“Advances in Hormone Therapy” – with Dr. Stephanie Lam and Dr. Michael Silverstein

In this episode of Healthful Woman, Dr. Silverstein and Dr. Lam join to talk about hormone therapy. They explain when and why women usually start hormone replacement, how treatment has changed to be safer and more effective over time, and more.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, welcome to Stephanie Lam and Michael Silverstein, three of us in one room at one time discussing hormones. This is just unbelievable. This is a new feat for our podcast, to have three people in the same place at the same time. So I’m very excited. 

Dr. Lam: I’m more excited. 

Dr. Silverstein: I’m even more excited than either of you. 

Dr. Fox: It’s awesome. We did have a podcast with three people, but one of them was remote, over the phone. I didn’t even realize we had three headsets. So this is great. 

Dr. Lam: Options, options for the future. We could keep going. 

Dr. Fox: Options for the future. So thank you both for coming. I thought this would be a really good idea for a podcast because number one, it’s a topic that a lot of people have questions about obviously. And number two, since both of you as well as Dr. Gottlieb, Aren, who’s not in the room at this time, has started giving hormone therapy in a…it’s not new, so to speak, but it’s a way that people may not know about. I thought it’d be a good time to just review hormone replacement in general, and then specifically how you guys are doing it in your office at Carnegie Women’s Health. So let’s just start in general. Mike, how would you explain what happens to our hormone levels as we get into our 40s and 50s? And we’ll talk about women predominantly, although a lot of this happens for men, and we can discuss that separately. But for women, what typically happens? 

Dr. Silverstein: One of the most profound effects is absence or the diminution of testosterone. Men and women, as they go through their 30s and 40s, testosterone wanes down. And the big four manifestations of low testosterone in men and women is less energy, brain fog, slightly greater risk of depression, and interrupted sleep. The fifth perk is libido issues, and sexual function. But it’s really the whole package. And the vast majority of people in their 30s and 40s have a lot on their plate, whether it’s with kids or jobs or stuff like that, and just kind of write it off to the environment. But this is actually diagnosable, low testosterone, and there are fixes for it that can often give you back more of energy, effective sleep, minimizing depression, as well as avoiding that brain fog. 

Dr. Fox: Right. And this is not due to menopause, meaning this happens prior to menopause, right Steph? 

Dr. Lam: Yeah, so I think in women in general, we reach a peak for our hormones when we look at estrogen, testosterone and other hormones. And then as we start to hit in our mid-30s, and 20s, hormone levels start to decrease. And Mike mentioned one of the hormones, which is testosterone. This is natural. This happens to all women. Change in hormones even happens to men. Men will have, and this is a separate topic, as we take care of predominantly women, but estrogen levels will start to decrease. Average age of what we call menopause, which is the period stopping for all women, and the definition is one year without a period, but average age in menopause here in the United States is around age 52. So you get a slow decrease in these hormones, eventually your periods stop. You still have a slower decrease in hormones, but symptoms or how you feel due to the hormone change, definitely start several years before your period stops. 

So like Mike said, as your testosterone decreases in your 30s or 40s, and eventually, for sure, in your 50s, you’ll have difficulty sleeping, you’ll have change of energy, mood, periods, all of it. 

Dr. Fox: And then when people sort of traditionally thought of hormone replacement, that was predominantly estrogen for women who were already at or after menopause, correct? 

Dr. Lam: Correct. Back when I think of my mom’s generation or the generation before, women would suffer, I mean really suffer. They would feel lousy for years leading up to their periods stopping, hot flushes, soaking, not being able to sleep, then their periods would stop. And at that point that their period stopped, the OB-GYN would start to talk to them about what options there were. And traditionally, I think at that time, the most common would be giving this synthetic estrogen and progesterone supplementation if they still had a uterus, and they’d give them pills. We’d give them a certain amount of years that you could definitely take it for. It was very cookie cutter. It was same dose of pill, maybe a couple choices, same type of pill and everyone got the same thing. 

Dr. Fox: Right. And what’s interesting to me is…so it, sort of, seems like there’s three separate reasons so to speak to address hormones. The first, Mike, what you’re saying is this sort of before menopause, this just natural decrease in some of our hormones, maybe predominantly testosterone, which gives you these symptoms that a lot of people have and may not realize that it’s related to their testosterone. And then there’s the second for women specifically when they get around menopause where their estrogen drops and they’re having symptoms, you know, the hot flashes, the sweats, the classic menopausal symptoms. 

But then the third thing which was done a lot in the past is there was this thought that after menopause, all women should be placed back on the hormones that they don’t have anymore, but not for symptoms. That was for health. They thought, you know, better for your bones, better for your heart, better for your skin, better for, you know, not getting Alzheimer’s, whatever the benefits there were supposed to be. And there’s a lot sometimes of confusion between what are the three reasons that someone talks about hormone replacement therapy. Which of those three are they talking about? And which of the three, for example, are being studied in various studies. And I think that’s caused a lot of confusion for women. 

Dr. Silverstein: It has. And in the ’70s, ’80s and ’90s there were a lot of studies that supported estrogen replacement therapy as being very helpful for the bones, because loss of estrogen often causes bone loss. It supported lipids and heart health, mental health and skin health. And then in the late ’90s and 2000, 2001 when the Women’s Health Initiative came out, and found an increased risk of breast cancer on hormone replacement therapy, but it was relegated to the group that took estrogen with a synthetic progesterone. 

And the women who took estrogen alone only had the benefits and did not have an increase in the risk of breast cancer. And so retrospectively, we realized that it had to have been the synthetic progesterone. And so using the bioidentical hormones, we feel more comfortable administering estrogen with bioidentical progesterone without ramping up the risk of breast cancer. 

Dr. Fox: Right. And also in that particular study, which is…it was a huge study. I remember when it came out and… 

Dr. Lam: Yeah, it was a huge… 

Dr. Fox: Yeah, it was like life-changing. Yeah. 

Dr. Lam: It was impactful. Like, it really made a difference how I think we all practice or how we studied, and how many women potentially suffered, because people were scared, right? 

Dr. Fox: Yeah. 

Dr. Lam: You didn’t necessarily want to take hormone placement therapy after the WHI study. 

Dr. Fox: Right. When someone says, “Yeah, a big study came out and said, taking hormones increases your risk of cancer,” that’s like, “All right,” well, mic dropped, you know, “Okay, we’re done.” But one of the issues that I always had with that study was number one, the women that they studied were ones who were mostly over the age of 60. And they were on hormones for 10 years, meaning, it was that third category where, “We’re gonna give you hormones forever to, like, improve your overall life.” And it said, “Okay, you know, maybe it does, maybe it doesn’t, there’s a downside, there’s an upside, like you said, you know, if you use one versus the other.” But it sort of got thrown on to women who are 50, who are having horrible hot flashes, and they feel miserable. And now they can’t get the hormones just to get through those couple of years of menopause, they think that they’re going to get cancer from taking it. 

Dr. Lam: Really, we’ve been doing a lot of catch-up and a lot of fixing, or clarifying and debunking some of the myths that may have come out of this study, which may not be applicable to all women. 

Dr. Fox: Right. 

Dr. Lam: Yeah, I agree, it wasn’t an ideal study. 

Dr. Fox: Yeah, I mean, so for women in their 40s, and 50s, who have symptoms from their hormones dropping, most of the data shows that it’s very safe to use hormone replacement. It doesn’t have to be used, there’s other options. They may not be as good, but whatever, you know, people can make choices. But it’s not the same consequences or implications as giving it to someone who’s 65 for the next 15 years of her life. 

Dr. Lam: Correct. 

Dr. Fox: And that’s a totally different situation. And I agree that it’s become almost like taboo, to talk about hormone replacement. People think, you know, it’s like witchcraft, but it’s not. Like it’s been used forever. 

Dr. Silverstein: Well, the caveat that came out of the Women’s Health Initiative was for hormone replacement therapy, the lowest dose needed for the shortest duration warranted. And so people treated it like a pariah, like, “I’ll use this just like I’m suffering tremendously from my hot flashes, but then I have to walk away from it.” So it no longer has that taboo-related feeling to be able to give somebody medication that’s going to alleviate very, very dramatic symptoms and lifestyle alterations. 

Dr. Fox: What have you guys found in terms of testosterone? Because that also has some controversy around it, whether how effective is it, how do you follow it, what do you do? And the studies are mixed on this, and you’ll see different opinions on giving testosterone for that reason. What has been your interpretation of all this, Stephanie? 

Dr. Lam: I would have to say when I first started breaking into doing training and going into OB and GYN maybe 18 or 19 years ago, nobody really was talking about testosterone supplementation. It was not part of my every day how I dealt or spoke with a patient. And I think some of the people who were doing really truly bioidentical hormones were doing it. A lot of it was done in Europe. A lot of it was done outside the United States. Most of it was given to men. And how we gave it was a little bit tricky. I mean there’s different ways of giving testosterone. There’s a nasal inhaler. You can give a cream. There were some injectables. 

Dr. Fox: We learned a lot about this in the ’90s in baseball, also. The cream and the clear, right? 

Dr. Lam: Right. Now, most recently, which we kind of have started to embrace and what we’re doing here in the office is supplementing testosterone in a pellet form that goes into…underneath the skin into the subcutaneous area. And it’s slowly released. And the cool part about it is, is that each of the doses of hormones that we give for the testosterone is individualized to the patient. So we look at all these different things, and we decide how much testosterone do we need? How often do we need to check the bloods? Well, typically we check the bloods prior. If someone’s coming in with complaints, we’ll look at the patient and see, could this be a hormonal related type of thing? Check their levels, find out if their testosterone is low. And then if it is, we titrate it back accordingly. 

Dr. Silverstein: And we call them a month later and find out how they’re doing. And if they’re asymptomatic, with a borderline testosterone, we can do a boost. So besides the lab values, we can adjust it to the patient’s reaction. 

Dr. Lam: Right. And then we check the blood about five weeks to six weeks after they get their supplementation that…in this particular mode of giving it back. And then after that, you don’t really have to check the labs except for once a year. We typically check to see how they’re doing. But as far as other forms and how you can give it, there’s different ways of giving testosterone. It just becomes a little tricky, because some of the different ways can stay on your hands. You have to be careful of touching other people. The pelleting, which has really kind of taken off, I would have to say, is easy. It’s done in the office. It’s a quick procedure. And patients really do get immediate improvement like within…I would have to say, like, days to a week to 10 days, they’re feeling much better. 

Dr. Fox: How would someone know if they might benefit from getting some form of hormone replacement therapy? 

Dr. Silverstein: I really feel these symptoms dominate low energy, brain fog in the middle of the day, interrupted sleep, depressive symptoms, poor libido. I mean, these are very common symptoms that people just write off to being in their 30s, 40s or menopausal. And if you approach a gynecologist, if you come with your partner, or by yourself to Carnegie Women’s Health, it’s a discussion. We’ve had lots of couples come in, sent labs on both, after doing a review of their symptoms. And there are a handful of couples that we’ve taken them both in and done pelleting for both with a very positive reaction. 

Dr. Fox: Right. So Stephanie, when you’re seeing them, how do you evaluate them, other than asking them of their symptoms? If someone comes in, you know, they have this symptom and that symptom, you do some bloodwork. And is there anything else you have to do, like an exam? Are there any other tests you have to do to make sure that they are candidates? 

Dr. Lam: Every patient that comes in, we typically sit with them in the office first, right? We do our intake, ask them how they’re feeling. In our particular office, over the age of 40, we give them a questionnaire, and that questionnaire is basically geared towards asking them a bunch of questions. So by the time they walk in the office and I peek at this questionnaire, I kind of have an idea of how they’re feeling. I look at their age. I ask them how old their mom was or siblings were when they went through menopause. The average age of menopause is 52. So if someone’s 25, I doubt that they’re coming in for menopausal issues. So you kind of just create a picture. I do an exam if someone’s complaining of painful intercourse, they feel very dry. Other symptoms like that, we do a full exam. And then afterwards, I offer them blood draw. I say, “I think we should check some labs.” 

Typically, the labs take about a week to come back, maybe a little sooner. And depending upon what I’m kind of thinking or what they’re feeling, we typically will set up a follow-up appointment to talk to them. We could do it via Zoom. So we’ll do a Zoom visit. We’ll talk about their hormones, what we found out. And then we kind of break down what we think is the right treatment for them. Very young patient, very few symptoms, here, we can follow this. Older patient in menopause, they want to be more aggressive, we may tailor different types of hormone therapy. And although we’re talking a little bit about testosterone, hormone replacement therapy, which has been around for years, can come in all different forms. 

Dr. Fox: Right. 

Dr. Lam: Pills are still popular, patches, excellent form of hormone replacement therapy. I mean, I really love a good patch. And then you also have pelleting, which can be used as well. So I think seeing how patients feel how comfortable they are. And just because you started one thing, you could switch months later. You don’t have to stick with it, it may not work for you. 

Dr. Fox: Right. And then what are the options in terms of the hormones that you might give? So there’s testosterone that you might give, there’s estrogen. Are you ever giving progesterone or… I know there’s thyroid that also is given. 

Dr. Silverstein: Those are oral medications. So the only pellets currently are the testosterone and the estrogen. If they have a uterus and are getting estrogen, they’re going to take an oral bioidentical progesterone, safe and effective. We’ll screen their thyroid. And we also use a thyroid supplement for patients who have borderline thyroid values. 

Dr. Fox: Because a lot of those symptoms overlap with low thyroid 

Dr. Silverstein: Significantly. 

Dr. Fox: I suppose you must be finding people who end up having a thyroid disorder as well, because that’s common as people are into their 40s or 50s. 

Dr. Silverstein: Well, it’s so interesting because the normal values for thyroid function have a low end and a high end. And we don’t call it a thyroid disorder until you’ve crossed the line at the low end. But if you’re a tenth of a point above it, we label it normal. But you’re a tenth of a point above where you would have gotten replacement, and so we feel those patients are a candidate for a boost. We’re not dousing them with thyroid. We’re just trying to get them back into the middle of the normal range. 

Dr. Fox: Right. And again, I imagine that since we’re talking about symptoms, we’re not talking so much about the health. I mean, if someone’s thyroid is borderline, and you decide not to treat them, they’ll probably be fine from a health perspective, but they may not feel as well. 

Dr. Silverstein: Well, that’s true. But also if they’re borderline with their thyroid function, will they be exercising, will they be vigorous, will they be gaining weight? 

Dr. Lam: Women come in, and especially in their 40s, and their 50s, and they will say, “I eat the same, I feel like I’m exercising the same, and I cannot budge my weight.” And metabolism, definitely, and how your weight is carried changes as we get a little bit older. And I think for women, if we do check their thyroid, which is very much a part…and I think we here are very proactive about looking at thyroid dysfunction. For patients, they may fit into that normal value he’s talking about. But once again, normal hanging on at the edges isn’t necessarily “normal.” And I think getting them back to the middle of the road or even on the little bit of the lower, faster side, patients notice they feel a lot better. 

Dr. Silverstein: Right. And if it didn’t work, or they had side effects, you would always just stop it. Yeah. 

Dr. Lam: Right. 

Dr. Fox: When you’re talking to patients about this, you know, you’re evaluating them, and you think it might be an option for them, is there any downside to doing the hormone replacement? Meaning what are the things you go over with them in terms of potential, not just like the risk like, “Oh, there’s a rare chance of this or a rare chance of this,” but just in general, what would be the downside of trying this for patients? 

Dr. Lam: As far as when we look at who’s a good candidate for hormone replacement therapy, once again, it depends upon what hormone you’re talking about. How old is the patient? Do they have any medical conditions? Had they been on it? Had they stopped it? Are they starting again later in life? And I think all of that plays into play. We look at breast cancer. We look at family histories of cancers. Are they good candidates for hormone replacement therapy? And in general, I think, we always, before we start something here, are thoughtful about making sure their screening tests are up to date. 

We won’t give testosterone or hormone replacement therapy, if they really haven’t had an up-to-date mammogram. You want to make sure their screening tests are completely normal. So if we know that they’re healthy, assuming they also don’t have high blood pressure, high cholesterol, anything that we think may be a factor to follow up, I may send them back to their primary care doctor to just say, “Hey, are you okay with this?” But really, mostly anybody can get hormone replacement therapy, especially if you’re doing it in a way that’s not taken orally and is taken through the skin. Blood clotting disorders, I mean, we see it all. There’s options for patients. 

Dr. Fox: Mike, has that been your experience as well, that it’s not usually risky for them in the sense, not contraindicated? 

Dr. Silverstein: So far that’s what all the data supports. There’s a handful of menopausal women who will take an estrogen pellet with progesterone and bleed, spot or stain transiently. And that’s completely normal because their body is seeing estrogen for the first time. There are sometimes a response to the testosterone with some very temporary, short-lived hair growth that is not pronounced, and goes away, and can be dose-adjusted, but certainly no devastating effects. And as Dr. Lam mentioned, we’re very meticulous about screening our patients before we pellet them to make sure that the whole package is in good shape, and that we’re just enhancing it with the pellets. 

Dr. Fox: So if someone is going to undergo this, how does it work logistically for, let’s say, they’re going to do the pellets, which is what you’re talking about? So take us through step-by-step from the moment they decide, we’re going to do it, right? You did all the tests, you’d sent the bloodwork. How does that work? 

Dr. Silverstein: So again, it’s a three-step process. The first is the intake, where we talk about whatever symptoms they’re having, and we send their bloodwork. Two weeks later, it’s a Zoom conference, where we’ll review their labs, have a discussion with them. And if they’re motivated, we’ll book them for the pellet insertion. And Dr. Lam will tell you what that encounter is like. 

Dr. Fox: And there’s a video of you doing this as well, on our website. 

Dr. Lam: I love it, yeah. 

Dr. Fox: All right, it’s short, under two minutes. 

Dr. Lam: Check it out. So then, the day of the pellet booking, they come into the office. We sit with them in the office beforehand. We go over the benefits. We go over the risks. We have them sign a consent form. And then after that, we take them to our exam room. The positioning is fairly easy and the procedure takes about five minutes. Everything is done sterile, meaning that every time that we do a procedure, it is done with a sterile instrument that’s been cleaned for every single patient. Patient lays on their side. The insertion is done just towards the tushy area near the hip. We clean the area with a sterile solution. We take a little bit of numbing medication. We inject a small needle under the skin. We inject numbing medication so the patient’s comfortable. 

Dr. Fox: That’s the only part they would feel uncomfortable because it burns a little. 

Dr. Lam: That’s the only part because it’s [crosstalk 00:19:13]. Right. 

Dr. Fox: Like getting a mole removed. 

Dr. Lam: Yeah. It’s like a bee sting, so, well, like any type of injection. So you inject a little numbing medication. After that, we make a little nick in the skin with a little scalpel. It’s tiny, the size of a rice. Literally, that’s how tiny it is. And we insert under the skin into the fat pocket adjacent to the area this pellet that contains the hormone. And once again, each dose of hormone is specific and individualized to that patient. So my dose would be different than someone else’s dose. And then that dose is slowly dissolved over about a three to four-month period for females. And for males, it may even last for up to six months. 

Dr. Fox: Right. And the dose is determined based on their symptoms, their size, and their blood levels or something? 

Dr. Lam: Right, correct, height, weight… 

Dr. Fox: Yeah. 

Dr. Lam: …age, liver function tests, you name it, and what their labs actually show. 

Dr. Fox: Right. 

Dr. Lam: So it comes up with a dose, let’s say testosterone, it could be 100, 125. It means nothing right now on the podcast. But we look at what the dose is. And each of those dosages are broken up into little pellets, which literally once again is the size of a grain of rice, don’t you think? And it gets inserted onto the skin. And then it’s slowly released. The nice part is, is that, typically, you don’t have to worry about highs and lows of hormones. So where in other hormones, if you take a pill, you know, when you take a birth control pill, there’s a high and a low to it. This is a steady-state. The only thing that you really have to worry about for the pellets is for women, there’s really no exercise for three days afterwards. Because you want the pellet to really settle in. You don’t want those glute muscles to be working so that it doesn’t come out. And for men, it’s about a seven-day rest period. 

Dr. Fox: Right. And then they go home just with a Band-Aid basically right? There’s no stitches or anything? 

Dr. Lam: Band-Aid. 

Dr. Fox: Yeah, Band-Aid and they can shower. And then, is there a lot of soreness in the area afterwards, typically? 

Dr. Silverstein: Most people will say a day or two, Motrin, Tylenol, Advil, Anaprox. 

Dr. Lam: [crosstalk 00:20:56] 

Dr. Silverstein: It’s like a small paper cut. That’s about it. 

Dr. Fox: And then, so after that’s done, they don’t exercise for three days to a week? 

Dr. Lam: We call them a day or two later, “Hey, how are you doing? Any symptoms? Are you feeling okay? You could expect a little bruising, obviously, because we’re making a little cut.” And then we typically call them again at week four, “Hey, how are you feeling? And it’s remarkable. Our menopausal patients who have been doing the pelleting feel young, no hot flushes symptoms resolved. For patients who are doing the testosterone, they notice a boost of energy. They’re less anxious. They feel less moodiness, libido is improved. So they really have been feeling great. There are a couple of patients, just like anything when you give them hormones, there’s an adjustment period. And then at week five, we check their levels again. We want to see how it looks after the pelleting. And then we schedule them again, they’re back in three to four months for women. 

Dr. Fox: And is it every three to four months indefinitely or for X amount of years? Or how do you determine how long it continues? 

Dr. Silverstein: Several patients have gotten it for years. And I’ve already had a couple of patients that have set up a four-month appointment, but called me three months later and said, “I’m beginning to get symptomatic. I’d like it a little bit sooner.” So it’s not a hard stop. 

Dr. Lam: We’re newish to this game. I can’t say that we’ve had patients in decades because this is something that we just started to break into about a year ago. Anecdotally is the only thing that we could speak of and other doctors who have been doing it longer. Patients can do it indefinitely. 

Dr. Fox: Really, so someone could start testosterone in their 40s and be doing it for 10, 20, 30 years? 

Dr. Lam: In theory. In theory. 

Dr. Fox: Is there any thought behind how or why someone would wind down? Is there something like physiologically you’d expect them to be able to or just trial and error? 

Dr. Silverstein: It’s got to be trial and error, because they have some very long-term studies from this organization and from other organizations that people have done very well with these medications for years to come. 

Dr. Fox: So what has your experience been thus far? You guys have been doing this for about a year now, plus, minus. How has it been just in terms of your patients’ sort of openness to this and the response to it, and how has it grown over this time? 

Dr. Lam: I think when we first started out, we were excited. I think as with anything else, you know, you’re nervous. You’re used to what you’re used to with regards to practicing medicine. And I think hormone replacement therapy was very traditional. Women either had pills, women either did patches, women who are menopausal did even vaginal estrogen, right? This one’s kind of breaking into something new. And in New York, not a lot of people had really been doing it, although, talking about it and thinking about it. And I think the idea of bioidentical hormones is not new. I mean, that’s been around for years and years. But the idea of adding back testosterone has really taken off. And I think when you see the patients and you see how happy they are, and then, they talk to their friends, and then they’re doing more research, it has taken off. And I think it’s exciting for us here. 

Dr. Fox: Yeah. Mike, have you found the same, your patients have been pleased with it, overall? 

Dr. Silverstein: There’s a good percentage, a good majority of the patients, I would refer to it as a game-changer. It’s really been a dramatic change in their lives. I’ve had no patients with no effects. They’ve been all positively received, but some significant game-changer type responses. 

Dr. Lam: Like with anything else, are there zero side effects? No, I think that would be a misrepresentation. I think, with any type of hormones, sometimes at the beginning, the patient could feel a little bloated. Patients are always concerned about weight gain, “Am I going to get fat? Am I going to gain weight?” Well, I think always there’s a little bit of water retention with anytime that you do hormone replacement therapy. And I always set the bar, “Be aware, I’m giving you some hormones. You’re going to notice a little change in how you feel. But in the long term, you’re going to feel so much better. In the short term, you just have to get adjusted.” Sometimes patients can notice a headache. That’s normal, you’re restarting hormones that either you haven’t had or have been low. And if you can kind of prepare them for what to expect, you don’t get the calls on the other end. It’s when they’re not prepared for it that it’s really the issue. 

Dr. Fox: Right. Now you guys both mentioned a couple times “bioidentical” as an adjective before hormone. How would you explain what that means specifically versus just hormones? 

Dr. Silverstein: Same exact molecules that are in the hormones your body makes, but they all come from plants. None of it comes from animals. None of it comes from pigs, from horses, from horse’s urine. There’s a whole litany of hormones that come from animals that have all sorts of other stuff. And these are the identical molecules that your body’s making but all from natural sources. 

Dr. Fox: Is that just because it seems cleaner, like, you know, clean technology, or is there any specific advantage to have it coming from a plant versus a horse? 

Dr. Silverstein: I’d imagine cleaner and less foreign parts. 

Dr. Lam: Everyone seems to be leaning more towards an organic, more natural-based kind of life. And I think patients get excited when they can hear that it’s something that either is going to be matched directly with something that came from your body, or specifically, that’s going to be matched to a dose that’s right for them, right? 

Dr. Fox: Right. 

Dr. Lam: When you look at antibiotics, and there’s doses that are specific that could fit anybody, how can my hormones be the same as someone else’s hormones? And when you look at the bioidentical portion of it, it’s geared specifically towards the individual patient, it’s ideally come from a plant-based, and it’s not synthetic. 

Dr. Fox: Right. And especially because again, the treatment here is to relieve symptoms. 

Dr. Lam: And quality of life. And quality of life. 

Dr. Fox: So if someone has, yeah, more symptoms, potentially, they would need more and based on also their lab value. So it makes complete sense individually, just like pain medicine. 

Dr. Lam: And the cool thing about hormone replacement therapy, which, you know, over time you get better at, when we first started something new, there’s no set dose. And so whether we do this in the pelleting world or whether we do it in the patch world, you may try out something and then four or five weeks, find out that they’re feeling better, but not that much better. Well, we can rejigger it, right? We just necessarily adjust it specifically. 

Dr. Fox: For those of you out there, jigger is a medical term. 

Dr. Lam: It is. 

Dr. Fox: It is Latin, the jiggerous. Okay, go on, to rejigger. I like that. 

Dr. Lam: We can redose. 

Dr. Fox: No, it’s… 

Dr. Lam: We consider… 

Dr. Fox: Lam, you’re the best at explaining things so people would understand it. Rejigger is exactly the right word, by the way, just so you know. 

Dr. Lam: We can rejigger it based on what you should necessarily need. 

Dr. Fox: How do people find you guys if they’re now clamoring for their bioidentical hormone? 

Dr. Silverstein: We’re online. 

Dr. Lam: We’re everywhere. 

Dr. Silverstein: We’re everywhere. 

Dr. Lam: We’re everywhere. 

Dr. Fox: We’re everywhere. Stephanie Lam is running around the Upper East Side with pellets. 

Dr. Lam: Flyers on posts. 

Dr. Silverstein: Carnegie Women’s Health. 

Dr. Fox: Yeah. So Carnegie Women’s Health and your website, carnegiewomenshealth.com, all one word, right? 

Dr Lam: Yeah. 

Dr. Silverstein: Yeah. 

Dr. Fox: Fantastic. Guys, thank you so much for coming on. It’s really cool that you’re doing this. I know that you guys talk about this, you know, patients coming in and it’s…it’s nice to be able to help people. It’s a really nice thing. 

Dr. Lam: It’s great. It really is great to help people and make them feel good. 

Dr. Fox: All right. Thanks, guys. 

Dr. Lam: Thank you. 

Dr. Silverstein: Thank you. 

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. 

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.