HRT and TRT Part 1 with Joe Miller – Ep. 180

In this episode, Dr. Jade Teta has a conversation with Joe Miller. They talk about the importance of balanced hormones in relation to a healthy lifestyle and weight loss goals. Hormones are an important biomarker for every individual to know whether or not they are living an optimized, healthy life. Hormonal imbalance can be indicated by low energy levels, hunger, cravings, and even a lack of sleep.

Talking specifically about estrogen and progesterone, Dr. Jade explains that essential female hormones can directly impact fat burn. For instance, estrogen acts as a fat-storing, as well as a fat-burning hormone, and a disproportional estrogen/progesterone ratio can cause weight gain. Dr. Jade also dives deep into testosterone replacement therapy and its connection with a man’s health.

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Connect with Dr. Jade Teta

Website: www.jadeteta.com

Instagram: @jadeteta

TRANSCRIPTION:

Podcast Intro: [00:14] welcome to the Next Level Human Podcast. As a human, you have a job to do. In fact, you have four jobs; to earn and manage money, to attain and maintain health and fitness, to build and sustain personal relationships, to find meaning and make a difference. None of these jobs are taught in school and that is what this podcast is designed to do. To educate us all on living our most fulfilled lives through the mastery of these four jobs. I'm your host, Dr. Jade Teta and I believe we are here living this life for three reasons and three reasons only; to learn, to teach and to love. In this podcast, I will be learning, teaching, and loving right along with you. I'm grateful to have your company; here is to our next level.

Joe  1:18 

Guys, we're here with Dr. Jade. So Dr. Jade, thanks for joining me this morning. Happy to have you on Dr. Jade expert on all things, human performance and just kind of Optimal Living and things. And so we're excited to kind of open up some discussions about it. But first, I thought maybe if you could tell everybody out there a little bit about yourself your passions. And, you know, you put out a lot of great content, a lot of free stuff. And so just kind of what inspired you to do that and bring it to where you are today?

Jade  1:49 

Yeah, well, you know, I think probably why we have sort of good alignment is because I come from a background of personal training, I believe it or not, I started doing that when I was 15 years old. So I actually started earning money 15 years old to write programs for people on my football team and their family members. And that kind of went into a love of you know, obviously fitness and then nutrition for performance that basically took me to undergrad in biochemistry. And then I kind of reached a crossroad there. Because I was looking at traditional medical school. Of course, I had already been doing lifestyle medicine, all through undergrad and even in high school. And I was kind of shocked at that time to see that, you know, most MDs, at least at the time, the curriculums I was looking at, at UNC Chapel Hill and UNC Greenville. Those curriculums were no exercise, no nutrition, and very little psychology, which was all of my interest, you know, coaching and counseling and writing fitness programs and doing nutrition. And so I decided to go to naturopathic, the naturopathic route. And at the time, being a science based guy, it was a big leap of faith, I had no idea that functional medicine, integrative medicine was going to become, you know, sort of a mainstream thing at the time, I just wanted to do lifestyle medicine. And that's why I went in that direction. And it kind of turned out nicely for me. But after I graduated from that program, I basically wrote a book back in 2010, that was a best selling book called the metabolic effect diet that launched me into the internet space. And now you can kind of think of me as sort of a personal trainer mixed with a nutritionist, mix with a natural medicine, physician, and a strong bit of psychology and philosophy on top of that, and so, I like to say I specialize in mind, muscle and metabolism. And funnily enough, a part of what my clinical work was a lot of female related metabolism. And so I kind of got into the specialty of endocrinology and hormones. And obviously, that's why I love you all, and kind of is the synergy there. So that gives you a broad spectrum of sort of my base. And I would say functional medicine is what I do functional endocrinology is mostly what I do, and I write books and educate, you know, other health care providers in physical change using metabolism and also personal development as well. So that's my area of expertise and what I love to do.

Joe  4:20 

Yeah, that's great. Yeah, I just noticed, looking through your site, there's a lot in some of your content, there's a lot of different angles that you tackle that obviously, it's a very complex topic for people trying to lose weight. I think a lot of people out there too, they beat themselves up because they think it's as easy as you know, I'm going to just eat a little less and then they when they, they struggle with that, maybe they're beating themselves up where I'm going to, you know, just get after an exercise more and they, you know, maybe don't adjust certain things and then they're kind of not seeing the results they thought they would or their friend is seeing and things of that nature because I found it interesting. So I think my point in bringing that up is So just, you know, looking at a lot of your content, what you're doing, as well, as you know, some of the like the testing that we do, I think it just gives people hope, you know, they can see. And, and I'll kind of touch on this in a minute a little bit more. But there was the I was looking at the flexible metabolism podcasts you did recently. And I think it's just, it's just so helpful for people to know, oh, there's more to this. And I'm not a failure. And there is some hope, personally, at the end of the tunnel, because people have different metabolic conditions or little things going on in the background that they just don't understand. And will they have someone like yourself, educating them? Maybe some questions that check in on and process or through, you know, our partnership and things gives getting some more thorough testing and diagnostics to say, Ooh, that's a roadblock in my, in my pathways here to do that. So yeah, I would like to just to kind of ground on that if we could maybe start there. If you could talk briefly, no, you did this in your podcast, but just on the study, I found very interesting with the women who are exercising, and didn't lose weight. And just kind of give the group of the audience out there just a little brief overview of what that was, and kind of what your what your angle was on that in your in your talk. Yeah, it's

Jade  6:14 

perfect. And let's, let's do a little background. If you don't mind, Joe, just really quickly into that particular study. One of the things that I think we have to realize it when we talk about, I guess we'll just focus on weight loss in general. But you know, obviously, metabolism is in charge of that. And the idea is that we are working from a model, the industry as a whole is working from a model that is incomplete at best, and perhaps at worst, wrong. And so let's just give it the benefit of the doubt and say it's incomplete. And so what essentially that means is we've all heard this idea that eat less exercise more or create these energy deficits is required for weight loss. Now, more specifically, we want fat loss, we want to maintain our muscle, which we'll get into a little bit with some of the hormones and why those can be powerful there. And I would say that is absolutely true, right? This this idea that we absolutely need a calorie deficit. And that calorie discrepancy if we're going to lose weight, however, we need something else, not only do we need a calorie deficit, we need a sustained calorie deficit. So what that essentially means is, well, what helps us sustain the calorie deficit? Well, the hormonal communication network in the body is what is controlling and informing things like hunger, and energy, and cravings, and sleep and mood and motivation and focus and exercise performance and exercise, recovery and all of these things. So you can certainly create a calorie deficit. But if that changes hormones in a way that causes hunger to go up energy to become unstable and unpredictable, and cravings to become out of control, then that calorie deficit is not going to be sustained. And so what the whole world is doing is saying, Oh, I'll create a calorie deficit and inadvertently, in that process, creating a hormonal situation that causes the metabolism to push back to compensate. So to me, this would be law, one of metabolism, a new law that we all need to be aware of, which essentially says the metabolism is not a calculator or chemistry set. It's more like a stress barometer, and thermostat. In other words, it is adaptive and reactive. So you create a calorie deficit. And it goes, Wait a second, I don't like this, this is a stress to the system. And it changes all its hormonal software to create hunger and cravings. And then you reverse what you just did. And we all know what this is like. And so the first step here is to understand we need a calorie deficit, we need a sustained calorie deficit. And that's about hormones. Now, this particular study, is one of the first studies that kind of blew my mind as an exercise guy that was like, Wait a second, something is happening here. And so if you if you followed what I just said, There, you'll understand this study, and we can break it down a little bit. But this study is known as the alpha and beta trials that was were done in with Canadian women, mainly in the peri menopausal range. These are women, you know, basically 40 to 55, in general. And they basically said, Look, we don't want you to do anything consciously to change your diet, what we want you to do is we're going to have you do either 3045 or 60 minutes of essentially treadmill jogging five days per week. So there were three groups, one group did 30 minutes of Treadmill jogging five days per week, the other did 45 And the third group did 60. So that is a lot, a lot of energy being burned. And if you're not consciously changing your diet and doing what you were doing previously, and we should see if the metabolism works like a calculator, we should see weight loss, and indeed, indeed we did. In about 10% of those women they lost actually more weight than was predicted But 25% of those women lost some weight, most of them did not lose as much weight, as would be predicted. So that's great. But then you might say, Well, what happened to the other 75% of these women? Well, 50% saw no change in weight at all. And shockingly, 25% actually gained weight as a result of this. Now, in the old model, we would essentially say, Well, that can't happen because they created this calorie deficit. So what then happened? Well, obviously, they weren't able to consciously control their diet. So they compensated with increased food intake, enough to wipe out the calorie deficit created by the calorie deficit created by exercise, and in some cases, to completely not only wipe it out, but actually go into calorie excess. So as a result of this exercise, 75% of the women either did not lose weight, or actually gained weight, and only 25% saw weight loss, most of those not as much as predicted. And of course, there were some that saw more than predicted. So this tells us a couple things about metabolism, one, the law of compensation, whatever you do to push on the metabolism, it oftentimes is going to push back if you try to speed metabolism through exercise through fat burners through hormones, actually another way to do it, if you try to use cold therapies or anything like that, you're usually inadvertently also speeding hunger and cravings in the vast majority of people. So rule number one from the Tasman says the metabolism is more like a thermostat. It's adaptive and reactive. This study also told us about Rule number two, that we are each individual. And so there's going to be individual reactions, not everyone responds the same way to diet and exercise. And so if you understand that, then it starts to change the equation for us, as practitioners it sensor says, How do I begin to understand how people are compensating? And how do I switch my model to go from speeding metabolism to creating a more flexible metabolism. And when I would say what mate, most hormones do if you get it right, they're not actually speeding metabolism, they're making the metabolism more flexible, more adaptable, and this is why they can be so powerful, but only in the context of doing all the other lifestyle things like we all know, we can't just give patients hormones and see them magically turned around. However, we can give people hormones, have them do some of the other things lifestyle wise, and see those things have a better response as a result. For example, we know if that we have someone who's hypo thyroid, and we try to put them on a diet, they're mostly going to compensate, it's gonna be very difficult for them to get the results. However, if we put them on hormone replacement therapy, and create a narrow gap in calories rather than this wide gap, and make sure we have a balance between sort of energy output and recovery, we can do amazing things with the use of that hormone. Same goes for testosterone replacement therapy. Same goes for bioidentical HRT, we can use these approaches in a way that can make a big difference. But only in my mind, if we are looking at the new science of metabolism and understanding what we're dealing with, we're going to have to do both the calorie deficit and the hormonal balance. And that is how we begin to make a difference, which is why working with your company is so exciting to someone like myself, because I do mostly now education. And so from my perspective, I have all these people saying, Hey, Jay, can I work with you as an individual clinician now? And I'm like, Well, I'm mostly educating other physicians now in what I do. So I need to send them to a place where they can actually get these therapies, and be able to avail themselves of this new way of looking at things. Now, of course, as you and I know, it's still not easy, but it's much better than the old model. And so hopefully, that helps sort of open up discussion about what we're missing with metabolism, and why you can never look at a calorie deficit in isolation without looking at the communication network of the body, which is hormonal therapies. And these two together can begin creating better outcomes. Now, there's still a lot we do not know. And we just have to be clear about that. And most people in science, understand it's an emerging sort of topic, but this is far better than the old model, which just says, Hey, exercise more and eat less.

Joe  14:33 

I appreciate you walking through that. And I think part of what really grabbed me was I've seen it firsthand with family members and friends and people I've helped or people our clinic has helped to where especially myself personally like living in Michigan, you know goes from cold weather to hot weather. And I've seen as soon as the season starts to change, some people will drop 510 15 pounds others remain the same. him and I go on what is going on? And I think a lot of it is that's that signaling, as you're talking about when that changes to where energy expenditures go up, you start doing yard work, you're outside more, you're more active. And then you start snacking, more overeating and those things will signaling. And if you look back at the other studies that also talk about reporting, you mentioned like conscious and unconscious, right? They're unconsciously doing this. And it's not that people are malicious, or failures, or whatever the case is that they're, you know, people just beat themselves up so much over this, it's just having an understanding of this is what's going to happen in your body first and foremost. And then you know how to counteract that. So I just really found that, especially this time of year, I'm sitting here in mid June, and it's going to be like high 90s, for the first time here in Michigan today. So that really spoke to me as I was going through your content recently, it was like, definitely want to unpack that with you today. So I appreciate you walking through that, because it's just, I think it's really, really eye opening for people and can help shine a lot of hope. As far as you know, this is a process, you know, and some people are going to, you know, hit a little bit earlier in that process and others got it you got to work through a little bit, but stay in the fight, and you're going to be okay, so

Jade  16:05 

yeah, you want to know it, I'll just I'll just mention something there as well. Joe's, like a lot of people don't understand either, that when you look at the calorie model, right? It is an incomplete model in itself. Anyway, research actually tells us 20% of food labels and 20% of what we believe we know about how many calories are in foods is skewed either too high or too low. And the research shows pretty conclusively now that we humans are dramatically under estimating what we eat i as much as 30%. So that is basically one meal a day, we are essentially missing over time. Now we can certainly track that day one, day two, day three, but over two weeks, three weeks, if researchers follow people around, they realize that they miss remember what they eat to such a degree that eventually they cannot account for 30% of their calories on average. Now, of course, this is individual, some people are going to overestimate it even or underestimate it even more than others. Some may be just you know, right around. But this is what is happening here. So again, it does illustrate this sort of downfall of the calorie model. Now it doesn't mean it's wrong, I certainly don't think it is wrong. It is just now we're getting into the practical application of it in terms of weighing and measuring. And in terms of tracking of foods based on the individual psychology. That's why I say if we're going to work with patients, we got to look at their physiology, which we do. But we also have to look their psychology, and then their personal preferences and their practical circumstances. You know, these four things are what make up the individual. And if we want to talk about evidence based medicine, one of the interesting things about that is that there's that's become such a buzzword now. And most people take it to mean just research. But what evidence based medicine really means is what is the body of research, say? What is the physiology, psychology, personal preferences and circumstances of the person in front of me, and then what's my clinical experience as a clinician, that is evidence based medicine, the research body to individuals sitting in front of us and the experience of the clinician. And so once again, we really have to, if we really look at this closely, we'll see a lot of what we're missing, we can't just do input A and expect to get out, you know, input B, we have to realize that when we're dealing with a person, there is a big web that we have to begin to uncover. Now, of course, the reason I deal with hormones on a regular basis, and I'm always talking about hormones is because the metabolism doesn't speak English, it speaks metabolism. And it is and it is a communications hub, basically. And it is using the signaling molecules of hormones, Myokines, incretins, all these things to communicate this, and especially when we look at things like testosterone replacement therapy, or estrogen and progesterone, they are informing, and communicating with and balancing out this communication symphony and can make a big difference in lifestyle, you know, sort of adherence for individuals, which is why I think it's so critical, and we have to be looking at this. But again, I think we can't make the other mistake where we're simply saying, Okay, now we're gonna go all hormones, right? It's a both it's not quantity, quantity over quality. It's not quality over quantity. It's both it's not calories over hormones or hormones over calories. It's a both, and I think that's, I think, where you and I, especially in your company is, you know, in complete alignment, and I think that is important that most clinicians start to understand that because the tool is only as good as the framework in which it informs in my opinion, right. So we have to essentially be able to understand how to use these tools in a way that does make a difference,

Joe  19:49 

right? Yeah. You know, you're talking a little bit, getting into kind of hormones a little bit and talking about, you know, testing and things you know, versus like to get your input on bloodwork, what you generally see that's recommended age appropriate, you know, have it be male, male, female, certainly have a lot of from panels where we can maybe unpack a little bit of that and just what you're seeing as a clinician and what you're putting out there as education, as far as you know, what are some of the key things that you look for or recommend people look for in bloodwork? And then we kind of unpack that a little bit further?

Jade  20:25 

Yeah, well, I'll kind of break down at least my model, the way I see it, if you can visualize a pyramid, you know, to me, if we're looking at body comp, which I'm filtering, just to, just to remind everyone, I'm kind of filtering this discussion through body composition, changes in weight loss, we can certainly go in other directions here. But from that perspective, I look at the hormonal pyramid, and essentially, the way I look at it, and I say, calories are at the base of that pyramid, okay? It doesn't necessarily mean again, the whole pyramid, if you don't have the pyramid, you don't have the structure. So I'm not saying calories are the end all be all, but you can't overcome, you know, calorie excesses and expect to lose weight. So I put that first. Now, you can't separate that from a lot of the hormones either. But if we're looking at laboratory testing, I go, okay, so calories come first. Now, what are the hormones that I would most want to look at, to give me an indication of metabolic flexibility? We know that insulin resistance, for example, is creates a metabolically rigid state. We know this because no matter what you do, you'll see the body cannot use blood sugars and blood fats, and they both rise. So you got triglycerides high, and you got blood sugar high. So I look at those to assess insulin. And the other one, I would say the stress hormone is cortisol. And both of them are influencing this because insulin has a negative impact on cortisol in terms of also makes up on the first thing I'm looking at is any laboratory measures that can tell me about insulin and cortisol, either directly or indirectly. So that's going to be triglycerides, that's going to be fasting blood sugar, that's going to be fasting. Insulin is also going to be looking at, you know, ASD and ALC and some of the liver markers that basically tell us are we dealing with non-alcoholic steatohepatitis? Or what are we dealing with here? So to me, I'm looking at those things first. So as clinicians, I would say we have a lot of tests that help us infer this directly. Another one that I think is right there above calories. If I said insulin, cortisol, I think vitamin D because it does so much is another one that I'm looking at that I would be putting on top of a chem panel plus a CBC. So I would be looking at those to me next up is going to be things like looking at all the other downstream things related to the hypothalamus pituitary axes. So I'm interested in the HPA the HP T thyroid and the HB G don't matter so that to me is neck so now I'm looking at thyroid related dysfunction. And to me in that regard, TSH is not in my mind. All we want to be looking at because obviously what we now know with you know, tissue level hypothyroidism, you can be hypothyroid at the level of tissues and not see that showing up in the blood so to me, a full thyroid panel becomes next in line so we got campaign on we got CBC, we got vitamin D. And then for me, I'm looking at okay, I want to know what's going on with the firework. So for me, that's TSH, free T three, free T four, reverse T three, which I know is very controversial, but you can't tell anything about tissue level hypo thyroid without getting that marker. And then sometimes obviously, if you start seeing that there's an issue there you may want to go and look and see what's going on is there Hashimoto’s involved so maybe you're getting TPO and TBG antibodies. Finally from there then I go into testosterone, high sensitivity estrogen if you're a male and then estrogen progesterone, if you're a female and maybe SHBG, which by the way, SHBG also can tell us about tissue level hypothyroidism since estrogen and these things can or you know, thyroid can impact SHBG. So can estrogen and testosterone. So that is kind of where I start, I go calories. And I go what are the next three most important communication hormones in my mind now that all of us are professionals, so we could argue about this, but in my mind, I go instantly cortisol, vitamin D next, then I go thyroid, then I go testosterone and estrogen and progesterone, of course, there's some ancillary markers around that, like I said, as hBg, fasting insulin etc. So that's kind of where I start. I'd be interested to see how you evaluate that and what you think I'm missing but that is essentially how I break this down first, when I'm looking at what hormones do I want to measure. And by the way, what's really interesting about this, if you look at especially insulin and cortisol, you can tell an awful lot about those two hormones simply by i The biofeedback, the language, the metabolism the speaking. This is why oftentimes talk about a funny little acronym I use called SHMEC, sleep hunger, mood, energy and cravings, especially hunger, energy and cravings, insulin and cortisol, those two hormones are dramatically impacting hunger, energy and cravings, we oftentimes forget insulin is a hunger hormone both perhaps in and of itself, and also the impact it has on leptin. We also know that cortisol basically increases the motivation or decreases the motivation centers in the brain amplifies the reward centers in the brain, we know stressed out, rats tend to eat more highly palatable, foods tend to eat less often bigger meals, same thing happens in humans. But when you start seeing this SHMEC, sleep, hunger, mood, energy and cravings go out of check is a good indication that this hormonal software system is perhaps not doing well. And metabolism is under stress. And it would even if they're not running those tests, I would say, okay, right away, you're gonna see those issues sort of pop by so then I'm dealing with cortisol level issues and insulin issues. But that's kind of the big overview picture of how I look at endocrinology from the clinicians perspective, and actually what I teach because from my perspective, if you don't have a framework, then you're doing just, you know, running random tests and chasing numbers around. And what I want to know is okay, what's going on with sleep, hunger, mood, energy, cravings, exercise, performance, exercise, recovery, libido, erections, menses, all this stuff, which I would say is SHMEC, and expanded version of sleep, hunger, mood, energy, and cravings. And then on top of that, I go, Alright, here's how I look at the hormonal sort of system of running a campaign on CBC and then working my way up from there. And let's get back to the show.

Joe  31:23 

Yeah, and I appreciate that. I mean, I think as you just laid it out, like there's a lot that goes to it and a lot of things that assess, to assess and that all inter intertwine with each other. You know, everything that we do is elective based, of course. So I think one of the early on hurdles we really tried to press into as educating people on why they may need a more comprehensive panel or testing from the start. If they do come to us with specifically, pretty, pretty obvious, you know, low testosterone or different hormonal issues that we can kind of pinpoint, we do have some standardized panels as overtime and just from clinics, or from clients and patients that we kind of have packages out there to kickstart they're assessing what's going on, but then adding on as we go from there, and generally what we see is, you know, generally about six to eight weeks after we're treating somebody, whatever the initial eye popping gap was, we're follow up testing, to see are we you know, fixing what we put in there. And then taking a layer deeper, a lot of times looking at the metabolites of those hormones and testing those to see, how's it by declaring those hormones after? How's the, you know, everyone's so individual? How's the patient doing their side effect profile? Or symptomology? Did it improve? And then, you know, also looking at the different markers in regards to cortisol and things of that nature. So, generally, I'd say it's been shifting more and more, we're getting a more full comprehensive look right from the start with patients when they begin to get them to understand that full picture, but definitely within that first, you know, two months of working with us, because for some, I think it can be a lot to where they did a lot of research, maybe if it was a male and low testosterone or female, maybe some, you know, Perrier, postmenopausal type symptoms, but there's a lot of information out there for them. So they kind of come in with that information. And so it's breaking down some of that saying, Yeah, we can help you with those things. But let's take a look at the full picture here and figure out a way to move forward. So

Jade  33:22 

and not only that, I think one of the things that I know you guys pay close attention to and clinicians need to do once you get people on these, you know, hormonal therapies, you have to look, you know, for example, you got to run a hematocrit on a male, you got to do some of these things, just to make sure that and most always, you're gonna see the men are just fine, but you need to rule those things out and pay attention to that stuff. So that's why it is incredibly nice to have individuals who actually look at this stuff and understand it, rather than are missing things. That's another thing that I think we all could agree on. One of the things that's happening right now is people are there's many different avenues opening up where people are beginning to distrust, you know, some conventional medicine and, you know, going towards one direction or the other or working with people who don't have the background to understand some of the negative aspects of some of these treatments, and to be able to have a situation where you go, okay, yes, we're going to do this full panel, we're going to get you started. And then we're going to go and look and make sure that you know, you're not how your metabolism is responding to these appropriately, that you're not over aromatizing, that you're not having elevated or hematocrit as a result of this, that you're not having other mood changes and things of that nature. One of the things we do know, of course, is that these are some of the set if not, I would argue the safest medications on the planet. And part of the reason they are is because they're literally just our own hormones. And that's another thing I love about evolve in the way you guys do things. It's you know, it is very, very safe for the vast majority of people but of course, everyone's an individual and as a clinician, you have to make sure that you're not doing damage and so looking after those other things and then the other thing I would say there too, which is just a clinical part All for people listening, you know from this, one of the things with any kind of bioidentical hormone replacement therapy, you oftentimes see this a lot. Most people think, Oh, well, you get on testosterone replacement therapy, or you get on estrogen and progesterone or you get on thyroid hormone, and you're immediately going to see weight loss. Oftentimes, it's just like the study we talked about in the beginning, that speeds metabolism, and that can speed hunger. And so one of the things that I've learned in my clinical practice is we have to do some of the things that we now know can blunt that stuff ahead of time. So one of the things I'm doing is making sure I'm getting at least lean body mass in grams of protein per day, up to body weight in grams of protein per day. So make sure that if I give these this hormone replacement therapy, and I educate the client on that, we're gonna have to do something fiber based protein based, perhaps mainly I choose fiber, protein and water, because those are the low calorie, hunger, suppressing things to make sure we're not speeding up metabolism, and then speeding up hunger and educating the client about that, right, this is gonna make the metabolism a little bit more flexible, you'll feel you'll get a little bit more recovery from your workouts, but we still can't just give you these things. And how do you keep living a crappy lifestyle? Sure, leave those get you moving, get you hopefully lifting weights, get some protein on board, this, then this is where we talk about this idea of like lifestyle plus hormone, and then you get amazing results, putting hormones on top of a crappy lifestyle is gonna be better than not having them. Right. Like, you know, if you're, you know, if you have a low testosterone man who's eating all kinds of junk food and give him some testosterone, you're gonna, you're not gonna necessarily see him lose weight, but you may see his metabolic markers getting a little bit better. But ideally, we are doing some of the lifestyle things. And again, the reason I love evolve, because you guys are all into that it's kind of what you do, it's not to me just looking at, you know how you guys speak about this, you get that this is a lifestyle intervention that is done in the context of lifestyle changes. And that is where the power of these things, I think, is, I think a lot of clinicians and a lot of users get a little bit jaded from the perspective of if I don't change my lifestyle, and I take hormone replacement therapy, I don't necessarily see the body composition results that I would want, despite perhaps seeing the health benefits.

Joe  37:27 

Sure. Yeah, this one just for everybody out there to kind of give a brief overview of labs and starting and then what's out there in industry, and then kind of tie it back to what you were saying is, you know, general practitioners, where I've been told from physicians, they may have a course or to endocrinology or some of these topics, there's not a specific specialty, if you will, from in medical school. Generally on some of these topics, there's outside fellowships and things of that nature. So most of the time, and what I've experienced and in the feedback I've gotten out there is your general practitioner may or may not be comfortable enough to move forward with some of these treatments, and they're going to tell you, you're fine. And the range is pretty huge. And by the way, that range is based on a populace of people over the course of time. And so if you watch it over the last 50 years, and then the actual range itself little side snippet you may not people out there may not know is the range has gotten smaller and smaller, because the populace as a whole is testosterones gotten lower, which is a whole nother topic, we can talk about what's happening with our food quality and things of that nature. But the second thing is a lot of times too if you don't have a severe enough symptom, ology you know, some of the markers we have on our panels are that you have in an elective type setting, your insurance not going to cover there for your primary care may not write that up. So I think that that takes it from, you know, primary care, we certainly partner with those primary care folks out there. But then it goes to like, you know, your testosterone mill, right, there are clinics out there that they just focus on testosterone, and it's in their name, and it's in what they do. It's been, I think, again, it's kind of a progression up from, you know, not knowing what they're doing. But then it goes to the third phase, which I kind of just look at more than individualization as far as lifestyle management and then checking, you know, as far as dosages go of hormones, frequency of administration, lifestyle changes view mentioned, there's a lot of things that can affect that to where I think if you're, if you're at a clinic, where they're throwing a lot of Pharmacology at you, every time you have symptoms, you might want to put your hands up and say, Whoa, let's talk about this. And, and I think that's, that's really important for people understand that even you mentioned a little bit about, you know, estrogen elevating and a man will estrogen does a lot of things for our bone, or libido, brain and heart health and things start to get a little too high, maybe there's something going on there with estrogen methylation and how your body's actually metabolize faster and we can work on instead of throwing a bunch of other Pharmacology at you there right to kind of improve that which I know you've had some guests on your podcast kind of discussing that as well. So I It's important to look at that, as well as I, we've had a lot of patients come to us. And maybe we can unpack this a little further, but where the physician sees a slight elevation in hematocrit, and they kind of freak out, and they think that you got to go off this Astron away, because if I'm feeling great, what do you mean? And then, you know, some of the things I've heard out there from clinicians, I like to get your perspective on it, as you know, someone's from adequate isn't a normal range that happens develop a few points from testosterone. I think the argument out there is, you know, first and foremost, why didn't this person have a cardiovascular event when they were 20 years old when their testosterone was at that level. So in other words, if you have low testosterone and Andrew, the androgens induce elevation of hematocrit, by supplementing it right, so getting you back to where you were, when you were 20, then generally your hematocrit is actually just going back to where it was 2030 years, it was just like your testosterone is and so that's something that, you know, I think is a lot of, again, I'm not a medical professional, per se, this is what I'm hearing. And I'm just kind of scratching my head. And I've talked to other clinicians out there and practitioners, and I'm like, Am I seeing this? Right? Because just seems like there's a quick jump in the scare. And it's like, well, maybe, again, we're not talking to him adequate of 60 or something, we're talking a few points that it's elevated, and it's right away, they have to stop treatment, but the guys, you know, the gentleman's feeling amazing from results from that. And so, I'm wondering out there and just do your research and what you look at speaking specifically to some of the bloodwork, you know, we know if if you could talk a little bit about Federico cytosis, what you see there, you know, some of those subsets, probably SEMA and vice versa, and how that, you know, when it's kind of alarming in bloodwork, and just what does that range look like? or what have you seen it? As far as well, first

Jade  41:46 

of all, you were you rarely ever see it, right? You rarely ever see, as matter of fact, I can say I have not seen it in my clinical career at all. And also to your point. You got it. From my perspective, when we when we look at these numbers, I think it's a mistake to focus on single numbers and single labs. What we need to look at is we got to go okay, what's going on with this person? So for let's take insulin, insulin resistance, and let's say metabolic syndrome, for example, we're going to see a lot of the things already that we are scared of with, let's say TRT right, we're going to see some of those some of the issues for example, some of the things that a lot of people will complain about with testosterone replacement there, you get afraid, well, what's happening with the liver, right? What's What are we doing with the liver, the liver has to deal with these hormones, what's happening with some of the blood numbers automatically being one of them. To me, if this is an individual or I see their blood sugar's have gone down, which will you see on TRT, almost immediately, their triglycerides have moved down into the normal range, which you will see almost immediately with TRT, they have lost a couple of inches in their waist, which again, you will see almost immediately with TRT, and especially if you are doing some of the lifestyle stuff and then their emetic rate jumps up a little bit. I'm not concerned, I wouldn't be concerned about that at all. And I have seen those changes, but you have to look at in the context. And by the way, blood pressure comes down, right. So everything that we would relate to metabolic syndrome, which in my model is a you know, the extremely rigid metabolism begins to clear up with GRT. And then what you'll see is people will go off and say, Well, what about this particular number? To me you've had and I think you're looking at it the exact same way I look at it, I go, I'm not going to chase numbers around unless those numbers are way out of range. Right? And most of us right but this is the other thing that no one talks about in medicine most of us Doc's don't even know we work with these things we don't know we have to we look at the ranges as well. We don't all have these ranges memorized in our heads. But to me, I think the mistake that a lot of clinicians make and a lot of people who are commenting on this as to you always got to look at the holistic thing if you see everything moving in the right direction, in terms of what all the vitals and most of the blood labs moving in the right direction, then I don't think you need to be really concerned at all unless you see something go way out, for example. And here's an example that I do see a lot with TRT, actually with men, most of the time, men will come and want TRT because they're starting to see less responsive erections. Right this is the thing that scares them into I better get but I have seen TRT be you know, going higher in TRT, causing issues with erections in men who do not have it, because you alluded to it estrogen is very important and libido and erections and it needs to be in the Goldilocks zone. So what we should and the my whole point of bringing that up is that we need to look at symptoms first, not just blood labs, and then you can go and look at the blood labs, right. So you say oh, your erections got worse. Let's go and look Oh, you're you're strongly aromatizing your estrogen went up. It must be too high. then we adjust either through using natural compounds or Arimidex or something like that, to control that. But we don't jump on board in my mind you don't go Oh, you're you aromatized like crazy, your estrogen is high. And then the guys like, I feel great, my erections have never been better, you know, I'm not getting gynecomastia, mountain Wiener, my blood sugar's have gone down, my triglycerides have gone down. I'm not as concerned about that. Now, of course, you want to monitor it, because you go, Okay, well, maybe he's aromatizing, maybe we'll see some issues there. But you can't divorce the labs from, you know, the patient. And we do that a lot. So to me, that's my take on it. And I think that's in line in line where sort of you are, it's really just measuring these things to make sure that this is not an individual metabolism, that are doing things because we are all unique, and the way we toxify, estrogen and testosterone and these things can be unique. And for some people, we need to make sure that we're not making things worse, and it almost never happens. And so it's really just one of these things like you know, we all took an oath first do no harm. That's part of what you're doing. But the idea is by withholding a lot of these treatments simply because you're afraid of one or two numbers going off on the labs, instead of looking at what's going on with the individual patient. That's also violating first do no harm. So that's, that's sort of my take on this. Yes, we should be following up. Yes, we should be looking at these numbers, they should not be scaring us because to your point, if everything else is going in the right direction, and you see thematically jump up a little bit, or you see estrogen rise a little bit, but everything in this man is better overall, then that's not something I'm going to do. I'm just going to make a note of it and say, Okay, let's watch this. I'm not going to all of a sudden come off. Replacement Therapy, especially when I've seen how much healthier they are. And I think this is the right approach too many people are chasing labs around rather than looking at the client sitting in front of them. So that's how I address that.

Joe  49:39 

No, I appreciate that. I think two things as you were talking that just popped out in my mind. The first is whenever you're starting any form of new exercise nutrition program, you know, therapies, pharmacology nutraceuticals there's always some form of a risk factor to starting it right. There's something that may counteract a certain weigh in your body. But I also think it's I don't know, if I want to give him the benefit of doubt, I think a lot of people out there maybe just not as well informed. There's other I think people should be educated on the risk of not taking action as well. So there's very well documented studies on Well, if you don't do X, Y, and Z. Yeah, you know, if you go do this type of, you know, workout, whatever the case is, you could injure yourself. But if you don't take partake in these activities, like these are the health consequences, the same goes with hormones to where, yes, you know, there may be some things that we have to massage and work through in your protocol. And that's why it's important, someone's constantly assessing someone along the way. But also, hey, by the way, while you're concerned with those things, I want to make sure you're aware of these things over here that this is also what the research tells us. And, you know, the clinicians and people have worked with people for 50 plus years. Now, this is well documented that not take action. These are the other consequences that come with not taking action as well. And I think sometimes that's, that's often overlooked.

Jade  50:59 

And there's a big misconception, especially among the public, right? There's this I'm an I'm a naturopathic doctor, okay, so I if I have a bias, it does skew slightly to the natural medicine side of things. However, the natural medicine bias that is dominating in the, you know, sort of in the medical world right now, I'd say it's even in the medical world, and it's definitely in the lay public world is a problem, especially when it is keeping, you know, what I would say is the bioidentical hormones are about as natural as they get when people are foregoing thyroid treatment when they're foregoing testosterone treatment, estrogen and progesterone. These are some of the best anti-aging compounds we have, if not the best. And so part of what's happening too is this natural medicine bias is every bit as dangerous as the conventional medicine minds. Remember, we used to hate the idea that conventional medicine was just throwing pharmaceuticals at us. Well, we should be every bit of skeptical on the other side, that the natural medicine world is saying, Oh, just take metals and pie GM and, you know, this kind of stuff, instead of taking the remedies. You know, that's not how we should be looking at, we should be doing an evidence based process, what works. And we have the data that tells us, these are the best anti-aging health, pharmaceuticals, we can have. I don't even want to call them pharmaceuticals, because they're, they are the natural hormone we would be replacing, or making in our bodies in the first place. And so I do think that's part of the reason we get confused with some of these discussions, the natural medicine bias is getting in the way for a lot of people and I do know people constantly, I don't want to take my thyroid meds, I'm just like, that is going to lead to issues way down the line, you know, increased risk of dementia, increased risk of heart disease, increased risk of all kinds of things if you're not taking your thyroid medications. And I would say the same thing with testosterone replacement estrogen and progesterone, there are just so many benefits to these hormones that I think the skepticism in medicine right now is. It's not it's no longer warranted, the data is simply there to show us that these are powerful anti-aging, health giving hormones, and yet, there's still this huge sort of resistant to it, which kind of blows my mind, the only way I can wrap my head around that is just this anti pharmaceutical natural medicine bias that people have. And it's unfortunate because it's starting to permeate, you know, into the professional ranks as well. And it might be surprising for people to hear me as a naturopathic doctor say this, but that's absolutely the case. And we always have to guard against bias and dogma in the way we do medicine. So to me, I go, the only bias you should have is a bias against bias. Right. And we have to be very careful about that. So that's my thought on that. I don't know if that's off topic for you or make sense. But that's what made me think of.

Joe  53:58 

Yeah, I appreciate that. Actually, I think it brings up a good point. Maybe if you can talk through just in your expertise on how the difference between like synthetic hormones and bioidentical hormones. I think there's, you know, some misconceptions out there of how those work and some pros and cons and things that maybe you could walk that walk us through that a little bit.

Jade  54:18 

Yeah, well, first of all, the big thing is, right, it's like, you know, people think if they're, if you're taking, you know, Primobolan or you're taking trenbolone, or you're taking something like that they equate this with testosterone therapy, these things are not testosterone theory, they're not even on. They have some anabolic properties and androgenic properties. That course testosterone has anabolic and androgenic properties, but they're different compounds and test and they're not testosterone. So that's the first big mistake people make. They think anabolic steroids is testosterone. It is not these. These are two different things. Testosterone has a amazing safety profile because our bodies are used to these other things. NGS, by the way, still have a pretty good safety profile, believe it or not, because they are analogs, oftentimes of testosterone and things like that. But these are the ones that can be a little bit dangerous, especially and this brings me to the other point in the way a lot of people use these, it's when you're doing TRT testosterone replacement therapy, you are restoring physiological range, and maybe we're pushing to the upper physiological range. And to Joe's point, right, you know, that range is probably much higher than we think, you know, it's probably, you know, right now we think, Oh, 800 to 1000 is where people should be, well, there's an argument can be made, it's closer to 1200 to 1600, based on Paleolithic individuals, and things like that. So we don't necessarily know but what I'm doing is pushing people up to 1000, you know, up near the higher range of physiological, and I'm mostly doing that not based on numbers, but based on how they feel. So again, these are not super physiological, or ranges and doses were getting. So that's the other thing. They're not anabolic. Anabolic steroids are not testosterone replacement therapy, too, we are not doing super physiological doses of this stuff to get you up near 1600, or 2000, or that kind of thing, we are basically getting you restoring optimal levels to where when you were younger, and we're looking at that, of course, taking into context and saying, and this is the third and last point here, it is also taking into context, this individual and where they are in their life and what they are actually doing, and then how the testosterone is actually impacting them. And that is why the follow up tests are important not because we need to be terrified of them adequate, simply because we want to understand how this hormone is currently interacting with the other side of the equation, which is the lifestyle, and then we make changes on both sides, if necessary, but I think that kind of gets people to understand, which drives me nuts. They're like, Oh, you're on, you're given anabolic steroids. That's very different than most clinicians, I think, understand that most of the lay public, does not. And those are those are very different things. I don't know if I missed anything there that you want to cover as well. But that's kind of how I think about that. Yeah, no, I

Joe  57:10 

think I think that makes a lot of sense. I think that's, that's definitely something when we get our phone rings, or people are reaching out, it's to kind of talk through the differences and what our goals are, what we're actually doing, and what they can expect from it. We'd like to shift a little bit in I know a lot of your content, and it's both male and female. But I know you also have some really good stuff and, you know, women, female, endocrinology, and, and content and a lot of things that you've done to help women out there that are struggling some of these issues. Can you walk through kind of the same hormone cascade, and just what you're seeing overall and some of the big hormones with women, and what are some of the questions you're getting and how are you helping?

Jade  57:51 

Well, I mean, one of the things that's really interesting, right, as you look at estrogen and progesterone, I like to think of them is not identical twin sisters is the way I like to explain to them and twin sisters because they rely on each other obviously, they prime each other's receptors, and they work in rhythm together non identical because they do slightly different things now both help control cortisol, but they're antagonists. So after ovulation, she's essentially making sure that some extra triglyceride and some extra blood sugar around in case that egg gets fertilized the way I like to say that now the way I like to look at this is that most of the time at a young woman it's going to be lifestyle oriented, we can begin to we don't need hormone replacement therapy. Once a woman starts going into perimenopause, progesterone drops off first. And so almost progesterone alone therapy for Peri menopausal women is fantastic. And pretty much all that is needed. Once you get into menopause and post menopause. That's to me when you start to bring the estrogen on board. And so that's the kind of the way I look at that. It's like younger women. Certainly they can have some hormonal related issues that usually can be addressed through natural therapies, things like vytex and things like that natural changes in diet. Once you start getting into perimenopause and menopause. To me, there are other things you can do. vytex does work very good in the peri menopausal period. But to me, that's when you're looking at progesterone alone. Because what happens is progesterone drops and then estrogen starts being volatile and bouncing all over the place. So you put in progesterone that calms assistant, the estrogen goes, Oh, my sister is still here. I don't need to freak out. And when estrogen drops as well, that's to me where you begin to add in some of the estrogen therapies. Now obviously, that pre-menopausal period lasts a very long time. And I have had women on progesterone, I like oral progesterone therapies rather than, you know creams and things like that oral progesterone therapy for a very long time and they do incredibly well. Then when they start moving into menopause based on symptoms again, based on looking at the individual, you can either take them off the progesterone and they do just fine or you transition into progesterone and estrogen So to me, it's a very interesting way of doing this. Now one of the things that we see a lot is testosterone in women as well, which I also like and can be really useful for especially postmenopausal when you start seeing those changes, and you're kind of getting a two for one there, right? Because you are getting some estrogen from that testosterone. And estrogen and testosterone are kind of doing very similar things in women, estrogen is anabolic. It is insulin sensitizing. Testosterone is also anabolic, and insulin sensitizing. And so oftentimes, you'll see people in post menopause go to testosterone replacement therapy, especially if you're dealing with people who don't tolerate estrogen. Well, and that's another option, because you're kind of getting a two for one there. But that's kind of how I look at sort of the female cascade younger women, I'm not really doing anything other than adaptogens like vitex to help get the system back and, and lifestyle medicine and then progesterone therapy by itself, and then adding in estrogen to the progesterone and then possibly testosterone in lieu of those or sometimes in addition to those as the woman ages and gets into sort of a postmenopausal period. Sure if the way I see that,

Joe  1:01:13 

yeah, no, I appreciate that. Now, if I remember I'll come back to lifestyle and things that you're doing with younger women, but I did have one thing I wanted to make sure we capture is, you know, Peri menopausal I think that's when a lot of women that at least I'm in discussion with them seeing is they think it's kind of more of a on off switch like I'm you know, a healthy vibrant everything and then all sudden boom menopausal, right? And so perimenopause, what, what are some common symptoms or things maybe women are experiencing that could kind of, you know, turn on the aha moment to say, I should probably call someone or get checked or check my values or things of that nature? What do you what are you seeing

Jade  1:01:51 

out there to me is a really important point, right? Because most of the time when people think they oftentimes think sexual symptoms, most of the time with men too. The first thing you're gonna see is Brain Stuff. Men will start losing TRT, they'll start losing their drive, they'll start losing their focus their ambition, then I go, oh, something's going on here for usually before they lose, you know, sort of erections. Same with women, what you're going to start seeing is progesterone. Some of them which progesterone metabolites influence GABA, GABA is the number one relaxing neurotransmitter in the brain. And so one of the first things you will begin to see is worry and anxiety that was not there before and emotional volatility. Most women by the way, I get this right away, it's sort of like they get into if they've ever had PMS, which not all women do. And PMDD, the mood related PMS. That's a lot of what perimenopause can feel like to a woman. And it starts to feel very volatile. And of course, estrogen controls dopamine and serotonin, which makes you relaxed and focused. And so sometimes, because progesterone goes away and estrogen starts to jump all over the place, you can start feeling a little bit like volatile and almost like bipolar in a sense, one minute, you feel focused and normal and good and high self-esteem. And the next minute you feel exactly the opposite scatterbrain worry insecure, all of that kind of stuff. And so that's how you begin to know that a lot of times it's going to be a mood related stuff. And it may not be as as pronounced as I'm describing it here. But I would say the first thing you begin to notice is that now in terms of physiology in the body, and not physiology in the brain, you start seeing an increase in waist circumference despite the weight staying the same and that's because the way I like to explain this is like imagine Joan of Arc with her armor on and her shield. Well estrogen is the armor gives a little bit more protection, but progesterone is the shield. So they are the armor and the shield against female belly fat. Once progesterone goes away, you're losing a piece of your protection. So now cortisol can exert a more pronounced impact on the midsection and of course when estrogen goes away, you really start to see this but you can see that starting to happen in perimenopause as well. So what you end up having is this volatile, unstable mood fluctuating a lot, you start to see some of the hot flashes that occurred not in all women, but estrogen in the hypothalamus, we believe and progesterone might be playing a role as well. But this fluctuating estrogen can cause temperature changes as well. So you begin to see some hot flashes, you begin to see that that temperature regulation and mood and then you start to see increased fat deposition around the middle regardless of what they're doing lifestyle wise, and this is when it really starts to be like what is going on. Nothing has changed in my diet. And by the way, this will happen despite any increase in calories. Now this is the part where we can see some of the primacy of hormones and body Opposition because, you know, there's no change in diet, there's maybe they're not even responding with hunger and cravings, they just become more insulin resistant as a as a result of loss of progesterone. So that becomes an issue.

Joe  1:05:14 

Yeah, and I think that's a lot of assumption, I think we're going to pop up earlier than say, you know, women have that kind of, you know, 20 day cycle that is constant giving them feedback. As far as how their hormone health is doing, so I think it's important to pay attention that, but you know, anything you would see later as far as, or you've had reported, or things of that nature, as far as when progesterone starts to drop off as far as how it affects that cycle and things of that nature?

Jade  1:05:48 

Yeah, well, you know, think about what ends up happening right. So once you the progesterone comes along, after ovulation, the follicle becomes the corpus luteum, which then it becomes a source of progesterone. So if the woman is not ovulating, which at time she will, and at time, she will not in perimenopause, then sometimes she will feel normal and have normal progesterone. And sometimes she won't. But what I described previously, when that's happening enough, you're not necessarily going to see all the changes at once. So what I would say is, if you're seeing, let's say, some beginning mood issues, and you realize you didn't have a menstrual cycle, and then you had one, and you're seeing on the on the times you have it, the mood sort of goes away, then you can kind of see, okay, this is what's happening. By the way, I have prolonged this in many of my patients using vitex, which is why I love it, it kind of can. And it's I've even seen it bring menses back in women who are younger in menopause, so like, let's say, early 40s, and that kind of thing, and then getting on vitex, and the menses sort of coming back. But it's when all three began to occur, that there's a problem. And then later on to kind of follow that through. That's when you usually start to see after perimenopause, once estrogen falls, this is where you start seeing vaginal atrophy. This is where you start seeing a lot of the libido lowering progesterone doesn't necessarily get involved there as much. But this is when you start seeing some of the sexual dysfunction as you progress through period menopause. So there can be sort of this linear sort of way that you're kind of looking at and saying, oh, maybe it's beginning because the mood is starting next seems to be Oh, now all of a sudden, I'm seeing some increase in body fat deaths deposition around the middle. Oh, now I'm starting to see some of the sexual signs and things like that. Whereas I think most people just go, Well, I'm fine, because I'm not seeing any of the sexual issues yet. Right. And then they don't realize that these things are impacting brain as much as they're impacting, you know, the ovaries and all this kind of stuff. So hopefully that makes sense.

Joe  1:07:57 

Yeah, no, I appreciate that. In anything in regard to I've seen some information out there on during perimenopause will not sure if you can unpack it further. Or if it's just the when the adrenals starting to take over when progesterone goes down, and just kind of how it how it affects that you were talking a little bit about the cortisol and some of the strains that puts on some of those other systems, when that's going on. Anything there to that you can unpack a little further from there?

Jade  1:08:26 

Well, I can clear up what I think is a common understanding, which I think we now know does not work this way. There's something called progesterone or pregnenolone steel, that a lot of people in the functional medicine world still teach, which most of us who take endocrinology very seriously would say, this is not actually what's happening. So the old thought, in men and still is in many of the functional medicine circles is that as progesterone drops, that of course, in the adrenal glands, you produce progesterone as well. And it's biochemical pathways going to cortisol. And it was believed that the this could be essentially a primary source of progesterone in the blood that then the body could use in lieu of ovarian progesterone. So this is this, we believe is probably not at all what is happening here, it is probably more a result of the the idea that what progesterone is doing to antagonize a cortisol effects. And then as progesterone drops, those cortisol affects become more pronounced. That is probably what is going on there. But it still right, whichever way that you look at this, this is the good news clinically, that you still do the exact same thing and the exact same thing is, at this point in time, you really have to make rest and recovery and these kinds of things. priority for the women. This is where things like spa time walks in The woods massage, you know, sex and physical affection time with pets, creative pursuits, anything that begins to decrease that stress burden becomes a primary intervention. And this again shows the weakness of just the Eat less exercise more approach. Because ultimately, there's another aspect to this, and this is the mindfulness component. And the way we see and adapt to stress is all is a lot about what can we do to lower stress. And there are many, many lifestyle things that lower stress, by the way, if you eat too much or too little, you're going to have negative stress impact. If you exercise too much or too little, you're going to have negative stress impacts. So to me, it's this Goldilocks idea. And when you reach this stage of life, it's basically saying, okay, yes, diet and exercise are both very important. However, I can't do too much or too little. So you got to regulate that. And then secondly, I have to move into this more mindset, mindfulness oriented lifestyle, where an extra hour in bed may actually be a better treatment than an extra hour on the treadmill. And this is what a lot of women don't understand. And I think a lot of clinicians are confused about that as well.

Joe  1:11:13 

No, it's a great, great point, and you articulate it? Well, as far as how that it's a, you know, it's a whole big cycle, where things you know, on the outside and the inside are affecting each other. And I think all the more reason to test, assess and adjust as you're going through those things. And having that that well balanced are there so.

Jade  1:11:33 

And to me that what you just said right there to me is the end, the end result of what we all should be doing. You know, it's test, assess, adjust, right, I use the assess, investigate, modify the aim process, if we're doing good medicine, that is what we are doing. And we're when we are adjusting, we should not be just adjusting pharmaceuticals. And we certainly should not just be assessing labs, when we assess, we want to assess all the stuff laboratories, SHMEC, sleep, hunger, mood engine, cravings, all that biofeedback, and vitals and blood labs. And then when we adjust, we also want to not just be adjusting pharmaceuticals. And I don't really put Bioidentical Hormone Replacement Therapy in that category, I see it as a natural treatment. But we also want to be doing that in with the lifestyle as well. So I think, again, it's a more holistic view. And I do think a lot of whichever direction clinicians are coming from now, whether they're more natural, functional medicine oriented, or whether they're more conventional oriented, I think we all could agree that the more holistic view is the more effective view clinically, for the end user. And so that's kind of how I look at that. It's very important. But yes, you do have to look at this and then adjust and then look at it and then adjust and make sure you're assessing the right things, not just laboratories.

Joe  1:12:52 

Well, doctor did your wealth of knowledge, appreciate you walking through everything with us today, I have a list and I could go on and on all afternoon, but I want to be respectful of your time as well. So we'll definitely have to do this again sometime soon. But I want to give a chance to just to get it just where can where can people find you? And just your website and things of that nature where they can find more content?

Jade  1:13:14 

I'm at Jade Teta on all the social medias. Jadeteta.com is my website. My podcast is next level human. And absolutely love, love what you guys are doing, Joe and so appreciate you as well. Thank you for my work or for your work. And thanks for having me.