Hormones with Dr. Dominique Fradin-Read: Rational Wellness Podcast 121
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Dr. Dominique Fradin-Read discusses Bioidentical Hormones with Dr. Ben Weitz.
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4:20 Perimenopause is the period during a woman’s life when her hormones start to decline and her period starts to become irregular. She may start to feel tired and moody and some women become miserable. Not only do her ovaries start to produce less hormones but her thyroid as well. Low thyroid function can lead to weight gain, sleep issues, moodiness, and anxiety. Progesterone is really the first hormone that starts to decline during the perimenopause. There are some natural methods to balance your progesterone, including eating yams and taking some nutritional supplements, including Vitex or Chasteberry, omega 3 fats, and also evening primrose oil.
9:00 During menopause some women have a very tough time and some women sail through menopause with very manageable symptoms. Genes play a role. In some parts of the world, like Africa, women don’t know about menopause. The stress of our society tends to make menopause worse. Our stress hormone, cortisol, can interfere with progesterone. Menopause is often a time of upheaval in a woman’s life. Her kids may be leaving for college or moving out. Such family changes are stressful and can add to how a woman feels. Dr. Fradin-Read said that she notices that women who get good support from their husband tend to do better. Also, a poor diet and lifestyle can make going through menopause worse.
11:46 After menopause, women do not produce very much estrogen. A small amount is produced by the adrenals. During the perimenopause a woman can have too much estrogen and be in estrogen dominance and they will have breast tenderness, feel bloated, have trouble sleeping, and feel anxiety. She likes using a supplement during perimenopause called DIM Detox from Pure Encapsulations, which contains DIM and broccoli extract and other nutrients to promote the detoxification of estrogen.
13:50 Dr. Fradin-Read said that she does not prescribe hormones to women. She explains the benefits and the risks and lets the patients decide. She always believes in using the lowest dose possible. She knows that breast cancer is the biggest concern with taking estrogen, but she has never had any of her patients get breast cancer with the dosages that she recommends. Also, taking estrogen topically is much safer to reduce the risk of clotting and cardiovascular disease. Oral estrogen increases the risk of clotting. She screens her patients for clotting problems and also counsels them about diet, exercise, sleep, and stress relief. She provides a comprehensive approach to using hormones.
16:10 Dr. Fradin-Read tends to recommend bioidentical hormones. She likes to use a mixture of estriol and estradiol. She never prescribes estrone, which has a much higher risk of breast cancer. If a woman has a lot of hot flashes, she will tend to recommend a slightly higher dosage. If patients prefer the ease of an estrogen patch, she is also ok with that. She does not like pellets, because is the dosage is too high, you can’t take the pellets out. She likes women to be their own boss as to how much hormone they need on a given day. If they have breast tenderness, that means they need to decrease the dosage.
18:35 Dr. Fradin-Read will sometimes prescribe progesterone in a rhythmic fashion and sometimes she’ll use it daily since it helps so much with sleep, which is what she does for herself. On the other hand, too much progesterone can cause depression and it can increase the risk of high sugar and insulin resistance, so for patients with a weight issue, doing progesterone for two weeks at a time per month may be favorable. But it can bring back a woman’s period. She has a few patients on the Wiley protocol where you try to mimic a woman’s natural cycle of hormones. You start low with the estrogen. You go progressively up to day 12, so just before ovulation. Then, you add progesterone at that moment at a relatively low dose, and you go up, up, up until day 20, 21. Then, both of them, you are done through the end of the cycle. It does involve a higher dosage of hormones and this tends not to work as well in women that are heavier, because they store estrogen in their fat cells.
23:26 There are various ways to test for hormones, including blood, urine, and saliva. Dr. Fradin-Read tends to do blood testing for hormones. She may test on day 3 or 4 to see the resolve of eggs with FSH at that time, on day 12 or 13 to see how to go with estrogen levels, and on days 19-21 when we are the highest with progesterone. Sometimes for women taking hormones topically she may do saliva testing. On the other hand, for women not taking hormones, saliva testing does not make sense and can yield unusual results.
26:40 When Dr. Fradin-Read recommends hormones for her female patients, she tends to prefer Biest, a combination of estradiol and estriol, which is a less potent hormone. For women who have a lot of hot flashes and other menopausal symptoms, she might recommend 80% estradiol and 20% estriol. If a patient wants to take hormones who has a family history of breast cancer, she might recommend 80% estriol and 20% estradiol.
29:00 In order to reduce the risk of blood clots from taking hormones, Dr. Fradin-Read screens her patients for genetic clotting risk, like Factor Leiden V. She asks about their history of blood clots and stroke and their family history of clots and stroke. She cautions her patients to drink a lot of water. The biggest risk factors are if they fly long distance, get dehydrated, or if they have an injury or sickness and are resting in bed for a while. When you go on a long flight, Dr. Fradin-Read recommends taking a baby aspirin, drinking a lot of water, and using compression stockings.
31:35 The best diet for menopausal women is the modified Mediterranean Diet that is lower carbs than the traditional Mediterranean Diet, but is rich in colored fruits and veggies. She sometimes uses a ketogenic diet for a short period of time with her patients, but it increases your cardiovascular risk because it has so much animal, saturated fat. She likes the pescatarian diet, which she uses for herself.
34:02 Men sometimes have low testosterone and Dr. Fradin-Read does treat men as well as women. The first thing Dr. Fradin-Read looks at is their BMI and their belly fat, which if it is high, will reduce their testosterone levels. She also asks if they are exercising and if they are sleeping well. Men make their testosterone when they sleep at night, so if they are not sleeping well, they can’t make as much testosterone. Men also need to make sure they consume enough protein to make testosterone. A lot of alcohol can also decrease testosterone levels. If men are under too much stress, cortisol will lower testosterone levels. The first supplement she will look at this DHEA, which is a precursor for testosterone. There is a medication, Clomid, that can help with testosterone levels. Also, HCG, human chorionic gonadotropin, is an injectible drug that can increase testicular production of testosterone and it may also help them to drop some fat. She may prescribe bioidentical testosterone get or cream that you rub on your shoulders. But some men prefer the injectible testosterone and she may recommend 50 or 100 mg per week. If men take too much testosterone, it could increase PSA and increase their risk of prostate cancer. Dr. Fradin-Read also pointed out that she monitors the red blood cells in men taking testosterone, since they will tend to produce more red blood cells and this can lead to clotting, so she monitors this (red blood cells and hematocrit) regularly.
Dr. Dominique Fradin-Read is an Integrative Medical Doctor in Santa Monica, who is board certified in Preventative and Anti-Aging Medicine. Her clinic and website is VitalLifeMD and her office phone is 424.325.3368.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health. Hello, Rational Wellness Podcasters. Thank you so much for joining me again today, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcast, no longer iTunes, Apple Podcast and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast. Also wanted to make sure everybody knows that if you want to see the video version, you can go to my YouTube page and search for Weitz Chiro or the Rational Wellness Podcast, and there’s a video version on the YouTube page, as well as videos of a lot of our functional medicine meetings that are not included in the podcast. Then, if you go to my website, drweitz.com, there will be show notes and a complete transcript of every episode. I also just wanted to make sure the listeners know that I am currently open to accepting new patients in my functional medicine practice.
Our topic for today is hormones and our understanding of what happens with hormones throughout life, particularly during perimenopause and menopause in women and in men during andropause, and then, what are the most effective and safest interventions especially for functional medicine-oriented practitioners to take with their patients. Menopause is when a woman’s body is shutting off its reproductive capabilities. There’s a decrease in estrogen and progesterone production by the ovaries, which often results in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, depression, weight gain, vaginal dryness, hair loss and fatigue. The long-term effects of menopause include risk of osteoporosis and of cardiovascular disease. Testosterone and DHEA also decline, but in contrast, they decline with … They also decline with age, but in contrast, not as precipitously with menopause as estrogen and progesterone do.
Dr. Dominique Fradin-Read is board-certified in Preventative and Antiaging Medicine. She was born in France and started her medical practice in Belgium. She moved to the US in 1999 and did an internship in Internal Medicine at Loma Linda Medical School, Loma Linda University Medical School, and she’s currently an assistant clinical professor at Loma Linda Medical School. Dr. Fradin-Read has an integrative medicine practice in Santa Monica. Dr. Fradin-Read, thank you so much for joining me today.
Dr. Fradin-Read: My pleasure. It’s a pleasure to be here with you, Ben, and with your audience.
Dr. Weitz: Can you explain what is a hormone, and why are hormones so important to our bodies?
Dr. Fradin-Read: Well, hormones play a crucial role in various, various functions and various organs in the body. They are very small molecules, tiny little molecules secreted by various glands in the body, and they have targets, so they go to different organs, and they bring messages to these target organs. The organs will respond upon what that hormone tells them to do, so that’s why hormones are so important. They are messengers of good health.
Dr. Weitz: Great. What is peri, the perimenopause, and what happens to a woman’s hormones during this period?
Dr. Fradin-Read: Perimenopause is the period where you are not fully, fully done with your ovarian function. There are still some eggs in your ovary, but they might not be as good qualities as the one you had when you were 25, and they are not doing the good job of having a regular cycle every month and helping you feel vital, healthy, young, full of life. Your brain is functioning well, so you have all kinds of decrease in functions in all these target organs I was talking about, so you start having mood issues. You start having some irregular periods because your uterus is not supported in the same way it used to be. You start feeling tired. Your thyroid might be a bit off too because they talk to each other with the harmony of your body that is a little bit imbalanced. It is a period where some women are miserable. They come to me crying and tell me, “What I can do, doctor? What can I do to feel better?” That’s an important period of their life too to help those nice women.
Dr. Weitz: How is thyroid involved in the perimenopause? How is that affected?
Dr. Fradin-Read: Thyroid is often involved by a lower function. When we get older, all these hormones, they tend to go down, so low thyroid function is going to cause being tired, putting weight on in your midsection, sleeping issues, mood issues. Anxiety is a big one. Some women come to me and say, “I don’t know. I’m so anxious. I’m anxious about things that I was never anxious before. What’s going on with me?” I tell them, “Don’t worry. It’s not you. It’s your hormones. If you fix your progesterone that talks to the thyroid,” because they are all, again, in harmony, “You will feel better, and we have to adjust the thyroid, of course.”
Dr. Weitz: Progesterone is the first hormone that tends to decrease during the perimenopause?
Dr. Fradin-Read: Actually, the first part of the changes in hormones in women, it’s a low luteal phase. The luteal phase is the second part of the cycle after ovulation. Most women still have some eggs, as I can see, that are there waiting to be expelled, but it’s hard. The ovulation is delayed, and you don’t have progesterone before ovulation comes, so if you are not ovulating very well, your progesterone goes down. Progesterone is the feeling good, feeling rested, feeling calm hormone. It’s the very, I would say, calming hormone among the two, so now, you’re on estrogen dominance. You’re going to be nervous. You’re going to be excited. You’re going to put weight in your midsection, so that’s why it’s very important to balance out your progesterone to the level that it should be at that moment of your life.
Dr. Weitz: Are there natural methods that we can use to balance our progesterone?
Dr. Fradin-Read: Absolutely. There are some natural supplements, or eating a lot of yams can be a good thing in your diet. You can start with the diet. Then, there are some supplements that are going to help directly and some a bit indirectly. The one that I like are things like Vitex. I don’t know if your auditors know about Vitex.
Dr. Weitz: Yeah, I think we often refer to it as Chasteberry.
Dr. Fradin-Read: That’s it, beautiful, and also, we have the evening primrose oil that does a really good job, okay? Make sure they have enough EPA DHA. That means Omega, they’re the good pills because Omegas are helping your hormones get at a good place. Make sure that you eat enough fruit and vegetables who have fibers to also eliminate some of the toxins that would interfere with your hormones, okay, so a good diet.
Dr. Weitz: What are the dosages of Chasteberry and evening primrose oil that you think are necessary to be effective?
Dr. Fradin-Read: These are good questions. I would not answer directly because it’s very much patient-dependent.
Dr. Weitz: Well, just give us a range-say.
Dr. Fradin-Read: Well, I would say 120 to 300, okay, for the evening primrose oil.
Dr. Weitz: Okay.
Dr. Fradin-Read: The Chasteberry will be, I’m not sure. I’ll have to check on that one, okay? I will check.
Dr. Weitz: Okay. Okay, so what happens? Let’s go into menopause, and why do women often have very different journeys? Why do some women have a horrible time? Why do some women sail through menopause with not very manageable symptoms?
Dr. Fradin-Read: Good, so first of all, there’s definitely a genetic component of it, okay? There are families where a woman goes through menopause with actually, with no issues, and you know families that’s the opposite. There would be women who suffer a lot, and it could be in good genes, but it could be also the way we were raised. When you heard your mom complain about menopause some years ago, you are more prone to focus on that and see what could happen to yourself, okay? We know also that civilization. Women who are away from civilizations make menopause much worse. In Africa, in other countries, in South America, they don’t know about menopause. They go through it with no complaints, nothing. Trust is a big one. In our civilization, we are running all the time. We are in the traffic. We are worrying about our kids, so this is definitely a big component because it implies the action of cortisol.
Cortisol is the hormone of choice, which interferes with progesterone. It also is linked to the diet. As we were talking, your diet that help with lessening the symptoms, and your diet that make it worse if you have wasteful diet with a lot of fat and saturated fat and a lot of sugar, you are more prone to have symptoms. Lifestyle is a big one. Genetics plays a role. Environment, support from your environment. You know, I had noticed that when women are supported by their husband, for example, they do better. Hormones is there. Understand that their wife might go through a bit of challenge, and often, you know, I had a husband one time calling me, “My poor little wife, she’s going through the challenges. Can you help her?” “Of course, I will, but if you are close to her and nice with her, that’s the best support you can give her.”
It’s not your fault if you’re having mood imbalances. On top of that, it’s the moment of life where this woman, they go through a lot of challenge in their family. The kids are leaving for college. All of a sudden, their life changes drastically. If you have hormone imbalance and all these challenges, no wonder you’re going to feel not yourself and feel bad.
Dr. Weitz: Do some women produce more estrogen during menopause than others? Then, what role also do environmental estrogenic substances play?
Dr. Fradin-Read: Yeah, so in postmenopause, when it’s really done, normally, we should not have that much estrogen. In general, you might have a little bit to your adrenals. I had one day, today, I’m sorry, one patient today who still had a little bit of productions, but it’s really minimum, okay? We are not talking in that period of change before we go in full menopause, the perimenopausal, so some women have tons of estrogen, and this is the problem because as I said, when the progesterone is down, and now, you’re in estrogen dominance, so breast tenderness, feeling bloated, not sleeping at night, being anxious, being nervous, always on the go. These are some symptoms of estrogen dominance. We need to have that estrogen dominance go down. There are supplements that can help and balance out the progesterone.
Dr. Weitz: What supplement can help with that estrogen dominance?
Dr. Fradin-Read: Well, one that I like is called the DIM, D-I-M, okay? I have one that is actually DIM Detox that I really like. They have a very good lab, which has also some broccoli extract, so everything that’s going to help detox the body. You are gaining too, so recommend that maybe we change the diet a little bit, okay? Women that abuse soy sometimes might have a little bit too high estrogen. Phytoestrogen can increase, or in some culture, we recommend estrogen yielding isoflavone. I tend to be a bit careful because that can make it worse, that period of perimenopause. It’s good after menopause but not before.
Dr. Weitz: Okay. What can we do if … First of all, is it safe for women to take hormones after menopause?
Dr. Fradin-Read: That’s a very good question. Again, I need to say it depends on the patient. I don’t have a rule like for example, one does fit all does not apply, okay? Each patient is different, and we are going to talk to a patient with all the information that, that patient needs to do, to have, to receive to make their informed decisions. I do not prescribe hormones. I suggest, and patients decide. That’s always the way I practice here. If we stay at a reasonable dosage, the menopause society in America says start with the lowest dose possible. You lower the dose. We are talking about one major estrogen, and nobody … Sorry, everybody knows it’s basically breast cancer, so that’s the big thing. I’ve never had any breast cancer among my patients. I’ve been practicing that kind of medicine for years, and I have to tell you, with the dosage I recommend, so far so good. We never had any issue, so reasonable dosage, that’s one thing.
The second thing, the kind of estrogen and the form that you’re using. We have tons of studies that show that through the skin, the estrogens are much more safe, much safer in the sense that they do not increase the cardiovascular way, so that’s the second risk that we are talking about. The risk of clotting. If you take estrogen by mouth, it goes through the liver. It increases the risk of clotting. Through the skin, it’s almost no risk or very little, except if you have thrombophilia. That, you need to diagnose before. Then again, it’s a question of putting the prescription in a global approach. I’m not giving just a prescription for hormones. I need to talk about diet, talk about exercise, talk about sleep, talk about stress relief. You have a comprehensive approach to hormone, not just a prescription that you give to the patient and bye, bye, see you next year.
Dr. Weitz: What type of … You’re talking about topical estrogen like creams and patches?
Dr. Fradin-Read: Yeah, yeah, so we have different options, you know? We have, of course, the bioidentical hormones that are similar to the hormones that the body produces. Basically, the estriol and the estradiol, I never prescribe the estrone. The estrone is an old prescription that some doctors still prescribe. I avoid that one because the risk of cancer is too high. With the two others, in the good mix, something that is called, be estrogen biest, you can really manage most patients at a very low dose. Then, you increase as needed, okay? Some patients need more because they have a lot of hot flashes, a lot of symptoms. Some can stay low.
If patients prefer to have a patch, that’s still very good because a patch is still bioidentical. It’s a bit more synthetic. It’s made by pharmaceutical companies, but it’s a good way to balance out a hormone and be very regular in the diffusion. Sometimes, if you apply a cream, morning and night, you can have some, I would say, more risk, or you won’t have enough in your body. If the patch is there all day, it’s a better coverage for the some women, okay?
Dr. Weitz: What do you think about pellets?
Dr. Fradin-Read: The pellets, I personally don’t like them too much, okay? I know that some of my colleagues use them. I have the experience of woman that have put a pellet in, and they come to me, and their hormones goes super crazy high, so what do we do? Do we take the pellet out? Do we let them suffer with high estrogen and high testosterone until the pellets is gone? You don’t have much liberty to change. For me, what is important then is to have my patients be their own boss. I educate them. I tell them, “You are going to be the one deciding how much hormones you need today, so they know breast tenderness means I need to decrease a little bit. I feel a little bit down with my mood, maybe I’ll up a little bit. They have a prescription, and they are not going to use the same dosage all the time. They will balance out, like I do for myself and figure out what is best for them that one day.
Dr. Weitz: Do you like prescribing progesterone in a rhythmic fashion like have them take it two weeks in a month?
Dr. Fradin-Read: Yeah, so it depends. Progesterone is excellent when patients cannot sleep well, so for those patients I will use progesterone as a sleep aid, and I would probably prescribe the whole month, okay? I do that for myself because I know that my progesterone is a good hypnotic, natural, never took any pill for sleep myself, but my progesterone is very, very important, so for those patients, you want to have a continuous dosage of the hormones, progesterone in particular. For those who are sensitive to progesterone, some woman get depressed on progesterone, so yes, you try to cycle them and you tell them, “You take two weeks hormones, okay?” You warn them, “You might have a little period, okay, because now, we are making a little bit of cycle, okay, in a way,” so they can have a bit of spotting, of bleeding. That’s normal when they do only two weeks per month. It all depends on how the patients react and how much they need. We know that too much progesterone can increase the risk of high sugar and insulin resistance, so those patients with a little bit of weight issue, I sometimes prefer only two weeks per month because it limits the risk.
Dr. Weitz: Okay. Now, what about the concept that doing it rhythmically mimics a woman’s natural hormone cycle?
Dr. Fradin-Read: I think you are talking about the Wiley Protocol here.
Dr. Weitz: Yeah.
Dr. Fradin-Read: Yeah, so I have a few patients on the Wiley, okay, and what we do, we do exactly a mimicry of what happens with our cycle. You start low with the estrogen. You go progressively up to day 12, so just before ovulation. Then, you add progesterone at that moment at a relatively low dose, and you go up, up, up until day 20, 21. Then, both of them, you are done through the end of the cycle. That’s really copying, mimicking the woman’s cycle. Some women are able to do that, but it’s a lot of risk because you have to look at the package that you receive, and look each day how many lines of your syringe you need to apply on your body, so it works for some women. It doesn’t work for others. Also, I know very well Suzie Wiley. I like her, and her idea is great. The only thing, it’s a little bit on the higher end for these hormones in her protocol, so sometimes, some woman have some overload of these hormones and are not doing so good with the Wiley. Others do fantastically well.
I have quite a few people on the Wiley Protocol, okay, and they like it, and they love it. Most of the times, these are women that are not overweight, okay, relatively thin. Then, they need a higher dose of hormones because they don’t pile the estrogen in their fat cells as others do, okay? We have that at a disposal, and I use it whenever it’s in demand or if I think that’s a good candidate for it.
Dr. Weitz: I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.
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Now, back to our discussion.
Dr. Weitz: How do you test for hormones? Do you use serum, urine, dried urine, saliva?
Dr. Fradin-Read: Good, so that’s one question that I like because to tell you the truth, testing is important, but medicine is an option, okay? I think the experience of a physician with dealing with hormones and the instinct, what I call the clinical instinct, when you have a nice lady coming to see me, I need to say, “Tell me your story.” I’m not going to start taking their blood, okay? “Tell me your story. When did you have your first period? Do you have kids? How did you do with birth control pills?” Those kinds of questions. Then, we come to that moment of their life, “What are your symptoms now? Do you have hot flashes? Do you sleep good at night? Are you anxious,” are all the questions that I ask so that I see the clinical picture. Then yes, I do labs to help me, I would say, confirm or comprehend a little bit better what I have identified as a problem. Most of the time, the labs are just going to be a tool to confirm what I thought, okay?
I do different testing. I usually do a blood test because it’s easy, and again, with clinical experience, a blood test is usually sufficient. You have to do the blood test at the right moment of the month, okay? You want to do a blood test sometimes on days three or four to see the resolve of eggs with an FSH at that time, the follicle stimulating hormone that tells me how far advanced we are in the changes. You need tools, so maybe do a blood test around mid-ovulation, on day 12 to 13 to see how high we go now with estrogen, for example. Then, we do a blood test at the 19, 20, 21st when we are the highest with the progesterone. Then, you have the full pictures of the blood test, and that usually is sufficient.
For some women, I like to do saliva tests because essentially, once they are on treatments, it tells me how the skin absorbs the creams because sometimes, if you use creams, they go in your tissues and not necessarily in your blood, so you might miss a little bit of the evaluation if you do only blood. What I found really not helpful and a little bit ridiculous, to tell you the truth, is some patients, unfortunately, that’s not their fault, but they come to me with blood tests, with saliva tests and they are not even on hormones. The saliva test is going to show, sometimes, things that are a little bit erroneous. I have one recently. She’s not on hormones. She had high progesterone. What do we do with that? That’s her normal way to be, and she was told, “You have too much progesterone,” but it’s her own production. What is necessary to test like that when it’s not necessary. You just have to … Something like high progesterone does not really exist in the normal way to test, okay?
Dr. Weitz: You were talking about estrogen, and you were saying you don’t like to use estrone, and I think you were saying that you like to use a combination of estradiol and estriol. Is that correct?
Dr. Fradin-Read: That’s what I like. It’s called Biest.
Dr. Weitz: Right, so do you use like the 80:20 version? Which one do you use?
Dr. Fradin-Read: Again, I’m not going to answer that question because it really depends on the patient, okay? If a patient needs a little bit stronger estrogen, I will go more with the estradiol. It’s a more potent estrogen, okay, and less with the estriol, which is less potent. If you have tons of hot flashes, you might need an 80:20 but 80 of estradiol and 20 of estriol. Now, if you have a past history of breast cancer in your family, but you really want to go on hormones, and you do not have too much risk yourself, I might suggest, “Why don’t we stay on the conservative side, and I will give you 80 of estriol, the protective one.” We have studies in Europe that estriol may protect against cancer and a little bit less of the estradiol, the E2 that is more cancer risk although it’s not super high in cancer risk.
Dr. Weitz: We were talking about testing. What about, is there value in doing the urine testing so you can see the metabolites?
Dr. Fradin-Read: It is. I will be honest with you. Every doctor has their favorite, okay, and what we learn in medicine is, do well what you know and stick to something, okay? I have not gone too much in the urine testing. I use urine testing maybe more for cortisol, for adrenal issues. That helps to see if you are in adrenal fatigue or adrenal exhaustion, these kinds of things, but the 24-hour urine cortisol, things like that. I am not using urine for the hormonal balance of the sex hormone. I personally do not find it the most useful in my practice, but it’s a personal opinion.
Dr. Weitz: Do you use the salivary cortisol testing?
Dr. Fradin-Read: Absolutely, that’s my favorite, okay?
Dr. Weitz: Oh, okay.
Dr. Fradin-Read: Yeah.
Dr. Weitz: Let’s see. How do we make sure that women decrease the risk of blood clots that could possibly be increased from taking hormones?
Dr. Fradin-Read: Okay, so first of all, most of my patients, if I put them on estrogen, I test them for what we call Thrombophilia. Thrombophilia are a group of genetic changes in your DNA that can increase your risk, so the most known one is the Factor Leiden V, okay? Factor Leiden V, it’s rare, but still all are likely present. I had recently two young ladies that were diagnosed, so I know these ladies will never go on birth control pill. I had one 52-year-old that just turned into menopause, and she came to me with hormonal response of symptoms, and she’s a Factor Leiden positive, so I know with her, I will be very, very conservative. I gave her a baby dose of estrogen through her skin because I know that through the skin, again, the risk is lower, okay? That’s one thing. It’s to test first to see what is your population at risk. You also ask, “Have you had any clot in the past?”
One of my patients had a clot because she had surgery, and after the surgery, there was some lacking treatment with any kind of anti-clot medication, and she had a thrombus. That’s also another risk that you have to take into consideration. Then, if everything is clear and clean that women are okay, you decide to give them advice. Drink a lot of water. Hydrate yourself. When you are on the plane, maybe take a baby aspirin before flying. That’s what I do myself each time I go long distance. I fly to Europe quite often. I take my baby aspirin. Sometimes, I take one over Greenland because it’s a long, long trip, okay? I tell them, “Put compression stockings.” I always have a hard time putting them on when I travel, but I put my compression stockings because the moments at risk are essentially when you fly long distance, when you get dehydrated, if you have an injury and you’re bed resting for quite a while, so those moments at risk, you have to prepare the patients to take all the precaution. In your everyday life, if you’re active and you exercise and you work, it’s not that big of the risk.
Dr. Weitz: What is the best type of diet for menopausal women to follow?
Dr. Fradin-Read: Good. Well, I am very partisan. I mean to be honest with you, the Mediterranean diet has been proven to be the one with the longest longevity. I don’t know if you read the recent studies, but in France, you will live until 82 if you’re a woman, 83 if you’re a man, which is more than most civilized countries, and we use the Mediterranean diet. The one little difference that I do with the full Mediterranean diet, I tend to recommend a low carb Mediterranean diet because some of those, you have bread, you have couscous if you are in the Mediterranean Sea. You have a lot of potatoes if you are in the northern part of France. I think that a modified Mediterranean diet, if you have a little bit of higher lipids, high cholesterol, be careful with berries, for sure, okay? Go with low fat yogurt. Don’t abuse any creams and any half and half but tons of veggies, tons of fruits, calored diet. The most colored diets you can, that’s the better, okay? Try to, of course, avoid any processed food. try to avoid too much sugar. It’s basically an anti-inflammatory diet.
Dr. Weitz: It’s very popular right now to recommend the ketogenic diet, which is a super low carb diet. What do you think about recommending that for menopausal woman?
Dr. Fradin-Read: I use it on a short period of time, Ben, okay? I am very careful with women who have a tendency to have high cholesterol and high lipid because as you know, the full keto is basically a lot of animal fat, saturated fat, and it can increase the risk of cardiovascular disease in women because at menopause, our LDL goes up, okay? The reason being that our LDL is not used for our hormones anymore, so all of us, we have a little risk to have higher cholesterol when we go into menopause. What I like, what I call the pescatarian.
Dr. Weitz: Okay.
Dr. Fradin-Read: Okay, that’s my favorite. I think I do that for myself, actually.
Dr. Weitz: You treat men in your practice as well, don’t you?
Dr. Fradin-Read: Absolutely. Most of the time, it’s the husband that comes to me when the wife tell him to come.
Dr. Weitz: When you see a man and he has a lower total and/or free testosterone, what’s the first thing you’ll do?
Dr. Fradin-Read: First of all, I see their BMI. I look at their belly fat, and I ask them, “Are you exercising? Are you sleeping well?” I look at all the reasons why a man would have low testosterone. Men make their testosterone when they sleep at night. Most of men do not know that, so if you don’t sleep well, if you party too much, the young ones, if you travel a lot and you’re often in jet lag, you might have very low testosterone just because you don’t sleep well. Second, “What is your diet?” If you have a lot of alcohol, if you like beer, you have these parties where you can drink quite a bit with your friends during the NFL or the NBA viewing, okay, so that’s going to decrease your testosterone. If you’re under stress, your cortisol impacts your ability to produce your testosterone. Do you go to exercise regularly? Men make more testosterone when they exercise. Proteins are crucial. Some men do not realize that they need one gram of protein per kilo minimum just to keep their testosterone where it is. If you want to increase it, you need more proteins. All these things are going to be important elements to evaluate before I can judge what needs to be done.
Dr. Weitz: Are there supplements to raise testosterone levels or to raise free testosterone level? Do you tend to see more men with low total testosterone or free testosterone or both?
Dr. Fradin-Read: I think it’s a combination of both, okay? Sometimes, men have a high binding, sex-binding protein that can decrease, of course, the …
Dr. Weitz: SHBG, sex hormone-binding globulin?
Dr. Fradin-Read: That’s exactly it. Yeah, thank you. That is part of my patients, but when patients have low testosterone, the Low-T Syndrome, it’s usually both of them that go down, honestly, in majority, okay? We need to enhance the global prediction of it and free as much as we can because the free testosterone is the one that is available in your tissues, of course.
In terms of supplements, the first thing, also, we need to look at is your DHEA, the Dehydroepiandrosterone. It’s basically a hormone. It was discovered in France by Dr. Baulieu when I was in first year medical school, if you don’t know. Dr. Baulieu was my professor, and he thought that it was the fountain of youth, the hormone that could repair everything in the body and rejuvenate the body. DHEA is actually important. It’s maybe not the fountain of youth, but it’s very important as a precursor of the testosterone. DHEA goes down when we are under stress. It’s a hormone that helps with stress. If you have low DHEA, of course, you cannot make your testosterone. One thing that I often do, push the DHEA a little bit if it’s down with supplements. You can buy supplements over the counter for good sources, of course, so write prescriptions for company pharmacy if you need a bit of a higher dosage. That, sometimes, suffice in young men to bring their testosterone up.
Dr. Weitz: Okay, so you find taking DHEA helps raise testosterone levels?
Dr. Fradin-Read: Yeah, yeah, in some men, not in every man, okay?
Dr. Weitz: Right.
Dr. Fradin-Read: It depends on the ability of their testes to make it, to make the testosterone, okay? If they are in testicular dysfunction, okay, or a little bit weakness, we need to help differently. We have ways to push through the Clomid. I don’t know if you know what Clomid is. It’s a medication.
Dr. Weitz: I do.
Dr. Fradin-Read: Yeah, of course, and it’s basically something that is made to help with your testicular function produce more testosterone. Some men respond very well to HCG, the human chorionic gonadotropin. It’s a little injection that you have to give to yourself three times a week, it’s not a big deal, underneath the skin, and it helps also with the production of testosterone. It helps also with weight loss. HCG can also help with those men who have a little bit of belly, and they want to loose a bit of weight. Then, we have thos emen that need to have testosterone replacement because they are in testicular failure for different reasons, their testes is not responding.
Dr. Weitz: When is it appropriate to prescribe testosterone for men?
Dr. Fradin-Read: Well, two categories. I would say some young men that, for any reason, have some important decrease in their production and you have tried all the natural approaches that I mentioned before. You have tried them on HCG or Clomid and they do not respond. That means that for a reason, sometimes, you find the reason. Sometimes, you don’t, but they need to have substitution. It’s important because they are young. They need their libido to be at the highest level. They need stamina. They need to preserve their muscle mass. Then, the one part of men that we definitely need, it’s like we female. Men go through something that is called andropause later than us female. Usually, 10 to 20 years later, okay, and they will have no more production in their testes. At that point, if they want to have some support, they need substitution.
Dr. Weitz: What type of testosterone do you usually recommend?
Dr. Fradin-Read: Again, in wanting to be a bit varied if you ask me a question like that, because it depends on the patient. Some patients are not at all ready to inject themselves. They want something that is easy to do, so we have some gels and some bioidentical testosterone, I would say, formula that we can prescribe for them, and you rub that on your shoulders in the morning so that it gives you energy during the day. Some men tell me, “Give me the big game. Give me the big game. I want to go right away to the injections. I’ve heard about that. I’ve seen that on TV, the Low-T Syndrome.” Those men are going to have injections. Again, the dosage will depend on their needs. Sometimes, you give 50 milligrams a week. You give 100 milligrams a week. Sometimes, you give more depending on the patient’s need, and it’s a self-injection. We teach the patient to inject themselves. It’s pretty easy to do, and I have a lot of patients who are on self-injections weekly.
Dr. Weitz: Is there any worry about prostate problems arising from taking testosterone?
Dr. Fradin-Read: When I treat a patient, my patient will know that they need to do a blood test at least three times a year, okay? Sometimes, I have to call them and say, “Hey, where are you? You need to come for your blood test,” because we need to look at various things. First of all, you have said it right, the prostate can be an issue. In majority of the men, it is not, okay, but a few cases in the past have raised their prostate specific antigen, which can be a sign of prostate enlargement in general, benign, but we need to be careful not to overdo the testosterone because that could [inaudible 00:42:20] increase also the risk of prostate cancer, okay?
I had a man who went for a trip in Armenia recently, and he felt a little bit week, so he doubled his testosterone. He comes back. The PSA has doubled. I say, “Oh, let’s be careful.” Now, I’m always tracking his dosage until the PSA goes down. I want to retest him in six weeks from now. Then, we have basically other tests that need to be done, okay? It’s not just the prostate. You need to look at the red blood cells because as you know, some athletes use testosterone to enhance their testosterone, and not only the testosterone but their red blood cells, so that they have more oxygen, and they could climb the alps better. I’m not going to name anyone, but we know we are talking about.
Dr. Weitz: Can you say Neil Armstrong, Lance Armstrong?
Dr. Fradin-Read: That was one of them, okay? I think they were all doing it, and the poor guy was taken on the spot, but definitely, it raises your red blood cells. If it raises your red blood cells too high, you are at high risk of clotting. It’s called polycythemia. You don’t want to go that high, okay? I look at my patient’s red blood cells three times a year just to make sure we are good. We need to look at the liver. Normally, testosterone would not increase the liver risk, but in certain cases, especially if men drink a little bit too much, that could have an impact on their liver, okay? I test their liver three times a year, okay? I also look at their liver to makes sure that they are not going to go crazy with the injection, to tell you the truth, okay?
Dr. Weitz: Great. I think those are pretty much the questions that I had prepared for today. Are there any other thoughts you want to leave our listeners about hormones?
Dr. Fradin-Read: Again, thank you so very much for having me on board here, and I’m so happy to talk to you about the topic. The one thing I would like to summarize, we physicians, we are here to first do no harm. That’s our medical oath, so I’m not going to give you your health back as when you were 25. I need to help you stay young and healthy, full of vitality but in a safe way. That’s very important. You talked about Loma Linda. I really love the logo, the motto that we have over there. It’s first, “Make man whole.” Again, a comprehensive approach to health, look at all the various thoughts of the health you can improve and not just jump on the prescription of hormones. That’s not the goal. It’s try to rejuvenate the body, your mind, your emotions, everything in a harmonious way.
Dr. Weitz: Great, so how can listeners get a hold of you and find out about … How can they contact you? Should they go to your website?
Dr. Fradin-Read: Oh, actually, we do your website. We have a brand new website, I think, next week, to tell the truth, maybe a little bit more full of life because the previous one was a little bit, I would say, esoteric and very intellectual, so I had some counseling, and its going to be a bit more vital.
Dr. Weitz: Which website address?
Dr. Fradin-Read: It’s basically www.vitalifemd.com.
Dr. Weitz: That’s great.
Dr. Fradin-Read: You’re welcome.
Dr. Weitz: Is your practice open to seeing new patients?
Dr. Fradin-Read: Absolutely. Listen, sometimes, I tend to say, “Wait a second,” or maybe overload with patients, but it’s not true. I select a little bit. I have to tell you, I have patients coming from all kinds of things. Gastroenterology issues, I can deal with that. I’ve done in the past, but I really want to focus on hormone and anti-aging and help my patients. The most important thing for me is to keep them healthy as they get older, add vitality to your life. That’s my motto here. Those kinds of patients, I will see them myself. Other patients who want to have an integrative approach can see my assistant. I have a wonderful nurse practitioner. Her name is Carley Cassiti, and she is fantastic, very well-trained. She takes, probably, the patients that are a bit less into hormones.
Dr. Weitz: That’s great. Thank you, Dr. Fradin-Read.
Dr. Fradin-Read: Thank you so much, Ben, and have a good day. Thank you for all your audience who are listening to us.
Dr. Weitz: Thank you.
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[…] Dominique Fradin- Read, MD: Hormones are the essence of life. They act as messengers to control various functions in our body including supporting reproduction and sexual function, development and growth, maintenance of the internal environment, and regulation of metabolism and nutrient supply. […]
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