251-SYNCPodcast_DrPaige-BioHRT

[00:00:00] Jenny Swisher: Welcome friends to this episode of the Sync Your Life podcast. Today, I have Dr. Paige Butile here. We actually just recorded our announcement podcast that I just had on the podcast as well, sharing our announcement that we are offering virtual consults now, which is super exciting. But we wanted to take time.

[00:01:14] Jenny Swisher: We’ve been wanting to do this now, I think for months. to just come together and hash it out over bioidentical hormone replacement therapy. This is something that, you know, I think is on the rise for women. First of all, I mean, hormone health was the number one trending topic on Instagram in 2023, still is.

[00:01:30] Jenny Swisher: And I think for good reason. I think women are finally waking up to this idea that they are not currently living with maximum energy. And And they may be gaslit in the doctor’s office when they’re feeling off and their check engine lights are flashing doctors, oftentimes they’re saying, oh, everything looks normal.

[00:01:46] Jenny Swisher: Everything’s fine. Right. But thanks to other women speaking up and talking about it and different research that’s coming out. Women are starting to say, Hey, like, could I feel better on bioidentical hormone replacement therapy? And what is all this? Right? So we’re starting to see it trending, but I always like to say, it’s not just trending as a fad.

[00:02:03] Jenny Swisher: It’s trending for a reason and we should pay attention. So I’ve loved working with Dr. Page for the last several months, excited to keep moving forward. And I thought, you know, she’s the perfect person to have on here because now I think we’ve done, I don’t know, several, virtual consults together. And bioidentical HRT comes up often, if not every single consult.

[00:02:22] Jenny Swisher: So, uh, let’s just kick this off. First of all, before we talk about that, let’s talk about you. Just share with us again, you know, who you are, what you do, and your training and all that stuff.

[00:02:33] Dr. Paige Gutheil: Yeah, for sure. So I’m Dr. Paige Gutile. I’m a board certified osteopathic family medicine. Physician in Columbus, Ohio, so I have a local practice as well as serve women virtually all over the nation.

[00:02:49] Dr. Paige Gutheil: And most of the women that come to me, as I describe it, have some element of a syndrome where they are feeling Stress, tired, overwhelmed, overweight, or generally older than they should. And so, so many of us as we go along can relate to that. And there are many factors as you know, that influence that.

[00:03:12] Dr. Paige Gutheil: And so I love really taking a broad, comprehensive approach. I like to combine what I call the best of. A fancy science, the safest of the fancy science with the most natural and functional and integrative approaches, kind of blending that together to help women and really looking at not only the internal factors of health, mind, body, spirit, but also our lives because we have to fit our health into our life and our life influences our health so much.

[00:03:44] Dr. Paige Gutheil: So as I’m talking to women, we dive into all of that. And like you said, Hormones are a huge factor. They’re a huge factor for all of our lives, but especially as we get into that perimenopausal menopausal period, things change. And so I love helping women navigate those, those adjustments.

[00:04:05] Jenny Swisher: Yeah. I love seeing in our course community, of women who have, have worked with you.

[00:04:10] Jenny Swisher: I love seeing the testimonials that are popping up in the group lately of just how much feeling and how heard they feel, which is really key. So, all right. So let’s talk about this. Let’s talk about bioidentical hormone replacement therapy and my friends, I will link up for you in the show notes, different solo rounds that I’ve done on this as well, so that you can also dive in there.

[00:04:27] Jenny Swisher: But let’s just start off by just. hearing from you, you know, what, what makes bioidentical hormone replacement therapy different than other forms of HRT and how do we know the difference?

[00:04:37] Dr. Paige Gutheil: Great question, because when you hear bioidentical hormones, there’s have been a lot of years where that term has been used almost as a marketing term or a gimmicky term, but I think even mainstream medicine, adopts that term to reflect a compound that is biochemically identical to what your body produces.

[00:05:01] Dr. Paige Gutheil: So even if it’s made in a lab, it is biochemically identical to what your body produces. And so what our first introduction to hormones for a lot of women comes through the birth control pills, right? Those are synthetic. So one example being related to estrogen, ethanol, estradiol is not the same as estradiol.

[00:05:25] Dr. Paige Gutheil: Our body is very accustomed to producing estradiol, and that is what we use in menopausal hormone therapy most of the time, for example, as a bioidentical form. Now, when you look at, bioidentical hormone therapy, there, we could then stratify from there, right? There are FDA approved formulations of Estradiol, progesterone, testosterone, those big three, hormones that we oftentimes supplement.

[00:05:55] Dr. Paige Gutheil: There are FDA approved bioidentical formulations that are available in your local pharmacy. So we oftentimes use those. Another category of bioidentical hormones that people I’m sure have heard of are related to compounded versions, right? And, you know, compounded pharmacies have been around. Forever, right?

[00:06:19] Dr. Paige Gutheil: They’ve done a great job. They’ve served women and gynecologists for a long time. I know when I was going through infertility treatments, there were just some things that weren’t available in the larger pharmaceutical industry that our local trusted compounding pharmacist produced perfectly. Um, so that’s another option.

[00:06:41] Dr. Paige Gutheil: And oftentimes we use compounded versions of bioidentical hormones if we need special formulations that aren’t available or, um, commercially or maybe certain dosages that aren’t available commercially. So there are a lot of options these days, both options that are approved through insurance and then compounded versions often aren’t approved through insurance.

[00:07:06] Jenny Swisher: It’s interesting because usually when women have the question, they’re, they’re, you know, they, they have a friend who’s started some sort of pellet therapy or cream or, or capsule or whatever. And it’s, it’s so interesting because, it’s important for us to understand the differences, right?

[00:07:18] Jenny Swisher: And I know for me, I’ve been surprised just as a hormone health educator, how many women are confused by this very topic, right? Like even when we talk about simple things like birth control pills, which you mentioned, a lot of times women don’t realize. What’s in birth control pills or what it’s actually meant to do, right?

[00:07:36] Jenny Swisher: And we don’t need to go into it today, but it shuts down ovulation. And that’s the whole point. And that’s what keeps you from conceiving. Right. But then when you talk to women and they’re like, well, I want to cycle sync. You’re like, well, you can’t really cycle sync because you’re kind of in a state of flatline hormones from the birth control bill.

[00:07:49] Jenny Swisher: Now that’s not to say that there’s not a time and place for the birth control pill. But I also know that a large percentage of women are using birth control for reasons other than birth control. So yeah, I think you’re right. Like that is how a lot of us hear about things like, you know, exogenous hormones or hormones that we’re taking.

[00:08:05] Jenny Swisher: Um, but there’s actually a huge difference. I know for me, when we were going through fertility treatment, right. Um, one of the things that. Our fertility doctor had me do was you have to go on birth control and then you come off with a birth control and you do these different injections and all these things.

[00:08:18] Jenny Swisher: And I literally, I always say, and I’m going to say it, I was batshit crazy. Like I don’t even know, my poor husband, like he deserved a medal. Like I don’t know how he made it through that. We made it through that. Because the synthetic hormones, just for me, especially knowing what I know now about my body and its poor methylation abilities, it was not, it was not handling it, right?

[00:08:39] Jenny Swisher: And I felt crazy, because I would, I would tell my doctor, like, I don’t know, I feel like I’m gonna pass out, or I’m gonna have a hot flash, like, I don’t know what’s happening. And they just look at you like, oh, I don’t know, that’s odd, you know? Well, as soon as I started on progesterone cream, I In my 20s, which was bioidentical progesterone cream, derived from yam root.

[00:08:58] Jenny Swisher: I felt so much better. It was a completely different experience. Um, and so, you know, if you’re listening to this and you’re like, Oh, I’ve, you know, I’ve been on hormones before and they made me feel crazy or they made me X, Y, Z, like, just know that there is a huge difference between the synthetic and the bioidentical and how the body receives that.

[00:09:15] Dr. Paige Gutheil: Yeah. I’m glad you brought that up. And I have so many similar stories, from my little sister included that call, like, what did they put in this pill? Um, But really, it is so important that we look at hormones for what they are and the variety that they are. I frequently talk to women and they may I have the impression that like hormones didn’t work for me, or I can’t take hormones.

[00:09:42] Dr. Paige Gutheil: And when my brain hears that it’s kind of like hearing, like, I can’t eat food. It’s kind of like, Oh, well, yeah, what, what kind of hormones are we talking? And when did you take them and how did you take them and what’s the situation? And so. I would just urge women who have had negative hormone experiences, whether it’s through pills, synthetic bio, there are so many options nowadays that we really can look at those previous experiences.

[00:10:12] Dr. Paige Gutheil: Use that as data and as clues to what your body really needs because I mean the Reality is our hormones are very innate to us, right? We have a Miraculous menstrual cycle that is four roller coasters of hormones that are perfectly coordinated Over the month and so our bodies do Wonderfully with hormones.

[00:10:39] Dr. Paige Gutheil: It just gets a little tricky when we’re supplementing You but we can do it

[00:10:45] Jenny Swisher: well, you know, I really think, and this is probably where we should begin. I really think that women have just been misled a lot about hormones. And so let’s kind of start there. There was a women’s health initiative study done years ago, that really sort of, you know, we can talk about that and all the flaws, I guess, but it sort of set the stage for what I think now has become this sort of fear around hormones.

[00:11:08] Jenny Swisher: Whether that’s, modern doctors just not sort of keeping up with the science and then they’re kind of basing everything off of that study or, you know, what we’ve heard through the grapevine just as women. Right. So, so let’s talk about that health initiative study and what was flawed about it.

[00:11:24] Dr. Paige Gutheil: Yeah. So the women’s health and health initiative. I graduated 2002. And I remember like yesterday, like the hoopla around the release of the Women’s Health Initiative and the press conference that was covered on the morning news shows nationally and, women calling the Clinics, worried about the, results of it.

[00:11:52] Dr. Paige Gutheil: And so it really was extremely impactful event, both for women navigating perimenopause and menopause mostly, as well as physicians. You know, in that time, and as it turns out, with what we know now about the data that was presented then, as well as all the knowledge of additional studies that have, come out over the years, and really even that study being continued and those women being followed for an additional, you know, what, two decades now, um, the, the picture is just very different and a lot more clear.

[00:12:32] Dr. Paige Gutheil: The take home message from the Women’s Health Initiative, which primarily, well, only focused on synthetic menopausal hormone therapy in the form of a brand name called PremPro and Premarin. I think a lot of us probably remember Our aunts and mothers and grandmothers taking primpro, right? And so, they use synthetic, hormones, and for women that have a uterus, they use a combination of synthetic estrogen and a progestin, that was the form of primpro.

[00:13:08] Dr. Paige Gutheil: If the, a woman did not have a, what we call intact uterus, which always kind of makes me, Giggle because what’s the opposite? A non intact uterus, right? But so, uh, woman without a uterus only needs, you know, from Primer and, um, in that case, and so they followed these women, you know, across time and ended up stopping the study on arm of the study early for an in perceived increased risk of breast cancer.

[00:13:40] Dr. Paige Gutheil: And we won’t go into, you know, all of the details related to the statistics per se, but there were so many flaws to the study, and one was in the way the results were reported. So the reality of the study was that one arm, the arm that, represented synthetic Estrogen and synthetic, progestin showed an increased risk of breast cancer at that time.

[00:14:08] Dr. Paige Gutheil: And, when we kind of boiled it down, it represented one added case of breast cancer in about a thousand women. But the way it was reported made it sound like a bigger percentage, was represented. And so the other thing about the study that we now know, and I have to say, even back then, and it’s, it’s almost embarrassing.

[00:14:35] Dr. Paige Gutheil: I know a lot of menopause experts, around my age have kind of walked to this for, for years, and there’s really, I’ve, I’ve heard them talk about this sense of regret that like, Oh, why didn’t we catch this sooner? Right? Like, why didn’t we see this sooner? And I remember even in my younger, you know, study years, I remember thinking, why did they think that would work?

[00:14:59] Dr. Paige Gutheil: And it’s, it really is baffling because, one of the biggest factors is that the age of the women that they, um, included, the average age was early 60s. So to study a group of women to find out if hormone replacement therapy is preventive, which was the main goal of the study, does hormone replacement therapy add some preventive benefit related to heart disease, cancers, et cetera.

[00:15:31] Dr. Paige Gutheil: Why would we wait to let these women be without their natural hormones for a decade, right? The average age of menopause is around 51, 52. Average age in the study was fast forward a decade, so we’ve taken women, they’ve been without hormone benefits for 10 years and then given them hormones back and seeing if they help prevent these conditions.

[00:15:58] Dr. Paige Gutheil: So that’s one flaw. And then just the natural, um, you know, age of studying a woman’s a risk of, um, heart disease and cancers and starting in their 60s. By that time, unfortunately, we’ve had the opportunity to develop a higher rate of, um, those conditions, right? We’re, in that study, looking at women who have the early stages of, plaque buildup, for example, or have their risk of breast cancer that’s already increasing.

[00:16:30] Dr. Paige Gutheil: So, really problematic there. And then probably the biggest, thing that we know now is the, just that kind of going back to what we talked about, the difference between synthetic and bioidentical. So, we’re giving women primpro synthetic hormones that were taken orally. So rule of thumb in medicine, just, you know, really big picture hormones are really hard to take by mouth, right?

[00:16:58] Dr. Paige Gutheil: They’re very delicate compounds and to be able to pass through the digestive tract, the stomach is rough. It’s high acid content, go through the digestive process, then be sent through the liver. The liver is meant to conjugate and change and metabolize what’s sent through there to expect us to Take an oral hormone and have it go through the liver and end up Having a natural effect, like a bioidentical hormone just honestly makes no sense.

[00:17:34] Dr. Paige Gutheil: So when you combine all of that drama, there really were some false conclusions that were, were drawn.

[00:17:41] Jenny Swisher: Yeah. I know when I was, when I first heard that the study was done on women over 60, I thought, Oh my gosh, like we, why didn’t we just throw this out a long time ago? Like, this doesn’t make any sense.

[00:17:49] Jenny Swisher: And then you throw in the fact that it’s synthetic hormones and not bioidentical. The best way I can describe that, I just saved a photo down and put it in my Instagram today. It said something about comparing synthetic hormones to bioidentical is like comparing jelly beans to fruit. Like, it’s just not the same.

[00:18:05] Jenny Swisher: So, you know, if you’re someone who has been hesitant to ask your doctor about estrogen or progesterone therapy or, you know, bioidenticals, just know, again, jelly beans and fruit, these are two different things. And also, that study needed to, to be thrown out the window a long time ago. So

[00:18:21] Dr. Paige Gutheil: one of the complex things about menopause care that I both love so much, but also complicates the hormone picture is it’s not only a complicated physiologic time, right?

[00:18:37] Dr. Paige Gutheil: I love looking at the body as a whole. unit, right? Our medical system makes us think about it in terms of system by system by system, which isn’t really realistic. So I like looking at the big picture, one of the things that I both love about menopause care, but is also a challenge, it is such a complex time physiologically, you know, our hormones affect every system in our body.

[00:19:05] Dr. Paige Gutheil: But it’s also a very. social and culturally charged topic, right? And so part of the reason that, um, this studies information has kind of hung on is just, where do we learn about hormones? We learn about them through our families. And we have sometimes these perception and families and our culture of, um, thinking about menopause as a rite of passage and something we should just kind of age gracefully through.

[00:19:39] Dr. Paige Gutheil: And we don’t necessarily look at it enough, in my opinion, as a hormone deficiency. And yes, a stage of life that all women go through. But that does not make it a stage that women have to suffer through.

[00:19:58] Jenny Swisher: Absolutely. And I think that’s one of the most powerful things about, you know, seeing some of these women. You know, we’ve, we’ve worked with women in these previous consults, you know, anywhere from 20s, you know, looking to conceive or newly pregnant to women in perimenopause who are like, what the heck happened after 40.

[00:20:15] Jenny Swisher: And then we’ve got women who are postmenopause too. And we’ve been able to really see, I mean, I’ve, I’ve really been impressed with just. How much their quality of life has improved, um, when bioidenticals have been introduced and, you know, I think I heard recently somebody was saying something about like, well, I don’t want to have to take hormones, right?

[00:20:33] Jenny Swisher: Or I, I should just be able to like, adjust my nutrition or all these different things. And I’m like, well, I see it the way you do, which is like an actual deficiency, right? Like, and if we think about what happens as we age, progesterone declines first, estrogen follows, like, You know, these things to me, like, couldn’t we not suffer?

[00:20:50] Jenny Swisher: Like, if we can not suffer, then let’s just do that. Like, let’s, let’s, and let’s save our brain. Let’s save our bones. Let’s save everything else. So I want to touch on that too. Just it’s a good place to go next. Is this, what are the benefits, right? Cause I think a lot of times people will say, you know, yes, let’s talk about the pros and cons, but like, when it comes to what can this really help me with, right.

[00:21:08] Jenny Swisher: We, we think about what are a lot of women suffering from. Brain fog, you know, they walk into a room and they don’t remember why they went in there, right? Like, they’re like, what did I do? What was I doing in the laundry room? I don’t remember. Um, brain fog, short term memory loss issues, migraine headaches.

[00:21:22] Jenny Swisher: Like, that’s been the case for me, right? With age, they’ve gotten worse. Libido issues or lubrication issues. Like we could go on and on and on about the things that happen. And these are all things that can be benefited by things like bio HRT. So, so tell me more about just your perspective on, you know, why is bio HRT good for us?

[00:21:40] Jenny Swisher: Not just for sexual health, but for other reasons too.

[00:21:44] Dr. Paige Gutheil: Great question. I frequently find myself saying when I think about the benefits of hormone supplementation, I kind of travel in two lanes and one is based on symptoms, which are very unique to you. How you navigate perimenopause and menopause will be expressed very differently.

[00:22:10] Dr. Paige Gutheil: Then your best friend or your mom or your aunt or whoever. And so it’s important to know kind of all those things. systems that, our hormones provide resilience to and when those hormone fluctuations start happening and eventually hormones decline starts happening, we can exhibit many symptoms and you literally, like you said, could list head to toe the benefits like Emotional.

[00:22:38] Dr. Paige Gutheil: We know that women, experience higher rates of depression, anxiety, and perimenopause and menopause. Cognitive function. Feeling like we’re firing on all cylinders and we can remember that word and remember where our keys are and such. And from, then we could go down the body. Ringing ears, dry hair, skin, nails, palpitations, changes in gut microbiome.

[00:23:02] Dr. Paige Gutheil: Libido, hot flashes, vaginal dryness, sexual health, changes in body composition. Even if you are doing everything the same with your nutrition and fitness or during the perimenopausal period, you will likely see a change in body composition and the increase in visceral fat, a tendency to store excess fat in the abdominal area versus others.

[00:23:27] Dr. Paige Gutheil: And so these are real changes that happen. That we can attribute to hormone fluctuations and eventual decline. So from a symptom perspective, those are the things that we can improve. And then from a prevention perspective, which is kind of the other lane we want to navigate, more and more data is, is coming out and we really do need more, concrete research.

[00:23:51] Dr. Paige Gutheil: But, you know, again, looking back on my medical school years and I trained in an osteopathic medical school that is. I’m so proud of I teach there now and really taught me a lot of the foundations of whole health and looking at the body as a unit. And so they were ahead of the game with a lot of this stuff.

[00:24:13] Dr. Paige Gutheil: , but then, you know, you get Get thrown into the health care system and things happen, but I remember even back then learning about, certain conditions and it’s almost embarrassing, um, that we just kind of took for granted. Well, you know, women’s rates of heart disease were fairly protected against heart disease.

[00:24:32] Dr. Paige Gutheil: Well, until our late forties and fifties, and then the risk of heart disease really skyrockets. And, oh, things like fibromyalgia. You know, musculoskeletal pain syndrome that really only happens to women. And oh, by the way, peak onset in age forties and, um, fifties and oh, autoimmune issues, whether we’re talking about, lupus, MS, thyroid disorders, much, much more common in women onset forties and fifties.

[00:25:03] Dr. Paige Gutheil: And the list goes on and on of these. Things that were much more common in women with an onset in the forties and fifties. And you just have to think, my goodness, why weren’t we think stopping to think what else is happening in our forties and fifties? Our hormones are, you know, going through this, um, through this fluctuation and eventually, you know, retiring.

[00:25:29] Dr. Paige Gutheil: So now, thankfully, a lot more research is coming out. The strongest research, as of now, related to prevention really is in the area of heart disease, risk of diabetes. A lot of new research coming out related to, cognitive function, mood, even perhaps risk of Alzheimer’s, which again, by the way, Alzheimer’s is double the, or more than double, more like two thirds women, and not just because we live longer, right?

[00:26:02] Dr. Paige Gutheil: A lot of that science is being cleared up. So we have to think both in terms of symptoms. But even if you are, and there are women out there that are thinking, Hey, I went through menopause, you know, perfectly, I didn’t feel a thing I’m doing great, which is wonderful. We still want to have that conversation about, the risks, , and more benefits of hormones now.

[00:26:27] Dr. Paige Gutheil: And that’s not to say that hormone therapy is for everyone. It’s not to say that there aren’t, risks. The real risk that we have to consider and it’s again different for everyone. , with some oral hormone, uh, formulations, we have an increased risk of blood clots.

[00:26:46] Dr. Paige Gutheil: Much, much less than the birth control pill, which we very commonly use, right? We do have a risk of stimulating the uterus. So an increased risk of uterine cancer, if and only if you are not protecting, um, your uterine lining by having a very balanced hormone approach. But the biggest, um, conversation, the biggest fear that I hear, is related to breast cancer, right?

[00:27:12] Dr. Paige Gutheil: The, conversation between breast cancer and hormone goes hand in hand, but many, many studies show an actual decrease risk of use of estrogen and breast cancer. Now, the connection between estrogen, or the conversation, I should say, between estrogen and breast cancer will always be tied together. you know, let’s face it, our breast tissue is very rich in estrogen receptors.

[00:27:41] Dr. Paige Gutheil: And so that’s a very nuanced conversation. We probably all know. Women who have had a estrogen receptor positive breast cancer, meaning not that estrogen caused that breast cancer, but that that breast cancer arose in a cell that retained its estrogen receptor. And so those women who have an active breast cancer should not take hormone therapy, at least until they have.

[00:28:09] Dr. Paige Gutheil: Finished their, course of treatment. And then even breast cancer survivors deserve a conversation with shared decision making and the most up to date data, which is, seems like it’s coming out daily about the risks and the benefits. What is your risk of breast cancer recurrence versus what are the other benefits of hormone therapy?

[00:28:33] Dr. Paige Gutheil: You know, the reality is that the biggest killer of women is heart disease. And so we, we don’t want to let fear of any one thing guide our, um, guide our decision making. And we really have to look at all of our risks and more than that, all of our benefits and all of our quality of life measures to decide whether hormone therapy is right for you.

[00:28:59] Jenny Swisher: Yeah, it’s, it’s been interesting, um, just sitting in on some consults with you and, and hearing this, this, this comes up often from women, this whole fear of estrogen therapies in particular, when it comes to, you know, maybe, maybe their mother had breast cancer or their sister, or maybe they themselves have before, the one thing that I’ll say is, you know, this is the benefit, uh, to another benefit of doing like proper testing through something like Dutch because Dr.

[00:29:24] Jenny Swisher: Page is able to look at it. Specifically how your body metabolizes estrogen, how it’s actually, like, utilizing it, or is it going down a protective pathway or destructive pathway? And it’s been really interesting because, you know, again, I’m thinking of one, uh, woman in particular who raised that concern.

[00:29:41] Jenny Swisher: She’s like, I’m actually a breast cancer survivor. I, I was told I’d never go on estrogen. But then through looking at her Dutch, you know, Dr. Page is like, you’re, you’re, you’re favoring the, the protective pathways. You have a family history of, you know, cardiovascular and Alzheimer’s and these other things.

[00:29:55] Jenny Swisher: Like, we really need to have a conversation about this. So, it’s not really, you know, for anybody who, who is fearful, you know, always ask the question, always advocate and ask the question. But I like that you just took the time to answer that for them to, to, to hear that side of the story. Okay, so I want to ask this, and I don’t want to go too deep into this because I feel like this could be a podcast in and of itself.

[00:30:13] Jenny Swisher: But one thing that women ask me often is, you know, maybe there’s like a hormone health clinic in their town, right? And they’re like, okay, my friend’s going to this place or whatever, and they do pellet therapy or they do, you know, whatever. So I want to talk about, there’s obviously tons of different forms.

[00:30:28] Jenny Swisher: You’ve mentioned FDA approved. There’s also compounding pharmacies. Um, there’s creams, there’s trochies, which are lozenges. There’s vaginal insertion gels. There’s, I mean, pellets. So what is, what, what would you have to say about like understanding the different variations. Cause I mean, what I, what I could gather sort of the Cliff’s notes of what I would say would be, it’s very specific to the woman, her symptoms and what’s going to work best for her.

[00:30:54] Jenny Swisher: But I would love to kind of hear, you know, your perspective on some of that.

[00:30:57] Dr. Paige Gutheil: Yeah, definitely. And you know, don’t get me wrong. There are a lot of, integrative health clinics that are doing a very good job. I’m sure. I think that the misinformation with the women’s health. initiative really increased the demand for some integrative clinics and compounded versions of hormones because there was such a culture of fear within the mainstream medical community and kind of a freeze on FDA approved formulations.

[00:31:32] Dr. Paige Gutheil: And so in a lot of ways, you know, women who are frustrated with mainstream medicines turn to whether naturopathic or integrative clinics to come up with compounded versions. And so, like I mentioned earlier, you know, sometimes compounded versions are necessary, but there is value to using FDA approved bioidentical formulations.

[00:31:57] Dr. Paige Gutheil: That have an added layer of protection of, kind of security related to the processes that they that they follow and the standardization among those formulations. So, in my practice, I. do make an attempt to start with FDA approved bioidentical hormone therapy. Um, it also has the added cost benefit of, you know, being covered through insurance.

[00:32:26] Dr. Paige Gutheil: So even when we start within that FDA approved, formulations, If we just take estrogen as an example, we can get bioidentical estrogen orally, we can get bioidentical estrogen through a patch that’s absorbed through your skin, we can get bioidentical estrogen through a gel, and we can get bioidentical estrogen through a spray.

[00:32:47] Dr. Paige Gutheil: And so that’s just one little decision. And then we add progesterone to the mix, which is typically given orally, and the oral formulation is the one that’s been Most proven to protect the uterus. So that’s important. Although sometimes we use other formulations if we don’t need that uterine protection.

[00:33:09] Dr. Paige Gutheil: And so, and then from a compounded perspective, , sometimes we do get into using , the , troches or troches, depending on your area of the country that are given orally, but not digested. So they’re absorbed through the, um, oral mucosa. and then other options as far as creams and injections and such.

[00:33:30] Dr. Paige Gutheil: So it really is very personalizable. It’s like coming up with a recipe. , and that’s where working with a clinician that one knows the nuances of Kind of what routes are better than others. , didn’t even mention, you know, vaginal formulations, vaginal estrogen, which really has no contraindications, is absorbed to the genital urinary area, the vaginal area.

[00:33:56] Dr. Paige Gutheil: , and there are also systemic, hormones that you can absorb through the vaginal mucosa that affect the whole body. So you can kind of get to there. So when I’m meeting with patients, it’s really a matter of a lot of , personal preference, lifestyle. Um, cost comes into play.

[00:34:17] Dr. Paige Gutheil: Sometimes personal medical history, depending on, if you have some risk factors that increase risk of oil or oral, um, formulations, scheduling, convenience, you know, just so much.

[00:34:30] Jenny Swisher: So

[00:34:31] Dr. Paige Gutheil: that is one of those areas that yes, we could talk about all day. Um, and really goes back to what I mentioned before, like, if I don’t never want to give the impression that it’s just trial and error because it’s a very informed decision.

[00:34:44] Dr. Paige Gutheil: We should be able to, you know, hit the nose on the head up front, you know, but we don’t hit it out of the park on the first swing every time. Right. So there’s a lot of nuances to kind of making adjustments as you go.

[00:34:56] Jenny Swisher: Yeah. And I mean, even, you know, so you talked about estrogen, there’s progesterone, there’s testosterone, there’s And then there’s different dosages of each and as you guys have heard if you’ve been following along on the podcast, like I recently had an epiphany about the cream I was using for progesterone and realizing I was using a 20 percent progesterone cream, but there’s a 10 percent and there’s a 5 percent and there’s, there’s so many different variations.

[00:35:16] Jenny Swisher: Same thing with I know estradiol patches. And it’s just so specific to you. Right. And so, again, working with someone knowledgeable on this is so key. The other thing I want to just say, and this is my opinion, so this is just me saying this. It’s my podcast, I can say my opinion, I guess. But women will often ask me, you know, I know that these things are popping up, like hormone health, telehealth is popping up in places, or, um, and it’s, again, I think everybody has the right intentions, but at the same time, like, if you’re in a situation where you are, , just providing lab work, Which is blood work.

[00:35:50] Jenny Swisher: If you’re just providing like one set of blood work and then you’re being given estrogen, progesterone, testosterone, I would have questions about that. Uh, and I’m seeing that happen now. I’m seeing that pop up in places and people always ask my opinion and I’m like, I’m not cool with that because I know how bioindividual HRT should be.

[00:36:08] Jenny Swisher: Um, and also the, you know, just knowing what I know about blood work and accuracy and not being a super in depth look and just, you know, That red flag central for me. So I just wanted to say that because I do get asked that question.

[00:36:21] Dr. Paige Gutheil: I am so glad you brought that up because I you know, I Mentioned before like I never want to you know, kind of downgrade Any, you know, clinics that are doing good things, but I would, I will, you know, put myself out there to say, if you are going to a clinic who only offers pellet therapy or who only draws blood and then makes your formulation, that is not the standard of care in mainstream medicine or any other kind of medicine, you know, whether functional integrative or what have you, you are not a number on a paper.

[00:36:57] Dr. Paige Gutheil: I’m not a number on a paper. Nobody’s a number on paper. And, , there are so many disadvantages to that method. And it’s, it’s tricky, right? Because it sounds good. It sounds like, oh, then that must be well informed, but it’s just not the case. So. Um, I’m glad you brought that up. Pellet therapy is, is one of the things that I didn’t mention pretty intentionally because I’ve never honestly prescribed it.

[00:37:23] Dr. Paige Gutheil: Now pellets do intrigue me, , and that in theory, it sounds really convenient, right? Like if we’re out there taking a pill every day or rubbing the, , cream on every day, It would be nice to have a slow release formulation that, , you just set it and forget it. But, , my experience with pellet therapy is really misguided.

[00:37:47] Dr. Paige Gutheil: Um, there’s different variations, but a lot of them really are using very supra physiologic levels of testosterone and other hormones in women that are causing very much unwanted side effects. Keep in mind when we’re talking about hormone supplementation or hormone replacement therapy, we are looking to restore your hormones to a level where you felt great.

[00:38:18] Dr. Paige Gutheil: We are not looking to have the highest level that we can. As women, we are not looking for testosterone levels in the male range. And that’s, I’ve seen that so many times with pellets and the downside of something that you have to. Just that you can set it and forget it is that even if the formulation is not correct with you, you have to set it and forget it.

[00:38:43] Dr. Paige Gutheil: And so those pellets wear off gradually over time, meaning months. And if you’re stuck with unwanted side effects for months, it is not pleasant.

[00:38:52] Jenny Swisher: Yeah, exactly. And I’ve seen this happen too many times where women will get testosterone pellet. And they usually within a couple of weeks, they start to feel better.

[00:39:00] Jenny Swisher: I had one friend of mine who was like, actually I’m having some like heart palpitations. I feel like my energy is soaring. Like she was having good sensations after a couple of weeks. And then as I’ve seen on different charts, you know, testosterone pellets will peak. around 30 days after insertion and then what happens is they wane.

[00:39:16] Jenny Swisher: And so, you know, two months later she’s reaching out to me and she’s like, I don’t know what’s wrong. Like I’m, you know, I’m losing my energy and I’m like, well, you’re kind of on that. I hate to say like, in theory, like you said, pellets would be convenient, but are they, you know, or is, are they, I’ve heard too many things.

[00:39:33] Jenny Swisher: I mean, clearly I’m a nerd here. So I, I tuned into all the podcasts and all the things, and it’s the resounding message I hear is just usually not a fan of pellets. That doesn’t mean there’s not a place for them, but okay. So as we wrap this up, let’s just do a little rapid fire here. I want to, I was going to ask you, you know, What benefits have you seen in patients?

[00:39:50] Jenny Swisher: I mean, obviously you’ve worked with so many, but if you have any stories or anything that you want to share of just, of just, you know, women that you’ve been able to help and things that they’ve improved in, I’ll share one for me just in working in these consults. , one woman in particular reached out to me after we met with her a second time.

[00:40:06] Jenny Swisher: And she was just like, I just have to tell you, thank you. But I also want to tell you that my husband thanks you because, um, not only did she feel like her marriage was going down the drain and perimenopause, um, because of all the changes she was experiencing. I think the common thing I hear in Perry. Is I just don’t, whose body is this?

[00:40:24] Jenny Swisher: Like whose body is this? I don’t feel like I’m, I don’t feel myself. So of course you can also throw in things like libido and just, we’ve already mentioned brain fog and all the things, right? You’re not exactly the most, the easiest maybe person to live with. I’m just saying. So, uh, it was funny because she was just like, you know, I wanted to thank you, but I also just wanted to tell you that my husband thanks you because.

[00:40:44] Jenny Swisher: , through, you know, lifestyle changes too, right? Like nutritional changes and prioritizing sleep and bioidentical hormone therapy and being heard in the doctor’s office. Like she now is feeling better and feeling herself, which then translates over to her, you know, her marriage translates over to her children.

[00:41:02] Jenny Swisher: And that’s why I always say like the goal is to help you reach maximum energy so that you can be the best for those you love. And that’s as women. That’s what we, that’s what we’re all doing anyway, like we’re wearing all the hats and we’re trying to be the best for those we love, but a lot of times we’re just letting ourselves sort of fade away.

[00:41:19] Jenny Swisher: So I would love to hear if you have any stories or anything, any benefits that you’ve seen and patients.

[00:41:23] Dr. Paige Gutheil: Oh, yeah. And I think truly the biggest one and. It’s it really strikes me and we’re getting better at this, but we almost don’t have the language to describe some of these hormonal effects. Like we can go through all the symptoms, but the biggest thing is the sense of I just don’t feel like myself.

[00:41:45] Dr. Paige Gutheil: And mainstream medicine does not do justice to a statement of that like that. Um, you know, my doctor brain is like, okay, like what, what does that mean? Right. Um, and our English language, our culture does not give enough credence to women’s experiences and, you know, feeling like ourselves. And we are quick to dismiss it to a million other causes, but that’s what I hear the is.

[00:42:10] Dr. Paige Gutheil: I just feel more like myself. I feel more confident. , the other, from a symptom perspective, I think some of the striking ones, , are related to, , brain function, like physicians, uh, accountants, like people who are really having to make critical decisions and are working with spreadsheets and all these things who were feeling like, what is happening to me?

[00:42:35] Dr. Paige Gutheil: Do I have Alzheimer’s? I, I, I can’t, you know, I don’t feel motivated and I can’t manage these numbers and, and they feel like, okay, I got my confidence back in my job arena. , pain is probably the other one that we don’t talk about enough. Um, just waking up achy and creaky and all over body pain and. A lot of women are quick to dismiss it too.

[00:42:59] Dr. Paige Gutheil: Well, I haven’t been working out or I probably worked out too hard. So that’s why I’m sore. And it’s different than that. , and so I’ve had women start hormone therapy and say, Oh, you know, my shoulder that’s hurt for months does not hurt my knee that hurts for months. Does not hurt. And I don’t have this all over body pain.

[00:43:19] Dr. Paige Gutheil: And if you’re in pain every day, what does that do to a mood and relationships and such? And absolutely sexual health is an area related to menopause that has the opportunity to really thrive. And it, again, like I talked about before, menopause era is like, it’s an era, right? Like it has physiology, it has culture associated with it, has social implications.

[00:43:45] Dr. Paige Gutheil: And it just has this era of like women maturing and Really coming into their own and saying, you know what, not only do I want to get rid of my vaginal dryness, but I want to have more pleasure and I want to speak, you know, with my partner in a different way about our sexual relationship. And I want to explore new things.

[00:44:08] Dr. Paige Gutheil: And so, and that sometimes comes after an era of maybe feeling shy or having kids at home. And, you know, so there’s so many. physical, , transitions during perimenopause and menopause that also have almost this like blooming of confidence and boundaries and vulnerability and badassery as you like to say.

[00:44:32] Dr. Paige Gutheil: , so that’s the most fun, honestly, is helping women kind of discover that sassiness that maybe they haven’t had before. So true. They’re not going to take any more shit is what they’re saying.

[00:44:44] Jenny Swisher: Yeah, that’s so true. , I wrote down in my minnow era, cause I love that. Yeah. So I think that, you know, just kind of echoing that when it comes to the sexual health piece, you know, I was just thinking about that today.

[00:44:56] Jenny Swisher: , I was thinking about the fact that very rarely, even in, even in consults, do women bring up sexual health, but if you inquire, it comes up, you know, or they say a lot of times, I would say the majority of the time. There’s an issue there or there’s a frustration there, right? And so, and then in some cases, when women do volunteer the information, it’s, it’s almost out of shame.

[00:45:17] Jenny Swisher: Like it’s like it’s their fault or, uh, and so I, yeah, there’s so much power here. I mean, that’s the thing. It’s not just about HRT. It’s about everything. It’s about. It’s about your food. It’s about your sleep. It’s about, it’s those fundamentals of hormone balance, , that I, I feel like a broken record for saying, but when you can work with a practitioner, who’s willing to look at all of those and have that conversation and say, okay, let’s, let’s see like where we need to focus.

[00:45:41] Jenny Swisher: That’s when you can really make strides. And instead, so many women are in a 15 minute, 20 minute max appointment with their doctor where there’s no background, there’s no lifestyle conversation. It’s just, what are you going through? And I would say 80 percent of the time, here’s some birth control pills, but you know, so anyways, um, I wanted to just wrap this up though, with my, my last question, which is what would you like women, especially over the age of 35 to 40, to know about bio HRT?

[00:46:12] Dr. Paige Gutheil: , the biggest thing is just that you deserve to have education related to it and have a conversation related to it. I think in so many arenas, , the magic of life is kind of just always challenging. Thinking about why do I have this opinion? Why do I feel this way? Where did I learn this? Does this apply to me?

[00:46:35] Dr. Paige Gutheil: And so a lot of what we know right now about hormones in the in the lay world is informed by what we’ve heard and fear and this and that and really isn’t based just things that we’ve absorbed along the way, right? And really isn’t based in a honest conversation of knowing how your body works. The pros and the cons, thinking about how your different things that are going on with you, thinking about what your health goals are, and just so often, you know, as women, as humans, we don’t take the time to really sit and reflect and investigate and make those goals.

[00:47:19] Dr. Paige Gutheil: And so, really, it would just be that, like, you deserve to take the time for yourself and Know your health goals and know how hormones truly can affect you and then go from there and make an informed, confident decision.

[00:47:38] Jenny Swisher: Yeah. And let’s be honest, like most of us did not really receive a lot of hormone health education.

[00:47:43] Jenny Swisher: , you know, even thinking back to like middle school sex ed class, you know, I know for me growing up in a small town, that class was dedicated to helping. Yeah. Girls not get pregnant basically. Right. And not a lot of conversation around anatomy and, , certainly no conversation around like pleasure and sexual health and those kinds of things that wasn’t discussed.

[00:48:03] Jenny Swisher: Right. And so I know for me, like. It was at least age 35 before I really started to dig in, dig in, um, and really want to uncover things on a deeper level, but the other thing I would say too, is just, you know, again, feel like a broken record, but normal is not optimal. And so I swear, I’m going to have somebody create me one of those little giffies that you can put on.

[00:48:22] Jenny Swisher: Is it jiffy or giffy, you know, on, on a social media, I’m going to have somebody create one. That’s just somebody holding up a sign that says wrong doctor. I just, I say it all the time. I’m like, I just need that to be something that I can pull. , but it’s so true, right? Like if your doctor’s telling you, you know, your labs are normal, everything’s fine, or not paying attention to the timing of your testing, if they’re not looking deeper than blood work, if they’re, if they’re not sitting with you and asking livestock questions, and if they’re not working with you, there’s no in depth intake form, right?

[00:48:50] Jenny Swisher: Like there’s no like real true relationship there in the, in the way of really helping you get to that maximum energy, you’re going to continue spinning your wheels. Congratulations that it’s covered on insurance, but you’re going to continue to spin your wheels in this environment of getting no answers and being told everything’s normal when in fact you’re not, and you’re not optimal.

[00:49:09] Jenny Swisher: So, all right, well, Dr. Page and I could, we know this for a fact, we could go on for days. , someday we’re going to host some sort of retreat or event or something where we can have Dr. Page and Kelsey and all of these amazing people that have sort of come into the sync corner of the world. And, uh, really go even deeper in something like that, which will be awesome.

[00:49:28] Jenny Swisher: But for now, this is what I wanted to do. I wanted to kind of debunk. The women’s health initiative study. I wanted to talk about the reality of bioidentical hormone replacement therapy and the benefits for women. So hopefully you guys got that out of this episode. I will link up for you in the show notes.

[00:49:43] Jenny Swisher: , I always like to link up research articles too. So I will link up more than just what we talked about so that you guys can do your own reading. I’ll also link up for you previous episodes that I’ve done on this topic. , if you guys have any questions, you’re always welcome to reach out. But again, we just announced this.

[00:49:56] Jenny Swisher: We’re now offering. consults with Dr. Page. So if you’re interested in working with her, , those are now live. So you can go to sync. jennyswisher. com slash virtual consult. You can sign up for any of our consult packages to work with Dr. Page directly. Everything’s virtual. So even if you’re not located in Columbus, Ohio, , you can still meet with her.

[00:50:15] Jenny Swisher: And actually, I’m really excited to also soon announce, um, some expansion in this room too. I won’t announce it just yet, but we are, we’re going to really be able to serve a lot of women here. So, thank you, Dr. Paige for being here, for being awesome, for teaming up with the SYNC community, and, uh, we’ll talk soon.

[00:50:32] Jenny Swisher: My pleasure.