Ep. 176 – Hormonal Imbalances, Testosterone Deficiency In Women! The Role of Testosterone in Women with Dr. Kyrin Dunston

I am happy to have Dr. Kyrin Dunston back on the show today! Dr. Kyrin was with me before in Episode 119: Master Midlife and Stop the Menopause Madness. I invited her to join me once again today to take a deeper dive into the topic of testosterone in women.

Dr. Kyrin Dunston is a leading OBGYN & Functional Medicine Expert. She has been featured on numerous podcasts and summits on NBC, Fox, Great Day Washington, Reader’s Digest, The Huffington Post, Best Self, and more. She is the host of Her Brilliant Health Revolution Podcast and Her Brilliant Health Secrets YouTube channel, which gives women the knowledge, tools, and support they need to take control of their health and not only heal but to thrive in life.

In this episode, we discuss the role of testosterone in women. Dr. Kyrin explains why there is so much ambiguity around testosterone and why it is a controlled substance. She talks about where testosterone is produced in the body, how we test for it, the signs of low testosterone, and how to treat it. She also talks about hormonal illiteracy in traditional allopathically-trained providers, explains how to advocate for your hormonal health, and shares some information about women who have had their ovaries removed in conjunction with a hysterectomy. 

Testosterone is a misunderstood sex hormone that is intricately related to almost every system in the body. Tune in today to learn all you need to know about testosterone in women and find out why it is vital for you to advocate for your health when navigating midlife. 

“The medical gaslighting that goes on with women is rampant!”

Dr. Kyrin Dunston

IN THIS EPISODE YOU WILL LEARN:

• What does testosterone do in the body?
• How medical gaslighting happens with women.
• Why you can no longer allow your health care provider to have all the control of your hormonal health.
• Why is there so much ambiguity and misinformation around testosterone for women?
• Some of the more common signs of low testosterone levels.
• Why a good sex life is vital for a woman’s health.
• The function of the ovaries.
• What happens to women who have had their ovaries removed in conjunction with their uterus?
• Why there is no shame in women taking hormone replacement therapy.
• Is there any benefit to women ten years into menopause taking hormone replacement therapy?
• The pros and cons of various forms of testosterone supplement administration.
  

Connect with Dr. Kyrin Dunston

On her website

On Facebook, Instagram, and Twitter

Book mentioned:

The XX Brain by Dr. Lisa Mosconi 

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website
• Check Out Dry Farm Wines: www.dryfarmwines.com/cynthiathurlow

About Everyday Wellness Podcast

Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field.  Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health.

Cynthia: Today, I am joined by Dr. Kyrin Dunston. She joined me on Episode 119, Master Midlife and Stop the Menopause Madness. I asked her to come back today to talk more about testosterone in women. She is a leading OB-GYN and functional medicine expert. She’s been featured on numerous podcasts including my own, and summits on NBC, Fox, Great Day Washington, and Reader’s Digest, Huffington Post, BestSelf, and more. She’s the host of Her Brilliant Health Revolution Podcast, and her Brilliant Health Secrets YouTube channel, which gives women the knowledge, tools and support they need to take control of their health and not only heal, but to thrive in life.

Today, we talked about the role of testosterone in women, why there’s so much ambiguity and why it’s a controlled substance, where testosterone is produced in the body, how we test for it, what are the signs of low testosterone, and how to treat it. She also provides recommendations on how to advocate for your health including information on women who’ve had hysterectomies including removal of their ovaries, which is an oophorectomy. I can’t wait for you to tune into this episode. I think, this will really be incredibly beneficial, and she talks all about hormonal illiteracy by traditional allopathic trained providers, and how advocating for your health is the most important thing you can do to navigate midlife.

Well, I’m super excited to connect with you today, because I think there is a lot for women to learn and unpack about the role of testosterone, and I was talking to one of our colleagues and other GYN, Dr. Shawn Tassone, and he feels that low testosterone for women is really an epidemic and has been so greatly misunderstood and not properly addressed.

Dr. Kyrin: Oh, yeah, it’s a huge problem, and I’ve been really passionate about it. So, JJ is like, “Well, that’s what you’re going to write a book about” I’m like, “Really?”

Cynthia: No, I think it needs to be talked about by a healthcare professional, because as I was prepping for the podcast today, and was really diving deep into testosterone and learning even more than I knew, I started to realize that we’re not talking enough about this. I think a lot of women as they’re navigating perimenopause and menopause trying to decide whether or not they’re going to use bioidenticals, or HRT, or not, do menopause au la naturel as someone said to me recently, I think we have to start talking about the role of testosterone.

So, I’d love for us to start the conversation and discuss the roles of testosterone, because I think there’s a lot of misconceptions, I think women suspect that if they are using testosterone in a supplemental way that somehow, they’re going to start looking like a bodybuilder. Our bodies really aren’t designed unless we’re using hyper doses of anabolic steroids, and that’s not what we’re recommending. But testosterone is so intricately related to nearly every system in the body and far more than we actually give it credit for. I think, it’s the woefully misunderstood sex hormone.

Dr. Kyrin: Oh, absolutely. So, yeah, happy to dive into it.

Cynthia: Absolutely. I’d love for you, because I think that there are a lot of people that don’t fully understand or appreciate how critically important it is, and I know we were talking at the event we were at a few weeks ago and I had said, I’ve never felt better being on testosterone, and I’ve started very openly talking about it, because I feel like, first of all, talking about sex hormones and HRT or bioidentical seems to be very taboo. There’s a lot of misconceptions.

So, let’s unpack what testosterone does in the body so that we can really dive into some of the nuances why we suspect it is not being properly addressed, why there’s no FDA approved drugs right now for women, which is really a crime in my opinion when I show you would agree as well.

Dr. Kyrin: Yeah, absolutely. I think that testosterone is very underserved among women. Men get a lot of attention when it comes to testosterone. But what most people don’t realize is that, we’re not fully feminine without all our full complement of sex hormones. That means not only estrogen and progesterone, but testosterone, and don’t get me started on the lack of progesterone which is systematized neglect in women’s healthcare, where we say, if you don’t have a uterus then you don’t need progesterone which nothing could be further from the truth, and it’s really what I call a form of medical gaslighting.

The medical gaslighting that goes on with women is ramping where we first off say that, no, all those symptoms you have are not due to hormonal imbalance, they’re not due to menopause. That’s the first form of gaslighting. It’s all in your head. You just need a hysterectomy, hyster meaning hysterical, and a hundred years ago, we used to have hysterectomies because we were told that that’s what made us hysterical was our uterus. So, just take it out, and you get rid of the hysteria in the woman. So, we haven’t come that far from those dark ages and it was in the early 1900s, when they started giving horse estrogen, equilin to women and saying, “Well, this stops the hysteria in women.” They said, it’s the elixir of life, why they didn’t give naturally occurring estradiol or estriol is because they couldn’t get a patent on it. But we can take a horse estrogen, and we can get a patent on it. So, let’s give that to women.

Then they said, “Oh my gosh, it’s causing uterine cancer. What are we going to do about that?” So, they couldn’t just give naturally occurring progesterone to counteract the effects of the equilin in the uterus that was causing the cancer. They said, “Well, let’s go in the lab and make another drug that we can sell, then we don’t only have one drug that’s patented, we can have a second drug that’s patented,” and they made medroxyprogesterone acetate by chemically altering progesterone. What most doctors, and a lot of scientists, and even in the research literature that we have about women’s health and hormones in our contemporary literature shows is that, we, clinicians are very confused about actually what are naturally occurring hormones, and what are synthetic hormones? And we are hormonally illiterate.

Well, it’s no wonder that the general public is confused as well, because you have doctors writing papers and doing research who think that progesterone is the same as medroxyprogesterone acetate, which is a progestin, which is not progesterone, and they use the two interchangeably, and then they draw conclusions in the Women’s Health Initiative study, and they say, “Oh, my gosh, it causes breast cancer.” No, progesterone does not cause breast cancer. If that were the case, then women with the naturally highest levels of progesterone, women in their 20s have higher sex hormone levels of anybody else. They would be rampant with breast cancer. Is that the case? No, that’s not the case. So, I always tell women that, I’m not the kind of doctor who’s going to tell you what to do, because I’m the expert, “Do what I say, I know better.”

Those days are gone. But the days now are of you need to have a working knowledge of how your body functions, what are my basic seven metabolic hormones, how do they work, what do I need to know, and what do I need to know about what’s commercially available so that I can make an intelligent decision, you cannot abdicate control of your hormonal health to your healthcare provider any longer because they are ignorant? Not on purpose. They’re well-meaning people. But because they’ve been brought up and brainwashed in a culture that at its foundation is ignorant and was created by a commercial company to make a profit.

So, they have a vested interest in you being confused. Because when you’re confused, guess what? You make poor choices for yourself, your doctor advises you incorrectly, and you’re pretty miserable. So, what does that mean? You need lots of pharmaceuticals to try to make yourself better and put Band-Aids, pill for every ill, so that you’re limping along in life, and they can keep you on these medications for years or decades. So, you never really achieve what’s possible and you’re always looking for answers to purchase from the medical establishment to try to make yourself better. And I know I get on a rant, but I’m really angry about it.

Cynthia: Well, I love that you’re sharing what you’re most passionate about, and clearly this needs to become the part of a book because there are so many women that are lost and confused. I know that– I spoke at an event this past weekend and the discussion I did, five strategies for your success with intermittent fasting, four were focused on both genders, one was focused on women, and of course, it comes up as it always does. There’s always a question about hormone replacement therapy, and so much confusion when to start it, how to do it, synthetics versus nonsynthetics, what’s best, how do I navigate lifestyle medicine?

I told them, I said, if it makes you feel any better even as a woman in middle age, I was confused even as a clinician, and I’m sure it’s really magnified by a lot of misinformation. I’m sure, it’s from well-meaning individuals on social media, but I feel like there are a lot of experts that really don’t know any better–. They don’t know what they don’t know. So, that’s why I always encourage people to connect with a licensed healthcare professional, someone who’s knowledgeable in that area that doesn’t just hang a sign that says, “I do women’s hormones,” because that doesn’t necessarily speak to the fact that they really understand the physiology of the body. They really understand the things they need to be looking out for.

Now, I know that you touched on some of the issues surrounding misinformation, synthetic hormones, advocacy. Why do you think there’s so much ambiguity about testosterone in particular, because it’s unlike estradiol, or synthetic estrogens, or progesterone, or synthetic progesterone. Why is there so much misinformation, why is there so much concern about prescribing testosterone for women irrespective of their life stage? I can see you smiling. So, I know this is really resonating, because I feel this is an area that’s so taboo, I was talking to a woman who was in her 30s, and she was taking supplemental testosterone and was saying, she felt it was life changing, and I said, “I don’t just think hormonal replacement is necessarily just for women of a certain age that there maybe times throughout our lifetime that we may require some additional support after we’ve done all the foundational approaches that I know both of us talk to patients about on a daily basis.”

Dr. Kyrin: Right. So, it’s a given that we need estrogen and progesterone as women to function in terms of our fertility, and to have all the benefits that these hormones give us. They nourish our brain, and our nervous system, and our gut, and they help our immune system, and our skin. So, they work all over the body and we need those, and that’s a given. And most women are not aware that we have testosterone. Sure, men have 10 times the testosterone. We have 10 times the estrogen. It’s what makes men, men, and it’s what makes women, women.

In utero, when the gonads stimulate the tissues, this is what develops our sex characteristics whether we have male genitalia or female genitalia. But it goes on throughout the life cycle. Nature has great economy. It doesn’t just make one– use one substance to do one thing. For magnesium, it has over 450 actions in the body. Well, it’s the same with the hormones. Most hormones don’t just have one action. So, testosterone is not only to make a man, a man. It has benefits in all of these areas that we just mentioned for estrogen and testosterone. Your brain has receptors for testosterone. It helps to balance your neurotransmitters, particularly, dopamine, which is your drive initiative neurotransmitter. It helps with your cognitive functioning.

We’ve known for a long time that men generally have a larger area in their brain for spatial awareness, and mathematics, and science. Well, that’s partly because of testosterone, baby. If we had adequate levels of testosterone, we would have those capabilities to do. This hormone is important for our skin, it’s important for our eyes, for our bones, for our muscle mass. We, women start losing muscle mass at the age of 30, and this is one of the biggest reasons why we gain weight starting at the age of 30 at about a rate of 3% per year. If we don’t maintain that muscle mass, then it’s replaced by fat, and this is why 60% of us by the time we’re 50 at menopause are obese or overweight, which is an epidemic.

I talked to a woman yesterday who said, and my doctor told me, I just eat too much and I don’t move enough. I get so livid with that lie, that fallacy that we are fed. Well, maybe if your testosterone was at an adequate level, then you would have an adequate muscle mass, and you wouldn’t be replacing that lost muscle mass with fat. So, testosterone has implications all over the body, but somehow, our society, we’re strange when it comes to talking about sex and sexuality. The idea is that, a man’s hormone could be necessary for a woman, and most people think about it as a man’s sex hormone, and that sex hormone could be important for a woman, is really taboo to even think about or talk about for a lot of people, which has a lot of cultural implications. So, I think that, it’s just gotten pushed off the table very readily by most men, and medicine still is a male dominated system.

But also, the women like me who were trained in this system were brought up in a culture that was the same. There’s only one commercially available preparation for testosterone. It’s an oral preparation that comes in combination with equilin, the horse estrogen, and I actually don’t recommend this for anybody, because when you take estrogen or testosterone orally, you get what’s known as a first pass effect in the liver, which can be damaging to the liver. You really want to take testosterone parenterally, meaning outside the mouth. So, a topical cream or pellet, there are injections available, although if we get into it. I’m not a fan of the injections. So, I think that we have taboos around talking about sex, we have equated testosterone with sex, and therefore we can’t talk about it for women, and I think that this just reflects a lot of our cultural hang-ups.

Cynthia: It makes a lot of sense. Although, I think the more I learn about the net impact of testosterone, the more I recognize how critically important it is for women throughout our lifetime. So, if you’re listening to this, and you’re taking perhaps estradiol as a patch, and you’re taking oral progesterone, bravo. If you’re still feeling like you’re not 100%, and for full transparency, one of the reasons why I started getting very interested in testosterone replacement for myself was that, I’m already osteopenic. Even though, I’m doing all the things, I eat plenty of protein, I strength train, I walk every single day, there’s some genetic susceptibility. I acknowledge that. Both my grandmothers were osteopenic and osteoporotic. So, I knew that this was going to be something I would be dealing with as I was losing testosterone, I just didn’t expect it to be so early.

The other pieces, we know that sarcopenia, which is this muscle wasting is a normal function of aging, unless you are doing something proactively about it. That means, adequate protein, strength training, adequate sleep, etc. For myself, over the last two years, I have lost so much muscle mass. I kept saying like I was putting all these pieces of the puzzle together. Then I read a book called The XX Brain, and it’s a Cornell-based researcher, Dr. Lisa Mosconi. It was almost as if everything came together for me at the same time. It was like, “Okay, there’s far more to testosterone than I realized. I knew there was a lot of estradiol signaling, progesterone signaling in the brain, and that was of concern making sure that I want to be cognitively intact till the day I die.”

You start to just unpack the fact that our body’s going au la naturel for the rest of our lives, then many ways can make living a whole lot more challenging. I speak with great reverence and respect, because I have some girlfriends who have breast cancer, estrogen sensitive breast cancer. And so, they’re in a position where they’re not able to take some of these hormone replacement therapies, and that’s a separate issue. But for the rest of us really thinking proactively, and that’s why it was so important for me to bring you on because we were having this separate sidebar conversation on social media, and I was like, “Women need to learn more about testosterone.” We talked a little bit about it, what its impact is, everyone makes this association with libido. There’s far more to it.

In fact, when I was reading last night and I started listing where the receptors are, they’re nearly everywhere, breast, heart, blood vessels, brain, spinal cord, bladder, skin, bone, bone marrow, and muscles, and that’s just to name a couple things. So, if you’re hearing me and you’re thinking, “Well, I don’t think it really has that much impact.” It impacts everything in our bodies. So, let’s kind of designate, what are some of the more common signs. I obviously identified my own, but when you’re working with your female patients, what are some of the things that they’re able to– they’re trying to differentiate, is this an estrogen issue, is this a progesterone issue? So, what is specific other than libido that you commonly will see when someone is starting to struggle with lowered testosterone levels?

Dr. Kyrin: All right, that’s a great question. How do I differentiate which hormones I’m deficient in and one of the problems is that nature has great economy. It doesn’t just make one hormone, do one thing. And so, it’s not so clear cut that estradiol is blue, and progesterone is red, and testosterone is green. It would be great if it was like the stoplight at the corner, and you could go, “Oh, it’s my testosterone. Oh, it’s my estrogen.” I do want to just add and I’m going to go through what are some of the symptoms that you might notice is that it’s sometimes an afterthought, you are doing your hormones, and you’re taking your estradiol, your estriol, and your progesterone, and you’re just missing something. So, what are some of the things that you could miss?

Well, just like in a man, testosterone, when we you think of a man, you think, strong, lots of muscles, muscle definition. That’s the same for women. So, lack of muscle mass, if you have a bone dense, I’m sorry, a body composition done, you might notice that your muscle mass is lower, or maybe you’re clothes are fitting looser, or you’re not having the muscle definition that you had when you were in your 20s. And yes, you should have great muscle definition at every age. So, this consensus that they did in 2019, they got all the scientists together and looked at all of the literature on testosterone in women. They said, “You know, is there clinical evidence that replacement of testosterone is beneficial for women?”

They basically wanted to know, is it important for libido? That’s all they really cared about. Because as far as they’re concerned, that’s what’s important for testosterone. They did look at some other like for bone health, and heart health, and muscle, and things like this. Basically, they came to the conclusion that the decrease in testosterone with age– is normal with age. Therefore, because it’s normal, there’s basically no reason to give it unless it’s for libido in small amounts for a short period of time. But sometimes, some of these effects that you notice from testosterone definitely are with the musculoskeletal system. So, you’ve mentioned osteopenia, there’s osteoporosis. I too, have a family history of that. In fact, my mom has the worst osteoporosis I’ve seen on any human ever. I think she’s like at a T-score of -5, and basically has dust for bones. So, this is a concern of mine, too.

I had a personal story where I was replacing my hormones and I thought I was doing great, but I didn’t feel 100%. Then, I checked my levels, the right way using a DUTCH test and found that I was very testosterone deficient. So, I started using testosterone pellets and bam, it was like the lights went on. I always knew that it was important, but this really highlighted how important it is for women to live optimally. That’s what I’m all about is having optimal health so that you can live an optimal life. So, there’s the musculoskeletal effects, you can have bone loss, you can have muscle mass loss, and then this can be replaced by fat, so, weight gain. So, those are probably the three hallmarks that I would tell anyone to look for.

But then, there are effects around your brain, your mood, and your cognitive functioning, and your memory. In fact, testosterone replacement is a key factor in Dr. Dale Bredesen’s reCODE Protocol for the prevention and reversal of Alzheimer’s. Why is that? Because testosterone is a vital ingredient to nourish the receptors in your brain, keep your levels of dopamine high, your neurotransmitters balance, your serotonin, but it also helps to consolidate memories. It helps with that drive and initiative in life. When you think of males with a lot of testosterone, you think they have initiative, they get up and go. In fact, that’s one of the things they tell men, when you kind of lost your oomph in life, it might be your testosterone. Well, the same is true for women.

Men don’t have different brains than women have [laughs]. We have the same neurotransmitters and the same tissues. So, if you’re feeling depressed, if you’re having anxiety, sluggishness, fatigue, ennui, “I don’t want to know what I want to do, I just don’t care. I just want to make it to retirement.” When I hear a woman say this, I know her testosterone is low.

Cynthia: [laughs]

Dr. Kyrin: I just want to make it to retirement so I can retire and sit on the beach. No, no, no, your testosterone is low. So, all of the mood disorders, if you’re having any of them which are rampant in women at all age ranges, but particularly associated with menopause, it can be associated with sleep disturbance, which a large majority of women have. So, if your sleep disturbance remains a problem for you, and you’ve gotten your estrogen and your progesterone dialed in, well, maybe look at your testosterone.

Yes, there is that sexual component which we talk about sexuality in women or rather, we don’t talk about it. But we talk about it as if it’s a throwaway thing. That’s not important. But your level of sexual satisfaction in life actually is directly correlated to your health in life and your overall level of other diseases. So, the better your sex life, the lower your number of prescription medications, the lower your number of disease diagnoses, the better your satisfaction in life. I’m talking about, yes, libido and desire, but I’m also talking about ability to achieve orgasm–, intensity of orgasm. Why are these things important for men but they’re not important for women? That’s a whole sociological study.

We just want to deny that women have sexuality, but the clitoris is way more sensitive than the penis, and women are known to have a naturally higher sex drive than men at the midlife when their testosterone is at an optimal level. So, yes, it’s about sexuality, and yes, sex is important. How many marriages have ended because a woman didn’t have adequate testosterone, and she did never care,

I wish I had a dollar for every time a woman said to me, “I don’t care if I ever have sex again.” We really want a world of women who don’t care if they ever have sex again. No, we don’t. Women, who are on fire with their libido for life and for their sexuality. But we didn’t even get into anemia, hair loss, heart disease, metabolic syndrome, there are so many effects of testosterone.

Cynthia: That’s beautifully stated, and I think that on so many levels, I, myself, and I’m not a GYN, but I certainly over the last five or six years, I’ve had the privilege of being able to connect with women and for them to share their private thoughts, and I would say 98% of them tell me they have no libido, they have no interest in sex, they have mercy sex, which is, I’m using their terminology, and it’s really sad because most if not all of them want to feel connected to their spouse or their partner. They just have completely no interest in sex. I believe most of its hormonally mediated. When I share in a very generalized fashion with my husband, some of the comments that I will hear never disclosing any information about the patient, he always says, I think men from the day they’re born till the day they die, it’s always like, they’re ready, they’re ready to go, they’re happy to do it. He said, “It is so sad that there are many women who either stop having orgasms, or sex is painful, or they’re too embarrassed to talk to their healthcare professional about this.”

I think as a middle-aged woman myself that sex is still very much an important part of my relationship with my spouse. So, I think, it’s really sad that we’re losing opportunities. Hopefully, these kinds of podcasts when women can hear that this is normal in the context of hormonal imbalances, and that there are ways to get around this. In fact, I’ll just mention with testosterone therapy, the strength of my orgasms is what it was gosh, probably in my 20s. So, to me, that’s been an added benefit. Yes, I’m able to build muscle again, yes, I’m helping my bones and my brain, but heck, that’s a good thing. That’s certainly a good thing. If we had more oxytocin flowing in our bodies, we would be much happier individuals. If we think of oxytocin is like the mother hormone of all hormones, we want to be doing things that help facilitate this. Whether it’s having special time with our significant other, hugging our kids, hugging our pets, that my dogs probably get a lot of hugs. They love it, because they’re–

You’re mentioning you have a dog. I have two doodles, and so, they play a large part in my social media and sometimes in my podcast, but thankfully today, they’re a little bit quiet. So, we’ve talked about things that we need to look out for. I do want to touch on and I know this question comes up so often. Women who go through hysterectomy, especially, those that have had oophorectomies or when they’ve had their ovaries removed as well, not anticipating what is to come. There was a statistic I read in Dr. Mosconi’s book that talked about women that have their ovaries removed in conjunction with their uterus are even greater risk of developing cognitive dysfunction.

I think, sometimes, there are discussions that are not had preparing women for these kinds of surgeries and what is to come, but I know that, that removing the ovaries in and of itself not as much the uterus. But let’s talk a little bit about what the ovaries do, what hormones are produced there? Because I think a lot of people just think about progesterone, but there’s more to it than that.

Dr. Kyrin: Yeah. So, the ovaries in women are the predominant manufacturer of the three types of estrogen, and also progesterone, and a half of the testosterone. It’s insane that we castrate women, and there is no discussion about what these hormones do. We’ve talked about there’s economy and nature. So, it’s not just that you’re losing your ability to make a baby and reproduce. You’re losing vital– your hormones are really like the nectar in your body. They’re the regulators that keep everything flowing smoothly. So, you’re losing at least half of your testosterone and the large majority of your progesterone and estrogen. These hormones can be made and other tissues like the adrenal glands and some others at lower levels.

Female castration, if we were castrating men at midlife and this is either the number one or number two surgery that’s performed, and the number one might be C-section at any given time or hysterectomy. We basically are castrating women, and we tell them what you need your ovaries out because then you don’t want to have a problem and need to have surgery for that ovarian problem in the future prophylactic oophorectomy, which is insane because the rate of needing surgery for an ovarian problem after you’ve had a surgical hysterectomy is extremely low and doesn’t warrant putting a woman through the loss of her sex hormones.

Any woman who’s ever been pregnant or gone through puberty or menopause can tell you the dramatic effects that these hormones have on how she feels in her own skin. We all know that. If you have a 28-day cycle, you can tell this, right? You’re different every single day. You’re different in how you think, you’re different in how you feel, your emotions, you are different in how your gut functions, how your physiology functions. Any woman can tell you these 28 days in a cycle you’re different. So, the idea that you’re going to take out the factory and you’re not going to have any problem is insane. Women will tell you that they feel like they got hit by a Mack truck, and they don’t even know who they are anymore. That was my personal experience.

You’ve mentioned earlier said that you want to go to a licensed professional, but I’m going to take it a little further, and it might be a little controversial. There are lots of licensed professionals who are hormonally illiterate. So, I don’t think that qualifies us as knowing what we can do to help you. You need to find someone who’s a woman over 50, who’s been through this herself, who knows what we’re talking about, because I’m sorry, men, you can be intelligent, but if you’ve never experienced what we’re talking about, you’re going to poo-poo and dismiss it. Because that is the prevailing culture in medicine. Women before you’ve really gone through that holy mother of hormonal decimation, you cannot know what you’re talking about. So, I think you need to find someone who’s experienced it.

I’m one of those people. I am not the only one, but once you experience it and you know, I don’t care what the scientific literature says. I know I can’t put two thoughts together when I don’t have my hormones on board. I need my hormones in order to be a fully functioning cognitively complete person who feels good in her own skin. So, definitely think twice about the oophorectomy, but even if you don’t have it, just the fact of taking out the uterus at hysterectomy reduces the blood flow to the ovaries by 50%. The rate of menopause in those ovaries is significantly increased within the 12 to 24 months after hysterectomy even if the ovaries are left in place. That blood flow disruption does decrease hormone levels. So, you’re in for a change period even if you keep your ovaries and you have a hysterectomy. And you’re likely going to go through the change sooner rather than later, and it is going to affect everything.

When you then go to your doctor and you say, “I just don’t feel like myself,” and you feel embarrassed to even say that because your doctor is going to go, “Oh, well, what do you mean? You look like yourself. I’ve had women have that said to them.” “I just don’t feel like myself in my own skin anymore. I don’t know how to describe it.” You are basically going to be gaslit. So, find someone who understands what you’re going through. I think it’s kind of insane, Cynthia. I have to bring this up. This is the example I like to give that we even have some of these conversations that we have around these hormones. Nobody questions replacing your calcium if it’s low. There’s no emotional discussion. If you go to your doctor and you say, “I just don’t feel like myself. I think my calcium is low. Well, what happens?” They check your calcium. [giggles] If it’s low, they do something about it. But you go to your doctor and you say, “I just don’t feel like myself. I think it’s because I had a hysterectomy. You know, what? Can we check my hormones?” We’re told, “Oh, no, we don’t check women’s hormones,” which every woman listening should say, “No, that’s insane.”

We check everything in medicine, but we don’t check women’s hormones. Then if you can cajole your doctor into doing it, they’ll sometimes recalcitrantly, “Okay, we will do it.” Then they don’t know how to read it. They do the wrong tests, and they read them the wrong way, and they tell you, “You’re fine.” Or, they don’t do any tests at all, and they’re going to give you a patch, or a pill, or this, or that, that’s a one size fits all, which medicine is not one size fits all, we’re very different. Then you’re never going to feel as good as you could feel.

The Dalai Lama is quoted as saying that the western woman is going to save the world. I think, it’s Western menopausal women who have hormones.

Cynthia: Yes.

Dr. Kyrin: Because then, we can put the neurons and the synapses together to use the wisdom that we’ve accrued throughout life to solve these big problems that we’re facing.

Cynthia: Well, I love that you say that because one of the things I’ve started very openly saying and my team wants me to get on reels on YouTube talking about this. I always say, “I don’t want to get strength training advice from a 32-year old female who has an eating disorder hidden under the guise of intermittent fasting. I don’t want to get recommendations from someone that’s not fairly close in age to where I am,” because they understand the gaslighting is real. I can tell you, even though, even as a healthcare provider, I have handpicked the people that I work with. I had one tell me at the start of perimenopause, when I started feeling badly, when I was complaining about gaining weight, which was not something I’d ever struggle with before and he said, “You know, you are 44 years old. This is just the way things are.” I said, “That’s BS.” I refuse to accept that, and it’s a sign that something is off. So, down the rabbit hole you go.

I think it’s so important for women to feel comfortable supplementing hormones. I know I was reticent to go on thyroid replacement at the start of perimenopause, and yet, as soon as I did, I felt 1,000% better. There’s no shame in taking hormonal replacement therapy. I think that is something that unfortunately, we’ve got and I respect people that don’t want to take hormonal replacement therapy, but I wouldn’t be the person that I am, had I not been taking not only sex hormones, but also now thyroid replacement. I would be suffering, and I don’t think I would be able to sleep well, I probably would have no energy, and I very likely would not be where I am professionally or personally. So, if you’re listening to this, and you’re still in that camp of, “I’m going to push through needing thyroid replacement therapy, I don’t need to take hormonal replacement therapy.”

I hope that when you’re hearing our discussion, it’s at least starting to change your mind set a little bit or at least entertaining the possibility of options for yourself, because you can change your mind in the future. I do want to touch on, I have several women who were in that five-year window, you know, what I was always taught was that the first five years of menopause, that’s the most optimal time to be adding in hormone replacement therapy. There are women in their 60s who obviously are 10-plus years out into menopause, and they were asking, “Is there still benefit to taking hormone replacement therapy at that point or are they– I’m using their terminology, a lost cause?”

Dr. Kyrin: Oh, gosh, that’s so sad. I do want to comment on that, but I have to comment on-

[laughter]

Dr. Kyrin: –I’ve got to go. So, this idea of respecting people who choose not to take hormones, well, I think we are the ultimate arbiters of what’s right for us and what’s not. But what I find more often than not is that, that decision is made from a place of lack of proper information and fear. The women who choose that don’t understand what they’re choosing. Just like we talked about with calcium, there’s no emotional content to I’m going to replace my calcium or not. If it’s low, you replace it, and I find that that’s why I educate women like in my Mastermind to become hormonally illiterate. So, then once you know all there is to know, once you really understand what hormones are, that they are the regulators, and how that they speak this language to all yourselves, and that basically you’re opting out of having that language spoken to yourselves, and you make that choice once you’re educated and you are hormonally illiterate, more power to you. But I think it’s a rare woman I come across who once she is properly educated, doesn’t say, “Oh, my God, I need that and I need that now,” particularly, testosterone.

So, back to your question about this timeframe. Well, receptors that are not stimulated die in the body, that’s just a fact. Your body uses economy again. It up regulates receptors, it down regulates receptors. When they’re needed, this is how addictions occur. There are more receptors that come for a certain substance like alcohol, and then you have to feed those receptors, and that’s what makes the addiction. So, the same is true for these hormones, when their hormones are plentiful, there are plentiful receptors, and they can stimulate and do take action. But with the naturally occurring menopause, or surgical menopause, these receptors will decrease in density, and they will start going away. There is this kind of magic five-year mark where they say, “It may not be beneficial past that point to institute hormone replacement therapy.”

Now, having said that, when you give hormones, you increase receptors. So, for any given woman, I would never be the one to say what you said that she said “a lost cause,” which I don’t think any of us are, after five years post-menopausal. I would always give her and her body the benefit of the doubt and let her take them, and you may need some higher doses to start recruiting those receptors, and then you may– you need a comprehensive approach as you know, Cynthia. If your cell membranes are crap, because you’ve been eating horrible fats your whole life, and your cells are all coated in fats, and that actually is considered the brain of the cell is the membrane, because it’s what allows communication from the outside world into the cell. If you’ve been eating crappy fats and all your cells are hard, and the membranes can’t communicate, and they couldn’t even get a receptor out there, if they wanted, well, then it’s kind of a moot point to start throwing hormones in there. So, it’s a part of a comprehensive anti-aging health restoration program that includes replacing all your cell membranes with healthy fats. So, it goes to diet, but it also goes to managing your other hormones like your cortisol.

Most of us have a tanked cortisol by the time we’re at menopause, and that’s why we have so called pathologic menopause. But mainstream doctors, licensed professionals don’t understand that. So, they’re not going to do a salivary cortisol profile and remedy your stress response system. They’re not going to look at your HRV, and look at your parasympathetic, and your autonomic nervous system, which really if those aren’t tuned up, then the hormones aren’t going to do any good, and in the studies that they did looking at this, they didn’t look at any of that. So, I do never think that a woman is a lost cause. If you look at Cher, I think, she’s what 75 now? If you look at JLo in her 50s, Shakira in her 40s, you look at Oprah, you look at all of these so-called stars who are in their 50s, 60s, and 70s, and flourishing, that’s what’s possible for every single woman. They just know the right places to go, and they know to get their bioidenticals, yes, and their testosterone, you heard it here. This is possible for every woman and I think her birth right.

Cynthia: Well, I love that you come from a place of positivity. I know it. It really broke my heart, and I’m sure it’s the same way with a lot of your patients that some of the scarcity mindset that goes on that people feel fixated like so, I’ve been doing this for so many years, and I can’t do anything differently, I’m like absolutely. You talk a lot about mitochondrial function and you’re talking about cellular function, and that’s why I’m such a passionate advocate of intermittent fasting. Just to tie into the diet and its impact on the mitochondria, the quality of our cells, Dr. Cate Shanahan came on earlier this year and talked a lot about seed oils. So, one of the things I talked about a lot is, if you do nothing else, avoid seed oils. So, read food labels, ask when you go to restaurants, most of them use canola, soybean, safflower, sunflower, because they’re cheap. But we don’t want to be ingesting these kinds of poor-quality oils because they do have such a negative net impact on your cellular health.

Two other areas that I want to touch on before we end our discussion today. So, you’ve mentioned the DUTCH, what other types of tests do you like to utilize when you are evaluating a female patient? Because there may be women listening who are going to take notes and want to take it to their healthcare provider to say, “I know these tests are available.” What are the other really key tasks that you think are critically important, and the DUTCH for anyone that’s not familiar is a dried urine and saliva test, it is one of the most powerful tests I’ve ever worked with? I’m sure Dr. Dunston would also agree, but what are the other tests you like to look at when you’re doing an evaluation, if we’re doing a snapshot evaluation?

Dr. Kyrin: Yeah, the DUTCH Plus also includes the salivary cortisol, and then all of your estrogens, testosterone, progesterone, that’s for sure. Then a comprehensive thyroid profile is so key, and that’s different parameters of thyroid. That is not your just your TSH and your thyroid profile that mainstream medicine uses. Because that will miss a lot of people who are subclinically hypothyroid. You could do the Barnes test to figure that out. You can take your basal body temperature every morning for a month and see where you fall and If you’re low, your thyroid is your temperature regulator, then you don’t even need a lab test to know if you’re low thyroid. Then, I look at all the seven major metabolic hormones. So, that also includes insulin, which gets to the intermittent fasting issues, Cynthia, because for a lot of us, we are on what I call the blood sugar rollercoaster. If you’re on the blood sugar rollercoaster, even if you get your testosterone right, your estrogen, progesterone, you’re not going to have normal or optimal hormone function, and you’re still going to struggle with weight, and probably sleep, and cortisol problems, and immune system problems.

For most all of us that blood sugar rollercoaster, that insulin is up and down, because we’re eating rice, potatoes, we’re eating sugars number one and we’re eating fast carbs. We’re on that blood sugar rollercoaster, and what we don’t realize is, I think when I balance– couple woman balance their hormones, I consider it like, it’s a ball of yarn–, it’s like unknotting a knotted ball of yarn. When I was in college, I had a kitten and I used to knit and that kitten would take that yarn and roll it all over the place, and then I’d be left with this massive knotted yarn, and I would have to unknot it. So, this is a woman’s hormones by the time she gets to midlife. What do you have to do to unknot that ball of yarn, you’ve got to find the loose thread. Well, that loose thread in your hormones is insulin function. You have got to balance insulin before you do anything else. So, for most women, you’ve got to have a fasting insulin, a fasting blood sugar, and a hemoglobin A1C.

But when you get those results, you’re not going to look at what the lab says is, “normal or reference range.” You’re not going to look at that for your thyroid, either, because that’s defined by what 95% of the population has. Well, look around, 60% of us are overweight or obese. So, basically, they’re saying, “You’re pretty good for an obese person. Is that what you want to be?” No, you want to be pretty good for a nice, healthy, slender person. So, you use different values when you read those. Most doctors are not trained in this, it’s not their fault, they love you, they’re brilliant, they’re good people, they mean well. They’re just doing what they were taught like I did. What I was taught for, like, when Oprah says, “When you know better you do better,” until I weighed 243 pounds, and I was like, “What’s wrong with me?” Means that I was trained in a system that was designed to make me overweight, and tired, and lose my hair, and have no sex drive, and be on five prescription medications, and depressed, and anxious. That is our system. So, if that’s the kind of health you want, that’s what you go for.

But when you get those tests, you got to use different values. So, then, the cortisol and DHEA would be on the DUTCH. I am definitely a proponent of the dried urine sex hormone test. Blood is not an appropriate way to check these hormones. So, I tell people, don’t even bother with the blood. We want to check everything in blood. It’s so easy here, draw my blood. But these are steroid hormones, they’re made from cholesterol, which is oil comes from animal fat, and oil and water don’t mix in your blood is water. So, this is why you need other ways to properly measure these hormones.

Cynthia: That’s a fantastic explanation and definitely will give individuals an idea of what they need to be asking for. Now, last but not least, I kind of alluded to it already. When you’ve identified that someone, a woman’s testosterone is lower than what it should be and she’s symptomatic and doesn’t feel good, you mentioned topicals or creams, you mentioned pellets, and then you also mentioned administering intramuscularly. So, let’s walk through each one of those, and I would love to hear what you don’t like about injectable forms of testosterone.

Dr. Kyrin: Sure. I forgot to mention troches and sublingual drops, there are those as well. So, we did mention the oral form not recommended, because you get that hepatic first pass effect. So, with testosterone, troches are little kind of wax imbedded testosterone that you can stick in the mouth between the gums and it’s absorbed through– into the bloodstream. Although, the studies have shown that with that route of administration and the sublingual drops, probably, more of it does get swallowed and become an oral dose. So, they’re not my favorite, but you can use those as routes of administration.

Then there are transdermal creams, which probably transdermal is the purest form that you just put it on your skin it’s absorbed into the bloodstream. Now, I will say that you can get something with transdermal creams, that is called tachyphylaxis where you use these creams over a long period of time, and like we said, these hormones come from cholesterol, they’re fat. So, when you put them on your skin in your inner wrist or inner thigh, they are absorbed into the subcutaneous fat, even if you’re slender, you have some, and then it creates this kind of depot effect where it’s released into the bloodstream over time. So, you dose it once, but it’s being released over 24 hours, and then when you dose it repeatedly, it’s continually being released. But your thought has a limit to how much it can absorb, and then the levels in your bloodstream will start going down. This is actually what happened to me. I kept putting more and more and thinking what’s wrong with me.

Cynthia: [laughs]

Dr. Kyrin: I don’t feel like myself, I don’t feel like myself. Then I checked my DUTCH, and I had no testosterone. When that happens, you have to switch to a pellet. So, I put testosterone pellets and Holy Moses, the lights went on.

Cynthia: [laughs]

Dr. Kyrin: I think–, I don’t know if God wanted me to have that experience, again, of having no testosterone and then having testosterone, and it was like, “Oh, my gosh, the lights went on” so that I could really start speaking about this and educating about this more for women because the dramatic difference. So, the pellets are implanted in the subcutaneous fat, they’re very easy. It takes just less than 60 seconds to put it in. They last four to six months, and then there are injectables. Now, I’m not a fan of injectables, I’m going to tell you why. So, with every dosing method, you get a peak and trough. When you take a Tylenol, it’s probably going to peak in about an hour and a half, and then within four to six hours, it’s going to go away. When you dose any type of medication repeatedly, those peaks and troughs get lower and lower, and you get more to what we call, a steady state level. The pellets have that too, but it takes several months to get to peak, and then the trough will be many months later after that.

But with the injections, it gives a very large bolus or dose and the levels go up very quickly. So, one thing you have to understand about these– all of these hormones, estrogen, progesterone, testosterone is they are steroid hormones. Steroid hormones stimulate your endogenous opiate system. So, what is that? That’s your natural opium high system. You’ve heard of runner’s high or that runners get these natural opiates, and then they get high from running, well, you can make anyone into a sex hormone addict if you give them enough sex hormones. Give them a high dose of estrogen and they will be jonesing for their next estrogen dose.

Cynthia: [laughs]

Dr. Kyrin: Because they make you feel so good, not only because of their inherent intrinsic benefits, but because they stimulate this system. So, when you dose the testosterone in a large bolus of an injection and it goes in the body, you stimulate that system and people feel amazing. Within seven days, they’ll come and say, “Oh, my God, I feel so good. This testosterone is the best thing ever.”

Cynthia: [laughs]

Dr. Kyrin: But then when they hit their trough several weeks later, they come back, “Oh, no, I feel terrible. I need my testosterone,” and they get another shot. What happens is, women want more frequent doses, higher doses, they want more, more, more, more. So, you create this addictive cycle, which is not the reason we’re using testosterone. The peaks are not as high and the troughs not as low with the other modes of delivery. So, having done this for many years, I’ve seen that way too often. So, I usually don’t recommend injectables and definitely start with a transdermal cream, I’ll go with the troche, pellets, and each woman’s different. You have to get what’s right for her.

Cynthia: I love that you are sharing your personal experiences as well as professional. I want to be respectful of your time. What is the easiest way for ladies to connect with you? Are you working distantly with your patient population right now? I know with the pandemic, there’s a lot more flexibility over state lines, and let people know how they can connect with you on social media, and how to find you.

Dr. Kyrin: Sure you can find me at Kyrin Dunston, MD pretty much everywhere. I’m going to spell it because it’s a little different. It’s K-Y-R-I-N-D-U-N-S-T-O-N-M-D dotcom is my website. You can sign up there for a Masterclass that I’m doing. Educating you about how women over 40, enlightened women like JLo and the other celebrities we talked about keep their weight off and their energy up after 40, so, there’s a free Masterclass there. You can find me on Facebook and Instagram @kyrindunstonmd. I do group programs, my Hormone Balance Mastermind all over the United States. I actually have a telemedicine company, The Hormone Club, where we have doctors who can do these tests that we’ve been discussing with you and prescribe for you in almost every state in the United States while I educate you, so, you can become hormonally literate.

Cynthia: I love it. Well, always a pleasure to connect with you. I’m so glad that you joined me today. This has been a topic I’ve wanted to explore more on the podcast and you’re the perfect person to bring on to talk about it.

Dr. Kyrin: Thank you so much for having me, Cynthia. I really appreciate it.

Presenter: Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating, and review, subscribe, and remember, tell a friend. And if you want to connect with us online, visit the link in the show notes.