 Hello everybody thanks again for joining us today on this Friday afternoon depending on where you're at the time here in Colorado it's a 61 degrees in January it's absolutely gorgeous. As well as days where I was just in the slopes of Breckenridge this morning skiing and beautiful day and then come back here and you could probably golf I don't golf but it's that kind of a beautiful Colorado day. I have just an esteemed guest who I have such great deep respect for, and as I was telling her before we get on the call. It's just an honor to have her time. She serves in so many capacities and so many ways and has always been just a brilliant writer mentor. And in so many ways in my life so I really appreciate that. Let me introduce her. Dr PM Smith spent her first 20 years of practice as an emergency room physician in the Detroit Medical Center, and then she's been. I don't know how many years that this might be old 26 years as anti aging functional medicine has it been longer Dr Smith. Anyway, long time she is again just a great teacher I think we first met through a for m but we've crossed paths and so many levels and, like I said just so she just is a producer of great content great lectures. What I love about Dr Smith way of writing and teaching is it's just so succinct in this like, you know, list and formulas and super easy to consume for those of us that are learning so she's just been a great mentor, and I bet. Most every position who's in functional medicine or an integrated holistic personalized precision medicine has some story of Dr Smith being a part of their training on some level. I wouldn't say so much more but I just have greatest respect that you are here today with me Dr Smith and I thank you for your time. Thank you for the invitation truly. Yeah, so today we're going to talk about hormones so if you're listening as a patient or a client or someone who has seen a doctor about your hormones. We're going to start with a little bit of the basics and I'm going to ask Dr Smith to kind of lay the groundwork here. But what's really important today is, we are at risk. And if you're listening as a patient of losing our ability to get bio identical compounded hormones. These are tools I always say our toolbox as conventional allopathic MDs is quite small and it's very powerful we use medications and surgeries. And any of us in the field find those tools incredibly helpful. I know like Dr Smith I value my training in conventional medicine because it's giving me this rich foundation of diagnosis and treatment. However, now that we're doing precision and personalized medicine. There's this greater toolbox and one of the tools that I think is probably the most powerful thing we have outside of just the conventional pharmaceuticals is competent hormones. So Dr Smith, I'm going to let you talk just a little bit about why is this important for women and men and really all ages. Let's just set the groundwork first. Thank you so much truly. The hormonal therapy is really interesting. People ask why do you need to be on hormones. Do you need to be on hormones, etc. So just follow the science. What is the science really show. Let's start with women estrogen has 400 functions in the body 400. So it's taste touch smell hearing skin tone. It's cholesterol blood sugar blood pressure. And there are many studies to show that for women, it is your memory, literally. And so that is the reason that it's so important to look at estrogen, but there's three And a lot of doctors even don't know this. There's a one estrone e two estradiol and e three estriol. When you need hormone replacement of estrogen, we do not replace a one is the one that is linked to breast cancer. And two is the 400 functions. e three is the one that helps prevent breast cancer. A lot of people ask us is this new information on e three. It's not the first article came out in drama, and well, 96 years ago. Wow. It's been a long time that we have known about e three. And it does matter if it balances with the other hormones. estrogen has to balance with progesterone. And not every woman needs estrogen in her life. Some women never lose estrogen, estrogen is stored in fat cells. So if you're a little bit overweight, then you may not lose estrogen lighted and some women never lose it. We only replace the hormones that you lose. Progesterone is its balance and symptoms of progesterone loss are anxiety, irritability, insomnia, mood swings, depression, heart racing, bladder problems, gut disturbances, etc. We tend to lose progesterone or have an imbalance of progesterone to estrogen at any age. PMS, PCOS, perimenopause, menopause, PMDD tend to all be low progesterone states. So it's important to have progesterone for balance. It's just huge. When it comes to testosterone, that's a different story. Testosterone, not all women lose testosterone. I will be 67 in July. I still have very normal testosterone. It's dead center of normal, which means I probably will not lose testosterone in my lifetime. Not that remaining one half of people, one half of them end up with high testosterone, one half end up with low. And that can occur at any age. PCOS, or polycystic ovarian syndrome, is high testosterone. We don't want to leave it there because high testosterone drives up the risk of heart disease and it drives up the risk of blood sugar being elevated. We don't want to leave testosterone too low because it's very important for sense of well-being, sexual interest, and strength of bone. So all those hormones are made in the ovaries and it does decline with age, but it's important to replace them at the right time. There are now several studies showing that when it comes to heart health and for brain protection that we try and replace estrogen as soon as the woman loses it. Would we still replace it 20 years later if she's a candidate for it? We would, but there is more brain and heart protection if you replace it as soon as it's gone. This is a hormonal symphony. That is the way God made us. It is supposed to be balanced. And so DHEA and cortisol made from the adrenal glands are part of that balance. And DHEA makes estrogen and testosterone and balances cortisol, our stress hormone, and who isn't stressed in today's world. It's a hormone made from a hormone called pregnanolone. If you've not heard of this hormone, I am going to spell it because even some doctors have not heard of it. And of course it's hard to say and hard to spell because it's your hormone of memory. It's P-R-E-G-N-E-N-O-L-O-N-E pregnanolone. And it makes estrogen, progesterone, testosterone, DHEA, and cortisol in both men and women. And it is the hormone of memory and has many other functions in the body. It's made from cholesterol. And sometimes cardiologists don't realize that the total cholesterol has to be at least 140 to make pregnanolone. If they get the total cholesterol too low, then the body doesn't make pregnanolone or the remainder of those hormones. So again, it's about balance. And the same thing when it comes to men. Do they need hormone replacement? Many men do, yes. They lose hormones as well with age. So what does testosterone do for men? Of course, we talk about sexual interest, but it lowers cholesterol, blood sugar, blood pressure. It is muscle mass and it is their memory and energy. So it's so important. They make DHEA, they make pregnanolone, they make progesterone, and believe it or not, they make estrogen. Men need estrogen. They need it for memory and bone structure. Too much estrogen increases their risk of heart disease and increases their risk of prostate cancer. So are hormones important? They are. They're extremely important to maintain vision, memory, mobility, energy, and all the things that I just mentioned. Now you all know why I love Dr. Smith, because as you just heard, she just gave us this like overview that covered almost every little bit as far as why we need hormones as men and women, what happens as we age. And what we see in clinical practice is I like to frame it in the sense of maybe 100 years ago without the toxic load in our environment, without the infectious burden, without the stress levels, without the EMFs. There's so many factors now that are affecting our hormonal cascade that probably I would love to hear if you agree, Dr. Smith, but more than ever, we are getting hit with things that deplete our hormones or that affect our hormones. And then there's things in our environment that have a chemical effect that have either estrogen like effects or other hermetic effects on our body. So what we're seeing in clinical practice is a lot more disruption in these cascades. And I would say in younger and younger women as well. Would you agree, Dr. Smith? I do. In younger women and younger men as well. In both. When I first started practicing, I never saw a man under 47 years of age with low testosterone. Now we do. Right, frequently. And with women, polycystic ovarian disease, when I went to school was thought called Stein-Levin-Thall syndrome. Yes, I remember. And I was told I would see one or two cases in my entire career. Now I see 10 cases a week. Yes. So have hormonal balances changed in the last 40 years they have dramatically and pretty much not for the better. But the good news is the science is here to help us go back and balance it and customize it for each and every person. Yeah, and that's again, the importance of our talk today is there are available options. What Dr. Smith and I can do is there is a myriad of compounding hormones that can create the exacting mixes and doses based on good research. And that's the thing I want to talk just a little bit about as well as there is lots of strong evidence to support the use of hormones. Would you want to just address that just a little bit because some doctors and patients have been told that there's either no evidence or there's no science to support what we're doing with compounding hormones. Number one, there are myriad of articles supporting the use of hormones to begin with, and both men and women, but let's take women because that seems to be what is most controversial at this time. Are there articles to say that estrogen equals memory hundreds of them in traditional medical journals. Are there articles to say that it is important to have natural hormones, it is. And what does natural mean. People usually think it means it comes from a plant and hormones honestly do come from soy or yams, but that's not the definition of natural and medicine natural means the same chemical structure. And that's the actual definition. When you use synthetic hormones, which are not the same chemical structure, you get disrupted messages, you get incomplete messages, you don't have balance between hormones. And now there's several studies to show that if you use synthetic hormones. It's not guesswork. There's actual clinical trials that if you use synthetic hormones there as an increased risk and other diseases, for example, an increase in breast cancer. Are these small trials. No, some of the trials are 80,000 women. So large clinical trials showing that hormones are necessary. They're important to balance, you have to measure, and that they should be compounded and used natural hormones for the patient, meaning the same chemical structure. So let me summarize what I hear you saying and then I'd love to hear if there's anything different from what I'm saying that that is more accurate. It sounds like from the research this is what both of us do. As soon as a woman starts to lose her natural hormone. So we measure this so you and I are scientists first. And as you would, I always would start with a measurement. There's multiple different ways and multiple different studies that show blood levels, urine levels and saliva levels can all be accurate. I would love your comments on that in just a minute. But either way, we're measuring hormone levels. And then as soon as that woman, whether it's 40 early menopause or 50 or 60 is starting to really decline and have symptoms. So what I would do in practice is start to replace those at physiological levels so that she has that function back in a safe way. And then I typically will monitor them and watch and make sure that we're doing, you know, safe and balanced levels. And I think you said, if you would just give estradiol which is e2 without the progesterone to balance that these things some of them cause rapid cell division, and some of them cause the stopping of that division and differentiation. So that's this checks and balances that our body naturally has so we want to replace them in conjunction as well so basically testing treating when a woman is symptomatic. And then as far as how long we treat, I always talk to the patient with informed consent, and we decide together what they'd like to do what the risk are but I'd also love to hear your thoughts on when you might just continue how long you would keep them on I know there's like Dale and he's giving hormones for memory in women over 80, because for them, the memory is more important. And I do believe that that is appropriate in certain cases. What's your thought on that process is there any of things you would do differently, as far as assessment and then treatment and then how long. Well, for one thing, honestly, I never stop hormones, unless the patient wants to stop. My oldest patient currently on hormones is 102. And she's sharp as a tan. Yes. And she still flies around the world. So she's just an absolutely fabulous person. So that's for both men and women. It really is again about balance, but you have to measure. It's important to look at physiological as you just stated levels. We don't just give a lot of hormones so it's quote unquote feel good. It's just about symptoms. It's not, of course, symptoms are really important, but these are hormones of repair. They build bone structure, they help prevent disease, but that's in physiological levels, usually very small doses. For example, when a woman's 25, she makes her peak hormonal level. And for estradiol, the e to pre literally, she makes about 365 micrograms micrograms baby some out. And when people give a massive amount of warming, just so that she feels good and the hot flashes are gone. That's not the idea. The hot flashes come from stress. We want to look at the cause of the problem. So we replace it physiologically and balance. So I give hormones forever. At almost 67 I don't plan on ever stopping my own hormones. I did this year for one month over the holidays, because for the first time I was not on call during Christmas ever. My partner took a call for me. And I always offer to take it as a senior partner this year. I did not. And so I stopped my hormones for a month just to see what would happen. Because as a scientist, of course, the first person you look at is yourself and what happens. It was amazing. First week, no problems. Second week, it was like, I think I'm just a little bit tired, but yeah, it's the holidays. Yeah, third week. Oh gosh, I just, my clothes feel a little tight. I just, you know, don't by the fourth week I had no brain. It's a good thing my partner was on call for me. So I started back up my hormones. I really I had not I've done on progesterone for 29 years. So it had been a long time since I had stopped everything. And now I'm even more proponent for hormones. But again, small doses, you have to measure when we see patients in our practice and I'm sure you do the same thing. We see them, we test them, we start hormones, we recheck them in 90 days, and then every six months thereafter. Yes, that way we know they get the perfect dose for them. Yes. And are you typically testing blood urine or saliva or a combination. I know there's a lot of controversy on this. So we actually just finished a clinically controlled trial in our practice. And we're going to publish this wonderful because there's been a lot of controversy. So there shouldn't be any more. Dr. David Zava had studied this for many years, and we wanted to reproduce the studies and see where they indeed accurate. So I can absolutely tell you today that if you put the hormone on the skin, it will not show up in blood. We prove that. And estrogen for women and testosterone for women should always be transdermal, meaning on the skin. So if it's on the skin, blood is out for measurement. Also, when it comes to cortisol, the stress hormone, there's six clinical trials showing that the gold standard to measure cortisol, not for Addison's or Cushing's disease but for hormonal balance is salivary testing. Even Quest and LabCorp offer salivary testing for cortisol. So when you measure cortisol, that does have to be by salivary, transdermal, that has to be by salivary. If you measure something that you're taking orally, perhaps progesterone, for example, or DHEA or pregnanolone, you could use serum, but it's more expensive. It's much more cost effective to do all of it by saliva. Urine is a very important test, but it's a metabolite. It's a breakdown product. See, honestly, you can't dose off of a breakdown product. Do I do urine tests to look at breakdown? Yes. I want to make sure that her estrogen is breaking down into the right estrogens. So she has a decrease in breast cancer, et cetera, and all the other hormones too. But I don't recommend dosing off of urine because then you're dosing off of a metabolite and not the hormone itself like you would be with saliva testing. Oh, see, this is so tremendous because so many, like you said, there's a lot of controversy and you hear everything out there. And one thing I want to talk about for those of you listening is Dr. Smith mentioned oral dosing. So if we give oral hormones, they have to go through the liver phase one and phase two, and there's a lot of other dirty, it's kind of a dirty way to do it. And it actually stresses the liver. The liver already is doing the detox work of chemicals and everything else. So the less we can put through that pathway, if we do it trans-Germany, we're doing it much more like how the ovaries actually release it into the tissues. So I couldn't agree more. Is there anything else you want to say about first pass metabolism and why it's more dangerous to give them orally? Well, you know, some hormones are fine given orally, like progesterone. The HEA and pregnant alone can be, but particularly estrogen never should be. Because estrogen, when it's given orally, there is an increase in clotting. People can have a blood clot, et cetera, a pulmonary embolus. That trial has been done several times. When you give estrogen orally, it's inflammatory. Every disease you can get after 45 is inflammatory in nature, including memory loss. When you give estrogen on the skin, it's anti-inflammatory. It decreases inflammation. And then, of course, there's many other reasons why estrogen should be on the skin. But a really big one is the following. It lowers growth hormone, the hormone that keeps you young if you take it by mouth. So if you want to stay healthy, put it on the skin. When it comes to testosterone, it has to be on the skin because the oral version, methyl testosterone, there is an increase in cancer of the liver. So we do want the liver to be healthy, but newer information is also showing the part of estrogen is broken down in the gut. And so we can now measure that. There is a test to measure estrogen metabolization in the gut. So is it important for the gut to be healthy? Yes. I mean, you are the expert in the area of gut gel. Truly, as you know, if the gut's not healthy, the patient's not healthy. Well, and this is great to know. And since we have no, we can say anything if you want to share. What is the test for the gut? Is it a commercial laboratory or something that physicians can order? It is. It's called Biome FX testing. Oh, yes. Yes. And so it's right on that test. It's a fabulous test. And it's made by Closet Lab. And they are right outside of Washington, DC. They actually do some of the blood work for the White House, no matter who's sitting in the White House. And it's a fabulous stool test to look at how the body is really, the gut is functioning, but there's literally an estrogen breakdown test out there. Wow. So this is so funny. Right here sitting beside me. I just recently got it because I was checking out the company and I have not looked at the results. So guess what I'm going to be doing after this call? I'm going to dive in. I literally have my results right here, hot off the press. I was like, oh, that's amazing. So I will be learning right alongside on that. So I'm going to, I don't think I'll put you on the spot because you are so good with details and stuff, but I'm curious. So I had breast cancer at 25. I had ERP or negative and her two new positive, which is a very aggressive. It means the cells as you know, but for people listening, it means the cells were kind of mutated way away from the normal kind of healthy cells that have estrogen progesterone receptors. I was not a candidate for hormone therapy because the breast cancer cells didn't have hormone receptors on them. And I had three-door chemotherapy. Now I know now there's so many things like the chemicals. I had a silent celiac. I had massive inflammation, lots of things. And I had grown up on a farm with atrazine, which is a known endocrine disruptor, probably in utero exposure from my mother, because I actually at 25, when you get cancer at 25, you probably have the cells that go bad at like 10 or five or way before that age. So you and I know a lot of these pathways and how it kind of makes sense. Now since that time, it's been this year is 20 years since my breast cancer diagnosis. So it's amazing. And I feel like hormonally, I'm in the best shape of my life. And I'll tell you what, I feel like even though there's probably not another doctor out there that would say, Jill, you could take hormones. I know if I wanted to, you know, do that, I would feel comfortable monitoring and doing that. I'm curious if you'd be comfortable saying to someone like me who has that history, but also knows and actually monitors her things like for hydroxyestrogens, which we can talk a little bit about that's the type of estrogen that Dr. Smith was mentioning that can come down this pathway and damage DNA. So that estrogen is really, really high, which in the past it was now it's not because of the stuff that I've done for detox. So my question to you is, I'm 44. Would you consider giving me hormones if we monitored them as a breast cancer survivor? That's a great question. Even OBGYNs now that are traditionally trained have looked at the idea that 20 years is the draw line. If you are cancer-free for 20 years, and you've had breast cancer, then we do consider hormone replacement natural, the lower end of normal, and that is for the heart and brain protection. Because at this stage at 20 years, there is an increased risk in having heart disease and cognitive decline, which outweighs your risk of getting breast cancer again. So I knew you'd have a beautiful answer. I'm so glad I asked because again, this is even for me. Now I know I'm comfortable taking that risk if I were to choose, but I also am curious about another professional and what they would say to me and that's brilliant because I did not know that that was the kind of data. And I have had those discussions. What I typically do is one-on-one with the patient with informed consent say, hey, there is some risk. Here is what it is. Let's monitor it. But I didn't realize there was kind of a 20-year cutoff. So I just hit that. And I'm assuming just like anyone else, you would test every six months and monitor that for hydroxy. Is there anything besides the for hydroxy that you would watch in someone who had had previous breast cancer, anything other that you would think about in someone like myself? Yes, because the 16 hydroxy, you need a little bit for bone structure. Too much is really increases your risk of breast cancer as well. And I do want to measure the entire methylation pathway. Like you, I have not had breast cancer, but I have a very strong family history. On my mother's side, I never met my grandmother. She died of breast cancer during World War II. So before I was born, I have a cousin on that side who never had shoulder, which is a risk factor for breast cancer. And she died of breast cancer at 51. On the other side of my family, I had an aunt who got it, who died of breast cancer. Another aunt who got it, who survived. Both of them drank alcohol. The new studies that are out now show that you can very much mitigate your risk factors if you have a family history like me. Number one, women metabolize alcohol at a much slower rate than men. And so for people who drink alcohol, one drink a day is max for women because of our slow metabolization. And if you have a family history like mine, you shouldn't drink it all. And if you ask me, am I a tea toddler? I am because of my family history. So I don't, I don't drink it all. And the American Cancer Society came out very recently and suggested that women should consider not drinking because it is a risk factor. You have to mitigate them. And do I want to look at homocysteine and the rest of the methylation pathway? Yes. So 50% of people don't methylate well. For those of you who don't know what that is, it's putting a CH3 group on a pathway so that they not only go through methylation, but through detoxification and the transfer filtration pathway and then into the other side of that pathway for energy production. I have a high homocysteine. So of course, I have a family history of heart disease. My dad had his first heart attack before a week before he was 45. The family history of breast cancer, of course, I had a high homocysteine. But fortunately, I have known that for 29 years. So at that time, the only test that was available was methotetrohydrofolate. Looking at that measurement through homocysteine, the reductase part of the whole pathway was not available. I started taking methotetrohydrofolate 29 years ago. My homocysteine is normal and has always been. But now we can look at the whole pathway all of it. So can we do a lot? Yes. Absolutely positively to mitigate these risk factors because many people have them. Yeah, that's exactly how I feel. I feel like over my 20 years that's been my education is how do I fix the pathways that were dysfunctional back then and do the detox. So things that I often think about with hormones and would love any comments you have, glucuronidation is a pathway through the gut and estrogen. So often if a beta glucuronidase is high on the stool, you can give calcium deglucidate to aid that pathway and that can help with hormone detox. As you mentioned, methylation is key and some of the urine metabolite test and of course some of the blood tests, you can see the pathways and the different metabolites you can basically infer which ones might be needing more support. And those types of things would be methyl B12, 5MTHF, which is methyl tetrahydrofolate, as Dr. Smith mentioned, and then B6 or P5P and riboflavin, those are all pretty important in that pathway. Other things, dim is really important. And yet I find postmenopausal, I think that can be too much and I'll actually turn things the other way as far as osteoporosis. So if you're more careful about how much dim I give postmenopausally, any comments on those and then of course we could talk glutathione and AC, what's your favorite nutrients that you would say you want to make sure that patient has for detoxic hormones. Well, I actually like to measure. I measure everything. And so it is a customized approach. Not all my patients are on dim. If there's a problem with the CLMT pathway, et cetera, then great. There's many ways to fix all of these pathways. So I do measure them in every single patient. And that includes gut health as well. And looking at beta agrogrammatization, the science is here. Well, we probably should also mention is melatonin. Melatonin is not just for sleep. It's part of the immune system. And it's made in the pineal gland in the brain, but it's also made elsewhere, particularly the gut. And melatonin is a key component for the immune system. We actually treat stage four breast cancer and other kinds of breast cancer with melatonin, with or without chemotherapy, and they are getting very, very good results. So there's a lot of different ways of mitigating these pathways. The other thing is, please, everybody who's on today, do not go out there and take methylated vitamins. You can over methylate and increase your risk of getting cancer and other diseases. So we have these tests. Please come see a functional anti-aging practitioner and please come have it measured. Come see a compounding pharmacist and determine, do you need methylated vitamins because we don't want you to over-methylate it. Right. And I find if you're super toxic for other reasons and you don't know it, and you all of a sudden just replace all your methylated bees and all your detox, you can really overdo it because your body can't handle. It's almost like you're mobilizing toxins and you can excrete at that same rate. So I find people who are very toxic, you have to go very slow on these processes or you tip them over. It's a bell-shaped curve and you can throw them right over the roller coaster bell-shaped curve into overload, over-methylation. And it can cause, if you're over-methylating, you can have anxiety, insomnia, agitation, even diseases like bipolar schizophrenia can be parts of these pathways. So just be careful. Yeah. So in maybe less 10 minutes or so, let's talk a little bit about right now, we have access to these kinds of hormones that will basically individualize protocols where we can compound exactly what the patient needs based on testing and then change it if needed and do it trans-dermally or for progesterone or DHEA maybe orally. I would love to hear your, this is how we first started about this conversation is accompanying pharmacists for us are key, they're part of our toolbox. So what is that risk with our accompanying pharmacies and what do people need to know to be advocates for this tool that we have that we could lose if we're not careful? Well, it's important to understand that compounding pharmacists have specialized training. They're not just a pharmacist and people who go to school now are actually PhDs or pharmacy called FarmDs. So they have a lot of education, but compounding pharmacists have even more. They take additional training to learn how to actually make hormones, make skincare creams, not just for, hey, wrinkles, but psoriasis and rosacea. Again, they make many other things. And they also make different kinds of chemicals for people who may not be able to take something over the counter because they have an allergy. And so all these reasons, sometimes it needs to be in a different base. There's different bases you put hormones in, for example, so they actually do get into the skin. So how do we know if it's made right? People always ask me that. Number one, do they have training? They do. And they have updated training all the time. But you can always send off anything, hormones or anything else to Eagle Laboratories or any other outside lab and have them analyze what is being made. So we know it is very safe. We know it is very accurate. And I do send it off now and again. In my personal practice, I use 11 different compounding pharmacies in six different states. And now and again, I do send it off just to make sure of accuracy. I, so far in all these years, I've never had anybody be less than 98.7% accurate, and most people are over 99.5% accurate. So when people think, oh, it's just made like in a back room, that's not true. You know, they, there's sterile hoods, there's all kinds of things, there's training, and there are checks and balances. But I love compounding because it is personalized. And that's where medicine is in 2021. The science is here for a personalized approach. Thanks for sharing that because again, a lot of patients, they just expect us to get what they need and we take care of it, right, which is fine. That's what our job is. But what they may not realize is, and this is funny because we're transitioning to an EMR and I'm like in the dark ages because I still my paper, I love my paper charts because I can like flip through, but all that to say one of the hindrances to that that's been the most difficult is most patients I see, I might have four prescriptions and four different pharmacies because I know this one does really good at this and are good price and I know this one does be 12 and I know this one does. So and I know those just like you I have my book of pharmacies that I know and trust that I know are accurate and they do a great job and they have the good prices for the patients, and they might be depending on the state the patient I'm seeing, you know, so there's a lot of things that go into that and having the knowledge to know and trust and pick the right pharmacies, all that to say, patients may not know that number one that we rely as physicians on these experts that have training to get the tools we need to help the patients. If we today lost our ability to have company pharmacies. It'd be like my hands were tied right Dr Smith like would be literally like practicing either blindfolded with our hands tied behind our back right. Let me give you an example I said earlier that I have normal testosterone. So I do need dha as most people would in my age group, because I have normal testosterone, or if you had high, you need the keto form of dha. That means they put a keto group on and it breaks down into estrogen but not a lot of testosterone, because you already have it for the first things that they're trying to take off the market is the ability to compound keto dha. That would be a disaster for me, I would have terrible acne, because my testosterone would go right. It would be a disaster for my patients as well. Now some people do, you can get keto dha without a prescription, but the trouble is the doses are usually very large. I only take one milligram of keto dha. Wow, just one milligram. Otherwise I get acne. And if there wasn't the ability to have compounded, then I would not have the same energy and brain power without the dha, because I would have a hard time taking it. I probably have to buy it over the counter, open it up, take a lot out and close it back up, which would not. Dr. Smith, the ones I know, they start at 25. Exactly. I would literally be doing the story most of it out. Absolutely, no. And then, like you said, we didn't talk today about like muscle activation and some of these, but I see a ton of patients that are incredibly, exquisitely sensitive to the environment. So I need to compound minuscule doses, just like you mentioned, or very specific ketotaph and we can't get commercially. That's a mass cell stabilizer, really critical to a lot of my mass cell patients. So it's not just hormones. So what, is there an action or is there a link I could share or anything that I could share for anyone who's interested in taking action and just speaking out about the value of this, whether it's a physician. Is there anything you can give us for resources so that we can have our voice heard? Absolutely. I can send you a link. And please share it with everyone, because we'd love to have your story. So please share it. And we'd also like you to contact your congresspeople, both in the Senate and in the House of Representatives, because they do listen to their constituents and let them know how important it is for you, your parents and your family to maintain the ability to have compounded hormones and everything else. One of the most hardest things to make in the world is compounded thyroid. But at least 40% of my patients are on compounded thyroid for two reasons. One, everything over the counter is either T4 only and the body makes T3 and T4. Or it's a desiccated thyroid, which is four parts T4 to one part T3. That ratio is not perfect for every single patient. But a compounded pharmacist can make it any ratio we want it to be, one to one, 20 to one, 10 to one, and then the patient has the perfect amount. Also, there's one study showing that if you have Hashimoto's thyroiditis, which is an autoimmune hypothyroidism or autoimmune disease, most patients are hypothyroid to have it, meaning low thyroid function, then you shouldn't be on desiccated thyroid. You should be on non-pore sign. And you should have, according to clinical trials, 98% of people need T3, T4. There would be no other way of getting that desiccated compounded. Yes, thank you for mentioning thyroid because it's a whole another issue and a lot of patients are dealing with that. So we will be sure I'll get that link. If you're watching on Facebook, that will be added. If you're watching on YouTube, that will be below in the notes. And if you're on the podcast, I will put that in the show notes. So this will be on anywhere you see this podcast, you can find this information. And please, please help us by putting your voice out there because this is going to be critical going forward for us to do our jobs of personalized medicine. This was again, one of the first reasons of the main reason why I wanted Dr. Smith to come. And among that, all the other amazing knowledge that she shares. And as you can tell just such good concise information based on research, she's a scientist at heart. Anything else that you want to leave us with as far as hormones, hormone replacement, what we can do to be advocates for ourselves or patients or physicians? Yes, from the viewpoint of hormones, it's important that you measure. And I think this has been part of the problem when it comes to looking at hormones going away, is that not all doctors measure. Please make sure that you see a physician, a nurse practitioner, APA, a pharmacist that is fellowship trained. They actually have training in this area that is a fellowship attached to a medical school, and they didn't just come up with a dose from anywhere. They didn't take a one day course. Make sure that you see someone who is really an advocate for you in a personalized medicine approach. And they took the time and effort like Dr. Carnahan did to actually become a fellowship trained in this field and be a wonderful prescriber and a patient advocate. Thank you for saying that because that's maybe one of the biggest questions I get is where can I find another doctor like you or Dr. Smith? Is there a website or place I know that we both worked with A4M and where would you recommend people find the training or doctors that are trained in this? I will send you a link to that as well. So we'll have two links for this. Perfect. We'll add that on. Fantastic. Thank you so much Dr. Smith for sharing your knowledge. I know people have been, I've been seeing the feed and the questions and I know it'll just continue with the viewers. Thank you all for listening today. If you have any questions, put them in the box and I will come back and answer those in the future here. And if you want to find more of our videos, you can find me on YouTube at Jill Carnahan, the playlist there. Please subscribe because you can get these and all the rest that are there for free, free content, and we'll be back next week for more. Thank you so much. Thank you so much.