The Dr Louise Newson Podcast - 16 - Talking about our relationship and how my husband supports me

Episode Date: July 15, 2025

He became a familiar face to millions on Channel 4’s Embarrassing Bodies and Live From The Clinic – boundary-pushing shows that challenged taboos and brought sensitive health issues into mainstream conversation.  Behind the camera, however, consultant urological surgeon Paul Anderson has established himself as one of the UK’s most experienced urethroplasty surgeons, having performed over 2,500 procedures in the past 19 years – more thanany other surgeon in the country. Beyond his clinical practice, Paul also trains surgeons in Zambia, Ethiopia, Malawi, Tanzania, and Pakistan, addressing a critical unmet need for reconstructive urology in resource-limited settings.  In this deeply personal and candid episode, Paul joins his wife, Dr Louise Newson, to offer a rare insight into both his professional journey and their shared life together. They explore the often-overlooked impact hormones have on the health of both men and women, emphasising why recognising hormonal changes is vital to supporting physicaland mental wellbeing.  Louise discusses how hormonal changes have affected her personally and influenced their family life. Together, they examine how greater awareness could help demystify hormones, not only for the public but also for healthcare professionals. We hope you love the new series! Share your thoughts with us on the feedback form here and if you enjoyed today's episode, don't forget to leave a 5-star rating on your podcast platform. Email [e-mail] with suggestions for new guests!   Disclaimer: The information provided in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. The views expressed byguests are their own and do not necessarily reflect the views of Dr Louise Newson or the Newson Health Group.      LET'S CONNECT   Website: Dr Louise Newson  Instagram: The Dr Louise Newson Podcast (@drlouisenewsonpodcast)• Instagram photos and videos  LinkedIn: Louise Newson | LinkedIn  Spotify: The Dr Louise Newson Podcast | Podcast on Spotify  YouTube: Dr Louise Newson - YouTube  

So on my podcast by popular demand is my husband, Paul Anderson, who is a consultant urologist for the NHS. He's a reconstructive surgeon, has done thousands upon thousands of operations, transformed men's lives. So we talk about his work, not my work for a change. We talk about the impact of hormonal changes had on me and our family. We talk about conversations with nurses. We talk about how we can help demystify hormones and maybe help healthcare professionals. think differently about hormones too. So we cover a lot and it's just lovely having him here with me. Paul, you're here in real life. Very excited that you're here with me.

2021 apparently was the last time that you came on my podcast but you were downstairs and I was upstairs. It was much more low tag. And now yes. Well you've progressed, developed. You're even more famous, infamous it's fantastic it is good because actually some of the nurses refer what do they refer you as in the hospital pool well I should probably change my name to mr. Newsom because people have known for years decades will come up to say oh my god you will Louis Newson's husband you like that don't you I've got used to it so I want to just shine the light onto you actually because lots of people know who I am they know exactly what I do but they don't know so much about you. That's where I like it. I want to shine light on you because

you're really, I don't know how you measure success, but you're a very inspirational surgeon. You're top of the game, what you do. You're more modest than me, probably. But I just think what you do is incredible, but people don't know about it. And actually, compared to even what you were doing four or five years ago, it's got even better. And I'm telling you this because I was at a conference, recently in Perth, a urology conference, and you were a bit annoyed because you were at the same conference last year and you are a urologist and I am clearly not, but I was invited to talk.

And the more drunk your colleagues got, the more they told me how amazing you are and what a fantastic surgeon you are and they've never seen anyone operate like you do. So it's not because you've told me you've good, it's because others have. But just explain a bit about what you do. what you do because some people might not know what a urologist is,

but they probably don't know what a genitone, reconstructive urologist does. So urology is the branch of medicine that deals with surgical problems, as in things that can be solved through surgery, not through drugs, that affect the kidney, the tube that drains the kidney, the ureter, the bladder, and the urethra, which is the water pipe. And within that field, there are people that deal with, say, cancer, people that deal with kidney stones.

And I specialize in reconstruction of the male genitone urethral organs. So I spend most of my time fixing water pipes, urethras. I do a lot of time with the penis. You know, sometimes it's bent through Peronis disease. And certainly I just do all those for embarrassing bodies. And I deal more commonly, you know, these days people are getting bigger, so I deal with buried penises. I also deal with rarities like,

People have injected silicon into the genitalia, removing it, skin grafting. Hang on a minute. Injecting silicon into the genitalia, is that thing? Yeah, totally. It's pretty popular. It makes your scrotin look larger. It can make the shaft look bigger. I do not recommend it. I do not condone it. But lots of people do it, and I just see the people have complications with it to remove that silicon. That's a very small amount of my job. It's mainly water pipes. Yeah. What's the biggest myth about male genital health that drives you, mad. Having a longer penis is going to improve your life.

So it doesn't? I see so many patients who blame the length of their penis for their current state of unhappiness. You know, either it's body dysmorphobia, you know, they're coming to me because they want to me to do an operation to make the penis longer and actually it's just a symptom of not being happy. I'm actually making the penis longer so surgery can give you about an extra inch but I would not recommend it. It does nothing really. So people who have injuries as well, when the

urethra has been damaged, then they can't wear. I know this sounds really obvious to you, but to many of us it's hard to get our head around. They can't weigh out of their penis. So they have a catheter, don't they often? So I mean, it depends in which country you're talking about. You know, in the previous podcast, we've just my work in lower and middle income countries. So in a lower middle income country, such as the ones that go to in Africa, they will just have a catheter tube that go straight through their stomach into their bladder, and that would be the end of it. Whereas in the developed country, they will have stretches, dilations, cuts to keep their water pipe open until someone does a reconstruction. And that's the sort of thing which I particularly specialize in. And it could be people who are in car crashes and they have a fracture of their pelvis and their water pipe is ripped off their bladder. So there's no communication. It can be people who have had injuries due to. during other urological operations such as for their prostate, where the water pipe gets damaged. It can be people who are born without a water pipe

that goes all the way to the tip of their penis, like hypospadius. So the water pipe opens in the wrong place, further down the penis, and they need that reconstructing. And how do you make a new water pipe? We predominantly use the inside of the mouth because the inside of the mouth can cope with being wet all the time.

Other parts of your skin can't. If you spend too long in the swimming pool or the bath, you know your skin gets macerated you get like Christmas trees the end of your finger so it can't cope with being wet especially with urine all the time so it's mainly the inside of the mouth so you do a graph from the inside of the mouth and then put it into the water pipe just to make it wider so that's an augmentation adding to what's there but sometimes with say a pelvic fracture I have to join the two ends together no mouth graft and that can involve using you know a hammer and chisel to take out big pieces of bone to re-root the water pipe

to attach it back onto the bladder so that they can weep properly. And I spend a lot of time teaching those techniques in Africa. Because over there, they don't have airbags. They don't have good scaffolding. They don't have health and safety at work. You know, they're falling down wells. They've been kicked by donkeys. They're coming off their moped.

If they survive the head injury, they've got a pelvic fracture. And there's lots of young men who have a catheter through their tummy, who've got a financial catastrophe. They might be responsible for making money for a family of 15. If they're 22, 25 years old and they can't work, that is a big problem. Because they can't work when they've got a catheter in. Well, especially poorly maintained catheters in a hot country when you get to the bladder stones, urinary infections. Some people go on to kidney failure.

But also there's a stigma isn't there for people who have an indwelling catheter in some communities? Definitely. Because I remember, you've been going back and forth to Africa for many years. And I remember one time there was somebody who walked from an orphanage for about an hour. just to be assessed by you and you have you can't operate on everyone but you chose this person and he wrote to you didn't he afterwards yeah so I mean an hour's not bad something I'm traveling for three days you know I'm going to places where there may only be one urologist serving you know 40 million people it's crazy but this particular gentleman was in an orphanage

and then when he came back the owners of the orphanage you know that were running it's got in touch with the surgeon I've been training over there and sent a video saying how gratefully he was and how it changed his life. And other people's around him as well. Yeah, totally. And you've also done quite a lot of work with military in the past as well, which I remember the first time you came back from operating on a soldier. I've never seen you so white.

I've never seen you so quiet. And it was quite shocking. Do you remember we were in the old house? Yeah, well, that was sort of 2008, 2011, Operation Helmand. And this is really before the pelvic protection got going. So when these servicemen stepped on improvised explosive devices, they would lose their legs to get the rectum blown apart, they'd lose the genitalia. Fortunately that period of time was only about 18 months, maximum two years before the pelvic protection came in.

And then they just lost their legs. That sounds terrible, just lost their legs. But they hadn't got the same injuries to the genitalia and the rectum. And so there was a large cohort of men coming back to the Queen Elizabeth Hospital in Birmingham, which is the major military hospital, which I would. work nearby and have a contract with but to see a 19 year old who was so devastated you know to see these young young men with injuries that were you know so severe that they wouldn't have survived in times gone by was emotionally very difficult you know I mean and I'm just a person who's treating

them I'm not living without injury but it got easier to see past that than what I could do for them you know time went by but you really did transform the quality of their lives yes I'd like to think so I'd like to believe so did you did because I've heard them talk about it so well GQ did an article May 2000 whenever it was talking all about the soldiers and interviewing them but I am as you know when I had that hysterectomy I had bladder problems and I had a catheter in in fact I wore your pyjamas for a few weeks because then I could have the catheter bag out it was the most undignified thing I had it was horrible having a

catheter I thought everyone could smell me I thought everyone could see it even just you know having the leg bag and wearing a floaty skirt just at night time it's horrid and I don't know there's something about urine I don't really like but I realized then how we just take having a we for granted and like I can't imagine some of the patients you see the stories that you tell me that how it's gone on for so so long and like I like to think the work I do is transformational but your work is really transform or in a different way?

One of the things that attracted me to urology in the early days before I decided to be a urologist was how much you could improve the quality of older men just by performing fairly straightforward cross-age surgery so that they could pee on demand and not be incontinent. And that is absolutely transformational to not be incontinent. And I've carried on in that vein

and I strongly believe that people should come forward with their incontinence problems, not just suffer with pads. Because somewhere out there there will be someone can help you. You know, urinary incontinence of women is really common. The current urinary tract infections are really common. How much do you remember being taught about hormones at medical school? Very little. Yeah, I mean, we did train together. Very little. So you did spend some of the lectures more hungover than me, so I'm not quite sure how much you learned.

But your notes were always very good. You had this really, you still have this really annoying skill of remembering everything. I have a photographic memory. I know you have a photographic memory because I'm you also don't like throwing things away do you darling so and we've got like your old lecture notes and and every so often they sort of fade because you you know would I don't know not listening properly and I thought good my notes are going to be better and I had my highlighter and I had my coloured pens and you sometimes draw a little mouse on my notes and I thought you're not concentrating and then you did really well and got

distinction in the exams and you just remember everything don't you but isn't it interesting that you remember that we weren't thought about hormones at medical school and I don't think it's really improved you know the junior doctors that comes through are they talking to you about hormones in respect to your incontinence in women no no not at all what do you think of that well I think we should all be thinking about us a bit more I think about it more because of you and I've preferred so much of your work over the years so if I you know so even And if I see, when I do my week on call and I see children, I see women, I see men, you know, if I see a lady who's got a fragility fracture, I'm often saying to them, you know, why aren't you on HRT,

who's thinking about your bone density? You know, it's not just about HRT to improve the urinary health, but it's just about general health. And so you've educated me, and I've read around it a bit. And it's also there in the European Association of Urology Guidelines. that we should always be considering HRT, or at least topical estrogen to the entroitus vagina for infections. So we are thinking about it more, and it gets more coverage in our conferences. And, of course, you've been to those conferences and lectured on it yourself.

I know. I was really nervous, actually, lecturing in front of you and your colleagues last year. I was actually really struck how friendly urologists are. And I say that because different doctors are not always as friendly, and you've been to conferences where they're not all urologists are not quite as friendly. but urologists are such a great group and what i've found about them is that they've got this sort of professional curiosity they want to ask they want to challenge they want to learn they're not just and i say just in verticromous surgeons they actually want to learn about the whole person so it's great that they're talking about it more but there's still very few people who have

recurrent urinary tract infections who are given vaginal hormones to continue in the future and it's so simplistic isn't that yeah exactly Totally. And I was out that, you know, when I was passing through the surgical specialties and deciding what to do and going through orthopaedics and general surgery and plastic surgery, you know, by far and away, the nicest bosses with the urologist. And in the end, that's what made my mind up. It is important to have good colleagues because it's not easy, is it? And mentors. Yeah, absolutely. You need someone you want to be like, to aspire to be like. That's what's the drives, what drove me forward.

well you've had especially a couple i can think straight off but you've had some great we still have great mentors yeah someone who's been on your podcast you know a few times steve pay yeah i know um and i've really struggled to find mentors who you know who i want to be like there's bits that i want to be like but it i think maybe it's just the area that i'm in maybe it's because i'm a woman but i it's it is hard finding the right mentor um but when you were doing embarrassing bodies so so we did embarrassing bodies when i say we i was just more of a advisor but you did a lot in embarrassing bodies i was the most prolific contributor say that again sorry i was the most prolific contributor which means what poor just explain i i had more sections on that show than anyone else

and why is that because if you're going to think about things which are embarrassing it's usually the penis isn't it so i was doing loads of penis surgery genital surgery all the time yeah and from the second season because the first season was embarrassing illnesses and then it was embarrassing bodies and for 10 seasons I was in every single one often multiple times it was great it raised awareness amongst patients you know I had people coming to my clinic saying I saw you on television I didn't know something could be done for this condition because the thing about my area of urology it's not cancer it's not quantity of life it's about quality of life so there's lots of things that decrease your quality of life a bent penis making penetration difficult

or painful for the partner. You know, if I can correct that for them, you know, they're delighted. Their wife is delighted. The partners, you know. So I did all sorts of operations that improved people's quality of life and came forward.

And even now, there are repeats on, you know, Dave and Channel 4 and people can find me on YouTube. And I say, I saw you on television. Well, it's interesting, because I was thinking it was a long time ago now and social media wasn't such a thing. So it's quite hard to find information. So that program was really out there,

it really just I think they should be commended and they their website was fantastic as well and they were you know they were one of the first websites to put up pictures of the whole variety of what penises look like what nipples look like what breasts look like so instead of people going to you know adult entertainment sites and trying to compare their own penis is something that's absolutely perfect and really long they could go on to embarrassing body's website and look at all these penis think well I'm just normal yeah I'm just normal you know I think they did a great job of that program yeah and And, you know, people really like the way that you are very direct, but also can be a bit funny as well, the way, you know, surgery, but also the way, like you say, transforming and improving people's lives.

Yeah, certainly. But it does make you think, because even back then, I was, do you remember on the studios, I was, people would phone in and I would do some sort of Zoom, like, not consultations, but just conversations. And I was really shocked then, actually, thinking about how hard it was for people to be listening. to. So people would say, oh, I've got this rash and I've had it for seven years and the doctor keeps dismissing me or I've had migraine and I'm not on any treatment. Just lots of things. And I remember then just thinking, wow, gosh, I don't understand. Like, even as a doctor, if I don't know how to treat, I would always ask someone else's opinion or I'll try and find out, but these people were just being told they're a bit of a nuisance. And so that was interesting, but also

the fact that it was a Zoom, like remote, because this was all pre-co. long time before COVID. So we didn't really do remote consultations then. No, not at all. But that's open and changed the way we practice medicine as well, hasn't it? Yeah, I mean, for so much of our follow-up, you know, from a hospital perspective, we can deal with it now either through a Zoom-style consultation, although I still don't get them to show the genitalia to me, you know, on Zoom consultations. They will send in photos in advance, which we can then discuss. Or just telephone call. And it makes life much easier because you don't want to

do a two-hour round trip to then speak to the doctor for 10 minutes, everything's going fine. Yeah. So I think some good things came out of COVID, you know, and those teams and Zoom meetings we have all the time. Yeah. That's part of it. Yeah. And I think just the way within various bodies and social media, it's made us as doctors more accessible and also the knowledge that they have. So I know some of the people that come to see you, they've spoken to other people who have been operated on by you.

They know what to expect. They know what you're like. They know about previous results. And that probably didn't happen quite so much in the past. I mean, the younger patients I operate on, who could be 16, 20, 20, 20. They will go on to forums discussing their problem. And they'll often, you know, have chat with someone who's been dealt with by me. But, you know, you're saying about people living with these problems, even now,

I see people that have problems for decades that never get referred on. I know. I think the doctors who just keep passing them on the head, and just repeating the same treatment that doesn't really work all that well, have not got a professional curiosity to find that way you could refer on to. Why is that, do you think? I don't know. It might just be the amount of workload they're dealing with

doesn't give you that sort of chance to think about how you can improve what you're doing. Sometimes you need time at your desk doing nothing to think about how to improve your service and how you can do a better job. But when you're just a hamps in real dealing with so many referrals, and so many patients you just tend to the same thing over and over. It's interesting. I mean I often think about our training and I think we were really lucky with some of the people that we were trained we both were in Manchester obviously but people really took

a long time like teaching us how to take a good history how to really learn from the patients. Do you remember we spent hours literally hours and then we went with Professor McGuire down in Wittington who was a psychiatrist. who worked with oncologists and tried to talk and not be scared of asking questions. Do you remember? Yeah, I do. And even psychiatry, that was really good. You know, if someone's got really poor mental health issues

or they've got dark thoughts, how to really ask those questions and not be scared. I mean, looking about that was quite unique, I think. It's hard because I've stayed much more narrow than you. But I do remember my psychiatric attachment is being fascinating. I learned a lot that makes you much better at the time. asking questions, getting that information from patients. But I've got very little else to compare it to because I've not used it. Well, I've not gone down the rest of my career.

But if you compare, like sometimes I hear you, and you've made a diagnosis of endometriosis, not that long ago, somebody who had it in their urethra. And you were saying it's so obvious. And I said, how? You never see people with endometriosis. And you were saying, well, it's obvious when you take the history because it changes throughout the cycle.

Yeah. But you think that's really obvious to ask about period and if symptoms are changing with a period. But that's only what most doctors don't ask at all. Yeah, but you're trying to change that, aren't you? I am. You're right. But thinking about, you know, PMS, premencial syndrome, PMDD, premencer disorder, you know, we see people with these awful mental health symptoms and they've been on these psychiatric medications

and no one has said, does your mood change with your cycle? it's really not hard, but because we've had good training, that's what I mean. I think we just take it that everyone else does the same. Yeah, I mean, I think one of the most upsetting and some of the most rewarding bits of your practice is dealing with the severe mental health illness that comes along with hormones fluctuating. And I know that you have given up your own time and driven to see patients who've been sectioned to assess them, you know, on a Sunday, on a Saturday. and when you've spoken to them, it's obvious it's related to their hormones.

And putting them HRT has really improved them. And then the psychiatrist, who have a body, as a body of doctors, has been really receptive to what you're doing, have then contacted you and thanked you and said, we need to know more about this. Because some of that really refractory depression, suicidal ideation, you know, is related to hormones. And there's been some fairly high profile and tragic stories that you've covered.

You know, and we'll cover in future positive. So I think that the I know because you know I talk to you a lot and you tell me things, but I think that the severe mental health aspects of perimenopause and menopause is just not appreciated. No, it's not. And just to go on about hot flushes and, you know, rubbish drugs that just deal with hot flushes is just wrong. It's wrong. Yeah.

Well, in fact, we've just looked at our symptoms of people come into the clinic. You know, we've got that new symptom questionnaire. And hot flushes isn't even in the top 20. So obviously we've got three daughters and we're quite open as a family. I think maybe being medical, nothing phases us at all. We don't judge the children. We're really open in our conversations. But obviously we've been doing, we talk a lot about hormones, don't we?

Yeah, you do. We do. But you know what? I'm still a bit annoyed. Should I tell you why? You're going to. Because I had symptoms for about six months that were, and when I was, Killeeli perimenopausal, age 45. And you didn't recognise them and neither did I.

I was too busy trying to avoid you. But, you know, you help the nurses at work now, but you probably didn't men. But you know what? I remember waking up every night, dripping in sweat, and I'm not a sweaty person. And I was too scared to wake you up, so I'd get a towel out of the airing cupboard and then lie on the towel. But I thought I had lymphoma. I just thought there was a phase and hoped it would end. but it's hard isn't it because how do you know what is related to hormones or not well looking back

I'm surprised I didn't think about it because you know you've spoken about this on the tour it's Sophie who picked up on it because there was no doubt that I would have would no longer have wanted to live with you if you carried on like that but then that'd be really hard for the family so I can see why families break up yeah I remember that argument in London yeah if for our relationship wasn't so strong, you would have left me, I would have left you, and I'd be broken without you because you'd prop me up more than you realised, but like it's really sad actually because so many relationships break up. And you can see exactly why it happens, exactly what happens. But it shouldn't, should it? No. Well, I suppose that's why you've got to also educate the wives,

the husbands, you know, or the partners of the women who are going through menopause and perimenopausal. And the children, because like I said, it was Sophie who picked up on the fact that you were actually poem in the portal. But, you know, it scares me because I love our children so much. But then I didn't. I didn't love anything. And so many women are bringing up children in homes without love because they don't have the right hormones. But again, it's not being picked up. It's been blamed on their circumstances or mental health or whatever else.

And, you know, we see it in the children when they've got step parents, maybe stepmothers who aren't being. nice and then they thank me after they're feeling better but the children thank me because they go to the people's houses and they say it's just so much calmer just feels so wrong when there's such an easy solution but you've got to think of it first yeah oftentimes these people might be in situations which are which you can't fix and one component of the problem of the hormones but if you don't try and fix that one component you know it's a shame it's a shame so the good thing is that I take hormones and we're very happily married. But I don't think other areas, like in urology,

they don't challenge in the same way. They embrace new operations or new treatments, don't they, and try them? Totally. I don't know why. Is it because it's women or is it because it's that area of medicine that's still misunderstood by so many people? I don't know. Like I said earlier, and you've mentioned as well,

I think urologists are a friendlier than average group of surgeons who look out for each other and want to see everyone, you know, do well and bring them on. You know, at the conferences, we're not really cutting people down to size or criticising a lot. You know, someone presents something interesting. We think, oh, I'll try that, I'll look into that. Which is great, isn't it?

Rather than trying to think, well, no, they're getting too big for their boots. We need to see them, you know, cut down to size. Now, we're not getting any younger. And when the girls were younger, I spent a lot of time working part-time to really look after them, and now my work's really increased and you very kindly are doing a lot more but they you're super busy you do a lot NHS a little bit private you do a lot abroad you do a lot of teaching and you know when you go abroad sometimes it's showcase operating where people will watch what you do are you thinking about retiring no Jesus no not at all don't have to prize the scalpel for my cold dead

hands. I mean, we're really lucky, aren't we, to have jobs that we enjoy? You know, if you've got the job that you love, you know, you don't work for the rest of your life, do you, whatever the saying is? So yes, I still really enjoy my job. I'd like to shave off, you know, maybe half a day during the week or something. But, no, I just don't see myself stopping. I don't want to be one of these really old surgeons who's a bit doddery and they say I was past his prime and don't get operated on by Mr. Anson anymore. He used to be great 10 years ago. So I've got to listen to my younger peers and look at my outcomes. Yeah, absolutely.

But, you know, if I'm not going to spend time with a family or going out with friends, then choice number three for me to pass the time of day would just be operating. And where you work in NHS is such a wonderful place in the black country. The nurses mostly are just incredible. All the stuff are, you know, Joe, everyone is just brilliant. But you've worked there for quite a few years. And you have watched them change some of them when they've had hormonal changes, haven't you? Yeah.

You've seen the differences. Totally. But you've helped them, haven't you? Yeah, we've had conversations, you know, whilst operating, just talking about, you know, if they're clearly not what they used to be. If they're not quite as sharp as good as they were and you ask them, you know, what's going on. And it's just that time of life. And then having a conversation about HRT because they all know that I'm married to you, get them to download your app. and then maybe, you know, talking to them again,

and then for some of them, as you know, you've had, you know, chats with them. And it's been, well, transformational is the word, isn't it? They've gone back to being much more their normal self again. But there is loads of scaremangering. You know, I would say to one of the nurses that thinks she'll be in the HRT, they're just worried about breast cancer straight away, and it's absolute rubbish. We know that that a million women study was completely flawed.

And there's been a fantastic, you know, know dissection of it by that professor of was in guiney from washington who came over it gives a great lecture and it's disgusting how it just set women's health back well the million women study and the women's the women's health initiative studied both of them terrible but it's been amazing because you've really helped these people and i i like to think if i hadn't done that work well i i wouldn't like to think because you wouldn't have helped them but this is where like the conversations can't just be about women who are suffering It has to be people in work, men as well as women,

because you're very frank and outspoken, and the nurses know you for that. So actually for you to tell them in a non-judgmental way that you're changing, could it be your hormones? No, you just need HRT. Yeah, but they're grateful for you, aren't they? Sometimes. Most of the time, yeah.

But who else is going to talk to them like that? Yeah, good point. And I'm sure you can see people are leaving, taking time off not well they're wanting often the classic thing is they want to reduce their hours yeah but how can the energy it's difficult to reduce your hours because if a nurse wants to shave 10 hours off a working week you can't employ someone for 10 hours to back fill so it's very difficult for them that either goes up you know i've had these chats with them yeah so we need to keep going and keep helping people so three take-home tips i always ask for i'm just

Keen to ask three things that you think going forward is going to make the biggest difference to women actually, knowing what I do and knowing sometimes the battles that I have, blockages that I have for the work that is detrimental to women. What three things do you think is going to make the biggest difference to women's health going forwards? I think you've got to keep on putting out that message that HRT does not cause breast cancer. and actually in those studies, pure estrogen, proper estradiol, actually reduced your incidence of breast cancer because no one knows that. So if people weren't so scared of HR2, they'd take it more easily. The other thing is that with dosing of HRT,

and again, I completely agree with you because I see this in dosing of testosterone as well, that some people just need more than the recommended guideline, and it's just a bloody guideline. It's not the law, it's not the rule. You know, if people need more patches than another group decrees, you're not doing anything wrong,

especially when you back your back up with blood levels. So people shouldn't be afraid of having more than, you know, 100 micrograms. And finally, just to make people think about hormones, not just in the context of psychiatric illness, where I think it can be most disastrous if it's missed, but just in terms of general health, I'm always thinking it in terms of, UTIR, UNA tract infections with gentile urinary syndrome of the menopause.

Now I think I'm even better because I see the older ladies who've got fragility fractures, that's osteoporic fractures. And I'm thinking, are you on HRT? Why aren't you on HRT? But I think if all doctors start to think, could hormones play a role in this person's illness, then that would be fantastic. Wouldn't that be nice? Then I might retire.

Thank you very much for joining me today, Paul. It's been a pleasure. it. See in four years. Subscribe to my newsletter for exclusive insights and updates on new episodes.