Yeah.

One is, um, uh, the cis female level of testosterone that we're targeting is...

You know, I- ideally, I look at between, uh, 40 and 50 nanograms per deciliter.

Like, that's typically what I think about.

That's really, like, the highest level that you'll see most women in their 20s when their testosterone is at its peak.

That's typically what you'll see.

Now, some women's level go up to 70, and so that's really the edge of the bell curve.

So maybe you can make our audience a little bit more aware of the difference between, you know, micronized progesterone, synthetic progestin, and why that makes a difference.

Yeah.

It's not a hormone.

Bremelanotide is a different drug that targets the melo- , um, melanocortin receptors.

So melanocortin, um, are, they're receptors, and it's a, w- a kind of a molecule that's all over the body, and it stimulates the, uh, the dopamine receptors as well or dopamine release in the brain.

This drug is different than flibanserin.

Flibanserin is a daily medication, and so you take it every day.

Bremelanotide is a PRN, which means it's as needed, and it's a little auto-injector.

Right.

Right.

Right? And so there's a really big benefit to doing that for some people.

It really helps with abnormal bleeding.

It really gives them a steady state of hormone.

And for a lot of the perimenopausal symptoms like hot flashes, it makes it a lot better.

Now, some people may still have hot flashes just 'cause the ethinyl estradiol works a little bit differently in the brains and in the bone, but it really, for the most part, controls the vast majority of perimenopausal symptoms, and it works as a birth control.

And people in perimenopause can get pregnant, so that's the argument that the people who are the universalists, right? We just said that some people say everything should be this way.

Okay.

Right.

So it is not a plot to give people synthetic hormones 'cause we don't wanna be giving them something that's, quote, "natural." It's that what is our goal here, right? And the goal is to suppress ovulation, and it's not just about birth control.

Suppressing ovulation prevents recurrent ovarian cysts.

It actually prevents ovarian cancer because the cells are turning over less.

It even prevents uterine cancer, endometrial cancer, people who have painful periods.

There's many reasons why there's a benefit, but you have to have synthetic hormones to get the benefit, and that's where it gets messy.

Ethinyl estradiol is a form of estrogen that is incredibly strong.

Right.

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So I'm really excited to be here to talk to you about kind of our current understanding of where the science is in terms of menopause management.

Now, I want to just be clear that I've been given 30 minutes to give that talk.

So I'm going to get through what I can get through, but we can have, there are multi-day conferences on this topic.

So I'm going to hit the highlights of really thinking about what people ask us, what are kind of the key questions that I get asked, and hopefully I can answer some of your questions before the Q&A, which will happen right after my talk as well.

Okay, these are my disclosures.

And then these are the objectives.

primary

Like what you hear? Consider making a donation at uctv.tv slash donate so we can continue to bring you more great programs.

So I'm really excited to be here to talk to you about kind of our current understanding of where the science is in terms of menopause management.

Now, I want to just be clear that I've been given 30 minutes to give that talk.

So I'm going to get through what I can get through, but we can have, there are multi-day conferences on this topic.

So I'm going to hit the highlights of really thinking about what people ask us, what are kind of the key questions that I get asked, and hopefully I can answer some of your questions before the Q&A, which will happen right after my talk as well.

Okay, these are my disclosures.

And then these are the objectives.

primary

Like what you hear? Consider making a donation at uctv.tv slash donate so we can continue to bring you more great programs.

So I'm really excited to be here to talk to you about kind of our current understanding of where the science is in terms of menopause management.

Now, I want to just be clear that I've been given 30 minutes to give that talk.

So I'm going to get through what I can get through, but we can have, there are multi-day conferences on this topic.

So I'm going to hit the highlights of really thinking about what people ask us, what are kind of the key questions that I get asked, and hopefully I can answer some of your questions before the Q&A, which will happen right after my talk as well.

Okay, these are my disclosures.

And then these are the objectives.

primary

[instrumental music] So I'm really excited to be here to talk to you about kind of our, our current understanding of where the science is in terms of menopause management.

Now, I wanna just be clear that I've been given 30 minutes to give that talk.

So I'm gonna get through what I can get through, um, but we can have...

There are multi-day conferences on this topic.

So I'm gonna hit the highlights of really thinking about what people ask us, what are kind of the key questions that I get asked, and hopefully I can answer some of your questions before the Q&A, um, which will happen right after my talk as well.

Okay, these are my disclosures.

Mm

... at higher risk of bone loss, if somebody is, um, you know, quite a low BMI, doesn't do weight-bearing exercise, for example, um, I think those are people who actually could benefit earlier on from estrogen.

Yes.

And I've seen it and I've diagnosed it.

So you have to take something to protect the uterus.Um, and so we have traditionally given a progestin, which is a synthetic progesterone that targets the receptors, works better than natural progesterone, but has more side effects sometimes.

So, I just with that said, we oftentimes then say, well, the only role of progesterone or progestins is to protect the uterus.

And natural progesterone does so much more than that.

There are progesterone receptors all over the body.

So there's progesterone receptors in the brain.

Yeah.

Mm-hmm.

And so they have really high levels, and the truth is, some of them feel fabulous, and they really are getting all these benefits without all of the side effects.

And then it turns into a conversation, and I just wanna be real about this.

It- at that point, I'm not here to say it's bad.

I've oftentimes hear people say it's dangerous.

I take care of, of transgender men who have testosterone levels in the 500s and 600s.

They, you know, have uteruses and ovaries, and the data actually shows they have lower rates of breast cancer.

Right.