Hi, guys. It's Tony Robbins. You're listening to Habits and Hustle.

Crush it. Before we dive into today's episode, I first want to thank our sponsor, Therisage. Their Tri-Light Panel has become my favorite biohacking thing for healing my body. It's a portable red light panel that I simply cannot live without. I literally bring it with me everywhere I go, and I personally use their red light therapy to help reduce inflammation combinations in places in my body where, honestly, I have pain. You can use it on a sore back, stomach cramps, shoulder, ankle. Red light therapy is my go-to. Plus, it also has amazing anti-aging benefits, including reducing signs of fine lines and wrinkles on your face, which I also use it for. I personally use Therasage Tri-Light everywhere all the time. It's small, it's affordable, it's portable, and it's really effective. Head over to therassage. Com right now and use code B BOLD for 15% off. This code will work site-wide. Again, head over to therasage, T-H-H-E-R-A-S-A-G-E. Com, and use code B-Bold for 15% off. This code will work site-wide. Again, head over to therassage. Com T-H-E-R-A-S-A-G-E. Com, and use code Be Bold for 15% off any of their products. All right. Well, hi. Nice to meet you.

Same.

It's really nice to meet you. You've been doing very well with this book, I have to say. I've seen you everywhere.

Yeah, it's overwhelming, but it's great.

I can imagine. I can imagine. I mean, first of all, I think it's the way you describe and explain things in such wonderful layman's terms that people can really understand what you're talking about, really, which I think is half the battle, right?

I think it's my superpower that I've done it for years with patients. It's just one-on-one in the office. Then I just was able to take that skill and start talking about it on social media. Who knew? I started with no followers like everybody else.

Wow. When did you actually... Oh, by the way, we can start and we could talk about this because we actually haven't... Well, let's just say we started because it's actually very organic this way. I think it's great. I wanted to who you are. The book is called The New Manipulase by Dr. Mary Claire Haver. It's a wonderful read just because you explain things, like I said, exceptionally well. And you explain it in a way that everybody can understand, sometimes very scientific things that are quite difficult. And you were just, not to interrupt you, you were saying you started on social media. How long ago have you... When did you actually start?

I want to say I started on Facebook like everybody else in our age demographic, really just for friends and family. And then before there were business pages or anything. And someone asked me a question one day, it's just about gynecology stuff. And I answered it on social And then like, that's... And a lot of people were like, Oh, my God. I was like, Does anybody else have any questions? And it just grew organically from there. And then we had a business page. And then during the pandemic, my kids were Mom, you should be doing this TikTok thing. And I was like, No, that's for kids and dancing and whatever. But I was like, Whatever. And so I just put a toe in the water on TikTok, and it exploded. It was crazy how fast it grew. And then my dopamine's firing every two minutes. And you're like, Oh, my God. And I grew to a million followers on TikTok within a few months. And then that conversation just got bigger and bigger. And then we really started getting busy on Instagram, which really was where most of our demographic hangs out now. Wow.

You know, it's true. I think that Instagram became the new Facebook. When we would be like, Oh, our moms were on Facebook, and now it's like, actually, our grandmas are on Facebook. And you're right. I believe Instagram is for our demo and then TikTok, which is for the younger. However, you were just saying you thrive Live on TikTok, which is actually- There's a lot of crossover. There is.

But I do tailor my message depending on how I explain things, knowing that TikTok skews younger and mostly male. Well, no, actually, 89 % of my followers on TikTok are female, 98% on Instagram are female. So I'm a little bit broader and trying to talk to a wider audience. So I really do tailor. And Facebook is my age plus, like 55, 65, 70-year-olds who still want to learn. But I have to really curate that message. But it's fun. It's a good game.

It is. But do you still have a practice? You still see patients?

Yeah.

How often are you in office seeing patients?

I'm in clinic about two days a week, and I have a team who fill up the rest of the day so that I can work on my other businesses and social media the other three days a week.

Wow. So social media has become like, how much of it would you say is your business now, social For me, yeah. Like 70 %?

So what... You know, time spent 70, 60 %, probably. But it's like I'm researching something for the book or for the next book, which we are still playing with. And I'm like, oh, this particular subject would make a great informational video for Instagram. You know? And so then I'll make a long-form video for YouTube, which is where we do long teaching, and then we can cut that down. We've gotten really good about being efficient with the same message.

Right. You know what? Actually, now that we're talking, it makes sense why you would do so well on Instagram, because if it is the age demo of '40s, '50s, late '30s, let's say, that's who would be affected by perimenopause, menopause, right? So you're right in that strike zone of information that is completely of interest. And what I was going to ask you, and now I just figured it out myself, is it because I'm in that It's a cage demo now and it's possibly affecting me that all I seem to see now are things about metapause and perimenopause and hormones.

Me too. And I just think, well, that's all I... We're talking about Anything else? Anywhere else? I'll see some of my favorite creators on TikTok, and they're like, now you've seen the video about Lo and the crop top. I hadn't seen it. I had to go dig and find it. The algorithm is only showing me Dr. Menopause stuff. But that's my fault.

Well, I also think, though, in this business, I talk to a lot of people in productivity and health, wellness, fitness, longevity, all the things, and obviously also business mindset. But I will say I have noticed a major uptick and upswing in even people who don't necessarily talk about hormones and metapods are now putting these guests on their shows because it's a very hashtag friendly thing now, right? So people are what they're doing is they're gravitating to people who will get them views and what's trendy and popular. And this has become a very trendy, popular area because I guess- It was a vacuum.

There was a dark zone. No one was talking about it. I think I was willing to talk about it before a lot of other people were and before other people had educated themselves. We don't have a great medical training program. Part of the medical curriculum for a standard standard osteopathic regular MD or a DO, does not include a robust menopause curriculum. So you have this whole generation of practitioners who are out practicing who really know the most cliché minimum about menopause.

And I went back to school and educated myself and decided to talk about it and share what I'd learned.

Some of it is shocking. And then I found the menopause, which are my social media friend group of other like-minded practitioners who are doing the same thing, some in sexual medicine, some in general medicine, some cardiologist. We've all bonded together, this sisterhood and a couple of good men. And it's incredible. And so I'm always like, Oh, I'm booked here. Here, go talk My friend Dr. Men. Yeah, yeah, yeah. Put her on your podcast. Trust me, she's amazing.

I love that. I love what you call menopause. That's hilarious, by the way.

And we're in the metaverse. That's so great.

Okay, so Let's start from the beginning, okay? Because there's a bunch of stuff. When I read your book, and a couple of things really were shocking to me, and I'll get to that in a second. But let's first talk about what really is the difference between perimenopause and menopause, because I think there's a lot of confusion, and nobody really knows.

Let's start in the middle. We'll go back to the very beginning, and then we're our way back forward. Okay. Menopause is one day in your life. That's it. One day. Medically, it is one day after or the day that is one year after your last menstrual period, the LNP, the final menstrual period, if it's naturally occurring. That is a terrible definition. It was designed by people who, what if you don't have a period? What if you've had a cystryxemia? What if you have an IUD? What if you have polycystiovarian syndrome? You can't define your menopause that way. What it represents is the end of your ovarian function. Of the ability to create estradiol and progesterone. Let's go way back to the beginning. When we were in our mother's uterus, so you're in your mom's tummy and you're a fetus and you're growing and you're about five months along, okay, He's five months pregnant. You have the maximum egg supply of your whole life right then and there before you're even born. And they start deteriorating from that minute. By the time we're born, we have one to two million eggs in our ovaries that are active.

Very different than males who have testies that make their genetic material, what we call germ cells in medicine. So the eggs are the female germ cell, the sperm are the male germ cells. They make their stuff fresh every day, from puberty till death, if they're a healthy man. Females have to live with a set egg supply, and then it ages, our ovaries age twice as fast as the rest of our body. This is the fascinating thing to me. So here we go. We go through puberty, and we start ovulating. Every month, you lose about 11,000 eggs in the race to have the one ovulate. And the quality of those eggs is deteriorating every single day because you were born with them. They get hit by X-rays and environmental things, and they're just getting older. They're aging very, very quickly. So by the time we're 30, we're down to 10% of our egg supply. And by the time we're 40, we're down to about 3%. This is why fertility declines as we age, as well as the risk of a chromosomal abnormality like Down syndrome and the others. Because that egg quality, the health of that egg is deteriorating with age.

Menopause represents you're done. The eggs are gone. When that happens, you can no longer ovulate. There's no more eggs left. So there's no more. And in that ovulatory process is where the estradiol is made and then the progesterone after ovulation. What is perimenopause? Okay, so here we are, normal reproductive refractive cycles in a healthy female. Okay? Your ovulation every month is a cycle. So we have the hypothalamus in the brain, right? And then the pituitary sits right below it. Two glands that are part of our endocrine system. The hypothalamus has a little sensor in the blood that is always looking for estrogen, and it's also looking for thyroid hormone and some other stuff. Okay? So it's like, All right, estrogen. We're good, we're good, we're good. We're getting low. It sends a signal to the pituitary gland that says, Hey, tell the ovaries, we need more estrogen. So the pituitary sends out LH and FSH in different pulsital fashions. I'm simplifying this greatly.

Thank God.

It says, Hey, ovaries, let's get an ovulation going. We need some estrogen. So the ovaries are like, Got you, boss. They start looking for that one egg to ovulate, and the cells that line that egg are starting to produce estradiol. More estradiol, more estradiol, more estradiol. It's pumping water around that egg, and then that makes a cyst that pops, the egg comes out, gets caught up by the fallopian tube, blah, blah, blah. And the whole thing starts over again every single month. The second half of the cycle, the progesterone is made in the corpusludium, that little sac left behind where we ovulated from. And that is a very predictable, repeatable pattern for healthy women month after month after month after month after month. It looks like an EKG when you look at the hormone surges every month, which is why we have this phase, we act like this, that phase, we act like that, and we have metabolic changes. We have all changes throughout the month. Parabenopause. The ovary is starting to not respond to those same signals because it can. It's harder. It can, but it needs more juice. So the hypothalamus is like, Hey, I told you we need more estrogen.

And the pituitary is like, I sent the signal, and And the hypothalamus is like, Well, it must not have heard it. Send more. So we get these bigger surges of LH and FSH. And the ovary is like, Okay, it's coming. It's coming. It might be a little delayed. You might skip a period or it's a few days late. But then all of a sudden, All right, we Got it. And the egg comes out. Because you had so much more stimulating hormone to make that happen, we have a bigger surge of estradiol. So what used to be this very predictable EKG month after month after month, now becomes erratic. You get surges of estradiol, much lower drops, progesterone lags quite a bit. It's often quite low. So now you're in the hormonal zone of chaos in perimenopause on your way to those final eggs until you're done. And that perimenopause process could take 7-10 years.

Okay, yeah. I mean, so that's what's interesting. But I want to go back a second because I know that you've said that. I've heard you talk about it. I'm still on the fact that you are at 30 years old, you only have 10 % of your eggs. That is an insane number. That's almost like 90 % of them gone.

But doesn't it make more sense now? Why this is happening to you?

Does that mean, though, at 30 years old, older, then you could be technically in perimenopause because you are losing these eggs. It's like at such a rapid scale?

So average age of menopause is 51 in North America, okay? Normal is still 45 to 55. So 95 % of women will have their final menstrual period between 44 and 54 years old, meaning menopause is 45 to 55, right? Because it's a year later. Okay. And so that 7 to 10 years, let's back that up. So most women will start seeing some disruption in the force between 35 and 45.

You're following me? Yeah, I totally am.

Now, 30 is possible, but that's putting you in a different category, either early or premature menopause. But it's possible.

Okay, so my question, is there a way, is there a natural way to keep your eggs healthier and healthy at a younger age?

Great question. Wouldn't there be a great study on that? But we haven't done it. Now, we know that there are things we can do to chip away at our eggs. Histerectomy, you lose four and a half years off the shelf life of your ovaries. Having one ovary removed, you lose a year and a half. Being African-American or having African genetics, you lose two years. You go through younger, your symptoms are more severe. So if you smoke, you lose about two years. If you have chemotherapy, if you have abdominal surgery, there are multiple things we can do to chip away at the natural shelf life of the ovary. But we have yet to discover things that will... You take twins and they're otherwise healthy. What can one do to push her menopause out? We have no idea. Now, there's studies going on right now looking at medications that can turn off the signaling that causes the ovaries to age, but they're all experimental. We're not there yet, but they're looking at it.

Basically, you're saying there's nothing that you know of as of yet that could- No, and I literally read every study the subject.

We know that there's things you can do to mess it up, but there's no pill, potion, no matter. What anyone says on the internet that will extend the life of those ovaries.

And also what that is interesting, which is interesting is because let's say people have fertility problems, right? And you look at somebody who you think would have no problems, who are super healthy. They appear to look super healthy. They're doing all the right things. They're eating well, they're exercising, they're not smoking, doing drugs, and they're unable to have a child, which means there's some disruption in their air quality. But then you see a crack addict on the street, and they can have 47 kids.

As a OB/GYN resident who was older, who had massive fertility issues and needed lots of drugs and medication and all the things to actually have a baby, I lived with that. Looking at people, making all of these incredible choices and able to conceive, and I couldn't. It was hard. Hard to not be resentful. And then you have your baby, and you eventually get pregnant. For me, I was lucky. But yeah, it's almost like menopause symptoms. You can definitely, if you make poor lifestyle choices, you're not going to have as easy of a menopause. But even people who have the most on-point nutrition exercise, the whole nine yards, can still suffer horribly. So it's not 100 %. Right.

So does it really depend? How much of it is genetics then, of what your experience is, versus lifestyle?

Well, we know that in the age of menopause, it's definitely genetic. There's a huge genetic component. So if your mom went through early, especially if she had premature or early menopause, you're much more likely to have that than her. Now, of course, you get half your DNA from your dad, so that's going to play in a factor, too. But we always ask, How old was your mom? If she knows, when does she go through menopause? If she can figure that out. Most ladies don't know in my mom's generation.

Yeah, I know.

I don't think- We never talked about it.

We never They never clocked it. It was very... I don't know if it was... It wasn't a shameful thing. It was just something that you just never... It's something that was private or you just dealt with on your own in the back.

So my mom was on HR team, and she never came off of it until her 70s. She did really well. She's not doing well now. In her 80s, she's on a walk. She's been on a walker for 10 years, and she's now demented and dealing with dementia. She's a mess. But I remember her being in a dark room and shutting the door. Now, I was one of eight kids, so our house was crazy. But I would lock myself in a dark room, too, if I had that many kids. Yeah, me too. And my dad would blame menopause. It's menopause, it's menopause. And then she got on hormones, and I don't remember that being a thing again.

I have a lot of questions about hormones, but I want to first ask you about a couple of different things, because some of these signs for perimenopause really surprised me. One of them, because I had this last year, people made fun of me, but I had a frozen shoulder. My friends were like, Oh, that's the old person. No. That's the old person. No. Middle-aged woman. Middle-aged woman. And so my sports medicine doctor was like, Oh, yeah, because a lot of middle-aged women get frozen shoulder. I was like, What are you talking about? I thought I got it because I'm a workout fanatic, overused wear and tear.

Well, that may be a part of it. I'd like to think so. But adhesive capsulitis is directly... You are much less likely to develop adhesive capsulitis if you're on HRT.

Okay. I'm not on anything. I've never taken anything. I've never done anything because I have something that most people are... I think a lot of people are fearful, which I want to talk to about. And by the way, HRT is hormone replacement therapy.

Replacement therapy, yeah.

For people who don't know. So to me, that frozen shoulder symptom was Shocking to me that that could be one. So it's because it decreases. So can you explain why?

So here's what your audience should understand. Estrogen does a lot of fabulous things in our body that we take for granted. What? It is a huge A lot of people say, Oh, it's really powerful anti-inflammatory hormone. When it goes away, we lose resilience to a lot of musculoskeletal inflammation and diseases. We see more joint pain, we see arthritis, we see arthritis. There's a The collagen is not as healthy without estrogen. The tendon joint where those things hook up is less elastic. We see more stiffness. I mean, 80% of women will have some form of musculoskeletal syndrome of menopause. For 20% of us, it's going to be their most severe symptom, their most bothersome of all things. This correlation was just made in the last few years. What we learned in modern menopause medicine, which is going to take a whole generation to propagate back through the ranks, is that there are estrogen receptors everywhere in our body, our brains. So cognition issues, mental health changes, our heart palpitations, our lung's asthma, our gut health, the quality of your gut microbiome, how you absorb glucose, everything is related when estrogen goes down. The musculoskevular system, muscles, bones, joints, osteoporosis, the general urinary system, both the bladder, the urethra, the vagina, the vulva, the labia, all of it, terribly affected by the loss of estrogen.

Our ability to sleep, our ability to process alcohol, our ability to be resilient to stress and mental health changes. How our liver, hugely affected. Massive increases in cholesterol with no changes in diet and exercise through the menopause transition. Massive changes in visceral fat for most women. Through the menopause transition, zero changes in nutrition or movement. And we see increasing visceral fat in position.

So when do we know if a symptom or an ailment we're having is because of a lack of estrogen versus just some other type of- Something else. Yeah.

So the thing about perimenopause and menopause is that it's usually a constellation of things. And so we have validated scoring systems that were developed, I think, in Australia, where they look at severity of 12, 15 different symptoms, and then you get a number score. And the higher the score, the more likely it is to be related to your perimenopause. So I have a patient coming in with multiple vague complaints, and she's still having regular periods. So I can't use her cycle to judge where she is in the process. I will do blood work to rule out Hypothyroidism, autoimmune disease, multiple different things, nutrition deficiencies. I want to make sure I have a good baseline on all of that. But if everything else comes back normal, we're not checking hormones in perimenopause. Why? Because it is the zone of hormonal chaos and depends on the minute of the day as to what your levels could be. So a one-time blood test, a one-time urine test, a one-time saliva test is rarely diagnostic for perimenopause. Those of us who do what I do, we don't use hormone levels. They're not helpful. So they'll come back normal 98% of the time.

And so even though you are just completely chaotic, remember, in a regular healthy cycle, the estrogen level is peaking mid-cycle and dropping off. It's low at the beginning, it peaks in its cycle, it drops off, then you have a second small rise, and then the whole process starts over again. So without predictable timing of when the blood is drawn in relation to your cycle, which goes away because it's so chaotic in perimenopause, it's not helpful. So if your doctor is charging you hundreds of dollars for all these hormone tests, I would save your money and find a different provider.

That's interesting because everything goes through where your hormones are.

What do you mean?

I'll tell you. So they'll say, Oh, you have low No testosterone, you have low dysp.

Testosterone is very stable in a woman. So there is a low level of T. That's different. Estrogen goes crazy, progesterone goes crazy. T is stable or down. So that's a good one to check.

Is there some type of correlation with perimenopause and low testosterone? Because I have zero testosterone, and a lot of my friends are the same.

Absolutely. So women have a more steady-state decline in testosterone throughout their life, just like men. So men have about... They peak at 19, and they drift off a little quicker until mid-30s, and then it's a 1% decline until they die. So only about 30% of men have testosterone low meaning function. For women, once we go through menopause, we lose half of our testosterone that's being produced in the ovary. That drops off 50, 75%. We never go to zero. I mean, it's going to be low, but you still the adrenal pathway working to produce some testosterone. But not to say you wouldn't benefit from replacement, but it's not surging and falling throughout the cycle, and it's not chaotic in perimenopause. It's usually low. So that's a reasonable one to check. But I just put people on testosterone. I know they're low. They're in perimenopause, especially if they have no libido.

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Trust me, you will feel incredible. So I wanted to ask you about HRT, hormone replacement therapy. Who's a good candidate? Who is not? Is it a myth that HRT is something you should stay away from if cancer or breast cancer runs in your family? I think there's a lot of fear around it.

So the HRT is hormone replacement therapy or a menopausal hormone therapy, depending what you read. And basically, I You look at it as giving your body back the exact same hormones that you used to make when you were your healthiest to allow these critical processes to continue unfettered as well as they could. What's happening is when we lose our estrogen, we have an acceleration of cardiovascular disease, we have an acceleration of neurodementia, we have an acceleration of osteoporosis and frailty, we All these things skyrocket. Rather than go with this usual path with aging, we have an acceleration of the chronic diseases associated with aging. The disease is specifically affecting women, including autoimmune disease. Women on HRT, especially starting young in their menopause, like early in their menopause, in perimenopause or in the first 10 years of menopause, have a lower all-cause mortality, 50% decrease risk of cardiovascular disease year for a year, and a decrease in cancer.

So where did this come from? Don't eat soy because it's estrogen-producing, right?

Oh, God. Women who have high soy diets have lower breast cancer rates, by the way.

So where did this whole thing... Remember this whole thing about 20 years ago? I've been staying away from soy my entire life because I thought that that was going to kill me.

That was never been proven. Never been proven. Nothing. And now when I go and look at demographic data on women... Sorry, my lips are dark. On women who have naturally high soy diets, like women, who eat edamame all the time, they don't have breast cancer like we do. So here's what happened. We've known for years that women on hormone therapy, as 38% of women were on before the WHI, so about 40% of menopausal women were on HRT, not only for hot flashes and night sweats, but for the protected benefits of decreased osteoporosis, decreased heart disease. We knew that that was the thing, but it was observational data. There was the healthy woman hypothesis, meaning, are women on Is the HRT just healthier because they're wider and more educated and they have more access to health care, and we're just seeing an artifact? Or is this real? The way to prove it is a randomized control trial. Finally, we had a female leader of the National Institutes of Health. She puts this study together. We're so excited. It's a high quality study, thousands and thousands of patients. They're like, Okay, the end result that we're looking for was, is heart disease going to be delayed or stopped with hormone therapy?

They chose the average age of the patient as 63. 63, okay? Yeah. Not 50, the average age of the woman starting hormone therapy. 63. Why? Because they can't run the study forever. It's too expensive. So we're going to start later to see if there's cardiovascular benefit because these women aren't going to have heart attacks until they're in their 70s or 80s. So to save money. And that made sense. They were also tracking multiple factors. They were looking at frailty scores, all stuff. So here we go with this study, and we have two arms. We have women who have uterus and women who don't. Two Two groups, okay? The women with uterus got estrogen and progestogen or placebo, and then the other group got estrogen only because they don't have a uterus or placebo. Here we go. So remember, average age 63. They see that versus placebo, the rate of breast cancer went from 4 out of 1,000 women per year to 5 out of 1,000 women per year on the medication. So that is a 25% increase in relative risk.

Not absolute risk, not absolute risk.

Relative risk. They stopped the study, call a press conference before the paper was published, before any physician could look at it. It was the number one news story, medical news story of 2002. It was on the cover of every single newspaper, ABC, Good Morning, America. Nancy Sniderman got on there. It was like, I took all my patients off. People are throwing their estrogen in the trash. The estrogen-only arm showed a 30% decrease risk of breast cancer. It was the progestagen, which was synthetic. So Then, but what did the headlines say? Estrusion causes breast cancer.

This is so interesting because all of- Relative risk, which is what is your individual risk as a patient, was 0.8%.

Less than 1% per year.

So then you're saying that anybody who's in perimetopause who has deficient hormones should be going on HRT?

They should consider it. They deserve the conversation, and that's what's not happening. The conversation. Not that they would not choose it. It is a shared decision between the patient and her provider. They're being denied access in conversations around it. Doctors are just saying they don't believe in it, like it's Santa Claus, or it's going to kill you, they haven't. All of those findings have been redacted.

Okay? And what is the reason behind it, like this whole it's going to kill you? Because if you're just supplementing your body with what it had before, where is the disconnect? How is that something that is dangerous? Okay.

So say you breast cancer is a healthy cell that has gone through a malignant transformation, through dits to the DNA. If we look at how we're dividing cells and all that. If your breast cancer cell, through the malignant transformation, retains its estrogen receptor, which healthy cells have to have to be healthy.

We need estrogen receptors to make the breast cells do what they do.

If it retains its breast cancer, its estrogen cell, it is now estrogen receptor positive, and they can use that receptor against the cancer cell to stop the breast cancer from growing. If you have an estrogen receptor-positive cancer that we don't want to feed, then you might be getting tamoxifen or a CERM or one of the anti-estrogens or an aromatase inhibitor to fight your breast cancer. That's totally reasonable. So not everyone is a candidate for a hormone therapy. If you have a hormone sensitive cancer anywhere in your body to that particular or to estrogen or progesterone, you're not a candidate. If you have severe liver disease. You're not going to process and break down estrogen the appropriate way. You're not a candidate. If you have unexplained vaginal bleeding, you've not had the ultrasound or workup or biopsies, you're not ready for HRT. So there are patients, all of these are very nuanced conversations. But just because you've had breast cancer does not mean that you are going to be categorically denied hormone therapy.

But what was the first thing you said? If you have hormone... You said something like, if you're somebody that has a hormone issue- Positive cancer? If you have cancer, not to go on it, yes, obviously. But the other, you said cancer, vaginal bleeding, you said enough, and you said- Severe liver disease. Other than those things, you think that anybody else- Those are the big ones.

So family history, no problem. Blood clots, don't do oral estrogen, do transdermal. Again, nuanced conversations, so much misinformation. These poor women are crying to me who are absolutely suicidal at At the end of their rope. They are miserable. And they've been told, Oh, your grandmother had a blood clot. I'm like, What? These people don't know, haven't educated themselves. The system is not educating them.

I agree.

We have so much work to do.

This is why the truth is, most people I know who are getting hormone therapy, they're not going to the regular OB/GYN, a regular doctor.

No, they're going to some back alley place.

They're going to a back alley place. They're going to these randos doctors, these functional medicine yajus, and I don't even know who they are, who are giving them, I don't know what, are these meds? They're going to med spas, really. It's where they're going. They're going to med spas. That's the truth.

Dressed up as functional medicine.

That's where they're going.

And they're going- Masquerading. Oh, and you can get your Botox.

And you can get your Botox. You can get your fill up.

I love Botox.

Listen, I'm just saying is you're going to these second-rate places that are not even a proper medical facility.

So women have a long history in this world of having to go to alternative or back alley places for needed medical services, and they're going to do it. And this is just another example.

So where do people find it? If I went to my OB/D- It's getting better. Yeah, no, no. Well, she'll say, Oh, here, take this. If you do so, are you saying, go to your doctor, your regular normal doctor, try to have an intelligent conversation about hormone therapy? That does include not just estrogen, but you're saying hormone therapy is also testosterone, progesterone, everything, right? Now, are they those subcutaneous shots that people are putting in, or is it like- Maybe, but you can get safe, efficacious, high-quality bioidentical hormone therapy from your local pharmacy with insurance, if that's your jam, for $30 a month. For all the hormones?

No. So testosterone in the US is not FDA approved, and I don't know what the same board is in Canada, but you're going to have to pay out of pocket for testosterone because FDA has not gotten around to improving it for women, even though we have tons of studies to show how helpful it is. For my patients, I usually do an estradiol patch, an oral micronized progesterone, and we do some topical testosterone in the form of a cream, usually from a compounding pharmacy. Right.

That's what my doctor always recommends, these creams. But the creams, from what I understand, because I haven't done any of these, but I want to, they don't do anything. The creams are not very- So you never want to do a progesterone cream with estrogen.

If you do a progesterone, remember, it's a huge molecule and it doesn't absorb- No, that's testosterone. Oh, testosterone. Yeah. I've got a couple of trusted pharmacies that work very closely with the pharmacist, but still, they're not as regulated No one's going in to test to see an account found in pharmacy. This is really what they're putting in there. Were they having a bad day that day? Things coming from Walgreens and the FDA-approved stuff, they go through extensive testing and monitoring. We know 98% of the time, what they say is that it is in it. So that's my preferred source. I don't have that option for testosterone because there's not an FDA-approved option. It's really hard in Texas, where I practice, to get them the men's version. There's a gender ban in Only if you have gender dysphoria or you're transitioning, can you legally get... They'll turn you in.

Wow.

Yeah.

So what about pellets? You can't even do that, right?

Absolutely not. No. No. Pellets I don't want to demonize the pellet. It is simply another compounded form of therapy. There's nothing magical about it. It's not better, it's not safer. It might be more convenient, but you can't take it out once they put it in. You're stuck for three months. And let me tell you, It is the most profitable for your physician. So here's the red flag. You go into your pellet care provider and they only offer you pellets. All we do is pellets.

Run.

Because you are there to make them money. Because if they're not having a logical A little discussion, and they're making you promises like, Girl, you're going to feel so good. I don't make those promises. I'm like, Listen, we're going to try this. We're going to try this. Nothing's better than your 25-year-old ovaries. I can't put those back in you. We are just trying to get you to some level of you can function again, and then we'll figure out the rest.

It's so funny. I'm only laughing.

People who do only pellets are in it for the money and not in it for the patient. And they're not dealing with the side effects. I mean, it's horrible. But if your physician is like, Look, we got pellets, we got patches, we got rings. My patients can't afford pellets. They're hundreds of dollars a month where they can pay 30 or 40 or 50 maybe and go get what they need.

I'm only laughing, not because it's ha-ha funny, but I live in LA, and everyone's running to these particular doctors that I know here. And he's basically banking. He's doing like 100 pellets on these people, poor people. Here's what...

Yeah, guess what about pellets? Mount Biot. They don't make a woman's version of the testosterone pellet. They just put the men's low dose pellet in the women. And so normal physiologic range of a healthy female, you can Google it right now for testosterone, is about 25 to 70. Okay? Pycagrams for a deciliter. Don't worry about that. The Biot literature, I went and signed up on bio-tea because I wanted to see what they were teaching these people. They say, No, no, no. No one's died yet. Let's run them between 150 and 250. Okay? That is a transitioning level. So basically taking these women and turning them into teenage boys. And sure, their libido goes up. But this is not without side effects and risk. And so, no, thank you. I would just want... I try to get my patients 50, 60 in the high normal range. They're very happy, and they're not having the beards and the cholesterol and the side effects and the androgen and the acne and the hair And the... You know, because- See, that's what I'm scared of. These women are coming to me after getting a pellet. I'm drawing their levels.

They're in the three and four hundreds, and I'm like, Girl, what are you doing?

That is why I am scared to go on these things, because it was going to... The guy says to me, because I went to one of my friends who's like, this girl, she's a famous girl. She's like, You have to go see my doctor. He's amazing. He's going to make you feel amazing. So I go. She's like, Yeah, you will. Yeah. But at what cost? Right. And he wanted to put it. He's like, don't worry, we're going to start really low. It's going to be at about 150 whatever amount.

That's double. That is double high normal for me.

And I said to him, my doctor told me it was about my normal level should be at this place, or whatever. He's like, medical doctors don't have the knowledge. They don't know. Okay? And so- Guess who taught him that? Bioty. Right. And this is the best- When the company She who's giving you the medicine to put in the patient is teaching you, there's a problem. Well, and also these pellets are, to your point, $800 a pellet. But obviously, I do not have any pellet. But the thing that really was scary for me is all these side effects. Like, yeah, it doesn't work for... So it's a really 50/50 split. If I talk to 50 % of my friends or people I know who are on it, they like it. If I talk to another 50 %, they gained weight, they got bloated.

It's an anabolic sterile.

Yeah. So this is the question I have for you. Who's a good candidate for these for testosterone? I mean, women, not men. Why are half the women just thriving on it, and then the other half are really just not liking them. Who's a good candidate for?

So were they not liking it because they were overdosed and they were in super physiologic- They've all got the same dose Like, let's say, out of 10 friends- It's all the pellets. They were overdosed. So they don't like it because they're overdosed.

No, no, no. Like 10 of the women, five of them, let's say, loved it. Five of them did not like it.

What were their levels?

All pretty low. Listen, I'm no doctor, but what I noticed were the friends of mine who liked it, they were naturally very thin already, and it wasn't a weight... They didn't gain weight. The ones who didn't like it gained weight because they didn't have as a genetics that was going to keep them at a baseline of being very thin. The thin friends got thinner and more fit. The friends who were a little bit more voluptuous got more voluptuous and didn't like the- So higher levels of testosterone, you also convert more estradiol.

So we start really low and slowly, slowly titrate up. Most of my patients have three indications to put a patient on it. Though the sexual medicine docs think that we have testosterone receptors everywhere in our body as well, and they feel like it's probably helping with cognition, with sleep, and lots of different things. I started it for low muscle mass. My whole life, I've It just was genetically very low muscle. I'm super high risk for fracture and frailty as they get older based on my family history. I'm just fighting that tooth and nail. I lift heavy, I do all the things. I was like, I'm going to add some testosterone. I started really Totally low dose. I never thought I had a libido issue, which is what I put most of my patients on for decreased hypoactive sexual desire disorder. We've rolled out other causes, and it's just down to desire. But I definitely have seen an uptick in that area, and I think I would miss it if it was gone. I never complained before, but I'm just having a little more, and I am having gains. But I am working out like a main...

I am heavy lifting very consistently, much more than I ever did, and then I'm eating much more protein than I did before.

So what number are you taking testosterone as a doctor?

What are you doing? So I'm doing 10 milligrams a day, transdermal.

So that comes up. So your levels would be at what point?

So my last level checked was at 59.

59? So transdermal, Does that mean cream? Cream. Cream. Okay. I've got so many other questions. Okay, so let's talk about exercise. We have to talk about exercise. We test upon it a few times. I'm a big believer in strength training and lifting heavy, especially as you age. I know you talk about that as well in your book. What can you tell us on the research that you've done of how strength training and metapause, or as you age, the importance of those two are together?

Most women peak at their muscle mass at about age 30, and then we have an age-related decline in muscle mass. In order to overcome that natural progression, we have to work harder and harder and harder every single year, or we're just going to have to give As we're living longer than men, we're becoming more and more frail in those years. When you look at long-term care homes, 66% are female, 33% are male, and they're most likely reason a woman is going to be admitted is for dementia. Then for frailty. She can't get off the toilet, she can't lift her legs, she can't get off the floor. If she falls, she can't pick herself up. This is the end result, or she's fallen and broken a bone and can't take I've heard of herself. All of this is pretty much avoidable. But my generation, our generation, I was a cardio queen. I ran. Everything was about to be thin. My whole focus for movement was to be skinny, which I had skinny privilege. I ran marathons. I did all this stuff. Super proud of that. But God, if I could go back and talk to that girl, pick up some freaking weight, because I chipped away at my bone and muscle strength to be thin.

I never looked at nutrition outside of calories. I tried to eat healthy. I didn't know what that was until I went back to school. They didn't teach us that in medical school. Just, don't eat French fries. Okay. But for movement, 2-3 days a week of progressive load resistance training, that scares the hell out of women because they've never done it. They don't know how. But it is so important. So when they did studies on elderly women, which is 65 plus. Okay, I am eight years away from that or nine.

How old are you?

55.

Oh, you look great, though.

So almost 56. So they were Looking at vibratory training, they put them in 10% weighted vests. They had them start lifting. They were doing deadlifts. These women were making major gains in their 70s and 80s for muscle mass and bone strength and osteoporosis. And I'm like, Okay, osteoporosis prevention program, let's go. There's great studies on collagen. There's great studies on wear a weighted vest. I wear one all the time now when I'm walking the dog, when I'm doing housework, when I'm walking on my treadmill, which I do a lot of work on my walking desk, but I put the weighted vest on to do it because I'm cheating the system. I'm just... I'm never going to be obese. That is not in my genetics. It would be a lot of hard. I could do it. It would be a lot of hard work. But for me, it's avoiding the frangalty card. And I want to be 90 and playing on the floor with my grandkids. Yeah, I agree. My great grandkids. I want to be climbing a mountain. I don't want to be on a walker like my mother at 85 who can barely get around.

She can't get in and out of the tub. We're trying to figure out converting her bathroom right now. She sits on the toilet and does a sponge bath. That is the best she can do right now. No, no. So I'm doing squats like nobody's business right now because this is my mother. So these are the things I talk to my patients about. They're not coming in saying, I want a bikini body. Those ships have sailed, and it'd be great. I mean, who doesn't want that? But they're like, Look, I'm looking at my future. I'm looking at my aunts. I'm looking at my mom's. What plan can I get on right now? What habits can I change? What do I need to focus on so that I can be healthy and vibrant as long as possible and not 10 years of horrible morbidity, not be everything in pain, breaking hips. So 50% of women will have an osteoporotic fracture before they die. And men don't do that. Very few men. So it happens, but it's rare. And so I want to be like a man. I want to die like a man. They just die. They live and die.

We have a protracted, horrible last 10 years of our life, completely dependent on others, and that doesn't have to be like that. So this is what we talk about when we talk about menopause care.

And this is what we talk for straight training is an essential piece of it. Do you think that cardio... Because cardio is known to break down muscle mass, right?

I think you need a walk, a brisk walk, a brisk walk with a weighted vest. I stopped running. I stopped going from my knees. I might do a few sprints just to get my VO2 max going, but A few sprints here and there, a little bit of tabana. You don't have to go crazy. But if you're on the couch, get up and walk, baby. That's it.

Just walk for me. The weighted vest is amazing. That's what I talk to my patients.

I love it. Okay. All right. You're walking. Good. Grab a weighted vest. Let's get some hand weights. You have to meet the patients where they are. And saying you need to do three days of resistance training, she's going to run out of my office screaming. But she's like, Hey, I'm walking every day. This used to work for me. It's not working anymore. I measure their muscle mass in clinic. I have an Embody scanner. So I'm doing visceral fat, muscle mass, and I really can look at their insides and be like, Okay, here's the path you're on right now. Here's what we can do to reverse this.

Yeah. I'm a big believer in strength training for your bone density, for the weight of vest is amazing.

And now the cardiovascular data. Women are much more likely to decrease their risk of cardiovascular disease by 20 to 50 % if they strength train.

Yeah, absolutely. More than men.

Like, They can do less strength training and have more benefits than a man.

They can?

They will have more cardiovascular benefits with less work.

Oh, I love that. Okay, let's talk about semiglutide. And semiglutide, the GLP one. Is there a benefit for going on something like that, like the Ozempix of the world, if you are gaining belly fat from menopause or for perimenopause?

So most of my patients, Again, I usually defer to people who have training in obesity medicine. I don't have... Unless my patients are obese, and especially patients with lifelong obesity, and they've done everything, they've done every diet, this is a whole It's more than just mindset for so many patients. But I do think that there's a place. I have a handful of patients on it. We monitor them very closely. Before they leave the office, they know they're coming back every six weeks. We're monitoring their muscle mass. We talk about acceptable muscle mass loss. We talk about protein intake. Going to the long term success of you being on semaglutide, where you're going to end up healthier in the long run, is really dependent on the doctor who gives it to you and how they take care of you and monitor you. Weight loss at any cost is rarely sustainable and rarely better for your health long term.

The reason why I'm even asking you this question is because we're talking so much about muscle mass, right? And lean muscle mass on in your body, it breaks down your... When you lose weight, you are losing fat and muscle.

If you severely calorically restrict half of what you lose is muscle, which is why so many people yo-yo, because muscle is what controls our basal metabolic rate. So you've lost 10 pounds, five of it's muscle. You immediately put on another 10... You go back, but you've gained 10 pounds of fat, and you could never get that muscle back without eating all the protein and doing all the resistance training. So this, Simaglutide is a tool in your toolbox. To be healthy. You cannot ignore the value of nutrition, of movement, doing the right movement. Just getting your shots and not eating is not going to serve you long term.

But also, when you get out... I mean, you're the doctor. I'd like to ask you, once you get off of it, your appetite, I would imagine, rebounds.

If you don't change your habits and you go back to your old habits, you're going to gain the weight back.

How do you change your habits? It's not a habit for... It's not about habits. It's about making... It's turning off your hunger.

I'm seeing something different. So my patients are using that food noise going away, that time that they now have in their day as a time to... We talk about this, how they're going to... This is a multifactorial disease, and we talk about habit changing. Is it successful for everyone? No. But I've seen some beautiful results. And when the patients come in and they've held on to their muscle mass and they see that visceral fat going down, they're watching their cholesterol go down. Even in semaglutide plus HRT, they lose 30% more weight, by the way.

Really?

More fat, yes. Wow. Menopausal women on semaglutide lose X amount. Women on semaglutide plus HRT lose 30% more.

Wow, I'm signing up.

And they're more likely to keep it off because you're more likely to maintain your muscle mass if you have your hormones on board, including estrogen.

That's amazing. I thought estrogen, again, this is a myth, doesn't it make you gain weight? No. Is it more- No. No, it doesn't. Okay.

No.

Because when you're menstruating, you feel like, why do you feel so bloated and- Water.

It's progesterone.

It's progesterone. Okay, gosh.

It makes you retain water. Which is why we blow up when we're pregnant. Is that why? Because the progesterone is so high.

Okay. Does that mean semi-glutide? I've heard there was a correlation between inflammation and that. Does it help with inflammation?

So talking to the obesity medicine specialist, this is not my They feel like because of the lowered insulin levels, which is pro-inflammatory, they don't feel like the semi-glutide is in and of itself lowering inflammation. It's directly acting on certain receptors that will lower inflammation. They feel like because insulin levels are going down and that means your visceral fat's dropping, that those two things combined are lowering inflammation because insulin is a pro-inflammatory hormone.

Well, semaglutide is like an old... It's like the old version. Now everyone's talking about- Tersipotide. Tersipotide. What is the difference between... They were from two- My friends call it iPhone 12 versus iPhone 13. Yeah, that's exactly it.

Patients are having less gastrointestinal side effects, less nausea, less diarrhea, less to a patient on their tersipotide. Now there's so many that are coming out, and they're looking at oral versions as well to make it easier to prescribe. I think it's pretty exciting in the next, and you think you spent money on developing COVID vaccines. These people are spending money because they know people are going to buy it. And so developing the latest and greatest on decreasing side effects and improving efficacy.

Wow. Okay. And then how about in terms of supplementation? Is there any particular supplement that you recommend?

Yeah. So remember, supplements are not a menopause cure. Take that away. Okay. And supplements are meant to supplement a healthy diet. You cannot swallow a handful of pills and expect to have miracles if you don't eat what you're supposed to be eating. Okay. Okay. Most women are not getting enough fiber in their diets. I really advise, try to get your fiber from food, 25 grams per day, push to 30, 35 with your supplement. Most of my patients are deficient in vitamin D, our gut changes, We're protecting our skin from the sun for good reason. There's lots of reasons why we live in climate. Well, it's sunny today in Texas. Massive amounts of vitamin D deficiency, so I am recommending a routine vitamin D. I am recommending a certain bioactive collagen for prevention of osteoporosis. Pretty good studies on that. It's called Fortabone. Turmeric is not for everyone, but I sometimes will recommend turmeric, especially if they're having osteoarthritic pain. It does seem to help with visceral fat. It's a pretty powerful antioxidant anti-inflammatory. If you're doing teas or supplements, just be careful because too much tumor can be liver toxic. It can. To make sure you're staying...

Oh, yeah. Too much of a good thing is not always the best thing. We have some supplements that we take to correct deficiencies. Magnesium is a big one of that. Others, we can take it a little bit higher doses. Fda is to keep you out of a deficiency. Sometimes higher doses of things can be a medicinal, like magnesium. Magnesium alternate has been studied in SSRI-resistant depression. It crosses the blood-brain barrier really well. And a lot of my patients use it for sleep. So then we're looking symptom by symptom to see where we can shore up. I'm iron studies and all stuff on my patients to see where they're decision.

You mentioned magnesium. Which magnesium would you recommend? Because it's very confusing. There's a lot of different magnesium forms.

There's a million. So like milk of magnesium, right? That gives you diarrhea on purpose. It's for constipulatory patient. Depending on the formulation, some of it stays in the gut and it makes everything move quicker. Some goes into the bloodstream but doesn't get to the brain. So that's like glycinate and tarrate. Some cause the blood-brain barrier okay. So most of my patients are on MAG for the neuroprotection, neuro and cognitive benefits or sleep or calm. We're going with the L-theranate is what I'm usually recommending, but probably glycinate is not a bad choice either.

What does that one do? L-theranate is for your brain, basically. Yeah.

And glycinate, it crosses pretty well into the brain as well. It's cheaper, too. So if there's only one manufacturer of L-theranate in the world, I know this because I looked into trying to provide it to my patients, and it was just too expensive And he only farms it out to three or four companies, or I think it's a he. Anyway, so that one's a little more pricey. Which one is it, though? He still has the patent on it. The L-tharinate. No, no, no.

Which company? Which brand?

Oh, Magtean and Neuromag. So Life Extensions is the brand I get it from.

Oh, Life extension. Yes, yes, yes. Got you. Okay, good to know. Wow. Okay, well, listen, thank you for this. I think this is great information. And I love that you... Like I said, I love that you came on this podcast, you guys. The book is called The New Metapoth by Dr. Mary Claire Haver. She is an OB/GYN. Are you accepting patients right now?

Not right now. I'm full. We're expanding our clinic, but right now, I cannot take up more patients.

I don't blame you.

I have to take care of the ones I have in my little...

Sure. Wow. Well, listen, the book is fantastic. It gives a really good overview of all these things that we spoke about, and it goes more in-depth. I'm really just I'm grateful that you came on this podcast. So thank you for being a guest. You're welcome. And where can people find more information about you if they- So we have thepawsalife.

Com is our website. We have free We have free guides. We have free blogs, tons of information, how to talk to your doctor, what test to ask for, et cetera. We are all over social media, Dr. Marie Claire, Dr. Marie Claire Haver, on every channel you can think of, except for Twitter. I just never got around to that one, and then now it's weird. But I'm on Facebook and Instagram and TikTok and YouTube, or the big ones in Pinterest.

All the things. All the things. Thank you. I appreciate you being here. And thank you for just some great, very, very pertinent information. I'm going to send this to all my friends.

Well, thank you.

Thank you. I'll speak to you later. And maybe I'll see you when you come to LA sometime.

Yeah, I'll be heading out there in May, I think. We'll have our people send you the stuff. I think May 11th. We'll be out there for a few days.

You are? Oh, my gosh. I wish I would have known. I would have had this in person. I very rarely do these virtual tools because it's sometimes very technically challenging. Let's put it that way. Yeah. Yeah. But I think we're going to make this work. So thank you again. Okay. And I'll speak with you soon. You're welcome. Okay.

All right. Take care.

Bye.

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