Please also review the “corrections” audio recording for this episode when it becomes available.
I’ve set this link to the YouTube video we reference during the second half of the discussion to the time stamp for Dr. Sarrel. We are discussing the testimonies made by experts for the next 30 minutes from the time stamp.
Link to YouTube Video of FDA Panel Discussion
Our entire podcast episode is about an hour long. The first 30 minutes are my own experience with misdiagnosis when the only thing wrong the whole time was perimenopause.
TRIGGER WARNINGS AND DISCLOSURES FOR THE EPISODE:
Discussion of suicidal ideation (my own)
We are not medical professionals. In this, we refrain from mentioning specific forms and delivery methods of hormones for human use, but we do mention the delivery methods of the ones I use.
None of this is intended to be medical advice. Talk to your doctor and if your doctor dismisses you and won’t do lab tests then the only advice is to get a doc who’ll order labs.
When we discuss depression, anxiety, and ADHD diagnoses, it is important to note that we are not dismissing the fact that many people have legitimate need for therapeutic medications. What we are mentioning here is that some people are misdiagnosed with neurological diseases when are actually suffering from an endocrine disorder.
We definitely get some facts, figures, and the names of some molecules incorrect. I cringed when I listened but I’m not going to go back and make corrections at the moment. When I have a couple hours to sit down and listen again then I will make some notes and create a “corrections” audio recording to accompany this episode.
Other Links:
Let's Talk Menopause "Find a Physician" page
Dr. Diaz-Brinton's CV and research
Dr. Sarrel's CV and hormone-related research links
Dr. Vondra Wright's personal website
Dr. Casperson's personal website
Transcript with Timestamps Removed (Thanks, Gemini!)
FDA Discussion Epidsode Without Timestamps
I'm Erika.
And I'm Jeremy.
Hi, Jeremy.
So this is the What About Women podcast.
And last week we recorded one on aesthetics and I have not finished editing that.
I guess, yeah, that was last weekend, right?
But I think I'm going to end up fast tracking this one because I had a lot of editing to do on that one.
And hopefully I won't have a bunch to edit out on this one because this one to me is really important.
And I think important for a lot of people.
So another thing that I did last week is I went live with notifying people that I had the blog and the podcast.
So I opened up about that previously.
I had just had a few people start following me.
And I...
um, hadn't really told anyone that I was doing it.
And so last week I, I got a little vulnerable and I posted my story about, uh, perimenopausal hormone replacement therapy on Instagram and Facebook on my personal page.
And I linked it back to my, um, what about women page on Instagram, which then has the link to my subset
And what's cool is that when I record one of these podcasts and I post on Substack, it automatically sort of syndicates out via RSS feed to Apple Podcasts and Spotify.
It's possible for people to listen on those platforms, which I really like.
It simplifies the process, and I don't have to do a lot once I've got one edited.
The problem is that editing requires my free time, and so that makes things difficult.
So, oh, we skipped a part that's really important, and I'm going to go back and edit it.
I just wanted you to let us know, what are we wearing today?
Today we are actually not wearing any hats today.
Today we're not wearing any hats.
What are we wearing?
Straight personality.
Actually, just sunglasses.
Sunglasses and our personalities.
So we're naked again in the hot tub.
And hopefully it doesn't rain on us.
If it rains on us, then I'll just, like, you know, I will go back and edit and cut that part out while we're going back inside.
And we're drinking Pepsi.
I'm having a Pepsi Zero today.
Or, yeah, and Jeremy's having a...
Dr. Pepper, zero sugar.
Dr. Pepper, zero sugar.
We're not lubricating our discussion today because we've lubricated other times during the weekend.
Yeah.
And so, but we are having busy drinks.
So hopefully I don't like burp or get throat bubbles while we're talking.
And we are sunscreened.
We're wearing sunscreen too.
So that's helpful.
Jeremy may have to get out to reapply.
A little disclosure before we get into this episode.
We're going to talk about some things that might be triggers.
So there's a suicide discussion or a suicidal ideation discussion.
We're also going to talk about different medical treatments and neither one of us are medical professionals.
I am not going to go into the details of which estrogens are being discussed in the panel that we're going to talk about in this episode.
I'm not going to go into talking about the delivery of hormone replacement therapy other than to say what I have.
And when I talk about things like SSRIs and other medications, I'm not saying that you shouldn't seek help for those things when you are experiencing depression or anxiety because 100% you should have a little bit of support for brain health no matter what and it's very possible that you just may need those things more temporarily than you might have otherwise if you have correct hormonal support as well.
Mental illness affects so many people in this country and I don't want to diminish the the real mental health issues that people have by saying that if they have hormone replacement therapy that they won't need mental health medications.
And that's my big disclosure.
I just want to make all of that super duper clear before we get into this discussion.
I wanted to have this discussion today because something very, very timely has happened.
The FDA had a panel on Thursday, and they discussed the black box warnings on women's estrogen, and it's a topical estrogen, that is very important to women but the panelists really used their uh speaking time as an opportunity to highlight more than just vaginal estrogen they used it to talk about the importance of hormones and hormone replacement therapy to women across the board and so I'm going to start with my story which is something I've like alluded to in other in other moments um on other podcasts and in some of my blogging but i want to like really dive into what i went through and sort of tell my story from the beginning so um in my mid 30s is that cool with you if i do that yeah yeah you're cool with that all right so you'll just kind of be silent for a moment but then you've watched some of the panel discussion now and so you can give some feedback once we dive into talking about the panel
Yeah, I don't want to pretend that I'm completely unknowledgeable since I just watched the entire panel.
Yeah, you watched about like, well, I made you watch 30 minutes of it.
Oh, yeah.
But I felt like it was the most important part.
So in my mid-30s, I started having like a lot of different things that were going on that...
um seemed like they could have been unrelated seemed like maybe i should have been seeing different doctors and specialists for um i went through migraine with aura didn't know it was migraine with aura because i just had the aura didn't have pain and i didn't know what migraines were i'd never experienced them before
Migraine with aura is super scary.
I thought I was stroking out or something.
When I went to the doctor to get that checked out, they put me through an MRI machine.
They couldn't find anything wrong with my brain, but they found thyroid nodules.
I had to go back and do ultrasound guided biopsy of my thyroid nodules.
I started bleeding through a marina at one point in time.
And Marina is supposed to be delivering a localized dose of progesterone, which was stopped bleeding.
What I didn't realize is that my progesterone had dropped so low and my estrogen, my progesterone had dropped so low, my estrogen was spiking because estrogen is erratic.
During perimenopause, this is something I understand now, my estrogen was spiking and I was experiencing that spike and it was causing me to bleed through my Mirena IUD.
So when they removed it, I still had that hormonal condition in that roller coaster and started just bleeding profusely.
Like so much so that I was wearing overnight pads and I was having to wear biker shorts over them to prevent them from being too loose.
And I was having to change them every hour in order to prevent leakage from an overnight pad, which is supposed to help women that have heavy flow overnight.
um called the the gynecologist that i had started seeing on someone else's recommendation and she she prescribed me this really weird um routine of estrogen or i know it was a a progestin based birth control where I had to take a bunch of it at one time basically a whole pack over the course of five days like an escalated amount in the beginning and then reduce the dose each day in order to slow my period down which did happen but I was still bleeding then she recommended endometrial ablation in this particular stage a significant number of women end up getting hysterectomies
I got an ablation.
She recommended tubal ligation at the same time because otherwise I would have had ectopic pregnancy if I had ended up conceiving while we were having sex after endometrial ablation.
That way, with tubal ligation, you and I could have sex and not have to worry about anything happening that would be detrimental to my health.
And then...
I went through that procedure.
Um, I also had a lot of brain fog and I started to self isolate, had a lot of anxiety and, Um, the endometrial ablation didn't really slow down the bleeding completely.
I still would bleed through sometimes, um, and have like irregular periods.
Um, trying to think what else I went through.
I felt very moody.
I felt like I was someone else a lot.
I kind of like withdrew from my friends, wasn't as interested in like doing anything.
And I felt a lot of self doubt in myself as a professional, um, Um, at the same time that I was going through all of this stuff, I lost my dad, the depression got deeper.
I am a social butterfly.
Am I, would you say that I'm a social butterfly?
Oh, definitely.
Especially compared to me.
Especially compared to you.
But I like kind of live for like social interaction and social connection.
It like keeps me happy and it keeps me sane.
Oh yeah.
Um, and so for me, like that was weird that I was isolating.
Wouldn't you say?
Yeah.
Yeah.
Um, and our son had been doing, uh, competitive gymnastics at the time and he was supposed to go to this like three day thing in Austin.
And, um, he, uh, I normally would go and take him because you, you just don't like being around a bunch of people you don't know and having to deal with those sorts of things.
Yeah, I prefer to get dragged to things, you know, not actually... Be in charge of doing them.
Yeah.
Yeah, and having to deal with all that.
So I skipped out and I sent you to go hang out with him.
And you guys had a good time.
You all went to pay spend and stuff.
Yeah, we did.
It was my old stomping ground in Austin.
Yeah.
yeah so um but while you were there and i was alone i contemplated suicide and i contemplated suicide to the extent that i was trying to figure out how i could do it um in a way that the two of you wouldn't have to deal with like finding me when you got back like have someone else find me and all these things like i got pretty deep into this thought process i remember
your graham in vermont had a neighbor that was like a farmer that had committed suicide but he had done it in a way that his family like wouldn't have to and that was like in my mind and i was like that guy was like a really thoughtful guy because he did it that way and and i could do it the same way and then suddenly within like
The next second, I was like, what the fuck am I thinking?
Like, it's not just about them finding me.
It's also about how this would affect my husband and my child.
Like, he's still in his developmental years.
This is insane.
And so I immediately stopped thinking about that.
Didn't think about that again for the rest of the weekend.
Found some stuff to do.
And then I think I binged some Netflix shows or something.
Didn't do anything real constructive.
and then the next week i made an appointment with my doctor and was like no i need to get in like asap my primary and i and i told her i was like so i had suicidal ideation this week and i've been putting off like accepting the fact that i'm going through some depression and um i need some help so she put me on um an antidepressant and an anti-anxiety medication.
And she, you know, explains that like sometimes people that haven't had clinical diagnosis need something to sort of get them over that hip.
And, um, I also had like a lot of symptoms of like, I would say ADD and, uh, it's going to sprinkle on us a little bit, some rain.
Um, We may have to go in.
We'll see.
It's passing.
Yeah.
You think we're okay?
All right.
While you're talking about having symptoms of ADD.
Well, yeah.
There's clouds.
Clouds and rain.
I can get back on topic, though.
That's the key thing.
I can get back on topic.
We didn't totally leave...
Leave the platform there.
So getting back to my symptoms.
So I had all these symptoms, the brain fog, the ADD symptoms, the depression symptoms, all these things, and the bleeding.
And I became so desperate after having surgery, after having the bleeding, after having the thyroid nodules, all these things.
I had been at UTMB within the League City area, which is just southeast of Houston.
And it's supposed to be one of the best hospital systems in the world.
where they do research and they have fantastic teaching and like the best of the best, right?
And I had been shuffled from a primary there to an endocrinologist to a neurologist to an OBGYN.
I'd had surgeries.
I had done all these.
I would prescribe diet drugs because that's another thing, like weight gain despite calorie deficit and exercise, all these things.
So all of these things...
I had been getting treated for separately or not treated for at all.
And then I got desperate enough that I was like, you know what, I'm going to switch to a different doctor.
I'm leaving UTMB because I'm tired of this.
And I went to a small private practice.
in league city.
And it was a nurse practitioner named Pamela Morgan.
And I gave her my chart and she looked at, that's an app for like your, you know, your medical files.
And she looked at everything and she's like, I reviewed all this.
She's like, I can't believe that they did all of this to you and they never just checked your hormones.
Um, And then she gave me progesterone, which was what I needed at that time.
I didn't really need estrogen because my estrogen was, it turned out through the roof.
It can have the same effects as androgens, like in terms of facial hair, things like that.
So I got on progesterone and then she put me on a supplement just to help balance out estrogen.
And I really felt a lot better.
Like I could sleep.
My mood stabilized.
I did eventually like come off of my SSRIs.
I felt kind of like a whole human again.
She put me on this stuff, but it was not...
approved by my insurance which is a big kicker i think that's a really important thing to state it was not not not approved by my insurance very expensive i think at the time yeah it was very expensive at the time and i think that something that's also important to note um is that within the utmb system every time i saw someone or asked a question i had several doctors that were very quick to say like no i can't do that or test for that because like there's no way i can get your insurance to cover it and i remember being like i
I will pay out of pocket, you know, and I didn't understand at the time the ability that I had to like order things for myself or to cash pay for things for myself elsewhere if I wanted them.
But people shouldn't have to cash pay for things.
Yeah, they shouldn't have to get order these things.
And the real frustrating thing to me during that time is that I had all these invasive procedures, went doctor to doctor, spent thousands upon thousands of dollars in deductibles because we had a high deductible plan and depleted HSAs just so that I could do nothing, to accomplish nothing, to get treated piecemeal for all these different things when it really all just had to do with my hormones.
Yeah.
And I remember going to see Hope.
I had a girlfriend that died from breast cancer around this time, too, like a couple weeks before my dad died.
And I had gone to see her when I was going through all the bleeding.
And Hope was a doctor nurse, so like overachiever doctor.
you know um she was an instructor uh she was a nurse practitioner she was a stroke specialist um just like the like a freaking light in this world and man she loved to like party when she wasn't working um and like one of the coolest people ever and i remember i went to go see her at md anderson and
and take her book and she was like enough about me she's like what's going on with your shit and I had told her and she was like your doctor did what she's like it sounds like you need progesterone and that was like one of the last conversations that she and I had before like her cognition started failing her you know
And, uh, and I remember that being her advice to me.
And, um, and then I remember kind of forgetting that and then continuing to shuffle through the system.
And then I remember going to Pamela Morgan and her prescribing progesterone.
I was like, God damn it.
Hope was like right all along.
And I should have written it down when she said it, you know?
Um, and then we moved to North Carolina and then once we got to North Carolina, uh, I couldn't find a doctor within any hospital systems or groups who would do the work.
Couldn't really find a doctor that would prescribe hormone replacement therapy.
And I tried to go without for a little bit using like
Some kind of like wild yam cram or something, which is really fucking stupid because I knew how important it had been to me.
But I was like living in the camper for 10 months while I was building the house and couldn't find a doctor that would do it.
And so for several months, I tried to do that.
And then eventually found Biltmore Restorative.
And this isn't like a promotion of them.
Don't get paid for this.
But that went in there, and they are not conservative.
with treating people because it's a cash pay place so you walk in there and they're like oh yeah you need hormones like let's do labs and work you up so they continued my continued my progesterone the same as i had been getting from pam morgan and then they also added testosterone which we'll discuss again in a minute um
testosterone was like really life-changing for me
Because it helped me with libido, it helped me with the stubborn weight gain that I had experienced, and helped me a lot with sleep and mood as well, and with a little bit of brain fog.
So it was kind of like a piece of the puzzle that was really cool.
And then fast forward to like more recently, and this is important to note because like perimenopause can last four to 10 years up to menopause.
And perimenopause is categorized by decreasing progesterone.
And our androgens decrease at a steady pace.
They lower over time.
So that's progesterone and testosterone.
But our estrogen during perimenopause is erratic, which is why periods get irregular, sometimes very heavy, sometimes persistent.
You don't have the progesterone to cancel it out during that luteal phase.
So...
that's why that happens.
A lot of women end up getting hysterectomies during that time, which is huge recovery time after that and possibly completely unnecessary.
Um, so more recently though, I had a couple of events I did not understand.
And I remember telling Jeremy like, man, that was like, like I had this weird brain thing or this weird eye thing.
And then he kind of witnessed me have one
When we were on vacation, I thought it might be just like heat exhaustion.
So we like iced me down and stuff just in case it was heat exhaustion.
And then I had the same thing happen at home, was pretty sure I was going to die.
And he was out walking the dog and I was like, God damn it, do I have like a brain tumor?
Like what is going on?
You know, because that's where your brain goes.
I didn't even have to WebMD it to get that worried.
Um, so then I started really thinking about it and I was like, this is the thing that happened to me that one time I ended up going in and getting the MRI.
It was exactly the same thing.
And they found nothing.
So like, what is this that I just experienced?
And I Googled it.
And when I googled it, doctors get so mad at people googling things.
But if I had gone to the doctor after experiencing that, I would have gone through the same shit again.
They would have been like, there's nothing wrong with you.
Right?
Yeah, yeah.
I do have a Google story from recently with a doctor, though.
Yeah, yeah, yeah.
And so I Googled it, and I was like, oh, it's a migraine with aura.
And I didn't know what this was before, and I'd never experienced it up until then.
And it makes sense that I would have had it during perimenopause, because perimenopause is erratic estrogen.
So I experienced it when my estrogen was very low.
Right.
And then didn't experience it when my estrogen got high again.
And then my estrogen has been on its little roller coaster while I've been getting progesterone, testosterone.
And I was thinking about it, too.
And I had been like kind of experiencing some other telltale signs of my estrogen depleting my getting hot flashes again, which I hadn't had in a long time.
Um, I started experiencing, um, lots of brain fog, having trouble sleeping and felt irritable a lot and like very tired, kind of like a hangover.
And that's another thing with the, with the migraine with aura, no pain, but it feels like a hangover for several days afterwards.
And I don't know what it is about how they function that makes that happen, but it's just like exhausting.
So once I figured out what it was, um, I sent a message to Meredith, who's the nurse practitioner at Biltmore Restorative, and said, hey, had this happen, and I also have this happening, and this other thing happening, and I've just realized that what's going on with me is my estrogen has exited.
And she was like, cool.
And she called me in a patch.
And I went and picked it up at the pharmacy the next day and started on that.
So I've been titrating that a little differently, trying to adjust.
I think I've come pretty close to finding my level.
I feel really good.
It takes a few months to adjust to, but I feel pretty good.
And the patch is just tiny.
And I switch them out every Sunday and Thursday.
And I think that's really awesome.
So at the moment, I'm not on any SSRIs or anything else.
I feel...
better cognitively my energy level has improved i would say wouldn't you say yeah like overall um i feel like a whole human i think which is like kind of a wild experience considering i haven't felt like that in a while so it's a long story but I wanted to finally get this out because I know I've alluded to it and said eventually I'll tell this story.
I wanted to get this out, and I know it's rambling and it's kind of long, but it really is so many things, and when you're going through it, it feels like my story sounded.
Definitely, especially early on.
I mean, the way that you ended with having these couple events or whatever where you didn't know what was happening, I mean, the really cool thing, like as scary as that was, is that that whole process was actually only a couple months of, like, versus, like, women actually that don't seek care for it, they go through that for years and years.
And it only took you a couple months to figure out, like, okay, like, this is what I need to do.
Yeah, yeah, because I have become more, like, in tune with what's going on.
And I think this is two things.
It's like one, this is why women don't trust doctors because so many times they're not helping us out.
And to say the statement like to another woman, like if I were to tell you that you could go see a doctor and you could end up with just three prescriptions, like two of which are either creams or patches.
and one that's a pill and never need amphetamines for ADHD, never need an SSRI, never need to take medication to prevent osteoporosis, never need, you know, if I could, if I could never need to take medication for blood pressure, like to tell someone that when they're in their mid thirties or in their forties, people are not thinking that far in advance and it sounds insane.
And And I'm not going to say that people shouldn't take those medications when they truly need them because those things can still happen.
You can still need those medications.
But there are tons of healthy women that potentially could not need those medications if they were getting a simple, non-invasive lab test when they present with any of those symptoms.
Yeah.
I mean, it's obviously like lack of education and experience on...
Both the doctors and women don't know, right?
Which is why you're doing this.
To me, for a doctor to discount those possibilities almost seems like willful ignorance.
But there's something else that's been preventing them from doing it, too, that we will get into.
Well, considering that the only people that ever helped you actually began their careers as nurses...
yes yes yeah the people that actually have experience talking through issues with patients yeah yeah and and i had you know and i had that endocrinologist that one time who was a younger woman and she was younger than me and she what i kept telling her i was like my body is holding on to weight and i don't understand why and i feel like it has to be hormonal and people will say and i've seen men say this like the trolls online will say like uh
You know, the only way to lose weight is with calorie deficit and exercise.
And I remember going to this endocrinologist and being like, there is something wrong with me.
And I don't understand what's happening.
And she put me on a diet drug.
The body absolutely knows how to hold on to weight, gain weight or lose weight completely based on.
On hormones.
Yeah.
Yeah.
And you can be in a calorie deficit and you can be working out and you can still gain weight.
And she, she put me on a diet drug and I still hold a grudge.
And I have tried to be nice about it before and said that like, I hope she doesn't go through what I, but honestly, I hope that bitch has the worst symptoms during perimenopause and gets diagnosed with the wrong shit and has the frustration that I felt because she's one of the ones that told me I was a hypochondriac and that I shouldn't be Googling what I was going through.
And I fired her early on.
I was like, I'm not coming back to you.
I wrote it out in a note.
Cause I, I was like, this is ridiculous.
And it sent it through the app and I just never went back.
Um, that's insane to me.
Yeah.
So, you know, and so I brought up the Google thing.
So I, you know, I don't love my primary care physician, but, but mostly just because he's a lot older than me.
And so he tells me that like, as you get older, you know, aches and pains should happen.
Like all that's normal.
It's okay.
And I just tend to disagree.
Um, Fundamentally.
But I was having some issues and we went into the medications I was taking.
And while I was sitting there, he actually Googled it and used the AI response to confirm that the medication I was on was causing these symptoms.
And I thought that that was like the most forward thinking thing I've ever seen from a physician ever is that he actually used Google in front of me.
He's relying on Gemini.
He's like, huh, yeah, it does cause that.
Yeah, yeah.
So I think it's super important to note that, yes, sometimes the doctors do too.
I think it's also important to note that in the world, though, of AI, that they're learning models, and so their responses are based on their access to the internet.
Yeah.
And the sources that they use to feed you information are not always the best sources.
Yes.
I'm not.
Yeah.
And I'm in no way saying that you should 100 percent rely on Google.
But there's a lot of information out there that Google can pull from that doctors actually haven't read.
Right.
Yes.
And I think that this is a really great segue because one of my things that I always look for in the Google response, because I will use Google or I will use Wikipedia as a starting point, like as a springboard for the rest of my personal research when I'm looking into something.
And so if I read something on the AI response or I read something in Wikipedia, I want to go down to the sources.
And I want to look at the sources and I want to look at and see whether those sources are research, like peer-reviewed research articles.
I want to know if they're animal models.
I want to know if they're meta-analysis.
I want to know if they are large-scale studies.
I want to know when the study was conducted.
Then I want to potentially look at studies that have cited it that may have debunked it or anything else.
Because there are so many times that a study has been debunked and we think one thing is going on, but in fact it's something else.
They're pulling from some 1997 information.
Right, right.
And so I think that it's really important to understand when you get an AI response, it's not always correct.
You need to verify, verify, verify.
Figure out what the source is, where it got it.
And I will tell the AI.
I'll go back and I'll type and I type to it like it's human.
And I'll be like, I'll go just to the Gemini page, not even like the little Google thing that comes up.
And I'll be like, Gemini, this is incorrect.
You just told me this, but look at this.
And Gemini will be like, oh, I'm sorry.
You're right.
That's not correct.
And it will like reword and reconfigure the entire response.
That's brilliant.
um so it's it's pretty funny but yeah so i love that the doctor used it in front of you that's hilarious to me i love that he used it to verify i hope that he looked at what the sources were before he was like yeah this is correct well yeah um so so about those sources all right so i i have not read the extent like this this whole um journal article that discussed this research study that was conducted over two decades ago.
But what I do know about it from the people that I follow on Instagram is that there was a research study that came out in, I think, 2002, where it was so compelling and so scary that the National Institute of Health felt it necessary to hold a press conference to tell physicians and patients that The hormone replacement therapy, specifically certain types of estrogen and certain types of estrogen in combination with progesterone, were statistically shown to increase risk of death from cardiovascular disease, from...
all these other different potential side effects that could be caused by hormones.
And so that was the thinking for a long time, definitely for over a decade.
And as a result of that specific study, there was a black box label that was placed on certain types of women's estrogen.
And that black box label states that there's a
disease all these things increased breast cancer risk tons of stuff and for years that's what people have thought and that same black box label only exists on things that are can be truly harmful to you when they're used or when they're used the wrong way so there were tons of women that potentially needed hormone replacement therapy that were not receiving it because of a peer-reviewed journal article that cited a study and
Then there were several doctors over a decade later that looked at this study and they were amazed at the fact that the evidence had actually been extrapolated and interpreted in the wrong way.
And they tried to raise the flag and say, hey, like women are not getting the care that they need to have.
because this black box label exists.
And even when we prescribe it, they're still afraid to take it.
So I was actually talking to Cammie about this.
She is a kidney doctor at a hospital here in Asheville.
And I was telling her that I was watching this YouTube video.
And she said, I love that.
She said, I, you know, prescribe estrogen to women for UTIs and it's low dose vaginal estrogen.
And she said, if you go to, she said, there's a guide that physicians have access to that's put out by the FDA that basically says, ignore the black box warning, but the black box warning still exists.
And then the patient gets it and they're like, I would rather take antibiotics every now and then for a UTI than die or get breast cancer.
Yeah, yeah, yeah, exactly.
Have a heart attack.
Yes, exactly.
And so I thought that was really interesting because I didn't know this guide existed.
And so that was really interesting to me to find out.
And that brings us to the panel discussion.
And it's about a two-hour long video of a discussion that was had at the FDA – where experts were invited to come in and discuss the removal of the black box warning.
And this panel includes PhD researchers.
It includes MDs with all different types of specializations, DOs.
People are in there, they're discussing from an orthopedic standpoint, they're discussing it from a urology standpoint, they're discussing from a gynecological standpoint, they're discussing from a neurological standpoint.
So we have all these people who are specialists all talking about removing this black box warning.
But what's really interesting to me is that the first 30 minutes I didn't have you watch really focused on mostly the localized.
delivery of vaginal estrogen and then um i started you at a specific doctor he actually is a i think he's a researcher and i have to check my notes here because i had a google doc working where i like was keeping oh that's not my phone you have my phone over there and
Where this guy is talking about the octopus.
And we'll get into the octopus.
There we go.
Went too far.
This is Dr. Serral.
He's a Yale professor.
And he discusses the biological importance of hormone replacement therapy.
He talks specifically about estrogen.
And he goes into brain function, mood disorders, outbursts, temperature regulation.
And he talks about the octopus.
So what was striking to you about his discussion?
Yeah.
Well, you know, so I would say that at this point in time, I've heard a lot of information around, you know, how estrogen affects those different systems, right?
And it is, I mean, it's a cool thing at this point in time, like hearing these researchers on the national stage, all in agreement that this is...
this is, this is what's happening, right?
Um, you know, women are experiencing bone health issues, you know, the brain fog, the outbursts, um, and you know, the percentages decrease in these incidents when they're put on estrogen.
And now of course he does end his, uh, His time, his speaking time, talking about how octopus have used estrogen to basically control their motor functions.
And melanocytes and things, which is like how they are able to change their color.
And it's really cool and interesting.
And he nerds out about it.
And so that's enjoyable for me to watch.
Uh-huh.
Yeah.
Yeah.
No, I love it.
I thought it was like super cool.
And, um, so he does, he does nerd out about it.
So something that I thought was interesting.
So what they did is they took data in the first part of his, they took data and their research from women who were employees of fortune 500 companies.
And they looked for women who had gone to the doctor within a specific age group who had gone to the doctor because of hot flashes.
Right.
Right.
And they looked at women who were in the same age group that had not gone to the doctor for hot flashes over a specified time period on their insurance.
They didn't have the names of these women, but they had their ages, and they could see the other things that they had gone to the doctor for.
And they found these massive differences in the number of doctor visits reported for claims in women that had gone to the doctor for hot flashes.
And so his argument was, we could be saving on insurance costs, but also saving these women's lives, like literally.
I think just from the group, if I remember correctly, from the group that they studied...
which was like a couple hundred thousand women or something that had gone in for hot flashes, that would have saved potentially like $400 million.
Or more.
It might have been in the billions.
I can't remember.
But it was a lot of money.
And it was a staggering amount.
And it also was a staggering amount in terms of their...
hospital their their claims and their visits because the women in the hot flash group had like one point something million claims over that time period whereas like women who had not gone for hot flashes had something in like the like it was more in line with the number it was like one visit per or two like a couple visits per it wasn't
like five or six visits per with different claims for different things.
And they also looked at death and they looked at different mortality risk in these women.
And they found that when looking at these women later or different, you know, certain women later, 10 years later, the
women who were put on estrogen therapy specifically, in this case, not the hot flash group.
This is a different study.
When looking at a study of women that were given estrogen therapy in their 50s, between the age of 50 and 59, there was reduced mortality.
In their 60s before they reached 70.
The group that was not given estrogen had a higher mortality rate, like all cause mortality rate by the time they reached age 70.
And it was a statistically significant difference.
So that was really compelling for me.
the thing that I loved about the octopus is, you know, I love nerding out about how things have evolved.
And one, one thing that I loved about the octopus is that he's like, this thing is made, it has nine brains and three hearts, right.
And it relies on estrogen and it relies on estrogen in order to convert and use nitrogen oxide, um, in the brain for brain function.
And, um, And it was one of the first things to evolve to use estrogen.
And he talks about the importance of it in the, in the function of the, of the, of the, the octopus.
And, and, and so I love that because I, we dive with scuba dive and I loved the, um, like, you know, having this, this Marine creature.
Um, and I love, I love them so much.
And so that was that I got real excited about it.
Kind of nerdy nerded out about it a little bit, but he basically said that, you know, estrogen in the brain is, helps us with temperature regulation, mood disorders, outbursts.
He talked about what we call a lot of times like the glass ceiling or the perimenopause glass ceiling, which is where women start to doubt themselves because they are experiencing these weird effects to their cognition.
And he talked about bankers who thought about retiring.
Because they felt like they couldn't do their work anymore, couldn't remember names of people they worked with, things like that.
He talked about a woman who was a waitress who was like, I'm at work and I got so angry I started smashing dishes.
This is like out of character for me.
And he talked about how these things resolved within a matter of months.
Yeah.
Because they were prescribed estrogen.
Yeah.
And then we had, after him, we had Dr. Diaz-Brinton.
And Dr. Diaz-Brinton, she's a PhD, and hers takes this a step further.
And I also loved her segment because her segment talks about how the brain processes glucose.
We need glucose in the brain for proper brain function.
Yeah.
And estrogen affects our brain glucose levels.
And in the absence of brain glucose, what does the brain do?
It eats our lipid matter.
So the white matter within the brain.
And it starts to use that as energy.
And that depletes neural connections and brain function.
And so they were saying that, or she was saying in her segment that...
by giving people estrogen, you're improving their brain function, but you're also minimizing their risk of Alzheimer's, Parkinson's, MS.
I mean, she went on a long thing and I love that she used the meme that so many people have seen where it's a woman and she's sitting at a ball game and it's obviously like a little chilly outside.
It's a football game, like a high school football game.
and somebody films her and she looks over she's smiling but she just has steam rising from her head it's a meme about hot flashes and you remember my hot flashes would get so bad they would wake me up at night sometimes we would be watching like tv and i'd be like i'm burning up and you actually went and got like frozen peas one night and put them on my hands you know and um sounds nice of me you did you did do that i was like you gotta get me something frozen yeah
So I love that she used the picture of the woman with the steam emanating off of her head when she was talking about the temperature regulation piece.
I think she was the one that goes into...
Women, on average, live like four and a half years longer than men, right?
Yeah.
But they also represent two-thirds of the Alzheimer's cases.
Yes, two-thirds of Alzheimer's cases are made up of women.
And a lot of it is because we don't have...
the same capacity to utilize glucose in the brain because of estrogen depletion.
Yeah.
Which is really interesting as a, as they're still trying to determine, um, causes and things that, um, that, I mean, among women, when you have two thirds that it's probably more attributable to estrogen than anything else.
Yeah.
And I don't know the validity of this, you know, but I think they're like brain function is such a difficult thing for us to understand.
Um, but, we do know that things like cholesterol, fats, um, all of these are important to brain function.
Glucose is important to brain function.
When people are on, for example, like fad diets eliminate certain things from their diets, they can, they can suffer from some like dementia, like cognition effects.
And that is something that is scientifically studied.
And I think that hormonally that can happen too.
Like if you look at people, sometimes when people go through thyroid disorders, thyroid disorders can look like bipolar disorder.2
They can look like people can enter a manic state because of thyroid dysfunction.
Um, we should not discount the power that estrogen, progesterone, testosterone have in our bodies because
It's not just about your ovaries and your uterus and your ability to reproduce.
Just because you're not of reproductive age anymore doesn't mean you don't need these hormones anymore.
They're extremely important for overall function.
And so we've highlighted...
Like the, um, kind of more of a, on the urology side, like the UTIs and things like that.
We've talked about, um, we talked a little bit about sex pain, but sex pain ends up being a big thing.
Lubrication, sex pain.
We talked a little bit about, we've talked about brain function and like pretty much in depth.
And so I want to go into, um, Dr. Bondra Wright to follow Dr. Bondra Wright.
She's fantastic.
She's an orthopedic surgeon.
She used to be a nurse.
She I follow her on Instagram and I love that she lifts like because I lift and I love that she lifts and she lifts heavy and she talks about how important that is for joint health and and for maintaining.
uh health span for longevity right we talked about health span in the aesthetic one we'll talk about a little bit about it here health span is not just about how you live it's how long you're healthy in life yeah because longevity is great but being healthy while you're living a long life is really super important yeah the ability to get up and not fall and yeah yeah and so she quoted she talks about it from a bone health standpoint so women who are on estrogen are less likely to need um osteoporosis medication.
They're less likely to develop osteoporosis and they're more likely to maintain their bone density as they age.
And she talks about a woman that she treated in the ER who had fallen in her kitchen.
And she shows this really compelling image of the woman's hip and the large rod that she had to insert in this broken hip in order for this woman to continue living.
And she states in hers that there is a
I think she said a 30% chance.
I could be wrong with that.
A 30% chance that a woman will die within a year after hip fracture.
Due to complications from that surgery.
Yeah, due to complications from the fracture.
There is a 50% chance that they will never...
reach their pre-fall physical ability right um and she talks about uh how horrible it is that this is something that's preventable and that for you know for years we've been demonizing estrogen and
Well, specifically, though, with that woman that she's using as the example, she's actually presenting all of the issues at the time that she is going in for pre-op.
Yes.
That you see with women that don't have estrogen.
Because.
So her heart health.
And they actually had.
She had a UTI.
She had a UTI.
Once she came in.
And they, so they had to manage that.
Mm-hmm.
They didn't know if her heart was actually going to be strong enough for the surgery.
Because she had cardiovascular issues.
And then she has this broken hip from bone loss.
Yes.
Yes.
Yes.
Yeah.
And that was...
And so I think where we're heading here, because when we're heading here, we're heading into neurological.
We're heading into the orthopedic view.
We're not just looking at localized estrogen delivery at this point in the panel.
These...
experts have gone off the fucking rails, but they've gone off the rails for a reason.
And I feel like this was very coordinated and very well coordinated amongst them because we're now talking about when we're talking about the brain, we're talking about systemic
full system estrogen delivery we're talking about stuff that does not stay within this is not localized vaginal estrogen where we that we went and talked about the black box warning on this is systemic estrogen delivery and a lot of the the the success of the outcome has to do with when that treatment is started the earlier the better
So then after Dr. Wright, we go to Dr. Casperson, and I freaking love her.
Um, and I was telling you that she interviewed Whitney, uh, who does, who has BD energy.
Whitney is the, um, she's the LGBTQ plus sex expert that we saw at Nerd Night Nashville.
And, um, so I was like scrolling through and I was like, holy shit, like Whitney's talking to Dr.
Kelly.
Um, so I thought that was really fun.
So anyway, so Kelly Casperson is the next panelist and she's a urologist.
She talks all the time about the importance of hormone therapy from a urology standpoint, from a sexual health standpoint.
She really cares about her patients.
She takes the whole thing and just really...
She wraps it up with a really nice little bow.
Yeah.
And it really goes into like creating a strong, a strong women and you know, women that, uh, yeah.
This is what happens when you give women testosterone.
Yes.
Yes.
Yeah.
She goes into the trifecta.
She goes into the progesterone, the estrogen, the testosterone.
She states that several other countries have approved testosterone doses for women and
The United States does not.
We don't have insurance coverage for hormone replacement therapy.
I mean, she really nails like the landing on this one.
And I loved she and she said.
She was like, you give these people, and she was talking about both men and women.
She said, I treat both.
And she said, men go through hypogonadism.
Women also go through this.
We don't focus on what women need, but for anyone, giving them testosterone when testosterone is starting to deplete.
gives them a totally new lease on life.
She's like, they start businesses.
They have all this energy.
They have all this, you know, like improved brain function and are more physically able.
She just really dives into it.
And she really kind of takes the trifecta of the importance of hormone therapy and like packages it and delivers it.
I think, though, because what she did mention, which is important about testosterone, is there aren't a lot of long-term studies done on it for men or women.
Right.
The only studies that you have were men that were abusing it or athletes that were abusing it 40 years ago.
She did say that as well.
Yeah.
And a lot of what they were using wasn't coming from pharmaceutical companies.
You know, it was for cows or whatever.
It's like horse testosterone.
Yeah.
And so...
i think that the the good thing about what she's done and and you know i take uh trt so i mean i'm i'm not aware of the the long-term effects that that could have but i think that it will people like her will uh help with maybe generating some new studies uh yeah to to look at that and i don't mind being a guinea pig because i have uh
Like in, in my present state, because, uh, I've experienced a lot of benefits from it and women already make it and it depletes the same way that a man's does.
It does.
Yeah.
Yeah.
And so, and, and so, and you're right.
She, because she does cite, she's like, she's like, and we're not prescribing because of the, the, um, you know, because of the, the noise around Olympic athletes in the 1980s, like, right.
So she's talking about, yeah, it's, it's, it's basically based on a conspiracy about athletes in the 1980s, like Olympic athletes.
And she's like, that is dumb.
Um, and and i think it's like reefer madness for testosterone yeah yeah reefer madness for testosterone i love that i love that and so you have this like propaganda against or people that like you know i remember um i think it was one of the rocky movies where you see dolph lundgren and he's got like a big stare like a big needle and he's drawing up the oily yeah you know testosterone to inject himself and you know he's supposed to be the villain and
Those Soviets.
Dolph's a Rhodes Scholar and a good guy, and he sent you a cameo video.
Yeah, my good friend Dolph Lundgren sent me a personal video.
Your loving sister-in-law, my sister, got you a Dolph Lundgren video because she was your Dolph fan.
I actually love that so much.
We could have a whole podcast just about how much.
Just about Dolph.
My favorite Dolph role was He-Man in Masters of the Universe.
That was my personal favorite Dolph role.
um so anyway so i you know i think that you have this villainization of testosterone because of things like that and because of people like fucking liver king you know that guy but like anabolic he looks like shit by the way he does look like shit i was very surprised to find out his age he's like 48 years old he looks like shit he got arrested uh because he uh made threats against joe rogan yeah yeah
He was also on TRT.
He also is on all kinds of shit.
Joe looks great for his age.
He does.
Okay.
Like whatever you feel about Joe, Joe looks great for his age.
He does.
The frigging Liver King, they showed his mug shot and they had his age.
And I was like, I didn't realize he was this young.
Yeah.
I was completely freaked out.
Yeah.
By that.
Yeah.
48.
Yeah.
It looks like Pappy, Pappy Liver King.
He does look like Pappy Liver King.
Yeah.
Old Pappy.
Anyway, so I feel like we have exhausted this topic, but I wanted to cover that 30-minute interval.
And so if you want to watch the FDA panel, the part that we've discussed right now, we may have another discussion about it once I've had a chance to watch the rest of it.
But the section that we've discussed is from minute 35 to minute one hour and five minutes.
So it really is about a 30-minute section that
And I will post the link in the notes.
They'll at least be on the sub stack, but they might end up in the podcast notes when it syndicates.
I don't remember how that works.
But I want to make sure people have a chance to watch that.
If you watch the first 35 minutes, that also is super important.
And I love it.
It's really what they were there to do.
But it's the part where it goes off the rails.
And because I love the octopus part so much, I thought that was a really good section to start with.
And what did you think about it, the part that you, you know, watching it?
Well, so something I wanted to bring up during this is that I think it was brought up once or twice during the panel, basically.
But getting treatment within zero to nine years of when you experience benefit.
The onset.
is very, very important before you end up with the 20% bone loss and all of that.
And I think that Gen X and millennials being in their 40s and 50s now are the first generations that will actually experience the benefit.
I mean, you're talking about women that are already living into their 80s and 90s without the benefit of this.
They don't have the health span.
They don't have the health span.
And I think that Gen X and millennials are going to be the first people that can actually experience the benefits.
And so it's important to see somebody as soon as possible that will actually, that will actually listen to you.
Yes.
Right.
Uh, If you go to a provider who will not listen to you, I got so many messages.
I got, I got, um, Megan in Boston sent me a message, you know, um, Julie sent me messages and I was busy and I was like, Hey, let me call you and talk to you.
I was on my way to the gym, talked to her.
She had a hysterectomy earlier this year.
Um, Katie in Johnson city sent me a message.
Like so many people sent me messages and they were like, Hey, how did you know this?
Or how did you figure this out?
Or how did you, how did you talk to your doctor about this?
And I told them, I said, look, I didn't figure shit out.
Like I went, I was in the doctor nonstop for like two years with all these different symptoms.
And it was when I got fed up with the UTMB system and
And I'm not saying UTMB is bad.
Dr.
Mary Claire Haver is at UTMB in the UTMB system, and she is a big advocate for hormone replacement therapy and for proper menopause education for physicians.3
I wish that she had been...
a louder voice when I was going through what I was going through those years ago, but, but she didn't have that role and she had not like filled that research gap.
And as a healthcare system, I'm not sure that they will even let you see a doctor without presenting your insurance card.
Well, and that's true.
That's a hundred percent true.
And so, yeah.
And so the, so one of the, you know, so, so I don't want to talk badly about UTMB, but it wasn't until I got fed up and I left the
And went to a nurse practitioner.
And sometimes you just need the right, the right, the right provider.
There are like, there's a let's talk menopause website.
I think it's letstalkmenopause.org that has a practitioner finder.
So you can get on there.
You can put in your zip code, how willing, how far you're willing to travel for someone who's actually educated in perimenopause and menopause care.
And you can find someone that way.
I think that's a really great one.
Dr. Haver has one on hers, The Pause Life.
It's like patient reported or like it's basically viewer supported.
So crowdsourced so people can put in their doctor like, hey, here's who I went to.
And this person was really well versed on menopause care and gave me HRT.
So you can either print off a study or put one on your phone and walk in with it and see if they get pissed off at you.
And then you can fire them at that point.
Or you can just go find a different provider using one of the resources available by searching for them.
I think it's important to go see the right ones.
If at this point with this panel happening at the FDA, if they don't have the knowledge to give you treatment now with this happening, then they're not responsible.
They're not a responsible physician.
They're willfully ignorant if they're not providing care anymore.
and giving you proper consideration and treatment, especially considering the fact that paramenopause can start in your 30s.
Well, yeah, that's the thing with the age ranges, right?
I mean, this isn't something that somebody that's 50 should be necessarily looking out for.
If you're 28, 30 years old and you start experiencing symptoms, you could be possibly going through this, right?
Yeah.
Yeah.
So it's kind of a, it's a wide net, but it's still important for everybody.
Yeah.
Yeah.
Anyway, so thank you for having the discussion with me.
I really appreciate it.
Oh, you're welcome.
And I love how into it you were as well as me.
That was pretty important to me.
Oh, this one was super fun.
Yeah.
Oh, there's a factoid we forgot.
Yeah.
What percent of women are currently using estrogen therapy out of the total that possibly need it in this country?
I think it was 4% or 1%?
It was 4, yeah.
Yeah, you're correct.
I held up a finger and I don't know why.
Yeah, why'd you hold up one finger?
I don't know, because I'm like, yes, that's it.
Praise be.
4% of women.
Yeah.
That's a big gap.
Yeah, so we need to fill that gap.
We need more...
women receiving the treatments that they're supposed to be receiving and i have nothing else to add i just want to make sure we didn't forget that factoid that's important thanks and i love you love you and thanks for hanging out naked in the hot tub yeah
Awesome.
All right.
So this is Erika.
And I created the What About Women blog and podcast.
And we didn't write shit.
This is just a conversation.
Hanging out.
But it is produced by me.
So I'll have to edit this later because I definitely want to make sure it gets posted.
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