um what else would a man be able to support his wife with when it comes to being resourceful

Yeah.

So again, I think going back to when she's more open for a conversation, and now this is where my Western medicine is going to be a little biased, but it's hopefully going to be helping her get to a clinician.

And that doesn't mean that the clinician has to do hormone therapy.

Certainly, though, that is a thing that I think many, many women should consider or trial, but that it just may help even with just education or understanding what is going to happen.

So even if it's then kind of pulling up one of these directories or maybe like, hey, this clinician's now sometimes people live where they have to drive a long time or there's a long wait list.

So, you know, maybe he's like, I'll just get on the, I'll, you know, it'd be so helpful.

feels like for her, the most frustrating part is like, I just want to be able to talk to somebody.

Okay, so in your 20s and 30s, what should we be focusing on?

Yeah, so 20s and 30s.

So this is when you might be moving from your pediatrician to an internal medicine or a family medicine doctor.

So thinking about what you may have inherited.

So your family health, your family conditions.

Women in their 20s, they might start their cervical cancer screening with a gynecologist.

They may be thinking about family planning, pregnancy, so that's gonna be their OB-GYN.

What do we start looking for and what kind of doctor should we be looking for?

And, and, and when would we apply any and all of them?

Oh my goodness.

Yes.

Well, so the Thrive Method really was my way of thinking through like what I really do with my patients.

So T stands for tracking.

And that really helps us even know where to get started.

Like we may know that there's these three sex hormones, estrogen, progesterone, testosterone, and they decline.

Everyone kind of does, if they're doing hormones, they get the estrogen, progesterone, but why isn't testosterone? I know it's harder to get and that's its whole separate issue, but what percentage would you say?

Heather Hirsch is an internist that specializes in treating women in midlife.

I think it is the biggest transition a woman will go through, and we think about puberty, and this is actually puberty in reverse.

[gentle music] The biggest physiologic change is happening, which is that our sex hormones are declining.

And so we know that there is a lot of changes in the brain at this time.

The brain is changing in terms of both the sex hormones and then also the neurotransmitters.

And so that can change your mood, it can change your ability to process at fast speeds, to remember multiple things.

These are things that definitely frighten women when they cannot remember their neighbor's first name.

Mm-hmm.

Heather Hirsch is an internist that specializes in treating women in midlife.

I think it is the biggest transition a woman will go through, and we think about puberty, and this is actually puberty in reverse.

[gentle music] The biggest physiologic change is happening, which is that our sex hormones are declining.

And so we know that there is a lot of changes in the brain at this time.

The brain is changing in terms of both the sex hormones and then also the neurotransmitters.

And so that can change your mood.

It can change your ability to process at fast speed, to remember multiple things.

Mm-hmm.

Yeah

... what i- this is the first time I've ever said this, so just, just bear with me, but, like, data and re- data, research papers, I'm gonna tell you this, they're nothing more than just an artist's work.

We want to say, like, these are facts, and the, the, the more women involved in the study and the less bias involved in the study, the less confounding factors in the study, and the more blinding in the outcome of the study, the more on the spectrum of quantitative than it is in qualitative.

But look, let's be clear, research is really nothing more than artwork, and it's the artist who's gonna put their impression into the artwork.

I'm sorry, it is impossible for us to be biased about anything.

When we come to the even, like, the women's health initiative, I'll tell you what sort of other people who look at this say.

They'll say, this study wasn't designed specifically to look at only women 50 to 60, so therefore, that was not the primary objective of this study.

[laughs] Yeah.

I understand.

But if your F- F- sex hormone binding globulin, if your SHBG, wow, that's a mouthful, is high, sometimes your dose of androgens, i.e. testosterone and estrogen, it needs to be higher so that those hormones are more ap- are appropriately efficacious for you.

So SHBG is another lab that I really like to test for.

Um, I also, as an internist, I like to check thyroid right away.

I like to check a TSH.

I like to check a free T4.

I also...

Right.

"If I take estrogen, will I get breast cancer? Will it cause blood clotting, stroke?" Talk to me about the safety profiles.

Yeah, so let's actually look at the data.

Sometimes it's helpful to sort of, I always say to my patients, let's, let's do the logical, and we'll keep the emotional aside.

Because let's start with breast cancer.

It is very emotional.

I don't want any of my patients, well, we don't want any of our patients to get diagnosed with breast cancer.

However, on the logical side, we know that about one in eight women will be diagnosed, and that it's really common, and that luckily now, that doesn't lead to mortality or death when it's caught early.

Mm-hmm