Episode 28: Reading Labs for HRT with Touseef

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more.

Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone, and welcome to the doctor Sophia ObGyn podcast. I'm so excited to share with you today we are going to be going over to s

Touseef Mirza:
Hello.

Dr. Sophia:
Well, of course, Touseef Mirza, she's my friend and co-host extraordinaire, but we got to talk to her today about her menopause journey, let's get started.

Touseef Mirza:
Yes. So, yes, we're going to continue the conversation that we started

Dr. Sophia:
-In episode 12.

Touseef Mirza:
Episode 12 was where I divulged that I am 52 and that I have officially started my menopause journey. So just a month ago, I basically have had over one year without a period, which basically technically means that I am in menopause. Menopause. So with that I have had some symptoms and what we decided to do since also Dr. Sophia is not just a really good friend of mine, but she's also my obgyn. So she knows me very well inside it out, no pun intended. We thought it would be good instead of me just going through the motions of getting some tests done to understand where I am at in terms of different aspects of menopause, is to actually also share everything with you.

So episode 12 is where I'm asking actually all the questions related to menopause symptoms and if HRT or hormone replacement therapy could be good for myself? Now we are at the second installment of this series, which is where we look actually at the labs because I did get tested. So we're gonna go through some of the key points to consider as I continue on my journey and to see if HRT is something I wanna consider.

Dr. Sophia:
I think the beauty of this episode is the fact that we're gonna talk as if we were in my office. I'm talking to you from the doctor patient perspective, and I think this is gonna help a lot of women to understand, Hey, what are some of the questions or some of the things a doctor may talk to me about if I bring up that I may be feeling symptoms or curious about what's happening in my menopause or what my menopause status is. So let's get right into it.

Touseef Mirza:
Yes. So I'm also going to be asking questions that I would just normally ask because I wanna know as much as possible about my body.

Dr. Sophia:
Why don't we start with what were some of, what are some of your symptoms? What are some of the things or the changes that you have noticed over this last year, let's say as we've entered into full menopause?

Touseef Mirza:
So I would say brain fog would be one, and it's not something that is constant. I am a pretty sharp thinker. I am wide awake. I don't even need coffee in the morning. Like I just like to wake up and I'm sharp. But what I've noticed over the past year and it comes and goes, but all of a sudden I just feel more drained and I just feel more tired. It's sometimes just a little bit harder for me to concentrate and then it goes away. Like right now I feel like normal Touseef.

Sometimes, it just requires me to slow down or just say, okay, this is not working right now. In terms of the typical symptoms that people talk about, like menopause, hot flashes, flashes, I wouldn't say that's a huge issue for me. I think sometimes all of a sudden I'll get hot and a little warm, but it's, I don't get, like ridiculous sweating and losing my mind.

Dr. Sophia:
What about insomnia? Is that a problem for you?

Touseef Mirza:
Very rarely. Knock on wood, I'm a very deep sleeper and sometimes, I don't know, maybe once every two months I might have trouble, but I actually have been, I sleep very well. I sleep like seven, six to eight hours every night and I'm good. I think that one of the reasons why I'm sharp is because I have good sleep. That's one. The quality of my sleep is good.

Dr. Sophia:
That's really fantastic. Well, there's so many other symptoms that are associated with menopause and I'm glad to hear that. You know, your only really major one seems to be the mental fog, but a lot of women experience things like low libido, sexual dysfunction problems. Definitely changes in their skin. You know, things feel more dry. They may be experiencing more bloating or changes in their way that they digest food. They may have fatigue for sure is one of the things that can become more prominent or prevalent as a symptom during the menopause years. Mood disorders, things that change the way you feel. Like irritability or feeling just more emotional and things like that. So to be fair, so happy you're not feeling all those things.

Touseef Mirza:
Right. Well, I would say that I, I wouldn't say I am necessarily overweight, but usually in the past when I want to lose a few pounds, like usually in the winter I always gain a few and then I lose them. That has been much more difficult.

Dr. Sophia:
Well then, honey, it's your menopause.

Touseef Mirza:
That has been more of a, why isn't it going away now? Like, what is happening over there? Also, another thing that I started to do, just because I recognize that being a 52-year-old and menopausal, this whole aspect of a muscle loss and osteoporosis. I just started to weight train. Since a year that has helped, I believe much more in terms not necessarily my weight. I think my posture is much better, but it has helped, I would say maybe the fatigue or the mood.

Dr. Sophia:
Were you also experiencing any joint pain? Because that's also another thing that can happen during menopause?

Touseef Mirza:
Yes. I had joint pain. So that's interesting because I don't necessarily, I don't know if a lot of people associate joint pain with menopause, but that is true. I did have more joint pain and now I also just feel like my muscle infrastructure is holding my body like literally holding my skeleton up and everything in a much stronger way than before.

Dr. Sophia:
That's from just your workouts and stuff like that? Like having implemented that to really kind of counteract some of the things. Symptoms and things like that that could be associated. Yeah, I think that's great.

Touseef Mirza:
I am a full disclosure, I wanna live life to the fullest, so if there's anything that I can do to make my body feel better, you might say, well, you don't have that much, that many issues. Why didn't you even get tested? I'm like, well, I wanna be, the highest at-

Dr. Sophia:
-The top of your game.

Touseef Mirza:
All the time. So if that is done through lifestyle changes and if it is treatment in a way that is going to support my body that doesn't have a lot of side effects, and also by considering my history, I am totally into considering all the options.

Dr. Sophia:
Love that. Then you told us in the last episode that we did together that you had some family history or issues that you were concerned about.

Touseef Mirza:
Yes. My dad unfortunately passed away from Alzheimer's two years ago. He is the only person in the family that has had a mental illness. So that's one thing. In the family there is a lot of cardiovascular disease. There's not really cancer, but there are cardiovascular issues. A lot of people in the family have passed away from
heart attacks.

Dr. Sophia:
Well you know what, this is all great information and so let's dive into your labs.

So in front of me, I'm taking a look at a couple of things. There's just a few basic or baseline blood work that I like to do when I am thinking about the approach for a woman who is experiencing symptoms in perimenopause or menopause. I wanna make sure they don't have things like anemia, for example, that could be contributing to, let's say, feelings of fatigue or even changes in their mood and just mental fog and that kind of thing. So I'm looking at something called ACBC, which is gonna check to see what your blood count is, and it can help me also to direct me and see if you have any things like anemia, maybe from iron deficiency or a B12 deficiency, or even some other like, genetic components that may be contributing to things like anemia. So that's one thing I would like to know.

In your case, you're doing great. You're not anemic. I think you said in your family you do have thalassemia minor, which may look like an iron deficiency anemia or just iron deficiency, I should say. Not necessarily anemia because you don't have that, which is great. So other things that I would look at are like your thyroid function, for example. The reason why is because the thyroid is one of those hormones that's kind of working in the background. It helps your body to have all of your hormone functions working optimally. If your thyroid is working well, it helps everything else to work well.

Touseef Mirza:
When we say everything else, are we just talking from a hormonal standpoint or other functions as well?

Dr. Sophia:
All of your body's functions. We think about thyroid, we think about metabolism. When we think about thyroid, we think about your brain actually in terms of focus. We also think about things like your hair and your skin. We think about heat and cold regulation. We think about joints. So, like the thyroid really works with a lot of different things and affects a lot of different parts of your body. so even things like your blood pressure can be related to your thyroid. So we like to see that your thyroid is functioning and just functioning well.

Touseef Mirza:
And where's the thyroid located?

Dr. Sophia:
It's that little gland that's around your neck. We think of thyroid. Oftentimes it, it's just if you're low, if your thyroid hormone is low and you're experiencing weight gain or, or changes in your weight that make it hard for you to like lose weight, et cetera. But you can also be what we call hyperthyroid, which, oftentimes those people are on the opposite side of the spectrum, but can also have things like anxiety and panic attacks and other things. You know, like I said, it affects the brain and it can affect mood. So that's why it's important to make sure that your thyroid is also in balance.

Touseef Mirza:
It's amazing that a small gland like that has so much power.

Dr. Sophia:
In so many different ways. It definitely packs a punch. Then I'm gonna look at things. I just wanna make sure that your basic things, your kidney function is normal, that your liver function is normal. One of the reasons why your liver function is so important when we are looking at menopause is because sometimes when we think about some of the treatments, for example, hormone replacement is typically metabolized in the liver. You know, a lot of your hormones are the ones we would really consider estrogen. So someone who has sluggish liver or something maybe called fatty liver, may affect how your hormone replacement is administered.

Touseef Mirza:
You mean orally versus another way?

Dr. Sophia:
Yeah, for example, is it gonna be an oral version? Is it gonna be something called transdermal? Like on the skin more through the skin absorption?

Touseef Mirza:
So for example, if you would have some liver issues, then the skin would be better?

Dr. Sophia:
So we wouldn't give, for someone who does have a liver issue, then the likelihood of giving them an oral version of hormone replacement is very unlikely. You know, these are some of the baseline things that it's important to understand when someone comes in and says, Hey, I think I'm in menopause. Can you help me? Are there labs that I need to check? Then, of course we move on to things like the actual hormones that really signify you being in menopause. It's interesting, we say labs and we talk about perimenopause a lot as well, but the biggest difference between perimenopause and menopause is the consistency of your labs. So in menopause you have basically a consistent level of, let's say something called FSH or a follicular stimulating hormone is consistently high. At a level that's above, let's say 25, and your estrogen levels are on the lower side, and in some women completely absent, very low or, or like on the floor.

Touseef Mirza:
So this is after menopause or-?

Dr. Sophia:
This is after menopause. This is after you've gone through that full 12 months of no period, and you know, you're starting to experience, or not just starting to, but consistently experiencing certain symptoms of menopause. One of the ones that is the most common oftentimes people think of right, is the hot flash. That's usually because of the changes. The drop in estrogen levels actually pretty specifically is one of the bigger ones that contributes to the hot flash. In your case, your estrogen levels are a little bit low, but they're not so low that it's not surprising to me actually that you're not experiencing dramatic hot flashes because yours is not on the floor. For example, with estrogen levels, in your case between 20 and 30, then I'm, like I said, not surprised that you're not experiencing some of the estrogen related symptoms such as hot flashes or even vaginal dryness. You know, as a key symptom for you. Then again, like I said, looking at the FSH, the estrogen or estradiol is what tells me that-

Touseef Mirza:
Estradiol is?

Dr. Sophia:
A medical term for estrogen. That's how we're gonna look it up right there. Actually in the body, there are several different forms of estrogens in the body. But the one that is gonna affect you, when we are thinking about it from a menopause standpoint, I like to look at the estradiol level. Moving on from there, I would look at your testosterone as well. People are gonna be like, well, why would you look at testosterone? Isn't that the man hormone or the male hormone? Well, for some women, and for actually for all women, we are all, we all have testosterone. It is secreted both by your adrenal glands as well as by your ovaries. So like estrogen that goes down during menopause, testosterone also goes down. So why is it important? Testosterone is a hormone in women that gives us a sense of vitality. It, also helps give us a sense of like libido and sexual desire. It also plays a role in our bone health. It plays a role in our brain health. It helps with our mood, gives us a feeling of being even keeled like estrogen. So they actually participate in a very compensatory way together in terms of how they affect women.

Touseef Mirza:
So the the testosterone, the reason why that is lowered is because the amount that used to be-

Dr. Sophia:
-Secreted by ovaries-

Touseef Mirza:
-Ovaries are not occurring anymore?

Dr. Sophia:
Exactly.

Touseef Mirza:
And is that the same thing for estrogen?

Dr. Sophia:
Yes, exactly. Those hormones are coming from your ovaries and your ovarian function is becoming diminished. Over time and then until it completely stops, basically. So although when you go through menopause, your ovaries, like I said, everything is starting to go down until it gets to the point where it's on the floor completely.

Touseef Mirza:
Okay.

Dr. Sophia:
Basically, but in your case, your testosterone is, I would say low, right? But not on the floor. So I'm again not super surprised that you're not saying to me I can't exercise or my exercise is so difficult for me, or, because it, like I said, it's like the vitality kind of hormone. You're also not saying things like, I have zero desire for sex, or I have. You know, all these like vaginal symptoms, for example though, vaginal symptoms, like in terms of dryness, we usually think of as an estrogen issue. But there are other vaginal symptoms that can actually be linked also to testosterone. So for example, leaking, or having, what is, what do you mean by when I say leaking? Like leaking a little bit of urine, for example.

Touseef Mirza:
Like when you laugh,

Dr. Sophia:
You laugh or something like that. Like though we think about that as just stress urinary incontinence, it's also a weakening of the muscle tissue that's around the bladder. When women have really low, low testosterones, I find in my patient population that that is also one of the symptoms that they may have. You know, there's just such a gamut of things that we can look for and check , that are going to really affect how we think about treatment and treatment options. Lastly, a couple of vitamins. We're gonna look at your B12 levels. We're gonna look at your vitamin D levels, and in your case, your B12 level was great. Why is that important? B12 works on your brain, B12 works in terms of your energy. B12 helps so that you don't have what we call anemia that's related to B12 deficiency. So having a good B12 level tells me that you are less likely to have the fatigue and the things that are associated with that form of anemia. Why is that important? I wanna, again, make sure that there are not just baseline core things that can be causing some of the same symptoms as menopause.

Touseef Mirza:
So the vitamin B12 is not necessarily linked to menopause,

Dr. Sophia:
Right?

Touseef Mirza:
It's just you're checking to see if that affects how I'm feeling?

Dr. Sophia:
Exactly.

Touseef Mirza:
So that could be the same thing even before menopause.

Dr. Sophia:
Exactly. So let's say before, menopause ,and you came to me and you're like, oh, Dr. Sophia, I just feel so fatigued and tired all the time. Well, I would like to make sure that you're not anemic and I'd like to make sure that that anemia is not related to B12. so this is where you hear some people say, I need B12 shots. You know, because they're so low or you know, they're not getting enough of BB 12 from their food or they need to have other supplements. Then lastly, vitamin D, I mean, a major impact of menopause is on the bones and the concept of osteoporosis and osteoporosis prevention. Vitamin D plays a vital role in so many things in our bodies. Every day we're learning something else about why vitamin D is important and why it's important not to have vitamin D deficiency. so vitamin D works on the brain, it works on the bones, it works in terms of cardiovascular health, it works in terms of immune health. So, unfortunately, your vitamin D is on the floor

Touseef Mirza:
And I'm so upset about that because I do take a supplement. Okay. I'm not gonna tell what I take on air, but I guess maybe I'm not taking the right matrix, or maybe I'm not, because I know vitamin D, you have to take it with other substances for it to work the most effectively.

Dr. Sophia:
Well, for you to have the best absorption of it. We like to see vitamin D and when we're talking about here's like a D three and that it's absorbed with a vitamin K together only because vitamin K two is going to help with the absorption of that vitamin D.. You know, it kind of works to link it together and then helps your body to absorb it.

Touseef Mirza:
Are you supposed to also have it with a matrix like with calcium and magnesium?

Dr. Sophia:
Yes. Calcium and magnesium are equally important when it comes to your vitamin D absorption. You know, so you wanna think about it, it's like a little cocktail, right? That we come up with. What are some of the things that are going to just help your body work at its best? in menopause, we wanna get all these other things working super well so that we can stay focused on, let's say, whether it's your hormones, whether it's lifestyle changes that we have to really work harder at, or nutrition and diet, in order to kind of make everything work really well so that you can continue to feel that vital to Seth. . You know, one thing for me and, and why I like the fact that we're having this conversation is because hormone replacement in and of itself is not the end all be all or the answer to everything.

Dr. Sophia:
However, because these hormones are so important, estrogen, testosterone, thyroid in terms of functionality, your brain prevents cardiovascular diseases, your prevention of things like dementia , which I know you're concerned about, just to kind of mitigate some of these risks. So for some people, hormone replacement might just be a way to literally be anti-aging, literally prolonged life because you have decreased your chances of having things like a heart attack, breast cancer, colon cancer, osteoporosis. There's just such a long list of why maintaining a level of balance in terms of hormone health can help with prevention of disease.

Touseef Mirza:
So when we say prevention of disease, we're basically saying that we're not necessarily eliminating it, we're potentially pushing that further out, further out it. So instead of we're just gonna make a number up, I'm just gonna make a number up instead of if I am predisposed to dementia, for example, instead of, at 65, I could potentially push it to 80 because I've continued to remain in a healthy balance hormonal state, which I was already in before menopause perimenopause. That's correct. There's nothing new with this. It's not like all of a sudden we're coming up with a whole new way of looking at hormones. That's the way I've always been. Right. We're just bringing that to the level that is what the body was designed for in the first place, which I was there before.

Dr. Sophia:
Yeah. All we're trying to do is keep you up to a certain level that's gonna still maintain those preventative measures. listen, truth be told , some people just with their diet and their exercise routine are able to help their own bodies maintain a certain level. But remember your ovaries, no matter what, are still gonna be on the decline. Okay. That no matter how much you exercise, no matter how much you exercise, no matter how much you eat. Right? Okay. Let's just, let's just be clear. Okay. No matter how much you exercise, no matter how much you eat, right, your hormones, estrogen levels are still gonna go down. Okay. But we can still, like in your case, your estrogen levels are still relatively at a level at , like between 20 and 30, you're not experiencing hot flashes, but you may notice little skin changes, for example. You may notice some changes with your hair, for example, you may notice other smaller, similar subtle tees. No one ever said anything to you about it. You would be like, oh, I don't, I , it's not a big deal,and you wouldn't necessarily be able to trace it back to some of these hormone changes.

Touseef Mirza:
I think that preemptively I've started to use like, like lotion that is more moisturizing and more natural. Even the way that I deal with it, my hair is fabulous, by the way.

Dr. Sophia:
Yeah. You always have fabulous hair.

Touseef Mirza:
I've always had fabulous hair. If anybody's watching me right now, like I have fabulous hair I've always had, and I think my hair is even better than last year. I, and that, I don't know why, because I did lose some hair. It all came back. mind you, I do have an amazing shake that I take every day that is like flax seed, chia seeds. I put maca maca is very good for menopause and hot flashes for sure. I put, did I say chia seeds, flax seeds, hemp seeds. I put in pea protein, vitamin B12, and zinc. So look

Dr. Sophia:
At you with the supplement cocktail. I love it. Yes.

Touseef Mirza:
So I was just like, no, we're gonna live a fabulous life. so anything that I can do preemptively to continue that. So that's been part of the regimen. One of the things I wanted to ask you, considering that I have been working out since the past a year, so I basically go to the gym between two to four times a week, and I'm just doing heavy weights with low reps. How would you say that? That's, because we talk about lifestyle a lot, but we are sometimes we don't necessarily make the link in terms of how that's actually affecting my biology

Dr. Sophia:
From a hormonal standpoint. So the way, I'll tell you from a hormonal standpoint, adding that little bit of stress to the muscle, it's more than just doing a little aerobics or something like that. Or going for just a run. Don't get me wrong, that's super important. That type of exercise can also be very healthy in terms of brain health. The release still of, of dopamine for example, and the other and, and other endorphins. But that heavy lifting adds a little stress to the muscle. That little stress that you're adding to your muscles is also helping in that homeostasis of hormonal balance. That little bit of stress is adding even more in terms of your neurotransmitter dynamics.

Touseef Mirza:
And so it's like activating it.

Dr. Sophia:
It's activating it. That's a great way to put it or a great word, if it's activating it. So that's why it's so important that we talk about doing things like heavy lifting. Heavy lifting is adding that little bit of stress and counteracting things like bone loss and muscle loss that you're gonna have and experience during the
menopause time. so that's a part of why it's so important that we add the weights.

Touseef Mirza:
One of the reasons why I've understood how to work out the way that I'm working out is actually through this amazing woman, her name is Stacy Sims, and she did all this different research on what is the best way for perimenopausal and menopausal and menopausal woman to train for longevity. So this is not about, bikini mini. That's correct. I'm not about bikini mini I'm about like, I wanna have a strong flexible, long-term full-of-vitality body. That's what I want.

Dr. Sophia:
And that's what you're gonna have with your resistance training. With your weight. Your weightlifting type training. Yeah. We have to remember that the way that the body actually changes in terms of muscle mass and fat distribution during menopause. So that's another reason why adding in the weights helps to counteract some of the way that the muscle and the fat distribution is also happening and changing in your body.

Touseef Mirza:
And so would you say, or if you can't really make that conclusion that because of this lifestyle

Dr. Sophia:
Way that you live

Touseef Mirza:
The way I live, so let's just pinpoint it to weightlifting and your supplements? My supplements and high protein. Yes. That might be one of the reasons why the estrogen is not completely zero? Or is that not necessarily interrelated?

Dr. Sophia:
That's not necessarily interrelated, but what I will say is, is that your estrogen levels can still remain at a certain, it is, it's like stepwise kind of going down. honestly, women are still secreting some level of estrogen even up to age 65. So we're way past quote unquote menopause. We still can still be secreting even just a little bit of estrogen or the estradiol that really affects our bodies and our bones and our brains and, and things of that nature. so it's not like, oh, I went through 12 months of no period. Now my estrogen is zero. That's, I mean, yes, of course that can happen, but every woman is a little different. . We're all a little bit different in terms of how we go through this transition. For some people it's a lot more rapid. For some people it's a lot more, it's insidious and slow. For some people it's a constant roller coaster up and down, up and down, up and down as it's going down. Unfortunately, it's a little bit different for everyone. it's a matter of where we catch you in it. also we can never take away the fact that what are the symptoms you are experiencing while going through it? And we can try our best to address the symptoms in a way that is gonna make you more functional.

Touseef Mirza:
So now that we went through the different aspects of my labs and considering my symptoms which are pretty minor, a little bit of brain fog, a little bit of hot flashes here, and there are a little bit of trouble with weight loss. Considering my long-term goals, considering my history of obviously not wanting dementia and my mom's side, my mom's and dad's side. From a cardiovascular perspective, what would be the recommendation or if any, in terms of moving forward from a hormonal perspective?

Dr. Sophia:
From a hormone perspective? I think someone with some symptoms but not overbearing. I think that you could certainly benefit from a little bit of estrogen in perhaps an estradiol patch, for example. Then whenever we're giving a woman estrogen, we always consider and think about her uterus. Like for someone like you who still has one and just balancing the effects of estrogen on the uterus. So that would be balanced with progesterone. Progesterone also plays its own role. It helps women with sleep. I know that sleep is not necessarily your concern or main problem, but it can help women with sleep, for example. But aside from that, it's also gonna just balance out estrogen and progesterone in terms of the effects of estrogen on the uterus and progesterone just basically protecting the uterus because that's what it's doing naturally. That's what it is, that's what's going on in your body, you know?

Your estrogen is being secreted and your progesterone is being secreted and it helps to just protect that
inner lining of your uterus. so we would just mimic that same concert of hormone balance. So that's kind of where I see it for you. I think that the estrogen will help balance out some of that mental brain foggy kind of feeling that you're having. If you just wanted to do something maybe without estrogen, I would consider even testosterone as a supplement for you. It helps with, you are already on a great journey in terms of muscle building and you may even see a little bit quicker response by adding testosterone to your regimen, as well as, again, with the brain fog, it helps to help you feel more focused and clear. So, testosterone does more than just libido. It's more than just a quote unquote sex hormone when we think about it for women. You know, it does so much more and it's still gonna be heart protective. It's still gonna be brain protective
like estrogen.

Touseef Mirza:
I think it's key to understand when we talk about menopause, we usually have a tendency to just think about estrogen. But to understand that all the three estrogen progestin and testosterone actually are a trio that work together in concert, which is not something we talk about as much.

Dr. Sophia:
I agree. We don't talk about it as much, and especially in like obgyn training and as an obgyn, I mean, I had to really look outside of just my training from residency to feel comfortable with the idea of how to help women in menopause and what is really happening. I do think that it does require a lot of out of the box thinking, because if we're only looking at what the FDA is saying, for example, I mean even the concept of, of knowing that testosterone can help women who have let's say hypo sexual desire disorder. We still don't even have a quote unquote FDA approved method of giving women testosterone that is for that. So if we're only looking at these major institutions to help guide us, then we may fall short. Luckily, there are a lot of other very smart and out of the box thinkers who have done this kind of research and seen really the differences that can be made in terms of women's health and how women respond and what works and what's gonna just help women have longer, more fulfilling, happier lives.

And then of course we, I don't even wanna go back on this, but that study, almost 20 years, more than 20 years ago at this point the Women's Health Initiative really thought, had good intentions, really had changed the game in terms of taking away the concept of hormone replacement. then it, not only did it take it away in a practical way for women, but it also kind of led us down because we weren't doing as much, even just studies, even in terms of really looking at, it took several years to start to debunk some of the things that were so wrong with the Women's health initiative. It's really, I feel like even just in recent years that we've kind of gone back to understanding, hey, women really do still need their hormones or the way that the hormones act in women's bodies is still beneficial for them.

Touseef Mirza:
So I just wanna come back. So this is basically the study before that hormone replacement therapy was used much more common, much more common. Then this study came, and then this is why there's so much stigma around like hormone replacement.

Dr. Sophia:
I mean, like, it's huge, they basically said that hormone replacement is going to lead to breast cancer, hormone replacement is going to lead to blood clots, hormone replacement is going to lead to things that honestly are just not true.

Touseef Mirza:
It's just not true because of the patient population.

Dr. Sophia:
The population that they studied, that they studied, studied and how they studied it. You know, like me, I'm not gonna go into all the details. But it just wasn't the best way to produce a study like this. Right. For us to get the answers that we were seeking. And the reality was that at the time, they saw that hormone replacement was helping women in all these different ways. So they wanted to say, oh, okay, great. We should just throw it at everybody because we're gonna prevent all of these diseases. The problem was that they did it in women who were way past their menopause was the average age of women like in their sixties, as opposed to just kind of keeping you coasting. Right? So when you're in that perimenopause and early menopause phase,

Touseef Mirza:
Like I am right now,

Dr. Sophia:
Like you are right now, is coasting you through keeping your hormone levels at a level that, I don't know, I, I hate to put numbers out there or you know, don't hold me to this, but making your body stay like 40. Right? Like keeping you at a stage where you were at your best

Touseef Mirza:
In terms of the functionality of my body. Yes. That was it, it was working.

Dr. Sophia:
At the right amount and level.

Touseef Mirza:
Yeah. Also we're not saying that everybody should go on HRT, no. But we're just saying also that the study, we don't-

Dr. Sophia:
-Have to be afraid of it. That we can use it as a treatment regimen, as a part of the plan, the whole therapeutic plan on how we address perimenopause, menopause, the symptoms, and just to make sure that we are listening to women, hearing them and hearing what they're going through and not letting them suffer. We don't have to suffer.

Touseef Mirza:
No. We can be happy.

Dr. Sophia:
We can be happy and we can live long and vital lives, have a long life.

Touseef Mirza:
Yeah. I will say in full transparency, like when I was thinking about this, I had to go through my own mental journey in terms of saying, there's a part of me that says, well, I'm getting older and this is just a normal way of life, and so, why am I getting in the middle of it? This is how my body was supposed to function. Then the more I started to learn about what HRT actually does and the issue of why I've been brainwashed that it's wrong, because of that study, I started saying, oh no, actually it's the same. I understand that each person needs to check also, like what is, what is their medical background, and if that's going to be something that will be appropriate for them. But if it is, why not continue to be at the same level that I was if it's not going to cause any bad effects. So that's, that's where you have to like, take it all in. I think we need to understand menopause in a more holistic way, which is what I hope we're doing here. All of this said, I think, now that you have, thank you Dr. Sophia for giving me a recommendation in terms of what I need to do. So I think moving forward, like that's what I'm going to do. So we will come back on a subsequent visit?

Dr. Sophia:
Visit?

Touseef Mirza:
Yes. Because this is a visit. Yes. I'm gonna charge you and then we'll share, we'll continue sharing my journey and just see , did it make any change? Or how is the administration of the different things that I'm gonna take? And then we'll go from there and hopefully open up that conversation for all of you.

Dr. Sophia:
I think that's a great idea. I think every woman wants to know how Touseef is doing with her menopause journey. Thank you so much for joining us on the Dr. Sophia ObGyn podcast today. We had so much fun and I hope you enjoyed listening.

Touseef Mirza:
Yes. Thank you for listening. You can please check out if you wanna listen to the first installment of this series, which is episode 12: Touseef - Am I going on HRT?

Dr. Sophia:
Have a great day.

Touseef Mirza:
Thank you. Bye

Dr. Sophia:
Bye.

This is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body, embrace yourself.