Transcript EP 351 – Unlocking Vitality: Hormone Health and Bioidentical Therapies


Transcript: EP 351 – Unlocking Vitality: Hormone Health and Bioidentical Therapies

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Dr. Taz: If you go with a reputable pharmacy that is certified and has done their due diligence, I actually prefer bioidentical hormones for most patients compared to our traditional hormones. Why? Because I can manipulate the dosing and I can also manipulate the way those hormones are given.

Hi everyone and welcome to Super Woman Wellness. I’m Dr. Taz. I’ve made it my mission throughout my career in integrative medicine to support women in restoring their health using a blend of eastern medical wisdom with modern science. In this show, I will guide you through different practices to find your power type and fully embody the healthiest and most passionate version of you. I’m here for you and I can’t wait to get started. This is a Soul Fire production.

Hormone replacement therapy is so confusing. So many of you have questions about it, you’re not sure what the right form is. There’s a new study every single day. It’s enough to make your head spin and I get it, but I want to help you for just a few minutes, understand a little bit about the world of hormone replacement therapy, understand conventional therapy versus bioidentical, what the differences are, and then even all the different ways you can take them. So let’s talk about it first.

So hormone replacement therapy is usually traditionally referred to as giving you extra estrogen, extra progesterone, sometimes testosterone, thyroid, any of these hormones to bring your own levels of hormones back into balance. Maybe you’re trying to conceive or you’re in perimenopause or menopause and you’re hormone depleted. But either way, sometimes the body needs some support. I know this personally at 28 or so when I was diagnosed with PCOS and I was in a major depletion state, I actually needed some progesterone. It was just a very small amount, but I used it topically as a cream and needed it for three or to four years while my gut healed, my nutrition got back on track, but eventually stayed off of it through the remainder of my 30s and 40s. And now as I’m hitting 51, I am needing a little bit of progesterone and estrogen for the first time.

So let’s break it down. Conventional therapy when it comes to hormone replacement usually is using estradiol, which is the most active form of estrogen and progestin, which is a very strong progesterone. Those are in the conventional patches like a Vivelle or Climara patch that you might get a prescription for or a progesterone pill that you might get from the pharmacy. Typically, those pills are dosed around 100 to 200 milligrams depending on you and your provider and what you guys decide at the time. Sometimes oral estrogen is also prescribed, not a fan of that, and we’ll talk about why, or vaginal estrogen known as Estrace is prescribed as well to plump up, especially in women going through perimenopause and menopause, to kind of pump up the vaginal lining because they’re getting a lot of vaginal dryness and that’s impacting their desire to have intercourse and so much more.

So all of these that I’ve just sort of mentioned are in the traditional pharmaceutical sort of litany. They are used by the majority of practitioners and providers, and they’re the options that you’re typically presented with when you’re asking for or feeling like you need hormone replacement therapy.

Now, here’s the issue with some of that. The doses I mentioned are standardized. The forms I mentioned are standardized, meaning if you’re someone super sensitive like me, then you’re not going to necessarily tolerate a really strong dose of estrogen or progestin. You may have side effects like breast tenderness, weight gain, mood issues, joint pain, so much more, and I’ve seen this over and over again in practice, the CentreSpring MD. So if conventional is not the right option for you or you’re somebody who you know already have detox issues, or you have hormone metabolic issues, or in general you don’t tolerate things very well and you just want baby doses of things, the conventional world does not really give us the answers to that.

So I am a big fan of bioidentical hormone therapy. However, I know bioidentical hormone therapy undergoes a lot of debate and a lot of back and forth, and here’s the reason why. Some bioidentical pharmacies don’t submit themselves for regulation. So there’s confusion about that. There is also this debate about what’s FDA approved or what’s not. Here’s the deal. If you go with a reputable pharmacy that is certified and has done their due diligence, I actually prefer bioidentical hormones for most patients compared to our traditional hormones. Why? Because I can manipulate the dosing and I can also manipulate the way those hormones are given.

The other advantage of bioidentical hormones is that it’s not all straight estradiol and it’s not progestin. It’s bioidentical progesterone that looks and feels like the very same estrogen and progesterone that we make. What we are doing often is combining the highly active circulating estrogen, estradiol with a softer, more protective estrogen called estriol. And when we do that, we’re able to alleviate a lot of the hormone symptoms like the hot flashes, night sweats, and those type of things without sledgehammer approach, giving a massive dose of hormones that then your body may or may not be able to detox appropriately. So that’s why I like these because I can play with the dosing, I can use the clickers for the creams, we can use the injectors or the pens as well for creams, we can use suppositories. So injecting vaginally is a great way to ensure absorption of your hormone. And we can even do Troches which are dissolvables and they’re dispensed in a case like this typically, and they’re dissolving under the tongue.

Notice none of what I talked about was oral, where you’re swallowing it and it has to go to the liver, and because it has to go through the liver, you need bigger and bigger doses. These are all forms that very gently absorb into the system, work with the system so that we can get away with lower doses of hormones.

The only other form is an injectable. So a lot of testosterone shots, for example, and even some of our peptides getting into that world are actually injected. So this is drawn up and you give yourself a shot, typically an IM or a sub Q shot.

So the theory of hormone balancing when it comes to east west medicine, when it comes to a more holistic approach is that the smaller doses are better as long as they’re giving symptom relief and they’re getting our blood levels to where they need to go. Mega doses are out. They’re hard on the liver, they’re hard on the gut, they’re hard on you. That’s why I don’t like pellets. It drives those hormone levels up really far, brings them down, and we can’t manipulate it. They’re off running the races in your bloodstream and there’s no way to pull back and change course. So if you’re thinking about hormone replacement therapy, I would kind of divide your brain up into a couple of different scenarios. Do you want to try bioidentical or conventional? Conventional if you’re worried about cost, because sometimes the bioidenticals are more expensive. However, if you’re very sensitive, have a history of detox issues or cancer or inflammation, the expense is worth it when it comes to bioidentical hormones.

Next, you want to ask yourself, what are you going to stick to? Is a cream going to work or is it going to be a suppository or is it going to be a Troches, something that dissolves under the tongue? And pick one, and work with your provider to formulate the dose so that you’re able to effectively manipulate the dose that we can find for you.

The World Health Initiative study that came out years ago was so flawed and scared everybody when it came to hormone replacement therapy, but was done on postmenopausal women using Premarin, horse urine as the source of estrogen and then saying it caused cancer and had all these other effects to it. That is not the answer for women today. We need bioidentical hormones that work with our bodies in gentle doses with monitoring to make sure our bodies are able to tolerate it well and keep us vital, healthy, and active for years to come.

Hopefully this helps clear up. I’m sure you’re going to have a ton of questions, but hopefully this clears up some of the conversation around hormone therapy where I stand, what really is holistic and natural versus what is more of the very aggressive, overly ambitious, I would almost call it approach to hormone therapy. I talk about this and a lot more hormone stuff in my latest book, The Hormone Shift, which is now available for pre-order. Don’t forget to click the link to get your copy now and three months of entry into my Super Woman’s Circle where we chat about all things hormones, work on your health, and have this group accountability system to push us all forward and take really ownership of everything going on with this. So I hope to see you there.

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Understanding how to balance your hormones is something I want every woman to know because our hormones really do drive the course of our lives. I can think of so many patients that have come in and suddenly are acting like different versions of themselves. They’re crying a lot, they’re anxious, they’re having trouble sleeping. Maybe they’ve gained a ton of weight, but whatever it is, it’s making them feel and act like somebody that’s simply not them. Well, it doesn’t have to be that way. And the beauty of balancing your hormones naturally is that there’s so much you can do and so much you do have control over when it comes to hormone balancing. And this, by the way, is a really eastern way of thinking. They didn’t go straight to the most aggressive sledgehammer approach to solving something. They really thought more about, well, how do I gently tweak the body? What is the body missing? Is there a state of depletion?

So I want to take the next few seconds to really talk about how we balance hormones naturally using that east west philosophy, meaning we’re merging together the best of eastern and western medicine. So let’s break them down. I hope you’re taking notes. Here we go. We’re going to start with B vitamins, and I’ve got to brag about my product Boost, and here’s why. The lack of B vitamins in our diet was a pattern that I was seeing over and over again when I would do lab testing on patients. I’ve seen over 35,000 patients now at CentreSpring MD and the B vitamins were simply not absorbing. People were trying to eat healthy, trying to do all the right things, but their numbers weren’t going up.

Here’s the implication of low B vitamin levels, and I mean all of them, B12, B6, folate, all of them when it comes to our hormone balance, we know the BS are really important for estrogen. They’re important for how we build estrogen, how we metabolize estrogen, where estrogen goes, and so much more. They’re also super important for how we feel. Things like serotonin and dopamine are really dependent on the B vitamins. When I was starting out in practice, I couldn’t find a good B vitamin. It was a part of the story of Boost is that I just wanted a formula that would balance women’s hormones with the right combination of B vitamins. So if you’re out there and you’re watching and you’re thinking like, “My hormones are off, my breasts are tender, I’m moody, I have no energy.” Well, starting with a good methylated B vitamin is a good first step. And you want something that does have methyl B12, methylated B6, which we call P5P, methylfolate, and a host of other B vitamins to go with it.

So B vitamins, critical to hormone balancing. If you can’t remember anything else, that’s the one thing I want you to remember is please take your B vitamins to really help balance hormone patterns like estrogen dominance, and even things like your thyroid insulin and so much more.

All right, let’s move on. Sitting here is probably my next favorite. I’ve talked about this one a lot. Magnesium. Magnesium, I keep calling the miracle micronutrient, and the reason is, is that our soil and many of our healthiest foods, unfortunately today are depleted in magnesium. And so even here we go again with like I’m eating healthy, but I still don’t have the nutrient profile that I really need to keep my hormones balanced. Magnesium also helps with that hormone pattern of estrogen dominance. It’s critical in progesterone maintenance. So progesterone, remember that hormone that really is secreted in the second half of our cycle determines how we bleed, but really is also responsible for things like anxiety, sleep, and so much more, it’s an anti-inflammatory. Magnesium actually helps with progesterone balance as well. It also helps with thyroid.

So magnesium, 200 to 400 milligrams is what I’ve been telling patients forever at CentreSpring MD. But this one too, when we go to do lab testing, keeps coming up low over and over again. B vitamins, magnesium, I almost call them the bookends of hormone balance, and they in turn help to keep the rest of the hormones stable.

All right, moving on from that, let’s talk about vitamin D. This is a chronic deficiency and it’s actually actually a deficiency in women of color. That’s right. All my Indian, Black, Hispanic patients come back over and over again with low levels of vitamin D. We see it in the Caucasian population as well, and there are some reasons for this. One of the reasons is that you’re not absorbing vitamin D. Vitamin D is a fat soluble vitamin, so it needs some fat to be absorbed and used in the body the way it’s supposed to be. Now, if you’re not absorbing fat well or you have gut issues, then a lot of times, even when you’re taking vitamin D, it’s not doing what it’s supposed to do. So that’s one reason.

The second reason, everyone gets super confident. They’re like, “I’m in the sun. Of course I have great levels of vitamin D.” But unfortunately that’s not always true because we can’t convert a significant amount of vitamin D through just sun exposure. And people of color have even more trouble with that. Taking vitamin D is really important because it maintains hormone balance, it helps with estrogen levels, again, it helps with progesterone, it helps the immune system, and it also prevents depression and anxiety. So vitamin D is yet another one that I would add to my bookends of B vitamins and magnesium when we’re thinking about nutrients that really make a difference for overall hormone balance.

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All right, a couple more. Again, I don’t want to overwhelm. I never want someone, by the way, coming in with 20 different things they’re taking. I’ve been in that position before. People have the bag and they dump the bag on the table and it’s like bottle after bottle after bottle, and I’m swimming through supplements trying to help them figure out what to do. So that’s why we’re trying to keep this pretty tight. These are the things based on my experience that I’ve seen, super helpful, super efficient, especially when we’re talking about hormone balance.

Let’s talk about vitamin C for a second. Here’s the story with vitamin C. Vitamin C is an antioxidant. We have seen now study after study connecting the role of antioxidants to this concept of really building hormone. Again, a eastern medicine concept. They thought in terms of depletion and repletion. Vitamin C was really important in all the literature, if you look at Ayurveda and Chinese medicine and many of these Eastern systems of medicine, vitamin C was incredibly important for improving egg quality, improving hormone balance, providing the antioxidants for the hormones to do their thing, to circulate, go where they’re supposed to go and build somebody from the inside out.

When there is a lack of vitamin C, we see declining fertility levels, we see declining egg quality, and we see a lot of issues with ovulation. So getting in adequate amounts of your antioxidants, in particular vitamin C, is very helpful in the conversation around hormones. In fact, in practice we do something called a fertility drip. And essentially what’s in that IV is a lot of really high-powered antioxidants that are improving at quality, helping the hormones to function efficiently and resulting in natural hormone balance.

Last but certainly not least, your probiotics. Remember, gut, liver hormones. Eastern concept when it comes to balancing hormones naturally, gut health is so important. I’ve been talking about this. I’ve talked about astragalus. We’ve talked about gut health, but probiotics in particular. We know that the bacteria in our gut determine where your hormones will go. Here’s a quick example. Let’s take thyroid hormone. Maybe you have Hashimoto’s or hypothyroidism. We give you thyroid, we give you a prescription for taking maybe Armor Thyroid or Synthroid or whatever the medication might be. Here’s what actually happens. When the gut is not healthy, your body can’t convert T4 to T3, which is the active thyroid form. So you end up having all this thyroid in your system, but it’s not doing anything. So by taking probiotics, we assist in that conversion. Probiotics are a big part of that process. They’re a big part of making sure estrogen gets packaged up and sent off to where it needs to go, making sure the androgens don’t get super high and then in turn cause things like acne or hair loss.

So a probiotic is so important for the overall picture of balancing hormones naturally and for really keeping your hormones where they need to be. And when you’re trying to pick a probiotic, and here’s where honestly, there’s just a ton of confusion. When you’re trying to pick a probiotic, you’re wanting to look for something with at least 50 to 100 billion CFUs, that’s colony forming units, and ideally it has 5 or 6 different strains of bacteria in it, and it tells you exactly the amount of those different strains. That’s a quality probiotic.

So this is for me, I think when I’m thinking about somebody really interested in jumping into this conversation around hormone balancing and wanting to do it holistically and very naturally, this is really where I would start. I start oftentimes with nutrients and this idea of repletion and building. I still remember my Chinese mentor when I was in the beginning of my hormone journey, wagging his finger at me and saying, “No chi, bad chi.” And I really honestly didn’t know what he meant, but what he was trying to say is that I didn’t have the nutritional health to build hormones, and I don’t want that for you. So B vitamins, magnesium, vitamin D, vitamin C, probiotics, all a part of that nutrient equation to healthy hormone balancing. And yes, you can balance your hormones naturally, and we should start there before we even begin conversations around HRT and all the other more aggressive approaches.



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Dr. Taz Bhatia M.D.