Advocating for Women's Hormone Health with Dr. Liz Lyster

In this episode, host Mary Lee dives into the intricacies of menopause and hormone health with Dr. Liz Lyster, an OBGYN, author, speaker, and expert in perimenopause and menopause.

The discussion highlights the misconceptions brought about by the Women's Health Initiative study, emphasizing the benefits of hormone replenishment therapy using bioidentical hormones. Dr. Liz shares her personal journey, the importance of proper hormone testing, and effective ways to advocate for one's health. Key topics include the impact of hormone therapy on sleep, weight gain, brain fog, and overall well-being, the role of testosterone for women and managing health concerns with a family history of breast cancer.

Dr. Lyster is a graduate of Cornell University and completed her medical schooling at UC Irvine and received her Masters degree at UCLA in Community Health Education. In her private practice in the San Francisco Bay area, she helps women and men in midlife and beyond lose weight, have more energy, increase their motivation and drive, and generally feel great.

Connect with Dr. Liz through her website and on Instagram and Facebook

Resources:

• Avrum Bluming & Carol Tavris, Estrogen Matters  (not an affiliate link)
• Dr. Lisa Mosconi, PHD, The Menopause Brain (not an affiliate link)
• Download PDF from the Menopause Society 2022 Position Statement on Hormone Therapy 
• Dr. Liz Books 

Transcript

Dr. Liz Lister: Bioidenticals. I love that. Let's jump in. I do think that initially doctors sometimes get a little rubbed the wrong way by that word. Uh, it's possible that it started out 30 years ago as more of a marketing term.

But I think it has stood the test of time. It has made it into the vocabulary. It is a real term. It simply means that the hormones that we use to replenish what our bodies used to make plenty of is the same form as what a woman's human body makes.

Mary Lee: Well, hey there listeners, welcome back. Today I had the most candid conversation with Dr. Liz Lyster. Our conversation was all about the challenges women face in accessing proper education and care for menopause and hormone health.

 This is what I preach. This is my mission. Dr. Lyster reinforces some of the things that I have been trying to share. And more. We discuss the impact of women's health initiative study on medical practices and the need to debunk myths and misinformation. Around women's health, Dr. Liz shared her personal journey and motivation for advocating for women's health, emphasizing the importance of hormone replenishment therapy, and the benefits of bioidentical hormones.

Our discussion also touched on. Gaslighting and the intimidation some women face when trying to access good health resources or advocate for their own health during menopause, including asking for M. H. T. Our conversation also touched on different testing methods, such as blood, urine and saliva tests, and Dr. Liz explains them all, and the benefits and limitations of each method, to assess where you are in your menopause and your hormone levels. We tackled misconceptions surrounding testosterone replacement therapy, particularly addressing concerns related to breast cancer risk, and emphasizing the need for personalized treatment approaches.

Dr. Liz shared her insights on the importance of addressing health concerns, particularly for women with a family history of breast cancer. This and a whole lot more. We were All over the map, bookmarking when to get back to an important subject, because there was so much to touch on, and we both agreed, she's coming back. But before we get started in this episode, here's something you need to know about Dr. Liz. 

Dr. Lyster is an OB GYN medical doctor and a best selling author and speaker and an expert in perimenopause and menopause. She shares her time between the San Francisco Bay Area and Reno, Nevada. And Her private practice in the San Francisco is where she helps women and men in midlife and beyond to lose weight. Have more energy, increase your motivation and drive, and generally feel great.

That is her number one goal, and a litmus test to whether you're doing something properly or not. Are you feeling good? Let that be your guide. She graduated from Cornell University, went to medical school at UC Irvine, and got her master's degree at UCLA in community health education. And Dr. Liz walks her own talk.

When she turned 50, she celebrated by climbing to the top of Mount Kilimanjaro in Africa. How cool is that? She has two young adult sons and well, needless to say, enjoys hiking and Argentine tango with her husband. Okay, we didn't get into that. This is why I need to bring her back. Sit back, enjoy, get ready to take notes. We're diving in.

Welcome, Dr. Liz Lyster. I am thrilled, just thrilled to have you because getting a guy oncologist and one that is trained and educated in women's health and hormones is hard, sending women on a wild goose chase trying to figure out their answers or find answers on their own about what's happening with their hormone health, what's happening with their bodies as we go through menopause. You're here to unpack that. So first and foremost, welcome.

Thank you so much. Would you prefer Dr. Liz or Dr. Liz Lyster or just Dr. Liz? Dr. Liz is great. That is what most people want. I love it. Well, Dr. Liz, you have quite an amazing story. I've been following your blog after learning that you were going to come on the show. And I just love that you share for your 50th birthday. You climbed Mount Kilimanjaro. I know she's my new hero. Yes. 

Dr. Liz Lister: next year, 60. So it won't be a mountain. It'll be something different. I'm not sure what yet, but okay. 

Mary Lee: Sail around the world 

Dr. Liz Lyster: or I, 

Mary Lee: I'm working on that. We'll have to bring you back to find out. But before we get there, More mountains to climb work as in gynecology and in particular, demystifying debunking mistruths and misinformation around women's health. So what exactly is happening? First of all, with the education of a gynecologist. And why is it not so robust when it comes to women's health?

Dr. Liz Lyster: That's such an interesting problem that we are facing right now, as you were mentioning. First of all, we have, right now, an entire generation of OBGYNs. Since just over 20 years ago, the release of the Women's Health Initiative study, the initial release of findings. Unfortunately, that study, which we can refer to as the WHI, the WHI is still generating data, people are still publishing studies from it, uh, and it was all based on the wrong women, the wrong hormones, and the wrong route of administration of the hormones.

So we can definitely talk more about that. But what we've got now and what women are facing, you know, at least half of adult women in the U. S. are over age 35, and that's going to cover perimenopause and menopause. in millions of women. And we've got doctors who unfortunately are under the influence of the WHI findings without really examining what was in that study and why those findings really are not applicable to what we're talking about and women can get the help they need.

But unfortunately women have been scared away and their doctors have been scared away. Bingo. Yeah, tough 

Mary Lee: time. So as a result, is it that the system is just relying on the ghosts of the headlines of 2002 and it's just, it's easy. It's because it's in. easy, low hanging fruit from the tree. Oh, I remember that.

Just grab onto it and just keep sharing and spreading that rumor. 

Dr. Liz Lyster: Yes. Yeah. That's exactly what it is. It's sort of like stays like internal memos. We've had a lot of these kinds of things in medicine, you know, cholesterol and heart disease. Um, we've just had a lot of Um, big, important issues like this that got determined by wrong information. And it's really hard to undo that really, really difficult. 

Mary Lee: What was it that inspired you to take a hard look at woman's health and, hormone health and say, things need to be changed and I can do something about this.

Dr. Liz Lyster: I will say that I was seeing a lot of women, and this was about 14, almost 15 years ago, where they just weren't getting the help they needed. I had, at the time, a nutritionist friend who was working with a doctor, and the doctor did bioidentical hormones for this for his clients. And that doctor was retiring. So he looked at me and he said, you need to go learn about bioidentical hormones because I need you to help my patients. I said, great, fantastic. I love learning new things. I love school. I'm a total nerd that way. So I was good. I was like, sign me up for more learning. This was also right around the same time I was working on a book.

I knew that I wanted to get information out to more women than what I could do one person at a time in my office. So I was working on that. And then I'm working on the book and I think to myself, you know, I should probably check my hormones since I talk about doing that in the book. And I was 43 years old.

I did not have my period, but I also had the IUD that gets rid of the period. And I discovered with the lab work that I was fully in menopause. It was not even borderline.

Yeah, it was pretty interesting. I had a lot of distractions at the time. My kids were little, difficult marriage. I had a lot of things that women go through in life going on. And so that was really eye opening. So, 43 years old, in menopause, and really, I'm like, Okay, now I'm really gonna look at this for real and for my own purposes. So learning about the anti aging world, but I don't go all the way to that extreme. I really am all about women feeling well, sleeping well. There's just no need to tolerate not feeling good. So that's been my message for 15 years and counting and going forward. 

Mary Lee: Awesome. Okay. I want to focus on bioidenticals.

But I, it's important that we really get into the feel well, sleep well, is if there's two complaints, common complaints that I hear as a menopause doula is that they're not liking their bodies first and foremost with the changes. Why did they get the excess belly fat was so much harder to lose that extra few pounds. And then sleep deprivation, just walking zombies, the brain fog, the confusion, and then having to get up in the next morning and, you know, some semi professional, if you can pull yourself together and get to the office. Before we get to that, since you did open the door to bioidenticals, let's talk a little bit about that.

How important is HRT, the benefits? Versus the risks, which you talked about in the WHI. And how can a woman find balance in terms of what's right for her? 

Dr. Liz Lyster: Yeah, absolutely. All right. So the last part, let me just touch on it and then we'll get back to the meat of what you just asked about.

Very important for women to feel good. When we feel good, life goes much better for a lot of people. That's my number one point is that it's worth it to do what's necessary. We have a modern problem, which is we live decades now in menopause. Whereas a hundred years ago, that wasn't the case.

It was not an issue. 5 percent of women made it to age 50. That was it. So now we have this modern problem, as I call it, and it's worth solving. Bioidenticals. I love that. Let's jump in. I do think that initially doctors sometimes get a little rubbed the wrong way by that word. Uh, it's possible that it started out 30 years ago as more of a marketing term.

But I think it has stood the test of time. It has made it into the vocabulary. It is a real term. It simply means that the hormones that we use to replenish what our bodies used to make plenty of is the same form as what a woman's human body makes. As opposed to the WHI, I mentioned really quickly used the wrong hormones.

Hormones it used. Estrogen from pregnant horses, peremrine, pregnant mare's urine, that's the, that was the source of that estrogen, so not bioidentical. Also important is that it was oral estrogen, so we do want to avoid oral estrogen, that's really important, and if we have time we can come, we can say more about that.And then they used a non bioidentical progestin, they did not use progesterone. A woman's body does not make progestin, it makes estrogen. progesterone before she goes into menopause. She goes into menopause. The ovaries do go into full retirement. All right. A lot of people out there, which, and I love supplements.

I'm not disrespecting supplements, but there are people out there saying that you can completely replenish everything only with supplements. And that's not the case. Our adrenals are involved, our thyroid's involved, and supplements are really helpful in those hormone areas. But when it comes to the ovarian hormones, our ovaries eventually go into full retirement.

And it's really helpful to use those hormones to replenish. 20 year old. But we want to do some replenishing. Yeah. Sleep and belly fat. Let's bookmark those and, you know, put a pin in those, make sure we talk about those. Sleep for sure. Bioidentical progesterone calms the brain. It helps with sleep. It calms down anxiety.

And this is so huge. I know someone who had a huge menopause Facebook group and she has turned the entire focus of her work to anxiety and menopause. It's such a big challenge. And so progesterone, when it's bioidentical, does that without raising risk of cancer. Of course, breast cancer is the. Cancer that women are most concerned about naturally.

I can relate to that. I understand that. My mom had breast cancer in her 60s. I get that. So even the WHI had two avenues. It had two arms of the study. One arm of the study, the women were given the, they were given the oral estrogen and the non bioidentical progestin. That was the arm that was stopped because it trended towards an increased risk.

It never even reached scientific approval. Significance. It never even got to that point, but they stopped the study because they were in abundance of caution. The other one kept going, and these were women who had had hysterectomy, so they were only on estrogen. Again, it was not a good estrogen to be on, but they were only on estrogen.

They had a lower incidence of breast cancer than the women who were given placebo. these are really 

Mary Lee: Compelling facts. And this is information that still to this day is not well understood. Or is still, The, the lies, if you will, or the mistruths are still circulating and I want to get back to some of the nomenclature with the bioidentical. So in reality, we should be saying hormone replenishment therapy, not replacement. I like that. That is what I said. Yes. And in fact, in here in Canada and probably in nights throughout the United States as well as we're trying to say menopause hormone therapy and get away from the whole terminology of.Replacement all together. So, I love that. And I'm trying to get. 

Dr. Liz Lyster: I like that a lot. It is. I'm jotting notes. 

Mary Lee: I like that a lot. Oh, great. and I've also heard that BHT is now just being used. Yes, I like that too. In biochemical hormone therapy as well. So, really important to understand that. Now, when it comes to having the conversation then with the doctor, These are not everybody's going to have Dr. Liz in their back pocket and we wish we could, but we will talk about there's a way we can. but just for women who are just sitting here listening, going, okay, I've got an upcoming appointment with either my, my naturopath or my family doctor, and I want to sit down and have that conversation. Now I have heard already, some women are getting the complete, Um, gaslight effect, 

Dr. Liz Lyster: gaslighting. That's it. That is the word. Yeah. 

Mary Lee: And then, then the other, some other women have got the complete white coat syndrome where they just don't want to have that conversation and they just stay quiet and they're intimidated by their doctor. And therefore they lose their voice and lose their power, you know, in, emotionally in that they can't stand up for what they want. And I've been encouraging women, you need to take agency of your menopause and advocate for 

Dr. Liz Lyster: your health. Absolutely. I call that be the tail that wags the dog. I love that. Okay. I'm jotting that one down. 

Mary Lee: Okay. You can use that one. So we bookmarked a few things. Let's go right back to the oral estrogen. Tell us why it's not safe. 

Dr. Liz Lyster: Oral estrogen. Every time that we swallow something by mouth, it's not safe. goes into the stomach, and then there's what we call the first pass effect through the liver.

So the blood vessels around the stomach that absorb the nutrients and all the products that we take by mouth, the next place they go is the liver. Uh huh. Oral estrogen in that first pass effect through the liver, stimulates production of clotting factors. Which was one of the risks that they had identified. 

Dr. Liz Lyster: Exactly, exactly. Same thing with birth control pills. All right. Now it's very important for everyone to keep in mind absolute risk versus relative risk. So relative risk increases and sounds really scary, but absolute risk still will be very small numbers.

That's definitely the case with risks with birth control pills, but birth control pills are oral estrogen. back to MHT, menopause hormone replacement therapy. I like that a lot. We want to avoid that estrogen first pass effect on the liver. We want to use estrogen through the skin. That could be a cream or a gel that you rub on.

It could be a patch. It could be hormone pellet therapy. Those are the main ways of using plenty of options available. Compounded, regular pharmacies. less familiar with how, what we have in Canada, but I do know, last I knew, there's actually, if we have time, we can talk about testosterone, which I love for women.

Oh, yes. Canada has an option for testosterone that is officially on the pharmaceutical list. We do not have that here in the United States. Okay. 

Mary Lee: Okay. We'll park that. 

Dr. Liz Lyster: Okay. 

Mary Lee: Put a pin in that one also. I wanted to weave that in because when it comes back to the advocating and just having that little bit of information a woman can go to her doctor and say, I've done the research or I've been working with a coach and now I understand that hormone, the benefits outweigh the risks, the WHI headlines have proven false by many leading experts in the field.

And we now know that the oral is not effective because of the first pass effect. So with these little bits of information, what would be a piece of advice you would give to a woman to say when you're going in to have that talk? 

Dr. Liz Lyster: Okay, couple of, yeah, couple of things. First of all, what we just said, estrogen through the skin, also vaginal estrogen.

Vaginal estrogen can treat vaginal dryness and recurring bladder infections. This is really important. Some doctors are not quite aware that the lining of the vagina is the same kind of cell as the base of the bladder. And so, that's really helpful. Even if a woman has been in menopause, maybe is not on other hormones, and probably not having issues that would call for being on more hormones, but she might be having recurrent bladder infections.

So a little bit of vaginal estrogen, it won't help hot flashes. It won't help night sweats. It's just, it does not get into the body at a high enough dose, uh, to do that. So I just wanted to mention that as well. So that's number one is any estrogen through the skin, vaginal topical patch, anything like that.

Another important point is that using hormones to feel better and resolve symptoms does not commit you to using it forever. Okay. This is very important because that's one of the women's fears, right? Like, I can't sleep. I'm totally miserable. I can't be intimate with my partner, but I also don't want to take hormones forever.

No problem. That does not commit you to using anything, forever. 

Mary Lee: But the period of time that you do want to use it, obviously you're going to work with your doctor once you have your doctor. on board with you. Some are right away. Some still have to work on that. But once you are on MHT, then it is individualized.

Every woman is quite different. Symptoms appear quite differently. But is there a window of opportunity both to start and gradually stop? 

Dr. Liz Lyster: Okay, we'll take those two separate questions. So it used to be, and this came from the WHI, the window of opportunity theory, which is that starting the hormones within the first five years of going into menopause is probably most beneficial.

That data is still persevering. Out in the world of the scientific information. The difference is that in the WHI, they, they came out and said, don't start it. If it's been more than five years. since going into menopause. Luckily, and I've been saying this for 15 years, but just a couple of years ago, the most recent North American Menopause Society Statement, which is like a 20 page review of all the literature, they took that out.

They finally said, Okay, when you use certain kinds of hormone therapy, you do not need to, it's okay if it's been longer than five years. Half of women will never stop having symptoms. This is something that a lot of women don't realize. They're like, I'll just tough it out for a year or two years. I advise against toughing it out.

I advise in the favor of Feel better, and then we'll see what we need to do. That is, a better path for a lot of reasons. I 

Mary Lee: Love that. 

Dr. Liz Lyster: Yeah. It comes down to quality of life. Exactly. Exactly. Which I think life is about quality of life. 

Mary Lee: Yeah. And women who are going through their menopause.

Whether it's early or at the later end of the stick, such as myself, but in that 10, 15 year period, 40, 45 to about 55, they're at the peak of their careers and they're feeling miserable to the point where the symptoms are literally reducing them to the inability to carry out the full time job, the same quality of life.

Dr. Liz Lyster: A lot of what I see are women who have Puberty in the same household. They're going through menopause. They're going through the menopause transition and they have teenagers in the house. So that gets exciting as well. Oh my goodness. 

Mary Lee: That could be a real perfect storm right there. Exactly. So the first five years now, as we know, until you hit that magical line in the sand where you say, Oh no, I'm at menopause 12 months, no menses. And then you look back on your life for the last 10 years and you think, okay, now that explains everything. I mean, some of the more obvious, of course, the hot flashes.

Um, irritability, well, even then irritability, mood swings, we think distress with the job, stress with the kids, the spouse, whatever it might be, the cost of living, right? So in a new sleep disruption, the sleep disruption, and we do tend to think that, that hot flashes is the thing.

It's the one indication, which not necessarily, but it is a leading one, but there's so much more the brain fog in particular, and then the weight gain. And we said, we were going to talk about that, but I want to just quickly touch on this. When you say you mentioned earlier, checking hormones. Now, is that ideal to do that before deciding to go on MHT, or can you just know that you're at that stage in your life and you say, I'm ready for some hormone therapy.

And you don't need to necessarily go through testing. 

Dr. Liz Lyster: Yeah, I personally like to get a baseline panel. I do a very detailed initial panel with each of my patients. That is what I like to do. I work with women who, by the time they get to me, they've had some gaslighting going on usually. Oh, you're still having your period so it's not your hormones.

That's a common one. Even if her period is crazy irregular, she's still being told that it's not her hormones when of course it is. so I like to get a real detailed baseline panel. All the female hormones as well as vitamin levels and other basic tests as well as thyroid, adrenals, very detailed panels.

That's what I like to get and my patients tend to like that as well. And then down the road, as part of adjusting their regimen, is how is she feeling, that's the most important, and second, a close second to that is what do the labs show, how are we doing in terms of, budging some of the levels.

A lot of doctors, as I mentioned really quickly, will tell women, oh well, you still have your period sometimes so there's no point in checking levels. That's just not my approach. I like to have the information to be able to compare later on.

Mary Lee: Even though a doctor might be saying that, it doesn't mean that he or she is exactly right, nor do you need to follow their guidance. Because I think it goes right back to knowledge is power. And the more data I can have in front of me, Even if it means charting their own symptoms and you can go in with evidence based information and we all like the evidence based research and say, I've done my own research and I know my own body and I, my symptoms are saying one thing. Now let's go get those hormones checked, whether you like it or not, because it is our right.

Yes. Now the testing methods, blood testing, Dutch test. We've heard it all. What's 

Dr. Liz Lyster: blood, urine, saliva. Those are the three. I talk about those in the first book that I wrote. Urine of course is easy, painless. The Dutch test is nice. If it were covered on people's medical insurance, I would love to get a Dutch test on women.

I would do it on everybody. I really would. I like the test. IIt is useful even when a woman has been already. On hormone therapy. so that's definitely one way to do that. Some of the Dutch panels also include the cortisol testing, which can be very interesting and helpful. I get a lot just from my detailed medical history with my patients.

She tells me her sleep is disrupted. Uh, this is specific to cortisol disruption is the waking up with the mind going. Yes. The racing mind that can be particular to cortisol. And then I check a fasting first thing in the morning, and that can give me a lot of information. So I like the saliva and urine testing.

I normally do them as a secondary level of testing. I start out with blood work. Simply because it tends to be covered on people's medical insurance. I don't bill their medical insurance. However, we want people to use the insurance they're paying for. And so they can usually get blood work done pretty easily and usually pretty well covered.

So it's quick and we can check a lot of tests. So there are a number of things that I can have a patient get checked in one blood draw versus, you know, there's just some things that we don't have urine tests for them just yet or saliva just yet.

I just tend to use them a little further down the road. If I'm checking food sensitivities or, There's other things that are helpful and that we can do through other kinds of testing kits. 

One more thing about blood work is that it's a universal language among doctors. So to what we've said already, you're advocating for yourself. You're telling your doctor, look, I, I would like to try this. Most doctors are okay with that. They'll at least help you try. Even if they're not 100 percent comfortable, they'll usually let a woman try, especially if she's having a lot of symptoms.

Mary Lee: Yes. 

Dr. Liz Lyster: And then, maybe if they're willing to do some blood work, at least we've got some kind of baseline. 

Mary Lee: Talking about the baseline and the blood work, we're gonna bring it right back to testosterone. Sure. Because we talked about estrogen and if you still have a uterus, you should be on progesterone.

And that is to protect the uterine lining from Correct. Okay. Yes. But testosterone, Hmm. Its role in women's health. And going back to the feeling, I've heard it's great for libido. Let's talk about why we should be really taking a harder look at it now for our health.

Dr. Liz Lyster: Absolutely. I love testosterone for women. A lot of people don't even realize that women have testosterone. It actually has hundreds of functions in the body. The summary that I like to give is helps with the brain, helps with the bones, helps with mood stability. Definitely helps with libido. It's not a main driver for us as women. Our libido is so beautifully complex. There's so many factors. We have to like our partner. We have to feel safe in our relationship. We have to feel that other stressors are somewhat under control. So there's all kinds of factors in addition.

Testosterone alone doesn't necessarily fix libido, but if a lot of other things are in place, it definitely can be very helpful. Bone density, muscle building, metabolism, back to metabolism and weight. I think testosterone is the number one reason men have such an easier time with their weight compared to us women.

Mary Lee: Now our testosterone levels are fairly high. it's surprising to know just how higher levels are. And yet it's not as if it's, it's the leading sex hormone or body. But let's talk about the levels that we do have and why, again, with hormone fluctuation, estrogen egress, testosterone egress, that loss leaves a significant gap in our health.

Why is that? Let's talk about that. 

Dr. Liz Lyster: Oh, okay. One of my favorite topics. 

Mary Lee: Beautiful. yDr. Liz Lister: So we have a few things happening. So first of all, before menopause, our testosterone is generated half from ovaries, half from adrenals. And as we were saying earlier, eventually in menopause, the ovarian hormone production does completely go away.

Some folks out there assert that the adrenals fully take over. I can assure you they don't. I measure these levels and they do not fully compensate for what the ovaries used to produce. In terms of the quantity of estrogen, just to give you an idea and a comparison, uh, it's hard to say what's a normal level for women.

The laboratory ranges are usually anywhere from two to, to 45, let's say, all right? Now, that doesn't mean women feel good, so let's say she has a level of 20. That's on the low side, right? Now, once I start replenishing testosterone with women, and they like it, they tend to like their levels and feel their best with their levels between 40 and 100.

Oh, just for comparison. And then men, million dollar question of what level should a man have? Because for men, we go through, like you said, the obvious changes, the hot flashes, it's et cetera, going into menopause, right? It's kind of like subtle, subtle, and then, right. I call that the stock market phase up, down, up, down.

And then it comes out low on the other end. Whereas men have a little more of a gradual, they might be less likely. Um, to notice that they're getting cranky and tired, et cetera. All right. So for our audience here, uh, a lot of the men I see are referred by their wives or people in their life are like, you're really cranky and you need to get your hormones checked.

Uh, so, a good level for a man, if I have to pick a number is going to be about 600. Okay. Okay, and their range goes all the way down to 250. So I've had a lot of men who feel terrible and their level is 280 and their doctor says, well, you're in the range. You're in the normal range. That's, that's always bad when that happens.

We don't want to be just in the range. We want to be at an optimal place, a higher end. 

Mary Lee: Yes. Okay. And I've heard that some women, when they address testosterone, they're being told by their healthcare team, well, there's the risk of getting hair and the mustache and a number of other things. Let's talk about that.

What's going on here? Absolutely. 

Dr. Liz Lyster: So we've, so a couple of things. First of all, that happens to women, generally speaking, right? Because I measure levels on women and they say, I'm getting these facial, like these giant hairs that I have to pluck. And I measure their levels and their levels are close to zero.

So there's obviously other factors involved. There's genetics. Some genetic backgrounds have a predisposition to facial hair or body hair for the women. So there's that. Uh, and so there's obviously changes in the receptors because I've tried to pin down . For example, my dermatologist, and I've tried to ask her about it, and she says, well, there are obviously changes in the receptors.

Okay, so there's that. The next part that I would say is that those are side effects versus adverse health risks. Very important. As far as I'm concerned, and this is after ongoing in depth researching this. There are no health risks for women using testosterone. What can happen are some of these side effects.

Then the third step is weighing the risk versus how they feel. Let's say she loves it. Alright, I know that when I'm getting a little bit lower on my testosterone, my main issue is the brain sharpness and finishing my sentences. So true. The word retrieval where women freak out and they're, where are you concerned?

Am I getting dementia? No, you're not. MHT will help, you know, we can say more about that if we have time, but for the testosterone, that's kind of mine for other women. They feel it in energy level for others. they notice it more in their libido. All of that, uh, can be indicators.

So then let's say they really get those benefits and they're having, usually if a woman gets that side effect, it tends to settle down. 

Mary Lee: Okay. 

Dr. Liz Lyster: I will say that. Yes. Okay. That's what happened to me. I've been in menopause since I was 43, so that was 16 years ago, 59 now helps people with the meth and, uh, I started using testosterone nine years ago and I, I love it.

I definitely would stay on it. Hopefully, I will continue a few more decades and not get breast cancer. And if I, even if that were to happen, I would still stay on my testosterone. 

Mary Lee: I'm glad you brought that up. 

Dr. Liz Lyster: Lots of data to support that. 

Mary Lee: Dr. Liz, it's hard to believe that you are 59, honestly. So that obviously is testimony right there.

What it's doing for you when you say to help you feel good and sleep better. And I think that that. The byproduct of feeling good and sleeping better is just this glow, this, this useful presence that we still seem to maintain, even though we're, we're aging, because it's just replenishing what is missing.

That's always given us that little extra edge, to stay at our best inside and out. I'm glad that you mentioned staying on it, like for as long as you possibly can. So there's no actual date and time where it says, okay, ladies, you're 80. Now you need to wean off your testosterone or any MHT.

Dr. Liz Lister: That is absolutely correct. And I was delighted to see in the last, that North American Menopause Society statement that I referred to, they also stated that in there. They do that every five years. The last one was a couple of years ago, and they took that out. They said there's no data that says an age at which you must stop, right?Now, again, I circle back, it's using hormone replenishment to feel better does not mean you will have to use it. If women go off of their hormones, they use, I always recommend staying on enough to help your bones. Because hip fracture is way more devastating than even most cancers for most women who have one or the other.

Women who get an early diagnosis of breast cancer have a very high percentage of cure and go on to live a great life. That's not the case with hip fracture. That's my recommendation. But again, it doesn't mean that a woman has to do that. So I just, I want to, I want to reiterate it, reiterate that even though that's what I would do with all the information that I know and the books that I read and the conferences that I go to.

I always like to reassure women that that's not required. 

Mary Lee: Yeah, exactly. Do your homework, arm yourself with credible information backed by recent research and fully endorsed. in the community of leading experts in this field. It's in the books. I mean, I can talk about we have . I'm just looking at my shelf right now, at least in the scope and Dr. Lisa Moscone, the menopause brain menopause, or estrogen matters. That one's sitting right here on my desk as well. 

Dr. Liz Lyster: I'm going to share 

Mary Lee: that in the show notes, but I think it's very important to put in the show notes that the 2022, I believe it's the last one menopause society statement. It's changed its name now, um, but yes, exactly.

He knows it. Yes, it has. It's easier to roll off the tongue. Menopause society. Yes. I'm going to put that in the show notes to have that and download that PDF because listeners, if you are toying with the idea and you're sitting on the fence, whether to MHT or not. Take this piece of information in with you, pull out the poignant details because it is a long document. and make a decision, but it should be shared decision making. 

Dr. Liz Lyster: Yes. I like to share that document with other doctors. It's pretty technical. I often recommend the Estrogen Matters book, Dr. Avram Blooming, as you know, but that's great to put that in the notes.

That is wonderful, it just goes chapter by chapter dispelling myths. I also listened to it on the audio book and it's just excellent. Really, really good. 

Mary Lee: I'm thrilled that you brought that up and also that you touched on breast cancer because I wanted to circle back to that as well.

Again, this, some of the talk I hear the chatter amongst women and the mistruths I want to debunk. can't go on menopause hormone therapy because there's a history of breast cancer in the family and our doctor won't let us. This probably goes right back to our very first point. Let's give us a quick little summary of how to address this issue.

Dr. Liz Lyster: I take the first step as, how are you feeling? If you're not feeling well, I encourage. A woman to use the lowest doses possible of MHT. Your damage to your health is so much greater from not sleeping, maybe there's going to be other consequences in your life with your work or your relationships, that it's worth feeling better.

That's the first step. And again, saying that seems to be a theme of mine today is, you do that for right now, you're not committed forever. That's number one. So the more a woman is suffering, even with a family history, that is number one, it is worth feeling better. The second is the details of the family history.

Uh, was, and I have a friend in my life who. Her mother had breast cancer at age 30, and then again later in her 30s. Her younger sister had breast cancer at age 28, and then again when she was in her early 30s. so they have the gene. That's very important. If there's genetic testing that can be done, that's going to be really helpful.

Alright, and so, and my friend is now in her 50s. And then she's had her own journey also with all of that happening while her, while growing up with her mom and her sister. So family history, the details are very important. Uh, it can come through the dad. If there's a genetic piece, it can come through the dad.

If the woman or women in your family were over age 65. When they got their breast cancer, then that is a lot lower risk. All right, that's the case in my family. So my mom was 68. Now she's about to be 86. She's doing great. She underwent essentially a cure. I know that people don't like to use that word, but that's really what happened for her, was the lumpectomy, the radiation, and then that's that.

Okay. And that was coming up on 20 years ago. Okay. And even she is now allowed to use her vaginal estrogen to help her avoid bladder infections. Very, very, very important. Okay. As we get older. In my book there's just no reason to suffer. And then of course there's the data which is the most difficult to persuade, which is what I mentioned, that that WHI study where I don't like the hormones they used.

The women that they studied were also the wrong women because they were all 10 or 15 years past into menopause. That's right. But even in that study, the women who were given only estrogen without the non bioidentical progestin, When they were given only estrogen, they had less breast cancer. There's a lot of data to show that estrogen actually lowers the incidence of breast cancer.

That's probably the most difficult topic to broach. And so that's about the order that I do things in. Feel better. Let's look more at the details. And then lastly, most likely, we are actually going to reduce your risk. Yes. Not increase. I think it's, 

Mary Lee: uh, probably eye opening experience. And for us, for listeners and for many women to realize that they really are in the driver's seat.

They do get to make the decisions, call the shots, and you don't want to do it irresponsibly. Being armed with that right information and unpacking it because science, and I've heard this said before, so I'm just pointing their phrase, science marches on and it is constantly evolving. And we are now just looking at women's health studying it for the first time. And as Dr. Stacy Sims says, we are not small men. So why don't we start studying a woman's body as a unique entity all on its own without any, you know, comparison data and benchmarking against the men's markers of health. So really great. segue into your book.

Let's talk about your book and the program that you're offering women to work with you. 

Dr. Liz Lyster: Yes, absolutely. A few books going at this point, which is really fun. And another book waiting in the wings. called The Miracle of Menopause, so that's also coming soon, hopefully, working on that one. But the first book is Dr. Liz's Easy Guide to Menopause. Which is really more about perimenopause than it is about menopause. That was the first book that I wrote when I, when we talked at the beginning, I was just going into menopause and wanted to really explore what my patients were going through.

The most recent book that I published is Dr. Liz's, Go for great, Dr. Liz's guide to thrive at every age. and in both of those books, I talk a lot about the symptoms. Uh, we didn't spend time. We could talk a whole nother session, of course, on weight and the impact of each of these hormones. Estrogen that helps with fat metabolism.

Progesterone that helps with sleep, which is essential. Testosterone, which also helps with metabolism, cortisol balancing, thyroid balancing, all of that is important. So that book, I love the gopher great because, uh, great is an acronym, gain knowledge. Realize the truth about hormones, explore your expectations so that the hormones are not a quick fix. Takes a few weeks, months to dial things in. That's right, yes. A is advocate for yourself and T is for thrive. 

Mary Lee: So clever. I love it. And you can find your book obviously on your website, which we'll get in the show notes. I would like to bring you back to talk about weight gain and all the factors that are sex hormones.

Putting testosterone plays in managing weight and what happens when it does egress, I put out a little mini epic mini just to summarize it very quickly, just to give the Coles notes version about all the hormones that you just mentioned, cortisol, thyroid, insulin included, but it's always valuable to have it backed by the experts in the field and they can really break this down.

I, you, Dr. Liz, are certainly one of those amazing experts. Please tell our listeners where they can find you. 

Dr. Liz Lyster: My website is the, the hub of everything that I do. Great. Uh, so dr. Liz md.com, D-R-L-I-Z md.com. and I do have a special program for all the podcast listeners that I'll make sure that you have the information for that. The website is how to reach me to connect with me. there's some questions to answer on there to figure out. Is it your hormones? And uh, and to start to get answers, especially if you haven't been getting answers up to now. I just want women to feel better. Our world would just look a lot better if Everybody felt good.

Mary Lee: I 100 percent agree. There's a lot to be said about that. And the Dalai Lama, I've said this before in my podcast, to coin, paraphrase what he had said, that it would be women of the Western world that would heal the planet. But to do that, step number one is to heal yourself. And to get wise.

Because if you're going to step into that role, it's a big role. It requires a lot of compassion. But if you're beating yourself up and you're lacking self compassion, self love, what good are you? You mentioned that. What good are you to friends, family, colleagues, do your homework, empower yourself, advocate for yourself.

Read Dr. Liz's book, go to her website, all in the show notes, Dr. Liz. Thank you. Thank you. I learned so much. My pleasure. We're going to bring you back. To talk about awesome 20 some odd things we put in the parking lot to talk about. 

Dr. Liz: Fantastic. I love it. 

Mary Lee: If today's insights resonated with you, I'd love for you to be part of our growing community of menopause disruptors. Hit subscribe wherever you're listening right now. And if you know someone who can benefit from these conversations, please share this episode. Sometimes a simple act of sharing can be the first step in someone's healing journey.

And hey, if you're ready to take the next step in your menopause journey, I'm here to support you. You can find all my services at emmeellecoaching.com. It's in the show notes.

Want to stay connected and get regular doses of menopause wisdom? Follow me on Instagram at the menopause disruptor podcast, where I share tips, insights, and real conversations about navigating this transformative phase of life. Let's continue to disrupt this menopause conversation together. Remember, midlife should be the best life, and it will be.

Namaste.