In this episode, I am speaking with Dr. Stephanie Gray – a functional medicine provider who helps men and women build sustainable and optimal health. We will talk about hormones and how hormone imbalance affects your energy.
Table of Contents
In this podcast, Dr. Gray and I discuss:
- Dr. Gray’s concept of maintaining your health like you would your home.
- The symptoms of hormone imbalances that affect both men and women.
- Safe alternatives to testosterone-lowering statin medications.
- Why hormone testing is so important (and what to do when your doctor says your labs are ‘normal’).
- The difference between blood, saliva, and urine testing and when to use each one.
- The #1 hormone hijacker and how to keep it from tanking your health and energy.
- The difference between synthetic and bioidentical hormones (and how each can affect your health).
- Dr. Gray’s top tips for hormone enhancement.
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Ari: Hey, everyone, welcome back to the Energy Blueprint Podcast. I am here with Dr. Stephanie Gray, who is a functional medicine provider who helps men and women build sustainable and optimal health, and longevity so that they can focus on what matters most to them. She’s been working as a nurse practitioner since 2009. She completed her doctorate focusing on estrogen metabolism from the University of Iowa in 2011. Additionally, she has a master’s in metabolic nutritional medicine from the University of South Florida’s medical school. Her expertise lies within integrative antiaging and functional medicine. She’s arguably one of the Midwest’s most credentialed female health care providers combining many certifications and trainings. And I can attest to that I was just joking with her that she has more letters after her name then I think I’ve ever seen before. So, she has also completed an advanced fellowship in antiaging, regenerative, and functional medicine in 2013. And she became the first BioTE . Is that the right way to pronounce it?
Dr. Gray: Yeah, yeah. We’re going to talk about that.
Ari: Okay, BioTE certified provider in Iowa to administer hormone pellets, also in 2013. She’s the initial author of The FNP Mastery app, and an Amazon best-selling author of her book Your Longevity Blueprint. She’s co-founder of Your Longevity Blueprint Nutraceuticals with her husband Eric, and they own the Integrative Health and Hormone Clinic in Hiawatha, Iowa. So, welcome, Dr. Gray, such a pleasure to have you.
Dr. Gray: Well, thank you for having me here. Obviously, your summit is all about energy and I believe hormones play a strong role in energy production.
Ari: Indeed. And then so yes, I should say the topic of your presentation is all about optimizing hormones and stopping hormone hijacking to improve your energy levels. So, I’m super excited to dig in with this, dig into this with you, I should say. And I had a chance to look over your slides and this is really exciting material.
Dr. Gray: Wonderful. So, I think I’d like to, I always like to be organized. So, I like to tell the audience a little bit about what they can expect. So, I want to share a little bit about my story and what got me into functional medicine, and then we can talk a little bit about what hormones do for us, why they’re so important, how they can help with energy, and we’ll talk about the secrets to optimizing hormones, how important it is to stop hormone hijacking. I think it’s really important that everyone knows their numbers. We need to have hormone levels tested to know where we’re really ranking, how full are tank is full of gas, per say. So, we’ll dive into how important comprehensive lab testing is and then we will talk about ways to boost hormones naturally. So, I want to talk a little bit about reducing stress, fixing nutritional deficiencies, detoxing the body and discuss ways for natural hormone replacement therapy. We have a low testosterone epidemic, not just in men but in women. So, I want to talk a little bit about how we can, and boost those hormones even using hormone replacement therapy.
Ari: Excellent. Looking forward to it.
Dr. Gray: So, I’d like to share a little bit about my story. So, I, usually when I give talks I like to weave in my story. So, I’ll open and close a little bit with that. So, if you can imagine me sitting in my office, I was disoriented one day. I tried using my phone to call my husband, but I couldn’t get my finger to hit that right button and I leaned back in my chair here at work and I put my hand on my chest and realized that my heart rate was through the roof. I looked at, what seemed like my office doorway but really felt like a football field away. And I knew that in that moment something was wrong with my health. I was really short of breath and dizzy, but I got the strength to walk through my door and down the hallway of my clinic and my nurse found me leaning against the wall really pale, really short of breath, and she immediately called for my husband because he’s my office manager. That’s why I was trying to get a hold of him. We together run a private practice, a functional medicine practice in Iowa. And I was at this point someone who needed help, I had been helping others, but I was now in their shoes. I needed help. And I needed help not just with my heart rate. So, I was experiencing a really fast heart rate that made me kind of disoriented and short of breath, and what not. But I was also experiencing infertility at this point. So, many of my friends were on to kid two or three and my womb was empty, and the stress of having to track my cycles, my basal body temperatures, and waking up really knowing I wasn’t pregnant was dragging me down. So, almost every doctor I went to had recommended pills because that’s what they do. They recommend drugs, adoption, or to the come to the conclusion that I may not have children. And as a practitioner trying to guide others to healing, if you really knew my internal struggle. And so, what happened is I landed at Mayo Clinical. First in the emergency room, but then at Mayo Clinic and I was offered medication to control my heart rate, but I knew that taking the medication wasn’t going to tell me why this was happening to me. That that was only going to be a Band-Aid. But this wasn’t my first rodeo because for infertility I had been recommended on fertility drugs. But drugs don’t really solve the problem and I knew there had to be more to my story. And maybe you can relate, many individuals I know are taking a trail mix of pills themselves. And maybe it’s not for a fast heart rate or for infertility, but it could be for high cholesterol, or anxiety and depression, or brain fog, or insomnia, or reflux. Maybe for irregular cycles. Birth control pills are handed out almost like candy these days. Maybe for high blood pressure, that’s very common. Or skin disorders like eczema or psoriasis, for bone density issues like osteoporosis, or being overweight, or even for fatigue. So, patients are even recommended medications to stimulate them, right, to give them energy through the day. And have you ever thought maybe there’s another way, maybe there’s a better way, maybe there’s a drug-free way. If you’ve known for a long period of time that maybe you didn’t have the answer, that maybe the Band-Aid approach wasn’t the right way for you, but you didn’t know how to find those answers, I think the summit will help because I can tell you there is a better, a drug-free way. So, through my struggles and working with thousands of patients with myself at the Integrative Health and Hormone Clinic in Hiawatha, Iowa over the past 10 years. I’ve developed a unique way of viewing how the human body is structured. So, I created this longevity blueprint to help, and really build and maintain my health because I was needing a lot of help at that point in time, and this ended up being a solution for me, and now I’m sharing it with others. So, I want to introduce you a little bit to this concept and then we’ll dive into hormones, but I think it’s important to first introduce this concept. So, as I was going through my struggle, I felt like I needed to create a blueprint, also for my patients to know all of what we could help them with at our practice. And so, I’m comparing in my book the home and how we maintain our home, to our body and how we should be maintaining our health. So, within a house, there are several key components. We have the foundation of the house, the framework, the electrical work, the doorways, the laundry room, the heating and cooling, and the plumbing, and the roof, and the same is true for our body. We have several very important key components, organ systems that we need to be maintaining. So, with our homes we spend a lot of time mowing the lawn, keeping hair out of the drains, changing the furnace filters, whatnot, but we don’t always spend time on our bodies. Sometimes we don’t even know what to do to take care of those organ systems in our body. So, within my blueprint you’ll see on the graphic here, I’m comparing each room in the house to an organ system in the body, and I’m happy to provide this to you. This is also just free on my website, if you go to yourlongevityblueprint.com, you can see this. So, essentially our organs and systems of the body work together to build our longevity. It’s a bit like building a home, you need a blueprint to ensure that every system in your body is addressed to have a long and healthy life. So, again within each chapter of my book I outline the most progressive functional medicine testing options that we’re going to talk about today. So, today will be specific to hormones. And we also talk about, I talk about nutrition and supplements, what not, within the book as well. But chapter 6 specifically is discussing the heating and cooling system in the home. So, I’m comparing this to the endocrine system within the body, right. So, kind of easy comparison to make there. In the home during your cold and hot months your comfort depends on the ability of your heating and cooling systems to regulate the temperature of the house, and similarly your body’s comfort depends on its ability to heat and cool as needed. So, that role boils down to the endocrine system, which is a network of glands that secretes hormones that are chemical messengers coordinating a wide range of bodily functions. So, if your thyroid isn’t functioning properly your fingertips could be cold, your metabolism may be sluggish, and you may feel like your internal furnace just isn’t quite kicking in. And conversely if your sex hormone levels are low you could feel like you’re burning up on the inside, having hot flashes and night sweats. So, think of your endocrine system as that heating and cooling system in your body. When this system isn’t working effectively or when your hormones aren’t balanced per se, you may not feel well. You could even be tired, just being tired could be a symptom that your endocrine system isn’t functioning as well as it should. So, every week in my office I have patients who come to me saying, seeing a functional medicine provider is their last resort because they’ve already seen their doctor and they’ve been told that they’re normal, their doctor wanted to prescribe them an antidepressant but they knew they had a problem with their hormones and they’re coming to my clinic to get them tested. And I enjoy optimizing patient’s hormone levels because usually we can get them feeling pretty quick, we can get them feeling better pretty quickly by optimizing those hormone levels.
Who is affected by hormone imbalance
So, men and women both have hormone imbalances. This is not just about women, even though I have kept mentioning hot flashes and night sweats, what-not. So, women go through menopause, but there’s actually a term for men going through this transitional period which is called andropause. Sometimes we joke around calling it manopause but really the term is called andropause. So, why do these years even matter? Well, we’re living longer than we have before and we want to increase the quality of life amongst those years, right.
So, if women are going to go through menopause in there, I see women in their 30s and 40s, but the average age is 52 and they live to be 90, right, we want to make sure we’re optimizing those years of their life. That’s 40 years. We want to make sure they’re feeling well. If you haven’t experienced menopause or andropause yet, you’re in luck, because there’s still time to improve your hormones before you go through that transitional period. Which for women we call perimenopause.
So, I see women going through perimenopause every week in my office. And so, these women can be very tired. They can be depressed. They can have acne, migraines, low libido, mood changes, thinning hair, sleep disturbances, and then the hot flashes, night sweats, weight gain, irregular cycles and infertility can set in.
Now men many times come in to see me because they feel like they’ve lost their edge, maybe previously they were really confident, they did public speaking or maybe they were a CEO of a company, or a pastor. They used to be able to get up in front of people and speak and now they’ve lost their edge, they’ve lost their confidence, and their having depression, and anxiety, and weight gain, especially around the middle.
Maybe they’re having low libido or erectile dysfunction, or even bone density issues and they’re tired. So, men and women both experience this age-related change. But again, we want to optimize the years after that change, so they’re still feeling well through those years of life.
So, let’s talk about what hormones are. So, hormones are chemical messengers. They are made by our glands that act to control certain actions of cells and organs and they fit like a key into a keyhole. They’re gender specific. They send billions of messages and they’re made from cholesterol.
So, again, I want to emphasize this point, all hormones come from cholesterol. And one of my pet peeves is when men come into my office with low testosterone and that’s because of the cholesterol-lowering medications they’ve been put on. So, one of the first things I check in these men is always a cholesterol panel, because I want to make sure their cholesterol is not too low because many times it is and we actually need to lessen that medication, hopefully get them off it but lessen the medication so they can actually make some testosterone.
So, it’s really important to have cholesterol. This doesn’t just apply to men. So, if women have eating disorders, they’re really lacking healthy fats and nutrition that they need, their body’s not going to make hormones and they’re not going to cycle. So, it’s really important to have adequate cholesterol for hormone production.
Ari: Quick question for you. Are you sometimes engaged in battles with people’s doctors over statins?
Dr. Gray: Yeah. So, luckily there are other tests which we may not get to today, in chapter 7 of my book where I talk more about the cardiovascular system. I mention the importance of running an advanced lipid panel because we know just putting someone on a statin medication, just lowering cholesterol doesn’t necessarily translate into lowering risk.
Some doctors are so fixated on those numbers, but what I try to educate them on is, hey, we need to look beyond just the regular old lipid panel and assess an advanced lipid panel, looking at particle size, and inflammation, their oxidative stress to see really, how high is the risk? Do they really need the statin medication or not? Or is there something safer we could put them on? Because having for instance low testosterone is going to put them at greater cardiovascular risk. Then the statin isn’t going to be helping in the first place, so.
Ari: What alternatives would you suggest? Let’s say there are people listening right now who are on statins and maybe they start to, they have symptoms of low testosterone and they don’t necessarily feel equipped to go to their doctor and say, “Hey, I don’t want to take this anymore because I heard someone say that maybe the statins could be contributing to my low testosterone levels and so on.” And the doctor might argue. So, what alternatives might somebody examine in that scenario?
Dr. Gray: Yeah. So, first I would say depending on that individual’s risk will determine if the right decision is to really take them off that Statin medication. So, I don’t want to blanket, make a blanket statement that everyone should get off their statin medications. Because if you’ve had a triple bypass and you’re a smoker and you’re really higher risk, we need to always evaluate that. For patients who have to remain on those medications, we can put them on testosterone replacement therapy, and we can boost their levels. So, that’s one option.
If they’re looking for an alternative to the statin medication, I use a lot of plant sterols in my practice. I use a lot of, B vitamins can help, fish oil can help, citrus bergamot can be very effective. So, I will use that if needed. If I have to use a medication, the benefit of an advanced lipid test is that it will tell us if the problem with cholesterol is in the production, if it’s boiling down to the liver, if the patient’s producing too much cholesterol, or if we have more of a gut issue. If the cholesterol isn’t getting bound, if it’s getting reabsorbed because maybe the patient just needs fiber to bind the cholesterol so they can poop it out.
So, the benefit of the testing which you could, you should be able to receive through a functional medicine provider is that it’s going to help guide what that best decision is. What sort of supplement or medication the patient needs to truly reduce their risk. So, I wish there was an easy answer, but it’s a little more, it can be more complex than that.
Ari: Got it.
The role of sex hormones in health
Dr. Gray: So, if we talk about sex hormones, so sex hormones are primarily made by the ovaries in women, and the ovaries are shown in this picture here. So, they’re small glandular organs about the size and shape of an almond, and they’re located on the opposite side of the uterus. They’re the most important organs of the female reproductive system and as glands they secrete the hormones. So, the estrogen, progesterone, testosterone and they’re lit up pink in this picture.
So, estrogen is one of the primary female sex hormones. It helps women maintain that youthful appearance, maintains memory and cognition, balances the body temperatures, and regulates the cycles. It ensures healthy development of female sex characteristics like breast development, and fat distribution on the hips and legs during puberty. And it also ensures fertility because of helping with egg quality and egg production. So, lack of estrogen can lead to hot flashes, night sweats, insomnia, which can lead to fatigue if you’re not sleeping, poor concentration, wrinkling skin, and dull hair and dull nails.
And during puberty, estrogen controls the development of the mammary glands and the uterus. So, this helps to stimulate the development of the uterine lining which then the body is going to shed and cause that woman to have a menstrual cycle.
You may have heard of the term estrogen dominance and I have a lot of patients who come to my office who, this is what we find, we find their estrogen is actually too high initially and that their progesterone can be too low, which can set them up for weight gain, and fibroids, and cysts, and irregular bleeding, and potential risk of cancer.
Now progesterone is my favorite hormone. It’s the most soothing, calming hormone, great for sleep and anxiety and it works to balance the effects of estrogen. So, estrogen is a proliferative hormone. It causes the growth of the uterine lining like I mentioned, and then the body’s natural response is to bleed or to shed. Progesterone keeps that growth in check, its antiproliferative or anti-growth. So, you want to make sure you have decent levels of both estrogen and progesterone which can be tested, which we’re going to talk about here.
So, low progesterone can lead to PMS, amenorrhea, heavy bleeding, painful cycles, and anxiety, and depression, and insomnia as I alluded to.
Progesterone levels start to decline in the 30s. Low progesterone was part of my problem with my infertility struggle.
So, I believe, unfortunately, many women are heavily medicated with sleeping pills, and anxiety and depression pills, when many of those times their progesterone levels just were never checked, never optimized. So, this is the first hormone I see go in many of my patients, it’s the first hormone that needs to be replaced.
Testosterone is also important. It’s also secreted by the ovaries. It helps with mood, motivation, drive, libido, energy, and muscle mass. Low testosterone can lead to fatigue, and depression, and muscle loss, poor energy performance and stamina, lower libido, thinning hair, even bone density challenges.
I’ve had even men come to see me who have had to take steroids for various reasons and the steroids then lead to bone density issues because the steroids knocked out testosterone production, and now they need testosterone to improve their bone density. So, testosterone is extremely important in both men and women.
Men aged 30 to 70 will lose one to five percent of their total testosterone production per year, and women aged 20 to 40, 20 to 40 will lose fifty percent of their total testosterone production per year. So, that’s me, right.
Ari: Yeah, that’s amazing. I’ve never heard that stat. So, is that saying from the age of 20 to 40 you lose about…
Dr. Gray: Yep.
Ari: Women lose about 50 percent?
Dr. Gray: Yep.
Dr. Gray: So then on, we only have 50 percent left and that’s going to continue to decline.
Ari: After the age of 40.
Dr. Gray: Yes.
Ari: Got it.
Dr. Gray: But we’ll talk about ways to boost that today.
Dr. Gray: But women and men both need testosterone and I don’t know the average person watching this, but chances are they’re over 20 maybe a good chance they’re over 20. So, if you’re watching this your hormone levels are declining, and thus you need to have them tested. If you haven’t had them tested, I highly, highly advise for that.
And so, that’s my first point, something that I really want you to have a take home today from, is that you need to know if you have low hormone levels. So, how do you know that? You test. You got to know your numbers. Your labs serve as your health data. The reason we’re going to talk about this is that labs can show you where potential problems lie. So, if a light on your car is flashing, it’s telling you that something has gone awry, right.
So, symptoms are telling you something has gone awry and we can confirm that with labs. When something’s wrong with your car you take it to the mechanic, they run a test and they tell you, they give you a quote on here’s what we need to do to fix X, Y, and Z. So, my heart racing was a sign of an underlying problem, and my infertility was a sign of an underlying problem. Even fatigue can be a sign of an underlying problem. Testing helps us determine where that underlying problem is caused by.
And in my book, I mention a lot about human fingerprints. That fingerprint is actually on the cover of my book because I feel like our fingerprints are our unique detailed marker of our human identity, and so are our test results. Everyone’s test results can be different, right. A woman can think she has low estrogen but maybe she has low progesterone. The test results can help your provider personalize a plan to really rebuild your health.
And I know what you might be thinking. You might be thinking, I’ve gone to my doctor, Dr. Gray I’ve been told that all my labs are normal. But I’m here to tell you today if that’s what you’ve been told, those doctors could be wrong. They may not have run the right tests. They may not have interpreted your test appropriately. So, don’t get me wrong, we need conventional medicine, but I want to discuss a little analogy here today to share a little bit about why I got into functional medicine and why I think this is different.
So, I see conventional medicine as more of the fire department. They’re here to put out big, bad, ugly fires and their two tools are drugs and surgery. And we need those! Thank God we have those tools. But upon putting that fire out, prescribing that drug, whatnot, for the cholesterol or back to the bypass surgery, whatnot for the patient, conventional medicine doesn’t always tell patients how to get to the root cause of the problem. It doesn’t tell them, or explain to them, or always dig for the faulty circuitry that may be led to that fire in the first place.
And that’s where functional medicine really comes. So, in my book analogy that’s where I mention the importance of having a carpenter or a contractor. We need a fire department, we need the fireman, but we also need carpenters or contractors to help us repair and rebuild the body. And your audience may be very familiar with functional medicine.
Common hormone disrupters
Ari: Yeah. Absolutely. Yeah, we have lots and lots of functional medicine practitioners and doctors in this summit.
Dr. Gray: Wonderful. So, I don’t have to dive in too deep here, but with functional medicine we look at how and why illness occurs, and we try to restore natural balance to the body. And one huge piece of that, I mean we look at nutrition, and genetics, and toxins, we look at the foods patients are eating but one important piece of that is hormones, which we’re talking about today.
So, when I had symptoms that conventional medicine couldn’t find a root cause for this only really fueled my desire to, again, kind of find a better road to healing, and that’s where I furthered my knowledge with functional medicine. So, regardless of your symptoms, whether it’s irritable bowel syndrome, or fatigue, or fast heart rate, I truly believe functional medicine and a blueprint like this can help.
So, I want to give you an example of how this helped one of my patients. So, we’ll talk about Gina here. She had a hysterectomy very young, at the age of 28 for heavy bleeding and endometriosis. She also had irritable bowel syndrome and reflux, and she had her gallbladder removed.
Sadly, no provider offered to check her hormone levels or give her hormone replacement therapy until it was discovered that she had osteoporosis in her 40s, like way too young to have osteoporosis. And I see this a lot. So, only then did one provider offer her synthetic hormone replacement therapy, which is a start. I don’t like synthetic hormones, but it was a start.
So, at age 45, five years later, she finally visited my clinic. And up until that point she had been taking oral Premarin, which is synthetic horse urine essentially. That’s what Premarin stands for pregnant mares urine. That had helped with her hot flashes but not with her sleep, her anxiety, her energy, or her libido. So, she felt very emotional and she felt like she’d been falling apart since her 30s.
She had a high-paced, stressful job at work and wasn’t taking care of herself which wasn’t helping. And additionally, she had been on synthetic thyroid replacement therapy without ever having had comprehensive thyroid levels tested. And again, she had the IBS and reflux and was taking an acid blocking medication. So, on the synthetic oral estrogen she was taking, her estrogens, after we tested them were determined to be through the roof high. They were very high and that probably was leading to her weight gain.
And as I suspected her progesterone levels were really low. Her progesterone levels were probably low starting in her twenties, which is what led to the heavy bleeding and need for the hysterectomy in the first place. So, having the uterus removed didn’t correct the reason why it needed to be removed in the first place. She still had low progesterone and we still needed to give her that to help her poor sleep and her anxiety, which then helped her sleep.
I mentioned before, progesterone is the most soothing, calming hormone. So, it’s great for those symptoms and she needed that. Additionally, she had been on synthetic thyroid replacement therapy for years and she had never had any of these levels comprehensively tested. So, I went ahead and ran some comprehensive sex hormone levels and thyroid hormone levels, and here’s what we found. So, I found that her levels were considered normal, right, by her conventional doc. But normal is not okay, normal is not best, and normal is not healthy. Optimal is best, and that’s where we wanted her levels to be in the optimal range.
And this is also why you may need a functional medicine contractor or a provider because their interpretation of labs is different, it’s better. So, if we look at this bell-shaped curve here, Gina had never had her free T3, which is the most important thyroid level ever tested. So, free T3 helps with everything that thyroid does. Metabolism, basal body temperature, hair and nail growth, bowel regularity, memory, and energy.
So, we can see her T3 is sitting at the 10th percentile here, and I’d like to for my patients, I like a visual for them with their labs. So, I like to draw out where their labs are sitting on this bell-shaped curve and show them sure your normal, but you’re not optimal.
So, if this patient went home and heard, let’s say her child brought home a test score and her child scored ten percent on a test. That’s certainly not passing, that’s certainly not optimal, right. But yet we think with our physiology being at the 10th percentile is okay. No, that’s not okay.
We want her T3, her most important thyroid hormone, at least greater than the 50th percentile, if not greater than 75th percentile. So, this is just one example of kind of showing how this patient was not optimized on the thyroid replacement therapy that she had been on, and that was something we needed to change for her. So, you might be asking well what labs should I have tested? And that’s a loaded question because it depends on your symptoms. But because this example dealt with hormone imbalances, here’s what you can start having tested.
So, you might get lucky and have a primary care provider who is willing to order some of these labs. So, if you are not in menopause yet, you don’t need an FSH, for a woman, but if you have gone through menopause then having an FSH would be important. Testing more than one estrogen, so estrone and estradiol, both are important.
Progesterone, testosterone, and DHT would be a great start. If you’re interested in hormone replacement therapy, it is good to have a blood count run and then especially if one of your symptoms is fatigue or hair loss, checking iron and ferritin are really important. To grow hair, you need to have adequate iron and ferritin.
And then for thyroid, from a thyroid panel, look beyond the TSH. So, I think
TSH, one of my old mentors. Dr. Joe Collins shared with me that he thinks TSH stands for too slow to help, and I agree. So, by the time TSH is high, T4 and T3 have been low for a long time.
So, if you’ve only had your TSH tested you haven’t had the whole picture tested. Have a free T3, free T4, and reverse T3 tested. Reverse T3 is like the brake pedal on your metabolism and your energy. T3 is like the gas pedal. So, you don’t want your brake pedal on and your gas pedal off. So, yeah…
Ari: Quick question. So, you mentioned that someone can ask their doctor to do this. Let’s say someone doesn’t regularly visit their doctor, or their doctors resistant and their doctor says, “Hey, we don’t need to check all that panel. That’s a bunch of nonsense, but we’ll check your thyroid function via just a TSH measurement. We don’t need all the free T3 and RT3. That’s all this functional medicine nonsense.”
So, if somebody wants to not go through the hassle of doing it with their doctor, there’s places where they can order labs, and go to their local LabCorp get blood drawn, and get these lab reports themselves and then potentially work with a practitioner such as yourself to have you interpret those labs and guide them from their, correct?
Dr. Gray: Absolutely so you could find another doctor or if you want to stick with your current doctor, then absolutely. I think labs are popping up now a lot on the internet to do food allergy testing, or hormone testing, or whatnot.
And it sometimes can be pretty easy. Sometimes it’s even a little finger poke. Some companies will do testing even via a finger poke you can run at home.
Ari: And I don’t really see a doctor, ever. I mean I take my kids for like the required checkups that you’re supposed to do after birth. And other than that, outside of any sort of emergency scenario, they break their arm or there’s some kind of infection that’s not resolving or something like that.
I don’t really go to a doctor. I don’t go to one myself, but I get blood tests at least once a year just through Life Extension. I’ll order a comprehensive male panel which covers pretty much everything you’ve listed here. I mean obviously not the female hormones, but, well some of them.
Dr. Gray: They have a male panel. They have some sort of male hormone panel.
Ari: Yeah, a comprehensive male panel. They have comprehensive female. They have one for athletes, that’s typically the one that I get. But yeah, I mean, it’s relatively easy. I mean you just order it, a day later you can book your appointment or I think they send you some documents in the mail and then you go to your local LabCorp, which there’s like three of them within five miles of my house, and you can get your blood drawn in 10 minutes and they send them off to the lab and then five days later you get a report back.
Dr. Gray: Yeah, and I would, I say I recommend a lot to my patients because I see a lot of the menopausal, androposal women and men come in and I advise they have their children actually get tested. So, if we want to track trends and see if someone is having a subtle decline, it would benefit us to have known our hormone levels for the past few decades, right.
So, if you can start testing your hormone levels in your 20s, 30s, 40s, 50s. So, you can track your trend and know if your thyroid or your testosterone levels have been declining. So, I think that’s a great idea. You don’t have to have a doctor to get the hormone labs tested.
Ari: Yeah, I guess the only downside is just out of pocket expense. It’s not covered by insurance.
Dr. Gray: Correct.
Dr. Gray: Correct. Yep, but your health is your best investment. So, it’s worth it.
Ari: Agreed. Yeah.
Dr. Gray: So, Gina was a good example of a patient that I saw in need of The Longevity Blueprint we offer at our practice. She needed to have her hormones assessed and properly optimized. She needed more than she had been given. So, she had been taking a synthetic T4 only medication, Synthroid, and we switched her over to Nature Throid, there a lot of different brands for different desiccated thyroid options that have T3, we switched over to one of those. She also had been on oral estrogen which I wanted to get her off that horse urine.
So, she had had a hysterectomy. She needed hormone replacement therapy.
We switched her over to hormone pellets for the estrogen and for testosterone.
And we’ll get a little bit into pellets at the end of the presentation here today. Also put her on progesterone which she likely needed from very early on in life. So, we finally got her hormones optimized and she, we drastically change her quality of life. Her sleep was better. Her energy was better, her anxiety was gone. She had totally transformed. And that can happen when you get your hormones right.
Now, since your audience knows a bit about functional medicine, I won’t go in depth with this next slide here, but this patient also needed some additional assistance because she had the reflux, and she ended up having food sensitivities and other things.
So, I will skip over this little slide here, but the reason this slide is incorporated into this presentation is because this may give you an example of why you are tired. Maybe you need to have heavy metal testing run. Maybe you are toxic, or maybe we need to look at your genetics, or your digestion. There are other things besides hormones that can help with energy production.
Ari: Absolutely, yeah.
Different types of hormone testing
Dr. Gray: So, when we get into hormone testing, we just briefly touched on blood testing. So, blood testing is fairly easy, the caveat there is that if you’re a cycling woman you need to make sure that you get the hormone testing done during the appropriate cycle day. So, if we’re trying to assess if progesterone levels are peaking after ovulation, then you need to get your hormone levels tested a week after ovulation. Which in a 28-day cycle is roughly one of days, 19, 20, or 21.
So, just make sure you get the testing timed appropriately. Blood testing is the most widely accepted, FDA approved method of testing. So, I’m all for blood testing. My doctorate was on estrogen metabolism, really looking to see how one’s liver is detoxifying or excreting estrogen to look at their future risk of estrogen related cancers. And so, the only way we can assess estrogen metabolites is through urine, something we’re metabolizing out or excreting.
So, urine testing is also great for looking at hormone levels and for looking at metabolites. And then saliva testing is also very appropriate for fatigue specifically, because it’s one way we can look at cortisol. Cortisol is supposed to be high in the morning so we’re full of energy. It’s supposed to reduce throughout the day being lowest at night so we can sleep. So, how I choose blood, urine, or saliva testing really is based on that patient and what concerns they have. But again, it’s important that patients have comprehensive testing run, that the testing is timed and ordered correctly, and then interpreted correctly as well.
Ari: Yeah, a few questions here. So, obviously women are much more complicated in this regard because of the menstrual cycle. So, you need to time the testing generally, or especially the blood testing, has to be timed according to the cycle to really know how to interpret those numbers.
Dr. Gray: Correct. Yes.
Ari: So, do you want to speak to that briefly? And I know you could probably speak to it for an hour, but just kind of a very brief rundown of what that looks like.
Dr. Gray: Yeah. So, the first week of the cycle, hormone levels are going to be pretty low. So, don’t get your hormones tested the first week while you’re bleeding because if they come back low, they’re supposed to be low that week.
Second week, leading up to ovulation, estrogen ends up being a more dominant hormone, which is going to drop after ovulation and progesterone is going to peak with ovulation. So, even week two is not the best time to test hormone levels because we kind of have a flip-flop there. But what we want to assess is if when progesterone is supposed to be its highest, the week after ovulation, if it is.
So, in a 28-day cycle, blood, urine, whatever testing you do, needs to be done ideally a week post ovulation, which would be probably around 19, 20, or 21 in a 28 day cycle. So, that’s really important. If you’re doing saliva testing, there’s actually a saliva test available where you can spit into a tube the entire month. So, you can spit every couple days for a full month.
Which is awesome for fertility and it’s awesome for patients who have like ovulatory migraines, or premenstrual migraines, because my patients can log all their symptoms and then I compare that with the lab testing and then together we can say, “Okay, here’s what’s happening day 13, or here’s what’s happening day 26.” So, I can really see what they need. So, there is even fancy saliva testing that exists for that.
Ari: Interesting. So, I was going to say my impression, well just a quick anecdote. I’ve seen some, what was I going to say, it’s not really studies, but some examples from a few doctor friends of mine who have to run these kinds of experiments where they take one particular individual, get their blood, their urine, and their saliva on the same day, run a hormone panel and they all come back with totally different and contradictory findings.
So, one will say you have high estrogen, the other one will say you’ve got low estrogen, high progesterone. Low progesterone, high testosterone. Low testosterone and so on. I mean totally wildly contradictory. So, something of those tests are giving clearly bad data, and some of it is is wrong and just not valid, and not accurate. My understanding, just I’ll try and explain this very briefly, and I’m certainly oversimplifying here, but blood generally speaking is going to be the most accurate for most things. Saliva tests are really good for cortisol, but not so good for some of the other hormones.
And then urine is often very good at diagnosing excess levels of certain hormones, but sometimes limited in its ability to diagnose deficient levels. Because for example with cortisol, if it comes back low on a urine test, it could just mean you have normal cortisol, but more was being excreted through the fecal route instead of the urinary route, it’s sometimes hard to read that.
So, I’ve seen some caveats with urine and saliva testing, and I know a number of my friends kind of lean more heavily on the blood testing. They consider it more accurate. I’m just curious if you have thoughts on, your thoughts on that landscape.
Dr. Gray: Yeah, so there are even more details we could dig into if you think, I would agree. Generally speaking, I would agree, that blood testing is the most widely accepted, FDA approved method of testing. But testing the same day, were those patients tested at the exact same time? Maybe not necessarily, because hormones are going to, you’re going to get a surge, should get a surge or a peak in the morning. I’ve had patients who we do experiments on where we do the same thing, but we test different times of the day. There testosterone at 7 a.m, is not what it is at 4 p.m.
Dr. Gray: So, those patients did different types of testing, were they testing at the same exact time or was there a couple hour lag? Because that could influence levels. And then you mentioned…
Ari: To that point I’ve tested my testosterone at 9:30 a.m. and 4:30 p.m, and it’s about half of what it is in the morning when I test in the evening. Because like cortisol there’s a diurnal curve to it.
Dr. Gray: Yep. And a lot of people don’t even realize that.
Dr. Gray: Saliva can be easily skewed just based on what you’ve had in your mouth and I mean saliva is much more variable for sure. So, I’ll give you that. The other thing I should mention here is the type of testing that I select for my patient is also determined on the type of hormone replacement therapy they’re taking. Because if they’re on a topical progesterone cream, believe it or not their saliva hormone testing is going to be through the roof. Their level is going to look like it’s, their progesterone’s 2,000 points too high.
So, you have to find a provider who can also appropriately determine which type of testing you should have run based on what type of hormones you’re taking. So, blood testing is great if you’re on oral hormones or if you’re getting pellets, but if you’re taking a topical, if you’re using a topical gel or cream, or sublingual lozenge under the tongue, those are going to skew saliva right away.
And I have patients who come to me and their providers are testing their levels in saliva, and that’s the wrong thing to do. So, that’s where urine testing is very valuable as well. So, I think there’s great clinical utility of each type of testing, but it really does need to be uniquely decided upon for that individual patient. And bottom line is blood testing again has just the most research behind it.
Ari: Got it. Thank you for that explanation.
The #1 hijacker of hormones
Dr. Gray: Yeah. So, now that we’ve talked about how important it is to have your numbers tested to see if you’re low, let’s talk about the good news, right. If you’re not optimal, what can you do to improve your hormone levels? So, we’ll talk about three things. I want to briefly discuss how important it is to reduce stress, to fix your nutritional deficiencies and to detox the body. And I’m sure you have speakers that are going to go elaborate on each of these topics even more so, but I’ll make a case for each of these.
And I have a free PDF on my website, front page, for exactly what I’m about to talk about here. So, stress is your body’s biggest hormone hijacker. So, if we are familiar with the stress response, you may have experienced that fight or flight response initiated by the sympathetic nervous system. So, during this time the adrenal secrete cortisol, adrenaline, epinephrine, and norepinephrine, and many times this is followed by a crash and burn. And that was part of what I was experiencing with my fast heart rate as well.
So, we need stress. Stress is a physical response that alerts our body to that something is not going right, in acute situations. Our body switches to fight or flight to protect us. So, the fight or flight response is a good thing, but acute stress is different than chronic stress. And so, I really want to differentiate that today. But when we think of our nervous system, you have the parasympathetic nervous system, which is more the brake pedal.
I’ll use that analogy again, the brake pedal, more the rest and digest, the relax and the growth and development phase. And then we have, on the right-hand side of the slide here the sympathetic nervous system, which is more the gas pedal. That fighter, fight or flight response, protection and survival, where our adrenal glands are activated, are secreting those, the adrenaline like I mentioned.
So, ideally these would be in good balance, the brake and the gas pedal, right. Not lopsided to the right with stress. So, there are different types of stresses like slamming on your brakes or even giving yourself a B12 shot, right. That’s a little bit of pain. So, for a moment, you might have a little bit of stress, but then it’s gone. And these types of stressors actually don’t impact our health like chronic stress does.
So, let’s talk about chronic stressors. Maybe you have a toxic relationship with a family member who isn’t going away or long-term stress example of myself was I had just pushed through grad school. I started a practice. I had way too much on my plate, for way too long. And I thought I was handling it just fine, but my body was telling me something different. That I was not.
So, stress will rob you of even hormones like I’m going to get to, and in my case, it was depleting me of progesterone, which I needed to achieve a pregnancy. So, what about trauma, past abuse or trauma? Maybe it’s not physical trauma, but maybe you had a life-altering situation with your family happen, that could be trauma. Maybe you have chronic stimulation with technology. Maybe you are an engineer and you’re surrounded by computers and whatnot all day long that can also really stress our body.
So, chronic stress, bottom line is repeated exposure to the same stressor over, and over, and over again, that can lead to this sort of fight or flight situation and can rob us of hormones. So, what is the impact of this chronic stress? We all have different degrees of exposure to these different stressors. So, the impact of stress on our health is it impacts our ability to fight infection, which is really important during this day and age. Weakens our immune system, can lead to high glucose which can then lead to weight gain, which nobody wants.
Can also increase our cardiovascular risk, and risk for diabetes. Can cause insomnia and anxiety. I had a bit of that with my heart racing as well. My body was too stressed out, it just couldn’t calm down. And it robs us of hormones like I mentioned. So, if we reference back to Gina, the women who had had hysterectomy, so she didn’t have ovaries, right. So, her ovaries couldn’t help her with hormone production, but she did have her B team which was her adrenals.
However, her B team was so stressed that they couldn’t even help with hormone production. And that’s why she really needed that hormone replacement therapy. So, I am not an expert in any of these methods for reducing stress, I’ll fully admit to that, but I do coach my patients on them on a daily basis.
So, I will briefly run through these. So, counseling can be extremely important to get to the root cause of your fears, habits, emotions, behaviors, kind of your lens as far as how you see the world based on what you’ve been through, even based on past trauma whatnot.
It’s really important to focus on the present, which I have to remind myself every day. So, I tell my patients to not worry about or spend time worrying about the past or living in fear of the future, really focusing on the present is what we should be doing because that’s all we have. We’re not guaranteed tomorrow. A large number of the most successful people in the world start their days with meditation. So, that’s something we probably all should be doing, calm our nervous systems every morning. And really to incorporate calming exercises is important.
I have so many patients who are excellent athletes who just hammer out the cardio, but they’re never incorporating calming exercises like yoga to calm the nervous system. So, that’s important. As is deep breathing. I do a fair share of public speaking and I get nervous a little bit before getting up on stage.
I was attending a conference I was speaking at and without even knowing it, I wasn’t nervous one afternoon, I just got up on stage, and I thought what was different? What was different about today? How did I just kind of nail that out and I didn’t even get nervous? And I had reflected back on the day, throughout the conference, we had as collectively as a group done deep breathing, multiple times, and that just calmed my nervous system.
So, I just kind of was able to get through that very easily. So, I’m a huge advocate for deep breathing. So, hence that slides. You can add visual imagery to deep breathing, you can even add music. So, music can be calming. We have a miniature goldendoodle and she is so hyper, it is ridiculous. She also has separation anxiety and so I need to play music for her sometimes when we leave the home, to just kind of calm her down. So, find music that works for you and that can be very helpful.
Positive affirmations are important as well. Speaking positive truths over you, pick one that you like, put it on your mirror, read it over yourself every morning as you get ready for the day. Focus on gratitude. So, you could bookend your day with gratitude, and get a gratitude journal and start your day with three things you’re thankful for and end your day with three things you’re thankful for. Even forced laughter, sounds silly, but it can be very helpful. So, if you literally make yourself laugh for 30 seconds, you’re going to feel better after. So, consider forced laughter.
And then many times when I speak, I have the audience play rock-paperscissors, because we as adults don’t always play games and that’s why there’s a picture of two adults playing rock-paper-scissors here. So, maybe with your teams or your family, you can tonight go home and play rock-paper-scissors. Playing games helps calm the nervous system. Removing chemicals, toxic chemicals from our life and any extra stimulants like those emitting electromagnetic frequencies is also important when we think of ways to reduce our stress.
Nutrition is also really important for stress reduction. So, starting your day with protein is very important. So, what do you crave when you’re stressed? Is it a large green organic salad, or is it chips, or chocolate? It’s usually chips or chocolate. But we do need to be eating those greens also, right. The reason that we crave the chips and the chocolate is that they boost serotonin.
So, they make us feel good for a short period of time and then we feel lousy after. So, it’s really important to eat protein which converts to amino acid, which converts to neurotransmitters to help us feel well. That’s how we should be starting our day. If you have a donut and coffee, carbs, and caffeine, and sugar, that’s really the worst way you can start your day.
So, also consume healthy fats, like avocado, seeds and nuts, olive oil, coconut oil. Just in general think about what you’re putting in your body. Don’t poison yourself, eat organic when you can, reduce sugar and really increase water. That can help fuel detox. I could spend a whole hour on this slide just talking about supplements, but I’ll go through these briefly. So, magnesium is a top supplement that’s robbed or used by our body in times of stress. So, magnesium is usually a mineral we all need. So, taking magnesium of good form, like a chelated, amino acid chelated version of magnesium can be important. Just taking mag-oxide that’s going to help with constipation isn’t going to help your stress.
You need a high quality, higher potency, better absorbing version of magnesium. B vitamins are great for nurturing the adrenals, great in times of stress. And then speaking of amino acids, 5-HTP and L-Theanine are two amino acids I heavily incorporate in my practice. 5-HTP boost serotonin and LTheanine can help boost GABA. So, those are great. They can be used just short-term, situationally if patients need them, and I’ve heavily used them also, personally.
I mentioned high stress can raise glucose, fish oil can help lower it. So, Omega-3s are wonderful for helping balance blood sugar, especially in stressed patients. And then adaptogenic herbs can also be very effective. So, I’m talking about ashwagandha, and rhodiola, and holy basil, and herbs can be used very effectively. So, I mentioned, we’ll go on to the next point here, but I’m going to be echoing a little bit of what I’ve already said.
So, I mentioned three things that can help to boost your hormones naturally and we spent a lot of time on stress reduction. I want to talk a little bit more about correcting nutritional deficiency. So, vitamins and minerals act as cofactors for every single metabolic reaction in the body, including for hormone production. And our hormone and detox pathways are required on these nutrients to work. So, our body’s going to struggle to make hormones if we don’t have these nutrients, even things like healthy fats.
So, you want to, to correct nutritional deficiencies you want to reduce caffeine because caffeine is going to rob you of those nutrients. And as we kind of open this part of this presentation with the importance of not having low cholesterol, you want to make sure you’re getting cholesterol in your diet. So, increase your healthy fat consumption, you can supplement with healthy fats per se and fish oil. You need Vitamin D, you need magnesium, and you need selenium and zinc to make thyroid hormone levels and sex hormone levels.
And if you don’t know what nutrients you need, a functional medicine practitioner can test you and that’s the whole topic of chapter 4 on my book, just correcting nutritional deficiency. So, tests actually also exist for that, to know what you need. Third point to help boost your hormones naturally after we reduce stress and correct nutritional deficiencies is work to detox the body.
Why hormones play an important role in health
Ari: One quick thing to interject. I just want to emphasize and point out; there are a lot of people out there who kind of think of hormones as like a separate thing. So, what I mean is they might go get a blood test and let’s say a hormone panel, and there are certain abnormalities that come back on that test.
Let’s say cortisol is out of whack, and estrogen, and progesterone, and testosterone, and and DHEA, and whatever else, thyroid hormones and so on. And they immediately think okay, what are the specific, I need to take this hormone, or I need to take a supplement specific to this hormone.
And there’s a disconnect for a lot of people where they don’t realize that those hormones are intimately tied with their nutrition and their lifestyle. Their sleep, their stress levels, their circadian rhythm, their exposure to different toxins in the environment, to environmental disrupting chemicals, BPA, and fragrances, and phthalates, and things like that. Nutritional deficiencies, nutritional toxicities, all of these things tie directly into hormones.
And I just feel it’s worth emphasizing that point, which is everything that you were just talking about there. But I really just think that a lot of people when they see that their hormones are out of whack they immediately jump to some hormone specific thing or replacement therapy, without really addressing what’s often times the root cause is, at the nutrition and lifestyle level.
Dr. Gray: Totally. I think some patients like men, or not just men, well for an example men, a man with low testosterone could say, “Oh, all I need to do is take tribulus, horny goat weed. I just need to take this herb and that’s going to fix all my problems.” But while the herb can help with internal production, in a way the supplement is still a Band-Aid right. It’s not getting at the root cause of the problem. If you have a toxicity, you still need to correct that to help your body produce more hormones naturally. So, that’s a good point. And you pretty much covered this whole next slide on detoxing the body.
So, it is important to make safe swaps with our personal care products to remove the fragrances, parabens, phthalates like you mentioned. Choose safe home cleaning products, quit drinking out of plastic and out of aluminum. I keep saying eat organic, eat organic. Assure that your air is clean that you’re breathing in. I live in Iowa and we’ve had several major floods here, and I have so many patients who struggle with mold toxicity. And I have young women my age who have unfortunately been exposed to mold and now they have infertility because they have no hormone levels, but no one ever tied the mold exposure to the reason why they now can’t get pregnant, right.
And we’re finding this out and we’re able to help them identify their toxic environment, clean it up, and eventually get their body to produce more hormone levels. So, you’re right, this is, hormone levels as I said with my own example at the beginning, hormone levels or having hormone imbalances are a sign that something’s wrong within our body. So, it’s not as easy as just taking the replacement. If you had a hysterectomy though, you do need for sure, you need the replacement.
So, that’s really the third point and that section of this presentation. And now I actually want to get into hormone replacement therapy, because there is a time and a place for that. And in my case I did while I was correcting to get to the root cause of my low hormones and correct my stress, I did need to take some progesterone and I took that through part of my pregnancy as well.
So, the most common hormone that I prescribe, I mentioned earlier to women is progesterone. That can be prescribed in a capsule form. So, one option is to take compounded progesterone in a capsule form. There are also sublingual lozenges you can put under your tongue. So, for progesterone, estrogen, testosterone, thyroid even, some compounding pharmacies can make liquids that you can take under your tongue. But I use a lot of sublingual lozenges in my practice, primarily because you can also titrate your dose.
So, for cycling women, they may take half a troche for a couple weeks and then they might work up to a whole troche and then reduce back down. So, sublingual lozenges or troches can be very effective. And topical gels or creams exist as well. I don’t use a lot of those because they’re pretty weak. If we think of potency, I think topical gels or creams are the weakest, then we’ll get into like the capsules and the sublinguals, and then the hormone pellets are by far the most effective in my patients.
So, I’ll spend a little bit of time on the pellets. So, hormone pellets look like almost little grains of rice or little skinny Tic-Tacs, and they can be inserted under the subcutaneous or the fatty tissue in the upper bottom, lower back area. Sounds weird, it sounds foreign, but actually the pellets have been the most widely studied form of hormone replacement therapy dating back to the 1930s in Europe. So, they have been studied for a very long time and the dose is very refined.
So, for all of our patients in need of hormones, we put their height, their weight, their age, their labs, everything into the computer into an algorithm that personalizes a dose for them. The benefit of the pellets is that if we do have patients who have blood clotting disorders who couldn’t take oral hormones, they actually can take the pellets, can use the pellets.
And not that I advocate for smoking, but even patients who smoke can use pellets, because pellets are cleared through the kidneys, they’re released on cardiac output. So, they’re not going through the gut and the liver like taking something by mouth would. So, there is a time and place for pellets, and I’ve seen all forms of hormone replacement therapy significantly improve the quality of life of my patients.
Ari: And which specific hormones are given through pellets? Is it just estrogen and progesterone, or anything else?
Dr. Gray: So, thank you for asking that, I didn’t mention that. So, actually estrogen and testosterone are delivered via pellets. And that’s where BioTe gets its name. T for testosterone, E for estrogen. Progesterone is not given in pellet form. So, progesterone separately would need to be used as a topical gel or cream, a sublingual lozenge, or a capsule.
The benefit of the capsule is that we can compound a sustained release version also. So, for patients who can’t sleep through the night, who are waking up multiple times a night, which could be for various reasons that also needs to be discussed, we can give them a sustained release progesterone capsule. It can be very effective.
Ari: And then, for the troches, for the sublingual’s, is that estrogen, and progesterone, can you do testosterone as well via that.
Dr. Gray: Yep, yep. You bet.
Dr. Gray: And the benefit of the troche’s is we can easily change the dose, right. With the pellets, once they’re in they’re in. We can’t take them out. We can change the dose next round, but we, once they’re in they’re in. They’re not coming out. If we’re going to talk about hormones though the c word, the cancer word always comes up. So, I do want to differentiate synthetic hormones from natural hormones, I think that are a really important point to kind of wrap up with here.
So, what was used in the Women’s Health Initiative study was Prempro, which was Premarin which I alluded to earlier, and medroxyprogesterone acetate. So, a synthetic estrogen, synthetic progestin taken by mouth. So, that study showed 41 percent increased risk in strokes, increased risk in heart attacks, blood clots, Alzheimer’s, and cancer risk.
So, naturally, I don’t want to replicate any of that in my practice. So, guess what? I don’t use any of that in my practice. I don’t use synthetics. I don’t use estrogen by mouth in a capsule form. Progesterone is okay, if it’s natural but not estrogen in a capsule form.
However, many providers who see my patients who are taking hormones, they just assume the patients are on the synthetic hormones and that the risks of the Women’s Health Initiative study can be translated to what I’m giving my patients and that’s just not, that’s not the case. They are comparing apples to oranges. So, I have a little slide here to kind of show you maybe a trick, I’ll say a trick quiz here. But what’s the difference between what your body makes on the left and what bioidentical hormones are on the right? Nothing.
Dr. Gray: I answered that prematurely there, I should have let you answer that, but literally nothing. And so, patients sometimes ask me, “Well, is it risky for me to take this hormone?” And I say, “No because this is what your body used to be making more of, it’s now just making less of.” A quote in my book that I use a lot is, if hormones cause cancer then we’d have a bunch of 20 year olds with higher hormone levels walking around with cancer, and a bunch of 90-year olds very cancer-free.
And that’s not the case. The 90-year olds have the lower hormone levels and they’re at increased risk for cancer. So, hormones don’t cause cancer. I just want to make a clear point there.
Ari: But do you think that non-bioidentical hormones, which my understanding is most conventional medical doctors who are in the realm of hormone replacement therapy might deal with non-bioidenticals, or has that changed?
Dr. Gray: Most of the time, yeah. I would say most of the time. There are some bioidentical patches, estradiol patches that have become a little more popular. Sometimes progesterone not a progestin gets prescribed. So, there are some doctors who are learning more and are prescribing some bioidenticals, but the large majority are still prescribing the synthetics.
Ari: Okay, so not to digress too much, but I think it’s worth mentioning, someone might be thinking “Well if that’s what they’re prescribing maybe that’s what has the most scientific evidence to support it.” And there’s a confounding variable here which is pharmaceutical interests, which my understanding is they can’t really make money off of bioidentical hormones because they can’t patent them. So, they have to…
Dr. Gray: You can’t patent an apple.
Dr. Gray: You can’t patent a naturally existing, molecular structure per se so that’s…
Ari: So, they have to, they have to chemically modify it. So, there’s a huge financial incentive in the realm of hormone replacement therapy for the conventional medical industry, which is often times unfortunately, very heavily influenced by the pharmaceutical industry to push the synthetic nonbioidentical hormones. Is that correct?
Dr. Gray: Correct. Over the bioidentical, more natural hormones, what our body’s already making that would pose much less risk, some believe no risk, and actually more protective benefit, right. That’s what I believe for my patients.
Ari: It’s like don’t trust what your body’s making, what we’ve made in a lab that’s different is better, trust us.
Dr. Gray: So, and that also, so my doctorate was on estrogen metabolism. And so, what I studied was more or less hormone levels aside, what we think is more problematic is not even the hormones but it’s the metabolism. It’s the way, what does our body do with what it’s been given. Everything we consume has to be excreted. Air we breathe, the water we drink, everything that we consume has to be metabolized or eliminated. Our body uses some of it and we have to get rid of the rest.
And so, we think the problem lies with getting rid of the rest, of the estrogen per se. And so, with synthetics when there’s an extra molecule there. Well here let me go to my next slide. So, on the next slide here, you can actually see the difference and I have this in chapter 6 in my book, between natural testosterone on the left and synthetic on the right, or natural progesterone on top here and the medroxyprogesterone acetate on the bottom.
You don’t have to have a chemistry background to understand these molecules look different and when they do look different, they don’t bind like a key fitting in a keyhole. They don’t bind exactly they bind partially and then our body has to, it’s just more difficult for a body to eliminate the rest. And so, that’s why synthetics can cause more harm.
Ari: Got it. Excellent.
Dr. Gray: Almost wrapping up here. I want to mention a few things pertaining to males because I mentioned the Women’s Health Initiative study, and kind of talked a little bit about breast cancer, estrogen related cancers, but we need to include the males here. So, there was an exciting study. I remember when this came through my email actually in 2016 authored by Dr. Abraham Morgentaler who’s a Harvard urologist who taught in my fellowship program.
This paper came through talking about prostate cancer and testosterone, because there has been such kind of a controversy there. Do you give it, do you not give it? And he said there’s no scientific basis for any age specific recommendations against the use of testosterone in men. This paper showed, there was no increased cardiovascular risk, no increased prostate cancer risk, and there have been several studies that have followed that.
So, for men testosterone is safe. You need testosterone. We won’t get into the details of that, but I just wanted to kind of reference that. I also want to make one more point for men. So, one of the best ways that men can raise their testosterone levels, aside from everything we’ve mentioned above, is to lose weight.
So, when you have fat around your middle that fat secretes an enzyme called aromatase. And aromatase converts testosterone to estrogen. So, if you’re a man, you don’t want to have high estrogen, right. You want your estrogens to be lower, your testosterone higher.
So, losing weight will help get rid of the fat, but also there’s a supplement called DIM, and this is more or less what I studied in my doctorate. DIM is an extract from cruciferous vegetables like broccoli, kale, cauliflower, bok choy, brussels sprouts. DIM will help block testosterones conversion to estrogen. So, you should eat a lot of those foods, but you can also take the supplement DIM to help you lose weight, to help lower estrogen and keep your testosterone levels higher.
Ari: Is that also true for women? I know you mentioned low testosterone is a big thing for women as well. Is it true that carrying excess body fat will decrease testosterone levels in women as well?
Dr. Gray: Absolutely. So, a lot of my women, my women, my female patients, who have higher estrogen or who have that estrogen dominance, if they’re making cysts and fibroids, if they have heavy bleeding, I’m going to put them on DIM. Absolutely. DIM will help lower the estrogen and in their case also help keep their free testosterone, but their testosterone higher for sure. So, I used DIM in men and women, all the time.
Ari: Excellent. Excellent.
Dr. Gray: Yep. So, one of the most common questions that I get in my practice is, Dr. Gray, can you help me rebuild my health? Am I someone that would be a good candidate to see you? And the short answer is more than likely, yes. I sit down with patients every weekend. I walk them through The Longevity Blueprint and some patients need help with chapter 6, right, with the hormone system. Some don’t, some need helps in other departments. But like you mentioned they are all related.
So, every day you struggle with nasty symptoms, whether it’s fatigue, or hot flashes, or weight gain, brain fog, IBS, or maybe you have autoimmune disease or a cancer that’s really time spent away from your family, time away spent from your precious life.
So, we could take Gina for example, she spent years without having her hormones properly assessed, which is terrible. So, maybe had she come to see me sooner we could have prevented her hysterectomy and her gallbladder from being removed, but we can’t go back in time. We can only move forward, right. Focus on the present like I mentioned.
So, we were able to get her off her oral Premarin, like I mentioned we got her onto natural hormones, natural progesterone and testosterone, estrogen, and thyroid and her health has dramatically improved. So, picture yourself having a day where you wake up and feel younger with vibrant energy, and mental clarity, at an optimal weight, you have a lovely mood and everyone wants to know what you’ve done to turn your health around. Picture a day when your friend or family member says to you, “You’re like the Energizer bunny, you look amazing. What are you doing?” Picture a day when health isn’t holding you back from the life that you want to live. We can help get you there.
So, whether you’re someone who never thinks about your health, has just started paying attention to your health, or someone who’s extremely in tune to your health, working with a functional medicine provider, like myself can help you get to the root cause of your problems and allow you to live your life to the fullest.
So, the best is yet to come whether you’re 32 or 92. It can always start with filling out paperwork, like on my website, if you’re interested to become a new patient. Our website is, one of our websites is, ihhclinic.com and I want you to really imagine what life would be like at your best health ever.
So, I want to leave you with this. So, remember when I told you there was a better way. There is a better way, that doesn’t rely on pills and medications.
There is a better way that uses data to personalize a plan to build your health. There is a better way to get you feeling the way that you deserve to feel.
And I know this to be true, because the better way gave me my health back, the better way normalized my heart rate, and on February 27th, 2019 the better way gave me my beautiful healthy baby boy. So, join me and we can find you a better way.
Ari: Beautiful. Congratulations on your what, one month and, sorry 14-month old.
Dr. Gray: Yeah, yeah. You have a child I think similar or a little older maybe.
Ari: Yeah, I have one older and one younger. So, I have an eight-month-old, or eight-and-a-half-month old daughter, and I have a three and a half year old son.
Dr. Gray: Wonderful. Wonderful.
Ari: Yeah, it’s joy. Well, thank you so much, Dr. Gray, this has been awesome, and your website again is ihhclinic.com. Correct?
Dr. Gray: Yep.
Ari: Or yourlongevityblueprint.com
Dr. Gray: Yep. So, the free PDF I mentioned and then you can certainly use a 10% off code there if you’d like. If you just use ‘energy’ you can get 10% off there. All my blogs and videos, you can find on the website.
Ari: Wonderful. Well, thank you so much. This has been awesome and really fascinating to learn all these practical tips around hormone enhancement. We have a number of other speakers that are talking about especially female, optimizing female hormones and balancing that. And some deep dives on nutrition, but no talk of hormone replacement.
So, I think that’s really nice additional layer to the story that people need to be aware of. So, thank you so much for sharing your knowledge. I really appreciate it.
Dr. Gray: Thank you very much.