Episode Transcript
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Philip Pape (00:00):
Hey Wits and Wits
of Family.
Today is a quick bonus episode.
It's a replay of a conversationwith hormone specialist Karen
Martell about testosterone forwomen.
This was from early 2024, andI'm replaying this because Karen
is joining us for a live QAtoday, exclusively in Physique
University.
I wanted you guys to get ataste for the kind of specifics
(00:22):
that she gets into regarding themechanisms of our hormones, as
well as how to test, how tointerpret, what your doctor
might be missing, how to treatit, what options are available.
So very short, under 10 minutereplay today.
If you want to ask Karenquestions about hormones,
perimenopause, menopause,optimizing your health, join us
in physique university, go towits and weights.com slash
(00:43):
physique.
Use my code FREEPLAN to get afree nutrition plan.
And when you sign up today, youcan hop on the call at 12
Eastern.
If you miss it, there will be areplay.
But if you could join live,you'll be able to ask her your
questions.
I also want to let you know Ifixed a broken link in our most
recent episode with Karen.
There was a link in the shownotes to her hormone creams and
oils that you can get without aprescription.
(01:05):
So that link is fixed in theshow notes.
It's witsandweights.com slashKaren Martell.
And then use code Wits andWaits for 10% off.
I'll throw all that stuff inthe show notes, but enjoy the
replay on testosterone withKaren.
Let's go back to testing,right?
Because testing's always apoint of confusion, especially
in the traditional healthcaresystem where it's like, if you
could even get them to give youa test, it's blood work.
(01:26):
And usually that's notadequate, but it might be for
testosterone.
So let's let's break it down.
Exactly.
That's one thing that makes iteasy, right?
So how should a woman getaccess, get tested, and then use
the results properly.
Karen Martel (01:39):
So once again,
some really shitty man-to-woman
things here, which istestosterone's the only one that
they'll ever test free andtotal.
Women would they won't doestradiol free and total or
progesterone free in total.
It's only testosterone, whichis a little bit frustrating.
But you can't, that's a veryaccurate way to test your
(02:01):
testosterone.
And testosterone, we have alittle bit of a peak right
before we ovulate, I think togive us that drive to go out and
have sex and procreate.
But pretty much we don'tfluctuate like we do with our
other hormones throughout themonth with testosterone.
It stays pretty even keo.
We have that little flux on day12 right before we ovulate on a
(02:22):
28-day cycle.
But you know, besides that, youcan kind of just test whenever
in the cycle.
You probably don't want to teston that peak day.
Day 21 is what I wouldrecommend because that's where
we test the esterdiol andprogesterone in fertile women.
So might as well do yourtestosterone then too.
And so it is very accurate, butyou definitely want to do both
free and total in case your SHBGis too high.
(02:44):
And then test your DHEA sulfatein blood, test your sex hormone
binding globulin.
So we see if it's elevated.
Because one of the thingsthat's happening right now is
that a lot of women are fastingand fasting like hardcore
fasting, you know, one meal aday, two meals a day, and
they've been doing this for along time, or they've been
eating a really low carb diet,or and when they're fasting and
(03:05):
not eating that much, they'realso really low in protein.
So low protein diets, low carbdiets, too much fasting will all
raise SHBG because it makessense.
If we were back inhunter-gatherer days and there
wasn't a lot of food around, sowe're fasting, right?
Then the body is being told,don't get pregnant.
(03:28):
There's not a lot of foodaround.
And so SHBG naturally would goup because there's a food
shortage.
So it wants to bind up yourtestosterone, bind up your
estradiol, and so that you can'tget pregnant.
And so too much of that startsto signal to the system, don't
get pregnant, which is that'sreally the only reason why we're
(03:50):
here.
So your body's gonna compensatefor this, whether you like it
or not, where whether you wantkids or not, or care about being
fertile, this is what happens.
So we have to be really carefulwith that.
So testing that's a good idea.
Philip Pape (04:02):
So a couple of
things, because I actually just
put together a new episode aboutcarbs coming out.
And one of the interestingthings about a higher carb diet
was the increase in testosteroneto cortisol ratio that they've
seen, not in addition to theincrease in IGF one that you
talked about.
So the fasting and the low carband the low protein, are you
saying that that in general formost women that's not
(04:22):
recommended because of this?
Or what are you saying there?
Karen Martel (04:26):
It's it's a fine
line, is what I'm saying,
because we also become moreinsulin resistance resistant
because of the drop in hormonesas we age, which means
intermittent fasting can be areally, really important tool to
start implementing because wewill we need help being insulin
sensitive.
It's that women are taking ittoo far, they get results, and
(04:49):
then they're like, oh my God.
And then they stop gettingresults and they think, I better
do it harder longer.
Right?
Like, I better, oh, if I'meating two meals a day, I better
eat one meal a day.
Oh, I should be doing a 36-hourfast or a five-day fast.
And you you hear this from alot of like of the big
practitioners that are out thereon social media saying, like,
you, you know, do five-day fastonce a month, you know, do one
(05:12):
36-hour fast every single week.
And I'm like, no, most womencan't handle that, especially in
menopause.
It stresses the system out toomuch.
So you have to find thatbalance.
You have to know where yourcortisol levels are, you have to
know where your insulin's at.
So testing, of course, is superimportant.
We don't, we don't want toguess what's happening in the
body.
So some women that are insulinresistant, their cortisol's
(05:34):
okay, or let's say it's high,then I would probably say, you
know what, you need to beintermittent fasting more, but
you still want to make sureyou're getting in the protein
because if not, then that SHBGwill go up and it'll bind up
those hormones.
The other thing that will raiseit is thyroid hormones.
So if somebody's on thyroidmedication, which a lot of women
(05:55):
are, they don't realize thatthat's actually binding up their
hormones and sending them intomenopause early, which is
something that happened tomyself and nobody told me.
And I was like, what?
What's going on?
My total levels of estradioland testosterone are great, but
yet I'm missing a period, I'mgetting hot flashes, low libido.
And then I finally heard PeterAtia on who's huge, he was on
(06:18):
Huberman Lab podcast, and he wastalking about thyroid
medication raising SHBG.
And I'm like, what the frick?
Why isn't anybody talking aboutthis?
Like, how many women are onthyroid hormones?
So many.
Philip Pape (06:30):
A lot of yeah, it's
this is why women are so
frustrated, right?
And because it's I could justimagine like a piano of keys,
and every single key is like adifferent hormone.
And as soon as you press one,the other one goes up or down,
and they're all so interrelated,right?
Yeah.
Um, and even the thing aboutenergy availability, which
shameless plug, that's what wetalk about on your podcast when
(06:52):
my episode comes out, energyavailability, is that you you
need the energy there to supportyour hormones, but you don't
want so much energy that you'regaining a ton of weight, right?
And that's where it's like thisbalance for women to find out.
Karen Martel (07:04):
Like we can't be,
we got to get away from this one
size fits all because eventhough we know that we're still
doing it.
The majority of women are stillgoing, what's the next best
diet out there and trying it?
And oh, everybody's doing keto.
Well, I'm gonna do keto.
And it's like, but is that agood fit for you?
Like, where's your thyroid at?
Where's your adrenal system at?
(07:25):
Where are your hormones?
Like, you gotta look at thisfull picture and then decide,
okay, I'm you know, inflamed,I've got PCOS, I'm insulin
resistant.
Then yeah, keto could be greatand it could reverse all of
those things, but then you wantto, you know, start carb
cycling, and you know, there'sthere's a lot of nuances to it,
and everybody has to find what'sgonna work for them.
Philip Pape (07:48):
So going back to
the blood work, uh, free and
total testosterone, DHA sulfite,SPG, what else?
Karen Martel (07:54):
S HPG, yep.
And then of course you want totest your acidion progesterone
as well, because there is somesome evidence that shows that
women should actually be like ifyou're gonna replace your
hormones in perimenopause andmenopause, there is some
research that shows it'sactually better to replace
(08:15):
estrogen and progesterone firstfor three months, then put in
the testosterone.
So I always want to see thatfull picture.
The other way that I I wantpeople to test is through urine
metabolite testing.
Now, oddly enough, testosteroneis actually the least accurate
on urine metabolite testing.
So you think, okay, well, thenwhy are you saying that we
(08:37):
should do this, Karen?
Well, in the a Dutch test,which is dried urine hormone
testing, we have testosterone onthere.
We've got the DHEA sulfate onthere.
But if you have a genetic SNPwhere you're missing these
enzymes called the UGT enzymes,you won't pee out that
(08:58):
testosterone.
So it looks like you have nonewhen you actually have plenty.
So I always want women to doblood work on the same day or
the next day so that we cancompare the two just in case
it's more common in Asianbackgrounds.
So if you're you've got, youknow, if you're Asian yourself
or you've got Asian in in yourfamily history, then you may not
(09:20):
have that enzyme.
I don't have it, so I alwayslook like I have test low
testosterone.
But the other piece of thepuzzle that we want to see on a
urine metabolite test that bloodwork won't show is something
called five alpha reductaseenzyme.
And so there's a fan gauge onthe Dutch test, and there's five
beta and there's five alpha.
(09:41):
If you are leaning towards afive alpha pathway, so the on
the fan gauge, if you're wayover to the five alpha, it means
you convert your testosteroneat a higher rate to what's
called dihydrotestosterone,which is the most androgenic out
of all the androgens.
And so that's where we'll seewomen, if they go on
(10:04):
testosterone replacements, thenthey if that goes up, the DHT
goes up, they start having thehair loss, the greasy skin, the
acne.
And so that's not that's notpleasant.
Women can get whispers, have,you know, can start growing the
clitinous, as I call it.
So your your P your clitoriscan actually start to get
(10:26):
longer.
And you Yeah.
Which is not fine.
And I've heard of women thishappening to them, their voice
cracking, and just from being ontestosterone replacement.
Philip Pape (10:36):
And that's if you
lean more toward the alpha side,
you said?
Correct.
Karen Martel (10:39):
Yeah.
Philip Pape (10:39):
And does that mean
you shouldn't be taking therapy
if that's the case, or do youjust have to modulate it and be
more careful with the dosage?
Karen Martel (10:45):
Exactly.
And you have to possibly takesomething that's going to stop
that conversion.
So it blocks the five-alphareductus pathway.
There's herbals that do it.
There's also medication, uh,finasteride and doasteride that
will block that conversion.
So a lot of women will take themedication so that they can get
(11:06):
the benefits of testosteronewithout having the masculine
features.
But there's lots of that, likesaw palm meadows, really good
for it, pumpkin seed.
There's a bunch of differentthings, ink, that can help.
Philip Pape (11:17):
That's it for
today's replay.
If you want the fullconversation with Karen,
including naturalsupplementation strategies,
treatment options, you can goback and listen to the full
episode 135.
And remember, join us fortoday's live QA with Karen in
Physique University.
Go to witsandweights.comslashphysique.
Use my code FREPLAN again,witsandweights.comslash
physique.
And I will see you tomorrow forthe next full episode.