Hormone Optimization Deep Dive: Why Your Hormones Are Making You Age Faster (And What to Do About It)

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All right, everyone. Welcome back to Cell to Systems. On this episode, we're going to be digging deep into hormone optimization: what you need to know and every single detailed nuance about it. We have a special guest today, Dr. Kris Wusterhausen, who has a practice in Weatherford, Texas, just outside of Dallas. He is a board-certified family physician as well as certified in age management medicine, and he teaches all over the world about hormone optimization, which I think is super exciting. So, Dr. Wusterhausen, thank you so much for joining us. Can you take us through what we all need to know about hormone optimization for both men and women, and what are the big misconceptions?

Man, that's a broad question, but I'll try to handle it. So, thank you. I appreciate that, actually. I was talking about this today; it's been a busy day. I have had a few new patients and one of the things that I'm still blown away by, even with blackbox warnings being taken away by the FDA, is still how many patients and actually how many providers still believe that hormone replacement comes with these huge risks, right? And I think that's probably the biggest misconception that is out there: the safety of hormone replacement and how necessary it is.

I truly believe that there's so many females that don't understand the importance of just estrogen—how they're lowering their risk of dementia, how they're protecting their bones, how they're protecting their skin, their vaginal health, sexual health; how it all wraps around estrogen. And then probably one of the other biggest misconceptions that I run into all the time is that testosterone is a male-only hormone, right? Like guys shouldn't have estrogen and girls shouldn't have testosterone, which is utterly and completely false. In our practice, we always say estrogen does the job of protecting against all those things that we just talked about in addition to making hot flashes go away, but testosterone many times is the one that actually makes them feel good. It is so important for muscle mass. Like Leonard always says, there's two hormones that build muscle and burn fat: testosterone and growth hormone. So, I truly believe that most practitioners out there still do not even look at testosterone in women, much less talk about replacing it because it's considered a male-only hormone.

Moving over to the guys, I mean, again, testosterone is what makes a guy a guy, basically, and we're in a real epidemic in our country with low testosterone in men. And we're seeing it—and I'm sure Suzanne can back me up on this—we're seeing it at much younger ages than what I felt like I used to see in my practice. It's not uncommon now to get 20-year-olds with really low testosterone. I think that's due to a lot of things like environmental factors and mainly food and stress, but it's just critical. One of my favorite things is actually in young men to check their hormones. It's like, let's set a baseline of where you're at at 23, 24, or 25 so that we can compare down the road and really know what your blood looked like a decade ago. I think that's super important.

I just think the biggest misconceptions that I run into are the safety of it. Is it really safe for the heart? Is it not really safe for the heart? Prostate cancer, you know, that's still one I'm running into a lot with men. We actually know now that testosterone replacement doesn't feed prostate cancer. Heck, low testosterone is a risk factor for prostate cancer. And so these are just facts that we have to get out there. We have to educate our patients. Hell, we have to educate other providers to be really honest so that they understand. There's so many people still hung up on stuff from 15–20 years ago as providers because they're not staying current. So that would be kind of my take on that question.

That's a great overview of where we are with things today. And as we go deeper into this and talk about all the subtle nuances, I mean, to kind of bring something up, there was a lot of talk about testosterone replacement causing blood clots at one point in time. There's been all these different things that we've heard over the years and I'd love to hear your take on that just really quickly before we move on with regards to blood clots caused by testosterone replacement therapy.

Well, I guess what I would say is that hormone replacement in my opinion is safe when done and monitored by an adequate provider. The biggest side effects of testosterone—if you're doing the right labs, monitoring the hematocrits, doing the things that we're supposed to do—we're actually not raising the risk of clotting in these patients if you're doing the right things. I actually did a post, I don't think it's even been posted yet, where I was just trying to say like "who does these things matters." It matters who is monitoring your peptide therapy and who's monitoring your hormonal therapy. There has to be a baseline of knowledge in order to truly treat and monitor these patients correctly. It's why me personally, I'm not a big fan of like Him and Hers and these type of things. These are things that just come down to knowing how to monitor these patients and knowing how to adjust these patients. Anybody can start hormones, right? Like any provider can start somebody on hormones. It's when things don't go right, that's what really separates one provider from another.

In my opinion, it seems like there's two separate worlds. There's the DIY kind of world and then there's the sort of in-between where you get it somewhere somehow, and then there's the real comprehensive way that it should be done, which everyone here is a part of. So, I want to take it over to Christie really quickly and just sort of get your take on it. From an athletic standpoint, you see a lot of athletes in your clinic, a lot of professionals. I'm curious: how are people managing their hormones within your patient population?

I start with that, regardless of if it's an athlete, a teacher, a stay-at-home mom, or a father, we don't stop producing hormones because we age; we age because our hormones have started declining, right? And so, just breaking it down, hormones are such a vital part to overall aging. I think also as a society we've kind of normalized feeling tired, foggy, and inflamed. Sadly that's standard practice—that's a "normal"—but it's not. It's hormonal as far as when people start complaining of those symptoms. I'm a true believer that if you truly want longevity as a provider or as a patient, you have to care about hormones. Bottom line. You truly cannot have lasting health if your hormones are not optimized.

With the topics we've talked about as far as MBodies, so much of that is tied to the results on the MBodies and is also tied to hormonal health. Hormone therapy is not about reversing age; it's restoring cell functioning. How I break it down for patients is that hormones act like a text message between cells. And when levels drop, messages don't get delivered, which results in our symptoms: fatigue, brain fog, weight gain, poor recovery, mood changes, and so on. But the basis of it is that hormonal decline. I've been doing hormones since 2014. That's honestly how I started my first practice was just learning hormones. I started with creams because that's all I understood at the time and then moved to pellets. Now I think it's finding that right method for each patient matters. Timing matters and you have to individualize the treatment. Do we do a lot of pellets? Yes. But do I also do a lot of creams and oral and injections? Yes, I do. I think it's really individualized per the patient.

Yeah, getting a full sort of overview of what's happening for them, as Dr. Wusterhausen had mentioned previously, that's pretty important. Something you think about all the time, Dr. Furry, that you mentioned in the last episode and something I've been thinking about since that episode was that total sort of comprehensive look. Really getting that full sense of the patient and treating them holistically. Again, as Dr. Wusterhausen just said, really getting that sense of exactly how to do this the right way and managing everything. So from your perspective, how are you doing it?

Well, I hate to even begin to speak when we have the expert here in the room, but yeah, we do pretty comprehensive testing of these patients. We'll do either serum—sometimes we'll start with serum, sometimes we'll start with a urine test. I'm a big fan of the Dutch or the HU-MAP, whichever I can get them to do. They both give us really great information; they give us different information. We use them in different patients for different reasons, whether they're already on hormones when they come to us or if they're changing from one form to another.

This is where what Dr. Wusterhausen was talking about is so important—that you have a provider who knows what they're doing. All of us are people who continue to do research on a regular basis. I mean, I have every single day alerts delivered to my box about 10 new articles that have come out on hormones in general. So we're not just talking about estrogen, progesterone, and testosterone. We're talking about cortisol, growth hormone, thyroid hormone... we're pulling all of these things together because they all are critical to what we're talking about. You also need to understand—and I remember back when I was in medical school working on infertility research and learning that whole pathway—knowing the enzymes that are involved and having to memorize that in order to understand infertility. Well, that has played so well into what I do now on a regular basis.

Then we sit down and we talk to the patient about how these play together. This is not just "this is high" and "this is low," because they're all interconnected. This is a symphony of hormones. If the progesterone is high and the estrogen is low, then you might get estrogen deficiency symptoms, but you also might get progesterone excess symptoms. And the other way is true. If you make one little tweak, you're going to affect everything else. If someone in your family that you love dies, then that's going to affect the way your body handles all of those hormones. If I'm giving you testosterone pellets and all of a sudden you decide you're going to train for a marathon, it's going to change the way your body receives those hormones and it's going to change the way we're going to need to affect your diet, etc.

Keeping in mind always, as we talked about on the last podcast, that the terrain is what's important. What's in the base of the person's body, what's in their blood, what's happening with their tissues... if the patient comes to me, for example, I had one this past week; she's in her early 50s, probably about the same age as me, and her husband sent her to me because her libido was too low. His doctor had put him on testosterone and he'd heard about me on a podcast, so he sent her to me. There's so many things that go into whether or not your libido is high. You can't just attribute it to low testosterone. So, we had a very long conversation about all the environmental influences in her life. She's getting ready to retire. She's the mom of two kids. Her whole identity is about to change. And so, that may be also contributing.

We talked about that. Yeah, she might get some improvement in her libido, but there are several other things we use. We use other hormones we can capitalize on and hopefully soon we can capitalize even more on some of the other hormones like melanocyte-stimulating hormone that will help increase libido. There's a lot of ways we can do those things that will help us with improving libido in addition to optimizing your hormones. We also always forget all the other benefits of testosterone. Chris of course mentioned a bunch of them: urinary incontinence, bone density, cognitive decline. All of those things we need to keep in mind as we are treating these patients. You're not just coming to me to get your hormones so that you look better and you have a better sex life—both of which are very important—but we're also looking at trying to make sure that the patient stays healthy and well, which is what Christy was talking about all along. So, I think that we have to realize there are more than just one thing. It's all about a symphony and it depends on what the terrain is of the patient that you're treating.

Before we move on, the one thing I want to ask you about—hearing a lot lately about people getting divorced and Dr. Wusterhausen, maybe you can chime in on this as well—but there are a lot of women who get to a certain point in time. Dr. Furry, you mentioned testosterone, and there seems to be this aversion with women and testosterone, and yet the progesterone, estrogen, and testosterone combination from what I'm understanding seems to be the right combination for certain people. There was somebody talking about how they're a divorce attorney and they were seeing what was a certain point in time when women are going through menopause and they're very unhappy with their relationships because of their hormone imbalances. Maybe you could speak to that. Do you see that in your practice, Dr. Furry?

Sure. Yeah. And we'll see that this is about that 50-year-old time frame. And the question is: is this because of their hormone imbalances or is it because they're just not going to take it anymore? There is an element of women who come into this age who get to a point where sometimes they're trying to use hormones to silence some of that speaking their truth. They get to that age of 50 and they start speaking their truth and saying, "It's not okay. This isn't okay with me anymore." So sometimes they're trying to use the hormones to silence that truth. This is why for me these are big long conversations where I say, "Hey, you have to realize..."

But also on the other side of that, if men are getting treated with testosterone and they're not having the conversation with their wife about the fact that they're being treated with testosterone, that's also really not very fair. So part of the conversation with my male patients is, "Hey, do you need me to have a conversation or do you need to have a conversation with your wife? Because I don't want to start you on this therapy unless you are... this is a couple's hormone treatment, right?" We can't raise up your sex drive if hers is wherever it is. And if she doesn't know, then there will be a whole conversation about why is your sex drive so high? What's going on? Are you getting ripped because you're trying to leave me? There's so many things that are happening in that time that we want to make sure that we're preparing the couple and realize that you are not just treating one of the two. You've got to engage both members of this partnership in what you're doing for their hormonal health and their longevity.

If I could actually add on to what Dr. Furry was just saying—and I think that was perfectly said—is I actually see hormone replacement many times for my patients as marriage counseling. Basically, we bring marriages back together. And what I would say to someone who says about divorce in my practice: I think it's... don't get me wrong, we've had patients get divorced. I mean, that happens. Many times though, when you can actually bring these couples in and you can put them both on hormone replacement—as Suzanne said, it's not really fair if the guy's out there getting hormone replacement, not telling his wife, feeling better and like, "Well, I'm not going to share this with you." But most of the time this is an open communication.

In my practice, it's still females first, men second is still what comes into my practice. I always talk about a guy that one time came in. The majority of our patients we do pellets, but we do just like Christy was saying: oral, gels, creams, injections, everything. And he came in for a new patient consultation. This was a couple years ago. And I was going through testosterone and everything. He goes, "Hey doc, you can stop. Can you just put the pellets in because I got to feel better and keep up with her because her libido is better. Mine's not." And I'm like, "No, we have to go through this."

But I'd like to discuss libido for a second. Libido for a guy is pretty easy—I don't know if the other providers agree with me—but give them testosterone and if they just get a hint that their spouse or their significant other is interested in them, as guys, we're good to go. The ladies take a lot more effort. There's a lot more emotional sides of this. Their stress levels, how are they sleeping, kids... and I always say, "Do you actually like your spouse?" I mean, you do kind of got to like your spouse. They say, "Does he take the trash out?" Because sometimes it's like, "Hey, I can't fix that if you don't really like your partner."

By the way, JP, I'd throw one more in there. You said progesterone, estrogen, testosterone... thyroid. Really crucial to throw thyroid in there, too. It's sometimes the forgotten hormone that we should not forget about, and I know no one here does, but I'm just saying a lot of providers do. I see a lot of suboptimal thyroids that are told their thyroids are perfect. But anyway, hormone replacement should be something that's embraced for a marriage because the one thing I tell my patients: a marriage without intimacy is a marriage that's most likely going to fail. It doesn't even have to be a marriage, but you know, as I get older, intimacy should actually get better, not worse. As the kids move away and you have more time and you get back to the two of you. The reason I think so many marriages fail after the kids leave the house is people grow apart. I think hormones can help bridge that gap of bringing them back together and open communication.

Wow, that is so phenomenal. What an interesting perspective on that. As our kids went off to college and all of a sudden it was just the two of us, it was like, "Oh, wow. There's a real opportunity to do something cool and new and kind of like all these things that we couldn't do for years." And you know, Craig, you're right in the middle of little kids. So, I'd love to hear your perspective on this and coming back from vacation after that and how you do things in your practice.

Yeah. Well, I will say I am not yet on testosterone replacement therapy myself, but you know, have that on the horizon. I've been testing my levels and whatnot over the past couple of years and just not quite there yet. But it's something that I'd be interested in implementing for sure down the road. I do have my wife on HRT. She's in the thick of perimenopausal years and she does really well with a little bit of progesterone and some testosterone, and we have her on some thyroid optimization as well. Because that is the critical element that often goes overlooked and unfortunately it goes overlooked somewhat religiously in standard primary care practices, at least to the extent that we're diving in in these longevity cellular medicine practices—looking at thyroid and thyroid signaling in a much deeper level.

So yeah, and I think couples that are coming into the practice are really in it to win it. When they start seeing that positive changes are happening, it motivates them to perform at a higher level often in conjunction with one another. And these are the patients that from a practice standpoint are going to then refer their other colleagues and their friends and their family back to your practice, which really gives an excellent opportunity for clinicians to really capitalize on how we can help optimize people's health. It's a fantastic time.

One of the things that I really love to focus on is the fact that, as Dr. Wusterhausen mentioned earlier, we're seeing these much larger, much broader ranges with which people are benefiting from hormonal support. I mean, if you think about the various things that can drive down a young man's testosterone level—well, how many people out there have kids that are playing high school football? They're playing soccer, they're heading the ball routinely, they're getting minor concussive head injuries. There is some possibly component of pituitary hypofunction, right? And so we can see luteinizing hormone levels and things like that that maybe are not adequate for their age or their level of performance that they desire in their life. So we can use various different therapies. There's enclomiphene, which we can use to sort of augment LH levels and give the testes a little bit more of a push there to produce adequate testosterone.

And then on the other side of things, people that are aging, right? We know now that the 2020 re-evaluation of the Women's Health Initiative showed that, by and large, women before the age of 60 or within 10 years of menopause are benefiting from hormone replacement therapy. But that's not to say that women who are beyond the 10-year scope are not getting benefits. So we can look at the cognitive aspects of hormone replacement. We can look at the bone density preserving aspects and certainly look at some of the growth hormone aspects and how that relates to both cognition and bone density and other things like general energy and repair. So, it's wonderful to see positive changes in younger folks and it's wonderful to see these positive changes in older folks as well. Maybe they're in their late 60s or early 70s and they're really starting to just feel much better than they had in recent times.

Yeah, it's like a whole new world. Hey, Leonard, Craig mentioned growth hormone and how that plays a role in all of this. Maybe you can chime on that.

Sure. I did want to comment though, I've been learning a lot on this podcast. I've done the math myself and I'm realizing that I'm married and I have two young daughters, and in about seven to eight years all of them are going to be going through a lot of changes. And I also realized that I didn't take the trash out yesterday. So I'm getting more and more nervous as I'm listening to you guys talk. But I loved how you guys talked about relationships because I've actually talked to Dr. Chris's wife, Chris-Anne, and she's told me some stories about some marriages that have been saved with hormone replacement therapy. I've never really heard people talk about it the way that you guys have talked about it today and thinking about the couple as a whole. I think that that's super interesting and something that needs to be talked about a lot more.

I actually have some more questions for you guys because you guys are doing things the right way, but I do notice that this kind of turns into a business sometimes. And I have noticed that some younger folks coming in might be prescribed hormone replacement therapy a little bit sooner than they actually need it. And I know at one point when I was metabolically unhealthy, I was on the lower end of normal for testosterone, but still in a normal range. And I was lucky to be around people that had a different thought process, but I think if I would have walked into the wrong clinic, they would have automatically said, "Hey, you need to be on testosterone right away." And when I changed my health and when I changed my metabolism and my body composition around, my testosterone levels are actually really high and I haven't needed it yet.

But I was wondering, how do you know that someone needs to either start testosterone replacement therapy because it has so many benefits, or is there a route that you take where if we improve metabolism and improve body composition, a lot of these things kind of fix themselves where hormone replacement might not even be necessary earlier on in life? How are you guys judging that for your 30-year-old patients that are coming in that might be metabolically unstable?

I think it's really important to look first at just general inflammatory load alongside how the patient is sleeping and their micronutrient status. I mean, we know the steroidogenic properties of something as simple as vitamin D, and how many patients come into the practice and they've got a vitamin D of 26 or 33, which is really just not sufficient. A lot of times these patients are, as you alluded to, they're sort of eating like junk. They're not exercising. They're not lifting weights. So you have to take all of that into consideration first.

Besides just looking at that, you also have to factor in like, okay, for a guy, for example, 20s or early 30s, you don't want to necessarily give them testosterone if they have fertility aspirations and they want to have children.

I think that's a really big point. I've run into some people in their 30s and they got really bad advice early on and they were on really high doses of testosterone early on and they had trouble having children later and they wish that somebody would have talked to them about it. I think people are a little bit more aware, but it's kind of like Dr. Furry was saying: the terrain is a big part of everything. I've always struggled with this question: is it the chicken or the egg first? Because I hear people that I respect on both sides of it who say, "Hey, I think that the hormones are the foundation. We get that ready and then we can do all the other stuff." And I've heard the other side. And I see both of those practitioners having great success in the way that they do it.

So I think that that might be a little confusion out there for some folks that maybe their libido is low or maybe they don't have the energy and they're struggling and they're wondering: do I start hormone therapy now, or is it something that I need to kind of wait for? And that's why you asked a question about growth hormone and I think that especially growth hormone peptides are really interesting because, Craig, you mentioned sterogenesis and the impact that we can have on hormones when we just exercise or when we lift heavy things. I found that as people age, growth hormone declines as well. And it's not just about putting on more muscle or growing, but these growth hormone peptides allow people to exercise better and recover from exercise better; that also is going to have an impact on your other hormones.

So I think in the conversation around hormones, that one kind of gets left out, but I think it's important because like Dr. Chris said, there's two hormones that are—and we had this conversation in one of our last podcasts around body composition—there's two hormones that are catabolic to fat, which is what we want, and anabolic to muscle, and it's testosterone and growth hormone indirectly through IGF-1 signaling, but they're doing exactly what we want them to do. And Dr. Furry, you talked about it being a symphony. I think that's a perfect way to describe it because what are the things that are going to counter what we want? Things like cortisol that are going to be the opposite. They're going to be catabolic to muscle and anabolic to fat. So I think that growth hormone plays a role in all this.

From what I've seen, I've seen really successful practitioners out there using hormone therapy as a baseline. Because Dr. Chris says this all the time—I'm calling you guys all out because I learn so much from you guys—but Dr. Chris always says that he gets people stabilized on hormones and they're doing great and they feel great, and there's always this time period later on where it kind of teeters off and they're wondering, well, what's next for me? And that's when you can kind of throw in peptides and some other things to kind of get to that next level of optimization.

Backing up on what Craig said about Leonard's question—and I think he did a really good job of answering it—I think it's just about the phase of life that a patient is in or what's going on with their overall health. I agree with Craig. You'll get a lot of these young guys and girls that are really inflamed, insulin resistant, and where you can make a really big impact. You look at their phenotype and you see that we got to get this adipose tissue off. We have to get the testosterone up. Many of especially these young men, because it's going to be one of the major fixes, is just how do we do it? And like Craig was saying, I find too many practitioners not thinking about spermatogenesis for this patient in a few years. They're just thinking about today, not five years from now. Because a guy may tell you at 25 he doesn't want to have kids, but at 30 he's going to feel differently about that most likely.

But if you get a guy that's a little bit older, like maybe they're in their mid-30s, they've got two kids, they've already had a vasectomy, they're low T, they're not really that inflamed—that's typically when I will go ahead and progress over to actual testosterone replacement therapy. So, as Craig was saying, you just got to look at each patient very individualized. And to back you up on the growth hormone because, Leonard, you always talk about this study: an older gentleman has just as much ability to make growth hormone as a young man, right? We're not making it, but we have that ability, which is where those growth hormone peptides can be such a great symbiotic relationship to our hormone replacement, specifically testosterone.

How much tracking in your practices are you doing of IGF-1 just to look at the signaling there once you start somebody on?

For me, in my smaller experience compared to you guys, it's those people that don't like to cycle because they feel so good when they're on it and they want to be on it continuously is when we tend to try to look at it more. And especially with Tesamorelin because it's just a more potent rise in IGF-1. But yeah, I'd love to hear what you guys think about that as well.

We follow ours pretty closely. I mean, especially our new patients, we're going to see them super often at the beginning. And I'm going to do every six weeks for a little while. Especially like Leonard was saying, if they're on Tesamorelin, we're going to do an every six weeks follow-up. Probably close follow-up is the big key with that. Keeping in mind there is a third option. There's "don't give them any hormones and treat all the terrain," there's the option of "give them hormones and treat the terrain," or there's kind of a third option. This is what we've found has been really helpful in our practice.

Let's say it's your "no man's land" kind of patient that's 30 and not sure about his fertility because a lot of people are having babies into their 40s and 50s. This is the guy that you say, "Okay, here's an alternate way we can do this and we're going to do some sort of amalgam of what we've just been talking about." So, we might do a cycle of testosterone with a little enclomiphene for a while. We might be giving them some growth hormone as a third. So we do a cycle of growth hormone peptides. We might do a cycle of testosterone and a cycle of growth hormone peptides. All of this is trying to restart their systems to make their own rather than... and then while we're doing that, they're also getting into the gym. We're working on their sleep patterns. We're taking all of that information from their inflammation and decreasing that inflammation with all the things we know that work really well for decreasing inflammation. That's great. You can't do that with Him and Hers.

One thing I wanted to ask Dr. Wusterhausen is: how does somebody actually make the right choice? Because everyone's sort of brought this up in their own way. How do you know that you're going to the right provider?

Well, so first of all, I think it's really awesome how every one of us does it slightly differently, right? I think that's what's really cool because what you don't want to be is the one that does it exactly the same way every single time. I love hearing how everybody does it a little bit differently. I'm very proud of the fact that we use all modalities and every patient we treat a little bit differently. And I'm not always as hung up on labs as I am how they're actually feeling and doing. I always tell my patients after I start hormonal therapy, most of the time labs for me are just making sure that I don't feel like we're in any form of a danger zone, right? That's really what labs are for me after that because I know Suzanne could back me up on this: many times they can tell you what's going on and you pretty much already know what they're either too much of or not enough of. Like we talked about the other day about progesterone—I'm actually one that doesn't routinely measure progesterone; I use it as I feel it's necessary to use.

JP, unfortunately, there's no perfect answer to that question. I think that the biggest answer to that question is know your provider. Research your provider. Does your provider make you feel comfortable? I know this is a silly question, but every new patient before I move forward with them, I go, "Are you comfortable with what we just said? And are you comfortable with me guiding you from this point on?" And I always say if the answer is "I'm not sure" or "I don't know," or even if they make me feel uncomfortable, I say we're going to pause the visit. We're going to repick this up in a week or two when you're ready. Because the last thing I want as a provider is a patient that's not 100% on board with what we're doing.

I'm writing that down, Kris.

There was a time in the past where I used to treat a patient like, "Okay, we do a lot of pellets." And you consult a person and they're like, "Yeah, okay, let's do it." And they kind of give you that kind of nonchalant answer like, "Sure, let's do it." Which were always the ones that seem to give me the problems down the road. Not the lady that's like, "Oh my god, yes, please. This is going to really change my life." Because I do believe being mentally bought into something matters. And if you just are kind of wishy-washy on it, your success is going to be poor.

I actually did a... Leonard makes fun of me, I think, but I'm trying to get into social media. I'm struggling. But I did another video yesterday on literally in my area, peptide clinics are popping up by the day. And I'm not even joking when I say that. One's in a trailer. And I was like, not that that could be bad, I guess, but I'm just like, know your provider, know who they are, what's their education level? Are they learning? I think that you can get a feel as a patient if you ask the right questions to your provider. And please don't ever be afraid as a patient to ask questions. I mean, I think that's the biggest thing. And if you're not comfortable, you should move on to the next person. I tell my patients that all the time. If our personalities don't jive, you owe it to yourself to go find the person that does because look here: here's multiple people that do it slightly differently and that's just the way it is. And I think that's awesome.

If I'm having to try to convince a patient that a hormone is the way to go or even a peptide or whatever it might be, they're just not the right patient at this point in time—not to say that they will never become that patient. But it's something early on when I started doing hormones that I saw: you're passionate about it. I remember coming back from my very first training and I'm all gung-ho and you just want to... you're like, "Oh, I can fix this person." No, you can't fix every person. And you for sure cannot fix crazy. I mean, I think we've all made that mistake when we've thought, "Oh, they're just hormonally imbalanced; they just need some hormones." We've all made that mistake, but that's something that for myself—if I'm having to convince a patient to do something, they're just not ready for it. My staff makes fun of me, but I literally have a library and I hand out books all day long because some people want that information, or pamphlets of just what I've created and my other resources.

As far as one thing through my years that I first started that I was not paying attention to and I've become focused on in my practice is thyroid and gut. I feel like early on, look back even just five or six years ago, I was missing a lot of suboptimal thyroids that I should have probably been treating. And I mean thyroid supplementation can do amazing things. And then also the gut. I mean, having the gut-tides with Leonard and then the powders with the L-glutamine... it can truly change. Going back to that picture: if a patient is too young and they're still wanting to conceive a child and they have that inflammation—that typical patient we all see that older 20-year-old—it's like we don't want to touch this with hormones because of the liability. Just simply fixing their gut and getting them moving can completely turn the picture.

And then, I'm also a big advocate that you can't just treat one hormone because then you're just playing whack-a-mole with the symptoms, right? Through the years I've learned you've got to truly look at the whole system. Not only the whole patient, but the whole hormonal system, as we've talked about: the progesterone, the DHEA, the thyroid, the cortisol. It's not just about progesterone, testosterone, and estradiol. And then, progesterone for my younger... I mean, I can tell you story after story of these young women in their young 20s and even their teens that are just severe PMS that to the point of suicidal. I know we all have a story there, right? Progesterone is a phenomenal hormone for our younger population. And then obviously talking to them about their gut and Pentosan Polysulfate.

Pentosan Polysulfate? Let's go into that. Tell us more. What is she talking about?

It has the flavor of endometriosis, and mechanistically Pentosan Polysulfate works on reducing the production and activity of an enzyme called MMP9, which is the reason why endometriosis plots get stuck on the outside of intestines and are able to actually integrate themselves into the intestinal wall. So if caught really early, some of my patients with endometriosis get some improvement in their pain symptoms and decrease in the progression of their endometriosis when I use Pentosan Polysulfate.

Very interesting. Well, we have covered a ton today and there's so much more. I always feel like we could just keep going and talk for hours. However, we're kind of coming to that point in time when it's time to wrap it up. Dr. Wusterhausen, thank you so much for being here today. It's such an informed conversation. I learned so much. I think the entire group really benefited from having you here. Final thoughts? Anything that you want to share with the world before we go?

No, I just think that patients shouldn't be afraid to actually talk to their providers, find that right provider, get your labs checked, and really get a comprehensive look at what's going on. It really can change your life, and I know every one of us sees it literally every day.

This has been a fantastic episode of Cell to Systems. Thank you all so much for joining us. Remember to like, share, and subscribe. And for those people that might know some folks who are struggling with any of the things that we talked about today, please share this episode with them so that they can get the help that they need. Thanks so much for watching and catch you on the next one.