Menopause & BRCA: Hormones and Cancer Risk With Dr. Bruce Dorr - Episode 292 - Sandy K Nutrition - Health & Lifestyle Queen

Episode Transcript
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SandyKruse (00:02):
Hi everyone, it's me, Sandy Cruz of Sandy K
Nutrition Health and LifestyleQueen.
For years now, I've beenbringing to you conversations
about wellness from incredibleguests from all over the world.
Discover a fresh take onhealthy living for midlife and

(00:25):
beyond.
One that embraces balance andreason.
Without letting only sciencedictate every aspect of our
wellness.
Join me and my guests as weexplore ways that we can age
gracefully with in-depthconversations about the thyroid,

(00:48):
about hormones, and otheralternative wellness options for
you and your family.
True Wellness Nurtures ahealthy body, mind, spirit, and
soul.
And we cover all of theseessential aspects to help you
live a balanced, joyful life.

(01:11):
Be sure to follow my show, rateit, review it, and share it.
Always remember, my friends,balanced living works.
Hi everyone, welcome to Sandy KNutrition Health and Lifestyle

(01:31):
Queen.
Today with me, I have a returnguest.
Dr.
Bruce Door is back with us, andhe is going to talk to us all
about menopause, HRT, breastcancer, and what women with the
BRACA gene should know.
This is going to be a greatconversation.

(01:51):
Dr.
Bruce Door was part of mypodcast a couple of years ago.
I had him on and we werespeaking about how women have
been misled about menopause.
We broke down the New YorkTimes article.
I think it was called Women.
I can't even remember thedetails, but he was first on my

(02:13):
podcast, May of 2023, episode166.
If you want to go back to that.
And I included that episode inmy summer reboot series on July
28th, episode 282.
It's called The Truth AboutHormones, What Women Aren't
Being Told with Dr.

(02:34):
Bruce Dore.
And now we're going to talkabout the BROCA gene.
Now, this is a really importantconversation because often
there is older research recitedto patients who have this gene.
Then there's those who havebreast cancer.

(02:55):
I mean, this is such animportant conversation.
And while I do want to remindyou that this is a conversation,
this is not medical advice.
It is important that you takethis information to a
practitioner who knows youpersonally.
And I say that all the timebecause I think we kind of have

(03:18):
gotten into this habit where wehear something online and we
take that advice and we run withit.
And I think it's important thatwe almost go back to how things
used to be, where we don't justdo things on our own and we do
things that obviously have tohave resonance.

(03:38):
We need to go and look within,first of all, if we feel aligned
with it, and then go and workwith a practitioner who knows
us.
I've made the decision tochange the format a little bit
of my podcast.
And the reason I came aboutthis, most of you who follow me

(03:59):
know that I'm a big believer infollowing your intuition.
And this summer I had so manypodcast guest pitches, and
majority of them I didn't evenrespond to, at least not yet.
Something just didn't reallyresonate with me.
And I mean, I've even had guestpictures of guests that had

(04:22):
over a million followers.
Sure, that would benefit me.
Does that mean that this wouldhelp my audience?
Does that mean that this wouldcreate a really engaging
conversation or topic?
No, not necessarily, not for myaudience.
And over the last almost sixyears, I think I know that you

(04:45):
guys love that I put a lot ofheart and soul into all of my
recordings.
So I have decided that I won'talways have a guest on my
podcast.
And I'm not a big believer thatevery single guest is the only
person who is able to speak on aspecific topic.

(05:09):
Most of you are aware, I'm aregistered holistic
nutritionist.
I'm also a certified metabolicbalance coach.
I have numerous certifications,including peptides and aging
and endocrinology and hormones,clinical nutrition.
I could go on, and I am a bigbeliever that while you cannot

(05:34):
discount somebody's expertise inthe world, in their field, it
doesn't mean that somebody elsewho has exposure and knowledge
cannot speak about it,especially when you're adding in
personal experience.
So some weeks I'm gonna come toyou with topics that might just

(05:59):
be on an important topic tomyself that might resonate with
you.
I'm still gonna have greatguests, including guests like
Dr.
Bruce Doer, but I wanted toshare that with you because I
felt this change from deepwithin that authenticity is much

(06:20):
more important than publicity.
And a lot of the podcast hostsin the area of health and
wellness just circulate the sameguests, the same topics over
and over again.
And we have podcast hosts whopay to play, these are the

(06:42):
facts, my friends.
And I can't do that, I won't dothat, I won't charge my guests.
I feel there's a credibilityissue there, and my guests don't
pay me either.
I've done a lot of research inthis area with other podcasting

(07:04):
grades, and they don't chargeeither.
Whereas there's a lot of peoplein this industry in the
biohacking world that do charge.
I don't believe in it, I don'tbuy it.
I don't think there's anythingwrong with working closely with
advertisers to build I guesstrust and credibility.

(07:28):
I still haven't found thateither.
So I don't believe in one-offadvertisements, so that's why I
don't have sponsors.
A lot of them want to spreadtheir advertising dollars
amongst, you know, 20 podcastersand do one-offs here and there.

(07:50):
So this is me speaking my truthwith you guys who I appreciate
so much.
I appreciate that you come andlisten every single week, that
you share my podcast, that yousend me little notes.
And I just appreciate the factthat I have a voice and that my

(08:11):
voice might, might just helpmake a difference in this world
where there's a lot of darknessright now.
So I am more than happy to hearfrom you.
I love to hear from you.
Send me an email, sandy atsandyknutrition.ca.

(08:31):
Follow me on all my socialmedia channels.
It's Sandy KnutritionEverywhere.
Instagram, Facebook, TikTok,YouTube, threads, you name it.
Lemonade, that's another oneI'm on.
I don't even know.
I I do my best.

(08:52):
If you have any businesspropositions, feel free to check
out my profile on LinkedIn,Sandy Cruz, Sandy Knutrition.
And I'm always grateful,forever grateful for all of you.
And if you can, please reviewand rate my podcast wherever you

(09:12):
listen.
Apple and Spotify are the bestfor this.
And share this episode withanother beauty who would benefit
from hearing the wisdom thatDr.
Bruce Doer shares with us.
Thank you.
Hi, everyone.
Welcome to Sandy K NutritionHealth and Lifestyle Queen.
Today, with me, I have anamazing return guest, and his

(09:36):
name is Dr.
Bruce Doerr.
He is certified by the AmericanBoard of Obstetrics and
Gynecology in OBGYN and FemalePelvic Medicine and
Reconstructive Surgery.
He is a member of the AmericanEurogynecology Society and the
American Association ofGynecological Laproscopy.

(10:00):
There, I said all the wordscorrectly, didn't I?

Dr.BruceDorr (10:03):
I think you're doing great, Sandy.
Keep going.

SandyKruse (10:06):
Okay.
He became certified as a bioTmedical practitioner in 2015 and
provides hormone optimizationwith pellet therapy for both men
and women.
And so Dr.
Dore has some tenure in thisspace of hormones and women and

(10:28):
men's health.
And I had an amazingconversation.
I'm going to link the podcastwhere we talked about, I think
it was Women Have Been MisledAbout Menopause.
It was about that New YorkTimes article that came out
about maybe a couple years ago.
But today we're going to talkabout a very important topic.

(10:49):
And it is all about menopause,of course, HRT, BHRT, so
bioidentical.
I know people are usingdifferent terms interchangeably.
Breast cancer and what womenwith the BRCA gene should know.
So I will preface thisconversation just by saying none

(11:13):
of this is medical advice.
It is here, just as thosebreadcrumbs, for you to take to
your own medical practitioner todiscuss if any of this pertains
to you.
We're just putting this outthere as information so that you
have that in your back pocketif it applies to you.

(11:35):
And I'm a big fan of having ahormone practitioner who knows
you, who knows your situation.
So I just wanted to make surethat we preface this
conversation with that.
And now I welcome you, Dr.
Dorr.
Thank you so much for comingback.

Yeah, it's wonderful to be here.
Uh and with breadcrumbs, doesthat make me a crummy uh, you
know, ho or uh guest?
I hope not, right?

SandyKruse (12:01):
No, no, no.
These are breadcrumbs for youto follow for your own path to
wellness.
I kind of use that a lotbecause perfect, you know, it's
not specific medical advice.
But I think it's very importantthat you give us your
background because, you know, onsocial media you hear this all
the time.
Oh, well, they're not a doctor,or well, they're not this, and

(12:24):
they're not allowed to speakabout this.
Well, you certainly have a lotof credentials, and your
background is pretty lengthy inthis space.
So can you let us know whatyour background is?

Well, if you if you can't see uh from the lines
on my face, I'm an old guy.
Uh so you know, I've beenaround for a minute, uh, and I
was around and there beforehormones were labeled bad.
My cupboards, uh, what Iprescribed and how I prescribed
was uh very much hormoneforward.

(12:57):
And then when the WHI came outand said hormones were bad, I'm
looking at this and I'm like, Iknow differently.
My whole practice had beeninvolved in that.
And I was a general OBGYNdelivering thousands of babies.
I subspecialized inurogynecology and female pelvic

(13:17):
reconstructive surgery.
And what I would find is inthat practice, I was great as
far as helping and guide womenthrough painful situations or
maybe through their breastcancer or things like that.
I wasn't always great as far asreally sitting down and going
over and being good aboutlooking at this entire picture

(13:38):
of hormones and longevity andlifestyle.
And that led me and my bioTcertification.
Actually, our office wentforward in 2013.
Uh, and um, I it became sooverwhelming with the need for
this in our area and in ourpractice that all of us had to
do that.

(13:58):
I thought this would just be acouple people a month.
Well, it turned into 600 peoplea month, and I'd have women
say, Hey, you know, my biggesthormonal problem is my husband.
Uh so I had to get certifiedthrough that.
I'm now uh part of the SexualUh Society for North America.
It is uh Eurogynes andurologist uh for both men's and

(14:21):
women's uh sexual health.
And this led me to be thesenior medical advisor for BioT,
which is an educationalmarketing company, and I lecture
nationally on this topic.
And certainly I now talk aboutmany things, and I am sitting
for my functional medicinecertification next month that is

(14:45):
about root cause medicine.
So, why do we get disease?
Why uh are we struggling withour hormones?
Why do we struggle withdigestive issues or cancers?
Uh, and so it's just led me ina whole direction I never
thought possible.
And it you're absolutely right.
It does give me breadth uh anddepth to be able to help

(15:07):
patients and to be able toeducate providers also.

SandyKruse (15:10):
I actually love that because as I always say, we
have to look at the body in aholistic way.

Oh, yeah.

SandyKruse (15:19):
Right?
And whole meaning W-H O L E.
Whole.

Right.

SandyKruse (15:24):
And so I think that that's wonderful.
Now I have to, I think we canpreface this conversation by
saying, because you mentionedthis, why do we need hormones
now?
Maybe let's start with when atwhat point does, because this is

(15:45):
going to be mostly for women,does a woman need to consider
hormone replacement?
At what age?
Because like it's so confusingfor a lot of women.
They're like, wait, no, no, no,I'm still getting my period.
So should I even consider it?
But then they're having somesymptoms.
So at what point is menopause?

(16:06):
And you should start thinkingabout hormones.

Right, right.
You know, I see certainly seewomen in all phases uh of life,
and it's interesting.
I'll even see, you know, womenin their teens.
It's usually their mother, andI have now delivered them and
they're dragging their teen into see some old white guy.
Uh, but you know, they'repleasantly surprised because I
will find, you know, hormoneimbalances because of diet and

(16:30):
gut and digestive issues thatare going on for very young
women.
So the opportunity to go overhormone imbalances, not because
of hormone production, butbecause of hormone, say
distribution or how things arebound up when we're not careful
about our diets or relationshipsor those kind of things going

(16:53):
on.
When we look at hormones,specifically the sex hormones,
women start losing theirtestosterone, specifically in
their 20s.
And by age 40, women have halfof the testosterone production
that they had when in their umuh 20s or earlier on.
And starting about mid-30s orso, women start losing

(17:18):
progesterone production, whichis estrogen's counter hormone.
So you have estrogen made bythe ovaries that grows that
lining of the uterus.
And then at mid-cycle, usuallyuh women will ovulate, release
that egg, and on that spot fromthe ovary, that forms a cyst
that makes estrogen's counterhormone progesterone.
Progesterone then matures thelining of the uterus, and if no

(17:42):
pregnancy, progesterone falls,that causes that period.
Well, that progesteroneproduction starts coming down
mid-30s or so.
And that lack of progesteronecan be problems with sleep or
PMS or cycle regularity or cycleheaviness or flow that goes on.

(18:02):
So you have to start thinking20s loss of testosterone, 30s
loss of both testosterone andprogesterone, and then starting
in the 40s, about 10 years priorto that final menstrual period.
So uh menopause is not definedby lab values, menopause is
defined by cycles and no cyclesfor a full year in women who are

(18:26):
having their cycles regularly.
Uh so there's other conditionsthat interfere with regular
cycles.
But 10 years prior or so tothat final menstrual period is
what we call the perimenopause.
And so some hours, some weeks,some days, some months, pretty
good estrogen, and then not sogood estrogen.

(18:47):
It is a roller coaster.
And so people will startexperiencing night sweats and
hot flushes and classicmenopausal symptoms, sometimes
even in their late 30s or early40s, 10 years prior to when
their periods stop altogether.
And so that is another look athormone balance and and and

(19:07):
potentially things that can helpwith hormone supplementation
during that time.
Menopause, on average, age 51.
Most women by age 55.
I have women that still havetheir periods till into their
60s.
Wow.
It's not fair.
Uh, but is that good as far asestrogen and the positive things
that estrogen uh does?
Yes.

(19:28):
Uh, so it's all about balanceand figuring that out.
But it's women of every age.
So women that are experiencingsymptoms, they need to find
somebody who can sit down andtalk hormones with them because
I I get it right for a lot ofpeople on a regular basis.

SandyKruse (19:44):
Okay, I have to ask, just because you mentioned it,
like, is that unhealthy to haveyour periods still at age 60?
Like, can it be?

Uh, you uh when you are still having your cycles
above age 52, there's anincreased risk of endometrial or
uterine cancer.
So you got to be carefulbecause of that irregular
balance between estrogen thatbuilds and too much estrogen
over prolonged periods of timefrom the body or outside of the

(20:16):
body can cause precancer orcancer changes.
So you have to be careful inwomen that are still having
their cycles long term.
And so sometimes, yes, we haveto do biopsies and make sure
that they're careful.
Uh, prolonged estrogen in theabsence of progesterone is a is
a not a good thing.
So you you many times we'relooking at progesterone

(20:36):
supplementation uh for thosewomen to be able to help them
with the balance of thatirregular uh estrogen
production.

SandyKruse (20:44):
That makes all the sense in the world because it's
really it's not necessarilyabout that estrogen, it's about
that loss of balance that'shappening.
Because I hear it all the time,Dr.
Dorr.
I hear women saying, oh, youknow, I'm 55 or I'm 56 and I
still have my period, but damnit, I can't sleep at night.

(21:06):
I'm agitated, I have anxiety.
And so that's when it's anideal time to get tested to see
what's going on with the otherhormones.

Right.
And sometimes it's also youjust didn't look at that history
and you look at this menstrualcycle.
And like I said, that balancegiving women that control over
that irregular bleeding that cango on.
You start losing blood likethat, your iron levels go low,
and with low iron levels, yourthyroid stops working, you start

(21:38):
gaining weight, your cyclesbecome even more irregular.
So I catch imbalances not justin estrogen, not just in
testosterone, but in thyroid andmetabolic or nutritional things
that start happening.
Because when you don't feelgood, what do you do?
You you go out and you you eatcrummy, is the deal.

(21:58):
You you uh start stressing uhmore with your adult children or
aging children, and you havehigh cortisol, and that starts
shutting down your sex steroidproduction.
So it is a web.
When you pull on one piece ofthat web, other pieces of that
web start coming or gettingpulled on too.
So you have to look at thisentirety of the hormones and

(22:22):
people as a whole.
What is their nutrition status?
What is their relationship andstress status or work status,
and what is going on with themand how can you help them
rebalance?

SandyKruse (22:34):
You know, I I love that you didn't really put a
very specific age category onhormone balancing.
The reason I love that isbecause obviously I have a
daughter, and you know, I'veseen habits that you know we
didn't have when we were, youknow, I'm I'm a little on the

(22:56):
older side there too, Dr.
Dore, but there was noStarbucks in 1975, you know, and
our our poison was once in ablue moon having a can of
Coca-Cola, right?
And versus uh a Starbucksdrinks drink, which can be
triple the sugar.
I've analyzed it, trust me.

(23:16):
And I'm like, oh my gosh.
So their interference uh andhormone disruptors, and then
there's like the makeup and thestuff that they're putting on
their skin, and I think they'vegot way more interference, and
that might be like, what do youthink?
Is that maybe one causativefactor of why there's more
hormonal disruption now?

Yes.
So these EDCs, endocrinedisrupting chemicals, uh,
they're in parabens, they're inthese things that yes, we're
putting on our skin, or they'reyou're spraying on yourself, uh,
you know, to uh smell better.
Uh, there are uh, you know, theinsulin resistance and the high
sugar levels that are going on,or people carrying extra

(24:00):
weight, that is the body'ssignal to say, mmm, shut down
the sex hormones.
We have a lot of inflammationgoing on now.
And so testosterone andestrogen get lower when we're
inflamed, whether or not that'sfrom our diets or stuff that
we're putting on our bodies orexposed to in our environments.
So that's that whole window ofthe world that came into my view

(24:25):
that I wasn't quite ready foras a traditional trained MD
allopathic doctor.
That people are like, Why areyou doing all this?
Why?
And I'm like, because this iswhat is going on with us, and
you can't just think, oh, you'vegot this.
Let me give you thispharmaceutical.
No, people have to be aparticipant in their health care

(24:46):
because it's about diet,nutrition, stress,
relationships.
It's many different things, andyou get those under control.
Sometimes I don't have to putpeople on pharmaceuticals, and
that's a Christmas wish I haveof every patient I sit down in
front of.
What can I do that I can youcan incorporate this into your
life long term without having togo to the pharmacy every month

(25:09):
and think, ugh, what is thisgonna cause me cancer?
Is this gonna be you doingsomething bad?
Because that's when peoplestart popping pills, people
think, yeah, is this good or isthis bad for me?
Uh, is the thing.
And a lot of society, you know,will view that and taking
exogenous hormones as bad.
Okay, yeah, there are risks, soyou just have to balance that
all out.

SandyKruse (25:30):
That's actually a perfect segue into my next
question.
Because something I'm trying tohelp you, Sandy.
Yeah, you're doing a good job.
Um, because you know, we'retalking today about cancer, the
brackagene.
And truly, you know, one of thethings that I always say, I
know I'm not a doctor, but youknow, I am educated in hormones.

(25:53):
I know a lot about this stuff.
And so I'm always like, youcan't blame estrogen only for
cancer.
You, you know, as a woman, I'vehad a lot of estrogen ever
since I hit puberty.
So there's other factors thatcome into play.
And so I think there's a bigmisunderstanding.

(26:16):
We we we touched on it just nowof other things that are going
on in the body, um, as to youknow, hormones and breast
cancer, and especially those whowho carry the brackogene.
So maybe let's kind of get intothat whole part of the
conversation on what comes intoplay.

(26:36):
Is it just the brackogene?
No hormones do not ever take,or what's the situation there?

Yep.
So it's important to understandwe're making cancer cells every
single day.
So how we uh are able to repairand help prevent that from
taking off and becoming a thingthat takes us over, that's what
that cancer wants to do.
So, like I said, it's aboutwhat we're doing, positive

(27:05):
antioxidants, cancer repairingthings that we have in our
bodies to be able to help usthrough that.
And when we look at genes orgenetics, so you can have a
genetic predisposition thatthings that many people have to
help them repair a potentialcancer, the you sometimes we're

(27:28):
just genetically not able to dothat as well.
And when we talk about BRAC orgenetic predisposition, yes,
BRAC's got the press, andcertainly Angelina Jolie and
other people have been out thereuh pushing that forward.
But when you have asusceptibility, when you have a
strong family history, youshould get uh genetic testing

(27:49):
for the risk of that going on.
And so it's not just about BRACtesting.
Now there's at least 11, mostof the standard panels from the
National Cancer Umstitutes uhare 21 panels.
So that kind of drives us inthis area uh insane uh a little
bit because we um have uh itupdates uh about every couple of

(28:16):
years that all of a suddenthere's yet another panel uh or
another couple of genes that areadded on.
And then the people who I toldwere negative off their previous
panel, okay, now I've got twomore gene add-ons.
I gotta retest you again everyfew years.
So depending on what that geneis, will be a defect hormonally

(28:39):
or something that helps themheal or process cancer.
When we look at the BRAT genespecifically, these patients
have a problem with what we callthe progesterone beta receptor.
So you have receptors all overyour body, uh, and then
estrogen, testosterone,progesterone, these are
messengers that click into thereceptors.

(29:00):
So some of that interaction,when that clicks in, that makes
proteins that help us heal,proteins that can hurt us.
So there is a lack of aprotective effect of
progesterone in these BRACpatient positive.
But like I said, there's manyother genes uh when you're

(29:20):
looking at that.
So um, yes, they are about an80% risk of developing breast
cancer before age 50 and a 20%risk of ovarian cancer.
When you have that knowledge,people are like, oh, I don't
want to know that.
That's scary for me.
Well, you can uh pick it upearly.
So we're pretty good at helpingwith breast cancer if you get

(29:42):
it in an early stage.
Women in general are notnecessarily dying of breast
cancer, they die of ovariancancer.
So that's a big part of thatbrack is once you're done
childbearing, is to remove theovaries to save a life because
that is very rarely preventable.
But breast cancer with screen.
Knowing a patient has that kindof risk, we pick up at very

(30:04):
early stages and cure women ofthat.
Or some women, when they havethat positive gene, will be very
proactive and get aprophylactic mastectomy and uh
and uh have their ovariesremoved in in that situation.

SandyKruse (30:21):
So, okay, you said 80% chance of getting breast
cancer before age 50 if you havethe bracket.
That's pretty significant.

Pretty significant, right?
And then all the other genes,like I said, most people,
depending on the gene uh testfacility that you're going to,
it's usually a 21 panel, andthere's varying degrees of 30%
risk.
I mean, it all depends on whichgene that is that they're
positive for.
And and what we know now, so weknow what the gene as we look

(30:53):
at people's chromosomes, we knowwhat gene should be there.
And then we look and we seegenes that um or sequences that
are different than what shouldbe there.
And we're like, oh, is this aproblem?
Is this not a problem?
So sometimes I'm tellingpeople, you don't have what's
normally there.
We don't know if this is aproblem in 2025, but in 2028 or

(31:18):
29, it could potentially be aproblem.
So then we have to follow themfor what's called a variant of
undetermined significance.
So we don't know if thisabnormal sequence is going to be
a problem for them long term.
So then, you know, about 10% ofthose people that have an
abnormal sequence like thatbecome a it becomes a positive

(31:39):
gene for breast cancer in twoyears, in five years, and 10
years, as we get to knowpeople's genetic uh variations
uh across the board.
We're just getting more andmore knowledge as more people
get these tests.

SandyKruse (31:54):
I find that really interesting because I know
genetics, these genetics tests,they're they're a big kind of
fad right now.
And honestly, Dr.
Dore, I must have done at least10, 15 of them.
Different tests, differentones.

And I think you have the nice gene.
I think you got that one.

SandyKruse (32:16):
Oh, thank you.
But you know what?

You're you're coding nice all over you, yes.

SandyKruse (32:22):
Except you know, the thyroid thing, right?
So, and my uncle had somethingto do with thyroid, but this is
like old school Croatia, theydon't even know, they just know
they took it out, and that's allthey know.
So I the one thing I do know isI look at epigenetics and it's
like at what point first of all,it's never just about the one

(32:46):
gene, but if you're if you'vegot the BRACA gene and then
you've got that gene that makesdetoxification very difficult
for you, and you have a lot ofthat recirculating estrogen in
your body, like would people, Ithink it's important to touch on
that because it's never justabout the one gene, and you did
touch on that, it's kind of likehow what's the big picture?

Yep.
So, yes, in general, soestrogen does not cause breast
cancer, so it that's very clearbecause when you look if
estrogen, and it always didn'tmake sense to me when the WHI
came out and they said, youknow, estrogen is causing breast
cancer.
And when you look at what theysaid when that came out, they
said it almost achievedstatistical significance in the

(33:33):
WHI when they said that Premarinand Provera uh was increasing
the risk of breast cancer.
They said it almost reachedstatistical significance, almost
means that it can be still lefta chance.
So you have to be careful onhow things are worded and the
alarmists uh that are out there,and there's hormone haters that

(33:54):
are out there that way too, butestrogen doesn't cause breast
cancer.
So women's highest time whenthey have estrogen is during a
pregnancy.
So they can run normally womenare running estradiol levels,
say 60 to 90 around ovulation,maybe uh levels of uh 200 to
300.
Well, women during pregnancycan run 10,000, 20,000, 80,000

(34:16):
on their estradiol levels.
And and women in pregnancydon't get breast cancer.
So if estrogen caused breastcancer, you know, pregnant women
should be delivering a tumorthe same time as their baby.
So it's about healing, it isabout how we're able, just like
you said, how we detox andeliminate when you look at how

(34:37):
estrogen is detoxed and brokendown in the body.
Women that get young or earlieror more aggressive cancers are
much more prone to have a phaseone elimination or phase two
elimination problem with theirestradiol.
It goes down something called afour or sixteen hydroxyesterone

(35:00):
pathway rather than a twoestrone pathway.
Basically, what that means isthat genetically you weren't
gifted in forming anti-cancermetabolites.
You're unfortunately sentencedto cancer-causing metabolites.
Now, can you change thataround?
Yeah, to some degree, butunfortunately, if you're
constantly making cancer-causingagents, then it's a problem for

(35:21):
you.
Uh, and so that's uh a thingthat goes on.

SandyKruse (35:26):
I'm so glad that you clarified that.
I remember when I posted and Isaid estrogen in and of itself
doesn't cause cancer.
That's what I was saying.
I got really slammed.
Like, people do not want tohear that.
And it's like, well, you know,there's just so many other
factors.
Like, I know, I can't rememberwhich gene, but like, you know,
there's homozygous andheterozygous.

(35:48):
And I know this podcast is notabout specifically genetics, but
I think it's an important piecethat people, if you if you come
out of anything to understandabout hormones and cancer,
understand how your body ismaking do with everything that

(36:09):
you're putting in it andeverything that's surrounding
it.
And just like what we saidabout the sugar, about the
chemicals, about all that.
If you've got a ton of thatgoing into your body or around
your body, and your geneticsshow you have trouble getting it
out and and detoxing it, well,you need to work with somebody,

(36:34):
maybe, about that, right?

Yeah, it's also important because people get
confused when they come backbecause 80% of the time when
women get a breast cancer, 80%of the time it is estrogen and
progesterone receptor positive,meaning, yes, that is lighting
up that cancer because cancersare smart, they want that it
wants to grow and divide andtake over.

(36:58):
And so it makes the receptorsfor that.
It didn't cause it, but onceit's there, it propagates it.
So that's where that comes intoplay because yes, people get
that diagnosis and they theyhear yes, it was estrogen and
progesterone, or it is estrogenand progesterone fed.
That's not what caused it,that's what develops so the

(37:20):
cancer can ruin your life.
So that's what you need to shutdown short term, and so
hormonally positive cancers tendto be better able to be treated
because we can go anti-hormonefor a period of time.
Uh, but in general, hormonesthat's what makes us youthful,
that's what helps us with ourbrains and our bodies and our
sex lives and everything likethat.

(37:42):
So hormones are very muchneeded, but in the face of
cancer, do we want to shut thatdown for a time because of how
cancer grows and operates?
Yes, but it didn't cause it.

SandyKruse (37:54):
Yeah.
Uh, I know.
Do you know who Dr.
Jen Simmons is?
Do you know who she is?

Yeah, I I've heard the name uh specifically.
Yeah.

SandyKruse (38:03):
She talks exactly about what you're saying in
terms of because she used to bea breast cancer surgeon.
I think she stopped doing that,but she talks about the
estrogen um receptor positivecancers and how actually those
are like easier to work on andeasier to cure because they're

(38:24):
not rogue.
They're attaching to somethingthat's like inherent in your
body.
I probably didn't explain itproperly, but I love that you
you mentioned that.
Now, here's a question Is, andI don't know if there's any
research on this.
Is there any research out thereabout women who carry the BRACA

(38:45):
gene and go on hormones,bioidentical, hormone
replacement therapy, and thentheir incidence of cancer goes
up?
Is there any research on that?
Probably not, right?

Well, it's a limited population, and these
women are being followed veryclosely because, in general,
they have had, so when you lookat the screening guidelines, uh,
it most people know thatthere's badness going on in the
family.
So their mom had breast cancerunder age 50, or they have two

(39:17):
relatives with, say, a breastcancer and a pancreatic cancer,
uh, or they had a male in thefamily with uh breast cancer, or
they had uh somebody in thefamily with ovarian cancer.
So there's reasons to dogenetic testing early and
understanding that this canhappen all under age 50.

(39:39):
Many women are discovered priorto needing hormone replacement
therapy that they're makingtheir body's own natural
estrogen.
And just because they're BRACpositive, we don't necessarily
go in and remove their ovariesto decrease the risk.
We remove their ovaries in theface of a BRAC patient because
of ovarian cancer risk, notbecause of that estrogen going

(40:01):
on.
So she's running an 80% risk ofgetting breast cancer.
Is that because of the estrogenspecifically?
No, it's because of this defectin actually her progesterone
receptor uh problem uh that'sgoing on.
So those women you've got tofollow closely.
And so once we know a patientis BRAC positive, okay, when do
you want your ovaries out?
Because that can kill you.

(40:22):
And I can see a patient with anormal ultrasound, normal
imaging.
And the next month she's gotstage three out of four ovarian
cancer with a 10% five-yearsurvival rate.
So it is not able to pick bepicked up early.
We still screen with early uhblood tests and with
ultrasounds, uh and we followthem with alternating MRIs and

(40:45):
mammograms every six months.
So we pick up things as earlyas possible until they're ready
to do something about it.
Or unfortunately, if wediscover a early breast cancer.
But many of these patients werepicking up early actually
before they're on hormonereplacement therapy.
But we don't take out people'sovaries or shut down their
estrogen in the face of a breastcancer or a BRAC positive young

(41:08):
women, and that's a majority ofthe women who know that they're
BRAC positive.
Uh, once they're throughmenopause, uh you just have to
have that counseling session.
You know, what are you morelikely to die of?
Well, certainly with this BRAC,ovarian cancer.
That's that's gonna kill you.
So get those ovaries out, is iswhat we all say.
And then, okay, how are youfeeling?

(41:30):
How are you handling menopause?
Is estrogen a risk?
Um, like I said, it's it itit's once it's there, then it
tends to be very risky.
But prior to that, estrogen isa very positive thing for women.

SandyKruse (41:45):
So then for those women, let's uh this is totally
hypothetical, but uh you know, Iknow people are gonna have this
question.
So let's say I I let's say Icarry the brackogene and I want
and I'm suffering with hotflashes, and I've done my
research and I know how much theestrogen can benefit me and my

(42:10):
brain and my bones and all ofthat, and ease my suffering.
And I say to you, I want to goon hormone replacement therapy.
What would be the first thingyou would do?

Yeah, so um it's it's always so when I look at
hormone replacement therapy, youhave to look at that
individual.
And I say to my patients everysingle time, your dosing and
what we do is between you and I.
There are risks in you walkingout of my building and getting
hit by a car.
You know, I don't consent themfor walking out of my building.
So when we look at hormonereplacement therapy, there are

(42:50):
risks and benefits as we look atthat.
When you look at the oncologyworld, they feel like there are
many things out there that areequivalent or just as good as
hormone replacement therapy forbone or for symptoms.
And you can always go thatroute because it is a little bit

(43:11):
of a gray area.
Um, not in my mind, but when welook at research and when you
look at oncology or cancerspecialists, they like yes or
no.
They like, does this drug cureor stop this cancer?
Uh, you know, so they like yesor no questions.
When you go into hormones orestrogen, it becomes so

(43:32):
multifactorial, uh, and howpeople process and things like
that going on that it becomesthat individual uh decision.
When you look at not ahigh-risk patient like a breathe
patient, but if you look at itat hormone replacement in
general, as many women die about40,000 a year of osteoporotic

(43:54):
related fractures uh orcomplications surrounding an
osteoporotic related fracture asthey do a breast cancer every
year.
So, what are women most likelygoing to die of?
It's heart disease, it's braindisease, it's bone disease.
And estrogen can potentiallyhelp in all those brain gets a
little bit fuzzy uh when we lookat dementia and dementia risks.

(44:15):
But an abrac patient, they aregoing to die of ovarian cancer.
I worry about that most.
So we handle that.
And then for the patients whoare really suffering, I say, you
are running an 80% risk ofbreast cancer here.
So um is estrogen going tocause this?
No, but once it's there, it canfeed it.

(44:35):
So, how much are these symptomsaffecting your day-to-day
living, your sleep, your stress,your sex life, whatever it is?
And so we have thatconversation, and then we go
over okay, is hormones right foryou?
And I say, Yeah, you're at ahigh risk of getting breast
cancer here.
Most of those women are, in myexperience, have been proactive

(44:56):
and they've chosen aprophylactic mastectomy.
When their breasts are gone,uh, that risk of breast cancer,
you can't say is totally zero,but it's clearly less than uh
half to one percent, dependingon the study that you look at
after a prophylactic mastectomy.
So I say that to my patientsbefore we get this testing or
along with the testing, are youready for a positive test?

(45:17):
Are you ready for somethingevery six months on your
ovaries, on your breasts?
Is that gonna be okay to livewith?
Is this going to push you andyou are you okay getting your
ovaries out and or getting aprophylactic mastectomy?
Because that conversation isgonna happen on a regular basis.
And how are you able to handlethat?

(45:38):
And menopause or that going on,and in and how do we handle
that?
And what are the choices forthat going into those choices?

SandyKruse (45:47):
That's really you know, this is why social media
can be really not great, becauseyou get those tiny little
snippets of information.
I'm so glad we're having thisconversation that's a detailed
conversation.
You get a tiny little snippetof information and then you pass

(46:08):
judgment, like, oh god, youknow, Angelina Jolie, like
that's just crazy.
But now the way that you'rereally explaining it, it makes a
lot more sense.
And a lot of people don't takethe time to research it
thoroughly and have really deepdiscussions with their medical

(46:28):
practitioner, which is reallyimportant.
So, like you're kind ofchanging my mind about this, I
have to say.
I had a different opinionbefore.

Okay.
Well, I'm giving you a piece ofmy mind, that's for sure.

SandyKruse (46:42):
I like that though, because you're you're really
you're stating fact and like ofwhat is fact with these women
who carry this gene.
So here's another scenario.
Yes, it is, it is and you know,I'm not a big person who, you
know, I don't like to fearmonger.
I don't like that, but I alsobelieve that knowledge is power

(47:06):
as well.

So these women can get this BRAC positivity at 20
years old before kids, you know,or 30 years old because their
mom got an early breast cancer,or all of a sudden their dad got
an early prostate cancer orsomething that kind of that
going on.
And so that is a patient you'vegot to talk off the ledge and
go over all of these things thatare going on now.

(47:28):
Because I have women who are 18with a positive brac gene.
And okay, how do we handlethis?
How a screening and stuff likethat, I counsel them even before
we get it, you know, this iswhat is what may happen, and
these are the things that we'regonna have to do the rest of
your life until I get yourovaries out or unless you have
your breasts removed.

(47:48):
These are things that we'regonna have to consider that are
hard.

SandyKruse (47:53):
Yeah.
So let's say, again, ahypothetical situation that I'm
sure that you've actually seenin real life.
Let's say I'm 45, no breastcancer, no ovarian cancer.
I decide to prophylacticallyremove the ovaries, remove the
breasts, do that.

Yep.

SandyKruse (48:11):
And then I'm 52.
Wait, let's say I'm I I wantedto start hormone replacement
therapy.
Let's say I want to now.
Can I do it if I did all thesethings?
Is it possible with monitoring?

So if we remove the ovaries, you're in
menopause.
Yes, right, right.
That will be an immediate harshsentence.
So rather than your ovariesstopping and starting and kind
of giving you some estrogen attimes and giving you
progesterone at times and not,um, it's this gradual
introduction to no hormones onthe estrogen and progesterone

(48:52):
side.
You are done, you know, onceyou leave that operating room.
And so those levels come downand with a couple of weeks, you
some women handle that prettywell.
Some women are like, This isthe worst thing ever, Dr.
Dore.
So, how they're going to handlethat is kind of the thing.
Usually within a couple ofyears, almost all women start

(49:12):
feeling that negative effect ofthat loss of hormones.
And when it's abrupt, it tendsto be a harsher sentence than
that natural decline that goeson that way, too.
If the offending organs, theovaries and the uh breasts,
hopefully that doesn't soundharsh, but if those are removed,
your risk of having a breastcancer is it's not zero, but

(49:35):
it's extremely low.
What's going to kill you?
Heart disease, bone disease,and brain disease.
And what is going to affectyour life and your
relationships?
It's it can be those loss ofhormones that go on.
You can band-aid that withnutrition and or you know, other
things, acupuncture.

(49:56):
There's many things that helpus with stress and and other
hormone levels, cortisol andthings like that that go on.
Um, but the loss of hormones,that is not fair.
And that's, you know, everywoman is eventually going to
have that, unfortunately.
Uh, but how women are able tohandle that, and then it's that
counseling piece on how do youfeel about going on hormone

(50:18):
replacement therapy?
This is not zero risk, it'sextremely low risk.
But when I look at the risksand balances and how this can uh
positively affect, especiallyquality of life moving forward
after that surgical menopause orafter natural menopause.
Am I a hormone person?
Yeah, I'm a hormone person.
But I have that talk with everypatient.

(50:39):
I get patients who are like, Idon't want to go on hormones
after door.
What can you do for me?
You have to have other tools inyour chest, depending on what
is that patient's orientation,what they are comfortable in
doing, and being able to helpthem through those symptoms.
So you give them the bestquality of life that you can
with or without prescriptions orhormone replacement.

SandyKruse (51:02):
So you're monitoring them if they choose to go on
hormones, you're monitoringthem, which is really important.

Yep.
With levels, with symptoms, youknow, it all depends on what we
can incorporate into theirlifestyle and help them with
that quality of life.
And then what am I doing?
I'm helping in their heart inmany different studies uh that's
saying it's beneficial toheart.
There's some societies who say,you know, there's no long-term
prevent that hormone replacementtherapy shouldn't be done for

(51:30):
prevention.
But we know that estrogen invirtually every study out there
increases bone density.
And all you have to do is see amom or somebody suffer through
an osteoporotic fracture andthey can't walk again, they
can't do anything, quality oflife.
You you look at that, and weknow that it certainly helps
very consistently heart and bonefor sure.

SandyKruse (51:51):
So let's look at another scenario, which would be
let's say I had breast cancer.
I have the brac gene.
Let's say I have that, I'm inremission.
I had my ovaries removed, but Ihad the cancer.
Is that still an option to goon hormone replacement if I'm in

(52:17):
remission?

I think uh option being the keyword there.
Uh so it is in manyoncologists' mind, uh, kind of
heresy, or I don't want tonecessarily say malpractice, and
going on estrogen after anestrogen receptor positive
breast cancer.
There are 20% of women thatwill have estrogen progesterone
negative breast cancers.

(52:40):
So you're probably in a safespace, probably because you it's
not very well studied as welook at that long term.
There are observationalstudies, not randomized
controlled trials, on looking atthat.
There's a great book by amedical oncologist out of
Southern California, Fornia,Fornia.
His name is uh Dr.

(53:00):
Avram Blooming, uh, and he hasa book called Estrogen Matters.
I've read that.
It is an awesome chapter thatuh it goes over when women have
an estrogen receptor positivebreast cancer, putting them on
estrogen and how he decreasesboth their recurrence risks and

(53:21):
certainly their all-causemortality by helping them with
their bone and brain and thosekind of things long term.
And I see women who handle uhthat hormone loss very well, and
I see women who do not.
And I get regular referralsfrom uh medical oncologists in
the area that have tried all thenon-hormonal tricks, and

(53:42):
they're like, I need you to gotalk to Dorr, he'll put you on
hormones.
And yeah, I have thatconversation with my patients.
I'm like, there is no suchthing as no risk.
But how do you want to live?
Is this affecting your qualityof life, your sleep, your
relationships, all this kind ofstuff going on?
And we go very low to be ableto help them.

(54:03):
What's that minimum dose thatwe have?
And there's no, you know,studies looking at what that
dosage is.
Uh, but you know, when men getprostate cancer, yeah, we pull
them off and and you know, wemake their prostates sick by
depriving them of testosterone.
But once they're cured, theseguys go back on testosterone and
we're able to follow them withPSAs or other tests.

(54:25):
Uh, you know, we just don'thave a BSA, a breast cancer
antigen uh gene to be able tofollow women uh to catch it
early with recurrences.
So that would be kind of myhope and dream is could we come
up with a liquid test for womenthat once they're cured of their
cancer, I can then put themback on estrogen because

(54:47):
virtually everybody across theboard is like, this is how I
used to feel, and testosterone.
That's a whole nother uh bag oftricks that I use.
Uh, and uh then we screen themwith something we can pick it up
very early with.
So that would be my medicalChristmas wish with women with
pre-existing breast cancer iscan we get a liquid test to um

(55:09):
help pick up stuff early, likemen?

SandyKruse (55:12):
I think you raised something really important just
in that little uh segmentbecause you mentioned quality of
life.
So we all know that you don'tsleep, your stress levels are
through the roof.
All of that in and of itselfaffects your quality of life,

(55:33):
and that can affect you gettingsick again.
I mean, listen, I have hadstressful situations that have
brought me to my knees, and Iknow like there is nothing worse
than when you don't have acontrol.
Like I had hormones when mydaughter was sick.

(55:56):
I was 40 years old, so I was inperimenopause.
But I'm like, I'm just saying,like, even then I had trouble.
And so imagine having had uhbreast cancer, having your uh
double mastectomy or whatever,having your ovary ovaries
removed, and then you're notsleeping, you can't handle the

(56:19):
stress, and it's this viciouscycle, Dr.
Dore.

Yep, exactly.
Yeah, so uh, you know, when youdon't have your sex hormones,
what does your body do?
It stresses your thyroid, itstresses your adrenals, and then
you start to get negatives inthose territories that way.
So we start to see thisimbalance uh that's created.
And like I said, uh certainlyuh diet, lifestyle, nutrition,
uh, that all helps.

(56:43):
So you want to help them inthat kind of least invasive way
possible.
But am I a hormone believer andI see women turned around every
day on hormones?
I I do, uh, but it's importantto look at that whole person.
And what if they when they putthat cream on or when they put a
patch on, or when they get apellet, I say, if every time you

(57:06):
do this, you think you're goingto get cancer, you're going to
get cancer.
So the mind is a very positive,is a very powerful thing.
So you've got to be on boardthat this is okay.
I feel very comfortable inprescribing this for you.
Again, there's no such thing aszero risk, but if you are

(57:27):
powerfully going towards anegative direction, we got to
turn that around or you can't betaking hormones.

SandyKruse (57:33):
I agree.
Yeah, the mind is powerful.
And it's just like when youkind of get your hormones dialed
in a little bit, then yoursleep is better.
Then you want to eat better,then you want to go for that
walk.
Then you, you know what I mean?
Like then you want to make aneffort with your partner instead

(57:55):
of yelling at them all thetime, which that doesn't work,
right?

You know, it's interesting.
Uh, this is not a breast orbrack uh cancer patient, but I
had a patient I've been seeingfor years.
She's a major athlete and justdone wonderful with hormone
replacement therapy.
She goes, Dr.
Dork, you know, could could youdo you would you see my mom?
Do you think my mom couldbenefit from hormone replacement
therapy?
This is a woman in her um uhmid-50s.
I said, Oh, sure.

(58:20):
So, you know, she brings in her95-year-old mother, uh, you
know, who's, you know, she's gota cane, she's a little bit
unsteady.
And I'm like, oh boy, what youknow, why did I sign up?
You know, she'd never been onhormones, but she was getting
progressively weaker, shecouldn't open the doors.
They were looking at um movingher into a skilled nursing

(58:41):
facility.
Uh, and um, so I kind of wentover her and we start very low,
uh, you know, and slow onhormones, kind of went over all
that risk with her.
It's funny because uh she hadhigh high blood pressure and
some kidney concerns, and shewent to her cardiologist and he
said, Hey, uh, she said, youknow, I've got this gynecologist
who wants to put me on estrogenand testosterone.

(59:01):
What do you think?
And he says, You're 95 yearsold.
What's it gonna hurt you?
Uh and so anyway, so she wenton hormones and she came back
into me, and she's and so herstrength came back, so she's
able to open up doors, she wasable to cook for her eight
children, Easter dinner.
Um, and her biggest thing wason hormones, her bladder got so

(59:26):
significantly better that shewasn't getting up two or three
times in the middle of thenight.
So there were many quality oflife issues that improved on the
hormone replacement therapy.
And she said, Dr.
Dora, the biggest problem isevery guy around my place looks
fantastic.
Uh so uh, so I said, Okay,let's dial your hormones back a

(59:47):
little bit that way.
So I brought her her libidoback on top of all of her
strength and everything.
But now she's still livingindependently now at almost 98.
Um, and she got rid of a lot ofher negative quality.
Of life symptoms.
So, you know, that was anothereye-opener for me that I think
people of any age can benefitfrom healthier hormones.
You just have to watch dosingand how you get it there.

SandyKruse (01:00:10):
I'm glad you mentioned that because that used
to be what you would alwayshear.
If you didn't start by thistime in your life, you cannot
take hormones ever.
Like that used to be the commonthing that you would hear that
you just if you know you havethis like little window.
And if you don't start by thatin that window, then it's too

(01:00:33):
late for you.
You're done.

Dr.BruceDorr (01:00:35):
Well, you get the best benefits uh under age 60 or
within 10 years of menopause.
After that, you have to uh it'snot quite as good when we look
at uh cardiac data uh and whenwe look at uh but bone can be
regenerative virtually at anyage.
Uh, you know, it's still notFDA approved for uh uh for

(01:00:55):
osteoporosis, but certainly forosteoporosis prevention.
So you do have to be careful,especially with oral hormones on
women's women greater than 10years or uh, you know, above age
60.
Uh so that that was the biggestthing that came out of the WHI.
Don't put women on Prem Prothat are above age 60, they
stroke.

(01:01:15):
Uh so you do have to be carefulon oral hormones.
So transdermals tend to be abetter or through the skin, not
oral, uh taken, uh tends to besafer in those uh you do just
get less benefits and a littlebit riskier.

Okay, so we should we covered a lot on the uh BRCA
and breast cancer and ovariancancer.
This was so informative.
I think it's important that wejust kind of give a little
information about syntheticversus bioidentical because this

(01:01:50):
is a question that it's almostlike it never ends.
The same question over and overagain.
And that is what's thedifference?
Can't I just take anything?
So can you just explain whatthe difference is?

Yeah, so unfortunately, when uh the term
bioidentical has a negative kindof uh non-approved or not
medically indicated slant to it.
So when we look here in Americaand when we look at uh that
that slant, the the FDA doesn'tlike that.
Uh they like human identical orthey like isomolecular.

(01:02:28):
What we mean when we say thatis that you're putting the same
thing back into your body thatyou have receptors for and that
you were meant to respond to.
When you look at synthetics, itmeans that it is similar to
estrogen, but it's not the same.
So when you look at premerin,uh, for example, none of those

(01:02:50):
uh uh estrogens, uh there arehorse urine-derived estrogens,
none of them are what uh the uhwhat the ovaries made naturally.
It's similar, but when yourbody sees similar but not the
same, you start hitting otherreceptors, and how you process
and break those down starts tobecome negative.
So you do get positives, and weknow there are positives in

(01:03:14):
taking horse urine.
Uh, is it as good or the sameas putting in 17 beta astradiol?
No.
So, same with testosterone,there are modifications of that
that way too.
And when you look from apharmaceutical industry
standpoint, what you need is auniquely patentable drug.
So if it is identical to thehuman body, that can't be

(01:03:37):
patented.
You can patent the uh deliverymethod to it, but you cannot
patent 17 beta-estradiol.
You cannot patent testosterone,uh, you cannot patent insulin,
you cannot patent dopamine orepinephrine.
So they didn't want onepharmaceutical company to have
the rights on insulin or thosekind of things going on.

(01:03:57):
So the modifications and thesynthetics altered uh kind of
like progesterone, but it's aprogestin, starts hitting other
receptors.
It can block testosteronereceptors or bind testosterone
receptors, it can start bindingum glucocorticoid receptors or

(01:04:17):
other things.
That's why some women that goon progestins gain weight, uh,
or because you're hitting otherthings, not just the
progesterone receptor.
So it's important that similaris not the same and it has
different reactions in our body.
So when you put back in what'smeant to be there and you

(01:04:38):
deliver it in the right way, weweren't meant to get our
hormones uh, you know, throughour stomachs, uh and they uh and
through then process throughour livers, that becomes a
little bit more risky when youlook at that.
So similar and so samedelivery, same chemical, you
tend to be in a safer space.

Okay, yeah.
So I've I've heard that takingoral estrogen poses a whole
other uh risk to menopausalwomen, right?
Like what is that risk again?

Well, when you look at there was an increased
risk of clot and gallbladder uhrisk in the WHI uh when uh you
took uh oral uh synthetics uhand combined with uh the
progestin.
So again, that's notbioidentical and that's not the
same estrogen or estrogens, thatis not the same progesterone.

(01:05:30):
It is a progestin, specificallyit was uh madroxy progesterone
acetate uh in that that study.
But um, when you look atbioidentical, when you put in 17
beta estradiol, they don'tnecessarily even see that in
some of these big like 16-yearstudies, the Danish osteoporosis
uh trial that looked at womenover 16 years on uh it was uh

(01:05:53):
oral 17 beta astradiol, and theydidn't have an increase uh
clotting risk uh in those thatway too.
So putting in the same uh tendsto be better.
Uh oral tends to be less safewhen we look at that, but like a
patch or a gel or a spray or apellet uh that is uh that is not
going through the liver tendsto be safer that you uh decrease

(01:06:15):
the gallbladder and clot risk.

You know, this just totally just came to mind.
I just never understood, andmaybe you provide clarity.
Why is there no form of birthcontrol that is more of a I know
bioidentical isn't the rightterm anymore, but like all the
birth controls, the IUD, thepale, all of them are all

(01:06:42):
synthetic, all of it.
Why is why did nobody make abioidentical version of a birth
control?
Like everything is progestin,everything is the um estrogen,
okay, not the horse um urine, uhfemale, what is it, pregnant
mare's horse urine?

(01:07:03):
But why do you have any answersabout that?

It's about absorbability and it's about the
half-life of that drug.
So oral progesterone, uh, youhave to go to very high doses
for absorption and thenprotection and then potential uh
suppression of ovulation.
So the modifications of that umyou can get by with better
absorption and less expense uhwhen you look at progestins uh

(01:07:32):
over bioidentical progesterone.
It's very hard to absorb andyou have to go to very high
doses.
And the side effects of it areuh sleepiness, sedation, uh, and
that going on.
So bioidentical progesteronetends to be ill-tolerated when
you look at um suppressingovulation and to help with birth

(01:07:53):
control specifically.
Progestins do a better job ofthat.
Um, and then there have beenformulations with bioidentical
estrogen.
So birth control pills aremainly progesterone and
progestins uh uh, you know,modifications uh with a little
bit of estrogen to help with thebleeding.
And there are certainly whatthey consider now natural uh

(01:08:14):
forms.
It's called estrol uh that'sout there now.
It is a fetal-derived uhestrogen.
Uh, it is a quaternary uhestrogen, is what they call
that, but it is bioidentical,but it's not like 17 beta
estradiol or those kind ofthings that when we look at
hormone replacement therapy, butit's about absorbability, it's

(01:08:34):
about side effects andtolerability when we look at why
a progestin rather than a uhbioidentical progesterone.

Oh, that's interesting.
So, because aren't pellets, sothat's your expertise is the
pellets.
Aren't pellets customizable?

Yeah.
So uh again, the reason, andagain, you can customize many
different things.
Uh, the reason I like a pelletis because people forget to take
their hormones, or uh you get ahundred uh hundred percent
compliant when we look atcompliance when you look at uh
putting a pellet in.
And so a lot of people, youknow, just coming in a few times

(01:09:15):
a year do better because theydon't leave their prescription
for estrogen or progesterone,uh, you know, in the cabinet at
home when they go to Hawaii orwherever, uh, as a deal.
It sounds like Toronto is aswarm as Hawaii, so we just all
should be going to Toronto uhinstead, right?
Right now, yeah.
Right, right.
So you get that complianceissue.

(01:09:37):
Uh, and yes, it iscustomizable.
You just have to be careful onthe dose.
So when I look at a pellet, Iam clearly getting it into that
patient's body.
Whereas when you do atransdermal, when you do pills,
there's varying rates ofabsorption.
But the beauty is that you canstop those if they're having any
problems or concerns.

(01:09:57):
Pellet, you can't take out.
So that's a negative thing thatgoes on.
So it's cost, it's about uhcompliance, it's about uh, you
know, that dosing, and then howfrequently I give them that.
Uh, that is also the otherthing.
So you just have to be cautiouson how much you're putting in,
how frequently you're putting init.

(01:10:18):
And you start out low to figureout that you don't give them
too much, whether or not that'sestrogen or testosterone.
So there's a smart way to dothat, and that's what we do uh
at the company that I lecturefor.

Okay.
And yeah, because it it justgoes under the skin.
So if you if you need to takeit out, you have to go to your
doctor to have it removed.

Can't take it out.
Can't take it out, can't takeout a pill.
Uh so that is something itdissolves like a Tums or a
ROLAIS or a Tic Tac.
So it you can dig it out, butyou're gonna leave a big divot.
You do not want to do that, uh,is the deal.
So you have to look at likethis is going in you, and I
can't take it out.
So that's why you go very lowto see how they tolerate that,

(01:10:59):
because it will be out of theirsystem within a few months.
So that's the beauty of it, butit's also the negative of it,
is the thing.
Whereas other forms you canstop or take out, and that's the
criticism from many factions orsocieties is that yeah, you
can't take that out.
What if they have a problem?
And you can get problems.
So it's about that counselingpiece on what is incorporable.

(01:11:19):
Uh, you know, are you going toremember to do this or take
this?
Uh, but people that go onpellets, uh, in in my
experience, uh, you know, amajority of people continue with
pellets.
When I do other forms, peopleget fatigued and they don't want
to put a cream on every day orthey don't want to wear a patch
or things like that.
The compliance rate is not asgood as with pellets.
So it's just all figuring outwhat they need.

(01:11:41):
You just got to go very low andfigure out what their uh what
their tolerability andabsorption uh is.

That actually makes a lot of sense.
Cause even still, like just inmy brain, I'm like thinking,
okay, well, you know, I I'vebeen a lot of this up and down
hormonally initially, but thenyou kind of get to that point
where you're like coasting.

Yep.

Right?
Like, and you're you're you Iknow hormones, listen, we all
anybody who's listening wouldknow that your hormones are
affected by your circadianrhythms and you still have
hormones.
You you're not flat.
It's not like you go dead aftermenopause with no hormones.
So there is still a little bitof fluctuation, but you're more

(01:12:27):
stable.
So it kind of makes sense thatthat's a time that would be
okay, Dr.
Dorr, I'm having thisconversation with you as you're
you're my doctor, and and I knowI've been in menopause for a
couple of years.
I've pretty been, you know,pretty stable in terms of my
dosage on creams andprogesterone pills.
I want something that I don'twant to have to think about.

(01:12:48):
So that might be a good time,right?
Yeah, yeah.

Nice to be able to offer everything because
everybody's different uh as faras what their tolerability,
whether pocketbook, you know,all that kind of stuff going on.
So it's important to be able touh offer everything to a
patient uh because it, you know,pellets aren't for everybody
and uh and creams are not foreverybody and patches.
So, you know, we're all we uhall have different uh needs and

(01:13:15):
uh tolerability and uh andcompliance uh rates that they go
on.

Yeah, yeah.
I I I know from experience.
I walk around like this, youknow, when I put it for like,
don't touch me, I can't touchanything, you know, because what
is it like 45 minutes beforeit's completely absorbed or
something like that, right?

Yeah, depends on the cream or whatever that
you're using, sure.

Yeah, yeah.
This has been such a wealth ofinformation, and you definitely
you killed it, Dr.
Dore.
You you did like thateverything, you all the
information that you provide isjust so useful.
And I appreciate you so much.
I just want to know where canpeople find more information?

(01:13:58):
Where can they find you?
Where can they find informationon pallets?
Let us know.

Yeah.
Well, um, you know, I'mavailable uh or uh our my bigger
organization that I lecture forand educate uh providers, uh
certainly around the country andCanada, uh, that uh that's
biotee.com.
And you can find a uhprofessional just like me uh on
there.
Um I'm pretty busy uh here inDenver, but there's a locator

(01:14:26):
that you could find our clinicis a thing that way too.
So uh, but in general, uh we uhit's that over 8,000 plus uh
provider network uh throughbiotee that offers pellets, but
it's training on many differentaspects, not just uh pelleted
therapy.

That's great.
Thank you.
Thank you, thank you.
Thank you so much for your timetoday.

Okay, you're welcome, and thanks for having
me.
It's always uh wonderful uhtalking with you.

Yeah, me too.
I hope you enjoyed thisepisode.
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Menopause & BRCA: Hormones and Cancer Risk With Dr. Bruce Dorr - Episode 292

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Menopause & BRCA: Hormones and Cancer Risk With Dr. Bruce Dorr - Episode 292