PERI and POST Menopause Testing and Treatment Options with Dr. Jill Carnahan

Betty Rocker (00:18):

What’s up, rock stars Coach Betty Rocker here. Hey, thanks so much for joining me. My guest today is Dr. Jill Carnahan, a frequent guest on this show. You may have heard her before. She is dually board certified in family medicine, a practitioner of integrated holistic medicine, and is also a functional medicine expert. She’s the author of Unexpected, a very inspiring read, and she’s also the subject of a documentary called Doctor Patient. She’s got a fabulous podcast and a really, really helpful blog, just packed with great free content you can access anytime and is a survivor of breast cancer, Crohn’s disease and toxic mold illness. She brings a unique perspective to treating patients in the midst of complex and chronic illness. She’s the medical director at the Flatiron Functional Medicine Center just outside of Boulder, Colorado. And my own personal doctor and I always feel really lucky to get to work with her and also to be able to share her with you guys because she really helps make sense out of so many complex health related subjects that are relevant to us all. Please join me in welcoming her to the show. Great to see you, Dr. Jill. Thanks so much for joining me today.

Dr. Jill Carnahan (01:31):

You’re welcome. So good to be with you again.

Betty Rocker (01:34):

Yes, it’s always great to get to check in and, and have a conversation. And one thing I feel like has been on my mind and on the minds of many of the women I serve, um, is this conversation about menopause, perimenopause and post menopause. Right? The all-encompassing menopause umbrella, . And it’s great to see menopause having its day. I feel like finally we’re hearing more about it. There’s a lot more research than there used to be. And when I think back to our conversations maybe early on in my own perimenopause journey, I think about how much anxiety I had about hearing about things like bioidentical hormones or hormone replacement therapy and how that conversation kind of evolved and how much more we know these days. Why, why are people still, I feel like there’s still a lot of fear around hormone replacement therapy, though. I mean, just to get us into it, like where’s that come from?

Dr. Jill Carnahan (02:33):

Well, it actually comes from our profession and I’ll tell you the story and it’ll make so much sense. So I graduated 2001 and got out of medical school and that year was the year the Women’s health Initiative first came out in the news. As the researchers are compiling the data, the news took this information before they even finished compiling and said, oh my goodness, is there an increased risk of breast cancer with hormone replacement? And literally hundreds of thousands of women stopped their hormone replacement because this media took this story, put it out there. And even as a doctor, that was the story that we were told. So we all started, this is 20 plus years ago, being afraid of this. What happened in that 20 year sense is they analyzed the data in that largest randomized control trial of women on hormone replacement. And the data came out very clearly.

(03:18)
Number one, there was two arms, one was an estrogen only arm, and they used Premarin, which is actually a horse estrogen, not even the best cleanest bioidentical, but it is an estrogen. And the other arm was a Premarin, which is an estrogen plus, um, a purvey, which is a synthetic progestin. I’ll explain that real briefly in a minute. So these two arms, the first arm came out and this has been the last, uh, analyzed research, well documented by anyone who’s looked at this. There was actually a 34% reduction in breast cancer in that arm. So not only was it not neutral like just, or or harmful, it was actually a reduction. And we’ve known for all of this time that hormones, especially estradiol, helps the brain, the bone, and the um, menopause symptoms dramatically and the heart. So those things were never questioned. It was only this question about breast cancer.

(04:09)
Now, in that other arm, here’s where the controversy came in. They had this slight increase above baseline with the Premarin Provera arm for breast cancer incidents. But what happened is what they were, um, going against as the baseline actually had a higher incidence of normal. So it skewed the data. And the second thing about that was, as I mentioned before, this was a synthetic progesterone. It wasn’t progesterone at all, which can actually mimic progesterone deficiency in the long term because it hits those receptors, but it’s not a natural progesterone. So neither of these trials, even though they showed a decreased risk of breast cancer, were even using the kind of hormones that you and I are talking about, which is the exact same as our bodies, our ovaries produce. So I confidently, and you mentioned before, I’m a breast cancer survivor, so I am 20 plus years out.

(04:53)
And for me, this is a very personal issue. ’cause here I am in menopause and I’m like, what is safe for me? Because I’ve had breast cancer and I can confidently say without a shadow of the doubt, I used to think we had to choose. We don’t. I think as long as you have a good practitioner who knows what they’re doing, you’re checking levels. And we’ll talk about all that today. Um, this is a huge issue for women and it’s gonna affect bone, brain and heart in a good positive way. And now we think it may even be protective against breast cancer.

Betty Rocker (05:25):

I’ve been reading that data as well and it’s great to hear it from you. And part of why I wanted to ask you that question to start us off is so that you know that you would share that you are a breast cancer survivor. It is something that is so deeply personal to you. I know that there’s no way that you would’ve prescribed that to me. You wouldn’t have prescribed hormone replacement therapy to me or to numerous other patients you’ve served if you thought there was a risk for us. Now, of course, there are gonna be some people who it’s contraindicated for. There’s certain things as a clinician, I’m sure that you look at, I’m sure there’s the blood clotting factor. There’s all of these different things that we wanna watch out for, and that’s something that when someone’s individually working with a doctor, they need to care about.

(06:06)
But I think it’s really important to just, even though that was, to me that was a little technical, what you shared, and if you’re listening and you’re thinking, I didn’t quite follow everything she was saying, but it, you understand the data as mm-hmm . A doctor who reads the science, you understand that it’s safe. Yes. That’s basically what you’re saying. And like that these studies in some ways had some real flaws. Yes. They were studying, um, forms of hormones that we don’t actually use in women’s medicine. And also that the, the, and, and so it, and so there’s all this fear, there’s all this fear around it. And, and it’s not for everyone either, right? Like, you’re right. I know we’re not gonna say, oh, everyone needs to be on hormone replacement therapy, but

Dr. Jill Carnahan (06:46):

If you’re undergoing breast cancer treatment, for example, I would not give someone hormones during treatment. So that’s a very clear contra.

Betty Rocker (06:52):

Right. So there you go. There’s a, there’s a reason not that, and there are probably some other reasons too. And, and yet it should be an accessible, viable option that women have access to is all I’m seeing without all the fear. And, and that’s why I wanted to just start us off talking about that. ’cause you know, if we’re gonna get into some of the viable treatment options for women in the menopause years, it’s important to know that we’ve thought about this first and foremost, because I think safety, women’s safety and, and and their access to healthcare options is really important. It’s essential. Yeah. At every age, and this is an age that I feel like has been overlooked, has been ignored, has been too long, just sort of like, you’re just getting old. I can’t tell you how many women have written me, and you’ve probably seen this in your practice as well, saying, I’ve been dismissed, I’ve been told I was depressed. I’ve been put on anti-anxiety medicine. I’ve been told I need to just exercise more and eat less. I’ve been told I’m just lazy. Um, it’s all in my head. I’ve been put on birth control, like all of these different things that are like getting at symptoms but not really addressing the root cause, which is this shift in our hormones that happens. I don’t know, it’s just, it’s it’s

Dr. Jill Carnahan (08:05):

So true. And I love that you said it’s even today, every day in my practice, I have these discussions with women and there’s some who choose not to, and that’s okay too. But everyone deserves a discussion with an educated provider. Um, and if your provider is absolutely no, and there’s no discussion, then you wanna find a different provider because it isn’t for everyone. And there’s a very important choice. And if you have a lot of anxiety or fear, I never push anyone. So there’s still, I may be maybe 20% of my women that we talk about and they don’t go on hormone replacement, and that’s okay too. But to have the option and to know the

Betty Rocker (08:34):

Choice, you said choice. That’s the word. That is, that’s it. And the education about it, to know that you can make an informed choice for yourself to know there are risk factors for certain people, and then some of us there aren’t. Well, let’s talk a little bit about the, the stages of a woman’s life that we go through. There’s the perimenopause years, those years leading up to menopause, the event where our period stops for 12 months and then we’re in the postmenopausal years. So there’s really perimenopause and post menopause and menopause sort of like defines that cusp where we go to the next level, as we call it. Right? And, and so there are women who come to you at, at these different stages of their menopause journey. And they wanna know all kinds of things. Like, well, how do I know I’m in perimenopause? How do I know I’m, how do I, what, what should my hormones look like at these different stages? And I would imagine that those are the kind of things that you help address in your practice. So if, if someone comes to you and says, I think I’m in perimenopause, or I’m having these weird symptoms, what do you test for? And what kind of symptoms do they show up with? So that maybe you could, we could help someone out there who’s trying, who’s maybe struggling right now or trying to figure out what to ask their

Dr. Jill Carnahan (09:44):

Doctor. So commonly women as young as 35 can start to experience these perimenopausal symptoms. And usually from 35 to 45 is that realm. It can go as long as 55. I think the average age of that menopause date is around 52, 55. And then after is post. But this can again be almost a 20 year span from 35 to 55 that some women struggle. So one thing I’m a fan of, and not all doctors do this is testing. I use blood, urine, different types of things to assess different things. And this is a whole nother lecture worth of material because depending on if you’re using a cream or an oral or how you’re doing it, certain tests pick up things differently. And that’s a whole other discussion. But it’s important that you have a doctor that will assess where you’re at because you have the symptoms typically.

(10:26)
And the symptoms can, um, for example, in that early part, so say 35 to 45 or 50, often you start to first have a lack of luteal phase progesterone. That’s usually the first thing that drops. So you often experience estrogen dominance and hormones are all about balance within one another. So if we have our cycle follicular phase, estrogen goes up, second part of our cycle, luteal phase, progesterone goes up and that just yin and yang happens all through our twenties and thirties. Well, in our late thirties or early forties, what starts to happen is that progesterone will often diminish production. So you have this dominance of the estrogen throughout the cycle that can cause breast tenderness, moodiness, heavy, painful periods, uh, endometrial pain, endometriosis, fibroids, all these kinds of things. And that can be a symptom in and of itself that can be treated with natural progesterone or sometimes herbs that will increase the lead phase progesterone.

(11:16)
And that’s usually the first thing. Then somewhere in there your ovaries start to sputter. And I always say it’s almost like if you had a bottle of Heinz ketchup and you’re squeezing out the last bit and the, then the hormones are starting to go, you know, just kinda like this little just petering out. There’s a mess of a spurting out and somebody will have a day that’s high and low and high and you can’t figure out what’s going on. And even testing, you have to be careful because if you’re testing that period, you test one month, you might have high estrogen, low progesterone the next month it might be low and it just does this dance. And that’s the time when women are so frustrated ’cause like, I don’t feel well what’s going on? They might start to have hot flashes, but they’re still having heavy cycles.

(11:50)
And so in that window, women can still do bioidentical hormones. But it’s important to have a clinician that knows how to assess the symptoms related to what they’re likely experiencing hormonally. And then also test knowing that the test can be up and down. And in that phase it’s gonna be like the Heinz ketchup spurting out randomly. And then you get to a point where those ovaries just like, I’m done. And that’s when the estrogen starts to really drop. And this is when women would start to have hot flashes, night sweats, all of a sudden they cannot remember names. Places where they put their keys, where they’re going, they get in the car like where am I driving to? Like things where they literally, women have come to me and said, I think I’m losing my mind. They can start to have this like you and I have been driven women in our field.

(12:33)
And I know when I first hit menopausal, like the overwhelm, the feeling like I couldn’t handle things normally is really common with women. ’cause they’re driven and they’re doing well and the estrogen really helps our brain stay on track. And when that drops we’re like, oh wait, my executive function, the planning, the executing is impaired. And I’m like, I feel like I’m losing my mind. Or that the things that I used to be able to handle are harder. Mm-hmm . Emotionally, you’re up and down. You may be more tearful one day more angry, one day more sad, you won, don’t wanna get outta bed one day and when none of those things were there before. So I love talking to women because so many women literally feel like they’re going crazy if no one validates this and it’s a normal experience, but it can feel so disorienting. And you know, even the dad as far as broken relationships and divorces in this time, it’s not surprising that that goes up because women feel like they’re going crazy. And most men and many doctors gaslight them into thinking they are going crazy and it’s just their hormonal transition.

Betty Rocker (13:29):

So I hear you saying that there are these real distinct phases of perimenopause that we go through and this is why it’s harder to pinpoint sometimes because it’s a moving target. Yes. As we go through these, these years of our lives. And it’s surprising to hear you say that it can start as early as 35, but it also makes sense, right? And, and it, I guess you may not know exactly where you are. It may not go exactly with your age. Right? So if we stay on the perimenopause conversation for a minute, say

(13:57)
Say I’m a younger woman, or say I’m like 40 years old mm-hmm . And I come to you and I say, I think I’m in perimenopause. What would you specifically test for? I can remember some of the things you tested me for specifically when I came to see you. And of course I had complex symptoms and many different things going on. It wasn’t just menopause when we first started working together. But I do remember that over time you’ve tested me for some specific basic things. Yes. To help see what if, if it was perimenopause. So would you share a couple of those? Yes.

Dr. Jill Carnahan (14:31):

So one thing is this can be done at any conventional lab. And even though blood work isn’t always perfect, if you’re using like a cream or whatever, it’s a great place to start. It often will be covered by insurance. And what you’d wanna do is a basic panel. Estradiol is the main E two estrogen and you can get estriol and estro. But just estradiol is a good place to start.

Betty Rocker (14:48):

Just to say just she said E two and then she said all those things. So that’s E one, E two, and E three. There’s three types of estrogen. So estradiol is E two and that’s the one you wanna know about, right?

Dr. Jill Carnahan (14:58):

Yeah, that’s the main one. So again, it’s great if you can get ’em all, but if you just get one, get estradiol. And lately the lab now has a highly sensitive estradiol. So HS are highly sensitive is better because this is very, very, very tiny parts in the blood. So they’re measuring little tiny things and it gets a little more, um, specific and sensitive with that highly sensitive estradiol. You wanna get proactive.

Betty Rocker (15:17):

Do you have to get a special test to test for that. Does your doctor,

Dr. Jill Carnahan (15:20):

No, this could be just a regular LabCorp quest regular hospital lab. Just writing estradiol on the lab order would do it.

Betty Rocker (15:27):

Okay, good. Good to know. Okay. Sorry to interrupt. I just wanted to make sure there wasn’t something special we had to ask for .

Dr. Jill Carnahan (15:32):

Yeah, no, estradiol. And then progesterone also critical. ’cause we always look at the ratio. Just like we said, these two are the dance partners. So we’re checking those two in conjunction. Um, if I have a choice, I’m testing all these and I’ll continue with the rest of them on day 19 through 21 of the cycle. So that’s assuming you have a typical 26, 28 day cycle ’cause that’s gonna hit your LAL phase. And what you’re gonna see there is if the estrogen and progesterone are in balance. Right? So that’s the timing of what you might do for this. So estradiol, progesterone, DHEA dash S is how we test DHEA, which is another steroid hormone in the blood. Testosterone, I like to get both free and total. Mm-hmm . And then cortisol in the morning. ’cause that’s kind of a standard, although you could get it randomly through the day. And if you just get those five estradiol progesterone, uh, DHEA free and total testosterone and cortisol, you’re gonna have a pretty good idea. Now you can get fancy and get something like DHT. This is a, a very potent steroid hormone like testosterone that can cause hair loss or can cause acne or PCOS. But you don’t need to get that fancy. If you just get those mean five, that’ll give you a good map.

Betty Rocker (16:38):

And I remember those. That’s that basic panel I’ve had repeatedly and I wanted to touch on that because A, those, so you’ve had those tests done for me multiple ways over time. So in the beginning we would do a combination of the Dutch test, which is a urine test that we do on those very specific days of the luteal phase of the cycle. And you need to be tracking your cycle in order to know where you are and when your luteal phase is. And I find that it’s actually really helpful to be tracking your cycle when you’re in perimenopause because it’s gonna give you some indication of knowing as your cycle starts to get erratic. It, it’s easy to just forget about your cycle. Honestly, I often would forget I was even gonna get my period in my regular cycling years because it was just so like I I would be like, oh, this again.

(17:27)
Right, right. Yeah. I wouldn’t have much sense. Me too. Right. So, but now, like in perimenopause it’s been really helpful to track it, to have a sense of it. And I, of course I’m wearing my Oura ring and that really helps me. ’cause I can see my basal body temperature go up when around ovulation and it stays elevated through that second half of the cycle. But anyway, back to, um, these tests, I would typically do that Dutch test. You would order that Dutch test for me, the urine test. And then I would also go fasted first thing in the morning, early morning and get a blood test as well. And that was where you were checking that T three, the free T three, the, the free thyroid hormones. Right. The free T three and T four. One of ’em is free, I don’t remember. Mm-hmm.

(18:05)
But T three and T four. And then you, you’d also be checking the fasting cortisol in the morning ’cause we’d wanna see like where that was. And then we’d also also, I think you could see things like testosterone and you could see the other hormones mm-hmm . Um, but it was the, the combination of that with the Dutch test that together gave you a much clearer picture of what you wanted to see that would help you see if my hormones were in balance, how out of balance they were. We started to see over the course of the few years that we tested these two things back to back the, the blood and the urine, how my hormone levels really went down and down and down. Yeah. And I remember in the beginning I was able to get by with simply using some adaptogenic herbs that really helped support my stress response and helped nourish my hormones.

(18:52)
And, and I was able to feel better even though it didn’t really make my hormone levels go up much, I felt a lot better and it reduced a lot of the symptoms I experienced. But then as I got a little farther into the perimenopause journey, it became really essential for me to start using things like hormone replacement therapy. And then I feel like I’m maybe in the, the end of that middle stage of perimenopause now I’m like using a combination of different types of hormone replacement therapy. I have some props here to show you guys, in case you’re watching this on YouTube. I’ve got my patch mm-hmm . So I use this little patch and I’ll just open up the little foil packet so you can see it. It’s just a little sticker that I put on and, um, you change it every few days. Or Dr.

(19:40)
Jill had even given me some recommendations as I’m very sensitive to a lot of this stuff where we tried it for a longer period at the start to see how I responded. And then we tested again a few months later and I’ve also got some different creams, topical creams. She in the past had had me try, an oral progesterone. And we found that for me personally, the typical recommendation was I think to take it at night. My body didn’t like that, so I took it in the morning. So there’s just all of these fine tuning sort of nuanced aspects of this. And then there’s also a pellet, which I know you recommended for very specific situations, but if you’ve got a pellet injected under your skin, which we talked about in other podcasts, you can’t change that. Yeah. It’s there. You can’t take it out easily yourself. Right. So it just gotta do its thing so it’s less customizable. Whereas with the creams you like, you can do two clicks, you can do one click, you can really control your dosing, I think really, really well. Those are all things that I’ve experienced based on the testing. And I will also say that you and I tested a good amount, like it would be a, a few times a year we would test to see like

Dr. Jill Carnahan (20:51):

Every three to four months. That’s

Betty Rocker (20:53):

Great. Every Yeah. Absolutely. To see like, how did my body respond to the treatment? We wanted to give it enough time for it to, to have some effect. And we wanted to then see how was the body doing with these things. And then if there was, if something responded, we could see that. And if it didn’t, we could adjust my dosage. But we didn’t just go really fast into things we had to like take. And that can be, that can be a little bit of a process, right? Like, ’cause you want results immediately, but if you overdo it, you can feel worse. And that’s,

Dr. Jill Carnahan (21:26):

That’s like, you don’t want breast tenderness with the estrogen, which is the use typical. And one thing, a lot of people are worried about clot risk. And what if I have this, uh, there’s different gene things that you might’ve been told

Betty Rocker (21:35):

Factor V(5) Leiden, right? Like that’s my family. Yep,

Dr. Jill Carnahan (21:38):

Yep. Or, um, certain other ones out there. And so if you’ve been told that’s a risk, the deal is oral hormones, especially estrogens do increase the risk of clot. It’s why you will almost never see me prescribe oral estrogen because I don’t wanna even go in that category, right? Mm-hmm . Transdermals do not have the same risk. Transdermal just means a patch or a cream or something you apply to your skin. Our skin absorbs hormones really well mm-hmm . So I almost exclusively do the compound of creams that you showed or the patch that you showed. And, um, there’s different ways to do those, but those are really great and safe ways to apply. Now you mentioned often doing blood and urine at the same time. The dutch hormones is what you mentioned. I typically to follow the hormones, like to do the Dutch, because in the blood you won’t always see the true levels of a cream or a patch.

Betty Rocker (22:25):

Mm-hmm .

Dr. Jill Carnahan (22:25):

So I sometimes do both, like we did with you. If I have a patient who’s willing to do both, that’s the best. But you can see the differences because if you’re really following a cream or a patch or a protocol, um, your Dutch urine test is gonna show more the accurate levels of your body versus the blood.

Betty Rocker (22:41):

Mm. That’s super interesting. So if someone were just trying to follow their hormones, if they were just, if they could just test kind of consecutively, maybe not every month obviously, but like on a decent basis, maybe every three or four months they would use the Dutch test as their primary to, to see if they were doing hormone replacement therapy. Yes. Now you mentioned compounded.

Dr. Jill Carnahan (23:04):

Yes.

Betty Rocker (23:04):

That that’s, so, so there’s a couple of different types of these transdermal or cream-based mm-hmm

Dr. Jill Carnahan (23:10):

.

Betty Rocker (23:10):

Hormone replacement therapy types. Could you wanna speak on that a little bit? I feel like there’s a lot of

Dr. Jill Carnahan (23:15):

Sure.

Betty Rocker (23:15):

There’s, you hear about HRT, you hear about BHRT. Yeah. You hear about all this stuff. So tell us about the differences

Dr. Jill Carnahan (23:21):

There. Sure. And just to reiterate what you said about testing my standard patient, we might start them on a protocol and usually about every six months is kind of when, sometimes sooner if they’re having symptoms, but on a routine, and at the very least, I’m gonna check them yearly.

Betty Rocker (23:35):

Sure.

Dr. Jill Carnahan (23:35):

So everybody who gets hormones is required by me to do a yearly test. So I know, and sometimes more frequently if we’re changing doses, if they’re really stable, yearly does pretty good. Sure. Like I’m at a place now, I do once a year and I’m stable on doses. So what is available? So there are regular pharmaceutical pro prescriptions you can get at CVS, Walgreens or your regular pharmacy that are bioidentical hormones. Estradiol, as we already mentioned, is the main hormone that you’re gonna see. And this can be prescribed as a cream, um, as a, um, foam like a, roll-on, as a patch, which is my favorite most common ’cause women don’t have to think about it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s lots of different ways. And that is only one, it’s the E two, the estradiol that’s the most strong. It works, it’s a great way to do it. But a lot of times women want to have a combination and we can prescribe compounded estriol, which is that weaker form of estrogen. And for example, if we have someone who has recent breast cancer or very, very concerned, estriol is kind of a caboose, estrogen meaning end of the line. And the body doesn’t take and make other things with it. So it tends to be the safest, even among oncologist with someone being treated for breast cancer with vaginal dryness, they would say, oh, this type of estrogen is really safe. So if you have any concern, you can always compound these. And often I’ll do either 80 20, mean 80%, one 20% another or 50 50, and you combine these two estriol and estradiol into a cream. And because you can compound it, I can start with much tinier doses for someone who’s really sensitive. And you can also put progesterone in that cream. So many of my women have like a biased meaning like two types of estrogen with a little progesterone all in one, and they use a couple clicks on their skin at bedtime or morning. So it can be pretty easy to do, but that way I can actually pick the exact dosages for that individual patient and adjust it based on their results with fine tuning.

Betty Rocker (25:24):

That’s so cool. Uh, I love that. I, I feel like I’ve been having my own little apothecary over here. Yeah. And I can see that my estriol estradiol is a combo and I can, I have a separate progesterone mm-hmm . And I also have my little testosterone.

Dr. Jill Carnahan (25:42):

Yes.

Betty Rocker (25:42):

And that’s been I feel like really helpful. Um, yes. You wanna talk a little bit about that because we don’t often talk about testosterone and, and

Dr. Jill Carnahan (25:50):

I do because I get so excited about, just, so this is, we think of it as a male hormone. We have testosterone – lower than men, but we have testosterone. We need testosterone. It helps our bones, it helps our brains, it helps our motivation, it helps our body composition. Women who are deficient in testosterone. It’s one of the reasons why there is four times the incidence of autoimmunity in women as there is in men, because that lower testosterone actually increases risk of autoimmunity. So there is, I have even used off-label testosterone as part of a protocol to treat autoimmunity because it’s so powerful in women. So I’m a huge fan now. You don’t want excessive, but getting the right dose will literally change your life, your mind and all those things. In addition to the estradiol libido for women, it absolutely has an effect. Vaginal dryness.

(26:39)
And like I said, bone and brain are huge with testosterone. So testosterone can be given as a, we almost never want to give a pill where you swallow because your liver has to process estrogen, testosterone, whatever. And we don’t wanna load up the liver. So I’m always trying to bypass the gut with hormones that’s either a cream or a patch. With testosterone, there’s a couple ways you can do it. You can do a cream, but for women, wherever you apply that cream, inner thigh or wrist, you’re gonna get a little hair growth. So a lot of women don’t like that. And so instead of doing the cream, I will often do a trochexf or a sublingual tab that dissolves under your tongue so that you get that dose without getting into your gut and through the liver. Um, a lot of women, uh, do injectable now.

(27:19)
It used to be that the commercial forms were only for men. So to get the tiny doses that we needed, were really hard to draw it in a syringe. But I do find, well now we can compound it like women concentrations. And I do like, as long as women’s are afraid of doing a injection once a week or once every 10 days, that is a great way. It typically does give a level that kind of goes up and down every time you inject. So you have a little bit more variation than you would with a daily dose. So testosterone can be cream, it can be in troche or an oral sublingual, and it can be injectable. And those are the main ways. And because right now our pharmaceutical industry is geared towards men and testosterone, most of the commercial, if not all of the commercial, um, ones, patches, creams, even injectable, are typically made for male dosing. So this is typically compounded for women, um, to get that dose.

Betty Rocker (28:06):

And you and I have found that my body just loves that. It just, it just has really helped me a ton. Mm-hmm. And I’ve taken such a tiny dose over the, the time that I’ve been using it. It’s been really helpful, I feel like, for balance. And then I also take, um, the oral DHEA supplement to help, because that’s of course a precursor to is estrogen and testosterone. Right. It’s a precursor. It supports our adrenal production. Um, as, and that’s something that I always so found really interesting is that because of course we’re making our estrogen and progesterone primarily in our ovaries, but we also make some hormones in our adrenals. Correct?

Dr. Jill Carnahan (28:46):

Yeah. Yes.

Betty Rocker (28:46):

And if our adrenals get overwhelmed by stress, the stress response, it’s gonna be harder for them to make some of those backup hormones. And I remember a really interesting conversation. You and I had a while back where you were like, you know, you see women who have a really robust, um, adrenal function have an easier time in, in going through perimenopause because they are not strapped of the backup hormone system. Almost. Did I say that right? That’s

Dr. Jill Carnahan (29:13):

That’s exactly right. Because when our ovaries conk out and they’re like, I’m done, I’m for tired. Right. Which is what happens when we hit menopause. They ovaries stop producing the hormones, our adrenals take over. So we still do produce a little bit of hormones from the adrenal glands after menopause, not nearly as much as ovarian. But if those adrenals are so taxed, ’cause you’ve been working 80 hour weeks and not getting sleep and taking care of your parents and your children and all these generations, then it’s really common to have a much more difficult in menopause. And I love DHEA, first of all, it’s the only one of these that isn’t requiring a prescription. The rest of these, you do need a prescription. Right. Um, and just for the record, testosterone is still considered controlled, whether it’s athletes or there’s some things that they, so that is one of those that you can still get a prescription no problem.

(29:57)
But it’s in the category of controlled prescription. So you might have to get a lower amount, like six months versus a year or certain things. Um, but DHEA is available over the counter and women often do well on five or 10 milligrams upwards of 25. But that’s a pretty high dose for a lot of women. And what can happen there is that will support your production of cortisol. If the adrenals are low and you’re low cortisol, it’ll support testosterone and DHEA. So it’s kind of a nice adrenal support if your adrenals are in a weakened spot. If you’re really high cortisol and you’re prone to breakouts, those are the kind of people I probably would not put on DHEA. ’cause then you raise the cortisol and you may have some more breakouts, but usually women will know because they’ll take five milligrams, which is a tiny dose and they break out. So stop the DHEA.

Betty Rocker (30:41):

Right. Uh, I think this is a good opportunity for us to shift a little bit to the postmenopausal conversation. I wanna talk about everything all at once, everywhere, of course. But, but I really want, I’m really interested and curious because I’ll be in post menopause soon and I wanna know what to expect. And I’ve got a lot of women who listen who are in post menopause, and they wanna know, well, what should, is there something, how, what tests should I get? And then what options are there for me? What should we do and how can we help them?

Dr. Jill Carnahan (31:14):

Yeah. So there’s basically two or three ways this could happen. We talked about like, say you’re 35, 40, 45, and you’re starting up symptoms and your doctor’s open and you get some prescriptions. You can actually go through this very smoothly and then hit menopause and kind of have been on hormones. Sure. But what you’re talking about, I think is say that woman out there is 65 and they have never been on hormones. Never.

Betty Rocker (31:33):

Yes.

Dr. Jill Carnahan (31:33):

Right.

Betty Rocker (31:34):

Right.

Dr. Jill Carnahan (31:34):

And they’re like, well, what about me? Well, first thing is Dr. Dale Bredezen does a ton of research on Alzheimer’s. And he’s one Who’s that? Dr. Dale Bredezen. Okay.

Betty Rocker (31:42):

He

Dr. Jill Carnahan (31:42):

Wrote the book End of Alzheimer’s. And he’s one of our researchers and leading experts in dementia. And I mentioned this because in his protocols, there’s a type of Alzheimer’s that’s related to lack of estrogen in the female brain.

Betty Rocker (31:55):

Wow.

Dr. Jill Carnahan (31:56):

So he is putting 85-year-old women on hormone because it’s so crucial to our brain function. And, and so this old myth was that, oh, after 65, we don’t need hormones. So if we’re on hormones, we stop at 65. Or if we’re above 65, you’re too old for hormones. That is not true. Our brains, till the end of our life can use the hormones. Now, maybe at some point you need lesser doses, but I would say to any woman who’s postmenopausal and maybe having symptoms, maybe not, I would still start with testing and then talk clinically about symptoms and then talk about safety. Safety’s the same thing here. But what happens is, say you went, uh, into menopause at, or you hit menopause 55 and you’ve been without hormones for 10 years, your receptors start to and shrink up. So what happens is when you first start hormones, if you have never been on them, there’s a little bit of adjustment because you may not either be able to sense that hormone well, or you may very quickly get flooded with too much. So it just takes a practitioner who’s careful with that, but they’re truly with heart, brain, and bone. There is no age too old that does not benefit from hormones as long as there’s a conversation and all of that

Betty Rocker (33:06):

Happening, and it’s approached carefully. That makes total sense. And I’m so glad you said that. Um, some of the telehealth sites that help women with balancing their, their hormones post menopause, they say that they’re, they’re not gonna prescribe if you’ve, or they, they, there’s some wording about if you’ve been 10 years without having a period and you haven’t never been on HRT, like they, they wanna check in about that because of exactly what you’re talking about. Like these receptor sites sort of, are they atrophy, like you said? Yeah. But that there still could be, that you still could have that opportunity. So, so say, say someone came to you and she’s just like maybe a few years in to post menopause. What would you test her for? What would you be looking at? Would you look at, I mean, you probably still wanna see like what her levels of estrogen or like, you probably wanna check her cortisol, I don’t know. What, what do you sort of look at to, to help her? And, and obviously it’s individually based as well, but if she’s interested in some type of hormone replacement therapy, I guess what, what conversation and how do you test?

Dr. Jill Carnahan (34:04):

Yeah. So we’d still do probably blood work or Dutch hormones, one or the other, or both. And then what we’d wanna do is there is a risk of if you have uterine fibroids that are unchecked and very large, or you had severe endometriosis, so any of the endometrial diseases, this means like the lining of your, your uterus was abnormal or thick. Or you have these growths that are benign growth, but they’re stimulated by estrogen. Those conditions, um, could be stimulated even by healthy bioidentical hormones and fibroids are benign, but they’re a pain if you have them. They’re large or uncomfortable. They’re typically not malignant, which means like they’re not cancer. But those are caveats or things that as, as a physician, I’d be very concerned or have a discussion about. And also, if you are perimenopause or in those earlier years, forties or fifties, and you have had a massive issue with fibroids or endometriosis, those are discussions we wanna have about how to dose this and be watching that carefully.

(35:00)
So typically a woman who’s never had any hormones, I would screen them with a pelvic ultrasound to just look at that pelvis and make sure everything’s safe. Because if they have fibroids, those could grow with hormones. And you have to know that and then be able to watch it. If any woman has breast tenderness with these, uh, hormones, that’s a sign. I’m always like, oh, that’s, you’re hitting your threshold. We’ll, probably should lower it. So that’s like a warning thing. I’ll say, you don’t wanna have breast tenderness, or if you do and it’s just transient for a week and it goes away, that’s probably okay. And then the third thing is if you ever stop bleeding for over a year, that’s technically the definition of menopause. You’ve gone into post menopause, um, and you start to have bleeding that year without a cycle that requires you to get an endometrial biopsy and a workup to make sure your lining is not getting too thick. And these are just those careful things that a good doctor would do if you’re on hormones, because hormones can cause that lining to get thicker. And so if you have a high risk of that, or some reason, you’d have to have that discussion about safety and efficacy with your doctor. But I would always do a pelvic ultrasound and check their clinical history and then talk with them carefully. I would also probably start a 70-year-old woman on a much, much, much lower dose than I would a 45-year-old woman.

Betty Rocker (36:10):

Sure. Thank you for sharing that. And that’s so helpful to know as we go into these things, we wanna have our eyes open about risk factors. And you mentioned that you, you do a Dutch test as one of the options for a post-menopausal woman. But since she isn’t having a cycle anymore, when does, when do you, when do you do do that? Yeah, anytime You can do it that

Dr. Jill Carnahan (36:29):

Anytime. Right,

Betty Rocker (36:30):

Right. Because you’re just looking to see where her levels are at so that you could determine now. And then for someone who’s post-menopausal, are you gonna be putting her or an individual as an anybody, I guess, would they be getting on a similar protocol to what someone in perimenopause is getting on? Are you gonna be giving them all the same types of hormones? Would they need all of them? Or are you, are they more likely to be just getting on an estrogen or maybe some testosterone? Or is there a reason to still add progesterone? I’m just so interested.

Dr. Jill Carnahan (36:57):

Yes. So, um, the, the typical medical training is if you have a uterus and you use unopposed, estrogen, meaning all you get is estrogen, that’s a risk for that lining being thicker and actually developing endometrial cancer. So we as physicians who are doing good work, would never give a woman who still has her uterus unopposed estrogen by itself. You would always give it with progesterone. Progesterone protects you from having that. So whatever age it is, and if I think of order of operations as far as safety, and even from 35 on what you do, progesterone almost always comes first for many women, because many women from 35 to 45 do really well with just progesterone. They don’t need any estrogen. There’s estrogen dominant, that’s what the ketchup, the Heinz ketchup thing is.

Speaker (37:39):

Yeah.

Dr. Jill Carnahan (37:40):

And then eventually as they hit the ovaries starts to tank, then they, we add the estrogen. And so someone older, I would start with progesterone estrogen alone, before I would add a lot of testosterone DHEA, because then you could, there’s, as you can tell, the variables are almost infinite in how with, yeah. So it’s much easier to, to assess with some small amounts of estrogen, progesterone first, see how they do in two or three months, and then if needed, add a little testosterone. Um, and see, and I would say more women above the age of 65 are on a very small dose of estrogen, progesterone without testosterone. But even they can benefit from small doses if appropriate.

Betty Rocker (38:17):

Fascinating. Wow. Well, you’ve given us a lot of really great information to think about, but I think that one thing that we have not talked about yet, that’s always been a part of our work together that I wanna make sure women hear about is what hormones are doing in our body and how they’re actually excreted. Because there is a really important aspect of our hormone balance that has to do with our gut health. Right. And would you speak on that a little bit, because I, I think this is something that you care a lot about and you’ve guided me really well on as well.

Dr. Jill Carnahan (38:51):

Thank you, um, Bree, because it is, so what happens is estrogen, progesterone, all these hormones in our body, they’re treated by our liver, just like a drug or a chemical. So we have to detoxify these. And often when women get into trouble, even with risk of breast cancer, endometrial cancer, any sort of hormone related issue, it’s not that their hormones are the bad guys, it’s that they’re not able to get rid of the excess. They accumulate certain metabolites that can damage DNA, and that leads to bad things. And interestingly, in our world that we live in, there are loads and loads of things that mimic estrogen. They’re called endocrine disruptors on our body. So a lot of times the, our bath and body products are makeup, um, things that since we use in our house, um, even atrazine that’s used on corn in the Midwest, and these chemicals act like hormetic or hormone effects on our body, and it’s very toxic.

(39:43)
So it’s almost worse the environment than the hormones we take, but we have to think about that. So if I’m really going deep or someone has a lot of concern, I may even go as far as to do genetic testing on their liver’s ability to handle hormones, because there’s a few different genetic, we call them snips, which just means things that you don’t process normally. Um, like say a normal person is a hundred percent processing, you may process it 60% or 30%. So sometimes I look at certain ways that you process hormones. And those people, I might do lower doses, I might monitor them more frequently. Um, and again, that might be the 10% of the population. So if you have a family history of cancer, especially hormone related, or you have a, you might wanna get into a deeper discussion with your doctor, but at the core, what you can do is this, you can make sure that you are using clean products on your hair, on your face, on your body.

(40:31)
Transdermal medications work for a reason because we absorb everything through our skin. And if we’re putting stuff on our skin, conventional perfumes or full of phthalates, um, or any non-organic produce often has, um, glyphosate residues or, or, uh, pesticide residues and all these things have a toxic effect. So I like to keep it simple. And if we just start with clean air, clean water, clean food to the best of our ability, that gives us a foundation for safe hormone replacement because we’re not getting a bunch of extra signals to our body from the food that we eat or the water that we drink.

Betty Rocker (41:05):

Yes. And even, even without hormone replacement therapy, if our gut is not working optimally, we are not gonna be able to process excess. So like we talked a little bit about estrogen dominance a little bit ago, and I know that one of the things that can make estrogen dominance worse, even as we’re losing that progesterone, maybe we’re in the early stages of perimenopause, is, uh, not being able to process the excess estrogen that we do have out of our body. Right. And we’ve, there’s this section of the gut microbiome called the estrobolome that helps to process the estrogen. And if it’s not working, if it’s not able to function well, it, it’s gonna send that back into our system as dirty estrogen. What does that mean exactly? And how does that, how does that impact us?

Dr. Jill Carnahan (41:51):

So this is really big and I’m so glad you brought it up, because what happens is, um, our liver’s always doing the detox work and it just squirts out stuff into the bile that’s supposed to be getting rid of, and that’s in our stool. So if you’re a woman who has chronic constipation, that alone puts you at higher risk of reabsorbing toxins from your environment or food. And even if you’re on hormones and you have chronic constipation, you’re gonna have more trouble eliminating the same dose as a woman without constipation. So the bowels and eliminating are so crucial to this whole pathway and to replacing hormones appropriately. So if we’re not, basically that, that enterohepatic circulation, which is a really fancy word for the…,

Betty Rocker (42:28):

Did you say entero? And say it again.

Dr. Jill Carnahan (42:30):

Enterohepatic. So it’s like gut hepatic.

Betty Rocker (42:34):

Got it. Gut liver.

Dr. Jill Carnahan (42:34):

Kinda like another way for gut liver circulation, that pathway all the time is being reabsorbed. And so if we have a bunch of toxins in our gut and we’re not pooping out daily, um, we’re gonna reabsorb toxins and we’re gonna reabsorb hormones and we can get excessive levels. Um, so it is a really big deal to, it is like fiber alone, getting good fiber from your foods, which you’re pro at that with your meal plans and all the things that you do because that’s,

Betty Rocker (42:58):

But I’m an advocate for it as well. Yeah. As well as walking, walking after a meal Yes. Or walking more in general, like mm-hmm. That helps peristalsis all these things that help the gut and help you have your regular movement. Yes. Yeah.

Dr. Jill Carnahan (43:08):

And that’s part of hormone replacement, because if you’re not moving your bowels, you are going to get more toxic. And these things that are helpful and beautiful could become a poison to your system.

Betty Rocker (43:17):

Yep. Yep. Exactly. So I, I’m so glad that you talked about that because it’s, aside from any type of hormone replacement therapy, our body has this elimination process naturally for the hormones that we already have in our system, our natural hormones. And so if we’re not eliminating well already, and we go pile hormones on top of that, like bioidentical hormones or whatever kind of hormone replacement therapy you’re using, and you’re not eliminating well, you just set it so well, we’re poisoning ourselves rather than helping ourselves. You’re, you’re turning something that’s this potion into a poison. Right, exactly. Which exactly we don’t want. Right. We want wanna take. Yeah. So, um, we talked about fiber, we talked about walking more. I think staying hydrated also. So essential for supporting gut function, chewing more mindfully, chewing more, slowing down when you eat to help your salivary glands and the amylase and all of the things that help digestive digestion begin in your mouth. What other like little hot tips do you have for people to help them with better gut health? I just said a few.

Dr. Jill Carnahan (44:19):

Love it. So I think a good probiotic, I like to do spores. Um, but there’s so many good ones out there. I just spores have tended to work with even my tough, uh, you know, difficult to treat clients with gut issues. Those tend to be really well tolerated. Um, one thing really interesting is there’s a lot of natural substances that can help us on these pathways, and you can talk to your doctor about these, but some that are real common are sulforaphanes, which come from broccoli sprouts mm-hmm . And sprouted, um, seeds and things. So that’s a great place. You can buy it as a cap, but you can also sprout your broccoli and have that on your salads. Um, Calcium D Glucarate is a type of, it helps this phase two of the liver, so processing that hormones and we can actually see markers in the stool if we’re doing specific testing for someone who isn’t processing well.

(45:02)
And we can add that calcium deg glucarate as a supplement to help them eliminate in this liver gut access. And then a third one is DIM, and this is also a really powerful one. Um, the one caveat with DIM is it’s so good at lowering estrogen, and if someone was like 65 and already having osteoporosis and already really low estrogens, that’s strong enough that I probably wouldn’t use it in that population, but I would, if it’s a 45-year-old woman on hormone replacement, having a tiny bit of breast tenderness, those are kind of the ways that you could use that sulforaphane, Calcium D Glucarate, and DIM. And then of course methylated B vitamins, just B vitamins are crucial for this process. Um, and things like NAC, which is really supportive for the liver as well.

Betty Rocker (45:46):

So, interesting as you’re saying all of those, I’m remembering all the protocols we did when you were helping me heal from, uh, mold exposure, which was terrible. And it, that happened right at the beginning of my perimenopause journey and a lot of those things that I needed, the liver support, all of that. It was just in, it’s just interesting thinking back on it now, you know, there’s that great Steve Jobs quote that was that “you can’t connect the dots looking forward, only looking backwards.” And now as I’m thinking back on all of the different things, oh yeah. How you treated me, I’m understanding the connections that we made there and the ways that you really were trying to help support all of those holistic processes and all of those things I used in the past that I don’t need specifically anymore mm-hmm .

(46:28)
And that, that really gets me back to this thing that women need access to specific, individualized healthcare that is this, that has this breadth, that has this depth that, that cares about these different aspects of our health and is knowledgeable in that sense. You know, and and I, I have been so lucky to have you in my life, and for people who, who don’t get to have you because you have a practice. You, you have, you have an amazing book. There’s a movie about you . You have, uh, an incredible website with this depth of information so that people can learn more and become advocates for themselves with their own doctors. You have a supplement store where people can purchase a lot of these types of supplements for themselves. And I just, I feel like you have a lot of amazing resources. And is there anything I left out of that because, well, your social media, what else did I forget to say? Your

Dr. Jill Carnahan (47:28):

YouTube podcast guest, but yeah, that’s it.

Betty Rocker (47:30):

Your podcast, right? Your incredible podcast, which I’ve been honored to be a guest on myself.

(47:34)
Um, but where I was going partly with that, aside from saying, okay, ladies, we all need these resources and here’s some of what you can get from Dr. Jill. Um, and Dr. Jill and I were talking before this podcast started about, well, where else can women go? Yes. And I was saying, I’ve been researching these different companies that do that practice telehealth, and I’m gonna read a few and I’ll of course have all these linked in the show notes. And, um, I remember I ran them by you earlier, Dr. Jill. ’cause I just wanna make sure that this was a good, that I wasn’t going. You know, I, I thought they were great. But it’s good to hear your vote of confidence in these as well, because this is I think the future of that type of medicine. And, and for women specifically? Yes.

(48:15)
So here are a couple that I found. One is called Midi and I love midi. It’s like M-I-D-I and it’s, it’s a female founded company. It’s all these cool women doctors and it’s telehealth company. There’s telehealth options, right? And then they also will prescribe hormone replacement therapy or whatever you’re comfortable with and whatever you need. And I just watched a couple videos from one of the co-founders and was just so impressed. She reminded me of you. She was so cool and down to earth and like she, it was all very personal for her ’cause she’s gone through the journey herself. So I love Midi. Another one that I found, obviously you’ve probably heard of Winona. I think Winona’s been around for a little while and they’re great. They also have the telehealth options. Um, another one I found that’s down in Tampa, but they do, uh, telehealth and, and do quite a lot of cool prescribing is defy, like they’re called Defy, which I like.

Dr. Jill Carnahan (49:04):

Love

Speaker (49:04):

It. Def. I love it.

Betty Rocker (49:06):

Yeah. Defy. And then there’s one called Stella And Stella I thought was really cool. They’re also, they also have telehealth options. They have the hormone replacement therapy options. They are, um, they have a website for US based patients as well as UK based patients. Oh, nice. So you can, you can use one or the other depending. I know a lot of you guys are in the UK that, that listen to my podcast. Thank you so much. Um, and then I also, I was thinking about my, my people in Australia. Um, there’s something called Clinic 66, and if, if you’re, if you’re looking for options for yourself in your country, I think just using some of these keywords that Dr. Jill and I were talking about today on this podcast, like, look for things like telehealth, options for hormone support in menopause. I feel like I did that myself at different times and I’ve, and and I put it into different countries to see like, where are they doing this stuff? And then you just read what’s on the website and then you just kind of have to follow the threads and see where, where, where it’s gonna work for you. And I’ve noticed the US based ones, some of them have limitations by state Yeah. That they’re gonna treat. And do you know much about that or like, you know, I know you’re not gonna know what each person gonna do, but what are some of the limitations that you do know of in

Dr. Jill Carnahan (50:15):

State? Yes. Um, medical doctors are still licensed by state. So you really, um, typically are, unless someone comes to see me in Colorado, I am, I have to be more careful about who I treat outside of the state. So that’s a whole deal. One of the things that might be super helpful is if you have a compounding pharmacy in your area, that’s a great place to call because they know what physicians in your area are prescribing hormones. And usually the compounding pharmacies also know who really know, because they’re gonna be, like, for me, they know I prescribe a lot of hormones. I talk to the pharmacies all the time. And so a great way is if you know there’s a compounding pharmacy in your area, you call ’em and say, Hey, what doctors do you know in my area that are doing this? And that’s another nice way to get in your area. Someone who is legit and your compounding pharmacy will typically know who that might be.

Betty Rocker (50:56):

And in order to find a compounding pharmacy, would you just Google compounding pharmacy in my area?

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There is P-C-C-A used to be the biggest, um, organization that, uh, certified K, so PCCA, I don’t know exactly what it’s something “Coumpounding Pharmacies of America”. But, um, if it’s just pcca.org, I guess, I don’t know the exact site you should be able to find, uh, company pharmacies. But yeah, you can also just Google compounding pharmacy in my area.

Betty Rocker (51:21):

That’s great. And I, I think, I mean, and there are many more than the ones that I just, that short list I gave you guys. I, I’ve, I’ve, I love all, I love all these options that are out there for us. And I feel like it’s, it’s, it’s gonna get better. It’s, there’s gonna be more and more of them hopefully over time, but really just having this conversation, asking for what you need, advocating for yourself. I, you and I had a conversation, um, a month or two ago and we were talking about how you said today, like some doctors you feel like they gaslight their patients and it it’s because they don’t know. Right? They don’t have a clue. Right. And I said on a podcast where we were talking about this, I was like, I feel like the doctors don’t mean to be jerks about this stuff. They just don’t know. And if they knew, they would maybe try to get more information, right? Because they all

Dr. Jill Carnahan (52:07):

Have, you think about like, even me, if I graduated from med school and I’m told that this is dangerous and that I never look and never learn, which a lot of docs stop learning after, right? Then why wouldn’t I say, oh, nope, don’t do it. That’s what I heard 2001, which is old news now. Right? So that’s a lot of them just don’t know the latest data and the safety.

Betty Rocker (52:22):

If we were to expect science to be this static thing, and we can only take whatever’s been said before, I mean, we’d never have any women specific,

(52:29)
Right? Like we’d have nothing we, that we have to allow science to be this evolving like, learning process. That’s what science is. You know, they’re, they’re observing data and they’re reporting on it, and over time they get better and better at their methods, hopefully. And yeah, I mean, just seeing them, just seeing, not them, but seeing the more specific studies done on women specifically. I mean, it’s like a revelation. You’re like, well why didn’t we do that before? I know , it’s about time , right? Don’t y’all have a mom? Like, don’t you have a sister? Don’t. Yeah. So it’s just, it’s great to see that and I’m glad we’re having these conversations. But Dr. Jill, I just wanna thank you again so much for taking the time to talk about all of this today. We covered so much in a short time. And is there anything that I didn’t say or didn’t ask you that you’d wanna make sure to get across just in case?

Dr. Jill Carnahan (53:17):

No, just thank you for the wonderful work you do in the world and uh, thank you for having me on. It is always so much fun. It’s like having coffee with a friend and if you’re out there and you’re suffering for hormones, you don’t have to. And there are just, I love the resources you gave. There are so many people who do understand this. Um, and uh, I would just continue to search until you find those answers.

Betty Rocker (53:36):

I would agree. I would agree with that. Yes. And thank you so much for your work. And I’ll have links in the show notes of course. And with this video so you guys can follow up with Dr. Jill and get all of her incredible resources. She has so many, you’ve done so much work for women and so much work for your patients in general, men and women. Um, thank you again so much for being here and we look forward to talking to you again. Thanks you, thanks so much. And hey Rockstar, thanks so much for listening today. It’s been great to spend time with you. I hope you learned something that’s helpful and I’ll have all those links to the things that we mentioned, as well as a couple of books and resources Dr. Jill shared with me that we didn’t get a chance to talk about on the show. Be sure to check out the show notes page for this episode over on my blog at thebettyrocker.com in the podcast section for all of those links. And I hope that wherever this finds you, you are taking great care of yourself. Till next time, I’m Betty Rocker and you are so awesome, flawsome and amazing. Bye for now.