Kim Vopni (00:01.4)
Hi Donna, thank you so much for joining us today. In a conversation that, I mean, the conversation around menopause and hormones is definitely exploding and you are going to bring some, think, you're gonna help us condense this overwhelm maybe. You've been working in the field of women's health and bioidentical hormones for many, many years and you were doing this even.
past 20 years when the Women's Health Initiative sort of halted a lot of things for people. So I'm looking forward to some of the clarity that you're going to provide. Can you start out by telling us who you are, what got you into the world of biogenetical hormones and women's health?
Donna White (00:43.692)
Happy to, and it is an important conversation. And thank you so much for having me, Kim, because there is so much confusion around this topic of hormones. So I am Donna White. I am the founder of the BHRT Training Academy. We train providers in hormone therapy and how to get hormones balanced for women. And I also have a book called The Hormone Makeover. So this is my life, this is my career. I have literally been on bio-dentical hormones for 30 years.
the poster child. I've been through PMS which is why I got into it, perimenopause, menopause, postmenopause, I'll be 63 next week. So I've been through all of the ages and stages and I know what it feels like to have hormones that have gone awry and I know what it feels like to have balanced hormones and let me tell you balanced is so much better.
Kim Vopni (01:15.118)
You
Kim Vopni (01:37.282)
Better. Yeah, amazing. you, as you say, you have a book kind of more for the general public and then you have a training academy where you are training other practitioners specifically in bioidentical hormones. Is that correct?
Donna White (01:55.156)
Yes, and that's so important because unfortunately Kim, as you well know, and I'm sure your audience does as well, far too many practitioners just don't really know the nuances of hormones and hormone imbalance and how to get them back into balance. In fact, what we know from one survey, and this is so frustrating to me, so there's 75 million women in the United States are in menopause, but what one survey found that is
three-fourths of those women walk away from their doctor untreated. So they're going to get help, but if three-fourths of them walk away untreated, we have a problem here.
Kim Vopni (02:38.615)
Yeah, big problem, big problem. And that 20 year period, Women's Health Initiative, left two decades of women not being treated, but also two decades of doctors not being trained and not having the knowledge. And now we're trying to play catch up. And there's many women who are seeking...
help, but yet they can't find a practitioner who is qualified or who is willing to prescribe. So there still are some of them who, you we have women that might be afraid, but we also have doctors who are afraid. So maybe if we start there, when you first started, what did bioidentical hormone therapy look like back
as you said 30 years ago, and then what was that shift in 2002 with the Women's Health Initiative, what happened?
Donna White (03:28.78)
Well, it is so interesting because we have a long history of hormone use in this country and in Europe. Biodentical hormones have been used in Europe for well over 80 years. things were going along fine. Women were taking hormones. They were doing pretty well. Now the general population or general practitioners, conventional medicine, really didn't understand the difference between the different types of hormones. Okay, we can circle back.
to that because that's important. But what happened was in 2002 a study came out called the Women's Health Initiative and it hit the headlines so big because here's what that study seemed to have found. That estrogen caused breast cancer. Oh in that study what they were doing it on caused breast cancer, heart disease, and strokes. So the media says oh my god
are terrible and almost overnight practitioners stop prescribing and women were scared to death of hormones and rightly so. But here's what they didn't say. Now there's two points. First of all, they didn't say what type of hormones were used in the study. One was conjugated equine estrogen, which is estrogen derived from horse urine and it was taken orally. That's a problem. And one arm of the study used the equine
estrogen and a synthetic progestin. So anyway, the headlines came out. Everybody was scared, rightly so. But here 18 years later, they reanalyzed that study and said, wait a minute. The estrogen in the study actually prevented the risk of breast cancer by like 23%. The estrogen also helped prevent cardiovascular disease.
So there was misinterpretation. That study's been reanalyzed, I don't know, 18, 19 times by now, but that misinformation sent everything into chaos. But that was just one study. We have a plethora of studies that have been accumulating for decades on the safety of
Donna White (05:51.254)
Hormones, how hormones are cardio protective, reduce the risk of cardiovascular disease and heart disease by as much as 50%. Hormones, yes, reduce the risk of breast cancer as long as the right kind of hormones. Women on hormones live longer. They have a lower risk of dementia, lower risk of osteoporosis and fractures and a better quality of life. Well, what medical science calls quality of life is
sleep, mood, weight. So we have so much data, so much data on these amazing benefits of hormones. But you're right, it left women underserved and practitioners confused for nearly 20 years and it should not have happened. That whole FDA announcement sent us an American tragedy and I do have to agree with that.
Kim Vopni (06:47.531)
Yeah, yeah, I've heard several people talk about that being one of the biggest failures from a, you know, within the specific to the United States. but we're but thankfully that decision has happened. So anybody who doesn't know about the decision recently, the FDA announced that they would be removing the black box label warning now typically. So I think the initial intention was to remove it from vaginal estrogen.
Donna White (06:54.805)
Yes.
Kim Vopni (07:15.677)
and it ended up being removed from all estrogens. Now there still is language about increased risks of blood clot, heart attack, stroke, that type of thing. But again, the thing that's not covered in there is the nuance of what was the type of, what was the form of estrogen, what's the delivery method. So there still is potential for a little bit of confusion, but I think the...
The removal of the black box is going to now remove a lot of, hopefully, remove a lot of the fears that were unnecessarily created.
Donna White (07:49.952)
Yes, it's what I want.
people to understand is that removal, as historic and helpful as it is, because it finally gets the attention that hormones deserve, they're not so scary and risky, but that removal was not based on a study that came out this year that we've known this information. It's just that the FDA has finally caught up on what experts have known for years.
Kim Vopni (08:10.562)
Yep.
Kim Vopni (08:20.971)
Yeah, yeah, that's a really, really important point to make. So let's start with maybe, like go forward from here with the term bioidentical. What does that mean? There are still, for a long time, what I was hearing was more of the allopathic kind of conventional medical doctors saying that bioidentical was a marketing term. I still hear that a little bit. Now,
bioidentical, the delivery and that the form of many hormone therapies is preferred to be bioidentical. Yet I still do hear people say, it's just a marketing term. So maybe you could clarify the term bioidentical.
Donna White (09:03.958)
So important, you're asking all the right questions that I know your audience and so many people have. Okay, so you are right, bioidentical isn't an official medical term. Where it came from, let's talk about that. So where that term came from is hormones that are deemed bioidentical.
Kim Vopni (09:07.629)
Hahaha
Donna White (09:25.78)
are called that because they have the same molecular structure as the hormones our bodies make. They're the same. You can't tell if the estrogen in your patch or your palate or your cream, your body can't tell if it made it or if you used it exogenously. So really, the term just means biologically identical. Now some opponents have misconstrued that term
to say that, it's the compounded creams, they're bioidentical. That's not really true. So bioidentical forms of hormones, again, same hormones our bodies make, those are available from conventional pharmacies, like your local CVS or Walgreens and an estradiol patch or a permetrium pill. So they are available from conventional pharmacies and they're also available in individualized doses and dosing forms.
from compounding pharmacies. So they're available from both types of pharmacies, but really, unfortunately that term has caused confusion. But that's in simple terms, that's all that bioidentical hormones means. Same chemical structure, same hormones. As opposed to, we should clarify that, non-bioidentical forms of hormones. That's synthetic forms of hormones, like synthetic progestin.
Kim Vopni (10:42.978)
Mm-hmm.
Donna White (10:55.47)
which do cause cardiovascular disease and do, that's the only hormone that causes an increased risk of breast cancer, that synthetic progestin. And then there's also animal derived hormones such as the conjugated equine estrogen. So it's important that chemical structure, what form of hormone you're using. And there's one more thing. It's also important to consider the delivery system. We want
to stay away from oral estrogen of any sort, whether it's synthetic or equine estrogen or even bioidentical oral estrogen. You brought it up in your earlier statement talking about there could be still some risk. Well, that is where risk in lies is in oral estrogen because it does increase the risk of clotting and has some other downside effects as well. So it's important to tie.
of hormones and how you take them. And that's where we have our safety and our data to demonstrate the different effects.
Kim Vopni (12:05.102)
I want to also clarify, I want to talk about compound, compounded, compounding. I also want to talk about the term synthetic because I think synthetic can also create, there's so many opportunities for confusion with hormones. So synthetic, is, I mean, technically bioidentical transdermal estrogen could still be considered synthetic because it is manufactured in a lab.
Donna White (12:35.372)
Can we say synthesized? Yeah, can we say synthesized?
Kim Vopni (12:35.374)
Correct? Am I correct on that?
Synthesized. Okay. Yes.
Donna White (12:40.242)
It is confusing. It's just a term, synthetic is commonly used, not bioidentical, but you're exactly right. So these hormones, bioidentical forms of hormones come from plants. Now the end result doesn't have any plant, but there's a molecule inside the plant, inside the soil wild yam plant that is chemically, molecularly very similar to a human hormone, and it has to be synthesized
Kim Vopni (12:46.338)
Mm-hmm.
Donna White (13:10.286)
in a lab to create or for you to get melatonin or DHEA or progesterone or any of our hormones. So they do have to be taken through a lab process. But again, the end result is the same exact molecular structure as the hormones our bodies make. That's why our body, I can't tell the difference. Did I make it or did I put it on as a patch? It's the same thing.
if you think about it that's so important because there are hormone receptors in every single cell of our body and our body needs certain amounts of hormones. We've been making hormones in appreciable amounts since puberty unless they go awry or unless all these things happen like perimenopause or PMS and so forth. So yes you are right maybe that was a long answer. They are synthesized in a lab. Now let's think about what's synthetic or what we
might call synthetic would be like this synthetic form of progesterone. Like I said, it does cause breast cancer. In fact, they use it in the rat model of breast cancer so that they can give rats breast cancer to study it. So it is a different molecule. It doesn't fit in that hormone receptor. It doesn't dislodge. It has side effects. And even the synthesized estrogens or the synthetic estrogens, if oral,
do have side effects.
Kim Vopni (14:41.784)
Mm-hmm.
Before I go to the compounded, I just want to make one distinguishing, distinguish one term there as well. Progestin. People may hear progestin and they also may hear progestogen and then there's progesterone. So progesterone meaning it's the natural progesterone same.
Donna White (14:52.064)
you
Donna White (15:04.735)
human identical, bioidentical.
Kim Vopni (15:06.092)
Yes, it's human, identical, bioidentical. What's the difference, if any, between a progestin and a progestogen?
Donna White (15:15.432)
Well, the progestins are a class of progesterone type molecules and really that's what fits in there. like progestins are what's in the birth control pill and provera, which used to be used a lot to protect the endometrial lining from the use of estrogen because you do need to take progesterone along with estrogen.
Kim Vopni (15:39.631)
Got it. Okay, so now on the compounding, this is kind of like terminology, it's like the glossary of a book right now, but with compounding, a compounding pharmacist, compounding pharmacy, getting a medication compounded or a hormone compounded, how does compounding differ from...
Like you said, you can get this at CVS or you can get it through a compounding pharmacy. What is the difference? What's important for people to know there?
Donna White (16:09.674)
And that is another point of confusion. So thank you so much for bringing that up. some opponents will say that, compounded hormones are not safe, they're not monitored, they're not FDA approved. But there's more to it than that. So the hormones used in compounding hormones or compounded hormone products are FDA approved. So that estradiol, that's FDA approved, testosterone, DAP.
FDA approved and then compounding pharmacies can buy those in bulk and
format them or compound them into whatever form the doctor wants to order, whether it be a vaginal cream, whether it be a suppository, whether it be an injectable form, but they're in individualized doses, maybe a little estrogen and a lot of progesterone or unlimited dosing. So it gives the practitioner and the patient many different choices. Now, the same hormones like, let's go back to estrogen,
maybe in an estradiol patch, is bioidentical. Well, are manufactured. And so for drug manufacturing, yes, there has to be FDA approved approval, just like any medication. So they do have to go through that and they can patent those. conventional forms of hormones from conventional pharmacy like any other medication do have patents and FDA approval.
know, one-off dosing from compounding pharmacy, you don't need that kind of approval. So some people might say, but are they just making those up in the back room and mixing up some cream? No. Compounding pharmacists are highly overseen by pharmaceutical boards. So there can be that stigma, but it's not warranted. It's not warranted.
Kim Vopni (18:14.671)
And I always make the argument that really a pharmacy started out all being compounded. That's how a pharmacy started, right? And then when the pharmaceutical companies came around and they could make like this one particular dose of this one particular medicine and put their patent on it. Now all of a sudden it became regulated to for that particular drug and marketed that way.
Donna White (18:25.1)
You are so right.
Donna White (18:42.418)
I am more profitable. And the patent, you can't patent something found in nature. You can't patent garlic or echinacea, but you can patent the delivery system, like the matrix that they put the estrogen in for an estrogen patch. You can patent that. Patents mean profits. So some opponents would like to see compounders go out of business, because it does hurt the bottom line.
Kim Vopni (18:45.112)
Yep.
Kim Vopni (18:51.726)
Yep.
Kim Vopni (18:55.3)
Yes.
Kim Vopni (19:02.285)
Yeah.
Kim Vopni (19:11.137)
Yep. Yeah, but it's.
Donna White (19:12.588)
I don't know if we were supposed to go there or not, but we did.
Kim Vopni (19:15.289)
We did. But we have to clarify that's part of the confusion in this conversation is there's terminology. know, there's just there's so much opportunity for people to be overwhelmed by confusion and differences of opinion even. But we just need to say what the facts are and people can then go make the decision that's best for them.
Donna White (19:40.236)
Yes, exactly. And there's so many influencers and big names talking about hormones now and how beneficial they are. And I'm so thankful for that. But you're exactly right. Sometimes it can leave women a little more confused. So I appreciate y'all being able to help clear that up.
Kim Vopni (19:56.527)
So now let's get into the individual hormones. Let's start with estrogen. Most people think of estrogen when they think of hormone therapy typically. why is estrogen important in our body? And what are some of the reasons why we may need some support or augmentation via hormone replacement therapy?
Donna White (20:24.14)
Estrogen has at least 400 functions in the body. Many, many things it does. So estrogen helps slow down bone loss, therefore. That's why, as estrogen drops around menopause, or at certain times of the month, we start losing bone. Estrogen helps protect our brain and cognitive function. Estrogen actually helps rebuild the hippocampus. That's where we store our memories, as you know. So estrogen is very important for brain function.
function for things like verbal recall, for memories like, what did I go to the pantry for? Little things like that. Where's my keys? I'm talking on it. So estrogen was crucial for brain function and protecting against Alzheimer's and dementia and cognitive decline. So protects bone, brain, heart, very, very cardio protective in many different ways that helps keep blood pressure under control.
It plays a role in lipids or cholesterol, joint, it helps protect our joints, our eyes, our gums, and our genitor urinary system helping prevent vaginal dryness and urinary tract infections like some of the things that you really specialize in pelvic floor health, we need estrogen. So it plays many roles in the body, but it starts to decline
or fluctuate pretty wildly in perimenopause. So for some women, that is in the mid-40s, sometimes early 40s, and it trails off pretty much in our 50s as we stop having periods. And here's what that feels like. Hot flashes, vaginal dryness, weepy joint pain, aches,
Weight gain, what some people really don't realize is that hormones help prevent that weight gain associated with menopause. On average, most women gain 20 pounds at menopause and it shouldn't be. So estrogen doesn't cause weight gain, it helps offset that. And we need that estrogen to help prevent diabetes and help us utilize insulin better. So it has a long list of amazing properties. And to be fair, not every woman
Donna White (22:52.842)
even once they go through menopause, is truly estrogen deficient, but many are. That's why it's so important to have hormone levels tested and to bring women's hormones into optimal levels. Not just barely enough, but optimal levels to get the benefits that they need and the long-term protection. So yes, it's about symptom management. Symptoms can be life-changing and affect our life in so many ways.
but also the long-term health benefits are critically important and that's where estrogen really shines.
Kim Vopni (23:30.902)
Okay, I'm going to interject before we move on to progesterone with testing. When should somebody get tested? What type of test should they get? Or testse, maybe? And is there benefit in testing once you are now postmenopause and on hormone therapy?
Donna White (23:36.361)
Hmm
Donna White (23:55.926)
Yes.
Love this topic. women should be, I mean, it would be great if we all knew what our hormone levels were in our 20s when we were feeling really fabulous, but a little late for that. So when women are having symptoms, we focus this conversation on perimenopause and menopause, but we can't forget our younger ladies here. PMS, that's a hormonal imbalance. PCOS, that's hormonally
Kim Vopni (24:05.624)
Totally.
Donna White (24:26.744)
driven in many ways. So if you have any symptoms at all, even as a younger woman, you really should have your hormone levels tested and you want to have them tested on day 19, 20, or 21 of your cycle. So any of the PMS symptoms or PCOS type symptoms, you don't have to live with those. Find out what's going wrong with your hormones and get them tested. So the point I guess I'm trying to make is if you're
symptomatic, get your hormones tested. And how should you do that? Well, you do have options. There's four ways to test hormones. Urine testing, salivary testing, serum, which means blood testing, and then capillary blood spot. That's a little finger prick test that you can evaluate your sex hormones. When I say sex hormones, I mean estrogen, progesterone, testosterone. You can also check.
adrenal hormones. So as we're talking about this, let's make this one more point Kim. It's about more than just testing the estrogen, progesterone, and testosterone. To get hormones into balance, we really need to do comprehensive testing of thyroid.
insulin and adrenal stress hormones because you can't just give a woman estrogen and expect to get the hormones in balance. So we need to do comprehensive testing. Now your question was well how do we do that? Well for most
women and medical providers, it's pretty easy to get the estrogen progesterone, testosterone, the DHEA from blood testing, serum testing, or the finger prick testing. Often insurance will pay for that. You can go to LabCorp, West Whatever the lab is, or many practitioners. You can draw it in the office and you can get those levels. The caveat is for cortisol,
Donna White (26:27.646)
And for many of your astute listeners know that we call that the stress hormone. Well, that'll throw all of your other hormones out of balance. You cannot get hormones into balance without testing cortisol or dealing with cortisol imbalance. So cortisol, you do not want to test in serum. You don't want to go to the lab four times during the day because that's all.
Kim Vopni (26:51.031)
You
Donna White (26:51.612)
you really need to test cortisol morning, noon, evening, and night because you want to see what the stress hormone level is doing in that circadian rhythm. So that's the caveat for cortisol testing. You do need to do salivary or dried urine testing. So combining that too, and there's other ways and other people will have different opinions, but that's a simple way in my opinion and convenient way and it's effective to help
ascertain what is going on with hormones when you feel symptomatic.
Kim Vopni (27:27.182)
And in those tests, if somebody was in what somebody could look and say you were in the perimenopause phase and they would also be looking in there at FSHLH as well, correct? Yeah, yeah, okay.
Donna White (27:42.028)
Correct.
You know, Kim, can we say one more thing? It's not just the lab test. It's interpreting it and looking for optimal levels, not just quote normal. The normal ranges change, the lab changed those to expand and expand and expand because they're just trying to accommodate the population. We don't want barely normal. We want optimal levels. So that's where good training on the behalf of the medical practitioner comes in and
Kim Vopni (27:48.812)
Yeah, please.
Kim Vopni (27:54.136)
Mm-hmm.
Donna White (28:16.618)
looking at symptoms and lab levels from an optimal versus normal and hey let's explain this lady's symptom based on these labs.
Kim Vopni (28:26.062)
Is it possible to... There's so much nuance in there, but is it possible... Do you have what you consider to be an optimal range for estrogen in a perimenopause and then a postmenopause person?
Donna White (28:43.41)
Yes, and that's a moving target though.
Kim Vopni (28:45.654)
Yeah, okay, I was gonna say probably, yeah.
Donna White (28:47.156)
Women's estrogen levels fluctuate wildly during perimenopause. so if you test it different times during the day, you're gonna get a different level this month or tomorrow, mean next week, it's going to fluctuate. That's where that practitioner, that savvy well-trained practitioner comes in, because you have to look at symptoms as well. So it's hard to pinpoint a one
Kim Vopni (28:50.893)
Yep.
Donna White (29:17.11)
number, but if estrogen is lower than, well you have Canadian ranges are different than American ranges, but if I'm going by American ranges, if it's 50 to 80, I wouldn't want it to go a whole lot lower than that. And if the FSH starts climbing, FSH is follicle stimulating hormone which rises as we, it's the brain hormone trying to say, wait a minute, there's not enough estrogen here, come on.
Kim Vopni (29:18.018)
Mm-hmm.
Donna White (29:46.842)
follicles come on let's come on you can do it and so as it rises that indicates lower levels of estrogen and indicates menopause. However that can fluctuate too. You see where this well-trained provider comes in to play here and the importance of that.
Kim Vopni (30:02.814)
Mm-hmm. Mm-hmm. Yeah. And FSH, so let's say postmenopause with somebody on hormone therapy, if it was the, you know, inappropriate dose and they were absorbing well, then the FSH should be low.
Donna White (30:22.634)
Yes.
Donna White (30:26.82)
It should not come down to four like a 25 year old. We would like to see it come down to 40 or 30 and here's why. Because that lets us know that her systems, her cells aren't getting enough. So you do use that along with that estradiol level to see that tissue response. You really do want to look at both.
Kim Vopni (30:29.88)
No.
Kim Vopni (30:36.547)
Mm-hmm.
Kim Vopni (30:51.916)
Yeah, yeah, love that. Okay. Dosing, sorry, not dosing, delivery modes of estrogen. You've mentioned a few, so pellet, patch, gels, creams, oral, vaginal. So can you kind of give us the rundown of how are all the ways that we could possibly take estrogen? And can you take systemic, either the oral or the patch or the gel on your...
Donna White (31:09.196)
and
Kim Vopni (31:21.154)
body and vaginal estrogen.
Donna White (31:24.082)
Okay, wow, you are asking all the questions to clean up all the confusion. I love this. Okay, so let's just start out by saying I and my academy, our faculty, we do not recommend oral estrogen. When you swallow hormones, you're going through the digestive tract and that is called first pass metabolism. About 90 % of that hormone swallowed orally, even though it's bioidentical, is converted to metabolites.
Kim Vopni (31:29.248)
Hahaha
Donna White (31:54.008)
where issues and risks come in. So for estrogen, now this doesn't necessarily apply to all hormones, we'll get to that, but when you swallow oral estrogen you increase clotting, you bind up thyroid hormones, you get an abnormal ratio of the three different types of estrogen. It's just not the best form of estrogen to take and we have other forms like you said injectable estradiol and some
Kim Vopni (32:01.358)
Mm-hmm.
Donna White (32:23.852)
practitioners do use that some women do like it. that's what you want to do that's great as long as it's bio identical. Then there's patches which are very nicely sustained release that's why they work so well for women. As do pellets. Pellets are going to be a little bit stronger more aggressive dosing and hopefully your audience or your listeners are not going to practitioners that do overly aggressive doses of formulas. More isn't better.
is the right amount. So there's pellets and then there are creams and what we have found you know in the past I don't know five six ten years is that more and more practitioners are shifting towards mucosal delivery. What that means is applied creams applied labially and vaginally. That is how they're highly absorbable they're easy to monitor in serum labs so that's enough.
option, highly absorbable. And then old school we did put, know, how practitioners would have women use estrogen or any of the compounded hormones, maybe on their thighs or arms. But I'm seeing a little bit more of a shift away because of the superior absorption vaginally and labially. Now here's where some confusion's coming in, and I love this whole confusion conversation. So there's a lot of influencers out there saying that vaginal estrogen isn't systemic.
Kim Vopni (33:44.686)
you
Donna White (33:53.823)
That is not a fact. It depends on the dose.
Kim Vopni (33:59.331)
Yeah, so that was my question to, to, cause most, most regulated delivery, methods, I guess, are like the Vagifem, for instance, the tablet, or an esterase cream or, know, they're typically very low dose.
Donna White (34:13.836)
Mm-hmm.
Kim Vopni (34:22.146)
they stay actinically, they're not going to go through the whole system. But as you said, the vagina is a very good place for absorption. So if you used a higher dose of a vaginal estrogen, then it could potentially, it will go elsewhere in the body. So at what dose would that be? What would be considered something that would go systemic?
Donna White (34:40.204)
in
Donna White (34:45.568)
Well, depends. So one of the options is to use a bi-estrogen cream, which is Estriol. And in your line of work, that's a fabulous estrogen. I'm sure you've had many good conversations about that. Because Estriol, one of the three estrogens, is very supportive of the vaginal tissue. So a combination of bi-est, two estrogens, means estradiol, the primary estrogen, and estriol.
Practitioners may write that for one milligram or two milligrams or three and then a compounder would put that in a little delivery device, maybe a toppy click device, those are pretty popular, and the patient would use maybe one to two clicks. And we do see those levels, mean, those are the levels come up, the FSH come down. So you are right, the estrace and vagifem, those are typically used for symptoms of GSA.
and they are lower dose. But here's something to think about, just a tip for your audience here. Like if your insurance doesn't cover the Estres or maybe the D, Prasterone, that DHEA cream, that's $400 some dollars where a compounder can make a vaginal DHEA cream for 60 or somewhere in that 50 to 70. And they're cleaner. If you look at the ingredients to Estres,
Kim Vopni (36:08.152)
Mm-hmm.
Donna White (36:15.278)
and I'm sorry somebody's using S-Trace and it works and okay that's fabulous but if you look at the ingredients there's petroleum and some other things that you might not want to put up there when you can have a cleaner option that's just as effective so maybe I veer off a little bit but that's the dosing you were asking me about maybe one two milligram and it depends on whether it's just straight estradiol or just estriol but personally
Kim Vopni (36:27.138)
Mm-hmm.
Kim Vopni (36:37.229)
Mm-hmm.
Donna White (36:45.208)
Why not get the benefits of both of those estrogens? Because this DREAL is very protective. It fits in the hormone receptors, the estrogen receptors that are protective against breast cancer. So I want all the benefits of all the hormones. So why not, if you're going to be using them, why not get the most from these for your bowel?
Kim Vopni (36:48.994)
Mm-hmm.
Kim Vopni (36:59.694)
Mm-hmm.
Kim Vopni (37:07.566)
So do you in your practice, your personal practice and that of your practitioners, would you say a vaginal delivery of estrogen is the preferred?
Donna White (37:18.792)
Not necessarily. Let's look at it. First of all, women want options. And so when working with, you know, want four different kinds of black shoes, not just one.
Kim Vopni (37:25.399)
Yes.
Kim Vopni (37:29.998)
You
Donna White (37:31.368)
So it depends on what the symptoms, because when as a practitioner, what they need to be doing is help address what the woman wants. Maybe she doesn't have vaginal dryness, and an estrogen patch is great, that's all she needs. But maybe, and perhaps she starts with an estrogen patch, but she's still having vaginal dryness, then sometimes as one of our faculty mentors says, you gotta hit it at the front door, give a little bit vaginally.
Kim Vopni (37:44.078)
Mm-hmm.
Donna White (38:01.102)
So you work through what the woman needs and wants and give her an option. Is she, she want the cream or would she rather have a patch so she can get it at her local pharmacy? know, so there's options and there's, you know, benefits and limitations to each type of delivery. Some women love pellets and some women...
Kim Vopni (38:23.522)
Yep. Which is why it's so important to work with somebody who has training and knowledge and has been doing this and understands the nuance and considers all the factors. So, all right, let's move on to progesterone. So we've had a little bit of the conversation of the progestin, progestogen, and they are trying, those are synthetic molecules trying to mimic progesterone, but we know that it is really...
it's increasing risks of many things, we really want the true progesterone. Where is progesterone sourced from and how is progesterone delivered? Well, why do we need progesterone, I guess? And what would be some of the like kind of going down the same path?
Donna White (39:09.12)
Great place to start there. So progesterone is actually for many women the first hormone that declines. It starts dropping in maybe our early 30s. For some women younger, most of them are women struggling with PMS or progesterone deficient because women were under a lot of stress or for that type A personality under a lot of stress or just they become progesterone deficient early on. There's a number of other reasons as well.
women are going through their mid-30s they don't ovulate every single month.
especially as they get closer to their 40s. And that's how we make, or our primary source of progesterone is from ovulation. It's not the only way. Our brain makes progesterone. We do make it in peripheral tissues as well. But when progesterone drops, progesterone, I like to call it the peaceful calming hormone. And when it drops, that's when women can have that severe grumpy, irritable, PMS type symptom, breast tender.
before their cycles, loading and any of those premenstrual things and then as their women are going through perimenopause they can start having heavy cycles. Most of the time that is from a progesterone deficiency so it's heavy cycles are way too long, clotty, usually it's a progesterone issue there so that it's it's mood and sleep. Low progesterone does help
with that calming so that we can sleep. So we from women often feel it and they feel so much better when they get on progesterone. Now you know how we were talking about oral estrogen not being the best delivery or method of taking estrogen? Not so with progesterone. So as I said when we swallow hormones they're going through the digestive tract and 90 % of them get converted to metabolites.
Donna White (41:15.662)
Well, you know what those metabolites of oral progesterone are? Allopragmentolone and deoxycodic corticosterone. And they work on the GABA receptors. And so what that means in layman's terms, the side effects to oral progesterone, bioidentical, drowsiness and anti-anxiety. Well, bring it. That is why that is probably the most popular delivery of progesterone is
Kim Vopni (41:37.514)
Yeah
Donna White (41:45.534)
Orally because it helps so much with night sweats, sleep, and mood. But it's not the only way. Some women prefer vaginal progesterone. Now here's what we're learning. Some of this is so new, and when I say new over the past four or five years, what we've seen is that more and more practitioners are using vaginal progesterone cream because that's what's called the first vaginal pass.
proximity to the uterus there that it's helping so much with heavy bleeding and endometriosis or issues. So you have options. Personally I take vaginal progesterone. I've been on it for 34 years and I sleep pretty good and so I don't really need the oral progesterone. Some people don't tolerate oral progesterone. So it makes them too drowsy the next day.
Kim Vopni (42:41.806)
Mm-hmm.
Mm-hmm.
Donna White (42:45.408)
me, but I use the vaginal form of progesterone.
Kim Vopni (42:49.89)
Does it have to be a cream if you're using it vaginally or could you put it like a prometrium tablet in the vagina as well?
Donna White (42:56.404)
You know, I do hear that being done, Kim.
I don't know that I would. For me, that would not be ideal. Prometrium, which is a brand name, it comes from conventional pharmacies. It is in peanut oil. And does it break down and saturate that tissue? I don't know. I don't know because I haven't seen a study or any testing. So I suppose it's an option. Most of our
Kim Vopni (43:20.514)
Mm-hmm. Mm-hmm. Yeah.
Donna White (43:29.23)
Well, I don't think most of them, I don't know any of them that are using it that way, but if we find out one day it works, okay.
Kim Vopni (43:38.222)
Yep. So progesterone tablet orally or vaginal progesterone cream or potentially progesterone cream somewhere else in the body. So this next question is then for both estrogen and progesterone, if you are using transdermal as a patch or a gel, and I know progesterone is usually in the form of a cream.
where on the body should those be placed and should that be like if I put my estrogen cream on my thighs should it always be on my thighs or should I change it to my arms sometimes or should I put it on my belly or should I change where I'm putting my hormone creams?
Donna White (44:24.49)
We were taught a couple decades ago by compounding pharmacists that you should rotate application sites when using hormone creams, whichever it may be. It testosterone, progesterone, or biester, any of the estrogens. But here's where some confusion comes in. So we're back to this clitzclaro, a confusion conversation. So when you're using...
Kim Vopni (44:43.375)
Gah!
Donna White (44:48.768)
hormone creams on your your arm like some people were using it on their forearm or their thighs like you said it's hard to measure so some
practitioners and clinicians and researchers say, it's not absorbable because they weren't seeing it in the serum. Well, you're not going to see it in the serum. You would really only see it in tissue like saliva. So there was just too much, a lot of confusion about, it's not absorbable, it is, but you won't see it in serum, but you will see it in saliva. So I think that is why there has been such a more of a shift towards labial application.
or vaginal application. I personally used topical, you know, hormone creams on my thighs and arms and rotated for a year. I'd say, because you want to use hormones on your face.
Kim Vopni (45:41.497)
Mm-hmm. Mm-hmm.
Donna White (45:42.352)
estrogen progesterone for wrinkles. We updated to back that up. But I saw my levels go up, but it just wasn't consistent enough for the medical community to get on board. And that's why it's just it was a testing thing. Did they work? Most likely because women responded. They felt better.
Kim Vopni (45:46.286)
Mm-hmm.
Donna White (46:05.61)
medical community needed a little bit, a little more substantiation. So I'm not saying it's wrong. I'm just telling you what the shift has been. And we can, when we apply it, know, laborally as we said or vaginally, we can see the levels in serum. Makes more practitioners feel more comfortable.
Kim Vopni (46:10.04)
Yeah.
Kim Vopni (46:14.168)
Right.
Kim Vopni (46:23.884)
Yeah. Before we go to testosterone, which is where we're going to end, want one more question as there are combo patches that have both estrogen and progesterone in there. Right. So my general feeling is especially starting out, you wouldn't, you should go one in the other or even start with one because you want to know how you are reacting. If you put a patch on that has both, you, you may not know which
Donna White (46:32.556)
Hmm
Kim Vopni (46:50.402)
Like if you have some sort of a side effect, you may not know what it is, but I also think you can't nuance the dose. That's my feeling. What's your feeling on combo patches?
Donna White (46:58.54)
Okay, let's break it down. are, there is, there are estrogen, bioidentical estrogen patches. There is no bioidentical progesterone patch. There's something called a, I don't know, is it okay to say brand?
Kim Vopni (47:14.146)
Mm-hmm. Yeah.
Donna White (47:15.532)
a combi patch which has estradiol and synthetic progestin. So we never want to use a combo patch. But your question is quite astute because let's say you've gone to see your practitioner, your estrogen is low, your progesterone is low, maybe even testosterone. Should you just give all three and go for it or should you start one or the other? And this is another area of confusion because all the influencers are putting their opinion.
a wrong way to do it and I think it kind of depends on the patient and the practitioner. For decades, practitioners have given women estrogen and progesterone together and you're right. You might not know for sure which is causing symptoms but
If I were going to give two together and how we teach this is do give the estrogen and progesterone together because if a woman has low estrogen and low progesterone and you just give her progesterone, you're going to offset that balance and make her low estrogen symptoms worse. But if you just give her estrogen and let's say she's post-modoposal and you don't give that progesterone, then you could create some buildup in the lining. I just feel like those
Kim Vopni (48:27.215)
Mm-hmm.
Donna White (48:39.852)
two should be used together. Feel like it's not the right word. Clinical experience from across our faculty, most of them will give those together. But to avoid what you said, which is a very valid concern, lower physiological doses. And that's what we want. We're not trying to use the lowest dose, but you do start low because you don't want to create more symptoms than the lady walked in with.
Kim Vopni (48:41.967)
Mm-hmm.
Kim Vopni (48:58.18)
Mm-hmm.
Donna White (49:09.782)
start low, go slow, and yes I do agree 100 % with you that it could be like let's say some women they're low in testosterone, they're low in estrogen, they're low in progesterone, they're low in all of them. Should you give her all? Well some ladies are gonna say they're them all down and what else supplements can I take? What else can I take? And others are like, I don't know.
Kim Vopni (49:26.947)
You
Donna White (49:30.912)
You know, and so we're gonna maybe be more conservative and just start with maybe whatever form of estrogen she wants with maybe an oral progesterone, because good lord, most women have trouble sleeping. You can adjust, see where there are in 30 days, and then maybe add in the androgens like the DHEA and testosterone. So there isn't one way to do this. Is that how this is coming across? There isn't one way to do this.
Kim Vopni (49:42.467)
Mm-hmm.
Kim Vopni (49:58.072)
Yeah, yeah.
Donna White (50:00.798)
the patient. gotta, you know, listen to the patient, decide what you're going after most. If she's complaining about sleep, give her the progesterone. Well, estrogen helps sleep too, but...
Kim Vopni (50:03.437)
Yeah.
Kim Vopni (50:10.935)
Yeah, yeah, yeah. Okay. And then, okay, we're gonna wrap things up now with testosterone. So why is testosterone important in the female body? And what are some of the signs, like if we're low testosterone, what could we be having challenge with? And then same thing, how do we deliver testosterone for women? I know there's no FDA approved, but.
Donna White (50:24.426)
Yeah.
Donna White (50:31.564)
Yes. This is something that we're seeing so much more of in our younger women. Low testosterone. By the way, oral contraceptives lower testosterone and shrink the size of the clitoris. I'm just saying that's what happens.
Kim Vopni (50:50.945)
Important information to know.
Donna White (50:52.716)
Yes, so be advised. So testosterone when it drops, and it can drop early as I said, or maybe just more of a gradual decline with age and some women will never drop to severely low levels and I would call that one of the ways we teach that in the Academy is 40 on the serum lab, American Rangers 30-40. If they're symptomatic maybe give them some testosterone but it's so sad Kim.
I see so many lab reports because we do calls with our mentors, for our practitioners that are learning. So many women have two, 10, 12, such low levels of testosterone and here's what that feels like. Loss of motivation, weepy, eyelashes stop growing, hair on your legs stop growing. Okay, that's nice. However, you don't want your eyelashes and your scalp hair to stop growing. So it's a muscle mass.
need testosterone to maintain metabolism. Muscle mass, I'm thinking of you, pelvic floor muscles, you know, we need that. So we need testosterone for the structural integrity of our muscles, of our skin, of our bones, and yes, for our mood to keep us motivated and pursuing things. And some women with low testosterone, they also feel weepy. Like women with low estrogen, they can feel weepy. And crying at commercials, we know one of those.
Kim Vopni (51:58.96)
Mm-hmm. Mm-hmm.
Kim Vopni (52:22.519)
Yeah
Donna White (52:22.606)
Whereas low progesterone, just feel grouchy and wanna hurt somebody. So testosterone is so important and here's what a lot of, some women are afraid, well, no, I don't want a mustache. I don't wanna get all bulky and hulky looking. No, women actually make more testosterone than they do estrogen.
We only make a tenth of the amount of estrogen as we do testosterone. So it's not a scary hormone, but don't go to some practitioner that's not trained that's gonna way overdose you or put some testosterone pellet when the sky high dose, you don't wanna do that. So we do need physiological levels of testosterone, that's some of the symptoms, testosterone cream, and you're right, there isn't an FDA approved testosterone for
women, but here's what concerns me. Some of the very verbose influencers are having their patients just open a pack of androgel, which is for men, and use a little bit. Well, how much is a little bit? Please tell me.
Kim Vopni (53:31.821)
Well, and you know what I always think on that too is a lot of those are the people that can sometimes poo poo the compounding when they say it's not a regulated dose, but yet they're saying here, just take a little dab. And I think, well, that's exactly the same thing.
Donna White (53:45.216)
Yes, so if, you know, most of our practitioners will use either a testosterone pellet or testosterone, your very low dose testosterone injections or testosterone cream. That's probably one of the most popular delivery because you get it from a compounding pharmacy. One to four milligrams is a great starting place for a lot of practitioners to start with and apply it labially or clitorally because that tissue needs testosterone.
as well. So we haven't talked a whole lot about vaginal dryness. I'm sure you cover that regularly and tell, but testosterone is important to help prevent vaginal dryness in the outer area of our tissue there. And if you apply it to the, you know, to the clitoris and labia, you're saturating that tissue, helps things feel a lot more fun.
Kim Vopni (54:20.623)
Yeah.
Kim Vopni (54:37.737)
Mm-hmm. Mm-hmm. Yeah. Yeah, I love it. So if somebody was to I am recommending people to various locations in terms of finding a practitioner there's there's
Not a ton, but there's a few places and your academy is one place where, so people can come and find somebody who has gone through your training. They know they will be well-versed in hormones, specifically bioidentical hormone therapy. So where can people find your book? Where can people potentially, if they wanted to become a practitioner with you, get your training and where can people look for a practitioner?
Donna White (55:14.668)
Okay, so my academy is the BHRT Training Academy. We've trained 2,500 practitioners at this point. We're in six countries and we do have a certification exam. It's a very thorough comprehensive training and on our website you should be able to find a directory of some practitioners that are trained by our academy. But we have a lot more that are listening, getting them to, oh, when is your practice?
Kim Vopni (55:42.391)
Yeah.
Donna White (55:43.756)
So if you're having trouble finding a practitioner, yes, you can Google. Okay, we all do it. We all Google. But think of the, ask them. When you call, ask them, do they prescribe all different dosing forms? Do not go to a practice that only does pellets. Yes, go to a practice that does pellets, but that's not the end. You might not want that. You might not be a candidate. So you want to ask the questions. How long have you been doing hormones?
all the different type of dosing forms and do you test all of the hormones? Are you also looking at thyroid adrenal hormones? Are you also looking at insulin and vitamin D? You know, are you looking at it from a big picture? So ask the right questions, look at their reviews, and another way to find a provider is to look or to call your local compounding pharmacy because they know who's prescribing and they also usually know who's good.
Kim Vopni (56:42.115)
He was doing it well.
Donna White (56:43.788)
So that's another way. And then if you just, if you're a woman and you just want to read more, my book is The Hormone Makeover and that's available on Amazon.
Kim Vopni (56:55.489)
Amazing, amazing. Thank you so much for first of all for training so many other people and getting this out there so that there will be more practitioners and also for your book and all the information that you've shared with us today.
Donna White (57:07.126)
Thank you so much for having me. What an interesting confirmation. I love the work that you do, Kim.
Kim Vopni (57:11.727)
Thank you Donna.
