NWC 36 | Hormonal Balance

The Real Truth About Hormonal Balance With Dr. Shawn Tassone, America's Holistic Gynecologist

  • 12 December, 2022
  • Corinna Bellizzi

Watch the episode here

We hear and read so much about what happens in our bodies when we have a hormonal imbalance. But with all the information out there, it can be so easy to get caught up in misinformation. Helping you sift through those, Corinna Bellizzi sits with none other than America's Holistic Gynecologist and the host of Confessions of a Male Gynecologist, Shawn Tassone, MD, PhD. Here, Dr. Shawn dives deep into women's health, hormonal balance, and reproductive health for better energy and healthy aging. Join this interesting conversation and hear the REAL Truth that is often missed out!

 

Key takeaways from this episode:

-      The key archetypes that will help women identify how to manage their health

-      The difference between being pregnant in your 20s and having later pregnancy

-      Why thyroid is more common in women

-      What is the best diet for people undergoing hormonal challenges

-      How to attain your best hormonal balance with the SHINE Method

-      The negative effects of the Pellet Hormone Treatment

 

Guest Social Links:

Website: www.tassonemd.com

LinkedIn: www.linkedin.com/in/shawntassonemdphd/

Instagram: www.instagram.com/shawntassonemd

YouTube: youtube.com/c/ShawnTassoneMDPhD

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The REAL Truth About Hormonal Balance With Dr. Shawn Tassone, America's Holistic Gynecologist And Host Of Confessions Of A Male Gynecologist

Before I introduce our incredible guest, I need to first remind everyone that this show, and specifically this episode, is for educational purposes only. The information we share is not intended to treat, diagnose, or cure any health condition. If you are experiencing health symptoms of any sort, you should seek help from a trusted medical professional. Now it's going to become painfully clear why I had to make sure I hit that.

We're going to dive deep into the category of women's health and hormonal balance for reproductive health, better energy, and healthy aging as we meet with Dr. Shawn Tassone. He's known as America's Holistic Gynecologist. He's the first physician in the United States to be double board certified in Obstetrics and Gynecology and by the American Board of Integrative. He holds a Medical degree in addition to a PhD in Mind-Body Medicine. Dr. Tassone is a practicing OB-GYN in the Austin, Texas area.

He's a hormonal expert, author, speaker, highly rated patient advocate, creator of the world's first integrative hormonal mapping system, and host of my new favorite podcast, the Confessions of a Male Gynecologist. In his twenty-plus years of practice, he's listened to over 50,000 women's stories and is determined to remove the myths surrounding women's health. His work includes studies and publications on hormonal imbalances, spirituality and medical care, whole foods to heal the human body, and integrated medicine. His work is featured in many publications, including the New York Times, NBC News Online, and Stanford MedX. His latest book, The Hormone Balance Bible, published by Harper Collins, is available for purchase worldwide. Dr. Shawn Tassone, welcome to the show.

NWC 36 | Hormonal Balance

You've developed a fan here. This is how I discovered you, through this whole world of podcasting. Every episode I've had the joy of listening to, whether you guested on somebody else's show or even your own production. I do love the confessions at the end of each show.

Thank you.

I wanted to open this conversation and talk a little bit about why you chose to come forward and start something like a podcast.

Podcasts are interesting. For me, the podcast itself was an extension of my clinic. I felt there are a lot of things that I say over and over again and there's a lot of misinformation out there about women's health and hormones. I've seen many patients who came in and didn't know about testosterone, what birth control pills due with the body, or many things about fibroids, endometriosis, or whatever it was. Maybe I could reach more people if I put it on a different platform. One-on-one is great, but you're limited in the number of people you can reach. It was an extension. What I found, and maybe you have this too, is that I enjoy doing them. I like making podcasts. I don't necessarily like to listen to myself, so I don't listen to my own. I enjoy making them.

It's almost as if growing up as women, we're even taught that our hormonal health is a mystery. It's some of the mysticism of being a woman, that woman is unique and different. If you experience problems like hormonal breakouts, which I suffered from my whole life, honestly, I had reduced levels of breakouts when I took the pill but chose to go off of that in my late teens and haven't ever since. In my mid-40s, suddenly, my breakouts aren't happening as much. I know there's a hormonal shift, but I've yet to get to the bottom of it. My only other symptom is that I will admit I have a weakening libido. I know something's happening here. I went to your website.

You talk about the fact that you have a hormone-type quiz that you offer on your site and some archetypes that you've designed to help people figure out where they are on the path. Interestingly, I took the test once, but I got two email results. I was wondering if I could ask you about that. I was the nun. The second was the unbalanced heroine. What would this say about me? Perhaps we can use this as a jumping-off point to talk about how you designed these archetypes to help women manage their own health.

First of all, everybody in the space of hormones has a quiz. I didn't want to design a quiz that was, “Take these ten questions and I'm going to tell you what your problem is.” My quiz is a little bit more involved. It's about 36 questions. Each of the questions in the background is weighted differently. The way that you answer changes the weight of the mathematical equation on the back end. The fact that you got two answers means you probably had two things that were the same. They’re equal. One wasn't more dominant. They were similar. What I noticed was also when I talk to patients about, say, low testosterone, and I go through the symptoms, they resonate. If I told a story about a nun and how a good practice for a nun would be to go outside because nuns tend to stay in the cloister and they stay inside.

I would go through this thing. Good nuns obviously don't have sex. That's a decrease in the testosterone effect. Nuns are quiet, this is a grand generalization, but it resonated. At the time I was doing this, I was reading a lot of Caroline Myss, who's a Hay House author. She talks a lot about archetypes, and Carl Jung and another author named Sally Hogshead, who also talk a lot about archetypes. I always resonated with those. I always thought they were fun. I thought, “Wouldn't it be fun to put the twelve more common hormone imbalances that I see in my office into these archetypal storylines to try and resonate with women?” The nun would be low testosterone.

The unbalanced heroine, I felt like the ultimate hero's journey for a woman is pregnancy. The hormone responsible in pregnancy, the big one, is progesterone. Women with low progesterone, I call them unbalanced heroes or heroines. That's where I came up with that title. There are ten hormone imbalances, and then there are two that are blended. There are a couple of blended ones.

Progesterone would be something that would decline as we start to go into perimenopause or menopause because we're no longer trying to become pregnant or our bodies are losing that capability.

Progesterone is made after you ovulate. For women that are in perimenopause that may not ovulate every month, they may not have that progesterone coming in every month. The actual progesterone you make may be similar to when you were in your twenties, but you may not do it as frequently. That's where the problem comes in. That's also the hormone that's responsible for a lot of the symptoms with PMDD or PMS-type symptoms when you're progesterone's low.

This leads me to another conversation I've been itching to have with people who work in the OB-GYN space. I didn't enter motherhood until I was in my late-30s and into my early-40s. In the second pregnancy, I would be 41 at delivery. This was the first time I heard the term applied to me. The OB that was visiting me at that moment referred to my pregnancy as a geriatric pregnancy. The terminology isn't something that we as women would love to hear, but it is indicative of a movement that we have in our present society where women are waiting until much later in life to have children often.

They're putting career first like I did or choosing whether or not to have children and making that decision after they reach the 35 age point. Can we talk for a moment about some of the things that are different, perhaps about how women experience pregnancy at this later stage in life? What might you say to those women if they're planning to have a later pregnancy, the source of things that they should be aware of as they head into that?

The later pregnancy trend has probably been over the last several years. My youngest was born when his mother was 39, I believe. That at the time was considered pushing the envelope years ago. It's more common because women are working and not necessarily ready to have kids yet. I've always joked that it would be great if you could have a baby with a 20-year-old body and a 50-year-old brain because you know so much more. You're calmer and you're more together, but nature doesn't do that. The reason that the twenty-year-old body is better is because of the wear and tear of pregnancy, the fatigue, the joints. Not everybody's in tip-top shape as they age. That can play into it.

Mostly, too, it's the genetics that's involved, especially with the egg. The quality is not as good when you're 40 as it was when you were 20. That can lead to higher rates of miscarriage and potential genetic anomalies. It's still not super high at 40. It might be 1 in 180, but it's still it's not 1 in 10,000 like it was when you were twenty years old. You have to think about that. Women probably need to have their thyroids looked at a little more when they're pregnant because of the added demands on the body and probably try to eat even better than they would have more Omega-3 fatty acids and maybe supplementing with, first of all, a good prenatal vitamin.

Women need to have their thyroids looked at a little more when they're pregnant.

You want to take that folic acid or methyltetrahydrofolate before you even start to get pregnant because that can lower the risks of neurological issues with the baby. There are a lot of things you can do. Obviously, you're going to want to stay in good shape and exercise. It’s pretty much similar, but at the same time, realizing that your body's a little bit different. You might have higher rates of C-section and things like that, but ultimately, most of the time, you still have a healthy baby for the most part.

The research I've looked at, because I've lived in the world of supplements for twenty-plus years, specifically with regard to women during pregnancy, shows that women who do supplement with a good multivitamin and Omega-3s have babies with better birth weights, fuller term pregnancies, specifically related to Vitamins A, D, and Omega-3 fatty acids, DHA and EPA. They're protective, generally speaking.

One of the benefits of women getting pregnant later in life is often they're already looking at those things and they're taking those supplements and they're trying to optimize their health because they're planning to be their healthiest. I felt like I got a strong complement in the delivery ward. The nurse said to me, “You may be my oldest mom, but you're also my healthiest because all of my health markers were returned to normal quickly.”

I delivered my baby vaginally in both cases and didn't have any issues with that aside from long, painful labors. We all go through this. Generally speaking, I was able to retain my health and go the full 40 weeks with no issues other than a little bit of pain here and there. Your low back might start to bother you. You spoke to thyroid health. I wanted to bring this up because it's connected to many things that affect our health. It's also a bit of a mystery to many people. We hear things like hypothyroidism and hyperthyroidism. Without a knowledge base, it can sound like, “This is something that happens as you age. It means that your metabolism slows down or that your metabolism is overactive.” They don't necessarily get to this baseline understanding of it being rooted.

It's hormonal health in general and it affects your immune system. I personally was diagnosed with hypothyroidism at 29 after coming off of a fast and realizing I was having difficulty swallowing when I reintroduced foods. I knew that could be a symptom of hypothyroidism. I went to the doctor and confirmed my levels were wrong. I needed to be treated and have taken an NP-Thyroid basic product almost every day for the last several years.

During my pregnancy, I did have to have those levels checked a couple of times and adjusted. It turned out I needed less thyroid hormone while I was pregnant because my body was producing more. I'd love for you to talk about what it means to confront a thyroid issue and why we might be experiencing this more as women than men so that our audience can better understand what this might mean.

Thyroid is more common in women because autoimmune disorders, unfortunately, are more common in women. That's probably because of the hormonal shifting and the things that women deal with their hormones. Anomaly, that rheumatoid arthritis, lupus, Hashimoto’s, all these autoimmune diseases have a higher instance in women and lower socioeconomic women. There is that genetic component. The question is, why does it happen? It happens more frequently postpartum for a lot of women that thyroids will tend to go out of whack or with significant changes in their fluctuations.

The huge drop of hormones after pregnancy can unveil a thyroid disorder. The other thing that is going on is that we have a lot of neuroendocrine disruptors in the food supply, the water, the makeup, the things that we eat, and the plastics. That's going to throw the thyroid off, even in small amounts. It's those environmental toxins and the obesity that we have in this country mostly from the food supply, obviously, what we eat and the density of our calories. That sets us up for thyroid problems.

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In my case, there was a genetic component. My mother also has hypothyroidism. Hers was also discovered a little bit later in life. The doctor said because it was discovered later in life that that equals Hashimoto’s, which to me was somehow more scary. Also, to learn that it could affect my immune system. Unlike many others who are hypothyroid that I've connected with, I don't tend to get sick that frequently. I seem to be generally healthy. That tells me I'm keeping my thyroid in at least relative balance. The effects of stress and anxiety, I tend to notice more now.

When I'm experiencing physical stress, I will have things erupt, like my joints might ache a little bit or something along those lines. Generally speaking, when that happens, I go first to diet. I was eating too many foods that were high in Omega-6s, so I'm going to cut out some of that, reduce my grains, and then suddenly, I feel much better. Is there a specific diet that you tend to recommend for people experiencing these hormonal challenges?

It's a debatable hot topic. There are people on both sides of the aisle, from keto to carnivore to vegan. It's an interesting area. A lot of the dietary stuff is somewhat political and supercharged. It's hard. I would say though, in my practice, if there was one diet that I probably recommended over most, it would be a modified keto-type diet. The refined sugars, the flour, get your starches from vegetables and maybe an occasional fruit here and there, and then quality meats and a small amount of cheese if you want to eat that because you like it. That would be the first one I would go to, obviously. A Mediterranean diet is always good, too. The thing that's funny about the Mediterranean diet, we always think of olive oil and olives and vegetables and stuff, but they eat a lot of meat in the Mediterranean as well.

They just don't eat a lot of processed foods.  

Mostly lamb and stuff. They eat meat. They just don't eat the kind of meat that we eat that's hormone-ridden and things like that. Those two things are huge. I have women that are vegetarians. It's funny, I had a patient that told me she was 80% vegan. I said, “You're vegetarian.” She said, “No, I'm 80% vegan.” I thought that was a fascinating comment because that shows you how people sometimes want the label. “I'm 80% vegan.” That's not a thing, but for her, it was. Sometimes with veganism, I have a harder time because those women I don't always feel like I have the reserves to run their hormones well. You get to meet people where they are. I've had some women that had to go back on meat because their hormones were out of whack.

It's interesting because you mentioned a moment ago the carnivore diet. I've listened to a fair number of podcasts in that arena as well. You know who I'm referring to. I'm forgetting his name right now.

Paul Saladino.

Yes, that's it. At first, I was like, “It's not possible that someone that's a human being is a pure carnivore for a long time.” I learned that he's added dairy, honey, and fruits to that repertoire, which helps him to have a more balanced microbiome. He eats raw organ meat, which to me, I don't think I could ever get myself to that point. It could ultimately mean that your digestion would have a real tough time if you didn't have any fiber at all. It’s interesting to see these extreme diets. In many cases, they work well for a short period of time. Generally speaking, I've heard from many who work as endocrinologists that they don't see their patients do better on grains.

We'll make a baseline recommendation once they encounter a diagnosis, say, “Try not to consume grains for a while and see how you feel.” That does tend to get people back into the kitchen, focusing more on whole foods, fruits and vegetables. They see a cascade of health benefits that come from that. It's not to be super limiting because they could literally consume anything else that they wanted, perhaps not the sugary treats, but real natural whole foods and limit grains for a while and see how you do.

They see things like better-modulated blood sugar with time and things along those lines as well. There are some benefits that come along with it. I know you also referred to certain supplements you like to recommend in your practice. Here at Orlo, we're hyper-focused on Omega-3s, specifically this polar lipid form so your body can absorb it. Delivering that vegan source of EPA and DHA. I believe Omega-3s are in your top five. What were the other four?

I'm a big fan of maca. Maca, for me, is probably number one. The beautiful thing about maca is it helps with almost all hormone imbalances. We don't know its exact mechanism of action, but I can tell you from the thousands of people that I've had on it that stay on it, it does help. It can fill in the gaps where the hormones aren't necessarily getting with sleep sometimes and hot flashes. For women that especially don't want to go on hormones because of history of breast cancer or whatever, it's a great option. You mentioned the Omega-3s, that can be either fish or flax or plant-based, whatever you want. I'm a big fan of magnesium glycinate or magnesium supplementation with the number of things in the body that magnesium does.

NWC 36 | Hormonal Balance

 

We mostly don't get enough of it. It's super important. I'm a big fan of Vitamin D. Probably 95% of the population is insufficient with Vitamin D. I want to get a product that blends that with Vitamin K because Vitamin K will help with the absorption. Last, I have a product that I like. It's one of the only proprietary formulas that I will recommend because I'm a purist when it comes to these types of things. If I'm going to have a product, I want that thing in there. I don't want to sleep formula that's got lavender and magnesium and all these things. I'd rather have one thing, so then I know if it's working.

The one proprietary formula I like is called Zyflamend. It's a combination of holy basil, rosemary, turmeric, ashwaganda. It’s got a lot of research behind it. I take it myself daily. It's not just for wear and tear and inflammation. It works well with autoimmune stuff, but it's also good for your heart. It helps overall inflammatory processes. Those are my top five.

That would work well in combination with an Omega-3, too. That was one of New Chapter’s flagship products when they first brought that out. It was a game changer for many who experience things like joint pain. It was a precursor to the success of all these turmeric products that are out there. It has a lot of science behind it, too. You mentioned magnesium glycinate specifically. Is there a particular reason you like the glycinate form?

Glycinate absorbs well. It doesn't give you as much of the GI stuff.

The laxative effect.

You can take 800 milligrams of mag glycinate and not have diarrhea. Whereas with some of the other forms you do, mag threonate is nice. Sometimes I'll use that one if it's headache related because it does cross the blood-brain barrier. That's a great one. It's not a one size fits all, but most people do well. Mag glycinate also helps a lot with sleep. That's another. I see many women in their 40s and 50s that don't sleep. That's one of the reasons I use that one.

When I was pregnant, too, I would use magnesium by Peter Gillham's Natural Vitality. I'd mix it with some chamomile tea as my evening beverage because I didn't have a glass of wine because I was pregnant. I also found that it helped to keep me regular. I kept it to one teaspoon and not two because, if I jumped over that hurdle, I would have a close relationship with the bathroom for a little while. Is that safe for pregnant or nursing women? I know some herbs you need to avoid.

No, maca, I don't recommend for anybody that's pregnant or nursing because it can affect the estrogen and progesterone levels. There's no real data to show that it lowers estrogen or progesterone, but we do know from studies that in breastfeeding women, it will reduce the amount of breast milk. I won't recommend it in those two instances.

I figured you're the person to ask. Often, women, especially in that phase, are hesitant to add supplements that aren't the standard A, D, K2, Vitamin C, things like that, that are more common. That’s great to know. As we explore this conversation a little more, I have spent some time on your website as well. I understand that you developed this SHINES method as your approach to how people attain their best hormonal balance and live their most vivacious life. Can you talk about that?

It's one of those things where when people go to a doctor, they get a prescription. It's pretty common. I don't think it's too far from the truth to say that it happens a lot. When women come for hormonal issues, obviously, the plan is to replace hormones. I was doing the prescription part, but I wasn't helping them with the other things they could be doing. SHINES, you have to come up with a cool acronym so you can remember it. My PhD is in Philosophy. I spent a lot of time working with indigenous healers. I have that spiritual side. The first S is Spirituality. That can mean a lot of things to a lot of people.

Let's say for the nun. A spiritual practice for the nun is to get outside and be with people. Go out, go for a walk, get out of the house, don't cloister yourself. The H is Hormones, which we handle obviously with prescriptions usually. The I is what I call Infoceuticals. Infoceuticals are things that convey information to the body. That could be essential oils, acupuncture, or reiki. I call it my 20% woo factor. I wanted to give people that liked to try those types of things, some data-driven options for balancing hormones. The N is Nutrition. Nutrition is probably the key, the biggest piece of the puzzle.

If you're not going to change the way you eat and do things, it's going to be hard to achieve hormone balance. The E is going to be Exercise, which is self-explanatory. Everything has its own archetype. For the nun, to get your testosterone up, you're going to want to do resistance training, lift heavy weights, multiple joint weight lifting, like squatting and lunging and things like that. High-intensity interval training for cardio will get your testosterone level up. The last S is Supplementation. The great thing is you only need me for one of those. The other five, you can do on your own. Those are all DIY things. You only need me for the actual prescription part.

If you're not going to change how you eat, you're not going to change how you do things.

If you're getting to the gym and doing that resistance training, I have to admit I've done less of that these last few months and I notice a difference. I mentioned for a moment that my skin honestly has cleared up. When I was going to the gym, hitting it hard, and boosting my testosterone naturally, I was freaking out more. I tend to notice these two things are a little bit related. Honestly, I felt better and stronger and was toner and leaner.

We know from studies that longevity is now being tied to muscle mass. The more muscle you have, the longer you potentially live.

Longevity is now tied to muscle mass. The more muscle you have, the longer you potentially live.

If you boost your testosterone, you boost your body's ability to build more muscle. It doesn't mean you'll end up looking like the Hulk, but you can get toned and tight. Women need to also be less afraid of lifting heavy weight because it doesn't mean you're going to bulk up. It means that your strength will improve and your testosterone levels will also come up a bit, which can positively affect also your libido.

One of the things that you've spoken out a bit against on your podcast is this whole concept of pellets. I must admit that I didn't even know what they were until I heard you speak of it. I feel like in the spirit of, let's say, producing a PSA here, a Public Service Announcement, can you talk to us about why OB-GYNs and other doctors might prescribe something like pellet hormone treatment and what the negative effects of that can be?

I'm brutal when I talk about it. I'm probably being mean to my colleagues. I only think there are two reasons to use pellets. 1) Is money and 2) Is stupidity. There's no real reason to use pellets on humans. They've been used in animals for years, obviously. The thing with pellets is it's good in theory. It makes sense. “If we could give you a hormone and have it slowly released over 3 or 4 months and you didn't have to worry about putting the cream on or whatever, that would be great.” The problem is they don't get released.

When they promote them, it's always like, “It's the perfect release.” No, that doesn't happen. What happens is you get about 1 to 2 months where your levels go way up and then over about 3 to 4 months, they slowly trend down. Over time, it's a big saw tooth pattern. It's up and down. The other thing with pellets is there's no real great way to dose them and put you in the normal range. Most women that have pellets done have levels 5 to 8 times normal.

Of testosterone specifically or of all the hormones?

Any of them that are given are going to be super high. What happens is these companies, they come out and they pitch it. They make it sound nice. I've been pitched many times until they realize that I'm not going to do it. They pitch it. They look at the numbers. I figured it out. If I did pellets based on the numbers they gave me, I would make an extra $25,000 a month in profits. It's hard to say no to that because, “I'm already doing hormones. They told me they're safe.” That's the incentive. The problem is it's also protocol driven. What happens is they draw the labs and then they put it into this computer. The computer will tell them what they think you should be on.

There's no art and reason to it. The other problem is because of that, people that have no idea about hormones at all are doing these, plastic surgeons, and emergency room doctors. I'm not bashing these people, it's fine, but it's obviously money driven if that's the reason they're doing it. Plastic surgeons could care less about hormones. They don't care. They've got other things they're doing. It's a way to make extra income. These women are coming in want to look better. They want to feel younger, “Hormones, what a great idea.” You're paying a lot of money for them. Personally, I think they're dangerous. I question the motivation behind the insertion.

Could you describe for a moment how, and I know this might sound a little gross to people, but I was like, “Pellets, how do you take them?” At first, I thought it was like a sublingual thing, and then I heard you explain. You're carving out a space in somebody's rear to put these pellets under the skin hoping they don't migrate, create an infection, or do any other sorts of things. It can be painful as well or is a painful procedure.

I'd say it's a surgical procedure. They say it's not. Anytime you're draping the patient and prepping the site and putting something inside somebody's body, that to me is a surgical procedure. It's a big trocar. A trocar is just a needle, but it's thick because these pellets are probably like two grains of rice put together. They have to put it under your skin. They have to get it into an area that's well away from the poke hole site, otherwise, the pellet will spit back out. They have to tunnel it up into an area. They'll put in 1 or 2 of these pellets and then you're done.

You got to do that every 3 or 4 months. After a while, you would think that would hurt. Besides being overdosed, I see infections, the pellets getting spit back out, bruising, pain, irritation, and dimpling in the skin because the pellets have been put in so much that you have a dent in your rear. It's a surgical procedure. The problem, too, because of that, once you put them in, you can't get them out. You're stuck with them until they wear off.

Another side effect I also heard you mention is that sometimes they can have lasting effects if they get too much testosterone.

The two things that are permanent with high testosterone over time are voice deepening, that doesn't go back, and then clitOmegaly, where the clitoris gets enlarged and can look like a little penis because of the stimulation from the testosterone. If that happened, that also doesn't go down. The other thing is changes in cholesterol, high blood pressure, stroke risks. Those will get better if you stop the medication, but you got to keep an eye on those things while you're on it.

Essentially, you start to have the increased heart health risks that men of that age might have.

At the levels I've seen, most women have around 200 to 300 milligrams of testosterone on these pellets. A low number for a man is around 250 to 300. You're up in the levels of men.

Let's talk for a moment about your home hormone range. This is something that was also a mystery to me as I discovered that I had hypothyroidism. There's a low normal and then a mid-range and then high normal. Often, women get their results from their annual, and their doctor might say, “You're within normal ranges,” and the conversation ends there, but they still might not feel their best. What do you say to your patients or to women who might be confronting these sorts of realities where their energy's low, their sex drive’s low, they might be experiencing some undue weight gain, and experiencing some other health challenges that relate to their hormones, and yet they're told that they're in normal ranges?

The thing about a range is it's a range. Say free testosterone, which is the active form of testosterone. Normal's going to be 0.2 to 6.4. That's a 30-fold range. It's huge. Let's say you get your labs done and you're 0.4. You're normal. That's great. I always say it like this, normal means you're in the house. If you're 0.4, you're in the basement laying on the floor of the house. Maybe you'll feel better if you're in the middle of the house, but that would be an eightfold increase in your testosterone level.

It seems crazy to me to say to a woman, “Why wouldn't you want to be in the middle of normal, especially when you have fatigue, you're falling asleep in the afternoon, your hair is thinning, you feel meh, you don't have a sex drive?” When you have all the symptoms, just because it's normal, I could multiply an eightfold and it would be in the middle of normal. You might feel a lot better. When you feel better, you're going to eat better. You're going to maybe work out. You're going to have an active sex life, which is good for your health.

NWC 36 | Hormonal Balance

 

What I call that is lazy medicine. The reason that I say that is because it's lazy to say you're normal. I had a patient tell me that her doctor told her, “Everything's normal.” She's like, “Why do I feel like this?” He's like, “You're still pretty,” like that's going to make it better. I don't know. “You're getting older,” they hear a lot.

You should expect to feel crummy as you age.

We don't tell men that, “You're just getting older.” There are testosterone clinics every 5 feet. We know that women are obviously treated differently by the medical system, but to me, it's nowhere near as prevalent as it is in hormones because of exactly what you pointed out.

The methods of giving people treatment in this day and age you have pellets, which are invasive, you have injections, which are also invasive, and they tend to be something you have to go back for routinely. Are there oral treatments for women, or is it only topical from there? Where do we go?

There's topical, sublingual, a tablet you put under the tongue and let it dissolve, and capsules, which you swallow. We tend to stay away from the capsules if we can because when you take something orally like that, you're probably going to lose about half of it, 30% of it to the liver. You're putting a little bit of added stress on the liver. A sublingual tablet, you'll probably swallow about 10% of that, but still, a lot of it's going right underneath your tongue. It's going into the blood vessels. My two preferred methods of replacement are going to be topical or sublingual.

NWC 36 | Hormonal Balance

 

If I'm thinking about this overall, there are a couple of things that have come to mind as we had this conversation. When we first started talking about the injections and the pellets, I was reminded of this birth control method that was popular when I was in my teens called Depo-Provera. It was injections that you put underneath the skin on the inner arm.

The challenges with those were they would migrate and things along those lines, too. Many women are saying that they don't want to have to experience hormonal birth control, yet they aren't ready to get pregnant. What types of advice might you give the girls of reproductive age who are sexually active and not yet ready to have children but who might also want to shy from taking a birth control pill every day?

Obviously, there are condoms. No fun, but they're there.

It can break. That doesn't prevent pregnancy.

The only thing that prevents pregnancy is not having sex, but that's not going to work. Phexxi is a relatively new prescription that's been around for about a year. Phexxi is a gel that you put inside the vagina. All it does is lower the pH. It's toxic to sperm. The downside to Phexxi is that you have to put it in about half an hour before sex. You got to plan. There's always the non-hormonal IUD, the copper T Paragard. It's been around for decades. It lasts for ten years. It's a little harder to put it in women that have never had a baby because it's bigger. You may not be a good candidate for it if you've never been pregnant in the past.

There are a couple of things coming down the pipeline for men. I honestly don't think any of them will ever get picked up because men aren't going to buy them. They're not going to go on them. The best form of female birth control is of vasectomy because you don't have to do anything. Lastly, though, what I use a lot in my practice are fertility awareness devices like Daysy and iFertracker that check your basal body temperature.

The best form of female birth control is vasectomy because you don't have to do anything.

If they follow your data for about three months, the accuracy rates of those devices telling you when you can get pregnant. These are not birth control devices. They're fertility devices. They tell you when you're ovulating and they turn green when you should have sex because that's when you can get pregnant. The flip side of that though is if you know when you're ovulating, you also know when not to have sex. Not necessarily, maybe 100%, but it's about 98%.

It reminds me of a joke from the ‘80s. What do you call somebody who practices the rhythm method? It was mama. That was without the intelligence of something like this. When women were going off the calendar and saying, “I should be ovulating in these 3 or 4 days. I won't have sex around that.” Sometimes your hormone shifts. Stress affects when you're going to ovulate. There are many different things that can come into play. Tracking it with your body temperature makes a lot of sense to me.

To me, it's also more data. Let’s say you're having a lot of pain on your right side. You look at your fertility tracker and you just ovulated. It's a good feedback device because it teaches you more about your cycle.

Tell me again what this is called and where our audience can find out more about it.

Daysy is Daysy.me. iFertracker is another one. The difference between the two is Daysy is just one thing. It's a little thermometer that hooks to your phone. It's $300 and there's never anything else to buy. iFertracker is only $105. You put a patch on at night when you go to bed and it takes your body temperature, but you have to buy the patches every month for $15.

Six on one hand, half dozen on the other. Similar tools to do the job. That's interesting. If there was a particular message that you wanted to leave our audience with, what might it be?

You have to be your own best advocate. I don't mean this in a bad way, but they don't have the time to tell you when your labs are. If they're normal, they're normal. What I always say is normal doesn't mean it's normal for you and you have to be your best advocate. I have women all the time ask me on Instagram or something, “What do I do if my doctor doesn't want to order the labs because that happens?” Two, “They tell me my labs are normal, but I feel horrible.” Find another doctor. There are plenty of physicians out there that will listen. If they don't listen to you, you don't want to be around them anyway. Also, don't just take that at face value.

We've done that for decades. We've told women, “That's fine, don't worry about it.” They go home and suffer because nobody's helping them. Don't take that as an answer. I always ask patients that even if I start them on hormones and they come back in six weeks, “How do you feel? Is this how you want to feel? If you don't feel the way you want to feel, let's fine-tune things a little bit to get you maybe where you want to be.” Usually, you can get there. Sometimes I tell patients, “I might be able to get you 75% to 80% of the way, but you got to do the other things. You got to eat right and work out and do those things.” Don't take it at face value. Keep advocating for yourself even if nobody's listening to you.

That speaks to me. I'm in a medical system with an HMO now, where I have a little bit less choice than I used to have with who my doctor is. I've found that I get an automatic email with my test results and then a message that says things are normal. I have to go in and look at them and then get a list of questions together for the doctor, which I'll send to them, and then they'll respond. “We need to do something different. I can do something different.” I look at something and say, “This is within normal ranges, but I want to know more about what it means.”

Specifically, let's say with Vitamin D, for example, where I have tended to test low. I have Mediterranean descent. I'm perhaps not making it as well from the sun. I supplement with Vitamin D, but perhaps I wasn't taking quite enough or maybe not quite frequently enough. Maybe it was seasonal and do we need to check my levels again in six months? Being your own advocate, trying to get at least a basic understanding of what each of the results means for yourself. If you need to select another practitioner, go the route to do that.

You have to. There's no way around it.

I appreciate so much the time that you've spent with us. I would love to know if you have any news or what's coming in the future regarding your podcast or your efforts with your website. Are you seeing patients remotely? Is that something that's open to people that are outside of the Austin, Texas area?

I have started getting licensed in other states to do Telehealth because I was limited in the people I could help based on location. It's easier now after COVID to get licensed in other states. I'm pulling it up right now. I'm obviously licensed here in Texas. I'm licensed in Georgia, Oklahoma, Arizona, Utah, Ohio, Nebraska, Louisiana, Colorado, and Alabama. Anybody in those states I can see virtually. I'll be expanding that as I have people ask and stuff. It's expensive to get licensed. I can see people from other states. I'm also going to start, probably in January 2023, offering some online type stuff that women can do that will be, allow them to work with me and, and not just on hormones, but also on diet, exercise, and things like that because that's all part of it.

Thank you again so much for joining me.

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If you have questions about what we covered or topics that you'd personally like to see us dive into more deeply, please reach out via social channels @OrloNutrition, or you can send me an email note directly to Hello@OrloNutrition.com. I also want to remind all readers that you qualify for an extra 10% off your first order at OrloNutrition.com. Use the coupon code NWC10 at checkout for that discount. This could mean as much as 7% off your order as we're currently running a holiday promotion with a bundle that includes our immunity boost product, which is Vitamin D3, along with spirulina and a smattering of B vitamins to support your immune system. As we close this show, I hope that you'll raise a cup of your favorite beverage with me as I raise my coffee and say my closing words, here's to your health.

 

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About Dr. Shawn Tassone

NWC 36 | Hormonal BalanceShawn Tassone MD, Ph.D., known as Americas Holistic Gynecologist, is the first physician in the United States to be double board certified in Obstetrics and Gynecology and by the American Board of Integrative Medicine. He holds a medical degree in addition to a Ph.D. in mind-body medicine. Dr. Tassone is a practicing OBGYN in the Austin, Tx area, hormonal expert, author, speaker, highly rated patient advocate, creator of the world’s first integrative hormonal mapping system, and host of the Confessions Of A Male Gynecologist podcast.

In his 20+ years of practice, he's listened to over 50,000 women's stories and is determined to remove the myths surrounding women's health. As an integrative health practitioner, he believes that you should have an active role in your care. His work includes studies and publications on hormonal imbalances, spirituality in medical care, whole foods to heal the human body, and integrative medicine. Dr. Tassone is featured in many publications including The New York Times, NBCNews Online, Stanford MedX, to name a few. His latest book, The Hormone Balance Bible, published by HarperCollins, is available for purchase worldwide.

 

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