Ep. 207 – An Alternative Perspective on Beauty, Skincare, and Hormones with Dr. Keira Barr

Your trusted source for nutrition, wellness, and mindset for thriving health.

An Alternative perspective on Beauty, Skincare, and Hormones

I am thrilled to have Dr. Keira Barr joining me today! Dr. Barr is a dual board-certified dermatologist and menopause specialist. She is a prominent leader in women’s medicine, creating a bridge between hormones, skin, and mind-body medicine to optimize the mid-life experiences of women. She is a fierce patient advocate dedicated to uncovering the root cause of hormonal imbalances. Dr. Barr empowers women worldwide to take control of their health and hormones in menopause.

Dr. Barr takes a different approach to skin health. She realized that as women head north of thirty-five, the emphasis is always on the concept of anti-aging and finding ways to camouflage the effects of aging. So she helps women appreciate that their skin can be an ally because it can help them understand what happens in their bodies and empower them to make the changes that are within their control.

In this episode, Dr. Barr and I unpack the changes that happen to women’s skin from the age of thirty-five onward. We dive into skin physiology, the impact of hormones, and the changes that occur as we age. Dr. Barr explains how our skin reflects our physical, mental, and emotional well-being and talks about progesterone, stress, and regulating the nervous system. We discuss Botox, self-love, the social conditioning of women, the benefits of breath-work, getting enough sleep, and taking the time to enjoy yourself. We talk about psoriasis, food, choosing the best skin care products, and caring for your skin, and Dr. Barr shares her thoughts on skin peels, lasers, and bio-identical hormone supplementation.

I hope you gain a lot from this insightful conversation with Dr. Barr! Stay tuned for more!


  • What motivated Dr. Barr to help women navigate middle age and beyond?
  • What is Dr. Barr’s Alternative Perspective?
  • Dr. Barr unpacks skin physiology, the impact of hormones on the skin and hair, and the changes occurring in our skin throughout our lives.
  • How does our skin reflect our physical, mental, and emotional well-being?
  • The impact of progesterone on the skin and hair.
  • The impact of stress.
  •  The importance of regulating your nervous system.
  • How you see yourself will impact what shows up on your skin.
  • How to make your skin your greatest ally.
  • How can breath-work and rest help your skin repair, recover, and rejuvenate?
  • Some skincare tips.
  • Navigating the choices around cleaner and safer skincare products.
  • Dr. Barr shares her thoughts on skin peels, laser procedures, and bio-identical hormone supplementation.

Connect with Dr. Keira Barr

Social: IG: https://www.instagram.com/drkeirabarr

Linkedin: https://www.linkedin.com/in/keirabarr/

Website: https://www.drkeirabarr.com

Book: The Skin Whisperer

Books mentioned: 

Environmental Working Group

Breath: The New Science of a Lost Art by James Nestor

Estrogen Matters by Avrum Bluming

The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease by Lisa Mosconi

Resource mentioned:

Environmental Working Group

Connect with Cynthia Thurlow

“Taking care of your skin from the outside in is important. But taking care of yourself as a human being from the inside out is even more important.”

– Dr. Keira Barr


Cynthia: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

The impact of stress on skin, hormones, and wellbeing with an emphasis on the menopause transition is the focus of Dr. Keira Barr’s work. She is a traditionally trained clinical dermatologist as well as an integrative medicine specialist. We dove deep into not just the physiology of skin, but also the role of estrogen, and progesterone, and testosterone on changes that occur in the skin naturally. What I love about her work is that, she really emphasizes the net impact of chronic stress and anxiety that shows up on her skin, how stress impacts the symptoms and skin changes, especially as we navigate middle age, how she feels that we should use our skin as an asset to create resilient health rather than somebody to be fixed or covered up. We dove deep into some anti-aging protocols, the role of hormone replacement therapy, we even spoke about vaginal lasers and her experiences there. And [unintelligible [00:01:30] is an inside-out perspective with regard to how she views how women show up in middle age and elsewhere. Also, the importance of reconnecting to our bodies to help us feel more comfortable in our skin, literally and figuratively. I hope you love this conversation as much as I do.

Dr. Keira Barr, I am excited and so thrilled to have you joining me today to really talk and unpack all of the things about skin as women are hitting 35, 40, 45 and beyond all the changes that happen. I’ve gotten such great response and interest in this podcast episode. I’m so excited to have you with me today. Welcome.

Keira: Thank you, thank you. Excited to have this conversation.

Cynthia: Yeah. Tell me what got you so passionate about talking to women about how to navigate middle age and beyond? I understand from colleagues of ours that you got tired of treating acne, which we know can happen throughout our lifetime. But what made you feel particularly interested/vested in women that are north of 35?

Keira: Because I’m one of them.


Cynthia: Most Importantly right.

Keira: Most importantly. It’s all about me. No, I’m just kidding. I think part of it is, when I was practicing dermatology, so, I’ve full transparency. I’m not in a clinic right now, I really do take a different approach to skin health. But I was clinically treating skin cancer and melanoma and then I was behind the microscope. Looking anytime you had a biopsy, I was the one making the diagnosis. Always going beneath the surface. I wasn’t on the aesthetic side of things. And really, I think what bothered me the most is, as we’re heading north of 35 is the emphasis is always on this anti-aging concept and not being who we are, where we are, trying to camouflage, and cover up, and make feel pretty shitty about ourselves like, “Who you are is not who you’re supposed to be right now. You’re supposed to be x years younger.” Knowing what skin looks like underneath the microscope, what causes those things, I think it really informed my interest to help people view their skin from a different perspective that it’s not something to be covered up or fixed. It can be your greatest ally and asset to understand what’s happening in your body to empower you to make some changes that are within your control.

Cynthia: I think for many people, they don’t acknowledge or understand that what manifests on the exterior part of our body, it can be a reflection of what’s going on, whether it’s gut microbiome issues, or inflammation, or the choices we make in our diet. I would imagine that since you have this tremendous breadth of clinical experience and also a very unique lens with which you view healthy aging, which is incredibly refreshing, because I feel most women are conditioned to believe that we want to subjugate our needs, we want to become invisible, our needs are no longer important, and if we lean towards social media, or lean towards print ads, or what we see on movies, it’s a society that’s very focused on never aging. Never aging, never looking your age, never being your age, never admitting your age, all things that I think can be tremendously unhealthy for women to be exposed to on a chronic habitual basis, because I know that I’m at the stage and age, where a lot of my girlfriends that aren’t in the healthcare space will ask me questions, “What do you do, what do you use? Do you do laser, do you do Botox, do you do injectables, do you do this–?” Because there’s so much misinformation that’s out there. So, that’s why I’m particularly grateful to be able to connect with you, to be able to share your knowledge with our listeners.

I think if we start from the basics, let’s unpack a little bit about skin physiology, the impact of hormones and for those that are listening, there are some people that are still way before perimenopause, we’ve got plenty of people in the perimenopause and menopause phase, but the changes that occur throughout our lifetime in our skin.

Keira: Yeah, there’s a lot to unpack there and so much of what you said. I feel there’s so much to say.

Cynthia: [laughs]

Keira: This social conditioning is huge, and the beauty industry is a $500 billion plus industry, and it really is designed to make us feel not good enough in many ways. That’s not to say that there aren’t some amazing products out there and taking care of your skin from the outside in is important, but really taking care of yourself as a human being from the inside out is even more important, because more than just a reflection of our physical wellbeing, your skin is a reflection of your emotional and mental wellbeing, too. There is such a connection between our mind and our skin. If you’re embarrassed, you get flushed. If you’re stressed out, you may notice that your acne, or psoriasis, or eczema is flaring. Individuals, who are stressed may have trichotillomania. They’re pulling their hair, may scratch and cut them. It manifests in so many ways. I really want to emphasize that when we talk about skincare and the changes, it really is taking care of the whole person and that’s where I focus most of my time now is in the emotional and mental wellbeing. So, that plays into the role that hormones play in our skin over time.

Certainly, those of us in perimenopause can start in our mid to late 30s. For some women, for myself, it definitely was in my late 30s and it can last anywhere. The textbooks will say four to 10 years, but it’s very unique and individual. What we start to see, estrogen does play a significant role in the health of our hair and our skin. Estrogen plays a role in collagen formation, so, giving us that youthful appearance. It plays a role in skin hydration by production of the glycosaminoglycans, which is the hyaluronic acid. The filler that so many of us get injected into our face is hyaluronic acid, which your body makes naturally, which estrogen is playing a significant role. Estrogen also plays a significant role in the hair growth cycle. So, your hair grows in three phases. A resting phase, a growing phase, and a falling out phase. Estrogen prolongs the growth phase of the hair. That’s why when women are pregnant, their hair is lush and full, they give birth or I should say people, who are giving birth, when after they give birth, their estrogen levels drop. Their hair, all of a sudden, is falling out in clumps and they may not understand that’s actually normal. It’s just the natural process of your hormones diminishing.

When we’re in this natural phase of life, those of us who will go through menopause, your hormones are declining. What you may find is your hair is getting thinner and finer, not growing as quickly. You will also notice that your skin is getting drier and it’s not just on your face or your arms, your legs. It’s also in your intimate bits, because your vaginal skin is skin. Same thing with collagen. You may notice more fine lines, wrinkling, sagging, gelling. In the vaginal skin, that tissue is going to atrophy. It’s going to be thinner, because you’re not generating as much collagen. Because of that, people may also experience urinary frequency and urgency, because the tissue around the urethra and the–, everything is impacted. So, that’s just a beginning place to start. That’s a lot of information, but I just want to–

Cynthia: No, but it’s so helpful, because a lot of those connecting the dots pieces. People maybe think, “Oh, that explains why I feel I have to go to the bathroom more frequently.” “Oh, that explains why my ponytail isn’t as full as it was before. Because I think there’s a lot of focus on in the beauty industry are collagen and elastin, and people to understand like, “What does that actually represent?” And then also, unpacking things like progesterone and I think people think about progesterone like, “Oh, progesterone helps me become mellow and it helps me with sleep propensity,” but there’s so much more to it than that. I always like to think of progesterone and estrogen as doing this delicate dance and maybe as we get closer to menopause, we may have more circulating estrogen than we have progesterone, which explains some of the symptoms we experience. But it’s reassuring to know that we have these estrogen and progesterone receptors throughout our body. It’s not just localized in one or two places we’re led to believe.

I always say that, I went to a pretty darn good university and I know more about hormones. Now, I never had a healthy respect for the endocrine system until now. I feel now I really respected and understand this careful orchestration. You had mentioned autoimmune issues that can manifest as skin problems, you touched on the role of stress and how that can manifest. But when your cortisol is up, that can manifest as different changes in the skin as well. So, I think it’s really helpful for women to know/reassuring that a lot of these changes are very normal. If we are able to live long enough, we will see changes throughout our body. It’s not just localized to one organ.

Keira: Yeah, it’s so true and certainly, a couple of things. With progesterone in particular, there isn’t as much in the literature of how progesterone impacts the skin as estrogen. However, progesterone is thought to play a role in skin thickness and elasticity. Where progesterone can play a more significant role is with our hair. Typically, progesterone declines first, then estrogens behind that, then your androgens. Now, your androgens, testosterone is converted to a more potent form dihydrotestosterone and it does that through an enzyme called 5-alpha-reductase. Progesterone in normal healthy levels acts as a stopgap. It blocks that conversion from testosterone to its more potent form. As you’re heading into perimenopause and progesterone is declining, you don’t have that blockage as much. This is why some women may notice a widening of their part, because testosterone or dihydrotestosterone on the scalp, what it does is, it causes a shrinking of the hair follicles something called miniaturization. The hairs are more fine, more thin, you have this male pattern, female pattern baldness. On the face, it has the exact opposite. Dihydrotestosterone will stimulate hair follicles. Women may notice they feel they’re going bald or growing a beard, WTF, seriously.


Keira: This is not funny. That is exactly, part of it is, it is that lack of inhibition from progesterone and the relative dominance of the androgens at that time that’s causing. This is something that you’ll also see with PCOS and other– It’s not just as you so eloquently pointed out. Our hormones are always in this constant delicate balance and bringing stress into it. Stress is the worst for our skin on so many levels, because our primary stress hormone, cortisol, not only if you’re talking about aging gracefully, cortisol will cause a destruction of your collagen and your elastin and it will also prevent repair. That acceleration of the aging process, stress is going to do that every time. It also directly stimulates your oil glands. Those individuals who are like, “Oh, my gosh, I’m feeling stressed out, my skin is breaking out.” Exactly. It’s a feedback loop. You’re stressed out, cortisol is going up, it’s stimulating those oil glands.

More than that, all our hormones are derived from the same building blocks. In this beautiful cascade that our body has created, cortisol is going to be the queen and it’s going to basically shut down the other hormone production, which means your sex hormones, which are already on the decline are going to take a bigger hit. More dryness, more irritation, your skin is going to become more vulnerable to rashes, and redness, and a disruption of the skin microbiome. So, it’s a cascade effect, which is why I spend so much time teaching women how to regulate their nervous system, how to take back control of the things that we can control. Listen, we all have stress, but it’s a matter of our perception and how to help our bodies function the best that they can, because life is challenging enough, we are going through menopause at some point or another. It’s how can we do this from a place that is we can enjoy this part of our life rather than suffering and struggling through it.

Cynthia: Well, and I think really starting the discussion, I’ve come to find as I’ve gotten older, I’ve started to fine tune the women that I interact with. And on so many levels and I’m laughing, because last time I use this as an example, my kids know if I’m really busy with work, sometimes, when I’m having downtime other than exercising, being outside being with them, I will watch something mindless, I’ll stream something mindless on my iPad. One of the Real Housewives shows came up and sometimes, I’m just so fascinated with the degree and the depth of body dysmorphia that I see.

Keira: Oh, my God, yes.

Cynthia: It’s like a train wreck. I can’t help watching it. My 16-year-old last night was like, “Mom’s watching Real Housewives, again. I guess, she must be in busy mode.” I was like, “No, you got to look at this, look at this.” Not to be cruel, but I find it utterly fascinating that as a culture, we are in positions, where we are fighting so hard against what is otherwise a very natural process. I say this with love, because I’ll be honest. I’m fully transparent with all my followers, listeners, everything, but there has to be a point to which you draw a line in the sand and say, “I’m not going to do this” and that’s okay. For each one of us, that might be very different, but I’m utterly fascinated with the muppet look. I just call it, they look like muppets, because everything is so overfilled, overtaught, I’m not even sure if it’s all surgical. It might just all be injectables. But it’s utterly fascinating and also disturbing to be completely fair.

Keira: I’m laughing, because I literally just had this conversation with my teenage daughter and I said like, “We should not be watching this. This is so toxic for our brains. But it is. It’s like a treatment. You cannot look away.” It is just such a testament to our social conditioning. And just like you, I would be a complete asshole hypocrite if I said, I’ve never gotten Botox, I’ve not done fillers, and I think part of it is the studies, Botox, with depression, where I would say people, but especially, those socialized as women, who have been made to feel that, if your boobs aren’t this size and your butt isn’t this size, you’re just no good, that if you are looking in the mirror and you’re just scowling at yourself. That inner critic is just going to have their way with you. But if you cannot, if you paralyze those muscles, so you can’t make that nasty face. It softens a little bit and then when you look in the mirror like, “Hmm, maybe it’s not so bad.” There’s nothing magical about Botox, but it is this gateway of opportunity to maybe have a little bit more love and self-compassion.

I think it’s all about perspective like, “Why are we getting the Botox? Why are we doing the filler? Why did–?” Because earlier, that I straighten my hair. From a place of I love myself enough to take good care of myself and I want the outside to look as good as the inside versus if I do X, Y and Z, I will be lovable, I will be worthy, people will look at me, they’ll pay attention. We’ll never get a return on investment from that perspective. I do think that there is a place for all of these things. If we’re honest with ourselves as to why we are choosing to do them and I think that makes a huge difference. I was watching Housewives as well and there was a physician, who was making comment like, “A little dab will do this” and pointing up the person’s flaws and I was like, “As a woman, you’re a part of that problem.” Let them come to you and say versus a lot of times, people will come into an office and say, “What’s wrong with me? Fix me.” I’m like, “Nothing’s wrong with you. Nothing.”

Cynthia: That’s a really important distinction. Self-love is where things originate from and I think on many, many levels, there’s certainly, a culture of everything is fixable. If you don’t like the way your nose looks, if you don’t like the way your foot looks, if you want to appear to be taller, you’re going to wear super high heels. You can run the gamut from being very benign all the way to some extreme surgeries. I was trying to explain to my teenagers that probably before I even met my husband, many years ago, there was a show called The Swan. I don’t know if you remember this, but it was another almost a train wreck, where you were drawn into watching these women go from looking themselves to looking someone else’s version of what they should look like. I wonder if hundred years from now, things will have gotten to a point that people will look back retrospectively and laugh at the degree of ridiculousness. However, I would imagine things are just going to get more ridiculous as they move on that people can’t have, a lot of people not everyone. There are many people who aren’t happy with who they are, where they are in place and time, and what they do to their physical appearance is a manifestation of or a reflection of what’s going on internally for them.

Keira: 100% and that’s why where I am so passionate about this work of helping. I work with women in particular, but helping them feel comfortable and confident in their skin, because how you show up in this skin of yours impacts what shows up on it. If we’re worried about fine lines and pigmentation, yes, I can make some recommendations of products. I can give you a three steps skincare regimen, but it’s how we view ourselves and so much of it goes back to our childhood when we were shamed for some behavior. We have this protective mechanism like, “I don’t want to be seen, I want to be seen.” Like, “I don’t want the real me to be seen. I want the version of me to be seen that won’t be criticized I was back then.” I have the sign behind it. I have, it says, let’s go skinny dipping and the name of the program is Skinny Dipping Method. I use that as a reminder, because I am the person, who has all the layers on many times, I was made fun of as a kid for what was on my skin. I never put the dots together as to why I went into dermatology just because I felt so uncomfortable in my skin, most of my life. Just found the science really fascinating, but it’s a reminder that on a physical level, we have to get naked in order to save our own lives.

Skin cancer, melanoma, the most common cancer essentially in the world, melanoma the most deadly, but we have to in order to thrive be willing to get naked emotionally and mentally as well, and really be able to look beneath the surface, so that we can heal. So many of like stress is the number one reason people go to the doctor. Well, actually, skin-related issues are the number one reason people go to the doctor and the vast majority of that are have underlying stress-related issues. I think it’s just a matter of talking about it openly, there is no shame. So many of us have experienced so many microtraumas, macro traumas in our life and it shows up in our behavior, which is reflected on our skin. Your skin can be your greatest asset in terms of, “Hey, those dark circles under your eyes, you’re breaking out– Are you sleeping, are you adding any pleasure or joy into your daily routine, who are you spending your time with, what are you feeding yourself with, both with food and other ways?” Your skin can give you information that it needs your support, and it can also be your greatest cheerleader, and glow crazy when you’re taking better care of yourself. So, from that perspective I think that our skin is an amazing organ. [laughs]

Cynthia: Absolutely. You think of it as a litmus test or validation that you’re doing the right things, and I’m sure you probably would agree, because you probably trained in the 90s, I trained in the 90s, and I remember hassling the residents with questions in the middle of the night, not purposefully ever, always being respectful. But that’s back in the days when all healthcare professionals worked insanely long hours during their training, they were exhausted. You don’t eat good food when you’re stressed. You cravitate towards– In Baltimore, it was Krispy Kreme doughnuts, which I never liked, by the way, and copious amounts of caffeine and whatever you can readily just grab and go with, walking through– I can’t even remember. It just makes me cringe when I think about all the junk that we ate.

But acknowledging that our skin at that time was probably not a good reflection of how well we were taking care of ourselves. I look at photos of me in my 30s and I’m like, “Gosh, I look so much healthier.” Well, I got more sleep, I had met my husband, I definitely ate better, I definitely had more disposable income to eat better, I probably got in lots of exercise, slept better. So, I love that you tie in that our skin is a manifestation and a reflection how well we’re taking care of ourselves and that is impacted by so many of those lifestyle markers that I just alluded to.

Keira: Yeah. 100%. Yeah, when I was going through my training, there was no such thing as an 80-hour work week. I remember, I graduated medical school, my husband was a year ahead of me. It was a time when we were in training, post cut, we wouldn’t see each other for a week at a time. I remember thinking it was a good idea to follow him around the emergency room just so, I could get a glimpse of him, and then I saw him do a procedure, and I was like, “Oh.” I was like vomit. I was like, “I don’t care, but I don’t see you for two weeks. I’m never– This is fine.” Yeah, it is so true that your skin can be that litmus test and it doesn’t require doing a lot. You don’t need to invest a ton of money or even a ton of time.

One of the things that I always teach the people that I work with is breathwork is actually probably the greatest asset and tool that you can use to help your skin repair, recover, and rejuvenate. You don’t have to add anything on to your to do list. You’re already doing it. But most of us aren’t paying attention to how we breathe. Most of the time, we are holding our breath and just that awareness of breath can reset your nervous system from that fight or flight to that rest and repair, and your skin, it’ll start to show. You’ll feel a little bit more relaxed and more calm, because that cortisol level, if it is staying jacked up, it is just wreaking havoc on your skin.

Cortisol-melatonin, that interplay, it’s affecting your sleep-wake cycle, and melatonin is one of the most potent antioxidants our body produces so powerfully reparative for our skin. It helps repair DNA damage. We need that rest and recuperation. I think we live in a society. I see it all the time on Instagram that hustle culture. That’s the worst thing for your skin. It’s the worst thing from an emotional and mental wellbeing, too. I think just shutting all that, it’s so hard. But shutting stuff off, deleting stuff that isn’t serving you and really fighting that urge, that fear of missing out, I know that I have that at times, but I think that drives my stress response so much that I can just shut things down.

Cynthia: No, that brings up such good points. It’s interesting. The breath work piece makes me think of one of my favorite books I’ve read this year by James Nestor, Breath and I tell people all the time, I never would have imagined that a book that was talking about breath work would be so interesting, but really tapping into the autonomic nervous system. We have fight or flight, which is sympathetic and then we have this parasympathetic rest and repose. As a society, it’s a constant onslaught. Unlike when you and I were growing up, where I don’t care if you had cable TV, at some point during the night, the TV went off and that was just the way things were. There was no this total connectedness all the time. There was no FOMO, because everyone just went to bed. That’s not what happens now. When we really think about things that are serving our best interests and helping to support that hormone balance. You mentioned cortisol, talked a little bit about sympathetic dominance that I remind people that when cortisol goes up, you’re not going to get good sleep quality, you’re not going to tap into those master antioxidant benefits with melatonin, which the more you learn about melatonin the more fascinating I find that hormone to be, because it’s just about sleep, it’s about so many things, and how there are so many different receptors throughout our digestive system. In response to when we last ate a meal, and when we tried to go to bed, and what our blood sugar’s doing, and whether or not we’re eating more than we’re fasting really has a huge impact on our health in ways that we probably don’t even fully appreciate and realize, yet.

Keira: Yeah, it’s fascinating. It really is. To that point, when we are in that sympathetic overdrive, that shift in hormones. Cortisol is elevated and what gets shut down, like, your digestion is shut down. Your libido goes in the tank. The impact on metabolism and thyroid hormone too, and again, how that shows up on your skin, lateral third of your eyebrows is a classic sign that when those are thinning, it could be your thyroid. Your skin also can get really dry. Some people experience deposition disorders, myxedema, and skin is doughy. Again, we will always have stress, stress can be a great motivator, and, again, it’s not that something happens. It’s our response to it, and being in this chronically activated state, and it’s understandable. We are still in a pandemic. There are still going to be a ton of emails in your inbox that you have to deal with, bills to pay, social injustices in the world. Yes. And so, to equip yourself with tools to help you regulate that response to stress, so that you’re not always feeling anxious and overwhelmed is so key for your overall health and wellbeing for your sleep, for your ability to digest and assimilate nutrients.

But if we’re talking about skin health, so that your skin can truly repair, and regenerate, and recover, and glow. [laughs] We really need to focus our attention on that. I think we underestimate the impact that stress has and I was just at an Integrative Derm Conference a few months ago, because even though I’m not actively practicing, I’m still fascinated by the science since I’m certified in that, too. I think that’s an illness that some of us have, like, you just need more and more certifications [unintelligible [00:29:05] on with that. [laughs]

Cynthia: I think [crosstalk] curiosity.

Keira: Yeah.

Cynthia: I always think about it from the perspective like, we love to learn, and we always want to be learning, and so, I tell my kids like, neuroplasticity is a good thing with our brain. You’re creating new connections. So, I think it’s a way to keep us sharp. That’s what I tell my sons.

Keira: I love your rationale versus the– Again, still, we teach best what we need to learn the most. I teach about managing the stress response, learning self-love and self-compassion, because I’ve spent the majority of my life not being kind to myself. Always thinking that I wasn’t good enough, really thinking back to all the incidents of not being in front of other things like in childhood, so I’d rather take on your approach. But again, we’re learning, we’re evolving, and what came up specifically at that conference is, psoriasis, eczema, hidradenitis, some of these very chronic, very debilitating isolating diseases, because when people see psoriasis or really bad atopic derm or hidradenitis, they don’t understand that it’s not infectious, it’s not contagious. The individuals who struggle with this feel very isolated and don’t want to have intimate relationships or don’t feel like they can.

The thing that came up is, this creates a lot of stress, and distress, and emotional dis-ease. But it’s the missing piece in our field. There is a subspecialty called psychodermatology, but there are a very few dermatologists, who are trained in that or have the bandwidth if you’re an insurance-based model, so I feel like I want to fill that gap for people, because it’s such an important piece of the treatment protocol that we’re not including. If we can get help regulate our nervous system, no doubt the people who have psoriasis, acne, eczema, those are some of the top three things that people go to the doctor for, all of them, there’s a huge component. I wouldn’t say all, but a huge component that is tied to stress exacerbating it and the stress as a result of having the condition. So, learning how to manage that stress is going to be a key thing for resolving, improving, and maintaining skin wellness.

Cynthia: It makes complete sense and I might have thought I’ve shared this on the podcast before, but 20 plus years ago, I was bit by deer tick had the classic bullseye rash, happen to go in and see my primary care provider. She saw it and immediately started antibiotics and for which I’m very grateful. But six months later, I developed a patch of psoriasis on my forehead and I recall when I read about psoriasis and looked at photos. The photos you see in medical journals or in medical textbooks are like the worst-case scenario. Well, and there are a lot of people, who certainly suffer with more significant psoriasis. I had very mild psoriasis and I dealt with it intermittently with topical steroids over the years and it wasn’t until I met my first integrated medicine specialist and she said, “You realize your psoriasis is related to the fact you are on antibiotics and you developed an autoimmune issue, because of the antibiotic. It has impacted your gut microbiome.” And how my entire world changed, when I just took gluten out of my diet and my psoriasis went completely away. Again, it was very mild.

However, I recall as a 20 something being very concerned that I was going to end up with this really significant case of psoriasis, because there was such little information and what was out there was really scary to be honest. I love that you are marrying these two desires together in a way that will make things a whole lot less distressful for patients, because you’re right. Their traditional allopathic medicine model is you get five, 10 minutes with a patient if you’re a physician. If they gave you more than one or two complaints, it’s going to mess up how quickly you get on to the next person. Being a Nurse Practitioner, I always had more time, but we sometimes got saddled with hospital discharges, which were usually pretty much disasters. But the point of why I’m sharing this is individuals that are listening understand that it’s not that your healthcare provider doesn’t want to hear all the things.

Keira: Right.

Cynthia: But they’re not trained to do it. It’s extra training, this extra realization that you’re realizing there’s more to it, more to dermatology, more to skincare than just getting a diagnosis, writing a prescription, and sending you on your merry way, and giving you a 10-second spiel on, “Oh, by the way, don’t do this, this, and this.” And then the patient goes home and feels completely lost. One of the things that came up with some frequency on social media, when I mentioned that we were connecting was a lot of women feel that there’s, again, a lot of pressure on certain terminology, certain types of products. They “should” be using at the stage, and middle age, and beyond. So, do you have ways that you suggest navigating beyond the cognitive behavioral stuff that you’re already doing, ways to navigate choosing cleaner, safer products that are out there that came up frequently was, “How do I choose products? Are there brands you trust? What are the things I need to be looking for? How can I support my health in healthy ways?”

Keira: Yeah, I love that because it is a comprehensive approach. There’re so many different things that we need to look at from our gut microbiome, and the gut-skin connection, and your skin microbiome. From an inside out perspective, I think we touch on some of them really. Sleep is so key and as we’re heading into this perimenopause, post menopause phase of life, where hot flashes can make sleep a challenge. Doing our best to set ourselves up for success, sleep doesn’t just start at our bedtime. It really is a 24-hour cycle from the moment you get up, starting your day, maybe with getting outside in natural sunlight to make sure that you’re helping maintain that circadian rhythm, adding pleasure into your day. I actually have it in my calendar, pleasure first. Whether it’s reading a passage in a book, or petting my dogs, or something that really starts your day from a place of joy really frames the day. With regards to sleep, making sure that your room is really dark, and a cool temperature, and that there is not a lot of clutter. I don’t know about you, but clutter does stress me out. So, I’m not saying it to be a neat freak, but it’s really just using your bedroom for sleep and sex.

If you have a TV in your room, I strongly encourage you to remove it and use that elsewhere, because that blue light in your room is not a good thing. I actually just got this new eye mask that has little pressure points that I have found really helps my sleep tremendously. Nourishing, nutrition, I’m talking to like the expert here. That is so important with how we nourish Whole Foods, plant powered, but I truly believe there’s room for everything. I will never be dogmatic about what kind of food people should eat. I really want people– I’m all about embodiment and that somatic experience, eat for how you want to feel and not just in the moment for that instant gratification. In a couple hours from now, how’s your mood? Are you pooping? That’s an indication like what you’re eating may or may not be serving your body. With regards to skincare specifically, it’s tough. There’s a lot of great products out there. So, I know that you know Environmental Working Group is a good resource, but it’s not perfect, but it’s a place to start. I really like to keep a skincare regimen very simple, because I’m lazy and non-compliant. [laughs] I mean, perfectly honest. Yeah, I’m the worst. When it comes to that, I think most doctors are.

But washing your face, okay, and if you don’t wash your face in the morning, okay, wash your face at night for sure. Because air pollution is right behind UV rays in terms of causing damage to your skin, it can break down the collagen, the elastin causes hyperpigmentation. At least, wash your face at night to get all the daily grime off, especially if you live in a city. Washing your face with a gentle cleanser. An antioxidant serum, vitamin C and E at a minimum, those two synergistically work very well together to help repair DNA damage. You need vitamin C for collagen production. That’s the other thing with stress. Your adrenals need vitamin C to produce that cortisol and it’s going to be taking it away from your collagen production. Vitamin C, topically foods that are rich in vitamin C intake, and then in the morning, a tinted moisturizer with SPF 30. The reason why I say tinted and thankfully, there are many companies that have all shades to accommodate people of all colors. Thankfully, it’s about downtime is because okay, I’m sitting in front of a window glass. Is sitting in front of a window, UVA rays penetrate your window glass. UVA rays are the aging rays. Whether it’s COVID and you’re working inside or just that’s your life, you’ve always worked in an office, you are getting Sun exposure all day long if you are sitting in front of the window, you want to protect your skin.

Now, we are on Zoom right now. We are in front of our devices. Blue light coming off our screen. Studies have now shown that the blue light can also cause pigmentation issues and damaging hair collagen and your elastin. The iron oxide in a tinted moisturizer will help block the blue light. That is why tinted moisturizer SPF 30 or above. Most of us are not putting on the recommended amount of sunscreen on a daily basis. You’re not truly likely getting SPF 30. For those of you who are concerned, “Oh, but the vitamin D, we cannot wear sunscreen.” Okay, I call bullshit on that studies. Most of us, listen, yes. If you’re putting on the research study amount of SPF, it will block some UVB rays. However, studies have shown the vast majority are not doing that.

Cynthia: [crosstalk]

Keira: For your whole body, for your whole body. Most of us aren’t doing that, nor are we reapplying, and it breaks down most of the time [unintelligible [00:39:28] we’re wiping it off with our towels and such. No sunscreen blocks 100% of UV rays. It’s a matter of balance. Do I think you should get out in the Sun? Yes. Dermatologists are not like some ogres. We believe you need to get out there. At least, I do anyway. And get the benefits, the endorphins, the feel good. But you want to balance that with some protection. 90% of visible signs of aging are from UV exposure. Skin cancer is the most prevalent cancer in the United States. Non-melanoma skin cancers, so your basal cell or your squamous cell, which are directly correlated to cumulative sun exposure over time. It’s a big deal. It’s a big deal. You can prevent these things from an outside in approach. In the evening, so, this is long thing. Wash your face again. If you haven’t washed your face in the morning, wash it at night. Antioxidant serum again, and then instead of the sunscreen, adding in a product that can help with skin cell turnover like a topical retinol, retinoid, your prescription is tretinoin or Retin-A would be the brand name.

But the caveat there, it can cause dryness, irritation, rashiness, those of us may be very sensitive to it. If you cannot tolerate it, so, a little bit goes a long way, you start off using a little bit, maybe once a week then twice a week, build your way up. If you still cannot tolerate it an alternative is bakuchiol. There was a head-to-head study done with retinoids against bakuchiol, and the results were pretty impressive. Actually, bakuchiol in this study had, I think, even better results for wrinkling and improvement in the skin without the irritation. And it’s safe in to use in pregnancy, because retinoids when taken by mouth are category x. We do not want to harm the fetus. Can you use a topical retinoid when you’re pregnant? We always say not recommended. But the amount that you’re using is so tiny, tiny and the amount that’s actually absorbed into the body probably wouldn’t make an impact that we say safer than sorry, so avoid it.

Cynthia: Well, I think there’s such little research understandably done on pregnant and breastfeeding women that I always used to say to patients, like, better to be safe than sorry, even if it’s very minimal absorption. I got a lot of questions about peptides. Are you fairly interested/finding good research about peptides for skincare?

Keira: I think it’s really interesting. I am no expert by any means and I know in terms of peptides like injectable peptides and I’ve used some of those to try and heal my gut, and other things. Topical peptides, I was using this from a compounded pharmacy. I was curious about it. I think that there’s probably some benefit. I don’t know. I didn’t use it long enough. The research looks quite interesting. But again, it’s a matter of what vehicle is it in, can it really penetrate, can it absorb? I think there’s more to it. I would probably defer to someone who’s really into that. But some of these products are really quite expensive with a peptide. I really start from the inside out, nourishment of your skin, and again, learning how to breathe, and other practice. Not everyone can just sit and meditate. That’s why I also teach a whole range of practices. I’m one of those people. So, it’s not all just breathing and meditation, but finding practices to help you regulate that stress response, so that your cortisol is not messing with you. You’re like fighting a losing battle.

Cynthia: Right. No and I think a lot of people don’t even recognize when their cortisol is up. I can tell, because I will oftentimes get that sensation where my executive functioning, my ability to make decisions, because I’m stressed, it is completely overwritten by the part of your brain, the amygdala, where it just says, “Okay, we’re just focused on one thing at a time. We can’t think through things, We just need to very deliberately, one step at a time.” I got quite a few questions about peels and lasers. What are your thoughts? Do you have any recommended directions to go in?

Keira: Yeah, again, I am not the aesthetic guru expert. I don’t have specific brands of peels that I’d recommend. They can be incredibly effective. And peels, there’s actually the peel society. They do a lot of education on this. Their results are so impressive. When you do a series of more concentrated professional grade like medical grade peels, very impressive results for rejuvenation and helping with pigmentation and they’re noninvasive. Now, the more aggressive the peel is, more downtime that you will have, more peeling, more redness, more irritation. You have to protect yourself from the sun in those instances.

Peels can be a wonderful asset and adjunct to everything else that you’re doing. Laser therapy, same thing. Depending on there’s ablative lasers versus non-ablative. Lunchtime laser and facial versus investing several weeks in terms of recovery. It’s a matter of what the goal is, how willing you are to invest your time and energy into recuperation, and also cost, because some things are not inexpensive. But I think the technology has advanced and there’re many wonderful treatments available. But again, you can expect to do the laser and peel, and have long lasting results, and to get the return on your investment, and feel amazing about yourself, if you went into it with a perspective like you think that’s going to change your life.

Cynthia: Well, I think it can be this multilayered process. I’m very open that [unintelligible [00:45:19], I have a love-hate relationship with it. I love it about a week after I do it, I hate it while I’m doing it. But I think over the last 10 years, it’s really helped with some stimulation of collagen and elastin. It does have downtime. You do get a topical anesthetic? In fact, I think my team has convinced me that I should do some Insta Stories as I’m healing when I do it in January. But I think it’s also one of these things that’s so important for us to be transparent and say, “This is something that I’ve done that technically is invasive, but I’m with someone that I trust.” I’ve been going to the same person for over 10 years. But it allows me to perhaps use some cleaner products on my skin and not feel like I have to go overboard with heavily perfumed, heavily marketed products because when you see something in a magazine, the recognition needs to be that that company spent a lot of money to ensure that you saw that in Vogue or whatever magazine. Does anyone even get magazines at home anymore?

Keira: [laughs]

Cynthia: I know we don’t get anything. It’s really been wonderful, but if you’re looking at a printout, or you’re seeing commercial, or see something that pops up on whatever streaming service you use, the recognition, that company is throwing a lot of money to make ensure that got in front of you, so that you’d then be stimulated to them by it.

Keira: Yeah, totally true. I think, again, it’s a comprehensive strategy and understanding what your motivation is, and what your return on your investment you want it to be. Investing in procedures is, there’s nothing wrong with that at all. Again, just like you said, totally transparent. I’ve tried Botox, lasers, the one laser that I would recommend is vaginal rejuvenation. Hello. It made a big difference in terms of having gone through childbirth and things feeling a little looser, tightening the tissue. Good stuff. For function, I think that there are many benefits from some of these procedures and such. But again, asking questions like, “What is the goal that you are seeking to have this procedure for?” And making sure that it aligns, it matches up with the outcomes that you can expect. Having realistic expectations, otherwise, you will be disappointed and you’re like, “I just have ton of money and I didn’t get what I wanted.” Sometimes, it does require a more aggressive treatment with more downtime to get that result. So, you just have to go in fully informed. [laughs]

Cynthia: Okay. I have to hear more about this vaginal laser. What kind of the laser, what was the downtime, did it hurt, how many sessions did you need? Because this is going to be the follow up questions that people will ask me.

Keira: Yeah. There’s radiofrequency and it was a series of three treatments, I think about a month or so apart. It was a little bit, you put numbing medication in. It really in terms of urinary incontinence and frequency, some people are helped with that, but not necessarily, but it really, especially, you do the outside and you can do the inside. The outside in terms of tissue hydration, it’s supposed to help with hydration stimulating collagen stimulating the tissue to be rejuvenates. A little bit more regaining some function. There’s a few different– There’s the MonaLisa, is one type of laser. What am I blanking on? Some of the other ones.

Cynthia: [laughs]

Keira: I’m doing it on my hand and I’m totally spacing on the other ones. It’ll come to me. This is the mature brain, not as much sleep. Admittedly, I did not get much sleep last night. I was not practicing what I preach. I stayed up a little bit later, and I did not get good sleep, and that’s the thing. Using your functioning and what’s happening on a daily basis to inform us of like, “Hey, girl. These are opportunities.” [crosstalk] Yeah, take better care of me. These are opportunities. It’s going to kill me that I can’t remember the names.

Cynthia: That’s okay.

Keira: Sorry, for all out there. [laughs]

Cynthia: No. We’ll put links to all this. What is your personal methodology? Are you pro bioidenticals, are you–? I would assume that this is a kind of hot topic. The more I learn, there’s a great book I just read called Estrogen Matters and that just very aligned with my methodology and thinking about why it’s so important for women that are making that transition to be thoughtful about replacing what we’re losing.

Keira: Yeah, I agree and I would have directly [unintelligible [00:50:02] my copy of Estrogen Matters.

Cynthia: Yay.

Keira: This past through 2020, I actually did a mentorship with a physician, who’s been in the bioidentical hormone space for over 25 years, and I learned his method, and was actually prescribing bioidentical hormones. It all came about because having gone through early menopause, we had talked, I think, before we hit record that in my late 30s, I was running ultra-marathons, I thought I was a pillar of health, my period started getting really wonky, I was bleeding for weeks at a time, and not one of my physicians keyed into the fact like, “Hmm, your hormones seem out of balance. Progesterone is probably low. Maybe we should supplement you.” No. And then it just snowballed and I ultimately had a hysterectomy and the pathology was endometriosis, adenomyosis, and fibroids. That trifecta of just hormone dysfunction over many, many years that could have likely been mitigated. I don’t know if prevented, but mitigated stress management. I was putting too much stress on my body with the over exercising for my body, the emotional stress of not loving my job at the time. I literally was probably running away from my lab. [laughs].

Unfortunately, I had this hysterectomy. I still had my ovaries, but they weren’t functioning as well. I was in when it’s menopause a little bit earlier than anticipated. I had been on and off hormones. My naturopath suggested, “Hey, try this bioidentical hormone formulation. As a dermatologist, I think you might like it. It’s an oil suspension made from organic oils, jojoba oil, evening-primrose oil, and connect with the founder.” I did. Next thing, it is supposed to be meet and greet. Next thing, I’m headfirst into menopause medicine, learning all about it. As a dermatologist, it seemed to make perfect sense, because as we began this conversation, the impact that hormones have on skin health and appearance, women would come to me like, “Hey, wrinkles, and fine lines, and pigmentation–” They wanted to look better, but really, they wanted to feel better. It really comes down to estrogen, plays a significant role on our mood, and our cognitive function, and as those hormones decline, we become more irritable and especially, also as progesterone is going down, that great calmer, we don’t have that influence to help our neurotransmitters and GABA to help calm and relax us. So, really integrally related.

I began to learn about hormone supplementation and understanding like, we were unfortunately, as a medical community in the early 2000s with the Women’s Health Initiative study, it really did a lot of damage. It still reverberating. Even now that we think that hormones are so dangerous and cannot be taken even by women who have had history of breast cancer, which Estrogen Matters is a great example of, it was written by an oncologist that that’s not true. Everyone needs to be taken on an individual basis, but the fact that the risk of breast cancer is potentially diminished in those, who are replenished with hormones. Even those who’ve had a history of breast cancer, the risk of recurrence is lower in those getting hormones and those who aren’t. When I was prescribing, I actually had several patients with a history of breast cancer. Obviously, we were working closely with their oncologist, and their cardiologists, and having everyone in the mix. So, I am very supportive.

We are not replenishing hormones to the level of our 20s and 30s. It really is to improve symptomatology and benefit health, but it’s not to get it back to youthful levels. I think that there are some methods that may keep upping the level and also understanding that how we metabolize these estrogens are really important. If women are having hot flashes, you put them on hormones. All of a sudden, they’re having more hot flashes, that is not an invitation to increase your estrogen. It’s an invitation to say, “Okay, how are you metabolizing the estrogen? Does your liver needs more support? How’s your gut function?” We need to get rid of– You might be overshooting their threshold. And again, taking in the whole person and understanding all the facets that play a role, and again circling back to stress. Even though, women’s hormones were balanced on paper, they were still anxious, overwhelmed, not sleeping. Again, when I would teach them how to breathe, and meditate, and take them through a whole host of other practices, all of a sudden, the curtains were pulled back, they felt better, they felt more calm, more at ease, more confident. So, it’s not just a prescription. We need to address the entire person.

Cynthia: No, I could not agree more and you did such a beautiful job explaining all that. I think it’s really important that we honor who we are as bio individuals that we determine and really focus first on the lifestyle piece, because what I see happening and it happens so frequently that I now just preemptively tell everyone, “Yes, you may need hormones, but you probably need seven other things first” that to be dialed in before we start layering in hormones, because women will say to me, “I’ve gained 10 to 15 pounds when I was put on hormone replacement therapy,” because they’re still not sleeping properly, their diet is still terrible, they’re over exercising, or stress isn’t managed. I couldn’t agree more. I love that you brought up one of my books that I have completely devoured as of late Estrogen Matters. I’m hoping to bring the authors on the podcast to be able to really unpack.

For me, what I found really interesting about that book and certainly relevant to our conversation is that 2002 was around the time that I was still a new Nurse Practitioner and I recall my mom and all my aunts were taken off of all of their hormone replacement therapy. What I was saying to each of them fairly recently, is with everything I now know, that couldn’t have been a worse decision to have made. It impacted hundreds of thousands, if not millions of women. If you look outside the United States, they have far more progressive perspectives. Even in the EU, they don’t use synthetics. They use bioidentical hormones. I think women navigate the 40% of your lifetime, if you live long enough, they navigate that transition so much more easily. I think there’s still so much fear. Even as I’m getting ready to do a webinar tomorrow night talking about middle age, hormones, weight gain, all these topics that people want to learn more about, my team and I are recognizing that we have to be really ready. Normally, we don’t start with a disclaimer that says, “We are not providing medical advice,” but we are starting that, because already, we’re getting DMs about.

But I was told, and starts off and did something well-meaning, “Can hormones hurt me?” That was one of the questions that came out of the Instagram Stories. Someone said, “I’m really interested in bioidenticals, but I’m concerned it would hurt me.” It makes me very sad as I’m sure it does yourself. Because the recognition, the more you understand, the more you realize that a certain degree of maintaining certain hormones is incredibly beneficial. I think the book The XX Brain by Dr. Lisa Mosconi, which I’m sure you’re familiar with that work, that’s the one that made me realize there was so much more to brain physiology that I recall from 20 plus years ago learning and how critically important it is for proper communication and warding off Alzheimer’s.

For listeners, if you’re not familiar, women are at a reduced risk of developing a lot of cognitive issues until they go through menopause. The working presumption is that, there’s some degree of influence with insulin resistance and the loss of these sex hormones and brain physiology. Obviously, something we really wanted to continue these conversations. If you’re listening to my discussion with Dr. Barr, make sure that you enter into a discussion with your own healthcare professional. If you weren’t getting the answers that you want to need, certainly, reach out to individuals like Dr. Barr that are doing such great work with women. So, being respectful and mindful of your time, what are you working on now, what new things are you doing in your practice, how can my listeners connect with you?

Keira: Yeah, I love that. I just also want to add on not just the brain health, but cardiovascular risks too. We have a protective benefit up to age 60 and beyond that, we’re at a disadvantage. Again, please go to the webinar, learn, and listen, because we’ve really done a huge disservice. There’s so much to learn. What am I doing? As I mentioned, even though, I was supporting women’s bioidentical hormones, I felt that there was that gap just like there is in skin care of really helping women specifically, manage that stress response, and learn, and to be empowered. There’s so much we cannot control, but so many of us are disconnected. One of the exercises I do is it’s actually art and it’s really perception of ourselves, and it’s amazing how in one picture, there’s just a head, and then in another, there’s actually the body but it’s this realization like, “Oh, my God, my head is not connected to my body. I am so disconnected from what’s happening inside.”

And my work right now is to help women reconnect to themselves, learn how to really nourish themselves, not just with what we think of is primary nourishment, which is food, but really from a place of self-compassion, self-care, self-love, so that you can feel confident and comfortable in the skin, and it will reflect that on the outside, and get that glow. So, it’s really the work that I’ve been doing, and it’s been phenomenal, and right now, I’m in a teaching an eight-week course, and just in the first three weeks, the participants have been blown away how much better they’re sleeping, how much more at ease and control they really feel, they never realized that it was really up to them to regulate their mood, that how much control they actually have. I think as we head into our 40s, 50s and beyond, and we are made to feel invisible by media, and in the workplace, and other things to really have the empower to be seen and heard. It’s been really exciting for me.

Like I said, we teach, that’s what we need to learn the most. I do this work, because I still need it. Full transparency. I am not saying I’m above this, like I’m in the fray. So, I plan to continue this type of programming and I also work one on one with women, who may or may not feel comfortable working in a group like that. So, yeah.

Cynthia: No, it’s wonderful. I’m so grateful that you’re in this space and that we were able to connect. I know that this podcast episode will be particularly valuable for women as they’re navigating all the changes that happen in their lives in middle age and beyond. So, thank you for your time today.

Keira: Oh, it’s my pleasure. I could talk all day. [laughs]

Cynthia: If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.