abnormal. So I think that's a really important thing.

I get that it interferes with some people's messaging on social media. But, you know, all of the data I'm giving you is from Professor Sue Davis from Australia, who's, you know, probably study testosterone for women the most, pretty close to it. I mean, I'm sure there's a few other people, but, you know, she's a world, a world expert. She does the studies. And one of the issues we have is that, you know, many of the studies on testosterone are done with using radioimmuno assays, which are inaccurate in the female range. So if you're basing what you're telling people off of studies that we now know are inaccurate,

probably not a good thing and so you really need you know mass spectrometry which isn't available everywhere you know i still see studies now i mean you know i read some recent study that supposedly supported you know higher testosterone levels of brain health and what they use radio amino assay so what claims are they making regarding testosterone or women oh vital for bone health brain health you know prevention dementia prevention of heart disease you name it found of you everything and so the best that we can say is that testosterone when replaced and you know when we give it to people and keep it in the female dose in the female range and that's why we have to do levels after so we recommend doing levels before you start

to make sure someone isn't too high because you wouldn't want to start them in and then to make sure that you stay in the you know the typical female range otherwise you can get problems and people can be very sensitive to it and some people can even have vocal changes when their testosterone level is kept in the normal range because obviously they could have some excursions and that might be a concern to someone who uses their voice professionally right a single or a news anchor or someone like that. And so it is moderately successful for low libido. I would say that cognitive behavioral therapy

and medical mindfulness probably outperform it. And so, you know, but it's certainly a valid pharmaceutical option and it's working as a pharmaceutical, probably not as a replacement. Because studies don't really, you know, link levels. They're, you know, with outcomes. So it's not a,

natural physiologic change that you would have seen this is something that's being enhanced by the pharmacology of the exogenous medicine yeah i would say think of it like a drug that you're taking so don't think of it is because it's testosterone i'm getting something that's natural think of it it's working because it has this is a pharmaceutical effect of testosterone um if i'm making if that makes sense and so we don't have good data so people are saying oh it's important for muscle mass and, you know, prevention of sarcopenia. But we don't really see an effective testosterone on muscle mass until people approach the male range,

which, of course, then, would have other features. Other, you know, you know. And there's studies, there's a really well done study looking at people who are all in the low, the, you know, what we would consider to have, you know, the lowest amount of testosterone. And they gave them increasing amount, you know, randomized them or chose increasing levels

of testosterone to give them. And there wasn't an effect on cognition. There wasn't an effect on muscle mass. And so, you know, I go with what Professor Sue Davis says. You know, she's like the world expert. And, you know, when she says it's indicated for something else, then I'll go along with it. So currently moderate for low libido only.

And we don't have good evidence to support it for people who are perimenopause for low libido. It probably wouldn't be wrong to try. But we just don't have the data. And I would just say that, When people are going in and they're getting their testosterone level checked because they don't feel well, they are getting bad care. That is not evidence-based care. There's no low level of testosterone.

We would say you need to do something about that. One thing that people forget with both estrogen and testosterone and, you know, probably these are the only ones I know, so I can't speak about the others, is a very complex intracronology. So what's going on inside the cell may not be what's happening in the blood. And so we have to be really careful about making making far-reaching conclusions when we don't have clinical trial data to back that up. So, for example, if you talk about estradiol levels, people like, oh, maybe I should get my estradiol level to see how I'm doing on my menopause hormone therapy. Well, no, first of all, we go by symptoms. But secondly, because of the, you know, intertest variability and how estradiol is converted into estrogen. and then back into ester goes back and forth, back and forth is converted.

Your levels can change throughout the day, so it could be higher in the morning and lower in the afternoon and higher again in the evening. So what are we really measuring? Also, if you're taking a patch, well, we have to make sure we're measuring at exactly the same time, each time you're getting it done, right? So there's that variable. If you're using a cream, we know that there can actually be contamination to the other site. So that's also a variable. And finally, if your estrogen-levels are lower, is it because your blood levels are lower or because it's entered to sell more quickly? Right?

So until we have clinical trial data that says a level means this, we should not be doing them. And that's kind of the next level that I see, pun intended, I guess, with disinformation is just not enough to be on estrodial. Now you have to push your levels up into, you know, what would be a normal range for somebody who, is menstruating. Do you think anyone's weaponizing those levels? Like in testosterone for men, a lot of times I'll see younger men go to a testosterone clinic and instead of getting their testosterone level checked first thing in the morning, which is when you're supposed to test it, they'll get a test it later at night so it's low.

They don't know. Right. And they're like, oh my God, I have low testosterone. I need testosterone replacement therapy now. and the clinic is doing that so that they can prescribe them and keep them as customers and only upon educating them,

getting them off the medicine and then checking your first thing in the morning, you see that it was normal. Is anyone doing the same thing in your space? Oh, I imagine, you know, what's one mechanism at that? Oh, I think just people coming in and having an estrogen level done

and it's lower than they'd expect and so they're told they should be on higher hormones. And one thing that we're seeing now is people saying, well, you need to be on this higher level to protect your bones. that's not true. We actually have data from, you know, a 25 microgram patch, a half a milligram of oral estrogenile, which is about the equivalent, are protect against osteoporosis. Like, we have the studies, we don't need to do it. So there is no estrogen level that people need

to be on to protect their bones. And, you know, this is one of those things, I guess it's really fortunate when you've been around forever, like I have, is that, you know, this is all based on some data from the 19, I believe the 1990s, where people thought that maybe your estrogen level needed to be 60 to protect your bones or maybe you need to be 40 or this or that. And now we have better data. So we don't need to go back and quote those old studies. Now we know whatever one you want to be on, you know, take it. That's great. That's your symptoms. And people say, well, what if I'm a poor absorber with transdermal? Well, we don't even have a definition for what that is. Exactly. So I don't really know what that means. I would say that if you're on an appropriate

dose for your symptoms and your symptoms that are reasonably expected to be treated by menopausal hormone therapy aren't better, then why would you check your levels and push a mechanism of delivery that's not working well for you? Why don't you just switch to oral? Why don't you just switch? And then you can see, okay, you go on the other one, your symptoms are all still there, maybe it's not estrogen. And what we can see is people push doses higher and higher and higher.

Well, if you have a uterus, we don't know how much progestogen. I need to give you to protect your uterus with these super high levels. And sometimes people are on like birth control pill doses even higher. And, you know, we know that with age, we start, you know, to get more concerned about the higher doses. Remember, all of the safety data is not with those doses, right? So you have that issue. But also people can develop tachyphylaxis. And so they have awful symptoms.

They think those symptoms need to be treat with estrogen. They go on more estrogen. They get more symptoms. And it gets higher and higher and higher. And we're seeing more of that. used to be like unheard of and and I think that chasing levels is a big way that that's doing that basically if you're on a patch or you're on a cream or you're on a lotion and this is all pharma hormones because compounds a whole different story and it's not reducing your hot flashes

not reducing your night sweats then change to a different delivery mechanism as long as that mechanism is safe for you or switch to a different estrogen so we have permerin as opposed to estradiol. So you can make a logical switch and say, let's see. But however, if your, if your symptoms are something that we know is not well treated. So for example, when women have had their last period and they're in menopause, estrogen doesn't seem to do anything for depression. I mean, it makes you sleep better maybe, but it doesn't seem to affect that. So if you're saying, why is my depression still bad? I'm 52 and I'm on menopause hormone therapy. Well, escalating the doses isn't going to give you the answer because we actually have some

randomized control data to show that it's not effective. So it has to be put in context, right? So the clinical symptom that you're evaluating using, you need to make sure that's one that's actually evidence-based to be impacted. Right. And this is true in all of medicine. If you prescribe a medication and the outcome is not what you expect, one possibility could be that you need more. The other possibility could be that you were incorrect, and that is not the right medication. And you should always think, like, okay, when we're especially talking about symptom-based care, what else could be causing these symptoms? You know, do you have sleep apnea?

Is that actually why you're not sleeping? Maybe we should be screening you for that. Do you have iron deficiency? Is that why you have brain fog? We, you know, so you need to go through these lists. Maybe you actually have insomnia, and you need to see a sleep specialist, and, you know, and work with someone for cognitive behavioral therapy for insomnia.

So it's important to not have tunnel vision and to always be open to, why isn't this expected therapy working as expected? Sure. Do you think doctors are under treating menopausal symptoms by diagnosing them as something else? Depression, mood disorder, arthritis, rheumatoid, osteo, or otherwise, are they blaming weight to be the issue when it's true

menopause symptoms? Do you think that's happening? Because I see a lot of influencers making that claim. Well, I would say that I don't think that's limited to menopause. Whether that is uniquely in menopause or not, I'm not really sure. People get dismissed all the time. They're told that it's because they're overweight. People have heart attacks dismissed. They couldn't possibly because they don't have the standard symptoms. So I think that this, This is a pervasive issue for women in healthcare, first of all. I think that a lot of people have less clinical experience with menopause, and so is that magnified?

I think that's absolutely a possibility. So, but, you know, I mean, I see people with chronic itching. That's another one of my specialies, I mean, I would say that lots of people get dismissed with their chronic itch. It's not that bad. I'm telling you chronic it's awful. It's like, awful. What's some of the causes that most people, physicians?

Physician-wise wouldn't think of that could be. Well, eczema, obviously you can get that. Lichen simplex chronicus, which is basically the other word for that. Like in sclerosis, for women in menopause, it can actually be related to low estrogen, chronic yeast infections, how they look in the skin can be different than how they look in the vagina. And then there are also some less, you know, less common skin conditions. People get psoriasis on their vulva. But I think a lot of times people, you know, just think they need to put up with their itch.

So, you know, so it's always, you know, because we don't say, well, how disadvantaged are people with itch versus how does, it's hard to be specific. And we all know our own fields better. I'm, there's lots of women with nausea and vomiting and pregnancy who've been dismissed. And so I think that it's a global problem. I think that, and again, because a lot of people, you know, don't have, I think menopause is a double hit because you've got women and you have aging. And so you have these sort of two things together that are often dismissed and, you know, who's the most invisible person in the room probably, you know, a woman over, you know, over age 50. So I think that for that reason alone, yes, absolutely. And we know there's women being undertreated. We know there's people suffering with hot flashes. We know there's people suffering with not sleeping well. We know there's people suffering with joint pain. And we also have lots of options for those. When it comes to depression, that's kind of complicated because it can sometimes be both. And so again, you know, we actually have also good quality data for using antidepressants for depression in the menopause transition and in menopause. And so I think it just depends on the situation. So, for example, one of the biggest risk factors, if not the biggest risk factor for depression in the menopause transition is previously having had depression before. So if somebody comes in and they have a new, you know, a return of their depression,

if they said that that was incredibly well treated with, you know, whatever, satalopram. Would it be wrong to restart them on the medication that was incredibly useful for them before? No, it wouldn't be wrong to do that. If they're suffering from hot flashes and night sweats and not sleeping well, would it be wrong to say, well, what do you think about trying this, you know, menopause hormone therapy to see if we get you sleeping better? And I also wouldn't be wrong to do both. And so, again, it's very easy on social media to sort of. sort of to say, oh, antidepressants are wrong, but there's definitely a time. Like, are you going to

tell me if you have somebody in your office with the PHQ9 of 29 that you're, you know, you're going to give them an estrogen prescription and just send them out the door. I'd like to think that, you know, you're going to marshal some other things. And maybe you are going to give them an estrogen prescription, but maybe also talk with their psychiatrist, if they had one before, assess their risk of suicidality, all these other things. So it's very easy to make blanket statements when people are a lot more complex. Yeah, that's true. Why is it so hard to talk about obviously shifting topics? Why is it so difficult to speak on the topic of birth control, specifically OCPs on social media without a lot of animosity in the comment section?

The right wing. Is it really? Well, so. It doesn't feel political, the negative comments. I mean, I'm sure there are some pages where that happens. So, but I see, like, I'll give you an example of why I'm asking this. I went on a podcast of, uh, husband and wife. They talk about their lives. She saw something on social media about birth control being terrible for your body. And she asked how I counsel patients on it. And I explained that when a patient comes in, I asked them what they've heard to see if, in fact,

it is true what they've heard. And if not, I just try and explain to them why, perhaps it's not true and where my data comes from and maybe lay out some other options, not hormonal options, talk about long acting options. And that's it. I didn't even say anything. And the comments are like, you're controlling me, you're a male, you shouldn't be giving advice like this.

And I, because I don't talk about OCPs often, but what I did, it was very angry. So I'm curious where you think that comes from me. Yeah, you should spend some time on my Instagram. That's why I don't even bother TikTok anymore. So, you know, here's the issue. Two things can be true, and the Internet's really bad at that. Women can absolutely have their symptoms dismissed, and a medication can be very beneficial for a lot of people.

And so if somebody doesn't feel good on birth control pills, okay. You don't feel good on it. Let's try one of the other options. Like, that's okay. You know, I don't, like, I mean, I don't take many medications, but I'm sure if I felt bad on something, I would say to my doctor, hey, I don't feel good on this. Can I, is there a different option?

So you have to, there's all this sort of right wing disinformation, amplifying things. And you're not seeing the women who say I had incredibly, I was going to kill myself from my premenstrual dysphoric disorder and being on the pill saved my life. I have severe polycystic ovarian syndrome and being on the estrogen containing pill was the only thing that got rid of my acne.

and, you know, helped me feel better. Women who are at risk for endometrial cancer and, you know, need also contraception, that can be a great option for them. It's not the only option, but, but, you know, so there are reasons. There are people that it's the best way for them to manage their pain with endometriosis or their heavy bleeding. And so, you know, it can be true that a woman can come into the office when, and she wants birth control, to just have a prescription handed to her and she walks out the door,

and she wasn't given any information. and that's wrong and that obviously can lead to people you know people should be upset about that and people can also come in and they can have a nuanced discussion about all the different options and choose the one that's best for them and we do know that there is right-wing funding behind a lot of this sort of anti-birth control agenda online and there would be a reason why you see one kind of comment enhanced and another you know you don't hear from the people who are like the pill saved my life. What are you talking about? And both of these things can be true. People can not like it and they can feel it's been incredibly beneficial for them. As for harm, apart from, you know, the risk

of me no thromboembolism, which is obviously still much less than the risk of being pregnant or the risk of postpartum when it's incredibly high. I would say, you know, what specific harm are you talking about? And what often people say, well, it changes your brain. Well, everything changes your brain. Pregnancy changes your brain. Postpartum depression changes your brain. Me coming to New York today probably changed my brain. And so what does that actually mean? And so we see a lot of cherry picking about that. And so it's just, it's difficult because if you want to have a new, the internet doesn't favor nuance. If you want to talk about, you know, the net, you know, the net benefits. I mean, if you look at the economic gains that women have had since, you know, since the pill came out,

they've been massive. But we also have other forms of contraception now, too, and shouldn't people have choices and what's good for one person isn't going to be good for somebody else and that's okay but do we have to get all like you know attack you know I just end up restricting people because I'm just like you know what happens is then people get this biased sample right and then all of a sudden the propaganda perpetuates itself so do you think the internet scares women away from birth control OCPs unnecessarily I think the internet is both an amazing and a terrible tool and it depends where you end up, right? So I have people that come into the office who, well, this was pre-Trump, so when the CDC was of value, because I'm very suspect now about all the information. They've come in

with fantastic information about different methods of contraception and what they wanted. And they're incredibly informed. And people can also go to the internet and come away incredibly misinformed. In fact, there's a study looking at vaccine hesitancy and internet users were more likely to actually be uninformed. And when they use the internet, internet. And the reason for that is when you Google something, what comes up isn't what's the most scientifically valid. What comes up is the most popular. And so it's, unless you're a medical librarian, unless you know how to sort of, you know, jury rig your search, it's very easy for people to be led astray. Do I think people shouldn't go online? No. I think what we should do is teach

people how to look things up online. I mean, that's what I think. I think that the vastness of the medical internet shouldn't just be for you and me. It shouldn't just be for doctors. should be for everybody. This is a great thing for people to have, you know, all of the library of all of medicine in your fingertips, but you also have to know how to use it. I mean, the analogy like I gave is, you know, back at the day when we had card catalogs and libraries and micro-feesh, you had to learn how to use the library. The Dewey Decimal System. Seriously, you'd go in, you'd go to the card catalog, you'd look things up, and you had to be taught how to use the library. If I wasn't taught how to use the library, I could have walked in and been like,

oh, well, you know, I'm just going to look at the National Inquirer that they also have here, right, because that's easier. And there's a time and place to read about alien and abductions and, you know, all those kinds of things. But I think that we don't teach people how to question the content that they get online and, and or we teach, some people learn it. And so I would say that it's both. And this gets back to whether you're selling a product or you're selling a lifestyle and what we're seeing I would say is this rise in for I and I don't have a great term for it but trad wife adjacent type of like issuing birth control staying at home not getting a job and if that's your choice that is amazing for you but presenting this as something that's medically

beneficial is a different thing right and so you know choices in all things yeah I also think about this less from negative influencers spreading misinformation, and more so because social media empowered everyone to have a voice. And when you think about what messaging is most impactful is when someone is telling you a personal story that has impacted them. So when you have the most viral content on, let's say, TikTok of a person talking about perhaps a true harm that happened with an OCP, or perhaps something that was going on at the same time as the OCP, that lands for millions of people and therefore biases them the next time they're exposed to any even neutral information about OCPs. And I see that in my practice a lot. So I'm trying to

figure out how do we allow people and amplify people telling their stories, sharing their experiences, but not so much in a way where it biases people against legitimate medical interventions. I think going and informed is the best thing. I'm going to put in a plug from my book, Blood, the science, medicine and mythology of menstruation, where I talk about all of, explain all of these issues about hormones and about what you might hear online

about birth control and what's true and what isn't. And, you know, what are the statistics on depression? What are the statistics here? And so people can make an informed choice so then they can decide, if you hear an, I have a very low tolerance. If someone gives me misinformation once, you know,

I'm almost certainly out because I'm always worried, you know, what's going to be the next thing. And so I think that the answer is information. I mean, I could easily, and I, this is one of the reasons why I rarely talk about, like, on my own social media page about things that happen to me. This is not fair. I mean, I could scare people about pregnancies, right? If I talked about, you know, what happened to me, I may be like, hey, no one should ever be pregnant, but that's my story.

I could also say if I hadn't been on the birth control pill, I wouldn't have been able to be a surgeon. I had incredible heavy, incredible painful periods. And I was dismissed my, my doctor told me, I should eat liver. I'm like, really? Like that's the best. Was that Dr. Liver King? Yeah. No, right. She was ahead of her time. You know, and so I'm like 19 and I'm like, wait, what? Like, that's the answer. I was anemic. I went to give blood and I was turned away. And I was like, oh, really? You mean like bleeding for eight days? A cycle is not normal? I didn't know that. And so, you know, I suffered with the bleeding because I was like, hey, I guess there's nothing you can do. And I got into medical school.

And I was like, wait a minute, wait a minute, walked over to the OB2N clinic, stole some pills, rest is history. But I could not have got through a surgery that would be longer than two hours on my menstrual cycle without bleeding all over the place. So, you know, but should I be using that story to tell everybody they should be on the pill? No, that's wrong. That's what happened to me. And so I think this idea that stories are absolutely powerful, but they have to be used in context. And you also have to think like, what's the message? So if I was giving my birth control pill story and I had a whole wall of Jen's birth control pills behind me, right?

And I had a deal with whatever company, pharma company X, to sell Jen's birth control pills. That would be even different, right, with my story. or if I was funneling people to, you know, buy my genetic test to tell which birth control pill would be best for you. And so that's why I think it's really important for people to understand the motivation behind the influencer. Yeah. In those situations, like if you had the wall behind you with the birth control and you're working

with the pharma company that was selling that birth control, is there a world where you were so passionate about birth control that you did think it saved? life or improved the quality of your life and you're like well i'm going to do everything in my power to support this thing by working with pharma by doing this thing and you might be doing it in the correct way and it would be perceived as negative so i think it's very very hard for people to have those kinds of conflicts of interest and for them not to have an impact on what they say right when there's 20 30 40 100 $200,000 more than that involved behind the messaging do you think that's going to change what you're going to say is that going to change how often you make that

content I'm sure it would for me I'm only human so I mean that's that's why pharmaceutical companies want doctors in fact they want a doctor who's like oh I'm really evidence based and I'm going to give you just like they want that they don't want the person who's like it takes 50,000 from every company so I think it's really complicated I think there's people who feel that they can do that and and that's that's up to them um i think that one huge issue which i think is is unfair is that we collect data on what doctors get from pharmaceutical companies but we don't collect data on what they get from supplement companies right or from ads or other types of things and so it kind of gives this different weight that you know like if somebody's

talking about a supplement, I don't know how much money they got, or maybe that company bought 20,000 of their books. Like, I don't know. Like, what was the deal behind that? So I think that the problem when you only have partial transparency is, you know, it creates this farmishill. Yeah, uneven playing field for sure. Because I just, I did a debate against 20 anti-vaxxers vaccine skeptics. And one of the individuals that sat across from me started taking me down this lawyer-like line of questioning where he's like, do you overall trust people? Sure. Do you trust someone that has harmed you before? Well, maybe less so than usual. Would if they repeatedly harmed you over and over? Well, then I would definitely trust them

out less. Well, do you think pharma has ever harmed us? You get the line of questioning. And I understood where he was going and I said, well, I totally get what you're saying, but you're labeling pharma as like one thing, whereas it's an ever-changing group with different researchers, the people who are in the financial office in the marketing arm of the pharma company are way different than the scientists performing the research. It's also very different than the ACIP and the United States Preventive Service Task Force who are gathering and compiling all the data to decide if this is unbiased and true research. But then it hit me the other day I was thinking about this.

I could have just asked them the same question about supplements. Right. Well, there's been plenty of supplements that have lied to us, that still lie to us, that their ingredients of what's in the pill is not what's on the label, that have led to deaths, liver failure. Why do you take supplements? Yeah. I mean, my answer is, I'll be really honest, I love pharma.

I would have no children if pharma didn't exist. My kids would have died without surfactants because somebody decided they wanted to design a catheter my son was able to have his pulmonary valve opened when he was three pounds, you know, because somebody invested in creating a heart valve that could fit a pulmonary valve, then my kid got to have his heart valve replaced, you know, because somebody decided we needed to learn about, you know, erythropoietin, my kids were able to get that in the NICU and have less blood transfusions. So I'm all about innovation.

And I also don't think that, I do think we have a huge problem in the United States where a lot of the basic science research is done by NIH funded and then Pharma takes it over and then we're paying for it twice. Wait, I paid for that with my taxes. So I have a huge issue with that. And I do agree. I know a lot of scientists that work in pharma who are like incredibly dedicated and, you know, they want to solve problems. They really do. And so you do have to separate that from the marketing. But it is different, you know, I mean, think about it.

to think about the, you know, I could do a great ad for EPO, couldn't I? You know, I could do a great ad for surfactant. I could do a great ad for a lot of things that are also all being used now, I think. So let me ask you just to play devil's advocate. Why wouldn't you do an ad for EPO? I couldn't live with myself. I mean, you'd be engaging people about, like no one's going to be using it in a negative way based on your advertising, but you think that would bias you to the point where you become less trustworthy? Slippery slope. So it's a gateway deal.

Yeah, yeah. I don't know. I think that all these things become gateways. I'm going to do this just this one time. I mean, just do this. We're all graded, like, convincing ourselves. I'm just going to have this chocolate bar tonight. I'm not going to have one tomorrow.

I mean, that would be my equivalent of it right now. I know if I went tonight. I went tomorrow, which is fine. You should have chocolate if you want to. I like it. But I would say that for me, like, I just don't want that in tank. It just, I don't know, I just don't feel that I need it. I've been in that world.

I've been flown to a corporate lodge. I know what it's like, and I'm just like, yeah, I just, it's an easy, slippery slope. I mean, that was a long, long time and again, I've been in medicine for, you know, 30 years. So when I was very young, I kind of got poached by a pharmaceutical company. And I told myself those lies, I wouldn't make any difference. And I'm so evidence-based and I'm going to change their slides. So they don't, and they're just like, yeah, that's the perfect. That's the perfect.

So, you know, and then you were like, did you catch yourself at one moment where you were like, oh, man, I shouldn't be doing this? Yeah. When they sent a private jet. Wow. And I was like, oh, wait a minute. This isn't good.

Yeah. Well, no wonder you just opened the last clip by saying I love pharma. We're going to stitch these clips together really well. Dr. Mike. They sent a private jet. I love pharma. Exposet.

Well, I wasn't the only one on it, though. I want to just be like, you know, Fair. Be honest about that. Well, it was you, Dr. Gundry, Dr. Ozzy. Yeah, yeah. No. No, I just, that's when I was, and so it's very easy.

And so, you know, I did work for pharma for about three or four years. And I was really unaware of it. When I moved to the United States, you know, I was basically told by my department that this is how you make up for the sucky academic salaries, right? The guys in private practice are making two or three times. You're making, you know, a third. And this is how you make up the difference. And so that's what I was kind of told.

And then, you know, very quickly, I was like, okay, this isn't right. I just, and then there was, there was just, once you're in it, you realize there's no way to, you just, it's, you know, you have to get on. You're in the web. Yeah, you just got to be out of it. Like it's just, you know, the tendrils are sticky, I think. So, yeah, I think that, you know, if, uh, would I care if I made a message about a product being, you know, I just make message about products if I think they're good or not. I try to use generic names if I can. I'm a, you know, but yeah, I just, it's just not for me.

I think that I've been out. And Heinz, once you're out of something, it just gives you so much more perspective, kind of looking back. Well, let me ask you a controversial question. We turned down almost everything from pharma related. We did do a campaign with Abbott to encourage people to donate blood. It was a nationwide campaign. I would go to events.

made viral video content about it. Do you think that compromises my ability to give accurate information? So what's Abbott's? I'm curious. They're the largest tester of blood, donated blood. Oh, the largest tester of donated blood. But by your definition, it feels like it should compromise me. So I'm curious, if you're being honest right now, do you think?

I don't know. I think I'd have to think along the heart about that. I think that, yeah, I mean, I don't think I have an answer. for you and I'll see it's I'm very conflicted here because you know when my son was in the hospital last year having his pulmonary valve replaced he had a terrible complication 10 days later and had a massive GI bleed and exhausted the blood bank not a good thing to hear hey we're going to give your kid unmatched blood awesome um so so yeah an important message and I'm not saying I think that it's like I don't have an issue um for someone doing that message I just don't think I just don't think

for me because of I've also said like this is my thing I'm pharma free that you know I have to be true to that and so I just think that um is that an ethical use of your time yeah I mean maybe my kid got blood because of that you know um and so again two things can be true at once and I think that that's a hard thing um I know there's physicians who promote different drugs and they take money from companies and I know that many of them are good doctors. I know people take grants to do studies. I know they're good doctors. I think one of the big issues is being honest about disclosing. Of course. And I think that that doesn't happen in the way that it should. So for example, when they had the FDA panel on hormone therapy, whenever that was, people were glossing over

their disclosures oh they're written down they said it's like no you actually really need to talk about them they're super important um and so i do think that a lot and that social media makes it very easy for people to not be honest about that yeah i think the ftc needs to do a better job in policing that yeah i think so because at one point they were sending out letters and like getting the Kardashians warnings and such i believe it was a Kardashian yeah that's right over um one of the morning sickness drugs yeah yeah yeah yeah well i mean we've been approached by farmer And I'm very open about this because I'm actively trying to figure out being that my business is in advertising, essentially. That's what a show is.

And when we pick our sponsors, we try and be so thoughtful because we're representing a level of authority. And we're always trying to say, what's that line? So for example, us doing a sponsorship with a cybersecurity firm. To me, it's like not compromising my medical ethics. Cool, let's do it. But then pharma becomes trickier, right? Abbott, in that example for me, is like, I would absolutely love to get this message out there of improving blood donation, especially after the pandemic. Young folks completely stopped donating

blood. So we needed to get them excited. And we were able to partner to do something special. But then other times, they'll come to us and say, hey, promote this drug. It's a drug for a known condition. And it's a drug that perhaps I prescribe. But why would I prescribe that drug when there's a cheaper generic available? We're turning that down, even though there's huge sums of money. And it's like, it's almost like you could, you could, I could easily talk myself into it. Well, it's a drug I use. And I'm just talking about how it works. But I know I wouldn't recommend that to a patient.

Right. So if I, my bar is like, if I would say this genuinely to a patient, I'll accept the deal on that behalf. If I will not say it to a patient, we're not going to do it. And we've done the same with over-the-counter stuff, like pain relievers. Right, right, right. Oh, we have this new combo pain reliever pill, promote it and say it's the best for this condition. I would never say that to a patient. Right.

You know, it's such a benign thing. Right, right, right. Like, no one's going to come after me saying like, oh, he's going after a headache medicine. What a sell out. But it to me just doesn't, it doesn't pass that sniff test. So I try and be minutia about it, but obviously there's ways to mess up. I think also, too. I mean, you know, look, I mean, I have the same.

I really, I mean, I sometimes get some gifts from companies. Although these are, shoes are named after me. These are Dr. Jen Gunter shoes. way. Yeah, from John Fluvog in Canada. I have stores here in New York too. Hashtag not sponsored? Yeah. No, I don't. There's free shoes. I got three pairs shoes. Nice. But a percentage of the profits goes to an organization in Canada that helps women in northern communities and people of menstruate get access to menstrual products. So, you know, I'm okay representing a Canadian company. I'm a shoe influencer. I will do that. You can send me shoes. I'm known for my shoes. I'm happy to do

shoes. If Tiffany's wants to sponsor me, super. Chanel, call me. But, but, but, you know, medical, yeah, medical, no. But I do think it's a really interesting concept, especially about the idea about donating blood. Because, because people, you know, while Abbott makes money off of that, people absolutely need blood. And that's kind of a different situation. I would say, it's hard to, it's hard to equate that with, you know, take this, you know, new, neurokind and three receptor antagonist, you know, for menopause. Sure. So I think that that's kind of like a different, it's hard to draw the direct comparison.

Yeah. And what's funny is after my vaccine debate, a lot of people started calling me a shill for Abbott, which is hilarious because they don't make the vaccine. I know. And then second, they felt like they caught me because they looked at the Sunshine Act information. And I'm like, you could just open my YouTube channel. It's the first sentence, in the first sentence of the video.

and on the bottom and on the top, like it's as disclosed as cleanly as possible so everyone's on board and understands what the topic is. But people obviously weaponize anything these days. Yeah, I mean, I think that, again, nuance, what is it? It's gone. You know, and we don't have these conversations

where we talk about it. And, you know, there are also broader messages like, hey, everybody go out and donate blood. And I think that that it's just it is an easy slippery slope you know someone said to me well you know taking shoes is you know that's the first step i'm like again pardon the pun i'm like really like how yeah i just i mean you could be an extremist in either form you can be an extremist that you should never accept a shoe or you could be an extremist that you should accept everything that comes your way because who cares

you have one life so like it's usually something in between and that's going to be different individual to individual. Some people will have a level that they can go a little bit deeper. Some can't. I could see that. It's almost like health care. Yeah. I mean, again, everything is nuanced. And I think that one of the things that has happened in the last few years, I don't know how long has been happening, but our ability to have nuanced discussions and to sit down has become, I think, really difficult. And I don't know if it's because we all spend so much time online that we have shorter attention spans to someone getting to the point. You know, I see myself like that. Sometimes I'll watch a video and I'm like, five seconds have gone by where, you know, like, you know, give me.

But it's interesting how podcasting is growing because these are long, two, three hour conversations. Why do you think that in the era of so-called shortening attention spans, podcasts are growing? You know, I don't think I have an answer for that. And I rarely listen to podcasts. My husband loves them, though. Listens them all the time. And in fact, when I'm doing research for something, there's a podcast. He listens to it.

And then it gets me all the excerpts that I eat and gives me the time stamps. Nice. Okay. You know, some people like it. And I do have to say sometimes there, you know, the few that I do listen to, sometimes are super interesting. I just, I don't know, I talk to people a lot all day. I talk, sometimes I just like, I just want so quiet.

Like, I just want to hear the bullet points. Yeah. Or, you know, like when I go for a run, like I don't want, I don't want music. I don't want anybody to talk. I don't have to list of podcasts. Yeah. I just want like the sound of the outside and that kind of thing. How worried are you about the current state of health care with Maha in power?

I think the harm is going to be catastrophic. I think people have no idea about how bad it's going to be and it's going to be eroded in little bits here and there. and there'll be this two steps backward, one step forward, so people will get appeased. But I think that health care, as we know it, is going to be compromised. And I would say health in the broader sense, like, for example, fluoride, right? So the idea that, first of all, people are taking Floyd out of water is absurd. They already did that in Calgary. They ran the experiment.

Look what happened in Calgary versus Edmonton where they didn't take it out. Oh, wow, dental carries. Who's going to suffer the most kids? Kids with getting dental abscesses. And now we're seeing all this connection with obviously dental health and your health. And is that going to set your microbiome up? Like, who knows, right? All this potential catastrophe.

And, you know, now they're going to ban, you know, they're having this panel to discuss the science of fluoride tablets. It's, this is the supplement that shouldn't be out there. Wait a minute. Like there's all these other supplements that everybody in medicine is like, get rid of this one. Get rid of this one. And that's the one you're going for. And so it's, you know, I'm quoting it's the title of a book,

The Death of Expertise, Tom Nichol's book, yeah, which I'm in it. No way. I haven't finished it. I'm like 30% through. We invited him actually on the podcast. Yeah, it's about the whole like, why are people believing Guineth Paltrow over me? That was kind of the whole thing. And he said, you know, because she has a pedestrian-looking blog, I guess, you know, kind of thing. True. And so, you know, this whole death of expertise. And so we're going to get rid of fluorid tablets. And how are people going to, you know, so if you're wealthy, you'll find a way to get them. And if you can't get them, then your kid's going to suffer. Your kids are going to have more dental problems. And this is going to set them up for a potential, you know, lifetime of problems with,

with their mouth. And that's just one area. Are we going to have flu vaccines? Are we going to have, you know, are we going to have COVID boosters? You know, as someone who's got a kid who's, you know, had major, you know, surgery for their canal heart disease, like, you know, like I'm really concerned about that. I see a lot of patients who are immunosuppressed, you know. Are we going to have, are we going to have these panels? And this is, I think, one of the things that actually really keeps me up at night. Are we going to have the faux legitimacy of these panels where maybe there's like one or two reasonable people on the panel? Like, you know, we saw with the panel they just had on SSRIs in pregnancy. Are they going to say, well, SSRIs cause miscarriage? I mean, they don't.

But, you know, are they going to say that? Well, so then our pharmacists are going to be afraid to fill prescriptions for SSRIs for women of reproductive age and states where abortion is illegal? maybe? Are people going to be afraid to prescribe it? That could happen. So no, it's going to happen. We're going to have all these people with untreated depression and all the effects of that, which we know is significant. If we have, you know, there used to be a process. They'd maybe convene a panel, but then they'd have an appropriate scientific review. Where people come, they would have noted experts in the field, and I think we have an erosion of what a noted expert is. We have a meeting, with true experts, new research is presented, there's public commentary, they take feedback,

and then a decision is made. What if that process gets subverted? And that comes in and then McCarrie says, no, we're just going to do, I listen to them, we're going to do this. I'm not going to take the math. I just listen to the math's enough. Okay. Well, what if he says that about Miffipristone? What if he says that about SSRIs in pregnancy? What if he says that about whatever else pet peeve that, you know, he's God or whatever Maha whisper has told him or, you know, whatever RFK Jr. and him have cooked up. Like, so where does it stop, right? When you give somebody sort of godlike powers, you know, where does it stop?

And if you think about people now with all the, you know, the universities and their funding with the NIH and all this other stuff that's happening and grants being pulled away, If you've just finished your Ph.D. in STEM, especially in a sort of a medical field, would you want to do your postdoc in the U.S.? Or would you say, okay, well, what if my grant gets pulled? Or would you go, oh, wow, there's this lab in Amsterdam that also does what I'm interested in? So I'm going to see if they'll take me, right? So are we going to have this brain drain? We're going to have these people, because they can't get jobs. I mean, I've heard of people had their PhDs canceled because, you know, the grants are all gone.

So what do all of these things mean? And I think it's, I think that we're looking at catastrophic harm. And we're just talking about medicine. I mean, whatever's happening in medicine, you've got to assume they're putting the same people in in climate science and all these other things. I mean, you know, they got rid of, I believe, if I'm correct saying this, the whole scientific arm of the EPA. So you can dump whatever into the water, I guess that's okay. But we got rid of food diet and Cheerios. It's all a distraction.

It's bread and circuses. So, yeah. So, I mean, I always feel very like doom and gloom. And it's like, man, we're just like, oh, for drinks now. And, but I think that. Do you think the medical community is doing enough to combat this? I don't know what they can do. I think that there's problems.

There's people who, you know, you say you work at a university and the university's thinking of kowtowing to the government. If you speak up, are you going to lose your position? Like it puts people in really difficult positions. You know, difficult positions. I don't. Imagine every university and every medical school sign a letter that says he needs to resign, Secretary Kennedy.

Yeah. I don't think nothing would happen, though. Yeah, I mean, but what a message that sends to the people. So I actually believe that you are correct, that if every single person, every single dean, if every dean said, we have to stand up and do this. But are they going to do that? That's the whole thing. Do you trust these people to do that? And I'm going to give you an example about how I was sold out by a dean.

So I used to work at the University of Kansas. And I was one of the few people in the states that could do abortions at any gestational age. and Kansas used to have no gestational age limit. So it's a leftover from other times, I think, when the, I was told the previous chair of the department had a lot of information on politicians, so just leave it at that. Okay. That was the rumor. How true, I don't know.

And so, you know, so I would see lots of people with, you know, fetal anomalies and other issues, but I also see people with catastrophic complications who could only have their abortion done at a tertiary care medical center because you can't go to a clinic when you're an adult with inadequately repaired congenital cardiac disease who'd never been told you shouldn't get pregnant and now you're eight weeks in a cardiac failure right like so those are kind of people that we'd see and the the medical school university or the hospital the hospital get the entities right the hospital was suffering financially and some of this was related to what whatever, how the states allocate funds and buying and all kinds of complicated things.

And the hospital needed to divest itself from the state to be financially solvent. That's the best that I understand it. And they introduced a bill to do this and somebody put in a writer that it could only go through if they banned abortions at KU. Yeah. And so initially it was like, oh, this is terrible. We can never do this. Academic freedom, women, everything. And I'm like, I'm the only person at the hospital doing abortion.

right and I'm like hey this is super important because you know what's going to happen we're going to have these super sick women come in and I'm going to be like sorry I can't do that and I'm here on a green card I'm not even a U.S. citizen at this point I didn't even know if I had my green card at that point maybe I did I can't remember but you know not in like the solid like you know I'm not a citizen and yeah it passed they just decided sure they just rolled over great that's not really they can go elsewhere. But of course, I knew they couldn't go elsewhere. And so what happens? I get a call, you know, somebody who's really ill. And I'm like, well, call the dean. What do you mean? Call the dean. We used to call you and used to take care of it. Yeah. Remember that like faculty

meeting that everybody was supposed to be at to talk about this? Were you at that faculty meeting? You weren't. So, you know. I just can't imagine any med school dean that can, honestly look at what Secretary Kennedy has done thus far and call it a good job. Yeah. I just, I can't, with any logic. Yeah. Maybe with a very heavy political lens or something, but not with logic.

No, it's catastrophic. It's taken, you know, whole institutions. Like, I don't know how many cancer studies, like you read, I get lost in kind of the individual things that have happened, like somebody doing this incredible pancreatic cancer research. And apparently they're on like a cusp of a vaccine. gone right like this like lifetimes of research imagine if this had happened 20 or 30 years ago well maybe we wouldn't even know preons existed you know maybe that lab would have never been

funded yeah what are we gonna like these are the things we know about but what about the undiscovered science that's never going to happen like that's well what's weird to me is on one hand the maha group is like we need more research we need to understand how ultra processed food is bad for us We need to understand how vaccines impact the body, but then they're cutting budgets to do that work. Then they say, oh, well, the WHOI did a terrible job with hormone therapy, and we don't know enough about it, but everyone should be on it. It's like, hold on a second.

You just said we need to pause and do more research here, but then you cut the funding. There you said we don't even need more research, just give it to everyone. I don't even get what they're trying. Like, I understand if there's an, influencer who's trying to say, check your levels. And if they're low, take my supplement. I get what they're doing. But I don't understand what this group is doing. The goal is chaos. For what? Chaos leads to power. Like power into disruptive, crappy system. Well, that's because you're not a

psychopath, so you don't get it. That's the kindest thing anyone has said to me on this show. Thank you. No, seriously. I mean, the hypocrisy of, oh, we're going to ban ultra-processed foods. But here's my influencer code for AG1 Greens. And, hey, I have a protein bar that you can buy. Like, wait a minute, that's ultra-pro. Like the loss of Kevin Hall and his research. Oh, my God.

I had a podcast back in the day a while back. I interviewed him. He's amazing. He's, you know, losing somebody like that. Like if you really cared about ultra processed foods, if you really cared about You need to bring him in, give him on the funds. You need to give him all that. Like, I mean, and I wouldn't be happy about people taking money from cancer research.

Don't get me wrong. But if it was all going to fund legitimate labs, it would be a harder discussion. Right. Because then they're shifting budgets, not destroying everyone. And we can still say, hey, that's not fair. But. And so, yeah, I mean, it's, Kevin is, you know, amazing. his work is amazing he's incredibly ethical he's one of those people that only says you know he he speaks

a lot and well we don't know but then let's ask this question and let's take the next step and the idea that this metabolic lab that he had like it just doesn't exist anywhere else and you know i i actually had a fantasy about like participating in one of his experiments going to like hotel n i h and doing one of those two-week things because i think that would be super cool like i i i think that would be super cool like I think it would be super cool. I don't think I could have a catheter for two weeks, though, because sometimes they're like, I'm like, well, I don't know. Well, how much pay? But I think it's, and I don't know if they do that. I mean, I could be wrong. But I think it's fascinating. And what an amazing idea. And we're going to, you know, try to decide, like, when people

have presented this, this is what they do versus this. And life is, you know, and then to just be like, oh, we're just going to like take a hammer and just, you know, I feel like we're in some kind of, you know, horror movie where there's just, you know, someone taking a baseball bat and, you know, it's like a twilight zone or something. So yeah, I mean, speaking out is what you can do. I do think, like, like you have a massive platform. You saying things like every dean in the United States should be speaking up. Yeah, they should. I'm sure they have an association of medical school dean meetings. And, you know, I mean, there's doctors, you know, leaving states that are, You know, you have states where there's no, you know, because of the rules about abortion access, there's doctors leaving.

There are people who can't recruit for residency positions or for fellowships because they're like, oh, hey, my partner's in OBGYN and they don't want to move to Texas. So sorry, I can't come to your, you know, or, hey, I've got a three-year-old girl and I want her to grow up in a place where, you know, she may not be able to have an abortion. So all of these things are having effects. and the problem is, is how are we going to measure it because all of the people that measure these outcomes are like gone or all the, you know. Well, I'm hoping, like what my biggest fear is, is let's say primary care physicians. I think that's the bedrock of a good health care system. And I think about where primary care physicians get their guidance from, CDC, FDA.

In fact, during the pandemic, when people would ask me where to go, I would point them to these agencies. But now those agencies have been corrupted. I don't know where they're going to get their information from. I'm hoping from like the American Academy of Family Physicians, ACOG, but how long until they're corrupted? You know. Or put political pressure on them.

Yeah. I mean, there's super right-wing physicians in every physician organization. And so I think that it is. But the thing is, I don't think these are right-wing policies to, ban nutrition research. I don't even understand what wing thinks that is valuable. Do right wing

people believe that red dye is really the issue? So this is where my husband would say you're being naive and that he would say the goal is to be in power. The goal is to do whatever it takes to be in power.

And that's what's the strategy? So it's looking like you're doing something. It's all this theater while you're taking away the like we hear more about I know more about whatever dies being banned than I know about cancer studies that have been unfunded it's all this noise it's all this distraction it's you know it's the Romans having gladiators and you know killing people for spectacle so people don't realize what you know what's going on really behind it so I think it's it's a lot of that. Speaking of Romans fighting gladiators, I know that you've had a run in with Dr. Gundry,

one of our guests. How did that gladiatorial battle come together? Well, I won. So back in the day, you know, I would write about different celebrity scammy things and Gwina Paltrow was one of my targets in Goop because really telling women that bras cause breast cancer, like you don't have a better way to use your celebrity than that but it gets attention right she can monetize those eyeballs that's what she said to the new york times so you know i would write about her stuff and sometimes i'd drop some f bombs which which miss paltrow is um apparently fond of doing herself um i and i could have the quote wrong but i think it was something yeah anyway she's there was something that she'd used the f bomb out anyway so i i'd written something and and this was actually on my

birthday several years ago, I think maybe 2018, where they wrote a response to me from Goop about all my things. And they wrote, it was, when they go low, we go high. And I was like, I don't think that means what you think it does. But okay. And then they had this thing about this, this OB-GYN who wields the lasso of truth and who is she to say. And I'm like, well bitch i'm the expert that's what i i get to you know i did a fellowship and infectious diseases i run a clinic for vulvar and vaginal health i actually do get to say what's what's good and what isn't um and so they had written this like tone policing thing and then they got some one physician whose name i can't remember to write something

and then and then steve gondry to write this big long missive and it was all about don't i know this in my potty mouth and all this stuff and i was just like oh my god you are the most mansplainy surgeon. And anyway, so I wrote a response to that, and that went super viral. And I got all kinds of, you know, celebrities reaching out saying, well, that was, like, really well written. And I was just like, you know, you know, here you are saying that a woman who says that Jade eggs can be recharged by the energy of the moon, and so you should put them in your

vagina. You're saying that she's the expert and I'm not like why does that work so well like why do people believe jade eggs are the solution marketing and and probably why can't we take the power of marketing and use it for good stuff well because you don't want to lie to people right so alternative medicine is so certain and it's all like it's about this aesthetic I really think that what what goop did was they show that you can put aesthetic over facts. You can have this image that goes along with it. And, you know, it seems like exotic and, you know, all these other things. You know, it's really sort of more Western exoticism of, you know, of other cultures,

which is, you know, a big issue. And yeah, and it's like, well, okay, which is the misogynistic thing to tell people that they can recharge Jadig's by the energy of the moon and put them in the vagina to tell them not and hey if you're such an expert how come you haven't taught some solar company how to hardest lunar energy like i want to know why why don't we have lunar panels and so yeah so that so so so steve gandre was part of that that response to me and i was just like oh god um you know uh so and he was he was you know tone policing my swearing oh i was like okay well that's all you got them i was close to swearing on my podcast with him uh it came at a point where

i said that not everyone following his diet would be cured of any disease he said no no no i can cure every disease so i asked him if he's a prophet and he said well i'll just say this that at my age i no longer have to work but i continue to work because i can cure every disease i mean yeah i mean sure um i don't i really know what to say that sounds like something barnum would say, I don't know, I don't know, I don't know, I don't know, I don't really know the history of Barnum, so I can't say. But what I would say is, fantastical claims require fantastical evidence. And so, you know, where's your 30-year published clinical trial? How come Kevin Hall's not studying your diet? Well, he'll say, oh, I've helped thousands of people in my clinic and

no one wants to study them. And there's tremendous political backlash against me. But if he's made so much money off of all of that, why isn't he doing the studies to prove it? I wish I had you in my ear when I was doing that. Well, that's always my question when people are like, oh, but nobody wants to fund the supplement studies. I'm like, wait a minute, why don't the people who are making money from the supplements? Like, why is it up to the NIH? Like over 10 or 12 years, the NIH has spent $150 million studying turmeric, which is, you know, a substance that interferes. It's like one of these pan assay interference things.

I think the acronym is pains, which is like really appropriate. This is like basically muddies up equipment so you can't even really get good readings and things. And so we've spent $150 million on turmeric. Really? Really. And what do we find? There's no good evidence to support for anything.

It is liver toxic, though. And yeah, I know there's no good evidence. There's no good evidence for benefit. There's evidence of harm. Yeah, I mean, uncommon, but we don't really know. because it's unstudied, and how can you have a risk-benefit ratio when there's no data to show you what the benefit is, right? And you know, why do so many influencers push turmeric?

Well, it's one of the most taken supplements. I did not know that until I looked into it, apparently 11 million Americans take a turmeric supplement. Wow, I had no idea. I thought they just put on their salads. Yeah, it's great to cook with. I love myself a turmeric chicken, I love to make curry. I think that's all fantastic, but these supplements have other issues associated with them. And I just think that, you know, if a drug, imagine if there was a drug doing that

pharmaceutical drug, well, we're really having to get data to support it. And we know it's associated with liver toxicity. But you should buy my, my pharmaceutical. Because the branding's real. Yeah, because the banding's great and it looks good. Yeah, people would be like, what do you talk, you know? So, so, yeah. So I think that supplements because there's such a way to print money.

And, you know, like I set up my own supplement company to see how much money there was. that you could make. No, no, no. Tell me about this. So my husband was the chief marketing officer, so he's all over this. He's like, I can tell the marketing, speak here and here. And so I said, well, let's contact one of these white label companies and see how easy it is.

And I was thinking they'd be like, and I had him do it, you know, because I was busy, and he's really good at that. But two, I wanted the emails to all be from somebody who wasn't medical, right? Like it was just, there's no MD or anything. And it was like two or three emails and you just say what you want in it. So I picked, you know, whatever, turmeric and black pepper. I just, you know, copied, you know, one that was online. I picked a price point for whatever was on, for turmeric supple that was online.

And they will connect with your Shopify store. So you never have to get your hands dirty. They will make a label for you. You can work with Shopify. Whole thing's done. They'll take care of putting things on the shelf, off the shelf, shipping it all out. You don't have to do nothing. And I can't remember if the local.

lowest volume that we could order from this one company was 8,333 bottles. And I can't remember what we had to pay to buy to do the startup for those bottles. Let's say it was 100,000. It might have been a little bit less. But if I sold those 8,33 bottles, my profit would be about 197,000. So for my initial, you know, so that's the profit. And that's the minimum, like you weren't getting a good deal. Right. If I could order in bulk, exactly, repeat customer. And then also, too, you would be

cheaper down the road because you wouldn't have had to pay the person to design the supplement and set up your Shopify, right? So that's the least amount. The least amount of money I could make would be $197,000 for selling $8,33 bottles of turmeric supplement, something that's, you know, almost likely useless and has a risk of liver failure. And so if you're an influencer with two or three million followers, how easy is it to sell $8,000? bottles. Probably pretty quick, yeah. So my big belief is supplements are the wheel, the financial wheel that drives the wellness and maha industry. And I believe that if we had regulation of supplements in the same way had regulation of pharmaceuticals, you'd be cutting off this funding pipeline

for a lot of these people. And we would have a dramatic difference in the amount of disinformation out there. That regulation is never going to happen, you know, in the United States, but maybe somewhere else what do you think is the most spread inaccuracy about women's health these days um i don't think that's so hard because it's such a broad a broad topic um i mean i would i would get back to um the idea that um that that women that women and people get pregnant need to have access to abortion care whenever they want to have it that this idea that that abortion should be you know rare legal and accessible like like take the rare out of it it should just be what it is and I think that that to me that's still because this is the same like I've been in this

business for you know 40 years I'm still having the same conversation so that's probably got like the biggest sticking myth and you know the stickiness to it that that the the politicization politicization. I don't know how to say that. Anyway, how politics gets involved with women's health. We don't see that with men's health. So I think that's actually the biggest issue is that, you know, the politicking of women's health. You talked about work that you were doing with chronic yeast infections. Issue I see quite often in my practice outside of using fluconazole and then perhaps spaced out dosing of it, pulse dosing. What are other strategies? Are you using that could benefit primary care providers if they don't have access to a specialist?

Yeah. So if somebody's coming in and they give you a history for, you know, they have, so first of all, a white discharge and an unreliable sign of a yeast infection. So somebody's got itching, they've got burning, pain with sex, something like that. If they, if it keeps recurring, you need a culture because you need to know that's really what it is because there are other things that can absolutely present like that. So you need to get a culture. If the, if the culture is positive, then you need to know if it's sensitive or resistant. And you can ask the lab to run sensitivity testing. And if it's sensitive, then you put them on the standard, you know, regimen that Jack Sobel initially published in the England Journal of Medicine, where you would take a dose of fluconazole today, one in three days. You can sort of your third one, three days later, and then once a week. And whether you should do that for six months or a year, we don't have good data to say otherwise. I usually ask people kind of how they feel about it. It's a really safe medication. If you have a resistance strain, so the MIC for um, Fluquanazol is, you know,

generally over four or comes back and says, um, you know, that is resistant, then obviously you need to come up with a different agent. And usually we default to boric acid for that. Um, we used to use Brexifem, but it's not available anymore. Whichever drug company is making that, please get on that because this has really been a problem. And if the culture is negative, then, you know, what you want to do is, well, did I catch the patient? at the right time, you know, maybe she had symptoms that are gone away, but also make sure they don't have any redness or anything on their vulva

that would go so yeast can be in the skin and you can have symptoms and have a negative culture and think what else it could be as well. So that would be the thing, but there's no diet wearing white cotton underwear, all that kind of stuff make any difference. I never understood something that I even hear gynecologists say, the mechanism by which they propose this solution.

probiotics ingested orally somehow impacting the vaginal floor. What is the mechanism by which that could happen? And does it actually work in reducing the likelihood of yeast infection or BV? Yeah. So yeast has nothing to do with lactobacillia and other things like that. Even though there's pH changes that can... No, so yeast actually grows at a normal pH of 4.5. It's rare to see.

I mean, you can sometimes see it when the pH is elevated, but it doesn't grow well. So the standard pH should be like between, you know, 3.8 and 4.5 or some of the yeast infection. And we think this is the, we've got several issues going on. So first of all, there may be sort of an increase in virulent strains with yeast. What that's related to, we don't really know, temperature, climate, don't know, microplastics, who knows, something to do. So yeast is becoming, you know, more virulent.

meaning it's sticking better, causing problems. So that's one reason, but also there's subtle immune things that we just don't understand. Low iron is another one that, you know, probably 50% of the people I see with yeast infections have low iron. And so we don't actually understand why. So if we don't understand why, then obviously, you know, another specific therapy, we don't have data to support it. But we don't really think that there's any reason for that, for a probiotic to help. The idea, I suppose, behind oral probiotics is you colonize your gut and some of that gut bacteria is going to get into the vagina. The data for probiotics with bacterial vaginosis is actually really, really low quality.

The best data was published in the New England Journal. I can't remember how long ago. And it was a specific strain, I think, called Lactin v, which had, I think it had ramnosis and reuteroide, but I can't remember off the top of my head. And that was a vaginal insert. And it did reduce the risk of recurrence, but it didn't, you know, So it was statistically significant, unsure if it would be clinically significant, definitely worth further investigation, though. You see that. I think, okay, well, this is worth further investigation. But all of the commercial products for BB, like, they're untested in a meaningful way. And I would say the grander the claims they make, the more expensive they are. And there's a lot of money. And I'm not going to tell someone to spend $100, $200 a month on a probiotic when the company hasn't, you know, published something in a journal that I can look at in a peer-reviewed way.

say like, you know, like I don't care about the data on your site. That's like saying my mom liked my homework. That's a good line. Yeah. My kids are going to, my kids love to tell you how great my research is. And yeah, maybe it was good, maybe it was, but I want to see it published in a journal. I want to see it reviewed by somebody. We can see your methods.

We can understand everything. So yeah, yeah, my mom like my research doesn't count. That's really funny. I know. But again, insert makes sense to me. But the fact that you're going to say that, yes, some of it will end up in the vagina to be. Yeah, I do a lot of de-escalation with products. And it's, I feel-

You're also been quite vocal about products being on the market regarding intimacy, smell, things like that. Tell me about your stance. Yeah, it's like my pet peeve. So, well, I have a lot. So it's my pet peeve today. Yeah, so many products for women are marketed under the assumption that vaginas stink, basically. And that's, you know, vaginal mayhem cells. And I alluded to that earlier. Someone who worked for a big women's magazine told me years ago, and I completely believe this is true,

although it also agrees with my preconceived bias. So there's that. I'd just be honest. But that every month when they had a meeting, they had to have something about catastrophic vaginas. Like, they had to have that in there. What's the catastrophic vagina thing going to be like in your own pubic hairs? Like, if you got your health information from women's health magazines, like in the 90s, the aughts, and maybe even the last decade, they've gone away from print now. You would think the biggest issue, women's health issues, around pubic hair. My God.

That's like the biggest health issue. Like, really? Like, you have this, you could talk about incontinence. You could talk about menstrual ground, but really, pubic hair. Wow. Wow. So, yeah, so I hate that marketing. I hate it.

And it's sadly very effective. I think that, you know, we've got had, you know, weaponized decades of patriarchy you know if you know my mother was told bad things about her vagina and because you know a bad vagina is a dirty vagina dirty vaginas had sex with another man all that kind of stuff's all rolled into it and her mother was told that and her mother was told that and her mother was told that you know these messages they work for a reason you know and there's a lot of um they use a lot of god terms like purity and natural and you know um and i'm like like what is that for like a, you know, a show, it sounds like a show for like, you know, I don't know,

advertising for some kind of church, right? Then those are, in fact, you know, if you think about it back in the day, medicine and religion were, you know, very intertwined. And medicine was all about achieving purity and a balance with the humors because that would get you closer to God. And it wasn't until, you know, germ theory and the scientific method and all the things came to be that kind of medicine and religion separated. So these terms, these God terms, these marketing terms really, really tie into that concept of balance and restoration and pure.

I mean, who doesn't want to be pure, clean, and natural, right? And so, you know, but did they ever advertise things to men, pure, clean and natural? I'm just curious. Well, they have that, what is it, ball sweat? Dan, have you heard that? Yeah, it's like a ball wipes. I think they're called ball wipes. Or dude wipes.

Dude wipes. So yeah, they're starting. I guess they're starting, right? Slow. Well, you know. I never thought I'd say ball wipes. Yeah, I know. Well, they got a level of the playing field.

It's like when you look at the data for liver failure and supplements, it used to almost all be women. And now that men, it's increasing because of all the, you know, build you up, dude supplements, you know. The peptide world is scary. I don't even know what that means the peptide world. I mean, I'm aware of it, but, you know, I can only engage in. so many dark corners of the internet.

It gets only worse, the longer you engage. If you're a person who's worried about odor from the vagina, what should you do? You should see a health care provider. Because what would happen in a visit? So you should say, I have a vaginal odor. It's concerning. They'll ask you some questions. The first question that be, make sure that you're not using any duches or wipes, things

like that. Those can actually paradoxically increase odor. And then do an exam to make sure you don't have bacterial vaginosis or trichomonas. So yeast can sometimes, some people can say that they get an odor from it. It might not be something that is considered, you know, like a pathological odor like we see with bacterial vaginosis or trichomonas, but certainly might be noticeable to that person. But also it could be from sweat on the skin. People don't realize that, you know, obviously your sweat is made up with your bacteria and

all that kind of stuff. And sometimes overcleaning can, again, kind of lead to those problems with people having a lot of sweat. Like you're outside, it's like 95 degrees. and it's like the devil's breath out there, right? You know, you may have more odor and you have, you know, apocrine sweat glands and your groins and so you might notice there

so, you know, there might be topical products to you could use. And then, and so, you know, there's an appropriate workup for it. So if there's a product on a shelf that says cleansing for your vagina, do you believe that that is a misinformed product? Yeah, I mean, if it's for your vagina,

it's like cigarettes for your vagina. It's useful. Yeah, so cleaning inside the vagina, a self-cleaning oven, you know, you don't need to do anything to clean inside. As for products for the vulva, none of them are tested in any meaningful way, except like my mom liked my cleanser, so I'm selling it to you. And so basically you want a cleanser for your skin that, you know, it has a, you know, doesn't have a high pH, that doesn't have scent in it, it's not going to be irritating.

If you want to just use water, that's fine. Water might not get off sebum. And if you're using other products, like say you're dry, and so you're using vaseline on your skin or something, it's not going to remove that. And so I just recommend a gentle facial cleanser, you know, a non-scented serrivy, setafil, use sarin, you know, one that's unsented that doesn't have like salicylic acid or whatever else. Sure. Might be in those products. They're generally cheaper. They're good for your whole body.

They're not soap. And, and those are five-freyball. Well, soap is a no-go for you? Like a dove. Well, so, so is it a cleanser or is it a soap? And so they're different products. Bar. Yeah, well, a bar can be a cleanser.

Because people say ivory, like they prefer an ivory bar of soap. Yeah, so we'll say on the package if it's a cleanser or if it's or if it's a soap. And a cleanser is a gentle cleanser that doesn't have fragrance and is an appropriate pH, it's fine to use. I tend to, you know, recommend us sarin, setafil or serri. But, you know, I think as long as it's a gentle cleanser, there's, of course, are expensive gentle cleansers for the vulva. And I look at those products in two ways. So first of all, do they have destructive marketing?

Like, do they say odor? Well, then that's, I'm always against those products. Because sell your product without dipping into misogyny, please. So there's that. But, you know, some people like to buy expensive products, right? Like, I mean, I could buy $300 pair of shoes and I could buy a $50 pair of shoes. I'm still going to get where I'm going, right? So some people like that, and I don't want to take away that, like, joy.

Some people really like to spend on personal products. Like, one of my sons does a lot of, like, skincare, and this, he's the one teaching me all my skin. I'm like, I don't know. He's like, Mom. And so some people love that. And I don't want to take that joy away. If buying, you know, things in pretty bottles, those kinds of things are for you, that's great. But do you need it?

No, that's a different story. Yeah. You know, something that popped into mind, and I've heard conflicting answers from gynecologists who've trained me. During mencies, does that raise the risk of developing a yeast infection? And is there a potential tie to something you said earlier that those with low iron have higher rates of yeast infection? Is that potentially because they're bleeding more? Well, most women have low iron because of menstruation. So it's complicated. So with bacterial vaginosis, there's absolutely a menstrual association for a lot of people. And that's

probably partly related to the blood. The iron in the blood can actually change the microenvironment. The red blood cells that come out, lactobacillide bind to that. So your lactobacillide counts are basically the lowest and your pH is slightly elevated right from the blood. So that creates an environment where if you've kind of got a little bit of a dysbiosis where it could blossom. So that's why some people definitely report an exacerbation or recurrence of their BV after every period. And so, and one way we can actually help them with that is put them on hormonal contraceptions so they don't get a period. And the extra estrogen and the birth control pill may also help the good bacteria.

So that's that. With yeast, it's different. And it's, while low iron seems to be a risk factor for yeast infection, it's probably more related to the immune system. And the biggest thing is that probably the hormonal fluctuations are actually having that effect on the immune system or potentially on your itch threshold. That's also a possibility. So people can certainly a report often their itchings worse right before their period starts. And so that could be due to, you know, dropping levels of progesterone, dropping levels of

estrogen. It's hard to know. But so we often see these cyclic variations. And so I would say that's most likely more driven by a hormonal effect. Got it. Well, I think we covered a lot today. That's pretty good from from maha to to the vagina and back again yeah i think that's great uh where can people follow along your journey um people can find me everywhere at dr gen gunter and i have a substack called the vagenda with a jy dot com yeah and that's where i write about just all things that are interest me about about women and your book and my book my latest book is blood the science medicine and mythology administration is coming out a paperback um uh in september they tell me so So don't want you money on the hardcover.

Get the soft covers. Coming out soon. Or get it from the library. Awesome. Well, thank you so much for your time, Doctor. This was an insightful conversation. I think a lot of people will get benefit from. So thank you.

Thank you so much for having me. Huge thanks to Dr. Gunter for coming across the country and joining me for this interview. I appreciate how nuanced she is in her understanding of medicine and also how honest she was about her personal life. I know sharing those things isn't easy. So if you enjoyed this episode, I definitely recommend going back and listening to my episode with Dr. Elizabeth Potter. She's a plastic surgeon who specializes in a

unique breast reconstruction surgery for cancer patients. But this year has gone to war against the insurance industry for some behavior that is pretty hard to believe. So scroll on back and find that. If you enjoyed this episode, please don't hesitate to give us a five-star review as it truly helps us find new listeners and viewers. And as always, stay happy and healthy. Thank you.