Perimenopausal Treatments That Work: Lab Based Assessments for Progesterone and Estrogen

Hello everybody, and welcome to our class in conjunction with the Kalish Institute and Goova Diagnostics. We are going to talk today about perimenopausal treatments that work and lab-based assessments for progesterone and estrogen, something I've done every day for the last 31 years.

I learned at the feet of some of the most amazing masters in this field. My first teacher was Dr. John R. Lee, who, for those of you that are old enough to remember who John was, he was the original scientist, clinician, physician that started the whole revolution around using progesterone. Um, I used to call him on every new patient. I don't know why that guy was so nice to me, but I spent years working with him. Then I worked with Dr. Bill Timmens, again, one of the greats in the lab industry in terms of hormone testing and evaluation. I had, you know, nine or 10 years of work with those two fellows and really, you know, gradually learning how to understand the role of female hormones in health and disease, and then what are the bigger picture views of how we can correct these kinds of problems.

And I want to try to present today a new type of talk where it's an integrated talk. It's a talk, it's like a mini, mini, mini mentorship. My one-year mentorship, we teach you about adrenals, GI, female hormones, and um, organic acids. I'm going to try to teach all that in the next hour and show you an example of how you can put together a case because it's never just about a single hormone, ever. It can't be, really, because these hormones are interrelated. It would be like if you're listening to an orchestra playing, it could never be about a single instrument, right? It's this, it's this connection between the different body systems that makes people either healthy or sick. And so we want to talk about these interconnections, and we're going to look at female hormones and adrenals, the GI marker, and even the neutral markers that directly relate to your hormone assessment, so you have a bigger picture view of how this works. Okay, that's the goal.

And then we're going to have at the end, I'm going to get to the slides as quickly as I can, but you understand the premise of what we're working with here. And then we'll have a time to look at a whole set of labs for an individual so you can see how these pieces are put together. And at the very end, we'll have time for your questions as you may have them. And so, um, let's just jump right in and talk about this stuff.

So for those of you that are brand new and want, thank you for coming and spending your time to listen to this. I am Dan Kish. I've been training practitioners since 2006, trained over 7,000 doctors. And our fundamental concept at The Kalish Institute is how are we going to get successful functional medicine practices launched? And I've always said from the very beginning, female hormones are a great way to build to practice. They're one of the really easiest things to fix. Uh, a lot of people have the problem, and this is just a great way to get started.

I've worked with the Mayo Clinic. I've worked with all kinds of lab directors and leaders. My current teacher is a man named Richard Lord, who is a scientist that first developed organic acids, fatty acids, amino acids tests. He actually created the GI Effects test, just one of the things he did in his spare time. And, um, really just a genius. I just talked to him a few days ago. Um, very much like a father figure to me. He's long retired now, in his 80s, living on a lake in the mountains of Georgia. And, um, but he still talks to me, and he still trains me, and he still wants me to train you all in the work that he has developed since the 1970s. I know we were talking a few days ago, and he was talking about his job in functional medicine in the 1970s when he was starting one of these lab companies.

Anyways, we have a lot to offer, and a lot of this is based on the work of the people that have trained me, you know, and them, Dr. Timmons, Dr. Freder, Dr. Laura, just wanting to pass this on to the generation. And so I'm a conduit, very much for this. We have worked with Goova Diagnostics for a long time. Goova has been around for a really long time, and they're really the premier lab in our industry. If you're interested in learning more about how to interpret their tests, we have, um, this thing you can scan the QR code. You can scan there to check out, uh, specific courses that we're doing with Goova. And these are lab interpretation classes. They're very light on academic information and very heavy on lab interpretation. Look at the lab, interpret the lab, look at the lab, interpret the lab, and so on. And so that class is starting at the end of this month. If you're interested, check out the QR code there, scan it on your phone. Remember that there's a discount, you get a third off if you have GDX24 at checkout. And we'll be emailing this to you if you don't have your phone with you to scan the code right now, no problem. We'll email this out to you later so you can sign up for that course as well.

So I have a pretty ambitious agenda. So I'm going to talk a little extra fast. If it's too much, you can slow me down when you listen to the recording. Um, but we want to get through how to design a simple program. But the analysis part is quite complex. If all you get out of this is how you can use progesterone and how you should check a GI lab and a neutral on every hormone case, that's my goal has been met. Understand how to use progesterone and the necessity of doing a GI test and a neutral on every female hormone patient. You can't treat female hormones without knowing what the status of their microbiome is, especially the marker called beta-glucuronidase on the GI Effects test. You cannot treat any female hormone issues without a solid adrenal lab to look at and interpret. And you cannot even begin to attempt to treat progesterone or estrogen without understanding how the liver is clearing these hormones. It's one thing how much of the hormone is being produced, but what determines how much is in your body is your liver clearance of the hormone. And so you can't really try to correct something if you don't know what its levels are. And in order to understand the levels of the hormones, you have to really understand not just the blood work on hormones or the salivary testing on hormones, but what the clearance pathways are like, what's happening to those hormones as they're being broken down, so you again get a bigger picture. So adrenals, GI, especially beta-glucuronidase, neutral, especially liver detox pathways that relate to hormones, and then the female hormones themselves. That's the whole package. And if you're doing those tests, you're going to correct the vast majority of female hormone problems.

I have a general treatment model too, where we want to acknowledge that patients have symptoms that we want to treat, but we're doing this from a systems-oriented perspective, right? Body system. And we're also looking at the underlying cause, which we're not going to talk about today at all, but you should know GI infections, gluten intolerance, environmental toxins, genetic-based issues, all these kinds of things. So that there is an interaction or an interplay between what the patient's going through with their symptoms, what the underlying causes are, and then how are you going to address the body systems? And having this whole paradigm mapped out. And I would strongly suggest, if you haven't done it yet, list out the top 20 symptoms that your patients report. In fact, I had my staff do this many years ago. They went through the last year of patients and they just wrote down every top complaint. And I looked at that as a summary in a spreadsheet. I was like, wow, that was really helpful because it was pretty similar. And this is the list, by the way. This is the list that my staff generated for me. I was like, wow, everybody's complaining about the same thing. That's kind of interesting. And then on the flip side, on the green column here, write down what you think are the underlying causes for all health problems. There's my list right there. Take a picture of it with your phone if you want. Um, but write out your own list so you have a general sense of what you're going for in terms of underlying causes and what you're trying to treat in terms of symptoms.

Normal menstrual cycle, pretty straightforward. We have this peak of estrogen, peak of progesterone. And, you know, we can map this out with a month-long test. We're not really talking about that now, uh, but you can do. And then the symptoms that occur can range from cognitive things like anxiety, you can have problems like insomnia, you could have anything from low sex drive to hot flashes to night sweats to weight gain. All these things directly related to female hormones. And we're looking at the cause of these problems as being systems-based. Body system one, neuroendocrine. Body system two, GI. Body system three, liver detoxification. And the summary of the neuroendocrine, GI, and liver clearance issues is what the patient is presenting with all these things together.

Okay. There is a very strong adrenal-female hormone connection. And we've had a lot of doctors come into my mentorship class who have a very strong and successful hormone replacement therapy clinic that they're running. And when they add the adrenal protocols to that, they find their results are much more consistent, much fewer side effects, and much more stability with their patients. So if there's a female hormone problem that's significant, there almost has to be either an adrenal or a thyroid problem that's lingering in the background somewhere that you need to address. And you'll find that when you use DHEA and pregnenolone and you figure out all these hormone-related issues on the adrenal side, that the sex hormones, estrogen, testosterone, they start to respond more consistently, and patient results are dramatically better. In fact, I find in general, this is just from my own practice, basically at least at least half or more of female hormone symptoms are relieved just by doing the adrenals for a month or two. You know, it's sometimes it's enough. Sometimes people say, "Hey, you know, I feel so much better from this adrenal program. I don't even have hot flashes anymore. I don't even have to worry about that." But if you don't have this underlying foundation in place, then you're going to run into all kinds of side effects and problems.

And I'll just show you just from a pathway perspective, uh, very simply here, uh, let's take a look. So you've got cortisol, a stress hormone. When it's high or low or abnormal, you often are going to have an impact on progesterone. And you've got pregnenolone, another stress-related hormone, right? Because it's going down to cortisol. When cortisol is out of balance, we can use pregnenolone, which has a tremendous and beneficial effect on cortisol. And then we have our DHEA levels right here, dehydroepiandrosterone. So DHEA levels, if they're low, are going to often lead to problems downstream. Again, that could be either with testosterone or with the different forms of estrogen. So we find the adrenals are just linked in so closely. And the treatments using pregnenolone and DHEA can have a huge benefit for progesterone, estrogen, testosterone, all those hormones. And then the synergy of doing all these things together is really where patient programs come alive. So more than one hormone at a time. Same thing, low DHEA can lead to low estrogen. Low cortisol can lead to low progesterone. And it's not like these pathways, you know, are all happening at the same time in the same place, but they're linked. And you see these patterns very frequently with the labs.

Now, on the thyroid front, if you have a significant thyroid problem, it's going to undermine your female hormone corrections as much as an adrenal problem would. So I mean, the take-home on that is just screen for the thyroid, you know, not too complicated. That's the same diagram there again. Now, an adrenal program, an adrenal program in place will resolve 50% or more of these perimenopausal symptoms. If you layer on top of that an understanding of the microbiome connection to estrogen, to progesterone, vis-à-vis beta-glucuronidase, then all of a sudden things really start to come together, and you have an even higher percentage of people that are going to get better. And this is an art from Johns Hopkins about the microbiome-estrogen connection. And here's a nice little diagram from that article that talks about, uh, basically how the gut, the microbiome is related to estrogen and breast cancer risk. And to put it really simply, there's a molecule, there's a marker that we measure called beta-glucuronidase. Okay? And it's on a stool test because it's a GI microbiome type marker. And it turns out that if you have a problem with that beta-glucuronidase, you're going to be reabsorbing estrogen back into your system from your gut. Okay? You're going to be reabsorbing it, and that is not a good thing. Okay? Because the estrogen that's in your gut, you want it to leave your gut, you don't want to get it reabsorbed back. And that can cause what we call estrogen dominance. So beta-glucuronidase, bad if it's high, and it's a gut microbiome marker, it's going to lead to estrogen circulating back, recirculating back into the body. You don't want that.

So we've got the adrenal connection, the gut connection, just one of them with the beta-glucuronidase, and then the third here is liver detoxification capacity. So phase one and phase two liver detox pathways, I think we're all familiar with that. And when your body has a chemical compound, a heavy metal, a hormone, it has to be broken down in the liver and excreted. And so you need to have phase one and phase two pathways working really well. In the case of the estrogen breast cancer connection with metabolites of estrogen, there's a specific enzyme called COMT, C-O-M-T, catechol-O-methyltransferase. And that enzyme breaks estrogen down. And if that's not working well, then you can have some really big problems with harmful estrogen metabolites building up. And that COMT is a methylation process. You can see methylation is right here under phase two liver detox. So it turns out what's happening to your estrogen in the body, if you put the estrogen metabolite into your gut and you're about to dump it out in your stool, and it gets reabsorbed because the beta-glucuronidase is high, that's a big problem. Beta-glucuronidase goes up because of dysbiosis. Bad gut bacteria cause the recirculation of estrogen back into your body. That's a big problem. And secondarily, if you're not running phase two very well, and you can't excrete, you can't break down or metabolize the estrogen into safer compounds, then the estrogen is going to potentially circulate in a metabolic form which is cancer-causing. So it turns out it really matters if all these pathways in your liver are working. And they have fancy names, you don't have to memorize, but you should at least know them, be familiar with them: sulfation, glucuronidation, amino acid conjugation. The amino acids that are key are glycine, taurine, glutamine, ornithine, arginine. And when you're looking at supplement solutions, you're going to see the products have glycine, taurine, glutamine, ornithine, arginine, and N-acetylcysteine in them. Okay? So that's almost like an ingredient list for the products that we're going to use to fix phase two.

So getting the gut fixed lowers beta-glucuronidase, it stops those estrogens from recirculating back into the bloodstream. Getting phase two fixed allows you to break down estrogens into metabolites that are not harmful, that do not put you at risk for breast cancer. Phase two not working, higher risk for breast cancer. Beta-glucuronidase super high, higher risk for breast cancer. And you could extrapolate out instead of saying breast cancer, you could say, um, estrogen dominance. So let's substitute for that. So let's say beta-glucuronidase is high, estrogen dominance because estrogens are recirculating. Phase two not working well, estrogen dominance because you're not getting rid of the estrogen. So estrogen dominance causes hot flashes, night sweats, mood swings, irritability, low sex drive, vaginal dryness, headaches, eyesight problems, everything that you can imagine that's associated with perimenopause. Okay? And here's our beta-glucuronidase again, talked a lot about that. Ready? And here's our beta-glucuronidase on this one more time again. This is on a GI Effects test. I'll show you a sample test in a minute. And because this is not typically part of a hormone evaluation, I'm kind of harping on it. But the thing is, you're never going to fix these female hormone cases if you don't do a GI Effects test. It's just not going to work. And I'm not trying to force you guys into ordering more labs. I just want you to have like a really tight, essentials only set of labs that you can order for every one of these perimenopausal cases so you can fix them. Adrenals, gut or GI Effects, the neutral to look at all that phase two liver stuff, and the female hormones. If you get those tests done, you'll get almost all these people better. If you skip one or two tests, you're going to keep missing a chunk of the patient population. You know, like if I think about the hey days of my practice back, let's say when my son was maybe like five or six years old, so I was really cranking. This is 20, he just had his birthday, it's like 21 years ago. And I had 10 new patients a week coming in. And it was all female hormone oriented, the practice at that time. So I just did this over and over and over again. I did this like 40 or 50 new patients a month. If I look back on that phase and I think if I had only done female hormone testing, I don't know, maybe I would have gotten 20 or 30% of them better. But another 20 or 30% got better because I fixed their gut. And another 20 or 30% got better because I fixed the adrenals. And there's a small chunk of them that only got better because I worked on their liver. And you can't just look at somebody and know, "Oh, this is a female hormone problem. If I just do the liver detox test and the hormones, you'd be fine." You got to do all the tests. It's a big cost upfront for the patient, but in the long term, it saves you time and energy, which saves the patient a lot of money. If you're dropping, let's say, a grand or $1,200 on testing in the beginning, it seems like a lot. But if you do the wrong program for six months and it doesn't work, the patient just burned through thousands of dollars, and both of you just wasted a lot of time. So the more testing you can do in the beginning, upfront, again, GI Effects, adrenals, female hormones, and neutral, if you can run all those panels upfront, your results are going to be so much better. You're going to save the patient money in the long run. It is absolutely not effective to save people money by ordering fewer tests in the beginning. It just doesn't work. So anyways, just to point out all the mistakes I've made in the past.

So here again, we have our gut microbial beta-glucuronidase. When that goes high, it's going high because of a microbiome imbalance. But the net result of that, it's kind of strange that this can even happen. When I first learned about this, I thought, this is really strange and kind of creepy in a way. You have your estrogen that you're breaking down into a metabolite, and now your liver's gone through all this work. See the liver's right there. It's gone through all this work to dump that metabolite into the stool, which is a lot of work. I mean, you got to think about just from your liver's point of view, that's a lot. It's like a hustle for your liver to do this. Okay? And then after all that work, you have this metabolite circulating, and just because the beta-glucuronidase is high, you reabsorb it back into your bloodstream. Okay? And that puts you at risk for endometriosis, PCOS, and all these different things because you're estrogen dominant. Scary stuff. It's because of a gut problem. In fact, I would say the more severe that the female hormone symptoms are, the more likely there's going to be a pretty serious gut problem. Lightweight female hormone problem, lightweight gut problem. Bad female hormone issue, you're going to see a pretty bad gut test that is going to be consistent across all age groups for women, whether they're 26 years old or 56. It really doesn't matter. Okay? And by the way, we'll have time for questions at the end. So type them in and I'll get through as many as I can. Okay? Uh, so we already talked about this quite a bit. Lifestyle changes, basically get your gut working better, you know, fiber and all that basic stuff. Oh, there's a pathway in the liver, glucuronidation, that I showed earlier, that's going to obviously be related to glucuronidase. So you want to improve that. But that's right back to fixing the liver to help with the beta-glucuronidase. So fixing the gut reduces the reasons why the beta-glucuronidase would be high. Fixing what phase two liver detox pathway, see support glucuronidation there, that is going to help the liver do its job again properly, okay, because it's overworked. And glucuronidation directly relates to beta-glucuronidase. It's the same, same thing, you know? And then supplement options, calcium D-glucarate is the obvious one. You don't want to use it if they have low estrogen. And then just getting the liver to work better, silymarin, resveratrol, curcumin, all the basics that you would think about for liver support, plus if you're doing the labs, the phase two liver support amino acids that I just went through. Okay?

So I'm really into body systems. Talked about that a little bit. And I think that, you know, one of the things that helps, and this is what I'm trying to do in this this short webinar, is like, you should have a model. You should have a model of what's happening. You know, and functional medicine is such a huge subject area, it's so complex that most people don't have a clear model. You know, one of my old students who I love dearly, uh, just a wonderful guy, we'll call him, we'll call him, we'll call him Matt. That's not his real name. But Matt, just so smart, and really understood functional medicine at a higher level than I ever will. And his model, it had like, I'm not making this up, it had like 17 different systems, and each system had like five different counterparts. And it was very accurate, very well done. But I looked at that and I was like, wow, this guy's a little too smart. Like, no patient's going to understand this. So if you're thinking about systems, keep it to a low number of systems. Keep it simple. Three. Everybody can handle three. So I have three body systems: neuroendocrine, GI, and detox. That's it. I have a female hormone problem. Okay, we want to check your neuroendocrine system, obviously. We want to measure your hormones. But we also want to check your GI and detox because I believe that when people get sick and they have a female hormone issue, they're going to have not only hormone imbalances, but also GI and detox problems. So let's just do all the testing right away. Test the hormones, test the gut, test the detox pathways. And then when we get into the corrective phase of the work, we're going to treat the hormones, and the GI, and the detox in that order. We're going to start with a hormone treatment immediately in the first month. As that starts to get better, we're going to work on your GI tract. Once that's mostly better, we're going to clear out all your detox pathways. So the three body system breakdown, the way that people get sick, we are doing the same order in terms of the correction. And so I like that model. It's very simple, it's very easy for patients to understand. And, um, I try to follow it as much as I can. But you can create your own model for sure. Okay.

So this is an overwhelming diagram on all the facets of methylation. And why is that in here? Well, because it turns out that you need to break down estrogen as part of this. And so the body's making estrogen and putting it into the bloodstream. And we already saw that that can go bad if there's a gut problem. And, um, you know, pretty easily, right? But what about the rate at which you're breaking the estrogen down? Comes down to this enzyme, COMT, C-O-M-T. And that comes down to the process of methylation. And this is the process of methylation, then, is the way that you're going to be breaking down your estrogen to make it neutralized so it's not so harmful, so you can get the estrogen dominance under control. And methylation is strongly linked or directly linked to oxidative stress. And when I first learned this, I thought it was really interesting. This is one of Richard Lord's slides. So when we have oxidative stress in the system, we obviously need to increase our glutathione production because that's the master antioxidant that we can increase at will, which is amazing if you think about it. You can't just sit around and think about it and increase your vitamin C levels at all, but you can increase glutathione moment to moment based on your oxidative stress load. So the more oxidative stress that you're under, the more of an increase you get to this pathway, but more of a decrease you get to methylation. So oxidative stress, protecting against oxidative stress by the production of glutathione, works directly at odds with methylation. And remember, methylation is one of the ways, the prime ways, that we're breaking down the estrogen. Okay? So oxidative stress being high can lead to estrogen dominance type problems. So you kind of got to check that too. And there's a bunch of studies in here, which we're not going to have time for, but this you want to know about. Okay?

So here we have estrogen, estradiol, and then how it's metabolized. So it goes down one pathway, the CYP1A1 pathway, into the two-hydroxy form. COMT, you see the enzyme there, there's your COMT, breaks it down to this harmless two-methoxy. Alternatively, go down the four-hydroxy pathway, which is potentially harmful. COMT can neutralize that into the four-methoxy form. Or if COMT is not there, if you can't methylate, let's say that enzyme's screwed up, then the four, the dangerous one, can eventually come down and form DNA adducts. And that's the part where you've got damage to your DNA, and now you're at higher risk for different forms of cancer. So you don't want that to happen. So if you have great methylation, it won't happen. If you have great antioxidants, you can nip it in the bud at this phase here, or here. So antioxidants and the ability to methylate are what protect us from the estrogen turning into something that's potentially harmful. It's that simple. You're protecting your DNA, basically.

Now, estrogen dominance, in a sense, kind of implies that something's wrong with progesterone. Yeah, because the two hormones are imbalanced. So if estrogen dominance is dominant, it means basically that progesterone is either absolutely or relatively low. And so you can correct a lot of these problems by just working on the liver, working on the gut, and giving progesterone. We were talking about this in class the other day with one of the mentorship students. She's an OBGYN, and she's done, you know, female hormone balancing programs for decades. And she's like, "Yeah, I always start with progesterone. Doesn't everybody?" You know, like when doctors have been doing this for 30 or 40 years, they realize, "Oh, you know, a lot of times if we just get the estrogen metabolites under control, improve the liver, improve the gut, because the gut is putting the metabolites back into circulation if it's screwed up, right? The liver is getting rid of them. So you improve the gut, improve the liver, and give some progesterone. You have a high percentage of people getting better from that." And if you layer underneath that progesterone and adrenal program, then you've got a recipe for complete success the vast majority of time. So again, estrogen dominance, you want to clear the estrogens appropriately. But then there's often times, not always, but most of the time, an associated progesterone deficiency.

And so Dr. Lee, who I mentioned at the start of the talk, was my original teacher. When I was in my late 20s, I went to a menopause conference in Oakland, California, near the lake, for those of you that know Oakland. And there was over a thousand people in the room. And I counted, there's like four men and 996 women. And Dr. Lee was the keynote speaker. And at the end of that talk, I charged up on stage and I shook his hand. I said, "Dr. Lee, that was the most amazing thing I've ever heard." And he said, "Good on you, kid." And he invited me out to his farmhouse, and he became my teacher on the safe use of natural progesterone. And he coached me for years on how to do this. And I can just tell you, it is, it is very difficult to harm somebody with progesterone. Very difficult. If you're using natural progesterone or bioidentical progesterone, you, I mean, the only way you can really do it is if you give a progesterone cream and you don't monitor things, then the progesterone can build up. That's really the only time I've seen these go bad. So if women are on a progesterone cream, you for sure need to test them because those can build up and they're very difficult problems to resolve when there's a progesterone toxicity. But if you're not using the creams, you have like almost zero, you know, pretty low risk of causing a problem using it.

So the overall treatment plan then for estrogen dominance: figure out the progesterone. And we'll get into that in a minute when I show some labs. Get the liver detox pathways. We'll show you some lab work related to that so you can clear the estrogens. Get all the environmental toxins out. So there are a lot of xenoestrogens out there. Those are chemical compounds that get into the body and mimic estrogen. So they, you got to get the liver to clear that out. Fix the gut, we talked about that a lot. Balance the adrenals and thyroid. And then consider genetic issues also. So MTHFR is kind of a famous one. COMT can have genetic issues associated with it. That means that you're not clearing the estrogens well for a genetically based reason, not because you're not eating right or something like that. Make sure you got glutathione in this system. So we test for that. So you're dealing with the oxidative stress that could screw this up. And then, you know, get the whole, um, protection of the DNA going.

Treatments for estrogen dominance: the classic ones are calcium D-glucarate and DIM. And they work really well. You can also just go broader and just work on the liver as a whole and the gut as gut, gut as a whole. This is like going narrow, you know, DIM and calcium D-glucarate. But if you fix the entire liver and you get the detox pathways working, you're going to be fixing the estrogen component of the problem plus some other things. And if you fix the entire microbiome, you're going to be fixing that whole side of the equation too. So these are more specialty products that you can use maybe for a short term while you're working on these other things. If you really want to get estrogen dominance under control. And all the supplement companies we work with will have calcium D-glucarate and DIM. They're often put together in the same product. You can also get people to eat foods that are going to help facilitate this whole detox process, including but not limited to things like broccoli, cabbage, Brussels sprouts, etc. That'll get the liver working properly. So there's a dietary component to this that you can study too.

And then we've got estrogens that are synthetic, right? They're man-made, human-made estrogens that get into the body. That's a problem. Excess body fat is going to be a problem because we make a lot of estrogen if we have a lot of body fat. And nothing screws up female hormones as well as much as alcohol consumption. Just absolutely devastating for female hormone problems, absolutely devastating. And so we need to, as practitioners, learn how to screen for alcoholism in people that are addicted to alcohol and have an alcohol problem. And that's not something I learned in school. It's something I was taught by Lynn Elliot Harding, a colleague of mine and a teacher of mine, who is an addiction specialist. And when I was maybe in practice for five or six years, I met Lynn and she taught me how to screen for alcoholism in my practice. And I started doing it. I realized, wow, I have a lot of alcoholics in my practice right now. I didn't even know. They're coming in every week. I didn't know. I didn't ask the right questions. And so we don't have time to cover off on this today, but something that's very important. If you're drinking alcohol consistently, that's going to cause enough problems with your liver that you're never going to fix a female hormone issue if the person is consuming alcohol on a regular basis. It's just not going to work. You'll constantly be fighting against that. And as estrogen levels drop in perimenopause, alcohol helps mediate the negative effects of the lower estrogen. So a lot of women follow a pattern in their 20s and 30s, they occasionally have a glass of wine. Now, in their late 40s, 50s, it's every night. And they're using it to unwind. For some reason, it's almost always wine. Every case I've ever had that had this problem, it's wine. It's not like vodka, it's not beer, it's wine. And now they're drinking a glass or two of wine every night, and they're trying to self-medicate for their low estrogen. But that makes the liver function quite a bit worse, which makes the estrogen problem worse. So you have to have everybody stop all alcohol, work on the liver. They can start drinking later in their life if they want, you know, not it's not a forever thing, but get all the alcohol out, get the liver fixed, get the hormones fixed, and then you can, you know, think about what you want to do later on.

For the COMT pathways, the treatments are very straightforward: B6, B12, folate, magnesium. You guys have seen this list a million times. It's probably the same list as the methylation treatments, exact same products. Okay? So COMT treatments are the same as methylation treatments, same stuff. Just so you can see the cell. And every company will have, you know, methylation products like this. You don't have to use all of them, but you want to have, you know, a good balance of those. Liver detox treatments: glycine, taurine, glutamine, N-acetylcysteine, cysteine, methionine. It's the sulfur amino acids, the phase two detox related amino acids. Get that working along with some B vitamins and antioxidants, and you got things up and running. Okay.

So we're going to look at labs in a minute. For those of you that were late, we have an interpreting Goova female hormone labs and protocols that work class starting. And so this is a couple months. This is like pre-recorded lectures, live calls where we review tests. You get a third off if you use that code. Scan it with your phone. There, we'll send out emails to that same effect for those of you that are interested. It's only a couple weeks away, it's like 10 days away. We're starting this class. So sign up in the next few days if you want to do it. And this is basically how you can learn how to interpret these labs through live calls where we review tests, the tests that you're doing, hopefully you're sending in tests and we're looking at them in class. And then I have a whole curriculum built out around how to interpret the test. It's sort of a today sort of a summary of it, you know, but the actual full-on course is really how you interpret these labs at a deeper level so you feel like you have the confidence to do that properly. Okay. All right.

So now let's look at some labs and then we'll have time for questions because we're right on time. How handy is that? Uh, let's see. Let me just pull these up. I got it all queued up here. Sorry for the delay. I was going to say my assistant screwed up, but that's kind of a joke because I don't have an assistant. So it was me. It was me. Here we go. All right. So now, because this is a hormone class, let's start with the hormone test. Al, kind of a cool thing that Goova just did recently this past year is they have a test kit now where you can pick and choose salivary, urinary, blood markers. You put them all into one panel. If you've been doing these tests for a while, this is sort of an amalgamation of a whole bunch of them. But anyways, that's available now. But I just want to show you an example here. Um, so on the perimenopausal side, that you have a bunch of different testing options. You can do blood work, you can do salivary, you can do one day, you can do several days, you can do a whole month-long test. Um, most of the time for people who are perimenopausal, the month-long test seems like a little overkill to me. Um, they have a couple day tests that you can do at Goova or a single day. Most of the time people end up doing the one-day profile, just, you know. And, um, you can, uh, also do estrogen metabolites through urine, okay? And estrogen through urine as well as saliva. So you have all these different options. And most practitioners end up finding out what their favorite is, and it's just personal bias. So my favorite is, um, for sure salivary hormones. That's what Timmons trained me on. I'm the most comfortable with it. But some of you may want to do more urine-based tests or more, um, blood work or blood work tests. And then for the urine, the urine is the only way that you can actually get the metabolites. So that's another kind of important thing to think about. All right. So there's that beast of a test. And then let's go to an adrenal one here. And just to make it clear, uh, always, I always start with the adrenals. But if you have a female hormone case, you can pair the adrenal and female hormone programs together. Together, you start them together. Most of the time, that looks like an adrenal protocol plus some natural progesterone plus the things that you need to do to get the estrogen balanced out, which goes back to the gut and the liver and all those things. Yeah.

So this is a standard adrenal panel from Goova called the Adrenal Stress Profile. And they have the CAR, or Cortisol Awakening Response, which is very helpful. And then they have the actual cortisol levels themselves, and then the DHEA. So in this particular case, you've got a very low DHEA. Now, you're going to want to give this patient DHEA, which is dramatically going to improve their estrogen because, as we saw earlier, DHEA is the direct precursor to estrogen. So as you're balancing out their DHEA because they have low DHEA, you're going to be correcting their estrogen. And I would argue if their estrogen is a problem and you just try to treat the estrogen and you leave the DHEA low, it's not going to work very well, or the odds that it's going to work consistently over time are just diminished. Why not fix the precursor also? So it just makes it so much easier to do the estrogen treatment. And for DHEA, I like the liquids. They come in like a 1.2 milligram drop, you know, per drop. Usually for a case like this, we'd use maybe three or four drops, three times a day, three or four drops three times a day to get the DHEA back. But that's also going to help with the estrogen. Now, on the cortisol side, this person has high cortisol at night. So we want to bring that down. So you can use phosphatidylserine to bring down high cortisol, super handy. And now you're starting to work on an adrenal protocol.

Now, if this person also had, let me just find another sample test here. Let me find a good one. Uh, here, sorry. Uh, hang on a sec. I just want to show you one other example. Uh, so this makes a little bit more sense here. This one will be good. I think these are easier to read. We go here, just a little cleaner format. Here we go. So estrogen metabolized. So this is done from a urine sample, obviously, not from saliva. And you can combine them with that new test kit, so you can do salivary and urinary on the same kit. But this will show you what I was just, uh, showed you the diagram of a minute ago, right? Estradiol, and it can be broken down into the two form or the four form. The four is generally considered the dangerous and bad one. The two is considered the safer one. And how all that plays out is going to be dependent to a certain extent on COMT, that's the methylation process, say. And if things are going bad, you want a lot of antioxidants to protect the DNA. Okay? So if you want to look at estrogen metabolites, you have access to that kind of a test. And then that's not all. GI Effects, again, Richard Lord, my teacher, developed this test. Became really the number one ordered test in functional medicine. Thank you, Richard. And we're not looking at the whole thing. We're just looking at the beta-glucuronidase. So you can see here, beta-glucuronidase is high. That's bad. That means that now you know, "Oh, estrogens are recirculating," and I know that's going to create estrogen dominance. And there it is. It's just this innocent little marker. And they don't put a whole bunch of stars by it or something. But if I was in charge of the world, I would put a whole bunch of stars here so that people didn't miss this. You know, like, "Hey, this is extra important, extra important." So if this is high, it means that the person's recirculating their estrogen and they're going to have a problem that you want to. So what do you want to do? You want to correct their gut, obviously, and get the estrogens cleared by supporting their liver.

And here's the final one, the neutral. So let's look at this. Toxin exposure and oxidative stress. When those are high, you know that there's a problem with the liver. And then they have really, again, on neutral, really amazing tests. They have a section here, just in case you're a little overwhelmed with your whole life, that's clearly labeled toxins and detoxification markers. Pyroglutamic acid being high means there's a lot of toxins and glutathione levels are low. You need the support of the liver to reduce that marker. And that in and of itself will help the body clear estrogens. You can see the other markers here related to toxins are also high. So now you know right off the bat, this person has a big problem with detoxification. And if they have a problem with detoxification of chemicals and heavy metals, that's going to extend out to, um, to hormones. It's all the same liver, right, that's doing all this. And then here's a nice marker, maybe the most important marker on the test, glutathione. So glutathione levels low, the detox markers all over the map in a bad way, oxidative stress markers also high here. So now you know there's a lot of damage going on in the system. And you want to protect it by boosting up the glutathione and getting the liver working. And that's going to allow the body to clear estrogens appropriately. Okay. Good liver function, good gut function is kind of like the core to getting the hormones balanced out. And then on top of that, and this is the easiest part, this is part Dr. Lee taught me, is that you just use natural, use the bioidentical progesterone if the progesterone levels are low, which almost by definition they are for most women in perimenopause. You run the labs, see the progesterone, and you give either a liquid progesterone. The creams are problematic, but there's many companies that sell it in a liquid form that's non-prescription. Or you can do a prescription for him in a capsule, a tablet, you know. And either way, it's pretty straightforward. Um, you have to decide, are you going to do two weeks on and two weeks off, or do the whole month depending on her age and whatnot? We have a doctor in the class, and we're just talking earlier this morning, she's the patient, the doctor is the patient. She's perimenopausal, she's in her mid-50s. When she was in the first call in the mentorship, she was sleeping about two or three hours a night. And I was like, "Rosie..."

That's not her real name. Are you serious? He's like, "Yeah, I'm sleeping like two or three hours a night." She was not doing well. She was not working it. You know, she's not doing well.

The next week, I'm not making this up, this just happened in class. The next week we put her, we did her labs. She was low in progesterone. We put her on the progesterone at night. The next week I'm like, "So what's happening, Rosie?" She's like, "I'm sleeping for six or seven hours every night." Like, "You serious?" He's like, "Yeah." They just happened with one of the doctors in class. If you can do that with a doctor, you can do that with anybody because all these doctors are under so much stress. You know, this is not a difficult thing. The progesterone part is the easiest part of this. The progesterone's low, find the liquid progesterone or use a pill form if you want to prescribe it. Um, the liquids are non-prescription, the pills are prescription only. Avoid the creams because they're kind of hard to work with and you'll be set. But these other variables I'm trying to cover off on today are really where you're gonna get tripped up, okay?

All right, so sign up for this class if you're interested in doing more of this and let's get into some questions. Uh, oh, yeah, we have a lot of time for questions. That's great. Okay, does a course include interpretation of neutral and GI effects as well as hormonal tests? Natasha, the, okay, all right. Yes, so there's no, here, let me, let me explain the class. So the class, all the lectures in this class are about how to fix female hormones. There's no lectures about interpreting neutral versus and there's no lectures about interpreting the GI effects. However, what I encourage you to do if you're in the class is we want you to submit your own cases, yourself or your patients, and can upload any GI effects test. When you upload that case, so you have a female hormone lab, female hormone case, upload it, put up the neutral and the GI effects. Also, there's no curriculum around that, but in the live call, we want to handle the entire case like I just presented to you, okay? So it's not a lab interpretation on neutral. We have a class for that too, which is separate, but we will interpret neutral vals on the fly for you guys, okay? So I just want to be clear about that.

Uh, yeah, for women that have low estrogen, thank you, Marie, for asking that. Um, well, I mean, that's even easier in a way. You check their DHEA and give them DHEA because they're almost always going to be low DHEA. And then you can use a non-prescription liquid estrogen or you can do a prescription form of estrogen like an estrogen patch or a Troy or something like that. So that's all based on the labs and that happens. I mean, that's going to be most of these women that we're talking about that are perimenopausal. Oh, I should explain that. Are going to be low estrogen, obviously, because they're in perimenopause. That's what's happening is their estrogens are do, are dropping. However, you can be low in estrogen and estrogen dominant. Did we know that already? I don't know if we knew that. Um, if that's confusing, um, I'll explain it. If it's not confusing, I won't. I'm going to explain it because somebody's going to find that confusing. So, so as you're entering ages 45, 50, 55, your estrogen levels are declining. If you're stressed enough, your progesterone levels are going to decline even more rapidly. So as women are going through perimenopause and their estrogen and progesterone are both dropping, typically progesterone drops more, drops earlier, and drops more. So you end up with low estrogen but estrogen dominance because estrogen dominance refers to the balance between the hormones. It doesn't mean that there's an objectively large amount of estrogen in your system because obviously you're going through menopause, so the estrogen levels are dropping. So on the way down as estrogen levels are dropping, if progesterone drops more and drops faster, you can become estrogen dominant even though your estrogen is low. That's kind of confusing. So for a lot of those women, they're actually going to benefit from taking estrogen also, even though they're estrogen dominant. You just have to do it right. How do you do it right? You fix a gut, you fix the liver, you get that working, you give them the progesterone, then you can introduce the estrogen without any problem. But you don't want to dump a bunch of estrogen into a body that has already got the beta oxidation, beta glucuronidase problem and the liver clearance problem, right? That could be a bad outcome.

Okay, so let's see. Uh, let's see. If DHEA is high, then you have more of a PCOS type pattern and you definitely don't want to use DHEA. Then you have to flip gears into something else, okay? Um, so good alternatives for DHEA and pregnant alone. So it could be that you're in the UK. It could be that it's a woman who has a history of breast cancer. You can't use hormones. So as a substitute for DHEA and pregnant alone, you can use adaptogenic herbs for the adrenals and blood sugar support and even adrenal glandular. So you have a lot of different options there. You can use. So if you have a thyroid problem, that's for a different day. I don't think we have time to talk about correcting thyroid, but you, you definitely should. I don't, uh, I don't have a class coming up on that, but you definitely need to, you know, study that separately. Um, we still have time to cover off on that. So is there a problem giving glutamine and taurine to breast cancer patients? So every nutrient can be a toxicant. That's a Richard Lord quote. Every nutrient can become a toxicant. So it's absolutely dangerous to give anybody anything. Even vitamin E could take you out, right? You know, glutathione could put you, you know, out, you know. So every nutrient that we're talking about, these things are powerful. I'm not kidding. Like glutathione is powerful, super powerful. So the only way to protect yourself from really screwing people over is to do the labs. If a person has low glutamine on a lab and low taurine on a lab, absolutely you have to give it to them just to get their levels back to normal. That is not only safe, that is like required. It would be like if someone showed up in your clinic and they were starving, they hadn't eaten in three weeks, they were physically starving. You would make a pretty quick assessment that in order to normalize this patient, we need to give them food. Like, is that dangerous to eat food? Well, it could be if you're starving. You have to do it properly, right? But in general, that's going to save that person's life. So if there's an outright deficiency, we have to reestablish normal levels. If your glutamine and taurine levels are normal already and you give a ton of it, who knows what could happen? I don't know. You could look that up. But any nutrient can be toxic. That's why we do the testing. If you're replacing nutrients that are missing based on the labs, you're really going to avoid almost every problem that could occur. If you're just giving people things randomly, willy-nilly, without lab testing, then I mean, I think it's dangerous to be honest because these supplements are powerful. You could definitely make somebody sick just with something as benign as vitamin E if you gave them too much of it and they didn't need it. Now, if their lipid peroxides are high, like that last case, then the vitamin E could be a game-changing and positive thing.

Okay, uh, I don't think low beta-glucuronidase is a problem clinically. Um, um, let's see. You guys will get a copy of a recording. So in terms of female hormone, pelvic organ prolapse, that's a little different, but, you know, there could be soft tissue weaknesses. It could be problems with things like glycine or collagen. Glycine is one of the amino acids that makes up collagen. Could also just be structural adhesions and things like that. So visceral manipulation can help those people quite a bit if you find an osteopath that does that kind of work. Let's see. So does beta-glucuronidase lead to fibroids? Well, at least to anything that excess estrogen can cause. So fibroids would be on the yes list. Do you give postmenopausal women phyto? Um, yes, absolutely. If they're, if they need it, yeah, absolutely. That's one of my favorite products and it's in a liquid, but you absorb it through the mouth sublingually. You're supposed to, you know, swallow it down quickly. Uh, what tests show the levels of beta-glucuronidase? That's the GI effects test. Let's see how much time do we have? Oh, we got four minutes now. So hormone imbalance and rosacea. Yeah, so you start, the beauty about having a system is you start in the same place. So you do an adrenal and female hormone lab as soon as you can. You do the gut and the neutral, okay? So whether they have rosacea or an autoimmune disease, whether they want to get pregnant or they have chronic fatigue, whether they have perimenopausal symptoms or postmenopausal, it's the same basic workup in my mind because it's just the essentials of functional medicine for the human body. Adrenals, female hormones, GI, and the neutral. Those, those tests. So for someone who cannot afford these labs, that's what lifestyle medicine is for. So the more the budget is limited to do the testing, the more we focus on lifestyle coaching, diet, exercise, sleep, meditation. Those things. Let's see. I'm not going to be able to get to all the tests because we're at like the one-minute mark and they're still coming in. So I apologize for that, but it's good if you have a ton of questions. Just sign up for this class and we'll answer them all in the class, okay? Um, we have one more minute. Yeah, we got like a minute or two left. A lot of really advanced questions here too, like you guys are just firing them in. Uh, so topical progesterone can work well. The second problem with it, besides the fact it can build up, is you can transfer it from person to person. So if you rub progesterone cream, you know, on your chest or something or your legs and then you go and you touch somebody soon after, you can transfer it. We've had two and three-year-old kids, babies basically, that had high levels of progesterone because their mom was using the cream on themselves on the mom. Mom was putting on cream, mom was picking up baby, baby got cream. We had a grandmother in Florida that this happened to. Grandma went to see grandkid. Grandma's putting cream on her body because she uses progesterone cream. Grandma picks up kid, kid gets progesterone. We've had it between couples that are married. Woman is putting on, you know, progesterone cream and the joke in the class was, well, at least you guys are still having sex. They were having sex, still, they were touching each other. Husband had sky-high progesterone levels. So you can transfer the, the progesterone that way. Now, if you're a single woman and or you're not in a relationship where you're touching other people, I don't think it's a big problem. Um, but it can be, you know, uh, depending on what your lifestyle is like. Um, is there a test that checks heavy metals? Yes, absolutely. The whole another series of testing for heavy metals as well. All right, okay. I'm going to wrap it up for now. Thank you guys for all the great questions. I'm sorry I can't answer them all. Uh, and I hope some of you join us in our class that's coming up at the end of the month. All right, bye for now.