Navigating Bioidentical Hormone Replacement Therapy – with Karen Martel

Dr. Mindy  

On this episode of The resetter podcast, I bring you Karen Martel. Now, this is a conversation I’ve been wanting to bring to you all for a very long time. It just haven’t found the right person to do it. And I believe that what you’re about to hear is I found the right person. Karen is not only a hormone and perimenopause specialist, not only does she have incredible clinical experience with bioidenticals, she has a huge heart. And she has a unique approach to helping us all understand. If we should be doing HRT bioidenticals. How would we know where the door in to these exogenous hormones would be for ourselves in our own unique way. And so what you’re going to hear in this episode, is we talk about the difference between HRT and bioidenticals. So for those of you that don’t know that you’re about to get a lesson on that, which will be hopefully really helpful. But then we go into the individual sex hormones, testosterone, estrogen, and progesterone, all the different ways we can use these hormones, through bioidenticals, through creams, through pills, through tablets, through shots, you hear it all, we talk about all the different ways that we can go after bringing in hormones into our body as we go through the peri men, menopause and menopausal years. Now, you’ll also hear in there that I’m experimenting with bioidenticals, as well. And so I use myself as an example, knowing my hormones quite well, what my door in would look like for bioidenticals. And you’ll see that Karen has some very strong opinions, which we’re all very welcomed. So if you’ve been trying to figure out the exogenous hormone game, you’re trying to understand where you sit on the topic, I really hope that this message sits with you, I hope this conversation opens up your mind, I hope you’ll see that that everybody’s path, using exogenous hormones is different. And again, I’m hoping you’re gonna get answers here. I love Karen, I love her heart and love what she’s up to in the world. I’ll leave all the links in the notes for you, so that you can benefit from her services, if that feels great to you. But most of all, I want to educate you on when and when not, we would use these exogenous resources for our hormonal benefit. So as always, I hope this helps and changes the direction that your health is heading and for my perimenopause and menopausal women out there, I’m with you. I hear you. I know the struggles you’re going through, which is why I’m so glad to be bringing you this conversation. Karen Martell, enjoy

Dr. Mindy  

It’s doctor Mindy here and welcome to season four of the resetter podcast. Please know that this podcast is all about empowering you to believe in yourself. Again. If you have a passion for learning, if you’re looking to be in control of your health and take your power back, this is the podcast for you. Enjoy.

Dr. Mindy  

Let me just start by welcoming you Karen to I always feel like this is my home. Welcome to the recenter podcast. Yes, it

Karen Martel  

is in our home, really? So yes. Thank you for having me.

Dr. Mindy  

Yeah. Can we start this conversation just for those people that are listening? Can you explain the difference between HRT and BHRT? What’s the difference between those two? And then maybe in that, can you also explain your passion behind bioidenticals? And how you got involved in this? Yes,

Karen Martel  

absolutely. So back in the 1950s. HRT came on the scene. Now. Hormone Replacement Therapy is actually 1000s of years old. There’s actually documentation that goes way back into China where they used to collect the urine from youthful men and women and then the Emperor’s emperors and emphasis or whatever they were would somehow ingest the urine, they would dry the urine and then they would ingest it. So this

Dr. Mindy  

will be drinking on for a while. Yeah. From a glass, drank it. We’re not going to recommend that for those. No, we’re not recommending that my God.

Karen Martel  

So in the 1950s, they made Premarin which was from pregnant horses urine, again urine. And so that was the first kind of on the scene, estrogen replacement therapy, and it was taken orally, and this became the number one One most prescribed medication in North America. And it remained there for a very long time. So you can imagine, every woman was on it, like it was it was so highly sought after. And they realized, as they you know, the years went on that they needed to create something that was that would mimic progesterone. They didn’t get this from horses. They made this in a lab. It was a synthetic chemical, which we still have around today and birth control pills as well as hormone replacement therapy. And that was Provera, also known as progestins. And the frustrating thing is, is if you start to look through PubMed research, you’ll see progesterone, the word progesterone being used in a lot of research when it was actually progestins that were used in that research. Yeah, interesting. Yes. And so the progestin had to come in, because they needed something to counterbalance the growth in the uterine lining, because without a progesterone in there, the uterine lining because of the estrogen, and estrogen is a growth hormone would grow the uterine lining, and it would become uncontrolled growth, and then there was an increased risk of uterine cancer. So they’re like, Okay, let’s get this. Let’s put this into the mix. So they did that that was also taken orally. Into that or night, in the late 1990s, the Women’s Health Initiative came onto the scene. This was the one of the biggest studies of its kind. There’s over 600,000 women they set out to say, let’s prove that by that hormone replacement therapy is of benefit. And so they set out to do this research and with all these women, and they started the study. They had a couple different arms of the study, of course, one being both the Premarin and the progestin. One arm of the study of just estrogen but the Premarin this, we can’t even really call it estrogen horses. Estrogen, we’ll call horses, which is nothing like our

Dr. Mindy  

own you guys. Right? Silly. But it worked. It worked.

Karen Martel  

Yeah, it have symptoms. And then so they had the arm of the site where women didn’t have a uterus. So they didn’t use the progesterone. They just use the Premarin. And so in this, and I’m telling you have this because this leads into the use of bioidentical hormones. And this is where a lot of the misinformation comes from. Yeah. And so these this study went on for a couple of years. And then in 2002, they actually stopped the study. This was about four years into it. They stopped the study, because they saw that there was an increased risk of heart attack and stroke, uterine cancer and breast cancer. Now, this when they when they reanalyze, this study, they actually it showed that there was an extra one woman in every 1000 that developed breast cancer from taking the combination of progestin and Premarin. So we didn’t hear about this all all the world heard was, oh, my gosh, get women off of hormones. Hormone Replacement Therapy is killing them. It’s giving them breast cancer and uterine cancer now stop.

Dr. Mindy  

Yeah. And Can Can I say something on that, because I think this is really important. When we look at science, science studies are multifaceted. You have when you look at a study, you got to look at the sample size, you got to look at at the parameters in which they studied the people, you’ve got to look at the backing behind the people. And even once you’ve looked at all of that, there are often little things that get highlighted and pulled out that now become this like flashy statement. And this is so this has still happens to to this day in studies. And we need more rich conversations like this one, to talk about what was going on in that study. I mean, we have this in the fasting world all the time. This is right, this is wrong. No, there’s a lot to unpack here. Now let’s unpack it. So I just have to make sure that I say that that was really well was

Karen Martel  

really Yes. And you can start to when you start to actually dig into the research. There’s been so many people that have reanalyzed the study and it’s shocking what the truth was of this study and how nobody still to this day is talking about it. Right? Was it you can ask a woman still to get it all day long, every single day in my practice where you tell a woman like hey, maybe you could use some estrogen replacement therapy and they’re like, they just like covered their breasts. It’s like Right yeah. What like I’m gonna

Dr. Mindy  

We’re a media it’s crazy. And doctors

Karen Martel  

to you’ll go to your doctor and the doctor will say like, Oh, I’m not gonna give you estrogen that will kill you. They live really will say that that will give you breast cancer. When they looked at the study later on, there’s so many faults today there was like they couldn’t find any women that weren’t on Premarin. So they ended up with women that were unhealthy over the age of 60. well past the their 10 year window of being in menopause, all of the things, but what they, what was shocking about it was it was the arm of the study that use the progestin that had the increased risk of breast cancer. The in the arm of the study, were just the Premarin was used horses estrogen, there was a 33% reduction in breast cancer cases. Which once again, when you look at it from like the overall view of how many women etc. It was, it was still small, what the difference was of how many women didn’t get cancer, and then the ones that did in in their, in their progestin group, but still, that’s why you got to look at the studies like you were saying, like you really have to dig into that research. Yeah, so we didn’t hear anything about this. And still to this day, how many like 20 years later, we still think that estrogen is going to give us breast cancer. And so most 80% of women stopped using their hormone replacement therapy, and really started to suffer because of it. And then eventually, we started to see what was what is now known as BioIdentical Hormone Replacement Therapy, which is made from either from soy or from yams. Now, these are chemically made still in a lab. But that is where they’re derived from, and they are identical. So you can think of them as body identical hormones. The chemical structure is exactly the same as your own. And we typically like with the estrogen, we really even though there is bioidentical oral estrogen. I always say you use it topically because one of the reason why there was an increased risk of heart attack and stroke with the Premarin was when you swallow estrogen, it can increase the risk of stroke. But if you look at the research, there is no increased risk of stroke and heart attack when you use transdermal through the skin. Astra dial. So that’s a huge distinction to make.

Dr. Mindy  

Okay, now, before you go any further because I have, you know, full transparency, I’ve tried bioidenticals I’ve tried HRT, I’ve like I test everything on myself. And I will have tried every cream on the planet. And I will tell you that the creams did not work for me. And now I’m doing a bio identical pill, small dose of progesterone at night, and I’m doing some little trophy of estradiol estrogen sort of combo, and it finally worked. So are you telling me even if it’s bio identical, that that increases risk? Because otherwise I don’t have a solution for me.

Karen Martel  

Okay. Have you tried injection of estrogen?

Dr. Mindy  

I haven’t have the shit out of me if you’re gonna jack. I mean, I’m on such little amounts of these hormones. So it was it’s just, I’ve worked so much on my lifestyle. And I finally you know, progesterone, I just want to point out for everybody like, you know, progesterone, I think is the real needle mover for menopause. That’s that’s been my personal appearance, feeling that’s in what I’ve seen after looking at literally hundreds of 1000s of hormone tests that have come through our our platform, that I think progesterone is one of the biggest needle movers. But then when we go to put the creams on it’s it’s a whole different game.

Karen Martel  

Yes. So sometimes people won’t absorb the creams very well. It’s really is about finding what delivery form is going to work best for you. And also what type of hormone therapy are you going to do? There’s several types. There’s static dosing, a lot of doctors will do every single day and they’ll have progesterone as well as every single day of bias, which is a combination of estradiol and estriol. There’s three kinds of estrogen there’s estrogen estradiol and estriol as throne is the more inflammatory of the three estrogens. It sits 100% on what is called the Alpha receptor, the estrogen the e to the e one Alpha receptor, so there’s alpha, there’s better there’s other ones, but those are the two main ones. We produce estrone out of our fat cells, and estrogen can convert down to estradiol and SQL can convert over to Estro. So they go back and forth, and then the two of them can also convert down into estriol, which is the weakest of the three and that only binds to the betta Recep Dirt. And so the doctors will oftentimes mix estradiol and the estriol together because estradiol will bind 50% to the alpha 50% to the betta. So they’ll put in the estriol because it only sits on the better receptor and the better receptor isn’t proliferative. The alpha is so the stone is the one that’s linked more to breast cancer because it can be proliferative, so it doesn’t cause it. But if you have breast cancer cells, it can make it go there and grow when we swallow estrogen of any kind, so it sounds like you’re on a bias trophy. So we end up swelling on a trophy. Yeah, yeah. So we end up still swallowing about 40 to 50% of trophies, even though they’re sitting in like, obviously, right, we’re going to swallow some of that. When you swallow estradiol, it has to go through the first hepatic passes deliver, and then it will be converted to s thrown. The stronger of the ones now that’s said Is Member It can still convert down into extra die all throughout the system proliferate, like, you know, inside the body, not through the liver, inside the body. So when you swallow it, you’re going to be getting a lot of s drone, which is the more inflammatory one, and then is not the one that is our primary hormone. So estradiol is like the mother of all hormones in our body who’s the I think it’s the most important one because of its far reaching effects on our health. Progesterone, though, is needed to counterbalance that estrogen. So progesterone is wonderful. So some women are really like, I love my progesterone because it’s so calming. It’s a very sigh. Yeah, it helps us sleep. It’s like, Yeah, amazing man, sister. All right, yeah. And that can be great. And it gets very safe to take it to assert up to a certain amount orally. So up to about 200 milligrams, that is safe to take, there’s a little bow, I’m

Dr. Mindy  

only taking, I’m only taking 20 milligrams, I’m super small amount.

Karen Martel  

Oh, yeah, that’s very tiny, because 80% of oral progesterone converts to the metabolites. So you’re, you’d only be getting a very tiny bit of progesterone. So we always try and start with about 100 milligrams to 200 milligrams for menopausal women, because that’s gonna give you about what your body would normally produce of progesterone. And that’s enough to counterbalance the growth typically, of the estrogen. So we want that in there. Because that’s breast protective, it’s been shown to be very breast protective, uterine protective, bone protective brain protective, we want that progesterone even if we don’t have a uterus, right. So when you also swallow it, you raise something called sex hormone binding globulin. When you swallow estrogen. When you raise this protein, SHP, G, and CSPG, you can think about it as a little bus that shuttles your hormones all over your body. And when it’s when it’s on the bus, when your hormones are on the bus, you can’t utilize the hormones, the hormones have to get off the bus in order to dock onto a receptor and send its message through. So when you’re swallowing, you have to watch that sh BG number because what it’s going to do is if it gets too high, it’s going to bind up primarily testosterone, second to that estrogen third to that dihydrotestosterone. So then you’re kind of it’s, it’s like, mute, moot, you know, you’re taking it and it’s like, you’re you’re binding up these hormones that you’re trying to get into your system. And so, so I personally don’t recommend swallowing the estrogen to progesterone. Yes, it’s fantastic. But testosterone and estrogen will raise that sh VG and Estrada will convert to estrogen.

Dr. Mindy  

Yeah, Sam, what’s what do you want your S SP sh BG to be?

Karen Martel  

I like it to be below 85. Okay, okay. Yeah, yeah. So there’s other things. So

Dr. Mindy  

raise that to Yeah, and just so we’re clear for everybody listening, because that was a that you just got a crash course in hormones, and by identicals. And this is why it’s so complicated, is that to sum up, what you just said is we have creams, we have pills, and now I’m learning we also have injections, and so and allows the Tories. Okay, so what I’ve figured out in in solving this for myself, and what I’m going to encourage everybody listening to do is it’s all personal. And this is your eye. Yeah. This is why we can’t make one blanket statement and say All women should do this. You have to find a practitioner, like Karen, that you can work with to figure out how to get it very customized to you. And that’s what actually I did is go to a friend of mine and say, hey, help me through this. So I just want to point that out right now. Yeah, make sure that we Don’t fall prey to people saying, well, I should be doing it this way or this other. It’s it’s it’s a personal approach. And that doesn’t fit into our patriarchal healthcare system. We like one size fits all. But when a woman’s body is not one size fits all,

Karen Martel  

no, and there’s pellet therapy two, which is very popular right now, and I can’t say that I’m really ready for that, really, I think for some women, it works 100%. So if that’s working for you, awesome, personally, we don’t use that in my practice. So but to each his own on that one, too, but with so going back to what you were saying like you that you really feel like progesterone is great for you. A lot of women do that. And a lot of doctors will say use your progesterone every single day use this very tiny amount of biassed and and that’s a very, very common thing to hear in from hormone practitioners. The problem with that is estrogen is need extra dial. So I’m going to be very specific here, ASTRA dial is needed to upregulate progesterone receptors. So if we use progesterone every single day, it’s actually a great way to lower estrogen because it starts to suppress it, I’ll use it and women in their fertile years that have like super high amounts of estrogen and no progesterone. I’ll say use your progesterone every day for a while. So let’s to lower your estrogen because it does do that. But the problem is, you eventually and this can take a year it can take two years. But eventually what starts to happen is women will say I don’t feel my hormones anymore. This is because with all of this progesterone that’s being given every single day, it starts to suppress that estrogen estrogens needed to upregulate progesterone receptors. So if you’re not getting your estrogen in the right amount, you’re not going to be up regulating those important receptors for your progesterone. So then eventually, you don’t even feel that progesterone anymore. And then progesterone is needed to upregulate the estrogen receptors, it’s a fine balance. So we want to take a little bit of a break, because naturally, that’s what Mother Nature does. And we can never mimic it 100% But we want to try and get somewhat closer to it. So I always tell menopausal women, you know, take a week take two weeks off your progesterone to give just for that receptor. Yeah, I know it’s like, that’s why I say three weeks to some women because their legs naturally we only produce it for two weeks when we’re fertile. But you might make sense. If you get your estrogen dialed to where it needs to be Mindy, you may find that that that counter bit like that, you’ll get the benefits. And you’ll see the benefits of the extra dial for like, it’s a bit different than progesterone. But you think about what we what it feels like even in a cycling when we’re cycling, first half of the month are we not a little bit more energetic or a little bit more outgoing, we want to go out into the community, we’re a little more flirtatious, more sexual, this is estrogen, so as estradiol so this is when estrogen is at its highest. And even on day 12 of our cycle, we have massive surge of estradiol right before we ovulate. All for purpose, this upregulates the P 53 enzyme, which is a tumor suppressing enzyme. So I have a lot of my women on day 12. If they’re you know, throughout the day, 12 of the month, I say triple your estradiol. Let’s just get like to like just

Dr. Mindy  

just someone mimic that. And let’s see what happens. Let’s see what happens. Okay, but what do you do if you don’t have a cycle? What do you I mean, that’s great for Peri menopausal women. So

Karen Martel  

then I just say like, day one of the month is is month, what like day one of the month is day one of this the full cycle?

Dr. Mindy  

Right? Okay, so just to recap, if what I’m hearing is that, even in the peri menopausal years, you if you still have a cycle, you’re going to want to try to mimic the hormones that are naturally coming in, you’re just adding some support. And I think that’s really, really important. That makes perfect sense to me. It’s like, you know what, the analogy I use is when people when exogenous ketones first came out, everybody was like, let me just take them all day long. And my feeling was well, ketones aren’t supposed to be there when glucose is high. That’s an unnatural state of the body. And I would say the same thing with what you’re saying is that what you’re recommending is we take these bioidenticals in our Peri menopausal years and we support what our hormones are already naturally doing. And then is that right? Do I have anything I need to say on that?

Karen Martel  

In the fertile years? It’s the kind of depends on where where you’re at with your cycle, there’s still a lot you can do prior to jumping into the hormones. So just be clear about that, like, there is a lot that we can do, we’re not talking about that, really today, because we have a short amount of time, we’re gonna really hone in on the bioidenticals. But, you know, there’s a lot we can do as far as supporting the hormonal system, and you know, kind of ringing out every last drop of those hormones that we can get out of the ovaries, as well as supporting the adrenal system, because we will make some of our hormones through the adrenal system. So all of those things are very important. There’s great supplements to take lifestyle, things that we can do. But eventually, you cannot diets or fast or anything out of hormonal dysfunction and loss, right? So at that point, yes, if you’re starting to feel the effects of the loss of estrogen before you lose your period, which it’s very challenging to find a doctor that will ever prescribe you extra dial before you lose your period. But I believe 100%, we should be addressing those women because that is when all the symptoms start. I know personally, for myself, I was like, I still had a bit of a period, but I was nice sweating and hot flashing all day long and rapidly gaining weight. I felt like garbage. So I started my Astro dial when I was quite young, and saved me it like it was so me, I’ve been on progesterone since I was in my 30s. But adding in that estrogen was like, Oh my gosh, thank goodness, because it just it made these last couple of years, so much more smooth. We should not be waiting for women to be 30 pounds overweight, a hot mess depressed, like women will quit their jobs, they’ll lose their relationships. They just they don’t even know who they are, because they are so sensitive to the loss of their estrogen is some women poof, they’ll just be like, oh, yeah, I’ve had like one hot flash. And

Dr. Mindy  

yeah, I’ve heard I’ve met those. Yeah, so something I want to point out, is that when we’re looking at menopause, in my mind, there’s the peri menopausal years, which is a little bit of the wild, wild west in everything we’re talking about. Then there’s the menopausal transition time, which you brought to my attention. When we when you were speaking this weekend at the women’s health event was that why do we say a year and now you’re officially in menopause? Like that’s just how it, yeah, but I can tell you, I can tell you as a woman who has gone now, eight months without a cycle, I can feel the effects and loss of estrogen, which is why I reach I started to reach for bioidenticals. And I would say I have my lifestyle very dialed in, with the exception of the Russian woman. And that is that is one that I’m working on unwinding now. But I say that to say that I do think there comes a point where you’ve done everything you possibly can. And the loss of hormones just still are there. And you have to make a decision on what you’re going to do. And I think it’s in that transition year as you go into the postmenopausal years.

Karen Martel  

Yeah. And a lot of women will say yes, but this is natural. We’re supposed to be going into menopause. But we also didn’t live past 50. And we’re doing so much for our health besides that, at least a lot of our listeners, right? Yeah, they’re eating right. They’re exercising, they’re doing all of these things, taking all of the supplements and really taking trying to take care of their health. And unfortunately, like I said before, we For some women, the loss of hormones, is devastating, and can be can really, really affect a person. And we do see that in the long term research that women that replace their hormones actually have a reduction in all cause mortality by 39%, which is huge. So you know, we know that it helps us with our with to prevent Alzheimer’s. There’s a massive study that was done out of the University of Arizona and just a couple years ago, 4000 women, it showed that women that use transdermal Astra dial therapy for six years or longer had a 75 to 80% reduction in dementia and Alzheimer’s. That’s crazy for a disease that you can’t see that there is no no solution for. And there’s probably there’s many reasons for that we have a ton of estrogen receptors in our brain. But also estrogen helps us to be insulin sensitive. And we know that Alzheimer’s is a type three diabetes. So it helps us to process our glucose better. It helps to prevent Type Two Diabetes, we know that it helps prevent heart disease. These are all the major killers of women. And so what is the alternative? We can go out there and we can wait and do I’m gonna do this all natural and that’s great, you know, but what’s going to happen if you do get heart disease then what’s Are you going to say no to the medications because you’re trying to do this naturally, when we can just simply give back our body what it needs and it’s not going to it doesn’t mean that you’re not going to get heart disease or tai chi or Alzheimer’s. But it certainly helps to support our system. We know that Astra dial, there’s a great PubMed research that shows that women in menopause if you can get your Astra dial to 65 pico grams per milliliter. And above, then you can prevent osteoporosis. And that’s huge. And we know that most women that unless they’re really, you know, weightlifting and doing all the things, most women will get osteoporosis unless they do replace that estrogen and progesterone is very important for bone as well. Testosterone, that’s, you know, everybody thinks is the man’s hormone. But testosterone therapy is really important for some women, I find that about 50% of women will lose their testosterone 50% of what we produce, but 40% out of our adrenal system, which is quite a bit. So if you’ve got a healthy adrenal system, you can have actually isn’t that amount? Yeah, because estrogen and progesterone is not the same, we’ve produced much less amounts of the adrenal system. But testosterone in are fertile years is our most abundant hormone, you know, produce more of that than progesterone or estrogen. And so that’s important for of course, muscle tissue for sex drive for energy, some women motivate diagnosed with chronic fatigue syndrome, when it’s a low testosterone. So that’s how important it is for that energy. And I always think gives you your lady balls, because it really does it gives you that like, oh, to get out there and out and face life.

Dr. Mindy  

Yeah, fascinating. Okay, let’s use myself as an example. So And because so that we can make this very applicable to people listening. So I’m, I’m 53, I’m seven to eight months without a cycle, I have very low progesterone, historically, low testosterone. And now, you know, in the last test, actually, the last test that I did, showed that my estrogen was actually normal. Like it was, it was in pretty good shape. So his progesterone that was really tanked. And testosterone was tanking a little bit, but estrogen was, and that was a blood test that I did, because I didn’t have a cycle. So we did that before we put me on. What what would i What would you do with that kind of situation?

Karen Martel  

I want to do your hormones. spendy. Let me get my hands on. Yeah.

Dr. Mindy  

I’ll totally give them to you. I’ll totally give them over to you. And, and let’s play. I mean, I use myself, I am a human lab, I have decided, I’m a hormonal lab. So I am totally happy to hand my hormones over to you, and you tell me what I what I do what to do. But I also want women to I want to demystify bioidenticals. And so if using me as an example, to do that, I just want to kind of give you a scenario of what I know today.

Karen Martel  

Yeah. So I would look at your estradiol levels and see where they’re at. So if they’re below 50, then I would say they’re not okay. Hmm. Do you remember what the number was?

Dr. Mindy  

I don’t, I don’t have this was back in February that we ran all these in July now.

Karen Martel  

So when we do blood work, we’re testing bound hormones are bound to the bus the effects hormone binding globulin bus. So that means that we’re not actually seeing what your free available levels are. So I typically do both a Dutch test which is urine metabolite testing with bloodwork so I combine the two because I want to see how a woman is detoxifying her estrogen before we put her on it. If you don’t have any estrogen, you’ve been in menopause for a while. I’ll typically say Okay, let’s try some estradiol first, and let’s base the numbers on the bloodwork. And then in three months or six months, then we do a Dutch test to see okay, how are you breaking this down? And I can usually tell just by symptoms, if a woman’s not breaking it down very well. So that’s, so that’s what I would look for first is okay, what number are you at with your estradiol, not your estriol not your restaurant, what’s your estradiol and what’s your sex hormone binding globulin if we’re just looking at bloodwork progesterone, on the other hand, really doesn’t show up great in bloodwork, it’s one of these ones that’s like topical progesterone doesn’t show up almost at all in bloodwork and so a lot of doctors won’t use it because they don’t think it works. Well. That’s not true and absolutely works because if you were to test their urine, it would show up not that great but it does show up better in urine if you test saliva. Progesterone over shows if you’re using it topically so to look like you have these like super physiologic amounts. So with progesterone, I go a lot on symptoms. How are you feeling? Are we having symptoms of estrogen excess and not enough progesterone, and that’s how I go and so I don’t use often use the labs for progesterone very much with testosterone own bloodwork is great book because it’s the only hormone that it’ll test free and total testosterone, of course, the man’s hormonal, right?

Dr. Mindy  

For you, Oh, give me going on that. Don’t get me going. But go ahead. Yeah.

Karen Martel  

And so there’s ways that I’ve worked with 1000s of women with hormone replacement therapy. And I have definitely seen some things that work better than others. So oral progesterone can is definitely fantastic works really well, I don’t go higher than 200 because there is some evidence that shows it can cause breast inflammation if you go down a certain pathway with your metabolites, which can increase your risk of breast cancer. So oral can work great because it’s has all those beautiful metabolites almost like you’re getting to drugs, you get this, you get your progesterone and all the things that that’s good for, but then you’re gonna get all these like a heavy dose of these metabolites, which are very anti anxiety and help women to sleep which for menopausal women, it’s like it’s a godsend. But I love topical progesterone as well. I personally only use topical because I have a sensitivity to the oral progesterone because of the metabolites. So there’s a small subset of women who take progesterone orally and have GABA receptor sensitivity. And so they’ll take the oral progesterone and they get weepy and depressed. Right, yeah, what happens to meet up? So if that’s the case, that’s because there’s too many metabolites being produced and you it’s not that you’re getting too much. It’s that you have that sensitivity to the grabbers with the GABA receptors. So we want you on topical because it doesn’t go into those metabolites got it? The world does. Yep. So yesterday, I’ll cream shots are not the best actually. But if you’re if you’re not absorbing the creams very well. Then you can look at either suppository or putting the cream on your labia you’re using an estrogen patch, I definitely find that the estrogen patch is one of my favorites. Oddly enough, even though it sucks because it’s glue, like you’re sticking the sticker on your skin. And the glue. Of course, it’s not good for us. But it does give me a nice steady dose of estradiol and I find it raises my levels.

Dr. Mindy  

That’s Is there a difference in the patches of the of like, there’s a bio identical patch and then there’s like a particle. It’s all bioidentical. Um, because I will tell you I went on the patch and I almost murdered somebody. It was it was no it was literally I literally felt like I was going mad. I ripped the patch off. It was horrible. So I don’t know. I mean, I will hand my hormones over to you. But I just want to point out to everybody listening that it this is so personal. This is so perfect. How

Karen Martel  

did you feel when you when you took the cream? You just didn’t feel anything? And was it biased?

Dr. Mindy  

I don’t know if it’s biased but I can tell you the progesterone cream also made me want to kill somebody. The estrogen patch made me want to kill somebody. The estrogen cream I do okay with I actually feel okay with it. And the progesterone pill I feel okay with and then I have a small taking any. I know I’m not taking much. Yeah, I’m not taking like are you really feeling it? I’m Yeah.

Karen Martel  

Oh, yes. Okay. Oh, yeah. You’re very sensitive.

Dr. Mindy  

I’m very diverse. I took it. I was like, Whoa, like, wow, I remember her. Like she, she can actually sit on the couch. Now. It was like, it was like somebody gave me a joint and I smoked a joint like I was, I was like I was so chilled at 20 milligrams. So it could be but you also have to understand my lifestyle is so clean, it is so clean. So the only thing I know I can work a lot better on is is stress and I’m doing that. So but but for the sake of people listening I want to really make this applicable because it gets if you’re listening to this and you’re like this is so confusing. It is it is so I’m trying to use myself as an example of somebody who has tried all the different things it has dialed in her lifestyle knows the parts of her lifestyle she’s got to work on and I’m still trying to dial in how to use bioidenticals that’s how complicated this is.

Karen Martel  

Hmm. And have you tried testosterone?

Dr. Mindy  

I have and I do really well with testosterone Okay, so I’ve been doing a testosterone trophy again so if that’s I don’t I again I’ll hand over all my dosages to you. Yeah, but I do everything very I’m not I haven’t take just so you know, I haven’t taken a medication in about 30 years until I actually took these I don’t I don’t even do Advil. I don’t do any medication. I haven’t done an antibiotic since I was a kid like I am. I am completely medication free kind of gal. So that might be why I’m so sensitive. But I would

Karen Martel  

say it’s probably genetics. There’s some of us that are even like, in when we look at our genetic profile, there’s women that are more androgenic than they are estrogenic. And the androgenic women, they’ll, they’ll, they, they really miss their androgens when they’re lost. And so you’ll feel that. And so when you take the testosterone and the DHEA, you’re like, Oh, I feel like myself. This is amazing. Rather than women like myself were estrogenic, the more curvier, you know, with the hips and the bud and struggle with the weight loss. And I’m estrogenic. So when I lose just a little bit of my estrogen, I’m like, Oh, my God. Oh, yeah. So I need the estrogen. But then I’m overly sensitive to oral progesterone, you do well with your. So every single one of us is going to be different. I know women that need to do what’s called physiologic restoration of their hormones. And this is like trying to mimic the amount of hormones that we produce when we’re in our 20s. And you cycle them, there’s days where you go really high, we’re talking like hundreds of milligrams of certain for a while and then down. But sometimes the static dosing the small amounts, do nothing for those women, they need copious amounts, they need to try to they need to cycle and they need lots of it, to feel their best. And that’s okay. There’s lots of 1000s and 1000s of women on that protocol that are feeling unbelievably well. And then there are some women that just need these little tiny doses, which is somebody like yourself, where maybe you need to be a little bit more heavy handed on your testosterone, little bit of the Astra dial probably estrogen, I’ll cream, not the patch clearly, and then split the dose because it really runs out. You’re a person that can’t take on a lot at one time. So splitting the dose would probably be a good idea for you. And then doing your estrogen your progesterone three weeks on one week off because you do really well with that oral progesterone.

Dr. Mindy  

Yeah, and and I really liked the cycling, you know, everything in the female body needs to cycle so that makes incredible sense to me.

Karen Martel  

Yeah. menopausal will cycle with the moon, which is

Dr. Mindy  

Yeah. How would you love that? Yes, yes, I and I feel it was interesting. When you were talking about bioidenticals. Coming from wild yam. I’m like, yeah, it makes sense that anything that’s nature made, the more I study the female body, the more I see how synergistic we are with nature, all parts of nature. So that was brilliant. To sum this up for just like somebody who’s listening to this, and they’re trying to understand, what’s my Dorinda? bioidenticals? How do I help myself? What What advice would you give them? Like, where do we take this? What could appear to be a very tangled conversation? If you just stepped into this listening to all these fancy terms? How do we help people move forward and get some support and help? I think,

Karen Martel  

first and foremost, everybody’s got to educate themselves on this because there is so much misinformation, and it is very hard to get good information about hormone replacement therapy. My podcast, of course, will plug myself here, but my podcasts go for a ton of vote hormones. We’ve got 270 episodes, it’s, you know, beautiful, yes. And so they’re a great resource. I I’m all I never talk about my ass. I always, you know, research based. I’ve got some great, great guests on that podcast that are hormone experts that know their stuff. So that educate yourself first and foremost, so that you’re not afraid that you’re not coming into this going, am I gonna get breast cancer? Am I gonna get that? You know, right? No, if there’s help to be had, you need to feel your best and hormones may help you with that. So find a practitioner that is going to look at you from a hole, not a cookie cutter, like here’s what we’re going to do and push you on this. Here’s your pellets and you shove them in your app car. No, yeah, you want somebody that’s going to look at your whole profile and say, Okay, are you eating right? Are you eating the right diet? That’s for you, not for your friend for you and your hormonal profile right now? Because menopausal metabolism is completely different than our metabolism when we’re in our 30s Yep, so Amen. Remember that detoxification? There’s a lot of issues nowadays with our toxic load. And I’m sure you talk about this all the time and you and your podcast, we got to detox. We have Xeno estrogens sitting on all of our freakin receptors. Your body prefers the Xeno estrogens which are fake estrogens in the environment from plastic, they are stronger, so they will sit they’ll dock onto that receptor before your natural estradiol. Well.

Dr. Mindy  

Yeah, that’s crazy.

Karen Martel  

So clean up your environment.

Dr. Mindy  

Let me ask you one quick question on that because I spoke of this last Friday, you know, there’s as menopause is coming back into vogue, I know that sounds so crazy, but it it I’m gonna call it coming back into vogue when Oprah starts talking about it. There is is sort of this moment of like, Oh, it’s just a matter of HRT, bioidenticals. What do I need to do? But you just brought up lifestyle? If if a woman chooses to go on HRT or bioidenticals, does that make her exempt from having to deal with her lifestyle? Where does lifestyle play? At

Karen Martel  

least not? So once in a blue moon, I’ll see that woman will come across, it was just like, just give me the hormones, forget the rest. And it works out for her. Oh, great. Good. I know, that’s like one in every million. But most women because of what’s happening in our environment, right now this is we’re going to time that’s never been before, the toxic load has never been like this stress on women has never been like this. Yeah, so all of this comes into play. If your cortisol is running super high all the time, your adrenal system is not going to be making progesterone and estrogen is going to primarily be making that life saving, you know, fight or flight hormone cortisol, because that’s what has to come first. So yeah, you have to stress manage, you’ve got to detox, you got to watch your environment, you do have to start taking more time for yourself, your body is screaming at you during this time to take time for yourself. Yeah. And it will hit you hard. If you don’t listen.

Dr. Mindy  

Yeah, it will hit you hard. And I will tell you two interesting things is that through my menopausal journey, I’ve picked my mom’s brain a lot. And she’s like, it was a note nothing. It wasn’t anything big. Well, if I remember back to what my mom was like, in her 50s, it was like, she was like, she had no stress. So eating really well, like I get it. So I stopped asking her questions. That would be the first thing I would say. And then the second thing that I would say is, I think that we have to work on our lifestyle harder. And I mean that I shouldn’t say harder, because some women will just go in and I should be careful of like, we need our lifestyle matters more after 40 than it’s ever mattered before, which is why I wrote the menopause reset, it was like, Okay, here’s what we know we need to do. And maybe that’s why I’m so sensitive. Because I’ve got everything other than stress really dialed in, I just need something a little extra as I transition out of not having any period at all.

Karen Martel  

But I will say this, Mindy, that we have to be really careful with our words here, because a lot of women are doing it all right. They are managing their stress, they’re eating perfectly. They’re intermittent fasting, they’re exercising, they’re detoxing, they have it all dialed and they still can suffer. So I don’t want you guys to think that, that there’s something that you’re doing something wrong, because sometimes hormonal loss can hit the best of us. I haven’t drank in for 15 years, I have an extremely clean lifestyle I live where there’s no Wi Fi towers, I live on property and like up in the woods. I you know, I work from home, I have an amazing family, I have a great support, I have all of the things dialed in. And I will tell you I suffered immensely. If I could show you a before and after picture of what I looked like at 42. And what I look like right now you would be floored. You doesn’t even look like the same

Dr. Mindy  

person. Yeah, and I and you bring up a really important point I it’s like to and thank you for bringing that up. Because it’s two ends of the spectrum. You can’t go into HRT M or BHRT with this trashy diet and stressed out lifestyle. It’s that’s where I think it gets dangerous. And much like you I have done so many things that it just became this moment in the last year really where I was like, Okay, it’s time to really open my brain and look at the possibility of bioidenticals. And the little bit I’ve dabbled in have actually really helped tremendously. So So I think you’re exactly right. We can’t go on either end of the spectrum, for sure.

Karen Martel  

Yeah, I just don’t want people to think that they can be exempt because they’re doing all the right things, and then beat themselves up if they’re not, because yeah, we have to have all of those pieces are foundational pieces, we can’t forget about them. They’ll make this time in your life that much better. And in you taking on hormones that much better. Because you’ll be circulating them, you’ll be detoxing them, well, your guts going to be healthy, so you can get down that estrogen. All of these things have to be there and it’s very important. But it doesn’t mean though, that you’re not going to still feel the effects of hormonal loss because it does affect it affects everything in it’s not just about oh do I have hot flashes or not? Do I have a dry vagina or not? We have hormone receptors on every organ in our body. So it’s about how is your heart function in your gut. I mean it’s really important for your gut it estrogen is really important for your immune system. We know this from COVID Women didn’t get is sick. And it was because of their estrogen and progesterone levels. Well, not now. But partly partly because in general, in general, they did show that it’s very important for the immune system, brain protection, skin protection, eye protection, even like hunger, hunger receptors in your brain are affected by the loss of estrogen. I just read a study yesterday that showed that in rats, that when they injected this intracranial injection of estradiol into the brain caused anorexia, so in they use the word anorexia not in the term that we use it in, it’s more like it caused them not to eat as much. So their, their food intake went substantially down. When they were injected with estradiol in the brain, these are overreactor, they had their ovaries taken out the rats, so they were had a loss of estrogen.

Dr. Mindy  

So that actually lines up exactly perfect with fast like a girl because what estrogen that I, you know, all the estrogens I’ve noticed, do really well when glucose is down. So you are and you typically if you look at the menstrual cycle, we aren’t as hungry in the front half as we are in the back half. And when progesterone is coming in, we need to bring glucose up. And the reason we get hungrier is because our bodies like feed me feed me more, I need more glucose to be able to make progesterone. So I think that’s brilliant. So I and literally, I could talk about this all day long, this might be one, this might that we might have to well, okay, so this is what we’re gonna do, just so we can use it as a teaching moment, I will hand my hormones over to you. And then we’ll bring you back and let’s break it down. But But primarily so that other women can learn. And that’s part of why I’ve always used myself as as a big laboratory. And I’m always very vocal about what I’m going through. Because what I and you and I have, you know, we chatted about this on Friday as it’s just been so much silence for women for too long. And, and the silence needs to end. And these conversations need to start. So if you are listening to this, you’re massively confused, please go reach out to Karen, please keep having these conversations, let’s find a way to come together as women and start to understand this for ourselves. So I really want to make sure that we’re clear on that, that this is the beginning of a really important cultural conversation that’s not been had. So well. So with. With that in mind, I’m gonna finish up with my standard question, which is, do you have a self love practice? And if so, what it is, what is it and what’s your superpower you’re bringing to you bring to the world.

Karen Martel  

I don’t have a self love practice, but like not something that I do on a routine basis. But I do practice self love. Just, I watch what I say to myself all the time. Yeah, well, my superpower would probably be the the knowing that I am here to love and to learn. And I always remind myself of that with every opportunity I have, because the bad the pain, is it just another learning opportunity. And I am in charge of how my life goes and how I perceive my life. And my superpower is seeing that glass always half full, not half empty. Amazing, amazing.

Dr. Mindy  

And I that I will tell you, you and I met for the first time last week and I feel that from you. I feel the love from you. I feel the non judgement, you definitely are one of those humans that you just instantly go whoa, there’s a spark there. There’s there’s a compassion there. So I want

Karen Martel  

to thank you. Thank

Dr. Mindy  

you. So how do people find you just because i do i There’s so many women listening to this podcast that are lost. And I want to make sure that that they have a way of getting some help. So how do people find you?

Karen Martel  

My podcast is the other side of weight loss. And my website, Karen martell.com. I have a great hormone quiz that that’s a really good place to start for everybody. It’ll say like what hormone could be stopping you from losing weight. But it really kind of breaks down each of the hormonal imbalances that can start to happen in women in their 30s and 40s. And it can just give you an idea of what are the some of the things that you can start doing about it. So that’s a great place to start. And then we do offer we offer group coaching. We offer private coaching and we also have I worked with a team of doctors who are amazing and that do bioidentical hormone therapy so if that’s something that you’re interested in great, I also work with people and their whoever their practitioner is

Dr. Mindy  

amazing. Amazing. Well thank you Karen for what you’re doing and you know, we’re more powerful together. So I’m just really, really appreciate you and hopefully this will touch some people who really need to hear it. Yes. Thank

Karen Martel  

you for having me on.

Dr. Mindy  

Thank you so much. for joining me in today’s episode, I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we’d love to know about it. So please leave us a review, share it with your friends and let me know what your biggest takeaway is.