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Foreign. I'm your host, Dr. Norris. This is a show where I share my knowledge gleaned in family medicine, preventative medicine and aesthetic medicine to shed light on aging, or better yet, how not to feel or look like you're aging. I will divulge studied and safe ways that you can look younger, feel fabulous and put off the tolls of crying chronic disease. My listeners are not proponents of growing old gracefully or letting nature take its course. This show will unravel the mysteries of aesthetic procedures, the mystique of bioidentical hormone optimization, the secrets to getting fit in midlife, and controversies associated with navigating healthy living in our world. My wish for my listeners is to always be mistaken for being 50 something or even less in mind. Action and appearance. Here we go. Welcome to the third episode of the Dr. 50 Something Show. I'm your host, Dr. Norris. In the first episode I introduced myself. In the second one I gave you the why and what. My subsequent podcast might be about eight. In this third episode is the beginning of what I will call season one. In season one, I'm going to take you on an adventure to an exotic country called hormones. What a weird word. It comes from the Greek word horman, which means to set in motion or excite. I describe hormones to my patients as a natural chemical in the body that attaches to receptors on cells to create a signal for something to happen in the body. There are millions if not billions of receptor sites on cells in the body that have different chemicals or hormones attached to them all causing a chain reaction of important functions. So think of it like a symphony. Many sounds and instruments creating one song. So what do these hormone signals do? First and foremost, they create, well, being really important, right? The ability to reproduce. They prevent diseases of aging. They help us to stay a healthy weight by affecting metabolism. They give us energy. They create our mood, good or bad. They affect our relationships, especially those intimate ones. So super, super important things. There are over 50 known hormones in the body, but the ones we are going to talk about are the most important ones. So I'll give you a laundry list. Estradiol, progesterone 2. Testosterone in men and women. Vitamin D3. Yes. This vitamin is actually a hormone, not a vitamin. Dhea, Pregnenolone, cortisol, thyroid. I hope I'm not losing you. To many of you, this episode is going to be like going to a foreign country. Everything I tell you is going to be new and different and you may have preconceived notions of what this country is like, but when you get there, you may realize you you were completely wrong in your assumptions of the place. It really is. I have mentioned in my previous episodes something called confirmation bias. I know I keep talking about it. Why do I keep talking about it so much? Because it's really important. It's really important to understand and to subsequently change the cultural mindset about hormones in this country. This bias is basically whatever you learn first is what your brain always wants to believe. Even when you hear something new that has great research behind it and even evidence based medicine behind it, your brain will always want to revert and believe whatever it learned first. So a really good example of this related to Hormones is in 2002, a very large study on 16,000 women was stopped prematurely because the investigators announced taking Prempro, which at the time was the most popular synthetic combination hormone of Premarin and progestin had health risks that outweighed the benefits. So the investigators stopped the study before it was actually over because they were seeing a very small increased risk of breast cancer, cardiovascular disease, blood clots and stroke in women who were receiving Prempro in the study. You heard about this because besides being in a medical journal that your doctor read, it was also on the COVID of a popular magazine in July of 2002 with big letters that said the Truth about Hormones. But you know what? It turned out. After further analysis, the investigators of that study made huge mistakes in analyzing the data and their research should not have been applied to all women or to all hormones. The study flaws were published a few years later. That was not in the news. So in a nutshell, millions and millions of US women were deprived of hormones over the next 23 years because of the fear of fear and confirmation bias created by this flawed study. I am going to ask you to remember your own confirmation bias about hormones as we travel to this new country. So let's continue our adventure. You will also be quite surprised that your tour guide is me, a physician. I know the conversation topic. I think I need my hormones checked. Used to be the one I most was annoyed about to have brought up when I saw my female GP patients for their yearly exam. It wasn't that I didn't care that they didn't feel good. The true reason was that my own confirmation bias was telling me that hormone replacement was risky and also because I honestly did not know much about anything about checking hormones and especially I didn't know what to do with the results if I did check them. So as a physician I can humbly admit that the saying if your doctor is not up on it, they are down on it. May be true. From my experience, I think that often healthcare providers are down on bioidentical hormone optimization because they're not up on it. Before you start your own hormone journey, it will be normal for you to have some preconceived notions about hormone replacement and we will work through that with repeated education, you using very important information that is considered grade A evidence based medicine. Another word for this is randomized control trials. So this is more education for you. All medical studies are not created equal. If any of you have ever taken a statistics class, these words might sound familiar. And I am going to do you the favor of telling you the information that you need to know from statistics so so you don't have to take a whole class. So it is very important that when you are taking information gleaned from a study that you do not believe the assumptions it makes unless it is a well designed randomized control trial. Many studies that we hear about in the news are not randomized controlled trials. They are actually what's termed observational studies. These studies draw conclusions from data. But as any scientist or stats teacher will tell you questions Correlation does not prove causation. So whenever I talk about studies in this podcast, I will only mention ones that are grade A evidence based medicine or randomized control studies. I will not talk about observational studies. I mean observational studies are what's called grade B, C or even D evidence. Okay, don't worry. That was the last of my stats lessons for this podcast. Next up, your language lesson for the country of hormones. You definitely will not speak the language upon arrival to this country, but by the time you leave you will be fluent. So first we are going to do a little foreign language practice. There are some initials to clear up. Hrt, ert, bhrt, bho, hrt, HRT is hormone replacement therapy and they are the initials to describe replacing the hormones you lose in perimenopause, menopause and andropause with synthetic hormones. So what does synthetic mean? Synthetic means to imitate a natural product. Synthetic hormones are made by a pharmaceutical company to look similar to our natural hormones, but they are not the same. Per the US Federal Food and Drug Administration, identical hormones made by the body cannot be patented by a pharmaceutical company. This is really important. When a pharmaceutical company creates a new drug unlike any other, they ask the FDA approve it so they can patent it for seven years. During the time of the patent, no other company can produce it. The specific company that got the patent and the FDA approval for it can essentially charge whatever they would like for it during that time of seven years because they have no competitors. When the drug goes generic, after they lose the patent in seven years, other drug companies can make it too. And typically, because there's competition, the the price drops. So it stands to reason, if a drug company cannot patent a drug, I. E. Like the hormones natural to the body, there is not much money to be made making them. So, key point. Synthetic hormones are not our natural hormones made by the organs in our body. And they are ones that are used in many cases to replace the ones we lose as we age, but they are not natural to our body. So, example Premarin. Premarin is not natural to the human body. Premarin is used in hormone replacement therapy for women as a form of estrogen. But where does Premarin come from? Premarin comes from pregnant mare urine. Get it? Premarin. For those of you without horse knowledge, a mare is a horse. Definitely not natural to the human body. Okay, next up, ert, estrogen replacement therapy. Estrogen is a broad term that encompasses many types of estrogen. Okay, so let's use the example of wine. Wine is a broad category which includes many types of wine. Cabernet, Merlot, Pinot, Grigio, all different types of wine. Women's ovaries and men's testicles produce several forms of estrogen. Both women and men lose these estrogens as we age. But the most important form of our natural estrogen that we lose as we age is called estradiol. Females also make estriol, estrotrol and estrone besides estradiol. But estradiol is the most important form of estrogen that we lose when our ovaries shut down with menopause. So here is what is confusing with this foreign language. Often in these medical studies, estrogen is referring to Premarin, but estradiol is also a form of estrogen. So when I look at a study about estrogen, I have to determine first which type of estrogen was studied. Premarin and estradiol are not the same. And we cannot extrapolate findings of studies of one on the other. So to be very clear, I am going to be using the words premarin or estradiol, but not estrogen, which is a general category of a hormone and not established helpful. So Premarin is a synthetic hormone that is 15% estradiol and 50% conjugated estrones naturally produced in a female horse. By the way, this is the only Estrogen to show a 15% increased risk of blood clots. In a randomized control trial, estradiol is 100% estradiol, which is produced in the ovary. In a man, testosterone is made in the testicles and and then actually converts to estradiol and other hormones. So both men and women need estradiol in our bodies. Okay, I remember in foreign language class, Father Arthur would make us all say the new word and then use it in a sentence. So here we go. Premarin and estradiol are both types of estrogen used to treat menopause. Premarin is a synthetic made in a drug company with female horse urine. Estradiol, made in the ovary, is what a woman actually loses when her menses stop menopause. Estradiol is also an important hormone for men that they lose as they age. When we replace testosterone in men, we are actually replacing estradiol. So, key point, we cannot extrapolate studies done on premarin to studies done on estradiol. Totally different chemicals. This is absolutely the key to understanding the confusion and debate around taking hormones as we age. Why do some people say it's good for you and others say it's not good for you to replace your hormones? The answer is they are both right, but they are not speaking the same language. Next. Initials bhrt. Bioidentical hormone replacement therapy. This is replacing the actual hormones that you lose with aging or that we lose due to something called endocrine disruptors. Bioidentical hormones are the natural form of the hormone produced by our ovaries, testes, pituitary, thyroid, pineal gland, adrenal gland and pancreas. There are a few pharmaceutical companies that do make replicas of our natural hormones. The other way to get these natural hormones is from compounding pharmacies. Compounding pharmacies make bioidentical chemical structures of our natural hormones with plant based ingredients. The main difference I have seen between the two different types of pharmacies that are is that compounding pharmacies can get bioidentical hormones to be absorbed better so that I can get patients to more optimal levels. A lot of practitioners who do hormone optimization for health benefits prefer good compounding pharmacies to a pharmaceutical company because you can get better absorption of the compounded products as well as you can customize dosing and types of administration. So types of administration, think patch, pellet, cream, pill. And let me tell you, that is a whole nother podcast. The way you take a hormone can actually mean life or death. Bho Bioidentical Hormone Optimization. That's what I do. I don't just replace what you have lost and get it back to your age's normal range. I optimize it. So the studies that I have read and the teachers I have learned from tell us sometimes you just don't feel better until your levels are optimized to that of a younger person. When you most often when your levels get back to normal range, sometimes your symptoms are not better. Confusing, right? This hormone country is like a country with 100 different languages. So let's talk checking labs and levels. First of all, laboratories set their normal ranges based on population averages based on age. So example, if I am a 51 year old female, my normal ranges are set for people over 50. So they are set for a population of old sick people. Given this, it is very possible that the level that I feel good are not going to be much higher than what the lab says is normal. Over and over in the practice of medicine, we as physicians learn we should treat the person, not the lab value. And this lesson definitely applies to hormones. Another thing that is affecting hormone levels are chemicals in our environment. There is actually something really tragic that is affecting every single person in our population due to chemicals in our food and water supply and even chemicals in our self care products. This is referred to as receptor site resistance. Okay, so remember what I said about how a hormone works. A hormone needs to attach to a receptor on a cell in order for the cell to start the biological process that we need. So it stands to reason if something is blocking the receptor, the hormone can't do its job. So the levels of hormone may build up in the bloodstream and the body might say oh we have too much of this hormone and so it slows down the production of the hormone. So whatever receptor site is blocked, that hormone that is supposed to attach there can't do its job. So what is causing this? EDCs Endocrine disrupting chemicals are found in our environment, in our food supply, our personal care products, our clothes, and possibly even some water supplies. When EDCs are blocking receptors, the only way to treat this is to increase the hormone levels to higher than what would be normal in order to stimulate the production of more receptors sites. Of course we can try to decrease our exposure to EDCs, but in this country that is near impossible no matter how clean you eat or how many organic products you buy. To summarize, Bioidentical hormone optimization is boosting your natural hormones above the quote normal range either because you are aging and your normal range is set for old sick people or you are a younger person whose hormones have been affected by endocrine disruptors. And sometimes I think it's both. So in my preventative medicine practice I use bioidentical hormone optimization to improve patients sense of well being, to reduce the symptoms of hormone insufficiency and prevent the diseases of aging including heart disease and several types of cancer. In my practice, the normal range is not the optimal range. Neal Rosier, MD, an emergency room physician in California, made it his life's mission to collect all the studies he could on bioidentical hormone optimization from around the world and analyze them. He offers an 80 hour training program through the Academy of Preventative and Innovative Medicine for Physicians that goes over all of these Grade A evidence based medicine studies. He is my mentor and if you are a medical provider listening to my podcast, I highly recommend his training. He has also written several books. There is one written for patients called None Other than Normal is Not Optimal. I will put the link for his book in my show notes. However, if you are like me and don't have a ton of free time to sit down with a book, keep listening to season one. We will continue our journey through the exotic country of hormones and immerse ourselves in the language. After all, you have to understand the language to get the most from any visit to a foreign country. Thank you for joining this episode of the Dr. 50 Something Show. If you are intrigued by this show and never want to miss an episode, click the follow if you are a really great friend, share it. The content of this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider to answer any questions you may have about your personal medical conditions. Until next time, get fit, get fabulous, get firm, and take care of yourself. Sam.