September 3, 2025 • 24 mins
It’s pretty obvious that our healthcare system is not helping midlife women thrive. The limited and often suppressed information available to women is confusing enough on its own. Then once you finally dive in and make some sense of how you want to approach your hormonal health, why is it so hard to find a good prescriber to work with?
Take my Udemy Course about the basics of bioidentical hormone replacement therapy for some basic empowering knowledge.
send me a message: healthcouragecollective@gmail.com
Visit my website for freebies, updates, upcoming programs, etc: www.healthcouragecollective.com
Providers certified in Physiologic Restoration Hormone Therapy : https://womenshormonenetwork.org/find-a-provider/World Link Medical Hormone Replacement Certified Providers:https://www.directory.worldlinkmedical.com/search_results I don’t know about BHRT Training Academy, but they have a provider directory here: https://bhrttrainingacademy.com/directory/
Are you ready to give your cells their best chance to not have to stop living before they die by allowing them access to physiologic levels of hormones, but aren't sure how to even get started? Join the waitlist for my new beta program here and help me figure out how best to help wonderful women like you get the hormone care they deserve!
Come visit me: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
Take my Udemy Course about the basics of bioidentical hormone replacement therapy for some basic empowering knowledge.
send me a message: healthcouragecollective@gmail.com
Visit my website for freebies, updates, upcoming programs, etc: www.healthcouragecollective.com
Providers certified in Physiologic Restoration Hormone Therapy : https://womenshormonenetwork.org/find-a-provider/World Link Medical Hormone Replacement Certified Providers:https://www.directory.worldlinkmedical.com/search_results I don’t know about BHRT Training Academy, but they have a provider directory here: https://bhrttrainingacademy.com/directory/
Are you ready to give your cells their best chance to not have to stop living before they die by allowing them access to physiologic levels of hormones, but aren't sure how to even get started? Join the waitlist for my new beta program here and help me figure out how best to help wonderful women like you get the hormone care they deserve!
Come visit me: www.healthcouragecollective.com
email me: healthcouragecollective@gmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
It's pretty obvious that our healthcare system is not helping
midlife women thrive. A limited and often suppressed information available
to women is confusing enough on its own. Then, once
you finally dive in and make some sense of how
you want to approach your hormonal health, why is it
(00:20):
so hard to find a good prescriber to work with?
You're listening to the healthcarege Collective podcast, Episode two hundred
and eighteen. Why is it so hard to find a
good hormone doctor?
Speaker 2 (00:36):
Welcome to the Health Courage Collective podcast, the show for
women who are too busy to slog through hours of
generalized and applicable and often contradictory health information, but too
smart to ignore that a few minutes of focused attention
now can prevent years of suffering in the future. I'm
your host, Christina Hackett, a pharmacist who doesn't want you
to live on prescriptions, a certified coach specifically trained to
(00:58):
maximize your potential, and a compulsive learner obsessed with preventative,
cutting edge, holistic and integrated medicine. I'm on a mission
to increase your physical and mental resilience so you can
fearlessly look forward to your next forty plus limitless years.
Your time is down. Let's go.
Speaker 1 (01:17):
Thank hey, welcome to another episode. I'm so glad to
be here with you today. I hope that you are
doing great. How is your heart rate recovery? It's a
free and easy check from home thing you can do
yourself at home to get some information about your risk
for the number one most likely thing to kill you.
Even better, if you find you could use some improvement.
(01:40):
There are totally things you can do to become more
resilient unless like the general population who stops living before
they die. Today, you are going to talk about finding
a doctor to help you with midlife hormone health. We
all know that menopause is way more than just the
end of having periods or babies. I don't think most people,
(02:02):
including the women experiencing it in real time, appreciate the
huge extent to which perry and menopause affect every aspect
of their biology, psychology, health span. But we do know
that it's let's say extensive. So who would you go
to for help navigating the physiological consequences and symptoms of
(02:26):
these dramatic hormonal changes. What do you think you're obgyn?
An internal medicine doctor, your family practiced physician. I think
any of those sound reasonable. Half of the population will
go through the dramatic biological changes of menopause, so it
only makes sense that those doctors would all be prepared
(02:47):
to handle midlife female hormone changes as they are. Pink eye,
which affects approximately twenty percent of the population in their lifetimes,
or pre diabetes, which affects about forty percent of US
adults currently, a strained ankle about one percent of the
population per year, high blood pressure, which about forty eight
percent of the adult US population has, low back pain,
(03:10):
which about twenty six percent of the US adult population
has at any given time, or pregnancy, which about forty
three percent of the population experiences at some point. But
here's what we do know. An AARP study of internal
medicine residency graduates revealed that greater than eighty percent of
them said they would not be comfortable or prepared, nor
(03:31):
have they been adequately trained to even discuss menopause, let
alone treat menopausal women. Only twenty percent of OBGYN doctors
are even offered any training about menopause. These are the
female health doctors. Eighty percent of them aren't even offered
(03:52):
the opportunity to learn about menopause. According to doctor Rachel Rubin,
less than six percent of internal medicine, be gyn or
family practice doctors even get one hour of menopause education
during medical training. One hour. That's not enough to actually
help anyone, and ninety four percent of doctors don't even
(04:13):
get that. That's insane, it's insulting, and it's bad for
society economically because the cost of healthcare goes way up
for women who have to suffer all of these diseases
caused by their rapid loss of hormones. But much worse,
the world is worse off when wise women are unnecessarily
(04:36):
suffering and unable to shine brighter and live and give
more as they get older. So why is this the
nightmare that we can't wake up from? Well, the study
called the Women's Health Initiative that ended in two thousand
and five led to a crap ton of misinformation that
scared everyone away from using hormone therapy for women. We
(04:57):
could spend an entire day or more talking about how
poor the science and the conclusions from that study are,
and many people have, but suffice it to say that
it's rubbish, but it scared an entire generation of doctors
so thoroughly that when the doctors who knew how to
properly prescribe hormone therapy for women retired, there were almost
(05:21):
no new doctors trained to take their places. So while
most people are sort of waking up to the fact
that we unconscionably harmed a huge portion of women, we
still have this major brain drain within the medical system.
Doctors don't know what to do. A wise patient and
(05:41):
doctor both know that there are some risks to taking
hormone replacement therapy, most doctors have a distorted idea of
what those risks are to be fair to them. Hormone
replacement prescription products have these scary black box warnings to
prescribers about risks of breast cancer and of matrial cancer,
cardiovascular events, blood cloths, and dementia, which is part of
(06:03):
the idiocracy. But doctors are trained to air on the
side of caution, which is usually a good thing, but
in this case, out of an abundance of caution, women
are being materially harmed via negligence. So we're left with
all doctors obgyn's family practice, doctors, internal medicine doctors and
are chronologists, you name it, saying yeah, this really isn't
(06:26):
my thing. They'll say it's not in my scope of practice,
I'm not familiar with it, I don't feel comfortable. In
a typical five minute office visit, they'll typically just dismiss
women's requests and concerns so that they don't have to
deal with something that they haven't been taught how to do,
or they'll offer something that they do know how to do,
like writing a prescription for prozac or telling you to
(06:48):
eat more greens. The real problem is that nobody sees
menopause as their problem. Many of them fear that their
malpractice insurance won't cover them if they put a woman
on hormone replacement therapy, and maybe they wouldn't. I don't
know that's a legitimate concern from the doctor's perspective, But
most doctors wouldn't stop for even two seconds and ponder
(07:11):
the physiological implications of prescribing birth control prescriptions to women,
and that stuff is really really bad for your body
and your future and is a way more dangerous in
terms of blood clots and everything. But it's a no brainer,
and hormone replacement from praiimenopause and menopause is a non starter.
(07:31):
It really makes no sense. The real truth is that
they are killing women by trying to protect them. Women
are unnecessarily suffering with not only the traditional disruptive symptoms
of menopause, which are horrific enough on their own, but
all of the downstream consequences of estrogen, progesterone and testosterone depletion,
(07:51):
including depression, anxiety, sleeplessness, concentration and memory problems, Impaired immune
system function, decrease libido, pain with sex, skin and hair thinning,
decreased energy, increased fat accumulation, muscle mass loss, decreased bone density,
and increased fracture risk, increased risk of colon cancer, decreased
(08:13):
survivability of diagnosed with breast cancer, drastically increased risk of
the number one killer of women, cardiovascular disease, and double
the risk of the scariest disease of aging dementia, and
I'm sure some other stuff that I'm forgetting here. There
are few doctors who are willing to entertain the idea
of writing a prescription for hormone therapy for women, and
(08:35):
way fewer who actually know how to do it properly.
Doctors who are competent of helping women properly are like
this tiny niche of medicine, which would be fine if
that weren't all we had to serve half the population.
It's truly crazy, and also unfortunately means that the few
(08:58):
doctors who are able to help are usually cash pay
because insurance is horrible for a myriad of reasons. So
the only women who might be able to be helped
are upper class women with disposable time to learn a
very complicated topic for themselves and disposable income to pay
for better treatment than the standard of care. That and
at least some connections to figure out where to go,
(09:21):
which excludes the vast majority of society, which is not okay.
If you're not economically privileged, you're not going to get help.
That's horrible. There's also a whole nother rabbit hole we
could go down about how pharmaceutical industry drives medical education
and medical practice, and big Pharma doesn't care about women's health.
(09:43):
Their cash cow died with the vilification of women's hormones
in two thousand and five, so they're not interested in
doing anything to help women Moving forward, This isn't just
my opinion. I've heard from researchers who said that they
will get started on organizing a clinical trial, and then
after a month of work would talk to someone at
the pharmaceutical company who says, oh, sorry, we've let the
(10:05):
women's health department go. We're focusing on allergies now, or
oh sorry, we just got a new CEO, and he
said women's health is no longer a priority. And doctor
Rachel Rubin went to the FDA and got a bunch
of smart, perymenopausal aged FDA women together in a room
to say, this is so crazy, we need to get
(10:26):
this scary black box warning taken off vaginal estrogen products.
They all agreed with her that it wasn't accurate science,
but then they said, oh no, we need industry, meaning
pharmaceutical companies to initiate. And when she pointed out that
the pharmaceutical companies had no financial interest in doing so,
(10:47):
they just shrugged their shoulders. Yet, there was a very
similar warning on testosterone products for men, and as soon
as that black box warning got put on testosterone replacement
therapy products, a new study was designed, like within minutes.
It was very poorly done, but concluded that testosterone placement
therapy doesn't actually increase cardiovascular risk, so the FDA took
(11:08):
away that black box warning immediately. Hmmm. Doctor Rachel Rubin
said this quote, which I think sums up this whole
topic so well. Women's health menopause in particular, is important
to nobody. When it's nobody's problem, nobody takes ownership over it.
End quote. It's so true. I think this is slowly
(11:31):
changing a little bit. It's more talked about now, there's
some celebrity buzz, which I think helps normal women feel
more comfortable talking to one another, but we still have
a long way to go and not nearly enough medical
providers who are competent at helping them. This opens the
door to another problem, as if all this weren't bad enough,
(11:51):
because there is a huge group of smart, successful women
who are being woefully underserved and not okay with that.
They are now all of products and services geared toward
helping midlife women, but that aren't actually what she needs.
Some of them with good intentions trying to be helpers
where no one else is stepping up, and some of
(12:11):
them who just want to make a quick buck from
this underserved market. Many of them are driving their sales
under this disguise of activism or feminism. So now we
have a whole different problem to be on the lookout for.
We can discuss supplements and multi level marketing companies some
other time. In terms of finding a medical provider who
(12:31):
will prescribe hormone replacement therapy for you, there are new
hormone clinics popping up with prescribers who don't really know
the nuances of prescribing hormone replacement for women. Some people
call them talk in a box clinics or boutique clinics.
I think they're mostly there in the hopes of helping women,
but they're staffed with providers who don't realize how little
(12:55):
they know. This could potentially be worse than not having
anyone help you. Well, I don't know about that. Maybe,
but it's not good. It's not what's going to give
you a huge amount of leverage in safely and enjoyably
preventing more drastically delaying all of the chronic diseases of
aging the way a well designed personalized hormone replacement regime does.
(13:17):
I have heard some crazy things over the years, like
doctors who keep pushing more and more and more testosteronee
women till their levels are as high as men's levels.
Because the women feel great, they have tons of energy,
They're libido is higher than it's ever been. The provider
thinks they're doing this great thing for her quality of life. Meanwhile,
(13:38):
her voice has completely lowered, she has facial hair, and
is physiologically different than an optimal female should be, and
is pumping out all kinds of androgen metabolites that are
not natural in high levels. Then there are lots of
clinics who basically treat everyone the same. They know the
basics of what worked for one or two women, what
(13:59):
they saw one per do for someone one time, and
they use that to cookie cutter treat every woman. So
now we have two problems. The majority of doctors are
not willing to help women with hormonal health, and then
the ones who are, many of them are incompetent. Ah,
So what the girl to do? While I believe we
(14:21):
deserve to live in a world where science is science
and professionals who took solemn oaths to first do no harm,
use evidence and experience to build one another up to
all be able to treat women with compassionate and expertise.
We just don't, And given that that's our reality, I
think that the biggest advantage you can leverage for yourself,
(14:44):
the best shot you have at sailing through perimenopause and
menopause and aging differently than most people, is to acquire
knowledge for yourself. To understand typical premenopausal hormones, perimenopausal hormones,
and menopausal hormone To know which are hormones that your
body naturally makes and the implications of those that are not,
(15:07):
To know what questions to ask, and red flags to
watch out for to make sure you're an astute consumer
of healthcare, not the end product someone else is trying
to cash in on. I'm sure there are more red
flags than these, and that you have an intuition that
can guide you better than any laundry list I could
(15:28):
give you here. But some morning signs that I thought
of are if your provider brushes you off with a
terse answer that demonstrates that she's not willing to dive
deeper into your questions about whether your hormones could be
causing your problems. If he makes a blanket statement about
hormones increasing your risk for breast cancer or cardiovascular diseases,
or being wildly dangerous for everyone. This is a tricky
(15:50):
one because this is what the authority, the North American
Menopause Society, which was recently renamed just the Menopause Society, says.
But if he keeps re iterating they you absolutely need
to take the lowest possible dose for the shortest possible duration,
that's a problem. If she says that you don't need
progesterone because you don't have a uterus. If she recommends
(16:12):
or prescribes a synthetic progestine like madroxy progesterone acetate nor
ethendron norgestimate or a marina IUD which contains lemo norgestrel,
I would turn around and walk out the door if
the doctor called a progestin a progesterone. But that's a
pretty high bar. I hear some smart doctors do that
all the time, and it makes me want to jump
(16:33):
out the window. Oh, if the doctor recommends premarin or
conjugated equine estrogens, just run away. Another recommendation by the
Menopause Society is that you should never test for any hormones.
They should only be used for the short term relief
of symptoms. I think this is wrong and testing can
be valuable. I think the Dutch test is wonderful, though
(16:54):
many more traditional prescribers don't. Maybe not a game changer,
but I do think good prescribers use testing related to this.
If they just think hormones are for short symptom relief
like hot flashes, in that they don't acknowledge the benefits
of proper hormone levels to your mood, mental clarity, sleep,
bone density, risk of cardiovascular disease, colon cancer, muscle mass,
(17:18):
et cetera, et cetera. It's really about whole body health.
If they don't see it that way, maybe they're not
the best. I think those are more typically things that
would happen with a hormone hesitant provider. Then there are
the red flags on the other extreme, I would consider
it a problem if a doctor is overly anxious to
start you on hormones, especially if you are hesitant. If
(17:42):
they out and out dismiss your questions or concerns about
family history of breast cancer or blood clots, if they
tell you they are one hundred percent safe and there's
absolutely no risk and nothing to worry about, be worried
about that. If they tell you have to start right
away and continue till you die, definitely be suspicious. If
(18:04):
they tell you where to buy the hormones that they're
going to prescribe you. If you're paying them the doctor
for your prescriptions, consider running away. If they don't give
you the option to pick your own pharmacy, be super suspicious.
I think it's okay to suggest options for people who
don't have any idea of where to go, but they
(18:25):
absolutely should not have a vested interest in your paying
money to a certain pharmacy. I'd be extra cautious of
telemedicine doctors. That can obviously be some good ones. But
if it seems like some kind of doctor in name
only situation where the only people you communicate with are
all not actual medical professionals, and an unseen doctor just
(18:49):
allows them to use their name to meet legal requirements,
that's a problem. If they don't get a thorough health
history from you or understand what it is that you
are wanting to achieve with hormone replacement therapy, that's a
big issue. If they have a standard hormone recipe that
they give to everyone, that's a problem. My personal preference
(19:10):
is that you should not take estrogen orally. If that's
their standard, I'd be worried about that. I'd be personally
suspicious if they never mentioned the normal premenopausal twenty eight
day hormone cycle to you at all, If they can't
answer your questions or want to help you understand their
approach and their reasoning, If they don't look at estrogen, progesterone, testosterone, DHA, cortisol,
(19:33):
and thyroid as all important and working together, then of
course you want to find someone that you vibe with,
someone whose mindset matches yours. Do they think you're not
a woman anymore if you don't take hormones. Do they
want to try to make you look like you're twenty forever?
Do you want those things? Do they emphasize cosmetic benefits
(19:54):
as the most important things? Is that what matters most
to you? Do they deeply believe in mimicking your premenopausal
twenty eight day cycle of different amounts of hormones on
different days, even though it means having a period every month.
Do you do they think that's ridiculous? Do you do
they think hormones should only be used for the worst
(20:16):
symptoms that you just aren't strong enough to power through
on your own, do you? Are they pointing out important
things that you never thought to ask? Are they willing
to say they don't know? If they don't, how do
they plan to make adjustments if you don't feel right?
Are they giving you a list of warning signs to
watch out for. Are they explaining how what they're recommending
(20:40):
applies to your whole body health and that hormones do
not exist in isolation. Are they emphasizing how lifestyle factors
and habits affect all of this? How expensive will it be?
Are they locking you into some kind of crazy ongoing
payment schedule. It can be hard to find the right
(21:02):
prescriber to help you maintain the biology that you want
to have to be able to age at an elite
level so that you feel left out when all of
your friends are complaining about normal aging. But it is possible.
I hope you can understand why it's so hard a
little bit more now, and that the best chance you
have of to get working with an awesome provider who
(21:24):
can be really a game changer in helping you love
your life is to be armed with knowledge knowledge about
hormone levels, how they change throughout the month, how they
change at perimenopause and menopause, and the body systems that
they affect, which is virtually all of them. Developing your
own principles and I don't know if i'd say ideology,
(21:45):
but tenets of health that feel right to you, so
that you know if what they have to offer matches
with what you want for yourself. There's been a brain
drain with twenty years of doctors not being trained at
all about prescribing hormones to women, followed by a new
pop up of questionable clinics trying to fill the gap
(22:07):
but not prepared to safely do so. This is why
it's so important to know what questions to ask and
what are legitimate risks and benefits to using hormone therapy. Then,
of course having your radar up for the red flags
we discussed and the ones I forgot to mention, but
I think you'll catch them because you're smart. You don't
have to settle for the standard of care. You don't
(22:29):
have to have the same experience that you might have
seen your mother or aunts or grandmothers go through as
they got older. It takes some extra sleuthing and research
and learning and most importantly, implementing in reality with routines
and habits that are different than typical. But it's so
worth it to keep your cells supplied with what they
(22:52):
need to help you live and give more as you
get older, rather than less. It's exciting to think about
how great your future can be. I'll put a link
in the show notes to a list of providers who
are certified in physiologic hormone restoration therapy. It's not the
only way to go, but I do think it's a
good one. That's a good place to start. There's also
(23:13):
another place called world Link Medical that trains providers in
hormone replacement prescribing. I'll put a link to that in
the show notes too. The late Suzanne Summers used to
have a good provider directory on her website, Forever Health,
but it doesn't work anymore. I'll put one other link.
But I don't know much about this BHRT training Academy place.
(23:33):
It may or may not be any good, but it's
a starting place to see who's out there near you.
Of course, use all of your other resources to look
around to word of mouth, asking trusted providers, pharmacists or
midlife age women around you who appear to be aging
exceptionally well. Success leaves clues, as they say, I'm excited
(23:54):
to see what kind of difference you still have to
make in the world. So thank you for being here today.
Next week we're going to talk about ten mistakes that
are commonly made with hormone replacement therapy. Until then, know
that you have the ability to find the doctor you
need on your elite aging team and don't be normal.
(24:15):
Thank you so much for tuning into the Health Courage
collective podcast. I am truly honored that you have paid
me the enormous compliment of your time and attention. I
would be so grateful if you would share this podcast
with someone you know and subscribe so you.
Speaker 2 (24:28):
Never miss an episode.
Speaker 1 (24:30):
This podcast is for entertainment and information purposes only. Statements
and views on this podcast are not medical advice. This podcast,
including
Speaker 2 (24:37):
Christina Hackett and producers, disclaim responsibility for any possible adverse
events by use of information contained here it If you
think you have a medical problem, consult a licensed position
It's pretty obvious that our healthcare system is not helping
midlife women thrive. A limited and often suppressed information available
to women is confusing enough on its own. Then, once
you finally dive in and make some sense of how
you want to approach your hormonal health, why is it
(00:20):
so hard to find a good prescriber to work with?
You're listening to the healthcarege Collective podcast, Episode two hundred
and eighteen. Why is it so hard to find a
good hormone doctor?
Speaker 2 (00:36):
Welcome to the Health Courage Collective podcast, the show for
women who are too busy to slog through hours of
generalized and applicable and often contradictory health information, but too
smart to ignore that a few minutes of focused attention
now can prevent years of suffering in the future. I'm
your host, Christina Hackett, a pharmacist who doesn't want you
to live on prescriptions, a certified coach specifically trained to
(00:58):
maximize your potential, and a compulsive learner obsessed with preventative,
cutting edge, holistic and integrated medicine. I'm on a mission
to increase your physical and mental resilience so you can
fearlessly look forward to your next forty plus limitless years.
Your time is down. Let's go.
Speaker 1 (01:17):
Thank hey, welcome to another episode. I'm so glad to
be here with you today. I hope that you are
doing great. How is your heart rate recovery? It's a
free and easy check from home thing you can do
yourself at home to get some information about your risk
for the number one most likely thing to kill you.
Even better, if you find you could use some improvement.
(01:40):
There are totally things you can do to become more
resilient unless like the general population who stops living before
they die. Today, you are going to talk about finding
a doctor to help you with midlife hormone health. We
all know that menopause is way more than just the
end of having periods or babies. I don't think most people,
(02:02):
including the women experiencing it in real time, appreciate the
huge extent to which perry and menopause affect every aspect
of their biology, psychology, health span. But we do know
that it's let's say extensive. So who would you go
to for help navigating the physiological consequences and symptoms of
(02:26):
these dramatic hormonal changes. What do you think you're obgyn?
An internal medicine doctor, your family practiced physician. I think
any of those sound reasonable. Half of the population will
go through the dramatic biological changes of menopause, so it
only makes sense that those doctors would all be prepared
(02:47):
to handle midlife female hormone changes as they are. Pink eye,
which affects approximately twenty percent of the population in their lifetimes,
or pre diabetes, which affects about forty percent of US
adults currently, a strained ankle about one percent of the
population per year, high blood pressure, which about forty eight
percent of the adult US population has, low back pain,
(03:10):
which about twenty six percent of the US adult population
has at any given time, or pregnancy, which about forty
three percent of the population experiences at some point. But
here's what we do know. An AARP study of internal
medicine residency graduates revealed that greater than eighty percent of
them said they would not be comfortable or prepared, nor
(03:31):
have they been adequately trained to even discuss menopause, let
alone treat menopausal women. Only twenty percent of OBGYN doctors
are even offered any training about menopause. These are the
female health doctors. Eighty percent of them aren't even offered
(03:52):
the opportunity to learn about menopause. According to doctor Rachel Rubin,
less than six percent of internal medicine, be gyn or
family practice doctors even get one hour of menopause education
during medical training. One hour. That's not enough to actually
help anyone, and ninety four percent of doctors don't even
(04:13):
get that. That's insane, it's insulting, and it's bad for
society economically because the cost of healthcare goes way up
for women who have to suffer all of these diseases
caused by their rapid loss of hormones. But much worse,
the world is worse off when wise women are unnecessarily
(04:36):
suffering and unable to shine brighter and live and give
more as they get older. So why is this the
nightmare that we can't wake up from? Well, the study
called the Women's Health Initiative that ended in two thousand
and five led to a crap ton of misinformation that
scared everyone away from using hormone therapy for women. We
(04:57):
could spend an entire day or more talking about how
poor the science and the conclusions from that study are,
and many people have, but suffice it to say that
it's rubbish, but it scared an entire generation of doctors
so thoroughly that when the doctors who knew how to
properly prescribe hormone therapy for women retired, there were almost
(05:21):
no new doctors trained to take their places. So while
most people are sort of waking up to the fact
that we unconscionably harmed a huge portion of women, we
still have this major brain drain within the medical system.
Doctors don't know what to do. A wise patient and
(05:41):
doctor both know that there are some risks to taking
hormone replacement therapy, most doctors have a distorted idea of
what those risks are to be fair to them. Hormone
replacement prescription products have these scary black box warnings to
prescribers about risks of breast cancer and of matrial cancer,
cardiovascular events, blood cloths, and dementia, which is part of
(06:03):
the idiocracy. But doctors are trained to air on the
side of caution, which is usually a good thing, but
in this case, out of an abundance of caution, women
are being materially harmed via negligence. So we're left with
all doctors obgyn's family practice, doctors, internal medicine doctors and
are chronologists, you name it, saying yeah, this really isn't
(06:26):
my thing. They'll say it's not in my scope of practice,
I'm not familiar with it, I don't feel comfortable. In
a typical five minute office visit, they'll typically just dismiss
women's requests and concerns so that they don't have to
deal with something that they haven't been taught how to do,
or they'll offer something that they do know how to do,
like writing a prescription for prozac or telling you to
(06:48):
eat more greens. The real problem is that nobody sees
menopause as their problem. Many of them fear that their
malpractice insurance won't cover them if they put a woman
on hormone replacement therapy, and maybe they wouldn't. I don't
know that's a legitimate concern from the doctor's perspective, But
most doctors wouldn't stop for even two seconds and ponder
(07:11):
the physiological implications of prescribing birth control prescriptions to women,
and that stuff is really really bad for your body
and your future and is a way more dangerous in
terms of blood clots and everything. But it's a no brainer,
and hormone replacement from praiimenopause and menopause is a non starter.
(07:31):
It really makes no sense. The real truth is that
they are killing women by trying to protect them. Women
are unnecessarily suffering with not only the traditional disruptive symptoms
of menopause, which are horrific enough on their own, but
all of the downstream consequences of estrogen, progesterone and testosterone depletion,
(07:51):
including depression, anxiety, sleeplessness, concentration and memory problems, Impaired immune
system function, decrease libido, pain with sex, skin and hair thinning,
decreased energy, increased fat accumulation, muscle mass loss, decreased bone density,
and increased fracture risk, increased risk of colon cancer, decreased
(08:13):
survivability of diagnosed with breast cancer, drastically increased risk of
the number one killer of women, cardiovascular disease, and double
the risk of the scariest disease of aging dementia, and
I'm sure some other stuff that I'm forgetting here. There
are few doctors who are willing to entertain the idea
of writing a prescription for hormone therapy for women, and
(08:35):
way fewer who actually know how to do it properly.
Doctors who are competent of helping women properly are like
this tiny niche of medicine, which would be fine if
that weren't all we had to serve half the population.
It's truly crazy, and also unfortunately means that the few
(08:58):
doctors who are able to help are usually cash pay
because insurance is horrible for a myriad of reasons. So
the only women who might be able to be helped
are upper class women with disposable time to learn a
very complicated topic for themselves and disposable income to pay
for better treatment than the standard of care. That and
at least some connections to figure out where to go,
(09:21):
which excludes the vast majority of society, which is not okay.
If you're not economically privileged, you're not going to get help.
That's horrible. There's also a whole nother rabbit hole we
could go down about how pharmaceutical industry drives medical education
and medical practice, and big Pharma doesn't care about women's health.
(09:43):
Their cash cow died with the vilification of women's hormones
in two thousand and five, so they're not interested in
doing anything to help women Moving forward, This isn't just
my opinion. I've heard from researchers who said that they
will get started on organizing a clinical trial, and then
after a month of work would talk to someone at
the pharmaceutical company who says, oh, sorry, we've let the
(10:05):
women's health department go. We're focusing on allergies now, or
oh sorry, we just got a new CEO, and he
said women's health is no longer a priority. And doctor
Rachel Rubin went to the FDA and got a bunch
of smart, perymenopausal aged FDA women together in a room
to say, this is so crazy, we need to get
(10:26):
this scary black box warning taken off vaginal estrogen products.
They all agreed with her that it wasn't accurate science,
but then they said, oh no, we need industry, meaning
pharmaceutical companies to initiate. And when she pointed out that
the pharmaceutical companies had no financial interest in doing so,
(10:47):
they just shrugged their shoulders. Yet, there was a very
similar warning on testosterone products for men, and as soon
as that black box warning got put on testosterone replacement
therapy products, a new study was designed, like within minutes.
It was very poorly done, but concluded that testosterone placement
therapy doesn't actually increase cardiovascular risk, so the FDA took
(11:08):
away that black box warning immediately. Hmmm. Doctor Rachel Rubin
said this quote, which I think sums up this whole
topic so well. Women's health menopause in particular, is important
to nobody. When it's nobody's problem, nobody takes ownership over it.
End quote. It's so true. I think this is slowly
(11:31):
changing a little bit. It's more talked about now, there's
some celebrity buzz, which I think helps normal women feel
more comfortable talking to one another, but we still have
a long way to go and not nearly enough medical
providers who are competent at helping them. This opens the
door to another problem, as if all this weren't bad enough,
(11:51):
because there is a huge group of smart, successful women
who are being woefully underserved and not okay with that.
They are now all of products and services geared toward
helping midlife women, but that aren't actually what she needs.
Some of them with good intentions trying to be helpers
where no one else is stepping up, and some of
(12:11):
them who just want to make a quick buck from
this underserved market. Many of them are driving their sales
under this disguise of activism or feminism. So now we
have a whole different problem to be on the lookout for.
We can discuss supplements and multi level marketing companies some
other time. In terms of finding a medical provider who
(12:31):
will prescribe hormone replacement therapy for you, there are new
hormone clinics popping up with prescribers who don't really know
the nuances of prescribing hormone replacement for women. Some people
call them talk in a box clinics or boutique clinics.
I think they're mostly there in the hopes of helping women,
but they're staffed with providers who don't realize how little
(12:55):
they know. This could potentially be worse than not having
anyone help you. Well, I don't know about that. Maybe,
but it's not good. It's not what's going to give
you a huge amount of leverage in safely and enjoyably
preventing more drastically delaying all of the chronic diseases of
aging the way a well designed personalized hormone replacement regime does.
(13:17):
I have heard some crazy things over the years, like
doctors who keep pushing more and more and more testosteronee
women till their levels are as high as men's levels.
Because the women feel great, they have tons of energy,
They're libido is higher than it's ever been. The provider
thinks they're doing this great thing for her quality of life. Meanwhile,
(13:38):
her voice has completely lowered, she has facial hair, and
is physiologically different than an optimal female should be, and
is pumping out all kinds of androgen metabolites that are
not natural in high levels. Then there are lots of
clinics who basically treat everyone the same. They know the
basics of what worked for one or two women, what
(13:59):
they saw one per do for someone one time, and
they use that to cookie cutter treat every woman. So
now we have two problems. The majority of doctors are
not willing to help women with hormonal health, and then
the ones who are, many of them are incompetent. Ah,
So what the girl to do? While I believe we
(14:21):
deserve to live in a world where science is science
and professionals who took solemn oaths to first do no harm,
use evidence and experience to build one another up to
all be able to treat women with compassionate and expertise.
We just don't, And given that that's our reality, I
think that the biggest advantage you can leverage for yourself,
(14:44):
the best shot you have at sailing through perimenopause and
menopause and aging differently than most people, is to acquire
knowledge for yourself. To understand typical premenopausal hormones, perimenopausal hormones,
and menopausal hormone To know which are hormones that your
body naturally makes and the implications of those that are not,
(15:07):
To know what questions to ask, and red flags to
watch out for to make sure you're an astute consumer
of healthcare, not the end product someone else is trying
to cash in on. I'm sure there are more red
flags than these, and that you have an intuition that
can guide you better than any laundry list I could
(15:28):
give you here. But some morning signs that I thought
of are if your provider brushes you off with a
terse answer that demonstrates that she's not willing to dive
deeper into your questions about whether your hormones could be
causing your problems. If he makes a blanket statement about
hormones increasing your risk for breast cancer or cardiovascular diseases,
or being wildly dangerous for everyone. This is a tricky
(15:50):
one because this is what the authority, the North American
Menopause Society, which was recently renamed just the Menopause Society, says.
But if he keeps re iterating they you absolutely need
to take the lowest possible dose for the shortest possible duration,
that's a problem. If she says that you don't need
progesterone because you don't have a uterus. If she recommends
(16:12):
or prescribes a synthetic progestine like madroxy progesterone acetate nor
ethendron norgestimate or a marina IUD which contains lemo norgestrel,
I would turn around and walk out the door if
the doctor called a progestin a progesterone. But that's a
pretty high bar. I hear some smart doctors do that
all the time, and it makes me want to jump
(16:33):
out the window. Oh, if the doctor recommends premarin or
conjugated equine estrogens, just run away. Another recommendation by the
Menopause Society is that you should never test for any hormones.
They should only be used for the short term relief
of symptoms. I think this is wrong and testing can
be valuable. I think the Dutch test is wonderful, though
(16:54):
many more traditional prescribers don't. Maybe not a game changer,
but I do think good prescribers use testing related to this.
If they just think hormones are for short symptom relief
like hot flashes, in that they don't acknowledge the benefits
of proper hormone levels to your mood, mental clarity, sleep,
bone density, risk of cardiovascular disease, colon cancer, muscle mass,
(17:18):
et cetera, et cetera. It's really about whole body health.
If they don't see it that way, maybe they're not
the best. I think those are more typically things that
would happen with a hormone hesitant provider. Then there are
the red flags on the other extreme, I would consider
it a problem if a doctor is overly anxious to
start you on hormones, especially if you are hesitant. If
(17:42):
they out and out dismiss your questions or concerns about
family history of breast cancer or blood clots, if they
tell you they are one hundred percent safe and there's
absolutely no risk and nothing to worry about, be worried
about that. If they tell you have to start right
away and continue till you die, definitely be suspicious. If
(18:04):
they tell you where to buy the hormones that they're
going to prescribe you. If you're paying them the doctor
for your prescriptions, consider running away. If they don't give
you the option to pick your own pharmacy, be super suspicious.
I think it's okay to suggest options for people who
don't have any idea of where to go, but they
(18:25):
absolutely should not have a vested interest in your paying
money to a certain pharmacy. I'd be extra cautious of
telemedicine doctors. That can obviously be some good ones. But
if it seems like some kind of doctor in name
only situation where the only people you communicate with are
all not actual medical professionals, and an unseen doctor just
(18:49):
allows them to use their name to meet legal requirements,
that's a problem. If they don't get a thorough health
history from you or understand what it is that you
are wanting to achieve with hormone replacement therapy, that's a
big issue. If they have a standard hormone recipe that
they give to everyone, that's a problem. My personal preference
(19:10):
is that you should not take estrogen orally. If that's
their standard, I'd be worried about that. I'd be personally
suspicious if they never mentioned the normal premenopausal twenty eight
day hormone cycle to you at all, If they can't
answer your questions or want to help you understand their
approach and their reasoning, If they don't look at estrogen, progesterone, testosterone, DHA, cortisol,
(19:33):
and thyroid as all important and working together, then of
course you want to find someone that you vibe with,
someone whose mindset matches yours. Do they think you're not
a woman anymore if you don't take hormones. Do they
want to try to make you look like you're twenty forever?
Do you want those things? Do they emphasize cosmetic benefits
(19:54):
as the most important things? Is that what matters most
to you? Do they deeply believe in mimicking your premenopausal
twenty eight day cycle of different amounts of hormones on
different days, even though it means having a period every month.
Do you do they think that's ridiculous? Do you do
they think hormones should only be used for the worst
(20:16):
symptoms that you just aren't strong enough to power through
on your own, do you? Are they pointing out important
things that you never thought to ask? Are they willing
to say they don't know? If they don't, how do
they plan to make adjustments if you don't feel right?
Are they giving you a list of warning signs to
watch out for. Are they explaining how what they're recommending
(20:40):
applies to your whole body health and that hormones do
not exist in isolation. Are they emphasizing how lifestyle factors
and habits affect all of this? How expensive will it be?
Are they locking you into some kind of crazy ongoing
payment schedule. It can be hard to find the right
(21:02):
prescriber to help you maintain the biology that you want
to have to be able to age at an elite
level so that you feel left out when all of
your friends are complaining about normal aging. But it is possible.
I hope you can understand why it's so hard a
little bit more now, and that the best chance you
have of to get working with an awesome provider who
(21:24):
can be really a game changer in helping you love
your life is to be armed with knowledge knowledge about
hormone levels, how they change throughout the month, how they
change at perimenopause and menopause, and the body systems that
they affect, which is virtually all of them. Developing your
own principles and I don't know if i'd say ideology,
(21:45):
but tenets of health that feel right to you, so
that you know if what they have to offer matches
with what you want for yourself. There's been a brain
drain with twenty years of doctors not being trained at
all about prescribing hormones to women, followed by a new
pop up of questionable clinics trying to fill the gap
(22:07):
but not prepared to safely do so. This is why
it's so important to know what questions to ask and
what are legitimate risks and benefits to using hormone therapy. Then,
of course having your radar up for the red flags
we discussed and the ones I forgot to mention, but
I think you'll catch them because you're smart. You don't
have to settle for the standard of care. You don't
(22:29):
have to have the same experience that you might have
seen your mother or aunts or grandmothers go through as
they got older. It takes some extra sleuthing and research
and learning and most importantly, implementing in reality with routines
and habits that are different than typical. But it's so
worth it to keep your cells supplied with what they
(22:52):
need to help you live and give more as you
get older, rather than less. It's exciting to think about
how great your future can be. I'll put a link
in the show notes to a list of providers who
are certified in physiologic hormone restoration therapy. It's not the
only way to go, but I do think it's a
good one. That's a good place to start. There's also
(23:13):
another place called world Link Medical that trains providers in
hormone replacement prescribing. I'll put a link to that in
the show notes too. The late Suzanne Summers used to
have a good provider directory on her website, Forever Health,
but it doesn't work anymore. I'll put one other link.
But I don't know much about this BHRT training Academy place.
(23:33):
It may or may not be any good, but it's
a starting place to see who's out there near you.
Of course, use all of your other resources to look
around to word of mouth, asking trusted providers, pharmacists or
midlife age women around you who appear to be aging
exceptionally well. Success leaves clues, as they say, I'm excited
(23:54):
to see what kind of difference you still have to
make in the world. So thank you for being here today.
Next week we're going to talk about ten mistakes that
are commonly made with hormone replacement therapy. Until then, know
that you have the ability to find the doctor you
need on your elite aging team and don't be normal.
(24:15):
Thank you so much for tuning into the Health Courage
collective podcast. I am truly honored that you have paid
me the enormous compliment of your time and attention. I
would be so grateful if you would share this podcast
with someone you know and subscribe so you.
Speaker 2 (24:28):
Never miss an episode.
Speaker 1 (24:30):
This podcast is for entertainment and information purposes only. Statements
and views on this podcast are not medical advice. This podcast,
including
Speaker 2 (24:37):
Christina Hackett and producers, disclaim responsibility for any possible adverse
events by use of information contained here it If you
think you have a medical problem, consult a licensed position
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