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Ep. 245 Women's Sexual Health and Longevity with Dr. Amy Killen - Cynthia Thurlow

Ep. 245 Women’s Sexual Health and Longevity with Dr. Amy Killen

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

I am honored to connect with Dr. Amy Killen today! She is a leading longevity and regenerative physician specializing in “Sex and Skin.” She is also an international speaker, author, educator, mother of three, a should-be rapper, and founder of the Human Optimization Project (HOP).

Having had three kids within two years while also getting up at 3 am to be on time for her 4 am ER shifts made Dr. Killen’s life sleep-deprived, crazy, and stressed. Then, she noticed that many ER patients were coming in with acute problems related to issues similar to her own and realized that she needed to learn a whole new set of tricks and tools if she wanted to help them and herself.

Dr. Killen has positioned herself as the female expert on biohacking, sexual health, and skin health. In this episode, we dive into her medical background and her transition into a longevity and sexual health guru. We discuss longevity, functional and regenerative medicine, ovarian aging, the impact of lifestyle on our sexual health, de-stigmatizing women’s sexual needs and health, microdosing, supplements, and addressing changes in our skin and hair in perimenopause and menopause.

“I’m a firm believer that menopause is a disease unto itself.”

-Dr. Amy Killen

IN THIS EPISODE YOU WILL LEARN:

  • How Dr. Killen shifted from being an ER doctor to doing what she does today.
  • Dr. Killen explains why she believes menopause is a disease unto itself.
  • How the Women’s Health Initiative created fear around taking or prescribing hormones.
  • Only one in five mammals go through menopause, so why does it happen to humans?
  • How do diet and lifestyle impact the aging process?
  • The serious ramifications of environmental toxins.
  • The importance of de-stigmatizing sex.
  • The role nitric oxide plays in sexual health.
  • Dr. Killen discusses various regenerative therapy options for women.
  • The pros and cons of some new and novel medications and supplements for weight loss and longevity.
  • Dr. Killen discusses her recently-launched longevity product, HopBox.
  • Some of the modalities Dr. Killen uses to help middle-aged women improve their skin and hair.

Bio

Dr. Amy B Killen is a leading longevity and regenerative physician specializing in “Sex and Skin.” In her Utah-based practices, she combines stem cell injections with photobiomodulation, shockwave therapy, bioidentical hormones, peptides, and an old-fashioned healthy lifestyle to give patients unparalleled synergistic regenerative effects for skin, hair, and sexual systems. Dr. Killen is an international speaker, author, educator, mother of three, a should-be rapper, and founder of the Human Optimization Project (HOP).

Connect with Cynthia Thurlow

Connect with Dr. Amy Killen

On her websites:   www.dramykillen.com, www.hopbox.life, or www.docereclinics.com

On Facebook, Instagram, and YouTube

Transcript

Cynthia Thurlow: 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.

[theme music]

Today I had the honor of connecting with Dr. Amy Killen, who is a leading longevity and regenerative physician specializing in sex and skin. She is also an international speaker, author, educator, mom of three, should be rapper, and founder of the Human Optimization Project. Today, we dove deep into her ER medicine background and transition into a longevity and sexual health guru. We spoke at length about longevity and functional and regenerative medicine, the role of ovarian aging, the impact of lifestyle on our sexual health, the need to destigmatize women’s sexual needs and health.

And then we dove deep into a group of different topics including micro-dosing semaglutide supplements, including rapamycin, resveratrol, and how to address changes in our skin and hair in perimenopause and menopause. I hope you will enjoy this conversation as much as I did recording it.

Well, Dr. Killen, it is such a pleasure to finally connect with you. I know my listeners have been really looking forward to our conversation.

Amy Killen: It’s great to be here.

Cynthia Thurlow: As a former ER nurse, I am innately curious why so many of my colleagues leave ER medicine. I mean, I can probably guess, but how did you go from being an adrenaline junkie fueled ER doc, to doing the work that you’re doing today?

Amy Killen: I think a few things happened. First of all, I had my three kids within two years, so I had twins and I had another one, 20 months later. I was still working this [04:00] AM ER shift where I was getting up at [3:00] to go to work. You can imagine how just sleep deprived and kind of my whole life was just crazy. The stress and not eating well and having no time to exercise, all of that was a problem. I started seeing that my patients in the ER were coming in a lot of times with problems that were very similar to what I was experiencing. Like they were experiencing chronic diseases or even acute problems that were actually just manifestations of stress and not eating well and not exercising and not sleeping and all of these things. I just kind of realized in order to help them and to help myself, I needed to learn a whole new set of tools and tricks. So I left the ER in 2013 and haven’t looked back.

Cynthia Thurlow: Well, and it’s interesting because I was an ER nurse for four years in my 20s before I became an NP. I was an NP in my 20s and transitioned to cardiology. I always tell people in my 20s, I was such a people pleaser and I was like, where is the most challenging place to work in a hospital? And I loved the variety. I love the medical complexity of so many of the patients, but I don’t think that would serve me well at this stage of life. And it’s interesting, through podcasting, I’ve met so many ER physicians and nurses that have left for their health, for health reasons, for so many people that they just say it was fun in my 20s. And then as I started a family or I started to recognize like as I was getting older, I couldn’t deal with the sleep deprivation, the stress was out of control and I oftentimes have to remind my non-medical husband. When you work in healthcare, you’re lucky if you can empty to your bladder, let alone actually sit down and eat a meal which is not conducive to anyone’s health in any capacity.

Amy Killen: Yeah, I remember going entire shifts, like 10 hours, and I would drink 44 to 60 ounces of Diet Coke. I would have a Monster. I’d have multiple drinks and I would never go to the bathroom, for like 10 hours. Not because I didn’t have to, but because there was no time. Like, you just don’t have time to go to the bathroom. And so that’s not good. [chuckles]

Cynthia Thurlow: Yeah, well, I remember when I first started as a nurse, I worked the 7p to 7a which, as horrible as it was to work those hours, I had the best group of nurses that mentored me. I remember that it was always at [06:00] AM in the morning when I really hit a wall, I’d start getting tired and I’m like, “I haven’t peed all night long. What is wrong with me?” I would drink Diet Pepsi because I wasn’t a coffee drinker. I wasn’t an eater at night, but there would always be like, Krispy Kreme donuts because I trained in Baltimore, and that’s like the heyday of Krispy Kreme donuts and all this junk food all night long. Like, what’s the worst thing you can do to your body other than staying up all night is fueling it with hyper palatable processed foods and all this, like, sugary junk that all of us ate to stay awake.

Amy Killen: Yes, absolutely. I miss the camaraderie and I miss the really sick patients that we were able to turn around. There’s no feeling like that in the world. I do feel very lucky to have gotten out of an environment that is so difficult on your health.

Cynthia Thurlow: No, it definitely is. I think that’s interesting for me is I graduated from nursing school, like, now, 25 years ago. What’s always curious to me is how many people are still in it. Most of them have either left, they become NPs, or they’re doing faculty positions because they’re like, “I just don’t– that it was just the wear and tear on my body and my mental health.” And let me be very clear, I know both of us are super supportive of all of our people that are in the trenches and all the work that they do. I just know for myself, I wouldn’t be as healthy as I am right now if I were still in that degree of stress.

How did you go from ER medicine to where you are, because you really have positioned yourself as this female expert on biohacking and sexual health and skin health? How did that develop for you, because I’m sure it’s a probably pretty interesting trajectory.

Amy Killen: Yeah. When I left the ER, I became interested in longevity medicine, antiaging medicine, functional medicine, like all these things that are basically looking at root cause and prevention and trying to help you be healthier. And so, I started working in hormones.

I opened up a clinic doing a lot of bioidentical hormones for men and women. And I thought that was great. I loved it. What would happen is people would come in this kind of crisis state, like they’re not sleeping and they’re not eating well, and their motivation is low and they feel horrible and their energy is bad and their mood is bad and all of those things, they’d come in this crisis state. I would help them with hormones as well as lifestyle modifications, and then they would come back three months later or so, and they would say, “Okay, I’m doing better, energy is better. I’m out of crisis mode. Now can you help me with either my skin or my sex life?”

It was always one of those two things. It was like skin and hair or my sex life. I started thinking about those things as being almost like this next level of health. Certainly, those things aren’t the most important of things, but they are important and they make us feel good and they help us with connections and confidence and things like that. Once people lay a good foundation of health, then they can really start focusing on these other things, that just make their lives better and make them happier. So that’s how it started. I started looking at how can we improve sexual health and skin and hair coming from a different perspective, like using all the different tricks and tools that I have, from traditional medicine to integrative medicine to regenerative medicine, like stem cell medicine and using all the different things that are out there to improve those things instead of just coming at it from one perspective. So that’s the story. [chuckles]

Cynthia Thurlow: Now, I would imagine that it’s really gratifying to work with a population of patients that really want to come see you, because you’re helping them improve their hormonal regulation, you’re helping them feel like they can reconnect with their partner or reconnect with someone they’re dating. I think for so many of us, and I only can only speak as a female. I feel like as women are transitioning towards perimenopause and menopause, there can be all these changes in our bodies. I know libido and sexual health is a huge aspect of that. What’s interesting to me is, when we’re thinking about bioidenticals and hormone replacement therapy. When we start having those conversation, I’m oftentimes still surprised, shocked at how many patients, or even women on social media are still terrified to take any hormonal replacement therapy, how many clinicians because the Women’s Health Initiative are terrified to prescribe hormones.

I love that you’re part of the narrative to talk about the research and to share this objectively so that people can get educated, so they can then go to if they’re working with someone locally, they can be the best advocate for themselves, because my practitioner always says and it’s kind of crass, but he’s a man. He always says, “The way you know your hormones are properly balanced is that you are hungry, happy and horny. If you’re not all of the above, there’s something that needs to be done to better balance your hormones.” I always give him credit because I’m like, this isn’t something I per se would have said, but it really keeps things in perspective. That’s how we all should be. We shouldn’t just assume that, check the box, “I’m 45 years old, I have no libido. This is just the way things are.” But I think for many, many women in particular, this is the narrative that starts for them. They want to connect with their partner, they have no libido, and this becomes hugely problematic.

Amy Killen: Yeah, it’s so funny. I had a patient recently who told me that she had gone to another doctor previous, because she was having low libido, and the doctor said to her, “Oh, that’s a sign. It’s time for you to stop having sex.”

Cynthia Thurlow: Oh. Wow.

Amy Killen: [laughs] And she was like, late 40s. And she was like, “What? Is that right?”

Cynthia Thurlow: Oh. Wow.

Amy Killen: Yeah. I mean, there’s still that idea out there that your libido changes for a reason and that you should just listen to it and you should stop. I’m a firm believer that menopause and this is controversial, but I really feel like menopause is a disease unto itself. And that it’s not talked about like that because no one wants to say that out loud. In this longevity community, we talk about aging as being a disease because it increases your risk of developing all other diseases. It’s kind of its own disease that we can fight against. Well, using that same sort of logic, menopause is absolutely a disease because it increases your risk of many, many other diseases.

Once you go through menopause and you lose estrogen specifically, but also testosterone and progesterone and other hormones, you see this huge increased rate of developing cardiovascular disease and diabetes and depression and osteoporosis and anxiety and UTIs. The list of things that happen after menopause is crazy. Yet, 20 years later, from the Women’s Health Initiative, people are still afraid to prescribe or take hormones, which I just think is so crazy.

Cynthia Thurlow: It’s almost criminal. I say this now as someone that is middle aged, there was a podcast with Peter Attia that he did with Huberman, and I think about an hour into the podcast, he said, “I think the greatest tragedy that has happened in my lifetime as a clinician is the Women’s Health Initiative,” because the downtrodden effect, to your point, of what women go through in menopause. He said, “Depending on where our patient is, some people want to be on hormones, some people don’t want to be on hormones. If you understand the ramifications of the degree of inflammation and oxidative stress and you could be doing all the right things, I cannot tell you, and I’m sure you hear it too women will say, “Well, I don’t want to take hormones, but what else can I do?”

I was like, “But you can do all the right things with lifestyle,” but nothing is going to replace that. There’s no supplement. There’s no magic supplement that’s going to replace your progesterone or your estradiol or your testosterone. It’s really like leaning into what does your body need, but acknowledging that we have a whole generation of women, it’s my mom’s generation, they all got taken off their hormones. I’m watching the sequelae of many of my aunts that are dealing with significant osteoporosis, cardiovascular disease, memory changes, cognitive dysfunction, and it’s really sad, and I don’t want that to be anyone’s destiny.

One thing that I loved about your content that I was reading about in preparation for this was that you were talking about only one in five animals actually go through menopause. Maybe start there, because I found that fascinating. I was like, “Oh, my gosh, how is that possible? Is it because we live longer?”

Amy Killen: Yeah. It is interesting. There’s some whale species, killer whales, for instance, go through menopause. Now, there are a number of animals, of course, that stop producing children and having offspring after a certain age, but that reproduction is different than we’re talking about here, which is the hormone. But most mammals don’t actually stop making key hormones midway through their lives. It’s just not something that happens. Scientists have looked into it, “Why do we even have this?” As far as we know, there’s not really a good evolutionary reason that we, as humans or any of us, need to stop making those hormones. There were arguments for years against hormone therapy, like, “Oh, your body doesn’t need it after a certain age.” But that’s actually not true. There’s no good reason that we should stop making these hormones. And so, we don’t know why. We don’t know why humans do.

There’s a big push now in the longevity field is actually figuring out, is there a way to delay menopause, is there probably not a way to reverse it, because menopause is you’ve run out of follicles, your ovaries have run out of eggs, and those follicles are what make the hormone. By the time you’re about ten years into menopause, you have zero follicles left. Those first few years, you actually still do have some. You have about a thousand or so, but how can we slow down the dying off of those follicles so that by the time you’re 50, you still have many more, and you can continue to make hormones. That’s a big field of research right now, but we don’t have the answers yet. But it’s very, very interesting.

Cynthia Thurlow: No, it really is. An ovarian aging is something I had not considered before I started really diving into looking at what goes on. At birth, you have five million follicles. And for anyone that is curious, Dr. Amy has an amazing series of Instagram posts on this topic that I myself watch because I found it really interesting. We have five million follicles at birth, we have 500,000 at puberty, and then, as you mentioned, you have a thousand around menopause, and then it takes ten plus years to go through the rest of those follicles. Although at that point, you are no longer fertile, you’re not ovulating, etc. Other things that I found really interesting about the ovarian function is that they age faster than our other organs. And why is that?

Amy Killen: We don’t know. They age, yeah, two to five times faster than other organs in our bodies. They’re actually an interesting thing to look at with aging. it’s hard to look at treatments over an entire person’s lifetime and say, “Did it affect longevity?” You could look at, do treatments affect the ovarian aging, because we think that some of the same things that lead to aging in our bodies in general lead to ovarian aging as well.

People think that all of these eggs are– obviously these eggs, or one egg is being released every month for us to be able to have our cycle, or maybe two or a couple per month. There are about thousand eggs every month that are just going through this process of starting to develop into a follicle, and then they either become apoptotic, they die off, or they become senescent cells, like zombie cells, neither one of those eggs are any good anymore. So is there a way to slow down that process where we’re wasting a thousand eggs a month, up to thousand eggs a month and not using them for anything. That’s the question. There’s been animal studies that there’s some medications as well as some supplements that seem to be able to slow that process down, but it hasn’t been studied in humans yet.

Cynthia Thurlow: I think for listeners to understand that research starts with animal models and then sometimes we can extrapolate to humans, but really looking at human research is what is most beneficial. I would imagine that there are a lot of individuals who want to delay having children. People that freeze their eggs or people that are looking to say, “I don’t want to have children at 30, I want to have children at 40. And what can I do?” I’m sure this is an area of tremendous interest. What can I do to forestall the aging of my ovarian follicles so that I will not be in a position where I’m dealing with infertility, which you and I both know. I mean, it’s rampant now in the United States that there are so many people impacted by infertility.

What do you think about the impact of our nutrition and our habits, alcohol use, extreme stress? How does that impact our aging, and I would imagine in negative ways, but what are some of the things that you think are most important, most impactful when we’re considering the longevity aspects?

Amy Killen: I think it’s mostly lifestyle. Certainly, I think that there are some supplements that can help, and I have my own brand of that, which is awesome. I think it starts with the basics. I think sleep is foundational and it’s not talked about enough. It’s because it’s not super sexy. When I left the ER and I started sleeping for the first time in 15 years, like real seven or eight hour, sleeping sessions, it changed everything for me, for my health. And I think that’s a big one, sleep. There’s a lot of research on diet, on caloric restriction or time restricted feeding or intermittent fasting, as you know obviously, because you’re the expert on that and how those things play a role in aging, and they seem to, in some respects, slow down at least parts of aging.

Exercise, I think, is one of the keys as well, like sleep and exercise, obviously, diet. Sleep and exercise to me are like the one-two punch, because if you don’t do those things properly, you’re going to age faster. Avoiding the things you could have, like avoiding toxins of various sorts, whether that’s a lots of alcohol, which we know now that no amount of alcohol is healthy, no matter how much they tell you that red wine is good for you, it’s probably not. I’m someone who likes a little alcohol here and there, [laughs] but avoiding smoking and then all the environmental toxins that we’re learning about that are so bad for us that we don’t even know how bad they are yet. We’re starting to see that a lot of the obesity epidemic, at least part of it, is from environmental toxins, most likely. Just all the things around us that are soaking into our skin and putting in our bodies. I think we’re going to see in the next five to ten years just how detrimental those things are.

Cynthia Thurlow: Well, and it’s interesting, the endocrine disrupting chemicals. I don’t think that it’s not a sexy topic, people don’t want to think about, your food is wrapped in plastic and there are parabens and phthalates and all these chemicals that are in your personal care products, not to mention what you’re exposed to in your water. Something that I had never considered was the fact that women that are taking oral contraceptives or even taking HRT and we’re urinating into our toilets and not realizing those hormones are not filtered out of our water supply. So, we are bathed in synthetic hormones. We’re bathed in all these chemicals. I agree with you that we haven’t seen the full yet net impact, whether it’s our children’s generation or subsequent generations, the net impact of all of those exposures over time.

Amy Killen: Yeah. It’s funny because I’m not one that’s scared of the world around me. I’m not one that washes my hands 14 times a day. I love to just get in the dirt and be like, I’m not a super clean freak. That goes with like, I’ve never been super all that scared of things around me. Just in the last few years, just reading about the decreasing sperm counts and the infertility going up and all of these hormonal changes that we’re starting to see that have serious ramifications. Like, I have a 12-year-old son, and I would like him to be able to have children, and what am I giving him or doing to him that is making that potentially not possible. I have 14-year-old daughters, so I’m not as worried about myself because I have kids. Whatever’s going to happen is probably going to happen, but I am very worried about my kids and their kids.

Cynthia Thurlow: Yeah. It’s interesting because I have two teenagers myself. I have a 15-year-old and a 17-year-old and of course, I know nothing. They’re at the stage where mom knows nothing. All my concerns about nutrition, which they used to readily accept now. They’re constantly bucking the system. I just remind them, I’m like, listen, my greatest contribution to the world is raising two strong, independent, intelligent young people and I just want you to be as healthy as possible. Now, they could go off to college and they could completely do the opposite of the way they grew up, but I do endeavor and try to impress upon them that these lifestyle pieces really do matter. Even though right now they think I’m the least intelligent mom in the world. I just remind them this is part of the process, this is how you develop mentally separate yourself from your parents, and then you’re ready to go off to college. But let’s talk about destigmatizing sex.

I think one of the really important reasons that I wanted to bring you on the podcast and you started this off saying that one of your patients said that their physician told them, “Okay, you don’t have any interest in sex. Okay, then it’s time to just forget about that aspect of your personality.” I know that you talk about sexual health because it is such an important part of just our normal day to day communication and interaction. One of the statistics that I read that was surprising was that 20% of all marriages are sexless. That really was very sobering because I would imagine that there are many people out there that assume that because they have no desire to have sex, that’s normal and they’re uncomfortable having those conversations with their providers. There’s this stigmatization about talking about our own sexual needs with our providers. And I’m hopeful that will change. I know that you feel similar way.

Amy Killen: Yeah. I feel very strongly that sexual health is just one more aspect of health. It’s just like cardiovascular health or brain health or joint health or any other kind of health. And that if we can talk about it, talk about the health benefits, talk about the things that in our world that impact it in just a medical way, but that makes it accessible to people, that people will just think of it as one more part of their bodies. And I tell my patients that. I tell my audiences that, kids that, because I think it’s really important. Sexual health is interesting in that unlike some of the other types of health, it actually gets received input from all different types of health. Physical health for sure, but also our mental and emotional health are going to feed into our sexual health. You’re going to have your social health, your relationship health is going to feed into that as well as your environmental health, these detoxins and things like that. And your spiritual health. I didn’t mention that, but that’s something else that plays hugely into sexual health.

You have all of these different aspects of health that are kind of coming together in sexual health. So, when you have a problem, that’s a sexual health problem, whether that’s lack of libido, whether that’s lack of arousal, whether that’s pain, whatever it is, oftentimes it’s not necessarily like a problem with your broken vagina. It’s a problem potentially usually with one of those other things.

I like using sexual health as a way to a portal almost to get in there and look and see what else is going on, that could be the real problem. Is it hormones? Is it how you were raised and shame and guilt? Is it actual structural problem or blood flow problem? So, yeah, I think that’s so important, for men and women, I think especially women have a very difficult time saying, “This is not working well for me and I deserve better.” I feel men don’t have a harder time saying “I deserve better,” but women do. I think part of that is because women didn’t realize, or maybe don’t realize that there are so many options out there for them. They feel like they have a low libido or they’re not having orgasms or whatever and they’re like, “Okay, that’s just how it is now.” The truth is there’s actually so much that can be done, but you just have to ask for help first.

Cynthia Thurlow: Absolutely. I think it’s so important for people to understand that it’s not just one issue with impacting your libido. It can be multiple things. I’m so glad that you brought that up because I think there is a degree of shame that women feel like whether it’s because they are giving to everyone else all day long and they get in bed at night and they’re just exhausted and they’re like, “I don’t want to have to do the one more thing.” That’s exacerbated by other types of pressures and low testosterone and other things. One of the things that I think is really interesting is you talk quite a bit about nitric oxide. This brings me back to being taking pre-med classes many years ago.

I had this professor who was crazy about nitric oxide and I really do have to give it to her. She was like way ahead of her time. Let’s talk about the role of nitric oxide in sexual health because then we can then pivot and talk about ways to address this.

Amy Killen: Yeah, so nitric oxide is the main chemical that tells your blood vessels to open up to vasodilate, to go from being really small to being larger. You can imagine this is important for getting blood flow all over your bodies. People use nitric oxide in their pre-workouts to get blood flow to their muscles, but it’s also necessary to give blood flow to your genitals. In fact, when you have an erection, and that’s men and women, we both have erections, that’s a nitric oxide driven thing that basically increases blood flow down there. Medications like Viagra, the way that they actually work is that they prevent your body from breaking down its own nitric oxide as quickly. So, it’s just keeping it around longer. What happens as we get older, after about age 25, 30, we start making as much nitric oxide. Every year we make less and less.

By the time you’re 40, you’re making about half as much as your 20-year-old friends. And so you have less of the ability to kind of get blood to those different areas. Working on ways to maintain your nitric oxide is really important. The older you get, the more important that becomes.

Cynthia Thurlow: Yeah, it’s really interesting because like I mentioned, I had this professor in college who was crazy about nitric oxide, and I retrospectively working in cardiology, obviously very important, but when I was reading and preparing for this, I kept thinking, “I’m going to keep thinking of that same professor,” how brilliant I thought she was. Of course, at the time we didn’t because she was just really hard and challenging. Her feeling was, “If you can’t get an A in my class, you don’t deserve to be in any type of medical field in any capacity.”

What are some of the things that can help with boosting nitric oxide? We’ll start the conversation there and then we’ll meld into what is your methodology for working with women especially, most of my listeners are perimenopausal or menopausal women. Kind of your philosophy, governing philosophy about how you approach sexual health at this stage?

Amy Killen: Yeah. Okay. Nitric oxide, some basic things are just lifestyle. Exercise is going to increase your levels, getting a little bit of sun. Sunlight actually increases your levels or red-light therapy, if you don’t have access to a sun, [laughs] or any sun, those things are really key. You could also eat a diet high in nitrates, which we’re thinking more like vegetables and fruits. Green leafy vegetables, beets, citrus, things like that are high in nitrates. That’s a good way to boost levels. If you’re going to do that, you want to avoid using antiseptic mouthwash because that’s going to kill the bacteria in your mouth that you actually need to change those nitrates into nitric oxide in your body. Avoid the Listerine, or at least don’t use it very much. You also really want to avoid using acid blocking medications because that’s going to also prevent you from being able to make nitric oxide from food, especially the PPIs, the proton pump inhibitors like Protonix.

Those are awful nitric oxide, which is probably why they’re associated with such an increased risk of heart attacks and such. Those are some of the things. Breathing through your nose instead of your mouth is a very easy way to do it. That’s why if you’re out exercising, it’s really important if you can breathe through your nose or sleeping taping your mouth shut, it’s something you can do, that’s really helpful as well. Just some little things like that. There’s some like new-fangled kind of biohacker stuff like hyperbaric oxygen can do it, PEMF can do it. There’s a lot of things out there, but the main things are just exercise, get some sun, eat lots of green leafy vegetables, ditch the mouthwash.

Cynthia Thurlow: It’s interesting, my husband was a big Listerine addict. There’s no other way to put it. I finally got him weaned off of that after explaining to him. To your point, it impacts nitric oxide production, but it also kills off the beneficial bacteria in your oral microbiome, and the oral microbiome is tied in with our general gut microbiome as well as our vaginal microbiome for those people that are women. I think we do such a good job of trying to sterilize everything, not realizing that we don’t want to kill off all the beneficial bacteria. There’s a lot to that. Those are some nutritional things.

When women come to you and they’re saying, “My libido is in the toilet. I’m in perimenopause, menopause.” They come to you initially, possibly for hormonal replacement therapy. What’s your traditional methodology? Are you doing DUTCH hormone testing? Obviously, you’re doing serum blood testing. What are some of the things you’re looking for to help uncover why, although I’m sure you probably highly suspect specific things. What are some of the contributors to this low libido syndrome?

Amy Killen: We will start usually with blood testing of hormones as well. Certainly can do DUTCH testing or other testing if needed. I like to get blood testing is so– we know what those levels are. I really like to start with blood testing. Blood test, good history, a good exam is kind of the starting place. And then from there I kind of approach it, I think of it as these four pillars, if you will, of optimizing sexual health.

The first one is the mind. Mind the mind. Oftentimes it’s stress. Oftentimes this person is having too much stress, they’re not dealing with it properly or at all. That’s of course, going to affect everything from your hormones to your mindset. You want to be really for women especially, but for men too, you want to be in this parasympathetic rest and relaxed state to be able to really enjoy your sexual experience. Many of us just aren’t most of the time.

And so, getting into that state whether that’s something like ancient practices like meditation and breathwork and journaling, there’s also a lot of new stuff out there, like new tech that uses vibration or light or sound or apps that are focused on women and getting you in that mindset. That’s sort of the first thing is, mind the mind. Part of that, of course, includes if you have sexual trauma history or shame or guilt, I’m not a sex therapist, I’m not the person for that, but referring out to the people that can help with that. So that’s kind of the first piece.

The second piece I think about is blood flow. This is important for men and women like we talked about with nitric oxide, and then just looking at risk factors for cardiovascular disease because anything that’s going to decrease blood flow to your heart could also decrease blood flow to your clitoris and to your penis. Making sure that we’re optimizing just lifestyle in general, all the things that we know are going to affect the cardiovascular disease and just reducing inflammation.

The third thing that I look at is the hormones. That’s a really important, looking specifically in women at estrogen, progesterone, testosterone, cortisol is important, DHEA, there’s a whole bunch of different hormones that come into play. But is a person perimenopausal, are they menopausal, are they on birth control, maybe that’s contributing to it. There’s a lot of hormonal pieces that need to be looked at and everyone’s very different.

Last, I look at the actual structural organs, like is there a problem with the actual vagina or the actual clitoris. Usually there’s not, but you could have some kind of scarring or you could have like in Sclerosis or some sort of problem that’s causing pain or pelvic floor problems. The pelvic floor muscles can become really tight and that can make things painful or they can become too loose and that can make things make it hard to reach orgasm and such. So, looking at the structural health of those is important as well.

Cynthia Thurlow: I think that’s really helpful, having this kind of very structured methodology that you use with your patients to kind of get a sense of how best to support them. Now, I know that when I was preparing for this, I was trying to keep certain regenerative therapies straight because this is new for me. Talking about like PRP and stem cells and exosomes, what are the differentiators in general terms? How do you go about utilizing those different therapies with women at this stage of life?

Amy Killen: Yeah, so when it comes down to that fourth piece, if we’re looking to really maybe potentially increase blood flow or increase sensation, we might do some regenerative injection. PRP is platelet-rich plasma and that’s just getting the blood centrifuging it and then getting the platelets concentrated. Of course, PRP has been used for 30, 40/ 30-40 years at this point. Basically, it kind of acts as it signals the cells that are already in your body to become more active. Really, with all of these therapies, whether we’re using stem cells or PRP or growth factors or exosomes, what we’re trying to do is to send a signal to the stem cells and the other cells that are already there in the tissue, that already live there in the vagina, the clitoris. Tell those cells, “Hey, let’s become more active. Let’s stop just sitting around,” because what happens is as we get older, our stem cells become less active.

So, we’re just trying to sort of stimulate the cells that are already there to become more active to increase blood flow or blood vessel formation to improve nerve healing. All the things that they can do. We can use stem cells from the patient is one option and another option. Like bone marrow stem cells or fat derived stem cells. Exosomes are growth factors that are from other, we use them, they’re like growth factors from the stem cells, but not the cells themselves. We are not able to use exosomes anymore because of the FDA. But that was something that were doing for a little while.

Cynthia Thurlow: Do most people have to go through multiple visits to be able to utilize these therapies? This is all new to me. This is brand new territory. I was like, “I’m going to ask all the questions I know people would be asking me.” For the average person, obviously, how many times do they have to come in for these types of injections? Are they painful? I’m assuming you probably are giving topical numbing cream of some kind of, yeah.

Amy Killen: Yeah. So if you’re just doing like PRP, for instance, has been around for a long time and can be pretty easily injected. Usually, the injections we’re doing on women are into the clitoris. But, yes, we do topical numbing first, because that would be very painful. We’ll do kind of anterior vaginal wall, like up kind of where the G-spot or G-zone is, if you will. Those are kind of the general areas. Really PRP can be injected other places as well, if need be. It could be the labia if you had some scarring in there or some pain or something. And oftentimes that will be repeated. If it’s PRP, maybe it gets repeated again in a few months, maybe not, depending on the response. I do a lot of stem cell procedures in my office, and so we’re using PRP and stem cells. Most of my patients are traveling in from out of state or out of the country.

So, they don’t tend to come back at least for a year or two. Sometimes they’ll come back later, but just not right away because the stem cells are going to be more of a procedure. They usually just come in once and then we’ll do this. And then I’ll have them go back home. If they need to do PRP injections or some other therapy, then I’ll have them usually do that kind of locally once they get back home.

Cynthia Thurlow: And then, like a stepwise approach, you have those options and then things like shockwave therapy and lasers. I would imagine some people are probably using a combination of therapies. How does that typically work?

Amy Killen: Yeah, lasers. I don’t use as many lasers as I used to. I still will sometimes use like radio frequency, intravaginal radio frequency versus lasers can work. They can be helpful for lubrication, but they can also cause burns and problems like that. You got to be kind of careful with that. The radio frequency treatments are just kind of heating up the vaginal tissues and that can definitely increase the sensation that can improve lubrication as well. Although the best thing for lubrication, especially if you’re peri or postmenopausal is just getting on some vaginal estrogen, it’s game changing, especially in menopause for lubrication.

And then shockwave therapy is interesting. That’s been really well studied in men and I say really, it’s been used for about 10 years in humans for erectile dysfunction, but it’s just now started getting used in women. I haven’t seen the studies yet, but there’s definitely a lot of case reports and anecdotal kind of situations where it seems to increase blood flow to the clitoris and vagina and maybe even tighten up some of the labia, some of the tissue there in a very, very safe way. So, yeah, those are definitely options.

I also like some of the home options. I like the intravaginal red light therapy device that vFit makes. I don’t have any affiliation with them, but it’s just like red light therapy, but it just goes inside. It feels like a hot stone massage for your vagina, but you’re getting that increased mitochondrial ATP production and increased blood flow and all of that, which I think is kind of nice for the insides as well as the outside.

Cynthia Thurlow: Well, and I think for a lot of people, maybe they can mentally work themselves up to having a device at home and then going in for additional therapies. I would imagine when you’re prescribing estradiol and testosterone and progesterone are using compounded or using synthetic versus bioidentical, what is your kind of mindset around that? I got a lot of questions around this in particular.

Amy Killen: Yeah, it’s very confusing and I will tell you that the way these things are described is very confusing. Traditionally when people said bioidentical they were talking about these compounded made in compounded pharmacies, not pharmaceutical. But there are pharmaceutical products that are the exact same molecules, the exact same ingredients as these compounded versions that we tend to call those body identical. For instance, you can get progesterone as a pill by a pharmaceutical company and it’s called Prometrium, that’s one of the brands and that is body identical. It’s the same as the progesterone in my body. Or you can get progesterone compounded by compounded pharmacy and that’s bioidentical. Both of those things work, and I am agnostic to which one works the best. I do like for progesterone. I prefer oral progesterone to creams for sure. But same thing with estradiol, you can get it bioidentical, body identical.

What you don’t want, is you don’t want– they say synthetic but really all of these things are synthetic in some way, but essentially the things that are not identical-ish to your body. For instance, the big one is the progestins, like the medroxyprogestin products that were used in the WHI. Well, you don’t want is all of those things. [chuckles] You don’t want the ones that are made from horses’ urine or they’re made they’re very synthetic and not like the hormones that your body already makes.

Cynthia Thurlow: I think that’s important for people to hear because there are lots of options. Obviously, depending on who you are as an individual, it can influence what your body needs. What are your thoughts on pellets? I had to ask.

Amy Killen: Yeah. I have mixed thoughts on pellets. I’ve done pellets. I did pellets for many years. I haven’t been doing them as much in the last few years. I think that they work really well for some populations. For instance, I had a lot of military men and women who loved pellets because they could come in. It’s usually testosterone, sometimes estrogen or progesterone, but usually testosterone is the main component of the ones that I’ve used. You put it underneath their skin, like usually kind of in their upper buttock area, and it stays there for three to five months or so and it just slowly releases the hormones. I think it’s fantastic in people who are going out of the country or they just really can’t deal with all these other supplies. The downside to pellets are that once they’re in, you can’t get them out, or at least not very easily.

So, if you have a problem, if you develop acne, if you develop a change in your voice for women, or clitoromegaly, which is the swollen clitoris for women, which doesn’t happen very often. But if you did have those things, getting that pellet out is very, very difficult. It’s one of those things you just want to be very careful. If you use pellets, make sure you have a doctor who knows about dosing, really well and also has a really good, clean, sterile technique because you can get infections from those things as well.

Cynthia Thurlow: Absolutely. It’s interesting because I’ve had a lot of women that end up in programs working with me, and I work concurrently with other providers and what’s been my experience, and it’s probably skewed because they’re seeking other ways to address their hormone imbalances is it’s for some people and someone that it isn’t a good fit for. Sometimes they feel really great for a week or two and then when their testosterone levels will normalize or get back to where they were before, they’ll have this crash. Obviously, working with a talented practitioner and someone that’s going to select the best option for you, I think is really important.

Now, there are a lot of new novel supplements, medications that have come out and I’m curious what your thoughts are on– [chuckles] this is a big one, this is one that a lot of people are talking about GLP-1 agonists.

Looking at semaglutide, which I know a lot of people in Hollywood are using. I’ve had a couple of patients who were prescribed it before they started working with me and a lot of them suddenly became horrifically constipated, nauseous, but they were thrilled because they didn’t want to eat. [chuckles] Like this is a good trade off, I’m losing weight, but let’s talk about how these drugs work, whether or not microdosing is even a good option for people that are sensitive to the side effects. What has been your clinical experience working with them?

Amy Killen: Yeah, I’ve been using semaglutide with patients for about a year. I think it is an amazing drug. But there are some side effects and some downsides to it for sure. There’s a newer tirzepatide that just came out as well that’s similar and actually probably even better for weight loss. But basically, semaglutide is a GLP-1 agonist is a class of these diabetic drugs that have been out for a long time, actually. But this particular one was found to be really effective in helping people to not be hungry. It seems to work by a couple of mechanisms. One is it seems to affect your brain and tell your hypothalamus, “Hey, I’m not hungry.” Your brain is like, “Hey, I’m not hungry.” And then it also seems to affect the stomach itself and so it slows gastric emptying, which is probably why some of the side effects that happen.

The most common side effect is nausea. That one can be severe. Like you can just get these amazing severe waves of nausea, and throwing up too, like not just nausea, but yes, constipation can happen, or gassiness or diarrhea, but nausea is the one that tends to just kind of knock people out, especially when they’re first starting. The dosing is such that you do want to start at a very small dose of tenth or even less than the overall dose that you could go up to. The dosing is such that you start slotting you very, very slowly increase it if needed. I’ve had a lot of patients, actually, who have used just like they’ll use it. It’s a once-a-week dose normally, but I’ve had a number of patients who’ll just use it maybe once every two weeks or once every three weeks if they’re just trying to lose of weight or even just kind of maintain weight. I actually have seen that work pretty well. Certainly, if you’re trying to lose weight, then once a week is the dosing. It’s an injectable, just a subcutaneous injection.

The main downsides that I’ve seen are, besides the side effects, is that you can lose quite a bit of muscle and fat if you’re losing too quickly, and if you’re not maintaining protein requirements. I think Peter Attia just spoke to this as well. I was just listening to this and then he said, but and it’s true because all of a sudden, your appetite just gone and food is like, “Ah, I could eat that or I could go and do something else.” You just don’t care that much. I think that what happens is people just forget to eat protein, which they still need to eat to maintain muscle. And so, either you lose muscle and fat. That has to be you have to really watch that if you’re taking that drug, and just be very careful.

Cynthia Thurlow: Yeah, and it’s interesting because I think it was one of those garbage New York Times articles and I’m not denigrating New York Times, I’m just saying the things that pop up in your Facebook feed that it’s like clickbait. You then go down a rabbit hole and then you’ve read your four free articles for the month and they want you to pay for access. It was interesting because they were saying a lot of people on Hollywood are using it and now it’s gotten to a point where it’s gotten very expensive for people to gain access to. You’ve got people maybe who are diabetic or metabolically inflexible who really could benefit from the drug, but it’s now gotten so expensive that they can’t afford to even use it with insurance, if insurance is even covering it.

Now another thought out that I was thinking about longevity or medications that might be of interest. Rapamycin. What are your thoughts around rapamycin? Is this something you’re using with your patients? Are you a little controversial about this? What are your thoughts on rapamycin?

Amy Killen: I am pretty excited about rapamycin. I think that there’s definite downsides and side effects and it’s not for everyone and don’t go out and do it on your own and go buy it from some random garage somewhere.

[laughter]

I do think that there’s a lot of interesting data, it’s mostly animal data still, but basically showing that this drug could potentially improve longevity and improve health span. It is a drug that was originally approved for treating things like graft versus host disease. It’s actually classified as being an immunosuppressant, which is interesting. In the doses that are used for longevity, you’re taking it once a week and you’re taking much smaller doses or once every two weeks, there’s various dosing regimens. Certainly, it’s all considered to be off label and something that if done, needs to be done with a doctor who’s checking your blood counts, for instance, because you can have reduce your infection fighting cells like your white blood cells and your other blood counts, it can increase your blood sugar, at least transiently, and it can even affect some of your hormones, like your testosterone, it can go down for a period of time.

I personally have taken rapamycin for about four years and I’ve been pretty honest about all the crazy things I do. I also am very good about watching all of my own numbers and getting labs and I keep track of things and I know all about it and I accept the risk. So, I don’t think it’s for everyone. Right now, my patients, I only have stem cell patients that I see currently, so I don’t tend to prescribe it. But I am working with some advising some other companies and clinics and things, and we’re talking about it and whether to roll it out as a potential for a subset of patients who are very educated, very proactive, and are willing to do all of the lab testing and such to stay on that kind of drug.

Cynthia Thurlow: It’s really exciting. And then I also think about things like NAC and mitochondrial support. And are there general suggestions or recommendations? I know you said you’re only working with your PRP patients, but if we’re doing like a high level, these are the things I think about for women in terms of supplementation that have benefits and can be helpful at this stage of life.

Amy Killen: Yeah, so I actually just launched a longevity product that is for men and women, but it’s really, really good for women. It’s called HOP box, H-O-P-B-O-X and you got a HOP box a life, but basically it’s a whole, it’s like a month of supplements and it includes things like you mentioned. It doesn’t include NAC because that wasn’t available for us for a little while, but it will be in some of the ones, I think. Some of my favorites, I still like NMN, which is going to increase NAD levels, which is good for mitochondria. Spermidine is in there as well, which I think is fantastic for longevity as well as skin, like skin and hair, specifically calcium applicator butyrate has some interesting evidence for longevity and then some of the other basics like quercetin and fisetin and curcumin and vitamin D and vitamin K. Some of the things that are like that as well as Dihydroberberine or berberine is really, really good for blood sugar. If you’re someone who’s kind of borderline, could be on some medication or could not, then something like that is fantastic for getting those levels down.

Cynthia Thurlow: In terms of berberine, is that something that you recommend your patients cycle on and off of? Because I’m starting to see some of my patients, all have them take berberine with a higher carbohydrate meal or at certain times during their menstrual cycle. Do you have your patients cycle on and off or is this something that you recommend taking continuously?

Amy Killen: I think it depends as long as you don’t have side effects from it, some berberines can cause some stomach upset and can cause some problems. The one that we put in our product, this Dihydroberberine, is a little bit different and that it gets absorbed much more quickly and it has a higher bioavailability and so we don’t tend to see the GI side effects with that. But, yeah, as long as it’s not causing side effects and you’re occasionally checking your numbers and making sure that they’re good, that it doesn’t tend to drop your sugar too low. It’s not like a diabetes medication where it tends to drop it too low. Obviously if you’re fasting, don’t take it. If you’re eating, it’s probably fine to take it most days.

Cynthia Thurlow: No, thank you for that clarification. Before we kind of sign off on our discussion, I would love touch on skin and hair. I know this is an area that is of particular interest to you. I think there are a lot of women in middle age who start seeing– sometimes the first effects of aging that they’re seeing are in their skin. Maybe their hair isn’t as lustrous, maybe it’s not as full, but they start seeing the turkey neck, they start seeing more fine lines and wrinkles. Obviously, I know hormone replacement therapy can play a huge role in this, but what are some of the other modalities that you’d like to use when you’re working with women to help improve these areas?

Amy Killen: Yes, definitely hormone replacement therapy. Estrogen is your skin’s best friend and you can do that’s great as a systemic estrogen or you could even do a topical estrogen as well, like in very small doses. I do like to some other regenerative therapies, like the PRP, certainly stem cells, if you have access to it, just doing like micro-needling, for instance, and applying something like PRP. Or if you don’t have that, you could also do micro-needling apply, vitamin C serum or hyaluronic acid. It’s essentially anything that you want to get into the deeper layers of your skin. Micro-needling is great for that. There’s lots of great like lasers and radio frequency devices and radiofrequency micro-needling, which is great if you want to go to see a dermatologist or plastic surgeon. I’m a huge fan of retinoids. Getting a good quality retinoid, it requires usually going through a doctor or have a sort of higher, just a nicer skin care product or retinols, which you can get over the counter.

Basically, they have a lot of good evidence for just improving skin health over time. Big, big fan of sun block on your face, at least face and neck and back of your hands, the places that are out there all the time. I think that in the wellness communities, biohack communities, people really frown on using any sun protection, which I think is that’s fine if you don’t care about wrinkles and if you don’t care about the way that your skin looks, because the sun is the number one cause of skin aging, there’s no doubt about that. A good mineral sunblock, like a zinc oxide or titanium dioxide on your face every single day and your neck is going to go a long way towards helping to prevent future damage as well.

Cynthia Thurlow: I think for a lot of people, I mean, I certainly grew up at the beach and I stopped probably by the time I was like probably a sophomore in college because I stayed at college instead of going back home. I have friends that have laid in the sun all summer long, every year, and the sun damage is real. UVAs age our skin, UVBs burn our skin and you get DNA damage to your skin and you can really see an accelerated change in your skin tone, in your skin texture, and then couple in the loss of elastin and collagen that’s accelerated and exacerbated by loss of estrogen. It kind of creates the perfect environment for people seeking out what product can they use, what are the things they can be proactive about.

In terms of hair, is it the same types of things like, I know there’s minoxidil and I know people use that with some improvement in their hair, but I’m starting to see more people using collagen, supplemental collagen in their coffee or in a smoothie feeling like that’s beneficial. Beyond that, what are some of the things that you like to use or you generally recommend?

Amy Killen: Yeah. I like collagen. I also like hyaluronic acid, orally as well. That’s something that’s also great for skin and hair and joints and eyeballs and all the things that need of extra gooey, slimy stuff. I like that a lot. For hair, it’s really difficult. It depends on what’s going on. Certainly, avoiding the sun, wearing a hat, actually helping protect your hair from UV damage because your hair follicles can be damaged by the sun as well, is important. And then for men, DHT-blocking shampoos can be really helpful. Minoxidil works for both men and women. You apply it every day and you can’t just stop doing it. It does work for at least half of people who use it. It will help to increase hair growth. I think the regenerative treatments can be helpful as well. The PRP injections or peptide injections, peptides like GHK copper can be good for hair, PTD-DBM for men, zinc Thymulin for women. There’s a couple of different peptides that either you could use topically or potentially do, like sub-Q injections every day or every week or every month or whatever.

Cynthia Thurlow: It’s all fascinating. Well, Amy, it’s been such a pleasure to have you on the podcast. I’ve really been looking forward to this conversation, and obviously I look forward to interviewing you again because there were so many rabbit holes we could have gone down. Please let my listeners know how to connect with you, how to purchase your HOP Box, which I’m really interested in myself.

Amy Killen: Yes, thank you. This has been so fun. I’m so glad as well. So, I’m very active on Instagram and that’s @dr.amybkillen. I have a website which is dramykillen.com, where we’re doing that, it should be up soon. The www.hopbox.life is my new supplement launch that just happened this week, which I’m excited about. I also do have a stem cell clinic, which is at docereclinics.com. D-O-C-E-R-E. I’ll give you all those links to those things.

Cynthia Thurlow: Awesome. It’s been such a pleasure connecting with you.

Amy Killen: Thank you.

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

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