Live Like a Girl with Dr. Mindy Pelz - Navigating Bioidentical Hormone Replacement Therapy with Karen Martel

Episode Date: August 21, 2023

Get ready for a deep dive into everything hormones - both bioidentical and HRT - with our guest Karen Martel.  To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://www.drmindypelz.com/ep192. Karen Martel, a Certified Hormone Specialist, Transformational Nutrition Coach, and renowned authority on women's weight loss, is dedicated to transforming lives and empowering women to achieve their wellness goals. Check out our fasting membership at resetacademy.drmindypelz.com. Please note our medical disclaimer.

On this episode of the Resetter podcast, I bring you Karen Martel. Now, this is a conversation I've been wanting to bring to you all for a very long time. I just haven't found the right person to do it. And I believe that what you're about to hear is I found the right person. Karen is not only a hormone and perimenopause specialist. Not only does she have incredible clinical experience with bioidenticals, she has a huge heart and she has a unique approach to helping us all understand if we should be doing HRT, bioidenticals, how would we know where the door in to these exogenous hormones would be

for ourselves in our own unique way? And so what you're going to hear in this episode is we talk about the difference between HRT and bioidenticals. So for those of you that don't know that, You're about to get a lesson on that, which will be hopefully really helpful. But then we go into the individual sex hormones, testosterone, estrogen and progesterone, all the different ways we can use these hormones through bioidenticals, through creams, through pills, through tablets, through shots, you hear it all. We talk about all the different ways that we can go after bringing in hormones into our body as we go through the perimen menopause and menopausal years. Now, you'll also hear in there that I'm

experimenting with bioidenticals as well. And so I used myself as an example, knowing my hormones quite well, what my door in would look like for bioidenticals. And you'll see that Karen has some very strong opinions, which were all very welcomed. So if you've been trying to figure out the exogenous hormone game. You're trying to understand where you sit on the topic. I really hope that this message sits with you. I hope this conversation opens up your mind. I hope you'll see that everybody's path using exogenous hormones is different. And again, I'm hoping you're going to get answers here. I love Karen. I love her heart. I love what she's up to in the world. I'll leave all the links in the notes for you so that you

you know, can benefit from her services if that feels great to you. But most of all, I want to educate you on when and when not, we would use these exogenous resources for our hormonal benefit. So as always, I hope this helps and changes the direction that your health is heading. And for my perimenopause and menopausal women out there, I'm with you, I hear you. I know the struggles you're going through, which is why I am so glad to be bringing you this conversation. Karen Martel, enjoy. Hey, Dr. Bindy here and welcome to season four of the Resetter podcast. Please know that this podcast is all about empowering you to believe in yourself again.

If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Enjoy. Let me just start by welcoming you. Karen, I always feel like this is my home. Welcome to the Resetter podcast. Yes, it is in our home, really. So yes, thank you for having me. Yeah. Can we start this conversation just for those people that are listening? Can you explain the difference between HRT and BHRT? What's the difference between those two? And then maybe in that, can you also explain your passion behind bioidenticals and how you got involved in this. Yes, absolutely. So back in the 1950s, HRT came on the scene. Now, hormone replacement

therapy is actually thousands of years old. There's actually documentation that goes way back into China where they used to collect the urine from youthful men and women. And then the emperors and emperorses or whatever they were would somehow ingest the urine. They would dry the urine and then they would ingest it. So this has been going on for a while. Yeah. Yeah. Mmm, delicious. I'm thinking from a glass. They just drank it. We're not going to recommend that for those of listening. We're not recommending that. But go ahead. So in the 1950s, they made Premarin, which was from pregnant horses urine. Again, urine. And so that was the first kind of on-the-scene estrogen replacement therapy. And it was taken orally. And this,

became the number one most prescribed medication in North America. And it remained there for a very long time. So you can imagine every woman was on it. Like it was highly sought after. And they realized as they, you know, the years went on that they needed to create something that would mimic progesterone. They didn't get this from horses. They made this in a lab.

it was a synthetic chemical, which we still have around today in birth control pills as well as hormone replacement therapy. And that was Provera, also known as progestins. And the frustrating thing is, is if you start to look through PubMed research, you'll see progesterone, the word progesterone being used in a lot of research when it was actually progestins that were used in that research. Yeah, interesting. Yes. And so the progestin had to come in, because they needed something to counterbalance the growth in the uterine lining. Because without a progesterone in there, the uterine lining, because of the estrogen and estrogen's a growth hormone, would grow the uterine lining and it would become uncontrolled growth. And then there was an

increased risk of uterine cancer. So they're like, okay, let's get this, let's put this into the mix. So they did that. That was also taken orally. In two, or in the late, in the late, late 1990s, the women's health initiative came onto the scene. This was one of the biggest studies of its kind. There was over 600,000 women. They set out to say, let's prove that hormone replacement therapy is of benefit. And so they set out to do this research and with all these women, and they started the study. They had a couple different arms of the study, of course, one being both the premarine and the progestin, one arm of the study of just estrogen, the premron, we can't even really call it estrogen, horses estrogen, we'll call it.

Horses estrogen. Which is nothing like our own, you guys. No, right. So silly. But it worked, it worked to get rid of symptoms. And then, so they had the arm of the study where women didn't have a uterus. So they didn't use the progestin. They just used the premarine.

And so in this, and I'm telling you. you all of this because this is what leads into the use of bioidentical hormones. And this is where a lot of the misinformation comes from. Yeah. And so this study went on for a couple of years. And then in 2002, they actually stopped the study. This was about four years into it. They stopped the study because they saw that there was an increased risk of heart attack and stroke, uterine cancer, and breast cancer. Now, this, when they reanalyze this study, they actually, it showed that there was an extra one woman in every 1,000 that developed breast cancer from taking the combination of progestin and premarin. So, but we didn't hear about this. All the world heard was, oh my gosh, get women

off of hormones, hormone replacement therapy. It's killing them. It's giving them. It's giving them breast cancer in uterine cancer, stop. Yeah. And can I say something on that? Because I think this is really important when we look at science. Science studies are multifaceted. You have, when you look at a study, you've got to look at the sample size. You've got to look at the parameters in which they studied the people.

You've got to look at the backing behind the people. And even once you've looked at all of that, are often little things that get highlighted and pulled out that now become this like flashy statement. And this is so, this still happens to this day in studies. And we need more rich conversations like this one to talk about what was going on in that study. I mean, we have this in the fasting world all the time. This is right. This is wrong. No. There's a lot to unpack here. Now, let's unpack it. So I just have to make sure that I say that. That was really well stated. Absolutely. Yes. And when you start to actually dig into the research, there's been so many

people that have reanalyzed the study. And it's shocking what the truth was of this study and how nobody still to this day is talking about it. Right. And you can ask a woman still to the, I get it all day long, every single day in my practice where you tell a woman like, hey, maybe you could use some estrogen replacement therapy and they're like, they just like cover their breasts. It's like, right. Yeah. Well, like, I'm going to get breast cancer. The power of media. The power of media. It's crazy. And doctors too. You'll go to your doctor and the doctor will say like, oh, I'm not going to give you estrogen. That will kill you. They literally will say that that will give you breast cancer. When they looked at the study later on, there was so many faults to it.

A, there was like, they couldn't find any women that weren't on Premarin. So they ended up with women that were unhealthy over the age of 60, well past their 10-year window of being in menopause, all of the things. But what they, what was shocking about it was it was the arm of the study that used the progestin that had the increased risk of breast cancer. In the arm of the study where just the premarine was used, horses estrogen, there was a 33% reduction in breast cancer cases, which Once again, when you look at it from like the overall view of how many women, et cetera, et cetera, et it was it was still small what the difference was of how many women didn't get cancer and then the ones that did in the progestion group.

But still, that's why you've got to look at these studies like you were saying. Like you really have to dig into that research. Yeah. So we didn't hear anything about this. And still to this day, how many, like 20 years later, we still think that estrogen is going to give us breast cancer. And so 80% of women. stopped using their hormone replacement therapy and really started to suffer because of it.

And then eventually we started to see what is now known as bioidentical hormone replacement therapy, which is made from either from soy or from yams. Now, these are chemically made still in a lab, but that is where they're derived from. And they are identical. So you can think of them as body identical hormones. The chemical structure is exactly the same as your own. And we typically, like with the estrogen, we really, even though there is bioidentical oral estrogen, I always say you use it topically because one of the reason why there was an increased risk of heart attack and stroke with the premron was when you

swallow estrogen, it can increase the risk of stroke. But if you look at the research, there is no increased risk of stroke and heart attack when you use transdermal through the skin estradiol. So that's a huge distinction to make. Okay. Now, before you go any further, because I have, you know, full transparency, I've tried bioidenticals. I've tried HRT. I've like, I test everything on myself.

And I have tried every cream on the planet. And I will tell you that the creams did not work for me. And now I'm doing a bioidentical pill, small dose of progesterone at night. And I'm doing some little trokey of estradiol, estrogen sort of combo. And it's finally worked. So are you telling me even if it's bioidentical that that increases risk? Because otherwise, I don't have a solution for me. Okay.

Have you tried injection of estrogen? I haven't. haven't. That would scare the shit out of me if you're going to inject me. You're going to inject I mean, I'm on such little amounts of these hormones. So it was, it's just, I've worked so much on my lifestyle. And I finally, you know, progesterone, I just want to point out for everybody like, you know, progesterone, I think is the real needle mover for menopause. That's, that's been my personal apparent feeling. That's in what I've seen after looking at. literally hundreds of thousands of hormone tests that have come through our platform, that I think

progesterone is one of the biggest needle movers. But then when we go to put the creams on, it's a whole different game. Yes. So sometimes people won't absorb the creams very well. It's really it is about finding what delivery form is going to work best for you and also what type of hormone therapy are you going to do. There's several types. There's static dosing. A lot of doctors will do every single day and they'll do progesterone as well as every single day of bias, which is a combination of estradiol and estriol. There's three kinds of estrogen. There's estrone, estrogen, estradeal, and estriole. Estrone is the more inflammatory of the three estrogens. It sits 100% on what is called the alpha receptor, the estrogen, the E2, the E1 alpha receptor.

So there's alpha, there's beta, there's other ones, but those are the two main ones. We produce estrone out of our fat cells. And estrone can convert down to esterdial, and esterdial can convert over to estrone. So they go back and forth. And then the two of them can also convert down into estriol, which is the weakest of the three, and that only binds to the beta receptor. And so the doctors will oftentimes mix estradiol and the estriol together because estrodial will bind 50% to the alpha, 50% to the beta. So they'll put in the estriol because it only

sits on the beta receptor and the better receptor isn't proliferative. The alpha is. So the estrone is the one that's linked more to breast cancer because it can be proliferative. So it doesn't cause it, but if you have breast cancer cells, it can make it go there and grow. When we swallow estrogen of any kind. So it sounds like you're on a biased trochi. So we end up swalling about a trokey, yeah. Yeah. So we end up still swallowing about 40 to 50% of trokeys, even though they're sitting in the, like, obviously, right, we're going to swallow some of that. When you swallow estradiol, it has to go through the first hepatic pass of the liver, and then it will be converted to estrone, the stronger of the ones. Now, that's said, remember, it can still convert down into the liver. It can still convert down

into estradiol throughout the system proliferate like you know inside the body not through the liver inside the body so when you swallow it you're going to be getting a lot of estrone which is the more inflammatory one that is not the one that is our primary hormone so estradile is like the mother of all hormones in our body is the i think it's the most important one because of its far reaching effects on our health. Progesterone, though, is needed to counterbalance that estrogen. So progesterone's wonderful. So some women are really like, I love my progesterone because it's so calming. It's a very anti-anxiety. It helps us sleep. It's like, oh, amazing. Amen, sister. All of that. Yes. And that can be great. And it gets very safe to take it to a certain, up to a certain amount

orally. So up to about 200 milligrams that is safe to take. There's a lot. a little bit of research. Oh, I'm only taking, I'm only taking 20 milligrams. I'm super small amount. Oh, yeah, that's very tiny because 80% of oral progesterone converts to the metabolites. So you'd only be getting a very tiny bit of progesterone. So we always try and start with about 100 milligrams to 200 milligrams for menopausal women because that's going to give you about what your body would normally produce of progesterone. And that's enough to counterbalance the growth typically of the estrogen. So we want that in there because that's breast protective.

It's been shown to be very breast protective, uterine protective, bone protective, brain protective. We want that progesterone, even if we don't have a uterus. Right. So when you also swallow it, you raise something called sex hormone binding globulent. When you swallow estrogen. When you raise this protein, SHBG, SHBG, you can think about it as a little bus that shuttles your hormones all over your body.

And when it's on the bus, when your hormones are on the bus, you can't utilize. the hormones. The hormones have to get off the bus in order to dock onto a receptor and send its message through. So when you're swallowing, you have to watch that SHBG number because what it's going to do is if it gets too high, it's going to bind up primarily testosterone, second to that estrogen, third to that dihydro testosterone. So then you're kind of, it's like mute, you know, you're taking it. And it's like you're, you're, you're, you're, you're binding up these hormones that you're trying to get into your system. And so I personally don't recommend swallowing the estrogen. The progesterone, yes, it's fantastic, but testosterone and

estrogen will raise that SHBG and the estradiol will convert to estrone. Yeah. And what do you want your SB, S-B-G to be? I like it to be below 85. Okay. Okay. Yeah. Yeah. And so there's other things that will raise that too. Yeah, and just so we're clear for everybody listening because that was a, you just got a crash course in hormones and by identicals, and this is why it's so complicated. Yes. Is that to sum up what you just said is we have creams, we have pills, and now I'm learning we also have injections. And so what. And suppositories. Okay. So what I've figured out in solving this for myself and what I'm going to encourage everybody listening, to do is it's all personal. And this is why, yeah, this is why we can't make one blanket statement

and say all women should do this. You have to find a practitioner like Karen that you can work with to figure out how to get it very customized to you. And that's what actually I did is go to a friend of mine and say, hey, help me through this. So I just want to point that out right now to make sure that we don't fall prey to people saying, well, I should be doing it this way or this other. It's a personal approach. And that doesn't fit into our patriarchal health care system. We like one size fits all. But a woman's body is not one size fits all.

No. And there's pellet therapy too, which is very popular right now. And I can't say that I'm really for that really. I think for some women, it works 100%. So if that's working for you, awesome. Personally, we don't use that in my practice. So, but to each is own on that one too. But with, so going back to what you were saying like that you really feel like progesterone's

great for you, a lot of women do that. And a lot of doctors will say, use your progesterone every single day, use this very tiny amount of biased. And that's a very, very common thing to hear from hormone practitioners. The problem with that is estrogen is estrogen is need, estradiol. So I'm going to be very specific here. Estradial is needed to upregulate progesterone receptors. So if we use progesterone every single day, it's actually a great way to lower estrogen

because it starts to suppress it. I'll use it in women that are in their fertile years that have like super high amounts of estrogen and no progesterone. I'll say use your progesterone every day for a while. so let's to lower your estrogen because it does do that. But the problem is you eventually, and this can take a year, it can take two years, but eventually what starts to happen is women will say, I don't feel my hormones anymore. This is because with all of this progesterone that's being given every single day,

it starts to suppress that estrogen. Estrogens needed to upregulate progesterone receptors. So if you're not getting your estrogen in the right amount, you're not going to be upregulating those important receptors for your progesterone. So then eventually you don't even feel that progesterone anymore. And then progesterones needed to upregulate the estrogen receptors. It's a fine balance. So we want to take a little bit of a break because naturally that's what Mother Nature does.

And we can never mimic it 100%, but we want to try and get somewhat closer to it. So I always tell menopausal women, you know, take a week, take two weeks off your progesterone to give just for that receptor heart. Yeah, I know. It's like, that's why I say three weeks to some women because they're like, because naturally we only produce it for two weeks when we're fertile. But you might find if you get your estradiol to where it needs to be, Mindy, you may find that that counter, like that you'll get the benefits and you'll see the

benefits of the estradial for, like, and it's a bit different than progester. but you think about what it feels like even in a cycling when we're cycling first half of the month are we not a little bit more energetic for a little bit more outgoing we want to go out into the community we're a little more flirtatious more sexual this is estrogen so astrodial so this is when estradial is at its highest and even on day 12 of our cycle we have this massive surge of astrodial right before we ovulate all for purpose. This upregulates the P53 enzyme, which is a tumor suppressing enzyme. So I have a lot of my women on day 12 if they're, you know, throughout the day 12 of the month, I say triple your astrodial. Let's just get like just,

just just did someone mimic that. Let's see what happens. Let's see what happens. Okay, but what do you do if you don't have a cycle? What do you, I mean, that's great for peri menopausal women. So then I just say like day one of the month is is month one, like day one of the month is day one of the, the faux cycle. Right. Okay. So just to recap, if what I'm hearing is that even in the perimenopausal years, you, if you still have a cycle, you're going to want to try to mimic the hormones that are naturally coming in. You're just adding some support. And I think that's really, really important. That makes perfect sense to me. It's like, you know what? The analogy I use is when exogenous ketones first came out,

everybody was like, let me just take them all day long. And my feeling was, well, ketones aren't supposed to be there when glucose is high. That's an unnatural state of the body. And I would say the same thing with what you're saying is that what you're recommending is we take these bioidenticals in our perimenopausal years and we support what our hormones are already naturally doing. And then, is that right? Do I have anything I need to say on that? Yeah. In the fertile years, it kind of depends on where you're at with your cycle. There's still a lot you can do prior to jumping to the hormones. So just I'll be clear about that. Like there is a lot that we can do. We're not talking about that really today because we have a short

amount of time. We're going to really hone in on the bioidenticles. But, you know, there's a lot we can do as far as supporting the hormonal system and, you know, kind of wringing out every last drop of those hormones that we can get out of the ovaries, as well as supporting the adrenal system, because we will make some of our hormones through the adrenal system. So all of those things are very important. There's great supplements to take lifestyle things that we can do. But eventually, you cannot diet or fast or anything out of hormonal dysfunction and, loss, right? So at that point, yes, if you're starting to feel the effects of the loss of estrogen before you lose your period, which it's very challenging to find a doctor that will ever prescribe

you estrogen, before you lose your period. But I believe 100% we should be addressing those women because that is when all the symptoms start. I know personally for myself, I was like, I still had a bit of a period, but I was night sweating and hot flashing all day long and wrap. gaining weight. I felt like garbage. So I started my astrodial when I was quite young. And it saved me. It like, it was so, I mean, I've been on progesterone since I was in my 30s, but adding in that estrogen was like, oh, my gosh, thank goodness. Because it just, it made these last couple of years so much more smooth. We should not be waiting for women to be 30 pounds overweight, a hot mess, depressed. Like, women will quit their jobs. They'll lose their relationship. They just, they don't even know who they are because they are so sensitive to the loss of their estrogen.

Some women, poof, they'll just be like, oh, yeah, I've had like one half-flash. Yeah, I've met those women. I've met a few of them. Yeah. I'm always surprised. So, yeah, so something I want to point out is that when we're looking at menopause, in my mind, there's the perimenopausal years, which is a little bit of the Wild Wild West in everything we're talking about. then there's the menopausal transition time which you brought to my attention when you were speaking

this weekend at the women's health event was that why do we say a year and now you're officially in menopause like that's just now we can treat you yeah but i can tell you as a woman who has gone now eight months without a cycle i can feel the effects and loss of estrogen which is why I started to reach for bioidenticals. And I would say I have my lifestyle very dialed in with the exception of the rushing woman. And that is one that I'm working on unwinding now. But I say that to say that I do think there comes a point where you've done everything you possibly can and the loss of hormones just still are there and you have to make a decision

on what you're going to do. And I think it's in that transition year as you go into the postmenopausal years. Yeah. And a lot of women will say, yes, but this is natural. We're supposed to be going into menopause. But we also didn't live past 50. And we're doing so much for our health besides that, at least a lot of our listeners, right? They're eating right. They're exercising. They're doing all of these things, taking all of the supplements and really trying to take care of their health. And unfortunately, like I said before, for some women, the loss of hormones, is devastating and can be it can really really affect a person and we do see that in the long-term research that women that replace their hormones actually have a reduction in all-cause mortality by 39 percent

which is huge you know we know that it helps us with our with to prevent Alzheimer's there's a massive study that was done out of the University of Arizona and just a couple years ago 4,000 women is show that women that use transdermal estradial therapy for six years or longer had a 75 to 80 percent reduction in dementia and Alzheimer's. That's crazy for a disease that you can't, that there's no solution for. And there's many reasons for that. We have a ton of estrogen receptors in our brain, but also estrogen helps us to be insulin sensitive. And we know that Alzheimer's is like type three diabetes. So it helps us to process our glucose better. It has a ton of estrogen better. It helps to prevent type 2 diabetes. We know that it helps prevent heart disease. These are all

the major killers of women. And so what is the alternative? We can go out there and we can wait and do, I'm going to do this all natural and that's great, you know, but what's going to happen if you do get heart disease? Then what's, are you going to say no to the medications because you're trying to do this naturally when we can just simply give back our body what it needs? And it's not going to, it doesn't mean that you're not going to get hard disease or tight-to-old or Alzheimer's, but it certainly helps to support our system. We know that astrodial, there's a great PubMed research that shows that women in menopause, if you can get your astrodial to 65 picograms per milliliter and above, then you can prevent

osteoporosis. And that's huge, too. And we know that most women, unless they're really weightlifting and doing all the things, most of them will get osteoporosis unless they do replace that estrogen and progesterone is very important for bone as well testosterone that's you know everybody thinks it's the man's hormone but testosterone therapy is really important for some women i find about 50% of women will lose their testosterone 50% want we we produce about 40% out of our adrenal system which is quite a bit so if you've got a healthy adrenal system you can have actually a good amount of testosterone yeah because estrogen

in progesterone is not the same. We produce much less amounts out of the adrenal system. But testosterone in our fertile years is our most abundant hormone. We produce more of that than progesterone or estrogen. And so that's important for, of course, muscle tissue, for sex drive, for energy. Some women will be diagnosed with chronic fatigue syndrome when it's low testosterone. So that's how important it is for that energy. And I always say, gives you your lady balls. Because it really does. It gives you that like, umph to get out there and face life. Yeah, fascinating. Okay, let's use myself as an example. So because, so that we can make this very applicable to people listening. So I'm, I'm 53. I'm seven to eight months without a cycle.

I have very low progestrone, historically low testosterone. And now, you know, the last test, actually the last test that I did showed that my estrogen was actually normal. Like it was, it was in pretty good shape. So it was progesterone that was really tanked and testosterone was tanking a little bit, but estrogen was, and that was a blood test that I did because I didn't have a cycle. So we did that before we put me on. What would I, what would you do with that kind of situation? I want to do your hormones, Mindy. Let me get my hands on you. I'll give, Karen, I'll totally give them to you. I'll totally give them over to you. And, and let me. Let's play. I mean, I use myself, I am a human lab. I have decided. I'm a hormonal lab. So I am

totally happy to hand my hormones over to you and you tell me what I, what I do, what to do. But I also want women to, I want to demystify bioidenticals. And so if using me as an example to do that, I just want to kind of give you a scenario of what I know today. Yeah. So I would look at your estradiol levels and see where they're at. So if they're below 50, then I would say they're not okay. Do you remember what the number was? I don't. I don't.

This was back in February that we ran all these, and it's July now. So when we do blood work, we're testing bound hormones, so bound to the bus, the sex hormone and bioglobulin bust. So that means that we're not actually seeing what your free available levels are. So I typically do both a Dutch test, which is urine metabolite testing, with blood work. So I combine the two because I want to see how a woman is done. detoxifying her estrogen before we put her on it. If you don't have any estrogen, you've been in menopause for a while. I'll typically say, okay, let's try some estradiol first and let's base the numbers

on the blood work. And then in three months or six months, then we do a Dutch test to see, okay, how are you breaking this down? And I can usually tell just by symptoms if a woman's not breaking it down very well. So that's what I would look for first. Is, okay, what number are you at with your estradiol, not your astral, not your esterone, what's your astrodial and what's your sex hormone binding globulin if we're just looking at blood work. Progesterone, on the other hand, really doesn't show up great in blood work. It's one of these ones that's like topical progesterone doesn't show up almost at all in blood work. And so a lot of doctors won't use it because they don't think it works. Well, that's not true. It absolutely works because if you were to test their urine, it would show up.

not that great, but it does show up better in urine. If you test saliva, progesterone overshows if you're using it topically. So it'll look like you have these super physiologic amounts. So with progesterone, I go a lot on symptoms. How are you feeling? Are we having symptoms of estrogen excess and not enough progesterone? And that's how I go with. So I don't often use the labs for progesterone very much.

With testosterone, blood work is great. because it's the only hormone that they'll test free and total testosterone. Of course, the man's hormone. Right. What? Exactly. Let us test the free for you. Don't get me going on that. Don't get me going. But go ahead, Karen. You can be talking. And so there's ways that I've worked with thousands of women with hormones, replacement therapy. And I have definitely seen some things that work better than others. So oral progesterone is definitely fantastic. Works really well. I don't go higher than 200 because there is some evidence that shows it can cause breast inflammation if you go down a certain pathway with your metabolites, which can increase your risk of breast cancer. So oral can work great because it has all those beautiful metabolites, almost like you're getting two drugs.

You get this, you get your progesterone and all the things that that's good for, but then you're going to get all these like a heavy dose of these metabolites, which are very anti-anxiety and how women to sleep, which for menopausal women, it's like, it's like, it's a godsend. but I love topical progesterone as well. I personally only use topical because I have a sensitivity to the oral progesterone because of the metabolites. So there's a small subset of women who take progesterone orally and have GABA receptor sensitivity. And so they'll take the oral progesterone and they get weepy and depressed. That's what happens to me. So if that's the case, that's because there's too many metabolites being produce and it's not that you're getting too much, it's that you have that sensitivity to the gaberoz with the gaber receptors. So we want you on topical because it doesn't go into those metabolites. Got it. The oral does. Yep. So estradial, cream shots are not the best actually, but if you're, if you're not absorbing the creams very well, then you can look at either suppository or

putting the cream on your labia or using an estrogen pat. I definitely find that the estrogen patch is one of my favorites, oddly enough. Even though it sucks because it's glue, like you're sticking the sticker on your skin. And the glue, of course, is not good for us. But it does give me a nice, steady dose of estrogen aisle, and I find it raises my levels. That's, is there a difference in the patches of the, like, there's a bioidentical patch? And then there's like a more of a per-itical. It's all bio-identical.

Because I will tell you, I went on the patch, and I, oh, my. murdered somebody. It was, it was, no, it was literally, I literally felt like I was going mad. I ripped the patch off. It was horrible. So I don't know. I mean, I will hand my hormones over to you, but I just want to point out to everybody listening that it, this is so personal. This is so personal. How did you feel when you took the cream? You just didn't feel anything. And was it biased? I don't know if it's biased, but I can tell you the progesterone cream also made me want to kill somebody. The estrogen patch made me want to kill somebody. The estrogen cream I do okay with.

I actually feel okay with it. And the progesterone pill I feel okay with. And then I have a small- You're hardly taking any. I know. I'm not taking much. Yeah. I'm not taking much.

Are you really feeling it? I'm, yeah. Oh, yes. Okay. Oh, yeah. You're very sensitive. I'm very, the first. first time I took it, I was like, whoa, like, wow, I remember her. Like, shoo, she can actually sit on the

couch now. It was like, it was like somebody gave me a joint and I smoked a joint. Like I was, it was like I was so chilled at 20 milligrams. So it could be, but you also have to understand my lifestyle is so clean. It is so clean. So the only thing I know I can work a lot better on is is stress and I'm doing that. So, but, but for the sake of people listening, I want to really make this applicable because it gets, if you're listening to this and you're like, this is so confusing, it is. It is. So I'm trying to use myself as an example of somebody who has tried all the different things.

It has dialed in her lifestyle, knows the parts of her lifestyle she's got to work on, and I'm still trying to dial in how to use bioidenticals. that's how complicated this is. And have you tried testosterone? I have. And I do really well with testosterone. Okay. So I've been doing a testosterone trokey again.

So if that's, I don't, again, I'll hand over all my dosages to you. Yeah. But I do everything very, I'm not, I haven't take, just so you know, I haven't taken a medication in about 30 years until I actually took these. I don't, I don't even do Advil. I don't do any medication. I haven't done an antibiotic since I've, was a kid, like I am I am completely medication-free kind of gal. So that might be why I'm so

sensitive. I would say it's probably genetics. There's some of us that are even like when we look at our genetic profile, there's women that are more androgenic than they are estrogenic. And the androgenic women, they really miss their androgens when they're lost. And so you'll feel that. And so when you take the testosterone and the D-H-E-A, you're like, oh, I feel like myself. Yeah, this is amazing. Rather than women like myself who are estrogenic, I'm the more curvier, you know, with the hips and the butt and struggle with the weight loss. And I'm estrogen. So when I lose just a little bit of my estrogen, I'm like, oh, my God.

Help. So I need the estrogen, but then I'm overly sensitive to oral progesterone. You do well with you. So every single one of us is going to be different. And I know women that need to do what's called physiologic restoration of their hormones. And this is like trying to mimic the amounts of hormones that we produce when we're in our 20s. And you cycle them. There's days where you go really high.

We're talking like hundreds of milligrams of certain hormones and then down. But sometimes the static dosing, the small amounts do nothing for those women. They need copious amounts. They need to try to they need to cycle and they need lots of it. to feel their best. And that's okay. There's lots of thousands and thousands of women on that protocol that are feeling unbelievably well. And then there's some women that just need these little tiny doses, which is somebody like yourself, where maybe you need to be a little bit more heavy-handed on your testosterone, little bit of the estradile, probably esteradile cream,

not the patch, clearly. And then split the dose because it really, it runs out. You're a person that can't take on a lot at one time. So splitting the dose would probably be a good idea for you. And then doing your estrogen, your progesterone three weeks on, one week off because you do really well with that oral progesterone. Yeah. And I really like the cycling. You know, everything in the female body needs to cycle. So that makes incredible sense to me. Yeah. It's a lot of menopausal will cycle with the moon, which is how we used to. Yes. I love that. Yes. Yes. And I feel it was interesting when you were talking about bioidenticals coming to. from wild yam, I'm like, yeah, it makes sense that anything that's nature made, the more I study the female body, the more I see how synergistic we are with nature, all parts of nature. So that was brilliant. To sum this up for just like somebody who's listening to this and they're trying to understand, what's my door in to bioidenticals? How do I help myself?

What advice would you give them? Like, where do we take this what could appear to be a very tangled conversation? if you just stepped into this, listening to all these fancy terms. How do we help people move forward and get some support and help? I think first and foremost, everybody's going to educate themselves on this because there is so much misinformation and it is very hard to get good information about hormone replacement therapy. My podcast of course, I'll plug myself here, but my podcast, I talk a ton about hormones.

We've got 270 episodes. it's you know beautiful yes and so they're great resource i i'm oh i never talk out my ass i always you know research based i've got some great great guests on that podcast that are hormone experts that know their stuff so that educate yourself first and foremost so that you're not afraid that you're not coming into this going am i going to get breast cancer am i going to get this you know right no if there's help to be had you need to feel your best and and hormones may help you with that. So find a practitioner that is going to look at you from a whole, not a cookie cutter, like, here's what we're going to do. We're going to put you on this. Here's your pellets.

And you shove them in your aunt. See ya. No. You want somebody that's going to look at your whole profile and say, okay, are you eating right? Are you eating the right diet that's for you, not for your friend, for you in your hormonal profile right now? Because menopausal metabolism is completely different than our metabolism when we're in our 30s. So remember that. detoxification. There's a lot of issues nowadays with our toxic load, and I'm sure you talk about this all the time in you on your podcast. We got a detox. We have xenoestrogen sitting on all of our freaking receptors. Your body prefers the xenoestrogens, which are fake estrogens in the environment from plastic. They are stronger. So they will sit, they'll dock onto that receptor before your

natural estrogen will. Yeah, that's really crazy. So clean up your environment. Let me ask you one quick question on that because I spoke of this last Friday. You know, there's as menopause is coming back into vogue, I know that sounds so crazy, but I'm going to call it coming back into vogue when Oprah starts talking about it. There is sort of this moment of like, oh, it's just a matter of HRT, bioidenticals, what do I need to do? But you just brought up lifestyle. If a woman chooses to go on HRT or bioidenticals, does that, make her exempt from having to deal with her lifestyle. Where does lifestyle play in this?

Not. So once in a blue moon, I'll see that woman. I'll come across it when she's just like, just give me the hormones, forget the rest. And it works out for her. Oh, great, good on. That's like one in every million. But most women, because of what's happening in our environment right now, this is, we're in a time that's never been before. The toxic load has never been like this. the stress on women has never been like this. So all of this comes into play. If your cortisol is running super high all the time, your adrenal system is not going to be making progesterone and estrogen.

It's going to primarily be making that life-saving, you know, fight or flight hormone cortisol because that's what has to come first. So, yeah, you have to stress manage. You've got to detox. You've got to watch your environment. You do have to start taking more time for yourself. Your body is screaming at you during this time to take time for you. to take time for yourself.

Yeah. And it will hit you hard if you don't listen. Yeah, it will hit you hard. And I will tell you two interesting things is that through my menopausal journey, I've picked my mom's brain a lot. And she's like, it was a no, nothing. It wasn't anything big. Well, if I remember back to what my mom was like in her 50s,

it was like, she was like, she had no stress. So we were eating really well. Like, I get it. So I stopped asking her questions. That would be the first thing I would say. And then the second thing that I would say is I think that we have to work on our lifestyle harder. And I mean that I shouldn't say harder because some women will just go in and do everything

more. We need to learn. I should be careful. I'm like, we need our lifestyle matters more after 40 than it's ever mattered before, which is why I wrote the menopause reset. It was like, okay, here's what we know we need to do. And maybe that's why I'm so sensitive because I've got everything other than stress really dialed in. I just need something a little extra as I transition out of not having any period at all.

But I will say this, Mindy, that we have to be really careful with our words here because a lot of women are doing it all right. They are managing their stress. They're eating perfectly. They're intermittent fasting. They're exercising. They're detoxing. They have it all dialed. and they still can suffer.

So I don't want you guys to think that you're doing something wrong because sometimes hormonal loss can hit the best of us. I haven't drank in for 15 years. I have an extremely clean lifestyle. I live where there's no Wi-Fi towers. I live on property and up in the woods. I work from home. I have an amazing family.

I have a great support. I have all of the things dialed in. And I will tell you, I suffered immensely. If I could show you a before and after a picture of what I looked like at 42 and what I look like right now, you would be floored. It doesn't even look like the same person. Yeah, and you bring up a really important point. And thank you for bringing that up because it's two ends of the spectrum.

You can't go into HRT or BHRT with this trashy diet and stressed out lifestyle. that's where I think it gets dangerous. And much like you, I have done so many things that it just became this moment in the last year, really, where I was like, okay, it's time to really open my brain and look at the possibility of bioidenticals. And the little bit I've dabbled in have actually really helped tremendously. So I think you're exactly right. We can't go on either end of the spectrum. For sure. Yeah, yeah. I just don't want people to think that, they can be exempt because they're doing all the right things and then beat themselves up if they're not because we have to have all of all of those pieces are foundational pieces we can't forget about them

they'll make this time in your life that much better and in you taking on hormones that much better because you'll be circulating them you'll be detoxing them well your gut's going to be healthy so you can break down that estrogen all of these things have to be there and it's very important but it doesn't mean, though, that you're not going to still feel the effects of hormonal loss because it does affect, it affects everything. And it's not just about, oh, do I have hot flashes or not? Do I have a dry vagina or not? We have hormone receptors on every organ in our body. So it's about how is your heart functioning and your gut? I mean, it's really important for your gut. The estrogen is really important for your immune system. We know this from COVID. Women didn't get as sick. And it was

because of their estrogen and progesterone levels. Well, not, but partly because of that. In general. In general, they did show that it's very important for the immune system. Brain protection, skin protection, eye protection, even like hunger receptors in your brain are affected by the loss of estrogen. I just read a study yesterday that showed that in rats, that when they injected, this is an intracranial injection of estrogen into the brain caused anorectrine.

So it, and they use the word anorexia, not in the term that we use it in. It's more like, it caused them not to eat as much. So their food intake went substantially down when they were injected with estradiol in the brain. These are overrector, they had their ovaries taken out the rats. So they had a loss of estrogen. So that actually lines up exactly perfect with fast like a girl because what estrogen that I, you know, all the estrogens, I, you know, all the estrogens, I, you know, all the estrogens. I've noticed do really well when glucose is down. So you are, and you typically, if you look at the menstrual cycle, we aren't as hungry in the front half as we are in the back half. And when progesterone's coming in, we need to bring glucose up. And the reason we get hungrier is because our bodies like, feed me, feed me more.

I need more glucose to be able to make progesterone. So I think that's brilliant. So I, and literally I could talk about this all day long. No, this might have to be part one. I know, this might we might have to. Well, okay. So this is what we're going to do just so we can use it as a teaching moment. I will hand my hormones over to you.

And then we'll bring you back and let's break it down. But primarily so that other women can learn. And that's part of why I've always used myself as a big laboratory. And I'm always very vocal about what I'm going through because what I and you and I have, you know, we chatted about this on Friday is it's just been so much silence for women for too long. And the silence needs to end. and these conversations need to start. So if you are listening to this, you're massively confused.

Please go reach out to Karen. Please keep having these conversations. Let's find a way to come together as women and start to understand this for ourselves. So I really want to make sure that we're clear on that, that this is the beginning of a really important cultural conversation that's not being had. So. Well said. Thank you. With that in mind, I'm going to finish up with my standard.

question, which is, do you have a self-love practice? And if so, what is it, what is it, and what's your superpower you're bringing to, you bring to the world? I don't have a self-love practice, but, like, not something that I do on a routine basis, but I do practice self-love. Just, I watch what I say to myself all the time. Yeah, well-set. Yes. My superpower would probably be the, the knowing that, I am here to love and to learn, and I always remind myself of that with every opportunity I have because the bad, the pain is just another learning opportunity, and I am in charge of how my life goes and how I perceive my life. And my superpower is seeing that glass always half full, not half empty. Amazing. Amazing. And I, that, I will tell you, you and I met for the first time

last week and I feel that from you. I feel the love from you. I feel the non-judgment. You definitely are one of those humans that you just instantly go, whoa, there's a spark there. There's a compassion there. So I would agree that. I call the same to both you too. Thank you. How do people find you? Just because I do, there's so many women listening to this podcast that are lost and I want to make sure that they have a way of getting some help. So how do people find you? My podcast is the other side of weight loss. And my website, Karen Martel.com, I have a great hormone quiz that that's a really good place to start for everybody. It's like what hormone could be stopping you from losing weight, but it really kind of breaks down each of the hormonal imbalances that can

start to happen in women in their 30s and 40s, and it can just give you an idea of what are some of the things that you can start doing about it. So that's a great place to start. And then we do offer, we offer group coaching, we offer private coaching. And we offer private coaching. And we also have, I work with a team of doctors who are amazing and that do bioidentical hormone therapy. So if that's something that you're interested in, great. I also work with people and whoever their practitioner is. Amazing.

Amazing. Well, thank you, Karen, for what you're doing. You know, we're more powerful together. Yes, we are. So I'm just really, really appreciate you. And hopefully this will touch some people who really need to hear it. Yes. Thank you for having me on.

Thank you so much for joining me. in today's episode, I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.