August 1, 2025 • 44 mins
Welcome to The Dusty Muffins—a podcast where expert insights meet unfiltered conversations! Join your hosts, Dr. Aoife O’Sullivan (MD, MSCP), Dr. Christine Hart Kress (DNP, MSCP), and Dr. Rebbecca Hertel (DO, MSCP), as they dive into the ever-evolving world of medicine, women’s health, and the unexpected intersections of healthcare and pop culture.
In this episode, the trio tackles the hot-button topic of medical influencers and the growing role of social media in shaping public perception of healthcare. From the FDA’s latest advisory panel on hormone therapy to the challenges of balancing credibility with online popularity, they break down the complexities of being a medical professional in the digital age.
Key Discussion Points:
✔ The Rise of Medical Influencers – How TikTok and Instagram are changing patient education.
✔ Credibility vs. Popularity – Can doctors be both trusted experts and influencers?
✔ Women’s Health & the Midlife Treatment Gap – Why social media is filling critical voids in care.
✔ FDA Advisory Panel Insights – What recent discussions on hormone therapy mean for patients.
✔ Health Equity & Representation – Who gets a seat at the table in medical debates?
✔ Free Education or Misinformation? – The double-edged sword of medical content online.
Whether you're a healthcare professional, a patient navigating online advice, or just curious about the wild world of #MedTok, this episode is packed with insights you won’t want to miss!
Connect With Us:
✨ The Dusty Muffins: @thedustymuffins
✨ Dr. Aoife: @portlandmenopausedoc
✨ Dr. Rebbecca: @drrebbeccaherteldo
✨ Dr. Christine: @christinehartkress_dnp
🌳 Link Tree: linktr.ee/thedustymuffins
Other Links:FDA Advisory Panel Video: https://www.youtube.com/watch?v=_2ZRlOivC5M
(Disclaimer: The Dusty Muffins are doctors, but they are not YOUR doctors. Always consult your healthcare provider for personalized medical advice.)
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
In this episode, the trio tackles the hot-button topic of medical influencers and the growing role of social media in shaping public perception of healthcare. From the FDA’s latest advisory panel on hormone therapy to the challenges of balancing credibility with online popularity, they break down the complexities of being a medical professional in the digital age.
Key Discussion Points:
✔ The Rise of Medical Influencers – How TikTok and Instagram are changing patient education.
✔ Credibility vs. Popularity – Can doctors be both trusted experts and influencers?
✔ Women’s Health & the Midlife Treatment Gap – Why social media is filling critical voids in care.
✔ FDA Advisory Panel Insights – What recent discussions on hormone therapy mean for patients.
✔ Health Equity & Representation – Who gets a seat at the table in medical debates?
✔ Free Education or Misinformation? – The double-edged sword of medical content online.
Whether you're a healthcare professional, a patient navigating online advice, or just curious about the wild world of #MedTok, this episode is packed with insights you won’t want to miss!
Connect With Us:
✨ The Dusty Muffins: @thedustymuffins
✨ Dr. Aoife: @portlandmenopausedoc
✨ Dr. Rebbecca: @drrebbeccaherteldo
✨ Dr. Christine: @christinehartkress_dnp
🌳 Link Tree: linktr.ee/thedustymuffins
Other Links:FDA Advisory Panel Video: https://www.youtube.com/watch?v=_2ZRlOivC5M
(Disclaimer: The Dusty Muffins are doctors, but they are not YOUR doctors. Always consult your healthcare provider for personalized medical advice.)
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Dusty Muffins, where menopause meets sisterhood and strengths.
We're three minopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause, im paerimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and applicate all with a dash of
(00:25):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in. Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is
the Dusty Muffins. I am a doctor a re Recca Hurdle.
(00:48):
I'm a Board certified osteopathic family medicine physician and a
Menopause Society Certified practitioner. I have a private telemedicine practice
and I see patients in several different states.
Speaker 2 (01:00):
Doctor Efa O'Sullivan a Board certified family physician and Menopause
Society certified practitioner, and I see patients through my telemedicine
practice here in Oregon and Washington.
Speaker 3 (01:11):
I'm doctor Christine Harkrass, a Board certified Women's Health Nurse
practitioner and Menopause certified practitioner, and I see patients via
telemedicine in several states as well.
Speaker 1 (01:23):
All Right, hey, everyone, welcome back to the Dusty Muffins. Today,
we're going to discuss the FDA's live advisory panel on
July seventeenth, twenty twenty five. This focus on whether lo
dos vaginal estradial should retain the same black box warning
as systemic estrogen. This is viewed on the FDA YouTube.
You can actually go back and rewatch that. I've watched
(01:45):
it live and rewatch it actually with my husband, believe
it or not. He wanted to watch it and he
was like really excited to listen to everybody. So I
thought that was kind of neat too. This emphasized the
significance of perimenopause, general urinary symptom, and the broader midlife
treatment gap.
Speaker 3 (02:04):
So I did like the fact that that panel was
pretty diverse, although they had some what everybody calls influencers
from social media. On there, there was academics and the researchers,
So I think they did a fairly good job at
representation with one exception, and that is there were no
(02:24):
advanced practice providers on that panel, which we, you know,
take care of the largest proportion of these patients just
by the number of US, and so not having an
advanced practice provider, whether it be a PA or an NP,
is really that lack of representation is really a health
(02:48):
equity issue.
Speaker 4 (02:50):
You know that.
Speaker 3 (02:51):
That is my only really big critique about the makeup
of that panel. I thought the people on there were fantastic,
but I think that the events practice providers, there was
nothing that was said on that panel that we didn't
have the brain power to do.
Speaker 1 (03:08):
Echo. Nope, I agree.
Speaker 2 (03:10):
Oh, medical schools and residencies have been ignoring women's health
care for eternity forever and who's been taken care of
all the midlife problems and the apps have? So yeah,
I totally agree with you.
Speaker 1 (03:26):
Yeah, And I think and I think we can step
back for a second and say, Okay, they were influencers,
but it doesn't mean that they're still not experts, right,
And I think that when there has been some backlash
at the influencer stage, these are still practitioners that are
very well educated and experts in their field. And so
(03:48):
I think, you know, we've all talked about that point, Like,
you know, there is that little thing going around social media.
Are you expert or influencer? And well, gosh darn it,
we're we're all both. Like you know, we're experts in
our field and what we do, but we're also influencing
women to take a stance for their health, for their education,
and for what they need for you know, their midlife care.
Speaker 2 (04:10):
Yeah. I have really come to hate that word. I mean,
you know, if you want to call one of those
doctors an influencer, I would love to put their CV
up beside them. Yes, you know, I mean, these are
highly trained physicians and surgeons, and just you know, there
are people out there trying to reduce them to influencers and.
Speaker 1 (04:34):
Without credentials, right, without having their credentials inappropriate appropriate If.
Speaker 3 (04:40):
They weren't on social media and just had their CV,
no one would think any less of them.
Speaker 1 (04:49):
You know.
Speaker 3 (04:49):
And I think, you know, I think that the people
who are criticizing us for being on social media, I
think they really need to take a hard look at
the academics and the people and you know, the other
providers that are in the actual exam room gaslighting their patients,
gatekeeping hormone therapy. The only reason why we're over there
(05:11):
is because it's a creative and fun outlet to educate,
and we re educate people, but we're also educating in
so many other forums. And you know, when I you know,
lecture for the nurse practitioners, they don't refer to me
as an influencer. They refer to me as a thirty
(05:31):
year you know, veteran of women's healthcare. And so, you know,
the reason why we're over there is because we enjoy
the interaction with people and want to educate more women
because of these idiots in the exam room, who are
you know, just being absolute assholes to patients who really
(05:51):
just need to retire. And I've said this a million times.
If you're not going to give hormone therapy because you
are uneducated, you should not take care of these women.
Speaker 2 (06:00):
Yeah, the biggest issue I have with it is these
ninety percent of the people who are complaining about the
influence influencers are on their Instagram account complaining about the influencers.
Speaker 4 (06:15):
I'm sorry, right, gas lighting?
Speaker 5 (06:18):
I mean, are you telling me not to believe my
own eyes. You're fucking there on your Instagram account bitching
the other people on their Instagram telling someone vitamin D
and you have a book to sell, like you know,
come on, yes, just yes, it's ridiculous.
Speaker 3 (06:37):
It's you know, their page, right or me on page
and get on there and educate if you think that
there's other.
Speaker 2 (06:43):
Other and most of them are Christine, That's what they're
complaining from their Instagram page, and you know so they
are an influencer, right.
Speaker 3 (06:53):
Absolutely, Well, I see what you're saying. Oh, I just
thought you meant the stalkers.
Speaker 1 (06:58):
You know that you never know they're probably paid. But
you know, we all we all just briefly touched on
this before we started recording, and that was this is
a community. We are a community of practitioners that should
be encouraging each other, uplifting each other, having amazing conversations
(07:18):
for the greater good. And that came truth in this
whole you know, little Nicki Minaj thing that and it
was having these challenges of like this is amazing. You
just encouraged me to do something I never thought I
could try to do. You just encouraged me and so
and that can be with any of these things. You
just encouraged me to get on to social media where
I never would have done it before, to educate women.
(07:40):
So that's what I want this medical community, you know,
of practitioners to do. We should be lifting each other
up in midlife and in educating together and having great
conversations together. We may not all agree on the same thing,
and that is okay, but you know, bulling each other
and tearing each other down is not cool. It's not sexy,
(08:03):
it's not professional, and it's very you know, offsetting.
Speaker 2 (08:08):
Get online and have an Instagram live with the person
you're talking about, yeah, and ask them questions and have
a medical discussion because you know, usually it's it's a
physician and you know they've been treating patients for years
and you're both on the same side and you're fighting
the same fight, so you have lots to talk about
(08:31):
and then ask them your questions or bring up your
problems or whatever about their supplements or whatever else is
the issue.
Speaker 1 (08:37):
And then we wonder why people can't People say that
they're they don't trust doctors. Well, I mean, look at
what the hell is going on.
Speaker 2 (08:44):
Yeah, it's ridiculous.
Speaker 1 (08:46):
Yeah.
Speaker 2 (08:46):
So it's nice to see everybody come together for the
FDA channel. You know was a real united front.
Speaker 1 (08:53):
It was. And so what I'm interested in is what
what what do they these panels typically look like? So
for the first time we've had this type of panel,
what did they look like before? And to Christine's point,
did they you know, did they have nurse practitioners and
pas in this research setting when they would typically have
(09:17):
you know, these scientific get togethers or panels. Does anyone
know kind of how this worked? I know a few
people have touched on that a little bit before we
dive into you know, who was on there and what
was said.
Speaker 3 (09:28):
Well, I know that you can apply when they are
open to sit on the advisory committees. I do know
that the president of NPWH, which is the Women's Health Organization,
has applied several times and she's got quite impressive credentials
(09:49):
both as fmp CNM and Women's Health MP and has
not been yet selected. But I think probably more so
the case is is that people, I mean I didn't
know that there was an open call for candidates and
an application piece because I don't think any of us
(10:09):
ever thought, oh, I should be on FDA advisory committee, right, Like.
Speaker 1 (10:13):
I don't, I know, how did that even come about?
Speaker 3 (10:15):
I'm like, yeah, so, I mean I think probably, you know,
people closest to DC are probably on most of those
FDA maybe coming out of the NIH, which you know
now has been their research been gutted. So maybe, I mean,
it's kind of interesting that, you know, I'd love to
know why they expanded to physicians that have no research platform.
(10:41):
It's kind of interesting. And who else was requested but
not but didn't accept the invitation because there are some
folks that Lauren Striker or doctor Striker has been pretty
loud about the fact that she was asked to go
and elected not to because she didn't think that this
process would be good for women's health long term, because
(11:02):
this is not following the process on how you make
a decision to do black box warning and was afraid
that that would my understanding, would then be extrapolated to other.
Speaker 1 (11:13):
Things, right, systemic therapy and things like that, right.
Speaker 3 (11:16):
Or even like the in the abortion arena, some of
those medications. So yes, but yeah, I don't I don't
think anybody knew so the advanced practice providers just I mean,
and they didn't the FDA didn't even probably think I mean,
how many work yeah for them?
Speaker 1 (11:34):
Who knows?
Speaker 2 (11:35):
Yeah, I think this was It was a media event, right,
and we know that we're not stupid. We know that
nothing may come of it, but let's not throw the
baby out with the bathwater. I don't think any of
us are big Marty McCray fans. We know how he
feels about for women's choice and abortion, which is not
(11:55):
how we would think of it. But this was an opportunity.
I always looking on it as an opportunity to get
the word out, you know. And I knew this was
going to be recorded, and this would be something I
could share with patients and other clinicians, and having the
FDA label attached to it gives it some sense of,
(12:16):
you know, professionalism, you would hope. So it was an
opportunity to spread the word and hopefully take away some
of the fear that's been around for the last twenty years.
And I wonder how many people watched it and went, wait,
estrogen doesn't give you breast cancer, you know, Like that's
what I was hoping would come from this. But like
(12:37):
doctor Lawrence Striker, was saying, this is not how things,
This is not how you do things at the level
of the government, and there has to be a proper
scientific panel, and that's not what this is. This is
a media event, so it'll be interesting to see, I
suppose what actually comes of it. But for me, I'm
going to take what I can out of it and
I'm sharing it because there was such good information shared.
Speaker 1 (13:00):
Ish want the Dusty Muffins at your next event. We
do panels, live podcast and talks that bring the heat
literally corporate see me or retreats. We've got you, so
hit us up at the Dusty Muffins three three three
at gmail dot com or d ms on Instagram at
the Dusty Muffins.
Speaker 3 (13:16):
Do you think I got watered down at all with
I mean, because my understanding with the when when we
started hearing about it was just to remove the black
box warning on vaginal estrogen, which we'll talk about here
about why that so needs to happen. But then you know,
(13:36):
then there was the focus on the doctor's education, and
then testosterone and then cardiovascular risks, and then the breast
cancer data, which was all really good information. But you know,
and to your point about being a media event. I mean,
do you think that the panels panelists should have focused
(13:56):
on what seemed to be the goal, and maybe I
got the goal wrong. Instead of making it a why
we should have why we should allow MHT and have
it have the label changed for all hormone therapy.
Speaker 4 (14:12):
What are your thoughts.
Speaker 2 (14:14):
I don't think there's the right answer to that. I
think you could have kept it all to do with
imaginal estrogen and been a fantastic meeting. But I have
to say, we are living in crazy times, absolutely crazy times,
and there are no rules anymore, and none of us
know what Marty McRae could do with the swipe of
(14:37):
a pen. For all we know, he could get rid
of all these warning labels, label estrogen's appropriately, label our
hormones appropriately. He could take a testosterone off the scheduled
drug list. We don't know what this man could do.
There are no rules anymore. This government is loopy. So
(14:59):
I I personally it was like throw it all in
there and see what we.
Speaker 1 (15:03):
Can get in, you know.
Speaker 2 (15:05):
But I think there's no right answer to that. The
purists say it should have just been the imagine estrogen.
I'm one of those people who can't leave any white
on a coloring page, like everything is to.
Speaker 4 (15:16):
Be colored in.
Speaker 2 (15:17):
So I definitely would have been like, yeah, I'm gonna
try for the testosterrum. Definitely.
Speaker 1 (15:24):
I think I agree too. I think if you invited
the practitioners that you invited, knowing their platform and knowing
their you know, what's close to them, what is what
is the most important to them, I can't imagine that
you didn't think that they weren't going to touch on
(15:44):
those things. Whether it have been right or wrong or
indifferent or you know, I don't know what the letter
said that said, you know, hey, it's about taking the
you know, the black box label off or bring to
the table your five minutes of what you think is
the most important. I don't know. I'm kind of interested
to know, or you know, was it just hey, we're
(16:05):
going to take our five minutes and and yes it
needs to be off, but I'm really going to also
take this time to talk about some other things that
are really really important too. It's interesting and I kind
of agree to. I don't know that we lost the
concept of the true you know, the goal, but boy,
you took you took advantage of some time to be like, hey,
(16:27):
this needs to be done to, and this needs to
be done to, and this needs to be done to
while we're.
Speaker 3 (16:30):
At it, and I love I love like, you know,
like the people we read their studies, like like you
could see them, like you know, they're you know, more
of the academics, and you don't see them as much.
Speaker 4 (16:45):
Like Barbara Levy.
Speaker 3 (16:46):
I was like, oh, and look at Joe Prington, who's
right here in my neck of the woods. And I
mean we see Jim Simon, yes, every Monday, but most
people don't know about him.
Speaker 2 (17:00):
He Cerel and Ard hotus, Like it was so cool
to see everybody.
Speaker 1 (17:05):
Yes, it was like I get all the studies and
then I saw the faces and I was like.
Speaker 4 (17:12):
It was our super Bowl. It was our super Bowl.
Speaker 1 (17:16):
Yeah, Jim's Simon And I was laughing so hard when
he just came out. There was like it just doesn't
do that, and I'm like, no, it doesn't.
Speaker 2 (17:32):
And it's all related, right, Like if we go back
to should we should we've done this, should we've done that?
Let's let's be honest. It's all related. It's all wrong.
Everything is labeled incorrectly. There is fear attached to everything.
We're really harming women. We've loads of brilliant evidence on
(17:52):
female to male transitioning with ten times the dose of
test asternomic. It's all wrong. We're doing everything wrong. We're
harming women. So we have one chance to talk about
this because who knows of anything like this will ever
happen again. Like, how could you not try and squeeze
some of this in?
Speaker 1 (18:08):
Yeah? You know, And I loved the five minutes and
how it was put together. And have you ever seen
so much squalls?
Speaker 3 (18:18):
No, you can't even Like, I'm like, what on screenshot microprint?
Speaker 4 (18:25):
I would love to get those slides.
Speaker 1 (18:27):
Yeah, you know.
Speaker 4 (18:28):
One thing, one thing that.
Speaker 3 (18:30):
Resonated with me was doctor Leevy. You know, she talked
about not all hormones are the same and that estra
dial binds differently than conjugated aquine estrogen. And she said
that you can't classify the risks, but also said you
can't classify the benefits the same.
Speaker 4 (18:48):
So and we do.
Speaker 3 (18:50):
All the time, Right, any benefit we get out of
the w H I I mean there are a few,
but not a lot on I mean it made me
think for a minute, and I was like, are we
are we extrapulating the benefits? I mean, like, you know,
can we say that. I mean we think we can
because it's what we it's most like what we are
(19:14):
making ourselves. But we only know the benefits for the
most part for conjugated quin estrogen. So I you know,
like it makes me think. You know, I'm always thinking
when I'm when I'm when I am educating, I'm like,
because I don't want to overpromise, right, I've.
Speaker 2 (19:29):
Started the keeps in the Elite study, and that was
all estradyle. You know, like we do have studies.
Speaker 1 (19:36):
Sorry, no, no, I was going to say I when
I talk about the w H I I have now
really have made sure to say, listen, it was conjugated
equine estrogen. We have estradle. We are extrapolating from other
studies that this benefit also, but but really, when we're
looking at that study, it is conjugated equin estrogen. It
(19:58):
was not estradyle. So and women do appreciate that, you know,
same thing when we talk about medoxy progesterin acetatin and
into the micronized progesterone, you know, we believe this is
breast noll breast you know, as far as the MP
and but more data, more studies, as as we always
(20:19):
are saying, you know.
Speaker 3 (20:23):
Yeah. The other thing that I thought was interesting that
she said was, you know, you hear I hear quite
a bit, you know, you know the over sixty five
or women over sixty approaching into the age sixty five,
and their providers are trying to take them off the
hormone therapy. And she made a point not even the
(20:44):
WHI encouraged a stop time, you know, the grandmother's hypothesis
of you know, best benefit it started, doesn't There was
nothing in the WHI of risks of continuation.
Speaker 1 (20:59):
No. No, I just saw someone recently, a new patient recently,
and who said that her practitioner started her and told
her in a year she needs to go off. And
I'm like, well, where did that one come from. I've
not seen that anywhere. It made zero sense, and she
wasn't even close to sixty. I thought, we're just making
(21:19):
some shit up here.
Speaker 3 (21:22):
I think some of that she pointed out, has to
do with the fact that the meta for the for geriatrics,
which is what you are when you're sixty five, is
on the hazardous list. Yeah, and it impacts the heatis metrics,
which therefore then impacts reimbursement, and so.
Speaker 1 (21:39):
Yeah, maybe maybe I get that at sixty five. You're right,
I could see that at sixty five, but not under
sixty for them saying that. But maybe that's where she's
extrapolating it from. I don't know. It was nut so.
Speaker 4 (21:54):
I thought it was a.
Speaker 3 (21:56):
Good point of need to stop, you don't it's been
and more. And I didn't realize that it was probably
an insurance thing.
Speaker 1 (22:05):
Yes, oh yes, yes, you get yes, your myps and
myths and pips and heatous and all the things. You know.
I mean, I thought the panel you know, we can
go through a couple you know. Doctor Heather Hirsch was
on there. She argued that bageo estrogen was categorically safe
because it's not systemically absorbed. That's kind of you know,
the big Most of the panelists on there again discussed
(22:29):
that you know that that existing boxed warning is unsupported
by evidence and is misleading, discouraging both patients and prescribers.
I agree with that one hundred percent. How many times
have we had patients I actually, you know, I don't
go on there and exit, exit out because my patients
typically don't bring in their vaginal estrogen. But I make
it a point to tell them they are going to
(22:51):
read something that is going to be, you know, very scary,
and they need to crumple that up and throw it away.
And I tell them why they need to do it,
because you know they'll ask you, well, why is it
on there? Then? And so then I have to go
through you know, that just takes a lot of time
to then educate, right, so, and in an insurance model,
this education takes time, and so there lies the problem.
(23:14):
So it may not be us, as you know, those
of us in this concierge space where we are private
practice and can take more time with our patients, but
an insurance based model, when you have maybe maybe five
minutes after you have been roomed to then go through
all of that, it's tough. That was my little stillbox.
Speaker 3 (23:37):
Well then even doctor Pinkerton then was talking about the
studies crandall had done a meta analysis and they were
talking about the average serum level for women in menopause
is four point five puco grams per milli leader, and
then when they're doing vaginal estrogen it's somewhere between four
and fourteen puico grams per lead. And then with the
(24:01):
ring it goes up to nineteen, but by day two
it's back down to that four to fourteen, which is nobody.
Nobody's feeling good on an estradial level between four to fourteen.
But just about the fact that there's no systemic absorption
and it just doesn't do that, and your breast cancer patients.
Speaker 4 (24:25):
I think that it was also looking at.
Speaker 3 (24:27):
The breast cancer patients and put the breast cancer patients
that are, you know, in treatment, give them some vaginal estrogen.
Speaker 2 (24:36):
And just for reference, you know, our husbands, they're estradial
levels are probably somewhere between twenty and forty.
Speaker 4 (24:42):
Oh that's just for next year.
Speaker 2 (24:44):
Men have estradial two. Usually you are aund twenty thirty forty.
So when you have your vaginal estrogen and on your
estrogen's nineteen, which is as high as it gets and
then goes down.
Speaker 1 (24:57):
Yep, that's pretty safe. I think I love that men.
Yeah estrogen.
Speaker 3 (25:02):
You know, I don't study men's health. When I heard
that it just a couple of years ago, it just
made me laugh my ass off.
Speaker 1 (25:09):
I'm like, yes, when you tell your patients that, yeah, yeah,
the more patients that they're just like really, I'm like, yes, yes,
your spouse. Yeah, your male's spouse.
Speaker 2 (25:22):
Doctor caspercent. It might have been during her the Baby
Boomers Are Pissed episode, because I love that episode. I
definitely listen to that so many times, so I think
it was during that one. But she said about there
was a study where they blocked men's hormones, their testosterone
and their estrogen, and they lost all their libido and
then they just gave them back the estrogen and.
Speaker 1 (25:43):
They all got there.
Speaker 2 (25:45):
You know, I thought that was very interesting. I'd say
that was very difficult for doctor Rubin to tell that
story about her mom. She was very brave to do
that because I'm sure.
Speaker 1 (25:57):
If you would just break down. Yeah, I was on
like breaking now yea ice you for a long time.
Speaker 2 (26:07):
Yeah, and that information, but you know, just that story
of having to convince a first world country intensive care
unit of the importance of preventing a urinary tract infection.
I mean, working in the ICU, you lose patience to
urinary cepsis every day. They're in for pneumonia. You're doing great,
(26:28):
You've tried six antibiotics, the six one work. They've been
on the ventilator for a month and they're getting places
and the next thing, they get a urinary sepsis and
they're dead, you know, And to think that she had
to go in there as like a grieving daughter pretty
much and convince the staff to give them telling that
we have guidelines for and teach them. I mean, I
(26:51):
really hope people listening to that really went, what the
actual fuck? What ye like that we should not have
to do that.
Speaker 3 (27:00):
You know, the nurses don't do anything has to do
with the vagina. They don't touch the vagina. The vagina
doesn't exist as autistic.
Speaker 1 (27:07):
Catheter andy, you know that, Like they don't a little
bad lestrogen as you're putting that catheter in. But I
think people underestimate, even in just primary care or even
internal medicine. I would say that when you have a
patient that comes in act and loopy, a female in
particular that is number on my list, go out and
(27:29):
go give a yearine down the hall right now. And
if I don't, it is I would say in the
nineties of the percent that it is positive, right, I mean,
it just is, like you guys, this is on our
radar as just primary care and interness alone, right like,
so it just put we're not putting two and two
(27:50):
together here, Why does that happening? Well, there is a
distinct reason why. You know, have you looked probably you're
not looking at the volva and vagina to actually see
what has happened, that that laby has gone, and that
there's literal adhesions, that you know, all of the other
things that are happening too. Because I think if you
truly understood that, which you should, if you are a
(28:12):
primary care internal medicine let alone, you know your g
I N taking care of elderly women, you need to
know these things because.
Speaker 2 (28:20):
We're not taught that. Rebecca, were you ever taught to
had to examine evolva in your training?
Speaker 4 (28:26):
Okay?
Speaker 1 (28:26):
I was? I was only I was only because we
had a really strong women's health portion of our residency
and I went to extra training and I cannot for
the life of me where I went to go learn
kolposcopy and volvoscopy. I did that in residency on my own, yep, yep.
(28:46):
But otherwise, no feeling off in midlife. I'm doctor Becker
Hurdle and I offer concierge telemasine across multiple states focused
on hormones, weait, libido, and sleep and longevity let's get
you thriving. So visit www dot astopathic midline dot com.
Speaker 3 (29:01):
You know, I had a patient this in the last
month or so. She's sixty five on hormone therapy, just
doing some tweaks for her and we were talking about
going to the gynecologists because you know telemedicine. You know,
we haven't yet figured out how do your perp smear
via telemed And she's like, well, my she her primary
(29:24):
does her desert was doing her paps in her annuals.
And they said, no, we're not going to look at
your vulva or anymore, and you don't need a pap smear.
And I said, but you do need an exam. And
I said, I agree, you don't need a pap smear
your last seven or normal. You have no history of
you know, moderate to severe displasure.
Speaker 4 (29:44):
That's fine.
Speaker 3 (29:45):
I'm like, but someone needs to look look at your
vulva and look in your vagina. And she was like, well,
they won't do it. I'm like, well, then you need
to go see it. You got to go to a
gynecologist because you don't need paps, but you should still
have a look. And you know, if you're not having pain.
You don't need to buy manual, but someone should look
at the labia because man, the amount of the number
(30:08):
of labias that vanish or get paper white, like a
white piece of paper, and what they have leaves in
right where they have polyps or coming out of their urethreat.
Speaker 4 (30:21):
I mean we see that all the time, the caroncle
and they're like.
Speaker 2 (30:25):
If you're if you're not taught, if you're not taught
about any of those things, and you do not know
what they look like. And not only do you know
what they not know what they look like. If you
saw something you wouldn't know what it was and you
wouldn't know what to do with it. Why would you
encourage your patients to come back to you to look
at them like it?
Speaker 1 (30:42):
You know, it's just goes down.
Speaker 2 (30:44):
The demic problem right back to the beginning of day
one of training.
Speaker 3 (30:48):
Well, even in women's health, we used to tell people
when she turned sixty five, you don't need paps, don't
come to us anymore.
Speaker 1 (30:54):
Well that's where primary care, that's where primary care learned
it from. Oh, that's right, that as part of you
know guidelines, I believe at one point, right, I mean,
I'm making it up. Yeah, Okay, I'm like, I don't
think I'm making that up.
Speaker 3 (31:07):
Yeah, I think that's a really good education point that
we probably when we talk about, you know, preventative care,
like in teaching providers, we need to reiterate that now
that we're but you know, until we became got involved
with ish wish, yes, I mean, and.
Speaker 1 (31:25):
Paid for this education, can we put that in like
we didn't, just like it's not given to us. These
are these are things that you have to We've all
done on our own and in many of our colleagues
on our own paid money for and had to take
time off of our jobs and to go to these
conferences to listen to these webinars to do so these
(31:46):
are things that they need to be incorporated in these
medical schools, nurse practitioners schools, nursing schools, PA schools. They
have to be. It's expensive and we cannot expect and
I know we're going off on a tangent, we can't
expect these other practitioners to fork out all of this
money because they don't get much CME to begin with,
(32:07):
and they have to do all of the other things.
They're licensing their dea. You know, there are other CME
credits for intermedicine, family medicine, whatever it is, and so
these courses aren't inexpensive either.
Speaker 3 (32:21):
So if you have a midlife without sexual health, right,
you can't do And sexual health isn't just testosterone. It's
making sure the the volva looks good and is really healthy.
And that's so many other things that can that need
to be you know, addressed for sure. Yeah, you know,
(32:41):
one of my one of my one of my patients
who's a huge fan of the Dusty Muffins wants us
to do an episode about you know, the boomers and
you know how to approach them. And I think from
that from that panel, it was in presenting doctor Manson's
work when they really talk what I heard was over
(33:05):
age seventy, that's where the increased risk of mortality, stroke
and heart attacks are. And it was really good to
hear that because you know, I will start those over
sixties after, you know, looking at whole picture. But it
was really and I've had women over seventy like I
(33:27):
want a new start, and I'm like, well, here's the risks.
I'm like, we got to really talk about that. But
it made me at least hopeful for the sixty to
sixty nine year olds that never got the opportunity that
really would like to you know, they haven't slept in decades,
and you know, some of them are still having hot flashes,
and so that was really nice to have that included.
(33:51):
That really the biggest problem in the WHI were those
over seventy year olds. Yeah, and that was with oral
and that was with oral conjugate equin astrodam.
Speaker 2 (33:58):
Yeah, for our listeners, like we don't even have the
information for women in their sixties and seventies who start
hormones for the first time, because we will give you
transdermal estradio which goes straight straight through your skin and
into the bloodstream, not oral, which can increase your risk
of blood clot and stroke and heart attack, and the
(34:21):
way it acts. You know, A large part of that
in the Women's Health Initiative study was that majoxy progesterone acetate,
which seemed to follow the estrogen like the grim reaper
and just undo all the good that the estrogen was
doing ahead of it, especially at the level of the
lining of the blood vessels and the heart. So you know,
(34:41):
I really feel like that piece of information has been
weaponized against women, and really, if you scratch the surface,
that's not what we're using now, you know that's right,
So we really need we just you know, I know
we keeps, but we just need some really good studies.
(35:02):
Let's start some fucking studies. Why everyone says, you know,
can we just start some studies? Do not know that
all our NIH money is going out the window? And
really a different country can do, especially around testosterone.
Speaker 3 (35:19):
You know, like we're still on that exemption waiver this
year of not having to see patients in person, and
you know, as we get closer to the end of
the year, we're all going to be asking each other
the same question with since we're Tella met or we're
still going to be able to prescribe.
Speaker 4 (35:35):
And you know, I you know, I.
Speaker 3 (35:39):
Thought Kelly Caspersson did a I mean, as always, but
you know, someone else recently talked about estrogen's always the
damn star. But you know, we make five times as
much testosterone testosterone as really the superhero.
Speaker 4 (35:55):
So I've now stopped.
Speaker 3 (35:56):
I now talk about testosterone first, because women don't realize
how much testosterone they have.
Speaker 1 (36:03):
Yeah, yeah, nope, she did a really great job, and
I really thought that Vonda Wright did a really nice job,
you know, and was very passionate about bone health and
what she has seen in the operating room and the
women that have suffered from, you know, their hip fracture
(36:25):
and that they can't take them back and operate on
them because they have a UTI and you know, and
the fact that that sixty percent of hip fractures are females,
and you know, we know anywhere between twenty five to
thirty percent of those women will lose their lives when
the first year of a hip fracture, which that every
(36:46):
time I say that statistic to me is impressive. And
why we don't spend more time on preventing osteoporosis when
we know that one and two over the age of
fifty will have an astraproduct fracture, I think is just
absurd to me and is another one of my many soapboxes.
But she did a great job, she didd do we
(37:10):
kind of catch every I.
Speaker 3 (37:12):
Mean, the great thing about it is is that this meaning,
you know, most government meetings is invite only if you
don't have a if you don't have a cat card,
you're not invited. And the fact that this was you know,
televised or YouTube, but I don't know what it was
on YouTube live and now can be replayed. I think that,
(37:33):
you know, I don't have to pay for it for
the open door policy, because otherwise we would have just
heard about what happened. And so I think, you know,
when we talk about estrogen matters being something we recommend everybody.
I think listening to this panel, we I would echo
as another must must must do, must should.
Speaker 1 (37:56):
Yes, we can link. We can link that. I think
we can. We can link that and the show notes too,
so listeners can go and if you're like me, you
can listen to it on like one point five.
Speaker 4 (38:05):
It's fine, Ethan, I can't think that fast.
Speaker 1 (38:09):
But I don't know if I reutine stuff that I do. Now.
When I listen to on one, they're like so I
feel like, ah, I'm like it's just fine.
Speaker 4 (38:20):
But then I know I'm like, what the hell they saying?
I know, I'm like, no, this is fine.
Speaker 2 (38:24):
I can miss on one point five and then I
have to like go back because I've missed that whole
part where I was thinking this is fine. And then
I'll start play again.
Speaker 4 (38:32):
I'll be like, yeah, this is fine.
Speaker 2 (38:33):
One point five. Oh why not?
Speaker 4 (38:35):
Got You know, sometimes I do.
Speaker 1 (38:39):
Miss it, but I wouldn't miss it on one point
zero too, because my brain starts to think about other things.
Or I'm working out and I'm pounding my reps and
then I'm like, dang it, stop counting your reps. Just
go and tell you're fatigued, and listen to what you're
listening to.
Speaker 2 (38:53):
There was one thing I wanted to remind anyone who
has watched the Ft eight was doctor Howard Hotus, Like,
I just did a yes at the end when he said,
you know, if you've been studying a compound for sixty
years to see if it causes cancer, and after sixty
(39:15):
years of looking at it, you can't say it causes cancer,
then come on, guys, you know that is not something
that causes can through that, I mean, if you think
about anything else, yeah, I mean, if you were thinking,
like you know, we've been studying cigarettes for sixty years
to see if they cause cancer. We found pretty repeated,
(39:38):
you know, very quickly repeated studies showed you know, smoking
causes lung cancer. You know certain dyes called ladder cancer
and alcohol?
Speaker 1 (39:48):
Can we talk about alcohol? Alcohol is far less villainized
than estro dial and estrogen. If can I just say that,
you know, as someone that like does like to partake
every now and again, and I just can't because it
goes in my head makes me feel like crap, which
is probably a good thing, but a little sad at
the same time, Like how many different cancers? What seven?
Speaker 2 (40:09):
Now?
Speaker 1 (40:09):
It just had to have a warning on all of
the containers, the Surgeon General's warning. I mean, come on, guys,
that is far less villainized, far less. We don't even
educate as much, although we're starting to and we should be.
But really, there are a lot more you know, power
(40:29):
in these gas lighting physicians about estra dial than are
they asking about if you're you know, vaping, smoking and
having a drink.
Speaker 3 (40:38):
I've been thinking about that a lot, that I should
give up my wine club membership. I'm like, am I
ready to give up alcohol? I really have been like,
and I don't drink that much, but like, I don't
like the way it makes me feel. It's really I
like holding the glass and I like having wine, but
mostly I'm like, well, maybe I should start with giving
up my wine club membership A.
Speaker 1 (41:00):
Little step, you know, I'll put soda water in my
wine glass or my champagne glass.
Speaker 4 (41:06):
So I just haven't gotten there. I know I need
to do it.
Speaker 1 (41:10):
You want to know what it is? Is I like
that there? Yes, I don't care about the other Like
if they had a non alcoholic like wine that tasted good,
I'm cool with that, you know that didn't have like
a shit ton of sugar in there and all the
other things. I would be fine with that. The same
with like, you know, a champagne too, Like I would
(41:31):
be fine with that.
Speaker 2 (41:31):
But maybe there is funny I can sponsor our.
Speaker 1 (41:34):
Podcast, Yes, let us know, let us know some samples.
We will let you know.
Speaker 3 (41:41):
That's a great idea non alcoholic wine thing.
Speaker 1 (41:46):
Yes, yes, so, oh my gosh, all right, what a
fun You know anything else that you amazingly needs to
have to share in here? This was a fun little conversation.
Speaker 3 (41:57):
I wish we knew that when they would release it
outcome like doing anything?
Speaker 4 (42:02):
Or are we just meeting for a media event?
Speaker 1 (42:04):
But well, I mean at least got a foot in
the door. May take we'll take that. So you know
again it's cool that usually these things are gone behind
closed doors, and it was, you know, open, so we'll
take it.
Speaker 4 (42:19):
No, farm farm reps were there.
Speaker 3 (42:21):
Yeah, And I did find it interesting, did so that
the big investigator, the big epidemiologists and the w h I,
the one that talked about the bandwagon right about during
the w h I. He was the lead investment from
(42:43):
hormon therapy in the bandwagon and he was in the
audience with a pin that said I love the w
h I. I was like, oh, my goodness.
Speaker 1 (42:52):
And a woman's face that they got in the background,
she's like I thought that.
Speaker 4 (42:57):
I was like, this is better than a hospital.
Speaker 2 (43:00):
I know.
Speaker 1 (43:02):
There was a lot of hecklers I hear, and I'm
just like, good what are you heckling about? Like women
for fifty two percent of the population, how do you
not want the best things and the best outcomes? Just
don't get it.
Speaker 3 (43:15):
Oh, we'll wait to hear the outcome. I guess we'll
know how serious he there he is, Yes, there is.
Speaker 1 (43:21):
He's like, say, what do you want to take it outside?
Speaker 3 (43:24):
I know I love that woman, like, you're the idiot
who ruined everything for us. If you are not watching
this on YouTube, you at least need to go look
at the the old man in his plaid shirt with
his going.
Speaker 1 (43:37):
Oh who wants to take us home.
Speaker 2 (43:42):
Yes, so we all encourage you to go to YouTube
and Google, or not Google, but put into the search
box FDA vaginal estrogen.
Speaker 1 (43:54):
That should bring We'll link it.
Speaker 2 (43:56):
We'll also link it. It's two hours long. And share
this episode with your friends and loved ones and encourage
them to watch it too.
Speaker 1 (44:07):
All right, make sure you like and follow us, and
we will see you all next time.
Speaker 2 (44:13):
Bye bye
Welcome to the Dusty Muffins, where menopause meets sisterhood and strengths.
We're three minopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause, im paerimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and applicate all with a dash of
(00:25):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in. Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is
the Dusty Muffins. I am a doctor a re Recca Hurdle.
(00:48):
I'm a Board certified osteopathic family medicine physician and a
Menopause Society Certified practitioner. I have a private telemedicine practice
and I see patients in several different states.
Speaker 2 (01:00):
Doctor Efa O'Sullivan a Board certified family physician and Menopause
Society certified practitioner, and I see patients through my telemedicine
practice here in Oregon and Washington.
Speaker 3 (01:11):
I'm doctor Christine Harkrass, a Board certified Women's Health Nurse
practitioner and Menopause certified practitioner, and I see patients via
telemedicine in several states as well.
Speaker 1 (01:23):
All Right, hey, everyone, welcome back to the Dusty Muffins. Today,
we're going to discuss the FDA's live advisory panel on
July seventeenth, twenty twenty five. This focus on whether lo
dos vaginal estradial should retain the same black box warning
as systemic estrogen. This is viewed on the FDA YouTube.
You can actually go back and rewatch that. I've watched
(01:45):
it live and rewatch it actually with my husband, believe
it or not. He wanted to watch it and he
was like really excited to listen to everybody. So I
thought that was kind of neat too. This emphasized the
significance of perimenopause, general urinary symptom, and the broader midlife
treatment gap.
Speaker 3 (02:04):
So I did like the fact that that panel was
pretty diverse, although they had some what everybody calls influencers
from social media. On there, there was academics and the researchers,
So I think they did a fairly good job at
representation with one exception, and that is there were no
(02:24):
advanced practice providers on that panel, which we, you know,
take care of the largest proportion of these patients just
by the number of US, and so not having an
advanced practice provider, whether it be a PA or an NP,
is really that lack of representation is really a health
(02:48):
equity issue.
Speaker 4 (02:50):
You know that.
Speaker 3 (02:51):
That is my only really big critique about the makeup
of that panel. I thought the people on there were fantastic,
but I think that the events practice providers, there was
nothing that was said on that panel that we didn't
have the brain power to do.
Speaker 1 (03:08):
Echo. Nope, I agree.
Speaker 2 (03:10):
Oh, medical schools and residencies have been ignoring women's health
care for eternity forever and who's been taken care of
all the midlife problems and the apps have? So yeah,
I totally agree with you.
Speaker 1 (03:26):
Yeah, And I think and I think we can step
back for a second and say, Okay, they were influencers,
but it doesn't mean that they're still not experts, right,
And I think that when there has been some backlash
at the influencer stage, these are still practitioners that are
very well educated and experts in their field. And so
(03:48):
I think, you know, we've all talked about that point, Like,
you know, there is that little thing going around social media.
Are you expert or influencer? And well, gosh darn it,
we're we're all both. Like you know, we're experts in
our field and what we do, but we're also influencing
women to take a stance for their health, for their education,
and for what they need for you know, their midlife care.
Speaker 2 (04:10):
Yeah. I have really come to hate that word. I mean,
you know, if you want to call one of those
doctors an influencer, I would love to put their CV
up beside them. Yes, you know, I mean, these are
highly trained physicians and surgeons, and just you know, there
are people out there trying to reduce them to influencers and.
Speaker 1 (04:34):
Without credentials, right, without having their credentials inappropriate appropriate If.
Speaker 3 (04:40):
They weren't on social media and just had their CV,
no one would think any less of them.
Speaker 1 (04:49):
You know.
Speaker 3 (04:49):
And I think, you know, I think that the people
who are criticizing us for being on social media, I
think they really need to take a hard look at
the academics and the people and you know, the other
providers that are in the actual exam room gaslighting their patients,
gatekeeping hormone therapy. The only reason why we're over there
(05:11):
is because it's a creative and fun outlet to educate,
and we re educate people, but we're also educating in
so many other forums. And you know, when I you know,
lecture for the nurse practitioners, they don't refer to me
as an influencer. They refer to me as a thirty
(05:31):
year you know, veteran of women's healthcare. And so, you know,
the reason why we're over there is because we enjoy
the interaction with people and want to educate more women
because of these idiots in the exam room, who are
you know, just being absolute assholes to patients who really
(05:51):
just need to retire. And I've said this a million times.
If you're not going to give hormone therapy because you
are uneducated, you should not take care of these women.
Speaker 2 (06:00):
Yeah, the biggest issue I have with it is these
ninety percent of the people who are complaining about the
influence influencers are on their Instagram account complaining about the influencers.
Speaker 4 (06:15):
I'm sorry, right, gas lighting?
Speaker 5 (06:18):
I mean, are you telling me not to believe my
own eyes. You're fucking there on your Instagram account bitching
the other people on their Instagram telling someone vitamin D
and you have a book to sell, like you know,
come on, yes, just yes, it's ridiculous.
Speaker 3 (06:37):
It's you know, their page, right or me on page
and get on there and educate if you think that
there's other.
Speaker 2 (06:43):
Other and most of them are Christine, That's what they're
complaining from their Instagram page, and you know so they
are an influencer, right.
Speaker 3 (06:53):
Absolutely, Well, I see what you're saying. Oh, I just
thought you meant the stalkers.
Speaker 1 (06:58):
You know that you never know they're probably paid. But
you know, we all we all just briefly touched on
this before we started recording, and that was this is
a community. We are a community of practitioners that should
be encouraging each other, uplifting each other, having amazing conversations
(07:18):
for the greater good. And that came truth in this
whole you know, little Nicki Minaj thing that and it
was having these challenges of like this is amazing. You
just encouraged me to do something I never thought I
could try to do. You just encouraged me and so
and that can be with any of these things. You
just encouraged me to get on to social media where
I never would have done it before, to educate women.
(07:40):
So that's what I want this medical community, you know,
of practitioners to do. We should be lifting each other
up in midlife and in educating together and having great
conversations together. We may not all agree on the same thing,
and that is okay, but you know, bulling each other
and tearing each other down is not cool. It's not sexy,
(08:03):
it's not professional, and it's very you know, offsetting.
Speaker 2 (08:08):
Get online and have an Instagram live with the person
you're talking about, yeah, and ask them questions and have
a medical discussion because you know, usually it's it's a
physician and you know they've been treating patients for years
and you're both on the same side and you're fighting
the same fight, so you have lots to talk about
(08:31):
and then ask them your questions or bring up your
problems or whatever about their supplements or whatever else is
the issue.
Speaker 1 (08:37):
And then we wonder why people can't People say that
they're they don't trust doctors. Well, I mean, look at
what the hell is going on.
Speaker 2 (08:44):
Yeah, it's ridiculous.
Speaker 1 (08:46):
Yeah.
Speaker 2 (08:46):
So it's nice to see everybody come together for the
FDA channel. You know was a real united front.
Speaker 1 (08:53):
It was. And so what I'm interested in is what
what what do they these panels typically look like? So
for the first time we've had this type of panel,
what did they look like before? And to Christine's point,
did they you know, did they have nurse practitioners and
pas in this research setting when they would typically have
(09:17):
you know, these scientific get togethers or panels. Does anyone
know kind of how this worked? I know a few
people have touched on that a little bit before we
dive into you know, who was on there and what
was said.
Speaker 3 (09:28):
Well, I know that you can apply when they are
open to sit on the advisory committees. I do know
that the president of NPWH, which is the Women's Health Organization,
has applied several times and she's got quite impressive credentials
(09:49):
both as fmp CNM and Women's Health MP and has
not been yet selected. But I think probably more so
the case is is that people, I mean I didn't
know that there was an open call for candidates and
an application piece because I don't think any of us
(10:09):
ever thought, oh, I should be on FDA advisory committee, right, Like.
Speaker 1 (10:13):
I don't, I know, how did that even come about?
Speaker 3 (10:15):
I'm like, yeah, so, I mean I think probably, you know,
people closest to DC are probably on most of those
FDA maybe coming out of the NIH, which you know
now has been their research been gutted. So maybe, I mean,
it's kind of interesting that, you know, I'd love to
know why they expanded to physicians that have no research platform.
(10:41):
It's kind of interesting. And who else was requested but
not but didn't accept the invitation because there are some
folks that Lauren Striker or doctor Striker has been pretty
loud about the fact that she was asked to go
and elected not to because she didn't think that this
process would be good for women's health long term, because
(11:02):
this is not following the process on how you make
a decision to do black box warning and was afraid
that that would my understanding, would then be extrapolated to other.
Speaker 1 (11:13):
Things, right, systemic therapy and things like that, right.
Speaker 3 (11:16):
Or even like the in the abortion arena, some of
those medications. So yes, but yeah, I don't I don't
think anybody knew so the advanced practice providers just I mean,
and they didn't the FDA didn't even probably think I mean,
how many work yeah for them?
Speaker 1 (11:34):
Who knows?
Speaker 2 (11:35):
Yeah, I think this was It was a media event, right,
and we know that we're not stupid. We know that
nothing may come of it, but let's not throw the
baby out with the bathwater. I don't think any of
us are big Marty McCray fans. We know how he
feels about for women's choice and abortion, which is not
(11:55):
how we would think of it. But this was an opportunity.
I always looking on it as an opportunity to get
the word out, you know. And I knew this was
going to be recorded, and this would be something I
could share with patients and other clinicians, and having the
FDA label attached to it gives it some sense of,
(12:16):
you know, professionalism, you would hope. So it was an
opportunity to spread the word and hopefully take away some
of the fear that's been around for the last twenty years.
And I wonder how many people watched it and went, wait,
estrogen doesn't give you breast cancer, you know, Like that's
what I was hoping would come from this. But like
(12:37):
doctor Lawrence Striker, was saying, this is not how things,
This is not how you do things at the level
of the government, and there has to be a proper
scientific panel, and that's not what this is. This is
a media event, so it'll be interesting to see, I
suppose what actually comes of it. But for me, I'm
going to take what I can out of it and
I'm sharing it because there was such good information shared.
Speaker 1 (13:00):
Ish want the Dusty Muffins at your next event. We
do panels, live podcast and talks that bring the heat
literally corporate see me or retreats. We've got you, so
hit us up at the Dusty Muffins three three three
at gmail dot com or d ms on Instagram at
the Dusty Muffins.
Speaker 3 (13:16):
Do you think I got watered down at all with
I mean, because my understanding with the when when we
started hearing about it was just to remove the black
box warning on vaginal estrogen, which we'll talk about here
about why that so needs to happen. But then you know,
(13:36):
then there was the focus on the doctor's education, and
then testosterone and then cardiovascular risks, and then the breast
cancer data, which was all really good information. But you know,
and to your point about being a media event. I mean,
do you think that the panels panelists should have focused
(13:56):
on what seemed to be the goal, and maybe I
got the goal wrong. Instead of making it a why
we should have why we should allow MHT and have
it have the label changed for all hormone therapy.
Speaker 4 (14:12):
What are your thoughts.
Speaker 2 (14:14):
I don't think there's the right answer to that. I
think you could have kept it all to do with
imaginal estrogen and been a fantastic meeting. But I have
to say, we are living in crazy times, absolutely crazy times,
and there are no rules anymore, and none of us
know what Marty McRae could do with the swipe of
(14:37):
a pen. For all we know, he could get rid
of all these warning labels, label estrogen's appropriately, label our
hormones appropriately. He could take a testosterone off the scheduled
drug list. We don't know what this man could do.
There are no rules anymore. This government is loopy. So
(14:59):
I I personally it was like throw it all in
there and see what we.
Speaker 1 (15:03):
Can get in, you know.
Speaker 2 (15:05):
But I think there's no right answer to that. The
purists say it should have just been the imagine estrogen.
I'm one of those people who can't leave any white
on a coloring page, like everything is to.
Speaker 4 (15:16):
Be colored in.
Speaker 2 (15:17):
So I definitely would have been like, yeah, I'm gonna
try for the testosterrum. Definitely.
Speaker 1 (15:24):
I think I agree too. I think if you invited
the practitioners that you invited, knowing their platform and knowing
their you know, what's close to them, what is what
is the most important to them, I can't imagine that
you didn't think that they weren't going to touch on
(15:44):
those things. Whether it have been right or wrong or
indifferent or you know, I don't know what the letter
said that said, you know, hey, it's about taking the
you know, the black box label off or bring to
the table your five minutes of what you think is
the most important. I don't know. I'm kind of interested
to know, or you know, was it just hey, we're
(16:05):
going to take our five minutes and and yes it
needs to be off, but I'm really going to also
take this time to talk about some other things that
are really really important too. It's interesting and I kind
of agree to. I don't know that we lost the
concept of the true you know, the goal, but boy,
you took you took advantage of some time to be like, hey,
(16:27):
this needs to be done to, and this needs to
be done to, and this needs to be done to
while we're.
Speaker 3 (16:30):
At it, and I love I love like, you know,
like the people we read their studies, like like you
could see them, like you know, they're you know, more
of the academics, and you don't see them as much.
Speaker 4 (16:45):
Like Barbara Levy.
Speaker 3 (16:46):
I was like, oh, and look at Joe Prington, who's
right here in my neck of the woods. And I
mean we see Jim Simon, yes, every Monday, but most
people don't know about him.
Speaker 2 (17:00):
He Cerel and Ard hotus, Like it was so cool
to see everybody.
Speaker 1 (17:05):
Yes, it was like I get all the studies and
then I saw the faces and I was like.
Speaker 4 (17:12):
It was our super Bowl. It was our super Bowl.
Speaker 1 (17:16):
Yeah, Jim's Simon And I was laughing so hard when
he just came out. There was like it just doesn't
do that, and I'm like, no, it doesn't.
Speaker 2 (17:32):
And it's all related, right, Like if we go back
to should we should we've done this, should we've done that?
Let's let's be honest. It's all related. It's all wrong.
Everything is labeled incorrectly. There is fear attached to everything.
We're really harming women. We've loads of brilliant evidence on
(17:52):
female to male transitioning with ten times the dose of
test asternomic. It's all wrong. We're doing everything wrong. We're
harming women. So we have one chance to talk about
this because who knows of anything like this will ever
happen again. Like, how could you not try and squeeze
some of this in?
Speaker 1 (18:08):
Yeah? You know, And I loved the five minutes and
how it was put together. And have you ever seen
so much squalls?
Speaker 3 (18:18):
No, you can't even Like, I'm like, what on screenshot microprint?
Speaker 4 (18:25):
I would love to get those slides.
Speaker 1 (18:27):
Yeah, you know.
Speaker 4 (18:28):
One thing, one thing that.
Speaker 3 (18:30):
Resonated with me was doctor Leevy. You know, she talked
about not all hormones are the same and that estra
dial binds differently than conjugated aquine estrogen. And she said
that you can't classify the risks, but also said you
can't classify the benefits the same.
Speaker 4 (18:48):
So and we do.
Speaker 3 (18:50):
All the time, Right, any benefit we get out of
the w H I I mean there are a few,
but not a lot on I mean it made me
think for a minute, and I was like, are we
are we extrapulating the benefits? I mean, like, you know,
can we say that. I mean we think we can
because it's what we it's most like what we are
(19:14):
making ourselves. But we only know the benefits for the
most part for conjugated quin estrogen. So I you know,
like it makes me think. You know, I'm always thinking
when I'm when I'm when I am educating, I'm like,
because I don't want to overpromise, right, I've.
Speaker 2 (19:29):
Started the keeps in the Elite study, and that was
all estradyle. You know, like we do have studies.
Speaker 1 (19:36):
Sorry, no, no, I was going to say I when
I talk about the w H I I have now
really have made sure to say, listen, it was conjugated
equine estrogen. We have estradle. We are extrapolating from other
studies that this benefit also, but but really, when we're
looking at that study, it is conjugated equin estrogen. It
(19:58):
was not estradyle. So and women do appreciate that, you know,
same thing when we talk about medoxy progesterin acetatin and
into the micronized progesterone, you know, we believe this is
breast noll breast you know, as far as the MP
and but more data, more studies, as as we always
(20:19):
are saying, you know.
Speaker 3 (20:23):
Yeah. The other thing that I thought was interesting that
she said was, you know, you hear I hear quite
a bit, you know, you know the over sixty five
or women over sixty approaching into the age sixty five,
and their providers are trying to take them off the
hormone therapy. And she made a point not even the
(20:44):
WHI encouraged a stop time, you know, the grandmother's hypothesis
of you know, best benefit it started, doesn't There was
nothing in the WHI of risks of continuation.
Speaker 1 (20:59):
No. No, I just saw someone recently, a new patient recently,
and who said that her practitioner started her and told
her in a year she needs to go off. And
I'm like, well, where did that one come from. I've
not seen that anywhere. It made zero sense, and she
wasn't even close to sixty. I thought, we're just making
(21:19):
some shit up here.
Speaker 3 (21:22):
I think some of that she pointed out, has to
do with the fact that the meta for the for geriatrics,
which is what you are when you're sixty five, is
on the hazardous list. Yeah, and it impacts the heatis metrics,
which therefore then impacts reimbursement, and so.
Speaker 1 (21:39):
Yeah, maybe maybe I get that at sixty five. You're right,
I could see that at sixty five, but not under
sixty for them saying that. But maybe that's where she's
extrapolating it from. I don't know. It was nut so.
Speaker 4 (21:54):
I thought it was a.
Speaker 3 (21:56):
Good point of need to stop, you don't it's been
and more. And I didn't realize that it was probably
an insurance thing.
Speaker 1 (22:05):
Yes, oh yes, yes, you get yes, your myps and
myths and pips and heatous and all the things. You know.
I mean, I thought the panel you know, we can
go through a couple you know. Doctor Heather Hirsch was
on there. She argued that bageo estrogen was categorically safe
because it's not systemically absorbed. That's kind of you know,
the big Most of the panelists on there again discussed
(22:29):
that you know that that existing boxed warning is unsupported
by evidence and is misleading, discouraging both patients and prescribers.
I agree with that one hundred percent. How many times
have we had patients I actually, you know, I don't
go on there and exit, exit out because my patients
typically don't bring in their vaginal estrogen. But I make
it a point to tell them they are going to
(22:51):
read something that is going to be, you know, very scary,
and they need to crumple that up and throw it away.
And I tell them why they need to do it,
because you know they'll ask you, well, why is it
on there? Then? And so then I have to go
through you know, that just takes a lot of time
to then educate, right, so, and in an insurance model,
this education takes time, and so there lies the problem.
(23:14):
So it may not be us, as you know, those
of us in this concierge space where we are private
practice and can take more time with our patients, but
an insurance based model, when you have maybe maybe five
minutes after you have been roomed to then go through
all of that, it's tough. That was my little stillbox.
Speaker 3 (23:37):
Well then even doctor Pinkerton then was talking about the
studies crandall had done a meta analysis and they were
talking about the average serum level for women in menopause
is four point five puco grams per milli leader, and
then when they're doing vaginal estrogen it's somewhere between four
and fourteen puico grams per lead. And then with the
(24:01):
ring it goes up to nineteen, but by day two
it's back down to that four to fourteen, which is nobody.
Nobody's feeling good on an estradial level between four to fourteen.
But just about the fact that there's no systemic absorption
and it just doesn't do that, and your breast cancer patients.
Speaker 4 (24:25):
I think that it was also looking at.
Speaker 3 (24:27):
The breast cancer patients and put the breast cancer patients
that are, you know, in treatment, give them some vaginal estrogen.
Speaker 2 (24:36):
And just for reference, you know, our husbands, they're estradial
levels are probably somewhere between twenty and forty.
Speaker 4 (24:42):
Oh that's just for next year.
Speaker 2 (24:44):
Men have estradial two. Usually you are aund twenty thirty forty.
So when you have your vaginal estrogen and on your
estrogen's nineteen, which is as high as it gets and
then goes down.
Speaker 1 (24:57):
Yep, that's pretty safe. I think I love that men.
Yeah estrogen.
Speaker 3 (25:02):
You know, I don't study men's health. When I heard
that it just a couple of years ago, it just
made me laugh my ass off.
Speaker 1 (25:09):
I'm like, yes, when you tell your patients that, yeah, yeah,
the more patients that they're just like really, I'm like, yes, yes,
your spouse. Yeah, your male's spouse.
Speaker 2 (25:22):
Doctor caspercent. It might have been during her the Baby
Boomers Are Pissed episode, because I love that episode. I
definitely listen to that so many times, so I think
it was during that one. But she said about there
was a study where they blocked men's hormones, their testosterone
and their estrogen, and they lost all their libido and
then they just gave them back the estrogen and.
Speaker 1 (25:43):
They all got there.
Speaker 2 (25:45):
You know, I thought that was very interesting. I'd say
that was very difficult for doctor Rubin to tell that
story about her mom. She was very brave to do
that because I'm sure.
Speaker 1 (25:57):
If you would just break down. Yeah, I was on
like breaking now yea ice you for a long time.
Speaker 2 (26:07):
Yeah, and that information, but you know, just that story
of having to convince a first world country intensive care
unit of the importance of preventing a urinary tract infection.
I mean, working in the ICU, you lose patience to
urinary cepsis every day. They're in for pneumonia. You're doing great,
(26:28):
You've tried six antibiotics, the six one work. They've been
on the ventilator for a month and they're getting places
and the next thing, they get a urinary sepsis and
they're dead, you know, And to think that she had
to go in there as like a grieving daughter pretty
much and convince the staff to give them telling that
we have guidelines for and teach them. I mean, I
(26:51):
really hope people listening to that really went, what the
actual fuck? What ye like that we should not have
to do that.
Speaker 3 (27:00):
You know, the nurses don't do anything has to do
with the vagina. They don't touch the vagina. The vagina
doesn't exist as autistic.
Speaker 1 (27:07):
Catheter andy, you know that, Like they don't a little
bad lestrogen as you're putting that catheter in. But I
think people underestimate, even in just primary care or even
internal medicine. I would say that when you have a
patient that comes in act and loopy, a female in
particular that is number on my list, go out and
(27:29):
go give a yearine down the hall right now. And
if I don't, it is I would say in the
nineties of the percent that it is positive, right, I mean,
it just is, like you guys, this is on our
radar as just primary care and interness alone, right like,
so it just put we're not putting two and two
(27:50):
together here, Why does that happening? Well, there is a
distinct reason why. You know, have you looked probably you're
not looking at the volva and vagina to actually see
what has happened, that that laby has gone, and that
there's literal adhesions, that you know, all of the other
things that are happening too. Because I think if you
truly understood that, which you should, if you are a
(28:12):
primary care internal medicine let alone, you know your g
I N taking care of elderly women, you need to
know these things because.
Speaker 2 (28:20):
We're not taught that. Rebecca, were you ever taught to
had to examine evolva in your training?
Speaker 4 (28:26):
Okay?
Speaker 1 (28:26):
I was? I was only I was only because we
had a really strong women's health portion of our residency
and I went to extra training and I cannot for
the life of me where I went to go learn
kolposcopy and volvoscopy. I did that in residency on my own, yep, yep.
(28:46):
But otherwise, no feeling off in midlife. I'm doctor Becker
Hurdle and I offer concierge telemasine across multiple states focused
on hormones, weait, libido, and sleep and longevity let's get
you thriving. So visit www dot astopathic midline dot com.
Speaker 3 (29:01):
You know, I had a patient this in the last
month or so. She's sixty five on hormone therapy, just
doing some tweaks for her and we were talking about
going to the gynecologists because you know telemedicine. You know,
we haven't yet figured out how do your perp smear
via telemed And she's like, well, my she her primary
(29:24):
does her desert was doing her paps in her annuals.
And they said, no, we're not going to look at
your vulva or anymore, and you don't need a pap smear.
And I said, but you do need an exam. And
I said, I agree, you don't need a pap smear
your last seven or normal. You have no history of
you know, moderate to severe displasure.
Speaker 4 (29:44):
That's fine.
Speaker 3 (29:45):
I'm like, but someone needs to look look at your
vulva and look in your vagina. And she was like, well,
they won't do it. I'm like, well, then you need
to go see it. You got to go to a
gynecologist because you don't need paps, but you should still
have a look. And you know, if you're not having pain.
You don't need to buy manual, but someone should look
at the labia because man, the amount of the number
(30:08):
of labias that vanish or get paper white, like a
white piece of paper, and what they have leaves in
right where they have polyps or coming out of their urethreat.
Speaker 4 (30:21):
I mean we see that all the time, the caroncle
and they're like.
Speaker 2 (30:25):
If you're if you're not taught, if you're not taught
about any of those things, and you do not know
what they look like. And not only do you know
what they not know what they look like. If you
saw something you wouldn't know what it was and you
wouldn't know what to do with it. Why would you
encourage your patients to come back to you to look
at them like it?
Speaker 1 (30:42):
You know, it's just goes down.
Speaker 2 (30:44):
The demic problem right back to the beginning of day
one of training.
Speaker 3 (30:48):
Well, even in women's health, we used to tell people
when she turned sixty five, you don't need paps, don't
come to us anymore.
Speaker 1 (30:54):
Well that's where primary care, that's where primary care learned
it from. Oh, that's right, that as part of you
know guidelines, I believe at one point, right, I mean,
I'm making it up. Yeah, Okay, I'm like, I don't
think I'm making that up.
Speaker 3 (31:07):
Yeah, I think that's a really good education point that
we probably when we talk about, you know, preventative care,
like in teaching providers, we need to reiterate that now
that we're but you know, until we became got involved
with ish wish, yes, I mean, and.
Speaker 1 (31:25):
Paid for this education, can we put that in like
we didn't, just like it's not given to us. These
are these are things that you have to We've all
done on our own and in many of our colleagues
on our own paid money for and had to take
time off of our jobs and to go to these
conferences to listen to these webinars to do so these
(31:46):
are things that they need to be incorporated in these
medical schools, nurse practitioners schools, nursing schools, PA schools. They
have to be. It's expensive and we cannot expect and
I know we're going off on a tangent, we can't
expect these other practitioners to fork out all of this
money because they don't get much CME to begin with,
(32:07):
and they have to do all of the other things.
They're licensing their dea. You know, there are other CME
credits for intermedicine, family medicine, whatever it is, and so
these courses aren't inexpensive either.
Speaker 3 (32:21):
So if you have a midlife without sexual health, right,
you can't do And sexual health isn't just testosterone. It's
making sure the the volva looks good and is really healthy.
And that's so many other things that can that need
to be you know, addressed for sure. Yeah, you know,
(32:41):
one of my one of my one of my patients
who's a huge fan of the Dusty Muffins wants us
to do an episode about you know, the boomers and
you know how to approach them. And I think from
that from that panel, it was in presenting doctor Manson's
work when they really talk what I heard was over
(33:05):
age seventy, that's where the increased risk of mortality, stroke
and heart attacks are. And it was really good to
hear that because you know, I will start those over
sixties after, you know, looking at whole picture. But it
was really and I've had women over seventy like I
(33:27):
want a new start, and I'm like, well, here's the risks.
I'm like, we got to really talk about that. But
it made me at least hopeful for the sixty to
sixty nine year olds that never got the opportunity that
really would like to you know, they haven't slept in decades,
and you know, some of them are still having hot flashes,
and so that was really nice to have that included.
(33:51):
That really the biggest problem in the WHI were those
over seventy year olds. Yeah, and that was with oral
and that was with oral conjugate equin astrodam.
Speaker 2 (33:58):
Yeah, for our listeners, like we don't even have the
information for women in their sixties and seventies who start
hormones for the first time, because we will give you
transdermal estradio which goes straight straight through your skin and
into the bloodstream, not oral, which can increase your risk
of blood clot and stroke and heart attack, and the
(34:21):
way it acts. You know, A large part of that
in the Women's Health Initiative study was that majoxy progesterone acetate,
which seemed to follow the estrogen like the grim reaper
and just undo all the good that the estrogen was
doing ahead of it, especially at the level of the
lining of the blood vessels and the heart. So you know,
(34:41):
I really feel like that piece of information has been
weaponized against women, and really, if you scratch the surface,
that's not what we're using now, you know that's right,
So we really need we just you know, I know
we keeps, but we just need some really good studies.
(35:02):
Let's start some fucking studies. Why everyone says, you know,
can we just start some studies? Do not know that
all our NIH money is going out the window? And
really a different country can do, especially around testosterone.
Speaker 3 (35:19):
You know, like we're still on that exemption waiver this
year of not having to see patients in person, and
you know, as we get closer to the end of
the year, we're all going to be asking each other
the same question with since we're Tella met or we're
still going to be able to prescribe.
Speaker 4 (35:35):
And you know, I you know, I.
Speaker 3 (35:39):
Thought Kelly Caspersson did a I mean, as always, but
you know, someone else recently talked about estrogen's always the
damn star. But you know, we make five times as
much testosterone testosterone as really the superhero.
Speaker 4 (35:55):
So I've now stopped.
Speaker 3 (35:56):
I now talk about testosterone first, because women don't realize
how much testosterone they have.
Speaker 1 (36:03):
Yeah, yeah, nope, she did a really great job, and
I really thought that Vonda Wright did a really nice job,
you know, and was very passionate about bone health and
what she has seen in the operating room and the
women that have suffered from, you know, their hip fracture
(36:25):
and that they can't take them back and operate on
them because they have a UTI and you know, and
the fact that that sixty percent of hip fractures are females,
and you know, we know anywhere between twenty five to
thirty percent of those women will lose their lives when
the first year of a hip fracture, which that every
(36:46):
time I say that statistic to me is impressive. And
why we don't spend more time on preventing osteoporosis when
we know that one and two over the age of
fifty will have an astraproduct fracture, I think is just
absurd to me and is another one of my many soapboxes.
But she did a great job, she didd do we
(37:10):
kind of catch every I.
Speaker 3 (37:12):
Mean, the great thing about it is is that this meaning,
you know, most government meetings is invite only if you
don't have a if you don't have a cat card,
you're not invited. And the fact that this was you know,
televised or YouTube, but I don't know what it was
on YouTube live and now can be replayed. I think that,
(37:33):
you know, I don't have to pay for it for
the open door policy, because otherwise we would have just
heard about what happened. And so I think, you know,
when we talk about estrogen matters being something we recommend everybody.
I think listening to this panel, we I would echo
as another must must must do, must should.
Speaker 1 (37:56):
Yes, we can link. We can link that. I think
we can. We can link that and the show notes too,
so listeners can go and if you're like me, you
can listen to it on like one point five.
Speaker 4 (38:05):
It's fine, Ethan, I can't think that fast.
Speaker 1 (38:09):
But I don't know if I reutine stuff that I do. Now.
When I listen to on one, they're like so I
feel like, ah, I'm like it's just fine.
Speaker 4 (38:20):
But then I know I'm like, what the hell they saying?
I know, I'm like, no, this is fine.
Speaker 2 (38:24):
I can miss on one point five and then I
have to like go back because I've missed that whole
part where I was thinking this is fine. And then
I'll start play again.
Speaker 4 (38:32):
I'll be like, yeah, this is fine.
Speaker 2 (38:33):
One point five. Oh why not?
Speaker 4 (38:35):
Got You know, sometimes I do.
Speaker 1 (38:39):
Miss it, but I wouldn't miss it on one point
zero too, because my brain starts to think about other things.
Or I'm working out and I'm pounding my reps and
then I'm like, dang it, stop counting your reps. Just
go and tell you're fatigued, and listen to what you're
listening to.
Speaker 2 (38:53):
There was one thing I wanted to remind anyone who
has watched the Ft eight was doctor Howard Hotus, Like,
I just did a yes at the end when he said,
you know, if you've been studying a compound for sixty
years to see if it causes cancer, and after sixty
(39:15):
years of looking at it, you can't say it causes cancer,
then come on, guys, you know that is not something
that causes can through that, I mean, if you think
about anything else, yeah, I mean, if you were thinking,
like you know, we've been studying cigarettes for sixty years
to see if they cause cancer. We found pretty repeated,
(39:38):
you know, very quickly repeated studies showed you know, smoking
causes lung cancer. You know certain dyes called ladder cancer
and alcohol?
Speaker 1 (39:48):
Can we talk about alcohol? Alcohol is far less villainized
than estro dial and estrogen. If can I just say that,
you know, as someone that like does like to partake
every now and again, and I just can't because it
goes in my head makes me feel like crap, which
is probably a good thing, but a little sad at
the same time, Like how many different cancers? What seven?
Speaker 2 (40:09):
Now?
Speaker 1 (40:09):
It just had to have a warning on all of
the containers, the Surgeon General's warning. I mean, come on, guys,
that is far less villainized, far less. We don't even
educate as much, although we're starting to and we should be.
But really, there are a lot more you know, power
(40:29):
in these gas lighting physicians about estra dial than are
they asking about if you're you know, vaping, smoking and
having a drink.
Speaker 3 (40:38):
I've been thinking about that a lot, that I should
give up my wine club membership. I'm like, am I
ready to give up alcohol? I really have been like,
and I don't drink that much, but like, I don't
like the way it makes me feel. It's really I
like holding the glass and I like having wine, but
mostly I'm like, well, maybe I should start with giving
up my wine club membership A.
Speaker 1 (41:00):
Little step, you know, I'll put soda water in my
wine glass or my champagne glass.
Speaker 4 (41:06):
So I just haven't gotten there. I know I need
to do it.
Speaker 1 (41:10):
You want to know what it is? Is I like
that there? Yes, I don't care about the other Like
if they had a non alcoholic like wine that tasted good,
I'm cool with that, you know that didn't have like
a shit ton of sugar in there and all the
other things. I would be fine with that. The same
with like, you know, a champagne too, Like I would
(41:31):
be fine with that.
Speaker 2 (41:31):
But maybe there is funny I can sponsor our.
Speaker 1 (41:34):
Podcast, Yes, let us know, let us know some samples.
We will let you know.
Speaker 3 (41:41):
That's a great idea non alcoholic wine thing.
Speaker 1 (41:46):
Yes, yes, so, oh my gosh, all right, what a
fun You know anything else that you amazingly needs to
have to share in here? This was a fun little conversation.
Speaker 3 (41:57):
I wish we knew that when they would release it
outcome like doing anything?
Speaker 4 (42:02):
Or are we just meeting for a media event?
Speaker 1 (42:04):
But well, I mean at least got a foot in
the door. May take we'll take that. So you know
again it's cool that usually these things are gone behind
closed doors, and it was, you know, open, so we'll
take it.
Speaker 4 (42:19):
No, farm farm reps were there.
Speaker 3 (42:21):
Yeah, And I did find it interesting, did so that
the big investigator, the big epidemiologists and the w h I,
the one that talked about the bandwagon right about during
the w h I. He was the lead investment from
(42:43):
hormon therapy in the bandwagon and he was in the
audience with a pin that said I love the w
h I. I was like, oh, my goodness.
Speaker 1 (42:52):
And a woman's face that they got in the background,
she's like I thought that.
Speaker 4 (42:57):
I was like, this is better than a hospital.
Speaker 2 (43:00):
I know.
Speaker 1 (43:02):
There was a lot of hecklers I hear, and I'm
just like, good what are you heckling about? Like women
for fifty two percent of the population, how do you
not want the best things and the best outcomes? Just
don't get it.
Speaker 3 (43:15):
Oh, we'll wait to hear the outcome. I guess we'll
know how serious he there he is, Yes, there is.
Speaker 1 (43:21):
He's like, say, what do you want to take it outside?
Speaker 3 (43:24):
I know I love that woman, like, you're the idiot
who ruined everything for us. If you are not watching
this on YouTube, you at least need to go look
at the the old man in his plaid shirt with
his going.
Speaker 1 (43:37):
Oh who wants to take us home.
Speaker 2 (43:42):
Yes, so we all encourage you to go to YouTube
and Google, or not Google, but put into the search
box FDA vaginal estrogen.
Speaker 1 (43:54):
That should bring We'll link it.
Speaker 2 (43:56):
We'll also link it. It's two hours long. And share
this episode with your friends and loved ones and encourage
them to watch it too.
Speaker 1 (44:07):
All right, make sure you like and follow us, and
we will see you all next time.
Speaker 2 (44:13):
Bye bye
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