Considering HRT? A Natural, Informed & Safe Approach with Dr. Nasha Winters

On this episode of the Resetter podcast, I bring you Dr. Nisha Winters. Now, Nisha's been here before. She was actually probably either the number, the first guest or the second guest I ever had on the Resetter podcast because she wrote an incredible book that everybody should have in their health book library. And it's called The Metabolic Approach to Cancer. And she was one of the very first doctors that were, was out there saying, hey, in order to clean up cancer, you need to clean up your metabolic health. Now, over the years, I have brought her back over and over again to offer us a different look at some of the more traditional diagnoses that we have in healthcare, the prognoses that we give women specifically. And today I have brought her back to really talk about hormone replacement therapy. What do we need to think this about with this? What do we need to, to dive into a little deeper? Are we missing parts of the conversation? Now the thing to know about Dr. Nisha is that she is an integrative oncology expert. So her background is as a natural path. And as you'll hear in this discussion, she not only had ovarian cancer at 20 herself, but she created a whole practice around helping women with hormonal imbalances. So in my opinion, that makes her a great person to talk about, what do we need to know about hormone replacement therapy through the lens of who should do it and who shouldn't do it. So in this conversation, I'm hoping you will hear that there are some steps before we take hormone replacement therapy that we might want to entertain. So she talks a lot about genetic testing. She talked about some functional health testing. Don't, don't, don't get lost at that part of the conversation because we will have at the end of, once you listen all the way through in the notes, I have asked her to create a list of these tests for us. So you can take them to your doctor. She also trains doctors. So you can find one of her trained doctors, but she will ramble off a bunch of tests. Don't get lost. Hang there with me. This is important stuff that we need to be talking about. So I've asked her to give you all a list of it. So that's in the show notes. The second thing we talk about is what aspects of life, our lifestyle throw our hormones off. And if this part of our lifestyle is not cleaned up, then can it make hormone replacement therapy dangerous? So a lot of you are still unsure. A lot of your doctors are still unsure. So this is going to be a really important part of the conversation. We talk about emotional trauma. We talk about environmental toxicity. We talk about diet and how all of that can actually play into whether you will be successful with hormone replacement therapy or not. So that's the second part of the conversation. And then the last part of the conversation and what really is near and dear to my heart is that how do we redefine menopause as a transformational moment for women? And what is it that holds us back from transforming into the best version, the most authentic version, the happiest version, the healthiest version of ourselves? Because as you follow me more and listen to me more, I think you will hear that I am such a believer that this process is working for us, not against us. But we need to know our health state when we go into the perimenopausal journey. We need to know certain factors before we jump on HRT. And Dr. Nisha is here to educate us all. So as always, I hope this helps. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Okay. Well, Dr. Nisha Winters, welcome back to the Resetter podcast. I'm super excited to have this conversation with you. So much fun. I'm very, very excited to be here today. So things are happening back. So here's where I want to start this conversation. My audience knows how much I like to teach them to think for themselves. And you know, we're going to have a conversation about hormone replacement and where it may not be appropriate because right now the zeitgeist is telling every woman on the planet to get on to hormone replacement therapy. And there are some, some dangers still that need to be addressed. So we're going to talk about that. But I think before we do that, one thing we've never done with you and really would be a good preface to this conversation is talk a little bit about your clinical experience and what you saw in practice. Because I think that ties so well into where you're coming from when we look at bioidenticals. I first, I so appreciate that because I'm such a context is everything and what most of us see in the social media world is just a little clip, which is just enough to create a hook, which is just enough to create some polarity, which is just enough to just piss off a lot of people and really get us to know where in dialogue. And so I'm hoping that people will get curious and want to lean into the whole conversation and not just some little clip around this. But my experience with hormones actually started with myself and I should start with that. I was nine years old when I started menstruating, terrorizing and traumatizing the entire third grade. Nine. Right. Nine. Just stop for there. Nine is early, right? Yes, it is. Can we just point that out? Okay. And especially back in 1980. Right. So, right. Not normal and not common, still not normal, unfortunately more common. And so that, you know, a lot has changed in the last 30, 40, 50 years. But for me back then, it was definitely traumatizing. Thank God for Mrs. Richardson, my third grade teacher who helped me put on one of those pads that you could probably float down the Nile on and like a belt around it and show me how to do it. And just the terror of that and the young girls in my class, I learned later they actually had a whole like extra class just to help detop traumatize all of the other girls. I didn't know that until last year at a medical conference where I ran into one of my classmates from third grade that I had not seen since then because I moved away shortly thereafter. And I sort of wondered if I just was making up those stories in my own head and she's the one who, she's now actually a doctor, a medical doctor who still talks about and still keeps in touch with some of those people from that class that were still traumatized by that. So, just a funny little. Wait, they were traumatized by you getting your period? Because at nine years old, no one was getting a period. Nobody. Right? And nobody knew what to do with that information. By the time I was 11, I was put on birth control pills for my endometriosis and my polycystic ovarian syndrome. Right? And then that was they were increased in dosage and potency over the next several years because I had so much symptoms around extreme pain and growth of endometrial tissue everywhere. I mean, everyone's like, what the hell is this lady talking about right now? It's a hot mess. But no one treated it like it was a problem. It was completely normalized because there was just a quick script and a pill for that. And I can still remember my mom as I'm third grade, my mom has this moment with me where she's like, this is what's happening. Gives me a mirror. Oh, no. All my stuff shows me the drunk and the drunk. Oh, but that's good. I know. But that's good. My mom is kind of a badass. She was definitely ahead in those, in those places. And so it was very helpful for me to understand or to understand my body, even though it was still being highly medicalized at that time. So fast forward. Many people know my story as well. By the time I was 19, I'm just shy of my 20th birthday. I was also diagnosed with terminal ovarian cancer. So these stories that we've all been told and still are being told that birth control protects you from ovarian cancer, maybe not everybody. Let's just start with that. And that it was still. It was still two years beyond that diagnosis before anybody. It occurred to anybody. I should probably stop them. So that's where I had my own experience to go. Someone was going off my hormones. No one's asking questions. They just layer caked everything else and normalized everything. And so I didn't even know these were issues, right? It would take me into medical school into the mid 90s to start to learn maybe there was a different way. So let's put that one on. Yeah. Go ahead. My own toxicity curiosity is do you feel like there was an endocrine disruptor that caused you to have an early cycle that led to an early, what would I would consider an early ovarian cancer diagnosis? Not that we should ever get one, but that seems correlated to me. Yeah. Well, there's a few things. Now hindsight's 2020, right? So I would still and continue to 34 years later of my cancer diagnosis. But all those years later, I started learning things that, oh, look, we lived on in or around four superfund sites, lots of military bases around us in Wichita, Kansas. At the time I was in third grade in Evergreen, Colorado, my stuff was more likely exposure from when I was growing up in Kansas before I was there for a couple of years. I was only in Colorado for a few years at that time. The other piece that was no one was asking questions about was the, and this, maybe we're hitting this really heavy coming right out of the rands here, but sexual abuse is happening in my household and in my family of origin that was completely, even I can still remember Mrs. Richardson asking me questions and no one in my family of origin wanted to address them. It would actually be a taboo topic with my mother up until just a few years ago. We couldn't really talk about what was going on. Don't, I mean, it's who I am today, but it's like those were things that were changing my hormones. It would probably have been helpful for the doctors to have asked those questions when I was diagnosed with cervical dysplasia at 14 and again at 16. Nobody knew about HPV or those things at that time. So this, I'm just planting those seeds that there were contributing factors that were on the psychological, that were on the toxological, but also we were very poor. We lived on very processed food, very, you know, kind of latchkey kid type of stuff that it was very processed, highly ultra processed foods, lots and lots of sugar. I did not like meat as a kid. I only wanted veggies and by 16, I made myself a vegetarian, but it really wasn't. It was a carbitarian with like, yeah, yeah, I was one of those. Yeah, I was one of those in my, in my early 20s. That was a carbitarian. Right. And being a carbitarian, what that did was that it would take years before I understood that I have certain single nucleotide polymorphisms that mean that I needed an animal protein to get certain cofactors to help me methylate and detoxify. I also learned years later that I'm missing major SNPs, single nucleotide polymorphisms of glutathione. So my body doesn't know how to take out the garbage. So all the things I was being exposed to. And then because of my diagnosis, I was one of the early tests done on the BRCA mutation and learned I had BRCA mutation as well, not until 1996. And so now you look, and I guess the point of telling the story is there's never one reason, right? No, I was just, yes. And I was going to say, what a perfect storm in the wrong direction, like, wow. Beyond. Right. And then when you look at my SNPs, every single sort of bastardized process in how we metabolize our hormones, I have lots of those. So triple homozygous, Comt, SNPs, mutations in my CYP1B1, my mutations in CYP1A1, several other SNPs in SHBG. So no wonder I had polycystic ovary. Just all the patterns, I had the storm to not be able to even metabolize my own hormones well, but any exogenous disruptors. I also grew up in farmland in Kansas at the time when they started to spray more systemically. So likely endocrine disruptors from the pesticides and glyphosate, eating a very highly processed diet loaded with those things would still be years for I learned I had Celiac disease. Like all the layers. So I say that because this is also part of our discussion today is there's not ever one cause or one treatment and there's not one size fits all in how we look at this or discuss this. But for me, I had an end of one experience that said probably some problems with hormones. My mom also, as she had a hysterectomy at 20, right after I was born shortly after my brother was born, actually, later to find out like ovarian cancer, like process, PCOS, endometriosis, as well. She also got toxic shock syndrome. That's what led to her hysterectomy. But when they put her on at 27 back in that day, they put her on it on HRT because they did a medical surgical menopause for her. She was 27. I would wish it. And this would have been, let's see, I mean, I was, I would let's see, she was 24 when I was born. So she's 78 now. So just think about the timeframe. She ended up with a stroke. She ended up with blood clots and a stroke and blood clots in both lungs in the hospital. And we would learn that we had the Leiden 5 factor and other things that the doctor told my mom at that moment, never, ever again, do you do birth control pills or anything else? He did also tell her that I should probably be screened for similar things. You know, that we'd all learn later. How would people know? Like I just want to like say people listening to this who maybe don't know what SNPs are or what these genes are. The way my brain translates what you're saying is we had, you were marinated in a toxic culture environment, a physical, a physical, emotional, chemical, toxic environment that matched to your genetic profile. And those two came together to create cancerous situations. Exactly. I think is important because where we're going to go with this conversation is how do we know when hormone replacement therapy is right for us and not. And we do need to point out that some bodies, some human bodies have these genetic SNPs. They have these situations. They have this toxic overload, but we do not, you don't know going into HRT. Was there any sign through all of that that you knew? Like could you now look back and be like, oh gosh, I mean, we know early period is not great, but you know, acne or big time mental and stuff. So we're, and then can we use that as a litmus for women to know, wait, I also had that in my younger years. Maybe I need to ask more questions when it comes to hormone replacement. Absolutely. And that's just it. And I think that's why I like PCOS and in vitreous is already elicit red flag. In fact, both of those are precursors to both breast and ovarian cancer. No one's asking those questions. There's a disc, there's a problem with how the body is metabolizing their hormones. The cystic acne that went with that PCOS, well, no one questioned that. They just put me on antibiotics and on a round of Accutane and all the things that also very known carcinogen, very known, Iatrogen, you know, that's known to actually cause like damage damage to your eggs, right? Which then means damage to your offspring. And so these are the crazy things that we didn't know, we didn't know until we knew. And what's so weird to me is we actually have a lot of data that we know. And yet it's almost like we're rewriting history or rewriting our internal data systems despite the fact that we actually have a lot of signs and symptoms as well as a lot of labs and a lot of single nucleotide polymorphism tests and a lot of hormone metabolite tests to know what's working and not working for you. And maybe there's different ways to change that expression that's not causing you harm that may not be just quickly, blankly reach for a script pad and call it good. Right. Yeah. So I just want to, like I'm making a little check box here for people. So and those nucleotide tests are not my specialty. So is that something that every woman could do before hormone replacement? And maybe every teenager before birth control? Like are there a set of tests that we might want to do before we go into what, what Naysha and I are talking about is exogenous hormones and exogenous, meaning they're from the outside. And every time they're from the outside, you, you can change that internal environment sometimes for the negative. So what are those tests that you would think we would need to do if you could get every OB, every doctor to do it? What would those tests be? Well, I would love to see every baby being born to have their mouth swabbed, but everyone gets all freaked out about their DNA being, you know, order, you know, collected. I don't, I look at it as data. Like your single nucleotide polymorphisms are not set in stone. So just because you're born with that blueprint doesn't mean that's how it's going to play out. You, your diet and your lifestyle choices are what helps it play out. And so an example of this is that Brocka mutation we just talked about. Everyone looks at that and thinks that's the cancer gene. No, it's a methylation gene. It's a DNA repair gene. And if it's not working well, you can do things to make it work better. You can. And methylation. Yeah. And just to be clear, I always tell people methylation is like your, your cells ability to detox. Yes. So if you have MTHFR or we see some of these snips and like you, the Brocka gene, you want to go and try to figure out how to get your body to detox, especially if you're going to put in these synthetic hormones. Exactly. Exactly. And so we really could get that information right from the get go and say your, you have got some work to do to make sure your endogenous, your inside hormones are doing their job properly so that you never need to consider the outside possibilities. So that would be step one. Wouldn't that have been cool had I started with that role as a kid versus the way it would have been. But then also I think we're thinking birth control too. Yeah. You know, and I can tell you as the mom of a teenager, well, she's not a teenager anymore, but who did I wrestle with the birth control decision? And it was really a tough one because it was like, okay, do I want to risk her getting pregnant or do I want to put this toxic whatever in her? And so if there had been like a genetic thing that was like, here, test these things and you'll know if it fits for you, that would have been really, really nice. Yeah. And it's, you know, there's certain, like there's certain folks like people with Leiden five syndrome, which is a blood clotting disorder should not take exogenous hormones, you have a much higher risk of, of, you know, of clotting of a like throwing a blood clot. And so I mean, I have a story of a young woman by the name of Erica Langhart, her story made international news was I babysat her as a little girl and later she was under my care as a patient and she was so like wanting the easy pill of take the pill for PCOS and yet lived, you know, grown up, woman made her own choices. And when her parents were called to come out on Thanksgiving day to Washington, DC, where she was working as, you know, working as a lobbyist, like working in the in the political system, like her lifelong dream, her parents had to go out and unplug her life support on Thanksgiving day. And they ended up winning a hundred million dollar settlement from Merck and they refused it because they said, we don't want your effing money. We want you to change this. This Erica died from the Nuva ring. And there are thousands and thousands of young women who've died from this. And yet had they done some simple testing? In fact, women with polycystic ovarian syndrome already have problems with their clotting cascade. And so they aren't good candidates. And what's the first thing we do for PCOS as we put those women on birth control, whether it's through the nuva ring, whether it's right. Yeah. Yeah. To manage their symptoms. And that's what was crazy is while she was still in high school and living at home, her symptoms were perfection. But when she moved off out of the home was in DC, working late nights, drinking, eating differently, you know, to do the job that she was passionate about, you know, she got away from the diet and the lifestyle and the environment that she needed to take care of her body. And so when her symptoms started flaring, she defaulted to the script pad. She stopped asking the questions of the why. And it devastated an entire family. Her mother would take her life a few years after her, after that lawsuit and her father just died this past Christmas on, no, uncompletely unknown, just quietly. And it's affected all of us, the people who grew up in our small town around them, the massive news that it made. And it's like, they wanted to leave a legacy to say never again to anybody else's daughter or sister or, you know, best friend. And yet in our culture, we're so quick to write these scripts that I'm, I'm a little taken back by how when I started in medical school and naturopathic school, mind you, we were some of the early adopters being taught bio identical hormones. The standard of care world was absolutely no. You people are crazy. You're quacks. And we were all learning it, being trained, being, you know, courted by the compounding pharmacies, the big, big, big name ones that are out there. And we all learned it. But in my training in naturopathic school in the early nineties, we were still coming from what I call like the OG naturopathy, where we were still being taught to reign forward first. And to ask the questions of, do we need this to replace a function or should we look under deeper to restore a function? And my ethos, my philosophy, my training and my mentorships all taught me about restoration of function. It also happened when I went into private practice, I was in an unlicensed state of Colorado at that time in a small town under the scrutiny of my local medical community, there was no way I was ever going to write a script for anything or anything, even though I had the legal right to do so. And so as such, I had to learn how to restore function and not replace it. And in the 17 years I had my private practice, 80% of that practice being women and 80% of those women coming into me for some sort of hormonal or endocrine dysfunction at the root of their concerns. I didn't have the luxury of a script pad. And what was the best gift for me is I learned how to restore the function and correct those imbalances without the need for exogenous support and got women pregnant, got women's endometriosis, a PCOS under control, got women through, you know, menopause beautifully, their osteoporosis or osteopenia, their heart issues, their brain fog, their libido problems, their vaginal dryness, their UTIs. I didn't have to use the script pad for that. So, okay, now you've got me thinking about something. I just, and that I hadn't even really wrapped my head around, which is when we go into those perimenopausal years, when you say restore function, you're saying bring back age appropriate hormones. So a 48 year old has a different hormonal profile than a 38 year old. Absolutely. And so every woman coming into those perimenopausal years, we tend to be like, oh, you're low in these hormones, you need a patch. But what I hear you saying is, well, let's restore normal function first and see what's there. And if you restore normal function first, like what your normal body can, your body can normally make estrogen, your body can normally make progesterone, even at 48, it can do that. And then let's see if those symptoms go away, as opposed to just assuming menopause is the problem and let's put a patch on it. What you're saying is let's restore normal function, age appropriate function, and then let's look what's there. Which one more thought, because now my mind is completely blown because I'm thinking so hot flashes, irritability, trouble sleeping, we have normalized these as menopause symptoms. But if we do your restore function idea, maybe we're not supposed to have those symptoms. Maybe if we just restore normal function, because we're not talking about restoring normal ovary function, we're saying backfill in with what needs to be backfilled in, and then let's see if those symptoms are there. Am I thinking this through right? You're thinking it through perfectly, because I think that's it is what we've done today is we've medicalized something that's never been medicalized. We didn't even have a word for menopause until 1821. Oh, wow. Right? Menopause from Greek, pause, stop, you know, like that hot concept here and that even as far back as the, you know, a couple hundred years BC, we would talk about just this natural pause for women. And it was not medicalized. It should be. Exactly. And we should be pausing. Exactly. Here's what's weird to me. Mindy, what I was learning in, I've never really gone down the rabbit hole of the historical global, you know, story of menopause. I had no idea. I'm looking forward to this. It's probably going to be in your book. The average age of women going into menopause up until just about 150 years ago was between the age of 40 and 45. Okay. Wait, but I know, but isn't that, but we're living. Okay. Wait, explain that one to me because the average is 52 right now. Today it's 52. And so I had, I would, it caught me off guard. It made me do a little bit of mental gymnastics. And the difference since the 18, since 1826 is when we started to see a shift in that mid, you know, early to mid 1800s. Well, what also shifted in that time was the industrial food revolution. Industrialization, the industrial complex began. This was also leading into, you know, civil wars later to be world wars, you know, different kinds of stressors of modern times. We started getting access to things we normally didn't have access to. We started having a lot of metalloestrogens being dumped into our environment via coal burning plants, which dumped an enormous amount of mercury and mercury is a well known metalloestrogen. So I started thinking about this, like really we started shifting our neuro endocrine systems with the post industrial revolution movement, which means we started being exposed to hormones, endogenously and exogenously, or things that were impacting our hormones exogenously in modern times that we'd never been exposed to before. Right. Yeah. And so now basically we have more hormone. Like today we swim in a hormonal soup of exogenous, you know, from plastics to the pesticides to, you know, all the things that we have now never been exposed to in human history until the last 150 years or so. And even more so, like what plastics didn't even come around to the 1960s. So suddenly you're like, we're extending and we've seen in the literature for hundreds of years at many medical texts that the longer women are exposed to hormones or highest higher their risk of cancer. That's why we were all taught that medical school, you know, the generations before me were all taught that medical school. And now we're seeing that women are menstruating later and later in just a shorter, you know, short window of time. And so I thought that's really interesting. And so to your point of normalization, I'm not sure if it's been normal in the past 100, 150 years because of how quickly we've been exposed exactly to new things and our bodies are struggling to adapt. So the issue is that some of us adapt much better than others. Right. And that's where like the snips in the diet and the lifestyle choices come into play is how well do you adapt or not adapt? And how, how might you evaluate for that? And how might you approach it with that information? Have you seen women under your care when you were in clinical practice that if they went in at 40 and they changed their diet and they did the herbs you recommended and lifestyle changes that you recommended, did you see them go through menopause with very few symptoms? Well, it's crazy because a few things. When I would start to teach women well before they got to perimenopause and what I used to teach at a women's health course up at the college. So I had like 20 somethings, you know, teens and 20 something young women in my class. Thank you, Dr. Marcy Young. If you're listening to this later, she would allow me to come up and speak in that class. A lot of those young women, by the way, have gone off to become nature paths and other medical practitioners, which was really cool. But I've explained to them is that how your periods are, your experience of your periods and your fertility years is a is a is a magic crystal ball of what your menopause will be like. Oh, oh, that's so if you had issues in those little windows, you got some shit to clean up before you get to the bridge. Right. Yeah. And so that is we start to get clues. The moment we start to express our cycles, the moment monarchy starts, the moment our fertility years start, we start to get clues of how bumpy is this ride and how bumpy is it going to be? And so the women who tell me, oh, never had PMS, you know, got pregnant without even thinking about it. No problem with labor and delivery and lactation. No, you know, all the things, you know, didn't have like a flare of Hashimoto's after my babies were born. Everything was good. They're like, I never had to work with them through the perimenopause menopause window. Like it was like a nothing burger. Right. Yeah. But those, if I was lucky enough to see someone who had a history of some bumpy roads, like boy, howdy, that's what was good for me. I knew because while I was still in private practice, I was still menstruating. All right. And so I knew like by the time I was in my mid twenties from the things I'd learned, I no longer had PCOS or endometriosis. I had corrected that and cycled like a mofo 28 day, like just like clockwork, right? Until the last two or three years where it was a little bumpy, but that bumpy, I knew what was contributing to it. But it was so smooth compared to all my other friends who didn't pay attention to who it was really bumpy for me. If you're my, my menopause, you know, my menarche years, my menstruating years, my fertility years, but to your point, when women would come to me at the bumpy start of perimenopause and we just started to look under the hood and correct those imbalances, it was smooth sailing. Right. And we would do the testing of all the things that everyone says you have to get on HRT to correct, like the cardiovascular issues, the dementia, the bone health, all those things. I, I've never seen those issues in my practice. They just didn't, they would come in with them in some situations, but we'd correct them. We would reverse osteopenia and osteoporosis, not with hormones. Ever. Right. It's funny. Yeah. Yeah. Go ahead. It's, it's interesting because I, you know, look to my big sister, I look to my, I have a lot of my friends that are five and 10 years older than me. And when I, when things started getting bumpy for me in my late forties, I went to all of them and I, and none of them were on hormone replacement. Most of them were like, it was a no brainer. It was easy. And, and I kept trying to figure out what my outlier was. What was it that was making it difficult for me? And I will tell you that I have finally decided after taking a year of just by myself and resting and really rehabbing my parasympathetic nervous system, that it was my stress. That was the outliner that the other women did not have that my stress load, my, I was on planes, I was writing books, I was career in this career driven path. And this year, taking six months to be by myself, be at the beach, write this book, slow my life down, rehab my parasympathetic. I feel like my hormones all of a sudden balanced. And it has left me wondering if stress is the outlier. Is that the thing that sends all the symptoms into this accelerated place? Well, I mean, for my own issues, when I was noticing in those last bump years, it was precisely that. And maybe what, how I learned about you and fell in love with you was in reading your before it got like republished as menopause reset. Like your, your OG like pretty much like written on the back of a napkin book. It's totally that. And it's, you know, I said the other day to my husband, I'm like, this book actually could stand the test of time in the culture. Cause it's so simple. Here are the five things you do. And I did those. The one that I struggled with was the rushing woman and it's number five. And that was the one I couldn't figure out how to unwind myself. So, but yeah, you're absolutely right. Well, and it's funny because I have had a lot of people come to me and say, well, you read my book and endorse my book and, you know, I'll get into a few chapters and like, this is really good. And then I get to the chapter like, and then you just write a script pad and replace it all. And I'm like, close the book, put it into a burn pile and move on, which because it bums me out because I was waiting for you. Right. I guess is what I have to say. So when your book came out and I started like shouting this from the rooftops before I ever even met you and them to meet you and then I'd get to know you further, I would say that I have had this mantra my entire practice. So from, and or a concern, remember early on, I'm perhaps like, well, you don't understand because you're pre, you know, you're way out. I was in my, you know, 30s when I started practicing. And so I would have that except for when they started improving. And then they're like, kid knows something, right? But those were, I talked about the three S's all the time, sugar, stress and sex. And specifically, and to when I read your book, I was like, this is freaky. Sugar being insulin. Yeah, will never correct women's hormones if insulin is not brought under control. Period. Bingo. Bingo. But I, on that, I just want to say, do you know the thousands of comments we've gotten from fast, like a girl of women, of women that were like, my hormones balance, my hormones balance. Just by following the fasting cycle, like thousands. Exactly. And it's so because you can't separate out those three S's. And so the next one's stress. There's the cortisol. Guess what? When cortisol is high, insulin is high. Yeah. So even if you nail your diet, but you don't nail your stress response, you're going to still be in that dance. And then when I say hormones, everyone thinks I'm going to say, oh, you need progesterone or testosterone or something. No, folks, that's oxytocin. And so we all need all of us. Oxytocin can help us all. It sure can. And guess what? When oxytocin, so as much as he is controversial, you know, the winner from Mars, he actually says, throw that book away. But, but he, Dr. You know, Dr. Gray says, read the women on, or what Mars on ice and Venus on fire book, because he actually does get the physiology correct in our book. And he speaks to the fact that when in women, think about this now, we're telling all women that your lack of libido is simply a lack of testosterone. So we put all these women on testosterone in women in our physiology. When testosterone is high, oxytocin is low. Oh, in women, in women, actually in men to some degree, but not to the level it is in women. And so when we're in the armpit, like drive, like you said, rushing woman syndrome, we tend to be in like our dominance of, you know, all the things. Oxytocin's out the window. It's interesting. I'd be, I'm like a human guinea pig. If I learn anything, I'm like, let me try it on myself. Always. So I've played, I've played with the exogenous hormones and I played with testosterone. I had to get off of it because the rage that came out of me, I was like, so there was no oxytocin. There was just anger and I might have had the wrong dosage and things like that. But, but that maps to what you're saying right there. I just want to. And that was just that moment to realize, like, gosh, in the rushing woman syndrome, we're not kumbayaing with our sisters often, right? But how many times when you see, like just most of us women can look around and like think about what it's like when you go with your girlfriends away for a weekend or you go have dinner with a girl. Like just those moments when we get together. It's so nurturing. So healing. And the funniest thing is I will ask it like I can remember, like we used to joke in my little town. So if any of my girlfriends from this town are listening, we would laugh that our husbands were ultimately going to get laid every time we had a girl's night out. Oh, yeah. Oh, we did the same thing. Right. That's like a thing. Yeah. It's a given. So the guys are like, yes, go. Yes. Absolutely. Because first of all, yes, it was a strategy. It was it was definitely a strategy. Yeah. Right. It's a discharge of your frustrations and resentments and the relationship. It's the solid, you know, the women's circle, but the oxytocin coming up makes you want to connect. And so one thing is you and I talked about that we're so rushing, like one of the biggest complaints I had in my practice was not women like weirdly, not many women were worried about their cardiovascular health and whatnot, because we could see that easily in labs and their, you know, their other imaging and testing, but the big one was around libido. And so everyone's quick to be like, oh, you know, you're no longer a sexual sensual diva when you move into the perimenopause menopausal window. And I'm like, I don't know who you're hanging out with, but it's opposite in my circle. Like that's actually where women are fine stepping into their, their power in that place. But that's where my first question was not about are you hormone deficient? It's like, where are you frustrated in your relationships? Yeah. Yeah. You know, it's, it's so interesting you say that because last July, I went into a real depression and like the whole month and I was like, and I was burnt out. I was just completely exhausted, but I also was in this transformative place where I was starting to say what works for me and what doesn't work for me in my life. My kids are, you know, 23 and 26. Like, you know, I have a lot more at my, I don't have my clinical practice anymore. Like I had a lot more time. And one of the things that I realized is that I am depressed every time I am doing something I don't want to be doing every time I say yes, when I mean to say no. And the reason it was leading to depression is cause it was making me resentful. And so I started to think, well, gosh, we could look at low estrogen and say yes, estrogen stimulates dopamine and serotonin. But maybe just maybe you're supposed to have estrogen go down so you could sort of wipe the crud off your glasses and you could look at your life and you could become this sensor of like, ooh, I don't like this part of my life. Let me come over here and clean this up. I don't know about this part of my life. I think I need to let go of this part. Like the depression that happens could be a catalyst for a new you that wants to emerge. And if we're medicating all of that and you miss the depression, you might miss the moment to let go of something that you no longer can hold onto in your life. And that is, I don't think people want to hear that, but that's what I really think of that moment. Well, I mean, I got chills because I think when, you know, those are big truth, truth chills, truth bumps on that level. But, you know, that's what would happen in these conversations I would have with women in my practice. It ended up being almost like a counseling session. It ended up being more about that versus what supplements do you need or dietary lifestyle changes need to happen here. It was more of like, you know, do we need to, is there, is there something you're not asking for in your life? Is there something you're not voicing? Do you need a husbandectomy or a spouseectomy or a partnerectomy? Do you need a jobectomy? Like, are there things that say I need a purpose? A lot of women need purposes. Yeah. You know, I don't know. This sounds so esoteric and woo-woo, but it's, there's something to it. All right. Which is this idea that there's this concept of Saturn return. You heard about this. Yeah, yeah. I mean, Western astrology, even in Chinese medicine and Ayurveda, they use astrology in part of their medical diagnoses and medical pattern recognition. So you learn Jotish with Ayurveda. You learn Eastern astrology with Chinese medicine. And it's not like telling you if you're going to find your love, you know, next month, it's about understanding patterns and like patterns, but also transitions in your life. Like, where are you in how this aligns? And so these concepts of Saturn return, it happens in both men and women's lives around the first one is somewhere in our mid to late 20s. That tracks. Mm-hmm. So think about where you were in that time in your life. Like, we're just like, who am I? We are self actualizing. Many times we're stepping into merging with other through relationship, maybe through childbearing, you know, and it suddenly transforms the next few years of your or decades of your life. The second Saturn return is in our mid to late 50s. And I'm right on time. Right. Right. Exactly. And that is the other opportunity as my grandma would say to shit or get off the pot. And so what was working before may not work for you any longer. What you didn't speak up for it may now you don't have a choice to speak up. And what's very, very interesting in my world, as well as the world of literature, there's two, the cool study that came out recently that shows there's two times when we age the fastest around age 44 and around age 60. Wow. These are both times in our lives when we're like, what is my, what's the next phase of my life going to be like? Right. And how have I cared for myself to this point and what needs to change so I can make sure this meat suit is optimal for the next part of the race. Right. So I think that's really interesting, but it's also such an interesting time and that that mid 50s is also the highest rate of cancer diagnosis. Oh, how come you think it's incongruence? That, well, that's what I believe and that's what many of the vitalistic practices believe and many of the like the anthroposophical medicine, those realms believe is that, that, you know, we talk about cancer as the ultimate disconnect. So that incongruence, that loss of coherence is real. And it comes to that point in your life when you maybe through your child room, maybe you're coming into your retirement years, you said it perfectly a moment ago, which made me think about this. What is your purpose? Right. So it's like your first Saturn return is like, what is the purpose in this window? Your second Saturn return is what is the purpose from here on out? Right. So interesting, when I went to research age like a girl, the third section is or the third part is all about transforming ourselves and how do we use this as a moment to become the person we always wanted to be or shed identities that no longer served us. And so I dove into Joseph Campbell's hero's journey and I dove into Clarissa Pinkola Estes's life, death, life cycle. And I, and I spent weeks studying both of those. And then I mapped them to neuroscience. And I discovered a part of the brain and you might know this part of the brain called the anterior cingulate. And it lives in the prefrontal cortex and its job is to look outward and see if your external environment matches your internal environment. So if we talk about having a gut feeling or a hunch, like if we have a hunch, maybe we don't like the relationships we're in, or maybe we don't like the town. Like my, one of my hunches was like, I don't want to live where I raised my kids. I'm like, peace out. I want out of here. If, if we don't, if we don't listen to that hunch, then your anterior cingulate is having to take this information in and you are living in incongruence. And I'm curious if we've ever done studies on cancer and people who are living incongruently, cause basically then what the brain is saying to the body is stop sending me those signals. This is what's going on. And does the body become ill? I don't know if we'll ever know this, but I'm as a cancer expert. I'm curious what your opinion would be on that. Well, I'm not certain if there's explicit data out there. There's definitely anecdotal. There's definitely people as far back as the 1950s, like Robert Aider with the psycho neuro immunology world and Candace Pert and Bruce Lipton. I mean, Bruce Lipton's work was integral in saving my life 20 years before his book, biology of belief ever hit the airwaves, right? Like that was huge. We, oh yeah. It's pretty wild. But we also started looking at some of these, these kind of neural pathways and these developmental stages of where we are. I think we have some evidence that of course our in that incongruence or that in code at lack of coherence leads to stress response. And that is easy to test with, you know, salivary, IGA, certain cytokine profiles, natural killer cells, T cell, T cells, dendritic T cells. We can actually measure those. We can quantify those. We can also quantify today things like HRV, heart rate variability. Yeah, I was just going to say, can you put in like an HRV and look at and see if you can, yeah, change that. Yeah. Definitely see. And that's where, you know, there's some really cool studies I'm looking forward to them being published from Joe Dispenza and his massive group. I was just there. Yeah. Yeah. And he's doing a major, I mean, you probably, you probably spoke about it. He's like, he's doing major research, capturing as many biometrics as possible. I was just with him and actually had the pleasure of sitting in the classroom and meditable at dinner. And we got talking about his research and he has so much information. They just haven't gone through it all. He said, we literally have trillions of pieces of data proving that meditation control that you can turn your physiology around using meditation. Now, his path, he's focused on chronic disease and cancer. And, but he, but you sit in the seven day retreat and there's no, they just show you study after study, after study, all of it is, you know, it takes, obviously, you know this, but I don't think our audience does that it takes seven, some years for these research studies to come go into publication. But what he's discovered about the power of the mind on the state of the body, he said to me, it's going to change the way we look at healthcare. I'm so, I'm so all for it. Because yeah, it's really interesting. Yeah. Well, and even down to like the work of Dr. Kelly Turner, who's become a good friend and wrote the intro to my book, metabolic approach to cancer, you know, she went out in her data to look for those who spontaneously healed from the, like the terminal conditions, cancer being included in that. She wanted to understand what were their common denominators. No one else was looking at it. So she took 10 years to evaluate 10,000 cases of spontaneous remissions. And actually the title of her first book, radical remission, because there's nothing spontaneous about it, as well as her follow up book, Radical Hope. What she elicited, whether these 10 major factors, the first book has nine, the second goes into 10th, because I've added exercise in because that changes. That also changes the expression in the body, which I think is also another piece that can help with a hormonal transition is the movement of the body in different ways. But what she found is basically there's three tangibles and the rest are non-tangibles that impact this spontaneity of remission and improvement. And so of course, supplements, diet and movement are the tangibles, but the rest are the intangibles. And her data is there, even if it's somewhat anecdotal of thousands and thousands of intake, you know, of evaluating this data, it's there. And in our world, we were the beta, my community, my oncology community, our advocates and our patients and our allied health professionals and clinicians. We were the beta for an organization called Liberate, L-I-B-E-R and the number eight and Rajana, the co-founder of this, he and I got to know each other and we're like, we can we measure the impact of our thoughts, our emotions, all these things. And yes, we can. In fact, we've gone through and we've got some studies we're about to publish as well. But what we were able to do is map people's stories for simplicity and elucidate common patterns that led to certain, this specifically led to certain cancer diagnoses. And it was... What were they? The two biggest findings of patients with cancer, it hit over 70% of patients with cancer and we had thousands go through this. So it's not like 10 was not being seen and not being heard. Wow. Yeah. Wow. Wow. You know, I was not dealing with the same thing with menopause. Yeah. Yeah. And I was, you know, I, it's interesting. I was thinking earlier in the conversation when you talked about your ovarian cancer diagnosis and you referred to, I think, did you have some cervical to edit spread to the... Prior to that, prior to that, I had cervical. Yeah. Yeah. So one of the things I learned from, you know, Leanne Rimes is a dear friend of mine. And when I first started working with her and her health, we, I started geeking out on vocal cords. Like she would go to the vocal, she would go to the vocal doctor and she'd be like, do you want to see my vocal cords? I'm like, yeah, I want to see your vocal cords. And then we would end up in the sheets. She said to me, do you know that the vocal cords and the cervix were the same tissue in utero? And I'm like, what? And so then I had to research that. And I realized that she's absolutely accurate that in the embryo, the cervix and the vocal cords are literally the same tissue. And then they obviously go to the opposite sides of the body. But does that mean when a woman can't speak her voice, her cervix starts to have challenges or can build disease? And does it also mean that if we are raped or, or have some sexual trauma, which I'm starting to learn more and more women have, is that maybe we aren't able to fully speak our voice? Absolutely. And so the, you know, I think in context to everything we've been talking about, there's so much more to the human health picture than you went into a phase of life with low hormones. Now you need to supplement in with them. We're missing the opportunity to look at these snips. We're look, we're missing the opportunity to see what's not working in our life and fix that. Right. If the conversation is only around hormone replacement. Would you, would you, I know that you have been an advocate of women not doing hormone replacement. And I know you are a lone soldier out there fighting the fight. Lots of errands. Do you see them? Yeah. And so would you say that the biggest thing is because we're missing opportunities? 100%. To approach this from a more foundational level, is that the biggest challenge you have with hormone replacement? It is. And that's the place, you know, as I was even being educated on them in school, I was asking the questions like, why are we not understanding why they're exhibiting these, these symptoms? Like it was just so immediate when all of our professors in this field all worked for the compounding companies. So I started questioning. I mean, you guys, you got to remember, like I had to always look up this guy. So in 1960s, Robert, Dr. Robert Wilson, the gynecologist, started shouting from the rooftops that there's this tragedy of menopause and that we need to be feminine forever. If you go and follow the money, this is the dude that had all of the money and all the attachments to the premarin. So that's where this began was one man completely changing the narrative on women's health. And basically, you know, saying that we, you know, he said it coincides with his discovery of cheap estrogen and that pharma started training the next future generations that menopause is a disease. This is where it began. So it drives me effing crazy that at the time we were also creating like women's lib and all these other things, we were actually putting ourselves back into other prisons. We were actually not asking the right questions. And when we look at generations of the women throughout the 40s and 50s who were put on DES, we realized that was a big problem a generation later when we started seeing vaginal cancers and then their children, breast cancers and prostate cancers and on and on and on. We're not doing the same with us. It takes generations for it to fully show up. And so I was sitting in class as someone who'd had lots of problems with hormones and my mom, lots of problems with hormones and lots of other people that I was being exposed to at that time, plus knowing my grandmothers and my great grandmothers never had any menopause symptoms, you know, and asking those questions. I just started asking and I was like the lone star in the room asking those questions. And then when I moved, as I said, to an unlicensed state where we could even write scripts for that, I had to lean on my, my, my brains, right? I had to use critical thinking and I had to help women know their bodies and I had to help women know their biography that led to that biology and help them write a different story. And that's what I got to do for 17 years. And then as I got deeper into the oncology world and started learning about single nucleotide polymorphisms and saw like one of the examples, even though everyone's dismantling the, the in-hane study at this time, we did still see a big change that happened. We had the highest rates of breast cancer in the world was in Marin County, which coincided with the highest intake of hormones, of hormone replacement. They normalized to the rest of the population after that study came off and those women got off the hormones and we're seeing the uptick of it as they're all hopping back on. It's just through a different form now, but it's like seeing that again. It's like, I don't care that everyone's like cherry picking the data and saying, that study was a problem. We have some really big long-term studies that show massive changes in these pieces. The other side of it is that we don't need, like we don't need that tool. That would be a tool to me reserved for absolute last case scenario, worst case scenario. Why do we start with that? You know, yeah, we don't start with lifestyle. We're starting. That's what you, so where would you start? Yeah. Yeah. What would you understand? I want to understand what was your, what was your hormonal history? What was your menstrual history? What was your fertility history? What was your, depending where they're coming to me, your perimenopause or postmenopause, like I want that story. I want to know when, you know, where they lived, what their zip codes were, what types of chemicals were they exposed to. I want to know what industries they were in. I wanted to know if they ever took, you know, any form of like birth control pills or IUDs or any of those things along the ride. Then I want to look at their single nucleotide polymorphism and see how they endogenously process the world in on and around them to then decide how can we clean up your terrain to help your body do its job of bringing in the information, translating the information, sending out different signals. I mean, hormones are signals, right? To the body to do its job better and more efficiently. Then and only then, if we got, if we come to a crossroad and all the things aren't working that we've addressed, including the what's going on in your relationship, you know, and are you cleaning up? Are you dealing with those traumas of your, of your past that might have shut you down for protection? Yeah. When we've reached that, then we might consider exogenous support. But Dr. Mindy, knock on wood. I have not had to ever lean on the exogenous support. We've never needed to do that in 17 years of a private practice that saw thousands of women. I, that's not just anecdotal folks. And then those that I now train, please clinicians across the globe, many of which come to me that had their bread and butter from script writing hormone replacement practices. The feedback I'm getting from these clinicians is, oh, that, that definitely hit me in the bottom line in the beginning. Now the women are coming into them and the men are coming into them to say, I'm ready to correct my terrain, not replace the function of my terrain. And now they're drawing in a different clientele and they're inspiring the clientele that they had put on those to do something different. And so it might have been a lull in the beginning and very terrifying. And now they're like, because they see it, that the clinicians see it themselves. They're like, oh my God, it does matter if you deal with insulin cortisol, oxytocin. You know, I'm thinking about like, don't we, before we put your, put your kid in like the beginning of the school year, you have to have like a PE to get into PE. You have to have like a physical health exam. We used to do that. Yeah. Why? We should do that in your early forties. Okay. Let's see where you're at. Let's get an assessment so you can make the changes now. And of course that, you know, having a doctor oversee that could be helpful. I want to talk about your doctors here in a moment. And then like that seems actually really simple. I know these talks of snips and stuff might be complicated to the brain, to the people listening, but if you went to a doctor and you said, I'm 40 and I need to clean the train, I need to get normal function back. And so that I can take this next journey of my reproductive system with, with more ease. Yeah. That seems like, why don't, why aren't we doing that? I love it. Well, you know, there's an entire field out there that's a, that's opening up as pre-conception counseling and pre-conception preparation. Yeah. As it should. As it should, especially because fertility you're at a halt, all time low. And so it's not because you're deficient in, you know, I don't know, clomid. You know, that's not why you're pregnant. It's like, let's clean up the terrain to get you preggers. You know, I used to joke with my families. I'm like, we're going to get this cleaned up. And if you really aren't ready to have a baby, you guys need to be careful because it's going to happen. And then it did, right? So. Oh yeah. We used to do, we detoxed so many people in my clinic and then the next thing, you know, they'd come in, they'd be like, oops. I'm like, oh, sorry, God, I should have told you. Like 50 year old women that would get pregnant. I'm like, oh, so I started telling everybody we're about to detox you. We're going to clean all this up and, you know, just be aware you could get pregnant. Well, and even the example, like the average age of the women in my practice that I helped with fertility was 47. Yeah. Right. Perfect. And the amount of women who were in menopause are very close to it, you know, very like sporadic, would suddenly normalize their cycles for another few years with the type of care we were doing and be like, whoa. You know, what, what did that happen? I thought I was done. And you know, it's still, yeah. You know, that was one thing Joe said. Joe said that they see women who do the, his seven day retreat and they've been in menopause for like 10 years and then they get a cycle. Yeah. We've seen the same thing with fasting. Totally. A woman who hasn't had a cycle for 10 years. She starts fasting. All of a sudden she gets one or two more cycles. So it's, it's a really, those are really interesting examples. Yeah. Yeah. What, what, just like, I've heard from a lot of women who have been in menopause for a lot of women that are still scared. And I hope this conversation is helping them understand that there's some more cleanup you could do to figure out if you're a candidate or not. But what's your biggest complaint of, of hormone replacement? Like what do we, let's just go to what do we need to be worried about and instead of just blindly taking it? Well, what's freaking me out now is how many influencers and even colleagues that I call friends and, you know, really respect are out there telling women that it's absolutely safe to use this and in fact encourage to use this with cancer. I just like that one is like, I, I, I, I feel like my head's going to explode. I mean, I, let's just, let's just get very common sense here. Yeah. Let's be clear. I don't believe, I never say hormones cause cancer, meaning your endogenous hormones. Now miss, you know, like misuse or misfiring or miss signaling of your endogenous hormones can make you more vulnerable to the accumulation of exogenous, you know, endocrine disrupting things you're being exposed to and more vulnerable to exogenous hormones replacement. So let me be clear with that. There's a difference here. It's not like, because when they write, I fucking get crazy when they say, well, if that's the case and every menstruating girl would have cancer, well, guess what folks, that is happening today. Like every young girl. Well, uh, do you know Dr. I do. Absolutely. No. Yeah. Couple of years ago, I interviewed her here and she's like integrative cancer doctor and she was like the, the, the fastest growing age group for cancer right now is in the 20s. Yeah. Yeah. Under 30. And so it's not even that their own hormone, it's like the soup that we're in. And so like, God, guys, wake up because now let's just get out of it. Let's say we're, we're cancering now or we're on the edge or we're curious or we have a strong family history, we have a lot of risk factors. Do you want to put growth factors into the system, exogenous growth factors into the system? Estrogen's job is to grow things. Okay. So yeah, maybe it can grow new neural pathways, maybe it can grow new cardiovascular, you know, bundles, you know, different things. But if you've got a cancering process going, it absolutely will make that worse. And I will tell you that this isn't conjecture. This isn't the idea of this is what I see in testing. I'm a very avid tester. Every patient gets tested every single month for months on end imaging. We can even look at single nucleotide polymorphins. We can look at blood and tissue biopsies and we can see this is an actual cancer that is very, very sensitive to these particular growth factors. No, it is not okay. And it's also okay that we can support women to still be thriving without taking those things. Because I'm also not a fan of blocking women's hormones in the oncology space with drugs like tamoxifen and aromatase inhibitors because that's also overly simplistic of just turn off the lights, just block the garage. This is the thing that like standard of care is saying just turn off the switch. Alternative care is saying turn it on and I'm in this let's modulate world. And the modulation is about the terrain, the environment in which those hormones are communicating in. Not about the hormones themselves. We're asking the wrong questions and we're approaching the wrong things, both from standard of care's approach as well as the, you know, functional health's approach. It's they're both not, they're both wrong. And I don't mean that rudely. I just think you're missing the bigger picture and they're not day to day in it for the past 30 years to see that people think they're not, they think they're doing their patients a favor. They're not. Yeah. They're one of the questions that I have had that I don't think anybody has the answer to is we have this study that said don't take hormone replacement or you're going to get cancer. And then we all of a sudden said, oh, wait, we misread the study, which always cracks me up because I'm like, okay, wait, people, can you read the study? Right. Just read the study. Right. And then now it were on the wild, wild west that everybody take hormone replacement. My, my stance has been it's a personal, it's a personal decision between you and your doctor. You need to ask about it. But what I'm not able to rectify in my brain is we don't, what we don't have is long-term studies of what happens when somebody hits 70 or 80 years old and they've been on for, for 40 years on hormone replacement therapy. I, I'd like somebody to answer that question for me. Do we have that information? Well, as the, so in my data platform that we're building out, we hope to be able to publish on this information because I have personally seen hundreds of patients exactly what you just described. Okay. All getting weird. Yeah, cause you're dealing with cancer. Yeah. You're dealing with cancer. Right. So it's like, we used to think of cancer as a, as a disease of the age. It's so the standard of care won't look at these women because they're like, they're, you know, this is an age appropriate time to be getting cancer. But what they're not looking at is that these women were still bleeding into their 60s or that they still have breast tenderness in their 70s and fibricitic breasts and all these things are also precursors to breast cancers and that they have lots and lots of insulin growth factor because of their exogenous hormones and that their cholesterol levels are off the charts because your mother hormone is cholesterol and then pregnant alone and the other hormones come down from that. So now all of it just backing up and everything's just like kluge in there. And so I'm looking at all these women who are, and I'm looking at their hormone test. I'm looking at their duchess. I'm looking at there because I don't look at, you should not be seeing hormones in the serum folks. Like they should be in a receptor or out of the body. If you're seeing them in the serum, you're in trouble. Like that's pathologic when you're seeing them in the serum. So, but if you're looking at the metabolites and like you're in tests and whatnot and you're starting to go, oh my word, those two 16 hydroxy estrons or the four hydroxy estrons, four, these are super scary. Those patients, now theoretically a 70 year old woman should not have any estrogen in her, like it should be, we still make people don't understand that we have all these other tissues of the body and other cells in the body that will still produce estrogen once the ovaries stop. It's not just the ovaries that are in charge. But when I'm starting to look at labs of women in their 70s who look like they've got estrogen levels of women in their 20s, that's not right. Like that's really to end. You're seeing extreme discrepancies of the two 16 hydroxy estrons and the four hydroxy estrons. And you're like, now we're in toxic estrogen metabolites that this is absolute known car senogens. Like the data is very clear. That's not okay. And the fact that they put these women on thinking they're not at risk, we won't test. When I think about like Suzanne Summers, a lot of people bring her up to me, you know, 20 some years of stage four breast cancer, always on hormones. But I knew her medical team and her medical team, she basically tested her hormones every single month and she titrated it extremely carefully. Who has the resources to do that? Because we're talking somewhere between 500 and a grand a pop for the types of testing she was doing. Most of us don't have those resources. And so what it would have put if she'd put the energy into cleaning up her diet and lifestyle to the level that she did in titrating her hormones, maybe we'd have had a different outcome. She still rocked it, you know, for a long time, she is an N of one there. But it's like, this is where I just continue to come back to many we're asking her own questions, we're not doing the right testing and you're right, we don't have the long term data. And to me, that example of the Marin County is so classic and that highest in the world. Indian study comes out, everyone in that area jumps off the bio, you know, jumps off the hormone train, levels drop, normalize. But now they're eating back up as everyone's out there saying, Oh, just kidding, that study lied. I'm like, yeah. And that's the end. Yeah. And the everyday woman that's so confusing. It's like, you know, I still see the fear in our community and which is why I wanted to bring you on and really try to answer some of these. What would you tell a woman who says, Okay, I have, I have hormonal cancers in my genetics. I've never had it. But I want to make sure if that hormone replacement would be right for me or not. What would what would you advise that person to do? Well, I'd get their snips to know for sure. Like you just may be there to have them. And that's why they know that about themselves. I would do a hormone metabolite test and I would look at their and I would definitely take a full look at their terrain, especially things like vitamin D levels, which map manage your hormones, manage your insulin, manage all the things. I would optimize that. I would optimize insulin and I would optimize cortisol and I would optimize oxytocin. Then we create a really safety place here. But what's so funny is those same women who came to me saying, I really want to take the hormones and we optimize those things. They don't need the hormones. Right. Then they don't need them. Yeah. But I'd rather have that option. I mean, that's like knowing it from the background, like, okay, it's here. We need it. But yes, exactly. Right. Right. Exactly. And so that's where I think that's where I'd like to see us go is instead of just promoting and saying, these are safe and great for everybody and you're going to be a former shell of yourself if you don't take them and you're going to have higher all mortality, that's just not right. That's not true. And so my ask of the hormone community is that let's just like in the GLP conversations and other things, we are correcting the problem with those. Right. And so when people like, oh, we get on hormones to predict our brain, well, guess what? Type 3 diabetes folks. Insulin. That's what, right. Insulin. You correct. Yeah. Oh, we know, we know what, we know what causes all the timers. It's not a mystery. It is diabetes. Exactly. It's diabetes of the brain. Right. And so they're hemoglobin A1, C2. Exactly. Your insulin, your A1, C2, your C-peptide, your insulin growth factor, then they're like, oh, my bones, well, guess what? We get you into some weight training. Right. So sunshine. Get your vitamin D optimized, your K2 optimized. Guess what? Bones happy, reversed. I was osteopenic at 22 years old from years of being a vegan and vegetarian. I'm 53 years old, almost 54. My bones are like better than they were, you know, like way better. I mean, I reversed all of that, you know? So it's like never once taken anything. So we can do so much like the power plates and all those things like so much to like create some strength in our bones. And then when they talk about libido, when we talked about that, let's first talk about your relationships. Yeah, right. Right? Yeah. Right? Stress. When women, like my husband could like run over a cat and come in the house and be ready to go at it. Right? I like have to be like, every, like all, I, things have to be like organized in my life and brain for me to like be able to let go and relax. Like know that about yourself. Create the rituals that put your brain and your body in the mood in those places to connect, you know? If there's pain or dryness, there are so many say things we can start. I literally had a waiter come up to me or the chef of a really well-known farm to table restaurant in Durango come up to me telling me that I brought, you know, his wife and he back together again, like all the people around us like, I'll have what she's having. But she was having severe, severe, severe, painful, like vaginitis and painful intercourse. And they were young. She wasn't even menopausal yet. And I talked to them about Pharia pleasure, which was a TB, a THC CBD kind of vaginal lubricant for vaginal pain changed all their lives. And what really came up for her is she started realizing she was dealing with some unprocessed trauma at the same time. You know, so it was like this opportunity to heal some things there. But there's so much like vitamin E suppositories. There's so many safe lubricants out there. Gosh, I can't think of the one like these great hyaluronic acid suppositories to bring back the cheusiness, the plumpness, even, you know, just, there's just a lot. There's a lot of really safe ones that are out there. Yeah. Do you think, I think if I, you know, I try to put myself in the shoes of somebody who's having to make this decision. And when you hear a conversation like this, I even thought about it when I wrote Age Like a Girl, is it does require, if you're not going to go on hormone replacement therapy, it is probably going to require a lifestyle change. Absolutely. And you need to change your lifestyle to match the new hormonal moment. And what I think we're really seeing in this uptick of people taking hormone replacement is also underneath that is, is women saying, I don't have time to change my lifestyle. I don't know what to do to change my lifestyle. And there's no criticism on that. No, just it's life. I think that's part of the modern world is that when we go and we look at Japan, only 4% of women get on HRT. And, you know, then you look at, oh, they've got the highest amount of, of people hitting 100 in seniors and the way the seniors are treated and the amount of soy and the, and they walk everywhere. It's like, I think that's such a key part of the conversation is not being discussed. Is we are dishing this out like candy because we aren't stopping and saying, holy shit, the modern world is not working for the menopausal woman. And you're going to need to slow down and change your life and lift some weights and get some better, get some better relationships. That's a lot of work. It is. That's a lot to do. It is. It is. And I really appreciate you saying because I can't, you know, like again, through human history, we, we moved through menopause with no dramatic suffering. And yet today's menopause crisis is predictable of predictable symptoms of decades of metabolic damage mismatched to our environment, mismatched to our lifestyles, endocrine disruption, sociocultural conditioning, not a deficiency of estrogen patches and progesterone creams. And yet in a lot of the places where they're having least amounts of menopausal symptoms is in the environments where they're still in multi-generational homes and tribal communities that are supporting when you need that pause, that spaciousness in your life, you know, to do these things. So I think that is a conversation when we look at what has changed in the last 50 to 70 years, nutrition definitely has changed way more refined sugar processed foods, Omega six heavy oils, more stress than ever, chronic sympathetic activation, activation in cortisol dysregulation. Big one on that one, endocrine disruptors, sleep and circadian disruption. So thank you, artificial life, screen time, shift work, movement lack thereof, so sedentary lifestyles, social structures. So this is the big one, loss of intergenerational community and shared roles and contributing to these mental emotional distresses. So those are like the big ones at what has changed. And you're right, it's going to ask a lot of us to have to do a lot for ourselves. But wouldn't it be cool if and it's happening, Dr. Mindy, because it's you're doing it. What have we flipped the narrative and what have we leaned in and brought back that environment which allows us to thrive without depending on exogenous input, because even those places where you're depending on the exogenous input, almost all of you will inevitably have to come off at some point in time. You're right. Yeah. And so it's like you're delaying the inevitable. What if you had a community that allows you to lean in and smooth out the initial bumpy ride to go into a different phase of your life thriving in all of your gorgeous juiciness? You know, something I thought, I just feel like I should say because I recognize that people are going to say it looks into Judgy McJudgy-Nature on this, but let me just give some context. When you're 19, told you're not going to see the end of your 20th year on this planet, you don't give a shit about a wrinkle, a dimple, a gray hair. You wake up every day just so grateful to see another sunrise. Yeah. And it hurts me so much to watch so much energy put into not just cherishing the amazingness of who you are in all facets of your life. And I love being, I got to be with my great friends. I'm a godmother and a great godmother at this point. And to watch these kids, I get to step into the role of the wise woman. I didn't even know if I could have stepped into the role of a fertile woman at the rate I was going. And so I don't want anyone else to have to have that slap in the face reality check. But that does give me the rose lenses to look through of appreciating the depth and breadth of our lives and that each moment is welcome. And if you're unhappy with where you are, you can change it. You can change it. And menopause is a great time to change it. It's because you're neurochemically changing. So that's age like a girl. You're doing a great job promoting my book. I really appreciate it. Well, I can't wait for it to come out. I'm like, yes, please hurry up, hurry up, hurry up. Because because that's what I did in all the research I did. I really was like, wow, we're at an evolutionary mismatch, which is why HRT has become necessary. I'm going to put it in quotes is. And so we don't want to lose the part of the conversation that we're at an evolutionary mismatch. Yes. And we don't want to lose the part of the conversation that this is your opportunity to transform into another person for you to stop giving away all of your time and effort to everybody else and to turn around and give it to yourself. So I mean, that's really what age like a girl is. But I, but I, I really love this conversation because I feel like I hope people are seeing, there's a bigger part of the conversation. So even if you don't understand snips and even if you're like, oh, shit, I got to do all those lifestyle changes. What I hope you're hearing is let's pause for a moment and make sure that some parts of your life are cleaned up before you rush to the HRT. And if you've already rushed there, don't I even asked Mary Claire Haver this on this podcast, I said, does HRT give me a free pass from lifestyle? And she was like, no, does not. And I think every, every hormone expert out there right now could, would agree on that particular, particular thing. But what, what I hear from you as somebody who's been through a cancer diagnosis, that we can't be cavalier about this. We need to be strategic. And what you offer with the testing and the lifestyle is, is that strategy. And it's led me to wonder, I know you train your doctors to treat cancer. Can people go to your directory and find doctors that can help them with hormone replacement and approach it from this lens? Absolutely. And to be clear, they don't treat cancer, they treat the terrain. Sorry. Sorry. But, but, but that's just it is. Well said. Well said. Absolutely. They can come to them and help prepare their body. And like you said, as if they're going to take those hormones, but we'll quickly learn that the necessity for them quickly fades when you start to tend to the terrain in a meaningful way. And these folks can help you dive into your own assessment to understand what's making you tick, like, you know, an example of a hot flash. There's a million different reasons why you could have hot flash. It could be histamine, it could be an allergic reaction to something else beyond histamine. It could be cortisol, you know, it could be just like certain nutrient deficiencies, it could be oxalate, you know, excess. There's so many things that actually lead to the hot flashes. We could do a couple, you know, like troubleshooting and figure out what's driving yours and put it in its tracks. Like I know for me, as soon as I hit perimenopause, I can't drink red wine. Even the best dry farmed, cleanest possible, just doesn't work. It sets histamine off in my body. So I've learned those little tricks for myself, right? But we all need to learn those little tricks for ourselves. And one of the things I love, you know, like, you know, menopause did not just suddenly become dangerous. It didn't suddenly become like a medical ruin. It just became a conversation, it became an open conversation. Well said. And so it's like, how, what if we've treated our bodies like, what's dangerous to me is how we've treated our bodies and our environment for the last half a century? That's what's dangerous. And the solution is not necessarily overriding nature with more hormones. It's remembering how to live in harmony with those hormones. And so, you know, one of the things you said, and I want to just iterate this because it's so important to me, like there are physical changes with every season, right? And instead of rushing to medicate it, what are you ready to release? You know, not just from your body, but from your mind, your calendar, your spirit. So menopause, maybe that body's invitation to just lighten the load. Shed went no longer serves and to move into a freer, more authentic chapter of yourself. And that was the way we approached it in my practice. And then I've trained the clinicians to approach it in their practices. And man, we are creating a whole new revolution of really powerful and powerful empowered men and women who are really understanding this is pretty miraculous. Amazing. Okay. Where do, how do people find these doctors that are out there? You guys can start with going to drnisha.com, drnasha.com. That'll take you off to all the millions of spirals of things I'm doing. My book, The Metabolic Approach to Cancer, almost just ignore that word because it's more like metabolic approach to life. That are actually a lot of things that will help you in your hormonal journey. And there's an entire chapter on hormones. It's a go to, it's a Bible, by the way. I refer it to everybody. Thank you. I appreciate that. And then, but to learn more about their education, metabolicregion.com, if you are a clinician or an allied health professional or even an advocate wanting to learn more and apply this out in the world, there also on that has our directory, which are those who've come through our graduate, graduated in or endorsed people that apply this methodology and apply this approach. So lots of places. And then at some point, you guys will come over and listen to Dr. Mindy and I talking on metabolic matters, which is my podcast. And I'm not sure when this is coming out, but we hope that this becomes an annual event. But metabolic health day conference happening in Tucson is bringing together it's funny. So Mindy, I don't know if you know that's the same weekend of our metabolic health day conference that you are speaking at is also at the A4M's Women's Health Conference. Oh, interesting. In the, in, in Scott's, in, I don't know if it's in the same, it's in the same town, but not the same town, but the same time in the same region, which there'll be very different conversations happening. Yes. In those places. And I'm super curious and super intrigued because what the, you know, Dr. Mindy and I aren't feeling people having these conversations that are at our conference, but just up the road will be an entirely different one. And my hope is that somewhere down the road along the way, we will find a common, a common meeting point so that we can better share our, our patients. Yeah. Yeah. And that's really it. You know, earlier today, I interviewed Tamsin Fidel who wrote how to menopause. And you know, I, she, it was a beautiful conversation. And I really think what I am dreaming of and I'm getting hints of is that we are having a more collaborative discussion. All doctors coming together. And that's when women win, when we're like, Hey, Dr. Nisha is a cancer expert. What do we need to know here? And, you know, here's somebody who's a testosterone expert. What do we need to know here? Here's somebody who is saying doctors aren't educated on OBs, aren't educated on menopause. Okay. What do we need to know? Like, I feel like everybody needs to come into the conversation. So, and, and respect each other's similarities and differences. And if we do that, then we're going to see things change. So thank you so much. I mean, I, I love the way you think. I love what you're doing with cancer. I love the way you're training these doctors. So just a big huge thank you for taking the time to do that. I can't imagine training doctors is very easy. So, but I know some of them that have gone through your program and speak so highly and wow, we need, we need an army of you all out there. So just deeply appreciate you. And yes, everybody come hear me at the, at the metabolic event we're doing in Tucson and we'll leave, we'll leave links for that. So thank you, Nisha so much for just being you. I love you, Mindy. I love the work you're doing this world. My oxytocin is at an all time high after this conversation. And I hope that this brings a lot of curiosity and collaboration for future discussions to come. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends and let me know what your biggest takeaway is.