EP 674: "That's What She Said:" In Your Menopause Era? Tune in to Discover the Impact of Hormone Replacement Therapy on Women's Overall Health and Sexual Function

In this "That's What She Said" episode, Dr. Mistry and Donna Lee are joined by Dr. Larissa O’Neill of Bespoke Medical Aesthetics and Wellness in Georgetown, TX to discuss the importance of hormone replacement therapy in peri- and post-menopausal women. Despite the myths surrounding the use of estrogen and other hormones, supplementation improves overall health and maximizes sexual function in women. Hormone replacement has been shown to lower the risks associated with bone mineral density loss,  heart attacks, and Alzheimer's disease. If hormonal changes associated with aging have left you feeling "crazy," tune in to learn the pros and cons of each therapy. To schedule your consultation with Bespoke Medical Aesthetics and Wellness, call 737-275-0725 or visit them online today! 

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 3: 0:15

Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery , your host Ford certified urologist and all around great guy, great guy <laugh>. I'm also the founder of NAU Urology Specialist. That is the urology group that I started in 2007. We have six urologists. We have a interventional radiologist who does prostate artery embolizations. We have , uh, six advanced practice providers, two pelvic floor physical therapists. We have a sex therapist in house . We have a health coach in house . We do in-house sleep apnea testing. We , uh, we have a practice that I'm extraordinarily proud of, providing holistic urologic care, and I'm joined by my co-host Donnel Lee . Hey everybody,

Speaker 4: 0:54

Welcome to the show, and thank you for tuning in and sharing with your friends.

Speaker 3: 0:57

Donna, you add a lot of flavor to this show and to our practice. End of my life. Thank you so much.

Speaker 4: 1:01

You're welcome. A little spice, little spice it up. Little spice . A little Thai spice . Little Ty spice . You're welcome.

Speaker 3: 1:06

How do people get ahold of us?

Speaker 4: 1:07

You can call us at (512) 238-0762 . We're in Round Rock North Austin, south Austin in Dripping Springs, Texas. Our website is armor men's health.com. That's armor men's health.com. Isn't it better when I sing it? It is

Speaker 3: 1:21

Pretty

Speaker 4: 1:21

Good. Okay. You're welcome all and , uh, send us your questions. We answer them anonymously on the show. You can send those questions to armor men's health.com. There's a little button at the top right that says, submit your question here. So please reach out to

Speaker 3: 1:34

Us. You know what we haven't done in a while.

Speaker 4: 1:36

Uh, something dirty. No ,

Speaker 3: 1:37

Uh , that's what she said. State segment . That's,

Speaker 4: 1:39

That's what she said. That's right. We have great segments.

Speaker 3: 1:42

We are joined today by Dr. Larissa O'Neill from Bespoke Medical Spa in Georgetown, Texas. Thank you so much for joining us, Dr. O'Neill. Thanks for

Speaker 5: 1:50

Having me.

Speaker 3: 1:50

So , um, we have a lot of listeners that are women. Okay. And , uh, and you know, although this is a men's health show, I really came into town really being a proponent for female sexual health and female hormones. That's how I actually got started in my own practice. And , um, but men's health is kind of what most people associate with urology. Yes. Uh , you're a family practice , uh, physician and, and you've kind of really leaned into this whole topic of hormone treatment. Yes . And I thought maybe we could talk a little bit about what are the common myths and obstacles to hormone treatment in women, and what are some of the best options that women have for treatment? So first, well , why don't you give us maybe some background on the history of hormone replacement, like in the 1950s and sixties, <laugh> . Oh,

Speaker 4: 2:36

No. What did ,

Speaker 3: 2:37

What did all of our grandmothers do? Don't

Speaker 4: 2:39

Put her on the spot.

Speaker 5: 2:40

<laugh> . Actually, it's really interesting. I had recently listened to a couple of podcasts by Peter Atia , one of which was specifically on female health. And another one, which was a reevaluation of the Women's Health Initiative study. Women's hormone replacement prior to the Women's Health Initiative study was pretty basic.

Speaker 3: 3:00

Everybody did it .

Speaker 5: 3:01

Everybody did it. Everybody got estrogen, everybody got progesterone. If you still had a uterus, testosterone not so much, but definitively, estrogen and progesterone. And we all, all physicians really knew the benefits in terms of not only improving women's sexual health, but also just overall health in terms of protecting the brain and the bones and the heart. And overall , um, I'd say mental sanity.

Speaker 3: 3:25

So for some of our, like male listeners, yes, women have a pretty intuitive knowledge of what's gonna happen when they go through menopause. What , what for the male listeners, what, what , what's, what's gonna happen? Like, like , like , like what ? Like what , what's gonna happen to our wives?

Speaker 5: 3:38

Your wife's gonna go crazy. <laugh>. Um , really ? But there's medicine for that. There , there's medicine for that. It's, it's a really hard time for most women. And, and I, I joke that women are gonna go crazy, but I have a lot of women that come in and say to me, I feel like I'm going crazy. Mm-Hmm. <affirmative> , because you feel bad. You don't feel like yourself. You don't feel like you can do your normal things during the day because your brain's not functioning right. You're getting these crazy hot flashes and you're getting night sweats and you don't feel like yourself. Um, so they come in and they, they literally say to me, I feel like I'm going crazy. I don't know how to deal with this.

Speaker 3: 4:13

And over time, these, the loss of the estrogen and the loss of the normal hormones will cause bone mineral density loss. Yes. It can lead to increased risk for stroke and heart attack. Correct. What , what else can , what else can loss of estrogen lead to?

Speaker 5: 4:27

So Alzheimer's is a big one , um, in terms of, of how well both estrogen and testosterone protect the brain. When I talk about brain health with women, estrogen goes to a very specific place in the brain to help us kind of stay happy. And so when it goes away, losing your mental clarity is, is a big one. So really, brain protection is another really important thing for women when you lose estrogen.

Speaker 3: 4:51

Do you think grandmothers in the fifties and sixties had more sex and were more spry than, than than grandmothers? Like say in the nineties when, when estrogen use became less common?

Speaker 5: 5:01

Oh, I think so definitively.

Speaker 3: 5:03

You think that like, I mean, just , just Mm-Hmm . <affirmative> kind of the quality of life experienced by the 60-year-old and older woman in this country probably diminished.

Speaker 5: 5:12

Absolutely. Mm-Hmm . I think there's a whole generation of women that have had a really poor experience

Speaker 3: 5:17

With aging.

Speaker 5: 5:18

With aging be specifically because of the, the lack of hormone replacement due to the, the women's health initiative study.

Speaker 3: 5:24

So now briefly discuss what the Women's health initiative study and h and , and , and why it created a sea change , um, in terms of , uh, our opinion of treatment of women's hormones.

Speaker 5: 5:36

So the Women's Health Initiative study came out right when I started practicing failing practice. Um, and they had three arms where they looked at estrogen only replacement, estrogen plus progestin replacement and placebo. And they stopped the study early because the primary investigators said that there was an increased risk of breast cancer. That was the main reason that they stopped it. And since then, every physician that was practicing around that time, and every woman probably that was alive then has heard estrogen causes breast cancer. And

Speaker 3: 6:14

It's so pervasive. Mm . Yes . Mm-Hmm . <affirmative> , like I talked to OB gynecologist that still tell their , still tell their patients this . Oh, wow. And I'm like, you don't read nothing.

Speaker 5: 6:23

<laugh> . I know there's an amazing book called Estrogen Matters. Mm-Hmm. <affirmative> . And they really go through all, they go through the Women's Health Initiative study why it was, why the findings were not what they were, what everybody was told. But they also cite all of the other studies that are out there that really prove that estrogen is good for you . Estrogen actually helps prevent , uh, everything that the Women's Health Initiative study said that it didn't like heart disease, stroke has heart disease, stroke , breast cancer, women Alzheimer's women who are on hormone replacement actually do better if they get diagnosed with breast cancer. They have less invasive breast cancer. They, they have lower mortality. Wow . So it , it really was a disservice. And it's , um, I actually can't believe that we actually practiced medicine the way we, I remember when somebody came into my office and said, there's now a black box warning on all hormone replacement for women. And you have to have them sign this piece of paper that says that they agree to the risks.

Speaker 3: 7:17

Wow. In men, we have the same problem with testosterone. Testosterone, yes . And prostate

Speaker 5: 7:20

Cancer. Cancer with the prostate cancer and cardiovascular

Speaker 3: 7:22

Issues. Yep . And so, as smart as doctors purport that they are, we really are often times swayed by the New York Times more than the Yes . Journal of the American Medical Association, believe it or not. So, you know, even, even we are subject to common conventional wisdom, you know, purported by the media. Mm-Hmm. <affirmative> . But when it comes to hormonal health, I , I you've picked up right on it. I think there's a whole generation of women that really missed out on aging properly . Yes. And I think there's a whole generation of men that naturally assume that 60-year-old women don't want to have sex with them.

Speaker 5: 7:53

Yes. Because they don't, because they don't have estrogen or testosterone.

Speaker 3: 7:57

Precisely. Precisely.

Speaker 5: 7:57

And it , and it's not comfortable to have sex if you don't have estrogen.

Speaker 3: 8:00

And we talk, you know, we talk about all the time , uh, the 90-year-old guys that come in are confused that they don't have erections. Right. And I'm confused. They have somebody to have sex with. <laugh> . Yes. <laugh>.

Speaker 6: 8:13

They're a 60-year-old life . He doesn't wanna

Speaker 3: 8:14

Have sex. Wait a minute. What ? What's happening? Imagine that. You know, and , uh, and , and we see it younger and younger and, you know, my my generation , uh, even those of us in our late forties, early fifties, still many doctors are not doing hormone replacement. Yes. It's considered bougie. It's only done in med spas like you have. Yeah. And it's, it's so silly that it isn't commonplace. Uh , it is . And I think that because of that, the options that women are given are incredibly limited. Mm-Hmm. <affirmative> . So we talked about estrogen just briefly. You feel that there's also a role for testosterone replacement in women as well ? I,

Speaker 5: 8:50

I do. Yes.

Speaker 3: 8:51

Biologically what's happening in menopause that's causing this hormones to go away?

Speaker 5: 8:55

So our ovaries decide they don't wanna produce hormones anymore. 'cause they're aging. I mean, it's, it's, it is unfortunately an organ in the female body that shuts down.

Speaker 4: 9:04

'cause you're not having a baby anymore.

Speaker 3: 9:05

Right. I mean , uh, uh, our bodies are so interesting. Yes . Mm-Hmm . <affirmative> Once , once we are no longer deemed to be a reproductive animal. Mm-Hmm. <affirmative> . Yes. Everything goes away. Right ? Yes. And same in men. Like, once the prostate's like, well, I guess I'm not here to feed any sperm anymore . Right . I'm just gonna turn into cancer. Right. You know? Um , and so keeping a, an active life, you know, one full of sexuality, I , I think is something that is important to making our body keep living in a normal state. Yes.

Speaker 5: 9:34

Absolutely.

Speaker 3: 9:34

So why, why testosterone? So

Speaker 5: 9:36

Testosterone's, actually the hormone that women produce the most of over the course of their life. If you really look at, at the numbers side by side of estrogen, testosterone, progesterone, testosterone's, the one we produce the most of it is very important for muscle health. It, it helps improve bone health. It again, helps with brain health. It's a naturally anti-inflammatory. It's a vasodilator. It does all kinds of great things for us. So when it goes away, we don't feel very good.

Speaker 3: 9:59

Well, thank you so much for giving us such a, a great background on where hormones were and why hormones are important. In the next segment, we're gonna talk about how we replace hormones frequently in women. Thank you for joining us for this. That's what she said . Segment <laugh> . Dr. O'Neill, how do people get ahold of you and become your patient?

Speaker 5: 10:18

So we are in Georgetown. It's bespoke medical aesthetics and wellness. Our phone number is (737) 275-0725. And we'd love to see

Speaker 3: 10:27

Donna, how do they get ahold of us?

Speaker 4: 10:28

They can reach out to us by calling it 5 1 2 2 3 8 0 7 6 2 and visit our website, armor men's health.com.

Speaker 3: 10:35

Hello and welcome back to the Armor Men's Health Show. I'm Dr . Mystery , your host, board certified urologist and founder of NAU Urology Specialists, where we do men's health and wellness. We do all sorts of urologic interventions and we do an incredible job with testosterone replacement in both men and women. Donna Lee is my co-host and she joins us again today. Thank you so much for being here, Donna.

Speaker 4: 10:57

That's right. Thank you guys for listening. We appreciate

Speaker 3: 10:59

It. You really helped put together a great show. Very informative. We get so much great feedback from our, from our listeners.

Speaker 4: 11:04

I'm what they call a behind the scenes kind of gal.

Speaker 3: 11:07

Way behind <laugh> . That's

Speaker 4: 11:08

Right. I'm so behind that. I can't you way behind . I can't even hit the buttons right sometimes. So

Speaker 3: 11:13

How do people get ahold of us and become our patients ? That's

Speaker 4: 11:15

Right . You call us at (512) 238-0762. And you can reach out to us through our website, armor men's health.com, where you can submit your questions that will answer anonymously. We're located in Round Rock, north Austin, south Austin and Dripping Springs, Texas. Like we always joke, they're still trying to keep things dripping. They

Speaker 3: 11:32

Have treatment

Speaker 4: 11:33

Dripping, but we're trying to undrip the things that they're dripping.

Speaker 3: 11:36

So we're gonna continue our That's what she said segment . That's

Speaker 4: 11:39

What she said

Speaker 3: 11:40

With Dr. Larissa O'Neill from Bespoke Medical Aesthetics and Wellness in Georgetown, Texas. Thank you so much for joining us today, Larissa. That's right .

Speaker 5: 11:48

Thank you for having me.

Speaker 3: 11:49

So, you know, we see medical spas out there. Mm-Hmm. <affirmative> . And I guess people might be surprised there's really a doctor behind it. There

Speaker 5: 11:57

Is. Or there should be. There should be. There should be. There should be . What are the rules? That is the keys . There should be, what

Speaker 3: 12:01

Are the rules about medical spas? So

Speaker 5: 12:03

It's really interesting. I've learned a lot over the last five years. Med spas are supposed to be physician owned in the state of Texas. Texas is a lot of times the wild, wild west when it comes to med spas. You know, I can delegate to anybody. I could delegate to my front person to inject if I wanted to. That's stupid. Mm-Hmm. <affirmative> . Um, but you can, so there are regulations. They are supposed to be physician owned . There are supposed to be physicians or advanced nurse practitioners. PAs there, when you are doing medical procedures, a lot of med spas don't function that way. We do. I am there. My nurse practitioner is there. We don't

Speaker 3: 12:37

Why do you need a doctor? Don't I just need a big lift ? Big boobed, Brazilian butt lifted. Uh uh .

Speaker 5: 12:42

Yeah , lady ,

Speaker 3: 12:43

I would , lady just , I would just putting needles in me. That's just for you.

Speaker 5: 12:46

Absolutely. <laugh> <laugh> .

Speaker 3: 12:49

Well , but there is a science to what's happening there. There is . And so it's important there . And , and the things that you're doing could be dangerous.

Speaker 5: 12:54

Yes. 100%. You need a science background. Definitely to do hormone replacement. And you need a really good knowledge of facial anatomy to be able to inject somebody safely. So

Speaker 3: 13:05

When it comes to hormone replacement, it's interesting that in men we have creams that we can do for testosterone. We have some pills like clomophine and even testosterone can be given orally. Now we have injections and then we have pellets. Uh , the pellets we say in men are always the best because they give you a constant level. We see a lot fewer complications. A lot. We see less increases in estrogen. We see less increases in blood count. Yes. Uh, we just see an overall better , um, kind of , uh, uh, tailored treatment program when it comes to pellets. Uh, what are the options for hormone replacement in women And , um, uh, and , and and what are the pros and cons of some of these different treatments?

Speaker 5: 13:47

So we have pellets for women as well. Everything else is, is everything is , um, in terms of testosterone, we don't have an approved , uh, testosterone. Truly approved testosterone.

Speaker 3: 13:59

It's not FDA approved in women, women to use to , to , to use testosterone. And we use the biot pellet. And depending on where you are and what your practice is , these pellets, you know, for us as a urologist tend to be more expensive to , uh, put into patients. But when you get them done from a compounded pharmacy, which is kind of off the , you know, just some one-off. Mm-Hmm. <affirmative> the pellets are not as robust, they tend to break. Right. And the , the quality assurance is not as good. And a few years ago, a whole bunch of them were recalled because of the quality control and , and sterility of them. Yes. So I stick with this Biot brand because of the integrity of the pellet. I'm not a

Speaker 5: 14:35

Sponsor by the way . I need to

Speaker 3: 14:36

What do you use, what do you use for women? Remind people

Speaker 5: 14:38

They're not a sponsor. Yeah . In case they're wondering. Yeah . Are you kidding?

Speaker 3: 14:41

Who would sponsor this thing? Nobody

Speaker 5: 14:43

Sponsors us, but yes. So

Speaker 3: 14:44

I don't wanna be chained.

Speaker 5: 14:47

Absolutely not. So I use biot pellets as well. Again, for the same reasons that you do. Do I have some women on creams? I have some women on , um, vaginal suppositories or capsules.

Speaker 3: 14:56

You'll give them a vaginal suppository for systemic estrogen. Yes. What, what do you give them ?

Speaker 5: 15:01

It's a compounded Okay. Vaginal one that I, that you can put estrogen, progesterone, and testosterone in . And you actually get very good blood levels.

Speaker 3: 15:09

All that in one, one pellet up the

Speaker 5: 15:11

In one up the hoo-ha one . And , and it , and it dissolves in about 30 minutes. Okay . Wow . Um , so I use that for, for women who don't want to get pellets. 'cause there are women who don't want them , wanna get PTs , which is fine. And I have women who don't wanna stick somebody in their vagina every night. That's fine. Like penis. Yeah, exactly. <laugh>,

Speaker 3: 15:29

Their , their tinder accounts are very unused. That's

Speaker 5: 15:33

Right . But I use creams as well. There are people who don't absorb the creams. Well,

Speaker 3: 15:38

That's the main problem with creams. Right . In men we say it all the time. Yeah . That they don't get absorbed. So it estrogen patches, estrogen creams, even testosterone creams. We have patients that just don't absorb it. Right. And progesterone can only be given orally. Only orally. Right. Mm-Hmm. <affirmative> . Mm-Hmm . <affirmative> does, does the transvaginal progesterone work.

Speaker 5: 15:55

So it's interesting. I've been using those for about six months. And you do get good blood levels of progesterone because

Speaker 3: 16:01

You would know it because they'd start bleeding. Mm-Hmm . <affirmative> . Yep . Okay. And so we give progesterone to women who have a uterus in order to be protective of the uterine lining. Correct. Because if you give uninhibited estrogen, you

Speaker 5: 16:13

Increase the risk of uterine cancer , you

Speaker 3: 16:14

Increase of uterine cancer. So Right . That is a true risk. Mm-Hmm. <affirmative> . But it , but it's completely balanced out by the appropriate treatment program. Yes . Yes. Is there any other benefit of progesterone? Because I see women who've had a hysterectomy sometimes on progesterone and, and their doctors are doing it kind of all the time. And I don't do progesterone all the time. What? It helps

Speaker 5: 16:31

Women

Speaker 3: 16:32

Sleep, it helps women sleeps, helps women

Speaker 5: 16:34

Sleep . That's what I've seen . That is the biggest thing. Most women, postmenopausal women don't sleep well at all. Testosterone can help that a little bit. Estrogen doesn't help it, but progesterone definitively will help you sleep. So , um,

Speaker 3: 16:45

We , you use pellets, you use creams. Uh, I use testosterone injections. Although in women, that's always kind of a little more off-putting than , than in men. It's

Speaker 5: 16:53

Hard. I do have some women, because their husbands have done injectables, want to do injectables. When I do injectables in women, I have them do it subq. So you get less of a, you don't get the ups and downs. You can't actually get a pretty good steady state. If the women are good about doing it, you do it twice a week. 'cause you're doing it subq and not Im

Speaker 3: 17:12

And , and and for us, for me and you, we come now from a , from an educational background in which we are trying to avoid ingesting hormone. Correct. So we're trying to avoid the ingestion of hormones that goes through the liver. Right. We're trying to eliminate liver adenomas and other things that can, that can be caused by excessive hormones done orally. Even though for many of us, that may sound like the easiest way to handle this. Right. But

Speaker 5: 17:35

Oral, oral estrogen does have other risks that transdermal do not. Do not .

Speaker 3: 17:39

And so , uh, you know, for our practice as well, we like subcutaneous pellets or, or trans or , or , or skin based things. Mm-Hmm. <affirmative> . And we try to avoid estrogen done orally. Exactly. In our , in our , in our patients.

Speaker 5: 17:50

We do too. And

Speaker 3: 17:51

So, you know, there are , we , we , we talked about the benefits. Now there's this middle of the road patient that's the 50-year-old woman who's starting to have hot flashes and their quote unquote numbers may be normal. Right. H how do we deal with those women? I mean, I'm not saying I'm married to one mm . <laugh> .

Speaker 4: 18:07

I thought you were talking about me. I was like, I'm right here. I can hear you

Speaker 5: 18:10

<laugh> . There there is literature starting to come out about low dose estrogen for those perimenopausal women. I haven't personally prescribed that for women yet. I actually have them go get over the counter estrogen, some natural form of like a yam based product to try to even them out some, because they don't feel good.

Speaker 3: 18:31

They don't feel good. But their numbers don't justify anything.

Speaker 5: 18:33

Exactly. But if you put 'em on the, on the over the counter , basically estrogen supplements, they do feel better. Okay. And you don't raise their estrogen levels significantly, but you raise them enough and you get them in kind of this low steady state that they can hang out in until their ovaries completely shut down. That's how I've handled it with those women because they're, they're as miserable as women whose estrogen is gone. And they're, they're actually on a little bit more of a rollercoaster. 'cause they have times when they have plenty of estrogen around.

Speaker 3: 19:02

Yeah. They're doing fine. Yeah .

Speaker 5: 19:04

And then they have times that they

Speaker 3: 19:05

Aren't, they get a hot flash and the covers come off and there you go.

Speaker 4: 19:08

I'm saying a lot about yams, natural yams on social media. Yeah . And I'm like, oh ,

Speaker 5: 19:12

It's , it's a thing. Well , it's , I don't think they work very well when your ovaries totally shut down. Mm-Hmm. <affirmative> . But in that perimenopausal time, I think that it is something that has been useful in my practice. Hmm .

Speaker 4: 19:22

That's fascinating. Uh,

Speaker 3: 19:23

We use estrogen quite a bit in women who have recurrent urinary tract infections. Mm-Hmm. <affirmative> , we do it quite a bit in women who have lost their libido as well as those that have problems with estrogen of the vagina and, and , and , and lubrication from a sexual health standpoint. Uh, what are some other medications or techniques that you might use to help maximize sexual functioning in a woman?

Speaker 5: 19:42

So, estrogen's a big one. Testosterone's another one. If we have women who cannot take estrogen for some reason or don't want to, and their vaginal tissues are not healthy, there are laser devices out there that can really help resurface and improve vaginal health.

Speaker 3: 19:59

I'll also use , uh, vaginal testosterone in this group

Speaker 5: 20:02

As well. Yes. And DHEA, actually DHEA. Yeah. Vaginal. DHEA works very well for keeping the tissues healthy.

Speaker 3: 20:07

Right. And uh , and if you are out there and you have a history of estrogen receptor positive breast cancer and are very concerned about vaginal estrogen, I think we both know how safe it can be. Mm-Hmm. <affirmative> and we both probably have a lot of comfort speaking with your oncologist. Yes. To make sure that you can have some return of your normalcy, which is why you went through treatment in the first place. Exactly . Not just to live, but to live. Well. How do people become patients of yours, Dr. O'Neal? So

Speaker 5: 20:31

They can call us at (737) 275-0725. You can also text that number. You can go to our website, bespoke metastatics.com. We'd love to see you guys.

Speaker 3: 20:41

Thank you so much for joining us today. Thanks

Speaker 5: 20:43

For having me. The

Speaker 2: 20:44

Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.