Birth Control Masterclass: The Mash-Up Every Woman Needs to Hear

Transcript

So another question that I have a lot of women ask me, they say, okay, well, if I take a progesterone only IUD in my
40s, then that doesn’t necessarily mean that I need oral progesterone. Like, I’m going to be fine. And I don’t find
that’s always the case. Would you agree?
Yes. Not at all. So they’re going to get very little systemic progesterone from that. It’s going to be a local effect in the
uterus. So if they need progesterone for mood and sleep and things like that, it has to be taken orally and more
systemic. So we use bioidentical progesterone. And a lot of women that have IUDs in place, that progestin there does
kind of get rid of the menstrual cycles, and it does treat endometriosis and keep it quiescent in the pelvis, but it’s not
going to help you sleep. It’s not up here. It’s not going to help you sleep or affect your mood like progesterone does,
which is super important in perimenopausal women in their 40s, women really do benefit from having bleeding
control with the IUD and progesterone for sleep and mood and then testosterone therapy. All of that is along with
thyroid is very beneficial. The perimenopause is a tough place. Menopause is easy, right? Menopause is simple. You
just replace what’s gone. But in the perimenopause, there’s such wide fluctuations in estrogen and progesterone and
such irregularity and unpredictability that it’s nice to be able to use an IUD and not worry about bleeding and then be
able to use progesterone orally for sleep and mood and thyroid for all the benefits in testosterone. If you’re not
controlling bleeding with an IUD, then the perimenopause is a real problem. There’s a lot of irregular bleeding and
issues that go on there. So we just try to get to menopause because menopause is easy. Perimenopause is this
difficult bridge you have to cross before you finally get to menopause.
You get to the other side.
Yes. Yeah. No more fluctuation.
No more fluctuation. So yeah, so I have a lot of women who ask me, you know, in their 40s. Well, what, you know,
they don’t want to do IVs, right? They’re like, well, IUD, I don’t want to do, but I need something for birth control. And
so their go to is is birth control. But I think it is important for people to realize if you do synthetic progestin, synthetic
estrogen, you’re at a much higher risk of clots of, of lots of side effects. And so what do you tell women who, let’s say
a 45 year old comes to you and says, you know, I’m just not going to do an IUD, and I really want something for birth
control. Then what do you tell those women?

Yeah. So there’s not a lot of really good options, things like Nexplanon and Depo-Provera. Those are for young people
who can’t remember to take their pills. There’s too many side effects and issues. I don’t use those in women in their
40s getting a tubal ligation or really and truly a tubal removal is what people need nowadays. Salpingectomy or a
vasectomy are going to be much better options than getting on a quote unquote birth control pill. Now there are
some new birth control pills out. There’s a new one out called Nextstellis that has a different estrogen. For all the
years since birth control pills have been created, they’ve always used ethinyl estradiol. So it’s not 17 beta estradiol
like your ovaries made. It’s a synthetic different estrogen. So on a side note, if you’re doing a 17 beta estradiol test
on a patient who’s on birth control, it’s going to be zero. Their estrogen level would be zero because ethinyl estradiol
is a totally different compound than 17 beta estradiol. But there’s a new birth control pill out that uses a different
estrogen that is actually supposedly metabolized in the intestine before it gets to the liver.
For first pass metabolism, it’s called nextstellis. And I have been using it in some patients who have had really high
Shbg from the birth control pills. We haven’t seen as high of Shbg elevation with this particular pill. And the claims
from the company are that there’s no increased risk of DVT and PE. I’ve looked at their data. It’s not wonderful but it’s
pretty good. So there is a new birth control pill that doesn’t have first pass liver metabolism of the estrogen. It’s still
got first pass liver metabolism of the synthetic progestin. So it’s still a better option. So for some people I’ll transition
into that pill as they get a little bit older. If you’re going to do testosterone therapy and the Shbg is 150 or 200 or
through the roof, you really just have to keep going up on the testosterone until their free testosterone is to the point
where they feel better. But you have to be willing to not be so concerned about a total testosterone level that looks
too high.
Do you see in those women, they have more side effects of testosterone therapy because you’re pushing their
testosterone levels higher?
Not really, because that’s really all a function of the free testosterone. If the testosterone is not really bioavailable,
then it’s not going to cause a side effect. The side effects are more with the free. And if their Shbg is 150 or 200,
these poor ladies are not going to feel any testosterone you give them until they hit 400 on their total. Yeah. And
which, you know, that scares people to see a 400 on a total testosterone of a woman. But the reality of it is she’s not
having acne. She’s not having hair growth. She’s not having any side effects. All of that is bound in the bloodstream
to these proteins. And it’s not available to go into her cells. So sex hormone binding globulin is a big protein.
Testosterone is a tiny little molecule and it sticks to it like flies on a bug zapper. They’re not coming off. It’s a
covalent bond. In other words, it’s a permanent bond that testosterone sticks to Shbg. And it’s going in your
bloodstream, but it can’t get into your cells because it’s got this huge protein attached to it. So Shbg is powerful. It’s
a powerful buffer that your body has so you don’t get too much of anything. Well, unfortunately, when we do things
like birth control pills, we create an abnormal environment in your bloodstream with too much of this protein and it
binds up all your androgens. Great for complexion. Not so good for sleep and mood and sexual function and all those
kind of and energy, etc..
And it’s the same thing with oral estrogen. So, so people that take oral estrogen, right? Estradiol, because that’s what
we did for years. Those women have really high sex hormone binding globulins. And so it’s kind of a different patient.
But once you have made it through the graces of perimenopause into menopause, if you’re taking oral estradiol, a lot
of people will have very high sex hormone binding globulins. And then those women are started on testosterone and
say, well, this doesn’t work. I don’t feel any different. But it is the oral estrogen that you’re taking so similar. Although
oral estrogen after menopause is a different, it’s sort of the same as birth control, just different phases, different
doses.
Exactly. But still a synthetic, a synthetic. And it’s oral and it’s just for big pharma. The easiest way to get something
to market is to put it in a pill, let someone take it. But it’s also not a natural way to do it. So if you do something
transdermal, sublingual, subcutaneous, or like a pellet is subcutaneous or subcutaneous injection, you’re bypassing
the GI tract, which is more natural because the hormones that your body makes don’t go through your GI tract. They
go right into your bloodstream from whatever endocrine organ is making that your ovaries or your testicles or, or
your adrenals, it goes directly into the bloodstream. It’s not metabolized by the liver first. And then whatever is left
over then goes into your bloodstream. But that’s a cheaper way for big pharma to get a product onto the market.
Oral premarin or oral estradiol.
So I want to ask you one other thing. I have had several women that I’ve taken care of, and I think you have as well in
their late 40s, early 50s, who have continued to take birth control or who come to you on birth control, have been on
birth control for a while. And their question to me is like, well, is there really a risk of this? Is there really a risk of
clotting? And so I want you to answer that.

Yeah. There’s no question an increased risk of blood clots in your legs or lungs. But then as we age, those risks
become even more arterial instead of venous. In other words, risks of heart attack and stroke in your 40s on birth
control pills is a real risk. It’s a real thing. And the older you get, the higher cardiovascular risk that you have. So if
you’re taking a medication that makes that cardiovascular risk even higher, then you’re more likely to see a problem.
I’ve seen some devastating strokes in ladies in their 40s, and the only medicine they’re on is a birth control pill. And
they have no hypertension, no cardiovascular risk, nothing. Just taking a birth control pill. So if you don’t need it for
birth control, don’t take a birth control pill. And as you get into your 40s and closer to menopause, you’ve got to
transition into something safer. Correct. Yeah.
Yes, I agree. So either tubes removed, progestin only IUD, vasectomy.
Yeah. I mean, handcuff your husband and drag him to the urologist and make him get sniffed.
Well, I mean, if you say, hey, it’s either no sex or you’re getting a vasectomy. I bet they’re going to be at the
urologist.
Some proper motivation always works.
Motivation is always good, right? So I just wanted to bring you on and ask you about this, because I do have a lot of
women who ask, you know, they’re concerned about can I take birth control? Can I not? If I can’t take birth control,
what are my options? A lot of women get progesterone only IUDs, but are misled to thinking, oh, well, you don’t need
oral progesterone because you have an IUD. And so then they suffer with mood and sleep issues. And so I just
wanted people to hear from a gynecologist that I’m not necessarily crazy or mean when I’m not giving you birth
control in your late 40s or early 50s.
Yeah, there are safer, better options. And so we have to be really concerned with every prescription we write in our
office, the most seemingly benign prescriptions we write can hurt people. A simple prescription for Bactrim for a UTI
can cause a serious, life threatening reaction. I mean.
Skin reaction.

Everything. And so we have to be careful. We write so many prescriptions and we don’t think about it enough. Is that
okay? What are the potential problems that I could cause by doing this? And we dole out birth control pills like candy.
And the reality of it is these are serious prescriptions that have serious side effects. And yes, their use is important
for a lot of people. But we also we don’t just pass them out to everyone without thinking about the individual patients
that we’re treating, and we could potentially harm them. So that’s our first goal is not to harm anyone. Correct?
Right.
And I mean, I’ve had a whole section in my book, a whole chapter in my book about birth control and what it does to
your gut. And so again, in your 20s, you know, sometimes it’s probably better to not have a 20 year old pregnant that
doesn’t want to be versus having a bad gut. But I mean, you need to understand even in your 20s, like a birth or a,
an IUD may be a better option for you, especially if you already have a dysregulated gut. Because when we start
messing with people’s gut and the way their estrogen metabolizes and their T3 metabolizes and their insulin and
their cortisol, I mean, they end up with all these other issues later. And, you know, there is a type of PCOS, a post pill,
PCOS, where after people get off birth control, they have a lot of issues with PCOS and then infertility. So I think it’s
just something you really need to ask questions about, be educated about, and make sure that you realize a lot of
people think, I’m going to take birth control for ten years. I’m going to come off and then immediately get pregnant.
Some people will, but a lot of people won’t. And so it’s just something that you need to understand.
That same patient in their 20s may be the same person, but they’re a different person when they’re in their 40s and
50s and they have a different set of risk factors and a different set of problems and concerns in their life. And so you
can’t treat everyone the same and even the same person three decades later, you have to treat them differently.

The next question I have is my sister has PCOS and can’t lose weight. Please talk about that. I think that that’s what
we’ve been talking about, is we’ve got to lower our insulin. We’ve got to make sure that we’re working towards
building muscle, not eating in a calorie excess, and then monitoring and evaluating our cortisol. Right.
I mean, yeah, I agree. The thing is, most women with PCOS do know that to be honest, they know that they have to
be in a calorie deficit because they’ve looked it up and it’s clear from science. But we have to acknowledge that
women with PCOS, although if they are in a calorie deficit, they will lose weight just like any other woman with PCOS.
So there is no difference in metabolic rate between a woman with PCOS and women without PCOS. So this means it’s
not impossible for women with PCOS to lose weight. However, what what the difference is that women with PCOS
have different hormonal profile that increases their hunger, reduces their satiety, increases their cravings. Add to
that that they have usually insulin resistance and high cortisol, which increases inflammation, lowers sleep, which
worsens the cravings, worsens the worsens the hunger, and worsens the satiety. So it’s it’s not easy. I do understand
her sister. It’s not easy for women with PCOS, although they do have similar metabolic rates, and they can indeed
lose weight just like any other woman with PCOS, it is more difficult. And it’s not about willpower. It’s about the
hormones being in sync with each other and regulating insulin, regulating cortisol. And most importantly, one thing I
stress on is starting by adding rather than restricting, because I think this is the mistake most people make when
trying to lose weight. They start by restricting, let’s get off bread, let’s get off sugar. Which seems very sensible. It
seems very reasonable. But when you do that without adding the right stuff, you’re going to feel restricted. You’re
going to feel hungry all the time. You’re going to feel cravings and your diet will fail after a few days, or you’re going
to binge eat in the weekend. So focus, start, focus on adding and then go from there adding the right stuff.
Yes. And also, you know, a lot of people with PCOS, unfortunately, their doctors aren’t helping them because if
they’re giving them birth control, that’s increasing their cortisol as well. So like this was right. So like, yeah, this was
me. So it’s like, oh, you have PCOS, let’s give you birth control. Well then that I see it all the time. I see it at least five
times a week. People on birth control, their cortisol levels are astronomically high. I speak to them about it. We get
them off of birth control and they come down. So like, that’s the other thing is it’s not always your fault. Your
provider, unfortunately, sometimes is making your journey much more difficult in the way that we supposedly.
See birth control needs maybe another episode on its own because we have so much to talk about birth control. But I
think when I started my PCOS reset program, honestly, one of my main goals is to get women off the pill because not
because I don’t like the pill, because I’ve heard what women on the pill are telling me. And the main reason actually
women come to my program is because they either were told to start the pill and they don’t want to start the oral
contraceptive, or they’re already on the pill and they want to get off the pill. This is one of the main reasons other
than losing weight and getting pregnant. But the pill is another conversation. I know it has its uses. There are some
uses. We can’t deny that. Yes, but honestly, for 95% of people, for 95% of women, it’s prescribed unnecessarily.
I would say 99% of women it’s prescribed unnecessarily.
But I mean, some conditions like Endometriomas, for example, like you want to shrink the endometrioma not to have
surgery, for example, and some other rare indications, but yes, I agree 90, at least 95% of women are put on the pill
unnecessarily. Yeah.
Perfect. So a couple of other things I for sure want to ask you, how can you lower testosterone and DHEA if you have
PCOS? Now my understanding is lowering your insulin, right? Lowering your weight.
Lowering the number one, also increasing Shbg, which is also affected by insulin, but focusing on on liver health as
well, while reducing your insulin is the proper way to lower testosterone. And very important thing. I think these
these are the things most people know about. But we’re going to go back to cortisol. You know why? Because many
people think that the androgens in PCOS come only from the ovaries, but in fact, it’s 60% from the ovaries, in PCOS,
60% in the ovaries, 40% from the adrenal glands and the hormone androgen and the adrenal glands is DHEA and
DHEA and DHEA and DHEA are stimulated by ActH, which is the pituitary hormone. And when cortisol is chronically
high, your body forms some sort of cortisol resistance, like similar to insulin resistance and from cortisol resistance.
This stimulates ActH secretion that causes the negative feedback. And this stimulates the adrenal glands to secrete
more DHEA and DHEA s, which increases androgens and leads to PCOS symptoms. So again insulin cortisol. This is
the way for PCOS.

Agree. And the last question I really want to ask you can long term microdosing of GLP one offers sustained metabolic
and hormonal benefits. So I love microdosed GLP one. We were sort of briefly talking about this. I have phenomenal
success with PCOS when used correctly. I think that that also helps a lot with, you know, just lowering your risk of
diabetes. A lot of the things we’ve talked about the way.
What’s the dose that you use?
So it depends on the person. I start doses as low as 0.05mg of semaglutide, 0.1mg of semaglutide. I use tirzepatide
0.0 or 0.5 milligrams one milligram, so very low doses. My goal in using it is for people to not have symptoms, to not
even really know that they’re taking it. It just helps calm down inflammation. I see CRP levels go down.
I see and we’re talking about injectables as well.
We’re talking about compounded peptides like microdose peptides.
Obviously, I’m a very big fan of GLP one in the first place for people who have clinical indications for. For people with
excess weight and like diabetes, PCOS with obesity, I think they’re very helpful. I personally haven’t had experience
with microdosing. Maybe I’ll have to take some advice from you about that, but I don’t think there’s any reason not to
be pro microdosing GLP one, as long as it’s done under medical supervision and side effects are monitored. I think it’s
a good idea.
And what about metformin. Is a metformin a plus or a minus for you with PCOS.
So the thing is metformin is part of the clinical indications like we sometimes use it to restore to try and restore
ovulation. But the thing is metformin is working through insulin. It’s not like magic. It’s just it’s not reversing insulin
resistance. It’s just trying to improve temporarily insulin sensitivity. And this is what this is what’s happening at the
level of the body. So why not Break the cycle from the root. Why not tackle the problem from the start, from the roots
and just deal with it like properly instead of putting a bandaid, another bandaid? Because now we’re giving metformin
to try and restore ovulation, we’re giving birth control pills to try and reduce androgen symptoms. We’re giving
spironolactone to try and further reduce androgen symptoms. And then we’re getting to a patient who’s like 35 and
wants to get pregnant. And then we’re using letrozole to try and stimulate ovulation. You know, it’s just like, why not
properly treat the root cause, you know.
Correct. Because that’s not a very good business model because, well, care is not a good business model at least.
Exactly. I mean, I think yeah, I think the system does really need some type of hopefully people like you and I and
other people with who are adopting to the system and adopting a functional approach and really trying to heal
people can have an impact, a good impact on the system and on the medical system because it’s needed. People are
really struggling and suffering even.
Correct. Okay. So I think that you’ve covered a lot of the questions I have at the end of my podcast. I always ask
people three questions. So don’t overthink it. Very simple answers, but I want your answers to these questions. So
the first question is, what is one food that’s most beneficial and why.
Extra virgin olive oil? No competitor because extra virgin olive oil. I mean I am a little bit biased. I’m Lebanese
Mediterranean, but extra virgin olive oil. It’s high in monounsaturated fat. It’s anti-inflammatory. It’s really heart
healthy and everything. Like we’ve seen in every studies, the the more extra virgin olive oil you have, like the
healthier you are. You know, I think it’s like one of the healthiest, healthiest foods in the world. And it’s amazing
source of fat, even in cooking. So people are afraid to cook with it. It’s great for cooking.
I love olive oil. I have a patient who brought me olive oil back. From where did she where is she from? I can’t
remember, maybe it was Lebanon, but it’s amazing. So I love olive oil. And then I had another patient who just
brought me some olive oil from Greece. And so I’m excited to.

Try that too.
So the second question is, what is one thing that anyone can do for their health to improve their health? That’s 100%
free.
Meditation.
Meditation. I get that a lot because it lowers your cortisol, right?
Yes, exactly. Anything that lowers your cortisol is going to make you live a better life. Obviously, like exercise and
sleep, like, ah, this are exercise. Sleep and food are like basics, you know? But if you want to add anything that’s
free, it’s meditation. No questions ask.
The horribly to say this, but we would just put women on birth control pills and it’s still done today, unfortunately. But
I think I see a lot of younger women that have it, because those are the people that come to me, usually a daughter
of a patient of mine or something, and they’re diagnosed with it, but they’re not really given any options, first of all.
And then second, I see a lot of women that have been having issues for a long time. Like you’ll see their, their, you
know, I always ask them, if you look at your pictures throughout high school and college and whatnot, did you have a
period of your life where you gained like 30 or 40 pounds in a year or two? And inevitably. Yeah. And it’s like, and
nobody’s ever asked me, you know, I eat. Right? And I think when women say they eat right, they exercise all the
time and they keep gaining weight. The the medical system just says, yeah, sure. Right. Yeah. You know, of course,
you know, everybody says that and they’re minimized as more than usual. And so I think the lack of diagnostic
criteria. The. The desire. I always try to defend my colleagues because I think when you see 50 patients a day and
the high ticket item in ob gyn is ob, that’s where you make all your money. And they’re a five minute appointment for
the most part, to sit down with somebody for 30 minutes and talk about PCOS. It’s just not going to happen because
they don’t have the time and they’ll run some labs. And then it’s just like, yep, you got it. Let’s put you on a birth
control pill. So unfortunately, it’s just not getting treated. And, and I think sometimes they don’t even want to look at
the labs because they don’t want to know the doctors just, they know it’s going to be a pain in the butt. So they won’t
even draw the labs. They’ll just say, oh, you probably have PCOS. Let’s put you on a birth control pill.
Do you think that birth control is the best treatment for PCOS?
Well, as you I’m sure you would agree. It covers it up. It doesn’t fix it. I mean, it can fix the high testosterone because
you’re shutting down the ovaries. It might maybe help with insulin resistance in some patients. But the reality is,
once you come off the birth control pill, you still have PCOS. And so I’ve even seen women in menopause that still,
even though the ovaries aren’t working per se, still have the insulin resistant part of PCOS. So we always used to tell
women to, well, okay, now you’re in menopause, you don’t have PCOS anymore. But I don’t think it necessarily. I kind
of talk about PCOS now as a chronic disease process. Like it may never go away, but we can definitely, if we can get
you maybe under a certain weight, I think there’s just, I call it the a switch. It’s like there’s this switch that flips for
some women at a certain weight, and then all of a sudden they just pack on like 30 or 40 pounds in 6 to 12 months.
And if we can get you down under that weight, and I’m sure there’s some genetic component to that too, because if
you look at the family picture, you, you tend to see similarities. But I just, I think to make a long answer to say, I don’t
think birth control pills treat it. I think they just cover it up and they can help with some of the symptoms. But it’s a
band aid.
I completely agree. My I think most viral TikTok video I ever did has over 2.3 million views. Was the answer to PCOS
or the treatment for PCOS is not birth control. And I explained why. And I just think that to your. I said exactly what
you said, your ob gyn has five minutes to talk to you, and they don’t know how to interpret your labs or what to do
with them. And, but they do know how to write a script for birth control, and it shuts you up. It makes you feel better.
But when you stop that birth control, five, ten, 15 years later, your cortisol is still high, your insulin still high, and you
still have PCOS. So that’s where I think that we missed the boat. You know, we have these young girls that we never
talked to. And then unfortunately, you know, they come to you or I when they’re 35 and they want to have a baby
and nobody’s talked to them about their PCOS, haven’t gotten them ready for that, then that can take a couple years.
Well, then they’re 37, 38, and then we’re in trouble because their egg quality is generally worse than somebody
who’s healthy, right?

I call PCR, I call the birth control pill a the get out of my office prescription because it’s not only used for PCOS, it’s
used for abnormal bleeding, weight gain, headaches, acne, I mean, you name it. And it’s, it’s like they just like you
said, it’s like, well, I’m gonna do something for you now you can go, but and you got to give it at least three months.
So then they don’t have to deal with you. And I think if they do that long enough, you just end up leaving and trying
to find somebody else.
Yeah. No, I completely agree. So transitioning from PCOS, what about like PMS? So PMS is another thing. You know, I,
I, I hear lots of things on the internet. One of the things that you hear though from some people is like, you know,
your, your period shouldn’t be the most painful thing in the world. You shouldn’t have any pain at all. You should just
bleed and they should be very regular and perfect. What is the truth about that? Like, should we have pain? Should
we have mood swings? Like, should we have these fluctuations in our hormones? Or should we just be very like flat,
flat people all the time?
I think that, you know, again, as a man, I wouldn’t want something that hurts every month. I think if you have, you
know, if you have some cramping for part of the day, that’s probably normal. But if I always say if the pain is
interfering with the way you live your life, or if you have to plan your life around your period, if you dread your period,
if you’re missing school, if you’re missing work, well, that’s not normal. And you know, I don’t want to say some pain
is normal because I think pain is always a sign that there’s something going on. But like, you know, if you have a
headache, maybe you didn’t sleep the night before, you know, it’s not that. It doesn’t mean that there’s something
horribly wrong with you, but it means that you probably have something going on. And I think the same thing. Usually
I see young girls all the time, probably 14 to 22, give or take, that will come to me for really bad periods. And it’s
usually prostaglandin issues that are causing them to basically feel like they’re in labor every month. Heavy, heavy
bleeding, you know, that’s obviously abnormal. But again, I think a lot of women are meant to. Ever since Eve bit the
Apple, women have been taught that pain is normal, and you’re still kind of being punished for the original sin, if you
will, that, you know, you should suffer a little bit. And it’s the same thing. It’s not just with periods, it’s with
menopause. It’s a little suffering is okay. I asked my grandmother once, I think she was 85. I said, you know, what
was menopause like for you? And she said she was this for 11? Italian woman who would beat your ass? You know,
kind of a you know.
And I said, and she’s like. She said, what the hell is menopause? And I’m like, you know, when you had the hot
flashes, she’s like, she’s like, Sean, listen, I was a World War two mom and your grandfather went off to war. I had to
go work, and basically I made bullets for four years. And we didn’t talk about stuff like that one because people
wouldn’t listen to us. But two, we just didn’t have time for shit like that. Not that it’s a bad thing to talk about pain,
but this is a phenomenon that we’re seeing now because women have a voice, a more at least, than they did before.
And so I think that the more that we talk about it, the less we’re taking that stigma off of it. And we’re and I see
women all the time, as I’m sure you do, that feel like a, a completely different person just from hormone replacement
that they didn’t know was possible. They just thought they had to suffer. And we make fun of them all the time, like
sitcoms. You know, it’s like, I remember when my mom had her hysterectomy, she was probably 30 something. And
one day I think I was 16 or something, she was yelling at me because naturally she it was her fault, not mine,
because I was perfect. And I said to her, I made the mistake of saying to her, did you did you take your pill today? At
which was her premarin probably. And I even knew that at 16. So I had learned that from somewhere. Right. It had to
have been TV or whatever, that all women’s problems come from their uterus and their hormones. And I think that’s
still real today.
I want to know what your mom said when you said, did you take your.
I don’t even remember because I probably blocked it out. But yeah, it was, uh, like I said in our podcast, things you
should never say to a woman, that would be one of them.
That would be one of them. Did you take your pill today.
Especially your mom?

Yeah. And I think a lot of women just have a lot of PMS symptoms, you know? A lot of there’s a lot of people with
endometriosis, whether it’s diagnosed or not. There’s a lot of people with, you know, gut issues. We talked a lot about
that on your podcast. So if you’re already bloated and you already have a little bit of like Sibo or constipation, and
then your uterus starts cramping, I mean, you correct me if I’m wrong, you’re the surgeon here, but I think from
anatomy, your bowel is very close to your uterus. So if you have a bowel that is full of stool and you’re bloated and
gassy and your uterus is cramping, that just seems like a pretty big disaster for me in a small space, right? So, I
mean, I think there’s just a lot of things that can go on. But then the other thing that women really struggle with is
their mood, right? Whenever their hormones are fluctuating or as they go through menopause. So let’s talk about
that a little bit. Like some women will say to me, you know, there’s a certain week of the month or there’s a certain
time of the month where my mood is terrible. I feel like everything, you know, I’m going to die, yada yada, yada. It’s
typically right before they start their period, right, but they feel like they’re going to die doomsday, and then they
start their period and everything is fine. Is that normal or is that something people should be concerned about?
Well, again, even on Instagram, there’s reels that that women will do. Like they’ll show like me on my period and
they’re happy. And then the week before their period, they’re miserable and they joke about it. But the reason that
it’s joked about is because it’s true. It happens to a lot of women. I don’t think that, again, if as a man, I don’t deal
with that. And I would think looking at that, when women talk to me about it, I wouldn’t want to live like that. I
wouldn’t want I can’t stand if my back hurts for like two hours, let alone having to suffer for 7 to 10 days every single
month. I mean, I can’t even imagine that. So but again, we minimize it and we we make it seem normal. And women
also feel like especially now that, you know, women are working as much as guys do, if not more, and they don’t feel
like they can talk about it because they’re in a practice with, with men and they don’t want to lose time at work. They
don’t want to be the butt of a joke or feel like they’re weak. So yeah, we definitely I see that all the time. And it’s not
normal. It’s not the way you should have to live your life.
So then if somebody is listening to this and they say, oh, yes, I do have extremely painful periods and it affects my
life and my, you know, it changes my mood at certain points. What would your advice be to those people? Is it that
they should? Because if you’re listening to this and you can’t come to somebody like you or I, I would say that 99.9%
of the time that somebody goes to a doctor and says that they’re either going to give them birth control or an SSRI,
uh, that’s probably fair. What would be your suggestion? Is that good or is there something we should be doing?
Instead of like, what are your thoughts?
Let’s assume that everything is normal in the sense that there’s nothing horrible like endometriosis or cancer or
something weird like that. Usually what I, what I say with pain and heavy bleeding and stuff like that is that it’s
probably a huge release of prostaglandins. Prostaglandins. Cause we use them to induce labor. So the pain can be
pretty severe. Dilates blood vessels. So you have heavier bleeding can make you feel like you have the flu. Muscle
aches and pains, diarrhea, headache. It’s it’s horrible. And usually if women, in my experience, even add magnesium,
high doses of fish oil, because fish oil will move you from there’s, there’s a prostaglandin cascade. One arm is really
painful. The other arm usually is more relaxing to the uterus. Fish oil will move you to the relaxing side. I use a lot of
maca in my practice. Those three things. If you can’t start progesterone because you don’t have it, progesterone will
thin out the lining. So you have less prostaglandin release because you have less lining. Those four things, if you can
use all four of those, 75% of that goes away within 2 or 3 months just doing that. You can even get progesterone now
over the counter in like 20 milligram doses that you can buy on Amazon. Not a huge fan of doing that, but it’s out
there. But yeah, maca magnesium and, and fish oil 2 to 4g a day can make a huge difference.
Okay. Well, that’s very helpful. What about irregular bleeding? So some women will say, you know, I maybe have a
period every 75 days. And that’s really annoying because I don’t know when I’m going to bleed. But the even worse
part is some people will say I bleed every 14 days, or I bleed every 18 days. And I never know when I’m going to
bleed. What are some of the causes of that, or what are some of the things you would recommend if somebody is
having those issues? That is not birth control.

Usually depending on age, but if it’s a young girl, it’s like 14 to 18. It might just be that their hypothalamic pituitary
ovarian axis just hasn’t matured yet. So they, you know, we, we can throw a lot of stuff at them, but it might just be
they, they need to give it a couple of years. And if it’s not necessarily interfering with their life, then I don’t
necessarily get too involved with them. They just need to have that maturation process. Uh, women in their 20s, 30s
40s you could have PCOS. So we want to look into that because that’s probably the number one thing we think of
with an irregular period. But you also want to look at, you know, obesity can affect that. We talked about gut health
and the inflammatory process, the inflammation load in the body. And we throw around the word inflammation all the
time without really talking about what it is. But I think that comes down to lifestyle, food, sleep. We talked about
cortisol in high levels because of stress. And, you know, you can say, oh, you’re stressed, but what does that mean to
a person? You know, it’s like, you need to calm down. Okay, well, that’s another thing you should never probably say
to a woman, but I think it’s, you know what, I think a lot of the problems with cycling, if it’s if everything is fairly
normal, is probably lifestyle related.
I think we live in a very stressful world, and we live in a society where we’re on the phones all the time. We’re not
outside. You know, some women might exercise almost too much because of body image, things that can mess up
your cycle. I’ve had women in my practice where I have diagnosed that their cortisol is really high on like a Dutch
test, and I’ve had to tell them to not exercise as much for a few months, and then they’re stressed out because
they’re worried about weight gain. But if but if they slow down and they do some relaxation or just walk. I’ve seen 7
to 10 pound weight loss just from actually dialing it back a little bit. So it really depends on and that’s the other thing
we don’t do a lot of in our society is as physicians is we don’t ask those lifestyle questions really, because as we
talked about, doctors may not have the time to do that. But if you really just the first question I ask new patients is,
tell me your story. You know, like, what is what’s your journey so far? What have you done? What are your
symptoms? And kind of where would you like to go? Where would you, what’s your perfect day? Kind of a thing. And
most people, if you listen, will, will kind of give you hints as to what’s going on.
So a lot of it then could be stress. It could be. But I mean, it could also be Endometriosis, things like that. But I would
say that stress is probably a good answer for a lot of people with with the life that we live. Let’s talk about, you know,
we start having menstrual cycles in our teens. Some people are starting even earlier than that now, but we start
having menstrual cycles in our teens and hopefully we’re somebody who has them. Maybe they’re regular, you know,
we’re having normal menstrual cycles into our 20s, maybe beginning into our 30s. Although unfortunately, a lot of
women end up on birth control in their teens. And then that causes a whole lot of issues because they have painful
periods, right? And instead of using our brain and saying, why are we having painful periods? Let’s figure this out. We
just give people medicine to shut them up. But let’s say that we’re one of the few who have started our menstrual
cycle in our teens and have progressed into our 20s and our in our 30s, and maybe we we were even on birth control
and now we’re off. And maybe we’re even having normal periods. What are some of the things you’re going to start
seeing in your 30s as a woman, as your hormones change, like, you know, we’re not obviously going to have hot
flashes usually. But what I see in my patients, I’m curious with you is that in your 30s, you can start to lose not only
progesterone, but testosterone. That’s earlier than we used to. And so what are kind of some of the things that you’ll
see in your 30s as a woman, as your hormones change symptom wise and just feeling wise? Yeah.
So, you know, as our 20s are supposed to be our, our main reproductive years. And I think that’s part of it. A lot of
women are waiting later to reproduce, but especially if a woman has already had babies in their 20s, the combination
of that and then turning 30 just really decreases our testosterone production. And the first thing that a lot of women
don’t even realize that we make testosterone, it’s been, you know, purported as a male hormone and women actually
make testosterone or ovaries, you know, this make testosterone is a powerful hormone. It does peak in our 20s in our
reproductive years. But it’s not just about reproduction. It’s it’s so much about brain health and so many women.
What they’ll start feeling is a kind of a depressed mood, maybe more anxiety as their testosterone lowers and their
estrogen is still clocking along really good. They get a little anxiety, definitely mood swings and just energy overall
fatigue. They might start seeing body composition changes like they it’s harder to stay fit sometimes as their
testosterone lowers. But the biggest symptom, I would say women that I’ve seen women present with in their 30s is
depression, anxiety, irritability, mood swings, not sleeping well, and, and fatigue. Those are kind of the big ones. And
then every decade, those get worse as our levels decline. But we do start losing testosterone in our 30s. And you
mentioned birth control pills and birth control pills actually also lower testosterone in two ways. It shuts down ovarian
production of testosterone, but it also raises a protein that binds up free testosterone. So it’s kind of a double
whammy. Women that are on oral birth control pills have even lower testosterone than they would have off of it. So it
causes a lot of those symptoms. And then we’d be remiss not to talk about, you know, lifestyle and the gut and diet,
because that all plays a role in hormones and hormone metabolism and how all that works.

So yeah, and that’s one of the things I really like about your book is that you throw the, all the hormones in there. So
not just you and people about estrogen and testosterone and, you know, progesterone, but you talk about thyroid
hormone and you talk about melatonin and you talk about growth hormone and all these hormones that are really
important to your gut. And that’s the thing I think that we have a problem with in this country is that when your gut is
not healthy. It’s impossible for your hormones to be healthy. Like they, say. And so we have a lot of people who have
terrible guts, whether it be from poor lifestyle choices like food, stress, but also sleep. Some of it is just, you know,
the vaccines that we had or maybe how you were born, all the antibiotics your doctor gives you. I mean, there’s so
many things at play to it. You know, their doctor gives you birth control. Your doctor gives you an antibiotic when you
have a viral infection, just all these crazy things that then prevent your stomach from working the way your GI tract is
supposed to. And then that feeds into disrupting your hormone balance. And so in addition to that, you’re stressed
out and you’re, you know, trying to do a million things and you’re not sleeping and we’re not eating well. And just, it’s
no wonder that nobody’s hormones work well.
Younger and younger. Exactly. And, and then, you know, add in the layer of technology and never letting your brain
rest. I mean, it’s just it’s multi-factorial. And we’re seeing more hormone disruption in younger people now than ever
before in our history. And it can all be pulled back to the majority of it to to the gut and stress for sure.
Yeah, I would agree. And so I agree with that. And 30s, I see women who the, the anxiety, depression, the brain fog,
the fatigue, the my body is changing. And then I have a litany of women who are in their 30s who don’t like to have
sex with their husband. And that is alarming.
Yeah, I, I, I don’t even know, I don’t even know why I didn’t say low libido because that is the big one. And that’s kind
of I mean, I, I always kind of think that’s the obvious one. But yeah, you know, the relationship piece of losing
testosterone is the one that breaks my heart the most because, yes, women lose interest in sex. And that’s a deal
breaker for relationships. I mean, you know, I tell women all the time, guys can handle you being moody and cranky
and irritable, but all those things and not having sex is kind of like, ah, it’s a double whammy. So it’s it’s frustrating.
And, and, and men take it personally and, you know, it’s, it’s a whole dynamic that has to be talked about for sure.
And so that’s what I would see as well. And then as they transition into their 40s, you know, right around 40, I feel
like it starts to get really bad because I feel like not only are you losing more testosterone, but then they start to lose
progesterone too, right? Is that what you see? And so what do you do in your 40s typically?
Yeah. So it’s kind of strange. It’s almost like 40 in a day. All of a sudden it’s things change and progesterone is a big
one. And what happens is progesterone is somewhat of a calming hormone. So you so when everything’s in perfect
harmony, you’ve got estrogen, testosterone, progesterone is, if you’re to your point early, if you’re not on exogenous
hormones, if you if you eat well, if you’ve got a healthy gut, everything’s kind of in harmony, right? And then you
start to lose testosterone in your 30s, and then things kind of get out of whack, and then you start to lose
progesterone in your 40s. And that’s when the anxiety ramps up a lot more, especially right before their cycle. Pretty
much all those symptoms of moods and anxiety really just get worse when progesterone starts to decline. And the
telltale sign for a lot of 40 year old women is their menstrual cycles become very heavy, very cloudy. They’ll say, you
know, I can’t, you know, get out of the house without a, you know, super protection for 30 minutes. You know, it’s just
so heavy for the first few days. And that’s the that’s the telltale sign your progesterone is low. And a lot of women at
that point might visit their ob gyn and get put on a birth control pill, which is the worst thing to do in your 40s, or put
on an IUD or get an ablation, which is probably the least. It’s the least invasive as far as like putting yourself on
hormones, but it’s not fixing the root cause.