Ep.64 In the Know on Hormone Facts and the Weight Loss Connection

One of the goals of the Asking for a Friend Podcast is to bring thought leaders to the table in all matters that impact midlife women.  As things are rapidly changing, it is difficult staying current on hormone replacement therapy and the treatment of menopause.  It is vitally important that we are armed with information so that we can do our own research and feel empowered to have discussions with our healthcare providers.  

Nicole Lovat, MD, was two weeks away from opening her family medicine practice, when she attended a hormone education seminar held by World Link Medical.  She was blown away by what she learned, and as a pharmacologist, she was able to connect the dots in regard to what the underlying issues were for her perimenopause and menopause patients.  

Nicole did a 180 pivot and is now successfully treating women who were once struggling with low libido, tired, and gaining weight.  Her multi-pronged approach looks at inflammation markers, vitamin levels, symptoms from hormone pathways, and metabolic levels to devise an individual treatment plan that is science-based.

In this episode Nicole Lovat, MD, and I discuss:

- Why she did a 180 pivot two weeks before opening her medical practice
- Why women need estrogen, testosterone, progesterone, and thyroid and the impact on weight
- Pellets, creams, and oral hormones - what she prefers and why
- HRT, cancer, and the current risk
- The importance of identifying insulin resistance in patients even if they are not diabetic
- Vitamin supplementation to complete a treatment protocol 
- Rounding out her practice with esthetic offerings

https://www.instagram.com/fireflymedical/
https://www.facebook.com/search/top?q=firefly%20medical%20group%20pllc
https://fireflymedical.net/
https://worldlinkmedical.com/
 

_________________________________________
Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling rundown. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan

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Transcript

Asking for a Friend Podcast
In the Know on Hormones and the Weight Loss Connection
Michele Folan
Nicole Lovat, MD

hormones, women, thyroid, patients, estradiol, menopause, drug, progesterone, good, estrogen, insulin resistance, helps, perimenopause, work, testosterone, treat, storage hormone, questions, body, thyroid hormone

The goal of this podcast is to bring thought leaders to the table in matters that impact midlife women. It's important that we're armed with information so that we can do our own research and feel empowered to have discussions with our health care providers in order to ensure we are getting optimal care. Why is it that to my knowledge that only one of my close friends is on hormone replacement therapy? I'm very open about the fact that being on HRT has been a game changer for me. But either, we aren't being honest with our providers about how we're feeling. Our doctors aren't asking the questions, or they aren't comfortable or adequately informed on how to treat menopause and its associated symptoms, and I'm going to throw weight gain in there as well. I'm seeing opinions shifting for the positive and sometimes it takes one doctor to change the narrative with science and patient success.

Speaker 1  1:16  
Health, Wellness, career, relationships and everything in between. We're removing the taboo from what really matters in midlife. I'm your host Michele Folan. And this is asking for a friend. Welcome to the show everyone. Today's guest and I were graciously connected by one of my other podcast guests and I always love when that happens. Dr. Nicole love it is the founder of Firefly medical where she takes a progressive and science based approach to helping women better manage their menopause symptoms and live healthier through health and wellness optimization. Welcome to the show. Dr. Nicole love it.

Unknown Speaker  2:05  
Thank you so much for having me. I'm excited to be on.

Speaker 1  2:07  
I should also mention that you're not only an MD But you're also a PharmD you are a pharmacist,

Unknown Speaker  2:14  
actually a pharmacologist,

Unknown Speaker  2:15  
okay pharmacologist,

Speaker 2  2:17  
it's a PhD in pharmacology. So pharmacology is the science of developing drugs, designing clinical trials, repurposing drugs, figuring out toxicities therapeutic indications, whereas pharmacists help dispense medications and dose them and predict interactions. pharmacologists are actually drug inventors drug testers.

Speaker 1  2:39  
Now, that's very interesting. Yes, I was not aware of the distinctions. But I think that provides you a very unique thought process behind how you treat your patients. Let's back up a little bit if you could just tell the audience where you're from, and your background and education and all that good stuff.

Speaker 2  2:59  
So I was born and raised in Winnipeg, Manitoba, and Canada. I attended the University of Manitoba in Winnipeg, my undergrad degree was in biochemistry and physics, which was a unique degree that they basically made just for me and one other person who wanted to do it. It gave me a really rigorous background in biochemistry, which I've tended to go to medical school since I was the age of four. So I'd already had my sight on that. So I wanted to make sure I had a really good biochemistry background in the physics, I really loved problem solving and understanding how systems worked. So when I was admitted to medical school, during one of the tutorials, in the first few weeks of school, I met my PhD supervisor who was going on this huge side tangent of insulin resistance, what's the root cause of diabetes? And I was like, wow, I need to study this. So I ended up being recruited into the MD Ph. D. program. It's called the clinician scientist program. The idea is you have a doctor that knows how to practice science, how to test hypotheses, you can take something from the bench to the bedside. My study in female rats was studying the female physiology, both when you're not pregnant and when you're pregnant, and then do st gestational insulin resistance with a high sugar diet, and some different therapeutics and preventatives to help treat those routes. During the course of that graduate degree. You have to be an expert on all drugs, you actually write an exam where you're in front of a group of professors for three hours, and you have to answer random trivia, like what's the mechanism of action of this drug you've never used before? So it's very rigorous.

Unknown Speaker  4:28  
Oh, God, that sounds awful.

Speaker 2  4:31  
It was challenging, but it gave me a different perspective. Because when you understand how drugs work, suddenly you have a lot of questions and you have a lot of applications perhaps that other people don't because they just know you use this drug for this problem. Well, when I see a drug, I'm like, Oh, it works this way. And I could use it for this, this and this. My residency training was in family medicine in Canada. I did rural so we did obstetrics emergency medicine, ICU hospitalist. And then when I met my husband while he was in law school in the state It's I ended up moving here after he graduated.

Speaker 1  5:02  
Well, good. You've been at a couple other practices and things. Yeah, throughout the US in the northern Midwest, I should say. But then you started Firefly medical, which I think is super interesting and how all that came to be.

Speaker 2  5:19  
Basically, I've been practicing in primary care settings and all these different settings in different countries. And I just kept hitting a wall with people I could get them pretty well off like maybe 50%. Healthy doing the diet and exercise. I use low carbohydrate diets ketogenic diets carnivore that, like Whole Foods, Paleo. But people were hitting a wall, they just couldn't lose the last 20 pounds, they still felt tired. And I was getting frustrated practicing guideline medicine where you were told, Oh, you have cholesterol problem, we're not going to figure out why you have a cholesterol problem. You get a stat and now. So when my husband could see me struggling, he said, You need to open your own clinic. And initially we were going to do primary care, but in a different model. About two weeks before we opened in April of last year, I attended a hormone training by Worldlink medical by Dr. Neil Rusi. And I was sat there was a three day seminar. And I felt like I was going through the seven stages of grief, I suddenly knew what was wrong with the majority of the women that were in my office, especially in perimenopause and menopause. I knew what to do with all the women that were tired gaining weight cold, it just it blew my mind. And he was talking about studies that I'd read in grad school, and had never heard a clinician talk on I'd only heard a pharmacology professor, talk about it be pivoted 180 degrees decided to do a full hormone practice with aesthetics instead,

Speaker 1  6:45  
in two weeks. Oh, my, but that had to be life changing and freeing for you? Yes. I mean, to like say, oh my god, I just figured this out.

Speaker 2  6:57  
Yep, I've seen it. Over the past 15 months, I asked my patients zero to 10. Zero is dead. 10s a superhero. People are telling me they're eights and nines. And they're 70 pounds smaller, and they feel great. And their relationships have all gotten better, because they feel so much better. I couldn't get those results before without hormones.

Speaker 1  7:18  
We have had the hormone discussion on the podcast in the past, I like to get a wide variety of approaches and opinions. But your approach is a little different. And I would love for you to share that and how you're looking at each patient individually.

Speaker 2  7:39  
We start off with a consultation downs to the patient almost like random questions. But what I'm doing is I'm hitting all the different hormone pathways. For example, progesterone, do you have anxiety? Do you have trouble sleeping? Do you sweat at night? Do you have irritability is your husband very annoying, sometimes like when he really isn't being annoyed. And all those things they don't seem related. But basically, I tried to map out all the symptoms that they're having from those hormone pathways. We also measure nutritional levels, some important vitamins like vitamin D. And I also measure inflammation in the blood to make sure that's not a factor for them, because inflammation to the body is the fire that burns inside you that converts a lot of your fats and sugars into plaque and chronic disease. And we also measure their metabolic levels. So I do fasting insulin levels and a one C which is measures your average blood sugar. Once we get all these results back, I sit down with the patient and we go through what they look like on paper. And what's interesting is not many people know this. But normal ranges are not based on healthy people, or really evidence based for the most part. For example, the normal level of testosterone in men is based on a Medicare database study where they made 95% of 80 year olds normal. Like that's not normal for a 20 year old. Now, if you don't know that you could look at it lab work and like everyone, everybody's all in normal range. There's no problem here. But what we do is we try to match the symptoms up to the levels and say, Okay, I can't tell you exactly how much of hormone X you have binding your receptor because we can't look that closely at but I can tell you your level isn't as good as it should be for your age, and you have so many symptoms. Let's get you up higher and see if your symptoms go away.

Speaker 1  9:21  
This is my question. Do women need all three? You and I had this discussion weeks ago when we first spoke, but there's estrogen there's testosterone and there's progesterone? Yes. And they all do different things. Do we need all three

Speaker 2  9:40  
when you're in perimenopause or your pre menopausal so you're talking before menopause, you are still making estrogen. So in those women, all they need is progesterone and testosterone. I also optimize thyroid hormone because it's very important for your metabolism and your energy levels and as well as your lipid panel, your blood sugar's, once you're actually in menopause, then your ovaries are failed, they don't make hormone for you anymore. At that point you initiate estrogen replacement. To keep you at a nice early cycle level, not when you're feeling bloated and pmse. We shoot for a level of about 100 in the blood of estradiol, which is the healthy estrogen. But that can only be done once you're in menopause, because otherwise, your ovaries are still making estrogen and you get unpredictable levels and you can get a lot of side effects

Speaker 1  10:29  
that to the thyroid thing. This is intriguing to me. I have a friend whose thyroid never worked correctly, and she'd been on thyroid medication her whole life, does our thyroid start to poop out over time?

Speaker 2  10:43  
I does. The thyroid pathway is extremely complicated, we can simplify it down into a few levels. Basically, the brain controls the thyroid gland which sits in the front of your neck. And that gland then secretes a storage hormone called T four. That's what's in Synthroid, the commercially available thyroid hormone that it actually harms a lot of people because your body has to be able to convert that storage hormone into T three, which is active, that T three does all the good things thyroid does like body temperature, circulation, getting rid of your Raynaud's improving your energy levels, and improving your metabolism. Unfortunately, as you've aged, you lose the ability to convert that storage hormone into T three gradually, and that depends somewhat on your genetics, how heavy you are, what endocrine disrupting chemicals are in your body. What other drugs you take like pharmaceuticals for let's say depression, anxiety, statins, but long story short, every year you get older, you start making less and less of that storage hormone into active version. And then that contributes to basically muscle weakness, weight gain belly fat, specifically and fatigue as you get older.

Speaker 1  11:51  
My mind's a little blown. Let me tell you why. Because I'm sure that's part of my blood panel. I'm assuming when I go get bloodwork done.

Speaker 2  12:02  
Great question. So normally, they'll only measure the TSH. And the TSH is just a measure of how hard your brain is telling your thyroid to work. It's doesn't tell you about the actual levels of hormone you're able to produce are. And most insurance companies will pay for the T for the T three level. And they will only do that if your TSH is either really, really high or really, really low, like zero, and then it'll reflex and let you measure it. But most people like 95% of the thyroid disorders that I treat are past the brain level. It's not a problem with your brain. It's a problem with your thyroid or your body. And one of the big drivers of turning off your thyroid by lowering your TSH is actually inflammation. We get inflammation from what we eat, what we do all day, different medications that were on stressors. I mean, it makes sense. If we look back how we evolved and survived all these famines and wars, we had to have a mechanism to get fat on 300 calories a day. That's what our bodies do for us when we're under stress. Yay.

Speaker 1  13:06  
Wow, you know, if we don't feed it, we store it, right? Yeah, yeah. Okay. See, this is why I'm having you on the show. Because I'm learning. That's great. Yeah, I've got pharmaceutical background and this is all brand new. Now, when women come to see you typically, what are their complaints? What are their issues?

Speaker 2  13:27  
I'll probably divide these by the age group. So younger women like under the age of 40. It'll usually be obesity and fatigue will be a major complaint, or I'll see women with infertility so they can't get pregnant or they're having recurrent miscarriages. The next life stage would be perimenopause, where the initial step towards menopause is losing a hormone called inhibin. inhibin controls the amount of estrogen your ovaries are allowed to produce. Now you're making all this estrogen you get bloated, you get acne, you get mood changes, you feel snappy and you bleed because your lining gets thick. That explains most of the hysterectomy is that uterine ablations that happen around perimenopause, then you start to lose progesterone. So then you get really moody then you can't sleep you sweat at night you get hot flashes, and then finally lose your estrogen and then you're in menopause, but that can take 1015 years and some people Yeah, that's

Speaker 1  14:22  
a scary thing is perimenopause can be a really long time. I had this conversation with another guest that it's frightening to me that women will actually have to quit their jobs because their symptoms are so bad.

Speaker 2  14:40  
And the treatment the standard of care does not really adequately treat them. They'll often offer surgical removal of the female organs to control bleeding, which isn't a very aggressive treatment option when it's a hormone issue. Dr. ruzi, who I trained under for hormones calls it a no man's land like perimenopause. No one wants to talk So with a 10 foot pole, everything is normal no matter what you're experiencing, and they end up putting people on antidepressants like Effexor or birth control or progestin, which causes weight gain. So then you just feel even worse about yourself because now you're even getting bigger and you're out of control of your metabolism.

Speaker 1  15:16  
Are things starting to change? I mean, are you seeing any light at the end of the tunnel in regard to the medical community's perspective on treating perimenopause and menopause?

Speaker 2  15:28  
I think that the pharmaceutical industry has lost interest in treating menopause and perimenopause, since having those trials come out in the 90s, and 2000s, where they tested synthetic hormone replacement therapy and found that there was significant issues with synthetic progesterone called progestin. And unfortunately, I think the way they responded to those trials, instead of saying, Okay, we need to use bio identical because there's all this literature from all across the world that shows how great they are and how they improve quality of life and outcomes. They kind of said, If I can't have menopausal women, no one can. And instead, they just copy and paste all the risks of synthetic onto bioidentical. So when I can send my patients, I have to tell them, you have to consent to all of these things, because the FDA says that they could do them when the trials don't support that.

Speaker 1  16:15  
Well, and I think the first concern that every woman seems to have around hormone therapy is cancer risk because of that previous data that was out there. But what is the current data? Are you able to at least give people enough data so that they're comfortable making that decision?

Speaker 2  16:34  
Yes. And you look at the trials on estradiol, specifically, it actually is protective against breast cancer, the root cause of breast cancer, if it was female hormones, why would it strike women mostly after menopause? That doesn't make any sense. If it was causing cancer, it should be hitting teens and girls in their 20s or when they're pregnant when they have really high levels of progesterone and estradiol, but it doesn't it hits women and menopause perimenopause and in their 70s, and that's because the root cause is actually insulin resistance in the breast tissue. And here's of unopposed estrogen. Most women that end up with a malignancy in their breast actually have underlying PCOS, and don't make adequate amounts of progesterone and have had been stimulating their female organs for decades with estrogen without enough progesterone. Okay, when you look at the trials, that kind of associated synthetic HRT with breast cancer, it's really progestin synthetic progesterone, that was the problem, because it actually increases insulin resistance, weight gain and inflammation in the breast and blocks the progesterone receptor.

Speaker 1  17:39  
If a woman has though, estrogen receptor positive cancer, can you explain that to me, then

Speaker 2  17:49  
the recommendation would be to never treat any patient with a hormone sensitive cancer with hormones. But if it was my mother or my sister, I wouldn't be taking the standard of care, estrogen blockers that cause more deaths from cardiac events and diabetes than they protect events from breast cancer deaths. Okay, I kind of have to be careful what I say there. But

Speaker 1  18:12  
I know, opinion is starting to change. And people are starting to wake up and dig into the data and really look at the full mechanics of the body. And what's really important. I know some women who have had just horrible, horrible menopause symptoms, you look at the loss of bone mass from some of these post cancer drugs, and it's like, you have to start weighing out if my body is aging at a much more rapid pace, because I am blocking the estrogen. Where's the benefit is that I don't know.

Speaker 2  18:52  
The one thing too is your ovaries are not your only source of estrogen. Your body fat makes estrogen and some toxic estrogens that are not estradiol, which is helpful for the vasculature. What you have in post menopause is you have belly fat that you've got because you lost your hormones. And that belly fat secretes estrogens. And maybe you eat a lot of soy and processed food or a lot of produce with pesticides that are estrogenic. And that's what stimulating the estrogen receptors on those cancers. It's not the estradiol that you had before you were in menopause.

Speaker 1  19:26  
All right, since you keep talking about insulin resistance, and I get to ask you, all the glue tides like liraglutide and let's just say ozempic Because everybody knows what that is so magnetite. Yeah. Are you using that currently in your practice?

Speaker 2  19:43  
I am. It's a wonderful drug. It has multiple mechanisms of action specifically for women with PCOS. It helps with neuroplasticity, it helps with opiate pathways, whether you're addicted to sugar, alcohol, opiates, it helps with that. But I think it's being way overused. The downside for women is if you give them ozempic, or any of the Glip, one drugs that are in the same class without optimizing their thyroid first, it's going to be just like any other diet, your brain is going to realize it's losing weight, it doesn't want to lose. There's a hypothalamic setpoint, that's partially hormone dependent on thyroid, that will sense that, oh, we need to be 180 pounds, we're not going to 120 and then it shuts your thyroid hormone off, so you get cold and sad and fatigued. And then you gain the weight back, even if you're only eating 400 calories a day. Whereas if I optimize thyroid, first, I'm finding only maybe one in four women will actually need it to get the weight off. And 75% of them are fine just on thyroid hormone, and dietary changes.

Speaker 1  20:49  
I'm almost speechless, because you're the first person I've heard, have this approach. And I'm just impressed that you've tied everything together. And I just think that's really cool.

Speaker 2  21:03  
If you look at women and men, too, I guess the other thing with men is when they're put on ozempic, without having testosterone optimize, they lose lean body mass women do too. So I also put my women on testosterone before semaglutide. Otherwise, a lot of the weight you're losing is actually a muscle and not fat.

Speaker 1  21:21  
Okay, do you treat men too? I do. Okay, so you do more primary care practice?

Unknown Speaker  21:26  
No, no primary care at all. We do. 100% hormones.

Speaker 1  21:29  
Okay. 100% more, man. All right. I just want to make sure I understood. I didn't know if the reason you see men is because your female patients are dragging their husbands in. They are

Speaker 2  21:39  
Yeah, it's their brothers, their dads, their husbands their uncle's or their children.

Speaker 1  21:47  
Yeah. Oh, yeah. Next question is, could you share a patient hormone success story with us.

Speaker 2  21:56  
I'll pick a gal that saw me when we first opened. She was in menopause for about 10 years. She had about a 45 inch belly. She was diabetic, been trying to lose weight for 10 years just couldn't. She also had a lot of fatigue, restless sleep. She was on a couple different medications for cholesterol, blood pressure and mood. Because of her menopausal state, we put her on estradiol progesterone, testosterone and thyroid. And within six months, her blood sugar's were normal. She was off of all of her other medications. she'd lost about six or seven inches on her belly. And she was down to her weight that she had wanted to achieve for the past 10 years, and felt great. She's a very active lady has grandchildren. And she felt like she just got this second wind. You look forward to retirement your whole life and then you retire and you feel like garbage. It's not really fun.

Speaker 1  22:51  
No, it's not, I guess, can you do telemedicine with this type of? You can?

Speaker 2  22:58  
Yes, the DEA and FDA changed the rules may 12. Back to some of the pre COVID rules where if you're prescribed a controlled substance which testosterone is controlled, you have to establish care within 30 days in person with your provider, which is pretty easy to do. And then that's the only visit we have to do in person for the rest of the follow up. They can all be telemedicine,

Speaker 1  23:21  
you discuss the association between optimal hormone levels and Alzheimer's. Can you speak to that just a little bit?

Speaker 2  23:30  
Yes, Alzheimer's disease is now being called type three diabetes. It's brain damage from insulin resistance. One of the things that estradiol does for the human body is it helps reduce insulin resistance and it helps push sugar into muscle instead of having it stored as fat or stay in the bloodstream. So you can think of somebody with Alzheimer's as their brain is crying out for sugar. But because there's so much insulin resistance, the cells can't get the sugar that they want. And that sugar is being drawn in and then causing all this oxidative damage and plaque formation. By optimizing your hormones, specifically estradiol in both men and women, you are mitigating that insulin resistance and it helping improve that. The other thing that estradiol does is it helps remodel plaque. One of the things it up regulates is an enzyme that chews the plaque up and remodels it to make it skinnier. Some of the Alzheimer's we're seeing is multi factorial. They also have a vascular component to it. Like think of having a heart attack or a stroke, or vascular dementia is where you have like little plaque and all the little vessels in your brain. So it helps with that too.

Speaker 1  24:35  
Is there any age to where would you not treat somebody? Nope. If I'm 75 and I'm a female, would you be okay, using hormones for them?

Speaker 2  24:47  
Yep. The only limiting factor and treating more elderly people is that a lot of them end up in nursing homes. And the nursing homes won't give the hormones no one will prescribe it there. Unless you have a family member willing to go and put their testosterone cream on give them their estrogen and progesterone. It's challenging, but ideally you're trying to get on top of it before you get that far down the disease pathway.

Speaker 1  25:10  
Do you have favorite modalities? You like the estradiol vaginal cream, now,

Unknown Speaker  25:16  
Ester dial oral capsule,

Unknown Speaker  25:18  
oh, you're doing oral capsule?

Speaker 2  25:20  
Yes. Any transdermal or topical, so vaginal, there's something called first pass metabolism. So when you ingest a drug through your stomach, that stomach, blood gets filtered through the liver, and then all the liver enzymes have a chance to metabolize the drug. When you have oral estradiol that oral estradiol is metabolized into fatty acid esters. Those are what helped the cardiovascular system and improve HDL cholesterol, the good cholesterol, if you're not taking estradiol by mouth, then you're bypassing all the cardiovascular benefits. And you're only getting like bone density maybe and mood, you're losing 50% of the benefit. And that's why I don't pellet it either.

Speaker 1  26:00  
You don't do testosterone pellets, then

Speaker 2  26:04  
no Astra dials oral for me, not pelleted either, and testosterone I use a transdermal cream. I like the control because women get very unhappy if they're overdosed on testosterone, they lose lots of hair, they get acne, sometimes really bad facial hair. And if you put a pellet in, it's in for three to six months. And less frequently you dose a drug depending on its half life, the more ups and downs will get in the level. So you're going high and then you're falling. Whereas if I gave you a transdermal Korean, once we get the perfect dose for you, if you keep putting it on every day, you'll always feel like you do at the best part of your palate.

Speaker 1  26:37  
When I had a hysterectomy two years ago, I was very fortunate to go to a practice where they had a nurse practitioner who had a lot of experience with hormone therapy. Good. They started me on estrogen, I do the estradiol vaginal cream, and transdermal testosterone. At that point, I had been on Lupron prior to my surgery because they were trying to see if it would shrink the size of my fibroids, which it didn't, I had months and months of hormone suppression that was unnecessary. At that point, I just couldn't even look at my husband. I had no hormones. Yeah, it's just nothing was happening. But what was interesting, and I'm saying this because I think it's important for women to know that. I knew that testosterone was working. When I finally thought my husband was cute again. Yeah. Because the nurse practitioner said, Well, your levels look good. How are you feeling? And I said, Oh my god, I actually find my husband attractive. She's like, that's good. Yeah, let's go with that. How do you judge how the hormones are working for your patients,

Speaker 2  27:58  
symptoms, symptom control and any side effects. I usually tell women that transdermal testosterone cream will kick in. Usually at the 16 week mark, you'll go to bed one night without a libido. And you'll wake up the next morning. And they'll be like, Whoa, what was that? I think it's sad that we expect men and women to feel sexual and have health when they don't have any hormones. That's what they're supposed to do for us. They're supposed to make us feel good and behave in a way that makes others feel good. And if you don't have them, it's just not possible.

Speaker 1  28:30  
This is the other thing. I know that there's a trend right now separate bedrooms, and that sort of thing that Oh, my God. I mean, we're still young at 60 years old. Why do you want to not have a sex drive? Right at 60? I mean, if you can fix it. Don't do that to yourself. That's my opinion. But that's just me talking. anything new coming? What's the future of hormone therapy, what excites you?

Speaker 2  29:01  
I'm really looking forward to just taking on more patients. We have provider, Sarah, who has joined us in January, she's seeing patients. And we have a do and other physician who's looking at joining us in the fall. I just see patients a year ago, today, they're totally different people and so much happier. I just want this whole community to get on board and feel as good as they can and be as healthy as they can. And every time we get these success stories, it just makes me want to treat even more patients.

Speaker 1  29:33  
Well, that'll get you out of bed in the morning. You've also jumped into the world of aesthetics, yes. What advances are you seeing in that arena?

Speaker 2  29:42  
The biggest new guy on the scene in the US is RHA filler by teoxane. It's a new European design filler, which is what we use in our clinic because I'm from Canada and it was approved there first so I got to use it in Canada, and it's really nice, soft, supple, natural looking filler that's got less of the permanent chemical bonds between it so it's not as hard to dissolve, and it's not as inflammatory. And then I use Xeomin, which is a neuro modulator like Botox, but I use it because it's all cleaned off of all the proteins that don't contribute to the mechanism of action. A lot of people don't know this, but over time it can stop working Botox can because you can develop antibodies to it to those proteins that aren't even doing anything. So Xeomin is nice and clean. It has the lowest rate of antibody formation,

Speaker 1  30:31  
does it last as long? About three to four months. It works just as long as like Dysport or Botox.

Speaker 2  30:38  
Yeah, Dysport. Actually, if it's being properly dosed, it should last six to seven months. But a lot of people in this area underdose it and then it lasts only three months. Oh,

Speaker 1  30:47  
okay. I've been doing muscle relaxers for your neck or facial just my forehead for 12 years. I don't know.

Speaker 2  30:57  
It's preventative. I've been doing it since my early 30s. Like 30 or 30 ones.

Speaker 1  31:02  
I was beyond the prevention. My mother, I miss her. But she would always tell me from the time I was young, my teens quit wrinkling your forehead. It's just that expression that I had. And she was right. I mean, I got into my 20s and 30s. It was just lined. It was a natural evolution for me to go and start doing that. You have extensive experience in vitamin supplementation, how does that work into your practice with doing the hormones.

Speaker 2  31:39  
Some of the vitamins that we select are to help hormones work better. For example, magnesium and selenium help the chemical processes that turn storage thyroid into active thyroid. And then magnesium also helps people with sleep and blood sugar control. So there's sometimes supplements that will have multiple mechanisms of improving the patient's quality of life. Other ones like B 12, I use really high dose B 12. For energy, B 12. And folic acid are part of metabolic pathways that allow our cells to make energy. As far as I'm concerned, you can't have too much in your blood if your cells are getting it from your bloodstream. We also use high dose vitamin D. And other supplements. For example, if I have somebody with a lot of allergies, I'll put them on and acetyl cysteine, which helps with inflammation. If they have autoimmune, we might add in other things. And then we also have some hormones that we didn't talk about called DHEA and pregnenolone, which can help a lot with people who have concussions and just general weight loss while being that will add end depending on the level that they have in their blood.

Speaker 1  32:44  
Wow. Okay. This is super interesting. When you have someone who comes to you, and maybe they have osteoporosis or osteopenia, what would you suggest that they take at that point?

Speaker 2  32:59  
One of the big things people think that bones are mostly made out of is calcium. And bones are actually mostly a made of protein. One of the first things I do is tell women that they need to eat more protein, I have a really hard time convincing them. I'm like one or two grams a day per body weight. Good luck eating anything else that like protein, protein protein. I like to them to be on a vitamin D supplementation, and then we try to optimize their estrogen levels and our testosterone levels.

Speaker 1  33:26  
Alright. I was asking for a friend. That's perfect. It's me. That's funny. Oh, yeah, I've osteopenia and osteoporosis. Everybody knows the story already, because I've blasted it all over social media. But the doctor who was actually not my doctor, my doctors on medical leave, but he told me to up my calcium, my vitamin D. And we'd start on Fosamax. And I'll see you back in two years.

Speaker 2  33:57  
They just start on Fosamax. Oh, no. Okay, good.

Speaker 1  34:01  
No, I'm like, No, I'm not doing that yet. If down the road, I'm like doing a terrible job. gaining any kind of bone density, I would maybe consider something along those lines, but I just figure, I'm jacked up my protein. I am taking vitamin D calcium, like I have been. I worked with a physical therapist to show me some good exercise, bone impact type exercising, making sure I'm stretching correctly. All that good stuff, and then I'm gonna see what happens.

Speaker 2  34:37  
The bisphosphonates are up there with one of the most naughtiest and corrupt drug approvals ever. They don't actually help bone density. And what I mean by that is, I think you care more about whether you're going to have a break in your hip than whether your bone density test looks better on a DEXA scan or not. Yeah, and unfortunately, when we look at the studies, by phosphonates do not make any meaningful, clinically significant change in your rate of fracture. So you're not making better bone. Because of the way that they work. They don't actually prove bone building, they just interfere with bone breakdown. So you're building more dysfunctional bone.

Speaker 1  35:14  
My show that will be coming out Monday, next week, which, right now this is July. All she does is work with patients who have osteopenia and osteoporosis. And it's all how to build muscle and impact your bones. I just think we just know so much more now that we can try to be more proactive before we have to do anything pharmacologically.

Speaker 2  35:38  
And those drugs last in your body, the half life is like 10 or 20 years. So they're new forever.

Speaker 1  35:43  
All right, you've just convinced me if I wasn't convinced before, Dr. Lovett just did. Nicole, what's next, for Firefly medical plans for the future expansion which you got going on.

Speaker 2  35:58  
We're hoping to open out up on a Washington State location in the next three months with this other provider coming on. And then we're just going to try to keep building momentum and building time in our schedules to take on the patients. Currently, we're booking out about six to eight weeks. Having more providers, it's very important that they did the right training, and that they're the right type of provider for this type of work for us. So we're gonna take our time and find good people. And then I'm hoping that we can bring this to anybody who wants hormone therapy, and they can have excellent evidence based care.

Speaker 1  36:28  
That brings up the good question. If someone is in Cincinnati, or New York, or Miami, Florida, how do they find a practitioner like you that is progressive and treating hormones the way you are?

Speaker 2  36:45  
It's hard because even people who've taken Worldlink training, sometimes they have to take it four or five times just to get it all in and they still don't get it. They don't actually listen to Dr. vroozi. They argue with him and decide that they know better. So you really have to vet them yourself. But the best way that I've seen is to call a compounding pharmacy. Med quest pharmacy is what I use exclusively for my hormone work because that's the pharmacy Dr. Busey has been using and it's high quality. They have a list of Worldlink trained providers. So if you call them they're based out of Utah, and he was like, hi, live in the city, Do you have anybody here they can send them to a Worldlink train provider.

Speaker 1  37:22  
Okay, I'm going to put that in the show notes. And then where can people find you?

Speaker 2  37:27  
We have our website, www dot Firefly medical.net. And they can request information or book an appointment through there. We're on the mind body app. And our websites currently being edited right now. It should be fully developed in the next few weeks. But we'll have a lot more like frequently asked questions and descriptions right now. It's kind of just a landing page.

Speaker 1  37:48  
How about social media? Do you have a social media presence?

Speaker 2  37:51  
We're on Facebook at Firefly medical and on Instagram as well.

Speaker 1  37:55  
Wonderful. Wow, this was just really good. I really appreciate this. And like I said, my goal here is to help people try to vet options. We all have our medical providers, but are we asking the right questions? Are we getting the right tests to make sure that we're doing everything that we can? This just opened my eyes and I really appreciate it. Thank you so much for being here.

Unknown Speaker  38:22  
Absolutely. Thank you so much for having me.

Speaker 1  38:32  
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