March 12, 2025 • 30 mins
Does all the hype on hormone replacement therapy have you confused as to what synthetic, natural and bioidentical really mean? Are you curious about what your options are when it comes to hormone support? Perhaps you've heard testing for hormones isn't accurate. Maybe you've tried herbs or hormone replacement and didn't tolerate it well. In this episode I'm going to explain all the options for hormone replacement and support, the difference between natural vs bioidentical and the ways I'm getting creative to help my clients support their hormones.
What You'll Learn In This Episode:
- Why the term bioidentical isn't natural
- The best hormone testing options on the market
- How I help sensitive clients micro-dose hormones or blend herbs + hormones
- Why some women struggle to tolerate hormone support or replacement
Resources From The Show:
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to the Health Fix Podcast, where health junkies get their weekly
(00:05):
fix of tips, tools, and techniques to have limitless energy, sharp minds, and fit
physiques for life.
Hey Health Junkies, on this episode of The Health Fix Podcast, you get me, Dr.
Jannine Krause again. And today I am going to be talking about hormones and what the
heck to do with these buggers because they get kind of funky as we get older.
(00:29):
And how do you test for them?
What's like the legit way to test which ways make sense?
And I want to clear up some confusion in terms of bioidentical and natural
form of supplementation.
So let's get into the podcast.
So I'm often asked by my listeners, but also by my
(00:53):
clients, what is the best testing for looking at your hormones?
And my answer is it depends.
Now, if we're looking at real time, what's going on with your
hormones, blood is going to tell you what's going on in that moment.
And a lot of docs will argue like, Oh, well, you can't get accurate
(01:18):
results from hormone testing.
So why test it?
Because it changes every day.
Yes.
And here's the thing.
If I can get clients to take a snapshot of what's going on every single day in their life and we can pair it with the moon cycles.
We can pair it with just a standard old calendar.
You can write it down and note when do you feel the best and when do you not feel so great and when do you have your symptoms?
(01:44):
By doing that for an entire month, you are going to know when you don't feel the best.
those are the time frames in which you want to have your blood drawn.
Now, a lot of people will say doing the hormone testing between day 19 to 26.
And that's because estrogen is going to be a little bit lower.
It's not on the rise and it's kind of going to be kind of like,
(02:06):
humph, let's say, flat-ish and the progesterone is supposed to be higher at that time frame.
And so we can go to a good read of if progesterone is sufficient and if estrogen is doing okay too.
Now, that is good in theory because it is what's going to show in blood.
If you are using a topical type of hormone support, or if we are wondering, are there
(02:32):
any hormones getting stuck in the tissue, saliva is going to give you a really good sense of
what's going on in that case.
Say you've listened to Barbara O'Neill, say you've listened to other folks and you've
heard that like wild yam cream is a great natural option to put on your skin at night
to help you to sleep and help with some of the perimenopause symptoms.
(02:55):
Now that is true.
And applying it upper inner thighs, upper, you know, arm, inner wrists.
A lot of people say don't do the arm anymore because we have the lymphatics here that go
to the breast and okay, you know what?
I don't care.
Just rotate the locations.
I don't want to get an argument with anyone where to apply it.
Now, the other big thing here, like, yes, I do think that that yam cream can help, but
(03:20):
we have to look at it in terms of saliva to see, are we getting enough in?
Because blood traditionally will not show a super high progesterone level.
It's going to show a little bit more blunted.
Now if it's high in the blood, we know there's a problem.
Let's put it that way.
Otherwise we're going to see a blunted level compared to what you would see in saliva,
(03:41):
especially if you are applying your progesterone or wild
damn cream topically.
Now, another thing that you wanna be thinking about
in terms of saliva testing is if you're using
a vaginal cream that has DHEA, something that helps
with vaginal lubrication, that can also affect levels.
(04:01):
Same thing goes, if you've got a skincare product
that's helping with skin like anti-aging cream,
some of those have DHEA in them,
and they can cause a spike in your DHA levels
in a saliva test.
So we do wanna be thinking about those kind of things.
But what do I do when I'm thinking about hormones
and I'm getting someone into the practice
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and I wanna learn what's going on with them?
I will often do blood in saliva to start off with.
Even if they're not applying hormones
and I know that might sound strange too,
but it helps me to kind of see if anything's hanging up
in the tissues.
Now I may also do a hormone test called the Dutch test,
which is a urine metabolism of hormones test.
Now, I tend now to reserve that for later on
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in my practice, meaning with someone,
meaning I wanna see if we put them on herbs
or we put them on a hormone
if they're gonna break it down through the urine,
like, I'm gonna break it down through the urine.
They're gonna break it down through the liver
and then I'm gonna see it in the urine test.
But what I'm wanting to see here
is what's going on in that to see if there's anything happening.
(05:09):
And so if you are wondering where your hormones are at,
those are kind of the three ways to test.
Now, there is a different modification on a urine test,
which is known as Mira, M-I-R-A.
And it's typically used for fertility,
but I have figured that, and the company also has other folks
doing this and talking about it, is that we can also look
(05:31):
at Parramanopause to help with the weird fluctuating hormones symptoms because you can use this
mirror to test up to 20 times during the month.
So if you have a lot of symptoms that are all over the place and you're confused, the
mirror device can help.
What it is is a little device that you put a wand into, you pee into a cup, you put the
wand into the cup and then once it's saturated, then you put it into the device and the device
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has a readout for you in terms of your progesterone, estrogen.
It also looks at LHFSH in terms of ovulation and things of that nature too.
What's cool about it is you can see multiple reads throughout the month.
Once you buy the device, you have the device that's yours for life.
You just buy once each month as you're trying to figure things out.
(06:17):
I really do like that for helping to figure out complicated cases when it comes to say
I've been giving someone biodontical hormones and we just can't seem to get a good dosage.
not enough or it's too much, they're having lots of side effects.
This is a good tool to help with that.
(06:37):
Now of course I am being a naturopathic doctor, one of the folks that would see folks that
are more sensitive to hormones and herbs in life in general, but I also tend to see a
lot of folks who have trouble with balancing their hormones.
This is why I have a lot of expanded tests for hormone testing compared to the traditional
just look at the blood.
it's well documented that saliva testing is best for
(07:00):
if you're putting on topical hormones.
And this is where we can get into the weeds a lot of times
where folks will be putting too much of progesterone on,
they may be gaining weight, they may be getting acne,
they may be super tired and lethargic and being like,
man, I don't know about these hormones,
but my blood tests keep coming back
as that I have low progesterone.
Well, that's because it's probably building up
in your tissues and you're not seeing it in the blood.
(07:22):
So if you are using anything topical,
estrogens or progesterone or testosterone,
even I recommend using saliva testing
to get the most accurate results for yourself.
Now, if you're injecting something like say testosterone,
blood is going to give you a better result in that case.
And I do recommend, even with men that I work with,
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I do recommend looking at least once at a Dutch test
to see how you're metabolizing that testosterone,
because we make testosterone first,
then we back convert it to estrogen.
That's men and women across the board.
So really important to be thinking about that.
And if you're taking testosterone and you're injecting,
you do want to look in the blood and see what's going on.
(08:06):
And then the blood is filtered.
So that's what you get in urine.
So that tells us how you're metabolizing things, which
I like to see that.
Now if you're using testosterone cream
and you're a guy or a gal, saliva testing
is going to give you the best result there.
So that's the testing component of things.
And like I said, originally, the more data you have on yourself,
(08:28):
the better you're going to know when to test.
That has been my blanket statement lately.
Now, moving on from the testing question,
the next question that I get is bioidentical hormones.
A lot of folks will say,
I want to take bioidentical natural hormones.
There's no such thing.
Bioidentical hormones are synthetic.
(08:50):
They look like what your body makes,
but compounding pharmacies are making these
and putting them together into creams or troquies
or sublingual drops.
It's not, it's synthetic, it is not natural.
Now, where I think the confusion's coming from
is the creams that are made just from wild yam,
(09:13):
like the actual herb wild yam.
And you can tell the difference between this
because bioidentical progesterone is made from wildgam.
But what it says is USP micronized progesterone
or USP progesterone versus wild yam.
Same thing goes for, if you're looking for an herbal version
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of an estrogen booster, the creams will say things
like black cohosh or red clover or sage,
whereas bioidentical synthetic is gonna say 17-OH
hydroxy is a hydroxy group and it's going to say
estradiol on it or estryol, which is a
(09:57):
Actual estrogen that's your weaker estrogen, but it's a great estrogen for your skin and your vaginal tissue and vaginal lubrication
Now I think a lot of people aren't even aware that there are three main estrogens estrone estradiol and estryol
So when we say bioidentical
hormone support, we're meaning we can mean a lot of different things that actually need to be
(10:18):
specific on what we're what we're talking about here. Now estradiol like I mentioned the 17OH
estradiol that is the typical bioidentical form of estradiol. It's often just termed as estrogen.
Now there is another thing called bi-est which is two types of estrogen, estradiol and estradiol.
(10:41):
And it comes in normally in 80/20 balance ratio, meaning 80% of the bias is made from
estriole and 20% is made of astradiol.
But as a doc, I can change that ratio.
I can make it 70/30.
I can make it 90/10.
You can make it 50/50.
There are many ways to provide bioidentical hormones to folks.
(11:04):
But the most important thing here is to think about is like, that is synthetic.
It's bioidentical because it looks like your body's actual hormones, but there's nothing about it that is like an herb.
It's been derived from herbs.
It's not and and estrogens are not derived from herbs.
The wild yam.
(11:24):
Well, let me back up.
They're all derived from wild yam, but the more you're getting towards 17 OH,
estradiol, and the more you're getting to estradiol, this is like.
I'm getting myself into the weeds here even with this conversation.
The more it's synthetic, you're further away from it.
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And so you want to be really well informed that bio-identical does not mean natural.
It means bio-identical and it is synthetic.
So something to think about and yes, when you look at things that are compounded from
a compounding pharmacy, they're coming from Wild yam. But they're not just straight up
(12:07):
like mashed up Wild yam. I think that's the best way I can put it. It's a derivative.
All right. So that's one of the other things I want to clear up in terms of confusion.
The other big thing that I'm asked all the time is how do you work with hormones?
What's your philosophy? How do you apply them for folks? Because what I've seen, very standard in
(12:30):
the conventional medical community is that because of research, the gold standard is to give either a
stress which is a estrogen cream and progesterone capsules at 200 milligrams. That's kind of one of
of the standards, the other standard would be a .05 milligram micronized estradiol patch
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with 200 milligrams of progesterone micronized. And that's kind of the standard of what's
being handed out. But here's the thing. A lot of people can't tolerate 200 milligrams
of progesterone. 200 milligrams of progesterone can cause weight gain, it can cause puffiness,
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and it can cause acne. And that, a lot of people don't necessarily want that because
a lot of women are hoping, secretly hoping that estrogens and hormone replacement is
going to help them lose weight. And sadly, that is not often the case. I wish it was.
I wish it was. Same thing goes for estrogens. Now, a lot of times the standard, like I said,
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could do the estuary scream or we'll do a patch of estradiol. And I do these, I don't
do estuary scream because it has paraffins and I will not recommend that to anybody. But
I will use the patches because they're easy and we can cut them. Now that is not standard
treatment. It's a little wild west. And that's how I roll when it comes to hormone dosing
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because I think that sadly a lot of people are being overdosed on hormones. And especially with the
conventional pharmaceutical hormones like Estrace and I'm Vexi, I'm Vexi is a suppository.
They have respectively in Estrace parabens and in I'm Vexi that has phthalates in it. These are
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hormone disruptors. Why we have hormone disruptors in bioidentical hormone replacement therapy?
I don't know, but it's mind boggling. And so I do not recommend those. The only pharmaceutical
estradioli recommend is the patch. Otherwise, beyond that, it's bioidentical creams.
And there's a lot of debate out there. I've even seen multiple research studies saying that
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the creams don't work and the creams this that it's hype. It's hype. You know what works? What
What works is what your body tolerates best.
And sometimes we have to go through a lot of different things to find that out.
But typically starting with something like the patch and cutting the lowest dose patch
in half can be really great for a lot of women, even if they're still cycling.
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I've used it right after ovulation for women if there's a migraine and right before the
period, if there's migraines or even PMDD where their symptoms are so severe that they're
threats in themselves or their family. Now, most people don't fall in that category, but
sometimes you got to do what you got to do. And so I will use a 0.025, a Shirdial patch cut in half
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or cut in thirds or even cut into a sliver with a compounded capsule of anywhere between 10 and
30 milligrams of progesterone and a capsule. Or I will use progesterone cream, depending on the
person's preference. Now, I have found that for postmanopausal women, and I know that
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the compounding pharmacist that I like to work with too has found that around 30 to
40 milligrams of progesterone cream seems to be a good amount for most postmanopausal
women to help with supplementing progesterone. And unfortunately, a lot of people are getting
dosages of creams that are like 100 or 200 milligrams mimicking the oral 100 or 200 milligram
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capsules, which it's not one to one.
You will absorb things faster, especially if you're going to apply it to your vaginal
tissue.
If you're applying it to your glute or your low back, it's a slower absorption.
It's slower than using like your wrist or your upper inner thigh or your labia.
vaginally, like I mentioned before, if you apply it there, it's going to go that's super thin skin.
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It's going to go in very fast.
Labia or thin skin is going to go in fast.
So when you're thinking about using a bioidentical hormone replacement therapy,
you want to be thinking about your delivery.
You want to be thinking about how many days a week you're putting this on.
You want to be thinking about the whole picture.
It's not just here's a standard dose and boom, out the door you go.
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And this is why I've kind of dedicated a lot of my practice
to helping women sleuth out how to use their bioidentical hormones.
Now, I will also put in bioidentical hormones with herbs too.
It is not uncommon for me to use black cohosh the herb for estrogen support and use progesterone
for progesterone support like whether it's a capsule, whether it is a cream.
(17:43):
And often I'll do that in the perimenopausal stages.
Now, there's many different ways I have an article that I wrote in the naturopathic
Dr. News in Review where I talk about all the different ways that I blend herbs and
biowades anacles and I'll link that in our podcast notes at Dr.Jcrausnd.com if you'd
like to read further.
But the bottom line, you know, what I get asked a lot from, from clients is well, how
(18:07):
come my, my general practitioner wanted to give me capsules and estrace?
So, so pharmaceutical based progesterone capsules and estrace the pharmaceutical base cream.
Well, that's the standard and that's been what has been researched.
That's why it's recommended the most.
The patches are sometimes used just as commonly as the estuary screams.
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Now a lot of folks will ask me, well, is the pharmaceutical progesterone bad?
Well, it works.
The issue with it is that it's suspended in peanut oil and it also has titanium dioxide
in it, which has been linked to being a hormone disruptor as well.
So in link to cancer and other things.
So you have to think about these things like, do I want that in my body?
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Am I okay with it?
And then you move forward.
Now I will tend to compound the progesterone capsules from a compounding pharmacy so we
can remove the peanut oil suspension and we don't have any titanium dioxide.
It's just progesterone and cellulose for the capsule.
Now what's kind of cool because let's face it, sometimes folks have trouble with progesterone.
(19:15):
Like I said, puffiness, weight gain, or acne.
So what I've done is we can do something called
an extended release progesterone,
where you put in a little bit more of birch fiber,
which is more or less like fiber,
it comes from a birch tree,
and you can take that and slow down the uptake
of the progesterone.
And so instead of taking it night up,
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you'd be sleepy, you could take it during the day
and have an extended release of it
so that you're not getting the body hitting it
really hard through the gut
and having such drastic symptoms that some people have,
know that that is a possibility.
Now, you can also work on fluxing your hormones,
meaning you could take weekends off.
(19:57):
So you could apply bi-est,
which is the combination of estradiol and estradiol,
and you can apply that every day
and you could take your progesterone at night.
And then on the weekend,
Saturday, Sunday, you take it off.
Just don't do it, or you take one day off.
That gives the body a little chance to catch up
and clear out some of the hormones.
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This is a big deal that will happen
after someone's been using hormones for a little while
or for folks that can be a little bit more sensitive.
Sometimes when you're applying a cream
and you're rotating locations, let's face it,
the body can sometimes be slow to uptake
into the cells, metabolize it and move it through
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so it hangs up and then some people will tend to have side
effects. The most common side effects of progesterone I've already noted with weight gain and acne,
the most common side effects with estrogen are folks having trouble with bleeding. If they still
have a uterus, they'll get a little bit of a bleed. They might feel breast tenderness, they might feel
moody, they might feel a little more irritable, aggressive, things of that nature. Testosterone
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can also have side effects, breakage of the hair. It can also cause acne. It can also cause irritability
as well. So we need to be aware of the side effects that can happen with these things. And if you see
them, then the idea is, okay, how can I bring down the dosage a little bit? One, take a break.
Two, actually drop the dosage. Or three, we can use something called diindal methane or
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calcium decaluylcrate. These are both products that are meant to help the body to detox hormones
more effectively. Dain dol methane is an extract of cabbage cauliflower broccoli. It's called dim
for short. And then calcium decolu crate is literally a type of calcium that is able to bind
(21:51):
estrogen within the gut. And so for a lot of people that have gut symptoms when their estrogen
levels go high, this is great to grab it. And then also for people that are overabsorbing
back the estrogens through the gut, which can happen commonly in constipation. This can be helpful.
Now, there's a fine dance with calcium de-glucrate because it is a calcium that can cause constipation
(22:14):
in addition to help folks with the constipation balance or hormones. So it's a little bit of a
juggle, but nevertheless, those are options for you to help you to detox the hormones more
effectively. And a lot of times, I will help folks figure out the right balance of how much they
need of the daines ole matine, how much they need of calcium de-glucarate to get the desired
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effect.
Same thing goes with guys.
Sometimes soft palmetto can help to detox a little bit better along with them.
It's not a one size fits all situation.
This is the biggest thing that frustrates me with the anti-aging, let's call it movement,
and the hormone replacement therapy space.
(23:01):
being kind of touted like, well, you need this and you need that and that's it.
No, we this is a this is a tailored individual situation, especially if you're noticing you're
having side effects and you think, maybe the stuff isn't for me.
That may maybe the case, maybe you're better off of theirs, but you may need some help with
(23:22):
how you're detoxing these hormones or just how you're taking them.
I have people taking progesterone sometimes every other night at a very low dosage and
that seems to work and it can be capsules, it can be cream.
It just all depends.
Same thing goes with the patches.
I'll have people doing the week long replacement patches or twice a week replacement patches
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because there's those two options.
It just depends on what's going on.
And then like I said, the hormone holidays on the weekends.
So you can do a lot of different things with these hormones over time.
I'm going to round out the podcast with the last biggest question I get on hormones and
it is, do I need to be on these for life?
(24:08):
Great question.
It's a great question.
Right now, it seems based on the research you could use hormones for life.
And I do believe you could.
I think it's more of a matter of microdosing and I think you need less as you do get older.
Because what I'll see with a lot of women is after they've been using bioidenticals for 10 plus years,
(24:28):
the dosage needs to come down a little bit and sometimes even in five years.
I'm testing at least once to twice a year, by the way, to know where people are at.
I'm not leaving people go for too long. That's not a good idea. You want to know what's happening.
And for a lot of women, as time goes on,
they will start to have a little more breast tenderness.
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Or if they still have a uterus,
they might get a bleed and be like,
what in the world's going on?
Why am I bleeding?
Too much estrogen in the system.
Or they might start to feel puffy.
They might start to feel too sleepy.
And there's many different manifestations
of too much hormones.
And this is why testing is absolutely crucial.
And knowing where you stand each and every year.
And so some of my folks who've been taking hormones
for decades, I have clients in their 80s
(25:11):
that are still on bioidentical hormones
What have I seen? Their skin looks great. Their bones are great.
Their cardiovascular systems are good.
So we are getting protective effects.
Do I have thousands of people that I can report on? No.
I have tens of,
tens, how do I say this? I have like a dozen people max.
(25:32):
So I don't have a huge base to report on in terms of my 80 year olds that
are on biodemical hormones.
But what I can say is it does seem the longer I've been doing this that,
Yeah, we don't need as much going forward.
And so we can taper it down and kind of have like a microdose
as we head into our early stages of life
(25:53):
and see how it goes.
All these women there still on them are quite healthy.
So I think there's something to it.
Now, a lot of people are like,
can I just microdose hormones and just cruise through
perimenopause through menopause and beyond?
Yeah.
I kind of am wondering if you can microdose early
and just miss having a lot of the side effects
of a pyramid of pause, a man of pause.
(26:15):
Possibly, possibly.
I don't have a study on it, and so don't quote me on it,
but I'm wondering if it's possible.
Now, in my previous solo podcast,
I talked about autoimmune conditions,
and could we possibly be able to ward off
autoimmune conditions if we helped our hormones a little bit?
And I kind of believe we can if we help balance them.
So, one of the biggest things I do want to get across
(26:39):
about everything in terms of hormones,
because do people have side effects with hormones?
Absolutely.
Why do we have side effects by adding in hormones?
One, either you really don't need them
and you're already to the one or two,
your liver's not metabolizing,
your gut's not metabolizing,
your cells are metabolizing them.
Which means we've gotta get the foundational health work
done first before we add hormones into the picture.
(27:00):
They're icing on the cake, they're not the solution.
So if you're hoping the hormones are gonna solve
all of your gut stuff, all of your rashes,
all of your stuff going on. Start with the basis, you guys start with the gut health,
you guys start with the microbiome, you guys start with the liver working well and your
cells working well, then move into hormones and and thyroid. If you're eating like crap,
(27:23):
you're eating like a hot dumpster fire, like it you take hormones and you're not going to detox
them all. So we got to be thinking holistically when it comes to hormones, they're not a solution,
they're not a cure, they are definitely icing on the cake. So that is probably the best way to
round out this podcast in terms of the full spectrum. You can benefit from hormones. They're not,
(27:47):
I'm going to say they're not as scary to me as they used to be 10 plus years ago before I really
started to get into them and work with them myself. I definitely have looked at their research. I'm
not going to just give hormones and never test. I do think there are some risks, especially with
(28:08):
with lifestyle factors that may compound someone's propensity
to getting hormones and then suspect,
or getting hormones, getting cancer
and suspecting it was the hormones that caused it.
I think it's more on a detox level
where we could have issues.
So you want to be testing frequently.
(28:29):
You wanna make sure that you're liver,
you're gallbladder if you have one,
your gut, your microbiome,
all those things are working well
and your cells are doing all right
before you start upping hormone doses.
Now, will I give hormones while I'm working
on someone's general health?
Absolutely.
But I always want folks to realize
that it's icing on the cake
(28:49):
and something that can amplify.
It's not the solution.
So that rounds out the biggest questions I get on hormones
and my girlfriend and I are working really hard
over at the Center for Human Restoration
on a program for hormone support
that is completely holistic to help put together everything
(29:11):
you would need to ease into bioidentical hormone replacement,
whether you wanna do natural or whether you want to do
the bioidentical type C, even I just misspoke
on that one and you can see why it's confusing.
So we are going to help on the natural side
if someone wants to support their hormones naturally,
but also on the bioidentical hormone support side
(29:33):
and what you can do to just thrive with hormones,
but also age well, ward off some autoimmune conditions
and really just feel your best
in these times when you start to feel like
what is gonna happen.
Oh my God, am I gonna age faster than I imagined.
I mean, I'm gonna age like my mom, my grandma, my aunt,
(29:55):
my, you know, like what, who, what's gonna happen?
Let's take down that mystery
and help you feel like you're in the driver's seat
and in control of your hormones and how you age.
So stay tuned for more offerings coming out
from the program that we're putting together
at the Center for Human Restoration
in Crandon, Wisconsin.
And yeah, we'll see how that goes
(30:18):
and definitely for all my folks in Washington,
I will be also doing a little something there too.
All right, that's about it on hormones.
I'm gonna put all of my resources in the podcast notes
doctorjkrausend.com. All right. Have a great day. Whatever you're doing.
Hey fellow health junkie. Thanks for listening to The Health Fix Podcast. If you enjoy tuning in,
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please help support me to get the word out about the podcast. Subscribe, rate and review,
and just get that word out. Thanks again for listening.
Welcome to the Health Fix Podcast, where health junkies get their weekly
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fix of tips, tools, and techniques to have limitless energy, sharp minds, and fit
physiques for life.
Hey Health Junkies, on this episode of The Health Fix Podcast, you get me, Dr.
Jannine Krause again. And today I am going to be talking about hormones and what the
heck to do with these buggers because they get kind of funky as we get older.
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And how do you test for them?
What's like the legit way to test which ways make sense?
And I want to clear up some confusion in terms of bioidentical and natural
form of supplementation.
So let's get into the podcast.
So I'm often asked by my listeners, but also by my
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clients, what is the best testing for looking at your hormones?
And my answer is it depends.
Now, if we're looking at real time, what's going on with your
hormones, blood is going to tell you what's going on in that moment.
And a lot of docs will argue like, Oh, well, you can't get accurate
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results from hormone testing.
So why test it?
Because it changes every day.
Yes.
And here's the thing.
If I can get clients to take a snapshot of what's going on every single day in their life and we can pair it with the moon cycles.
We can pair it with just a standard old calendar.
You can write it down and note when do you feel the best and when do you not feel so great and when do you have your symptoms?
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By doing that for an entire month, you are going to know when you don't feel the best.
those are the time frames in which you want to have your blood drawn.
Now, a lot of people will say doing the hormone testing between day 19 to 26.
And that's because estrogen is going to be a little bit lower.
It's not on the rise and it's kind of going to be kind of like,
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humph, let's say, flat-ish and the progesterone is supposed to be higher at that time frame.
And so we can go to a good read of if progesterone is sufficient and if estrogen is doing okay too.
Now, that is good in theory because it is what's going to show in blood.
If you are using a topical type of hormone support, or if we are wondering, are there
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any hormones getting stuck in the tissue, saliva is going to give you a really good sense of
what's going on in that case.
Say you've listened to Barbara O'Neill, say you've listened to other folks and you've
heard that like wild yam cream is a great natural option to put on your skin at night
to help you to sleep and help with some of the perimenopause symptoms.
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Now that is true.
And applying it upper inner thighs, upper, you know, arm, inner wrists.
A lot of people say don't do the arm anymore because we have the lymphatics here that go
to the breast and okay, you know what?
I don't care.
Just rotate the locations.
I don't want to get an argument with anyone where to apply it.
Now, the other big thing here, like, yes, I do think that that yam cream can help, but
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we have to look at it in terms of saliva to see, are we getting enough in?
Because blood traditionally will not show a super high progesterone level.
It's going to show a little bit more blunted.
Now if it's high in the blood, we know there's a problem.
Let's put it that way.
Otherwise we're going to see a blunted level compared to what you would see in saliva,
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especially if you are applying your progesterone or wild
damn cream topically.
Now, another thing that you wanna be thinking about
in terms of saliva testing is if you're using
a vaginal cream that has DHEA, something that helps
with vaginal lubrication, that can also affect levels.
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Same thing goes, if you've got a skincare product
that's helping with skin like anti-aging cream,
some of those have DHEA in them,
and they can cause a spike in your DHA levels
in a saliva test.
So we do wanna be thinking about those kind of things.
But what do I do when I'm thinking about hormones
and I'm getting someone into the practice
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and I wanna learn what's going on with them?
I will often do blood in saliva to start off with.
Even if they're not applying hormones
and I know that might sound strange too,
but it helps me to kind of see if anything's hanging up
in the tissues.
Now I may also do a hormone test called the Dutch test,
which is a urine metabolism of hormones test.
Now, I tend now to reserve that for later on
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in my practice, meaning with someone,
meaning I wanna see if we put them on herbs
or we put them on a hormone
if they're gonna break it down through the urine,
like, I'm gonna break it down through the urine.
They're gonna break it down through the liver
and then I'm gonna see it in the urine test.
But what I'm wanting to see here
is what's going on in that to see if there's anything happening.
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And so if you are wondering where your hormones are at,
those are kind of the three ways to test.
Now, there is a different modification on a urine test,
which is known as Mira, M-I-R-A.
And it's typically used for fertility,
but I have figured that, and the company also has other folks
doing this and talking about it, is that we can also look
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at Parramanopause to help with the weird fluctuating hormones symptoms because you can use this
mirror to test up to 20 times during the month.
So if you have a lot of symptoms that are all over the place and you're confused, the
mirror device can help.
What it is is a little device that you put a wand into, you pee into a cup, you put the
wand into the cup and then once it's saturated, then you put it into the device and the device
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has a readout for you in terms of your progesterone, estrogen.
It also looks at LHFSH in terms of ovulation and things of that nature too.
What's cool about it is you can see multiple reads throughout the month.
Once you buy the device, you have the device that's yours for life.
You just buy once each month as you're trying to figure things out.
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I really do like that for helping to figure out complicated cases when it comes to say
I've been giving someone biodontical hormones and we just can't seem to get a good dosage.
not enough or it's too much, they're having lots of side effects.
This is a good tool to help with that.
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Now of course I am being a naturopathic doctor, one of the folks that would see folks that
are more sensitive to hormones and herbs in life in general, but I also tend to see a
lot of folks who have trouble with balancing their hormones.
This is why I have a lot of expanded tests for hormone testing compared to the traditional
just look at the blood.
it's well documented that saliva testing is best for
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if you're putting on topical hormones.
And this is where we can get into the weeds a lot of times
where folks will be putting too much of progesterone on,
they may be gaining weight, they may be getting acne,
they may be super tired and lethargic and being like,
man, I don't know about these hormones,
but my blood tests keep coming back
as that I have low progesterone.
Well, that's because it's probably building up
in your tissues and you're not seeing it in the blood.
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So if you are using anything topical,
estrogens or progesterone or testosterone,
even I recommend using saliva testing
to get the most accurate results for yourself.
Now, if you're injecting something like say testosterone,
blood is going to give you a better result in that case.
And I do recommend, even with men that I work with,
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I do recommend looking at least once at a Dutch test
to see how you're metabolizing that testosterone,
because we make testosterone first,
then we back convert it to estrogen.
That's men and women across the board.
So really important to be thinking about that.
And if you're taking testosterone and you're injecting,
you do want to look in the blood and see what's going on.
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And then the blood is filtered.
So that's what you get in urine.
So that tells us how you're metabolizing things, which
I like to see that.
Now if you're using testosterone cream
and you're a guy or a gal, saliva testing
is going to give you the best result there.
So that's the testing component of things.
And like I said, originally, the more data you have on yourself,
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the better you're going to know when to test.
That has been my blanket statement lately.
Now, moving on from the testing question,
the next question that I get is bioidentical hormones.
A lot of folks will say,
I want to take bioidentical natural hormones.
There's no such thing.
Bioidentical hormones are synthetic.
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They look like what your body makes,
but compounding pharmacies are making these
and putting them together into creams or troquies
or sublingual drops.
It's not, it's synthetic, it is not natural.
Now, where I think the confusion's coming from
is the creams that are made just from wild yam,
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like the actual herb wild yam.
And you can tell the difference between this
because bioidentical progesterone is made from wildgam.
But what it says is USP micronized progesterone
or USP progesterone versus wild yam.
Same thing goes for, if you're looking for an herbal version
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of an estrogen booster, the creams will say things
like black cohosh or red clover or sage,
whereas bioidentical synthetic is gonna say 17-OH
hydroxy is a hydroxy group and it's going to say
estradiol on it or estryol, which is a
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Actual estrogen that's your weaker estrogen, but it's a great estrogen for your skin and your vaginal tissue and vaginal lubrication
Now I think a lot of people aren't even aware that there are three main estrogens estrone estradiol and estryol
So when we say bioidentical
hormone support, we're meaning we can mean a lot of different things that actually need to be
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specific on what we're what we're talking about here. Now estradiol like I mentioned the 17OH
estradiol that is the typical bioidentical form of estradiol. It's often just termed as estrogen.
Now there is another thing called bi-est which is two types of estrogen, estradiol and estradiol.
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And it comes in normally in 80/20 balance ratio, meaning 80% of the bias is made from
estriole and 20% is made of astradiol.
But as a doc, I can change that ratio.
I can make it 70/30.
I can make it 90/10.
You can make it 50/50.
There are many ways to provide bioidentical hormones to folks.
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But the most important thing here is to think about is like, that is synthetic.
It's bioidentical because it looks like your body's actual hormones, but there's nothing about it that is like an herb.
It's been derived from herbs.
It's not and and estrogens are not derived from herbs.
The wild yam.
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Well, let me back up.
They're all derived from wild yam, but the more you're getting towards 17 OH,
estradiol, and the more you're getting to estradiol, this is like.
I'm getting myself into the weeds here even with this conversation.
The more it's synthetic, you're further away from it.
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And so you want to be really well informed that bio-identical does not mean natural.
It means bio-identical and it is synthetic.
So something to think about and yes, when you look at things that are compounded from
a compounding pharmacy, they're coming from Wild yam. But they're not just straight up
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like mashed up Wild yam. I think that's the best way I can put it. It's a derivative.
All right. So that's one of the other things I want to clear up in terms of confusion.
The other big thing that I'm asked all the time is how do you work with hormones?
What's your philosophy? How do you apply them for folks? Because what I've seen, very standard in
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the conventional medical community is that because of research, the gold standard is to give either a
stress which is a estrogen cream and progesterone capsules at 200 milligrams. That's kind of one of
of the standards, the other standard would be a .05 milligram micronized estradiol patch
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with 200 milligrams of progesterone micronized. And that's kind of the standard of what's
being handed out. But here's the thing. A lot of people can't tolerate 200 milligrams
of progesterone. 200 milligrams of progesterone can cause weight gain, it can cause puffiness,
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and it can cause acne. And that, a lot of people don't necessarily want that because
a lot of women are hoping, secretly hoping that estrogens and hormone replacement is
going to help them lose weight. And sadly, that is not often the case. I wish it was.
I wish it was. Same thing goes for estrogens. Now, a lot of times the standard, like I said,
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could do the estuary scream or we'll do a patch of estradiol. And I do these, I don't
do estuary scream because it has paraffins and I will not recommend that to anybody. But
I will use the patches because they're easy and we can cut them. Now that is not standard
treatment. It's a little wild west. And that's how I roll when it comes to hormone dosing
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because I think that sadly a lot of people are being overdosed on hormones. And especially with the
conventional pharmaceutical hormones like Estrace and I'm Vexi, I'm Vexi is a suppository.
They have respectively in Estrace parabens and in I'm Vexi that has phthalates in it. These are
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hormone disruptors. Why we have hormone disruptors in bioidentical hormone replacement therapy?
I don't know, but it's mind boggling. And so I do not recommend those. The only pharmaceutical
estradioli recommend is the patch. Otherwise, beyond that, it's bioidentical creams.
And there's a lot of debate out there. I've even seen multiple research studies saying that
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the creams don't work and the creams this that it's hype. It's hype. You know what works? What
What works is what your body tolerates best.
And sometimes we have to go through a lot of different things to find that out.
But typically starting with something like the patch and cutting the lowest dose patch
in half can be really great for a lot of women, even if they're still cycling.
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I've used it right after ovulation for women if there's a migraine and right before the
period, if there's migraines or even PMDD where their symptoms are so severe that they're
threats in themselves or their family. Now, most people don't fall in that category, but
sometimes you got to do what you got to do. And so I will use a 0.025, a Shirdial patch cut in half
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or cut in thirds or even cut into a sliver with a compounded capsule of anywhere between 10 and
30 milligrams of progesterone and a capsule. Or I will use progesterone cream, depending on the
person's preference. Now, I have found that for postmanopausal women, and I know that
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the compounding pharmacist that I like to work with too has found that around 30 to
40 milligrams of progesterone cream seems to be a good amount for most postmanopausal
women to help with supplementing progesterone. And unfortunately, a lot of people are getting
dosages of creams that are like 100 or 200 milligrams mimicking the oral 100 or 200 milligram
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capsules, which it's not one to one.
You will absorb things faster, especially if you're going to apply it to your vaginal
tissue.
If you're applying it to your glute or your low back, it's a slower absorption.
It's slower than using like your wrist or your upper inner thigh or your labia.
vaginally, like I mentioned before, if you apply it there, it's going to go that's super thin skin.
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It's going to go in very fast.
Labia or thin skin is going to go in fast.
So when you're thinking about using a bioidentical hormone replacement therapy,
you want to be thinking about your delivery.
You want to be thinking about how many days a week you're putting this on.
You want to be thinking about the whole picture.
It's not just here's a standard dose and boom, out the door you go.
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And this is why I've kind of dedicated a lot of my practice
to helping women sleuth out how to use their bioidentical hormones.
Now, I will also put in bioidentical hormones with herbs too.
It is not uncommon for me to use black cohosh the herb for estrogen support and use progesterone
for progesterone support like whether it's a capsule, whether it is a cream.
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And often I'll do that in the perimenopausal stages.
Now, there's many different ways I have an article that I wrote in the naturopathic
Dr. News in Review where I talk about all the different ways that I blend herbs and
biowades anacles and I'll link that in our podcast notes at Dr.Jcrausnd.com if you'd
like to read further.
But the bottom line, you know, what I get asked a lot from, from clients is well, how
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come my, my general practitioner wanted to give me capsules and estrace?
So, so pharmaceutical based progesterone capsules and estrace the pharmaceutical base cream.
Well, that's the standard and that's been what has been researched.
That's why it's recommended the most.
The patches are sometimes used just as commonly as the estuary screams.
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Now a lot of folks will ask me, well, is the pharmaceutical progesterone bad?
Well, it works.
The issue with it is that it's suspended in peanut oil and it also has titanium dioxide
in it, which has been linked to being a hormone disruptor as well.
So in link to cancer and other things.
So you have to think about these things like, do I want that in my body?
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Am I okay with it?
And then you move forward.
Now I will tend to compound the progesterone capsules from a compounding pharmacy so we
can remove the peanut oil suspension and we don't have any titanium dioxide.
It's just progesterone and cellulose for the capsule.
Now what's kind of cool because let's face it, sometimes folks have trouble with progesterone.
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Like I said, puffiness, weight gain, or acne.
So what I've done is we can do something called
an extended release progesterone,
where you put in a little bit more of birch fiber,
which is more or less like fiber,
it comes from a birch tree,
and you can take that and slow down the uptake
of the progesterone.
And so instead of taking it night up,
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you'd be sleepy, you could take it during the day
and have an extended release of it
so that you're not getting the body hitting it
really hard through the gut
and having such drastic symptoms that some people have,
know that that is a possibility.
Now, you can also work on fluxing your hormones,
meaning you could take weekends off.
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So you could apply bi-est,
which is the combination of estradiol and estradiol,
and you can apply that every day
and you could take your progesterone at night.
And then on the weekend,
Saturday, Sunday, you take it off.
Just don't do it, or you take one day off.
That gives the body a little chance to catch up
and clear out some of the hormones.
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This is a big deal that will happen
after someone's been using hormones for a little while
or for folks that can be a little bit more sensitive.
Sometimes when you're applying a cream
and you're rotating locations, let's face it,
the body can sometimes be slow to uptake
into the cells, metabolize it and move it through
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so it hangs up and then some people will tend to have side
effects. The most common side effects of progesterone I've already noted with weight gain and acne,
the most common side effects with estrogen are folks having trouble with bleeding. If they still
have a uterus, they'll get a little bit of a bleed. They might feel breast tenderness, they might feel
moody, they might feel a little more irritable, aggressive, things of that nature. Testosterone
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can also have side effects, breakage of the hair. It can also cause acne. It can also cause irritability
as well. So we need to be aware of the side effects that can happen with these things. And if you see
them, then the idea is, okay, how can I bring down the dosage a little bit? One, take a break.
Two, actually drop the dosage. Or three, we can use something called diindal methane or
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calcium decaluylcrate. These are both products that are meant to help the body to detox hormones
more effectively. Dain dol methane is an extract of cabbage cauliflower broccoli. It's called dim
for short. And then calcium decolu crate is literally a type of calcium that is able to bind
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estrogen within the gut. And so for a lot of people that have gut symptoms when their estrogen
levels go high, this is great to grab it. And then also for people that are overabsorbing
back the estrogens through the gut, which can happen commonly in constipation. This can be helpful.
Now, there's a fine dance with calcium de-glucrate because it is a calcium that can cause constipation
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in addition to help folks with the constipation balance or hormones. So it's a little bit of a
juggle, but nevertheless, those are options for you to help you to detox the hormones more
effectively. And a lot of times, I will help folks figure out the right balance of how much they
need of the daines ole matine, how much they need of calcium de-glucarate to get the desired
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effect.
Same thing goes with guys.
Sometimes soft palmetto can help to detox a little bit better along with them.
It's not a one size fits all situation.
This is the biggest thing that frustrates me with the anti-aging, let's call it movement,
and the hormone replacement therapy space.
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being kind of touted like, well, you need this and you need that and that's it.
No, we this is a this is a tailored individual situation, especially if you're noticing you're
having side effects and you think, maybe the stuff isn't for me.
That may maybe the case, maybe you're better off of theirs, but you may need some help with
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how you're detoxing these hormones or just how you're taking them.
I have people taking progesterone sometimes every other night at a very low dosage and
that seems to work and it can be capsules, it can be cream.
It just all depends.
Same thing goes with the patches.
I'll have people doing the week long replacement patches or twice a week replacement patches
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because there's those two options.
It just depends on what's going on.
And then like I said, the hormone holidays on the weekends.
So you can do a lot of different things with these hormones over time.
I'm going to round out the podcast with the last biggest question I get on hormones and
it is, do I need to be on these for life?
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Great question.
It's a great question.
Right now, it seems based on the research you could use hormones for life.
And I do believe you could.
I think it's more of a matter of microdosing and I think you need less as you do get older.
Because what I'll see with a lot of women is after they've been using bioidenticals for 10 plus years,
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the dosage needs to come down a little bit and sometimes even in five years.
I'm testing at least once to twice a year, by the way, to know where people are at.
I'm not leaving people go for too long. That's not a good idea. You want to know what's happening.
And for a lot of women, as time goes on,
they will start to have a little more breast tenderness.
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Or if they still have a uterus,
they might get a bleed and be like,
what in the world's going on?
Why am I bleeding?
Too much estrogen in the system.
Or they might start to feel puffy.
They might start to feel too sleepy.
And there's many different manifestations
of too much hormones.
And this is why testing is absolutely crucial.
And knowing where you stand each and every year.
And so some of my folks who've been taking hormones
for decades, I have clients in their 80s
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that are still on bioidentical hormones
What have I seen? Their skin looks great. Their bones are great.
Their cardiovascular systems are good.
So we are getting protective effects.
Do I have thousands of people that I can report on? No.
I have tens of,
tens, how do I say this? I have like a dozen people max.
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So I don't have a huge base to report on in terms of my 80 year olds that
are on biodemical hormones.
But what I can say is it does seem the longer I've been doing this that,
Yeah, we don't need as much going forward.
And so we can taper it down and kind of have like a microdose
as we head into our early stages of life
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and see how it goes.
All these women there still on them are quite healthy.
So I think there's something to it.
Now, a lot of people are like,
can I just microdose hormones and just cruise through
perimenopause through menopause and beyond?
Yeah.
I kind of am wondering if you can microdose early
and just miss having a lot of the side effects
of a pyramid of pause, a man of pause.
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Possibly, possibly.
I don't have a study on it, and so don't quote me on it,
but I'm wondering if it's possible.
Now, in my previous solo podcast,
I talked about autoimmune conditions,
and could we possibly be able to ward off
autoimmune conditions if we helped our hormones a little bit?
And I kind of believe we can if we help balance them.
So, one of the biggest things I do want to get across
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about everything in terms of hormones,
because do people have side effects with hormones?
Absolutely.
Why do we have side effects by adding in hormones?
One, either you really don't need them
and you're already to the one or two,
your liver's not metabolizing,
your gut's not metabolizing,
your cells are metabolizing them.
Which means we've gotta get the foundational health work
done first before we add hormones into the picture.
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They're icing on the cake, they're not the solution.
So if you're hoping the hormones are gonna solve
all of your gut stuff, all of your rashes,
all of your stuff going on. Start with the basis, you guys start with the gut health,
you guys start with the microbiome, you guys start with the liver working well and your
cells working well, then move into hormones and and thyroid. If you're eating like crap,
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you're eating like a hot dumpster fire, like it you take hormones and you're not going to detox
them all. So we got to be thinking holistically when it comes to hormones, they're not a solution,
they're not a cure, they are definitely icing on the cake. So that is probably the best way to
round out this podcast in terms of the full spectrum. You can benefit from hormones. They're not,
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I'm going to say they're not as scary to me as they used to be 10 plus years ago before I really
started to get into them and work with them myself. I definitely have looked at their research. I'm
not going to just give hormones and never test. I do think there are some risks, especially with
(28:08):
with lifestyle factors that may compound someone's propensity
to getting hormones and then suspect,
or getting hormones, getting cancer
and suspecting it was the hormones that caused it.
I think it's more on a detox level
where we could have issues.
So you want to be testing frequently.
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You wanna make sure that you're liver,
you're gallbladder if you have one,
your gut, your microbiome,
all those things are working well
and your cells are doing all right
before you start upping hormone doses.
Now, will I give hormones while I'm working
on someone's general health?
Absolutely.
But I always want folks to realize
that it's icing on the cake
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and something that can amplify.
It's not the solution.
So that rounds out the biggest questions I get on hormones
and my girlfriend and I are working really hard
over at the Center for Human Restoration
on a program for hormone support
that is completely holistic to help put together everything
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you would need to ease into bioidentical hormone replacement,
whether you wanna do natural or whether you want to do
the bioidentical type C, even I just misspoke
on that one and you can see why it's confusing.
So we are going to help on the natural side
if someone wants to support their hormones naturally,
but also on the bioidentical hormone support side
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and what you can do to just thrive with hormones,
but also age well, ward off some autoimmune conditions
and really just feel your best
in these times when you start to feel like
what is gonna happen.
Oh my God, am I gonna age faster than I imagined.
I mean, I'm gonna age like my mom, my grandma, my aunt,
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my, you know, like what, who, what's gonna happen?
Let's take down that mystery
and help you feel like you're in the driver's seat
and in control of your hormones and how you age.
So stay tuned for more offerings coming out
from the program that we're putting together
at the Center for Human Restoration
in Crandon, Wisconsin.
And yeah, we'll see how that goes
(30:18):
and definitely for all my folks in Washington,
I will be also doing a little something there too.
All right, that's about it on hormones.
I'm gonna put all of my resources in the podcast notes
doctorjkrausend.com. All right. Have a great day. Whatever you're doing.
Hey fellow health junkie. Thanks for listening to The Health Fix Podcast. If you enjoy tuning in,
(30:41):
please help support me to get the word out about the podcast. Subscribe, rate and review,
and just get that word out. Thanks again for listening.
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!