The Hormone Nobody Tests in Women

Show Notes

When women talk about hormones, the conversation is estrogen and progesterone. Testosterone gets treated as a sexual health issue and little else. Colin Renaud, PA-C calls that a big misunderstanding, and this episode is about what it costs.

Testosterone has a role in muscle, metabolism, bone health, mood, energy and overall vitality in women, and it is routinely left off the panel entirely. Colin walks through what actually gets tested versus what should be, the difference between total and free testosterone, what sex hormone binding globulin does, and why normal on a reference range is not the same as optimal.

He is direct that a symptom picture should never be dismissed on one lab number, and that the conventional system is not built to catch this. The episode closes with a case study of a patient with HSDD, hypoactive sexual desire disorder.

For educational purposes only. Not personal medical advice.

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Today is a super exciting episode. We're gonna be talking about testosterone in women. All right, we're gonna be talking, testosterone's role in women, their muscle, their mood, their libido. We're gonna be touching on hormones, functional medicines. It's gonna be a really exciting episode today. What if testosterone is one of the most important misunderstood hormones in a woman's health? We're gonna be talking about today. So when women talk about hormones, estrogen, progesterone, usually gets all the attention. But testosterone also plays a hugely important role in libido, sexual illness, energy, mood, motivation, muscle, metabolism, bone health, overall vitality in women. The problem is that the conversation has become confusing pretty fast. And some women are told testosterone does not matter at all while others are told it's the missing answer to everything. So what's the truth? The truth is more nuanced. Testosterone levels in women can decline with age. And by menopause, some women may have about half the testosterone they had earlier in life. At the same time, major consensus guidance says the clearest evidence-based indication for testosterone therapy in women is hypoactive sexual desire disorder, or HDD, HSDD, in postmenopausal women after a full psychosocial assessment. So essentially, the really only, and Collin, correct me if I'm wrong here, but the conventional thinking of testosterone in women's health is really just all, oh, testosterone, the only role it matters is in sexual illness. It seems like a big misunderstanding. Is that right? Yeah, it's a big misunderstanding. Yeah, so it goes deeper. That's what we're gonna be talking about today. So in this episode of the MedMatrix Method podcast where we go live, we're breaking down testosterone's role in women's health through functional medicine and a functional medicine lens, root cause lens. We'll talk about muscle, mood, libido, energy, metabolism, longevity, perimenopause, menopause, hormone testing, the testing you need, different therapies, and why symptoms should never be evaluated through one lab number alone. We'll also discuss why functional medicine looks at the whole body, hormones, thyroid, blood sugar, inflammation, sleep, stress, nutrition, body composition, lifestyle, all of it, okay? So everyone, welcome to MedMatrix Method podcast. I am honored to be joined here by Collin Renard, PA, one of the lead providers at MedMatrix. Collin, why don't you give a little background on your experience with women's hormonal health and anything else you wanna show the audience? Yeah, so thanks, Cole, for having me. I think this is really exciting. Like you said, I'm one of the lead clinicians here at MedMatrix. I have a pretty unique background. I am board certified in multiple disciplines. I have a background in alternative medicine, in natural medicine, and I'm fellowship trained in functional medicine and anti-aging. I hold, like I said, multiple board certifications, including nutrition and anti-aging. I specialize in hormone replacement for both women and men as well as a variety of other things, from gut health to weight loss to longevity to complex chronic disease and Lyme disease and immune deficiency. So I'm pretty well-rounded in terms of what I treat, but hormone optimization and hormone replacement is one of the biggest things. And I think having this discussion specifically about women is really important. I also wanna preface, we were talking about this before we went live, but I'm a man, right? So maybe some of our listeners might be like, well, why is a man talking about women's health? So we didn't necessarily do that intentionally. I think it just happened that way. But I think it's important to preface that women do have difficulties talking about their sexual health or their hormonal health with a provider that is not a woman. Same thing with men. I have male patients that are like, yeah, I appreciate that you're a man. It's hard for me to talk about my sexual health or more personal issues with a female. So I think it just happened this way that we set up the podcast for me to do it. But I wanna allow women to feel comfortable to share their issues with maybe a provider that might not feel, like it might feel a little weird because we all have our own experiences. I'm not a female, but I've been treating hundreds, if not more than that, women in my career with hormone replacement and hormonal health. So maybe it'll make women feel a bit more comfortable to share and be open with some of their issues, no matter who their provider is. That's really the goal. That's exciting. Yeah, thanks for sharing. I think that's important to say, totally. I think so too. Sexual health is, it's all health, but at the end of the day, yeah, health is a personal thing, right? It's weird. Yeah, it's a weird thing, yeah. Yeah, and it's great we can talk about this in the open and people can take different learnings away from this without having to kind of get a taste of the questions they should. Because a lot of times too, a lot of things get brushed under the rug or they're afraid to ask and some of these things don't get addressed. So it's cool we can do this online for everyone. All right guys, so quick little housekeeping stuff. Nothing today is medical advice. This is on that topic for educational purposes only. The way this, if you guys want healthcare advice, you can go to your provider or you can go to medmatrixusa.com and you can enroll as a patient and see if it's a good fit. As far as like what today's gonna look like over the next 50-ish minutes, we're going to start with our discussion as we go. If you have any questions, this is really important, make sure you drop them in the comments because after the discussion, we're gonna go through a case study to show what this can look like from a real life patient scenario from A to Z. And then after that, for my favorite part, is we're gonna do Q&A. And the more engaged you guys are, the better. If you have a question, odds are someone else has it. So make sure you drop questions as they go along. More times than not, we have too many questions than answers. So the earlier you drop in your question, the more likely it is to get answered. So with that said, let's jump right into it. So Colin, when a woman hears testosterone, what do they usually assume? Yeah, that's a great question. I mean, when women hear testosterone, they usually start to assume that testosterone is for men only because that's what most people kind of associate testosterone with. And also that testosterone is only for sex drive. So it's, or it's something that's automatically thought of as being masculine, right? Well, testosterone is given for people that are transgender, women that are trying to present as male. But women do need testosterone. It's really, really important for a lot of different things. So the biggest, most common misconception is it's just not a woman's hormone. But it is, it plays a big, big role. And I think we're gonna dive into that. And I think it's really important for women to know that because I think a lot of times it's underappreciated with their own healthcare providers, that they just focus on the women, the female dominant hormones for women. And while testosterone is not the dominant hormone in women, it still plays a big role. Yeah, so why do women need testosterone too? Like what, like what, like a basic level does testosterone do in the body that is so important for women that's gonna affect the way they feel? Yeah, yeah, women need testosterone because one of the major roles that testosterone plays is women's sexual health, sexual desire, libido. It's also really important for a woman's energy, her mood, her bone and her muscle health, as well as like motivation. I talk about testosterone with women as like the get up and go, type A, gonna get stuff done kind of hormone for women, which a lot of people need. Not only women, but everybody. And then really important for your body composition, testosterone is really important for muscle building and fat loss, as well as overall vitality. So the goal with testosterone is not to make women more masculine. The goal is to support its normal function. Like I said, if women are having significantly low libido, we'll talk about, you had mentioned this in your introduction, but hypoactive sexual desire disorder, really, really important topic. So things like sexual pleasure, overall satisfaction with sex, talking about muscle mass and physical strength and bone mineral density, and then your mood and your energy. So testosterone plays a huge role across women for not only symptoms that they might be struggling with in menopause or perimenopause, but for longevity as well. Yeah, so how do, because when you, I think it's pretty common knowledge that estrogen and progesterone are the main hormones in females. How do estrogen and progesterone work together with testosterone? So estrogen, progesterone, and testosterone work together more so in women than men, I would say. Both sexes have the three hormones, progesterone, estrogen, and testosterone. Men rely mostly on testosterone. It's very, very dominant. We do have some estrogen, but it's a very small amount. But women really need all of the hormones together to, they're almost married to each other in this nice little syncytium together. And it really, they play a role in being optimal together. So if one is low, it might be affecting the other, and then the third. So it's very, very rare, say, for a woman who is in menopause or post-menopause where most of her sex hormones are gonna be low, it's very rare for me to just supplement with one hormone and be like, okay, that's it, you're done, you're fine. Most of the hormones become low. So estrogen and progesterone kind of work together because they regulate ovulation, they regulate the menstrual cycle. So when a woman goes through menopause, the estrogen and the progesterone are often low. But perimenopause, you can start to see a shift in those things. So there's a huge, huge network of these things going together. And the biggest thing that women need to understand is that women's hormone health is not about just one hormone, it's really all of them together with the thyroid hormones, with your insulin hormone, your cortisol hormone, and all the metabolic health all interacting. So really, really important to understand. Gotcha. When a woman comes in and she might be of age where you might think testosterone might be part of the picture, what are the typical tells or signs on labs and anecdotally as far as their symptoms? Yeah, that's a good question. So some of the most common signs of testosterone deficiency or suboptimal testosterone in a woman can include low libido over a prolonged period of time, reduced sexual response. So what we mean by that is failure to respond to a partner's sexual cues, where there's lack of interest when sex is initiated by a partner. You don't get that spark that you feel. Also, there can be lower motivation. Like I said, testosterone for women is like the get up and go, type A, I'm gonna get stuff done kind of hormone. So if you're lacking that motivation, both physically and mentally, that can be a sign. Other things that are more general like fatigue, poor recovery, loss of muscle mass, changes in your body composition where you're gaining fat and losing muscle mass or having trouble building muscle mass, and then feeling less resilient overall. Like you just don't feel like yourself. You just don't feel like you have that oomph. Those are common things we see with testosterone. A lot of it is related back to sexual health, but like I said, it's not just that. It's your muscle health, it's your bone health, your energy and your mood. Those are also really important things too. Yeah, well, I guess my takeaway from that, as I imagine the audience is too, is that's a lot. Like that was a big bag of symptoms that could also be linked to a bunch of other different things. And I guess one of the things that comes to mind too is like, it seems like very rarely in conventional medicine is testosterone talked about in women unless it is the HSDD diagnosis, is that right? Yeah, honestly, I think it really depends on the woman's provider. I have met and have colleagues and I have patients that have gynecologists that are amazing. They are so on top of the hormone health, like let's do something, are you struggling with this? Are you struggling with your libido and all of that? But I would say, yes, you're probably right. And as a general, I'm overgeneralizing, I'm not being specific to anyone. But in general, I think testosterone is equated to women from a sexual perspective. That's really important, right? Women's sexual health is utterly important, especially through perimenopause and menopause and beyond. But certainly there is, it's more to it than that. So like you said, that's a lot of stuff that testosterone is responsible for. Imagine that plus the effects of progesterone and estrogen in a woman who's in menopause and postmenopause, it's a lot. Women are struggling often with a lot of stuff. So being really, really on top of women's health in these years of their life, I think is extremely important. Yeah, gotcha. So here's the question where you become more of an artist than a provider. Patient comes in with all these things. Patient comes in with all these different symptoms, right? Then it might be linked to low testosterone. And let's say you do labs and it does show low testosterone. How do you know what the root cause is? Is it something to do with their thyroid, their adrenals, their insulin? Is it a nutrition thing? Is it a genetic thing? Or is it time for hormone replacement therapy? How do you start to think about this patient and root causes when you're thinking about testosterone replacement therapy for them? Age is a really big factor. So if a woman is, say, in her early 30s and she's having symptoms of low libido or low sexual arousal and say her testosterone is normal, well, that's a bigger question, right? She's not perimenopausal, she's not menopausal. The hormone is normal. So what's really going on there? But I think it, I wouldn't say nine times out of 10, but most of the time when a woman is going through hormonal deficiency, it makes a lot of sense. She's of the age of perimenopause or menopause. She's showing signs of other hormone deficiencies. Her menstrual period might be changing. She's having poor sleep. Her mood is all over the place. And a lot of times women will just come in and say, I think I'm going through perimenopause. Like I watched my mom do it, my sister does it, my best friend's doing it. Like I think that's what. So a lot of times it's very obvious, but there are these cases where it isn't as obvious and you have to really go digging. But when a woman is of age for hormonal dysfunction, a lot of times it's that. And we can start there and say, okay, is this gonna be helpful, is it not? And then you kind of go from there and you start digging into other things to see if there's other root cause issues. Okay. Yeah. What are some of the most common root cause issues that you see? Of hormonal dysfunction? Some of the most common root cause issues of hormonal dysfunction in women is pretty much, the most common is being in some phase of menopause. So perimenopause, menopause, postmenopause. But hormones can be affected by thyroid issues. If a woman is diabetic and also some really big issues with nutrition. If there's under nutrient patient where she's not eating a lot, not eating enough protein, it'll be hard for hormones to be optimized at any age. Okay. Gotcha. So many questions from this dialogue. It's a lot. Yeah, it is a lot to unpack. I guess one of the things you talked about was diabetes and thyroid. Can you talk about, I see a comment here, Vic Larson asking about how thyroid is connected to testosterone? So the thyroid, it's often seen as something totally different. So with women specifically, thyroid hormones and testosterone are closely linked through certain proteins. One of the ones that we test for in the new patient panel for patients at MedMatrix is something called sex hormone binding globulin or SHBG. So if you have hypothyroidism or a low thyroid function, it can often lower SHBG, which can change the balance of testosterone in the body and can contribute to symptoms like fatigue and low libido and mood changes. So treating the thyroid can often help rebalance the testosterone. And this is to your question we just talked about a couple of minutes ago. If I'm seeing symptoms of low testosterone or low testosterone, say, in a young woman who's 20s, 30s, I'm not thinking about menopause. I'm not thinking about menopausal change. So something else is going on, whether it's a thyroid issue or it's a blood sugar issue. But that's a really, really common way that the thyroid connects to testosterone. Okay, gotcha. And then what about nutrition? You talked about, like what, like if I was a woman going through menopause and I wanted to mess up my hormones, what foods should I eat? The reverse question. Well, if you're a woman in menopause or going through menopausal hormonal change, perimenopause, whatever you wanna call it, the best way to mess up your hormones is to eat a lot of processed food, not eat enough protein, not get well hydrated, eat a lot of sugar. So the biggest thing we talk about all the time, I talk about, we talk about on this podcast all the time, is the role of protein in the diet for hormone optimization. And I think this is the other thing, too, is like, oh, high protein, that's a man thing. Nope, no, it's not. It's an everybody thing. So very important for muscle metabolism, hormone optimization. If you do not have some of these building block materials to make hormones, it's a real issue. And aside from protein, things like vitamin D and zinc and iron and B12, I mean, they all play a significant role in hormone optimization. So if someone's diet is just poor, or they're not eating very complex, nutritious food, we have to start there oftentimes because we could give all the hormones that we want, but we've gotta build the basics up first. Yeah. What about stress? The infamous stress. How does stress play a role? How does stress play a role in testosterone? We did a whole, we've done several full episodes of all, just all about stress and the mind-body connection. Yeah, yeah, we've talked about stress a lot. I mean, stress, stress can be related to poor sleep and can be related to other things, you know, blood sugar issues, but stress can affect your energy, can affect your mood, how many people wanna engage in any type of sexual activity if they're stressed, right? So when we talk about women's health and sexual health, it's like if you're stressed to the max, that's probably the last thing you wanna do. And it can also affect your ability to recover, it can affect hormone signaling. So a woman may think that testosterone is the problem, which it might be, but again, stress is one of the tenants of function in the body as a human. So if that is not working, it's gonna be very hard to get a woman better. We talk about all the time in this podcast. If you're not sleeping, if you're not eating, if you're not pooping, if you're too stressed, I mean, these are things we just cannot medicate away. So it becomes a real difficult issue if those are not there. Yeah. Yeah, so every time, I'm always reminded whenever we go live about how multifaceted and holistic health is, right? It's never just one thing, it's always like. Oh, never, no. No, and I think, well, that's where I think it's very interesting to have conversations about hormone health because, and I think I will make a guess to say that I think that's why in the conventional medical space, hormone optimization is not as, it certainly is. People do it, there's plenty of people that do hormone and metabolic medicine, but I don't, it's not as straightforward to just, okay, here's a hormone and it's done as other things may be in healthcare. There's definitely an art to it and you have to understand the nuance, you have to understand your patient, you have to understand all the clues. It's very nuanced. So I think that's why people are becoming really, really educated for themselves about hormone replacement and hormonal options. And I think that's why women are asking for hormone evaluations is because they're seeing all these changes and when they do a quick Google or like AI chat GPT, it's like, oh, you have hormonal dysfunction and it plays such a huge role, so it's very important. Yeah, we're, because I think a lot of patients, there's kind of like, when I think of like where patients are going now, it's like the conventional system and then there's like this kind of like popular, like telehealth clinics, right? Like where you kind of just like go in it, like go online and kind of like pick and choose your medications based off of like, you know, what you know and don't know. And there's kind of like us, like the more like, well, actually, I guess there's a fourth. The third, let's say the third is us, like the functional medicine clinic and the fourth is kind of like, these hormone clinics that they kind of go in, they give everyone like the same hormone protocol. Can you talk about kind of like the benefits and issues with kind of the other, like all the different ways that women are taking care of their hormones right now? Yeah, and I think this kind of opens up a broader question of like, where conventional hormone care can often just fall short for women. You know, if you're doing like an online clinic that's focused on anything, right? There's a lot of the online GLP-1 clinics for weight loss drugs. There's the online clinics for hormone health. And as you mentioned, a lot of them are just, it's all run by algorithms, run by AI. Obviously, there's some sort of medical provider in the helm of these clinics to sign the prescriptions, but it really comes down to, is it giving a patient, a woman or whoever the patient is, is it giving the woman a personalized like treatment plan? Maybe it is. Maybe it's good enough for some people. I would argue that if it's just a clinic to give a GLP-1 or a hormone and that's really it, there's no further evaluation. There's no talk about nutrition. There's no talk about food. There's no talk about vitamin status. There's no talk about your thyroid. There's no talk about any of these other things. I think it becomes a huge disservice for women because you're just getting a very fragmented piece of your health picture and it might backfire on you. So the way we do things at Men Matrix is we try to look at everything from the bigger picture of the female to her symptoms, to other variables, to other issues she has, and not just be so hyper-focused on one thing. While that one thing might be what she needs, I think you still have to do a deep dive into understanding the person from a holistic perspective. It just is, it's just important. And I think women are demanding it, especially because women's health has been so neglected, I think, in the mainstream medical community. I think women get dismissed very easily and they're told, well, this is just supposed to happen. You're supposed to go through menopause. It's just part of life. Just deal with it. And that's just not fair. I think it's just really, really sad that women are told that, especially if they go through menopause or a hormonal shift, say, in their 40s and 50s. A woman could live another two, three more decades. So it's like, you want me to feel like crap for three more decades of my life and then die? Well, that's not fair. I think that's where we're getting it right with the hormone discussion. It's coming from a place of personalized longevity care and not just, okay, here's your hormone, hope it works kind of thing. Yeah, totally. Well said. Yeah, what are some of the, I guess, tangible differences? For example, what testing markers are you looking at at new patients that are really important when evaluating someone's hormonal health, especially a woman? Yeah, when evaluating hormonal health in a woman, it's really important to look at her actual sex hormones, so the progesterone, the estrogen, the testosterone. Obviously, that's the forefront of hormone replacement therapy, but it's also really important to look at thyroid. Like I said, that plays a big role. It's really important to look at blood sugar markers. It's really important to look at inflammatory markers. It's really important to look at nutritional markers. And patients at MedMatrix get a full evaluation with about 80 biomarkers that we test from day one when you start your journey here. And on the first visit with a clinician, whether it's with me or one of my esteemed colleagues, we go over all of these labs and we give women and men, whomever you are, a really good baseline of where things lie so we can understand how to get started and what needs to happen to optimize their health journey. Okay, yeah, yeah. What are some of those markers specifically that you're looking at that aren't typically seen in a primary care checkup? Yeah, so the labs that we're pretty much looking at to get a full hormone picture, we're looking at all the markers of testosterone, total testosterone, free testosterone, sex hormone binding globulin, which I mentioned before in relation to the thyroid. We're looking at DHEA, which is a precursor to testosterone. We're looking at estrogen or estradiol, progesterone. We're also looking at all the markers of thyroid health, not just TSH. We're looking at all the actual thyroid hormones. We test for insulin, glucose, hemoglobin A1C, which is the marker of diabetes. We're looking at your cholesterol. We're looking at your inflammatory markers. Then as I said, specifically nutritional markers like vitamin D, B12, your iron, liver markers, and then understanding the woman's health history, body composition. All of it goes together in a picture to understand how the hormones are playing a role. Okay, awesome. And then when you, let's say you do put a woman on hormone replacement therapy, specifically testosterone for the sake of this episode, what are the markers that you're monitoring really closely? And how often are you monitoring them? Yeah, if testosterone therapy is considered, the things that need to be monitored include symptoms. Symptoms are important. So how is the woman feeling? Usually I'll follow up with women about three months after they initiate care, and we talk about her symptoms. We review the free testosterone, the total testosterone, sex hormone binding globulin, and then if there's other hormones that we initiated, estrogen, progesterone, blood counts, liver, kidney function. We all do all that at an initial follow-up. And we're also trying to understand how the hormones have affected the female, right? Is there a sign of like the testosterone's too high, right? Is she getting acne or abnormal hair growth, or is the mood changing in a positive way? Is the libido getting better? All of that is what we're looking for in a follow-up. Fantastic, right. And then what are the foundations that need to be addressed if you're ever gonna put a lady on hormone replacement therapy or consider it? Like you would not even put this person on testosterone without talking about these things, without addressing these things. Yeah, foundations that need to be addressed before or even alongside hormone optimization. We've sort of mentioned a few of these already, but nutrition is huge. If there's not a decent amount of protein intake, if that's lacking, that's a huge issue. Is the woman doing any type of exercise, right? Is there strength training or some sort of weight training that's going on? Is there diabetes or some sort of blood sugar regularity that needs to be addressed? How is the woman's sleep? If she's not sleeping, if she's stressed to the max, it's gonna be really hard to get her better. Is there some sort of gut health issue, right? Hormones are detoxified and secreted through part of the gut, right? Estrogen and gut plays a huge role. So we need to understand the gut health. My colleague, Dr. Rose, loves to talk about pooping all the time. We talk about pooping on the podcast when we're together all the time. But it's true, right? Are you constipated? Are you having diarrhea? What is that all about, right? And then understanding nutrition and nutrient depletion. Are you depleted in B12, vitamin D, iron? So all of these things need to be addressed. And oftentimes, how this is addressed can vary for women. So sometimes it's really appropriate to start a woman on hormone replacement therapy such as testosterone if some of these foundations are not addressed because it can help the woman start to feel better to address these issues, right? Well, I'm not strength training and I'm not active because I'm tired all the time. Okay, well, let's try to fix that so we can get you going. But it's always in my recommendations as part of my treatment plan that I'm doing my 50%, whether it's hormone replacement or whatever, but the other 50% must come from the patient. We can do this stuff, but if you're not doing the food, if you're not doing the stress management, if we're not trying to figure out your sleep, there's only so much I can do. There's only so much that this is going to offer you. It's not magic. So that's where it's really important that we set expectations from the get-go and we set goals in terms of long-term goals, short-term goals. It's all really important. Yeah, totally. Yeah, it's almost, because I guess, talk about the flip side. Like what happens if a clinician, because there are telehealth clinics out there that'll just kind of prescribe anyone testosterone or hormones. Like what happens when you maybe fix the hormone imbalance but you don't address the other side of things? Yeah, this happens a lot with GLP-1 medications where, and I use this analogy a lot with patients that are trying to lose weight. If you're just on a GLP-1 from a clinic online and they haven't talked to you about your diet, your protein optimization, your caloric intake, you might not lose any weight. You might actually gain weight if you're under-eating. So it's the same thing with hormones. If we are not optimizing some of the basics in the foundation, you'll probably get some benefit. You'll definitely get something from hormone optimization, but is it going to be as much as they need? It might not. So, or it might be, I'm not getting any benefit from this. Okay, well, we got to address all these other issues first then. And that really gives us a sign of what we need to do. Yeah, gotcha. Yeah. You talked about timeline a little bit with patients like coming in, making the lifestyle changes and kind of like seeing those changes in one month, three months, six months. What is like, when women do have like a legit hormone, like their, I guess, menopause, right? Like they've gone through menopause and their hormones are depleted. Yeah. What for you is a success? Like what do you view a success story as far as like the patient journey going through hormone optimization? Yeah, so it's a good question. The journey of hormone optimization differs from women, woman to woman and any patient to any patient. But most of the time when women are started on hormone replacement, whether it's testosterone or some other hormone, the expectation initially is that you'll start to notice changes within the first couple of weeks. Something like a testosterone, you might feel like your motivation is better. You might feel that your energy is better. You might feel, you know, if there's like a libido issue and this would be maybe a good place to talk about the HSDD issue next. But the expectation is that you're starting to notice some change in your symptoms within the first couple of weeks. But I always talk about my expectations and of the treatment plan, because that's really important. So if women are expecting the world in a week, it's not gonna happen. But you will start to notice some change. But most women will notice a more significant change in hormone replacement therapy, whatever it is, after about three to six months. Especially something like a testosterone where there's an effect on muscle metabolism and muscle mass and physical strength, right? Those things might not kick in in the first couple of weeks. But after three to six months, I'll have women say like, yeah, you know, I'm in the gym a lot and I'm lifting and I'm running and I feel really strong and my libido is really good. And so it really just depends on the female, but there are certain timelines that we have to talk about so that they have the appropriate expectations of what to expect. Okay, how come one woman's testosterone level can be normal, one can be optimal, one can be suboptimal and they could all feel the different, they could all feel different or they could all feel the same? So this just goes back to everything that we do within healthcare. I mean, you can have women that have different hormone levels, different testosterone levels, but feel the same or feel different, right? Some women have fairly normal testosterone levels that have symptoms of low testosterone. Some women have low testosterone and don't have any symptoms. So this is really where the art of medicine comes in because everybody is very different. So that's where we don't necessarily always rely on labs. Labs are important, but it's also important to know how the woman is feeling. And I've had plenty of patients, men and women, where they have low testosterone and it's like, okay, you have low testosterone. Are you experiencing do, do, do, do, do, do, do? And they're like, no. It's like, oh, okay, well, okay. So what does that mean, right? Do we treat it? Do we ignore it? It depends. It depends on some of the other parameters. So this is where goals come in. This is where it's important to understand what the woman is there for, right? If a woman is in my office to talk about a gut health issue and I see that she has low testosterone and I'm like, okay, do you have X, Y, Z, low libido? And she's like, no, I don't have any of those issues. I have gut health issues. Okay, well, then we need to address that. It's my job to give the facts, but also give what the woman is looking for. So everybody's very different. And some people, when we talk about sexual health, in general, because testosterone is linked very much to sexual health, some women and men have different, I guess, opinions on what their sexual health means to them, right? They might have symptoms of low testosterone from a sexual libido perspective, but it might not matter to them. They might not have a partner. They might be, the partner might have passed away. They might not think that sex is important to them or it's not important to them. So this is where the whole art of this comes down. So everybody's different. What their expectations are is different, and that's why we have to personalize the journey for everybody. Yeah, well said. And why does that not happen as much for those who kind of don't know? Why does that not happen? Because it seems pretty common sense, right? Like health should be personalized. It's very important. It's how we feel every day. Why is that not commonplace in the conventional system? It's a whole, how much time do you have? That's a whole nother podcast, right? So personalized medicine is not as robust in the healthcare system, just because I think the way the healthcare, the conventional healthcare system is built in a way that doesn't facilitate great personalized care. And the way I'm saying that is it's not built, it's not laid out in a way where a provider has an hour plus maybe to talk to you about. When you see your primary care doctor, you have like five, 10 minutes for one complaint, right? How do you view out your whole health journey and all of the things you're concerned about when you have five minutes with a provider? I think more providers want to help people from a more personalized and holistic fashion. They just don't have the ability to within the confines of their medical office job, the practice, the hospital, wherever it is they work. It's just not the way that the culture is. I think they want to, it's just not how it's built, so. Yeah, that makes sense. Yeah. I wrote this down, did a little memory note. You mentioned testing. I know we hear this question all the time from women who are coming to the practice, which is, oh, I was told that hormone blood testing is irrelevant, doesn't matter because my hormones change throughout the month. Can you talk about like what's true about that and what's not true when it comes to hormone testing for women? Yeah, hormone testing for women can be a little bit tricky because what you said is true. Hormones do change depending on where a woman is in her menstrual cycle. That's if she's still menstruating or if she's perimenopausal and still having menstrual periods, but they're irregular. Hormone levels do change. So for example, estrogen and progesterone are different if it's in like the first 14 days of a menstrual cycle versus the second 14 days of a menstrual cycle. So when we do hormone testing on a female who is still of menstrual age and is having menstrual periods, it is just a snap that day at that time. It's very difficult to hone in on hormonal dysfunction on a single blood draw lab because there is change going on throughout the whole month, especially if there's irregularity in the woman's cycle. So it is much more difficult. So sometimes if a woman is perimenopausal or still actively menstruating, it comes down to more of what the symptoms are, what she is subjectively saying. I'm having this, I'm having that. Okay, that makes sense with this or whatever. If a woman is postmenopausal, went through menopause, over it, when we do labs, most of the sex hormones are low and that's pretty typical of what we would see. So a lot of women will ask for hormone testing from their doctors, sometimes like their gynecologists, and the gynecologist will say, the hormone testing is not important. So I'm gonna play devil's advocate on that a little bit because if a woman is menopausal and postmenopausal specifically, do I need hormones to tell me that she's postmenopausal? Do I need that lab value? No, I don't. I know they're low because that's the definition of menopause. Definition of menopause is your hormones are low, period, and they will not come back. Where testing is important for women that are postmenopausal is when you start treatment because you wanna make sure that you are helping the woman's symptoms, number one, but you also wanna make sure that the labs are reflecting therapeutic range. So if I'm giving estrogen or progesterone or testosterone, I wanna make sure that I'm dosing it right, I'm not underdoing it or overdoing it or whatever. Most of the time for women's hormones, we are giving the least amount to be therapeutic but that's why we have to make sure we're testing at these follow-ups like we talked about a few minutes ago because I wanna make sure I'm not overdoing it. And if I've started a woman say on estrogen or testosterone and the labs are essentially the same as they were before, it's like, oh, well, the dose is obviously too low if nothing's happened. So they are important when there's treatment involved but like I said, I don't necessarily need labs to prove that a woman is postmenopausal and labs can be tricky in menstrual when there's menstrual regularity in perimenopause because of the changes. So it's a little bit complicated. Gotcha, what about the, I know one of the brands called Dutch Testing where they do the saliva and you do that every day and it manages it or it looks at it over time. What's your kind of opinion on those and when that type of hormone testing is necessary? Dutch Testing can be very helpful if there's a lot of irregularity or if we've tried treatment based on certain symptoms and it doesn't work or it's not being, it's not as effective. Sometimes, like I said, Dutch Testing, I think maybe is overdone. Like I said before, it doesn't necessarily, it doesn't take a lot of objective data to tell me that a woman is having hormonal dysfunction. She is very good at telling me I'm not sleeping, my mood is all over the place, I'm hot flashy, I'm night sweating. It's like, okay, do I need to do a Dutch Test to prove that those are hormone symptoms? No. So is it sort of a waste of time and money? Yes. Is it easier, if appropriate, to trial treatment and see how it works? Yes. It can always be stopped. So there's some instances where these tests are appropriate but I do think that, this is sort of a separate subject, maybe this is a good topic for another podcast but I do think that in the functional medicine space, I have met and know of a lot of clinicians that just kind of overdo it. They sell all this testing and it's like, is the testing even giving you any additional information that's useful? Nah, I don't know that it is. If you're a good clinician, if you're a good diagnostician, you should not need a whole bunch of stuff to get you to where you're going. You need some stuff and you need some specialty tests but I think in the functional medicine space, we sometimes overdo it and we sell that they need all these tests to know what we're talking about. I think that'd be a great conversation for another podcast. We should make another one. Yeah, that's so interesting. And on that topic, are there any other specialty tests that you typically, like if resources isn't an issue and a woman does come in with menopause that you would like to see and you view as useful? If there's a lot of gut health issues, that's often useful. Like I said, estrogen is metabolized through the gut. So if there are gut health issues, that can be very useful. The most important thing that women need to understand though from just a health maintenance perspective when doing hormone replacement is that they still need routine exam, right? You still need to get your mammograms. You still need pap smears. You still need all these things that are part of routine women's healthcare. You know, I'm not a gynecologist and I'm not gonna pretend to be one. So I don't have the ability to maintain mammograms for my patients or breast exams or female pap smears. So these are things that are really important for women to understand. It's like I still need all this stuff to make sure that I'm still healthy. But a specialty test is sometimes, but not all the time, not really, not too often. Yeah, perfect. Okay, a couple other misconceptions or just like common myths or truths out there around women's hormone replacement therapy, especially testosterone is hair and voice. If you overdo it with the testosterone, are you gonna grow a mustache and sound like your husband? No, no. And I think that's the common misconception with testosterone. We sort of started the podcast with this question of like, well, am I just gonna turn into a man? And sometimes I say that. When women don't know or if they're, you know, when we're talking about the labs and it's like, oh, and your testosterone, it's like women do have testosterone, they do need it. They're like, oh, I didn't realize that. I thought it was just a men's hormone. It's like, yep, you do need it. And when I talk about testosterone replacement, if it's a possibility of a treatment option, I usually will say the goal is not to turn you into a man. You are getting a fraction of what we give men. You know, for example, so up to like, and I don't wanna give specifics because we're not here for medical advice, but men can get up to or more than 100 times more testosterone than women per day. Okay. So it's like one of 100. Wow, that's how strong it is, right. It's like a hundredth of, yeah, the dose. So it's very strong effects for men and you just need a little sprinkle for women. So the whole thought of, you know, voice deepening or masculine features, it's a great question, but it's just not, we're not giving enough for that to happen. Can women sometimes, especially when they start testosterone, can they get a little bit of oily skin? Might they get a pimple that they haven't had in 20, 30 years? Could they get like a chin hair? Yes, very possible. But we monitor all that. And that's again, why, like I was saying before, follow-up laboratory evaluation is really important to make sure that we're not overdoing it, make sure we're not underdoing it. But it's not unusual for the hormone to kind of recalibrate, if you will, but we're certainly not trying to turn a woman into a man. That's, you know, that's not the goal. Gotcha, that makes sense. All right, cool. Let's, a couple more questions and we'll go into case study and Q and A. Guys and girls with us live, thank you so much for staying around. Now would be a great time to start popping in questions. Again, if you are thinking it, odds are someone else's and it's always helpful and better for learning if we can answer questions live. So go ahead and start posting some comments. So yeah, I guess when someone comes to MedMatrix wondering if testosterone is part of the picture, what would that process look like for them? Yeah, so if someone is interested in understanding their hormone health or if testosterone is a problem and they come to MedMatrix, this really starts with the patient going through a discovery call with one of our patient coordinators. You mentioned at the beginning of the podcast, you know, if you go to our website, MedMatrixUSA.com, that's really where the journey begins, where you get evaluated by one of our clinical patient coordinators. And then you'll go through a full health history review. You'll talk about that with one of the provider, sorry, the, what's the word I'm trying to use, Cole? We call it provider assistance. Provider, yeah, the provider assistance. It's like- The clinical coordinators. Yeah, clinical coordinators. To review your health history, you'll fill out a lot of forms to give us a lot of information about your symptoms and your timeline, your hormone health history. You know, you'll input all the medications that you take, all your supplements. And then when you meet with a provider, myself or one of my colleagues, we'll talk about your entire health history again, you know, your symptom timeline, when did this all start? How has this affected you? How has it advanced? If women are interested in hormonal issues, talking about that, right? The hormone history, are you menopausal? Are you perimenopausal? When was your last period? We talk about all your medications, your supplements, your stress, your sleep, all your nutrition, right? What are you eating? And then we do a full sexual health discussion talking about, you know, hormones specifically. Are we gonna treat with that? Are they appropriate? What are the risks? What are the benefits? It's a lot. It's a lot in the first visit. It's a lot. Patients get a lot. We give them a lot and we're talking about a lot as they go through the journey from, you know, the first discovery call to the first initial provider visit. So we are getting a lot of information. We're talking about a lot of things, but I really feel like patients are really, they're really yearning for that. They're yearning for someone to really take a look at all this stuff. So yeah, that's what we're doing. Fantastic, cool. All right, let's do a case study. Okay. So I had, and this gives me a bit of an opportunity to, I don't think we covered this, talked about this well, but I wanna make sure we talk about it. So I had a patient, this was a couple of years ago, actually, before I was a member of the team at MedMatrix, but I had a patient with HSDD, which we've mentioned a couple of times. So to kind of review this a little bit, because I think it's important, HSDD stands for hypoactive sexual desire disorder. It's a medical condition that really is defined by persistent or recurrent lack of sexual desire or sexual fantasies that are considered, fairly normal, that has to last, by medical definition, at least six months. HSDD can cause a lot of personal distress where a woman can feel, I don't wanna use the word inadequate, but when a woman doesn't feel, like in this particular case, it was starting to affect her relationship. There's a lot of relationship conflict where she felt her husband was seeking sex in their relationship at a pretty normal amount. She didn't feel like it was overly intrusive. It felt very normal, but she had no interest at all. So the most common signs and symptoms of HSDD, as I said, are little to no interest in initiating sex or participating at all. And then the spontaneous desire. So what I mean by spontaneous desire is most people who have a fairly healthy, sexual body and mind will have thoughts or fantasies on their own or with their partner. And then also one of the other biggest things that this woman was struggling with, and if I remember right, she was in her early 50s. She was definitely menopausal. But there's a failure to respond to a partner's sexual cues. And what we mean by a sexual cue is like, okay, if say this woman's husband was initiating, touching, kissing, trying to get the show on the road, basically, the woman is not responding. I think we can all kind of understand. I mean, maybe this isn't suitable for work, if you're listening, put your headphones in. But I'm an adult clinician, I treat adults. So we can all kind of understand that if someone initiates sex with you, if there isn't an immediate sort of reason to not want to be there, there's kind of a reciprocal something that happens, like, oh, yeah, okay, you get turned on. Basically, if your partner or whomever is initiating sex, there's this kind of cue that happens within you that is a response. So that's a big issue with women that suffer with HSDD is their partner can be initiating the sexual act, but it's like nothing happens, crickets, like no one's home kind of thing. So this isn't really much of a complicated case because at the end of the day, the woman was just menopausal and all of her sex hormones were low, including her testosterone. And once I got her on appropriate hormone therapy, things got a lot better. The issue really was how she got to me. She had struggled for many years, maybe I think like two or three years, being dismissed by a lot of her doctors. Her primary care doctor, her gynecologist, she ended up going to like two or three, if I remember, gynecologists, and they were women. That's the funny part. That's the really funny part that I find very interesting is when women have sexual health issues or women's health issues that they bring to their women clinicians and the women who are maybe of the same age are like, no, it's not a problem, you're fine. It's like, what do you mean? How do you not understand this? You're of the same age as me, you should get this. So that was really the biggest issue with this case. It wasn't that it was overly complicated from a medical perspective, it's just it was sad because she was dismissed. She was influenced to try to go on antidepressants or even like, well, maybe you need to spice things up in the bedroom, maybe you need a sex therapist, maybe you need this, maybe you need that. It's like maybe some of that might be true, but the point I'm trying to make is women's health, when women are of menopausal years, when the hormones start to change, is very much underappreciated in this country. And not that it isn't completely. There's plenty of people out there, gynecologists, doctors, primary care, whatever, that are very good about this. But I think as a whole, it's lacking. So that's kind of my takeaway from this case was you need to keep fighting as a woman, if you're having, and as a man, this is not gender specific, but if you're having issues with your health, something like sexual health to the point where it's affecting your relationship and it's affecting your self-confidence and all these things that it did with this woman, you just have to keep pushing to find someone that will listen to you, essentially. So like I said, not overly medically complicated, but just kind of sad. Yeah, I mean, it's good it has a happy ending. She met you, she came to you and figured it out. It was a good ending, yeah. Yeah, that's amazing, that's why it's like, I know, I get so much fulfillment, you get a lot of fulfillment out of seeing patients come to practice and change their lives, it's pretty cool. Yeah, we have tons of case studies on the website. If you're interested in becoming a patient, go check those out. Oh, sure, yeah, I forgot about that. We have tons, yeah. Yeah, but yeah, we're coming up on an hour here. We don't have a ton of questions. I'm a little sad, audience. I was hoping for more questions. Be nice, Cole, be nice. You know, I get it. Maybe we just did a really good job. We did a really good job of covering a lot of material. That's a good reframe, yeah. That's what I'm gonna call myself. You guys learned so much, you had no questions. Exactly. Yeah, or maybe it was personal and you don't wanna post your sexual wellness issues on YouTube, which I totally understand. I wouldn't, and you can go to MedMatrixUSA.com and talk to one of the patient coordinators and see if we can help you out. If not, share this. Then there's a couple questions, there's a couple questions, but I think we covered them. We answered the thyroid one. Yeah, can you please comment on thyroid? We did answer that. Please forgive me. Here's a great question that we did not answer. Oh, what is the role of testosterone levels in regards to sleep? We talked about this a little bit, but so having low testosterone doesn't necessarily, like if a woman is having poor sleep, usually that's an issue with progesterone. Progesterone is the rest and digest hormone. So, but if you look at it from a different way of if a woman is not sleeping well, could it affect her testosterone? Yes, that's very possible. And that's one of the reasons why hormonal health is really important for women is because if say a progesterone is low and she's not sleeping well, well, the result of that progesterone being low is poor sleep. Then the poor sleep is gonna make the overall hormone health worse. So it's like a double-edged sword. So yeah, you can kind of look at that from two ways. Okay, yeah, well said, yeah. I'll answer this one. Please forgive me, guys. I always forget to introduce myself, but my name is Cole. I'm one of the co-owners. So I work a lot with kind of what goes on behind the scenes. We are actively working on Massachusetts. It's just a lot. Massachusetts is a much more legally complex state. So getting different licenses and our provider's license there, we're booked up a lot at this clinic. So we need to make sure we can take care of all the patients in Maine before we can move on to mass. So yeah, stay tuned as far as figuring out goes, just follow us on social media and we will definitely make sure to let you know. Yeah. Cool. I think that was it, yeah. That was it. That was so much fun. That was, that flew by. I hope you guys learned a lot. Yeah, don't forget to subscribe. Share these episodes. You know, this is, health can change someone's life, right? And if these episodes give them a little tidbit of information that they can go and make, you know, change their life and their health and be preventative, that's mission accomplished. So, yeah. Colin, anything you want to leave the audience with? No, I think this was a great topic. We covered a lot of information. Women's health is insanely complex, can be. Sometimes it's really easy. Sometimes it takes a lot of effort. And I think that's why, like I said, the good majority of the medical community doesn't do a great job at women's health. It's just, they wish it was just really easy cookie cutter and sometimes it's not. But you know what? Women deserve that. Women deserve good quality healthcare. They deserve good quality attention to their issues. They deserve to not be misunderstood. They deserve to not be dismissed. Like I said, a lot of women are dismissed and they're told that it's just normal. You're just aging, you're depressed, you're anxious. So I really think that women fighting for their place at the table to get the appropriate healthcare that they need is really important. So if you're telling your story to somebody and they're not listening, or they're not giving you the time of day, find someone else to tell. Find somebody until they listen to you is basically the take home there. So women deserve to feel good and be healthy through that part of their life. It's not fair to just accept that this is the way it's supposed to be because it's not. Yeah, totally. You just wrapped the best little bow on the end of that episode, and then Rhonda just asked the best question. So we'll do one more question, 45 seconds or less. Because it's a really good question. We didn't even, we actually, we didn't even talk about it. Sorry Rhonda, yeah, these come in so quick. Can you speak to HRT for someone over 60, 10 years plus post-menopause? So there are some, I don't wanna say guidelines or rules, but when a woman is over 65, or it has been greater than 10 years since she has went through menopause, whichever of those apply, sometimes they both apply, it is often thought that hormone replacement will not work for a female. And that's not necessarily true. I think this is where individualized care comes in. I will say that as women age, especially into the 60s and 70s, sometimes hormone replacement isn't as effective I've seen in women, because it's just been so long since hormone replacement, or since their hormones were there. So you have to take careful consideration into all of those parameters. But it's not contraindicated for a woman to have hormone replacement over 60, or 10 years plus post-menopause. Awesome. Cool. Yeah, I think that's a big, you hear that a lot, like if a woman are over 60 in conventional medicine, a lot of providers will say nope, it's not even an option, is that right? That happens a lot, yeah. It does happen a lot. And again, sometimes that's appropriate, sometimes it's not. And it really, again, depends on the patient. Yeah, totally. Cool, well I will make you do another fantastic outro like you just did. If you are just joining us, go back like two minutes. Colin just did the best conclusion on this whole episode. Everyone. Other than that, thanks for saying thanks, guys. We appreciate you. We have so much fun doing these. And Colin, when's the next one? What's the next one you're doing? You know. Thursday. If you're listening to us in real time, today is Monday, August 10th, if you're listening to us in real time. Our next podcast is in two days, on Wednesday, August 12th, with my colleague Gabe. He's talking about all things parasites, which is really fun. And then myself and my colleague, Dr. Sasha Rose, are back on this coming Thursday, which is August 13th. And we are doing a really, really important topic about the EDS, POTS, and MCAS connection. We are both pretty well versed in these complex chronic illness issues, so we're gonna have a whole discussion about that, this in about three days. So if you're interested, tune in. Can't wait. Fantastic. All right, everyone, thank you so much for joining. Thanks for saying thanks. And if you're not a patient and you would like our help, you can always go to medmatrixusa.com and apply there. All right, have a good night, everyone. Thank you. Bye, Cole.