The Menopause Solution with Dr. Lauren Fitzgerald | Mind Pump 2752

Key Takeaway

The FDA finally removed the black box warning on hormone replacement therapy for women after 20+ years of misinterpretation from the Women's Health Initiative study. The real cancer risk came from synthetic progestins (in birth control), not bioidentical estrogen. This opens the door for women to access protective hormone therapy that can dramatically improve sleep, mood, energy, and body composition.

Episode Overview

Dr. Fitz discusses the recent FDA removal of the black box warning on hormone replacement therapy, explaining how 20+ years of misinterpreted data kept women from beneficial treatments. She covers the differences between bioidentical and synthetic hormones, and details how progesterone, thyroid, testosterone, and DHEA can transform women's health when properly optimized.

Full Transcript

Transcript of The Menopause Solution with Dr. Lauren Fitzgerald | Mind Pump 2752 from Mind Pump Show. Auto-generated from episode audio; may contain minor errors.

Welcome back to the show, Dr. Fitz. Thank you. It's good to be here. You are a favorite of our fans, listeners. Fan favorite. I wanted to bring something up. I told you a little bit about this off air. Obviously, you know about this, but I just read just read just read that they finally removed the blackbox warning on hormone replacement therapy medications for women. They did. They did. They did. So, let's talk about this for a second. What was the blackbox warning? Why was it there?

Why is it gone? So, the big C word, cancer. Everyone's scared of cancer, right? So, the Women's Health Initiative that came out in 2002, it was first of all, it was misinterpreted and by the time they realized that it had been misinterpreted, it had already gotten out. So, we have a generation of women that basically missed out on hormone replacement therapy because this misinterpretation of this data from the Women's Health Initiative, basically saying that hormones are linked to cancer. And so, estrogen got basically the label of blackbox.

it's going to lead to cancer. So now every woman is scared to death of cancer. And for 20 almost 5 years, no one has been on hormone replacement therapy, even though there's so many benefits and decreasing risk of all of the bad stuff. So the FDA finally was like, "All right, well, we were wrong." Uh because there's so much data that shows that it's actually protective. Um and they finally took it away. Now, am I excited about that? No, cuz I don't trust the FDA myself.

I mean, truly, like I haven't trusted them in a while. So it could this be moving in the right direction for us? Yes. But we're going to have to fight all of these 20 plus years of belief that estrogen leads to cancer. Yeah. What was the misinterpretation? What did the data say that they that that there is an increased risk of breast cancer if you take HRT? So what they didn't realize or they didn't um decipher was the difference because actually in the women's health initiative they used estrogen which it's it's not let's define bioidentical versus non-biioidentical right so bioidentical is what our body makes non-bioidal also known as synthetic doesn't match what the body makes right so all of these women were on synthetics estrogen or non-bio identical but they were also on progesterines and they didn't realize that the actual progesterines are the thing that increase your risk of breast cancer.

So even though I'm not a huge fan of synthetic non-bioidal estrogens, this is not what increases your risk of cancer. It's the progesterines. And the progesterines are in like birth control pills and I mean a lot. I was just going to ask you, it's so crazy that we've we've pushed birth control pills for so long and never said never say anything but then freak out if a woman takes a little bit of testosterone or estrogen. Correct. Correct. I mean, a true informed consent is not given to probably 99% of women that are started on birth control.

I I was not sexually active when I was started on birth control pills. No one told me that, well, if you start taking this, it will increase your risk of cancer, breast cancer specifically, but other types of cancer, increase your risk of clot, increase your risk of autoimmunity, increase your risk of all sorts of bad stuff. They just say this is it. It's going to help your cramps, and that's it. It's a band-aid. Now, progesterines, this isn't taking progesterone. These are uh essentially they're taking progesterone and tweaking it in a way to create a new chemical that prevents pregnancy.

So So let me the way I like to teach it is you think of the word estrogen as an umbrella term but under the umbrella there's non-bioidal and bio identical. So in the progesterrogen world progesterrogen is the umbrella term. You've got bio identical which is progesterone and non-bioidical which are progesterines. So, I think they intentionally try and confuse us because big pharma can't make money off of the n the bio identical. So, they basically take a molecule like progesterone, tweak it just a bit, create a progesterine, and now they can make a whole bunch of money and then they start confusing the people and medical people as well.

Like, I mean, I've been a doctor now for 20 years. I graduated 05 MD since ' 05 and I literally just in the last maybe three or four years truly understood the difference between bio identical and non-bioidal. So they start trying to confuse you from day one and and if you use so they can't make money off of biioidentical because of the way that the I guess the class classification works with how you patent things. things. things. Correct. Correct. Correct. If it's naturally occurring I can't patent it.

patent it. patent it. Correct. Correct. Correct. Okay. So in other words, if I make progesterone as a pharma company and it's naturally occurring or it's identical to naturally occurring, another company could just sell the same thing. But if I tweak it, then I can patent it and now I am protected against competition. Is that the deal? Exactly. Okay. And now some of the tweaks that they put to them can be for like what longer halflife, more of this, more of that. This is what they're trying to create when they make these birth control.

So like let's take progesterines for example. So progesterines, they connect to the progesterone receptor. They actually have a much higher affinity for those receptors. And so they will suppress your body's natural ovulation, but they won't give you all of the benefits. Like let me use a permenopausal woman, right? So a permenopausal woman comes in and she's complaining a lot of the standard permenopausal symptoms. I can't sleep. I want to throat punch my husband for no reason. Like that's a common one. You laugh, but that is a common went to it for number two.

100%. Please, Please, Please, the struggle is real. So, so all of these symptoms that can be described as per menopause come from a initial drop in progesterone. But if you have a woman that's on birth control pills, those progesterins, which don't match what the body makes, are connected to these receptors and you won't get any of the relief. So, this is a common like you come in, you get a birth control pill for your permenopausal symptoms and they don't feel any better. It it makes no sense.

But these progesterines are linked to increased risk of breast cancer, increased risk of clots, increased risk of all sorts of bad stuff. stuff. stuff. Right. Because they don't have the natural checks and balances hormone. Exactly. Exactly. Exactly. You brought up an interesting symptom of of parameopause which punching your husband. I did not know. So let's talk about this guys. This is very I mean this is real. This is very interesting because if you look at the data on divorce rates, there is a spike. Oh yeah.

right about when women start to go through parameopause and menopause. Totally. Totally. Totally. And it's not often talked about and this is this a big hormonal change when suddenly you are what you start to just be more irritable. You hate angry whatever. whatever. whatever. I got to think that's also exacerbated by that's also the timing when your kids are probably getting out of the house and you're now having to reconnect to the man you married for. Well, typically it's in their mid to late 30s, right?

So, most women hit per menopause in their 40s. can start as early as mid30s, but I I've talked to plenty of hormone doctors that have been doing this way longer than I have that elsewhere. Marriages could be saved if both are are hormonally optimized. And women, you know, are we're more menopause, but y'all go through hormonal changes, too. We like andropause. It's not quite as definitive as our menopause, but typically divorces happen in their 40s and 50s. And and if both could just get hormonally optimized, I think a lot of Yeah.

Just imagine, imagine you have I mean, how many times do you see this? We know this with watching friends that have gone through this. Maybe you even experienced it when you start having kids. You tend to divide and conquer. You lose that connection to your wife. That's okay, but we're building this family. Then the kids off and go, and it's like now we have to focus on us. Oh my god, didn't realize how much we didn't like each other. Hormonal issues are going on. It's just like they don't know it, which makes it even more.

more. more. Yeah. Yeah. And then Exactly. And then it's just like I would imagine that has a lot to do with with that statistic. I wanted to go through the different hormones that tend to be involved with hormone replacement therapy and what a woman I know okay so I want to be clear it's typically a combination of things right we don't typically look at hormone replacement therapy is like one correct correct correct okay okay okay but when you add one of these what are the things that that people typically experience let's start with progesterone if a woman is now using progesterone what is that going to what could that do for her in terms of how she feels changes your life I mean truly So unfortunately women that have had a partial hysterctomy, so that means their uterus has been taken out but their ovaries are left.

Those women have traditionally not been offered progesterone because when you start estrogen, if you have unopposed estrogen, you can have indometrial cancer. Well, you just took out the uterus so I don't have to worry about indometrial cancer. So now you have a woman just given estrogen and told, "Well, you don't need progesterone." Well, what about do I not want to protect my breasts and my ovaries and my bones and my brain? And I mean, progesterone has protective benefits for so many things. And the insomnia that hits us at midlife is very real.

Progesterone is the solution for most women that have insomnia. There's this. So you you take your progesterone, it goes through your GI tract, it gets absorbed through the blood, it goes through the liver, first pass metabolite, goes to the brain, and gives you all of the benefits of helping you sleep and with your mood. Interesting. Anti- anxiety 100%. 100%. 100%. Okay. So it's relaxing. So, so people that I know that will take progesterone, they'll take it an hour before bed and then it's like bedtime, they're like ready to get some good sleep.

good sleep. good sleep. So, in my parmenopausal women, I'll let them know the dose of progesterone that is right for you is the one that helps you sleep well, takes away the moodiness. You don't want to randomly throw punch her husband for no reason. Uh, takes away the anxiety. Um, makes your PMS minimal to nothing, and it makes your period minimal to nothing. So, everyone's different. I was just going to ask that. How do you know the right dose? Everyone is different. And does it take time to adjust?

Absolutely. So, in my program, I make patients commit to a full year because I know that it's going to take about a full year to find the doses that make you optimized. you optimized. you optimized. Is that because when you first start taking it, you're more sensitive and so you're like, I got to wait a little bit or is it just figuring it out? No, not necessarily. It I mean, hormones are just slow. And also, I always say hormones are bullets. They're not magic bullets. So if you have a patient that just gets on hormones but is not doing the diet, lifestyle, sleep, exercise, all the things, then there's you're not going to feel optimized.

So it has to be a entire approach. Today's giveaway is the super bundle. If you want to win, leave a comment below this video in the first 24 hours that we drop it. Subscribe to this channel and turn on notifications. If you win, we'll notify you in the comment section. Also, brand new program, MAPS 1540 plus. So, this is the MAPS 40 Plus program, but in the 15-minute a day version, and because it's brand new, it's 50% off. Just go to 1540plus.com. Use the code December50 for the discount.

Here comes the show. On average, I don't know if it's okay for you to say this, but on average, what is a typical progesterone dose look like? And again, it varies everybody. So, what you're about to say could be very different from person. Yeah. So when patients come to us already on some sort of hormone replacement therapy, it's kind of like a cookie cutter. Everyone is just started on 100 milligrams of progesterone and estradiol patch and they're still feeling terrible. So personally, I don't use estradiol in a woman in pmenopause because that's the last hormone for the ovaries to stop making.

And so when you give estradiol to a woman that is still making estradile from her ovaries, she can get the five Bs. So, the five Bs of too much estradile are bleeding, bloating, breast tenderness, blemishes, and bitchiness. and bitchiness. and bitchiness. And literally, when I list all of those and they're like, "Oh my gosh, yes." I'm like, "So, we're going to take you." Yeah. We're going to take Exactly. So, I take my permenopausal women off of that estradiol patch that they're almost always given, and then I minimum start them at 200 milligrams.

But I also I like to go through are they PCOS or not. So if they are permenopausal and PCOS often they need way more progesterone than a woman without PCOS. without PCOS. without PCOS. Okay. And then typically where does the dose of progesterone fall after a year for some women. I mean I have someone that needs as much as 1,200 milligrams. Now that's not average. The average permenopausal woman needs somewhere between two and 400. Okay. So that's on average. Yeah. Okay. So pro progesterone you it calms you down less anxiety.

get good sleep, rest. Are there any aesthetic changes from progesterone or is it more of a feeling hormone? hormone? hormone? So, so there are some that can have a little bit of water retention in the initial 3 to 6 months. Um, but we know that progesterines, not progesterone, but progesterines actually can cause weight gain. So, it's not just water weight, it actually can cause fat gain as well. Progesterone can you can have a little bit of water retention with progesterone. Now, how much does the thyroid play a role in all this?

That's a good question. So, let's start with the next hormone. Let's go with thyroid. What does thyroid do? What do people feel from that? What do they expect from my favorite? So, it's funny because this past weekend I taught um at a hormone course and um Saturday morning I taught on progesterone. Saturday afternoon I taught on thyroid and I'm one that I talk fast and when I listen to lectures I listen to them at 2x. And so, literally the the person that was the the instructor or the person that's over us kept saying like slow down.

And when I got to thyroid, I'm like I I got when I got to thyroid, I'm like I I'm hormonally optimized with thyroid and I think that that's why I talk fast. So it's my favorite hormone and it's the one that it's almost never utilized by hormone replacement doctors that they will they will, you know, prescribe the 100 milligrams of progesterone, the estradile patch, and then send you on your way. Right. Okay. So thyroid is my favorite because um it I've yet to meet a woman at midlife that doesn't have thyroid symptoms.

Right. And what will happen is they'll listen to a doctor like me online and they'll go to their primary care doctor or their OB/GYN and be like, "Hey, you're fine, too." Well, yeah. No, exactly. They'll be like, "I I have a lot of these symptoms. Can you check my thyroid?" And what they do is they ju just test TSH, right? So, TSH stands for thyroid stimulating hormone. So, it's a hormone that our pituitary makes. The way I like to expla explain it, it's like a text message that goes from your brain to your thyroid gland that says, "Hey, make more thyroid hormone." Okay.

So the TSH has been traditionally the only um lab that primary care doctors or gans or endocrinologists will use to tell you if you have thyroid issues or not. That is so interesting that just that that part where the brain's telling you because if you're not upregulating it or you're not absorbing it or your body's not like there could be a whole host of things I would imagine that would change that that that to their defense, right? It can be a pretty strong coralate. In other words, if it's low or high, it can give us some information.

It can give us some information on true hypothyroidism, but there are tons of studies that show that the the level of uh symptoms that a patient has does not correlate with TS. What what else where S where else? What else would we measure like that where the signal from the brain is what we're going to determine if you're at optimal rates? Wouldn't we normally what else? Exactly. else? Exactly. else? Exactly. Everything else we would measure by natural hormone. But but see this is a fun fact and I don't think most medical doctors even know this much less the lay person.

So every kind of doctor so I used to be an anesthesiologist. So I was a member of the ASA the American society of anesthesiologists right so each specialty has their own society and these societies come out with these guidelines every about 7 to 10 years. Okay so these guidelines you would think would be based on the most recent literature and the highest quality of research. Right? So like a randomized control trial, that's like grade A versus grade D, which is just someone's opinion or just a a retrospective look at at the the literature.

So it's not what it is. It's a group of physicians that are, you know, elected, you know, high ups in that society that sit around and decide, well, these are our guidelines. Now, are these people influenced by big pharma? Absolutely. So it is not the most recent data and the best quality data. Right. Wow. Right. Wow. Right. Wow. So when I found that out I was like how is this even legal? Right. Right. But so so the the thyroid society um and endocrinology society they have always said the guidelines are to only measure TSH even though there's tons of high quality research that show that TSH really doesn't correlate to how well the patient feels.

It's the free T3 and that's what's happening inside of the cell. But they say freeT3 is not a good test to to use even though it's 100% better. better. better. Absolutely. Absolutely. So when I look at labs, I'll let patients know like look, if you go to your primary care doctor, they're only going to look at TSH, maybe free T4, but they will not look at freeT3. And this is actually the number that I care about the most because the lower it is, the more likelihood that you're going to say yes to a lot of these low thyroid symptoms.

And so I will list them. There's 10 of them. And I'll be like, I want to know how many of these do you relate with? And they'll be like, oh my gosh, you know, at least half or sometimes it's like all of them, even though they've just been told your thyroid is normal. And what are those symptoms? So, weight gain or difficulty losing weight, cold intolerance, which is pretty much only in females. I've yet to meet a man. I mean, it's rare that men will be like, "Oh, I'm cold all the time." But it's typically a woman thing.

Um, brain fog, difficulty losing or difficulty recalling names, words, or numbers. uh low energy, uh dry skin, brittle nails, constipation, depressed mood, overall lethargy. Oh, and hair loss. loss. loss. So, somebody goes on thyroid, you you put them on thyroid. I'm assuming you're using uh like Armor, which is what? T3, T4. T4. T4. So, that's a brand name of natural desiccated thyroid, right? So, Armor is a brand name. MP thyroid is a brand name. I like to just use a high quality compounded natural descated thyroid.

This is actually what the FDA is trying to take away from us right now. So, we have a year to fight that. Um, because if they take that away, then we will not have a good natural desiccated thyroid hormone to prescribe. Well, we have to use synthetic T3 and synthetic T4. And you'll have to figure out whatever the ratio. the ratio. the ratio. Exactly. Exactly. Exactly. Now, is is thyroid also like is it is it um the way people respond to it individually similar to like with testosterone like for example for a male you know 400 to,00 this huge range.

Some men feel totally fine at 600. Other men feel not good at all and they need to be closer to 1100. So thyroid that's the whole point in in optimized health is I'm going to find the dose that makes all of those symptoms go away. So typically and I'll I'll let them understand like at the beginning of each new patient consult I'll be like look we're going to look at your labs and we're going to talk about how your normal labs are not optimal labs and if you let me take over the management of your hormones you'll find that this time next year all of them will be labeled abnormal and that's typically where people feel their best.

So, like when we're talking about thyroid, I'll let them know, look, your freeT3 will probably be labeled too high between about five and seven. Now, here's the thing. Your primary care, they don't te or they don't check the free T3, but what they will check is your TSH. And your TSH will be suppressed to zero. And I explained, so if you're going to take exogenous, meaning outside of the body, thyroid hormone. It's going to go through the GI tract, get absorbed through the blood, go to that center of the brain, the hypothalamus and the pituitary, and they're going to be like, "Hey, we have enough thyroid hormone." So, we don't need to send that text message to the thyroid gland, TSH, to say, "Make more thyroid." So, of course, it's going to be zero.

Same way with a woman who's on birth control pills. Their LH and FSH are going to be zero because it's being suppressed. We don't care about that. And in actually people that have a history of thyroid cancer, we intentionally suppress the TSH to zero forever. So we know it's safe. And in fact, one of my most recent patients, she's 38, history of thyroid cancer. She's been working with the endocrinologist forever. Just at her three-month appointment, I was able to suppress her TSH to zero. And she was like, I've never felt this great.

And the endocrinologist couldn't even do this. this. this. So they take thyroid uh and you get them in these ranges. They they they don't feel the lethargy. They feel they feel sharper. sharper. sharper. They feel amazing. And I've not I've heard thyroid is being referred to as one of the aesthetic hormones. What also happens with them when they take Oh, your body composition totally changed. Absolutely. So, the underlying root cause of so many problems is insulin resistance, right? So, if you when you think insulin resistance, you need to think about visceral fat, right?

I wish that we could require everyone to get a DEXA scan so that you can see exactly where you're at with visceral fat. Right. fat. Right. fat. Right. Exactly. Because the more visceral fat you have, the more likelihood that you have insulin resistance and all of the hormonal issues that come along with insulin resistance. Right. So if you have a lot of visceral fat and you're metabolically busted, thyroid hormone is going to be key in helping reverse that. Yeah. So people go on thyroid, they get more energy and they get leaner.

Absolutely. Absolutely. Absolutely. I noticed So I take thyroid. I take a little bit of thyroid. I noticed uh Yeah, I do in the morning. I take all I I know. He feels cold. Yeah. No, I I taking the uh I noticed with thyroid it made my other hormone replacement therapy work better. It seemed to have a synergistic effect with the testosterone. the testosterone. the testosterone. Um so which which is quite interesting. So So So when I have male patients I'll I'll let them know like look typically men are one of two stereotypes.

You're either just wanting me to help you with your testosterone or you're going to let me get all of your hormones optimized. And when I say that I think it gives them a sense of like okay I have some control, right? And they'll be like well yeah let's do all of the hormones. So, typically if I have a man that's like, let's do all of them, it's thyroid, testosterone, and DHEA. Yeah. Awesome. Awesome. Okay. So, we talked about progesterone, we talked about thyroid. Uh let's talk about testosterone for women.

Uh what does that look like for women when they start taking testosterone? And is there a wide variance with that as well? well? well? It changes everything. Okay. So, first of all, of all, of all, can I address the word overdose? Yeah. Yeah. Yeah. Okay. Because being a former anesthesiologist anesthesiologist anesthesiologist when I hear overdose death 100%. 100%. 100%. Absolutely. Absolutely. Absolutely. You overdose teddy anesthesia legit. Like I remember my very first day in residency Dr. was teaching me. We had an insulin uh patient or a type 1 diabetic and it was a long case and so we had to give them insulin and I remember she scared the poo out of me because she's like you can kill a patient if you do this wrong because if you give too much insulin you can literally kill them, right?

So that's an overdose, right? Or fentanel, you know, we use fentanel as anesthesiologists all the time. If you give them too much narcotic and you're not controlling their airway, that overdose can kill them, right? With our sex hormones, you can't kill someone. So, if I overshoot your testosterone, I'm not going to kill you. And in fact, testosterone in women is one of the most wellstudied hormones. We have 30 years plus of women that want to be men on really high dose of testosterone. And we know how safe is like insane levels of testosterone.

Absolutely. So, I know that roughly the range of where all of the women will feel their best. It's totally going to be labeled too high. And if they go to their primary care doctor and get it measured, their primary care doctor is going to scare them, telling them all of the m misinformation that, oh, you're going to get a clot and you're going to get cancer and all of the dumb stuff that I hear associated with just hormone replacement therapy and especially testosterone in women. But it literally changed your life as a woman.

I mean, what do they notice? Sexual benefits are literally like again, it changes everything in the bedroom. So, when I talk about testosterone, when it is fully optimized in a female, you have sexual and nonsexual benefits, right? So, it will increase your libido. It will help easier orgasms and better quality orgasms. It helps improve vaginal lubrication, which obviously helps everything in the bedroom, but also prevents UTI because dry vaginas lead to UTI that lead to sepsis that lead to death, right? And then the nonsexual benefits.

I mean, your performance in the gym. Yeah, absolutely. I mean, literally, I've been on testosterone now for two years, and people comment about my arms. This is like new for me. Like, it's it's literally the the muscle mass is crazy. your performance in the gym. It will help decrease both subcutaneous and visceral fat. So if muscle mass is going up, fat mass is going down, percent body fat goes down, so composition changes, right? Um we have testosterone receptors in the brain. So it'll give you better mood, better energy, more motivation, more vigor.

I mean, you feel like superwoman when your testosterone is optimized. I like I like to think of testosterone as like a do it's not, but like as a dopamine type hormone, like a drive, motivate, uh you know, I can do this thing type of deal. Um, and people typically feel really good on it. Absolutely. Absolutely. Absolutely. In combination with thyroid, that's your aesthetic combo. Like that's for for visual changes. visual changes. visual changes. Correct. Correct. Correct. Those two make the biggest ones. Correct. But with women, it's men, I can literally, and all of my patients, I require them to lift weights anyway.

But men, if they just got on hormones and didn't lift weights, they could still see body comp changes. We women have to put the work in. Yeah. Yeah. Yeah. If we really want to change our body, it has to be in combination. Yeah. You mentioned DHEA. Now, that's over the counter. So, why use that? Why would anybody use DHA in in this hormone therapy? therapy? therapy? Yeah, DHA has some great benefits, too. Um, it's a great anti-inflammatory. So, we're all in our 40s and this is the the decade where people start to complain about the aches and pains of getting older, right?

That typically when you get that in optimal range, it will typically take that away because it's such a strong anti-inflammatory. And in fact, there's a lot of autoimmune patients that will aim for even higher levels of DHEA because it it helps suppress the inflammation that comes along with it. I think, you know, when I think hormone replacement therapy, I the word the important word in this is therapy because you're looking at a combination of hormones, you're looking at how the person's symptoms resolve, how they feel, and then you're looking at the hormones in relation to each other.

Correct. Cuz, you know, I noticed for myself uh because of my testosterone replacement therapy, therapy, therapy, taking a little DHEA makes me feel better. And I don't think it's cuz I was low in DHA, but rather its relationship to my current levels of testosterone. And so you're looking at all these things when you're working with a patient. Absolutely. Are are are women generally harder to treat or Oh, yes. Oh, yes. Oh, yes. Okay. Okay. Okay. I mean, there are some days I'm like, I wish I could just treat men.

Y'all are so much easier. Put them onto levers really. levers really. levers really. Well, how how often do you have to So, we've obviously uh we've all personally I think personally have sent a lot of family, friends your way and that you've helped out. If that any of them ever come back to me like questioning or concerned, it's always because they're still speaking to their other practitioners. Absolutely. And they're always like, you know, Dr. Lauren's telling me this, but then I'm my doctor's saying this is crazy and this is this.

And I'm just like, oh my god. I'm like I'm like, stop it. Like go I sent you to her to listen to her. Like you you got to ignore that because this is why you're with her. It's like it hasn't worked for years seeing your regular physician. How often are you having that conversation? I've I've become more intentional at that initial appointment to let them know if you're going to let me take over the management of your hormones, these are going to be the areas that your primary care doctor is going to put you in an awkward position.

And with all due respect, your primary care doctor is a specialty. He specializes in primary care and not in hormones. If he did, you wouldn't be in front of me, right? So, let me manage your hormones. Let them manage your primary care needs. And I So, like specifically thyroid, that's probably the one thing. It's so annoying. So, I will let them know your TSH will be 0.0. That is almost 100% of patients. That's where they feel their best. It's completely safe. But this will freak out your primary care doctor.

They'll tell you that you have hyperyroidism and then you'll be like, "No, I'm taking thyroid." Oh, well then you're being overdosed. No, you're not. You're being optimized. And but they unfortunately they're not they're not trained in hormones. Like that's not their specialty. So they they're associating the bad side effects of Graves, which is an autoimmune hyperthyroid state, with being given the high dose of thyroid. Yeah. Yeah. Yeah. So So So because in Graves, that's when you see TSH at zero, right? right? right? But that's a symptom of this this autoimmune issue.

autoimmune issue. autoimmune issue. Exactly. So when you take a person's thyroid out that has Graves disease, you still get the bad side effects of thyroid that can lead to cardiac issues and all all of the bad things. But they assume that because I'm giving them levels that will suppress their TSH to the same as if it were grades that it's the same outcome. And there's not a single study that shows that. Do you work with growth hormone? What about growth hormone therapy? Yeah, growth hormone is so it's a great hormone.

It typically is done in our brain by the time we're 50s. So it like replacing growth hormone is typically something that I only do with patients that are in their 50s and beyond. Um if if I'm working with someone in their 30s or 40s and I want to induce their own natural growth hormone production, I'll use some peptides like testo or something like that. Yeah. How how much is has have peptides now been played a role in your practice? It's definitely becoming more of a role.

I mean they the way I like to explain it, hormones are bullets, peptides are BB's. Both can do a lot of great, but let's get your hormones optimized first before we play around with peptides. Yeah, that's a cool way to give that knowledge. I've always tried to explain it because people are always asking me like what I think about peptides and like cuz obviously it's popular [ __ ] right now, right? Everybody's seen it on the internet and everybody knows that I have access to it. So they're like send what do I need to do?

Like listen, let's first get the diet and working out first and let's go get your blood work. Let's see what your hormones are and then I can tell you what peptides it to take. They are awesome but it's like it's not the big rocks. No. No. Do do the other stuff first and then then then then it makes a big deal. Absolutely. Absolutely. Is it an issue if a somebody has uh let's say unhealthy lifestyle, they don't eat great, uh they're they're not exercising, so they're sedary, overweight, and they want to get on hormone replacement therapy.

Is that not a good idea to pu to push hormones up to a level when the person has is inflamed and unhealthy or is that just suboptimal? It's just suboptimal. I mean, often times getting them started on hormones will push them to be motivated. Absolutely. Absolutely. Absolutely. Because they feel better. Absolutely. Yeah. Absolutely. Yeah. Absolutely. Yeah. And that's a big part of your practice, too, is encouraging is that Let me ask you this as a doctor. Yes. Yes. Yes. I can imag I'm going to guess, but I can imagine getting someone to take their hormones is probably a lot easier than getting someone to consistently exercise and eat right all day every day.

Y'all know that. Yeah. So, Yeah. So, Yeah. So, yes. But I also I mean, we don't take health insurance, so it's a cash pay. And I got a little bit of a bi a bias. 100%. and and I make them pay for the full year because I know specifically women just being in the health and fitness world for so long, I know that they're not going to feel amazing by 3 months in and maybe not even 6 months in. So, I need them to buy in for the full year because nothing happens fast with hormones, right?

It's so good you do that cuz that's the other conversation that I've had is that like yeah, I've been doing everything she's saying. It's like it's been three months like keep going like keep going. It's not takes time to reverse a lot of this stuff. I literally have only had one patient at the 9-month appointment cuz I see them every 3 months, right? I've only had one patient at the 9month appointment that was not feeling amazing. And I think other things are going on with her.

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So, you're telling them like, look, it's going to take us a year year year totally totally totally to figure this out. I mean, the these were back from my Beach Body coaching days. days. days. All right. All right. All right. I mean, all jokes aside, though, literally, I mean, I did, you know, health coach for quite a while. And so, my experience with that, I just know how we're we want instant gratification, and we're so easy to quit if we don't see changes in the first three months.

So, I'm like, "Nope, you're bought in for the full year." So, and they also know that I will fire them. So, I mean, I I'm very clear about that from day one. like if you don't do what I ask you to do, I will fire you because I don't want your bad outcome to make me look bad. look bad. look bad. Right. Right. Right. Any initial side effects from hormone replacement therapy that you communicate like, hey, when you start on progesterone, you might feel lethargic at first or when you start testosterone.

Oh, yeah. Oh, yeah. And and some people feel worse before they feel better, too. That's that's the part of that three month. I feel I don't feel better. I feel like I'm worse than I was. I was like, yeah, that's you're changing. You're transitioning right now from exactly what's going on right now. Stay the course. This is where women are more challenging than men. Now, let's talk about the way that you cuz you are a huge proponent of uh how you advocate for testosterone to be applied.

So, let's talk about that cuz the traditional way of using testosterone is a once a week intramuscular injection. intramuscular injection. intramuscular injection. You like to use creams uh intra vas vaginal or vaginal? Absolutely. Why is that? that? that? Um so, it most closely mimics what our body was doing when we were hormonally optimized. So when you're 19 or 20 years old, your testosterone peaks and troughs every 24 hours. So that's why I like and it's easier for I I mean I can get really high levels with that cream.

So I I give patients the options, right? There's multiple ways that I can give you testosterone. Um pellets I'm pellets are my least favorite because because of the slowly you feel great in that first month and then month two, month three, month four, you're feeling not so great. So I want you to feel great every day, right? And when I first started testosterone, I was doing the once a week IM injection. So I I can speak from my own personal experience but then also now seeing so many patients taking them from the injections to daily cream and I let them know like if you are not feeling great by you know 3 6 months in we can always go back to injections and that never happens.

Is are there in this is probably speculative but are there receptors on the vagina that would make it so that when you use it vaginally that there's more sexual absolutely benefits. It happens all the time. So, it increases sensitivity now to the areas that you're interesting. Yes. I mean, women that are looking for a help in libido that like I've been on testosterone, my libido is crap. Like, just wait. just wait. just wait. I got you, girl. Put it on here. The reason why I'm saying that is because I actually saw some places uh promoting um like libido enhancing uh creams that had some testosterone in them, but also had uh Tadalapil, I think, was which is I believe a PD5 inhibitor.

And it was it was vaginal. I'm like, "Wait, testosterone?" The like, "I wonder if there's an increased improvement in sensitivity because you're applying it to that area." Absolutely. I I will tell my women that are still menrating, literally put it on your finger and literally stick it up your hoo-ha like a tampon. If you're bleeding, then put it on your labia. But literally, I mean, it's life-changing in the bedroom for Isn't the teddaphil or whatever? Isn't that like Viagra? Yeah, that is. Okay. So basically they're putting testosterone and Viagra on on on which just the mechanism of action is flow.

Exactly. Increases blood flow. So uh blood flow down there is effective for both men and women. What what are some of the So what are some of the big um myths you still have to overcome or or conversations. It's I feel like it's so people are so much more aware now. True. True. True. Around hormone replacement therapy. True. True. True. Um where it's not so taboo. But you know what are the big myths out there that when you go do these conferences and you're talking about this, what are the things that people want to want you to speak about?

speak about? speak about? The breast cancer thing always comes up. I mean because you hear hormones and you automatically think breast cancer because we've been brainwashed over the last 20 25 years that hormones cause breast cancer. So I always have to break that down and the literature is very clear that bio identical hormones not only do not cause breast cancer but they're protective against breast cancer. Really? Absolutely. Think about it. the the women in their menrating years don't get breast cancer for the most part. It's typically women that are postmenopausal, right?

If if if the natural hormones that our body was making would increase your risk of breast cancer, we would see it way more in menrating women. So, it's similar. So, wouldn't you say it's similar with men and testosterone? That's still the the stigma around men taking testosterone is increased cancer risk. And it's just like no, if you're an unhealthy low testosterone ma male, you're at a higher riskre than someone who's at optimized hormones. So, well, I also think there's might, you know, there's, it may come from here as well where when you, if you had breast cancer or you're treating breast cancer, they block estrogen.

Oh, yeah. Oh, yeah. Oh, yeah. At the receptor because in that situation, hormones can drive cancer growth once you have cancer. Yeah. But won't anything grow drive that? Like grow grow it once it's like at that point so you can make that case. Uh, Uh, Uh, so so here's the thing. I will not take a patient who's in the middle of breast cancer, but after she's over that, she 100% is safe to do hormones. The book that I always recommend, it's it's called Estrogen Matters. It is written by an oncologist and his wife is a breast cancer survivor.

And so, he dispels all of these myths that, oh, you have a history of breast cancer, you can't do HRT. That's just a lie. And he goes through it. It's a great book and it's written for someone that's not medical. So I always send patients to that because that's the biggest fear. I mean even one of my own staff, she has a history of breast cancer and I cannot for the life of me convince her that these hormones are not going to increase because it's scary.

Yeah. Of course. Well, some some when you have cancer, some of them are hormone sensitive. This is while you have the tumor, right? right? right? So for men, I'll just use a man example for men. If a man has prostate cancer, taking testosterone would may speed up its growth, but only if their total testosterone is less than 250. Got it. Okay. Okay. Okay. So, would I take on someone as a patient in the middle of of cancer? Um, if it was my dad, I would 100% start him on testosterone.

testosterone. testosterone. Interesting. Interesting. Interesting. But if it's someone that can sue me, and this is unfortunately, this is the life that we live in. Yeah. They'll teach us if it's you and your own, you can do this. But if it's if it's just a you know a patient that's not connected to you that can come back and sue you then don't do it. Back up for me there. So if you if you had tes testicular cancer and you were lower than 250 uh and it was your dad we're saying so you're not getting in trouble here.

Uh you would still take Absolutely. Absolutely. Absolutely. Wow. Wow. Wow. Absolutely. Absolutely. Absolutely. Wow. Yep. Wow. Yep. Wow. Yep. Okay. Interesting. What do you see when hor with hormone replacement therapy and other measurements like um blood lipid levels uh you know signs of insulin resistance stuff like that? What do you see any changes? Yeah, absolutely. We check lipid panel once a year. Um the the two numbers that I care most about are your good cholesterol, your HDL and your triglycerides. Okay. triglycerides. Okay. triglycerides. Okay. Um the triglycerides are almost always decreased in that first year.

Uh we see a pattern of in the first year typically a drop in HDL and then it bounce back bounces back in year two. Um, but overall LDL is almost always decreased. And more importantly, the LP little A, which they say there it's just genetic and there's nothing you can do. There was a a drug that I think just went through phase three trials in the recent past. I'm sure it's super expensive, that can apparently lower LP little A, but guess what? Testosterone can just lower LPA.

So, one of my patients dropped her LP little A in just one year from 300 to 200. Wow. Wow. Wow. Yeah. Yeah. Yeah. Wow. What about insulin sensitivity? Oh, thyroid and testosterone baby. Yeah. Yeah. Yeah. I mean, yes. And you see a big change there. Absolutely. Absolutely. Their their home IR and their fasting insulin almost always decrease in the first year. That's great. Tell me a little bit about your practice because people we get um you know people go to you who've listened to the show and they just come back and they just love you and I think they love you.

You do a good job. Thank you. you. you. But I think they love you because you guys you they seem to feel like they're really cared about. So tell tell us a little bit about your practice and what do you do that's different? Like what's going on? going on? going on? I mean I don't I don't know what we do that's different. We just really care. I mean I really like I'm in my purpose and um I've got amazing staff that really care. We all understand that it's not just a business, it's a mission and we have the tools to help people literally change their lives.

And so I mean, you know, I when you come in, whether it's to be hormone patient or maybe a weight loss patient or maybe just do functional medicine, there's always this initial evaluation. We'll look at labs. We'll talk about your options. But, um, just like with my weight loss program, we see you once a month. I don't I don't want you to become that, you know, ompic face, oyic butt person that loses 30 pounds in 30 days and you've lost 15 pounds of muscle. Like, I'm I'm not going to do that.

So, would it would I make more money if I didn't see them once a month? Absolutely. And just recently, one of my staff members were like, "Can we do we have to see them once a month?" Yes, we do. Talk talk to me a little bit about uh because obviously GLP ones are huge now. Uh give me some ideas like how how many patients are you seeing on it? What are what are you noticing? What are the challenges? Like challenges? Like challenges? Like I I think they are incredible tools when used appropriately.

And I have a lot of my patients that have reached their ideal body weight and they come off of it and they're like, "Can I just get back on a small dose for the inflammatory benefits?" So I will literally have patients that cycle on and off a very small dose of GLP1s 6 months on, three months off, 6 months on, six months off. Do you like uh do you have a preference over some versuside? I I mean, you know, iPhone 14 versus iPhone 15, iPhone 15, iPhone 15, right?

I mean, they're both great, but iPhone 15 does it better than 14, you know, and then Red True Tide, which has the three mechanisms of action, is even better. better. better. Are we using that already, or is that still still still is is is okay? Soon to be that's the one. That is crazy. That one just That's the one that the body I can't wrap my brain around the science on how it's possible to gain muscle and lose body at the same time. It is happening with re That's the one that's taken the bodybuilding world by storm.

Exactly. Has anybody reported like any changes in addictive behavior? Oh, 100%. I I mean, it is it's going to be used off label in so many different patients. I mean, I think last time I was here, I might have told y'all about my patient that had the addiction to the nicotine gum and she literally she wasn't a smoker. She just started it because she heard nicotine gum was good on a podcast and literally had this like crazy addiction. She was losing like a lot of money every month because she was so addicted to it.

And simaglletide broken. She was like, I don't care if I don't lose weight. This was 100% worth every single penny that I paid for it. So, yeah, I know. Those those areas in the brain. the brain. the brain. Now, talk about the challenges, though, because we I mean, this we obviously take a lot of live callers. We have written a program for GLP1. So, we we ran a group that you've talked to. Uh the thing that I I see probably the most common is someone like who's been on a GLP1 for like a year and let's say they had like a 100 lb plus goal and they did really good and they get like to 50 uh by just crushing the appetite and then they get to a point where they're like,00 calories or something like that and they've been at this hard plateau forever and they're walking they're doing all the things.

Um are you seeing that a lot and do you typically lower the dose reverse diet? What are kind of your strategies? I was about to say I I will send them to people like y'all to help them reverse diet, but also just uh splitting the dose has helped a lot too. So some of our patients are twice a week, some of them are even three times a week. And just taking the dose but dividing it. dividing it. dividing it. Oh, interesting. Oh, interesting. Oh, interesting. Yeah.

And that's so instead of taking it once a week, it's more frequent half dose. Correct. And what is that what is that producing? Just less of a crushing. Yeah. Less of a crushing appetite and just more subtle. I didn't even think about that. Yeah. So, what's funny about that, by the way, I don't know if you're already doing this. You're so busy, so I I don't think so. But if you ever read the bodybuilding forums, bodybuilding forums, bodybuilding forums, Yeah. Yeah. Yeah. these are the cause.

I definitely don't do that for the record. Let me establish that. But if you ever really say that, I do that every that every that every like like go into and and observe a group of people who are willing to experiment on themselves into the bodybuilding world. I do know that. and and they've they're the ones that have done all this and they're that's how they use reatr they don't use one dose they use like three or four small and that's that that's what they're saying those words oh yeah oh yeah so that's what they typically hey we're pushing the science forward dude dude dude asked asked asked I am grateful for that a few a few deaths here and there no big deal let's see what happens that's great so so tell us about I I I love that you're doing these speaking.

By the way, you're a great speaker. Thank you. Thank you. Thank you. Yeah. You and I both spoke at the the Peptide Congress, Peptide Congress, Peptide Congress, right? right? right? And uh when I was done, and I have to thank you guys because Dr. Seeds would have never known who I am if if it weren't for you guys putting me on your podcast. your podcast. your podcast. Well, I got to tell you, so I had this ego boost and then I was like, "What?" So I come off stage and people like, "You were the best speaker." So I'm like, "Wow, that's so awesome." And then the next day people were people were coming up to me, Dr.

Fitz was the best speaker. I was like, "Oh, I love it." All All All right, dude. That's great. So, tell me tell me about the speaking engagement. Who Why are they inviting you on? Is this This must be the Oh, come on. come on. come on. The the interest must be just exploding right now around this. Well, I think I think she's comm I mean, every time you've been with us, you've communicated. You communicate it really, really well. And I think there's a lot of women of women of women that are being told by their general practitioners, practitioners, practitioners, you know, but yet they know in their heart that they don't feel right and they're trying all the things and they're getting told you're fine or you're good and it just doesn't make sense.

And I think you do a really good job of communicating that and I just don't think there's a lot of resources uh for people like that. when I was preparing to come on your show this time last year, um I've been listening to you guys for a long time. So, I knew all of the great people that y'all had on board, but you'd never really addressed this thing. And so, I was like, I know that you have so many people that listen that need to hear this message because normal isn't optimal.

Yeah. And your normal labs, you're feeling like crap. Fire that doctor and find someone that will listen to you. Do you do you, this might be controversial, but do you think most women should be on hormone replacement therapy? therapy? therapy? 100% 100% 100% menopause. What about the whole like, you know, you know, you know, I'm sure you hear this argument like, well, it's natural. You're supposed to go into menopause. I I mean, that's fine. Like, you can do that, but I choose I know what my quality of life is when I'm hormonally optimized.

So, that's the beautiful thing about about hormones is that if you get on it and you're like, "This is not worth it for me." You can stop them at any given time, whether it's a year from now, 5 years from now, 10 years from now. I'm 45 and I will be the on this until the last day on earth because I understand it protects me from all of the things and I feel amazing. I I don't I don't remember the doctor who my mother-in-law was very close friends to, but she's been advocating this is the 30 years she's been advocating for this.

And I always thought it was interesting when I first met Katrina that she her mom was so adamant about when you were in your 20s and early 30s to get your blood work done, see where your where optimals are because you're soon going to be on hormones and you're going to want to be able to look back and be like, "This is what my optimal is." And she like that's and she helps coach life coach people and almost every single first thing she does with every woman she life coaches is send them to go get their hormones.

I this is what it so this how I explain it cuz I I have a lot of it cuz I I have a lot of cousins. We're around the same age. There's like nine of us that grew up together. So includes my brother and so it's a bunch of dudes that grew up and you know I'm the guy on all the you know hormone replacement therapy. Yep. Yep. Yep. And so they're asking me you look younger than all of us. Well, so I also have four kids and I was divorced, so I got that work.

But we'll talk and it's like, you know, um I'm like, look, you still get older. So it's not like I'm like, you know, I'm a 20-year-old. I could still tell that I'm 46, right? But it's definitely very different. Well, anyway, finally, one of my cousins who's my age went on some testosterone and he's like, dude, he goes, I I didn't know uh how bad I was feeling. feeling. feeling. Yep. you know, because you know, he he's a black belt in jiu-jitsu. He trains and we're talking all the time and he's always like, "Well, natural is better." And I'm like, "Listen, dude, it's not you're not doing crazy stuff.

This is optimizing you." I said, "You work out. You try to watch your diet. Do you like doing your jiu-jitsu? Do you like working out?" And I'm like, "You'll enjoy it more." And so he gets back on. He's like, "Dude, I didn't realize how low my tolerance for exercise stress was." He's like, "I would go to jiu-jitsu and I'd roll and I'd try to go easy, but I'd just feel beat up, you know? I was just feeling beat up from everything. He's like, "Man, I feel like um I could train again and I feel good." And he's on like a low.

He's like super conservative cuz he's like scared to go on higher. He's he's not like me where I'm like, "What's the most I can think?" But he's coming back and he's like, "Dude, this feels so different." So now everybody else is starting to kind of get convinced like, and I'm a big believer like, you know, as you get older, older, older, but you also have to remember it's not natural for us to eat processed food. It's not natural for us to breathe, you know, the chemtrails that we're un, you know, we're exposed to.

Did y'all watch that documentary, by the way? Dude, you've got to say that. I don't know. I collected more. I'm a full-fledged conspiracy theorist. Thank you very much. But, but I mean, it's not natural all of the things that we're exposed to. So, so if you want to go through it just, you know, naturally just to say you did it, here's your, you know, gold star. But I ain't doing that. Yeah, I know. It's quality quality quality so hard. I'm trying to convin I can't get him to I'm literally about to like finance it just so I'm like I'm going to finance it for like a year.

So what's what's stopping him though? I mean it's it cost a little bit cuz he's like cheap. I know. I know. Even just the steps of go get my blood work and just the step and him feeling like I'm okay and I know. I'm like no you're not. I'm on the outside going like no no you're not. I know. You know what I'm saying? I grew up with you. You know and again you be you just you get so adapted. the body is so resilient that you start to fool yourself of like, yeah, I'm fine.

I'm normal. And then you get on that nice little dose and it's like, oh, like, oh, like, oh, well, it's the same thing when I was talking. So, my parents were my very first two patients and got on Facetime with him. And my mom has always just done blindly what I tell her to. My dad, he has to hear it from Peter Tia before he believes it, right? Let's just be real. So, so my my mom is, you know, yes, let's do it. Whatever you say.

And my dad's like, tell me why I need this. I'm I'm pretty, you know, I feel like I'm pretty good. I'm like, you are, but you're not optimized. I don't know, Dad. Give me six months, and if you don't feel any difference in 6 months, you can go off of it. Okay. And sure enough, he was like, I'm starting to to see muscle again. I'm like, yeah. Mhm. So, you just you don't know how much better you're going to feel until you try it. And what's to hurt?

Like, worst case scenario, you invest and you do it for a year and you're like, "Nope, it doesn't didn't do anything." Okay, cool. Like the next time dad says that, you tell him. You say, "Hey, I've been on Mine Pup twice. Peter, you've never been on there." Totally. there." Totally. there." Totally. The way I look at it, there's a couple things. First off, we know that men's testosterone levels have been dropping for something like 50 years. This is well documented. well documented. well documented. Very well documented.

So, this is a this is not like this is not uh you know controversial in any way. It's for sure going down. Fertility in general is going down. Women are more hormonally imbalanced, natural women than ever. Why? There's a there's a lot of reasons possibly why. Probably a combination of things. Nonetheless, um, hormone optimization is becoming less of a like like that's cool and more of a might be more necessary for a lot of people because of the things that are happening to us through our unnatural environment exposure to things like xenoestrogens and microbiome being thrown off and our lifestyles and all that stuff.

So, um, yeah. Well, how r how rare is our business partner? I mean, Doug is like the only dude I know that's you know what his natural testosterone levels are? levels are? levels are? I heard y'all Totals are like,00. Yeah, that's not normal. Yeah, doesn't look at his face. Those are old numbers. Yeah. Oh, they're higher number number number guy over here. Easy. Easy guy. Easy guy. But but he when he was in his teenage years and 20s, he wasn't exposed to a lot of the integrated disrupting agents.

He's also, I would say, you know, the three of us are obviously the gurus, but he's the better student, right? right? right? He's he he's better than all of us. I think he he's he is better at working on his sleep. He's better consistent with Whole Foods. I think I think he's the one of the best. I think he at that. at that. at that. But she makes a great point. You know, he wasn't exposed the amount of chemicals now that you grow up with. Totally.

Totally. Totally. Justin, your just from the things you touch and the clothes you wear and the stuff you put on your skin is just insane compared to what it was. I have three families that I'm taking care of where I'm taking care of the mom and dad that are in their 40s or 50s and then their their adult children and the dad's testosterone is always higher than the the son's testosterone who's in his 20s. That's so crazy. Yeah. Yeah. Yeah. Because he's been exposed to all of these indocrine disrupting agents for his entire childhood and and adolescence.

The way I try to look at it, it, it, how much is this playing a role in all these weak ass men that can can can we will go there? I mean, I I know what it's like to have very low testosterone and you feel you don't feel like the the man you are on optimized testosterone. optimized testosterone. optimized testosterone. Imagine me being a single 45-year-old female trying to find a man that Yeah. Uhhuh. The struggle is real, you know. So, I mean, there's a couple ways too to to to look at this because there's definitely, and I'm just going to, you know, call it out.

This is what I struggle with. There's definitely you can go on hormone replacement therapy to really push the limits and and you might be a little too focused on aesthetics and that kind of stuff. That happens to me. But then there's this other side, which is, you know, it will it will improve the quality of your life so you could do the important things more often and better. So my kids at work, better sleep, so I feel better things I can enjoy the sports and activities that I used to enjoy which bring me joy and allow me to connect with people and I really I think that's uh the main benefit you know.

Yeah. It's how you show up to the world. Yeah. So Yeah. So Yeah. So if you are a better version of you then everyone in your world appreciates that 100%. We really appreciate when you come and speak to our groups. They love hearing you talk. How do you enjoy doing that? Cuz these are these are all like just coaching clients. Yeah. I know. I I love doing that. Yeah. What do you think of the Muscle Mommy group? I think it's awesome. Yeah. Yeah. Yeah. Yeah. But I will have to say I'm I'm not as good about getting on school versus the Facebook group last summer.

I I need to be better about that, but I've been juggling a lot. Well, you know, for your like own self business-wise, I tell you what, I'm blown away by school. Yeah. Yeah. Yeah. So, that's my that was my first introduction to it. And the UI is incredible and the things that you can do. So, I don't know how much you've dove around and we can talk off air about all the business stuff you can do with it. with it. with it. Very very cool. Have you thought about uh because you're you're very very smart especially with and even in business.

Do have you thought about combining what you do with like uh trainers and coaches and gyms because I just don't I I could see the synergy just so much where I mean we've talked about having our trainers and coaches work with doctors and stuff. Have you thought of that? Absolutely. Absolutely. I mean, I' I've thought about, you know, the three of you guys, you know, doing something with me because I mean, what y'all bring to the table versus what I bring to the table is what most people need.

You know, I've also talked about it with one of my best friends who has been in the fitness world forever. You know, she's the health coach, nutrition, whatever. And And And yeah, it's I I think it's the missing element for a lot of people. So do I because I and I even have a friend who's a psychiatrist and we've talked about this and she's actually learning about hormone replacement therapy for her practice. Oh, yeah. Because of all of the people that she sees and she's like, you know, a lot of some of these issues, what I'm telling you to be treated, what I'm telling you about my mother-in-law who's the life coach, that's like they come to her and oh, the husband this that and she's just like, go get your hormones take care of first and then we'll work on all the other [ __ ] because you're just battling uphill.

I could teach you all the tools on how to communicate with your husband and this and that, but if you're hormonally out of whack, you're just you're you're fighting an uphill battle. Do you understand how many people don't need to be on SSRIs? They just need hormones optimized. I mean, when I give the patient even hope that maybe they don't need to be on that SSRI the rest of their life, they're like, "Are you kidding me? I've been on this for 20 years." So, I know personally I know people personally who've done this and here you have.

So, the symptoms were uh anxiety, worry, you know, mood was kind of up and down. Doctor puts you on an SSRI, which comes with the side effects, by the way. Nobody talks about those erectile dysfunction. erectile dysfunction. erectile dysfunction. Not well it was a woman it was sexual dysfunction. dysfunction. dysfunction. Yeah. And so these are people these are friends of ours and it's like you feel numb or numb down there. So issues with orgasms sexual weight gain those are the side effects of this you know kind of numbing agent which kind of Okay.

So the anxiety got a little better, mood's got a little better but also sexual dysfunction also weight gain on the hormones. uh mood is better, no anxiety, sleeping better, except I'm leaner, not gaining body fat, and my sexual uh you know, how I respond and how I feel sexually has improved. So, it's like the best the best versus, you know, you get all these crazy side effects. effects. effects. Correct. Correct. Correct. I think there's a lot of women because again, you look at the data on women prescribed prescribed prescribed SSRIs and enzytics, it's right around the time the time the time absolutely absolutely absolutely when parameopause and menopause hit.

Oh, that's the standard. If they go to their primary care doctor, they'll be put on birth control pills and an SSRI. They're doing terrible hormone replacement. replacement. replacement. Terrible. Terrible. Yeah. No, it's I I I think that if psychiatrists really understood that their patients don't need all of these, you know, terrible drugs that are, you know, pharmaceutical drugs that these patients think they need to be on for life. They really just need hormones. It would it would take a huge portion of pharma out of business at the very least because I think there's a role in some of the stuff but at the very least you you could lower doses to optimize hormones but put it differently a hormonally optimized person probably needs less of everything else even if they did need something else.

else. else. Yeah. I I think the amount of the percent of people that are on some sort of a psychiatric drug, whether it's an SSR or whatnot, would be significantly decreased to like 10%. If maybe even less than 10%. If we just addressed hormones, diet and lifestyle. Does that happen with you? We get these clients and then they go on hormones and then they start coming off stuff all the time. All the time. I will let them know. I don't want to even talk about it until the six-month appointment.

And then at the six-month appointment, we can talk about you doing this with whoever is prescribing that because technically since I didn't prescribe it, I'm not supposed to deprescribe it. deprescribe it. deprescribe it. Right. Right. So, you work with them. Yep. Yep. Yep. Well, Dr. Fitz, you're always so awesome. awesome. awesome. Thank you. Thank you. Thank you. We love you being on the show. You're always such a great um such a gift to our community. our community. our community. Thank you. Thank you. Thank you. And um I'm sure your books are totally slammed and you can't I mean, are you just just just I'm booked out till March.

Are you trying to grow? How do you do that? I I I I go back and forth if I want to open a location in a warmer place because Chicago is really cold in the winter. Um but I I've I've hire I have two um other medical providers and I'm about to hire a third and then if I want to open a second location, I go back and forth, but um we take over one of the spaces right next door. next door. next door. I mean, maybe so.

I mean, the weather here is much better. I will say that it's it's snowing in Chicago today and I I sent a picture to one of my friends. I'm like, don't hate me because I'm not wearing a jacket. Well, awesome. Well, thank you so much for coming on. I want to thank you guys, though, because the amount of patients that have come to me because y'all put me on your podcast last year. I I will never be able to say thank you enough. I truly am grateful for that.

It's It's an honor because you are servicing people that we care about. So, the fact that they're going to somebody who knows what they're doing is good, cares about them, that for us is the best. best. best. Thank you. I appreciate you guys. You got it. got it. got it. All right. I know you like that episode. If you did, check this one out. shredded, ripped, defined singledigit body fat. body fat. body fat. Yes. Yes. Yes. You want to get there? Let's talk about it. it.

it. Difficult. And is it worth it? That's a follow-up question. follow-up question. follow-up question. Yeah. First off, we got to say, okay, so singledigit body fat obviously body fat percentages uh that could be represented by one digit like 3%, 5%, 6%, 9%. That's uh ripped for men. For women, add 10%. add 10%. add 10%. Yeah. Don't Yeah, exactly. Go you go up about