Podcast Drop Date: 8/7/2024
In this episode of the Functional Medicine Foundations podcast, host Amber Warren, PA-C, is joined by Tammy Hadfield, MSN, WHNP-BC, our newest Women's Health provider. They discuss the causes of irregular hormone levels and explore natural methods for balancing hormones, including diet and lifestyle changes. The conversation also highlights the significant connection between emotional well-being and hormonal health, offering practical tips and insights to help listeners achieve optimal health. Additionally, they dive into the often taboo topic of sexual wellness and its critical role in our overall health. Tune in for an empowering discussion on managing your hormonal and sexual health naturally.
Transcript:
Amber Warren, PA-C: Hi friends. Be aware because we are discussing sexual wellness in this episode. Please take a listen for yourself before you decide to share it with a younger audience. Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Hi, everyone. Welcome back. Thanks so much for joining us today. I'm here with Tammy Hatfield, uh, new our newest women's health nurse practitioner, um, with a lot of other credentials behind her name. With over 30 years in women's health, Tammy began her journey as a registered nurse, eventually earning her master's in nursing and becoming a board certified women's Health Nurse practitioner. Her impressive career includes military service, where she earned accolades as the Meritorious Service Medal and pioneering work in hormone replacement and age management medicine, specializing in bioidentical hormone replacement therapy for men and women, gynecological health, and age management medicine. Tami founded Embrace Wellness in 2009. Now she joins the FMI center for Optimal Health, continuing her work in hormone optimization, sexual wellness, and more. Outside of her professional life, Tami enjoys traveling, gardening, cooking, and spending time with her family. Welcome! We're so glad to have you not only on the podcast, but in clinic. Thank you. You've been with us three, three weeks, three, four weeks now.
Tammy Hadfield, MSN, WHNP-BC: Yeah. Yeah, just over a month.
Amber Warren, PA-C: Oh my gosh. Yeah.
Amber Warren, PA-C: It's been so fun to have just your your area of expertise and your knowledge and your wisdom and your passion and compassion. And we're just so excited to have you as a part of the team.
Tammy Hadfield, MSN, WHNP-BC: I'm happy to be here.
Amber Warren, PA-C: Yay! Okay. So fun. Good. So we just want to jump into kind of all things women's health. I don't think there could be enough spoken about this topic, right?
Tammy Hadfield, MSN, WHNP-BC: I mean, how much time do we have?
Amber Warren, PA-C: I know exactly, yeah. We don't we don't. We can't spend all night. But, um, there's so many good tidbits that I know you're going to bring to our community and to our audience. So, um, let's just I mean, I don't think we need we've we've talked so much about, um, hormone balance, hormone imbalances on this podcast, but let's just go ahead and dive in. Like, what are the primary female hormones in their functions?
Tammy Hadfield, MSN, WHNP-BC: Well, I think if you just basically talk about the two major ones, estrogen and progesterone, everybody knows they hear about it. The thing that I like to explain to patients, though, is that we kind of villainize estrogen. We make it sound like it's bad to be estrogen dominant. It's something that we say to patients all the time. We talk about it. But the reality is, is that we are supposed to be estrogen dominant the first half of our cycle. If we weren't, we wouldn't produce a lining. We wouldn't be able to have a menstrual cycle.
Amber Warren, PA-C: That's our physiology. That's our innate physiology.
Tammy Hadfield, MSN, WHNP-BC: We have to have that. So we have to have some estrogen. The problem is, is that we have so many environmental things that increase our estrogen levels that we don't want, and they're bad. Estrogens are not ones that really help. They disrupt things. Um, progesterone of course, we need progesterone unfortunately declines as we age. And so we lose progesterone. But progesterone is what helps us not to have to deal with so much of our PMS symptoms and kind of keep our menstrual cycles regulated. I always tell patients estrogen is there at the beginning of the month to build up your cycle. Progesterone is supposed to step in and tell that lining to stay there till the end of the month. And then we I love that drop both of them. And then the cycle starts over again. But then we also have the other two major ones that I look at with patients are testosterone levels because we are supposed to have some testosterone. It's not just a male hormone.
Amber Warren, PA-C: Just different amounts.
Tammy Hadfield, MSN, WHNP-BC: Just different amounts. Exactly way different amounts. And then DHEA is one of my other favorite ones that I like to look at with women in my younger population. It's mainly the other ones that I'm looking at versus DHEA. It just depends on the patient.
Amber Warren, PA-C: I love it, so I feel like we can't we can't skip over or minimize. One of the first things you said, which was talking about the xenoestrogens, these, these, these, these chemicals and toxins and structures in our environment that look like estrogen, but they're not I think it's really important for our listeners to know what are some of the top xenoestrogens that are that are impacting this estrogen dominance that you see in clinical practice that you're concerned about?
Tammy Hadfield, MSN, WHNP-BC: Well, the kind of depends on where the patient's coming from. I think in our area, because I have so many clients that come from farming areas, I'm always talking to them about pesticides. Pesticides are the more organically they can eat, the better. But the unfortunate thing is, is that we step outside and you're going to get hit with them. And so it was really interesting. I always loved the story about, um, you know, we're always concerned about animals and we want to know what's going on with them. There was actually a population of of frogs that was going to be extinct along the Mississippi River, one of the dirtiest rivers we know of in the United States. Why? Because all of our farming community, you know, water goes irrigation, water goes in it. So the species of of frog was being extinct because of biologically it was female. And physiologically it was male. And it was being extinct because its hormones were disrupted. That pesticide got outlawed. But we don't look at the ones that are there for humans. Like we don't pay attention to that. So pesticides, I think, in our community is a big one. But there's there's so many more, Everything from our skin care products. We always talk about the bpas, we're always talking about, you know, try to stay away from plastics and microplastics and there's tea bags. I didn't realize that tea bags have microplastics in it. So anything that they can do to keep clean, I know there's several websites and different things. I mean, we're always referring to those for patients to look at, you know, they can take a snapshot of their product and see what kind of chemicals are in it and which ones they're going to try to stay away from.
Amber Warren, PA-C: So you touched on this a little bit, Tammy. How do hormones regulate the menstrual cycle.
Tammy Hadfield, MSN, WHNP-BC: How do they regulate it?
Amber Warren, PA-C: Yeah.
Tammy Hadfield, MSN, WHNP-BC: So if you're talking about a menstrual cycle the first day of your menstrual cycle, all your hormones are going to go to zero in order to signal that lining to shed that first half of your cycle, estrogen is supposed to start kicking in, building up the lining. It peaks right before ovulation. We want it to do that. So obviously very estrogen dominant at that time. That's to get the lining nice and fluffy ready for implantation. If we were to have ovulation and um, basically pregnancy occur, we want something that progesterone is supposed to kick in. Tell that lining to stay there. If we get pregnant, progesterone goes up significantly to maintain that lining for a pregnancy. So when we're not, when we don't conceive, of course, 14 days later after ovulation, we are supposed to signal a cycle to start. So, um, those hormones fluctuate and change all throughout our lifetime. And after every single pregnancy, we have less progesterone production. We have to reset our hormones after pregnancy. Um, we get into our mid 30s, we start having a steady decline in our progesterone levels. And then of course, you get into your 40s and then estrogen levels start getting a little bit more erratic, not as steady. And we can see things like heavier periods, development of fibroids, um, more PMS, more irritability. Those are some of the things that start giving us a good idea that our hormones may be off, especially like breakthrough bleeding is another one. And sometimes we just chalk it up. Oh, that's just, you know, being a woman and these things are supposed to happen, but they really are a sign that we've got a hormonal imbalance that's going on.
Amber Warren, PA-C: And what's what are some of the initial ways you start to treat some of those hormonal balance. What are your favorite ways to start?
Tammy Hadfield, MSN, WHNP-BC: Uh, usually if it's if it's a younger patient who comes in when I'm looking at what's going on, if it's a lot of PMS, progesterone is my favorite. Oh, it works so well. It's the happy hormone.
Amber Warren, PA-C: It is the happy hormone. Yeah. And I don't think that's out there enough on how safe not only its efficacy, but how safe it is.
Tammy Hadfield, MSN, WHNP-BC: Well, the problem is, is that many providers, when they're educating their clients or their their patients, traditional medicine interchanges the words progestin and progesterone. And they are so vastly different. Micronized natural progesterone mimics your own chemical structure, reacts very differently in the body. We know that synthetic progestins, which are one of the brand names that's marketed under, is Provera. Provera. I hate to say it is. We call it the witchy pill, right? It causes fluid retention. It causes migraines, it causes weight gain, it causes severe irritability. And I don't want to give it to anybody. It also has a 2.8% increased risk in breast cancer associated with it.
Amber Warren, PA-C: So why is it still on the market?
Tammy Hadfield, MSN, WHNP-BC: That's my question. I mean, we knew this 20 plus years ago, and we still are prescribing it and giving it to patients. Um, but again, it's also they interchange those words. And so when someone is educating or a physician sometimes is even educating a client about it, they're like, oh, stay away from it. It's bad. You don't want to do it. But micronized progesterone, it can be a game changer for someone. It just they feel like themselves again just to have their irritability in check. Like to be able to have a period show up and went, oh my gosh, I don't think I even had any PMS this month. That is so refreshing for a woman to not have to worry about that, because we do. I mean, the thing that we worry most about is that when we're dealing with progesterone and progesterone is low, we also forget that it's affecting our neurotransmitters in our brain. And so there have been studies done. One of my favorite one, that was one that Doctor Daniel Eamon had presented on was that he did brain spectrometry and looked at how the brain was firing off and at different stages in the menstrual cycle. And when the woman got to, especially in women with severe PMDD, which is a severe form of PMS, there was frontal lobe missing like firing off. And we know our frontal lobe is what controls our impulse control. And I was explaining to women, it's like, do you ever have those moments where all of a sudden you feel like your head just spun around, you acted like somebody who is not even you, and you're like, oh my gosh, I don't even know who that is. And that's that horrible like, oh, well, what are you going to get treated with? Well, they're going to want to give you an antidepressant to keep your moods in check. And we need progesterone.
Amber Warren, PA-C: They really just need progesterone.
Tammy Hadfield, MSN, WHNP-BC: Yeah. It's just sad when it doesn't it it isn't presented as an option for someone.
Amber Warren, PA-C: Well and I think oftentimes too. Yes, absolutely. Those moments where you have that 30s at home where you're like, why did I just lose it like that? Or why did I just say it like that, like that? That was horrible. I think it can also be so subtle and how it starts to come on, you know, I think we as women. Excuse me, forget that these hormonal fluctuations, perimenopause, whatever you want to label it can last ten years or longer or really longer. Longer.
Tammy Hadfield, MSN, WHNP-BC: Yeah. I always tell women, mid 30s is when we start having changes in our hormones and especially depending on how many pregnancies that you have, a lot of women will come in and was like, God, I just feel different since I had my last baby. I'm like, well, when was your last baby? And especially if you have that last baby around your mid 30s that just can disrupt your hormones even more because literally you're resetting your hormones after every pregnancy. It doesn't matter if it ends in a full term pregnancy or if it was a miscarriage. We're still resetting our hormones and we're so hard on ourselves because we're always trying to, you know, be able to be the best mom and be the best wife. And these hormonal changes are happening and we feel kind of broken sometimes, like things are not working. Why am I acting like this? Well, I guess I need an antidepressant, right? You know, and that's not always the answer.
Amber Warren, PA-C: What do you say to women that say, I don't want a medication, I don't want a pill? What are natural ways? Because I know you get this all the time. I get this all the time. And you treat so much more hormonal dysfunction than I do. So I'm so curious what you say to women that are like, well, what are the natural ways I can increase progesterone?
Tammy Hadfield, MSN, WHNP-BC: First of all, I ask them, what is your definition of natural?
Amber Warren, PA-C: That's a great way to start. Great way to start.
Tammy Hadfield, MSN, WHNP-BC: Sometimes they're like, natural is just like, uh, you know, changing my foods or changing my exercise. That's the natural way of doing things. Is it adding in a supplement? Do you want to know about supplements, the things that help with hormone regulation? Or do you want a natural hormone? And when we talk about natural hormones, it's it's so important for me to educate them okay. What is really a natural hormone? Is it something that's made from a yam or a plant source. There are things that are bioidentical that aren't always made from a plant source, but they're still bioidentical. And so having to explain to them what is a bioidentical hormone, it just means that it mirrors and mimics your own cell structure, which are great. I love them because we can manipulate them so easily. Like if we have a problem with it, we don't have to wait weeks and weeks for something to happen. I always tell patients, don't be afraid to start because the worst thing that can happen is you go, oh my gosh, this isn't working for me. You stop it. Three days later, it's completely out of your system. You don't have to worry about a long term side effect from it. Yeah.
Amber Warren, PA-C: Uh, lifestyle modification to help improve progesterone, because a lot of my patients, that's their version of natural, right? They want to think about. I mean, we kind of touched on environmental toxicity as it relates to estrogen dominance, but other ways to naturally increase progesterone.
Tammy Hadfield, MSN, WHNP-BC: Well, on a day.
Amber Warren, PA-C: To day living.
Tammy Hadfield, MSN, WHNP-BC: Well, I think better thing is, is how do we keep things more in check from it being used up. Right. There you go.
Amber Warren, PA-C: And that to me would be a way to naturally increase progesterone. Absolutely.
Tammy Hadfield, MSN, WHNP-BC: I think that you and I agree that there are you call them pillars. I call them cornerstones. Love it. And I always start with those. And I'm like, you have to have good sleep. You have to have proper nutrition. You have to have exercise because we know that that's important. And growth hormone levels and keeping things in check. And then I always talk about connectedness. And so without that I mean just simply having that connection with your partner or intimacy with your partner is going to reset your hormones. And I don't think most women realize that they're usually too tired to even consider something like that. But we also have to talk about that. So nutrition is super, super important. The sleep is really important. Um, I think we forget about those basics and we just want something to fix it and we forget about. So sometimes when you tell a patient, these are the things I want you to work on them like, but wait, that's not what I was here for. I was like, yeah, but sometimes that's where we have to start. Root cause, yeah. Otherwise, no matter what we do with the hormones, I can hit you with all the hormones in the entire world. But if one of those cornerstones is out, it's never going to come into balance for you, right?
Amber Warren, PA-C: Um, nutrition. What are your for hormone balancing. Right. What are your, like, top level? I mean, I know we can get really deep. You and I are not nutritionists. We have a wonderful team of nutritionists to support us. But I know you also have been focusing a lot lately in your career on trying to really be able to make some key recommendations. So what are your favorite recommendations to make regarding my?
Tammy Hadfield, MSN, WHNP-BC: My favorite ones are to go back to asking him one question, and this goes back to estrogen metabolism in the body. Are you constipated? Yeah. We don't talk about that. Yes. Like we always we don't even think about that in terms of hormones. But we have to remember that if you're not having a bowel movement every day, those. That's our way of excreting, you know, the bad estrogen metabolites when most.
Amber Warren, PA-C: People don't know what I mean. Going back to like what's your definition of constipation?
Tammy Hadfield, MSN, WHNP-BC: Right. 100%.
Amber Warren, PA-C: Well, how often are you fully eliminating. Oh, every couple days. Wait, what?
Tammy Hadfield, MSN, WHNP-BC: What do you mean wait? What? Yeah.
Amber Warren, PA-C: So I do think it's almost reframing that question. Are you having a natural, normal bowel movement? By the way, this is what the Bristol Stool Chart looks like. This is a normal bowel movement every day 1 to 2 times a day. And then most people are like oh no. Yeah. So yeah, that that is a driver of estrogen dominant.
Tammy Hadfield, MSN, WHNP-BC: And actually it's really interesting how many women there. They're just considered that to be normal. Oh it's just normal for me to only have 1 or 2 a week. And I'm like, oh my goodness.
Amber Warren, PA-C: So plants.
Tammy Hadfield, MSN, WHNP-BC: Plants, fiber. I'm big on plants.
Amber Warren, PA-C: I know you are.
Tammy Hadfield, MSN, WHNP-BC: Fruits and vegetables, fruits and vegetables. Three cups of dense vegetables at least. Most people always tell me just one. So I'm like, if we can get them to three, I get excited. If we can get them to 4 to 5, that makes me even happier because the fiber is so much needed to help with that metabolism.
Amber Warren, PA-C: Yeah, no.
Tammy Hadfield, MSN, WHNP-BC: That's wonderful. So important. Such great advice.
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Amber Warren, PA-C: So we talked about what the hormones do in a normal cycle in our childbearing years. I want to backtrack a little bit because I struggle to treat puberty, puberty, pubertal females, to be honest with you. So I think there are hard, a hard, um, type of demographic of patient to treat. And you probably disagree because you're so good at hormones, but what is happening, um, in these younger girls bodies during puberty?
Tammy Hadfield, MSN, WHNP-BC: Well, one, hormones aren't always in balance. At the very beginning, they're having erratic cycles. Yeah. Um, we're dealing with, again, so many things in our environment and nutrition. And your adolescence is even so much more important than anything at this time. Because the nutrition. It was very frustrating. I remember years ago watching, um, one of the doctors on one of the morning news shows, and she talked about the fact that when girls were starting to have puberty much younger because we have such good nutrition, and I about, oh my goodness, came out of my skin, I'm like, that is the opposite. Yeah. Because we have such well, we have the, the sad diet, the standard American diet. And so the adolescents and helping them with that, making sure that they're not over they overdo it with sugar so much. And we know that that has such an impact on their growth hormone levels and how things are being. We also know that there's this is going to get into all the crazy stuff about hormones. We know that environmentally, hormones are shifting so much in young women and men. Boys, young boys as well. Yeah.
Amber Warren, PA-C: We can't leave them out.
Tammy Hadfield, MSN, WHNP-BC: No, when we're dealing with the hormones, because just their, their way of interacting with one another is changing so much. And by that, we know that when you're looking at girls being more aggressive, being more, um, girls are getting into more of the bullying than ever. And we're not talking just verbally. We're talking physically. There is a shift in hormones that is going on that is helping perpetuate that. They even know that when you look at crimes of passion versus violent crimes, and where the testosterone levels are in men and what we're seeing there. So there's an environmental shift with everything. I still think it goes back to a lot of our nutrition and probably all those other xenoestrogens and everything else that's in our environment. There's just a lot.
Amber Warren, PA-C: And we don't have to take this too far. But to talk about males, the demasculinization of males, we've talked about that as a group of writers. Right. Like, yeah, we want to blame culture, and culture for sure is to blame. But you can't ignore the physiology changes that are happening at that level because of the hormonal changes. I mean, the frog example you gave is a perfect example of what we're seeing. Yeah. And so I think it is really, you know, so many parents I think need to be more aware of that. Um, because there's this whole mental health conversation going on, but not enough of this conversation going on. So what do you really need to remove and put in the home to start to help your kids there?
Tammy Hadfield, MSN, WHNP-BC: This is a whole other subject.
Amber Warren, PA-C: A whole nother.
Tammy Hadfield, MSN, WHNP-BC: Topic is very interesting. It because the whole reason why I got into, uh, also seeing males, because even though I'm a women's health nurse practitioner, my secondary board certification is in, um, uh, anti-aging medicine. And this is where it came about, because I watched what was going on with my own husband, and we didn't know what exactly was happening when it happened. I joined the military. I went into a very male dominant position. He became the stay at home parent. I did not realize how much stay at home parenting affects a man's testosterone because he is constantly in caregiving mode. The oxytocin is much higher and the testosterone levels start dropping, and the only way to counterbalance that is to have him do masculine things. My gosh, that is so fascinating. It is it.
Amber Warren, PA-C: So tell her for for for our listeners, what's oxytocin?
Tammy Hadfield, MSN, WHNP-BC: Oxytocin is the nurturing, loving hormone. It is the hormone that women produce in order to contract the uterus to go into labor. But then it is also the hormone that gets released when we put a baby to breast and we nurse the baby, we release oxytocin so that we want to love and nurture our child. It is also the hormone that we release when we orgasm. And we do that because we want to love and nurture our partner. So that whole oxytocin also is stimulated by nurturing a child. And you put a male in a nurturing a child. And we want our husbands nurturing our children, right? Sure, absolutely. But when it becomes their primary job, that affects their testosterone levels. So you.
Amber Warren, PA-C: Started to witness that in your.
Tammy Hadfield, MSN, WHNP-BC: Husband? Oh my goodness. Yes. He went from being the most like going and getting projects done to sitting on the couch. And I was like, what's going on? He goes, I'm just not interested. I'm like, what? I don't understand what's going on. And the sad thing with him was, is that with his hormones, of course, with any male hormones, there's such a big wide range and if you follow follow anywhere in that range, they're going to tell you you're normal. It's insane. It's insane. We're talking a 17 year old to a 70 year old. And if you follow anywhere in there, you're normal. For a 40 year old, they shouldn't be a 70 year old's level. How did you fix that? Well, he started having to do hormone replacement therapy. There's probably only one way and an MSC in doing things. I mean, we we turned a whole new leaf in our in our relationship where I started letting him open the door for me again. I let him drive, I don't I don't drive the vehicle. He drives the vehicle. I know they seem like small little things, but if you ever look into. I don't know if you remember John Gray. Men are from Mars. Women are from. Oh, yes. Yes, I love him. Yes. Um, but he. Those were the little things that he talked about, and a lot of his books and teachings is that you need to allow men to be men and so that their testosterone levels. So, like, let him go out there and, like, decompress after work, he needs to decompress for 20 minutes after work. Why? Sitting in the recliner increases testosterone levels. I know that sounds weird, but he uses it up all day long, so we have to reboot it. So.
Amber Warren, PA-C: And similarly, there's books like James Dobson wrote a book called Bringing Up Boys. I mean, I have three boys, so I'm focused on that. It's a phenomenal book about, you know, just little things, like when my husband goes to put them to bed and it sounds like an earthquake's going on upstairs because there's a wrestling match and I come and stop it because I think he's getting him all riled up. No, that is boys being boys, embracing their physiology and being boys and making that connection and starting to raise testosterone. And it's like those are innate things that little boys need to do. You know, there's another book, Wild at Heart. Uh, I can't remember the author of that, but it is all about boys. Or let them be wild, let them roam, and we don't let our kids roam anymore. And unfortunately, there are security issues. There's, you know, as my boys call them, bad guys that we need to be concerned about. Right? We live in definitely in a different world. But take those boys into the mountain, let them chase animals, let them. Oh, I could just go on and on and on. But that's another topic for another day. So, um, I mean, okay, so let's let's stay on that topic of mental health actually. How do these hormonal fluctuations impact mental health?
Tammy Hadfield, MSN, WHNP-BC: Oh my goodness.
Amber Warren, PA-C: You touched we touched on it a little. You know let's not reach for the SSRI. Let's reach for progesterone. But I think even getting into estrogens or testosterone in mental health, I think that's a whole that we can talk about that as well.
Tammy Hadfield, MSN, WHNP-BC: Absolutely. Well, the biggest thing as far as like young women I get concerned about it is a lot of them already come to me. Being on birth control pills are I'm.
Amber Warren, PA-C: So glad you went there.
Tammy Hadfield, MSN, WHNP-BC: Yes. And at that point, we've already affected their hormones. We. We don't know currently. And you may correct me if I'm wrong. Um, but we don't know if that what what birth control pills do is they actually bind up testosterone and lower it. And for some women, that squashes their drive, their sexual drive is squash, which is kind of sad because we're taking them to be able to be protected so that we don't have a child and can be a little bit more free with that, and then it squashes it. We don't know if that squash, though, is long term, and there's a lot of talk within the sexual health community is are we able to fix that? There are ways to fix it, but we have to actually work on it. We can't just like, oh, well, it's just going to bounce back. It doesn't always bounce back. So hormonal birth control pills can do this. But the other thing that it's doing is it's zeroing out all the other hormones. So some of my gals still come in and they have PMS symptoms. I'll still put them on progesterone. It's not going to affect their birth control pill, but it may help them feel better. It may help them with their PMS symptoms so that they're not feeling like I have to stay away from my family for that week before my period. Or I might say something I'll regret.
Amber Warren, PA-C: So even if they're on synthetic progestins, that is in a lot of our birth controls, they will still benefit from the Or. You're not just canceling each other out.
Tammy Hadfield, MSN, WHNP-BC: No. Oh yeah. So you're not going to affect the birth control. It's not going to affect the birth control pill at all as far as its effectiveness. Right. But it is going to take sort of that edge off. And there are different ways of helping with that. Yeah. Yeah. What about women.
Amber Warren, PA-C: That can't do you find women can't tolerate progesterone the hangover effect the.
Tammy Hadfield, MSN, WHNP-BC: Once in a great while. And sometimes it can be just the, um, the dosage, which is the beauty of why we have compounding. And I love compounding so much, is because we can change those dosages, because what's conventionally available is only 100 and 200mg, but that doesn't fit every patient. We have some patients that benefit from like a small 25 milligram dosage, just enough to kind of take off the edge for them. And there's all different ways that we can do that. We have everything from, um, sublingual things that go underneath the tongue. We have creams, we have, um, pill forms that can be lower dosages. So that's why I like the compounding because we have an ability to adjust the dosage for them.
Amber Warren, PA-C: Yeah, absolutely. So um, we talked a little bit about testosterone, the two hormones testosterone DHEA, which we take a lot of pride in always checking DHEA on our patients. Right. I don't think there's a.
Tammy Hadfield, MSN, WHNP-BC: I love it.
Amber Warren, PA-C: A lot of practitioners that do they don't fluctuate during our cycles. They stay steady. Eddie, what is the importance of those two hormones?
Tammy Hadfield, MSN, WHNP-BC: Uh, DHEA is our hormone that's produced by our adrenal glands. And if we're under a lot of stress, we're not going to be producing enough DHEA. So that can be any kind of stress, whether it's environmental stressors or. I always tease my teachers who come in. I'm like, usually your DHEA is low during the school year, and then during the summer it's going to pop back up again. So kind of give them an example of how not being stressed versus being stressed is going to affect those levels. But DHEA is for memory and mood, stability and energy. And then I always say it's the four antes. It's anti-aging, anti-anxiety, anti-obesity and anti-inflammatory. Oh, I love that. And that just I mean, who wouldn't want that? Like most women are like, give it to me in a Costco sized jar. Totally like.
Amber Warren, PA-C: And that's the beautiful thing. You don't need a prescription. No. It's cheap. It's safe. Yep. It's really easy to monitor and follow up on levels and make sure we're getting it just right. And that's another I mean, really all of our hormones we're looking to optimize. But the amount of women I mean, I saw a DHEA level of 11 today.
Tammy Hadfield, MSN, WHNP-BC: 11 doesn't that you just look at them and go, oh my God, how are you functioning?
Amber Warren, PA-C: I know because we're looking to get them. I don't know what you say, but most women 2 to 2, 5200 to 250 upper limit of what we call normal.
Tammy Hadfield, MSN, WHNP-BC: Absolutely.
Amber Warren, PA-C: To get them optimal. And it's like oh my goodness and DHEA so testosterone I'll let you.
Tammy Hadfield, MSN, WHNP-BC: Oh testosterone. So testosterone is actually a de converts to testosterone. And so usually if we have a low de we're going to have a low testosterone. But testosterone and women I didn't realize I'll be honest with you, I've been doing this 24 years, and I didn't realize the significant impact of losing my testosterone was going to hit me until I went through menopause myself, and I was so frustrated with my patients at that point because I was like, girls, why weren't you telling me all these symptoms, like all these things that I started feeling that none of them were bringing up to me.
Amber Warren, PA-C: Yours plummeted when you hit menopause.
Tammy Hadfield, MSN, WHNP-BC: Yes, but I have polycystic ovarian syndrome, which is a very high testosterone most my life. And then when I hit menopause, it just tanked. Oh, goodness. Adhd symptoms really? So I couldn't focus to save my life. And it was so frustrating because I was like, oh my goodness, nothing is synapsing in my brain. Like I cannot keep two things together.
Amber Warren, PA-C: Probably couldn't figure out why.
Tammy Hadfield, MSN, WHNP-BC: No. And I was frustrated. And then finally I went. Wait a second. Let's look at what are what is my main hormone that's dropped her? Everything else was optimized. Yeah. Still dealing with. I'm like, why wouldn't I benefit from a little lower testosterone? Because I had PCOS all my life, right? Yes. No, I was used to operating at a higher level, and that focus was just it was like a light bulb. Like the first time I started taking it, I was like, oh, I feel like myself again. Like I can finally focus again. But testosterone helps with our energy. It helps with our, um, joint and tendon health. Yeah. Um, a lot of our joint aches can be helped by getting on testosterone. Bone density can be affected by it. Um, skin elasticity. Um, they're always, you know, chasing that next bottle of something that will take care of a wrinkle on our face. But testosterone is so important in that, um, testosterone for both personal and sexual drive. I always talk about sexual drive with testosterone. Everybody hears about that, right? But we don't talk about the fact that we lose our personal drive. Like, am I going after that promotion at work? Do I want to go and do activities with my family? Do I want to work out every day? Exactly.
Amber Warren, PA-C: I tell you, like kind of lose that oomph. I see it all the time.
Tammy Hadfield, MSN, WHNP-BC: But then with I mean it's that will effect too. So like we lose that, then we quit exercising. Well the exercise was also helping to keep our testosterone better. I mean, it's just a vicious cycle. Yeah. So yeah I love testosterone now.
Amber Warren, PA-C: So I'm always I'm so, so when your health history I'm so thank you for sharing your personal stories. So your testosterone plummeted right when you went to menopause. I don't always see that. I'm always surprised. I'll sometimes see women in their 30s. Testosterone is plummeted. And to be honest, I'm one of those women. Mine was so low when I got into like my mid 30s I had that I didn't have those same kind of symptoms, but I was shocked how low it was when I finally started to check it. And how many women actually get their testosterone checked in their 30s? Hardly any right. But I'll check some 65 year old post-menopausal women who still have really robust testosterones, and I can't figure it out.
Tammy Hadfield, MSN, WHNP-BC: Do you want to talk about that? I do okay, because I.
Amber Warren, PA-C: Like there seems to be no rhyme or reason. I mean, I mean, the biggest reason I can come up with is probably it's precursor DHEA. My 30 something year old women are stressed to the hilt, working, raising children, dealing with the world. Right. And so they're they're having that cortisol steal and they're stealing testosterone. Absolutely. But the fact that I've got some women that can go into their 60s and still have really robust. So enlighten me, dear friend.
Tammy Hadfield, MSN, WHNP-BC: Well, here's here's a very this is my favorite story to tell. So this happens to do with back in 2008, uh, with 2007, 2008, when Suzanne Somers and Doctor Phil and Oprah were all talking about compounded, did you say bioidentical hormones? Oh, I did, I'm just joking. Continue on. So everybody was hearing it, right? And so I had a group of ladies who came down from Orofino to see me, and it was a group of five of them, and they came down and they all just wanted their hormones checked. And I was like, well, what kind of symptoms do you have? Four of them had no symptoms. They're all in their 60s, except for one of them who was in her 80s, and the only thing that she said was her symptom is I have a very low sex drive, and I'm like, oh, and we want it back.
Amber Warren, PA-C: In your 80s.
Tammy Hadfield, MSN, WHNP-BC: I love it. Okay, you want it? We'll work on that. And so when I tested their hormones and they came back, I was in shock. They had estrogens all between 30 to 50, which we know usually without estrogen replacement. You're not going to see that. Yeah. Um, they all have beautiful testosterone levels. And again, they didn't have any symptoms. They were just wanting to do it because it was the thing that was being talked about on TV and everything, and Suzanne's books and everything. So I told them, I said, you don't need any of this. And I perplexed me for years as to why those four ladies did not have low levels. The other one had low testosterone but beautiful estrogen levels. Which 80 year old? The 80 year old. She had a 28. I mean, it's not perfect. It's not exactly where I'd want her estrogen, but her 28 for.
Amber Warren, PA-C: It's registering.
Tammy Hadfield, MSN, WHNP-BC: It's registering. It's not zero, right. She had a low testosterone. Replaced testosterone. She got her sex drive back, and I walked on water, according to her. Yeah, of course, but these ladies perplexed me. When you look at what's going on in the rest of the world, there are areas of the world that they don't do hormone replacement therapy. Right? But what are they doing differently? And that's what boil down to these ladies. What were they doing differently? They all owned farms. They all worked their farms. They were all eating their own organic produce off of their farms. The meat that they ate was the cleanest, probably protein that you could possibly get. They were a group of ladies who were all friends. They all did things together. They had this connectedness, and four of them were still having sex well into their 60s. So I'm like, there, there are those people who are out there, pillars.
Amber Warren, PA-C: They're there. They're they're meeting.
Tammy Hadfield, MSN, WHNP-BC: Those and they've got there's got to be something to that. Yeah. And they were just they, they were my aha moment. Those were the ones that I was like, oh my gosh. There really are people who can maintain good hormone levels that don't need replacement.
Amber Warren, PA-C: Okay ladies, I need you all to go buy five acres, start a farm, raise some beef, or at least find a rancher and have a lot of sex with your.
Tammy Hadfield, MSN, WHNP-BC: Husband, right?
Amber Warren, PA-C: And hang out together. So quit your jobs, start homeschooling, and hang out with others. Don't homeschool. Actually, that will not help your stress, but hang out with other women. Yeah, that's it's an easy fix for all of us, right?
Tammy Hadfield, MSN, WHNP-BC: Right. I wish it was that easy.
Amber Warren, PA-C: Be like the Orofino ladies. Yes, be like them. The be.
Tammy Hadfield, MSN, WHNP-BC: Like them. Amazing.
Amber Warren, PA-C: So what are we really? So you've spoken so much. And I know we're so big on like. Like you said, walking on water for our patients, giving them their libido energy, you know, lessening irritability, anxiety, depression. But I don't think what's talked about enough is some of these long term benefits, these preventative benefits that we're seeing. Right? Last time I checked, cardiometabolic disease was still the number one killer of men and women and costing us a gazillion dollars a year as a health care system. Right? Alzheimer's is on the rise and I see no sign of it stopping. It's its own epidemic. Type two diabetes. Right. So what do you see? And what are we looking to aim to improve when we're treating these hormones?
Tammy Hadfield, MSN, WHNP-BC: The three big ones that I always talk to patients about. One, we know bone density. That's been proven over and over again. We know that we lose the most amount of our bone density during the first 5 to 7 years into menopause. And it isn't just about estrogen, it's about all the hormones. It's so very important. And it's hard for those women who are out there who have had hysterectomies that are told they only need estrogen. That's like my biggest pet peeve. We don't want just estrogen. We are made to have a symphony of hormones. And so the bone density is a given. We know that. That's one. We had a hard time with the cardiovascular discussion because of course, after the WHI study, you know, more than 20 years ago, we scared women into going off of them. We know that we have a safer way of giving hormones, and that is by getting estrogen transdermally something that goes through the skin. So we bypass its first little stop in the body for metabolism, not in the liver, which is where those clotting factors come from. I always told women I explain their blood vessels like a garden hose. Your body without estrogen is like leaving a garden hose out in the sunshine without any water going through it. It's going to stiffen any dirt that's in there. It's going to get stuck on the inside of that hose.
Tammy Hadfield, MSN, WHNP-BC: Now, if we go and give you oral estrogen that causes system wide inflammation in the body, if we do that and we cause that inflammation to happen, we're going to cause a cardiovascular event to happen because that's plaques and leaks and blood vessels. But if we start estrogen replacement therapy closer to the onset of menopause, you're going to give that elastic protection to those those blood vessels. And that's such an important thing for women to realize that we want to protect your blood vessels as much as possible. Starting it. We know now, if we start it at the onset, that we're going to have that protective value, not waiting ten years down the road like the way I did. Right. But starting at the onset, we now also have the new data on cognition. And that is so exciting to see that, um, new book that's out called The Menopausal Brain. I've been having a lot of patients just get the, um, download it on audible and listen to it. I'm hoping that at some point now with this new data, that we know that it gives protection against dementia and Alzheimer's. We used to say that women were twice as well. We still do. We say that women are twice as more likely to develop Alzheimer's in their lifetime, and we used to attribute it to the fact that women live longer.
Tammy Hadfield, MSN, WHNP-BC: Well, there's areas of the world where you only live two years longer. That's not like 8 to 10 years, right? And we now know that it has to do with the estrogen. This is one of those other moments where I was like, because I deal with male hormones as well. It was that little light bulb that went off because I was like, wait a second, testosterone being low in men, they're at a higher risk of dementia. We know that, right? Right. But if they have low testosterone, they have low estrogen. They go hand in hand. Well, when men are optimized on their testosterone, their estrogen levels are higher. They're like at the level that I'm trying to get my female patients at. So we know that it's got a protective value. I'm hoping that at some point now that this new research is coming out from the neuroscience end of things that they'll finally come up with, like, hey, there might be this level of estrogen that's going to give us the most protection cognitively, and that would be exciting to finally have a number because we don't put it in conventional medicine. There's no number that's assigned to it. If you're menopausal, it should be zero. And that's not optimal. Yeah. Right. So for cognition would be the other big part.
Amber Warren, PA-C: Well so we look at using progesterone right I love how you said it should be a balanced symphony. Um but I think we too often ignore the data on how I mean, progesterone alone for bone health, brain health, um, breast health protection, right? Let's not even talk about other hormones. You're looking for a way just to calm down and protect you from breast cancer because it's in your family. So we scare them.
Tammy Hadfield, MSN, WHNP-BC: Because of that whole thing of using the word progestin versus progesterone. There's an innate difference between those two. And it's sad that we have even providers in our community that still confuse the two and scare women out of being on progesterone, and it's so important. I mean, it's such a perfect example. Women who go on estrogen replacement therapy after a hysterectomy, of course not. Given progesterone, they start having migraines again and they're like, oh my God, that estrogen caused my. No, it's not your estrogen that's causing the migraine. It's the fact that you're not on progesterone that's causing your mind. So it's just frustrating. It's it's more about an education to, I think women to know that they can demand more. They don't have to have just standard hormone replacement therapy.
Amber Warren, PA-C: Bring the research. Yeah. Yeah I know because now it's the research is at our fingertips. Right. And we can bring them or find a new provider. You might find a new provider.
Tammy Hadfield, MSN, WHNP-BC: Someone who will listen to you.
Amber Warren, PA-C: Yeah. Absolutely. Absolutely. Um so stress sleep, stress and sleep, how are those impacting your hormone levels?
Tammy Hadfield, MSN, WHNP-BC: Well, your growth hormone levels, more than anything. I mean, you think of it, there's there's some great there's so many statistics on sleep. Yes. I think the one that scares me the most is a study that was done on women working night shifts. It was actually night shift nurses. They had about a 40% increased risk of breast cancer if they're awake between the hours of one and 2 a.m.. Well, who else is awake between 1 and 2 a.m.? Probably our menopausal women. So when you think about that, that's kind of a scary statistic, that how important is sleep? Plus the fact that we reset our growth hormone levels, we're converting thyroid hormones during our sleep. And if you're missing that, all those good hours to kind of reboot our body to restore. And it's it's so important. It's also very, very important at this time in our life that if you even have an inkling of thinking that you might have sleep apnea at all, please go get it checked, because we don't know it's a chicken before the egg thing when it has to do with does low testosterone cause sleep apnea or does sleep apnea cause low testosterone? We don't know. Fix both. Fix both. Yeah. Exactly.
Amber Warren, PA-C: Yeah. And you will have remarkable improvement. Absolutely. Health. Yeah. Absolutely. That's so true. Um, so back to the conversation we were just having about, um, sleep and growth hormone. What's growth hormone? I think that's one. Again, let's talk about things that aren't talked about enough. Oh, we often talk about sex hormones. Yeah.
Tammy Hadfield, MSN, WHNP-BC: Well growth hormone is really so it's it's kind of a taboo subject. Um, there's thousands of citations on the benefits of growth hormone. There is actually a congressional hearing on growth hormone. It's it's publicized out there. They saw that, hey, growth hormone giving growth hormone. It was actually to military troop members. So when was this? Oh, gosh. Uh, a while ago. It had to have been before. See, I think it was presented at a 2006, 2007 conference. So it was quite some time ago. Um, but the fact that it, um, reversed cardiovascular disease, it helped with bone density, reversed type two diabetes. But we cannot prescribe it. We cannot prescribe growth hormone. Um, not that we can't, but you'll get investigated if you're prescribing it. So the, the new thing, which is an exciting field that we are so happy to be able to provide for patients, is looking at peptides that actually help with growth hormone levels and growth hormone taken over a longer period of time. And that's something to have a discussion with a patient about can help with boosting up those levels, which then in turn helps our hormones, which then in turn helps our mental outlook. It helps our body physique. It helps with like it can help with some of them help with cholesterol. Some of them help with sleep. Um, my favorite one helps with like skin elasticity.
Amber Warren, PA-C: What's your favorite one?
Tammy Hadfield, MSN, WHNP-BC: Bpc 157 your favorite peptide? Yes, it's my favorite peptide. Yeah. Um, but there's there's so many that are there. It's a newer field because I don't think most people even know what a peptide is, because you see collagen peptide and you think, oh, that's a peptide.
Amber Warren, PA-C: I'm taking it, I'm taking it, I'm taking peptides.
Tammy Hadfield, MSN, WHNP-BC: It's not a peptide. It's actually peptides are just signals to the body to do a specific function. And all we're doing is helping replace them, which is amazing medicine. Now the way that we can do that and help patients, even they're.
Amber Warren, PA-C: So innate and natural to the body, we just get to come and fine tune them.
Tammy Hadfield, MSN, WHNP-BC: Yeah, exactly.
Amber Warren, PA-C: And there's ways that we can do. Do you check IGF one in your patients?
Tammy Hadfield, MSN, WHNP-BC: I used to do a lot of it. I haven't anymore because of where I've been. But now that I'm. Now that I'm here. Yeah, I get to do that again.
Amber Warren, PA-C: I wish there was a little bit more of a direct way to look at growth hormone, but it's a good way. It's a good way to to see if there's, there's um, there's a and it's often not optimal. No. Yeah. Stress, poor nutrition, environmental toxicities. Absolutely. Things that will deplete you of growth hormone. Yeah. I can't say enough good things about the growth hormone peptides that were we chatted about them today in clinic. Like they're just so wonderful and so safe and so beneficial for our for our patients. But you're right. Bpc 157 is a wonderful peptide body protecting compound. So we've spent a lot of time talking about the benefits of bioidentical hormone replacement therapy. What are the risks?
Tammy Hadfield, MSN, WHNP-BC: That's a loaded question, I know. So here's the risk. If they're out of balance, can we cause other issues? Yes, absolutely. There you go. Um, and so I always tell patients that a lot of the side effects that we deal with, with hormones are because we may have been out of balance with it. If you start having breakthrough bleeding, for example, do we have too much estrogen or do we not have enough progesterone? Um, some of the side effects, you know, we talk about the side effects of DHA. Well, the side effects of DHA aren't actually DHA that's causing the problem. It's the fact that it's converted down to dihydrotestosterone. And now we've got acne, hair loss and hair growth in areas it shouldn't be. But there's all ways of helping those conversions in the body. And that's something that why my preference is, is that somebody see an actual hormone specialist that understands this, not just go pick up DHEA over the counter and start taking it without actually looking at your levels and seeing if you really do need it, because there's.
Amber Warren, PA-C: A wide range of dosages. Absolutely.
Tammy Hadfield, MSN, WHNP-BC: Yeah, absolutely. And and some of the absorption is different as we know from different companies and varied. I, I tend to usually use more compounded DHEA just because I, I'm kind of a control freak. I like to know exactly how much they're getting sometimes.
Amber Warren, PA-C: And exactly what's in it. Yeah. So you get it. Okay. Yeah.
Tammy Hadfield, MSN, WHNP-BC: Just everybody does it just a little bit different. There are companies, though that have really reputable data. Again, just you want to be following things and making sure that somebody is actually checking your levels and not just taking it because you heard your friend was taking it kind of a thing.
Amber Warren, PA-C: Oh my gosh, it's so true because.
Tammy Hadfield, MSN, WHNP-BC: A lot of these hormones are available over the counter. Oh I know, so.
Amber Warren, PA-C: It's easy to get. Mhm. Um any risks of. I mean, what do you say? I mean, I know what you say about breast cancer and estradiol. How about testosterone replacement? Even in the premenopausal women?
Tammy Hadfield, MSN, WHNP-BC: You mean as far.
Amber Warren, PA-C: As risk of being on it? Yeah.
Tammy Hadfield, MSN, WHNP-BC: Honestly, I again, it goes back to dosage thing. Like, if you're on too much testosterone, could we cause some there's going to be some problems. So if we keep things at normal at looking at where are they getting the most symptom relief and where are they not getting side effects? There's a fine balance between that. And some people don't get any side effects from it at all. But absolutely testosterone. I mean, there are a couple of patients that sometimes feel a little too edgy with it. So we decrease the dosage or if they get too much acne and you're like, I didn't sign on for this, well, then maybe we'll does it. Or we can add in things to help with the metabolism of testosterone so that we can get that under control. We call those bothersome symptoms. We can get the bothersome side effects to go away. Usually that.
Amber Warren, PA-C: Yeah. So good. Well, Tammy, you're just such a, um, a a wonderful addition to our team and such just a a voice of knowledge and wisdom and truth when it comes to female and male hormones. So we're so appreciative of that. So thank you so much for this conversation. I know it's going to be so valuable to all of our listeners. So thank you. Thank you. Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today. Specialties available at the FMI Center for Optimal Health and the highest Quality of supplements and more. Go to funmedfoundations.com.
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