Weight Gain on HRT: What’s Really Causing It | Solo

On this episode of the Dr. Tina Show, we're gonna talk about a very interesting topic. And if you're on hormone replacement therapy as a middle-aged woman, you're gonna wanna listen. HRT can actually induce weight gain. And going on HRT doesn't necessarily promise weight loss. And so I'm gonna break it down for you today on this episode. So let's jump in. You are tuned into the Dr. Tina Show with Dr. Tina Moore. For more, visit drtina.com. Okay, we're just going to hop right into it. I'm going to get personal here. I spent my entire life as a very low hormone girly. I have been testing my hormones since my 30s and they have always come back just bone dry. I am a low hormone girly. I feel best low hormone. I don't tend to do well on hormones. And going all the way back to college days when I was on oral birth control. Contraceptive did terribly on it, had to discontinue it almost immediately, gained a ton of weight on it like that. Fast forward to years later, I'm pregnant, blew up like a balloon during my pregnancy. Did not enjoy it. Was not one of those women who was like, oh, being pregnant feels so great. Did not feel great. My autoimmune disease was not happy. None of my body was happy pregnant. Did not enjoy it at all. It was a rough go. had my beautiful daughter, couldn't lose a pound, was not one of those women who went straight into breastfeeding and everything was great and lost all the weight. Didn't happen. Didn't actually lose a pound until I discontinued breastfeeding and I dropped 10 pounds like that. Just boom, gone. And in every situation that I just shared with you and I'm going to continue this story, the weight gain or loss is like that. So I know it's the hormones. All right, so we fast forward to my daughter's a few years old, I have a Mirena IUD inserted. That is a supposed to be local only progestin wrapped IUD that goes in intrauterous. And it did not stay local because I had the same exact experience that I did on oral birth control, which was I felt batshit crazy. I was in my first year of chiropractic college. I had a two-year-old. I could not manage what was happening. So I actually went into the restroom and pulled. I remember I was in a radiology course where you're in a dark room and you're looking at x-rays all day. I went into the bathroom in that building and I put my foot up on the toilet seat and I pulled my IUD out. I would not recommend anyone do that. It was completely painless. I've had multiple IUDs inserted and removed and I don't have a lot of pain with that. So, but it's not something, go to your doctor and have your IUD removed if you want to have it removed. But I pulled it out. It was shockingly small and I flushed it. And I was like, F that, not fun. So that would basically be like Depra-Provera, except in a IUD form. Did not do well on it. Do not like it. Have never recommended a Mirena for a woman ever, or Depra-Provera for that matter. And now we've got lawsuits coming out around Depra-Provera and brain tumors. So I don't have all the details on that, but you can go look that up. So then lost the weight immediately. Had gained a bunch of weight on that, lost it immediately. Years pass, I have used topical progesterone for years, decades at this point, on and off. Sometimes obviously at lower doses when I was younger, but I have been on a topical progesterone cream since my 30s, somewhere in my 30s. And more recently, obviously, kind of the whole arsenal of HRT, right? The estrogen, the progesterone, the testosterone. Now, in all cases, I am a proponent of natural progesterones or bioidentical progesterones. And so the creams, the topicals, the oils, those are all available over the counter. I'm not recommending you start them without some direction because you too can gain a ton of weight on them or feel lousy if it's not done appropriately. I had another episode in my 30, my late 20s. I would guess I was on a road trip and I was using a ton of topical progesterone because my doctor at the time had really ramped my dose up because of the symptoms I was having. And I felt like a crazy person again, and I gained a ton of weight. And what I remembered specifically about that trip to note was that my appetite went through the roof. And it got me thinking at the time, boy, I have always had a voracious appetite when I take too much progesterone. And so more recently, I am on a micronized oral progesterone, which is a prescription that you can get through a traditional pharmacy. This does not need to be compounded. I am on a, I've tried topical estrogens, estradiol, biest, which is estriol and estradiol. Don't get as good of results with a topical as I have with the patch, the topical patch. And so I have been using a very small dose of that. when you're in perimenopause, I do like to test hormones in all women, all ages. But when you're in perimenopause, you're kind of like riding the lightning, right? Like you're all over the place. And sometimes you have estrogen and progesterone and sometimes you don't. Depends on the month. Depends on what your eggs are doing. Depends on your stress levels and a lot of different variables. So have been playing around with that dose. And it's, I wish I could say this with certain, but it's never the same dose twice. And I, at this point, I'm like, can I just get through with it? Can I just get through the menopause and actually just then I can control the exogenous supply of hormones into my body so I can get them regulated. But this is a crazy time. And any of you perimenopausal ladies now, any of you perimenopausal ladies that are lucky enough to go on a dose of whatever hormone that your doctor gives you and just, it's great. And you just, it works every month the same. Bless you. because that has not been my experience and it's not the experience of many of my patients and clients. And then topical testosterone, I have done injectable testosterone, I've done topical. I really, you know, in female doses, I think it's a really valuable asset to have on board. But I would say that the one thing that has made me gain weight the most quickly and just kind of out of nowhere has been when I have used testosterone. at too high a dose. All of a sudden, my body likes to do the aromatization process of my aromatase enzyme kicks up and I convert all my testosterone into estrogen and it doesn't go well for me. And I will get weight gain like that. This is similar to those of you who are menstruating of whatever age and you find yourself that week before your bleed, right before your period starts, all of a sudden you've got like a sheet of fat on your stomach or your stomach gets real fluffy. And you're like, what is going on here? It's not just bloat. It's like all of a sudden you feel like you just puffed up like the Pillsbury Doughboy, you just puff up, right? And that had been my story all the way through my life. I mean, really, I just would get, I felt fat every week before my period. All of a sudden I gained a bunch of weight, nothing fit. It wasn't just like intestinal bloat. It wasn't just bloat. It was like, I don't know. Turns out, I do know now, it was insulin resistance. You become transiently insulin resistant. I'm going to get to that. Testosterone will do it to me quickly. Too much estrogen will definitely do it to me. Man, estrogen really is that Goldilocks spot. All of these are. All of these hormones, you have got to be finding that Goldilocks spot. But unfortunately, the finish line or the goal or the Goldilocks spot moves every single month when you're in perimenopause, especially during this period where I'm just, I'm still cycling regularly, but it's starting to peter out, right? And so it's a very frustrating time to be trying to sort out your HRT. And I wanted to share this information because I have been getting messages from you guys for years saying, I can't handle HRT. I gain so much weight. What is going on? And I'm like, okay, I'll breach this topic someday. And so today's the day. Recently, I had my estrogen dialed in. I had my testosterone dialed in. And I still was having some sleep disruption. And I was still finding myself riddled with some anxiety. And I knew it was hormonal. And so I upped my progesterone. And Lord, do I love my progesterone. I could write a love letter to progesterone. I love the way it makes me feel. I love how juicy and glowy and just bava boom I feel on progesterone. But once again, my appetite specifically for carbohydrates, which I'm going to explain in a minute, went through the roof. And within a week, boom, just puffed right up. Everyone's like, gosh, you look great. What is it? I'm like, it's adipose tissue. It's fat. It truly fills you out, right? It gives you a nice, you don't need any filler or anything and all your wrinkles look smoother because you have a nice layer of adipose. And I will say, and I've talked to many folks in the strength and conditioning community. I've talked to many hormone specialists. I remember Sarah Gottfried, Dr. Sarah Gottfried saying this like a decade ago. And I've always believed this as well. Women in middle age just don't look as good and feel as good when they're rocking a six pack. They tend to run anxious and they tend to run a little too squirrely when they are too lean. And I know some of you ladies are naturally blessed with six packs and I'm not talking about you. I'm talking about those of us who really never were and who when we try to get there, we just feel batshit crazy. So a little bit of weight is protective. A little bit of weight is actually going to help you balance your hormones a little bit better. A little bit of weight is your friend in middle age ladies. And if you talk to the strength and conditioning coaches, especially the male ones who've been training middle-aged women, they will tell you, truth be told, they will tell you this. They've told me this. Their clients do better and are stronger and have better gains and feel better overall when they allow themselves to have a little bit of weight on them. So I believe that. I have been telling middle-aged women that forever. I had to take a dose of my own medicine on that. I have to be okay with the fact that I do feel better. I sleep better. I have a better libido. Everything's better. I'm stronger. My joints hurt less. Everything's a bit better when I have a little bit of weight on me. So I'm okay with that. You know, I've given up on my bikini dreams, but this was out of control. And my husband was looking at me one night as I was devouring a bag of popcorn. He was just like, what is going on with you? And I'm like, carbs, carbs, carbs. And I joke, I say I'm being a little carb piggy. And it's because I do, I feel like a little piggy out of food trough. And I'm just like carbs, carbs, carbs. And I'm not a big carb addict girl. So I was. I was a refined carbohydrate addict in my 20s. I think I was severely insulin resistant at the time. I think, you know, there is a type of diabetes that they're discussing now in malnourished folks. And they're calling it type 5. And we'll talk about that on another episode. But it really is, I believe that I induced that in myself multiple times over, just a version of that. And so they speak of it in terms of like the malnourished, over-trained, underfed female athlete. But I would say it's probably true for those of us who just really... I dealt with anorexia and bulimia for a long time as a young person. So I do think you bust your metabolism that way. And I think I am now paying the price for that. So it's fun and it's real. And a couple different scenarios have come up recently where folks were saying, oh, you know, I gained so much weight when I'm on HRT or, you know, HRT, I've heard it can do this. I've heard it can do that. I've heard progesterone can do this. And I get all these questions and I've seen kind of all these different scenarios on social media. And I thought we would just address it here. But I wanted to start with that story because I live this. I get this. I am such a Goldilocks girl with my hormones. If I'm just ever so slightly too high or too low, all bets are off and I'm a mess. And I definitely gain weight on HRT. I do. And so this is something that I have to contend with. I'm going to share with you why and I'm going to share with you what you can do about it. And you're going to laugh because it's all the things I tell you to do all the time, but I'm going to explain why in a little bit more detail. This isn't going to be a college level hormone course, but I just wanted to make sure that you guys have a bit of a handle on this, especially those of you who are coaching others or who are treating patients or who are healthcare professionals, strength and conditioning coaches. If you are of the just try harder and be more disciplined group and you believe calories in, calories out is it, I highly encourage you to listen to this episode. If you want to fight about it, then get out of here because this is legitimate science. I'm going to share with you the mechanisms. I'm not going to go into all the specific studies. You can look them up. This is not hard information to find. It's all over the internet. We have known this for decades and there's iterations of it over and over. I will say a good deal of the research has been done in what progesterone is doing to pregnant women or women who are of reproductive age, but these mechanisms hold true. And if you are one of those women who gains that gut right before your period, then this is probably you. And none of this is to diagnose, treat, or give any medical advice, but I want to share with you mechanisms so that you know what you're getting into. I will say this is not intended to scare you away from HRT. None of this is intended to scare you away from taking HRT. But you need to know what's happening because unfortunately, a lot of doctors don't. And I'm not dissing doctors, but I would say that the majority of the clinicians I run into don't have a handle on metabolic health. And many of the so-called metabolic health experts that I run into look like their metabolic health has derailed. or they don't look like they've seen the inside of a gym. So don't really think they completely understand metabolic health. And again, that's not a diss. It's just you can't be a metabolic health expert unless you go to the gym. Because muscle is a part of this equation and we're going to get to that. Muscle is a huge part of this equation. And I'm not pretending to be the end-all be-all either. But I have a pretty good handle on this. I have a pretty good handle on HRT. I understand the mechanisms well enough. and I've treated countless patients and seen it in action. If you're going to take HRT, you have to go to the gym. You have to prioritize muscle. You have to prioritize exercise and movement. Why? Because the mechanisms where HRT can actually induce some level of insulin resistance, that's right, HRT can induce insulin resistance. Low hormones can induce insulin resistance. Too high of hormones can induce insulin resistance. And you need to offset that. And the only way to really consistently do that is through the foods that you choose to eat and the way you choose to strengthen and move your body and muscle. The foods we choose to eat are really being driven by a multitude of factors, which I can't get into detail on, but I will tell you hormones are up there. Your gut microbiome, which hormones influence, and then the hormone levels in your body. So as I just shared, when I was taking too much progesterone, which felt lovely, and it was fantastic for my sleep, and my skin was glowing, and everybody's like, you look so great. I'm like, it's all the progesterone I'm bathing in. But I also was eating like a little carb piggy. And I was munching down the carbs any chance I could get. I was craving them. I was waking up in the morning hungry. I'm never hungry in the morning. I was waking up like ravenous, like when you're pregnant, right? So we have to find that sweet spot and it takes some tinkering. And then we have to add in the reality that a lot of doctors, thank God they're getting on the tip and they're starting to prescribe HRT, but a lot of them don't know what they're doing, right? They're just learning this. And we all just have to learn and start somewhere, but they are going to have to see a bunch of I mean this is clinical practice you guys You have to see something happen a few times over so that you can start to And you can hear about it all you want You can learn about it at conferences. But until you see it happen in a patient, you're like, oh, that's what that is. And so until you see the hormones you're giving a patient inducing further insulin resistance in somebody who's coming in who's already insulin resistant because most middle-aged women are, or they're going to be as the estrogen leaves the building, you have to know what you're seeing. And that just takes experience. And so we're in this place where a lot of doctors are prescribing now and I'm very grateful for it. I'm sure you are too. And I pray that Gen X women get the hormones they deserve. I hope every Gen X woman gets the hormones they deserve. But we're dealing with a lot of newbie doctors who are newbies at it. And yeah, it's going to take a minute. So I'm hoping to arm you with information, whether you're the general public and you're a patient using these or you're a practitioner prescribing these or your health coach or your whoever. All right, let's jump into this. Right now, I'm in a season of recovery. 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So that's like diagnostic and it's therapeutic. And it's been understood at a really elementary level that estrogen builds, progesterone protects, right? And that's what a lot of the coaches who are... There's so many health coaches out there coaching on HRT and they're prescribing topicals. I mean, I'm not going to get into the ethics of all of that, but like there's a lot of people. There's a lot of people whose lane it should be and they don't know what they're doing. and there's a lot of people who are out of their lane. And then we're throwing in a bunch of peptides. You guys are injecting peptides from Fitsbo girls who used to be beach body girls who are now hawking peptides and you're injecting them into you. And I'm just like, that's a whole other conversation. And again, if a doctor isn't trained on these, that's no better. But man, we are in a weird place right now. Things are crazy. And I am watching Fitsbo girl after Fitsbo girl influencer, look at my perfect abs. I'm watching these women plagiarize me to no end, give me no credit, which is whatever. But they're not even getting it right. If they were plagiarizing me correctly, that would be one thing, but they don't understand the mechanisms deeply enough. And so they're just repeating the words that I say and several others. And then they're sending you off to research labs to buy peptides to inject into yourself. It's bizarre. I don't think any of these things are super benign. I just saw a guy today, a strength and conditioning coach, really, really intelligent guy on Instagram, knows his peptides, but he was saying like, you know, these are so safe and why are we, you know, throwing any shade on people for using them and they should be available over the counter type of thing. And I was like, what? Have you not, maybe not seen any problems happen? Because I have, you know, just the slightest bit too much of a dose of any of these things can really send, especially a very, we're talking sensitive women. We are sensitive women when we're in middle age. We are, we become extremely sensitive. I would love to say that we are super resilient, but we are most resilient in our 20s. I mean, come on, we could like spend a whole night in six inch heels and drink a bottle of vodka and chain smoke and, you know, go eat greasy food at two in the morning when the bar is closed and wake up and go to work and be fine. That's resilience. We don't have that anymore. That would kill me. I would die. I wouldn't make it more than a second and six inch heels anymore, but I would just die. My back would be hurting. I wouldn't be able to function. You know, like I drink a glass of wine now and I have a hangover. So we're sensitive ladies and we're taking our advice from 25 year old or even 40 year old Fitspo girls online. It's like there's a big difference between 40 and 50 when it comes to your hormones and how resilient you are. And there's a big difference between 50 and 60 when your hormones go offline. So anyway, do what you want, but buyer beware. So progesterone induces a state of physiologic insulin antagonism. So it antagonizes insulin to go by impairing insulin-mediated glucose uptake and altering hepatic glucose handling. So it changes the way our cells take in glucose and it's changing the way our liver handles glucose. and this is largely through receptor signaling effects and substrate competition and it's a big biochem lesson but the bottom line is normally when insulin binds a cell if it's healthy, if it's not insulin resistant it will hear the insulin, it will bind the insulin and then a signal will get sent and the cell will translocate a GLUT4 receptor, basically. And that GLUT4 translocation is what allows glucose to come in the cell and be used as fuel in a nutshell. And that's normal, but progesterone reduces that mechanism from happening. And this is because progesterone goes high in the luteal phase of your period, the second part of your period, right? The time between ovulation and bleeding. So just period lesson for those of you who don't know, your cycle is roughly 28 days. Day one is the day you start bleeding. You bleed for seven days. At day 14-ish, you ovulate-ish, just give or take. Day 14, we ovulate, meaning our egg releases a cell. That whole period is called your follicular phase. Once that egg releases from your corpus luteum, your corpus luteum starts secreting progesterone. That's called the luteal phase. You think the world is ending in the luteal phase. The luteal phase is rough. And then all of a sudden progesterone kind of leaves the scene and boom, if an egg doesn't implant, and boom, you shed your uterine lining. That's a period. You start back at day one. So progesterone is on the scene to protect. It protects the uterine lining. It keeps it intact. If an egg implants and you become pregnant, it keeps the baby. It's protective. And progesterone is designed to ultimately fatten us up and make us, keep us fertile. Low progesterone is a massive reason for miscarriage. I have had countless patients who had terribly low progesterone who kept miscarrying. I put them on progesterone. They get pregnant. The saddest part is when they go back to their OBGYN and their OBGYN is closed-minded, allopathic, very Western doctor and says, oh, that's hogwash. You're fine. You don't need that progesterone. They discontinue the progesterone. They lose the pregnancy. I've had that happen with patients because of course, the minute they become pregnant, we punt you to your OBGYN. I'm happy to co-manage, but there are some folks out there who really truly believe in allopathic medicine so deeply that they will just do whatever one doctor says, whoever is the biggest bully. And so that's happened. So think of progesterone as protective. And if you are somebody who has had trouble in the past carrying births to fruition, you're gonna wanna look at your progesterone. It's one of the factors. There's others, but a couple of factors in chronic infertility, but that's a big one. And I have yet to test a woman who had good healthy levels of progesterone. It's kind of chronically low in our modern society. And there's different reasons why, but we live in a toxic soup. We have a lot of stress and a lot of women are not making enough progesterone. I think the world would be a much better place if young women were tested and treated early and not given progestins. I want to be clear, progestins are synthetic progesterones. They don't bind the cell the same versus a bioidentical progesterone, micronized progesterone. And again, you get that at the regular pharmacy. I had a situation happen with a client recently and her doctor said, yeah, I approve you to take HRT, but not BHRT. And I'm like, dude, you clearly don't understand that BHRT is what you would get at your favorite pharmacy down the street, your CVS or your Walgreens or whatever. BHRT does not necessarily mean natural. It means bioidentical. And many of the hormones that are available through traditional pharmacies, standard prescriptions are bioidentical. So micronized progesterone, different than progestins. And so for the pregnant woman, she's going to have a transient insulin resistance. throughout her pregnancy. That is part of a natural, normal part of pregnancy, is this sort of transient insulin resistance. We don't want it to get out of control and turn into gestational diabetes, but we want the body to have enough progesterone that it has this sort of adaptive insulin resistance. And this is so that we can grow a baby healthfully and protect the uterine lining and the implantation and then start to create that hospitable little lovely sack of growth for the infant, for the fetus. So this also happens transiently when we get that big progesterone push in our luteal phase. That's where we get that gut right before our period for some of us. And this is also happening when we take too high a dose of HRT. progesterone. So that's happening. That's real. And it sucks. There's a couple different mechanisms here. It's basically, it's not directly inducing an insulin resistance. It's just sort of roundabout creating an insulin resistance state in the individual. And so that is why we crave the carbohydrates. That is why we turn into little carb piggies. And that is why we get a gut pretty quickly. And when you get a gut, I want you to think insulin resistance. If you are going through a really stressful period or what have you, and you all of a sudden develop a gut, that's probably some transient insulin resistance. I'll be honest, I didn't always think about what was in my protein powder. I just cared about the macros. 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And it's really easy to use. There's no freezer or prep or slime, unlike raw dog food, which just totally grosses me out. You just scoop it and feed, which is really nice when it comes to having dog sitters or the fact that I travel. They don't have to deal with raw food. Make the switch to Sundays, go right now to sundaysfordogs.com forward slash DrTina30 and get 30% off your first three orders, or you can use code DrTina30 at checkout. That's 30% off your first three orders at sundaysfordogs.com forward slash DrTina30. sundaysfordogs.com forward slash DrTina30 or use code DrTina30 at checkout. Then there is a second piece to this. When you take oral micronized progesterone. And it was Dr. Felicia Gersh who turned me on to this. And she's spot on. When you take oral micronized progesterone, it goes through first pass in your liver, meaning your liver metabolizes at first. It doesn't just end up in the bloodstream. And in that process, progesterone, a huge amount of it gets turned into allopregnantolone. And allopregnantolone is that neural calming agent. It's the reason why when you take oral progesterone, you get this awesome anti-anxiety effect. You get calm, you want to sleep. In fact, I will give patients oral micronized progesterone and I will say the first few times that you take it, I want you to be ready to fall asleep because you will want to lay down and fall asleep potentially. And this impact is stronger and weaker in different women. It depends on the woman. I have a great response to oral micronized progesterone. I get a nice allopregnantolone impact. The more I take of it, the stronger it is. It's very sedating in some people. It is very calming to my nervous system It makes you crave carbs It creates a carb response So now we got two different mechanisms as to how progesterone might be potentially causing us to gain weight. So we've got this transient insulin resistance induced, and then we've got this allopregnenolone driving like a carb. I don't want to say addiction, but all I could think about as my dose of progesterone went up was carbs. I just wanted to eat carbs. I wanted bread. I wanted savory. I wanted popcorn. I wanted crunchy salt. I wanted carbs. And that is not normally my style. So, I mean, who doesn't love a good carbohydrate, but not to the point of like, oh, hey, I think I'll sit down and eat this. My husband makes these great potatoes on the skillet and they are so delicious. And normally I'll have a few bites, but I wanted to eat the whole bowl of potatoes. That's not normally my style. So we've got allopregnant alone, we've got progesterone doing its thing that it's supposed to be doing, and we might end up gaining weight. All right. Some of you in the eat less, move more, just have more willpower group are going to say, well, just control that. You can control that. Okay. Well, it only happens when my progesterone's too high. It's like a hedonic craving and it's out of control. And then when the progesterone is lowered or removed, it goes away. So this is where the calories in calories out model starts to stumble a little bit because we're looking at women who don't normally behave this way. I remember when my mom was going through menopause and my dad was like, it's incredible how much food your mom eats. And my mom was gaining a lot of weight. My mom gained a lot of weight through menopause. And my mom had always been a tiny little thing. She ate like a bird. She truly ate like a bird. I mean, it was not great. She definitely needed to eat more, but she just had a ravenous appetite after menopause. And my dad was shocked by it. And I remember thinking way back then, I'm like, that's got to be the hormones. There's something here. And she was on HRT. I don't think they were quite as elegant about it back then. She was on HRT back then, but they were using a lot of creams and topicals and And creams can get, it can get messy with creams because they can really, they just kind of glom up in your fat, if you will. And so you get aberrant release into your bloodstream when you start glomming up and increasing levels in the adipose tissue. And it's not necessarily getting into the blood. So something to think about, at least with oral, we could assume it's getting to the blood faster, but we're also having to go through the liver. who knows how much of that's going to get turned into allopregnenolone. But allopregnenolone sits on those GABA receptors in the brain, and it's lovely, but it also can make you really crave carbohydrates. They say it doesn't necessarily increase hunger, but for me it did. And then that hedonic drive towards carbs, that's all I can explain. It's like hedonic carb-seeking behavior. It's really insane. And then with estradiol, which is what I generally prescribe for women, I'm not a big fan of Premarin. I'm a fan of using estradiol, which also is bioidentical. I like to use a cream, a topical, or a patch. And there's gels, there's pellets. I'm not a fan of pellets. Anyway, estradiol, it's this Goldilocks U-shaped curved. We don't want it too low. We don't want it too high. And like I said, when you're in perimenopause, it's kind of all over the map, right? Some months your body's making estrogen, and some months it's not. And I've done other podcasts in the past where I've talked about estrone. When you're just in a nutshell, when your ovaries go offline and you stop producing estradiol out of the ovaries, your fat will take over and your fat produces estrone, which is a different type of estrogen. I don't feel good when I have a lot of estrone in my body, but I don't feel good when I have a lot of estriol in my body either. Estradiol is really the good one. And this isn't even talking about the pathways. That's a whole other conversation. I'm going to have to put that inside a course somewhere because it can go down all different kinds of pathways once it's in your body, depending on how your body's handling it, depending on your stress levels and your gut health and your adrenal health and so many different factors. Like what you're eating, what you're drinking, what your toxicity level is, it can go down different pathways that are not always favorable. And so let's just assume if we're taking estradiol that it's going to stay estradiol for the sake of this conversation, but that's not really what happens. It kind of does whatever it wants. Anyway, too little of estradiol and you start to get flabby. You start to lose muscle tone. I'm sure this has happened to you if you've walked into perimenopause. You start to lose strength because estradiol helps with those satellite cells of your muscle. And so it helps with maintaining and building muscle to some degree, not necessarily anabolic like testosterone, but really is necessary to maintain that healthy muscle. You get lower energy expenditure. so you kind of want to go curl up on the couch and stop moving. You literally do. You have this incredible drop in dopamine as the estrogen leaves your brain and you just want to stop moving. And your pain will usually ramp up if you tend towards pain. So it's really a wicked situation because in my case, that's how I really knew I need more estrogen. I just didn't want to do anything. I wanted to lay flat on my back. I didn't want to talk to anybody. I didn't want to be social. I didn't feel good. And when they take the ovaries out of rodents, they go in the corner of the cage and they hide and they get fat. That's what happens. They get a bunch of visceral fat and they hide. And so I can't imagine it's a tremendously different experience for a middle-aged woman because that's how it felt to me too. So just know that that's happening when you have too little of estradiol. But then when you have the perfect amount, your insulin sensitivity dials in because you become insulin resistant as your estrogen's leaving. You become more and more insulin resistant. And if you've heard any of my podcasts, you've heard me talk about this, but there's that sweet spot where you become more insulin sensitive as you start to supplement it back. You start to feel better. It supports your muscle. It supports your muscle synthesis and strength. You feel like moving. Your joints get juicier. You feel like being more social and going out. You feel like ambulating. You actually feel like getting up off the couch. And then if you take too much estradiol, it starts to promote energy storage. And we get back to insulin resistance. So it's like this U-shaped curve on a graph. There's like, we don't want to be over here. We don't want to be over here. And we get this rising insulin tone. It suppresses lipolysis, which is the breakdown of fat. You start to get fat gain on both sides. You get fat gain without actually taking in more calories or having your appetite increase. And I will say, it's so bizarre watching women and men, but particularly young women who haven't hit menopause yet. It's so interesting to watch them talk about menopause when they're like, well the studies show that it's you know your metabolism doesn't slow down and that's true I have said that myself and I've shared those studies but then they follow it with you just it's purely lack of muscle you're losing muscle and I'm like I don't know because when I was really in the thick of it I was getting DEXA scans and my muscle tone didn't decrease at all and I was getting fatter and fatter and more pain and fatter and more pain until I finally figured out that I needed estrogen. Like I really needed to supplement more than just sometimes. So I feel like these women in their 30s and early 40s are having some very strong opinions. And a lot of them are big names in the space and they have some strong opinions, but they haven't gone through it. And truly, until you go through it, you don't understand. Until you go through anything, you don't understand. You can talk about it. But I was that girl. I was that clinician. I was treating all these menopausal women with HRT and they would tell me all their plights. And I remember thinking, man, that sucks. Like they would tell you, I can't drink any red wine anymore because it completely wrecks me now. You know, my muscles are getting flabby. I don't know where this belly fat's coming from. And I would think, God, that sucks. I believed them. I believe they were trying hard. In many cases, they're trying 10 times harder than they were in their 40s. And it's just getting worse and worse and worse, right? And so I think it's pretty unfair for some of these big voices to be like, oh, you just have to train harder. I'm like, okay, well, we'll see how you do when you're 50. That said, there definitely is some muscle tone being lost. But like I just said, some of it is the actual estrogen leaving the body. So you're training harder and it just doesn't want to lay down. You're eating all the protein. It just doesn't want to lay down and stay. It's called hard gaining. It's harder to gain when you're suddenly there. All of a sudden, your butt deflates, your thighs deflate, and you're like, why is all of the fat mass coming onto my midsection and my arms and legs are getting skinnier? That is the insulin resistance happening, but that is also due to the estrogen leaving. And so this is where I'm a huge fan of getting your hormones tested and treated before you think you need to. This whole waiting until menopause and a full time period after the last menstrual cycle, I just think is unethical and cruel and unnecessary because there are good studies coming out showing that getting to this sooner than later is better. There is a window. There's a magic window for sure. That doesn't mean you're screwed if you miss the window, but there truly is a magic window. And that is before you completely stop menstruating. Start sooner than you think you need to and get this handled because the minute that visceral fat starts happening and that belly fat and you're losing muscle and you're trying, man, you're trying as hard as you can. And you're listening to influencers tell you to try harder, just work harder. It's really frustrating and defeating. And I am guilty of that. I was that girl too, way back when. I'm like, oh, just work harder. You can do it. And sometimes working harder just cranks up your cortisol and then you gain more weight. It's a vicious cycle. This is why I'm such a huge fan of true microdosing. Not this nonsense that you guys are getting fed by the large majority of people online, but true microdosing, subclinical dosing. And it's not for weight loss. It's for metabolism management. But that is another topic for another day. All right. So we get this rising insulin tone and the suppression of lipolysis when our estrogen gets too high and we get this creeping visceral fat gain and insulin resistance when our estrogen is too low. So here's the sweet spot that we got to find. And it's way easier said than done. It's challenging. So I'm giving my body grace and just allowing, if I'm going to carry around an extra 10 pounds, my labs look good, I got a little belly fat, oh well. It is what it is. I don't have my washboard abs anymore, but my goals are different now. My goals, I truly, at the end of the day, I cannot express to you enough, having lived with the amount of chronic pain that I have lived with in the past five years, the fact that I am mostly pain-free, and it is down to a dull roar at this point, back to the dull roar it was. I've been living with chronic pain since my daughter, I was pregnant with my daughter. But hormones, hormones. But it is so much more manageable and better in Arizona. And I'm so much more active here because I want to go outside because it's lovely out. And I will trade that any day for the bikini body that I used to have. It's fine. My husband thinks I'm hot no matter what. So that's all that matters. Okay, so what else do I want to tell you about this? there is a combination where your estrogen is too high and your progesterone is too high. And I think that people probably hit this more often than they think they do. I'll be frank with you. I know that there's several practitioners out there, people I respect dearly and some of them are very good friends of mine. And I believe them. I do. I believe them. Their argument is that unless we can get estradiol levels to a certain level on labs, we're not protecting the bone appropriately. We're potentially not protecting the cardiovascular system efficiently enough. I believe you. But as a low hormone girl, as a girl who doesn't feel good with too much hormone in her body, I can't hang that way. Like I can't ride that line. I cannot dose myself to the point where my labs look perfect because I usually have a ton of side effects by then. And we have to consider too that too high of estradiol can mess up thyroid site binding. Too high of estradiol can mess up cortisol signaling. Too high of estradiol can drive autoimmune disease. The very simplistic version of that is progesterone protects against autoimmune disease and estrogen may drive it. This is why we don't want an estrogen dominant state. But depending on how a body is synthesizing and processing that estradiol, maybe my labs look great. And I'll say this, every time my labs have looked, every time the practitioners have gone, oh, your estradiol is perfect. I felt like complete and total shit. So I just, I can't ride with that. Like I am not gonna tell you guys that. I'm gonna tell you what I tell my patients, which is always symptom relief. And there's also some people online who say the answer is always more, more, more, more. And they are taking copious amounts of estradiol and copious amounts of progesterone. And the solution is always for them more, more, more. And some of these women are very, very thin and have incredible physiques. and I honor that, but I can't do it. I cannot do it. I blow up like a balloon. And I think that a lot of you might actually be in that camp too. I know this because I see it with patients and I know this because I hear it from you guys. So if you are just being told to take more and you're feeling worse and worse and worse, please listen to your body. There is a sweet spot where you will feel good. And my background was predominantly in pain, right? I was treating people with HRT primarily from the standpoint of trying to reduce their pain. They were coming in for musculoskeletal complaints. I was using HRT in that capacity. And so my version of what's the perfect dose is where was their pain decreased? Because for me, when I'm in that sweet spot of estradiol dosing, my pain goes away. When I take too much estradiol, when I take too much testosterone, my pain goes through the roof. When I am too low, my pain is crippling. So the answer for me when a patient would say, well, are my labs good? Should I increase my dose? Should I lower it? I'm like, how do you feel? How's your pain? And migraines are a big one. Any joint pain, spinal pain, hip pain, you name it. If you're having pain and you're utilizing HRT and your pain goes down on HRT, then we find the perfect dose that keeps your pain down. we don't keep escalating you because we need to hit a certain mark on a lap I hope that makes sense because there's so much noise out there right now in the HRT space and I can imagine it's so confusing for all of you it's confusing for me and I'm friends with a lot of these people and they are like I said brilliant minds but I just can't I can't jive with that so I'm not going to tell you guys that either I want you to feel good where you feel good, where you feel juicy where your pain is low, where your mood is good where your libido is good, and truthfully, where your vagina is happy. That's a huge one because I've had great markers on labs. I've had all of those things in line, but I had no libido and my vagina just wasn't like, you know, she wasn't doing her thing as well as she could. So these are factors. Sleep, where's your sleep at? If your sleep is solid, then we have to look at that. And that might be one of the bigger indicators that we finding that sweet spot for you right So consider this And again this isn medical advice This is just how I do things And I just I look at the internet as an observer and I just am so, I'm so frustrated for you guys because it's, have you seen those reels where it's like the life of a biohacker? It's like, don't eat this, don't eat that. Eat this, don't eat that, you know? And I can imagine you guys are so confused. I know I keep saying this every episode. Because I'm getting confused out there. And holy smokes this week, right, guys? This whole, I don't even want to get into it. But let's just say if you think that an influencer is creepy, then trust your gut. Because I thought he was creepy. And I've never been a fan. And then comes out, he's on the list. So just unfollow the people that don't make you feel good. If I'm on that list, then unfollow me too. It's okay. So there's another layer I wanted to just quickly discuss, and that is your mitochondrial health and your redox capacity. Basically, what can your mitochondria handle? What can your pathways handle? What are the cofactors that are available? And those would be the nutrients that you are consuming or might be deficient in. And so if we are driving pathways, because hormones are signalers. They're not, that's it. Think of them as less signal. They're a spark. They're a signal. And so if we're not supporting the mitochondria, which is where hormonal biosynthesis takes place, and we are driving pathways too hard, and our redox modulation is all screwed up, we're going to have a hard time processing and handling those hormones. And so that matters too. Your terrain matters. Your gut health really matters. And your mitochondrial capacity matters when you start throwing hormones and peptides at the situation. And then lastly, your muscle. So your muscle is the primary target tissue of insulin. And we want as much muscle there to hear it as we can, right? We want to build that meat suit so that we have that sink. We have that glucose sink. The other thing is that when we exercise, we spark different pathways that will protect us against the potential transient insulin resistance that these hormones might be inducing. So said another way, you're taking HRT and maybe it is making you a little bit insulin resistant. This is why I'm adamant that you strength train when you do peptides or HRT. I'm adamant about it. It's bewildering to me. It's bewildering to me to see sedentary women take hormones and expect them to go well. And it's bewildering to me to see sedentary women take peptides and expect it to go well. like it's these are just signalers and they can't do what they're supposed to be signaling efficiently if you're not moving and so you have to move if you this is why I say if you're going to go on the GLP-1 journey you have to take that as an opportunity and this is non-negotiable you have to take this as an opportunity to really get on that horse and figure out a way to implement those lifestyle changes as part of the journey because they cannot do the heavy lifting for you you literally have to do the heavy lifting like literally you have to pick up heavy shit and put it down you have to do the heavy lifting you have to move you have to keep that going and I've done this to myself you guys I have been in those positions where my workout routine got off thrown off or I wasn't able to keep a regular schedule for whatever reason or my stress got too high what have you and it all goes to hell in a hand basket pretty quick for me whether I'm utilizing peptides or I'm using utilizing HRT I would highly encourage the two together. We are just seeing study after study come out in support of that being. And I tried to introduce this concept back in 2023. I was like, this is the triad, strength training, HRT, and the use of a GLP-1. You can't have one leg of that stool taken away, or it will fall over. So think of it that way. But it's non-negotiable. So if you're on HRT, and you're not exercising, I think you're just missing the boat in a lot of ways. And it might potentially start sending you down pathways you don't want to be going down. And if you are rocking a lot of adipose tissue and you're sedentary and you expect HRT to do anything for you or peptides for that matter, I think you're really shooting yourself in the foot. You got to move. At the very least, you got to move. And no, you don't have to go lift a bunch of heavy weights in the gym. And what is heavy? Heavy is what is heavy for you. So it really helps if you can work with somebody. If you can't work with someone, start with walking at the very least, but you got to get moving. And Pilates is not enough. Pilates is amazing. I love it. I have two reformers. I have one in each house. I love Pilates, but it is not enough. And we have to have some capacity to lift heavy shit. And that's really important. So it has a lot to do with our central nervous system. It has a lot to do with metabolic pathways and how your body runs. It has a lot to do with that strength training really sparking and igniting the whole fire inside so that these peptides and hormones hit right and land right and process right. That is the most elementary way to explain it. But there's just no version where this is all going to go optimally or even well. I can't tell you the amount of times patients just didn't listen to me. They just want the peptide. They just want the prescription for the HRT. They get what they want and they make all the promises and then they bonk. And when I say bonk, I mean, it's about a 90-day window. You're like, I feel great. And then you hit the wall or you crash and burn. And I've done it to myself on repeat. And it's, you know, you're going along and it's just not working anymore. And there's really nowhere to go. Like doctors will tell you to take more or try harder, you know. Gym bro guys will tell you to try harder. Doctors will tell you to take more. And neither to me is the solution. The solution is your lifestyle factors and a huge one being your exercise habits and your strength, your overall muscle mass, all of it. A quality, I should say. The quality of your muscle really matters more than the size. You don't have to get bigger and bigger and bigger. Some of you need a lot of muscle to put on. But a lot of folks just really need higher quality, less pathologic skeletal muscle. And when you're in that metabolic compromise state and you think HRT is the answer, you've got 30, 40 pounds, maybe more, you're metabolically compromised and you keep seeing all this stuff on the internet about estrogen and HRT, you finally get your prescription and then you wonder why you feel horrible a few months later. and I hear from you guys all the time. People are constantly messaging me like, I can't handle it. I'm like, well, I can't help you because that's a long conversation that would require probably a two-hour intake and a lot of labs for me to look at everything and say, this isn't why it's working. But I can pretty much ask you, are you going to the gym regularly? And if you say no, I'm going to point to that first. And it's not try harder. It's just do the damn thing that makes it all work better. It would be like if you had a really awesome car and you had an awesome engine and you had an awesome chassis and you had awesome wheels and tires and everything was awesome and it was built for speed. But then it sat in the garage for 10 years and the gasoline got old and the oil got sludgy. And then the spark plugs or the, I don't even know, I don't know anything about cars, you guys. Alternator didn't work, whatever. My husband knows how to rebuild engines. But it would be like if that spark was gone, like you didn't have the whatever it was that made the gas ignite. And then you've got sludgy old gas that's not working and sludgy old oil. And so you can, you know, change all that out. But then you just don't run the car and you let it sit for another 5-10 years in the garage. It's all going to goop up again. And this is what we're doing with our bodies. And then we're throwing expensive peptides and hormones into them. And they're going down crazy pathways. And we feel like shit and we don't know why. usually people are taking, in my opinion, like copious amounts of things. And I heard of somebody the other day, they were taking like three different hormones and six different peptides. And I was like, what is going on? What are you doing? It's not work harder. It's just work consistently. That's the mind shift I want you to have. It's just put in consistent effort every day versus work harder. It's a very different kind of way of thinking about it. And you don't have to, you just don't have to crash out at the gym. Like you don't have to go as hard as some of these people are saying. Some of the big names in the space are just telling you to increase intensity, increase intensity. And I'm like, dude, I'm 52 years old here. By next week, it's my birthday. And like intensity is not on my radar right now. I am in the soft phase of my life. I need to quit cranking the cortisol and living off of copious amounts of it. And I need to chill the F out so that my hormones can actually be in some degree of harmony and stop going down pathways that aren't ideal because cortisol will drive you that way too. And so when this try harder motto, this intensify things, that really is going to start to crank the cortisol. And the cortisol is not our friend when it comes to all of this, to things working properly. Okay, what else do I want to tell you? So just to sort of recap, progesterone has important effects on carbohydrate lipid and protein metabolism. It induces this sort of roundabout hyperinsulemia, which is increased insulin. It has some direct action on our pancreas and our liver. And it has this antagonizing effect on our muscle, getting that GLUT4 receptor up to bring in the glucose. but basically just understand that its job is to deposit body fat so that we can have a baby. That's really what it's there for. It does work in the brain. It's a neurohormone, but that's predominantly through it turning into allopregnenolone and that allopregnenolone in and of itself induces carb drive, hedonic carb drive. So there's that piece. And then just remember estrogen, Goldilocks, U-shaped curve. We don't want to be down too low. We don't want to be too high. There's a spot where everything's just sweet and nice and happy. Down here is insulin resistance, up here is insulin resistance. And then testosterone, just real quick, like I said in the beginning with my own personal story, is if you've got visceral fat or belly fat, or you just happen to be built, this is just how your system drives, it can turn itself through the aromatase enzyme into, which is present in your visceral and belly fat, that aromatase enzyme will convert it into estrogen. And now you've got extra estrogen that you weren't necessarily planning on. And that, again, I'm not even getting into what's happening downstream. If you tend towards estriol, when you bring in estrogen and that pathway is driving that 16 hydroxy pathway is driving you to estriol, you're going to end up with estrogen dominant symptoms, but you're down here with estrogen deficiency symptoms too. And that's why you're taking the estradiol supplementation. If you're going down the 4-OH pathway, that's not good. That's the cancer pathway. If you're going, you know, if you don't methylate right, there's just different factors here. We usually use a Dutch test to look at that. So it's not just what the serum labs say on the front side of like, oh, do you have enough in your body? It's what is your body doing with it? that also matters too. All of this gets better when you exercise. All of this. Everything I just said does better when strength training and walking and regular exercises on board. You don't have to kill yourself. You don't have to turn into a sweat angel every workout. I can't tell you the number of middle-aged women. I had to tell them to pull back, stop with the intensity, get out of the orange theory, get out of the boot camps, get out of the CrossFit gyms that are just driving you into the ground. We need consistency, we need movement, and we need to get that spark going so that all of it works better and harmonizes in a really beautiful way. That's the most important piece. And none of this is going to go really well if you're rocking a lot of pro-inflammatory adipose, you're metabolically compromised, and you're not moving. And that's not even to say what people are eating. I didn't even address that. But your diet obviously has a lot of impact here. Okay, so that's it. That's in a nutshell how HRT could potentially be causing you to gain weight. And also conversely, potentially why it's not helping you lose weight when you go on it. Don't assume that it's going to be a natural weight loss aid. Some people lose weight. I would say the majority of patients do not when I put them on it. The majority of patients do not gain weight either. So I'm not trying to scare anybody off, but I wanted to explain what could be going on for you if it is. If you're not tolerating it well, and I'm not talking, there's progesterone intolerance and there's some other symptomology I didn't address here, but I just mean basic metabolic health, metabolic pathway signaling, insulin signaling. HRT can definitely contribute to the problem. But if you strength train and if you get that dose right, you're going to mitigate a lot of that. And so that's why it's absolutely necessary and critical that you go to the gym. So I'm going to leave you with that. I hope this is helpful. As always, if you guys like this kind of stuff, let me know. Rate, review, subscribe. Leave me a comment on YouTube. Come follow me on YouTube as well. I'm partial to Apple Podcasts if you want to head over there and rate, review, subscribe. I'm also on Spotify, I think is another one, but it helps get the word out. It helps the podcast rank higher. It helps more people see it. Your comments really help. It helps direct. I know you guys like to hear a lot about peptides and hormones and HRT and all the things. So I'll continue trying to come up with unique ways to deliver you information on those topics that maybe you haven't heard before. But at the end of the day, it all comes back to metabolic health. It all comes back to lifestyle. It all comes back to terrain and foundations. So I will see you guys on the next one. Thanks for listening to the Dr. Tina show. This is a wellness loud production produced by Drake Peterson. Theme song is by John the guilt. You can watch the full video version of this podcast inside the Spotify app or on YouTube. As always, you can email the podcast at podcast at Dr. Tina.com. That's D R T Y N A. And if you like this episode, please rate review and subscribe on your favorite podcast app. You can also find all of my offerings on my website at drtina.com. For more shows by my team, go to wellnessloud.com. See you next time. And thanks for listening. This podcast is for general informational purposes only. It does not constitute the practices of medicine, nursing, or other professional healthcare services, including the giving of medical advice. I am a doctor, but I am not your doctor. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is intended not to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. If you struggle with bloating, gas, constipation, digestive issues, yeast overgrowth, well, you may already know about Digest This. 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