Women's Hormone Optimization Therapy
Whether women are pre, peri, or post-menopausal, hormones play a significant role in a woman's wellbeing. When hormones are imbalanced inside a female body, it's very apparent and can result in a plethora of unwanted symptoms. Thankfully there are natural options that can not only help balance hormone levels but OPTIMIZE them to help you feel your best. On this week's episode we site down once again with Josh Porter, PA-C, to talk about the process he uses to help women feel their best through hormone optimization.
Meet Josh Porter, PA-C:
Joshua Porter serves as the Clinical Director for Optimize U Chattanooga. He has worked as a Physician Assistant for over 10 years. He has an extensive background in sports medicine, nutrition, supplementation, and athletic performance.
He is passionate about hormone and health optimization which led him to help start Optimize U Chattanooga. He and his wife Laura and their 5 children have called Chattanooga home since 2017. They love being active in a variety of sports and outdoor activities.
Some Points We Discuss:
- 4:01 - What should a woman do if she's unable to balance hormones with diet and lifestyle?
- 6:20 - Addressing the stigma surrounding hormone therapy.
- 7:17 - Hormone therapy has changed over the years.
- 9:28 - The Optimize U approach to hormone therapy (caring means listening).
- 10:30 - General protocol for postmenopausal women.
- 15:05 - Are there any dangers in optimizing hormones?
- 18:27 - How are hormones administered?
- 22:47 - Does hormone therapy cause hair loss and how to you mitigate that?
Josh Porter 0:00
You know, men and women, I do the same thing. I always tell them right up front, you know, because they want to know the very first thing they say, Would my last show. And I always say, I don't know. And I do it purposefully, because in order to care, I have to listen. Right. And so if I, if I if that patient's walking in, and I already have an idea of what those labs are, and now I know what I want to put them on. Well, that's not really fair to them. Because, you know, again, having a little bit of a history of where they come from, allows me to kind of know how to arrange that conversation whether, you know, is it something we need to be aggressive with? Or is it something we need to be a little bit more conservative with based off of what they tell me? And so, so I always tell him that I'm like, Look, we're gonna find out together, that's the fun of it, right?
Brian Strickland 0:43
You're listening to the nutrition world podcast, a show about navigating the intricacies of holistic wellness, where a natural health food store located in Chattanooga, Tennessee, and we believe that optimal health and peak performance should be accessible to everyone.
Ed Jones 1:06
So today, we're going to talk about something that over my 43 year career has been one of the most common questions I have heard. It's about women's hormones. And today, of course, we've got Josh Porter from optimize you, the Clinical Director of optimize you, welcome to nutrition world.
Josh Porter 1:22
Thank you, sir. Thank you for having me. You know,
Ed Jones 1:24
we've done one other of these recordings, and that was on men's hormones, right, yeah, and wonderful education for men. But the women's hormones is a little trickier. I guess I will use that word in my mind, because for 43 years, we have now we have over 300 320 people today who come into nutrition world, and they're looking for better answers than what tradition no options are offering. And, you know, women's hormones, because of the nature of a female are certainly different than men. And when they're going through these ups and downs with menopause, PMS, hot flashes, it can be devastating to the quality of life, men don't have to deal with that as much grip, but women do some, some don't. And, you know, I'm completely connected to lifestyle, that night, the power of foods, the power of the right supplements. And I know that in my opinion, about 50% of the women can manage their hormones pretty effectively using natural compounds that have very good research on them. Sometimes it's trial and error. It's not overnight, but it can be done. But the issue is, there's about 50%, who can't do that. And they are having the hot flashes, the lack of libido, the mood swings, just feeling rotten. And you know, the world of hormone replacement has a lot of stigma attached to it from previous issues. And a lot of studies that were conflicting this, that whatever. And I tell people when I consult with them, especially women, and they asked me about hormones, I'd say, I don't really believe that the lack of is going to make you live one day lasts or one day more, but it will lessen your quality of life if it can't be managed. And so for those who have tried everything, tried the natural remedies, and it hasn't done the job, it's time to move on to another level. And that's why you're here again, Josh, because I value you as as your experience, your expertise. And the fact that you, you don't live out of a small view of this, you actually bring in the whole picture of health, safety, right? Lifestyle, you're not just a prescriber, who says go home, here's your stuff, and I'll see you in a year. That isn't how it's done. That is mistake. And most health practitioners are not what I call, have the expertise to do healthy management of hormones. So with all that said, I want to just get your opinion, as everyone wants to know, what does a woman do? And what should she be thinking about if she hasn't been able to manage it with lifestyle and natural nutrients?
Josh Porter 4:01
That's a great question. And, and you're so right, in the sense that one of the things that I hear oftentimes when females come to me, especially the menopause, postmenopausal females, is, you know, they may have tried hormones in the past, but they just felt like no one was managing them. And women are unique, they are not the same as men, as we clearly know. And specifically when it comes to hormones, because it's, it's about balancing both. But it is much easier to balance a male than it is a balance of female. And so I think a lot of females, and fortunately, their experience with hormones has been they're just given something and said best of luck. And perhaps that's on the practitioner, the provider not really knowing how to manage it. And we have a very different take on that in that I probably get a little bit too involved sometimes, because I think it matters to be really connected and involved fairly quickly. You know, I mean, you know, so so when I see a female I mean I'm telling them, Look, we're probably going to have conversations in the next three or four weeks. And we're going to see you back in the office in six weeks. But, but by and large to your point, you know, when females come in to see me, you know, the very first thing we're going to do is we're going to look at labs, right, we're going to, we're going to have a lab panel, very thorough lab panel of looking at hormones, looking at some other factors and parameters. And then we sit down, and we kind of go through their symptoms. And just like you said, I mean, it ranges from hot flashes to low libido to brain fog, that's a really common one another common was weight gain. I'm doing all the right things, right, I'm taking all the right supplements, I'm hitting the gym, I'm doing the cardio, I'm sleeping well, and eating clean, and I just cannot get the weight off, I hear that, you know, 90% of the time with women. And and they're frustrated. And so so we kind of dive into those things. And then we look at hormones, and we determined, you know, hey, what are our options? What's it look like here? And that, you know, it's not a cookie cutter program. You know, I mean, depending on where that that female is in, you know, her stage of menstruation and you know, if she's on the front end, perimenopause, or even pre menopause, or, you know, right smack dab in the middle of menopause are postmenopausal all those things, and they obviously matter as to what hormones we really need to focus in, on in balance. And, you know, the other thing is, there is a stigma with hormone replacement, specifically in women. And, and as a result of that, you know, I can I can tell you, and I'm sure you feel the same way I can, I can tell you who that patient is, as soon as I introduce myself, right, you know, there's a little bit of a standoffish and I get that, and and, you know, rather than trying to convince them that, hey, this is this is the answers. You know, I always tell my patients, look, I as your provider, I care about your health, but I don't care about your health, like you care about it. That patient, you know, I care about my own health more than anybody else. And so my job is to educate. And so that's how I approach that is, you know, at the end of the day, we're going to, you know, I'm going to share with you, here's what the literature shows, I'm going to share with you, here's what I would recommend and suggest, you don't have to do those things. Because it's based off of what you're comfortable with, you know, with those preconceived ideas that they may or may not come in with.
Ed Jones 7:17
That's perfectly and I love the fact what the literature presents, because the issue and I've seen this for many decades, what the literature presented 40 years ago, and 30. Often, sometimes it holds true, but often it doesn't. And a lot of the things like the drugs that were given 30 years ago, is not the same options that you have now. And the things about blood clots and the things all that some of the negatives and breast cancer, that's the biggest issue too. And I'm a huge fan now of a I don't care whether you do hormones, or you don't up as a woman gets older, using things that help process some of these environmental estrogens, like indole, three carbinol, and some of these things that the liver can use to help lessen risk. And that should be used, whether it's with hormones or not. But the fact is, we have a new world here going on. But most health practitioners are still living in the old days of Premarin and all the other things that and had some big studies that were not positive. Well, of course, they weren't, they weren't using the right things. But it put a big, big dark spot on that whole conversation. So at this point, and I don't want to get too much into details. I mean, we know that women have, you know, different types of estrogen, three main ones, and you have, you know, progesterone, then you have testosterone, and then you can even go further down the list if you want. So you're right, man, we're so much simpler, we don't balance. But as far as and again, you said another word, that's key, you care about their health. You don't just care about their money, right? Their check they right or anything else. And the fact that optimize you, doesn't take insurance, right? It's a plus, that's not a negative, because when you get, you have to go to someone who takes insurance, the practitioners hands are somewhat tied, one and two, it becomes more cookie cutter, you individualize. Like I have never seen, I have so many people who talk to me and say thank you for sending me to optimize you. So as let's just say that you just saw a woman, I don't know what age but first, you're gonna do labs. Correct. And at that point, you're gonna wait for those to come back. And then there'll be a second visit, right?
Josh Porter 9:28
Yes, yeah. So they'll come back and see me at about a week usually takes five to seven days for most labs to come back. And and at that point, then we will sit down in my office and that conversations 45 minutes to an hour, most for most females. And, and I always, you know, men and women, I do the same thing. I always tell them right up front, you know, because they want to know the very first thing they say when my last show, and I always say I don't know. And I do it purposefully because in order to care, I have to listen. Right? And so if I if I if that patient's walking Yeah, and I already have an idea of what those labs are. And now I know what I want to put them on. Well, that's not really fair to them. Because, you know, again, having a little bit of a history of where they come from, allows me to kind of know how to arrange that conversation whether, you know, is it something we need to be aggressive with? Or is it something we need to be a little bit more conservative with based off of what they tell me? And so, so I always tell him that I'm like, Look, we're going to find out together, that's the fun of it. Right. But that by the end of that conversation, you know, we've usually got a plan. And, you know, when it comes to a very general, you know, protocol for a postmenopausal female, you know, some some things you got to know, right literature shows, when it comes to preventative health with hormone replacement. If a female doesn't start hormone replacement within the first five to 10 years, there's not a whole lot of preventative benefit. Now, there's symptomatic relief, right? Whether it's libido issues are brain fog. But when it comes to cardiovascular health, bone health, dementia, risk and things like that, that we can actually help prevent or lessen the risk factors. Some of those things are just we just lose if a patient's been on you know, postmenopausal for too long, too long being 10 years. Okay, so So I will still treat patients who are that far out, but it's, I always tell them, Look, we may not see the same preventative, I can't guarantee those things anyway. But But preventatively, we're missing out a little bit based off what the literature shows. But in general, you're you're looking at estradiol. You're looking at progesterone, and there's a little bit of, you know, conflicting information there, as far as you know, do women who you know, have had a hysterectomy. So if they don't have a uterus, do they do need progesterone? Well, interestingly enough, oral bioidentical progesterone has actually shown to be very favorable towards breast cancer. So it's a hot topic, right? So you're talking, there's several studies out there, where you've got somewhere between 25 up to 67%, decrease risk of breast cancer. So as a provider, again, you know, whether she has a uterus or not, if I have a medication that could actually lessen our risk factors for that, and then I'm going to likely suggest it, not to mention it has a great enhancement of sleep, right? So we call it the happy hormone. So it has a great mood stabilization. And so oftentimes, we couple estradiol and progesterone, and again, that's where the balancing comes in. Because you get one of those, you know, too high, too low, they're still not happy. And then, and that's the ones that the women most commonly think of right? Those are very common. They often look at me, like I've got three eyes when we bring up the idea of testosterone. And they think, Well, I don't want to grow beard, right, that's, I don't want my voice to be deep. I don't want acne and all those are good concerns. But I always have the same response, I don't want you to have those either. And so we're not looking for Super physiological levels, we're looking for high normal, optimal levels, right? without side effects. So my goal was always positive with little to no side effects. And so, but that can be you know, if a female and it's very common, low libido, right? That's a very common complaint in you know, a 50 year old female, to the point and again, men and women are different and libido. But even women will notice the difference of how I felt 30 at age 30, compared to 50, in that regard. And so testosterone makes a huge difference in that it also plays a huge role in my overall vitality, or quality of life, just that desire to kind of get up and conquer the day, men and women. And then the other one that we look at a lot that's not a sex hormone would be thyroid, you know, thyroid is very underappreciated. women, women respond to thyroid medication when needed, similarly to how men respond to testosterone, you know, when it's little, it's like water and a flower. Right? So when a female has a deficiency in thyroid and you introduce, you know, thyroid medication, whether it's fatigue, hair loss, dry skin, all those symptoms are associated with it. I mean, it's a noticeable difference. And one of the things I love about you guys, I had a patient this morning, I mean, she was, she was so optimize from a supplement standpoint on thyroid support, you know, and it was like you were talking about where she's like, you know, it's just not it hasn't helped all that well. And I'm like, Well, if this protocol that they've got you on hasn't helped, then we know yes, it's time to step in. Yep. Yeah.
Ed Jones 14:27
Yep. I have another podcast called The holistic navigator on there. The one that I did on thyroid, I have four different levels. Okay, this the first three are natural. The fourth one is pursuing someone like you because obviously, sometimes we just can't get a gland to start regenerating itself. Now, the big question before we run out of time, the two big questions again, to help women feel better about this. The method that you use is one cutting edge to your very experience. Three, it is more about identical, but they're worried about breast cancer. It's been in the field Emily, or they're worried about blood clots. Why is it better now with what you're doing than what it used to be?
Josh Porter 15:05
Well, because the studies have shown when it comes to double blinded, randomized controlled studies, right? So those are the most powerful studies. There has never been a study like that to show bioidentical has caused harm. All the studies that show harm are synthetics, right? That's Premarin, which is the synthetic estrogen and then Provera. And Provera is a synthetic progestin. And that's really, where the trouble lies is the synthetic progestins. Interestingly, the whi trial, which is the one that really kind of brought all this to light, you know, unfortunately, and it not, unfortunately, but it casts a shadow over all hormone replacement. And that's the unfortunate part. But what they don't ever really show is there were several flaws of that study. But one thing in particular is that the harm that the study showed in 2002, was actually gone by 2006. But so the follow up to it, right? So when they had these women in the study, and they continue to follow by 2006, what risk factors were associated with breast cancer was actually mitigating it was, it was going really, but you don't ever hear about that. Right? Now, that doesn't make headlines, that doesn't make headlines, because it's not a fear factor. And so, you know, my, my concern is, as a provider, you know, when it comes to liability, so if I've got a female with a history of breast cancer, you know, whether it's in her herself or in her family, we have to have a really Heart to Heart conversation and say, Look, there's no way I can guarantee you get breast cancer one way or the other, with or without hormones, right. I'm not God. So I don't know those things. Here's what the literature supports. But you're the one who has to make that decision, you know, understanding the risk and benefits. And as always, I have to go through blackbox warnings, right? So even though literature may be conflicting, you know, for example, with, you know, estradiol and testosterone, there's black box warnings or cardiovascular events, well, I have a different opinion based off what I have studied, but I still have to make sure my, my patient knows, hey, this is on on that prescription. And this is why, you know, and you have to be the one who decides if that's what's right for
Ed Jones 17:14
you. And I think, again, those who encompass the bigger toolbox of education, I'm just I know the body is so good at self regulating itself. And I think, you know, I say this often, like on my radio show in other places, you know, in 1972, Richard Nixon announced the war on cancer at that time, one in 32 people had cancer today is one in every two or three, we've done something totally wrong. And one of those is the choices of our foods and the fact that we're eating so many process, empty ingredients that then produce everything we don't want, which is excess insulin, and all these Xeno estrogens which are fake estrogens that cause things to happen in the breast. And then we disabled the liver, a system called the P 450. In the liver, which is what takes things like the toxic form of estrogen, which is like 16, hydroxy. Estrogen, and instead of it getting rid of it, it keeps it in there. Well, what gets rid of it, cruciferous vegetables and endo three carbonyl. And some of the nutrients and herbs can protect it greatly. So if you're on hormone replacement, I'm a huge fan of maybe even consulting someone else in our team to say, Okay, let's add another layer of protection if you're not doing it just for your own general health. But at so what, like what hormones how do they how do you administer their hormones?
Josh Porter 18:27
Yeah. So with estradiol we do oral and again, the reason we do rule is because of what the studies show when it comes to cardiovascular health. So when you look at the data, cardiovascular disease skyrockets, once a woman is in menopause, right, we know, and it's, you know, after age 55, I mean, it is through the roof. Well, that's the number one killer in men and women. So I want to do everything I can to limit to, again, to decrease those risk factors. And oral estradiol is the only thing that's ever shown that transdermal shows improvement, a lot of things, whether it's dementia risk or osteoporosis, vaginal lubrication, but it just does not show the benefit when it comes to cardiovascular safe, but just not that benefit. With progesterone, I typically use oral and that's because again, you get a little bit of the sleep benefit from world that you don't do with sublingual because of the first pass through the land, the
Ed Jones 19:17
progesterone lowers again, like you said earlier, the risk of estrogen side effects when under person and regular people practitioners don't seem to recognize that it's very frustrated
Josh Porter 19:26
is very frustrating. And that, again, that comes back from you know, some some guidelines that are, you know, as we know, most most medical guidelines are 20 to 30 years out of date, right? So you've got these guidelines that say if you know if you don't have a uterus, you don't need progesterone. Yeah, it's just not true. And the testosterone, testosterone is done through a cream, okay, mostly, I do injections as well for women. But majority of my women it's probably the exact opposite with men, but the majority of my women would prefer a transdermal cream that they apply,
Ed Jones 19:57
and I would guess if the cream didn't work, then you go to injectable So most women would come to you they get the bloodwork come back a week later, probably all creams are oral, no injections? Probably not correct. And then you would retest in six weeks
Josh Porter 20:10
initially. So I'm pretty again, I'm pretty aggressive with with testing. Because if you with men and women, but particularly in women, if I if you're asking me to manage three or four hormone balances, right? And I plethora of a list of symptoms, it's not fair to them, or to me to push them out three or four months, because there's no way because in three months, if they're not happy, they're, they're not going to continue on, right. And so, I've just found it more beneficial to say, look, here's what, here's how we're going to handle this. If you don't feel great in three weeks, you're going to call me yeah, here's some, here's some things you should see. So for example, sleep is one that you should, you should see pretty quickly, within a couple of weeks of starting progesterone, some of the other things that they want to see improve, it takes time, you know, weight gain, it's six months, I mean, it's not going to be something fast. So you just I think setting appropriate expectations as far as the timeline is important, but but I just have the opinion that it's, it's better for me better for them to be a little bit more hands on early on.
Ed Jones 21:11
One of the theories that I've thought of many years ago, was Father Time is somewhat cruel to us after we have certain get past a certain age. And that age is when hormones decline. Yeah, and we're put on this earth from a chemical physiological standpoint, to do one thing that's to procreate to have more children so the species can continue. That's why we have such primal prime health, until that so that we can make sure nature has us make sure we can do the best we can with that, well, nature kind of discards us at a certain point. That's why we have to up our game we have to up our game with exercise and managing our health and nutrients and, and hormones. And if we don't, well, it's okay. It is but you're gonna pay a price for that if you don't step up to that level. And you know, I think the world is in a great is very benefited by having lots of physicians and people who can take care of us in an acute situation, you get strep throat, you get you get other diseases, you fall, you break your ankle, they're the place to go to you don't come to nutrition worldview, if you do that, and it can be life saving, but they don't do well. That is the long term trading chronic or having prevention in their plan. And that's nothing wrong with that. That means create a team, keep that other person create another team of okay, hormones are important. I'm married or have a relationship. My other partner has this much libido I have this much, it's going to be very destructive many times to relationship. Or like you say it can't lose weight. I'm depressed. I'm anxious. I'm this Annette, last question. Does it affect hair loss? Or does it cause it? Does it help to prevent it?
Josh Porter 22:47
It does. And again, all kinds of back to balance right. So if you know if I have a female, for example, who is placed on too much testosterone, I can also stimulate a little bit of hair loss, but thyroid plays a role. estradiol plays a role for sure. In a thinning of the hair, and it's generally described as more of a globalized, it's not, you know, it's not really a patch here or a pattern. It's more just overall, they noticed a lot of thinning.
Ed Jones 23:14
But that's if it's mismanaged, and you're watching every six, this first six weeks and you see it, stop it very, very plainly. And clearly. Now I've said for years, and I'm huge about what inflammation does to the human body as far as not just pain, but destructiveness from Alzheimer's to joints to arteries, and estrogen is one of the stronger anti inflammatories. That's why women hurts so much when they lose it. Or if you're using some if a woman had to use some of the drugs for after cancer therapies. I mean, they ache their joints are like they just turned 25 years older. And so when they get on estrogen, obviously that's going to feel better tuned
Josh Porter 23:51
us. Yeah, no, I think you're exactly right. I mean, the the preventative things, the things that we just don't even appreciate until it's not there. Right. And that goes back to the cardiovascular health of why estrogen was important because of the anti inflammatory properties of of what it does. You know, estrogen plays a role in over 400 chemical connections in your body.
Ed Jones 24:14
I mean, it's impressive, and man made a little tiny bit, don't
Josh Porter 24:17
we do? Yeah, there's there's a healthy balance, depending on how how, what your testosterone was, yeah, yeah.
Ed Jones 24:23
Well tell people how they can contact you if they want to take the next step.
Josh Porter 24:27
Well, we are on the lower level of nutrition world, which is great. So we have a great partnership with you.
Ed Jones 24:32
And we have no financial connection, nothing off what you do. You pay a modest rent. That's it, you're here because I know that you're a hero and you do great work. That's it. That
Josh Porter 24:41
is very true. So you can you can stop by the office that way or you can call our office 423-206-9753 or on the website, optimize you chattanooga.com And then we're on social media, as well as Instagram and Facebook.
Ed Jones 24:55
And we always have your fliers that nutritional if you just forget and you want to come in or call us yeah I love the fact that our Wellness Center is growing by leaps and bounds and that we are the team approach if you feel comfortable with it, because of the variety of practitioners we have, and they're all handpick they're not here because they can write a check to pay rent. Right? So I appreciate you, Josh, all your people. I love the people who have working for you. They are, they are that's the kind of people who service you the way we used to be serviced in the world that seems to have gone to the wayside, but not completely. That's why people like you are going to rock and roll and you're helping so many and the feedback is wonderful. So thank you for all you're doing.