The Truth About Hormone Replacement Therapy

[00:00:01] Speaker A: Welcome back to It's a Kinetic Thing with Karen Cosell. Today we're going to talk about hormone replacement therapy and the benefits and side effects and all the things that come with it. So, Karen, I'm just going to let you start and kind of talk about what is hormone replacement therapy. [00:00:17] Speaker B: Sure. So, you know, we all make hormones in our body and we need those to survive. Both women and men make estradiol and other forms of estrogen as well as testosterone. Women also need progesterone. There's some other hormones not as widely known, such as dhea. And now we're also calling vitamin D a hormone as well. So they're naturally occurring substances in our body that not only have to do with our gender, but also, you know, our sexuality as well as our overall health and well being. [00:01:00] Speaker A: Okay. And so both men and women can get hormones. There's just different types. [00:01:06] Speaker B: Absolutely. And actually they, you know, some of the, some of them are, they have the same in common. [00:01:13] Speaker A: Okay. And the thing we, I think I always, when I first thinking about hormone replacement theory, I always think about Suzanne Somers. She seemed to be the first one that you really heard people talking about bioidentical hormones. Can you touch on that a little bit and just talk about what they are and how they work? [00:01:29] Speaker B: Yeah. So Suzanne Summers was a big pioneer in talking about bioidentical hormones. And if you've read any of her books or watched any of her podcasts, you know, she looks incredibly good for her age. And when we use the term bioidentical hormones, it basically, if you think about, if you have a lock and the key that came with that lock fits in that lock perfectly and turns the tumble mechanism to open the door. With bioidentical hormones, they look just like an exact duplicate of the key of the hormones in your body. And they fit in your cell perfectly, just like the original one did. And it turns that lock in that cell to release those hormones and let them work, just like our natural hormones do. [00:02:19] Speaker A: Okay, and then what? So as a woman, mid age, obviously, menopause, pre menopause, what age can you start getting hormones? [00:02:29] Speaker B: You know, women in their younger years, when they're still in their productive cycle, reproductive cycle, generally, we would do testosterone if they're deficient in that. And then we wait until they get into the perimenopause post menopausal period, when their estrogen levels start to drop off and their progesterone levels start to drop off, and then we can supplement those as well. [00:02:57] Speaker A: Okay. So let's Back up a little bit and talk about. So I come in to see you. I'm having lots of symptoms that obviously are related to hormone deficiency. What is the steps that you go through to make sure I'm getting the right ones? [00:03:10] Speaker B: So the first thing we do is we have you fill out a questionnaire that we know are common symptoms of hormone deficiency. And we have you rate that from I never have that symptom to I have it mildly, maybe once a month or so to moderate, maybe once a week, to severe, at least once a day to extremely severe. It's all the time. And that can be, you know, looking at things like hot flashes, anxiety, depression, low libido, fatigue, all of those things. Horrible sleep can be related to your hormone deficiency. So that's where we start with a questionnaire. And then we'll draw your blood and we'll actually do a full lab panel looking at all your hormone levels as well as some other markers of health and wellness. [00:04:00] Speaker A: So that just rang something in my head when you said that when I. Anxiety, which I never really attribute to hormone deficiency, but. But when I had a hysterectomy, which obviously went straight into menopause, I would wake up in the middle of night with an anxiety attack. And I had never had that before, and I didn't even know what it was. And speaking to a friend, she said, that's anxiety. That's part of your menopause. And I just remember being so surprised by that. [00:04:30] Speaker B: Yeah, there's actually some really good research study on getting people off antianxiety and antidepressants once you optimize their hormones. And in fact, a really interesting gentleman that I. Years ago, a couple years ago and back, I was traveling the country training people how to use different aesthetic devices, different lasers and microneedling. And one place I went to in Tennessee was really interesting. It was a psychiatrist who had a med spa. And next door to the med spa was a psychiatric practice. And I had to ask, I'm like, why would a psychiatrist get into the med spa business? And he's like, well, there's great research out there. And I really started to learn that when I looked at my very depressed and anxious patients, almost 100% of them were hormone deficient. And so then I got into hormones, and once I would correct their hormones, I could get them off a lot of their psych meds. And he said, of course, then they feel better about their selves, so now they want to start taking care of their skin and things. So he said, it Became a natural evolution. But I thought that that's the first time I'd had a psychiatrist really talk about the value of hormone replacement and mental health. [00:05:45] Speaker A: It is true. I mean, you think? I remember I taught aerobics years ago, and I had a woman in the class that was probably in her, I don't know, at the time, probably in her mid-50s. And I remember her talking about that. Her husband finally said to her, you lost your mind, like, you need to go get help. Something is really wrong. And it was just a hormone issue. And once she started working on her hormones, she became this kind, gentle person. But she said, my husband was ready to divorce me and kill me. And you don't. And at the time, you don't realize, you know, what's happening. It's just all of a sudden you just turn into this crazy person to other people is what they think, you know, you are. [00:06:23] Speaker B: I hear it every day in practice that you probably saved my marriage. I was. My husband was a jerk. I was getting ready to divorce him or my wife, you know, was never interested and being intimate anymore and grouchy all the time. And it's like there are different people now that you've optimized their hormones calmed it down. [00:06:42] Speaker A: I remember a guy saying to me one time, meeting him for lunch because we were dating. And he was like, why do I always get the crazy women? It's like, cause we're all crazy. Because we're all. You're, you're in your 50s. So that's just kind of what happens. Which is really sad. But I know it's part of just hormone fluctuation and yeah, it is. [00:07:00] Speaker B: And it really does affect your mental health and your personality. And it's amazing how different you feel once your hormones are optimized. [00:07:08] Speaker A: So tell me some of the symptoms that you hear often with women. [00:07:14] Speaker B: No energy, no libido. I go to sleep or I try to go to sleep. I can't go to sleep. If I go to sleep, I wake up. My mind is racing non stop. I'm just tired all the time. I feel like it's all I can do to drag myself off the couch, to even microwave a pizza or something. Those are big ones. I hear some not as common ones. Constipation. They only have a bowel movement once a week. Anxiety, depression. My hands and feet are cold all the time. They're never warm. That can be a sign of hormone deficiency. So those are some big ones that I see pretty regularly. Migraines can be related to hormone deficiency. As well. So that's another one that we see. [00:08:07] Speaker A: And so what's the process? You said you talked about blood work and then someone decides, okay, I want to, I want to do this. What happens after that? [00:08:14] Speaker B: So we get the results back, we bring them back, we sit down and we go over their results with them extensively, give them a copy of their lab if they want it. But we talk about there's a difference between normal blood level. So you, you know, I get this every day too. Well, I went to my OBGYN or I went to my primary care and they said my labs were normal. Well, you need to understand if you think about lab normal levels, they're normal based on what every other 50 year old woman out there who's doing nothing, what their lab levels are. So if you're a 50 year old woman than the average of what every other 50 year old woman out there, that's what they consider normal. So I tell people, think about it like you were in school. You can pass a class with a D minus or you can pass a class with an A. Your labs and your hormone levels are the same. You can be passing and be normal with the D minus looking lab, or we can optimize your hormones and get you an A and you feel like an A plus student, not like a D minus student. So normal is not always what we're aiming for. We're aiming for optimal. So if you're for instance a 50 year old woman, we want you to feel more like and your labs look more like a 27 year old woman. And that's what we're gonna shoot for. [00:09:41] Speaker A: And then what is that process once you decide what you're gonna do? [00:09:45] Speaker B: So once we decide, you know, that you are maybe hormone deficient, then we're gonna talk about how best to replace that hormones for you. And so there are multiple ways. We can use a cream that you apply generally for women. We recommend you apply it to your labia once a day and it has the hormones in it, it absorbs through the mucous membranes into your bloodstream and that will raise your levels. That's one way to do it. For females, a lot of the hormones we can replace with a pill or a capsule. Other than testosterone, that one will not absorb through the GI tract. So we may do a sublingual, they call it a troche or a rapid dissolved tablet that goes under your tongue and you let it dissolve. We can do injections of testosterone or we can do pellets, which I would say is probably our most common Most liked method of replacement. So for women, we just use kind of a large hollow needle and we make a tiny little puncture wound in their hip. We feed the pellets through that hollow needle and then we pull the needle out. The pellets stay in, we close it up with a little steri strip and they are time released. And they kind of mimic your body's own natural hormone release in that if you're more active, the there's more blood flow over that area, it releases more hormones. When you're more sedentary, sleeping at night don't need as much hormones. It doesn't release as much. The nice thing about the pellets is for women, we put them in once and you forget about them until about three or four months later. And we replace them for men with the pellets. They last five to six months. And they go in. The men, they go in their love handle area there. And since they don't have as much fat on their buttocks, and that tends to be where men carry their fat. And then they're not setting on them and feeling them with their wallet and things. But that's probably our most popular method. But again, we can. Depending on what you're deficient in, it may be oral, it may be cream, it may be injection, it may be pellets or some combination of those. [00:12:14] Speaker A: So once you start getting pellets or any of the hormone replacement, then it's for the rest of your life or until you decide you don't want to do it anymore. It doesn't fix anything. It just makes you feel better while the hormones are in you. [00:12:26] Speaker B: Right. Once your hormone levels are starting for the majority of people, especially as they're getting menopausal post menopausal, or for men getting up in their 50s and 60s, once your levels start to decline, we're not gonna make them suddenly start your own body start producing their own. So you either continue them or you go back to feeling like you did before we placed them. And I will tell you, I've had a patient here, there, who do they start, you know, when you first put the pellets in, or they first start hormones, they feel great. And then after a few months, I think they forget how bad they used to feel. And they're like, I don't think this is working anymore. I don't want to spend the money anymore. [00:13:12] Speaker A: Interesting. [00:13:13] Speaker B: And then two months later, they're back going, I feel horrible. I didn't realize how well that was working. Can I please come back? [00:13:19] Speaker A: Isn't that funny? You kind of have to like. It's like taking a picture of yourself so you see how far you've come. Because it starts feeling like your norm. [00:13:26] Speaker B: Yes. [00:13:26] Speaker A: And then you think, wait, it's not working. Yeah. So I want to talk about testosterone for women, because I know that's a topic that some women think they don't need it or don't want it. So how does that work in women? [00:13:37] Speaker B: So women naturally produce testosterone, and obviously, when you're younger, you'll produce more of it. That's why when we're younger, we have a stronger libido. We keep our weight off easier. We don't get that midlife pooch, that belly fat. We can work out and drop weight and build muscle much quicker. So as you age and your testosterone levels decrease, your libido goes down. Sex is not as enjoyable. But also, you get that belly fat that you didn't used to have. You work out and you work out and you diet, and you're not losing fat. You're not gaining muscle. Well, when we replace your testosterone, those things become much easier to get rid of that belly fat, to build that muscle. And, you know, for women and men both, testosterone is very important in your bone health as well. Cardiovascular health, as well as just muscle strength and tone. And I went to a lecture, and a gentleman said, I had to think about it for a minute, but he said, muscle is the currency of aging. Like, what do you mean by that? Well, if you don't have muscle as you age, you are much more likely to be debilitated, handicapped, incapacitated. The people that maintain muscle strength and muscle tone throughout their life age much healthier. [00:15:07] Speaker A: Makes sense. [00:15:08] Speaker B: Yeah, it really does. [00:15:09] Speaker A: See that with my mom every day. It does make a lot of sense. So we're talking about women a lot and menopause and women needing hormone replacement, but men do, too. And that's probably also a big topic for you. And your customer base is the male side of it. [00:15:25] Speaker B: Absolutely. Men really notice when their testosterone levels are low. I mean, I get everything from, you know, the second I get off work, I sat on the couch and I'm sound asleep, and I just don't have the energy to get up to, you know, I don't care if I ever have sex with my partner anymore or I want to, but I can't perform anymore, doesn't last, or I can't even get an erection anymore. I'm at the gym pumping iron like crazy with all these young guys, and they've got these Muscles and I have none. And I've got this big belly that I never had, so. And they also, you know, succumb to depression as well and feeling like I'm past my peak, I'm past my prime, my life is over. And those go away when we get their hormone levels up. [00:16:18] Speaker A: What do you say your percentage of male versus female customers? Is it that it's pretty. [00:16:25] Speaker B: I would say my personal group is probably, I'd say 65 female, 35 male. My partner's is probably the opposite. He's probably 65, 70% male and 30% female. And it probably goes, since I'm a female provider, he's a male provider. Sometimes the men aren't as comfortable talking to a female provider about erectile dysfunction and things like that. [00:16:56] Speaker A: Right. So who shouldn't take hormone replacement? Is there anybody that shouldn't have it? [00:17:04] Speaker B: Anyone? We generally won't do hormone replacement for the most part just because of the litigious legal system in our country. If you're actively undergoing some sort of cancer therapy, we typically won't do hormone replacement. But other than that, if you want to feel better, look better, have more energy, you know, you're most likely a great candidate for hormone replacement. There are hormone specialists out there that are fighting all types of cancers with high dose hormone replacement therapy. It just hasn't hit the mainstream yet. And I think that's sad. I think it has everything to do with big pharmacy controlling our health care and maybe not for the better. [00:17:59] Speaker A: So let's talk about that in cancer. Because I had uterine cancer and I was. Every time I go for my checkup, they remind me, no, hormones, don't take hormones. You can't have hormones. Stay away from hormones. So obviously someone that had uterine cancer had a full hysterectomy in my mid-50s. And so my hormones are horrible, horrible, out of whack. And I do feel horrible and I do have all the symptoms used named. But I'm also very afraid of it because I had a cancer doctor say, don't. So what's your thoughts on all of that? [00:18:31] Speaker B: So there was a research study back in the 80s called the women's Health Initiative. And it was a multi year, multi thousand women study. And it ended up stopping a little bit early because one arm of that study, the ladies in that study had a higher incidence of cancer, they thought. Also there's been, as we look back now, one of the sponsors of the study published the findings before the study was finished and he published inconclusive findings despite the Other researchers who did not agree with that. And so that study showed that women that took medroxyprogesterone, which is the brand name Provera, had a higher incidence of breast cancer. And so people have taken that and extrapolated that all hormones are bad, when in fact the only hormone that was ever found to be detrimental to your health is a synthetic medroxyprogesterone or Provera. Micronized progesterone, the type that we use in bioidentical, actually showed the opposite. It lowered your risk of cancer and of heart disease and things. And they've asked for that Women's Health initiative to be retracted, but it never got retracted. It got published in jama, the Journal of American Medical Association. And so it was taken as the gospel. And it's really sad because a lot of their physicians that say, no, hormones and hormones are bad, turn around when you have some dysfunctional uterine bleeding or things will put you on Provera, which is the only drug on the market with a black box warning for cancer. But then they'll yell at you for taking bioidentical hormones. Oh, no, don't let them put you on that. Yes, it's insane. But that's what big pharmacy is doing to our country and to our health care. And it's sad. In the European countries, you know, which don't allow all the junk we allow in our food and things, it's almost mandatory to go on hormone replacement therapy as you're older because they know, and they have. What's the word? National health care, you know, they know that you're healthier. If you're on it, your hormone levels are optimized. You know, the gentleman that I've probably taken 400 hours of education with hormone therapy was in his former life, before he became an expert and lecturer or teacher for hormone therapy, was an emergency room physician. And his famous thing, he says, is, you know, when I was in the ER and once I learned about hormones, every female over 70 and in every long term care facility, nursing home in the country would be on estrogen or estradiol because they wouldn't be coming in my ER with fractured hips. They wouldn't be coming in my ER with compression spine fractures. They would not be coming in my ER with sepsis from urinary tract infections. Those all come from an estrogen deficiency. [00:21:59] Speaker A: Wow. [00:21:59] Speaker B: If you think about it, I think one of my patients said it best. She was like, you know, my doctor was arguing with me. And I said, well, doctor, how come no 20 year olds get breast cancer or uterine cancer or urinary tract sepsis. [00:22:16] Speaker A: Good point. [00:22:16] Speaker B: Or hip fractures. If hormones are so bad, that's when they have high levels of hormones, they should be the ones. She said. So your logic makes no sense to me. And I was like, wow, that makes. [00:22:28] Speaker A: A lot of sense. [00:22:29] Speaker B: Yeah. You summed it up pretty easy for having no education in hormone replacement. [00:22:34] Speaker A: What was his response? Did she. Oh, you know, always had something. [00:22:37] Speaker B: Yeah, I've had the fight with my own obgyn. And she's like, I'm going to argue with you. And I said, you can, but I'll win the argument. How many hours of education do you have on hormone therapy? Well, we had a class. I said, well, I've had like 400 hours. I'm going to win this argument and I'm going to bring you the research that proves what I'm saying. [00:22:59] Speaker A: Yeah, that's so crazy. It's frustrating to me because it's. I mean, obviously working with you and being around you all the time, I would love to do it. And then. But on the. There's that little thing that just keeps me from trying because it just scares me because I don't want to go through that again. But you've told me, and you might touch on this a little bit, about the high doses of hormone that people are actually treating cancer with that you've studied. [00:23:24] Speaker B: They are. And there's a new article that came out recently from a physician, I believe her name is Barbara Levy. And it was actually put into mainstream medical journals, which I was shocked. But she's like, why are we still treating women like it's the 80s? And she lays out all the research that debunks the myth that hormone replacement is bad and all the research that proves it's good. And, you know, we have changed the way with men used to when they were diagnosed with prostate cancer, we immediately put them on testosterone depressing medications, androgen depressants, and they were told they could never have hormones again. And they were almost castrated chemically. And now we've stopped doing that. We treat the cancer. The second their levels are back to normal, they are put on testosterone because they know it's important not only for their mental health, but their sexual health, but their physical health. So why are we still doing this to women? We don't do it to men anymore. [00:24:36] Speaker A: That's crazy. [00:24:37] Speaker B: Yeah. [00:24:38] Speaker A: Wow. Well, it scares me, too, just because of, like you said, the other side effects with cardiovascular and the bone density and all the things that come with it. And I'm seeing it with my mom, who had a hysterectomy in her 50s. And I see what's happened to her, and I just keep looking, thinking, here's it's me, because I don't know what to do about it. [00:25:00] Speaker B: We are even now, and I have several patients, they have found that estradiol, the bioidentical estrogen, is not only so important for females. Used to. Years and years ago, when we put men on testosterone replacement, we would block their estrogen receptors, and we don't do that anymore. And because estradiol has been the only medication, if you will, even though it's a hormone that's naturally produced, the only one that they've ever found that not only stabilizes plaque inside the cardiovascular system, but over time will reverse plaque buildup and clean it out. And so now we are high risk men for cardiovascular disease. We're putting them on oral estradiol to keep that plaque from fracturing off, because when that plaque fractures, that's when you have a heart attack or you have a stroke. And so we can stabilize that plaque so it won't fracture, and then over time, reverse the buildup. So some of my high risk men not only getting testosterone replacement therapy, but they're getting estradiol. And one of the questions I get is, well, you know, am I going to grow breasts? [00:26:15] Speaker A: I can ask you what the side effects are. [00:26:17] Speaker B: Am I going to start crying at puppy commercials? And the answer is no, because we're not putting you at levels to try to make you a female. We're putting you at a low dose, but at the same time, we're keeping your testosterone level up where it should be. So when people are going through gender reassignment, they're suppressing their male hormones and boosting their female hormones through the roof. But for a healthy man that wants to remain a man, we're doing very low levels of estradiol and making sure that testosterone stays at a manly level. So that balance is right to help their cardiovascular system without feminizing them. [00:26:54] Speaker A: Okay, so the same thing would be said for women. Estradiol would do the same thing. [00:26:59] Speaker B: Yeah, we do. We. And obviously, women have a much higher estradiol level. They need testosterone, but not at the level men. So, you know, for women, we like maybe their testosterone level to be 100 to 200. With men, we like it 900 to 1200. [00:27:19] Speaker A: And what is the side effects for a woman taking testosterone? Are there any? [00:27:24] Speaker B: There can be, obviously, if. Especially if a provider is overzealous with how much testosterone they get. Then you get the, you know, the stereotypical things about women getting deep voices and growing a beard and mustache and, and, you know, looking like a female bodybuilder. Those generally don't happen when we keep the level at an optimal for a female. The other thing sometimes, especially when you've been deficient for a while and we first replace your testosterone in female, sometimes they may get a little acne on their back, which we usually can clear up pretty easy. And again, keeping your level good, they may get some water retention initially with maybe a little swelling in their feet and ankles that will go away as their body comes accustomed to it. But those are the kind of the big things. [00:28:22] Speaker A: Is there something that you can do once, like if you give them a testosterone pellet and they start having crazy side effects? I always think about myself because I always have crazy results from everything. Is there something you can do to eliminate that or is it kind of has to run its three months or so? [00:28:39] Speaker B: Well, you know, some things you could do is take a little extra estradiol or estrogen to counterbalance that. If the pellet's not been in too long, sometimes we can go in and pop it out. A lot of my people, if they're really, really nervous about it, well, first thing is I tend to underdose what I think they're going to need with the pellets for their first time. And then we draw their lab in four weeks and then we see where they're at and how they're feeling. I can always add more much easier than I can take some away. So that's one way that I kind of stop that from happening. Some of my people are really nervous and they start out wanting to do cream or the under the tongue. And they like how they feel, but they're not good about taking it every day at the same time and things. So they get comfortable and they've got accustomed to it and then they'll switch to pellets. And that's okay. I understand that. [00:29:37] Speaker A: Yeah. [00:29:37] Speaker B: And so I'm very willing to work with people with, you know, things like that. [00:29:41] Speaker A: That just made me think of a question. This may not even be related, but what is a nad? Is that a. [00:29:46] Speaker B: It's nad. [00:29:47] Speaker A: Nad? [00:29:48] Speaker B: Yeah, it stands for I can't come up with the right. But nad is a peptide. [00:29:57] Speaker A: Okay. [00:29:58] Speaker B: Okay. And that's a whole nother thing we can talk about. Talk about. Yeah. But nad is getting a lot of press right now because it's considered kind of the key Component to the building block of all our cells that turns on all the cells to do things. So it's really being touted as, you know, the anti aging peptide. Yeah. [00:30:20] Speaker A: I didn't know if it was related to hormones. I feel like I. There was a woman that was putting them on the back of her leg, maybe that she was. I just had seen her talk about it, but I didn't know what it was and I thought it might be a hormone. [00:30:31] Speaker B: It's a peptide. [00:30:32] Speaker A: It's a peptide. Okay. So you had mentioned that the women take it every three months, Men five to six is. If you're doing the hormone pellets. [00:30:43] Speaker B: Pellets? Pellets, yeah. Three to four months for females, five to six for males. [00:30:47] Speaker A: And then they come in, kind of tell you the process. So they come in, you're going to do the blood work, you're going to decide. Ask the questionnaire. [00:30:56] Speaker B: Yeah, questionnaire. Then we're going to review the blood work, Then we're going to decide which method of hormone replacement is best for that person. And then typically they're going to either get their pellets that day if they want, or get prescription for orals or for oral medication or creams or things. And then they'll go pick that up at their pharmacy. Whichever direction we decide on hormone replacement, we typically bring you back in about four to five weeks. [00:31:27] Speaker A: Okay. [00:31:27] Speaker B: We'll recheck your levels, we'll adjust your dose, whether it's pellets or the other, based on what your levels look like. And then if you're doing great at that point, your levels were perfect. See you back when it's time to replace. [00:31:43] Speaker A: Okay. And tell me the process of, like if they do decide hormone replacement with the pellets, what's that process? Is it a 20 minute, 30 minute in office? [00:31:54] Speaker B: 10 at most. [00:31:55] Speaker A: Oh, wow. Okay. [00:31:56] Speaker B: Yeah. Well, we'll just go over kind of, you know, how to take care of the site after we place the pellets, when you need to come back for your blood work and kind of activity restrictions immediately after the pellets. So we'll go over that. We numb up the area that we're going to put the pellets in. It's just a little local lidocaine. Like you get, you know, if you get stitches, we numb that area up, we use a little sharp blade to make a tiny little puncture wound that's not even an eighth of an inch. We insert that hollow needle, drop the pellets in, push them through, pull the needle out, put A little steri strip over the side and then a dressing over the top of that. We don't want you to get in like a hot tub, a swimming pool, a bathtub for about 72 hours. If you're a big gym fitness nut, we wouldn't want you doing things that are going to strain that side, like doing squats or like, you know, I have a couple of cowboys that go out and decide to break a new horse right after they put their pellets in and then wonder why their side is so sore. You know, that kind of thing. Okay, so mild activity restrictions for heavy lifting, a heavy work for about 72 hours. Oh, wow. And then that's it. [00:33:22] Speaker A: Easy, easy. So you're taking patience now? [00:33:25] Speaker B: We are, yeah, always. [00:33:27] Speaker A: So men or women can call and get scheduled at least for that initial consultation and see what they need. [00:33:33] Speaker B: Yeah. And they know we look at not just testosterone and estrogen levels, but we'll check your vitamin D level. I've seen almost everybody's vitamin D deficient and like I said, we now know it's a hormone and it's very important in not just your bone health, but a lot of different things, brain health and prevention of Alzheimer's. And so we'll check that, we'll check your B12 levels, we'll make sure your thyroid is functioning well. And we do a full thyroid panel. You know, I get a lot of people that really are thyroid deficient and their doctor told them they were normal because they only took one test and not a full thyroid panel. So, you know, we would help you with that. If our gentlemen are having erectile dysfunction and they need on top of the testosterone, some other help prescriptions, we can help them with that kind of thing as well. [00:34:30] Speaker A: So the great thing about you and Kinetic Clinic is that you just, you're kind of a one stop shop. It can help with weight loss, you can help with feeling better with hormones and peptides. [00:34:41] Speaker B: We do some aesthetics as well. You know, we don't function as primary care if you got a cold, you know, go to your primary care doctor if you got the flu. But anything to do with your hormones and those components of we definitely can help you with. [00:34:55] Speaker A: All right, well, we will be back in a couple of weeks. Stay tuned. And I think we're going to talk about peptides next time. So if you're, if you've been thinking about peptides, ask us some questions on the Kinetic Clinic website and we can answer them or on the. Not on the website, but on Instagram or Facebook and we can answer them in the next one. [00:35:15] Speaker B: Absolutely. [00:35:16] Speaker A: All righty. [00:35:16] Speaker B: Thank you.