The Dr Louise Newson Podcast - 52 – Why psychiatrists must start thinking about hormones

Episode Date: March 24, 2026

In this episode, Dr Louise Newson is joined by consultant psychiatrist Dr Gareth Jarvis to explore the important, and often overlooked, connection between hormones and mental health.  Louise and Gareth discuss how hormonal changes can often contribute to depression, anxiety, sleep disturbance and severe mental illnesses. They also explore why psychiatrists are rarely trained to consider hormones as part of their assessment and treatment, despite clear evidence of the impact of the hormones progesterone, estradiol and testosterone on brain function, mood regulation and long-term mental health. This episode highlights the importance of curiosity, education and collaboration across specialties.  Want more from the podcast? Sign up to my premium offer: https://www.drlouisenewson.co.uk/premium-podcasts  LET'S CONNECT   Subscribe here 👉 https://www.youtube.com/@menopause_doctor  Website 👉 https://www.drlouisenewson.co.uk/ Instagram 👉   / @drlouisenewsonpodcast   Download balance app 👉 / https://www.balance-menopause.com/balance-app/  LinkedIn 👉  https://www.youtube.com/redirect?event=video_description&redir_token=QUFFLUhqblo3cGZIUmNnS3RPUklhUHc3RE1jWlNBRHZJZ3xBQ3Jtc0tuYzVSX2pOLXB4NjRENEEwZVA5WDIxbmlfV0U3VUh3R2tGVm13dHEzY0I1NEw3OHJ4QlZpS3RRZVBUU0ptUjl3X21ySEYyb29OVElwZzR1cE9KUC1aTXZVdU4wV05MakdvUW1GemRSbVJ3a2xBSW0xWQ&q=https%3A%2F%2Fwww.linkedin.com%2Fin%2Fdrlouisen..&v=SVfThT3hXbM / https://www.linkedin.com/in/drlouisenewson/  TikTok 👉   / https://www.tiktok.com/@drlouisenewson  Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg   LEARN MORE  Download my balance app 👉  https://www.balance-menopause.com/balance-app/ Get tickets for my new theatre tour, Breaking the Cycle 👉  https://www.nlp-ltd.com/dr-louise-newson-breaking-the-cycle/  

Today on my podcast, I've got Dr. Gareth Jarvis, who is a psychiatrist who prescribes hormones. There's not many of those around. He's learned a lot from his wife, Rachel, who actually works with us in the clinic. And he talks about how important it is to think about hormones and mental health. Think about how important it is for us to be diagnosing properly in psychiatry and thinking about the important roles of hormones in our brains. So Gareth, thank you so much for coming today. It's always great having somebody who, like me, didn't really know about hormones at medical school and has just sort of seen the light almost. But you are a psychiatrist.

And I really enjoyed psychiatry. I did it in North Manchester, a very deprived area, but it was a really good unit, actually. Very cohesive. The doctors really worked together well. You know, my other students were really quite jealous that we were there at the time. We had eight weeks, which isn't long, but it is quite a good chunk of time compared to like one week of ophthalmology, I think that I did. But I've used a lot of my psychiatry training throughout, especially being a GP. But I never thought about the association of hormones and mental health, whereas every day I think about it now.

And you think about it more now, don't you? I do and I guess probably worth me saying full disclosure right up at the top of the podcast that my wife Rachel as a GP works for Newston Health and she's amazing and she's really helped bring me towards the evidence base around menopause because I'll admit Louise that I kept myself woefully poor not up to date in this area for many years it was it was it was a footnote at medical school. When I was up there in Edinburgh, we maybe had a day on it. I don't really, it's so much back in the midst of time now. And throughout my psychiatry training, again, at best a footnote at any point was menopause discussed. And yet I look at it now and think, I can't believe that we haven't, with how little attention was paid to it throughout that time. I mean, if I look back at medical school, that was around the time that the women's health initiative study was, well, we're, well,

was out. And so that message just came through of, oh, hormones cause cancer and stay away from them. The HRD is dangerous was basically the only message I can remember receiving about it. And I don't think I'd really updated my knowledge since then because it wasn't my specialist area. It wasn't sort of specifically what I was focused on within my training. I didn't have a single supervisor who knew about it or wanted to talk about it. And that's such a part of how we train as medical professionals. Of course it is you learn you learn on the job a lot don't you and also what you read is dictated and shaped by your like you say your supervisors your peers any guidelines so if it's if it's not on your radar it's really difficult isn't it and and i

I mean I trained before the WHOHI so I graduated in in 1994 and then I became a GP in 2000 so the WHO study came out in 2002, but I was writing evidence-based articles every week for GP magazine. So it's a free magazine that went to every GP. So I wrote key topics in various things that I could choose. And actually, I found them recently. So I wrote one in 2001 about HRT. And then I wrote another series that I did four because he'd only had was a small column and there's a lot to talk about, obviously with hormones, in 2002. And actually, it's interesting because in 2002 I say, oh, this is a study that's come out, doesn't show us anything that we didn't know. Might be a slightly greater risk of breast cancer, but again, that's with older types of hormones,

but it definitely helps with bone protection, helps people feel better, and we should continue, but obviously involve the patient in your decision making. But I was in my little GP practice then, and I had no idea externally the rest of the world, H.R2 prescribing had just fallen off a cliff. And for the likes of you, a little bit younger, not having that anywhere in your radar. But when I was taught it, it was literally, like you say, a day or so, or in a few hours, really, but it was more about flush your sweats or there's something. It wasn't really, nothing about the mental house. And also, you know, as you know, well, Rachel will see a lot of our patients have PMS and PMDD. And for those women, actually,

so premencial dysphoric disorder is about one in 20 so it's really common and you know patients say to me it's like light and day you know they they say the light goes out their whole personality changes those days before their periods and i must have seen it in general practice and psychiatry but if you don't ask about a change throughout the cycle and you only see the women in their crisis if you like you don't build up the big picture do you And that's the thing is that so as a psychiatrist, we were always trained to be really holistic in the way that we think about someone's health. And so we, and we've got the luxury of an hour to spend with someone really trying to understand fully what's going on with their lives. Can we actually figure out what's gone through the life course? And that's so often one of the distinguishing features we're looking for is actually at what point in their life cycle did the change happen. But at no point was this sort of brought into my sort of thinking around. actually focusing in on what happens on my own and the polls. Yet, you look at things that we know already about,

so as we know it about for decades. When does suicide peak for women? It's between 45 and 54. And what's happening around that age? And I kind of almost sort of feel a little bit sort of shameful now. So looking back of like, why wouldn't I have paid that more attention to actually focus in on the changes that happened for women at that time?

And I'm the same. But also when you read a stat, think what's behind it. And you might know that we funded a PhD student in suicide prevention with Liverpool John Moore's University and she's just got her PhD and she's going to come and work with us actually full time in research which is wonderful. And you know we've had some really interesting publications already about that but also you know one of the publications a lot of quotes from women whose lives we have saved with hormones and one lady quoted to say you know if I had taken my life, I would just be another statistic. No one would have known I was perimenopausal.

And this is a problem, of course, isn't it? And for many centuries, really, women have been dismissed and gas-lit and being told, well, it's their stress, it's their circumstances. And I don't know if you know, I was doing some volunteering in prisons. You know, a lot of people in prisons have a lot of mental health, all sorts of things that have gone on in the past. But they also, a lot of them have early menopause because of their drug abuse, because of what's gone on in the past, you know, and a lot of them are on heavy-duty psychiatry drugs. So a lot of them are on quittipine, a lot of them are on pragagabalin and gabapentin. Some of them are on lithium.

A lot of them have implants for contraception. And the reason I'm saying all these drugs is because they will not have their own natural hormones in their body. So a lot of them have physical symptoms. So a lot of them were having very itchy, dry skin, a lot of cystitis, urinary tract symptoms, palpitations. And they weren't having periods. So I was going just to educate about what hormones are and do, talking to some of the younger ones about PMDD, because we've known for many years people are more likely to commit a crime when they're angry and irritable,

they're doing for the periods. And a lot of them, it was a light bulb moment and they were like, oh my goodness, that's me, that's me. but they couldn't get access hormones from their GPs or the doctors in prison and I actually got reported to someone in the prison service because the doctors weren't happy I was there and they reported me to my responsible officer who does my appraisal and they said that I was saying

that all mental health was due to hormones and like it's just crazy because it's so many things that affect our mental health but if we ignore it. hormones the whole time were never going to get people completely well, I don't think. That's it for me is that I'm not going to sort of turn around and say that

HRT is some kind of silver bullet for all mental health problems but we cannot ignore it. It's such an integral part of a woman and making sure that she's optimised health and it has such a big impact on mental state that that's why on earth would we not be exploring that and being curious about it and and actually making sure we've got these incredibly low risk things that we can prescribe now

for someone who's in their peri monopause or menopause. And they've got all these other massive health benefits. I mean, it's one of the things that really captured my imagination as I've been talking with Rachel about it, is that we've known for a very long time now, this enormous mortality gap we have for people with severe mental illness. It's 20 years younger that you will die if you have a sort of. on average, if you have a severe mental illness. And what are they dying from? They're dying from cardiovascular disease.

They're dying from strokes. They're dying from dementia. They're denying from cancer. And if we're looking around at what's in our armaments are really sort of try and push back about that holistically as doctors working with people from whatever background are coming from in medicine to help close that mortality gap, this feels like such a potent tool to have in the box to actually support women

with making sure that their bones stay strong and healthy, that their cardiovascular system is protected, that their brain is protected. Why wouldn't we be describing it? Well, it's so interesting, and I'm very interested in the immune regulating effects of hormones, because I don't know if you know, I've got a pathology degree as well,

and I spent the whole year focusing on the macrophage and inflammation. And the more we look at about neuroinflammation, to inflammation in the brain, it does seem to be closely associated with mental health, schizophrenia, depression, bipolar. And, you know, we know that inflammation is associated with cardiovascular disease, osteoporosis, dementia. So there is a link as well, which we can't keep ignoring.

But I'm also, I'm interested in pathology, but I'm also interested in history because I think that can shape a lot, actually, especially in medicine. So thinking about the power of hormones in our brain, we've known for many years. I mean, we've only known about hormones since the 1930s when they were. were discovered. But even in the Victorian times before that time, there were lots of people going to asylums, as we know. But there were some really great writers of someone called Edward Tilf, who wrote a great book in 1888, which I've read, talking about the change of life. And he was talking about this time that was a real toll on mental health that seemed to improve with bleeding.

So he didn't know about hormones, but he knew there was something that was going on. He did talk about people going to prisons and committing crimes because of these symptoms. He talked or he wrote a lot about the toll of looking after children, the women, the mental health. And he was alluding to it being around the cycle. And I think then they didn't have the drugs that we have now. They weren't so short for time as we are often now. So he could really, really explore with patients. and he was really associating the physical symptoms and the mental health symptoms.

Yeah. And then they discovered hormones, commercialised them, and they went off down a different track. But then also the antidepressants and antipsychotics came out. And so a way of getting people out of the asylums was just giving them the antipsychotics, wasn't it? To clear the asylums and these people maybe got better temporarily, but then they realised the side effects of the antipsychotics. And this is the thing is that I've always been someone within psychiatry who's cautious about the prescription of psychotropic medication. Now, they are really important efficacious treatments that we have.

However, they're potent and they come with side effects. Yeah. And so they have to be used judiciously and carefully and fit for the right situation and for the shortest period of time that we can for somebody. And for me now, when I sort of, I look at a woman coming to my clinic and we're going through the history, I do want to stop and think about actually, if you're already on HRD, have we optimized it? Because there's so much variation in the practice of its prescription. Because actually giving a woman back her own natural hormones, why wouldn't we go there first before we start introducing a psychotropic medication into the system? it just feels you know if I said to you

look you've got an iron deficiency and you're quite tired yeah tiredness is a symptom of depression but I wouldn't give you an antidepressant I would try you on iron first yes yes yes it's sort of quite simplistic medicine isn't it and and the same you know we know that progesterone

testosterone and estrogen are made in the brain their neurosteroid so they have a role in the brain and you know there was there's even randomised control studies from the 1980s, women with severe mental illness who are in a psychiatric hospital given either placebo or eustodial in conjunction with their other medication. And the results are staggering. Thanks so much for listening to my podcasts.

Did you know that if you prefer to watch rather than just listen, my podcasts are available on YouTube every week. You'll find full episodes and additional educational content on our hormones, menopause and women's health, all grounded in science and real clinical experience. It's another way for me to share evidence-based information, challenge outdated thinking and make complex topics clearer and more accessible. So if you want to stay up to date, revisit episodes or share them with others who might benefit, make sure you subscribe to my YouTube. But the other thing about antipsychotics, that I never realised, because I didn't think too broadly, but antipsychotics, but antipsychotics,

affect metabolism. So we know that people on them long term, there's an increased incidence of heart disease, diabetes. People usually have their blood tested for their cholesterol, they have their blood pressure quite rightly done. But we know that they can increase prolaxin. So if they increase prolactin, they can switch off or suppress FSAH and LH to hormones in our brain. So basically give people a chemical menopause. We've known for many years that people on these anti-psychotics long term have amenorrhea, so stopping of periods. But I've been trying to work out guidelines, and I've been in touch with your Royal College of psychiatrists in case I've missed them, but they've confirmed to me there aren't guidelines

that we have to be testing or psychiatrists should test for hormones in women who are on psychiatric medication long term, and it doesn't make sense, really. Absolutely. I think this is where we get into some of the barriers that are there for psychiatrists in trying to sort of their practice and stepping into thinking about perimenopause, menopause. I know as an NHS consultant that it can be really challenging to do blood testing. Yeah. As a psychiatrist, we're often not well set up within the average psychiatry clinic to actually

just turn around and say, oh, hang on, I'll just take a blood test off you. And we're quite often having to ask our GP colleagues to help assist us with that. Or we're having to try and book in through one of our depot clinics. and it's complicated and challenging. So the systems just aren't really well set up for us doing blood testing on a regular basis. I'm not meant to be an excuse. It's just a reality.

It's practicalities, isn't it? Because I know for my own practice as I've been starting to try and sort of build up the way that I'm working here. And I read more into the evidence and read more of the guidelines around how you can practice in this area. I sort of realize that,

oh, I'd be really nice to actually know what the hormone levels are. So I've got a sense of where we're at. It certainly inhibits me. from wanting to go above the license limits, even though I hear all the time from Rachel just how much success that she has within the News and Health Clinic of actually knowing for women who are poor absorbers of estradiol

that actually if you not had success in this sort of lower levels, probably because they're a poor absorb. There was a CPD module that I completed a couple of years ago. So I know you assisted in writing, which was fantastic. I found that a really helpful model. module that's available on the Royal College website for our RCO and CPD training. And that really got me over the line, actually, in feeling confident about prescribing. Because it just really helps me understand exactly where.

All it actually did was reconfirm of everything that I heard from Rachel before and had all the papers put in front of me by her and we'd gone through and I'd read through a couple of the books. But actually then finally having the Royal College stamp on it helped get me over the line of feeling, okay, I feel comfortable and confident now that my practice. as being backed. Yeah, and I wrote that with some colleagues, but it took me a good two years because I got a lot of pushback to say, surely the evidence isn't this good, surely there's more harm,

but fair play. And actually I paid some of our money so that it would be free access because it was really important for me that it was free access, and then I did get a prize because it was the most downloaded module. And I went up to Edinburgh to receive it,

which was great. And every psychiatrist I spoke to, yes, we realised this is a problem, but most psychiatrists are not like you and they don't prescribe any hormones at all and I find that really quite frustrating because as a GP I'm expected to prescribe most things and hormones are safer than most other drugs

you know. I guess the thing for me that I've always been really lucky is that I've had Rachel on tap this whole time who I can sit and debate cases with over the dinner table and she's just like, you need to prescribe that woman. HRT. But also that

Rachel's she's giving me permission to talk about this openly is that she's been going through her own perimenopause. And so we've had our own personal experience of going through that journey and we started to notice lots of changes with Rachel that she was getting much more

tired. She was I mean Rachel is just the most organised person you've ever met in your life. She's on top of everything all the time. And it just found that she wasn't just quite on top of things the way she used to be. And then we started finding that there was lots of mood swings started coming in. And there'd be these moments of explosive anger that would come out of nowhere. And I'd be thinking, oh my God, what have I done now?

And because I'm the kind of person who just internalizes stuff straight away. I was thinking, oh, I'm a dreadful husband. I'm doing terrible things. And it started to become this real sort of, it was a difficult point in our relationship where we were having these sort of flashpoints of argument. And then she started to really get, get into the world of understanding perimenopause and menopause and has been able to be prescribed. But she's a poor absorber. Yes.

And a hundred microgram patch was not enough for her. And she had to go up and she's on 400 micrograms now. So she puts on four patches each day. And that's been, that's finally got to the point. And it's a world of difference. Yeah. Where she's a, she says, I've got my energy back. My mood is great again.

I'm able to function. And so having that personal experience and the confidence to see that that's made all the world a difference for her and for us, I think that's definitely made me want to go. More women should have the chance to feel this good. Yeah. And I mean, it's the same. I mean, I've been on HIT for 10 years, but I don't absorb well.

And I was on 100 micrograms. It did nothing. and going up to 200 and I was perimenopausal then so now I'm higher than that. But if I don't, I get migraines really badly anyway and they just get a lot worse and I get joint pain but my mood was terrible at times. But I have managed to persuade a few psychiatrists to prescribe.

There was one of my patients, it's really sad actually. She was doing really well on HRT and then there was an HRT shortage a few years ago. So her GP said, well, you don't need it anymore. so we'll stop everything. And her mental health deteriorated really quickly. And her husband was doing some washing up and she jumped. So she fractured her spine and was in a psychiatric hospital.

And he reached out to me. And I went to go and visit her actually one Sunday. I just turned up at the hospital. And I hadn't been to a psychiatric hospital for many years. And she was really agitated and she was absolutely mortified. I was there. And she was like a little sparrant. You know, she was, she wasn't one of my patients, so I didn't know what she was like before, but she was a clinic patient.

And I just felt really sad to see her. So she had very dry hair, very dry skin. She was ruminating a lot. She was fixating on the accident. She was so embarrassed that I was seeing her. So she had insight as well, which a lot of these people still do. And so I couldn't prescribe for her because she was under the NHS Psychiatry Unit. So the psychiatrist had done the module and recognised my name.

so agreed to prescribe for her. And I saw her as a review last week, actually, and it's just amazing. She's like, she's so well. But it was the testosterone that made the biggest difference. And a lot of people who have that poorly, the Eustodine and progesterone help, but it's the testosterone and it takes time.

And, you know, physically she looks completely different. But mentally, she's so different. And, you know, it's incredible. But having this rapport with a psychosovo. psychiatrists and actually giving them, telling them, you know, or advising them what would be good to prescribe, looking at the blood results with them. It's been really good and it's happened to another couple of patients again who have been inpatients and that's really amazing. But I, I would have even thought about it years ago. That's what frustrates me. But now, now it's there,

it's so obvious. And a lot of psychiatrists say, well, we need more evidence. But actually, there is really good evidence. Yes. Compared even to some of the other drugs. It's this sort of willful blindness really that they're using it as a reason maybe, but we need to change the conversations, don't we? And I find that a really tricky area to navigate Louise around that that relationship with other doctors. And so even as I've sort of started making this a more regular part of my practice of prescribing HRT for women after we've gone through figuring out that that feels like a right fit for something to try. And then we've had some amazing results where women have just come back and said, I feel this has really helped.

You know, it's not sold. But by the time they come to see me as a psychiatrist, they're pretty bad. It's usually pretty severe and complex mental health problems because actually the vast majority of mental health problems is managed by general practice. And so I'm seeing the most severe end. So it's not, as I say, not some silver bullet that's just taken away their problems. But they've said, this is helped. I'm sleeping better.

I'm not drenched in sweats. My mood just feels that a little bit. calmer and I'm just able, I've got that energy back to sort of start doing things again. And so I'd really like, you know, so great, let's get it continued. And I'll write back to the GP and say, you know, we've done this trial of HRT, please carry it on. And I've had some very rude letters back from from some GPs where they've actually come back and said, what do you think you're doing as a psychiatrist, right?

They're prescribing HRT. Or another one I had was a woman who, she'd had a hysterectomy. And she'd been given some HRT, but it was a very, it was 50 micrograms of, of I used to die on and that was it. And I said, well, do you know what, actually? I think if we add in some utergestan, because she was really complaining that her sleep was really poor and she's very anxious. I said, I just, I'm interested to find out if this would be helpful. And this is common practice in psychiatry in terms of trying things out.

Yeah, yeah. We're very used to therapeutic trials. Because the medications be prescribed normally in psychiatry that it's not like we're topping up your lack of certuline or whatever it might be. we're adding in the agents that your body doesn't normally have because we're trying to see if the effects of it are helpful or not and give some space for helping. So that's just normal way that we practice in the psychiatry. So I think if you can enter into HRT prescribing in that spirit of let's try something

and again just want to reemphasise that very low risk. So why wouldn't we give it a go? Because you can always not prescribe it again if actually turns out that that did nothing or we can play with a bit more and try and see if we can find an even better fit. But yes, so back to that story. Ladies had a hysterectomy. We introduced some eutragestan

and yes, after a few weeks. She came back a few weeks later and said, do you know what? That actually really helps. I'm sleeping a lot better. I feel a bit calmer. I'd like to continue that. I was like, great. So we wrote back to the GP and said,

we've increased the east jar. We've prescribed some from eutriestan. And she came back and said, well, she doesn't need utergestan. she hasn't got a womb. And so I then entered a bit of a back and forth in the emails of saying, well, actually, you know, she's benefiting from it. And we know that congestion has an effect on the GABA system, thanks to your module.

Very good. And that's going to reduce anxiety. It's going to help with the sleep. So why on earth wouldn't we continue that? And she then came back again. And I did have to send us quite a few more materials and papers. to try and reassure, because you should come back saying it's going to give her blood clots. And there's no evidence for that.

And it's amazing the amount of misinformation that's out there. And I feel like there's no other area of medicine that has this degree of misinformation in it. It's absolutely maddening, isn't it? Because we're arguing over a natural hormone at the end of the day. And the patient is central to that decision-making process. And actually, we are reaching a stage often where the patient's no more than the doctors, and that can be difficult. But a lot of doctors are are waking up and realizing

because it is basic physiology as well. And, you know, we can have the psychiatric medication alongside. It's not a one or the other. And often, you know, if people need both, that's fine as well. So there's lots we need to do. And I'm just really grateful that you're here talking about it and hopefully we'll change the minds of others. Well, do you know, that thing about changing minds is it preoccupies me a lot

because so as a psychiatrist, I'm really passionate about an approach to mental health care called Open Dialogue, which is really inclusive of family and trying to be transparent with the people that you're working with. Effectively, it's heart, it's that. It's making sure that you have all the conversations

you need to have about someone in front of them and that you include their social system around them, anyone who's important to them. And I've been working on that for about 10 years now with various people in the UK. and we did a big research trial around it called Adesi that will be publishing soon. And it's amazing the amount of resistance I've had over that time of trying to bring in a different way of working.

There's just this huge degree of conservat, small seed conservatism amongst the medical profession to anything that's new or different, this sort of level of suspicion. Yes, it is suspicion, isn't it? of just, you know, that, I mean, it's amazing the sort of range of responses I'll get to it when I start trying to explain this sort of way of working to people. The first of all, they go, oh, that's no different to what I do already. And then the next response is, oh, when they really get to understand, they go, that's too radically different from what we do already. Then it's, oh, no, it's too expensive. And no, it's, he'll take too much time.

And every excuse in the book will come out and be thrown in the way of anything but trying to embrace change. And I know we love our old stories of medicine. And I often think about the story of Semmelweis. Oh, yeah. Totally. The Hungarian obstetrician who the medical students were coming in from the anatomy lab and they weren't washing their hands and they were going to helping out deliver women's babies.

And he could see on the ward where the medical students were delivering babies rather than the ones where the midwives were that they had much high mortality rate. and presenting that data to his colleagues, he got utterly ostracized. He wasn't allowed to, well, he wasn't allowed to conferences, but the worst, saddest thing about Simmelweis is that he ended up beaten to death in a straight jacket. In an asylum. In an asylum. And don't be wrong, I mean, there's many times that I've thought about Simulvice

and thought about my own mental health. But we need to end on a happy note. Yes, yes. Things are changing and people are learning, and we need to keep looking at the evidence. we need to keep looking at basic neurophysiology because that's often what we're talking about. So three things, Gareth, what three things do you think

psychiatrists should just know about hormones? I'm not talking about prescribing, but just know so they can ask the right questions for their patients. So three things. So the first thing I would say, I would really strongly recommend the CPD module on the Royal College website. It's really straightforward and you can get it complete within an hour or so,

and it will just bring you right up to speed really quickly. So I think go there. Secondly, I would think about how you can start having these conversations with your patients in your clinic of actually just being curious, being curious about that life cycle and thinking about when did this change happen. and is this woman in that sort of age range of sort of 35 to 55 somewhere in that range of actually what should I be thinking hormones? And the third one, we'd be, don't be afraid to prescribe. You've got these really low risk natural products that you can prescribe to women, their own hormones, that you can give back to them.

And it's going to be part of the solution, not just for their mental health, but you're going to be promoting their physical health as well, which is such a core. issue for us to drive forward. Yeah, so important. So thank you so much for sharing your wisdom and thoughts today. Thank you. Thank you, Louise. I've got something really exciting to share with you. Every Thursday I'm going to be releasing an extra episode for those of you that sign up. It's an opportunity that I can have more guests, share more information, dig deeper into the research that I can share with you. And when you subscribe, this money is going to be used to help with research, much needed research that's away from pharmaceutical companies. So information is down in their show notes. So have a look and subscribe and enjoy.