ATHE_Transcript_Ep 569_Dr. Deb Matthew
JJ Virgin: [00:00:00] I'm JJ Virgin, PhD Dropout. Sorry, mom, turn four time New York Times bestselling author. Yes, I'm a certified nutrition specialist, fitness Hall of Famer, and I speak at health conferences and trainings around the globe, but I'm driven by my insatiable curiosity and love of science to keep asking questions, digging for.
Answers and sharing the information that I uncover with as many people as I can, and that's why I created the Well Beyond 40 podcast to synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode we'll talk about what's working in the the world of wellness.
From personalized nutrition and healing your metabolism to healthy aging and prescriptive fitness, join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100.
This is the interview I've been wanting to do for a [00:01:00] while because I feel like we really needed time to deep dive into hormone replacement therapy. What it is, what's the difference between hormone replacement therapy and bioidentical hormone replacement therapy? What are the risks? What are the benefits?
Should you, shouldn't you, if you hadn't done it, you're 10 years out from menopause, can you still do it? All those questions and some you maybe haven't even thought about, are about to get answered by Dr. Deb Matthew. Deb Matthew is a medical doctor known as the Happy Hormones doctor. She's a bestselling author, she's a speaker, educator, wife and mom of four boys, and it was very funny.
She's gonna tell you the story of how she personally got on bioidentical hormones. I'm gonna have you listen to this because it's pretty funny. But that led her into really deep diving into bioidentical hormones and changing her practice entirely. She's been featured on a bunch of different [00:02:00] podcasts and radio broadcast shows, NBC, ABC, CBS, and Fox, and she's also written a couple of books in the book that we are going to be sharing with you.
You're going to get for free by going to jjvirgin.com/estrogen and you will be able to grab that book there as a gift from Dr. Deb. So I just wanna tell you a little bit about, cause I get asked all the time, are you taking hormones? And I'm like, heck yeah. And I will tell you, when my son Grant got hit and was left for dead in the street, I was 49.
That was probably the most challenging. Thing ever. And then it completely tweaked my hormones. And I was just fortunate that one of my girlfriends, Dr. Prudence Hall, who was also Suzanne Summers' doctor, came to the hospital, brought me things because everything was crashing on me, threw me into early menopause, trashed my thyroid, et cetera.
But I still remember, you know, ways I could tell when my estrogen wasn't where it needed to be is I couldn't recover at the gym. [00:03:00] Like I'd literally work out and I'd always be sore and I wasn't working out nearly as hard as I used to. And of course night sweats. Holy smokes. But the ones that were so unusual for me, just in case you aren't putting the, connecting the dots here, was that, and then also bleeding gums.
And I went to my dentist, I'm like, what is going on here? And he goes, ah, estrogen. I'm like, oh shoot. So this is such a great episode to just unpack every bit of those things. I do now take a estradiol patch. I do. Oral progesterone compounded by a pharmacist that I do one week out of the month for most people.
Progesterone's, this great calming thing helps you sleep. It's anti-anxiety for me. It makes me wanna cry and eat cookies, but I'm one of those people, like both times I got pregnant with my boys, I immediately felt like I wanted to cry and eat cookies. And you know, progesterone goes up during that time.
So progesterone does not have the anti-anxiety effect on me. It [00:04:00] has the, I want a cookie, give it to me now effect. So I take testosterone shots twice a month, and then I also take a thyroid. I think I'm either doing WPthroid or MPthroid . So, That's what I'm doing, just in case you wanted to know. And then I take something called dim, which is Diindolylmethane, which comes from broccoli and it helps you detoxify bad estrogens.
I also do a lot of flax seed too to help with that. So there's what I do in case you are wondering and we're gonna talk about things that you can do, lifestyle factors, et cetera, too. So I will be right back with Dr. Deb Matthews. Super excited for this interview and to share it with you.
There is so much misinformation out there about bioidentical hormone replacement therapy, and I'm super excited that you are with me, Dr. Deb Matthew, so we can break it down and help end this confusion [00:05:00] and give women back their lives. So thank you for joining me.
Dr. Deb Matthew: Oh, I'm so glad to be here. This is a topic that gets me really riled up, so I will try to contain myself here, but I think this is important information.
JJ Virgin: I love seeing Deb riled up. I gotta tell you, it's fantastic. You were just telling me before we started the recording that your hill you would die on like, and I'd love to hear that. And then we're gonna jump in that hill that Dr. Deb Matthew is dying on.
Dr. Deb Matthew: What is it? The idea that women are so scared of hormones because they believe that estrogen is gonna increase their risk for breast cancer.
They believe it because their doctor tells them that. But the reality is that is not the truth. Estrogen replacement therapy does not increase the risk for breast cancer. That's just not what the medical science shows,
JJ Virgin: and we are gonna dig into that science. So you will have the information. To take back to your doctor or perhaps get a new one.
And I think we're gonna talk about that too because you know, you gotta make sure that whoever you're working on is really staying up on the latest information so that you can have what you need to be [00:06:00] in great health forever. I wanna play full out when I'm a hundred. Full disclosure, I've been on bioidentical hormones since my hormones started going wacky.
How did all of this information about hormone replacement therapy go so sideways and start all of this fear porn? It was
Dr. Deb Matthew: just one study. You know, when I was in medical school in the early nineties, we were all trained that all women should go on hormone replacement therapy for their own good. Because we knew from the preponderance of evidence that it helped reduce the risk of heart disease and osteoporosis and dementia.
We knew that estrogen was good. And then in 2002, this study was released. It was called the Women's Health Initiative Study, and it came out saying that there was an increase in the risk for breast cancer and overnight doctors' offices were, the phones were ringing off the hook from panicked patient, and as doctors, we were horrified because our motto is, first do no harm.
We were horrified to think that we were recommending something that was increasing the risk for breast cancer. That was 20 years [00:07:00] ago. And over the last 20 years as we've been able to re delve into the data, we've found that, in fact, that's not what the study showed, but it's so ingrained in our psyche.
Yeah. As women, right. We are so scared of breast cancer. The reality is, Most women are gonna die from heart disease, not breast cancer, but, but we just don't lie awake at night worrying about heart disease the way we're so scared of breast cancer.
JJ Virgin: And I was just listening to a podcast this morning, speaking of heart disease, because it is, it's what 50% of women die of heart disease, I think.
And estrogen plays a massive role in keeping your heart healthy. And I was listening to a podcast this morning that was talking about fitness and mortality, and there is a 400% higher risk of morbidity in people who are in the lower 25% of cardiovascular fitness than in the ones in the upper 2%. You know?
So how did that study get it so wrong?
Dr. Deb Matthew: So what the study did is they [00:08:00] took a whole bunch of women and they gave them hormone replacement therapy and they gave them the standard hormone replacement therapy of the day. And that was conjugated, equine, estrogen. The brand name was Premarin. And that's the kind of estrogen that we get from horses.
So while it is from nature, it's not natural to a woman's body because it's not the same as our, so if you had had a hysterectomy, that's what you got. If you did not have a hysterectomy, then you got that estrogen pill along with a synthetic drug form of progesterone. So estrogen and progesterone are our two main female hormones.
But this progesterone drug, it was chemical, it was manmade, it was synthetic. It's not the same as the progesterone that's in our bodies. And it turns out that that synthetic progestin, which is what we call a synthetic progesterone, that synthetic progestin is the one that had an increase in the risk for breast cancer.
Mm. So that threw us in a tizzy. And the number that was stated was that there was a 26% greater [00:09:00] risk for breast cancer in the women on that particular pill. And when we hear that, it sounds like. 26% of women were getting breast cancer, right? And that's not true. The actual number is for every 10,000 women years of being on the hormone, for every 10,000, there was eight extra breast cancers.
So that's less than 1% risk. There's 99 point something percent risk that you're not gonna have an increase in the risk for breast cancer. But it was so scary that it just got so ingrained and the media ran with it everywhere you looked. The media was talking about hormone replacement therapy in breast cancer, and all hormone replacement therapy got lumped into the same category as though it's one thing, and it's like saying antibiotics.
Well, we've got lots of different antibiotics. You need the right one for your particular infection, but hormone replacement therapy and just hormones in general overnight just became this very, very scary thing. It's a real shame because a whole generation of women got scared away. [00:10:00] Yeah. But now that we've had time to re delve into it, we actually find that even in that same study, there were a lot of really positive and important benefits.
JJ Virgin: But here's the thing. In that study, they were using oral estrogen, which I want you to talk about in a synthetic progestin, progesterone, and still seeing benefits. Yes. Right. So just imagine. If you were using the good stuff. So what were the benefits they saw? And then can you talk a little bit about oral estrogen?
Dr. Deb Matthew: So what they found was in the study, women who were on the hormone replacement therapy had a 42% decreased risk of death compared with women who were not on hormone replacement therapy. And even six years after stopping the hormones. Their risk of death was still 33% lower than the women that had never been on hormones.
And this was published in the British Medical Journal back in 2012. It just was hidden.
JJ Virgin: Right. A buddy called these the studies that you never hear about.
Dr. Deb Matthew: Yes. And then they found that for women who'd been on [00:11:00] hormones for more than 10 years, they found that there were 19 less deaths from heart disease.
Seven less stroke deaths.
JJ Virgin: In what size group of people or is that percentages
Dr. Deb Matthew: Per 1000 women. Okay. And then overall, they found that for women who were between the ages of 50 and 59, that their overall statement was that the benefits of the hormone replacement therapy far outweighed the risks. They found that there was less breast cancer, less colon cancer, less lung cancer, less osteoporosis, less bone fractures, less death overall in women on the estrogen only arm. There was a slight risk of breast cancer in the women on the estrogen and progestin arm. But when we look at women who are on the bioidentical form of progesterone, we don't see that.
So we found lots of benefits. For women on the hormones, especially the women who were on the estrogen only arm, and yet it was estrogen that got the bad name. Like it's not even progesterone that women are worried about is estrogen and estrogen reduced the risk for heart disease.
JJ Virgin: [00:12:00] This is also interesting cause when you look progesterone's still seen as like this.
It's over the counter, which always surprises me. And it's like, go ahead and use all you want. I'm like, it's a hormone, you know? So that's kind of crazy. I wanna dig into all of this and what the options are, how you know what to take, all of that. But before we get there, let's just go back to you're in perimenopause and what are some of the things going on there and maybe some things women wouldn't normally expect to have happening that they wouldn't know about?
Dr. Deb Matthew: Well, so when we first go into perimenopause, the first thing that goes south is progesterone, even before your estrogen starts to cause problems. And progesterone is the calming hormone. So it's the one that helps us just feel chilled out and relaxed. And when it goes down, we tend to feel more irritable, negative, impatient, critical.
I have a theory, totally, completely unscientific theory, but you know those Karens out there that are completely misbehaving and saying things they really shouldn't. [00:13:00] They need some progesterone. That's my theory. But progesterone helps us to just feel calm and maybe a nicer version of ourselves. Helps us sleep soundly through the night, and so we can end up having night sweats and waking up at two in the morning.
So those are some of the earliest things that women don't recognize as being hormonal. It can cause like heavier periods and more PMs, and you kind of know that has something to do with hormones. But if you are ready to just bite your husband's head off or you know you have no patience with your kids or you're lying awake at night, you may not recognize that that's hormone shifts that are happening.
And that tends to happen after age 35. Really common when we're in our forties, and then our estrogen level commonly dips by the time we get around 50 52. And then we can get the hot flashes, we can have the vaginal dryness. Sex can become painful and you kind of recognize that those things are hormonal, right?
Your periods kind of get lighter and they stop. But hot flashes, generally speaking are super annoying. But if that's the only thing you had to put up with for most women, you know, we would make it through the hot [00:14:00] flashes. The thing that a lot of women don't recognize is that estrogen has a humongous role to play in our brain.
So being able to spit out that word that's right on the tip of your tongue sometimes gets really hard. You can't remember the person's name that you've known for the last 10 years. You start relying on things like the thingamajig. Yeah. Or you know, those kind of words. You can't remember why you walked in the room or where you left the car keys.
So it has a huge important role to play in our memory, creativity, quality of ideas, our energy, our sleep, our mood estrogens, like a natural antidepressant. And progesterone's like a natural anti-anxiety. And so there is this whole cohort of women who are marching into their doctor's office to say, I don't feel like myself.
Like I just, I'm not so interested in things I used to be interested in. I'm feeling more anxious than I used to. Like, I don't know what's wrong with me, but this isn't normal. And they've walked into their doctor's office looking for hope and answers, and then they just walk out with another prescription for [00:15:00] antidepressants or for sleeping pills.
And the problem is, it's not fixing the right problem.
JJ Virgin: Right. I remember Deb, I was sitting in the pool with my kids out in Palm Desert and these women were talking, and I was in my probably early forties at the time, and they were talking about this very subject, One of the women had gone to her doctor and she was talking about how her doctor had given her birth control pills and Prozac.
Yeah.
Dr. Deb Matthew: If you complain of any kind of hormonal, menstrual, whatever, menopausal issues, if you're 45 and under, you were given birth control pills, and if you're over 45, you're more likely to be given hormone replacement therapy. And if you complained enough, we gave you the side of Prozac. All right,
JJ Virgin: well, fortunately, this doesn't have to be this way.
And now we know about bioidenticals. Can you just talk about the difference first of bioidentical hormones versus the Premarin and Progestin?
Dr. Deb Matthew: So the word bioidentical just means that the hormone is an exact match to the hormone that our body made. So at least in theory, your body shouldn't be able to [00:16:00] tell the difference between whether it came from the pharmacy or from your ovaries.
When I went to medical school and residency, I didn't know that there were different kinds of estrogens and you know, birth control pills were not real hormones. We, I had no idea, like, we don't know this as doctors. But the reality is there are many, many synthetic manmade chemicals that mimic our hormones.
So they do some similar things, but they're not exactly the same, so they don't have all the same benefits and they have some different risks. So bioidentical hormones is simply the natural form of the hormone that your body has always had, and we can get bioidentical hormones by a prescription from your regular doctor, from the regular pharmacies.
It's just that most doctors don't know which hormones are bioidentical and which ones aren't, and to regular doctors who aren't really well versed in all of this, the word bioidentical hormone to them means compounded. So a compounded hormone, that means that it's made in a compounding [00:17:00] pharmacy, which is a special pharmacy that personalizes the prescription just for you.
They take these hormones that come from pharmaceutical companies that they take the hormones and they mix them in the right. Dose in the right combination. They can put it in a cream or a lozenge that goes under your tongue. They can do it in all sorts of different ways, and it allows us to really personalize the dose.
So we're taking the natural form of the hormones and we're personalizing it. But bioidentical hormones don't have to come from a compounding pharmacy, and conventional doctors aren't used to working with compounding pharmacies. And so somehow in all of this, the word bioidentical, they've taken offense to.
And, and it's just logical and they prescribe bioidentical hormones all the time. It's unfortunate that somehow it's gotten almost a stigma. And so a lot of women will go in and they'll say, can I have bioidentical hormone? And their doctor will say, no, I don't do that. Even though that doctor's written five [00:18:00] prescriptions already that morning for something that happens to be bioidentical, you wouldn't eat a synthetic tomato.
Why would you want a bioidentical hormone if you're just trying to replace the hormones that your body's not making anymore? So, Bioidentical just means they're natural. The way that they get the hormone in the first place is it comes from a component that's from either yam or soy, but then it has to be extracted from the yam or the soy, and it does have to be altered in the lab in order to make it into the estrogen or progesterone or testosterone.
So you can't just like eat yams or rub yams on your skin and get the same results. So that's the difference between synthetic and bioidentical. So it's important what form? Of hormone. We give you the synthetic form of progesterone. We call that a progestin increased the risk for breast cancer. The natural form of progesterone has not been shown to increase breast cancer risks.
The other thing that's important is how we give it to you, whether it's a pill or a cream or whatever, and this is really, really important. Because when we give women the [00:19:00] Premarin pill, you swallow it, it gets absorbed in your bloodstream and it has to pass through your liver. Everything you eat passes through your liver before it goes to the rest of your body.
So your liver got slammed with the whole dose of estrogen all at once when you swallow it. And that increases the risk for blood clotting proteins. It doesn't matter if it's birth control pills or if it's hormone replacement therapy, but if we give you estrogen through your skin creams or patches, we've got all different ways we can do it.
It doesn't go through your liver the same way. And so we don't see the same risk for blood clots. You know, when you're 19 and you need birth control, we don't really worry about blood clots because your risk is so low. But by the time you're 49 or 59, there's just no need to take that risk. And I see a lot of doctors who advise women away from hormone replacement therapy saying it's not safe, and instead give them birth control pills, which is the most illogical thing that I've ever heard.
Because birth control pills are just higher doses of synthetic hormone. The synthetic hormone replacement therapy is just lower [00:20:00] doses, and it's by a pill that increases your risk for blood clot. It makes no sense to me whatsoever, but that's a really common thing.
JJ Virgin: It just sounds like it's lack of education, and I know that in California, at least the compounding pharmacists were getting like crowded out trying to get put out of business, and so that might be part of it too.
You know, it's like you look at who's educating the doctors. And it's big pharma. When I lived in Palm Desert, we had amazing compounding pharmacists who were like your family pharmacist who would go and help you with all sorts of things. It was just a different business model than going to C v s or Walgreens.
Right.
Dr. Deb Matthew: You know? Well, the pharmacist at CVS and Walgreens, they have to go into their computer system and then they can only dispense what the bigwigs, you know, in the company have sort of decreed what they're gonna carry. Whereas the compounding pharmacist can work with somebody and they can personalize things so much.
Doctors just don't know. Like I can tell you how I learned about bioidentical hormones. It sure was not at medical school. It was because I was freaking out at my kids over the stupidest little [00:21:00] things, and I was getting wigged out. My husband just didn't even know what the heck to do with me. And he was at the gym one day and he saw this book on the counter, and it was called The Sexy Years by Suzanne Summers.
Ah, he's smart, right? If she titled the book Women's Hormone Problems, he would've not touched that book with a 10 foot pole. He was like, I need this book. Yeah. And on the back cover, you know, where you list all the like, Do you have irritability? Are you not sleeping? Whatever. He saw all of those things for me and he brought the book home and he said, you know, like, have you heard of Bioidentical Hormones?
Which I hadn't. And he said, maybe you should read this book. So you have to give him a little bit of credit for being brave, right? What guy comes home and tells their wife they need to do something about their hormones? But I looked at the book and like medical doctors, we don't wanna get our information from celebrities.
And all I could think about was, you know, Chrissy Snow and the Thigh Master,and I knew though that how I was feeling was so confusing to me because nothing in my medical school training helped me understand what was happening to me. I knew it [00:22:00] wasn't normal. I knew that it wasn't me. I wasn't depressed, but I didn't understand and I read the book and it changed my whole life.
Because I read all these stories about women who were just like me and how messed up they felt, and then how they got back to feeling like themselves again when they got their hormones balanced. And that's what really allowed me to open my mind and to be receptive to the idea that there's this whole world out there that they didn't teach me about at medical school.
And it helped me to find places where I could go to learn, because this isn't woowoo, this is real science. It's based on real studies. And so I went back and retrained. And so for 16 years I've been helping men and women get their hormones back in balance instead of just prescribing sleeping pills and antidepressants to deal with their symptoms.
JJ Virgin: What you don't know, and I forgot all about it until you brought it up, so I know Suzanne, she lived in the desert. And her doctors, Dr. Diana Diana [00:23:00] Schwarzbein. I actually created a program with Diana and used to teach it. It was how to do Hormones, and then Dr. Prudence Hall. So I was like, I've known Prudence for years.
So I learned all of this stuff early on, which was fantastic. As I was starting to get into all of this, prudence actually was like, take this, you know, but suzanne books are so well referenced. She has such an amazing group of doctors behind her with the information. She's just a great person to get it out there.
And truthfully, if the doctors did it, they would've gotten attacked. She doesn't care.
Dr. Deb Matthew: Totally had a, you know, bullseye on her forehead. She slings in the arrows. And she was really strong and she stood up and I would've been one of the people who would've been poo-pooing her, right? Because as a conventional doctor, like who is she to be saying that we're not doing things right.
But she was right and,
JJ Virgin: and bless her for getting that word out. It's been
Dr. Deb Matthew: fantastic. That's right. She's done a lot for women's health. Yes, she has.
JJ Virgin: Amen. So [00:24:00] right now, like someone listening and I, I will tell you, here's one of the ways I knew I needed to do something. I looked for fights to pick. I was like, Ooh, that person cut me off.
Now I'm gonna get them. So I think what you talked about, the best way I could ever describe it was I really felt like I wished my body had a zipper suit and I could just get out of it and come back later because I was so uncomfortable in my skin. It was like And boy, you, you start hormones and you're like, ah, like the birds are out singing again, but short of those insane symptoms, yeah.
How do you know if you need it? When should you start it?
Dr. Deb Matthew: That's a good question. The way that you really know for sure is you can get your hormone levels tested. Okay.
JJ Virgin: And that's a whole thing, Deb, because is it like blood, saliva, urine?
Dr. Deb Matthew: All of the, any of the above are fine. What I would say is find a provider who can help you, and whichever one of those they are most comfortable with, it's gonna be okay.
You just wanna kind of understand like what's going on with your hormones. We all have a unique hormonal pattern. Not [00:25:00] everybody needs everything. You know, some people can still make a little bit of hormones. If your adrenals are stronger, if you don't have too much stress, or if you handle stress well, that actually helps minimize your menopausal symptoms.
There's all kinds of things that we can do to make it better. But we would want for you to get your hormone levels tested just to make sure that we're doing the right thing. And I get asked a lot, like, should everybody get their hormone levels tested? And to some degree, the younger you are, the healthier you are.
I don't know. It's not mandatory for everybody to get their hormones tested, but these symptoms can sneak up on you. So first of all, if you're miserable, if you feel crappy, then just go get it dealt with. And don't wait, like don't be scared. Don't feel like the best thing to do is to be strong and just power through it.
You know, this isn't natural childbirth. You don't have to do that. If you don't feel good. There are things that we can do to make you healthier. And you know, I, I really like this analogy. One of my colleagues talks about what happens with our, you know, vision as we get older. So naturally what tends to happen is we have to [00:26:00] start like holding the paper farther away.
Right. I don't know what you're talking about, Deb. Yeah. And so it's not that we tell people, oh, well this is a natural part of aging. Your near vision goes and you just won't be able to read anymore. What we say is, yes, this is a natural part, you know, often happens over 40. Here's some reading glasses so that you can just do whatever it is that you wanna do and carry on.
So it's the same kind of thing, and for me, this is my little story of how I started when I was in my late thirties. I needed progesterone. My husband was unsafe in my house, so I've been on progesterone for a long time. But last year I started having all these night sweats and I was following my estrogen along.
I could see that it was going down and I was just watching it a little bit, but I was having all these night sweats and my husband is a little bit like the princess and the pee. He has to have the right pillow when he has to have the fan. Here I'm having these night sweats and he finally said, this isn't working for me.
Like you gotta do something about this because you're disturbing my sleep. I got myself started on estrogen and the night sweats went away within like three nights. I was sleeping like a baby [00:27:00] and I expected that. But what I didn't expect is that my brain suddenly started working, and I hadn't appreciated that it wasn't working.
But my team would come to me like at three o'clock in the afternoon and they would say, such and such is happening, what should we do about it? And I heard myself saying, I'm hearing what you're saying, but there's nothing going on between my ears. Come back and ask me tomorrow. And then all of a sudden I got started on the estrogen and my brain started working again, and it was this miracle.
And then a few months later, I heard myself say that again to one of my employees. I hear what you're saying, but nothing is going on in between my ears. And I thought, wait a minute. I haven't had to say that for a long time. I forgot to refill my prescription. I've been six days off of the estrogen and my brain stopped working again.
Like when it went away, I could tell so. It's those kinds of subtle things. It's the fatigue, it's the irritability that I
JJ Virgin: couldn't recover from. Two things happened that were so clear, you know, all of a sudden I couldn't recover from my workouts. I was [00:28:00] like, I never get sore like this. Like what is going on?
And then I started to have bleeding gums. Wow. Yes. Weird little things.
Dr. Deb Matthew: And you know, testosterone is really important here too. We haven't even talked about testosterone yet, but again, when we talk about hormone replacement therapy, typically what we mean is estrogen with or without progesterone. But testosterone is important too.
And you know, women have 10 times more testosterone than estrogen. It's just that men have 10 times more testosterone than women do. But testosterone is humongously important, and it's important for, you know, maintaining our muscles and bones. So it helps prevent frailty because if you think about it, you had said at the beginning, right, like, you wanna be the best version of you when you're, you know, 90 years old.
And so we need our vision, our mobility, and our memory. And testosterone is one of the things that helps keep us robust so we don't fall down snap like a twig, end up in assisted living and wither away. So it's important for muscles and bones. It's important for everything [00:29:00] to do with sex, thinking about it, caring about it, becoming aroused, vaginal lubrication, the whole nine yards.
And it's so common for women to have sexual problems when they, you know, are going through this whole menopausal process, partly because it can hurt and it's like really unpleasant. One woman told me that it felt like somebody was shoving a cactus up her vagina.
JJ Virgin: Like, wow, that's a bad visual.
Dr. Deb Matthew: Yeah.
And then of course she was not very receptive to her husband. Right, because it's painful, but. Really even more commonly than that is this just general lack of interest. Like Suzanne Summers famously, her line is like, really, I would've just rather had a smoothie. And these things are so common and they impact families because it's one thing if you're the one who's lost interest, sometimes you don't really care, because you know, don't even think about it anymore.
But if you have a partner who's interested, it sometimes makes the partner feel like you don't care about them anymore. It makes them, you know, hurts their self-esteem. Sometimes the [00:30:00] partner has their own issues and then they're not interested in us, and that makes us worry about our own. You know, it just, It impacts relationships and it's unnecessary because we can help.
And so testosterone's not the only thing that affects intimacy, but it's an important thing. And then it's really important for how we feel. So we said estrogens like a natural antidepressant, and progesterones like the natural anti-anxiety. But testosterone is a mood stabilizer. It is our motivation, our confidence, self-esteem, assertiveness, decisiveness, get up and go get things done.
And so when it goes down, women will describe themselves as just feeling kind of flat, kind of blah. So you put your one foot in front of the other and you make your way through your day and whatever must be accomplished today, you'll make it happen. But if it doesn't really have to be today, we often kind of push things to the side and sort of procrastinate and you know, because they're just not really feeling it.
And so many women resonate with that. It's so common.
JJ Virgin: [00:31:00] So you mentioned it before, you said I started taking it three days in. I started feeling this way. First of all, I'd love to know a couple things because I remember reading a study and I went, that is the dumbest thing I've ever heard. And I'm sure it's just because that's the only study they have.
So therefore that is what it is, is. Because I thought, gosh, if this makes you feel so much better, couldn't you just start it whenever? There was this whole study that said, you know, if you didn't start it when your hormones were dipping and you've now been in menopause for X amount of years, or you're postmenopausal for X amount of years, you can't take hormones.
It won't work. Which I was like, what do you mean you still have the receptors? They didn't lock the doors, I'm assuming. So first of all, how quickly do you start to notice a difference with these things? Should you be focused with your doctor more on correcting the symptoms, correcting to the lab values?
What do you do there? And then I'd love to address that. If someone's listening to this now and they're 60, 65, they aren't on hormones, they were afraid before and now they're like, game on. [00:32:00] Can they start?
Dr. Deb Matthew: Those are big questions. Okay. So for the, you know, how soon should you expect to feel something, et cetera.
What I generally tell people is within the first 30 days of starting on hormone replacement therapy, you should be noticing a difference. So if you get to the 30 day mark and you can't tell one darn bit of difference, it means we've kind of missed the boat and we need to go back and rethink. Depending on how we're giving you the hormones, some forms of hormones kick in faster versus others.
So hormone pellets happen within sometimes 48 hours. Hormone creams can sometimes take a couple weeks, but even within the same form, different women respond differently, but at least within 30 days, you should feel better in some way. And in terms of whether you should treat to the test, my opinion is we just want you to be, we want you to feel good and be the healthiest version of you.
And measuring hormones is actually really tricky. Especially if you're on a topical hormone. Cream patches are a little bit more consistent. Hormone creams are really tricky to measure. [00:33:00] Hormone pellets, they change depending on how long you've been on the pellet. There's just all these variables, and for women who are not menopausal yet, our hormones change over the course of the month.
So one week and the next week and the next week, your numbers are gonna be different because it matters where you are in your cycle. So hormone testing is kind of complicated. It's not like paint by numbers. We do wanna make sure we're in the right general ballpark, but because it's a little tricky, a lot of doctors will tell their patients they won't measure their hormones.
If you go in and ask to have your hormones measured, whether you're on hormone replacement therapy or not, you may be told. We don't do that. You may be told you're too young to have a problem. You may be told that the hormone testing is not, not valid or it's, you know, doesn't work. There's a lot of reasons why doctors don't wanna do it, but you know, your blood sugar changes all day, every day, depending on what you've eaten.
And we still measure that. We just. Do it in a smart way so that we know, were you fasting, were you not fasting? We just have to know how to interpret the results. I would say though, that we [00:34:00] should be treating you to feel better and just make sure that the labs are in the right ballpark as opposed to trying to give you more and more and more hormones in order to get you to some arbitrary number.
Because one person might feel great at this number, one person might feel great at that number, so the numbers aren't the whole picture. Yeah, and
JJ Virgin: it always has made sense to me. Well, first of all, I keep looking at this going whatever time in your life where you are really in your optimal amount for you, yeah, would've been the great time to know.
But your optimal amount's, not necessarily my optimal amount. And wouldn't you want to really get your adrenals, really get all your lifestyle habits really good? You're sleeping well, your stress is managed, your adrenals are doing well, your thyroid's kicking. You know you've got your lifestyle habits in place and you use.
The hormones that you need to feel better, but not more than that. I think that
Dr. Deb Matthew: is so important because we always wanna put the hormones in a healthy body, and if somebody is gonna have risks or side effects from the hormones, it's not so much the [00:35:00] hormones, it's what your body does with the hormones. So if you don't have enough antioxidants in your system, if you're too inflamed, those are the kind of things that are gonna increase the chances that you're gonna get some of the side effects.
So when people come to see me, What we do is a whole wellness program. So we want to look at your lifestyle habits, your stress levels, your physical activity, your nutrition. We wanna look at your gut health and are you effectively getting toxins out of your system on a regular basis. So we wanna make sure that we're getting you the healthiest you that you can be.
And then the hormones are kind of the icing on the cake. So, But a lot of hormone symptoms get better just with lifestyle habits, so we still need to get back to those women over 65. But you know, when women come in, we start off by sending them off to go get a test for their hormones, and in the meantime we get started on lifestyle changes.
And a lot of times, by the time they come back to get their test results, they're already telling us I'm sleeping better, my hot flashes are less, my brain is waking up. There's so much that women can do on their own with lifestyle [00:36:00] habits.
JJ Virgin: I love that too, Deb, because you really wanna know how you can feel.
Before you do any of that stuff so you know what you need. Yes. Because you won't know. Once you start those, then you don't know. Was it the hormones? Yeah. Yeah. So that's fantastic. And I know I didn't forget, we are gonna ask about someone's postmenopausal, they're 65, they're hearing this. They're like, okay, is it too late for me?
Dr. Deb Matthew: This is a big, big, big one because there are a lot of doctors out there who will just say, no, you can't have it because you've passed that magical birth. You blew it. Yep. Or. Somebody will have been on hormone therapy and now they hit 60 or 65 and they're told, I'm not prescribing this for you anymore. You have to stop it because you're 65.
JJ Virgin: Because that was how long the study went for. Like why did they say that? Cause I've heard that one too.
Dr. Deb Matthew: What happened is they recognized from this study that, oops, women were having breast cancer when we hadn't expected it. At least the women on the synthetic progestin pill. So [00:37:00] the thinking became use hormones only when absolutely necessary.
Like when the woman is driving the doctor crazy enough that they just want to get you out the door, fine, I'll write the prescription for you, but only when absolutely necessary in the lowest dose you can tolerate for the least amount of time and get off of it because we felt like these hormones were dangerous, but.
In, I wanna say it was 2019, the North American Menopause Society put out a new position statement, and what they said was, there's no medical science to back up The fact that we're telling these women to stop their hormones, we know that these hormones are really good for bone health. We know they're really good for genital urinary health, so the vaginal dryness, urinary leakage, painful sex, they're the best thing for hot flashes.
So if women are getting benefit from being on hormone therapy, there's no science to say that we should be telling them to stop it just because they've reached a certain birthday. Despite that being the official recommendations from the North American Menopause Society, it doesn't seem to have seeped into doctors' brains, and so most doctors will still recommend their patients [00:38:00] come off hormones.
Now, if you've never been on hormones, the reason that doctors are hesitant to start is because in that Women's Health Initiative trial, First of all, the average age of the women in the trial was 62, so more than 10 years out from menopause. So they'd already been 10 years before they started them on hormone therapy.
The average women, a lot of them were 72 when they started, and what we found was in women who were relatively older, there was an increase in the risk for blood clots. So we know that any kind of oral estrogen and synthetic progestin can increase the risk for blood clots. But the older you got, the more important that was.
And for women who were 50 to 59, they really didn't see that. But when you were in your sixties, it happened a little bit in your seventies, it happened more. And so the thinking is that there's this window of opportunity we need to get you when you're relatively younger in order to prevent these heart disease risks.
Because a blood clot in your heart is a heart attack and a blood clot in your brain is a stroke. But when we really. Look at [00:39:00] how we give the hormones. If we were to give the hormones in the bioidentical form through your skin, the ones that don't increase the risk for blood clots, then it should be fine.
And we don't have studies saying it's not fine to give the bioidentical hormones through the skin, but it's just this old thinking based on the synthetic pills that we used to give to everybody. For me. If somebody comes in, even if they're more than 10 years out from menopause, certainly we should have a conversation about it.
They need to understand why some doctors think this way. I mean, I don't think we should be saying everything is sunshine and roses. What we do know is that while estrogen is really important for preventing heart disease in women, if you start it when you're say 65, it's not gonna go backwards and erase whatever things happened over the previous 15 years when you were menopausal.
But it can still help your bones. It still helps with mood and energy and skin health and, and sexual health. It still has a lot of benefits, [00:40:00] and so the question is, do the benefits outweigh the risks? And to me, if we're doing it the right way, the benefits still strongly outweigh the risks. So it's still an area of controversy and sometimes it can be hard for women to get the help they need from their doctors.
Speaking
JJ Virgin: of that, Because you just cited so many examples of practitioners taking their patients off of it or not giving it to them, or offering them Prozac or a birth control pill. How does someone get the help that they need?
Dr. Deb Matthew: So what you're looking for is you're looking for a functional medicine provider.
And what you're wanting, this is my opinion, you don't just want a prescription for bioidentical hormones instead of synthetic hormones. That's a good place to start, at least if you're gonna get a prescription for something, you want it to be bioidentical. But what you're really looking for is you're looking for a provider who's gonna look at you as a whole person.
They're gonna understand how the different hormones play a role, what's going on with your stress hormones and your [00:41:00] thyroid and your insulin, and how all of these interplay with what's going on with your sex hormones and what's happening in your gut. So many toxins in the environment are hormone disruptors.
So if you're full of toxins and then we put more hormones in the mix, sometimes that's not a great combination. So you're looking for somebody who can look at the whole picture. And I do have a couple of websites, if it's okay, that we can send people to.
JJ Virgin: Sure. And what we can do too is we'll put all of this in the show notes.
I'm gonna put your ebook, this is not normal in the show notes too. And we're gonna put that all at jjvirgin.com/estrogen since that seems to be the key hormone we've been talking the most about. We'll put all of that there. We'll put these websites. You wanna just mention them and what they have on them?
Dr. Deb Matthew: Yeah. One of them is called A4M.com. So the letter A, the number 4, the letter M, and the other one is I F M stands for institute of functional medicine IFM.org. And those are both organizations that train practitioners. The regular doctors are flocking to these places [00:42:00] in order to learn a better way to help their patients because more and more doctors are recognizing that just prescribing prescriptions all day long isn't really working.
JJ Virgin: It's not much fun for them either. It's not why they went to medical school.
Dr. Deb Matthew: No, it's so much burnout amongst doctors because it's so unsatisfying.
JJ Virgin: Yes. Well this has been really fantastic. It was exactly what I was looking for because I've been really wanting to unpack this subject and help people understand how much this can help.
You know, again, you look at just even from a quality of life standpoint, forget the, I always say brain, bone. Heart, and what was interesting, Deb, is I used to work out of one doctor's office doing nutrition, and I would also roll through and just walk them through the labs the doctor was ordering and. You know, so we were looking at cardiovascular profiles.
Back then it was the Berkeley Heart Lab, and so I would monitor people year after year, and I kept seeing women when they had gone through menopause. So I had their labs pre, and I had their labs [00:43:00] post unbelievable shifts. All of a sudden they're H S C R P, so this marker for systemic inflammation shoots up there.
Their small, dense L D L particles. They shoot up. Like all these things that are such risk for heart disease just shot up basically overnight. And these were people that everything was great. They were living a healthy lifestyle, you know, and then bam, it was like, holy smokes. And then, you know, the other one that was so clear to me is just physically, just skin.
Dr. Deb Matthew: So, Yeah, you turn into your grandma overnight.
JJ Virgin: I know. I was like, your skin, the shift in skin, the difference in your skin on hormones and off hormones is night and day. So just the basic quality of life is so huge for this. So I'm. Just glad that we can get the right information out there. This has been like a, a masterclass in [00:44:00] bioidentical hormone replacement therapy.
So thank you so much. And again, I wanna remind everybody you're gonna be able to grab all, I'll have A4M and IFM's websites, and also Dr. Deb Matthew has her book. This is Not Normal, so you'll be able to grab that. That's her gift. Thank you Deb for that. And thank you more for being. Really a voice for women out there, for taking a stand, for getting this information out there and for spending the time with me today.
I so appreciate it.
Dr. Deb Matthew: Thank you so much. I think this is an important topic.
JJ Virgin: Be sure to join me next time for more tools, tips, and techniques you can incorporate into everyday life to ensure you look and feel great, and more importantly that you're built to last. And check me out on Instagram, Facebook, YouTube, and my website jjvirgin.com.
And make sure to follow my podcast so you don't miss a single episode at subscribetoJJ.com.. See you next time.[00:45:00]

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