/ Podcast / The Truth About Hormone Replacement Therapy, With Dr. Felice Gersh

The Truth About Hormone Replacement Therapy, With Dr. Felice Gersh

You’ve probably heard conflicting information about the safety and efficacy of hormone therapy for menopausal and post-menopausal women—you may even have heard that it’s dangerous. As our guest this week says, “the bottom line is, that’s nonsense.” Let’s set the record straight. This week, Dr. Sandi unpacks the complex history and science of hormone replacement therapy with her friend and colleague, women’s health and hormone expert Dr. Felice Gersh.

In this conversation, Dr. Felice debunks the now-infamous Women’s Health Initiative study that drove decades of healthcare practitioners and their patients—including Dr. Sandi—to avoid hormone replacement therapy. She shares the science behind why this study was flawed and highlights the importance of bioidentical hormones, emphasizing their role in addressing conditions like osteoporosis, cardiovascular issues, and cognitive health.

“I just want to liberate women 60+ to feel entitled and actually feel benefited by going on hormones, should they wish to go on them. I want women to understand what hormones do, what happens when they don’t have them, how they can replace them in a safe and physiologic way.”

Dr. Felice Gersh

Ultimately, Dr. Felice is advocating for a paradigm shift in how our healthcare system views hormones, and health coaches will play a key role in that shift. While they will not be the ones prescribing bioidentical hormones, their power as educators will enable clients to better understand their options and advocate for themselves. For clients who might stand to benefit from hormone replacement therapy, health coaches can help sort through the fearmongering and provide modern, science-backed information that empowers clients to pursue all available options. In this way, health coaches will support their clients to more effectively self-advocate with their doctors so that they get the care they need and deserve into menopause and beyond.

Episode Highlights

  • Trace the origin of the idea that hormone replacement therapy is dangerous, and learn why the infamous Women’s Health Initiative study was flawed
  • Explore the science behind why hormones like estrogen and progesterone are critical for long-term health, and why osteoporosis is such a common condition post-menopause
  • Discuss what’s stopping the “shortchanged” generation of women from getting the care they deserve
  • Hear Dr. Sandi’s personal story of hormones, aging, and what she’s doing now to become a SuperAger

Meet the Guest

Felice Gersh

Integrative Medical Group of Irvine

Integrative Medical Group of Irvine

Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine. For 12 years, she taught obstetrics and gynecology at Keck USC School of Medicine as an Assistant Clinical Professor, and she now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine through the University of Arizona School of Medicine. Felice is a prolific writer and lecturer who speaks globally on women’s health and regularly publishes in peer-reviewed medical journals. She is the bestselling author of the PCOS SOS series and her latest book, Menopause: 50 Things You Need to Know.

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Episode Transcript

Dr. Sandi: Have you ever wondered about hormone replacement therapy? Whether it is right for you, if you are a woman, if you are menopausal, postmenopausal? This is something that I’ve wondered about. But I was scared by the Women’s Health Initiative finding. This was a major study. And it was enough to really scare me away from hormone replacement therapy. In this episode of health coach talk, we talk all about this study, why it was flawed, why the recommendations regarding what’s called the timing hypothesis are absolutely mistaken and should be thrown out. My special guest is a very, very good friend, Dr. Felice Gersh, an expert in this area. And we go into the details of the study, and then move on to talk about why somebody should be taking bioidentical hormones, why our bodies need estrogen. What happens when you don’t have it, when you are at risk for osteoporosis, for cardio metabolic conditions, when you are perhaps at risk for Alzheimer’s. And what is the role of hormone replacement therapy. We dig deep in this conversation.

I know that you are going to find it very informative, very insightful. If you’re a health coach, and you’re listening to this, of course, you’re not the one who will be prescribing bioidentical hormones unless you happen to be a physician, a licensed medical doctor. But you may be asked questions. And you may be asking questions of your clients regarding the decisions that they made. And perhaps as a result of these discussions, they might be curious, and they might go and ask their doctor get more information so that they are empowered because that’s what this episode is really about. It is empowering women, particularly women over 60, which happens to be where I am. I’m very interested personally, because I’m in my mid 70s, and I see so many of my contemporaries not thriving. So let me tell you about the fabulous Dr. Felice Gersh.

She is a multi—and I mean multi-award winning physician. She has dual board certification and OBGYN and integrative medicine. She is the founder and director of the integrative Medical Group of Irvine. Her practice provides comprehensive health care for women by combining the best of evidence-based therapies from conventional naturopathic and holistic medicine. For 12 years, she’s taught obstetrics and gynecology at the Keck USC School of Medicine. As an assistant clinical professor, she now serves as an affiliate faculty member at the fellowship in integrative medicine through the University of Arizona School of Medicine. She is a prolific writer and lecturer who speaks globally on women’s health and regularly publishes in peer-reviewed medical journals. She’s the best selling author of the PCOS SOS series and her latest book, Menopause: 50 Things You Need to Know. I hope you will enjoy this conversation with Dr. Felice as much as I did recording it.

Dr. Sandi: Welcome to “Health Coach Talk.” Today, I have a very special guest, Dr. Felice Gersh. Felice is also a good friend of mine. We’re going to talk about a topic that I know will be of great interest to so many of you listening, and that has to do with hormones, specifically hormone replacement therapy. I am in that age group at 74 where we’re scared off by the Women’s Health Initiative and so never ventured into hormone replacement therapy.

I want to start off by just, first of all, welcoming you. Welcome to the podcast.

Dr. Felice: Well, thank you. It’s always so fun to join you. And, yes, there’s a lot of us women out there who I call the forgotten or neglected generation of women that were told, “Oh, don’t ever think about hormones. They’re so dangerous.” So, I just want to bring it into the forefront of knowledge and let peole know what’s out there, so they could make their own choices.

Dr. Sandi: Absolutely. Well, let’s start by talking about this theory that some people might not be familiar with, and that has to do with timing, the timing hypotheses. What is that about?

Dr. Felice: Well, this and so much of what became almost like the folklore of hormone therapy is one of the offspring or legacy of the Women’s Health Initiative, this giant NIH-funded study that was abruptly ended prematurely over 20 years ago. And from that study, a lot of data was actually acquired, some of which is useful and some of which has been misapplied unfortunately. And one of the, I believe, misapplied data was that, if you give hormones to an older generation, then you’re gong to have bad outcome. And that was true, but it’s not just who you give it to, it’s what you’re giving. And that was the big part of the problem.

So, they used what was, at one time, the popular—in fact, it was pretty much all that was used, which had the brand name of Prempro. The “Prem” was short for Premarin, that’s a brand name for what was and still exists: conjugated equine estrogen. So, conjugated means it’s gone through the liver for a process that is called conjugation that converts the estrogen from being fat-soluble to being water-soluble so it can then go into the urine, which is like water, and then get out of the body through the kidney processing. So “conjugated” is that part, and “equine” is that it’s from a horse, okay? So, equine is like equestrian. It’s from a horse, and it has all these different estrogens and other stuff that just gets into the mix that would never, ever be in a human female. So, the horse is literally trying to get rid of it, and it is a pregnant horse. That’s where the “Premarin”—”mare” is horse, and “pre” for pregnant mare, okay? So, that’s where they got that name. So, it was a pregnant horse. So, even the estrogens were the estrogens of a pregnant horse, which we know in pregnancy things are different because the placenta is the source of the estrogen production.

It’s this conglomeration of estrogens from a pregnant horse that the horse is trying to get out of the body, that’s gone through the liver for this process called conjugation. But they collected this urine and then dried it, turned it into a tablet, and then fed it to the human women. Now, back in the day, that was all they had, because people didn’t know how to manufacture, in laboratories, identical molecules to what would be estrogen from a human. And this has been a process of really scientific breakthroughs that we could actually make hormones that are literally cloned, identical clones to what our bodies made. This was a huge breakthrough with insulin, because back a long time ago when we couldn’t make insulin that was human-identical, they used insulin from a rabbit. That didn’t work out too great, because after a while, you made antibodies to it. It didn’t work out. So, it was like a miracle, we could make identical insulin to a human-made insulin. And then it was amazing. We could make estradiol to be identical to what the ovaries would make. It’s incredible.

But that’s not what they used in the study because the study took years and years to put together, and they were using the old thing because it would be like a big deal to suddenly redo the whole thing with the new hormone product. And they combined it with medroxyprogesterone acetate which sounds like progesterone but it isn’t. It’s not. It’s just a different molecule that, if you looked at the molecular formulation, it’s different. And so it binds two progesterone receptors, but it can have like an on or an off effect. We call it antagonist or agonist. So, in the uterus, it acts as an agonist. Very powerful. More powerful than even natural progesterone to work on the uterine lining receptors in a turn-on mode. But elsewhere in the body, it acts as an antagonist, and that is not good because we want progesterone. So, it acted more like a progesterone blocker. So, when you put those two together and you give it orally, it’s not really that shocking that the results wouldn’t be necessarily fabulous.

But interestingly, when they looked at women in their 50s, which only made up 10% of the study population, because to get into the study, you weren’t allowed to have any menopausal-obvious symptoms like night sweats or hot flashes because they figured that group would immediately figure out that they were on the hormone product because their symptoms would be abated. So, you had to be asymptomatic. So, most of the women were pretty far out in menopause, but there were some in their 50s. It was a small group percentage-wise, like 10%. It turned out in that group when they reanalyzed everything, that group had a reduction of all causes of death that we call all-cause mortality of 30%. It was amazing. There’s no drug that lowers your risk of dying from anything by 30%. But in the older women, and the average age was 63, in that group, they had a small increased risk in the 20-percentile range like 24% of breast cancer and they had a significant increase in blood clots and that would be like deep vein thromboses, strokes, and so that was pretty much the negative. But it also showed a reduction that was pretty significant, and fractures and colon cancer but that, kind of, got washed away. Nobody paid much attention to that.

Well, when they reanalyzed and they took just the group of women who were on the estrogen product, the conjugated equine estrogens without the medroxyprogesterone acetate, later they actually realized that group had a lower incidence without the MPA of breast cancer. So, it’s crazy. But the conclusion was and has stuck that, if you’re going to start hormones, you should be in your 50s because that was the group that had benefit that they felt was significant. And if you’re over 60, too late. You’re too old. You shouldn’t start it. but then it became, you shouldn’t even continue it. So, even if you’ve been on it and doing well, when you hit 60, it’s like, “You’re done. You’re too old now.”

And that has really stuck in a lot of doctors and patients’ mind, that you have what’s called the timing hypothesis that is… If they keep using the word hypothesis, I think we should now say, “It was a hypothesis, and now it’s proven wrong.” But that’s the whole purpose of a hypothesis, and they keep it the timing hypothesis which is that, if you’re going to get benefit, you need to start before age 60 or within a window of 10 years from when you officially had menopause, which is defined as 12 consecutive months without a period. So, you’re in your 50s and whichever is earlier, so that even if you start going to menopause at age 55, they usually say, “Well, at 60, you’re done.” It’s like whichever comes first, 10 years since your official menopause or when you hit 60.

So, that is bizarre. It’s like working on this thinking that is, “Well, there’s something that really happens between age 59 and 61. We’re not sure what it is, but it happens and you should just stop those hormones.” And of course, recognize that the hormones that they used were the wrong things. They were not human identical, and we now know that, when you give the conjugated equine estrogen orally, because of the way that it gets modified and the effect on the liver, creating clotting factors, and then it gets into the bloodstream as a more of a proinflammatory type of estrogen, not the estrogen that the ovaries make or that we would give through the skin as a patch, a gel, or a cream for menopausal women through a bioidentical hormone, it’s a different product. And it works differently on the clotting system to increase the risk of blood clots by about 400% over what would be the baseline of, say, just standard risk because everyone has some risk, but it increases that risk 400%. Whereas transdermal estrogen, either from, like I said, a gel, a patch, or a cream, that doesn’t increase the risk above the baseline at all. So, you always had that baseline risk that just exists because of just age, and your lifestyle, and genetics, and so on. And your obesity status, which obesity is a big risk for blood clots because it creates inflammation, causes platelets to aggregate and creates the risk of blood clotting.

So, the bottom line is that it’s nonsense. That’s what the bottom line is. But it’s not going away any time soon, because the whole negativity towards hormone therapy is still pretty powerful. There isn’t any medical society that to date as we’re talking today has embraced hormones as a health strategy. That’s the part that is so frustrating. They’ll say, “Sure, you can use it short-term if you have really bad night sweats or hot flashes, but it’s not a health strategy. It’s not to improve long-term health status,” what we now call our healthspan. It’s not part of the healthspan strategy by any medical society including the American College of OB/GYNs, the North American Menopause Society. They acknowledge that there’s some people that may use it, but they’re not endorsing it. They’re not promoting it. And that’s where I think women are being hugely shortchanged, younger women who are entering the perimenopause. And, oh, my gosh, especially women who have hit 60 or over 60, they are the totally…I’ll call them the shortchanged generation because it’s so simple when you really think about what menopause is.

I’m a very simple thinker. I just think, “Well, if you lose a hormone, you should replace the hormone.” It’s just a hormone deficiency. It’s all that it is. If you lost your thyroid gland because you had a giant goiter, and you can’t breathe and swallow, it’s pressing on your trachea in your throat, so they take out your thyroid gland. That happens sometimes, okay? Not even cancer. Nobody would say, “Well, there you go. You don’t have a thyroid gland. You don’t have thyroid hormone but whatever.” It’s like there is a whatever attitude. If you had, oh, my gosh, type 1 diabetes and you were really going into ketoacidosis, no one says, “Oh, whatever, you have no insulin.” We don’t do that with… And you could go through very situation. If you’re a kid or you have trauma and you need growth hormone, they’ll give you even growth hormone. If you have pituitary failure, you’ll get whatever you need. If you have adrenal problems like Addison’s disease and you’re not making cortisol, you’re going to get cortisol. You’re going to get the mineralocorticoid. If you have an endocrine deficiency, we give you the hormone that you need. That’s the miracle of modern medicine. That’s why I’m not anti-medicine. I’m pro-medicine. I’m just saying let’s treat it for what it is.

And it’s all it is. It’s a hormone deficiency state. I don’t care that it’s universal, applies to every single woman. That doesn’t make it good. We don’t think tornadoes are great when it wipes out a city even though it’s natural. Forget global warming, we won’t go there. But it’s like, come on, these things have existed since the beginning of time: earthquakes, hurricanes, tornadoes, floods. Natural doesn’t mean it’s good for us. So, it’s so simple. And I just want to liberate women 60+ to feel entitled and actually feel benefited by going on hormones, should they wish to go on them. Like anything, I just want to… I know that health coaches do, too. They want to give people knowledge so that they can make choices that match their goals. That’s what I’m all about. I want women to understand what hormones do, what happens when they don’t have them, how they can replace them in a safe and physiologic way so that they can make their own choices as to what they want to do.

Dr. Sandi: Absolutely. Well, this is such useful information. It is profound, and I think that for women over 60, you go to your OBGYN and they’re just going to, as you’ve said, perhaps if you are very symptomatic, it’s symptom relief. But most likely over 60, you’re not going to be having those kinds of symptoms. And you’re interested in prevention. So, what I see, I look at my friends who are my age group in their 70s, and the risks of osteoporosis is off the charts. I don’t know one woman who’s not diagnosed with severe bone loss. And they are feeling like they don’t know what to do. So, can you comment on how using a hormone replacement therapy for bone health, for cardiovascular health, which is another problem area where this could have benefit. And one of the things that health coaches, and you touched on it, they can educate. They can help people by asking the right questions so that they are curious to learn more about HRT and find the right practitioner who knows what they’re doing.

Dr. Felice: Well, once you accept, which I hope everyone out there will, that estrogen in the form of estradiol… So, first, no, estrogen is not a hormone. It’s a family of hormones just like fats come in saturated fats, polyunsaturated, monounsaturated. B vitamins, they have a letter and a number as well as a name. And estrogens come in four flavors. And there’s E1, E2, estradiol, that’s the one made by the ovaries that we use, and E3 is estriol, the dominant one of pregnancy, and estetrol, which is now…that’s for another time that we’ll do a podcast on it. That’s a fetal estrogen that they’re now doing work on to create a drug for… It’s actually a birth control pill now, and they’re going to be using it for menopausal women. So, stand by. We’ll talk about that. That hasn’t come on the market yet, but it will soon so we’ll talk about that another time. That’s a fetal estrogen that’s going to be given as a pill. So, stand by for that.

But the estrogen that is bioidentical to what your ovaries made, that you lose that estrogen when you go through menopause is estradiol, and I call estradiol the life hormone. Not the sex hormone, the life hormone because the prime directive of life, whether we want to have kids or not, I love everyone to have their own choice in that matter, but it’s to reproduce. It just is. That’s what women’s cycles are all about. And the hormones for reproduction are the same hormones that support every organ system. So, it’s like fundamental knowledge to know that there are estrogen and progesterone, which is another topic for another day. It’s like Batman and Robin. You got to… They’re a team. And progesterone is also really important but not as quite as critical as estrogen.

So, there are receptors in all the organ systems for these life hormones, and they’re there to make sure that the whole body is working perfectly in synchrony to support fertility and pregnancy, and to be able to do it multiple times over, and to raise each child to their sexual maturity. That takes a lot of years. They’re really about supporting life and function of every organ system. Therefore when you lose these vital life hormones, when the ovaries cease to produce them, every organ system takes a hit. And for whatever reason, in one woman vs. another, there may be more of a predominance of a negativity in terms of the effect, but it’s happening in every organ system. But in some women, osteoporosis becomes a prime evidence in terms of loss of these hormones. In other women, it’s hypertension. It can be heart failure. In others, it’s dementia. In others, they get rheumatoid arthritis dysfunction. In others, it’s cancer, like colon cancer, breast cancer, because of the immune dysfunction and sort of this chronic state of inflammation that sort of develops. And so the bottom line is that… We’ll talk about this. There’s a couple of them because this is like a day-long program, right, if we get into them all.

But osteoporosis, like you said, that is universally affecting women to some degree. It’s either osteopenia to this degree or osteoporosis or 50% of women will sustain an osteoporotic fracture in their life or higher, at least 50%. So, it turns out that, as the life hormone, estradiol regulates every metabolic function, which includes growth, and repair, and replacement, and maintenance. That’s all under the auspices of estradiol, the estrogen from the ovaries. So, in the bone, there are these…we’ll call them the overseers. These are the osteocytes. These cells are regulating the other cells that work under them. One is called the osteoclasts. The osteoclasts are specialized immune cells. They’re modified macrophages. They’re the gobblers. They’re the ones that phagocytize, so they gobble up. So, their job is to gobble up old and dead and damaged bone. That’s their job. And then there are the osteoblasts. These are the bone builders. These are the cells that create new bone to replace the removed bone that died or got old or damaged by the osteoclasts.

And it should be in a beautiful balance. So, you take away the old yucky ones and then you put down new healthy ones. And guess what. The osteocyte is controlled by estrogen. So, the overseer, the osteocyte that regulates the osteoblasts and the osteoclasts is regulated itself by estrogen. Without estrogen, oh, lack of control. So, the osteoclasts become weapons of mass destruction with no control, and they don’t just gobble up the yucky old bone or the dead bone, they gobble up good bone. So, that’s a really big problem and it happens very rapidly. In the early part, the very, very first few years of menopause, a woman can lose significant amounts of bone. And the osteoblasts, because they’re not really doing their thing, their estrogen is not there to help them to do their job, they’re not putting down the new bone. So, you have some new bone but not nearly enough, and then you have these crazy out-of-control osteoclasts gobbling up bone right and left and creating big holes in your bone.

So, when you take these drugs like Prolia or the bisphosphonates like Fosamax, they work through different mechanisms, but basically what they do is they incapacitate the osteoclasts. So, the gobbler that’s gobbling up the good and the old bone goes whatever, and it doesn’t gobble much of anything. So, that’s good in that it’s not gobbling up the good bone but it’s bad in that it’s not gobbling up the dead bone either. It’s just like not doing much of anything. And the osteoblasts, they’re still not getting any help. There’s no estrogen to tell them, “Hey, get to work and make some new bone.” So, you end up over time… That’s why these drugs are problematic as more years go by. The first three years, it seems good because you’re not gobbling up so much good bone. But as time goes by, since you’re not putting down more good bone and you’re not gobbling up the dead bone, you end up with a lot of dead bone because bone cells only live about seven years. Every cell in the body has its own… How long does it live? A typical bone cell will live about seven years. So, they all have to die and they all have to be replaced.

But if years go by and you’re on these drugs that don’t gobble up the dead bone, you end up just getting a lot of dead bone, and that’s not viable bone. That’s not strong bone. So, you actually increase your risk of fractures. That’s why you can get osteonecrosis of your jaw or your… That’s why a lot of dentists are so afraid to ever work on any women on these drugs because they have to do a dental implant or work into the jaw, and they’re afraid the whole jaw will just crumble and there’s no fix. What do you do when your jaw literally falls apart? So, they’re afraid to work on these women. They’ll say crazy things like, “Get all your teeth fixed before you go on the drug.” What does that mean? You’re going to have a problem with a root canal, and you need to have a dental implant in five years. How are you supposed to know that? It doesn’t make any sense.

So, what you get when you take estradiol is you get back the control of the osteocyte. So, now the osteocyte is doing its job so the osteoblasts will actually lay down new bone and the osteoclasts are not going to go insane and start gobbling up everything inside, the good and the bad. So, basically you create order again. That’s why estrogen is the logical choice in a woman who has these problems unless she has an unexpected lifespan. This is my opinion of five years because those drugs are pretty good for the first five years because you’re mostly preventing good bone from being gobbled up. But in the long haul, if you have a long life expectancy, what is the long-term plan here? If you ask the endocrinologist or the rheumatologist, “Well, what happens after five or six years?” it’s like, “Well, we’ll rotate these drugs.” Well, you can’t just rotate the drugs that have different mechanisms but the same effect. And then they say, “Well, we’ll give you the other, the bone-building drugs like Forteo and stuff,” which you can only take for 20 months because there’s a risk they’re worried about of osteosarcoma, that it will cause bone cancer. So, what happens when women plan to live close to 100? That’s their goal, healthy longevity. So, what’s the long-term strategy? Well, there is none. That’s the reality of it.

So, I say chuck those drugs. Go on hormones and do all the lifestyle stuff that you guys are so great at. Remember, hormones are foundational. You build a house, you start with the foundation, but you can’t just move into a foundation. But you’re not going to have a house that’s sturdy if it’s built on a bed of sand without a foundation or on the side of a mountain and it’s like, “Uh-oh, you forgot to drill the fence into the rock.” So, you need that strong foundation but that’s not sufficient. It’s just where you start, and that’s all the lifestyle stuff with the proper diet, and fitness, exercise, sleep, and avoidance of chemicals, and modifying stress. That’s why I love everything that health coaches do because you need to have the total picture here. But without the hormones, the lifestyle, all that is going to be beneficial. No question. But it’s not going to be as beneficial because it’s like if you have no thyroid gland. Think of it the same way. You still are going to make a benefit if you’re going to do all the lifestyle stuff, but it’s not going to be the same as if you don’t also have the thyroid hormone. You need these life hormones. It’s just what it is. That’s why I say it’s simple thinking once you understand.

And the cardiovascular system, estrogen in the form of estradiol maintains vascular health. It helps to create nitric oxide, a very critical gas that keeps the artery lining all healthy, keeps the arteries from constricting. It also helps prevent platelets from aggregating. It’s like antioxidant, anti-inflammatory. It’s also great for the heart muscle itself. And estrogen is critical for mitochondrial function, so mitochondria, which are the energy producers and they’re of course everywhere, especially in the brain and in the heart. And without enough energy, the heart actually becomes energy deficient, and that creates a stiffer heart that can lead to a special kind of heart failure that’s much more prevalent in women called mild diastolic dysfunction. It’s where the heart doesn’t relax. It’s like stiff when it relaxes, and it can lead to what’s called heart failure with preserved ejection fraction. In other words, the heart is pumping but it’s not relaxing properly and it actually is very important to relax and open properly. So, that is a big problem and can kill women.

Also, the autonomic nervous system that controls the electrical system of the heart is estrogen-controlled. And without enough estrogen, you have an overload of what is called the sympathetic part like the stress part of the autonomic nervous system. So, you’re more prone to palpitations, tachycardia, and atrial fibrillation. So, there’s, oh, so many different ways that these vital life hormones are critical for cardiovascular function.

And the immune system is also controlled by estradiol and progesterone is also involved. And when you don’t have enough of the estradiol, the immune system goes into its pro-inflammatory state, and you have inflammageing where you have inflammation that promotes vasoconstriction, fluid retention, hypertension, and platelet aggregation, and all the problems of inflammation. And of course, you can go organ system by organ system because they’re all interconnected. So, what affects the gut affects the heart, what affects the gut affects the brain, and all these interconnected like a giant web. But everything relates to estrogen like every organ system, you name it. And in terms of the musculoskeletal system, without enough estradiol, you lose muscle. They call it sarcopenia. And muscle is an endocrine organ as well. It’s where you burn glucose. If you don’t have enough muscle, you’re going to become insulin-resistant and diabetic. And of course, you’re going to have poor balance. You’ll fall and then you’ll break those osteoporotic bones. So, you need to have muscle and joints. All the cartilage, the collagen is all related. Elastin that keeps joints flexible. Without adequate estrogen, your joints go down the tubes. And that’s why women have more osteoarthritis and more joint replacements than men.

So, all of these things really manifest in women who are over 60. The 50s is when things are covert like things are happening but you don’t feel them. You don’t notice them. Over 60, things really start becoming obvious. By age 65, 75% of women have hypertension, and we got to get on this early. But guess what. I say this whole timing hypothesis, throw it in the trash can, because wherever you are in the timeline, whether it’s starting a lifestyle program, getting your diet, your fitness, or going on hormones, wherever you are, I call it on the conveyor belt of life, wherever you’re on this journey, you are where you are. Start there and then do the best you can. Yes, it’d be better to start earlier with everything in life when you deal with health. But where you are is where you are and you can make huge modifications and changes to change the trajectory of the rest of your life. And I just say, let’s put hormones into that mix. Let’s just put it back into the equation.

Dr. Sandi: Wow, what a powerful, empowering message to women. And I feel like you’re speaking to me personally, because I regret I didn’t start hormones but I also didn’t start eating enough protein when I was younger. I regret that. I regret that I wasn’t an athlete and didn’t like sports and didn’t work out and build muscle as much as I could have at an earlier stage in my life. But I’m doing it now and I made that decision thinking that I got specific testing that showed my biological age is much younger than my chronological age. And so I am into an experiment. I went to a naturopathic doctor, knew what she was doing. And so I am actually starting hormone replacement therapy, going very slow because again, I’m 74, an age that would be unheard of. And if I went to my standard OBGYN, they’d think I’m crazy, but it’s an experiment. I’m curious. And because I want to age backwards and feel like this is the missing link, because I do have that family history of osteoporosis and cardiovascular conditions and dementia as well. So, stay tuned. I will let you know this experiment, but Dr. Felice, this has been such an incredible conversation. And I know that our coaches, this is something that you can do in terms of helping women to feel empowered, that you have the ability to make these choices at any age.

Dr. Felice: Absolutely. And your story is empowering as well. I love it. So, I want every woman at every stage to feel that she can become a SuperAger. And you’re a SuperAger, I can tell that. And I want to be and plan to be one as well. And to me, my definition of SuperAger is you can do everything, maybe not quite as well, but you can do pretty much everything at 95 or above that you could do at 35. You name it, you could still do it if you wanted to. You don’t have to, but you could if you wanted to. So, wherever you are, this is the time to get going. I’m so happy for you that you did what you did and that you’re taking these steps. And this is what healthcare should be. The combination of proper nutrition, lifestyle, everything combined with something simple like getting your hormones back on track.

Dr. Sandi: Absolutely. Well, Dr. Felice, where can people find you?

Dr. Felice: Well, I’m in my office. This is actually a converted exam room. I have an exam table right over there. So, I’m still old-fashioned. I have a brick-and-mortar office in Southern California in Irvine called the Integrative Medical Group of Irvine. I see patients every day. And because of state laws and licensing, I’m sure people know about that, that for the first appointment, if you’re from another state other than California, I have to see people in person and then I can do some telemedicine and usually only have to see people in-person once or twice a year. And it’s a great destination. I had a patient just today from Idaho, and she’s having a fun time here.

And so in addition, I have my three books, and I hope to write some more. My menopausal book is called Menopause: 50 Things You Need to Know. It’s like a little mini encyclopedia of everything that happens as you transition through the menopausal stages. And I have my Instagram Live, which I’m trying to really stick to doing every week to give some educational material out and then it’s archived along with other things on my YouTube channel. So, that’s basically it for me.

Dr. Sandi: She has a great Instagram Live. I love your Instagram recordings, your live, and your YouTube. So, check her out. You are my dear friend. So, thank you so much for talking with us today.

Dr. Felice: My pleasure.