Kim (00:01.667)
Okay, so we are back for part two because we ran out of time the first one and
like to kind of keep them around the 40, 45 ish minute. And again, we could have gone on for another few hours. So we're, we pressed record again, round two, and we're gonna carry on the conversation with Karen Martel. And we're talking about all things to do with hormones, hormone therapy. We talked in the last session about testing what some of the symptoms may indicate from a hormone perspective. And the natural progression is now into what do we do about that?
is hormone therapy. So when we were kind of wrapping up the other one we were on the you know how to improve methylation you were talking about the importance of understanding our detox pathways the three levels with you know methylation and what pathway it's going down how we support that and how we also have to make sure we're pooping every single day.
Karen Martel (01:00.258)
Mm-hmm.
Kim (01:01.563)
And so let's say we have those optimized and maybe it's a process of once we start, because you mentioned that testing after we reach our menopause is more, like if we don't, if we're not on hormone therapy, it doesn't really make much of a difference, but like we wouldn't necessarily test using the Dutch test. But if somebody is on hormone therapy, we could use the Dutch test, we could look at how their, what pathways.
Karen Martel (01:21.302)
No.
Kim (01:29.095)
removal of estrogen is going down and we can potentially optimize that. So let's talk then about what hormone therapy. So say you've got somebody who is maybe in the perimenopause stage because that's another point or question I want to ask because so many people think and doctors also say you need to reach menopause before you can start hormone therapy. And in the last conversation when we were talking about hysterectomy and what have you, like
Karen Martel (01:32.802)
Yep.
Karen Martel (01:50.219)
Yeah. Yep.
Kim (01:59.131)
So many people would benefit from being on progesterone to start out with, but if you've had a hysterectomy, then people say, oh, well, you don't need progesterone because you don't have a uterus anymore. And there we so we don't need to protect the uterine lining. And so, but I think that, am I am I mistaken in thinking that they could still benefit and could really use some progesterone?
Karen Martel (02:19.198)
Yeah, so once again, so much misinformation right there. Doctors, everybody should know this, a medical doctor is taught anywhere between zero to 7% on menopause in med school. That's how much curriculum they're, no, sorry, that's how many doctors will learn about it. Zero to 7%. What they do learn that small, let's say 7%, is not very much.
And there's no education on perimenopause. And there's no education on bioidentical hormone therapy. If a medical doctor wants to learn about bioidentical hormone therapy, they actually have to go pay out of pocket and take courses in it. They're gonna travel, usually if they're in Canada, they're gonna have to travel to the United States a lot of the time. So you can imagine.
Not too many doctors are doing this. They're not going and paying out of pocket to learn all about bioidentical hormone therapy. What they do learn about, of course, is hysterectomies, ablations, and birth control pills as being an answer. So it's super, super common that they will say to you, you cannot have hormones until you reach menopause. And even then, you're still gonna be hard pressed to find a doctor to give.
bioidentical hormone therapy properly to you in menopause.
So your question is what somebody without a uterus, right? The progesterone. The progesterone is not just uterine protective. It's also breast protective. Remember I said that estrogen can also cause breast proliferation. And if so, it doesn't cause estrogen doesn't cause breast cancer. It's that if you have cancer cells, estrogen is a growth hormone and it will go there
Kim (03:48.071)
somebody without a uterus who's had a hysterectomy.
Karen Martel (04:15.294)
Estrone is another form of one of our estrogens that is a more inflammatory estrogen causing create more inflammation in the breast tissue, which can also increase your risk of breast cancer. Progesterone is going to counterbalance that in the breast tissue. And there has been research that has been shown that women that take progesterone therapy have a greater reduction in developing breast cancer.
So it's very breast protective. What they found was that progestins increase the risk of breast cancer. Progestin is a fake progesterone that is in birth control pills. So it's so backwards that the doctor's going, you cannot have these hormones or you do not need progesterone if you don't have a uterus, but we'll give you birth control pills.
Kim (05:10.599)
Mm-hmm.
Karen Martel (05:12.098)
makes no sense, right? So we know that this body identical progesterone is very safe. It's very protective. It's also really important for bones. So estrogen is very important for bones, but so is progesterone. And we know that women that have hip fractures have an increased risk of like 50% in dying within the first year of having a hip fracture, which is to me, that's just like mind-blowingly crazy that we're not
on top of that more. So we know that progesterone estrogen are both needed for bone formation. We know that progesterone is really important for the myelin sheaths in the brain. So that helps with brain function that it is calming. Remember I said in the first episode that progesterone calms the brain activity by acting on the GABA receptors in your brain. So really important for anxiety and mood.
That's all very important. It's great for helping us get rid of water retention. It's really good for our skin. We can even put progesterone cream right on our face and it's gonna actually help with collagen production. So there's so many more benefits to progesterone than just in the uterus. So when a doctor says that, it really makes me very angry. And we shouldn't be waiting for women to have no hormones. So...
Karen Martel (06:42.994)
the fight against it, what they say is, well, we're not gonna give you estrogen, as estrogen can give you breast cancer, until you're in menopause. And then if you really have to have it, then maybe we'll look at giving it to you then. And this is functional doctors, this is medical doctors, endocrinologists. And my question is, why can we have boatloads of estradiol?
our entire fertile lives from the time we're 13 to the time we're 48, we have an abundance of estradiol in our body. And then suddenly in menopause, it becomes this death sentence that if we give you freaking estradiol, this is like whoa, and it's this dangerous hormone. And I'm like, but why are we waiting till a woman is 30 pounds overweight?
hot flashing, depressed, anxiety, losing her hair, getting wrinkles, getting sore joints, heart palpitations, dry vagina, atrophy in the vagina, no sex drive, now we'll give you some estrogen. And at that point, a lot of that is, it takes a long time to reverse. And if we could actually catch it as it's going down, so if we can catch women...
that are in that perimenopausal phase where the estrogen is now dropping. So we've given them progesterone, hopefully, in their late 30s, early 40s. Estrogen, as it starts to decline in our late 40s, typically, if we topped it up then, we wouldn't have half the symptoms that we have going into menopause. And 88%, I think, is the number.
of women have symptoms of menopause and 10 to I think it's 10% of those women are 12% have severe symptoms. And I'm talking suicide that when I'm saying symptoms that some women will commit suicide, they will leave their jobs, they will leave their spouse. I mean really life changing things that can happen to some women because of the loss of these hormones. So
Kim (08:52.732)
Yeah.
Karen Martel (08:56.446)
to be so afraid of this estrogen that we've had our whole lives and it's not causing all these teenage girls to be riddled with breast cancer. We know that estrogen when we replace our estrogen we actually have a decreased rate of developing breast cancer. That women post breast cancer can be treated with estrogen therapy and will have a less chance of it coming from returning.
And I mean, that's a whole nother episode in and of itself, but about breast cancer.
Kim (09:28.701)
Yeah. Well, and I said the same thing where I just I couldn't fathom why all of a sudden this really beneficial hormone like just like one day it's like, oh, really, really beneficial. Oh, really, really dangerous. It just made no sense. So a lot of this has come from the Women's Health Initiative. And this was a giant study. And now, I mean, I'm just going to kind of quickly summarize, you can go into it. But
There was some false information, some headlines were inaccurately portrayed, it created a lot of fear and we now, so I think it was about 50% of women were on hormone therapy at the time and then it went down to, I think it was like 5 or 7% and I still think now it's still hovering around that number of women. I think that's going to start to increase because there's so much more information coming out now about the real...
the truth of the information, but can you tell us a little bit about what the Women's Health Initiative was and why we're in this hangover state from a lot of the challenges of that study?
Karen Martel (10:19.031)
Mm-hmm.
Karen Martel (10:27.084)
Mm-hmm.
Well, back in the 1950s, estrogen replacement therapy, which originally came from a horse pregnant horses urine premarin, was the number one most prescribed medication in North America. So I would say there was a lot more than 50% of women on estrogen therapy. It was very common for most women to go on estrogen therapy.
Then they realized, oh, we need something to counterbalance that growth of estrogen. So they brought in that fake progestin to help counterbalance that. Then they do this. They run this study. They start this study, which is one of the largest of its kind. And as they get into it for a couple of years, then they saw this increased risk, very small increased risk of breast cancer and uterine cancers and heart attack and stroke.
So they pulled the study early, they shut everything down, word went out to the world that, hey, hormone therapy is gonna kill you, get off. And literally every woman jumped off her hormone replacement therapy, and every doctor still to this day says, hormones are gonna kill you. Dr. Peter Atiyah, who is a very well-known anti-aging doctor, he has publicly said he thinks that was the biggest screw up in medical history, was that study, yeah.
Kim (11:46.243)
Yeah, yeah, I heard that.
Karen Martel (11:47.926)
which I was so grateful for him for saying that. And it really was because when you actually looked at the study and what actually happened, it was the arm of the study that the women were taking both Premarin and progestin that had the increased risk of breast cancer.
Kim (11:50.631)
Yep.
Kim (12:05.915)
Yeah, the one with the estrogen only arm had a decreased risk of breast cancer.
Karen Martel (12:09.134)
Decreased, yeah. Yes, of both types too. Like there was, it was breast cancer as well as ductile cancer had a decreased risk. Small decreased risk when you looked at the whole thing and a very small increased risk on the progestin side. But it was there. And then also it was that they realized that the women that they found, because it was really hard for them to find healthy young perimenopausal women.
Kim (12:23.799)
Mm-hmm. And a very small increase risk. Mm-hmm.
Karen Martel (12:38.87)
that were not on estrogen already because most women were on it. So the majority of the women that they had in this group in this study were in their 60s and they tended to be unhealthy. There was a ton of smokers. There were a lot of women that were overweight. So what they saw was this increased risk of heart attack and stroke as well, which was very concerning. And so then they came out with, okay, it's only safe to take estrogen for 10 years post-menopause and then...
Kim (12:43.909)
Mm-hmm.
Karen Martel (13:07.686)
No more because you're going to get an increased risk of heart attack and stroke. Well, that was from swallowing the estrogen. When we swallow estrogen, it has to go through the first hepatic passage of the liver, which then creates inflammation. It mostly gets converted to Estrone, which is an inflammatory estrogen fat producing estrogen. And yes, it does increase your risk of heart attack and stroke, which is why I say never take estrogen, even if it's bioidentical through
your mouth because you will have an increased risk of heart attack and stroke. If you take it transdermally, which means through your skin or through the mucosal in the vagina, then there is no increased risk. None of heart attack and stroke. It doesn't mean you're not going to get one, but it will not increase your risk because you are not swallowing it. So it's very safe and it's actually been shown now in several studies to actually decrease your risk of heart disease.
by taking estrogen, very important for the heart.
Kim (14:10.683)
Yeah, yeah. Yeah, so I guess, again, in this confusing realm, we need to identify a few terms here. So, their hormone therapy was sort of the term that used to be used. Then it became HRT, hormone replacement therapy. Then some people thought, well, maybe we should call it menopause hormone therapy, MHT. Then we have...
the bioidentical, BHRT, bioidentical or body identical hormone replacement therapy. So I guess the main categories I'm gonna say are body identical or bioidentical and not bioidentical. Really, that's at the end of the day what it is. And some people will use the term synthetic hormone.
Karen Martel (14:40.412)
BHRT, yeah.
Karen Martel (14:55.25)
Yeah, yes.
Kim (15:00.375)
replacement therapy, but synthetic, even if you take a bioidentical hormone, it's still synthetic. It's still something that's manufactured in the lab. So I guess more accurately bioidentical and non-bioidentical, non being the conjugated equine estrogen and the MPA, which is the progestin that you were talking about, bioidentical being the transdermal estradiol and micronized progesterone. Do I have that all correct? Okay.
Karen Martel (15:06.97)
Yeah.
Karen Martel (15:16.641)
Yeah.
Karen Martel (15:25.454)
Perfectly. Yes. Yeah. And what's interesting is the research actually shows that taking Premren, the pregnant horse's urine estrogen, is actually still better for your health than taking no estrogen at all. Which is just to me is like, that's just craziness. So it just, when we start to really dig into the research.
Kim (15:48.039)
Yep.
Karen Martel (15:52.658)
we start to see and peel back all these layers because research, there's a lot of research out there that they don't identify what hormones, what type of bioidentical hormones or hormone therapy that they used. A lot of them, what a lot of the research has been done on Premarin and has been done on the progesterone stents. So it'll say progesterone in a study, but most of the time that's a synthetic progesterone that they used.
so that you have to really kind of pick apart the science and the research. But when you do, you see that actually, we are better off health-wise to replace our hormones than not to replace our hormones. That we'll have a reduction in all-cause mortality by up to 33% by replacing our hormones.
that we'll have a reduction in Alzheimer's by like 75 to 80% if we replace our estrogen for five years or longer in menopause. That is a disease that is apparently not curable. We can't prove like, and here we have this evidence. This was a study done in Arizona a couple of years ago. It was like 1920 or 21 that showed that
If you replace your estrogen for six years or longer post menopause that you had a reduction by 75 to 80% of developing dementia or Alzheimer's, 4,000 women. Like that's a great study. And yet, are we hearing about that? Yeah, that should be huge, massive hello.
Kim (17:25.475)
Yeah. And exactly why is that not major headlines? Yeah.
Karen Martel (17:34.91)
So it just, you know, and I can go on and on. I know all the, I know a lot of the stats on this because I obviously want my women to be safe and to feel safe about making these choices because they have been told so much misinformation. And even if they haven't been told, which I think is very interesting, they still have this major fear of it and they don't know why. You know, if you say, oh, you should replace your estrogen, it's like, oh, and they like covered their breasts. Like, oh, well, I don't think so. Like, is that, am I gonna get breast cancer?
Kim (17:44.466)
Mm-hmm.
Kim (18:02.883)
while they drink a glass of wine. While they drink a glass of wine.
Karen Martel (18:04.926)
while they start, while they're drinking their glass of wine, a hundred percent. Yeah. And in eating their hormone laden foods and spraying their perfume on, which is all of these, you know, estrogens, which has much more of a connection to breast cancer than our own estrogen does. Yeah, very frustrating, very frustrating.
Kim (18:08.765)
Yeah.
Right.
Kim (18:18.895)
Right, right. Yeah. Okay. So you're pro hormone therapy and bioidentical hormone therapy, as am I. So that so we've and okay. Yeah. So let's dive in now. Okay. So bioidentical is, is becoming more like
Karen Martel (18:30.063)
And starting at the right time.
Kim (18:41.263)
Back in the day, bioidentical was, oh, it's just a marketing term, oh, it's woo woo, oh, it's blah blah, nobody believed in it, yet it's now Health Canada approved, FDA approved, and it is, generally speaking, the most prescribed. So bioidentical hormone therapy, and you were talking about the oral versus transdermal or the patch or vaginal. So let's start there. From an estrogen perspective, let's start with estrogen. What is...
What are the forms of bioidentical estrogen therapy that are available for people?
Karen Martel (19:14.738)
Yeah. So the number one most prescribed by functional practitioners, naturopaths, some MDs and most hormone clinics of any kind are going to prescribe what's called bi-est, which is actually a combination of two different estrogens, one being estradiol, which is the one that's the most abundant and the strongest one that we have that we produce out of the ovaries combined with one called estriol.
which is our weakest form of all three of our estrogens and is what we produce mostly actually when we're pregnant is made out of the placenta and large, large amounts out of through a conversion of DHEA basically. But anyways, we produce a boatload of it pregnant. No other time in our life, besides when we're pregnant, do we produce a lot of estriol? Do we produce more estriol than we do estradiol? So a woman that's not pregnant
she'll make the estradiol and then a little bit of that estradiol will convert down into that estriol and give that woman what her body needs, which is a small amount.
So back, I don't even know how long ago there was a doctor, very famous hormone, Dr. Jonathan Wright, who taught many, many practitioners how to utilize bioidentical hormone therapy. And he said, basically, we need to be using BiEst, which is primarily 80% Estriol and 20% Estradiol. Because Estriol,
has no proliferation to it. So it's not going to make breast cancer grow. It sits on what's called the receptor. It sits on the better receptor, which is a very weak receptor, no proliferation. And then it gets right off. It's literally on there for minutes and it gets back off. So there's not a lot of signaling going on. Rather, estradiol has a 50-50 ratio from alpha receptor to better receptor. So there's some...
Karen Martel (21:20.142)
proliferation to it, which we need. We need some like bone health. There's many reasons why we need some proliferation. So it has this nice 50-50 ratio. So there, if, if you had breast cancer cells, yes, it could make those breast cancer cells multiply. So his theory was we need to just use Estriol mostly because it can't cause breast cancer. And so everybody jumped on board and they're still on board with this. So this is what you'll
practitioners prescribing is biased, which is always in a form of cream. There's no pharmaceutical company that makes biased, only compounding pharmacies do. And that is a bit of a distinction to make. Now, not that I'm like, you know, pro-pharmaceutical companies by any means, but it's a compounding pharmacy product.
rather the pharmaceutical companies have made some forms of estradiol only, which is the estradiol patch in different formulation, like different amounts. They made Estro gel, um, Divi gel. There's different names for them. Uh, there's ones that are just specifically for the vagina. Then we've got the E string, which is this little thing that you put up inside the vagina that
Karen Martel (22:48.014)
I think that's pretty much the main pharmaceutical ones that have been made and they have to be in a certain formulation, right? They can't, there's no creams because that has to be compounded then. So they can't patent that.
Kim (23:00.939)
And just on that note to elaborate, so the estrogel or the divi gel would be, this is not delivered through the vagina, this is to, or the patches as well, this would be like on your arm or right. And that's kind of the systemic, meaning it's influencing kind of the whole body. There's vaginal estrogen which is delivered
Karen Martel (23:15.71)
on your skin.
Karen Martel (23:23.566)
Correct.
Kim (23:28.543)
in or through the vagina and that is the E string. There's creams, there's Vagifem as a tablet. What's the bioidentical cream in Canada?
Karen Martel (23:30.326)
Yeah.
Karen Martel (23:39.358)
Yeah, because we don't think we have VagieFan.
Kim (23:42.243)
We do have Vagifem as the tablet, but we don't have the cream. So I'm unclear on that.
Karen Martel (23:43.378)
Oh, we do have hair. Okay.
Karen Martel (23:48.03)
I think most of it is a compounded. I don't think you can get like, you can get any farm, any compounding pharmacy to make of the cream that like that, that you can put inside the vagina, but there's no pharmaceutical company that makes a cream for the vagina. No, no.
Kim (23:56.563)
of the, yeah.
Kim (24:02.543)
A bioidentical one. Yeah, right. So the delivery, meaning not the skin of the body, but through the vagina is like somebody could have both somebody could be on vaginal bioidentical estrogen plus the systemic bio identical estrogen. Yeah. And that's because the systemic isn't necessarily acting locally on the tissues in the vagina, nor when we have just.
Karen Martel (24:17.546)
Yes. Yep. Yes, that's actually preferred. Yeah.
Kim (24:29.847)
acting locally on the vagina, is it going to help with things like hot flashes and bones and heart and brain, right?
Karen Martel (24:36.534)
So when you use estrogen on your arm or through a patch, you're right. It doesn't get really localized in the vagina tissue. It's like kind of the bottom of that stream. So it starts to go through your body and it's going to get everywhere and it is going to get down to the vagina eventually, but it can take a while. And so if you've got vagina atrophy and you're kind of prone to that, then you're going to want to use a suppository with it.
Once again, doctors are really hesitant to give both. They'll leave it kind of one or the other, or they'll say you can use the suppository, but only use it once every three days. And then they'll say, a lot of doctors will say, oh, if it's through the vagina, it won't go systemically. And I'm like, how is that possible if we can put cream on the inside of our arm and that goes systemic? But you're saying if I put it into
the vagina tissue, the mucosal tissue, that isn't going to absorb actually that much better than your arm. To me that just doesn't line up and it's so funny because I just was listening to somebody's podcast the other day of these two hormone doctors and they're like, yeah, you know, it's not supposed to go systemically, but whenever I test them, my women, they do. You can see that their levels go up and I'm like, yeah, no kidding.
You know, but most of the time it's not given in high enough amounts because it's like, oh, take this like 0.25 milligrams three times a week and then just do once a week suppository after that once the tissue gets back to normal. But if you were to use, let's say 0.5 milligrams in a suppository of estradiol every single day in the vagina, it is going to raise your levels systemically. You know, not that everybody needs to hear all that, but just it does. It goes systemically. Okay.
Kim (26:24.495)
Yeah, thank you for clarifying that.
Kim (26:29.363)
Oh, we totally need to hear that. We totally, because there's, because there are people that, because that is commonly it said vaginal estrogen doesn't go elsewhere. But again, you've made it an important distinction there. It's that it's the amount and the and how often they're using it and the form, because if somebody isn't using it daily at a higher dose through the vagina, it absolutely can. So that is a really important distinction because at least here in Canada, typically you're prescribed twice a week.
You may get on a loading dose of once a day for two weeks and then go twice a week thereafter, but typically people are using their vaginal estrogen twice a week. That is the most common. And there are many people who will say, oh, well, that's too much estrogen if you are taking it systemic and vaginal. But I follow Dr. Rachel Rubin, Dr. Kelly Caspersen are two familialgists who are really doing a lot in this space and...
Karen Martel (27:06.646)
Yeah.
Kim (27:25.047)
and helping educate and open up our eyes in terms of the research and the evidence and the modes of delivery and all that kind of stuff. So that's super important.
Karen Martel (27:35.862)
Yeah, and estriol is actually great for the vagina. So you can get a compounding pharmacy to do the estriol in the vagina. That's fantastic because we have most present actually is in the vagina. I think there's, there's no research on this, but estriol, I think we produce so much of it during pregnancy for a few different reasons. One of them being that it does lubricate the vagina so much and help for the baby to come out.
Kim (27:39.354)
Mm-hmm.
Kim (27:48.604)
Mm-hmm.
Kim (28:03.568)
Yep.
Karen Martel (28:03.85)
because we know that that's where it's most concentrated is in the vagina tissue. So estriol can be great for vagina tissue, but as a replacement, we as that 80-20 ratio, Kim, we typically do not see women getting the estradiol levels high enough to protect their bones, their brain and their heart.
Kim (28:27.023)
Yeah. And that was me. I was on, I first went on bioidentical progesterone and then eventually started on bi-est. And this was when, again, I'm still sort of learning. I'm in the research phase, but all the research I was doing was all with estradiol. And I kept thinking, I think I'm missing out, right? I don't think that I like, I don't, I'm not using the...
Karen Martel (28:45.47)
Right? Yeah.
Kim (28:47.887)
most evidence-based here. And so then it became, you know, diving deep and then switched over to away from bias and went to the estrogen. So, and that made a big difference, yeah.
Karen Martel (28:58.194)
Yes. Yeah. Same. I started with bias and then I got to learn more and more about it. And I've spoken a lot on my podcast and personally with a very famous gynecologist named Dr. Feliz Gersh, who is really trying to change that narrative because she is the she's like, why are we trying to mimic pregnancy and menopausal women? This makes no sense. And once again, sorry, but coming from a man and I'm like,
Kim (29:13.079)
Mm-hmm, I love her. Mm-hmm.
Kim (29:21.061)
Mm-hmm.
Karen Martel (29:27.69)
How would men feel if we were to say that we were going to just give them DHEA, not testosterone, to help with their symptoms of testosterone loss because testosterone causes prostate cancer, which a lot of medical providers think that. Okay, so this is a really actually a good comparison because a lot of doctors will say, oh, mention do testosterone therapy because prostate cancer, which is not true.
That's another, it's a myth, just like the estrogen and breast cancer myth. And DHEA can convert down into testosterone. It is an androgen. So it mimics a lot of the similar things, but it's nowhere, it is not their testosterone and it will not give them the health benefits that testosterone will give them. And I just know that would just never happen again, cause it's a man.
Kim (30:19.739)
Right, right.
Karen Martel (30:20.958)
And it's just like if a man's testosterone drops by just a little smidge and he's having any problem with his penis. Oh my gosh, here's your testosterone therapy. No problem. High doses. Everything you need to make sure your penis is working correctly. And then women are left to be completely dry with their estrogen. No estrogen at all. Now their vagina is dry too and they can't have sex. It's painful. It hurts. They're having urinary tract infections. All of these things. And now we're going to give them estrogen.
And then the testosterone, it's a woman's most abundant hormone. We actually produce more testosterone than we do estrogen in our fertile years. And so when that drops in menopause or perimenopause, it can be really profound. And doctors will never look at a woman's testosterone levels when that is important for our sex drive, for our muscle building, it gives us our drive, just our sense of drive in life.
I would say it gives a woman her woman balls, because it does, it really helps you to go after things and it gives you that umph, it gives you energy, really great for bladder problems. It can help strengthen the bladder by using testosterone in the vagina as a suppository or as cream. Can help with orgasms and better orgasm, can help with lubrication in the vagina. There's tons and tons of benefits to testosterone.
Kim (31:21.016)
I'm sorry.
Karen Martel (31:47.286)
But yet we're not being offered that.
Kim (31:49.147)
Yeah, and when you think so, right, and so myself personally having gone through this, I have been working with providers, so it hasn't really been a huge big battle for me to have access to hormone therapy except testosterone. Testosterone, so I live in Vancouver, there's very, very few doctors. It was a struggle to find somebody who would prescribe, so naturopaths are not allowed to, and so found one medical provider who does, and it's in the form of a,
compounded cream so it is not Health Canada. It's not a government regulated like the ester gel or the Prometrium that micronized progesterone but it Yes, yes exactly and so like
Karen Martel (32:29.65)
or the Andra gel which is covered for men but not for women.
Kim (32:36.539)
there's a here's another barrier we face so many barriers and this is another one. But if so if somebody wants to do hormones, sorry, if somebody wants to do testosterone therapy, so this is something that again we would be looking at you would be looking at in testing and also be thinking about the symptoms that the person is talking about. So if it's indicated for this person to benefit from testosterone replacement therapy.
How does that differ in terms of how it's applied to the body? Is it oral? Is it cream? Is it patch, gel, vagina, skin? How does it work?
Karen Martel (33:10.614)
So number one, again, never swallow testosterone or do a trochee. Is that same with estrogen? Trochee's you're gonna swallow. Trochee's are these little things that you put under your tongue or in your gum and it dissolves. You will swallow half of that. So if a doctor's trying to give you estrogen trochee or testosterone trochee, you wanna give that a hard no. Progesterone's totally fine and we'll get to the best forms of progesterone. So testosterone, you want to take it either via cream,
or injection. And I have seen, I work with a testosterone clinic. So, uh, we have seen in the clinic that testosterone injections work far better than cream, oddly enough, for raising levels and for feeling it. Like I hear constantly from women that switch from cream to injection, oh, I never felt it before. I was on the cream. I really didn't notice anything. Now I noticed something.
because the injection for some reason, it just, it's a better delivery form. So there's always like, you know, estrogen, it seems to be patch or gel or suppository, progesterone, cream or capsule. And then testosterone is preferred by injection, which is, yeah, interesting. So you can do them intermuscular or you can do subcutaneous. It is, it's typically in
Kim (34:25.833)
Where is it injected?
Karen Martel (34:35.538)
an oil like grapeseed oil. So it's very viscous, which is why they typically recommend doing it intermuscular, which can be hard for some people to do personally. I can't do it. You inject yourself. So that can be tough for some women. Yeah. So if, if you can't do that, you could try subcutaneous, which is means through the fat, which is how I do mine.
Kim (34:47.483)
So that's something that you would do, like you don't go have an injection, you inject yourself. So similar to, okay. Yeah.
Karen Martel (35:00.574)
Um, and then if you can't do injections, you don't like needles, then you would do a cream, but you just want to make sure you have a high enough dosed cream. So you have to go higher than you would if you were doing injections. So let's say you would be injecting the equivalent of two milligrams a day of testosterone. You to use two milligrams of cream a day will not give you much at all.
Like you will get, you have to actually go up to like five or 10 milligrams a day to get that equivalent to get the levels up. Yeah. I'm not, not sure why there's no research on this. Um, so creamed, it can definitely work. It can be great, but injection is preferred. So those, and that you give every day estradiol you give every day, um, progesterone. I do prefer to cycle progesterone and progesterone. You want to.
Kim (35:30.651)
Wow.
Kim (35:35.731)
Mm-hmm.
Karen Martel (35:53.418)
use either cream form and don't let a doctor tell you that cream isn't good for progesterone because what happens with cream, it doesn't show up in blood work. So there's all these little nuances to each of them. Testosterone injections over show in total testosterone. So you have to look at free testosterone in the blood. And then it sometimes will under show in urine metabolites. Estrogen will show up in blood work as well as urine very well, as well as saliva.
progesterone cream does not show up in serum blood work. So it won't, it'll look like you're not getting it. And then the doctor freaks out. It's like, oh my gosh, your progesterone levels aren't moving up. But if that person, that same person was to have tested with saliva or urine, it would show and saliva would over show it. So it's just like, no rhyme or reason here. It's just the way it goes. So.
Kim (36:44.1)
Hmm.
Karen Martel (36:47.99)
Progesterone cream is a great way to get it. It was used for the first many, many years of that coming onto the market. It was all transdermal. Now we'll see most practitioners will recommend the pill form. And the pill form has to come in a higher dose because it has to go through your first hepatic pass of the liver and go through your digestive system. So you're not left with much progesterone by the time it gets through all of those places. Most of it's gonna be turned into metabolites.
And those metabolites have a different mechanism all on their own. So it's almost like you're getting two different medications when you're swallowing it, because you're getting this abundance of metabolites, which are really great for calming the brain. And that's what acts on those GABA receptors. So women are like, oh my God, I sleep like a baby now, because they're taking this oral progesterone and it really helps calm them down and helps them to sleep really well.
But there is a small percentage of women that actually react negatively to the metabolites and that can be too, it can be too depressive for them. And higher doses of certain progesterone metabolites can get dangerous and they can actually cause inflammation in the breast tissue. Now there's only a very small amount of research on that, but it is there.
Uh, so you don't want to do really high doses, anything over 200 milligrams to me is too high of a dose of oral progesterone. Um, so if you've tried a real progesterone and you felt like you got the blues from it, you're moody, you're depressed, weepy, then that's a sign that you don't do well with those, that high amount of metabolites. And you'd be a bit, it'd be better option for you to either do suppository with progesterone or a cream because you don't produce so many metabolites when you go.
Kim (38:35.163)
Do you have as much protection for the uterus with the suppository or the cream compared to the oral?
Karen Martel (38:41.75)
These seem to all be the same. So that's what they worried about was that progesterone cream isn't going to protect the uterine lining because they didn't see the levels come up but there's research that shows that it's very protective of the uterine lining and stops that uterine growth. Personally, I've been on progesterone cream for, oh my gosh, over 10 years probably now.
Kim (39:00.071)
Cut it.
Kim (39:08.68)
Mm-hmm.
Karen Martel (39:09.882)
I don't do well with oral progesterone and I've been on estrogen therapy since I was 42 and I'm 47 so for five years and I by no means have any estrogen dominance at all or out of controlled growth. So I know that the progesterone cream is working and I have many, many clients that have to do progesterone cream or suppository and they do great with it.
Kim (39:22.409)
Mm-hmm.
Kim (39:33.111)
Is there bioidentical Health Canada or FDA approved progesterone cream or suppositories? No. So you need to go to the compounding. So we won't go into the compounding. I'll direct you to...
Karen Martel (39:40.31)
Nope.
Kim (39:48.187)
My friend Anne-Marie McQueen has a podcast called Hot Flash Inc. and she did an amazing episode about compounding pharmacies that I would direct to you all added into the show notes below. OK, so that would need to be through a compounding if you need to do a suppository. So that would be a vaginal suppository.
Karen Martel (40:06.134)
Yep, yep. And that can be great. Yeah, if you've got fibroids, if you've got that, you know, you've got uncontrolled growth down there where you're heavily bleeding, or maybe you're on HRT and you're in menopause, but you're getting breakthrough bleeding, then you can do a progesterone suppository and that can really, really help protect that uterus. Like it goes right there, and that can be really, really helpful. You can also find progesterone cream.
Kim (40:06.875)
Yeah, vaginal spondyloid or a cream.
Kim (40:25.783)
Uh huh.
Karen Martel (40:33.45)
over the counter in a lot of places. So I'm actually just coming out with my own line of creams. So I'm going to have a progesterone cream, estradiol, and a biased all over the counter that you can buy in the United States. Very clean creams, but you can find those. So I actually order mine from the company that's going to help produce my creams. And so I order it out of the states from Amazon.
Kim (40:34.704)
Mm-hmm.
Kim (40:39.587)
Cool.
Kim (40:46.939)
Mm-hmm.
Karen Martel (41:00.242)
And because it actually ends up being cheaper than going and getting a prescription through a compounding pharmacy. So is in its and I like their creams because it has no parabens in it. It's got no synthetic perfumes. It's got no crap in it. And the pharmaceutical brands, they don't typically worry about that kind of stuff. Some of them do compounding pharmacies. You can actually get a little bit more specific and say like, Hey, can you make it in oil or coconut or whatever? There's different options. But
Kim (41:06.158)
Interesting.
Karen Martel (41:29.674)
For now, I've just, for the last couple of years, I've just ordered mine online and it actually has shipped to Canada. And it's.
Kim (41:35.079)
So how can you do that without a prescription?
Karen Martel (41:38.142)
So in the United States, it's legal to have to sell them over the counter. And, but they just have to be marketed as a cosmetic cream. So you can't say like, Oh, we're replacing your hormones and we're going to help you with XYZ. It has to be like they're called performance creams or cosmetic creams, um, that are good for your skin or whatever. Right. So.
Kim (41:43.756)
Okay, interesting.
Kim (41:49.627)
Got it. Okay.
Yeah, yeah, yeah.
Kim (41:59.389)
Got it.
Kim (42:02.759)
So that's another question. I know we're, again, we're gonna run out of time here, but there's been a lot of people, I've seen now companies that have estrogen creams for under the eyes, for the backs of the hands, and for wrinkles. So is that technically what this would be then?
Karen Martel (42:19.55)
Exactly. Yeah, that's how it would be marketed right as a cosmetic cream. Um, I have always promoted using bias and progesterone on your face because the research has shown it to be so great for collagen production and drinking pores and, and it is I've used it for years on my face and I love it. Um, face and neck, um, every day. And I think it's really helped my skin. So.
Kim (42:22.526)
Okay. Got it.
Kim (42:46.095)
So would you then, like if say, so in Canada I'm getting the prescribed estrogen and I am using the prometrium, oh I have another question on that, sorry, and then I see this skincare company that has estrogen creams, am I not, like, am I going to get to the point where I have too much estrogen?
Karen Martel (43:09.218)
You could, the amount though that you end up putting on your face is very minimal, right? Like when you think about how much, so to get a full dose, let's say for your body of this estrogen cream, over-the-counter estrogen cream, you would do, you know, this great big pump of cream that you would have to like really rub in on your arms and maybe on your breasts or on your inner thighs and it would go quite a few places. Rather for your face,
You use this little tiny little like pea size amount on your hand and rub it onto your face and it just in the research it has actually not has been shown to not raise levels systemically.
So I'm about to go do blood work tomorrow. So I have been using this facial cream that's got estrogen and progesterone in it, estriol, estradiol, and progesterone. So I don't use estriol anywhere else. And so it'll be interesting to see what my levels are.
Kim (44:14.035)
Interesting. Okay, before we wrap up, I have one more question that you brought up that I hadn't, I hadn't really considered until I started hearing a lot more people talk about, which is cycling progesterone. So many people are on estrogen every day, maybe testosterone every day and progesterone every day. But in our cycle, when we were cycling, we wouldn't have had progesterone every single day. There would have been dips and.
Karen Martel (44:17.139)
Mm-hmm.
Kim (44:42.447)
But there would have been with estrogen as well too. But anyway, so why should we, or shouldn't we, cycle our progesterone?
Karen Martel (44:51.878)
Yeah, so great question. Once again, a lot of controversy actually over this one, because most will just say, Oh yeah, take progesterone every single day. What we've seen in practice, a lot of doctors is down the road, women will complain that they don't they're not getting that the same effects from their hormones that they did in the beginning. There are body does everything for reason.
And if we could actually mimic how our hormones go up and down in menopause, that would probably be best. But that is really, really hard to duplicate. So we should try to get as close as we can get to what Mother Nature does because she does everything for a reason. In the first half of our cycle, we only mainly produce estradiol and testosterone.
And on day 12, we have an estrogen spike, and that spike helps to upregulate progesterone receptors. So it's like it's preparing your body for that progesterone that's about to come in. So that happens, progesterone comes in, and then progesterone helps to upregulate the estrogen receptors. And so that once again, this beautiful yin and yang to each other, they really need each other. So what starts to happen when you start,
if you are on hormone replacement therapy and you're using that progesterone every single day, it can actually start to lower estrogen. It starts to suppress it. And it's actually one of the ways if somebody truly has too much estrogen, I'll say to them, use progesterone every single day for three months, and you'll watch that estrogen come right down. So when you're on this hormone replacement therapy for a while and it can work for a long time, year, you know, two years for some,
Kim (46:39.942)
Interesting.
Karen Martel (46:47.542)
But what can happen is that you start to take, you start to lower that estrogen, your body's not gonna get it anymore. And if your estrogen's lowering, you're not getting that estrogen, what's up regulating the progesterone receptors? So then eventually you actually don't get the progesterone that you're using either. So you start to not get the effects of those hormones. And so we want to, if possible, have that break from progesterone to let estrogen do its thing.
how, and I'll even triple my dose of estrogen on day 12 to mimic what my cycle used to do, to up-regulate those progesterone receptors. And it also helps with creating an enzyme called the P53 enzyme, which is a tumor suppressing enzyme. This is another reason why your body's just so freaking smart. So if you're using progesterone every single day, you're not going to get this. You're not going to get that tumor suppressing.
enzyme, you're not going to get the progesterone receptors to be healthy, have that beautiful back and forth. The problem is it can create a bleed if you cycle your progesterone. So a lot of women are like, no freaking way. We just had this big discussion in my group coaching call the other day where these women were like, I don't want to bleed. And I'm like, I get it. But it's actually a healthy bleed. And it is
Kim (47:56.027)
That's what I was just gonna ask. Yeah, I was just gonna ask.
Karen Martel (48:13.002)
like you are getting rid of dead cells and dead tissue when you bleed and so, and it's not like a period. It's not like it was when you were fertile. It's a very light amount of bleeding, but to get the, you wanna get your estradiol up to those protective levels. And when you do that and you're cycling the progesterone, you do have a bit of growth in the uterine lining that needs to be shed. And so it's very natural and normal.
and it can be really healthy for your hormone receptors and to get the most out of your hormone therapy. Now that all said, there are millions of women doing bias, doing it every single day with their progesterone and their testosterone, and they're doing amazing and they're thriving. And they're, you know, so everybody's different. I know some women that have to do really high doses and they have to cycle their hormones like.
really cycle them up and down every day. You're using different amounts to try and mimic your cycle, your natural fertile cycle. And that's where they feel their best is on that. And so each of us is going to need something different. If you don't want to bleed, then yeah, you would maybe take progesterone then every single day and hope for the best.
Kim (49:25.639)
Got it. Cool. You are a wealth of knowledge and I really literally could talk to you all day. So thank you so much. And thank you for the second round so we could have a two-part episode here. And I know we said this after the first, but let's say it again here in case this is the first episode that somebody's listening to. Where can people find you if they would like to learn more and also be able to work with you?
Karen Martel (49:32.238)
Any time.
Karen Martel (49:38.188)
course.
Karen Martel (49:48.53)
Yeah, so karenmartell.com, I'm Karen Martell, hormones on all the social media channels. And my podcast is the Hormone Solution Podcast where that's where you'll find the most information, of course, is on there.
Kim (50:01.583)
Yeah, yeah, absolutely one of my favorite podcasts. So thank you for all the amazing work you do. Thank you so much for your time today and for sharing your wisdom. And I'll have everything linked in the show notes below.
Karen Martel (50:04.162)
Thank you, I appreciate it.
Karen Martel (50:13.014)
Awesome, thanks for having me.
