What No One Told You About The Connection of Progesterone, Estrogen, and Hashimoto’s with Dr. Felice Gersh (Part 2)

Starts at 1:53 (so minus appox. 2 minutes to these times)

00:00

Now for progesterone, you mentioned that in menopause,  and a lot of times even like as people transition from  paramenopause to menopause, so often, conventionally, if their doctor even is open to doing hormones, right, after they’ve twisted their arm,  they will get this tiny level of estrogen, and  usually a fairly significant level of progesterone, I mean, it could be anywhere from  100 to sometimes even 200.

00:28

on a fairly low level of estrogen and typically the progesterone conventionally is given the whole time. And again, like we have a uterus but the uterus isn’t functioning, right? People say, well, you don’t need to cycle, right? It’s just gonna be consistent, but there’s a lot of intricacies behind that. Well, absolutely. the uterus, when you give hormones, every organ system in the body is rejuvenated because there are receptors everywhere.

00:57

And  it may not be our target organ, the uterus, to rejuvenate, but it’s part of you. And we can’t exclude it. We can’t put a sign up at the uterine arteries saying, hormones,  no entry allowed. We can’t do that. The hormones, we want to go everywhere and rejuvenate everything. And estradiol, among its many amazing, amazing attributes, is it creates growth factors. And of course, it’s dose-related, like everything.

01:26

If you give, and that’s why they give these tiny doses of estrogen most of the time in terms of  hormone therapy  in women who are in menopause, because they don’t want to grow the uterine lining. And of course it’s dose related. So if you give an adequate amount, remember when you have a period, you’re not growing at that moment the uterine lining, you’re shedding the uterine lining and the estradiol level is very, very low.

01:55

Okay, it’s the lowest, it’s in the menopausal range. Okay, so during the first three days. So  why would we want to replicate that? That’s not appropriate. But they don’t wanna grow the uterine lining because they don’t wanna create bleeding. So they give these tiny doses. Now, progesterone  down regulates the estrogen receptor. So you’re going to reduce the effect of whatever growth factors you’re creating. And they do that so that

02:24

to once again, like prevent the uterine lining from growing. But here’s the problem. In the brain, and there’s other problems which I’m gonna go into when you give it orally, which is a problem. But when you give progesterone all the time and you then reduce these growth factor, you give tiny estrogen, very little growth factors, you give progesterone, it knocks down the receptors, even less effective growth factors, because the estrogen isn’t working properly.

02:52

We’re not working optimally, which is fine in certain situations, but not like every day. This is not appropriate. This is not physiologic. No female ever would have this kind of a hormone scenario ever, ever. So when you do this, you’re not going to get growth factors much in your uterus, but you’re also not going to get growth factors in your brain. Well, what are those? Like brain-derived neurotrophic factor, nerve growth factor.

03:20

healthy rejuvenated neurons, neurogenesis, repair,  maintenance of neurons in your brain and elsewhere, you gotta have growth factors. What about your bones? What about your arteries? You have this vascular endothelial growth factor that creates new, like collateral blood vessels, it heals and you have tissue growth factors. You need growth factors, okay? That’s what repairs, maintains, rejuvenates, replaces dead cells.

03:50

It’s like crazy  and you need to have mitochondrial function. That’s what creates energy, controls the cell cycle, tells old yucky cells that time to die, you know, so you don’t become zombie cells. All of that requires  adequate growth factors. So they’re so intent,  I know they’re well-meaning, but they’re so intent on not having bleeding from the uterus that they basically are  negating so much of the benefits by

04:18

like knocking down the estrogen receptors every single day  and like giving such a tiny dose of estrogen. So you’re not getting like, you know, the dose effect of doing good things. But here’s like a crazy blessing curse. It takes in most women a whiff of estrogen to reduce night sweats and hot flashes. And it doesn’t take that much to slow bone loss, which is great. But if you really want to get optimization, it’s dose related. It’s like,

04:48

You could eat a little food and maybe you won’t die, you’re not gonna be,  like a little bit are gonna grow a lot. You’re gonna grow your muscles if you have like  a milligram of protein. It’s like everything is dose related. We have to do,  and it’s rhythm related because the  human body is designed to have growth and then not growth. And  you’re turning, and you’re not only just doing what I’ve mentioned before,

05:16

but there are tumor suppressor genes that are turned on and off by having the higher and the lower levels  of these hormones. So the  human female menstrual cycle is anti-cancer. It actually upregulates tumor suppressor genes, but this is dose related. It’s dose related, okay?  And so we just  have to get over this bleeding after menopause

05:45

is crazy. Bleeding after menopause is unacceptable. Bleeding after menopause is unnatural. Well, duh, so is giving hormones. So is taking out cataracts. So is replacing a knee joint. mean, everything we do in medicine- So is giving it a tooth filling, right? Right, how about getting a dental implant? mean, everything we do in medicine, every drug is unnatural. Right. Get over it. If you want natural, if you want  natural-

06:15

you know, then just do, and I’m not against a lot of this, you know, do healthy lifestyle and don’t do anything else. But if you want to have some intervention, you break a leg,  want, you know, putting a cast on is not natural.  And everything we do is some, you know, even taking a multivitamin, that’s an extra, you know, that’s not right. Right, right. I love that you say that because I think when people look at, you know,

06:41

people like you and I, and there are people who do more integrative things. They expect us to only say, like even thyroid medicine, I always talk about like thyroid medicine is essential, right? As you say, but I think sometimes people are surprised because they’re like, well, don’t you want to fix it with food? And it’s like, well,  yes, but if you don’t have enough, like you can’t,  I mean, fix it. You know, there are some things that food is essential, but there, you can’t do everything.

07:08

with an apple. mean, I love apple, can’t, know, everything is not fixable with  food. You know, there are some times, you know, we have to do more than food and I love modern science when it’s applied appropriately, right? You so that’s like,  I’m not like, you know, anti-science, I’m pro-science. I’m the  most evidence-based doctor I know. You know, everything is science-based, cellular mechanisms and how it is and so on. But here’s another thing that everyone needs to know.

07:38

The most common way to take progesterone in the US is you swallow it. Now this has problems. when they- Tell us because I think that most providers say, well, the studies show that this is the only way to protect your uterus and all the things. nope, nope. Okay, when you first, if you go back history of medicine, progesterone, when they first developed

08:07

how to make bioidentical progesterone. If you swallowed it, it was eaten up by the stomach acid.  Goodbye. It didn’t go anywhere, because it just got digested.  It’s like a protein.  So it just got digested. It didn’t get into the body at all.  Now they created this system, like in the  1980s, called micronization. That’s why they call it micronized progesterone, which allows it

08:36

to not get eaten up by the stomach acid. So it doesn’t just poof, there it’s gone, you know, in the stomach. So it gets through the stomach, but where does it get? It gets into the intestine and then it goes to the liver. And  somewhat this happens in the intestines and  mostly it happens in the liver. Now the liver is an organ of transformation. They even have a name for it, biotransformation. It changes one  molecule

09:05

into another for the purpose of creating new proteins and different products like sex hormone binding globulin.  And  it also takes old molecules and things and toxins that get into the body to get rid of them. That’s what we call detoxification. So we have these different pathways in the liver, conjugation, sulfation, glucuronidation, methylation, all these different pathways to change

09:33

molecules from one thing to another. That’s why we do not wish, and most doctors don’t, although some still do, but don’t give  estradiol orally because it gets transformed by the liver from, if you give estradiol,  largely into  estrone. So it’s a different form of estrogen, E1. And we want E2.  Estrone is an evil, but we don’t want a whole bunch of it coming in.

10:03

because it binds differently and has different effects on the receptors. We want E2, but if you swallow it, you get  some E2, but you get a lot of E1.  So with the same for progesterone, when you swallow progesterone, it ends up in the liver and the liver transforms 80 to 90 % of the progesterone into other stuff  called metabolites. So the amount of actual progesterone that gets into the blood

10:33

is actually quite low. It’s enough to lower  the risk of having  uterine cancer, which by the way has never been proven from bioidentical estradiol. It’s only been shown from what? From premarin, conjugated equine estrogens, which go into the body as other stuff, but primarily in terms of human estrogen, as estrone.  Estrone binds primarily to the

11:02

alpha receptor and the alpha receptor is the one that creates growth factors, which are good when it’s controlled. But uncontrolled growth or proliferation is bad. Everything should be controlled, right? We don’t want uncontrolled proliferation. Of course, that’s what cancer is. So, but if you have an environment like in an old inflamed lady, you know, who’s not healthy, and then you throw in this Premarin, which is what they did.

11:29

in the old days, you know, they would just give it to everyone and whether they were healthy or not healthy, and it was premon. So you ended up with a lot of  alpha  binding agonists, and that creates a lot of  growth and it can be uncontrolled. So when you have an environment of chronic inflammation and uncontrolled proliferation, that’s the ticket to forming cancer. Okay? That’s a bad thing. Okay, but you know, and that underlies estrogen,

11:59

and breast cancer that you have a lot of inflammation in the body. The body upregulates the enzyme aromatase, the fat tissue, and you have too much,  most women in menopause have too much adipose tissue. And then they make estrone, which is made from the androgens coming from the adrenal gland. Estrone has a different effect than estradiol. It has more pro-inflammation, pro-proliferative effect.

12:28

So we don’t blame estradiol for what estrone does combined with inflammation.  But the bottom line is you don’t want to take oral estrogens. And when you take progesterone, 80 to 90 % of it is converted into other stuff.  And you get too little progesterone, but enough if you give a low enough dose of estrogen that you will lower  the risk of uterine cancer, which has never been shown to occur from estradiol either is what the takeaway to.

12:58

But when you take the oral progesterone, the other stuff that’s made in the liver is good, but too much of it. You mostly make another molecule called allopregnanolone. Allopregnanolone is a metabolite of progesterone. It comes from progesterone. It’s supposed to come from progesterone. It’s even made in the brain, okay? And it has many good effects. It’s actually also anti-anxiety, antidepressant. It’s  neuroprotectant.

13:27

and it activates the GABA-A receptor.  GABA is the inhibitory neurotransmitter that creates sedation and sleep and calmness.  But too much of a good thing is a bad thing. When you take progesterone orally,  get  even at 100 milligrams, you get on average two and a half times the amount of  allopregnenolone that you would

13:55

ever have in a human female at the peak of the luteal phase. So you two and a half times as much. You’re doing that every night. What is that doing? It’s  activating the GABA-A receptor too much. And we have rat data. We don’t have long-term human data. No one did the study. But in rats, if you do this every night, what happens to the rat brain? The rat gets dementia.  The rat gets dementia.  And there is some data in humans that

14:25

it can lower the ability to form  memories. So it’s like taking a tranquilizer to your brain  every single night. And long-term, that is potentially harmful to the brain.  And we only have rat studies, but you know what? We don’t have any safety data. And by the way,  allopregnanolone is a pharmaceutical. A version of it  is…

14:52

actually a drug used for postpartum depression. And allopregnanolone as a drug is a scheduled for controlled substance, just like Valium  or Xanax. has, wow, it’s a controlled substance. you know, the DEA, the Drug Administration keeps track of it and it’s a special kind of prescription and it has all the same warnings on it like Valium. Okay, so it’s like we’re drugging. This is not recognized.

15:21

We’re literally drugging. We’re drugging every woman every night. Now some of them say, I love it. I sleep so well. Yes, you’re being drugged. That’s not a normal sleep. It’s  not exactly the same mechanism, but it’s a comparable. Like  the drugs that are used as tranquilizers like Valium and Ambien and sleeping pills,  they also activate the GABA receptors.

15:48

They don’t work in exactly the same spot, but  same effect. And it’s activating GABA and it’s like sedating. Now, you we know that if you take Valium every single night, every single night, it actually isn’t good for your brain. Now we feel like we don’t have long-term human data with, but here’s the thing, it’s not natural. You’re in 200 milligrams.

16:13

And a lot of, I’ve seen a lot of women get it every night, 200. Yeah, 200 is so common. see it all the time.  And they get five times on  average, five times the maximum amount of allopregnanolone they would  ever naturally have in their body during the luteal phase peak. So this is not, I’m a simple thinker.  I want to give things that are aligned with when we’re optimally healthy, like at 21.

16:40

That’s no human female ever has levels like this on a regular basis. It’s not natural. So  do you do  topical progesterone or vaginal?  Yes, and sometimes for the reverse. so progesterone, there’s no progesterone patches. No, they do have  progestins. That’s in a patch. We don’t want progesterone. OK, progesterone is a large molecule.

17:08

It’s really hard to absorb it through the skin. It can get into the skin, but we have unfortunately  no published data on efficacy and safety. Now, sometimes I use it, but people, you know, I tell them,  we have no published data, so we need to really watch you. We need to check levels. We need to see what happens with your cycles. If there’s any question, we’ll get ultrasounds. We’ll even do uterine biopsies because we don’t have any safety data.

17:36

But we do know that you can get it in, but it’s a big molecule, it’s hard to get in. We have a ton  of data on vaginal progesterone. It’s used  all the time. There’s so much data published. It’s used all the time on Pregnancy a lot of times, I remember having those suppositories. In all the IVF clinics,  all of them, they use vaginal progesterone. Sometimes they use shots, but they’ve gotten away from shots.

18:06

Because now we have data, when you give it vaginally, it not only gets absorbed well into the blood, and it eventually goes to the liver, but not  like a direct route. It gets there from the bloodstream, like it’s supposed to go there. And so some will be converted to allopregnanolone  as is appropriate, not like this crazy  surge of allopregnanolone when you swallow it. But when you take it vaginally, it’s used in all the IVF clinics, it’s used in early pregnancy loss cases.

18:35

We have a ton of data and it concentrates in the uterine lining, initially gets well absorbed, and it helps to convert the uterine lining to what’s called complete secretory conversion. And that’s in infertility cases, it’s  to create the perfect lining for receiving an embryo for implantation. But if you’re in menopause, that’s not the issue, but it makes the uterine lining perfect for the perfect period.

19:04

so that you don’t have lots of cramps, you don’t have prolonged bleeding, you don’t have heavy bleeding, because bleeding is not  the goal of having a period. That is a side issue. The goal is to eliminate the lining. But if you don’t have complete secretory conversion, it’s gonna come out more in dribs and drabs, and you’re gonna have more bleeding along the way. takes longer. The uterine lining,  in order to get it out, the uterus becomes more inflamed. You have more contractions, you have more…

19:33

pain, you know, and who wants that?  And so  by giving the progesterone and getting complete secretory conversion, you’re going to have a shorter, easier little bleed. And here’s the thing, we need to look at the uterus in menopause  as a  monitor of success, of function. So if you can create a perfect little period every month,

20:02

What does that imply?  It implies that you’re creating perfect scenarios in all your organ systems for growth, for  restoration. And there’s even some data that when you shed the uterine lining elsewhere in the body, and they did some biopsies in the breast, you’re shedding crappy cells elsewhere.  So think of it as when you bleed, it’s a body purge. Now we don’t have.

20:29

We don’t have biopsies everywhere to prove everything, but we have some in the breast that show that the breast actually eliminates like crappy old breast cells. We want to perch the body of old yucky senescent cells that can create inflammation, potentially turn into a cancer cell.  think of it as, instead of thinking of it as what was called when I was a kid, I can’t believe it, they called the period the curse. They say, are you on the curse? The curse, okay.

20:58

We have to not think of it that way. We think of it as a blessing. It shows that you’re working, that you have proper hormone function response.  If you’re taking a little bit of  transdermal estradiol, you’re not getting optimal effect. You’re getting some benefit. I don’t want to say there’s no benefit. There is some benefit, but it depends on what your goals are. If your goal is optimizing healthy aging, probably you’re not going to accomplish that, but you’re going to have some benefit.

21:27

But I’m really worried about this every night oral progesterone. There is some data, not enough, but to suggest that doing this may increase long-term dementia. I mean, that is not a little thing. That we may be increasing dementia in women by giving them this oral progesterone every night  because you’re down-regulating the

21:55

the growth factors in the brain that makes the brain functional and healthy. And then you’re drugging, and simultaneously you’re drugging the brain with this GABA receptor booster that is creating memory formation problems.  I’m really worried about this. Of course we need more data, but in the absence of proof of safety,  I say don’t do it. Yeah, I know that makes so much sense.

22:23

And you know, what’s also really interesting, cause I think so many people don’t realize that, but it’s when you say, you know, it’s I mean, the oral progesterone in general every day, but then also that the cycling of it, because that to so many people is like, you want me to have a period when I’m 65 or 70? like that’s weird, but I love how how I want you to poop? You know what? There’s stuff we do. Yeah, I know, but this is because I think what happens, and I really want to drive this point home is that,

22:53

And it makes sense that why  conventional providers prescribe things in a way so people don’t bleed because people say they don’t want to. But what happens is, and I have many clients like this where  if they’re bleeding, they’re like, there’s something wrong. Oh my gosh, I’m bleeding. Right? Because we think I’m bleeding, you know?  And  so  normalizing and saying, Hey, you can cycle your progesterone in menopause. You’re going to get, it’s a healthier way to be. It’s a more natural way to be. It’s actually more beneficial for you. And then you can.

23:22

actually be able to do a slightly higher estrogen dose because if you do build up that lining, you have the progesterone, you then shed it. So you’re not  getting into that same issue. But I think what’s also really interesting is that there’s many people who their whole lives may have had, you know, quote unquote bad periods, right? So maybe they had PCOS or maybe they had,  you know, who knows all sorts of different things, right? And they may have had a lot of cramps or very long bleeding, or maybe they had a lot of PMS. And so

23:52

Or maybe they got headaches, right? And so they always think, oh my gosh, like, it’s such a blessing, quote unquote, right, not to have a period. But I think what you’re saying is that  when the whole month is supported the right way, you’re not going to have the imbalances that you may have had beforehand that would cause some of these negative issues around the period. Would you agree? Absolutely. In fact, in the reproductive years,

24:17

The menstrual cycle officially is recognized as a vital sign of female health. So if  anything is wrong with the menstrual cycle during the reproductive years, they’re irregular, they’re too heavy, they’re too painful, you have PMS.  All of those are signs of dysfunction and they should be recognized as such and then addressed and not addressed with birth control pills in the majority of cases.

24:47

to just take the ovaries offline and shut them down, but rather it’s a sign, you know, it’s a problem in itself, like a symptom, but it’s a symptom of something else. Like maybe you are inflamed, maybe you have nutrient deficiencies, you know, maybe you have sleep disturbances, know, circadian rhythm dysfunction. The menstrual cycle is a reflection of the health of the woman. And when anything is wrong with it,

25:15

It’s a sign that something is wrong in that  woman and it should be evaluated and addressed as best as possible. They could be magnesium deficient. You know, there’s a whole host of things that go into play. If they’re inflamed, which now is coming to be the unfortunate standard is that people are inflamed and they could be  old because you lose hormones and then you lose nutrients because you don’t have good digestion. But young people eat a terrible diet.

25:45

They’re exposed to a lot of chemical toxins,  endocrine disruptors, and so on. they become inflamed, and inflammation  lowers the production of progesterone.  And so many of those women, they actually have insufficient progesterone production. They do not get complete secretory transformation of their uterine lining, so it’s not being expelled, eliminated properly.

26:13

each time they get a period. And so they have more inflammation, more prostaglandins, more pain, more cramping.  It’s not coming out in a good like,  we’ll say cohesive plan, know, in dribs and drabs. you have more blood loss, it lasts longer. And you you have inflammation which affects the ovaries and they’re not functioning right. You don’t have regular ovulation, you have irregular cycles.

26:43

There’s a whole host of things, but just pretending none of that is happening and then putting them on birth control pills, know, maybe that’s essential  now and again, but ignoring that this is a sign things are wrong and that you need to address, this is where lifestyle becomes critical. You know, are they fit? Are they eating the right foods? What’s their stress? What’s their… Oxycetes. mean, this is like a red flag, you know? And so women who have that in the past,

27:12

It’s like, don’t think that that means that you should go on these crazy non-physiologic hormone regimens when you do get into menopause because  it’s time to address all these things now. That are late than never. You Exactly. You want to like take a look at like, look at, that’s why we, I love data, you know? Let’s look at all these things. You know, we can’t fix what we don’t even know is broken. So we’d want to do evaluations. And now, because like going on these hormone regimens, of

27:41

Of course, we don’t have long-term data. We don’t have safety data. We don’t have outcomes data. This is a completely concocted regimen that never exists in nature. So why would we even think that that makes sense? This is what I think of it. It’s the equivalency, kinda, to when we thought we could do better with food. We could make food that never spoils. We could eat a creepy in a hundred years. The failed experiment of ultra-processed food

28:10

Let’s not replicate that in its own sort of  different but comparable way by creating hormone regimens that never exist in nature, that are not aligned with our metabolic and physiologic processes, the way genes are expressed, the way hormone receptors are expressed. Let’s not try to create a new scenario for hormones that never exist and that go against nature and physiology. Let’s not do

28:39

The mistake we did with food, have female hormones.  And  use organic natural food and human identical  levels and regimens.  Regimens in a way that align with your actual cycle, even if you don’t hide one, but align it as if you had one.  And recreate what is similar, not identical, to what you had when you were at your optimal health.

29:07

Yeah, absolutely. Now, Dr. Gersh, what if someone is listening now and say that maybe they are 65, you know, maybe even 70, and, you know, maybe like so many people, weren’t offered hormones 10 years ago, 15 years ago, right? And they’re listening to you talk and they’re listening to this conversation and they’re realizing, oh my gosh, I have seen such a decline since.

29:34

I was 52 and went into menopause. This is where my autoimmune flared. This is when my joints went offline. This is where I, you know, they see all the negatives. Is there something that those people can do? Because there is this thought, I don’t know if that’s correct or not, but a lot of people say, you know, if you don’t start hormones right on in menopause or before, then well, you were out of luck. can someone do something at 70? Well, of course, sad to say, you know, we have limited clinical data.

30:04

We do have some signs, but let’s say, where did that premise come from?  where that, you know, you’re too old. It came from really the Women’s Health Initiative and the HER study, which is like the Women’s Health Initiative using women who’ve had previous heart attacks or strokes. So if you give PremPro, if you give  a conjugated equine, you know, that’s from the horse, you know, those estrogens,

30:31

combined with Madroxyprogesterone acetate, which is not progesterone,  and it has a lot of harm. If you give that to older women, and in the women’s health initiative, it really started not at age 60, but at age 70. Those women had higher rates of like strokes and blood clots and possible dementia, but that’s based on probably vascular, know, blood clots, like little mini strokes from blood clots.

31:01

course, I would never give that.  I agree. Now, it’s also based on one monkey study from a long time ago that was where they gave old monkeys PremPro, the same thing. So their monkeys are primates, so they had the same bad reaction. Well, what about if you give a different type of hormone? We have very, very limited data. We have the ELITE study, which did a study, unfortunately they used…

31:27

a milligram of oral estradiol and then a low dose of a progesterone vaginal gel. But in that study anyway, they studied two groups of women close to menopause and over 10 years out from menopause. And just focusing on the 10 year plus out group, they’re older women, what did it show? No harm. It showed, it went for a few years, it showed no harm. They did not have an excess of any bad thing happen to them, nothing.

31:57

And they used oral, which isn’t even the one that you write down. Exactly, exactly. And it still showed  no harm. So that’s what we got. We have Dr. Dale Bredesen, who’s using transdermal estradiol and  some form of progesterone in women who have cognitive impairment and Alzheimer’s, and they’re not having excessive, any bad things happening either. So we do have some data.

32:25

Now, is earlier start better than later start? Absolutely. Can there be some degradation of the receptors for estrogen and progesterone that, you know, like use it or lose it? Like maybe, you know, but here we have women who have been on like the drug DepoProvera. That’s a shot that shuts down the ovaries. It’s used, not by me, but it’s been used for a long time and it’s for contraceptive.

32:54

Okay, but it’s a  long acting medroxyprogesterone acetate shot. Well, that shuts down estrogen production and women can be on that for 10 years or more and then they can have their own hormones back and they still work. I’m  anti that drug, but the body. Exactly.  have cases where women have been induced by drugs to not have any estrogen in their bodies for

33:24

decade or more, like even longer. And yet  they don’t have a heart attack or a stroke when you give them back their hormones, right? And their hormones come back again.  this is kind of crazy. We don’t have enough data. I agree, but we also have no mechanism for harm from, except maybe one. And this is hypothetical. This never been shown. And that is that if you have a, but this can apply to a younger woman too.

33:52

If you have high levels of inflammation, high levels of inflammation, and then you give  estrogen the enzyme that makes nitric oxide, that really important gas, in an inflammatory environment, that enzyme can become, the word is uncoupled. And instead of making the wonderful nitric oxide, it makes some nitric oxide, but it also makes some toxic bad stuff called superoxide.

34:20

which can combine with the nitric oxide to make even more poisonous peroxynitrides. This is what actually happens in our immune cells when it’s trying, when the immune cells are trying to kill pathogens like bacteria invading, they make poisons.  Our immune cells are so amazing. They make poisons to kill the invading pathogens. But this same mechanism  that is occurring with the white blood cells when they have inflammation and they’re trying to kill pathogens,

34:50

by making these toxic chemicals like peroxy nitrates can potentially, hypothetically, occur in our arteries  because we’re in a very inflamed environment and that same uncoupled  pathway goes down. So what I recommend, but we have no proof of this. We have none. We have  zero data. Yeah, you’re just thinking every potential possibility.  Worst case scenario. So what can you do?

35:18

Well, you lower, do everything  because you’d want to do this anyway. Because if those women have uncoupled nitric oxide, thin they see enzyme that makes nitro oxide, they’re still going to have it whether you give them the estrogen or not. Right. It’s not going to hurt them.  They’re going to have, yeah, they’re going to be inflamed and they’re going to have harm to their vascular system and brain and heart. So you do everything to increase  anti-inflammatory status. You want to give antioxidant diet. You want to do exercise. You want to do.

35:47

all the lifestyle things simultaneously that lower inflammation. You can give extra vitamin C that also helps to recouple the B complex vitamins. You want to give  every kind of food that has polyphenols, fiber to rejuvenate and restore the gut microbiome. So you want to do all the lifestyle things that can have a dramatic benefit. And you can also give supplements that increase proper

36:16

production of nitric oxide. We have companies that have made some very good supplements that can improve nitric oxide. You eat nitrate vegetables. My personal favorites are beets, bok choy, spinach, and kale. And  then in those cases, maybe we do start  low. Very low. Just to get the receptors back on board and to get things going. And we can monitor. We can look at vascular health.

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we can look at inflammatory markers. It’s not like we’re working in a void. So  I have to say that this is off-label. We don’t have long-term data. We have some data. We have some data showing no harm,  like in the elite study and some of the other doctors who have done other work and studies that have been published. But of course,  any woman who wants to start on hormones who’s older needs to know all these things and accept that we’re in

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situation that we often are in medicine, the answer is sometimes we just don’t know. So we make our best choices based on what we do know and the science, and it’s not illegal. That’s important. It’s not illegal to prescribe hormones to a woman who is over 60 and hasn’t been on hormones. It’s definitely not illegal. It’s not typical.  It is not standard of care. It is not illegal. And if a woman says,

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I have weighed all the pros and cons as best I can and I want to go on hormones because I was cheated, literally cheated out of hormones by misinformed doctors who said that they’re bad for me and now they’re telling me they’re good for me but now I’m too old. But I want to go on them anyway. I think it’s if you give all the information, you give informed consent and a woman says, know  what, I want to go on them, then

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I’m for it. Now, what do we know definitely is improved at any age? That the receptors are not dead. They don’t go into any bad state. The vagina, oh my God, they will prescribe everyone. The menopause society is strong advocates. Give  vaginal estrogen or it could be DHEA. That’s another alternative, but give the vaginal hormones to women at  any age. They could be 95.

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because it improves genitourinary health. You know, it improves bladder health, vaginal health, and that is health. So if you can give hormones to  one organ system, the genitourinary system, and have  benefit at any age, why would I think that that’s the only organ system that can benefit at any age? That’s nonsense. So we do have that research.  And if you give vaginal estrogen,

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I mean, wouldn’t it still absorb into the bloodstream? Well, yes, if you gave enough, but the typical- these are super low dose. Oh my gosh, they’re so super low dose. Like the estrogen vaginal creams, the dose is 0.1 milligram.  So,  it’s usually given twice a week, just twice a week. So 0.1 milligram, usually one gram, but of that, but it’s so little, twice a week. No, you get no systemic effect at all.

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None, know, just, mean,  marginal if any, usually none. So that’s why it’s not, it’s often given even in situations where people think they shouldn’t be on hormones, but maybe they should anyway. Then, you know, there’s so much  misunderstanding about hormones that is crazy. But in terms of the vaginal ones, it’s a local effect. But here’s the thing,  like the really takeaway is it doesn’t matter how old you are, how long you’ve been out in menopause, whether you ever were on hormones or not, they still create

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benefit at any age, even at tiny doses, with no harm. So why would I think that if I gave systemic levels, it’s suddenly going to create terrible harms? We did not see that even in the Women’s Health Initiative until women were over 70, and that was with ridiculous drug, PremPro. So of course, we need more data.

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We need more research. That’s one of my missions now is to try to get studies, to get clinical data, because this is how you actually make change on a massive scale, because otherwise we have it’s minutia scale. You really, you know, have a few random, not random, but a few doctors here and there that are willing to look at the science even without all these big clinical studies or limited clinical studies and say, this isn’t

41:08

not, this is like not making sense scientifically. Why would there be this arbitrary like change? Like why is it at 60? Why is it not like based on individual criteria? Like why are you making these blanket statements anyway? know? So like we look at each person, it’s personalized, individualized, precision medicine and as best we can rather than just making blanket statements and having random cutoff times. You know, so, you know, but

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that it’s not happening on any significant scale.  we have, won’t and it won’t until we get clinical studies that show safety and efficacy. And I’m desperate to get that to happen because otherwise we’re stalled because no medical societies will  ever change their position statements.  And when they don’t change, the massive doctor practitioner group will not change their practice.

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So it’s still a  big problem that I’m trying to address where it needs to be addressed, which is getting the clinical studies. But for those of us who live now, we can’t just wait for the clinical studies. We have to make decisions. Then it becomes a very individualized decision. And we try to make it based on the best data we actually do have available. Yeah. Dr. Gersh, I love your dedication to all of this, to your work, your knowledge. I mean, you are like,

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human encyclopedia  when it comes to hormones. I love it so much. I can talk to you for literally five more hours.  And we will don’t have to definitely do more for sure. But in the meantime, for everyone listening who wants to find out more about you, who may want to connect with you, contact you, follow you, where can they do all that?  Well, I am in my office right now. This is actually a converted exam room. have an exam table right over there.

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So I have a medical practice, brick and mortar building. I have a real office  and it’s in Southern California in the city of Irvine and it’s called the Integrative Medical Group of Irvine.  I can also do telemedicine.  And  so I’m a practicing in the trenches doctor.  I also have a pretty  active YouTube channel and Instagram live that I try to do on a regular basis. And we  post a lot of things on the Instagram.

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And I have written three books. hope to write a lot more  like you mentioned. And  that’s basically it. And I’m here to try to make a difference  one woman at a time. And hopefully it’ll be more in a population scale as we move forward. Yeah. Well, all of your lecturing and all of your appearances is definitely creating that and people are finding out more and more. thank you so much for all the work that you do. We’ll put all your information again in the show notes  for everyone to see.

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I so appreciate you and all this  and I can’t wait to chat more really soon. Me too.