The Biggest Lie Women Were Told | Casey Stumpf | Ep. 440

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Ep. 440: The Biggest Lie Women Were Told | Casey Stumpf

Host: Andy Stumpf
Guest: Casey Stumpf, Menopause Society Certified Provider
Date: April 6, 2026

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EPISODE OVERVIEW

Theme:
This episode is a deep dive into women’s hormonal health—especially perimenopause and menopause—with special focus on dispelling myths and medical misconceptions, notably "the biggest lie": that hormone replacement therapy (HRT) is dangerous and causes cancer. Andy is joined by his sister, Casey, an experienced nurse practitioner and menopause expert, for a wide-ranging, candid conversation. They tackle transitions in midlife health, their own family’s medical misadventures, end-of-life care, and provide actionable insights for both women and men.

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KEY DISCUSSION POINTS & INSIGHTS

1. Casey’s Background and Path to Menopause Specialization

• ER & Military Medicine:
  • 18 years as a nurse practitioner, starting in ER, transitioned into military healthcare at Camp Pendleton.
  • Observations of gender dynamics: male-dominated spaces, reluctance among male providers to manage women’s health, so Casey handled most women’s health cases.
  • [08:26] "I loved my time with the military...heavily male dominated...they don't want to deal with women's health. I love women's health, so I got all the women's health cases." (Casey)
• Hospice Care:
  • Found deep purpose and meaning in hospice, sitting bedside for hundreds of deaths.
  • The value of conversations around end-of-life choices and patient autonomy.
  • [10:02] "To me, [palliative care] is one of the most special areas of medicine that you can have a pivotal role in." (Casey)
• Choice to Focus on Menopause:
  • Witnessed generations of women in hospice who suffered poor quality of life from lack of hormonal support; this catalyzed her career shift.
  • [23:30] "I took care of a generation of women who were not on hormones and how the quality of life...I'm not dying like that." (Casey)

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2. Menopause, Perimenopause, and the "Biggest Lie"

• Core Misconception:
  • The belief that HRT (esp. estrogen) gives women cancer stems from a flawed interpretation of the 2002 WHI study.
  • [26:11] "In 2002, estrogen causes cancer. They ran with it. That study actually showed women on estrogen alone had 18% less chance of breast cancer. That did not get reported." (Casey)
• Data & the Fallout:
  • Only ~5% of the 75 million eligible US women are on HRT now.
  • Lack of research specific to women—medical studies often extrapolate men’s data to women.
  • [25:22] "Men, it's always been like 'Oh, you're not feeling good? Here's some testosterone.' ...Women aren't even studied. All the research...done in men. And they extrapolate that data to make it work for women." (Casey)
• Medical Gaslighting:
  • Women routinely dismissed or told to "exercise more," "drink wine," or are immediately prescribed antidepressants, masking the true problem.
  • [32:03] "If you look at your OB/GYNs...they get one hour training in this." (Casey)
• Why Hormones Matter:
  • Estrogen, progesterone, and testosterone work together and decline in chaotic, disruptive ways, especially in perimenopause.
  • Quality of life and health span (living vibrantly, not just living long) depend significantly on hormonal balance.

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3. Symptoms, Diagnosis, and Treatment Approach

• Perimenopause vs. Menopause:
  • Perimenopause lasts 7-10 years and is a period of wild hormonal fluctuation ("zone of chaos").
  • [54:11] On hormonal graphs: "Perimenopause...all over the place. That is the zone of chaos."
• Symptoms:
  • Sleep disruption, mood swings, brain fog, "menopause muffin top," diminished libido, anxiety, rage/irritability, night sweats, palpitations, and cognitive changes.
  • [39:22+] "You go to your provider: 'I don't feel like myself...I'm not sleeping, I'm tired at 2, 3 o'clock...I'm wired, I'm tired, I have a menopause muffin top...'" (Casey)
• Testing & Diagnosis:
  • Emphasis on treating symptoms, not labs—labs are snapshots and often miss dynamic hormonal shifts in perimenopause.
  • [55:23] "The typical perimenopausal woman, they're gonna look normal. You've got a woman who's not working, she's not sleeping, she's leaving her husband...being told in an office, 'Oh, these are normal.'"
• Treatment Philosophy:
  • Start low and titrate slowly; individualize therapy; avoid aggressive interventions like hormone pellets ("the body likes stability").
  • Foundation is sleep, then layered health/lifestyle interventions.
  • [47:51] "My foundation is sleep. If you are not sleeping, I cannot build and help anything above this." (Casey)
• Actionable Sleep Tips:
  • Dark, cool room (65°F), white/pink noise, magnesium (glycinate, not citrate!), and tech blackout.
  • [48:55] Discussion of sleep optimization strategies.

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4. The ‘Big Three’ Hormones

• Estrogen:
  • Vital for brain, bone, and heart health; loss contributes to Alzheimer’s, heart disease, osteoporosis.
  • Highest levels in pregnancy (shows body can tolerate much more than HRT dosing).
  • "No studies show increased risk of mortality with estrogen."
• Progesterone:
  • First to decline; loss causes sleep issues and anxiety; oral progesterone metabolizes to GABA ("Mother Nature’s Xanax").
  • [45:32] "Progesterone is our first one to leave...when we replace progesterone...one of the metabolites is Gaba...[it] brings this calm down."
• Testosterone:
  • Key for women’s brain clarity, energy, mood, and libido; women have 4-10x more testosterone than estrogen (by normalized measures).
  • Major provider resistance despite 80 years of data that it’s safe.
  • [67:08] "Testosterone is my favorite hormone. If I get a testosterone optimized in women, they're like, 'I feel like myself again.'"
• Pushback & Access:
  • Only ~4,100 Menopause Society Certified Providers in US; testosterone especially hard for women to get.
  • [74:24] "75 million women, 4,100 providers that have the title I do."

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5. Consequences of Ignoring Hormonal Health

• Health Outcomes:
  • Increased Alzheimer’s, heart disease, osteoporosis, hip fracture (30% mortality in 1st year after age 65), and loss of independence ("pudding years").
  • [81:03] "Not treating this leads to osteoporosis, heart disease, or Alzheimer's...You build her now—your 70, 80, 90 year old self."
• Societal/Economic Impact:
  • $26B/year cost in lost wages, women dropping out of workforce, healthcare, and leadership roles.
  • [44:17] "This whole thing…costs US $26 billion a year in lost wages, women stepping out of leadership roles and just getting out of the workforce, and healthcare costs."
• Divorce and Suicide Spike:
  • Divorce and female suicide rates highest in perimenopause; mental health meds often prescribed instead of addressing hormones.
  • [71:40] "Perimenopause is the highest rate of suicide for women that age range...when estrogen drops, serotonin drops, dopamine drops, norepinephrine—all the feel good, energy, motivation hormones."

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6. Men’s Role & Relationship Support

• What Can Men Do?
  • Educate themselves; support partners; help stabilize sleep environment; recognize fluctuating symptoms are physiological, not personal.
  • [106:01] "If I was a man behind the scenes...I'm trending when this bus may derail...She's gonna need more patience, more grace in this time."
• Anecdote:
  • Casey shares how her husband, once frustrated and “on the receiving end,” now says, "If I had to choose between giving you hormones or me, I'd give them to you, because the impact on us is so big." [40:41]

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7. Audience Q&A Highlights

• HRT Safety:
  • No increased mortality with estrogen; initiated ideally within 10 years of menopause.
  • Many alternatives if there are supply shortages (compounded creams, options other than patches).
• Access and Cost:
  • Insurance patchy; out-of-pocket varies, but resources: HRT Club, GoodRx, and telehealth might help.
  • [86:09] "Most people's insurance will cover estrogen and progesterone...Their progesterone for 30 days is $15, their estrogen patches are $48 a month."
• Symptoms & Optimization:
  • Treat to symptoms (esp. sleep, mood, libido); start low, retest every 8 weeks; individualize.
• Alternative Interventions:
  • Peptides (GLP meds at very low doses for insulin resistance and neuroprotection).
  • Focus on lifestyle: sleep hygiene, exercise, protein and fiber intake, anti-inflammatory diet.
• End of Life Care:
  • Have conversations about goals and wishes early; hospice involvement shouldn’t wait.
  • Use of vaginal estrogen (estradiol) to prevent UTIs and improve quality of life in older women.
  • [102:33] "This little tube will save women's lives...vaginal estrogen cream for anyone who's over, you know, perimenopause, post menopause. They need this in their toolkit."
• Resources for Finding Providers:
  • Menopause Society, ISHWISH, Dr. Mary Claire Haver’s provider list.

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8. Memorable Family & Audience Moments

• Storytelling:
  • Andy and Casey recall their parents' medical antics, Dad’s "biking while intoxicated," and Mom’s end-of-life letters and love for coffee and the Giants—a moving segment around [15:10–18:14].
• Humor:
  • On the chaos of hormonal cycles and relationships:
    • [53:15] "That crash is where divorces happen. That is where men get killed with forks in the eye. This is when they're hiding in the closet. I'm not coming home."
• Audience Validation:
  • Multiple testimonials from women whose lives changed after HRT; discussion of the importance of hope and validation.

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NOTABLE QUOTES & MEMORABLE MOMENTS

• "In the 60s, it was common practice to be on hormones. Then the WHI study comes out, ‘estrogen causes cancer’—they ran with it...they've been backtracking ever since." (Casey, 26:11)
• "If you are not sleeping, you cannot. I cannot build and help anything above this." (Casey, 47:51)
• "You don’t go see a dermatologist for your heart. You need a specialist for this.” (Casey, 32:54)
• "Men have always had access to testosterone. For women, it's a battle just to get anyone to listen." (Casey, 25:08)
• "You're supposed to be productive and live this life that you did prior to without hormones. And there's only five mammals who do this. The other four live underwater." (Casey, 37:20)
• “I have a box of Kleenex that sits in front of me for a reason. But I get to see them three months later and they say, ‘I'm back.’” (Casey, 131:54)
• "Life is a fatal event." (Andy, 22:03)
• On HRT as a journey: "It’s not a snap-your-fingers and problems go away. It’s a journey for sure." (Andy, 62:38)

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TIMESTAMPS FOR KEY SEGMENTS

• 00:22–10:27 – Casey’s medical journey, family stories, and early exposure to death/ER/hospice
• 24:09–32:09 – The hormone-cancer myth, research flaws, gender disparity in care
• 39:22–44:41 – Symptoms of perimenopause/menopause; impact on work, family, and relationships
• 45:31–48:55 – Deep dive: progesterone, sleep, and actionable optimization tips
• 54:11–57:42 – Explanation via slides: hormonal cycles, perimenopausal "zone of chaos," symptom management
• 67:08–71:54 – Testosterone for women—barriers, data, fears, and its effects
• 81:03–84:58 – Building long-term health, Alzheimer’s/cardiac risk, audience Q&A
• 94:38–98:04 – End-of-life care, hospice, and real talk about planning
• 131:54–134:20+ – Hope, next steps, closing reflections, resources

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RESOURCES & NEXT STEPS

• Find a Provider:
  • Menopause Society Provider Finder
  • ISHWISH (International Society for the Study of Women's Sexual Health)
  • Dr. Mary Claire Haver’s provider list
• Casey’s Website: theradiantwaltality.com
• Core Books:
  • Perimenopause Survival Guide – Dr. Heather Hirsch
  • Upcoming: Dr. Mary Claire Haver’s book

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TONE AND STYLE

The episode is refreshingly unfiltered, empathetic, and at times irreverent—equal parts science, dark humor, and personal storytelling. Andy and Casey blend medical insight with real-life anecdotes, family banter, and audience engagement, making this essential listening/viewing for anyone navigating, supporting, or simply curious about female midlife health.

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BOTTOM LINE:
Hormone therapy is not just safe and life-changing for many women—it’s been wrongfully stigmatized due to outdated, misinterpreted studies. Women deserve informed, personalized care; men deserve to understand the changes of those they love. With candid education, empowered providers, and honest dialogue—hope and vitality are within reach.

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For further contact, resources, and event info, see show notes or visit theradiantwaltality.com.

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Transcript

[A]

Okay, I got the red smoke. Sun runs north or south. West of the smoke. West of the smoke. Okay, copy. West of the smoke. I'm looking at danger close. Now give it to me. I need it. You're clean, hot, camping, clear.

[B]

Not. Oh, I get to start it.

[A]

Yeah, we're already going.

[B]

Okay.

[A]

I personally think you should start a little bit of your medical history and respect people up to speed on how you got into this.

[B]

Yeah.

[A]

What is this field called? Don't die.

[B]

Don't die. What do you mean?

[A]

The opposite of what our father is doing right now. Slowly decaying into the oblivion and the abyss through.

[B]

Well, he also thought he was going to be here.

[A]

I'm sorry.

[B]

Yeah.

[A]

While we were recording this, he thought he would be here.

[B]

Yeah. Because one of the questions was like, please talk about your dad when he was in the hospital and handed you a ton of cash.

[A]

Yeah. That's when he got the bwi. And for people who don't know that, that means that's biking while intoxicated, which he didn't tell my mom about. Which didn't it translate over to a dui, if he would have been.

[B]

The judge didn't hold that up, but, yes, it could have.

[A]

And mom opened the letter on that one. Right. The summons, if you will.

[B]

I don't know how it went down.

[A]

Yeah.

[B]

But I said, well, why do you think you're going to be there? Well, we have a lot of stories, and I can talk about my menopause. I'm like, what? I'm like.

[A]

He said, I mean, everything you're saying deeply checks out. His menopause.

[B]

Yeah. I said, now I. Men go through menopause. The technical term is andropause. But menopause to me sounds much better. But he's like, yeah, my menopause and my blood flow issues. I'm like, no one wants to hear about your bedroom blood flow issues.

[A]

No, no. He described it on the show, though, actually. He said there was morning wood and now he has kindling.

[B]

Yeah. So he wanted to come on and discuss his experience. Maybe he was going to give a patient feedback.

[A]

Yeah. All right, I'll use my phone because the laptop is an odd experience. A little bit closer. Whatever. As discussed this morning, he's decided to enter end of life care. He wasn't there for this conversation, but it's time for him to make his transition. Yeah. Yeah. I think you should start with how you got into this in the first place. What is the field called? Hormonal optimization.

[B]

Well, it could be a lot of Things. So I am a menopause certified provider.

[A]

Menopause certified provider.

[B]

Mcp, mscp, Menopause Society certified provider.

[A]

We got to work on that.

[B]

Yeah, they just changed, too. So. 18 years practicing as a nurse practitioner. Started my career in the er, actually worked at the hospital where dad had his incidents.

[A]

Yeah. You know, maybe you can tell the portion of the story that you were calling me in Virginia beach from the back of the fucking cop car. I was in a little panic, hammered, trying to tell the police officer, my brother's a Navy seal.

[B]

Yeah.

[A]

You just talked to my brother. He's a Navy seal. And the. The. He. The cop, God bless him, takes the phone, and all I said to him was, I am. Before he even said hello. I'm like, I am so sorry. Please hang up the phone. I don't want any part of this. Take her to jail if you want to. And my dad, too.

[B]

I wasn't the one in trouble. I was just in a mild panic

[A]

facilitating dad leaving the hospital without checking out. Is might be you being in trouble a little bit?

[B]

Oh, no, no, no. Checked us out. The criteria was he had to walk straight. That was it. They were done with us.

[A]

What do you think his BAC was if you had to estimate?

[B]

Well, so some people don't function well with a few drinks. He had a good training. Right. So he could live a lot higher than others and be really functional.

[A]

Yeah.

[B]

38.4. Him and Greg have been at the Aussie bar.

[A]

Yeah. Drinking greyhounds.

[B]

And I was at the open bar, and Greg showed up. We gotta go. Covered in blood. I thought something happened to him.

[A]

He was covered in Dad's blood.

[B]

Yeah, it was. Greg shows up. He's covered in blood. We gotta go. And I'm like. And then he's like, it's your. Your dad fell off the bike. You know, that was like. Sit back. Handlebars up here.

[A]

Michael, are you sure you want to travel with us to Australia? This is like, you may. Well, the fact that he will be 80 by the time we go there is. This doesn't change that all of this happened and likely could happen again, just for clarity. Sounds like a good trip.

[B]

Yeah.

[A]

Ladies and gentlemen, today's episode is brought to you by Montana Knife Company. You need to head over to their website, montanaknifecompany.com let's head over there right now. Look at this thing. The Blood Brothers Speedgo. This is coming out three days after this episode releases. That thing looks sick. The Super Cub. It's up and running right now. So you can order that if you're into that bad boy. The redacted knife just came out as well. The traditions knife. Look at the handles on these bad boy. Good Lord. And of course, the grand opening on the 11th, five days after this episode comes out down in Missoula. I almost said Frenchtown. That's where they are now in Missoula. I'll be there. Leah's gonna be there. A lot of people from Black Rifle Coffee are gonna be there because guess what, they have a coffee shop as well. But if you wanna go see behind the scenes, actually see the facility, I'm pretty sure they're doing tours. They. Josh Smith will sign anything you want to, from your forehead to other items that you may want him to sign. He's willing to do that. That's what he told me. Specifically. There's nothing that is out of reach. But for those of you who can't make it, those knives that I was just talking about, those things are unbelievable. And there's a bunch that are in stock right now. So if you want to support a Montana born and bred organization with lifetime sharpening, an amazing warranty program and an industry, or I should say a business in an industry bringing jobs back to the US Sourcing, creating, building, all right, here in Montana, head over to montanaknifecompany.com

[B]

so worked in that er, did er medicine between nursing and NP about nine years. You, you know, got out of the military and had a huge calling for me to give back to the military and went into the Navy not as an active duty, but civilian provider up

[A]

at Camp Pendleton for the new hospital, not the old one very well.

[B]

I did both.

[A]

Really?

[B]

Oh, yeah.

[A]

Why do they have that hospital like 30 minutes deep into Camp Pendleton?

[B]

I don't know their logistics, but the

[A]

new one seems a lot nicer.

[B]

100%. So did that. I got booted out of that because I couldn't work full time. That was a whole, as you've seen with the military, how my HRD did not sign a stinking line on my paperwork from Case hrd. It's like they're human resources.

[A]

I don't have any experience with the GS side of the house. So the way you were working with the military and the way I was working with the military were very different.

[B]

The command had agreed that I could work part time. Jason. Being a firefighter and having, you know, I needed to be home, they agreed I could work part time. Gets approved command do this for nine years, then all of a sudden we get a New CO in and says, no, you have to work full time. So they look through all my papers. Yep, that's fine. But one line had not been crossed and, you know, signed off. So how to leave that.

[A]

You didn't have five minutes to go into another room and come back with it signed.

[B]

It was above my pay grade, but I learned a lot when I worked there for the military.

[A]

Yeah.

[B]

So at. There was this one point, you know, they're gonna have me work Christmas Eve, no problem. I wanted to know, though, if that was going to be paid overtime. So I sent it to the people who were saying, okay, this is a paid holiday. And they said, thank you for working. Da, da, da exo somebody. I'm like, hugs and kisses. Like, this doesn't seem very appropriate for the military to be saying this.

[A]

Okay.

[B]

So I. Active duty, sitting next to me, Lieutenant at the time, I'm like, how can they say XO in the military? Don't you think that's a little bit

[A]

much to say, for the love of God? But saying just now clicked. All right. Yeah. That meant executive officer. That's literally. That's how this was nine years in and you learned this?

[B]

No, no, I was one year in there. I was at the old hospital. My situational awareness was not high at that point.

[A]

It's not situational awareness. That's familiarity with military acronyms. Yeah.

[B]

So loved my time with the military. But if you look at. So where I start with ER to military, heavily male dominated, especially at Camp Pendleton. Oh, yeah.

[A]

But did the. So at that hospital, did they bring. Were families getting service there as well, too, in treatment?

[B]

Okay, well, think about this. So in the er, mostly male, they don't want to deal with women's health. I love women's health. I was getting all the women's health cases.

[A]

Was the ER really the place to deal with women's health anyway?

[B]

Oh, yeah. Oh, yeah. Ectopic pregnancies, vaginal issues. They didn't want to deal with that. So I got them.

[A]

You go to the ER for those, though. I thought in general, you just go see your provider.

[B]

Some people will use the ER as primary care.

[A]

Yeah. I mean, if it's available, I get it.

[B]

Yeah. So they, you know, any female health that got shunned to me, especially in the military, you get all these guys in uniform. The women don't want to, you know, they're not really wanting to see that. So all the women health in. Within that group. I was running most of the women health for family medicine in my little group.

[A]

And no hospice care yet?

[B]

Not yet.

[A]

Okay.

[B]

So hospice care, actually that was supposed to be my retirement gig. That ended up way faster in my lap. So I went to an end of life conference because who doesn't want to just spend their Friday learning about that?

[A]

Me.

[B]

So I go this conference and one of my old.

[A]

Why did you go?

[B]

Because I love it. I wanted to learn more about it. It was so intriguing to me.

[A]

You loved it or it was intriguing? Those are different things.

[B]

I.

[A]

Because you weren't doing hospice care yet. You just.

[B]

I know, but I found it so interesting. Like the things you and I talked about just the other day, just. To me, it is one of the most special areas of medicine that you can have a pivotal role in. Okay, So I just couldn't get enough. Could not get enough about the education. So San Marcos State, which is right by the house, has a palliative care conference. Sign me up.

[A]

How often do people die in the er? Like, how often were you guys around death? Because hospice is. I mean, obviously you're intentionally putting yourself into that place, but in the er, I mean, you had to have some level of exposure to it. I'm just curious where the fascination or curiosity came from.

[B]

Well, that's traumatic death though, right? That is like. Okay. And I can remember the acute cases, you know, dying of pulmonary embolism, heart attacks, very comm strokes.

[A]

You're around it at least.

[B]

Oh, all the time.

[A]

But not in the palliative care sense all the time.

[B]

But ER death is very different than a hospice death. Now, I would see hospice patients come into the ER because families would panic. I get it. It's scary.

[A]

And the families know that they were in hospice. Isn't that defeating the purpose of hospice?

[B]

Families get nervous. They get scared.

[A]

Okay, well, we'll get to it. But then there's a question of that. How do you make sure that that doesn't happen? So the person who's electing to make that decision doesn't. That would really suck. You've chosen the path and your family goes.

[B]

It does.

[A]

No, we're not ready.

[B]

It does. So there's a farm, the polst farm that everyone should have. So it's life sustaining orders that you can describe.

[A]

Have we written dad's out form yet?

[B]

Yeah, I signed it.

[A]

Good. Let's make sure those are up to date. Yeah, he's. He's made the choice.

[B]

So, first line, dnr, do not resuscitate. Next line, attempt cpr. Okay, that's first. Right. So most people in hospice are. Do not resuscitate Just let this disease take its course, whatever it is.

[A]

Yep.

[B]

Next section, do you want full care? Do you want some care at home, or do you just want comfort care? Hospice, usually just comfort care. Everything helps. Third section, do you want to be fed artificially, yes or no?

[A]

No.

[B]

You're saying no, I agree with you. I think where people need to have this conversation is I asked dad this. I said, if you can't feed yourself, do you want me to feed you? Because I will see that a lot. You can keep a body alive on tablespoons of food.

[A]

What did he say?

[B]

He said no.

[A]

Good.

[B]

So, like Nancy, I'm her power of attorney. Do you want me to feed you?

[A]

What'd she say?

[B]

No. But so many people like, well, yeah. Okay, well, then you're living probably a bedridden existence, potentially years, whatever.

[A]

I mean, that's people's choice to make. Not my jam, for sure.

[B]

Right. But it's a conversation people need to have because they think just, oh, I don't want a feeding tube. Right. But you don't think about. Okay. To me in hospice and anything. Let the body guide this journey. If you can't feed yourself, I think it's speaking where it needs to go.

[A]

I would agree.

[B]

So, okay, so families fill this out. Supposed to be on the fridge. Firefighters are looking for this, right. They come in, families panic. Call 91 1. Okay. They're looking. Even though that can say that the family can insist.

[A]

What are the firefighters obligated to do?

[B]

Well, I don't want to speak out a term. Jason would be ideal for this when they arrive.

[A]

I feel like the DNR would take risks.

[B]

It should trump things sometimes, though, in a panic, you can imagine the chaos that can. Can happen in families or if. Or if it's not completed. So here you have someone who's dying, actively dying. Comes the er. All of a sudden, they've got a breathing tube. They're. They're pumping on their chest. The ribs are cracking. It is such a traumatic death. Like, I do not wish this on anyone to go through that.

[A]

They leave the rib cracking out on tv.

[B]

That. Yeah.

[A]

Yeah. If you've never actually compressed somebody.

[B]

Yeah.

[A]

Might want to stand by for the audio experience of that.

[B]

Yeah. I'm not strong enough to do it. I don't. I did CPR once and threw out my back.

[A]

I don't even really know what to do with that information. I'm still shocked. Or drinking champagne at 9:30 in the morning.

[B]

Oh, I have a reason.

[A]

Fire away. Let's just Take a left hand. Turn right. Now I am having coffee, everyone. Michael is. Go ahead, Michael. Show your cup as well. It was explained to me that champagne is a morning beverage.

[B]

Yeah, well, it's an anytime beverage, right, Michael? Stay hydrated.

[A]

Yeah, exactly.

[B]

At all times.

[A]

Fire away with the champagne.

[B]

Okay, so the other day.

[A]

It's a real bottle, by the way, people, and it's really intercompany.

[B]

So the other day, I was looking for the deed for our house, okay? And I'm digging, digging, digging, and I see mom's death certificate. And then behind it, I see this thing that says Andy and Casey things to keep.

[A]

Yep.

[B]

So you've seen some of it. You wanted some of her handwriting.

[A]

Y.

[B]

So the list that you read, you thought, I don't know if I can read it, I might let you read it.

[A]

Oh, you don't have your telescopic readers. Both you and Jason are hilarious if you don't have them on. It's like you're limited by your ability, the length of your arm.

[B]

Well, I think you should read it out loud because it. I think what it.

[A]

You're gonna ambush me with this. One of the last things mom wrote,

[B]

and it wasn't one of the last things, but I think to me, an end of life and how people.

[A]

All right, sentence one. The opener is a real. It's got a real hook to. Looks like I don't get to stay in the game as long as we had planned. But the notebook says.

[B]

You know the movie. The notebook?

[A]

Are you serious? God, what a fascinating woman. Diverging from this for a second.

[B]

What was that book? Nancy Drew.

[A]

Nancy. She, when she came up, brought a application letter. Essentially a. Wasn't a resume, but it was an application for a job at the local newspaper in Santa Cruz. Right. And I don't know what kind of job she was applying for, but in

[B]

there, she's a bookkeeper.

[A]

As a bookkeeper, she's just like, I'm a coward to the core. I've been scared to death. I can't watch scary movies. And the Nancy Drew books, I can't even finish them. Which reminded me she took me to go see the original Michael Keaton Batman movie. Have you seen this, Michael? Actually, yes, I have seen this one. Okay, you're not going to remember this, but in the opening sequence as the movie starts, the camera, you can't tell what it is. It's like moving slowly with cinematic music through this little architectural area. And as it comes out, it's the Batman logo that is on his belt. That he wears. I'm there with my mother, and she goes, we have to leave. I was like, what? She goes, it's too scary. And this was in the opening sequence.

[B]

The job she was applying for was an admin assistant.

[A]

All right, so, yeah, there you go. Nancy Drew terrified my mother. And I don't think we watched that movie because we couldn't make it through the opening scene. Okay, but the Notebook, meaning the movie, says, I can leave with you, the cards held in my hands. So I'm granting you my life share of chocolate, but only if you'll root for the Giants, which is her absolute favorite team. I mean, she was dying listening on the radio to the Giants. And all of my vouchers for cups of good coffee in the morning, son. You can have all the bottles of Missy. Oh, good coffee in the morning sun. You can have all the bottles of good wine I've yet to find, as well as the cheeses and champagne 2 double O to be opened for both small and grand occasions. God, her handwriting.

[B]

So how I tied this in. I was like, oh, my gosh, Andy has gone into the coffee world. Yeah, like. And I was like, I don't know, just how the universe sometimes lines up. I'm like, this is you. This is your coffee world.

[A]

She turned me off to coffee. I didn't have my first cup of coffee till I was 27 because I don't remember if you remember what she drank. It was like that Red Folgers, like old school. And now that I understand coffee a little bit, I'm not a coffee nerd by any stretch. I think she burnt it for about three days before she drank it. I remember having a sip, and it tasted so horrible that just like, no, I don't want anything. So I didn't have coffee until after I had kids. And then a buddy of mine overseas in Uzbekistan slid me a iced mocha, and I was awake for about two days.

[B]

Oh, yeah.

[A]

And then, you know, after your kids age a little bit, then you can just put your face under the espresso machine and drink it. But, yeah, she actually ruined me from coffee to begin with. But here we are, full circle.

[B]

Well, that's what I thought when I saw this. I was like, little did she know you would end up in a coffee world and I'll drink champagne the rest of my life.

[A]

But I feel like you're kind of, like, really shoehorning things in here just because you like them. But it's whatever, you know? But I think it's your world for

[B]

big and Small occasions. Like, to me, it's huge to be here.

[A]

Why?

[B]

Well, how long have you been podcasting?

[A]

Eight years, nine years? Well, yeah, I mean, I. Before you've been doing it before I've been here, so I don't know how many years before that. But that makes two of us. I have no idea. Eight or nine years.

[B]

But you're not coming on. You're not coming on.

[A]

Yeah.

[B]

So to be here.

[A]

No, you can come on and talk about medical stuff. We're not gonna go do like a chapter and verse of our life because trust me, you don't want to go down that path.

[B]

Well, that's fine. That's not meant for the Internet anyways.

[A]

Yeah, but yeah, I mean, again, I'm in a phase of my life where the stuff that you are talking about is I'm directly impacted by not only my own. You know, I'm on a two and a half year journey at this point to figure out my own endocrine hormonal system. But my wife is, you know, going through it as well. I mean, to tell you that what you don't get briefed on as a man is if you have a significant other, what they're going to be going through at some phase in their life.

[B]

Yeah.

[A]

So.

[B]

Well, and women aren't told that either. Am I allowed to swear on here

[A]

just the Internet, you can do whatever you want. Have you. We've Dad's been on here. What do you think?

[B]

Oh, that's true.

[A]

Yeah.

[B]

So end up in hospice care. So the military phased out. My girlfriend's there and it was just crazy that I go into this conference and I'm like, I really need to find someone in this conference who I can talk to about working in it. I was in a marijuana lecture of all things. I don't know how much that's been discussed in our upbringing, of our exposure to that with dad's hobbies.

[A]

A little bit he, you know, he forgets that he like lit half of a mountainside on fire and they had to do a, you know, one of those fire retardant drops and. Yeah, yeah.

[B]

So my bestest friend from nursing school, I hear my name, I look up and I see her name and Elizabeth Hospice. And I was like, oh my gosh. She's like, they have an opium. Here's the. Here is our hiring manager. He was the medical director. It just like fell in my lap. And I loved it. Absolutely loved it. And so many people, when I say, oh, hospice, they go, oh, oh, that must be hard. That must Be hard. I actually miss it. And I feel really guilty that I'm not doing it still because I know this gift I have. Most people cannot sit in the comfort of the. Of doing it.

[A]

It's a. It's a unique place. And if you think about it, most people will very infrequently touch death in their life. I mean, obviously then everybody. Hate to tell everybody this, but life is a fatal event.

[B]

Yeah.

[A]

So at some point you're going to be there, but. Yeah. I guess both you and I come from a slightly different world where it's not like I enjoy being in those moments necessarily, but I've been around my more than my fair share of people at the end state of their life.

[B]

Yeah. And unfortunately yours is. I could never sit on that side. I couldn't do that side.

[A]

You never know.

[B]

I couldn't do that.

[A]

When somebody's trying to kill you, you just try to kill them back.

[B]

I get why you have. You have to do it. I just couldn't do it. I'd be the one. Like a mom with. This is too much.

[A]

Let me just tell you. None of the stuff we were doing was making it into a Nancy Drew novel.

[B]

No.

[A]

So. So Batman opening credits.

[B]

But I think that is such a unique experience for me that you don't meet many providers who have sat bedside of hundreds of deaths. Listen to bedside stories of what matters they're not worrying about. Oh, I should have worked more. You know, I should have spent more time at the office. No, it's like I should have traveled more. I spent more time with my kids. This is what I heard repetitively. And so for my mental shift is. I mean, I work to travel. That is what I love to do, is to travel. And that's where my money goes. But also I took care of a generation of women who were not on hormones and how the quality of life. I'm not dying like that. And the people I take care of, both men and women, I'm not gonna let. Let that happen.

[A]

Yeah. It just seems like you've shifted your focus from the tail end of life to like, maybe let's delay how long somebody has before they get there or you arrive there at a better spot.

[B]

Well, both. So I had to do it, like, switch in my brain. So I'm like, okay, I'm doing hospice of the ovaries. Just switch it up. Okay. I'm still doing end of life care. Ovaries are dying and the testicles are a little bit slower. So end of life care, just different framework.

[A]

Whatever Works for you, that's what works. No idea what you just said, but whatever, as long as it lights your fire.

[B]

Menopause care, it's hospice of the ovaries.

[A]

How did women get so lied to like the again? And we can go through some of the exact questions, but one of the resounding themes is hormones cause cancer, which seems to be the biggest lie that was told that how many generations of women, when you say got caught up in that? 5 or 6, 50 to 60 years ago they made that it was seems to be improper determination because they just removed the. What is the black label warning on those things?

[B]

Black box. Yep.

[A]

Yeah, thanks for that. For the generation of women that had to their words, not mine. White knuckle it through.

[B]

Yeah, that's not pretty.

[A]

No. But why did that happen in the first place?

[B]

Well if you look at like in the 60s, it was common practice to be on hormones. So about 30% of the population men in women. I only know women. Okay, men of this is where I get a little bit frustrated. Men, it's always been like, oh, you're not feeling good, here's some testosterone. Access to care with hormones for men, night and day difference is that because

[A]

it was understood better?

[B]

I don't know if it's that but like even in well, nobody understands women well. We aren't even studied. So all the research that's been done

[A]

because you're not studyable is on.

[B]

It's been on men. And they extrapolate that data to make it work for women.

[A]

Like you guys are crazy at a genetic level. How can we study you? Men are like rock solid, always good to go.

[B]

But so like blood pressure medicine, sleeping pills, cholesterol meds. Those studies were done in men. And then they're like, okay, well we'll use this on women. There's been no like data that shows you give a woman blood like cholesterol medication and it's going to lower their all cause mortality. It'll lower her cholesterol, but it doesn't necessarily decrease her risk of death. You can't take numbers from what they study in men and put it to women. So we've been underrepresented there.

[A]

Well, let's also just be honest. I mean not too long ago they were drilling holes in people's head to get rid of headaches. So medicine is slow to evolve.

[B]

It's always evolving. It's a practice, it's science. So in the 60s they're using it like 25, 30% of the population who can be on it are on it. Right. Then the WHI study comes out. That's 2002. And that's when I was like, oh, estrogen causes cancer. They ran with it. The people who actually wrote the study, it got published before they did the final review.

[A]

And it was on mice, right?

[B]

No, no, no, no. It was women they studied. It was a double blind random control trial. Which is the gold standard. Which is what you want. You have two groups.

[A]

But wasn't the information recorded inaccurately or reported in accurately?

[B]

How it was interpreted was inaccurate.

[A]

Maybe it's not the gold standard. People would want.

[B]

How they ran the study was appropriate. The reporters, the before, the people who were working on the study got the final say of what was to come out.

[A]

Nice.

[B]

That is where the problem happened. They've been backtracking it ever since. That study actually showed the women who are on estrogen alone, not estrogen and progesterone. The estrogen alone actually had 18% less chance of breast cancer alone. That did not get reported. It was like, nope, this is going to kill you. And so all this fear happened. So all these women get ripped of hormones. So even right now, this is crazy. So within the US there's 75 million women either perimenopause, menopause. Post menopause, 5% of the women are on hormones. Still minimal.

[A]

Good God.

[B]

Yeah. Best of luck.

[A]

I mean, well, yeah, because if you have a. What do they call it, a black label warning.

[B]

Yeah. You. We. There's like, you should fear this hormone in your body. Like the litmus test for a lot of this. I'm like, okay, estrogen is highest for women when they're pregnant. That is like the peak. It's about 3,000. The level can get to 3,000 in the body. That's the highest peak. It's like a stress test for your body. So, okay, we can tolerate it in pregnancy. Why are we fearing it at doses that are like a tenth of that?

[A]

I don't know.

[B]

Or a 1% of that. Right. It's these women were told fear a hormone that has been so protective.

[A]

So I don't think I'm speaking out of school with this. Leah was talking to her mom and her mom's sister, which would be her aunt, verbatim, both of them. You're going to get breast cancer.

[B]

Yep.

[A]

I mean, instantaneously. That message is pervasive.

[B]

It's deep. I know. So if you look, think about it like, breast cancer rises as women get older.

[A]

Okay.

[B]

Estrogen's dropping. Doesn't make any sense. Okay, tell me. Tell me how you can make that correlation. One's going up and the other's going down. It doesn't even. Doesn't equal up should be other way. Right. If that's what they're saying, you should be getting a ton of breast cancer when you're pregnant, if it's the cause, and it goes down when you're older.

[A]

So I don't know. So where do we begin? We had hundreds of questions that were submitted. You said you kind of want to go through. And I think it's smart because I think in your. The way you want to go through this and reference your notes all you want to, I think a lot of the questions will be answered. I'm going to just turn it over to let you explain this, and then I can kind of surf through some of the questions that maybe might be on the perimeter of that after you get through it.

[B]

Well, do you want me to explain, like, what this is?

[A]

Yep. Lay the foundation. Go through what you have. Because I do think it's going to answer quite a few of the questions. And in listening to what you're saying, I'll kind of go through and see if there's any. Anything out there that's on the fringe.

[B]

Okay. So I think too, like, coming from that hospice background, you know, if you are lucky enough, you get to experience menopause. And I think back to, like, Mom's experience, she just was.

[A]

Say that one more time.

[B]

If you're lucky enough, you get to

[A]

experience this, meaning you're still alive.

[B]

Correct.

[A]

Okay.

[B]

Right. And I think that Mom's procedures she went through probably threw her into this. But she was such a stoic person. Did not talk about what she was going through.

[A]

I heard her yelling at Dad a few times.

[B]

Well, all right. That's probably what's related to other things.

[A]

She was fucking him up.

[B]

What do you mean?

[A]

He was just like.

[B]

So, yeah, if you live long enough, you're gonna go through this. The problem I see is, okay, in the 1900s, women were living to 50, right. So you would go through menopause. The average age of menopause is 52.

[A]

Okay, great to be going into it or being done with it when you hit menopause.

[B]

So menopause is defined as basically one year, no periods. So day 366. Okay, where's your badge? Which I realized I'm, like, cleared hot. Could be a menopause podcast coming in hot.

[A]

Go ahead with that if you'd like. Right. I won't sue you for IP that's fine.

[B]

But what about the women who don't have uteruses? Like, I'm going to be very transparent on this. And I've always been open with people about the hell I went through. And that is partly why I'm doing this. How poorly I was treated being a provider. I speak the language. Went into my provider and she's like, oh, gosh, I don't know, maybe I'll help you for five years. What happens when I'm at that age? I was 47. So I'm like, okay, at 52, you're not gonna help me. And they said, I want my testosterone checked. Well, if we check it and there's something wrong, then we'll own it. I'm like, oh, so I speak the language. I know what to say. What's happening to the women who don't.

[A]

They're just doing what they're told.

[B]

Right. Or they're being gaslit and being like, told, oh, you're just supposed to just have some more wine, exercise more.

[A]

Do you think that the people who are gaslighting them are doing so or they're just repeating what they were told a long time ago and they're not keeping up with what's evolving?

[B]

Or probably, I don't know that having more wine was ever taught in medical school.

[A]

I didn't go to medical school, so I couldn't tell you.

[B]

Well, I'll tell you that this, the type of care I provide is not taught in medical school.

[A]

Yeah.

[B]

Even your OB GYNs, who a lot of people think this is where you get the care from. They get one hour training in this.

[A]

Yeah. And you can also apply that wider too. I mean, how many doctors have a solid understanding of nutrition? They don't get taught about that either.

[B]

No, 100%.

[A]

So. So that's what I'm saying. Do you think that they mean to, we'll say, have subpar information or they're just not keeping up with the times.

[B]

Well, and I also don't fault them in that. Also, like, if you look at your OB GYNs, we need them for delivering healthy babies. That is a critical time. Focus on that. I mean, I spend hours a week training and always learning in classes. They don't have time to do both.

[A]

Yeah.

[B]

So I want to. People need to shift from thinking that their primary care knows about this, their ob. You need to find someone who lives in this arena, like myself. And like, you're not gonna go see a dermatologist for your skin. You're gonna see a podiatrist for your feet, orthopedist. There's all these specialists you need. This is another arena. Find someone that. This is all they do. Yeah, that makes sense because the OB doesn't have the time. You know, they may want to be able to do the best that they can, but how are you gonna stay up on all that? You just can't. It's just too much. I mean, I do this full time. I couldn't start, you know, learning some other path of taking care of babies.

[A]

Slightly off topic. Are asshole doctors. Like, they focus on assholes? Are they weird people? Proctologists.

[B]

Proctologists.

[A]

Who in the is like, I know what I want to do. Stare at other people's.

[B]

Well, GI docs do a lot of that, I guess with the colonoscopies too. I don't think I met any. I don't think I've met a proctologist in all my time. I don't think I have.

[A]

Just. I don't know why that thought came to me, but I'm just gonna let it out so it doesn't occupy free rent in my life.

[B]

I mean, even when I worked ER medicine and people accidentally fell on a bottle or a light bulb got stuck, they just fell.

[A]

I hate it when that happens. By the way, you know who I call? Michelle.

[B]

I just fell.

[A]

Careful with those nunchuckus that you.

[B]

I don't remember if I don't think it was Jason, but I think it was another like first responder who some how they fell or a device got stuck and was still vibrating their whole drive to the hospital.

[A]

Let's just say there's an entire website and Instagram pages dedicated to this. So go to town, people. The accidentally have a wiffle ball bat up my. Like just. Just own your Also put a lanyard on it.

[B]

Yeah. So I'm going to backtrack then. So. Okay. We before 1900s, we're living to 50. All right, so you're not dealing with this. So current day, we women lived longer than men. Our average lifespan is about 80. Men are 72.

[A]

So is that it in the US right now?

[B]

Yeah. So dad is passed. He's extended his lifespan. We should.

[A]

He's overextended quite a few things.

[B]

We should make him aware of that today.

[A]

Off topic because we've been joking so much in front of him about putting him in a home.

[B]

We were, but we're not quiet about our discussions.

[A]

No.

[B]

And actually the thought process in front of him.

[A]

Yeah, I told him yesterday. I can't wait to figure out how much of your money we can spend to put you into a home before we have to pay for it. Verbatim is what I said now. This morning on a call, he's like, I'm not going to a home. It's like, don't worry. It's being decided for you.

[B]

So we are not supposed to outlive our ovaries. So women, I don't know. I think we're just one of the most unique creatures. When you are born, you are born with all the eggs you're ever gonna have in your whole life. And what's really cool, if you're pregnant, like say, when I'm pregnant with Ella, she's got all her eggs, so you are carrying your grandchildren. Does that make sense?

[A]

It does, yeah.

[B]

Yeah.

[A]

I haven't thought about it like that.

[B]

Amazing to me. So women are. They're ovulating, they're releasing all these eggs. Releasing all these eggs by age 30. We've got 10% of our reserve left. Okay, that's not that. That's not that old.

[A]

No.

[B]

Right. So you can. Why it's harder to get pregnant when you're older. The body's working harder, harder, harder to ovulate. And you're not getting the best of quality of eggs. Hence why you can see more chromosomal abnormalities at that point. Average age of no more ovulation, no more eggs. That is menopause. You stop having periods, can't get pregnant anymore. Okay, so 52. So our ovaries are aging twice as fast as our body.

[A]

Okay, I'm with you so far.

[B]

They provide all the hormones that have making our world run and they're done. We get castrated like this. Done drops off men. Not like that, you guys. You go through menopause, but it's definitely way more gradual.

[A]

What did you call it? Androgen.

[B]

The real term is andropause. That's kind of boring.

[A]

Menopause is.

[B]

Menopause is way better. Dad is. I forgot his term was that he came up for himself. Why he needed to sit here with his comments.

[A]

Clinically insane.

[B]

Yeah.

[A]

Yeah.

[B]

So, okay, so here are women who have outlived their ovaries, and it's. You've been castrated. And you're supposed to be productive and live this life that you did prior to without hormones. And there's only five mammals who do this. The other four live underwater.

[A]

Okay.

[B]

So I just. We're just such unique creatures in this way. So we have a long lifespan. But I want to get people's health Span to match a lifespan. Have you heard of that? Yeah, before.

[A]

Brigham talks about a lot about that.

[B]

So. Okay, great. You're gonna live. You're a female, you live to 80, but you're. That's your lifespan. But say your health span is only 65, 70, where you're not using a walker, where you can get off of a chair. Right. You can still remember people's names or what car keys are for. Right. What if that only goes to 70? Then you've got that 10 year gap. Right. That is where I'm trying to bring that discrepancy of those two matching together.

[A]

We call those the pudding years.

[B]

Yeah, we're seeing. It's coming up.

[A]

He's in him. He doesn't know it, but he's in him.

[B]

Yeah, I can just hear him listening to this episode. Just.

[A]

Oh, really? Let me just. We don't have enough space on the hard drive for me to repeat the number of things I've been forced to listen to. So.

[B]

What do you mean by that?

[A]

Do you know our father? The number of things I've had to tolerate him saying to other people and to sit there and listen to.

[B]

I see what you're saying.

[A]

Yeah, yeah, yeah, yeah.

[B]

So you've got a whole generation of women that I took care of. No hormones. It's a compounding factor. It's not being taught in med school. And you have now a lot of women being educated on this. Thank goodness. Or interested. It's all over. You see it, maybe. And that's not on your Instagram feed, but it's all over mine.

[A]

Well, yeah. The algorithm is not some person with the, you know, twirling their mustache behind the scenes. It feeds you more with what you engage with. And you live in this world. So it actually should makes sense that your feed is dominated by this.

[B]

So here you are, you're a female. You have. You go to the. Your provider and you're like, I don't feel like myself. I can't remember things. I'm tired at 2, 3 o' clock in the afternoon. I just want to go to bed. I'm not sleeping, I'm wired, I'm tired. 1 to 3am My head's repetitive thinking about things. All of a sudden I have a menopause muffin top. I'm exercising, I'm eating the same. My clothes don't fit. Depending on where I am in my cycle, I may want to kill my spouse. Like, don't talk around me, don't breathe, don't chew. It's like not even recognizing yourself. So it's pretty scary.

[A]

Every month.

[B]

Every month.

[A]

Hard pass.

[B]

But you live it if you have a partner. And like I said, I have very open book about what I've been through. And I asked Jason about this. I went on a podcast last week before I went up. I said, how honest can I be about what we went through? Right? Because I'd be very, like, respectful of that. And I said, you know, I have my story. And he's like, well, I have a story too. I tell people, so. Oh, okay. Well, tell me your story. And he's like, well, I tell people if I had to choose between giving you hormones or me.

[A]

He said this to me this morning.

[B]

Right, Right. Because he.

[A]

Women's gonna get him first.

[B]

He's like, I would give it to you because the impact it had on you was way better for us. So I personally, like, when I was in the thick of it, I didn't know I was. I don't have a uterus, which means I don't have a way to track anything of what's going on every. Every month. And it was 47 at that time. I was like, there's no way in hell I'm in menopause at 47. Well, what they don't tell you is when you have a hysterectomy, you're more likely to go into menopause four years early. So I didn't know that. So who knows how long it was going on? It's just where it finally hit. So I called. I'm like, I'm leaving, Jason. I'm filing for a divorce. Hire the best divorce attorney in San Diego, who's now one of my patients and my biggest advocates, and that's whose podcast I went on.

[A]

Jesus Christ. I was on the receiving end of some of those phone calls. Yeah, yeah.

[B]

No, 100% I was done. But I hear it every day in clinic, too. I'm done. I'm leaving my husband. I can't do this. And I get it. How can you.

[A]

If they go down that path, though, it doesn't actually resolve the problem. Right. Because there's still the battle you're talking about is within. Well, and actually, not that these people, you know, maybe they're not a great match for their spouse, but I'm just saying, right? That's. That's probably not the one single factor that's making them feel that way.

[B]

Oh. But it's. When you are in the trenches of. That you can't even think outside of. Everything is just too much And I was talking to Amy, the divorce attorney on her. Her podcast. I'm like, how much more effective could you be in these mediations or even divorce proceedings? If I got them a few months ahead of time and I got them stabilized, maybe they don't even go down that road.

[A]

Might not even get that far.

[B]

Maybe they don't, but say that they do for that just isn't going to work. The mental resilience and just who they could be. I think divorce would look so different if I could optimize somebody ahead of time.

[A]

So that makes sense.

[B]

So, yeah, I'm here. I am in this chaos, trying to get help from my primary care provider. Can't get help. The mental health was really scary. I, you know, I've had times of depression in my life. When mom died, of course, I've taken antidepressants throughout my life. That was one of them. I think there's a time and a place for them for sure. But this was a different kind of like, this was like, not that I was gonna hurt myself, but if a bus hit me, that would be okay. It wasn't nothing I was gonna act on, but it was just. I couldn't see a light.

[A]

It's a general malaise, if you will.

[B]

It was just. And it's scary. And I see women, you know, all the time crying about it, and I get it, and I'm so open because I want to validate how they feel and that I have been them and who I am now is very night and day that there is hope on the other side. It takes time to get this dance done, especially in perimenopause. But there is hope for sure.

[A]

Peri is before.

[B]

Yeah. And that. So perimenopause can last seven to ten years before menopause. So you think about that. Oh, you think about that from an economic standpoint. So this whole thing we're describing costs the US 26 billion a year in lost wages, women stepping out of leadership roles and just getting out of the workforce, and healthcare costs. There's a huge economic impact of what's happening here. But if you think about that from a relationship standpoint, and you're like, what is going on here? This can be seven to 10 years of this chaos. Then you have your one day at menopause, and then the rest of your life is post. So you can have seven to ten years of chaos.

[A]

Yeah. That doesn't sound awesome.

[B]

No.

[A]

Life. Life's hard enough.

[B]

Well, life's hard enough. But when you are just your. Your brain Cannot even filter our function because of hormones being fluctuating. I mean, I have friends. Like I just couldn't go to work today. I just couldn't do it, you know, or they're like certain times of the month too. I don't. I would like to teach to this on the screen too because I think

[A]

it will help on this particular slide.

[B]

Help men know when to hide in the closet. I'm actually wonder if I threw it up there. Sorry, Michael. I don't know if I threw the slide I wanted up there.

[A]

Okay, do you remember which number it is? Is this slide correct?

[B]

Well, we can start here. We can start here. So this here is a description of what happens to females. Hormones. So testosterone, you can see at 25, just starts on a slow decline. Now progesterone and estrogen, those decline, but it's a zone of chaos. You see how those fluctuate up, down, up, down, up, down. Progesterone is our first one to leave and estrogen will follow. So progesterone, how that presents for women is this looks like disrupted sleep. They're not sleeping.

[A]

Yeah.

[B]

And they have anxiety. So think. I think of like a pot on a stove and it's just bubble, bubble, bubbles. Right. So no progesterone. It's bubbling over the resilience of mental health. Just bubbling over. So when we replace progesterone, when we take it by mouth, it goes to the liver. One of the metabolites is Gaba. And that is the feel good mother nature. Xanax.

[A]

Gaba is gaba. Is that in any way tied to gabapentin? Because that's what fucked me up.

[B]

So gabapentin is used off label for sleep.

[A]

Okay. Because they gave it to me off label for neuropathic pain control and it jacked me up.

[B]

You were on a high dose. And my understanding too though is you were on a lot of other meds at that time.

[A]

Just like 14.

[B]

And also washing it down with. What was that?

[A]

Crown Royal?

[B]

Yeah. No, no, no, not that. I can't remember the name of the alcohol.

[A]

Crown Royal is alcohol.

[B]

No, no, no, I know, but it wasn't that, Morgan. That was it.

[A]

Yeah, I went through some phases. Yeah, Captain. And diets, not a big deal.

[B]

So. Okay, so progesterone is the first one to. To leave the body and so disrupted sleep. You may have, may or may have not experienced this in your household. Someone who cannot sleep.

[A]

Well, again, I'm not talking out of school. Leah has a later shifted schedule as well too. So it's kind of compounding, I think it's hard to separate one from the other. She teaches an evening Jiu Jitsu class sometimes I'll go to it and then I'm in bed tired and wired like you're tired, but your endocrine system is alive. And. Yeah, that. So again, compounding factor. Is it A or is it B or is it C, which is the combination of A and B.

[B]

Right. Well, it doesn't help when that hormone's leaving.

[A]

Yeah, for sure.

[B]

So if you think of this as Mother Nature's Xanax just brings this calm down. So where I think for your population is primarily male. So I want to give some action items for people of how they can help. The first thing for me. What are those things that dad builds? I don't want to say it wrong. The. Where you stack the rocks. Karen.

[A]

Oh, Karen. Rock Karen's.

[B]

Karen's. So when I teach not to be

[A]

confused by the lady who runs the HOA that's just a cunt. Karen. These are rock Karens.

[B]

So in my office, I actually have a model of this.

[A]

Okay.

[B]

Because my foundation is sleep. If you are not sleeping, you cannot. I cannot build and help anything above this.

[A]

Let's just also clarify. This applies to men as well, too. Like, this is anybody who actually wants to try to optimize anything they're doing 100%. Yeah.

[B]

But we're going to have a challenge in this situation when a hormone that helps sleep is leaving for sure. So things that both the men and women can do to help protect the sleep. Dark environment. So blackout light. Right. Keeping it cool. So 65 degrees. Putting a fan on cooling blanket.

[A]

I have no relationship with this company, but Lee and I got one of those eight sleep things that has the thing you lay on top of and the COVID is. Got the liquid flowing through it. Yes.

[B]

Yeah.

[A]

And you can split it down the middle so you can have your own side.

[B]

I have never slept in one of those, but I hear good things.

[A]

They're very expensive.

[B]

That is why I haven't done it. Then.

[A]

Okay. Have some more champagne. We'll get your credit card out here in a little bit. With the WI FI connection, we can make it happen. Very, very impactful.

[B]

Yeah. So. And then another thing too, is you can listen to white noise or pink noise. My personality is. I'm gonna listen to pink noise.

[A]

Pink. I don't know what that is.

[B]

So white noise is like. That's like raindrops. That's actually pink noise.

[A]

Okay.

[B]

So pink noise is more your nature sounds the wind going through the trees, the ocean waves.

[A]

What would you classify Dad's noises? House currently, since he doesn't wear his hearing aids. The smoke detector. Beep. Going off every minute.

[B]

Well, I haven't been there since this happened.

[A]

Did you not hear it? He was on speaker. You could hear it every minute.

[B]

Oh. Oh, really? I wasn't paying attention.

[A]

Don't worry, neither was he. Is that pink noise?

[B]

Oh, I didn't realize it was that bad. The fire. The firefighter didn't fix that.

[A]

I don't think he's been to the house yet.

[B]

Yeah, he was there yesterday.

[A]

Did he go inside?

[B]

Yeah, he said it was sad.

[A]

No, it's still beeping. I heard it on the phone.

[B]

So those are kind of some action items. Protect the sleep.

[A]

Okay.

[B]

Things to start with.

[A]

What do you think about those? The glasses. The red glasses and stuff that. So.

[B]

For the blue light.

[A]

Real BS marketing.

[B]

I don't know the data on it. Magnesium glycinate at night. Love for sleep, just calming.

[A]

Be careful on your dosage, people. I've played this game with magnesium. Oh, yeah?

[B]

Was it glycinate or was it citrate trait?

[A]

I don't know what it was, but there were almost accidents, so it was

[B]

probably citrate shit trait. And that's the problem.

[A]

Be careful your dosage.

[B]

Well, that's the problem. Right. People are desperate and they're like, magnesium. Oh, I'll take that one. Right. And they're like, yeah, yeah, I'm doing my colonoscopy prep. I'm not sleeping.

[A]

Yeah.

[B]

Right. So first thing, foundation is going to be sleep. So that is the progesterone. Michael, I don't think I wrote down this the slide for you on the one I wanted.

[A]

He can kind of surf through. I can look.

[B]

Can you just scroll? Are you able to. You just shared that file I sent, right?

[A]

Yep. Okay, do you want him to go towards the beginning, to the.

[B]

Yeah, keep going to the right. Yep, keep going. Yeah, yeah, it's number 30.

[A]

30. Okay, about it. Oh, here.

[B]

Okay. So this is the every month cycle that is supposed to happen.

[A]

Okay.

[B]

This is.

[A]

I mean, are we working for NASA now?

[B]

Jesus.

[A]

Are we trying to put a fucking satellite into orbit?

[B]

Well, this is what's happening behind the scenes in women. So. And this is what I love. This is the science of what I get to do every day. So you can see these fluctuations going up and down, up and down. The brain likes stability and that is my job, is to try to make things more stable. So estrogen is going to be that blue line. And progesterone is the pink. So starting day one, that's when period starts, day one, hormones are really low. Then estrogen peaks. Right. In the beginning or not in the beginning. Excuse me, Ovulation, that is mid cycle. And okay, so women get two to three days where they feel good, they have energy, maybe they want to have sex then. Because mother nature wants you to get pregnant.

[A]

This is around that heart.

[B]

Yep.

[A]

And for people who are just audio only, there's a. Right around the middle of the month,

[B]

there's a little day 14 for a 28 day cycle, mid cycle.

[A]

So you probably get a day in front, day on the other side of

[B]

that, you feel good. This is all we get. Okay. So then the body is looking to see, am I pregnant? That. So progesterone is the hormone of pregnancy. Progestation, okay? That is progesterone. So progesterone is climbing, climbing, climbing. I'm getting this environment ready for a pregnancy. It's waiting. It's waiting. Okay. There is no fertilized egg. I'm just gonna crash. So day 21 on. You can see that progesterone tanks. The estrogen looks kind of purple in this slide with the overlay.

[A]

Yep.

[B]

You see that? That crash is where divorces happen. That is where men get killed with forks in the eye. This is when they're hiding in the closet. I'm not coming home. Nothing I do is right. It's. That crash is where like for women who have bad PMS or pmdd, perimenopause. This is where it really has a negative outcome.

[A]

The tail end of the month.

[B]

Yeah.

[A]

And this is not a calendar month. I'm assuming this is the.

[B]

This is a cycle.

[A]

Yeah. So it doesn't.

[B]

Like this isn't January 1st. You can't.

[A]

I don't want men circling the 14th on their calendar and assuming that this

[B]

applies, gonna get to have sex on January 14th.

[A]

Okay. Yeah.

[B]

No, this is a cycle month for women. So right there, that crash after day 21, or could be earlier, depending on a female, is where. My job is to soften that blow. So the brain likes this, right? This fluctuation of hormones, it just becomes the zone of chaos. Michael, can you go back to that first slide I wrote down for you? Actually, sorry. Slide 19. Okay. So.

[A]

Jesus.

[B]

So pre menopause. You see how it looks? Nice cycle. You can follow the pattern. Perimenopause. Look at that. It is all over the place. That is the zone of chaos.

[A]

There's a sweet dong there Two thirds of the way to the right, you see it, Michael.

[B]

And then post menopause, like myself, where you're flatlined. So just. There's just nothing happening. So perimenopause is this zone of chaos. This is where estrogen and progesterone, they're just fluctuating so much. So what I will do for women in this. When that dip happens, of estrogen, this is where I'll put on an estrogen patch, bring it up, support that hormone. So people who are. Some of the questions were like, oh, migraine with aura, or migraines are triggered. Yes, because the brain doesn't like that switch. And they can bring on migraines. If we kind of soften that out, I can correct a lot of headaches. Okay, I will. We're always. I personally always bring up progesterone, and I may have women take two pills during that dip to give them extra support.

[A]

Are they doing that based off just how they feel? That's how. When they know to take two.

[B]

Okay, so one. Like, one of your question was, what about labs? And I think labs is where women can really get gaslit.

[A]

Okay, like that you're meaning blood draws, Correct?

[B]

Okay, well, I want my labs checked. I want to know my hormones. Tell me my hormones. The typical perimenopausal woman, they're gonna look normal. And then they go in, their provider said, these are normal.

[A]

And you're like, well, I've heard you say this enough times now that the labs are giving you a snapshot of where you're at that day. And if you were to get them taken the next day or two days later, it might present a completely different picture. So it's a snapshot, not a holistic view.

[B]

Well, and I could check a perimenopausal woman's labs in four times a day, and they'll look different, but they're still probably gonna fall in this normal range. But you've got a woman who's not working, she's not sleeping, she's leaving her husband. She doesn't like how she's showing up as a mom at home being told in an office saying, oh, these are normal. You're fine. Exercise more, eat more protein, how's your fiber intake, drink some water. You know, all these things, and they're just like, well, it's me, it's me. And it. It's just. It makes me really sad to hear that. So I honestly can sit down and listen to a woman after taking care of so many women and be like, Know exactly where I need to navigate these hormones. And I think it just comes with how much I've invested in this. Perimenopause is a dance. And that's why for women, it's not like for myself in menopause, you know, your dose and your set. Right. But body's really funny. I may get some women and like, they're like, yes, I'm back a few months later. I don't feel this. We gotta shift, correct?

[A]

Well, yeah, because the body responds to. If you add something else, a variable up front, it might shift some stuff on the tail end, right?

[B]

Well, the hormones are always decreasing, always decreasing until you get to menopause. So it's always this dance. And you need to find like a provider who can do this dance with you in this journey and knows how to navigate it. This is not cookie cutter. You don't go, here's your recipe. This doesn't work for everyone. Everyone is so different. How we metabolize. Some women aren't really good absorbers of patches and maybe they need oral estrogen. You know, it just depends. We don't use much oral estrogen. But you've got to find someone who knows how to navigate the changes.

[A]

Okay. All right, where to from here? Which slide do we look at?

[B]

I'm trying to think of what their questions would be.

[A]

Well, so where do you. So, okay, where do you start women when they reach out?

[B]

What do you mean, where do I start them?

[A]

Do you. I mean, obviously labs are going to be important. No, do you talk? You. So somebody reaches out to you. Like, Casey, I have an axe in the back of my car and when I get home today, I'm going to use it on the door or whatever happens to be on inside of the door. Is it a conversation? You listen to their symptoms and you treat to symptom. I'm just like, so somebody who enters into this journey, what can they expect? And what kind of timelines are we talking?

[B]

Yeah, and I feel like you almost have to put them in two buckets. You've got your perimenopause and your post, like your post menopause people. So your perimenopause. When I hear that rage, that is not enough estrogen. Throw a patch on. I always tell women, keep it in your purse because if you get pulled over by the cops, don't roll down the window, peel off that patch, show them what you're doing and put it on. So rage to me is a lot of estrogen deficiency.

[A]

No police officer is going to know what that means, just so you know.

[B]

Well, that is what I tell them to do.

[A]

I would say crack the window and just let them know that you're traveling and it's your personal conveyance.

[B]

Now, in the menopause world, we know we have to keep estrogen up to a certain level to be bone, heart, and brain protective. What is crazy is so you make estrogen. You have more estrogen in your body than a menopausal woman does if she's not treated. Okay, so the thinking right now, I know everyone's like, well, how much estrogen do I need? What level do I have to be at? We don't have really good data on that. So we have to just take what we have. We think we want it at least. Estrogen higher than 60. My guess is we're gonna want to push higher than that. Probably get to 80. So I am dosing women, one to get rid of symptoms, but two, also for their bone, brain and heart health.

[A]

What type of. Because I know people will say, I am feeling like the person with the ax if I do start this. What are we talking about? For any appreciable difference in symptoms.

[B]

So estrogen can be pretty fast. So say a woman's having a hot flash. You put a patch on her. I got it done.

[A]

Really?

[B]

Yeah. Oh, yeah. I went to work the other day and had forgotten to put a patch on. And I had this pleather cute dress on. And I'm sweating to death. Girls are freezing because I got the air going on. And I know if I just put my. It'd be done.

[A]

Maybe just don't wear a pleather dress.

[B]

No, one. One must dress too.

[A]

But what is pleather appropriate for work?

[B]

For my office.

[A]

I don't even know what to do with that.

[B]

Listen, I wore a white lab coat for 17 years, so you have to

[A]

wear one in your current role because that's how you know the person you're talking to knows what they mean.

[B]

No, I show up in my sequin boots.

[A]

Oh, I fucking know. Trust me. Dad was marveling. This is off topic too. But he was just like, did you know that Casey rents her clothes she doesn't buy? What? I didn't even know that was possible.

[B]

Yeah.

[A]

Is this for, like, you're going out attire? Because you do.

[B]

This is a rental.

[A]

What does that mean?

[B]

There's this company called Nuuly, and you get a box that's shipped to your house, and the basic package is you get six items and so you can wear them for like a month. And then you ship them back like, I'm leaving for Japan, you know, next week. So I rented a box that was just specifically for stuff. I'm gonna travel in Japan.

[A]

Just kimonos and wooden sandals.

[B]

Yep, yep. But. So it's like a thousand dollars retail. What comes in this box? Yeah, I'm not gonna wear this probably ever again. Like, some events I've done, I'll never wear a 500 dress again.

[A]

Michael, up until about 30 seconds ago, were you aware of clothing rental? No, this. Isn't this for guys.

[B]

Do they. Well, I mean, you look like kind of. How is that Viori?

[A]

What?

[B]

Your top. Is it a viori top?

[A]

What are you talking about?

[B]

The brand of top you have on.

[A]

Oh, I don't know. Flylo.

[B]

You know guys. I don't. I mean, if they want to. I wish they did, but most men are pretty.

[A]

What does that noise mean?

[B]

You kind of have your just routine of what you do.

[A]

Yeah, it's T shirts and board shorts in the summer, and then T shirts and pants in winter.

[B]

But you know what? I did the lab coat for 17 years, and I'm gonna let my personality shine when people see me.

[A]

You could get a different color lab coat.

[B]

I'm gonna tell. I'm not. Everyone cup everyone's cup of tea because I'm champagne.

[A]

So what I get from this is you don't mind wearing clothing that other people have worn.

[B]

They clean them.

[A]

How do you know?

[B]

It says on the.

[A]

Oh, that's great. That's great. Yeah, that's nice. Just sharing clothing with serial killers. Okay.

[B]

They're just perimenopausal women who are pissed off.

[A]

I worry that people think it's. They snap their fingers and the problems go away.

[B]

Oh, it's a journey for sure.

[A]

And so what's a realistic expectation to get to a place. I was open about getting my blood work checked, and my testosterone was like. Or what does dad call it? Testosterone? Fuck. Was. Well. And I didn't have any. What sucks is I didn't have a baseline. And one thing that I. That I would recommend to men is, you know, or probably to women, too. Like, get a baseline when you're younger. Because I don't know what my numbers were at and I did limited research, but talk to you too. Some people naturally sit in the higher range of normal, which this normal range is like saying a size 10 shoe fits for everybody. Which works great if you're near a size 10, but not if you're a 14 or 7.

[B]

Well, it's the same thing for Women.

[A]

Yeah.

[B]

The testosterone is by far my favorite hormone. Yeah, by far.

[A]

My point being it's been over just over two years and I think I'm finally like, because I'm working with you on the labs, you'd like titrating to the point where like, this is exactly where I want to be. That's two plus years. Today's episode is brought to you by Brunt Workwear. Let's talk about the craziest thing about these boots. They let you wear these things on the job site before you fully commit to keeping them as being your own. If they don't work for you, you can send them back for a full refund, 100% risk free trial. They sent me a pair of their omen boots. These are the first. It's like a Chelsea style boot, I would say. It has no laces. First type of boat pair of boots that I've ever had that are like that. And I was amazed right out of the box. Normal pair of socks. Threw these things on, zero break in period. And they're kind of my Montana winter helicopter flying boot. You may ask yourself who came up with this idea. Well, the founder, Eric Girard, grew up blue collar and started Brunt Workwear after his friends in the trades kept telling him that big brands had stopped listening and they hadn't changed anything in a hundred years. They had sold out and essentially become fashion brands. And his buddies encouraged him to start a brand built for them. And that's why all Brunt products are named after the guys he grew up with. Real hardworking tradesmen. There is no break in, no sore feet because people out there doing the real work shouldn't have to choose between comfort and durability. In 2026, Brunt isn't just about work boots. They offer a full range of high performance gear built for tough jobs. From heavy duty work pants and to weather resistant jackets, Brunt designs durable, reliable workw to keep you protected and productive in any condition. Brunt was tired of the workwear brands out there cutting corners. You work too hard to be stuck in uncomfortable boots that don't hold up. So they built something better. Boots that are insanely comfortable and built for any job site for a limited time. Listeners get 10% off at Brunt when you use the code cleared hot at checkout. Just head to bruntworkwear.com, use the code cleared hot and you're good to go. After you order, they're gonna ask you how you heard about Brunt. Do me a favor, tell em it was either me or the show or both. Back to the show. Help.

[B]

Yeah. I think you worked with some different formulations.

[A]

And I also intentionally went into it and worked with everybody that I've worked with. I said I wanted to go incredibly slow because it's. It's not like a choice where you're like, okay, I feel great now. I have to get off of this. This is much more of a long term.

[B]

Well, I think it's a forever.

[A]

I would agree. That's what I mean. So why rush and have these massive. In my opinion, or at least for the. That my involvement in the care. Why have this pendulum that's just like smashing left and right. Like, let's just narrow the ups and downs a little bit to land where we want to be.

[B]

Well, and the same thing with women. And that's where I'll see it. Like, we're women who do pellet therapy. Have you heard of that?

[A]

I've been pitched that actually by a bunch of male doctors. So I know what you're saying. I'm assuming it's the same thing.

[B]

Oh, for you for treatment.

[A]

Yeah.

[B]

Okay. So pellet therapy for people who don't know. Looks like a grain of rice.

[A]

Yeah.

[B]

Right.

[A]

They put it in with a turkey baster.

[B]

It looks like it is a surgical procedure and it could extrude, meaning it could pop out. But it's also. It's in your body for months, releasing these hormones. Well, what happens if you have side effects? We can't dig this out.

[A]

They cannot dig it out.

[B]

No. Oh, you're screwed. You're stuck with it.

[A]

Why can't they dig it out?

[B]

It's just like this small. You don't how much work that would.

[A]

No, they don't dig in there with the jeweler's loop. Just like, you know.

[B]

So think about pellets. You're at sea level. Go to Mount Everest. The body. Yeah, the body does not like that.

[A]

That.

[B]

So up and then you titrate down, down, down, inject up. This is not physiologic.

[A]

Yeah. Nor is that actually a fun ride.

[B]

No. And people feel great here. Of course you feel great. You feel really good up here. And it comes down. And then you get used to living here at this higher range. The brain likes steady state. So testosterone is my favorite hormone. If I.

[A]

For women.

[B]

Yeah.

[A]

I think that might be surprising for a lot of women to hear.

[B]

Oh, 100%. So the brain fog. Why did I walk into this room? I was giving presentations and having to do, like present on patients and I couldn't remember medical terminology. I'm like, oh gosh, what did you

[A]

do in that moment?

[B]

I just look like an idiot. I was like, oh, no.

[A]

The move is you make something up.

[B]

You know, presenting these cases, going, oh my gosh, I know this stuff. And I couldn't present on it. Depression, anxiety, testosterone decreases. So it comes down for women age 20 starts slowly coming down. But when I can get a testosterone optimized in women there, I feel like myself again. The fog has been lifted. So we got estrogen and progesterone, but when I get all three together, they're back.

[A]

What's an average range testosterone for women?

[B]

Well, if you look, this is another thing. They took some women in the 90s, about 600 women, and took an average and said, this is your normal range.

[A]

What is it for men in comparison?

[B]

So we'll give an average range for women. Could be, depends on the lab, say 9, 9 to 45, maybe 60. Depends for a man, could be anywhere from like 250, 700. It depends on the lab, 700. So big variance in the numbers again though, you'll go in and say the average 40 year old is going to have a testosterone level. 19, 20 falls normal. They get told I'm, you're normal. I'm sitting about 130 right now. That's how, where I'll put myself right in the case.

[A]

Women are terrified of that. By the way, the, the thought of. And again, I'm not speaking for all women, but I think this is a fair statement that applies to a lot. I don't want to look like a dude.

[B]

I know. And I'm like, tell me this does not look like a man. You know? You know, I got up at 5 and shaved my beard.

[A]

Yeah. Dad's genes passed to you, not me. What can I say?

[B]

But it is a fear that they think, oh, I'm gonna look like a man. Right. I have more energy now than I did probably in my 30s or 40s. Okay, Michael, can you do for me? Slide 23 for me, please.

[A]

That is honestly one of the resounding things I've heard is women's fear of testosterone. It's like broad jumping the Grand Canyon. They immediately go, I don't want to look like a dude.

[B]

Yeah. So I think what's surprising for a lot of people. So estrogen and testosterone in lab are measured in different variables. But if you were to normalize them, the PG is picograms per milliliter. Women have four times, sometimes 10 times more testosterone in their body than Estrogen. This is a human hormone. Yeah. We live off of testosterone, so the ovaries can make some of it, but they also, in the peripheral tissues, be it your brain or other organs that need it, will aromatize it, which means they can convert testosterone to estrogen. But we actually have way more testosterone in our body than estrogen. But you. It doesn't reflect that because on labs, it's not measured in the same value. So this slide here is the normalization. If you actually were measuring it in the same.

[A]

What is for your average patient? We'll have to hypothesize here a bit. The woman you're talking about who goes and gets the labs and is advocating for their care, and they have a doctor that says you're normal. Where does that.

[B]

That's not me.

[A]

Well, where does that leave them? That leaves them going home saying, I'm the problem, and I'm the problem.

[B]

Yeah, this, you know. So I think too, like, for a lot of women will go in with, I, I'm depressed and anxiety. Sex drive comes up a ton on testosterone.

[A]

Or just. You're talking about when optimizing all the

[B]

hormones, just in general, they'll go, I. I don't feel like myself. I'm depressed. They check their labs and they're like, you're normal. This is fine. So they go home thinking that this is them, there's something they've done wrong, or they're given an antidepressant. Antidepressants, which I see all the time.

[A]

What does that do to hormones?

[B]

Nothing.

[A]

Okay.

[B]

So it does nothing.

[A]

It may not be the solution, but it's also not going to negatively impact.

[B]

It doesn't impact this. But they're missing. They're missing why these women are feeling like this. Yeah. Now, I think a really scary thing. And you, I mean, you see this within the military, that perimenopause is the highest rate of suicide for women that

[A]

age range, you mean?

[B]

Yes.

[A]

Okay.

[B]

Right. So when estrogen drops, the serotonin drops, your feel good hormone, dopamine drops, norepinephrine, your energy, everything drops. So we see divorce rates go up and we see suicide go up.

[A]

Okay.

[B]

The VA did a really good study, and they saw when they introduced hormones that actually depression, anxiety went down, but women go in and they're given an antidepressant. It's totally missing the mark.

[A]

Yeah.

[B]

There's a time and a place for antidepressants, and I will give them to women. I'm very, you know, I think I've taken them Do I think that this is the answer, though, for hormones? It's not. And you talk about, like, if you're already having sexual dysfunction and you add an antidepressant to that, that's going to compound potentially to this issue.

[A]

I didn't know that.

[B]

Mm. Well, I didn't tell dad that.

[A]

Yeah, we don't. I don't ever need to hear about Dad's sex life, ever.

[B]

Casey. I need to go on and talk about my blood flow issues.

[A]

Yeah. And for those of you who are lucky to catch his Instagram story, like Michael, you're welcome.

[B]

So testosterone, by far, is my favorite. Even though it is my favorite, it takes its sweet ass time to show up. Up. This is the hard part. Estrogen, you're having a hot flash, you're irritable, Throw a patch on. Okay, Much better. This can take three to four months for it to get its full effect. Okay, so. Casey, this isn't working. This isn't working. Just wait. Just wait. Some women are faster, but I always like to set the stage. This one takes a little bit longer to show up, and so I will start low on my dosing and titrate up. This is where I do follow last. You know, I like to live at about 120, 130. I don't like to push supraphysiologic dosage for women, so I keep them in a. In a narrow range. I'm following it, but I do follow testosterone.

[A]

How often do you recommend people get labs?

[B]

So for me personally, once I start someone, it's eight weeks after initiation. If I go up on a dose or down, I'm doing another eight weeks. If they're pretty stable, I want at least a couple times a year just to make sure that I don't have any other changes on that.

[A]

Quarterly or biannually.

[B]

I'd like biannually be fine on that.

[A]

Okay.

[B]

Yeah.

[A]

Okay.

[B]

But then you have the pushback of finding providers who will do this. So, like I said, I have my mscp, which is the Menopause Society certified provider. I said there's 75 million women in the US right. Of peri. Menopause or post 4100 providers that have the title. I do. It doesn't mean that there aren't other providers who can.

[A]

That's rough math, though.

[B]

I see what you're saying. Yeah, I mean, there are other partners well versed in this, like myself, but it's low. So then you want to find someone who is trained in doing testosterone for women. So if they're not seeing myself. A good resource for women is ishwish. It's isswh. And they will list out a list of providers per state where women can go. These are sexual med providers who are trained in testosterone. Okay, but I went to that conference in Long beach last month. And you thought 4,100 was. Not many talk about sexual med. It's about half of that. So really underserved. Really underserved area for women.

[A]

Okay, what else you got in your notes there? Before we dive into some questions, anything else you want to cover baseline before we try to hit some specifics?

[B]

I would like, because testosterone is my favorite, I would like to talk about some of the pushback that women will get. We don't have the data. We don't have the data. I'm not going to prescribe this to you. We have 80 years of data. We know it's safe. There was a five year study done for the FDA. It was a $1 billion study, showed it was safe. But then they're like, oh, women have breast tissue. We're gonna need five more years. Another billion dollars. The companies were out. Yeah, no, I know. So I'll hear that. It's not safe. We have the data. You're gonna, you're gonna look like a man. We don't, you know, we don't know long term. Well, we actually have really good data on trans. So if you have a woman transitioning

[A]

to men, can we stop right there and just acknowledge that scientifically that's not possible? What? There's never been a successful sex change operation. No man has ever transitioned into being a woman, or vice versa. Having said that, I have complete and total empathy for somebody who feels like they are trapped in the wrong body. But can we be honest about the ability to switch back and forth between the two?

[B]

I'm not talking about switching back and forth. I'm just saying we have the data of women who take the dose who want to transition to that gender. So your dose of what you take is 10 times more than mine.

[A]

Okay.

[B]

Okay. So we can look at 30 years of data of women transitioning to men and show no negative outcomes. So how can you say it isn't safe on women in a tenth of a dose if it's been fine on this end?

[A]

So I see what you're saying.

[B]

Right. So these are the pushbacks. I will hear for women. We don't have the data. It isn't safe. We actually have a lot of data.

[A]

And then what happened recently with the testosterone shortage I don't know if this ties into estrogen. No, but remember, specifically the cipudate.

[B]

Oh, for you. I don't know what happened with that. For women. We can't get patches right now.

[A]

That was like pharmacy many farm. Like, almost like, nationwide.

[B]

It was. Wasn't the sippy name. It wasn't it.

[A]

It was sipping it.

[B]

I thought it was the Ethan.

[A]

Oh, ethanate. Yeah.

[B]

You couldn't find.

[A]

And then fate.

[B]

Yeah.

[A]

Well, actually, you tell me. I don't know. I know it starts with a name.

[B]

I had the sippy and 8. You needed the other one.

[A]

Yeah. Or I wanted the other one.

[B]

Yeah. Yeah.

[A]

What is that? What is that all about?

[B]

I have no idea.

[A]

How is there a production hiccup? I mean, you want to talk about augering in a section of society. Holy shit.

[B]

Well, yeah. The women right now can't get patches.

[A]

Why?

[B]

I don't really. I have my own really biased, angry opinion on this, of why we can't get it. It's like, if you can't get an erection, they're gonna run to your house and give you Viagra and a cup of water.

[A]

That's actually not how that works at all, but go ahead.

[B]

Like, the access for that is. So when I talk to CVS Pharmacy, I'm like, do you have this? No. Do you know when you're getting patches for my patients? No. Do you have Viagra? Yes. We have no shortage of that.

[A]

Well, dudes have been trying to get their dicks hard for a long time, so they've been working on that for a while. Do you think that that could be a metric of. I feel like I'm not connected to this world, but I feel an undercurrent of the social circle? Right. This is like my own anecdotal social circle. There is an undertone of a lot more people paying attention to this. And that doesn't necessarily mean that the production behind it can keep up yet if it's starting to leap forward in demand for.

[B]

But still that much 5%.

[A]

Yeah, but I mean, you know, I don't know. I don't know how. Like, I don't know what our national estrogen stockpiles are.

[B]

It's. They're empty.

[A]

That's what I'm saying. So it could be. It could be that person was like, whatever, screw the women. Let's just take care of the dudes. Or it could be, holy shit. We weren't prepared for this to start catching fire the way that it has. And if the stockpiles were already at Zero. And you deplete those. Those. It takes a little bit of time for the production to catch up.

[B]

So for those women who can't find patches, alternatives are a cream you can put on your forearm every day. The patches I like, they're set it and forget it. You can just wear, you know, mine's twice a week. But there are alternatives. There are creams that you can do. So.

[A]

Okay. Yeah, I think some of this honestly is. Well, it's tough. Again, anecdotally, I wasn't also paying attention to any of this for the vast majority of my life. And it's, it's like the yellow car theory. You never think you see one until somebody says, oh, man, you know, how many. See how many yellow cars are. And then it's all you can see. So maybe there's a little bit of that too. But I just feel like the undercurrent of women saying, we've had enough at this point and asking for these things is increasing. I think it might be more of a production issue.

[B]

Let's hope that that's all it is.

[A]

I'd hope so. Because the other side of that, like the evil twisting the mustache theory, that's not awesome either.

[B]

No, it's not.

[A]

Okay, so what other obstacles are people going to run into? I'll start getting some questions here.

[B]

I think testosterone, finding a provider, that's well nuanced in that.

[A]

Yep.

[B]

Estrogen supply right now for patches is a problem. I see this every day.

[A]

Can. Okay, so I mean, I was going to say can people stockpile, but then at the end of the day that might end up screwing over somebody else who wants to get one. But at the same time, maybe you want to stockpile.

[B]

You really can't though, because it comes down to a prescription. Right. So if your prescription, and this is what's like, I may write a person for 90 days of progesterone and they, they insurance only give them 30. So I, I will get called. Casey, please give me three months. I'll look back. I've given you three months. Well, that's an insurance reason.

[A]

Okay.

[B]

It has nothing to do with me. I think the biggest obstacles are just going to be finding providers who, who understand this type of care.

[A]

Okay.

[B]

I think too, for men who listen to this, you want to be able to enjoy your partner for a lifespan. And a lot of not treating this leads to osteoporosis, heart disease or Alzheimer's. And, and people think of these as like later in life diseases, but really these are midlife diseases that are forming now. And so I think here's where a hospice comes in again for me is when I tell my patients I am thinking about your 70, your 80, your 90 year old self. We are building her now. But people don't really think in that mindset that we are building her now.

[A]

Okay.

[B]

Right.

[A]

I mean, one of the first questions from a woman I had on the show, Kara the Huntress, she used to work in the anti human trafficking world, gaslighting, demanding the tests.

[B]

Yep.

[A]

Dan Hart says he hasn't really heard anything on this topic, which makes sense. Yeah, You answered that one directly. Trying to think women in testosterone. You hit that? My wife says she can Google everything that she's going through. Is that true? Is it true?

[B]

Sure you can Google it.

[A]

You gotta be careful with google because you can find anything that you're looking for.

[B]

You can, but like I was just trying to explain, if you're in perimenopause, this is this shift that happens, you've got to find someone you trust that knows how to shift with you.

[A]

So with that, should we push to have our hormones tested independently? And why do doctors say that testing our hormone level is not important or relevant?

[B]

Right, I think we covered that.

[A]

Yep. I've never yelled and hung up on a doctor until two weeks ago in London to the gp, which I may assume means general practitioner, was trying to tell me that my dizziness in Virgo, which I'm going to throw at a T and an I in there and assume they meant vertigo because I don't think the doctor cares what month you were born in. We're not related to perimenopause.

[B]

This is an interesting one. So I have a girl very near and dear to me who, if she was just so mistreated and couldn't get out of bed, could not get out of bed because of her vertigo. And so estrogen, you've got a receptor everywhere on your body for estrogen, testosterone, progesterone, everywhere. And when they. You're not feeding these hormones, they. You may have the repercussions of vertigo or dizziness. So if estrogen is low, people who struggle with vertigo, you're gonna. You're gonna have worsening symptoms.

[A]

Okay. If you start HRT hormone replacement therapy during perimenopause, is it recommended to take indefinitely or taper off once postmenopausal, or is it more nuanced and dependent upon the individual? Individual.

[B]

Both can be true. So hormone therapy, you should always have the risk and benefit discussion with your provider and your. Your what you may experience in your health can change. You may develop breast cancer, you may get other breasts. You may have other cancers, other health situations that arise. You're always going to have to have these conversations. Does this make sense? I would say for most people like myself, when I die, probably die before you because I'm older. I want a photo of me with that testosterone in my hand. Like, I will take this.

[A]

What do you want me to do with that photo?

[B]

Just put it out there. You take this to end a life. This is. You can do what you want. But for me, I will take this forever. I know how bad it was before. I don't want to ever live like that ever again. And I saw bedside of hundreds of women who weren't on hormones.

[A]

Yeah. Who do we need to lobby? And what pressure do we need to exert in order to get all the forms of bhrt? What is bhrt?

[B]

So BHRT by. I think they're talking about the bioidentical.

[A]

Yeah. Well, let's assume it's this topic covered by insurance. What should people expect when it comes to the cost of this? Can insurance cover this? Or is this something you're going to have to invest in yourself, yourself out of pocket?

[B]

So I am seeing. This is California where I live. I am seeing people like myself who specialize getting out of the insurance model, if you like. For my initial visit with people, I spent an hour with them. An hour. Plus, if you're using insurance to pay your bills, you need. You get 15 minutes. You are pumping people through like cattle. I refuse to do that.

[A]

Yeah. What's the stats Dr. Docs are with you in like. Like if you go to just in general, a doctor has like eight minutes with you or something like that.

[B]

I mean, and I think you. It takes longer than that for someone to trust you. The questions I ask people are very intimate. The things we discuss can be really challenging. No one ever talks about like light bulbs and stuff. Light bulbs. You need more than eight minutes.

[A]

Okay.

[B]

That being said, most people's insurance will cover estrogen and progesterone. I can push those through.

[A]

True. Let's say they. They can't. What would be a. Give me a range. Obviously don't, you know, hold. Don't let nobody hold Casey to this or. Because providers will be different. But let's say you have to do this completely out of pocket.

[B]

Right.

[A]

Give me a range of what you could reasonably expect to pay.

[B]

Well, I think there's two ways you can approach this. There is this company called The HRT club, they run it by a membership. So it's. You pay $99 a month right now. They have not run out of supply, so I've been leaning heavily on that. So their progesterone for 30 days is $15. Their tube of vaginal estrogen, I believe is $25, and their estrogen patches are $48 a month. Okay, so that is them for now. Like when I ran out of patches and we went on vacation to Palm Springs, I had to pay cash. They wanted me to originally pay $120. And it's like, no, no. You can always try to use like a GoodRx coupon, negotiate a cash price.

[A]

I was able like a Walgreens or

[B]

something like that and say, no, I want to pay cash. And I got mine down to like 30 bucks.

[A]

Insurance is such a scam.

[B]

Well, and testosterone's even harder because to get it for the women, I. I will have them say so like the. An alter. I use compounded testosterone. Like the. You've seen it comes in the. The applicator there. You can. Some women will take testem, which men use, and they'll use one packet it and put it on their chest. You can try to write that for insurance to cover. There's pushback of. This is for men. We won't give it. There's a lot of pushback. But with that formulation you're asking women put a pea size on. Your pea size could be different than mine or Michael's. I don't like relying on that because that's where I see variations and levels.

[A]

Okay.

[B]

Everyone is different.

[A]

Switching over here to peptides. What peptides are good for post menopause?

[B]

I think we would need a whole peptide.

[A]

Give me your top five discussion. Yeah. Which, by the way, I know we are focusing heavily on these hormones, but just to let people know you, you are deep into the peptide.

[B]

Love peptides.

[A]

Yeah.

[B]

Well, I think where peptides really tie in for this is insulin resistance for women and men. Men will see this too. In the menopause of. All of a sudden, your pants don't fit right. You. You just. You feel inflamed, you're exercising the same, you're eating the same, and you're still. The scale is just getting higher and higher. So. I love the GLP medications. I love what's coming out, the data on them. I swear, every month there's. It's showing to be neuroprotective.

[A]

Yeah, it's for clear. And I think you should clarify too, based off just Listening to you talk and watching you work with people on this, you're not talking GLPs at a weight loss dosage, you're talking essentially micro dosing. And I just think we need to clarify that because the utilizations are different and the dosages are different.

[B]

100 and for people in my office I have a shape scale which is an AI device which gives me body composition, the muscle mass, the visceral fat. So I'm doing this in a very responsible way. I am not letting people get like to where you'll think the ozempic face or because honestly that is not a good 80 year old self. That's a hip fracture waiting to happen if you lose your muscle. So I love the microdosing of it, bringing down the inflammation, helping with that extra fluff, that food noise that can

[A]

happen, the neuroprotective aspects like you said,

[B]

that keeps you neuroprotective. It's indicative for sleep apnea. They have had studies that if you have a heart attack and you're on these meds, you have less heart tissue death and less mortality. They did a study for people who had colon cancer for five year survival rate was higher if you were on these drugs, which makes sense. So cancer, we have it happening all the time, firing off cancer cells and the body is trying to calm this. But if you're so inflamed, that's where you can see problems happen.

[A]

Yeah, the systemic general inflammation.

[B]

Right.

[A]

HRT and blood clots.

[B]

So birth control, there's red flags on this of oral estrogen, potentially increasing clotting risk. If you do hormone replacement for estrogen transdermally, be it a patch, a gel, a ring, there is no increased risk in baseline. And I really see this as a problem where other providers will be like, no, you had a blood clot, I won't give this to you. No, you have a migraine with aura. So there's really only, I'd say four reasons you cannot be on hrt. Four red flags. Active breast cancer, undiagnosed vaginal bleeding, recent mi, heart attack, stroke or blood clot. And when I say recent six months. But I will treat breast cancer patients with hormones. Everyone is so different. It just depends.

[A]

That's literally my next question.

[B]

Yeah, everyone depends on what type of cancer it has and their quality of life. And that is where hospice comes in for me too. So I have a cute little 83 year old woman coming to see my next week. She has a history of cancer that was estrogen receptive, meaning estrogen did not cause it, but estrogen feeds it for her.

[A]

It reacts to it.

[B]

Right. It makes it grow. She is 83. She is suffering. I will let her know the risk and benefit, but let's run this out. Do we think that she's going to die from breast cancer? I don't. But for her quality of life and what she has left, that's what's most important for me. Like, she is. She is miserable. So for everyone, I believe that this is your health journey. And I think in medicine, women are told no too often, but I think everyone deserves the discussion of the risks and benefits.

[A]

Asking for a family member of the family. Are there options for a woman who completed five years of tamoxifen? Is that a cancer medicine? After a breast cancer diagnosis, doctors to date have said any type of hormone replacement therapy is off the table due to increased risk in the cancer coming back. Which, again, touches what you're just saying.

[B]

Same kind of thing. But I do think that there's a role for testosterone for people here. So even if they have a. ER Positive, which means estrogen receptor positive, meaning estrogen can fuel a tumor, there's this fear. Oh, testosterone, like in this, can convert to estrogen. There's this fear, oh, you're gonna convert to estrogen. So say I take a man and I get him optimized. Say he's at 300, 400, I bring him to a thousand, his estrogen levels may only go up five points in that. That's a tenth of a female's dose. So you take a tenth of that. We are barely raising estrogen levels up to where they were baseline. So testosterone, I'm much more likely to help give women with history of breast cancer.

[A]

This goes into what you were saying. I know multiple women who were told hormone treatments are a waste of time and dangerous, and they could have prescription for an SSRI drug instead. So just reinforcing that. This, you know, we were talking about this. This ties into your question about doing content. If it gets good traction, could you see if your sister could do a live video where people could ask questions in real time? So this is you kicking around that idea of whether you want to have an online presence? Just letting you know. It seems as if one data point, Right. That people out there would probably consume that. Here, um, woman here, perimenopause in full swing. Currently 23 days late. I assume that means on her cycle.

[B]

Mm.

[A]

I've noticed when I'm late that the night sweats are so much worse. Mm. I was hoping to get through the other side without hormone therapy. But now I'm second guessing myself. Help. Hormone therapy. Is it safe? Question mark. I mean, if you've gotten to this far in the episode. I think we've answered some of that, but.

[B]

Well. And there is no study that shows increased risk of mortality with estrogen. None. There is. For people who are really, really do not want hormones, there is called vioza. It works on the brain and the thermoregulatory system to help with hot flashes and night sweats. So for people who. But it's pricey.

[A]

Yeah. Okay, shifting gears this. Somebody has a question about end of life. If this topic is appropriate. Plus, you and Andy feel comfortable talking about it. How to navigate end of life care for a parent and the do's and don'ts, y' all learned along the way.

[B]

You want to start with that?

[A]

I was at the tail end of mom's end of life care and was a shell of a human being. So you may actually want to answer that one. Why are we reapplying lip gloss? What's. How do you know when you're supposed to reapply?

[B]

Oh, how's it look? Because my lips are dry.

[A]

Okay, More shams.

[B]

Well, I think you and I had a private discussion about this the other day.

[A]

I've talked openly, I mean, again, I wrote in the book openly about my experiences and what I wish I would have changed. I do understand that mom knew who I was and that the last interaction that we had was, you know, that doesn't define our entire relationship. I just wish I could have been in a different headspace, which is impossible given the velocity of the environment that I went from to. And it's not the velocity that I went from, it's the months spent reordering your headspace to make very complex decisions in a binary fashion as fast as possible, oftentimes around life and death choices. And then all of a sudden you're back home. And you can't just turn that off because the best way I can describe it is you get home from a deployment like that and the world's just kind of on mute. Like, you're in the world, but, you know, people hit you with something, you're like, whatever, I don't even care. What was it? What? I'm not even paying attention unless it's like a. If a decision needs to be made, you're like, boom, got it. Next, next. And you're just in this next, next, next, next, next headspace. And it was months before I got out of that. So that unfortunately, just happened to be the headspace I was in with my last interactions with mom. You, on the other hand. And again, we were talking about this yesterday. I went from seeing her in February of 2010 when I left to August of 2010 when she died. So I didn't have snapshots in between you and dad and everybody else got to kind of see the decline. So it was a little bit more jarring for me as well, too.

[B]

Well, the question is, what have you

[A]

learned end of life care, do's and don'ts for a parent. Do's and don'ts, do's and don'ts. So how to navigate the end of life care for a parent and the do's and don'ts you've learned along the way?

[B]

Well, I think the biggest thing is have the conversation now while they are. Have the ability to make their own decisions. That can weigh really heavy on people when they have to make end of life care decisions. Am I doing so? You know, dad and I have been very open. He is very easy to have very blunt conversations with of he doesn't take

[A]

it seriously when we say we're putting

[B]

him into a home having those conversations. I think people get hospice involved too late. I understand that when hospice is called, it can be a big reality check for people, and that can be a hard call. But for people that I had more time with, I know I could improve their quality of life, end of life, if I had more time. I actually, this is where my big vision board is, where I think I want to go of bringing hospice back in my world.

[A]

Stretch goal. If you were.

[B]

Stretch goal. I don't know when it'll happen. But introducing hormones with hospice, because if you think about end of life and say cancer for people are tired, they have brain fog. Testosterone helps with this. People can't sleep. Progesterone helps with this. I somehow want to start teaching providers how we can introduce hormones at end of life to optimize what we have left.

[A]

I mean, what's the downside? You're gonna die.

[B]

Listen, when I.

[A]

That's what I'm saying. There is no downside there.

[B]

When I was doing hospice, I had a male medical director and there was things I was doing. He just sit and roll his eyes at me.

[A]

Yeah.

[B]

Were my patients happy? Yes. You know, but that is where. Where I can bring both of my loves together.

[A]

Just a random comment here. Best investment ever. If you have a wife, it'll make her a different person entirely. How different are your and Jason's stories when they're told

[B]

that was a comment or did he write it?

[A]

That was not. Well, well, it would be a ghost account if he did write that.

[B]

Well, I mean we had a very open discussion about it just last week when I was going up to la.

[A]

Yeah. So there's some. Let me see here. What are the best ways to help manage hormone changes naturally, especially if you work in a high stress job, that can spike cortisol? Do peptides help with the hormone changes or are they independent of each other?

[B]

Well, nothing's going to replace a hormone, but you're going to see cortisol spike more in perimenopause. So the brain is already up, down, up, down in that slide that I showed. So cortisol is going to rise. It's a stress response to this fluctuation of hormones. So I think if you want to do lifestyle, sleep's got to be number one. Exercise is going to be number two. Eating healthy is going to be my number three. And this is how I teach in clinic, that we build that way.

[A]

This is more of just a comment, but it reinforces. Thank you for doing this. I am of the age where I was told estrogen therapy was a death sentence. And I'm finally past the typical menopausal stage. Ten years in, in parentheses. I am wondering if there's anything I can do at this, at this late time to help with sleep, nighttime hot flashes or dietary suggestions for overall health and feeling better. So this is something that looks like they're past menopause, but still.

[B]

Right. So in the data that we see, there's like this sweet zone and they want, that was studied 10 years of menopause, you want to initiate hormones within that. So say it's 52. The ideal window would be 62 to

[A]

start or be already on by that point.

[B]

Well, that's a whole thing because I like to start women in perimenopause and I want to do want to talk about that. But so say you've gone menopause and you're 52. When you go into it, you're 54. Are you too late? No. The window they study was a ten year window. That was the sweet spot. However, if I see someone who is 70, I will optimize their quality of life any age.

[A]

Yeah.

[B]

The where the data is really strong is that 10 year window.

[A]

Okay. Information on endometriosis, diet and inflammation and perimenopause. It's hard to understand to be supportive. My wife is very proactive. Oh yeah. Proactive with her symptoms. It's a burden I wish I could carry. Carry for her.

[B]

What's the question in that one?

[A]

The information on endometriosis, diets and inflammation and perimenopause is for people who have endometriosis. It seems like something there's not a lot of data about. What are you seeing when it comes to the hormone optimization? Does it have a net positive, net negative, net unknown impact?

[B]

Well, the hormone optimization is separate from the endometriosis, so. Endometriosis is lining of the vaginal tissue, the endometrium outside of the uterus. Some peptide therapy has been promising on this. Again, you're looking at retrospective data. You're not getting these randomized control trials. So anything that's lowering inflammation, like your kpv, could help with that. Ratatrutides, the big one coming down the pipeline. They're waiting on the FDA approval next year, but anything that can lower inflammation can help with those.

[A]

How does a lady get through menopause without prescription drugs and. Or hormones?

[B]

What do you think? After what we've shared so far?

[A]

White knuckling.

[B]

Yeah. End of life is not pretty. So, top three things that end. Women up in a nursing home. Alzheimer's disease, hip fractures and neurosepsis. A bladder infection that travels throughout your whole body.

[A]

Oh, that sounds horrible.

[B]

Yeah, I actually have a little prop here.

[A]

So you're like, oh, God, what are you grabbing? Yeah, like, we're talking about a bladder infection that is systemic, but. And you're reaching to get something out of your bag. I just don't know where this is going.

[B]

So if any. Your podcast actually could save lives just. Just from this. I'm not sure where things pick up or where they're saying things.

[A]

Estrad.

[B]

Estradiol.

[A]

Yeah.

[B]

This little tube will save women's lives.

[A]

Okay.

[B]

Right here. So vaginal estrogen cream for anyone who's over, you know, perimenopause post menopause. Your mom, your cousin, they need this in their toolkit. This is cheap. So say insurance doesn't cover this. This should be about 15 bucks.

[A]

Okay. Is that, like, used when you're feeling.

[B]

This should be used at least twice a week.

[A]

Yep.

[B]

So what happens when you go in menopause? Estrogen goes down. Estrogen feeds the good bacteria around the bladder. We replace estrogen. It keeps it healthy. It keeps the vaginal pH low. So bladder infections go up in menopause. Okay, that does not present the same. Like someone in their 40s and be like, I gotta pee all the time. It hurts. An elderly female is Gonna look confused. So if you have like a family member who. She's just not making sense, first thing I'm thinking is she's got a bladder infection. This can prevent bladder infections. Jason went on a call the other day and he was 83 year old, found down in the bathroom. I said, I bet broker hit probably. I'm like, you could have prevented it with this right here.

[A]

I mean, I feel like that is potentially a stretch to say that, but I understand.

[B]

Oh, I don't think so at all. If you can calm the bladder with this.

[A]

Yeah, I mean, long term usage for sure. But I don't know if it would have, like one application would have saved you.

[B]

No, this is something you do twice a week. But if you can calm the bladder down and you don't have elderly women who maybe have a bladder infection and they're confused.

[A]

Totally.

[B]

Right. This can prevent that.

[A]

Insulin resistance in menopause.

[B]

That's interesting. So that's the menopause muffin top that shows up, up. So insulin resistance, I can look at a woman's labs and watch her cholesterol trend up and be like, this is where perimenopause started. So when estrogen goes down, the liver becomes less efficient of filtering out cholesterol. It also becomes less efficient of getting insulin, getting blood sugar into the cell. So you have more insulin circulating in the body. So if you think of insulin, insulin's like a key, right? So you've got your cell. Insulin's a key when you're younger. Opens a lock just fine.

[A]

Yep.

[B]

Insulin resistance, that key becomes rusty, can't get it in. Oh, I'm gonna make more keys. I'm gonna make more keys. So you become, you get more insulin going up. And what follows insulin is fat. So we see as the hormones go down, insulin resistance goes up. You can see increased risk of diabetes, the cholesterol goes up. So what do they do at women? Here's a statin, here's some metformin. When we're really missing the mark of

[A]

how to get that down, this kind of reinforces. I want to ask how HRT or other recommendations change for women 70/ versus perimenopausal. You already talked about that. Basically treating the symptoms and focusing on the health span. This woman says HRT is a game changer. The ability to sleep through the night was one of the best feelings. Like you said, it's the foundation that you're building. On top of that, how do you make a hormone? I wonder. I'm assuming that's a Question inside of

[B]

the human body, how do you make a hormone? Well, it's part of the endocrine system. Not sure what they.

[A]

How can I help my wife who's entering perimenopause? Not just emotional, but physical support. Could be the most important question I've asked so far.

[B]

Okay. We talked about the sleep environment, right? Building the sleep environment. But also I showed you that luteal crash. If I was a man behind the scenes, I would be like, okay, I'm trending. When this bus may derail. It's coming. We're gonna need more carbs. We're gonna need more sugar. There's gonna be. She's gonna need more patience, more grace in this time. Now, if she's with a provider who helps support that, that crash is gonna be much less. Yeah, but if they are not, this is where the brain just isn't functioning as well. You have less resilience, you're not sleeping. So it's going to be a lot more patience during that time.

[A]

There's hundreds of questions and this is odd. The comment section is like, refreshing itself.

[B]

I know. It did that to me.

[A]

Yeah, I can see some of the same ones. I'm just trying to catch the wave top. Oh, I would like to hear about how to get my libido back, especially because my husband does not deserve to feel undesired. It's not him. He is amazing. But it is a general lack of desire. Now, you said you have personal and private conversations with women. I'm assuming this topic comes up, or is this something that you actually specifically ask about before them even bringing it up?

[B]

Oh, yeah.

[A]

Yeah.

[B]

Well, I was like. I thought this would be a good topic if you were ever open to it, to Leah sitting in that chair and her and I having a conversation about women's sexual health.

[A]

Health. I.

[B]

Is it a little. It's a little odd for you and I to sit here and talk about sexual health.

[A]

I have to listen to dad talk about it. So you guys can have that conversation if you want. I don't know if I'm listening to that episode. If the world wants to hear that, I mean.

[B]

Well, I will tell you this. Why do men care? This is one of the top reasons men care for sure. And I get it. It's part of women's whole vitality also, though. But I will ask women when they come in, where the top three goals that they want to work on. Decreased sex drive is one of them. Now, can testosterone help? 100%. But I'm not going to Hang my hat on that and say if I get your testosterone this high, but you hate your husband. I can't fix that.

[A]

That is true.

[B]

So sex is biopsychosocial. Bio meaning I can fix their hormones. Psychological is a time of. They may have high intense careers. They're juggling families, all the sports. Right. You've got aging parents. There's just all these elements that can play into this. There are peptides that I like for this. The PT141 is a peptide that can help with arousal. There is.

[A]

What does PT stand for?

[B]

I have no idea. So that's the peptide name you can get. It's an injectable that you use 30 minutes prior. And it works in the brain. So it's. Serotonin is kind of the brakes on that. It increases in norepi, which is kind of the gas. So it works on the neurotransmitters. Testosterone works on the hormones. This works on neurotransmitters 30 minutes prior. I like it with the peptide versus the pharmacological brand. Because it's a set dose, peptides you can titrate to yourself. There is the pink little pill. Have you heard of that? For women?

[A]

No.

[B]

It's called Addi.

[A]

A D, D?

[B]

Yeah, A D, D Y. I. Yep.

[A]

To spell like that.

[B]

So how Viagra to.

[A]

Is this women's Viagra. So when do they call it Niagara? Just checking.

[B]

Viagra took six months to approve. How long do you think this took to approve?

[A]

Oh, 26 years.

[B]

Yeah. A long time. A long time. So you have to take it every night?

[A]

Yeah.

[B]

It shouldn't really be taken with alcohol. So that's one thing that women have to be careful with. Side effect is it can cause drowsiness. Okay, great. We're not sleeping anyway, so let's try that.

[A]

Yeah.

[B]

It can cause decrease in appetite. Okay. So it found that there was one more sexual encounter per month because the sexual encounters were so low, it became statistically significant.

[A]

Yeah, that's a lot of the, you know, the risk versus reward ratio there. I don't know if it hits that

[B]

one For a lot of people it's one per month. It takes about six to eight weeks to be effective.

[A]

Oh, good God.

[B]

So that's kind of too. Where I lean on the peptide where it's an as needed. Now here's a problem with that peptide. The arousal can last for hours. So strap in. Say you have.

[A]

You know what I mean, Michael. Say strap on. He's a different doctor demographic.

[B]

I have a lot to learn from Them. But say you have young kids in the house, you've got to be. This might be more of a vacation Peptide you take.

[A]

Okay. Truth about hormone blockers, I don't know.

[B]

So for like men. Aromatase inhibitors.

[A]

Oh, okay. I didn't know where this was going.

[B]

I think that. Is it a man or women? Can.

[A]

Christina, are there hormone blockers for women?

[B]

Well, for breast cancer treatment. Okay.

[A]

It's literally all it says, so there's no context. Okay. Generations of women were crushed because they never took women's health seriously. I don't. Well, I think they mean they by the medical community, not the women actually going through that. So I think. Oh, here's a good one. How do we get women to think logically?

[B]

Was that from a man?

[A]

It's hard to say.

[B]

I think it can be very hard to have clear and calm thoughts when your hormones are all over the place.

[A]

I mean, yeah, I mean that what you just said makes sense.

[B]

With your hor. Estrogen dipping, there goes your serotonin, your feel good hormone. You have fluctuations. And I will see this in men a lot. The men I treat, a lot of them come in because the penis isn't working. And then I ask them at follow visits, they're like, well, I just feel so good, Casey. I never expected to feel this good. I'm like, yeah, yeah, testosterone works between your ears. It is a mood hormone.

[A]

How do they describe their penis not working? How do they.

[B]

It works at like 70%. That's a hard one. Right. Because they see me, I'm in my rhinestone boots.

[A]

And your pleather, whatever you were describing.

[B]

Yeah.

[A]

So how do they try to bring this up without being just on the Internet?

[B]

It's a. Usually. Well, I have a questionnaire so they don't have to talk to me directly. They fill it out online. Right. So I bring up the issue. Yeah, I'm pretty like, dad, I'm very

[A]

blunt about how do you bring it up?

[B]

Is your penis working? Nice, straightforward. Are you having issues?

[A]

Like does it sit them back in their chair a little bit?

[B]

Like, ah, sometimes they're, you know, but. But what comes out is more I have more energy and I. My mood is better.

[A]

Yeah. This is a longer one, but it ties into Australia, which, by the way, I've talked about on the show. People know you were born there near Melbourne. My question is how do we get health industry and practitioners all up to date and on same page now we'll come back to that. I'll add, I'm in Australia. I have one doc for an annual full medical and anything of a conventional nature that arises, a different doc who is prepared to prescribe my hrt and a clinical nutritionist with whom I am working at the deeper level in nutrition supplementation and lifestyle. P.S. each of these protect. Excuse me, practitioners is aware that I'm working with the others. But how do we get everybody on the same page, essentially is the question

[B]

that's going to have to start with the schools they go to. I went to a functional medicine conference last year in San Diego. That Functional Med tends to be pretty forward thinking on things. They've got the eBoo machines like you experience when you went to Texas. They have, you know, very forward thinking on ozone and other things. And I sat next to this young man, I was like, okay, he doesn't look like he's been out of medical school that long. And he was doing testosterone therapy for men. And I told him, I use the same for women. And he looked at me like I had three eyes. He's like, you're kidding me. Use this for women? I was like, you want to make money in New York, you start treating the women. Yeah, but it's, it's got to start with the, the.

[A]

What does it take to change, to change that, though? Does it do. What are they waiting for 20 years of seeing this before they start implementing it? I mean, like, what does it take?

[B]

Well, and that's what you're seeing. You're seeing people like myself who were going out finding our own resources to get educated.

[A]

Yeah, but that doesn't change the foundation that these people are coming out of medical school with.

[B]

With nothing. They're coming out with nothing.

[A]

What would it take for them to make a change? I mean, neither of us went to medical school, so I guess this is a slightly rhetorical question that neither of us can answer. But what do you think it would take for them to update what it is that they're teaching? So the guy fresh out of medical school doesn't look at you like you have three eyes.

[B]

Well, maybe it's going to be the next generation who is going to demand this education. Yeah, right. Because the new ones coming out already are not being taught this and no fault to their own. How are you going to practice in an area we're never taught to?

[A]

Or maybe it's a divergence. Maybe it's people like yourself who just focus in this and maybe that would, I don't know, maybe there's a world where if people are going to offload this particular type of treatment from their General healthcare practitioner. Maybe that would let them be better general healthcare practitioner because they know to point somewhere else.

[B]

Well, I think. Exactly. OBs don't have enough time. Yeah, right. You need to find someone like, who practices, like myself, that this is all I do.

[A]

Yeah, but they also have to have an inherent understanding and belief that what you're doing is effective. And you know, I mean, all the things that would let them point in that direction, which if they're coming out of the school and don't have an understanding of it, you get back into this place. Do they have enough time to educate themselves to be able to point? It's a self licking ice cream cone. A little bit.

[B]

Yeah. I. I think that's a really hard. I think the next generation. I'm hoping. I mean, test Carter can give a Testosterone lecture. He's 12.

[A]

Well, that's because he's been to a lot of them though.

[B]

No, but he, you know, for what he. His vocabulary and what I do is amazing. If you start him young and that they normalize this. This is what we do. Oh, you get birth control, you know, when you're young. What about in perimenopause? You start in hormone replacement therapy. When women are pregnant, they're given this book, what to Expect when youn're Expecting. Have you seen it?

[A]

I've read it many times.

[B]

You've read it?

[A]

Yes. Oh, okay. It's the number one gift you get when you announce that you're going to be having your first kid.

[B]

Okay.

[A]

Like eight copies of it will just immediately converge on your house.

[B]

Perfect. So when you turn 35.

[A]

Yeah.

[B]

How about some of the perimenopause books that are coming out? Like we need to start that. Normalize that. Well, there's already two really good ones out.

[A]

Oh, okay.

[B]

Well, there's only one published author in this room.

[A]

I'm not published yet.

[B]

What do you mean?

[A]

The book doesn't come out till next month.

[B]

That's not what you told Jason at Bananagrams.

[A]

That's true. Speaking of Carter's vocabulary, he was pushing back on some of the words. I still took a picture, but I'm actually really proud of my performance. He was like, you can't. One of my words was dongs, Michael. That's a real word. The other one was penis. Yeah, those both work. Yeah. And he's just.

[B]

Well.

[A]

And then Ella also was just like. You can't use those words.

[B]

But. So how normalized is that in the pregnancy world?

[A]

Yeah.

[B]

It needs to be this literally.

[A]

If you announce to the world that you're gonna have your first child, you will get. I'm telling you, six copies of that book will descend on your address.

[B]

So when you turn 35, you should be getting, like, a perimenopause survival guide.

[A]

Well, what are the two books that you wrote? The two that were written.

[B]

So who I trained with is Heather Hirsch, and she wrote the Perimenopause Survival guide. The big name in the menopause world is Dr. Mary Claire Haver.

[A]

Okay.

[B]

Her book comes out next month. And she also wrote a perimenopause book.

[A]

Okay.

[B]

So I hope that this is happening. She had such a huge following and also saw, like myself, the perimenopause is where we're missing the boat. And I think for your listeners, if you want to impact your end of life, you've got to do something in midlife.

[A]

Yes. I, knowing nothing about medicine, I completely agree with that.

[B]

So that is Alzheimer's. Alzheimer's disease, the amyloid plaques. So if you think about how nerves talk to each other, you're doing telephone game. Amyloid plaques are like this sticky tissue between. They can't talk. Right. And there's tau proteins, these tangles in the neurons. So they're mixing up. How Communication happens. We know that estrogen can help decrease the amount of the formation, but sleep is when we clear these. So sleep happens then. But Alzheimer's is not an end of life disease. It's a midlife disease that shows up. So I think what's really scary is when women. So in your 40s, 50s, 1 in 5 women will have Alzheimer's. 1 in 10 will.

[A]

Will.

[B]

Men will have it.

[A]

That's what I'm talking about.

[B]

Huge discrepancy. When women get to 65, they're twice as likely to die of Alzheimer's than they are breast cancer. But they're fearing breast cancer. What do you think kills women with breast cancer most?

[A]

I think kills Alzheimer's.

[B]

Heart disease.

[A]

That's not what I guessed.

[B]

No. Heart disease is number one killer women.

[A]

Okay.

[B]

So you go through your breast cancer treatment. What we have now and for treatment is great. Survival rate is really high. So you're more likely to die of heart disease. So you need estrogen early on. Palpitations is another big thing. Oprah had palpitations for two years. Oprah has access to all kinds of care. Right.

[A]

Economically, for sure.

[B]

Right. Two years. Cardiologist. I see this all the time. Went to the cardiologist, did the halter monitor. Oh, she just needs some estrogen. So in the heart we have a pacemaker called the SA node. It's very sensitive to estrogen. When that is impaired, you're going to get this palpitation. So I hear this all the time. Women tell me I'm having palpitations. Let's bump the estrogen up. It'll calm it down. So I think more than anything, what I want people to learn from this is midlife. The time is now. It's not waiting to 60 or 70. You are. We're trying to prevent Alzheimer's disease now. Alzheimer's disease is not. I can't find my keys. I'm losing things. It's. I don't know what my keys are for. Right. So Alzheimer's falls in this big umbrella of dementia, all kinds of dementia. You can have Lewy Body dementia, vascular

[A]

dementia, frontal temporal lobe dementia.

[B]

We have close. We know how that presents. Hope this gets to the right people.

[A]

Yeah.

[B]

But that being said, estrogen is neuroprotective. It lowers the inflammation in the brain, it helps the glucose utilization in the brain. So if you don't have estrogen, the communication between the cells is messed up. That looks like memory problem. Attention problem. I thought I had adhd. I. This is crazy. I speak the language. I was given Vyvanse a stimulant because I convinced my provider I had this. Couldn't convince him to give me the hormones I needed, but. Oh, they'll give me a stimulant. Guess what? It didn't work. That wasn't the problem. The problem was my hormones.

[A]

You don't need a stimulant.

[B]

No, but I'm just. I'm saying they were more likely to give me a stimulant or an ssri.

[A]

Like many of the people said in the comments.

[B]

Yeah, but the hormones. No. And then the other thing too is hip fractures. Do you know much on that one?

[A]

Only that if it happens, it's per certain portion of your life, it's like your all cause mortality, death goes through the roof.

[B]

Yeah. So for. If you're over 65 and you get a hip fracture, 30% will die in the first year, which is insane.

[A]

Yeah.

[B]

And another 30% were. Or 30, 50% have decreased morbidity. So they. They. Sorry. Decreased motility. A lot of them.

[A]

Mobility.

[B]

Mobility, yeah. So you're using a walker, You've got a cane, you're in constant pain.

[A]

Let's. Let's get Dad a walker. Well, he needs one whether he needs it or not. I think it would be an emotionally devastating blow. I'll wrap the Entire thing. I'll be like, we don't know what it is. Go ahead and unwrap it. And it'll just be sitting there like a walker.

[B]

You could have a cup holder, a bell, some streamers, tennis balls on the. You know.

[A]

Yeah, he's coming to live with you. That's all I'm saying.

[B]

So bones are hugely important. There's only three indications, FDA approved indications for estrogen. One is hot flashes and night sweats. So vasomotor two is for treatment osteoporosis. And the third is for urinal urinary symptoms that vaginal estrogen treats for.

[A]

Okay, we have to get out of here relatively soon.

[B]

Oh, gosh, it's already 11:16.

[A]

That's fine. We get plenty of time. We've been out for a couple hours anyway. How can people get a hold of you? So actually, let's talk about where you are licensed to practice. Because people will hear this all over the world. That doesn't necessarily mean you're going to be able to help them. And I think a lot of this information or people reaching out to you might be in the form of, how can you help me find somebody where I. Because the laws and the stuff associated with this, so.

[B]

And I get this. This is really hard. So I practice in California, just got my Montana license. Unfortunately, my heart wants to help everyone and doesn't always come out cleanly. If they're not practice, they're not living in a state that I practice us.

[A]

It is possible that you could continue to grow and go state by state.

[B]

Well, and I've had some very interesting offers of pe actually. Patients be like, I'll pay you whatever it cost just so you can prescribe me in this state.

[A]

Well, there's also, you never know, where your relationships could build. And you might end up finding somebody who already has licenses and you're working as a. You know what I mean, underneath their umbrella. In many other states as well, I

[B]

still have to be licensed, so. Especially testosterone.

[A]

Can you tell how much I know about the medical world? What I was just laying out was a turnkey solution to this, and you're just crushing my dreams.

[B]

Well, testosterone is a dea, controlled substance because of the doping that happened in the Olympics in the 90s, which, by

[A]

the way, I think should be completely legal. You just have to be honest, like, I don't give a shit what you're taking, but let me know because maybe I want to take a look at it, too.

[B]

So what happened, though, is depending on what state you are, like, in California, that's in the same drug class as Vicodin, your oxy Sweet. Yeah, it falls in the same drug class. Some states is the same as fentanyl. So I have to have a specific license in my prescribing is. You have to be very careful because of that.

[A]

So Montana and Cali for me personally.

[B]

So say you live out in the US I can speak to. There is that Menopause Society. You can go on there and you can search by your state and find providers. Ishwish, that's going to be more your sexual med. So maybe your primary care provider is going to give you estrogen, progesterone, but they're not giving you testosterone. That's where Ishwish is going to come in.

[A]

And I'll get these links from you. I'll put them in the show notes to make it easy for people.

[B]

Dr. Mary Claire Haver, she's the big menopause. She has a provider list. I'm on her provider list. So you can go to her site and she's got provider. So I feel like it's like this grassroots effort of us women coming together of how we're going to support other women.

[A]

It's not going to be guys that solve this problem, I can tell you that much.

[B]

No, when I go to these conferences, there's three or four men.

[A]

Yeah.

[B]

So those are going to be the big. The Menopause society website. Ishwish. Dr. Mary Claire Haver has her list.

[A]

Where can people get a hold of you though?

[B]

Well, are you going to link that on here?

[A]

Yeah, but sometimes people are listening to this versus looking at the show notes. Go ahead and throw out your Yahoo email address. Fucking psychopath. It's 2026.

[B]

I don't have a Yahoo for work.

[A]

Oh, I'll just link your personal email then. It's fine.

[B]

Yeah.

[A]

What's your website? Jesus. Let me help you market the website.

[B]

Theradiantwaltality.com okay.

[A]

What does the landing page look like?

[B]

The landing page.

[A]

Michael, pull this up. The radiant.

[B]

The.

[A]

Yeah, the radiant.

[B]

Waltality vehemently.

[A]

Look this up, Michael.

[B]

I think it's got. It's got glitter and sparkles.

[A]

I'm just trying to guess the picture. Is this you? What color outfit are you wearing?

[B]

It's actually not.

[A]

I'm just trying to guess. Oh, that's not it.

[B]

Pink sequins.

[A]

But here's the thing. Get a lab coat made out of those sequins and then you're right in your sweet spot. Butt.

[B]

That is a Coat.

[A]

That's not a lab coat.

[B]

I'm not wearing a lab coat ever again.

[A]

But what if it looked like that but was a lab coat? That would be dope. You're ready for professional settings and a disco party at exactly the same time.

[B]

Here's the. Not as gorgeous as the one you're about to release.

[A]

I know. I like it though. That's excellent. Excellent.

[B]

It's a starting place.

[A]

We should talk a little bit too. You just. You have a new vice president of operations. I mean, this is an amazing time. We really need to talk about this. Just like improvements in your business are coming rampant opportunities inside of Casey Stumpf llc. Here. Talk to us about your new vice president of operations.

[B]

Well, I would also like to highlight on that that besides being a nurse practitioner, I'm also a dietitian.

[A]

Okay.

[B]

Right. So in that some people will throw up. I'm a nutritionist. Right. What is. What's the difference between a dietitian and nutritionist? Yeah, I have a bachelor's of science in dietetics that I.

[A]

You know, because we started with your nursing. That's what you were getting that up in Davis, right?

[B]

UC Davis.

[A]

Yeah.

[B]

So then you have to do a year of postgraduate work. I went to Indiana. Worked at Ball State Hospital for a year.

[A]

No, for its mountains. Known for its mountains.

[B]

And then you have to take a national exam, and that's how you become a registered dietitian. I do not do the CES or continuing ed for that anymore. I can use dietitian because I have the education on it. But do I have a California license? I don't, but I have the education. So that's the difference of nutritionist and dietitian. So my new vp, we are really working on the platform for people I work for of every month they get recipes say nutrition, low inflammatory foods, high protein. This month, how to introduce fiber. I mean, we didn't even get to talk about gut health. So my new VP has all the time to do the behind the scenes. My gift is to take care of people.

[A]

How often do you guys think you'll do performance reviews? And then what template do you think you'll use for your new version? Vp.

[B]

What? What template? What do you mean?

[A]

You're going to start with what he's doing? Well, maybe open with places for improvement. Just General Fe. You're going to grade him on a 1 to 10, an A to F scale.

[B]

He comes from a very male dominant background.

[A]

Her new vp, by the way, is her husband, which is. That's why I'M saying, how's this feedback going to go?

[B]

His level of patience is not like mine with certain topics. Clicks. So he's working on that. He's already had a performance review on that.

[A]

Oh, how'd that go?

[B]

It was well received. He can come in with an intensity you've seen with the.

[A]

Yeah, we're about to go. Get it on. You know, choke him again.

[B]

Okay, exactly.

[A]

I'm only gonna choke him with the thing he told me. I'm not allowed to, though.

[B]

You have seen the intensity he can bring, which intensity is really good for certain situations. I need intensity in certain areas. And he's like, laser focused on some things. When it comes to maybe personal relations with women who may be a little sensitive, that's where we need to.

[A]

Room for improvement. This is good. We're gonna get him there.

[B]

Yeah, he's working on it. He received the feedback really well. I have to say, though, this is the. In our relationship where I have felt the most supported and a teamwork between the two of us, like we have a bigger goal, if not. If just what we can build to help other people.

[A]

It's an interesting pairing because. And I've talked about Jason many times being a San Diego city fire captain. He. I mean, you. You know, hospice care, you spent a lot of time that. What people probably don't realize is most of the calls the firemen go on these days are medical, depending on your station. Like, I'm not trying to take anything away from.

[B]

Remember how he said he was gonna die in the fire department?

[A]

Yeah. And so again, I'm not trying to take anything away from firefighters, but the statistics show that a lot of this medical call. So he has touched a lot of people earlier before they got to you, and you know what I mean? So it makes sense to me that he would be interested and passionate about this as well, because although maybe not considered a healthcare provider, when you call 91 1, from what I can tell, a lot of the times the firefighters get there before the ambulance, you know, so they're right there at a first line, first responder.

[B]

Well, and he also not only is my husband, but a patient of mine. Yeah. I look at photos of him when you got. You and Leah got married, and I was like, oh, he looks sick and where he is now. And I take full credit for what I have created.

[A]

Yeah. Like, no work on his part whatsoever.

[B]

This is all my creation. And I take full credit for the before and afters, but like, just his mental health, his. The muscles, you know, everything that he is now like Leah even said yesterday, he is really strong and stable table and that wasn't who he was two years ago. But he. I've got him optimized. I'm gonna keep him run. Just pump that testosterone through him. Keep him running.

[A]

Okay. Whatever works for you guys. Anything else you want to close it out with? Because we do need to get to the house and then head over and I'm legitimately only going to choke him via the means. He said he's not going to let me.

[B]

I think my biggest thing is for people to know that there is hope on the other end of this. And I I have a box of Kleenex that sits in front of me for a reason. Unfortunately. How many people are just feel like there's no other options but then I get to see them three months later and they're like I'm back. You know some of my patients actually responded onto the post. Right. And I appreciate that they're sharing that they're my patients. But it end of life of what I've seen does this generation we're now doesn't have to be the same. There's definitely.

[A]

And you can be contacted through your website, I'm assuming.

[B]

Yes.

[A]

Okay. That's all I got. You're up here doing oh, you're up here. Not that this will be out in time, but you're up here doing a like an in person. I'm sure it's going to be a presentation followed on by Q and A at the coffee shop. My guess is there is going to be between 60 to 80 women that are there. And I think what it's safe to say is that we can plan on doing that again in the future. So.

[B]

Well, this talk is going to be strictly hormones.

[A]

Okay.

[B]

My next talk is gonna be adult sex ed.

[A]

I will not be attending that.

[B]

I would like to know where in the coffee shop my supplies are going to be.

[A]

Are we talking like a shelf of

[B]

dildos or what dad said. Well where in the coffee shop is Andy gonna have all these products?

[A]

There's a difference between a presentation and selling a line of products cleared hot.

[B]

It is a menopause line.

[A]

Go ahead. I don't want any part of that. I'm not attending that talk. Michael can go and take notes.

[B]

I know some of my friends were like I don't think Montana's ready for what you're bringing for adult sex ed. But it's an important topic and it's whole body health is bringing that and it's partner related too. And There aren't many people who talk like I do to that topic.

[A]

Well, point being, you'll be back up for in person stuff again in the summer. Well, yeah. And the Internet being what it is, obviously this will go everywhere, but anybody in Montana or if what. Let's do this though. The next time that you're going to come up and do something, let's get it on the books a little bit farther ahead because it'll be after this episode comes out. I can reference this episode and if it's in the summer, people can honestly combine it with the most tourist heavy season of the year anywhere. Because. Or any way because it's a great time to see Montana. But then we can.

[B]

It will be summer. This one was a little harder because we were waiting on the Montana board.

[A]

I'm just saying they could. It's. It's an additional reason to come visit the Big sky state, which I highly

[B]

recommend for everybody with sexual tools.

[A]

Sure, whatever.

[B]

That's the line dad wanted in the coffee shop.

[A]

I'm not sure if he's allowed in

[B]

the shop that he was stealing from my office.

[A]

Yeah, that's. Let's just leave it there. Okay? We're out of here. Marketing is hard, but I'll tell you a little secret. It doesn't have to be. Let me point something out. You're listening to a podcast right now and it's great. You love the host. You seek it out and download it. You listen to it while driving, working out, cooking, even going to the bathroom. Podcasts are a pretty close companion. And this is a podcast ad. Did I get your attention? You can reach great listeners like yourself with podcast advertising from Libsyn Ads. Choose from hundreds of top podcasts offering host endorsements or run a pre produced ad like this one across thousands of shows. To reach your target audience in their favorite podcasts with Libsyn Ad ads, go to libsynads. Com. That's L, I B S Y N Ads. Com Today.