The Truth About Testosterone, Estrogen, and Hormone Replacement Therapy, with Gary Brecka

A lot of women my age, we don't sleep well, you know, it's like the menopausal process, which I've now found out takes forever. Yes. Like the can start in your late Perry menopause. Like, yeah, it's like 15 years. You're stuck in like whatever para menopause or menopause. I don't even know what it is anymore, but you don't sleep well. I don't know anyone my age female who sleeps well. So I've told the audience before I did start HRT, which I really like good for you. It's been actually kind of miraculous and that I do do the estrogen. I do the cream. It's great. Yes. And I'm so dumb to think like, of course, those hormones can pass through my skin, but I'm fine with a self tanner. Okay. I needed this conversation. Exactly. Anyway, so the progesterone though, it's a problem for me and a lot of my girlfriends. Like not everybody tolerates progesterone. Well, it makes me, for example, super bloated, like uncomfortably bloated and I hate it. Right. So then the doctors are like, well, you can do it. IUD. I'm like, I don't want to do an IUD. I don't want to do any, I'm not sure I want to do any of that crap. But the problem is if you don't, you have to do progesterone. If you're taking estrogen to protect against uterine cancer, that's what the doctors say. But the problem is progesterone makes you uncomfortable. And yet it's the key part of HRT that helps women like me sleep. It's what makes you sleep. It gets you through these menopausal weirdnesses. And I wonder if you have any thoughts on that. Like, is there any solution for women who are between 40 and 60 having sleeping difficulty, but who either don't tolerate progesterone well, or who just don't want to do HRT? Yes. So first of all, let me back up. This happens to be a core competency of mine. And I think it's one of the most underserved areas of all of modern medicine is female hormone therapy, perimenopause, premenopause, and menopause. You know, as you know, the U.S. Food and Drug Administration just recently removed the black box warnings from female hormone therapy because nearly 51 million women suffered for decades because they thought that hormone therapy, and specifically estrogen, led to an increased risk of breast cancer. We know that that is patently false. You know, if you look at the study that that came from, which was called the Women's Health Initiative, one of the largest hormone studies ever done, it was bastardized and misreported. And essentially what came out of that study was not that there was a 20% concomitant increase in breast cancer. There was a 20% relative risk reduction in breast cancer. And that's why I applaud the FDA for that. Marty McCary did that before his tenure ended. Yes. God bless him. And they removed the black box warnings from female hormone therapy. So let's just back up a little bit. And let's just talk about what premenopause and menopause actually is, right? I mean, when you're in menopause, you still have a cycle. It's just that your amplitude is lower. So you have a very high amplitude cycle, very definitive cycles between follicular ovulation and luteal as you are menstruating female. And as you get older, this amplitude begins to drop. You still have a cycle in menopause. It's just very, very low. So it's important to understand, first of all, that this cycling decline can begin in your late 30s. And the signs are not things that drive you to the emergency room or take you to the ER or get you over to the urgent care. They are signs like brain fog, waking, water retention, poor focus, poor concentration. The hallmark sign is exhaustion upon waking in the morning, which is an inverted cortisol and melatonin cycle, which I'm going to talk about in a second. There is a gold standard test for women. And if your female audience is listening, I think they should write this down because it may completely change their life. There's a gold standard test called a Dutch test. One of the most dangerous things to do in female hormone therapy is to prescribe your entire complement of hormones based on a blood test, just a simple one-time blood test. A blood test is a snapshot in time. A menstruating female, it's perfectly normal for her estrogen to be in the 400s. It's perfectly normal for estrogen to be in the teens. So who's to say that 172 or 210 or 68 or 99 is high or low? Well, you don't know unless you know exactly what stage of her cycle she's in, follicular ovulation and luteal. And you know whether or not all of those hormones are entering or exiting the cycle together. What happens in these different stages of menopause is that all the hormones in a woman's body don't get together in a conference room one day and go, okay, girls, it's been a great run. We're all out of here, right? They get together in the conference room and estrogen goes, no, no, no, I'm going to stick around a while. Progesterone says, I'm out. Pregnenolone says, I think I'm going to hang out for a few months and then I'm going to leave. Testosterone's like, I'm totally out of here. I've been in here long enough. So you get this weird cascade of everything from lack of libido, to brain fall, to waking, to water retention, to mood changes, to emotional changes. A female's attraction to their spouse can shift during this period of time. Does it mean that they don't love their spouse? It means that, and very often, sadly, in relationships, we couple libido and arousal with love and attraction. You can be deeply in love with your spouse, you can be very attracted to your spouse, and you can have no ability to be aroused and no libido. That's usually because free testosterone is low. So these strange things happen where you're like, well, I'm still in love with my significant other. I'm still attracted to my significant other. I'm just not aroused. I have no libido. Or you wake up in the morning more exhausted than when you went to bed. Or someone that is extraordinarily organized. This is what happened to my wife. I'd encourage you to go watch the podcast that I did with my wife, Sage Workinger, because we went through menopause together. We did the Dutch test and then she was very transparent, put her entire cascade of hormones. She had every symptom that a female could have, all the way through to frozen shoulder. Something called adhesive capsulitis. I have a friend who has that right now. It's menopause. I will tell you, your friend is between 42 and probably 54 years old, and it's very painful for her to lay it on her shoulder. She probably has a difficult time raising it above level. Yeah, she just got a shot in it. Oh, boy. So you got cortisone, and the next recommendation, tell her to be very careful, is they're going to recommend manipulation under anesthesia, which is where they actually put her to sleep, and they break those adhesions while she's sleeping. They physically break those. Oh, my gosh. It's called adhesive capsulitis. Within three weeks of starting hormone therapy, her frozen shoulder will be gone. My wife's shoulder went from being raised to here to straight up in the air, no pain. Your friend will also tell you that it's very painful to lay on that shoulder. If she rolls over on it at night, it will just wake her up, and she'll tell you that it's restricted, and then she'll do simple things like she'll bend down to tie her shoe and forget that she has this, and it will take her to the floor. It's very, very painful, this adhesive capsulitis. This is a byproduct of estrogen metabolism, and if you wanted to have one lever to torture a woman, it would be estrogen, right? Estrogen is a category of hormones. There's E1, E2, E3. It's called estradiol, estrione. These different hormones are high and low at different times in a woman's cycle, in her life cycle of her menstrual cycle, until she goes into menopause. By moving these estrogen levers, you affect skin elasticity. So all of a sudden, they look in the mirror, and they're like, I feel like I've aged 10 years in six months. So the elasticity is leaving their skin. For the first time since World War II, our national debt has exceeded the gross domestic product. America's reckless government spending keeps catching up with us. Higher inflation, higher prices, higher cost of living expenses, and higher interest payments on the national debt. Every dollar Washington spends on interest is a dollar it has to tax, borrow, or print. Smart retirement planners prepare for potential setbacks, and they can do that by diversifying with a time-tested asset known for weathering the storm. 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This also happens to women that eat in a very narrow feeding window, which is why one of the most dangerous things that menstruating women can do is intermittent fasting in a very, very narrow feeding window. You want to frustrate a female when they start intermittent fasting with their spouse. The husband's got all the energy in the world. He's putting on lean muscle, sleeping like a bear, wakes up like a tiger, doing great in the gym. The woman's eating in the same narrow feeding window, can't get out of bed, is starting to get bloated, is also exercising, is barely eating, and is gaining weight. That's because you throw off the estrogen cycle, and the body starts to retain water. Let me walk you through what the solution to this is. The solution is a 24-hour urine test called the Dutch test. You do this test once, and what it shows is the entire complement of hormones. Don't assume that because some of the hormones are tanking heading into menopause, that all of the hormones are tanking. In fact, I'd be very surprised if the reason why you react poorly to progesterone is because your progesterone in its cycle is probably normal. You may be low on pregnenolone. You may be low on one of the three estradiols, the estrogen hormones. You're almost certainly low on testosterone and free testosterone. So when you treat women for hormone therapy, you replace the entire complement of hormones. We do not shoot women with rifles. In other words, you don't take darts and throw them at hormones. You replace the entire complement of hormones. And the reason for that, because it's called hormone replacement therapy, is that hormones are not cumulative. So I often will open some of my hormone lectures by asking a room full of physicians. Let's say you have two men. One has a testosterone of 200. One has a testosterone of 600. And you're going to put them on hormone therapy. Who gets more testosterone? The guy with 200 or the guy with 600? And the answer is they get exactly the same amount. Reason for that is as soon as I replace their testosterone, both of their production is going to zero or near zero. So if I give each of them 200 milligrams of testosterone, they will end in the same place. Because if a man stops taking testosterone, will his body kick back in and make the testosterone again? Depending on how long he's been taking it, which is why I'm a much bigger fan of peptides like kispeptin, ganadiriline. I'm a big fan of something called n-clomiphene. These will signal the testicles to increase their production. So then they're high on their own supply. And no matter what anyone tells you, there is no better hormone than one the body makes on its own. So as men age, they can develop something called primary hypogonadism, where they cannot produce their own testosterone. And in that case, absolutely replace testosterone. The evidence is clear. 2018, the Journal of American Urology updated all of their clinical guidelines on male hormone therapy. Having low testosterone is a risk factor for cardiovascular disease. Replacing testosterone does not increase your risk of cardiovascular disease. In fact, it produces it. There are 10,000 receptors for testosterone in the male heart. It's the highest of any organ in the body. So you don't want to deprive it of testosterone if you're a man. There is not an increased risk of prostate cancer. There's not an increased risk of prostate enlargement. And there is not a correlated risk or a causal risk for cardiovascular disease. So you replace it if you can't produce it. You stimulate it if you can produce it. So I want to go back to women for a second and close that loop. A Dutch test will give your OBGYN, hopefully a functional OBGYN, everything that he or she needs to say, okay, here are the hormones that are deficient. I am going to bring those back into the normal level. Here are the hormones I'm going to leave alone or I'm going to replace. And then you replace that entire complement of hormones. And it is a game changer for women. We really, really value your input and your support. We may not always agree, but we are always going to talk about it and respect. No BS, no agenda, no fear.