The Dr Louise Newson Podcast - 127 - Introducing Alistair Darby, CEO of Newson Health

Episode Date: November 23, 2021

In this episode, Dr Louise Newson explains about an exciting new appointment for Newson Health and introduces Alistair Darby as the new CEO. Coming from a hospitality background, Alistair explains what led him to apply for the role of CEO of a menopause healthcare company, and he shares how his awareness of menopause increased after he witnessed the devastating impact on his wife 5 years ago. Alastair and Louise discuss the problem of the menopause in the workplace and the resulting gap of female talent at the top. They talk through their joint mission to normalise getting treatment for the perimenopause and menopause and speculate on what a difference this would make to relationships, the workplace, healthcare and society. Through his role, Alistair hopes to: Get men to wake up and smell the (menopause infused) coffee! This is a huge gender inequality issue. Work together to scale up what we do and give more women access to treatment and HRT than is currently the case. This will have a transformative effect on many more lives. Help women to feel fitter, and more energetic as they grow older, so they can continue to make an amazing contribution – for them, their families, society and the economy.

Hello, I'm Dr Louise Newsome and welcome to my podcast. I'm a GP and menopause specialist and I run the Newsome Health Menopause and well-being centre here in Stratford-Bron-Aven. I'm also the founder of the Menopause charity and the Menopause support app called Balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause. So today on the podcast, I'm very delighted to introduce to you, Alistadabee, who I've only recently met, actually, but he's going to become a very important part of

my life. I'm still happily married, but you'll be pleased to know. But Alistair has come as the CEO of the clinic, but it's a bit bigger than the clinic, actually, he's really come to help shape the future with me for women's health. So welcome, Alistair, to the podcast today. Thank you very much. So Alist's, this is his third day working. He's had no warning. We found a half-hour window and I've yoked him into the studios to do the recording. So this is completely from the heart, which is how I do most of my things. There's no pressure there, then. No pressure at all, Alistair. So as some of you know, I've run a clinic. and it's a private clinic because when I wanted to do more menopause work as a specialist,

I couldn't actually find a job. And it's not because I wasn't good enough or I didn't have the right qualifications. But actually, NHS menacour's care is a huge unmet need. And I approached two different CCGs. I went to various GP clinics to say, could I just come and do a clinic for you? And they said, no, no, no, it's not a need. We need help with osteoporosis, heart disease, diabetes. I said, yeah, but I can help all that if I do menopause care.

And we said no. So I wanted to do more work. So as a lot of you know, I set up on my own five years ago and just did one day a week to see really some of my friends who were struggling with the menopause. And quite quickly I saw people from all over the country who was telling me horrendous stories. And I knew I had to do more. So three years ago, I set up this clinic, instructor upon Ava. And we wanted to really just have four doctors working here. We've now got 76 doctors and nurses and a couple of pharmacists working with us. We see. over 2,500 women a month, but our waiting list is thousands. The demand is huge and I am not a business-minded person and I never knew how to employ someone three years ago. So I've been sort of winging it and I feel embarrassed because there's lots of people now we employ who are amazing. It's a massive team effort what I do here and we provide really good support and education and all sorts of people who actually don't ever come to our clinic. So a few months ago I decided I really need professional help. So I went to a recruitment agency and advertised for a CEO position thinking maybe a few people might be interested in coming to work with us. And we had over

800 applicants, which is quite staggering, actually. And we met some amazing people, but we chose Alistair for lots of reasons, which hopefully will come clear in the podcast. But actually, number one, he's a man, which I'm really excited about. So because a lot of people think the menopause is a female problem and of course it directly affects women but it indirectly affects men as well. So, Alist, if you don't mind just starting me talking about where you've come from really because you haven't come from healthcare which might confuse some people. So are you able to just put in the context? And also why you even applied for a job in a menopause clinic that's run by a woman and has mainly female employees? Well, I think the first thing I will say is let me

start with the second question first, which is this, for me, is the kind of dream job. And there's a kind of amazing piece of sort of fate, a serendipity, which I'm sure we'll explain in a moment. But, you know, I'm just absolutely delighted to have the opportunity to work with you, Louise, and with your incredibly talented team. But going back a step, yes, I'm not a clinician. I'm not from healthcare. In fact, many people say I'm quite the opposite, or maybe a form of healthcare, in that I spent all of my career as a senior business leader in hospitality, so running pubs and restaurants and selling beer. But joking aside, there are huge similarities between hospitality and what you do, Louise, which is that we have talented people in hospitality who look after

guests. And what you're doing in the Newsom Clinic is having got an incredibly talented team of people who are doing amazing work for the women who come to see you. And of course, beyond that, and it's a much bigger story than the clinic. So when I saw the role advertised the beginning of September, I picked up the phone instantly and spoke to the headhunter and I'm delighted to say that the rest is history and I'm sure we can talk a bit more about how it was. I was so enthusiastic to work with you. But I've long had an interest in healthcare. So this is, you know, fantastic outcome for me. Well, it's very interesting for me because up until I did the menopause work, I was very much

a clinician who 90% of my job was with patients and then the rest of my work probably maybe even slightly more than 10%, I've always worked over 100% anyway, was with education, education for healthcare professionals, but also for patients as well. But I've never looked at business. I've never looked at technology. I've never looked at designing a website. All these things, the skills that I've learned so much. And it's really interesting, isn't it, when you use certain skills that you have and you

translate into something else. So I'm quite pedantic. I like things in a certain way. And that's really useful. when you're designing a website, for example, because you want to make sure there's no typing errors or spelling errors or grammatical errors, because that's what people will remember.

They remember the bad things. They won't remember how you've designed the logo and how the imagery is really good. If there's a typo in the first page, you won't go any further. And that's a bit like medicine, actually, for me. If I make one small mistake, actually, patients don't care if I was nice to them or polite

or I gave them the right treatment. If I, you know, give them the wrong dose, that's it, isn't it? So it's very interesting, actually, you coming from a non-houscare background, but actually it's really crucial, isn't it, that the customers for you in the past, patients for you now and me now, but also not just that for women in general need to be served really well and to be given the best treatment that's available.

But even before they have treatment, the best advice and support, which is so crucial, isn't it? In anything we do, I think in any business, it's really important to, set that foundation so that people feel that they're going somewhere that's really trustworthy. Well, when a family comes out to visit a pub for a meal together, it's a really big decision because it might be, you know, one of the most expensive things they spend their money on that month. Now, take a step back and look at what a woman who is struggling in the menopause, or perimenopause, making a decision to stand up on seek, push to get treatment because they might be getting help from their GP, that makes the decision to go out for a meal look absolutely

tiny. This is a big, big decision for people and they're making a really powerful decision to choose to get help so they can live their lives better. You know, we used to obsess about detail and we still obsess about details in pubs and how you get every single step of when a customer comes, how you make it absolutely perfect. But that sort of pales into insignificance when you think about a woman who presents themselves at your clinic and does all the research that they do before they get here. It's a huge step and incredibly important. Absolutely. And it's very interesting. actually. So if I'd met you, I think, maybe 10 years ago. So before the nice menopause guidance that came out six years ago, I was a GP and I was doing some HRT prescribing for those women who

came to me with very obvious symptoms or those women who asked, I would always explore it. But that was as much as it went. And so if I had met you and I'd said to you, what do you think you'll be doing in 10 years, I'd be interested in here what you say, but if you'd said to me, I would have said, well, I'd still be a GP, doing a bit of education, everything else. And if you said to me, would you be running the largest menopause clinic in the world? I'd say, no, absolutely. It's all ridiculous. I wouldn't know.

Never do that because actually the menopause isn't a big priority, Alyssa. Let's see a few women, but it's not big. And now I'm like, oh my goodness, it's the biggest health risk, actually. It's the biggest drain for, I can't think of any other condition, disorder, disease. I don't know what you call the menoples, but it is a health risk, this hormone deficiency. I can't think of anything else that affects heart. of the population that has risks that really a future health, but also morbidity, mortality.

It's just a car crash economically for women and the economy in general globally. So now, as anyone who's heard me talk before, it's all I do is think about how can we help more people, how can we reduce costs to the economy, how can we make the world better with women receiving their own hormones. But if I'd met you 10 years ago, Alistair, and I'd say, oh, you were really,

excited because you've seen this job in a menopause clinic. Would you have believed me or would you have thought, yes, that's my calling to be in a menopause clinic? Well, I've had the very privilege. I think 10 years ago, I would not have been as well informed as I am now. And I've probably been much better informed about menopause for about five or six years because I did actually, I applied to be chairman of two kind of hospital trusts. And as part of that journey, did a lot of research. And although I didn't manage to join up the dots at that time, one of the things was a really big issue for those hospital trusts was this kind of, it's a horrible term, a hate's term, and they use it a lot, it's this thing of bed blocking. And particularly older people, being in

hospital when they don't need to be in hospital because they've had slips or trips and broken a hip and it's not a care home for them or supervised living. And I haven't really clicked at that point that this whole problem with people as they get older, encountering all sorts of problems like osuporosis and Alzheimer's, how there was this unbelievably powerful link back to hormones and estrogen and the menopause. And it really kind of all clicked into place when my, my wife went to the menopause, and she had breast cancer, went through chemotherapy, so it was kind of surgically meant into the menopause. And for the first few years, did really well, actually, was recovered well from cancer and was living life pretty fully. But then because she was

brachia positive, we decided proactively, she had a double uferectomy, which is very successful. and then it all went horribly wrong. And my wife was very well researched on menopause and HRT in the works, but had managed not to need it until in the kind of spring of 2019, it all went absolutely horribly wrong. She went from being, you know, the woman who was full of energy and drive and everything that we all know to a kind of just emptied out shell, and it was unbelievable.

And thank goodness that she had, first of all, she resisted the advice from doctors to, go on under suppressants because she knew that wasn't the answer because she was well researched and done a lot of reading. And this was before your balance app. She'd read a lot of your articles, but balance app wasn't available then. And she was one of your first patients. And the transformation was absolutely amazing. So I think that was back in 2019. So I've been on a kind journey where certainly but surely the, you know, somebody is very interested in health care and well-being. The blocks all began to fit in place. So 10 years ago, I probably wouldn't have understood it.

But I think if we were having a conversation five or six years ago, it would have been a a really interesting conversation because it's been kind of building in my mind for quite a long time actually. And it is interesting. I think someone said to me recently, once you see it, you can't unsee it. And I think that's so true. And before I left my general practice, I did a search, actually, to see how many women who were in nursing homes, residential homes, warden control flats, sheltered accommodation, were taking HRT. And you can imagine the number was zero. And then Rebecca Lewis, the other clinical director here with me did exactly the same. And then I've just asked some of our other clinicians working here to do it. And a few of them have come from very, well, they work still,

in very big practices and they've all come back and said, no, a few of them are on vagina and estrogen. That's absolutely brilliant. And that's not proving that HRT is going to keep you out of these places. But doesn't it show something actually? Because the women who take HRT, so they're just replacing their missing hormones and estrogen and testosterone are so important for the way our bodies work. These women are generally women at working. They're women who are looking after their children or their grandchildren. They're just out. They're having a good time.

You know, my mother is, I'm not going to tell you her age because she'll go mad, but she's still working as an examiner. She's a speech and drama examiner. She had an operation three weeks ago and she said, oh, I'm a bit tired today, Louise. I speak to every Monday. And I said, why? She said, well, I was working yesterday.

She said, it wasn't so bad. I started at 10. I saw, that's good mom. And what time do you finish? Five. I said, so you've done a full day's work and you had an operation three weeks ago and you're however old, but, you know, I'm 51. It doesn't take much to work out how old she is. It's incredible, actually. She wouldn't do that without HRT. There's no way. She's been on it for decades. And yes, you could say she's just got good genes. But, you know, her friends are crumbling around her who aren't on HRT. But actually, whether it is that or not, does it matter, actually? She's made the choice she's taking it. I've made the choice I take it. I'm really, really scared of osteoporosis, but also dementia. And I've got no guarantee, but if it reduces my risk,

if it reduces me going to see other healthcare professionals, that's got to be good. And you may know you've got so much that you need to know about a clinic, but we did a study just looking at people who, before they come to the clinic, how many GP appointments they've been to, and 17% had been at least. six times, just in the year before they came to the clinic. And those women who have then been

to the clinic, not saying they're all on HRT, but those that have been given individualised advice and treatment, the year after, 0.1% had seen at least six GPs. So even if you're not a mathematician, that's saving not just a lot of money for the NHS, but actually these women, a lot of women who go to the doctors have to take time off work to go to the doctors or time out and be with their children. And so there's this whole liberation almost once women get the right treatment, which is so important. And even on our mission statement on our website, we're very clear that we want to ensure all women from all backgrounds and cultures have access to good menopause care. And there's so many, I know you've got ideas, I've got ideas, how we're going to do it beyond Stratford-upon-Avon,

because it's not fair, is it, Alistair, that women are missing out. Well, I think there are so many layers to this. It's like peeling an onion, isn't it, Lewis? And that's what's so excited about this. And I think one of the things that is both exciting, but also scary, is how many women would like to get some form of treatment, but are actively making active decision not to get treatment? And so this is a small story, but at the weekend I was doing shopping, and I have always taken shopping this from me. And I was in a particular shop, and this lovely woman behind the counter was very chatty, and she said, do you mind if I'm asking you a question?

I said, no, of course. She said, are you a doctor? And I said, no, I'm not a doctor. I said, but funnily enough, I've just started a job as helping an aide, leading a, you know, the biggest menopause clinic in the world. And she looked at me and she said, oh my goodness, you're just the man I need to speak to. And I looked at her and I said, why. And she said, oh, well, you know, I'm kind of struggling with it a bit. And thankfully, I've got a really understanding husband. And so, you know, we're kind of getting through. And I said to her, well, that's great. Thankfully, you've got a understanding husband. How many husbands are not understanding. That's good news. But then I then said, you know, how are you getting on speaking to your doctor? And she said, oh gosh, I wouldn't waste my doctor's time with this. And I was really struck that we know about all the people who actually see a doctor, but then get, have to see so many appointments, don't we know who is? But this woman who's actually making, just actually choosing not to see her doctor and not waste their time. Yet, you know, she was very quick to tell me how her quality of life was suffering. And although she was working in the particular shop, you know, she was clearly having to really push herself. And thank goodness that she said I could go

home. My husband's cook food when I get home because I'm wiped out at the end of the day and all the rest. And I said, oh my goodness, you don't have to do this. You know, download the balance app. She'd never heard of the balance app. And by the end of it, you know, I was hoping to get my shopping free, but I didn't. But, you know, I was a wonderful encounter. But she's part of the iceberg below the water that we don't see. She's not even presenting, but she's struggling. And this is so common because the menopause were guaranteed every woman if they lived long enough. And, you know, a lot of women are very young when they're menopausal. So we're all going to experience the menopause. We're not all going to experience menopausal symptoms. And there's no guarantee how long these symptoms are going to last for.

And I think for many years, because people have been so scared of HRT, they've thought that's a failure's medicine, actually. Let's only do that if we're really, really struggling. And because it's a natural process for many women, then we just need to just get on with it, really, because that's what we have to do. But actually, people haven't been taught that there are health risks of it. You know, there's more of a risk of having a heart attack after the menopause when the hormone levels are low than there is if someone's got raised cholesterol. We all know about raised cholesterol and statins. Blood pressure, blood pressure is raised. There's a risk of a heart attack. We get our blood pressure check. Every time we sniff a doctor or see, a doctor or nurse,

or wherever we go, we have to give anti-hypertensives, blood pressure, low treatment. And that reduces a risk of a heart attack. But actually, HRT reduces the risk even more. But we have to do. But we don't see it as a treatment to reduce disease. We see it something that might have a few hot flushes and like this lady saying, well, why am I going to bother a doctor? Well, actually, if you don't bother a healthcare professional when you're perimenopausal or menopausal, you can pretty much be sure that you will do later because of the complications of the menopause. And it's this whole narrative, is the menopause a disease or not? A lot of people just think it's hot flushes, but it could be seen as a disease in the same way as obesity.

disease. A lot of people would say it's not. But other people would say, well, yes, of course it is, because people who are with obesity have an increased risk of types of your diabetes, heart disease, all cancers as well. So actually, it's imperative and it's a massive public health thing, isn't it? We need to address obesity because it's leading to all these other diseases. And it's exactly the same with the menopause. But how do we change this shift? And this is what, a very interesting analysis. So, as you know, I saw Tim Minchin at the weekend, who's just a gene, He's amazing. But he was talking about confirmation bias.

And I think this is really key when we think about menopause and HRT because people are expecting to read about risks of HRT. So if you have a friend who gets breast cancer who's on HRT, that confirms how dangerous HRT is. So if your wife had been, I don't know if she was or not, if she was on HRT, that would confirm how dangerous HRT is. It doesn't prove anything. Of course it doesn't. And all the women, maybe like your wife as well, who weren't on HRT when they were diagnosed, you would ignore that because you're confirming your

bias against. And that's the same with that's been going on and on and on for years. And so how do you change those people that have this massive bias against HRT and against thinking about the menopause as a disease? Because that's really difficult to shift. Well, I'm not a big business book reader, but I think most of us know about Stephen Coe's kind of seven habits of successful people. And the one habit that I always remember is his rule of start with the end in mind. And I think if we can start thinking about menopause and the effect it has on women on a much, much bigger scale and work back from a desired solution, you get a much different perspective. And what I mean by that is, is that if you take for at the moment, and you'll see where I'm

going with this, if you take the whole COP26 climate conferences going on, let me ask you, how many senior influential people are female at that conference. It is dominated by men. And indeed, you know, the two most powerful countries and the economies in the world are run by men. Now, why is that? Well, part of the reason surely must be that highly talented, highly capable women who are really, very successful and, you know, do great things, you know, up into their 40s and 50s, they grind to a halt because they hit the menopause.

And they don't have, you know, the whole testosterone thing is fascinating. They don't have the kind of drive. and all the things that these men have. So all of a sudden, you're looking at a world which is unbalanced because there is all these hugely capable women and people are going, hang on a minute. Why don't they go further in their careers? Why aren't they on board?

Why aren't they in senior positions? Well, I think we can make a pretty good stab at the reason for that. And how different would the world be if we were enabling women to fulfill much more of their potential into their older years, both in terms of well-being, career? And you've got some amazing statistics about the impact of the menopause on women at work. And you know, you highlighted the fact that how many menopausal women work in the NHS.

These are staggering statistics that are both frightening in terms of how women are not able to realise their potential. You flip it the other way around, well, what would the world be like if we were able to really help women to be themselves as they grow old in the way that men are? Because that is fundamentally unfair. Yeah, it's so true. I play a lot of mind games just because, Because, and one of them is, you know, what would the world be like if every woman who wanted and needed her own hormones back had them? How would it be? What would be the incidence of heart disease, diabetes, dementia? You know, dementia is so much more common in women. We know that every three seconds, I'll say repeat that, every three seconds, there is an osteoprotic fracture. That's huge, isn't it? We know that women to take HRT, their bones are strong. But,

no one's looking at that. There's no research project that I can see looking at osteoporosis and menopause. So this is really wrong, actually. So, you know, I do think about how people would be, how they would feel, how they would function. The NHS, you've said, you know, 40% of NHS employees are menopausal. That's a lot of women who are just hemorrhaging out of the workplace. And when I worked with West Midlands Police, you know, when you look at these stats, they're just stats on a piece of paper. A very much. two-d they're very too-d. Yes, that's, oh dear, what a shame. But when you listen to these women, I remember the police and they say, you know what, I'm just going to retire on number 50.

I can't even pick up my grandkids. I can't put my little grandson on the slide because my joints are so stiff. I can't be bothered. I just sit in the chair having a cigarette thinking, oh, it'll be wine time soon. And my grandkids just on his laptop because I can't on my iPad or whatever. And these women often are young and they've got young children, so they've got grandchildren when they're still quite young. And I'm looking at them and thinking, gosh, they're my age. And they're talking about not even being able to go to the park with their grandson. Like, what's going on, actually?

And they were just resigned. They just said, well, that's it. I've gone off the beat. I've got an office job now because I can't go out because I can't, I'm too sweaty. I can't wear the uniform. And I've got no muscle strength. I can't run after anyone. And so when I started with them, I said, you know what, I can't help you with policies about how to

reduce your hours or do flexible working. all I can do is tell you that it sounds like a lot of you should be on HRT. Oh no, we don't want that. We'd never trouble the doctor. And so over the year I was there, more and more of them took HRT, and it was absolutely amazing. The same stories we hear time and time again, women are saying, gosh, actually, I've not only got my job and kept my hours, I've been promoted.

And a lot of them have been in the police for decades, actually, since they had left school, and they're just giving it up. They don't want to, but they can get this option of earlier retirement. And so it was then I thought, gosh, this is just not a number. This is not a statistic. And this is not just affecting them. It's affecting their grandchildren or their relatives or their colleagues and their friends and their family. And wherever you look, it's this suffering that really worries me because it's needless.

I think you've touched on the bit that really bothers me, but I think is the amazing opportunity here. Because I think you've just described this kind of ripple effect. This isn't just about the individual woman who's suffering with a menopause. It's the impact it has on everybody around them. And, you know, it's both that will not be able to achieve their potential when they were perfectly capable of achieving that potential if they're treated properly. But it's then the impact it has on everybody else. And this is a terrible waste of talent and energy and drive and, you know, dreams and aspirations.

And I think that's the big unanswered question for me, which is if you rightly say, Louise, if we were able to give the hormones back to those people who need them and they were able to, as a result, achieve much more of their potential, how different would the world be? Well, I think it would be different in a million and one ways, and not least to which, surely, at the highest levels of power, there would be a gentler, more intelligent, more compassionate voice. And there would be, you know, in terms of all of the issues at the moment,

it wouldn't just be men talking about the issue. I mean, I think we're all a bit fed up of hearing, for example, and I'm a father of four daughters, we're all a bit fed up of hearing politicians talking about how they're going to make the world safer for women, you know, who are just walking home. Well, why is it more often than not that it's men talking about this? Hang on a minute.

You know, women should be part of the solution. And I see menopause treatment, HRT and bringing this to the forefront. Because as you rightly point out, this happens to women at a certain time of life inevitably. It's inevitable alongside tax and other things. And we should be addressing it. We shouldn't be turning our back on it. It's crazy. And you know what's really crazy for me is that the point you make that by not treating menopause,

we then store up a whole series of problems for people who may be living longer, but their quality of life is rubbish. You know, that's a terrible waste. Absolutely. And I think, you know, also a lot of it is down to choice. You know, we can choose. No, you're not saying to me, what do you have for breakfast? You know, what are you eating?

Are you drinking? Are you smoking? It's up to me what I do, actually. And if you were my physician, then you would advise me to not wake up and have a cigarette. Not that I do if anyone's thinking that. I can still choose to do that actually. But people are just having this choice taken away. They're not allowed almost to have their hormones.

They're given antidepressants or they're told it doesn't matter. Or like this lady who served you doesn't even think that there is a treatment or they should be bothering the doctor. But it's very scary. I mean, I know when I started experiencing some perimenopals or symptoms, I didn't think I was, I didn't even know what was going on. I thought I was just getting a bit old and a bit worn out with life. And I really wanted to set up a clinic because I really wanted to set up a clinic because I just knew this. It fits into me. I'm very interested in the immune system, as you know.

And if our immune system isn't working properly, it becomes very pro-inflammatory rather than anti-inflammatory. And if we've got this low-grade pro-inflammation going on, it's associated with diseases such as heart disease, osteoporosis, diabetes, dementia, clinical depression, even some neurodegenerative changes. And so, you know, you know all these diseases are related to the menopause. So without estrogen, we have this. pro-implanatory state. So I've been really interested in the pathophysiology of the menopause for a long time. So when the nice guidance came out, I really wanted to do more and become a specialist and set up a clinic naively, I thought, in the NHS. And there was a menopause meeting and it was on a Thursday night in Birmingham. And I said to my husband, could you be home to look after the children? I need to leave at six. I really want to go because I think this is going to be the

start. This is just after the menopause guidance come out. So this is going to be the start of me really being committed to this. So he left work home and came home at 10 to 6 and I was just in my jogging pants and he said, Louise, what are you doing? You're going out? I said, no. He said, why not? I said, because it was in November. I said, it's raining outside Paul. I don't want to go. He said, what are you doing? I said, well, it's in Birmingham. It's miles away. It's like, what? I said, I just, I just don't want to go because if I go, I might disperse into tears people and I feel really vulnerable and I just think maybe I'm just a bit tired because I'm not sleeping very well because of course I was

menopause and waking up in the night, didn't realize. And he was like, I'm really surprised you've never been this person before. And at the time, I thought it was quite normal to be like that. So I wasn't questioning it. It was only because he was just, cares about me, but he could have easily just said, oh, you're not the person I'm married, I'm going. And I would have gone, okay, that's fine because I don't need anything. It's a really scary feeling. And I felt like that just for a few months. But, you know, and you don't know, and that's what's really hard. You need these other people around you to notice.

And with the workplace, it's not about having a policy. It's about those work colleagues saying, oh, Louise, are you right? You're not quite yourself or your family or your friends or whoever. So, yeah, there's a huge amount of work to do. But I'm really excited, Alas, I can't tell you. I did tell you, actually, the day that you started, I didn't really have much sleep because I was excited and nervous, but it's having the ability to share this journey with other people,

and I know you haven't met everyone yet, but I'm hoping everyone that you've met so far, whether they're in the clinic or outside people that I work with. We've all got this sort of excitement that we know that we're making a difference. And actually, I know we've talked about the clinic, and this certainly isn't an advertorial for the clinic, because for one person, every one person we see in the clinic, I don't know the numbers.

I don't think we can ever find out, but I think it's probably several hundred, maybe several thousand who we reach without seeing them. And those women that I see without coming to the clinic through balance act or through the education work I do, I actually get more pleasure out of those people. And so it's a very weird business model, isn't it, getting pleasure out of people you don't make money out of. But that is going to make such a difference going forward.

So I'm hoping maybe in a few years time you can come back to the podcast and we can talk about what we've achieved together. Look, I've only been here a few days, but there's absolutely. I completely agree with you. There's no doubt that there's a group people here who are on a mission. And I think the amazing thing is that they're not on a mission in relation to your clinic. They're on a mission to what I would say is normalize HRT. And I've had personal experience of how my wife went from being bright, lively, energetic to absolutely hitting the wall. And then being prescribed HRT, so it happened to be you at Newton Clinic, but it could have been anybody.

But the transformation and particularly the role of testosterone played in giving her drive, was absolutely astonishing. Yeah, she returned to being, you know, the kind of energetic, optimistic, powerful, you know, woman that she was had been only kind of months earlier. And I think our mission is for us to be a kind of beacon of not only the clinic, but the research we do in the evidence base and the balance app, so that we create, as you described it in this amazing ripple effect, because I have seen how HRT has transformed my wife.

And, you know, you have seen numerous examples of how it has transformed people. and you also regret horribly that if only we've been able to treat some women, maybe they wouldn't have done, you know, dreadful things or, you know, committed suicide or whatever. So this is a mission of huge importance, and why would you not be incredibly excited and privileged to be part of it? Absolutely. So I'm very excited. And I'm also very grateful again that you came and agreed to record the podcast with no notice at all. So before we end, which you might know because you have listened to some of my podcasts, I'd just like three, I asked for three take-home tips, but actually what I would really like from you,

Alistair, is three things that you think you can really do in the short to medium term that's going to make the biggest difference to women generally. Well, I think one of my first duties is the man is to make men wake up and smell the coffee. Brilliant. Like that one. Yeah. I think there is a huge gender inequality issue here. Secondly, I would clearly like to help you, Louise, to work out how we can scale up what we and I don't just mean at the clinic, so that we can give far more people, women, access to, you know, menopause treatment, HRT than currently is the case, because that will have a transformative effect on many, many more lives. And thirdly, I would like us to prove out the point that I think this whole story is much bigger than their menopause and HRT. It's about the whole massive benefits of helping women to be feeling weller and fitter and more energetic as they grow older so that they can continue to make an amazing contribution. That must be good, not only for them and their families, but for society and the economy,

and that surely is. I would love to see that kind of proved out some way. So this is a kind of massive long-term mission, isn't it? Yeah, but, you know, it's power in numbers, isn't it? So I'm sure there's a lot we can achieve. We've done quite a lot in a short period of time, but I've got lots more plans. So thank you ever so much. And, yeah, look forward to seeing what the future holds for us all. So thanks, Alistair.

Great stuff. Thank you. For more information about the perimenopause and menopause, please visit my website balance hyphen menopause.com or you can download the free balance app which is available to download from the app store or from Google Play.