I’m Chadwick Steendam and I’m a PA here at Cassie Lane Aesthetics. I provide our bioidentical hormone replacement therapy program, and I provide our weight loss program. Bioidentical Hormone replacement therapy, or BHRT is where we replace or supplement hormones that naturally decrease as we age. And so the bioidentical part of that is where we use hormones that are chemically and structurally the same as the ones that are created in your body rather than using synthetic hormones. Symptoms that people might experience as we age are things like brain fog, weight gain, low libido, changes to your hair, skin and nails, fatigue, hot flashes, night sweats, any of the things that women go through as they age or go through menopause. And so with bioidentical hormone replacement therapy, we can address a lot of those symptoms and concern. Not everyone’s going to be a candidate, but that’s why we do a really good health screening. We look at all your risk factors, we talk about the side effects, pros and cons, and we can see if it’s a good fit for you. But really we’ve shown in the data that it’s really safe and effective for most women and can actually really improve your quality of life.
Initially, when patients first started it, they might feel like they get a little bit of increased energy, a little bit of increased mood, and then as they continue and as the hormones really get in their system and kick in, people will notice an improvement in the way they feel, the way they look, the way their hair and skin feel. They’ll notice they have more energy, they have better libido. They feel like their mood is improved, and especially women in menopause who suffer from things like hot flashes or night sweats, those can be drastically improved. And again, like I said, just some of the health benefits to women are noticing they have lower risk of stroke and heart attack, lower risk of osteoporosis, lower risk of breast and colon cancer. I encourage any woman who’s experiencing any sort of hormonal imbalance symptoms to come in and see if it could be a good fit for them.

Hi, Chadwick. Thank you for joining me. I want to ask you a bunch of our most frequently asked questions that we have at Cassie Lane Aesthetics about BHRT. Perfect. I was actually trying to find some extra questions to ask you when I was Googling and going down the Reddit hole, and I found that actually a bunch of celebrities do BHRT, which is really cool. So I found Oprah, Angelina Jolie, Jane Seymour, Suzanne Summers, Kim Catrell Madonna, and Cindy Crawford all have come out saying that they do BHRT.

I love that. That’s probably why Kim Cottrell’s sex drive is so high. Love that.

Why do you think that celebrities or anybody is drawn to doing BHRT? What are some of the benefits of it as far as looking young, feeling young?

Yeah. I think people, when you’re in your thirties, you think you’re going to be young forever. And then as you start to age, menopause symptoms can come on even 10 years before you start menopause. So even in your late thirties, early forties, you can start experiencing some of these symptoms and that can lead to things you notice externally, such as changes to your hair, skin, and nails. And then internally as well. It can start with fatigue, brain fog, lower libido, and then you get those really common menopausal symptoms like hot flashes, night sweats, things like that. And really it’s your body’s response to having all these sex hormones like estrogen, testosterone, progesterone that you’ve had all your life and you’re losing them, and so your body’s kind of going haywire. So I think a lot of these women probably have access to some of the best doctors, the highest medical attention, basically, and so they can find out about it. It’s more easily available to them, and they’re finding, Hey, there’s things that we could do to combat some of the signs of aging and then symptoms as well.

Yeah, it makes me think about, I think there’s two different ideas in medicine, right? There’s just trying to treat illness, and then there’s also this idea of more of functional medicine, which is okay, living to the best that you can, feeling the best you can, optimizing how you feel, exactly. So trying to optimize your numbers and make your quality of life the best versus just fighting off in illness or disease that you already have, trying to be more preventative. So I definitely feel like BHRT for sure falls into that category. Since you kind of talked about it being a long span of ages that this comes on easily, like a decade before full menopause, when’s maybe a time that a woman might start doing BHRT and when is there a time that you’re like, okay, you should stop doing it.

What does that range look like? Yeah, absolutely. So hormones can be safe for anyone who’s done with childbearing, so does not want to have any more kids because messing with your hormones could affect your fertility. But then after that, typically women in their later thirties, a lot of times will first start to notice that lack of testosterone. And so testosterone is an easy one to check the levels and see if you could benefit from that. And I mean really all the way throughout the rest of your life, potentially, it’s the window of time they’ve shown that is the most safe and effective and actually has the best health benefits is within the first two years of menopause, sorry, 10 years of menopause. And menopause is that one day of your life, one year after your last period. So in that 10 year window, sometime around that you can start it. And then once you’ve started, unless you have some sort of health history that makes it unsafe, you really can continue it throughout your life.

That’s awesome. Yeah, I know we checked my testosterone and it was in the gutter, and I think you attributed a lot of these symptoms and feelings to, oh, I’ve got young-ish kids. I’m busy. I’m driving everybody everywhere. I’ve been married for 15 years, what have you. So that was really interesting. So one question that we get a lot too is could you take a break from it? If you’re going to start this as early as in your late thirties or early forties, sometimes people feel like, well, this is a long time I have to do this. Can you take a break from it? Can you stop? Is there any downside to doing that?

Yeah, so if you think of hormones, kind of like you would a birth control pill, the way birth control pills work is they kind of trick your body into thinking that you don’t need to make the hormones getting it from an external source. So it kind of shuts down your ovaries, takes over the work. And so if you’re on a birth control pill, you can stay on that. And then once you come off, then your ovaries kind of power back up and do their job again. And that can take a little bit of time. So if you think of hormones kind of like that, we’re going to kind of support your hormonal levels and you can be on them and it’ll be safe and effective. And then when you stop, it’s going to reset back to wherever you were before. And so if you’re perimenopausal and still in that early phase and you’re just going to kind of go right back to where you were, it’s not going to delay menopause or make it come quicker. And if you’re postmenopausal, then we’re just going to remove those hormones and you’re going to go back to wherever you were before. So if you were experiencing some menopausal symptoms, those could come back as we stop.

Okay, that’s good. It makes me think about, it’s not like when you start dying your hair and then you stop and you’re going to have a big line. You can kind of seamlessly come on and off of this if for some reason you wanted to.

Exactly.

I see a lot of women coming in and they’re on an estrogen patch only, and is that enough? They still seem to be having not all of their, some things are improved, but not everything. And what do you think about, I think a lot of times doctors are just slapping an estrogen patch because this woman’s coming in complaining of symptoms and they’re like, okay, here’s an estrogen patch. See you next year. Something else we can do better than that.

Totally. There was this interesting survey that went out recently that looked at OB GYN residents and how much training they get on menopause, and the average was eight hours, so maybe one workday in a four year period about menopause and hormonal health. And that’s not to say everyone, but a lot of these doctors, you expect them to be your OB g menopause expert, but really they’re kind of more aimed towards those childbearing years and when something goes wrong. And so a lot of times they just think, let’s try some estrogen because you’re losing estrogen and menopause, but there really is an art to balancing it. And so some of these symptoms are estrogen related, but you also have to balance that with progesterone, and you’re never going to get a bioidentical progesterone in a patch. And so you might be getting synthetic hormones. And then testosterone. Testosterone is a huge one, especially for mood libido, lots of different things. Energy. Energy, a huge one. And so making sure you’re adding all of them in, and there are lots of different ways you can do that, but kind of making sure they’re all balanced and not just sticking a patch on it, which you’re right, is super common from an OB GYN, and sometimes that can fix things, but a lot of times it’s just kind of putting a bandaid.

I just feel like it’s really incomplete because we’re not addressing Right, those progesterone. Exactly. And testosterone, I think like you’re saying, is a thing that really makes us just feel that much better. And I think it speaks to medicine the way it is in society a lot too, which is all the energy and the marketing and the time is being put on this fertile years. And then when it comes to another huge transition time in menopause, it’s like we’re just left with not a lot of tools and it’s like, well, this is normal. Exactly. Well, a lot of things are normal for men too, but we are whipping out those prescription pads to write some pills for men. Exactly. We’re telling women, well, this is just normal and it is normal, but so is childbirth, and I definitely got an epidural for that. So I think it’s normalizing a little bit of that.

Well, we can make this increase the vitality and longevity of feeling our best, and I think that menopause is inevitable. We’re all going to go through it, but suffering is not, and it’s about your right, quality of life and longevity. You could live the next 30 years in menopause, but if you’re suffering, those aren’t going to be high quality years. And so if we’re just replacing your tank with what you previously had, which is bioidentical hormones to help you through that, there’s so many good things in terms of how you feel and quality of life, but also health benefits that I think people don’t even realize When you lose that really vital hormone such as estrogen or testosterone that your body’s been used to all these years, there’s receptors in your brain and your bones and your kidney, liver, skin, blood vessels, and so you lose those and then the way they function changes and your health can change and go downhill rapidly sometimes because of it.

Yeah well, and they are discovering now that there’s so many benefits with BHRT and it’s kind of counterintuitive even for some of us in medicine. And that was one common question that comes up, which I saw when I was typing into Google, and it was like, why are some doctors against BHRT? And I think that’s a complicated question, but it ties into exactly what you’re talking about. So why might we have heard that?

Yeah, so in the late nineties, early two thousands, they did this study called the Women’s Health Initiative, and basically because of the past 40 years, they had seen women on hormones doing really well, having lower risk of cardiovascular disease, lower risk of osteoporosis, lower risk of strokes, things like that. They kind of attribute it to being this miracle drug. So they decided, Hey, let’s look at women who are postmenopausal and see if giving them hormones prevent some of these things like heart disease. So that was the main driver of the study, giving hormones to prevent heart disease. What they did though is they gave hormones to mostly older women, so in their sixties and seventies who some of those women were 15 years plus post menopause.

And you had said, really that the best time to start hormone therapy is within the first two years of 10 years, sorry, first 10 years. And so a lot of those people were outside of that window.

A, not the best candidate outside that window, B, they used high dose oral, synthetic hormones, and then they tried to see again if they could prevent heart disease. What they did notice was a slight increased risk in heart disease and breast cancer. And so they stopped the trial, kind of made this big fuss and said, hormones are bad for you, watch out. And so overnight, millions of women went off their hormone. Since then, we’ve done a ton of data and research and even looked back at that study and they’ve shown, well, it was I think four women out of a thousand over five years had an increased risk of breast cancer, not that they died more from breast cancer, not that it was more aggressive. And then even in actually one of those arms of the group, they noticed a decreased breast in breast cancer. And so I think since then they learned that 10 year window, the women actually who are younger, so 50 to 60 had lower risks of heart disease, breast cancer, things like that.

And so knowing that age window, using bioidentical, using transdermal, these are things that we’ve all realized have lowered that risk. But in that time for the past 20 years in medical school, we’ve been teaching hormones are bad, hormones are bad. There was this one study, granted, it was a big study, but we’ve now since noticed there were a lot of flaws. And so I think providers are just really scared of it. And so really now it’s taking time to reeducate people and putting the word out there that it’s not as bad. And we have some really great resources in terms of books and podcasts and websites people can look at if they just want to see some of those fashion data.

I think education is a big piece not only to patients, but even to prescribers and doctors who as we know are not getting really much education on the matter. And one thing that you keep talking about is synthetic hormones versus bioidentical. And in that study was done with synthetic with not the right patient population to boot, but what’s the difference between synthetic and bioidentical? And it sounds like patches are typically going to be synthetic. So just tell me a little bit about that.

Yeah, so I basically bioidentical means that the hormone is the same chemical structure as the hormone that you’ve seen in your body. So when your body sees that, it responds exactly how it would to a normal estrogen or testosterone or progesterone. A lot of these ones that they’ve used that are previously in a lot of the birth control pills are synthetic. So the most common one, and the one they use in that study is called conjugated, equine estrogen, and that is made from pregnant horse urine. And so that estrogen, part of that estrogen, like a small percentage is that which is the bioidentical form. Other ones are different estrogen. So your body has to see that kind of break it down, change it, and those can be kind of more inflammatory and you can have a different response to that because it’s not the one your body’s used to.

And so these bioidentical ones come with less risk of some of that inflammatory process as well as it’s just filling up the tank with the gas that you’re used to. I’m sure if you fill your car that only takes premium gas with regular gas, it’s going to run, but it’s not going to be fully performing. And so thinking about using that exact specific hormone that your body’s used to. And so a lot of the pills can be synthetic, although there are some bioidentical and there are some bioidentical patches for estrogen, but you’ll never be able to find progesterone in a bioidentical patch. And so we like to use bioidentical, estrogen, progesterone, and testosterone, and we like transdermal approaches here just because when you take it by mouth, it has to go through first pass metabolism, meaning processed by your liver. Your liver makes a lot of your clotting factors, and so you can kind of rev that up and then in that case it can increase your risk of clotting. And that’s like when women are on birth control. You take that risk knowing, Hey, when I’m on a hormone, I have an increased risk of blood clots. So that does increase your risk factor a little bit. So that’s why we like to be very specific with patients and see what’s going to be the best approach for you and making sure we’re using bioidentical.

And so transdermal is going to mean creams, it’s going to mean patches, it’s going to mean pellets that actually getting started underneath the skin. Exactly. So you’re not having to do that first pass through your GI track, which then can kind of create some more issues with clotting, which we don’t expect to see as much risk with that if we go transdermal.

Exactly. The only one that cannot be transdermal is oral micronized progesterone, and that’s the bioidentical version of progesterone that doesn’t carry the same risks of the blood clots. And that one, the reason it has to be oral is because all of the data with the bioidentical shows that you get the best protection or uterine lining protection by taking it orally. And so that is what all the data shows in terms of safety and efficacy, but women actually really love their oral progesterone because it makes you sleepy, and so you take it at night and it’s like the world’s best sleeping pill.

A lot of women say, oh, I used to sleep really well, and then as I’ve gotten older, I’m no longer a good sleeper. And that can really be a symptom of losing that progesterone. Exactly. And so you can sleep better when you have it. Some other benefits that we’ve found in our research too is even actually decreasing the risk of a number of things. I know osteoporosis, but what else can replacing your hormones, bioidentical hormone replacement, what else can they help or prevent or make them?

Yeah, so a lot of studies have shown 100% osteoporosis proven because you need those hormones to help with bone ization, so osteoporosis and actually some reversal of osteoporosis in women who started early enough colon cancer, which is becoming more and more prevalent these days, but they’re actually showing decreased risk of colon cancer in women on hormone replacement therapy. There’s some recent studies and good data to show that it can prevent things like Alzheimer’s or dementia because again, you have tons of estrogen receptors in your brain. They’re showing that more women when they go through menopause are having mood disorder or mood changes in terms of new onset anxiety, depression, A DHD, and a lot of those things. We slap a bandaid on it by prescribing an SSRI for some of these things, and which some cases people do need, but sometimes it can be a hormonal imbalance. So lower risks of some of those things overall.

And so even random stuff, we’ve heard frozen shoulder and some ortho stuff. I mean a lot you have estrogen in other receptor hormone receptors all over your body, so there are really far reaching symptoms and we’re living so much longer, right than we used to. So I definitely have seen something where it’s like a lot of women spend a third or more of their life, so it’s extending those feeling good years, and the fact that it can actually prevent some diseases is really great and opposite to what it’s really set back, it’s a shame because that study did set back, it really did hormone therapy for a number of years. I’m glad that it’s back on the table and that we can help women again and start to see them in this time. Exactly. One thing that we haven’t talked about is weight gain. So we all know, we hear all the time, it becomes so much harder. I used stability nurse diet a little do X, Y, Z, and I could drop the weight, but now that I’m in menopause or nearing menopause, I just can’t lose the weight. What’s that about? How does hormone replacement kind of play into weight gain and weight loss?

Yeah, so again, you start losing that estrogen, and really what it is helping with is anti testosterone, the prevention of visceral fat, and that’s that bad fat kind of accumulates around your organs versus subcutaneous fat, which is kind of the external. And so a lot of women will say, I’m getting this inner tube that I can get rid of or struggling to lose weight or maintain my weight like I used to. And so we do find that as you go through menopause and losing those sex hormones, that happens. And so women who are on hormone replacement therapy, not that it necessarily is going to be like a weight loss medication, but it helps you to even out that balance of your weight loss, weight gain to where exercise lifestyle can continue to work. And so yeah, we see that all the time. It’s that weight gain with menopause, and so hormone replacement therapy can kind of help negate that a little bit.

Definitely feel like at minimum kind hits that pause button. Exactly. It’s interesting that not having those hormones causes weight gain, replenishing them, doesn’t necessarily make you lose weight, but it does kind of hit the button. And then we see a lot crossover here in our office with people doing our weight loss program as well with doing hormone replacement, and we can just see such amazing results when we attack it in that way. But those were all the questions that I had on my list. I really appreciate you letting me pick your brain. Of course. I guess if somebody’s interested in wanting to learn more about bioidentical hormone replacement at Cassie Lane Aesthetics, how can they just make an appointment with you

So they can book online if they’d like, they can go to Cassie Lane Aesthetics.com and book online for hormone consultation. We do do quick, easy, 15 minute virtual ones as well. If they just want to kind of get a little down and dirty, this is how we do it. They can also come in and it’s a really comprehensive 60 minute consultation. We go over all of your health history, talk about your hormones, we can draw your blood to kind of see where all your levels are, and then go from there. They can also call the office, and so they can book it that way, but really find us online, social media, all those things, and then everywhere you can click the link and get it booked pretty easily. Awesome.

Well, thank you so

Much. Thank you.

Let’s see. I’ve been here for about five months. Old nurse learning a new place, but it’s been fantastic. All the girls here are great, and I met Chadwick who does the bioidentical hormone replacement therapy, and I talked with her. I’ll be 60 this year, and I’m fighting that battle and I intend to win it at least as long as I can. So she did some lab work. I decided that hormone therapy was a really good fit for me. I had some surgery done years ago, so put me into early menopause. And I think as most women know at my age, menopause is a bear and it is very difficult to deal with sometimes. So speaking with Chadwick in regards to the hormone therapy, she drew my labwork, said I was a good fit. And so now I have pellets. I have testosterone and estrogen pellets inserted, and then I take progesterone at night. And it has made such a difference in my life. Changed everything about my relationship with my husband 100%. And I just feel so grateful that they are offering this therapy for women. Because typically what most women hear is, well, it’s menopause. You just have to deal with it. And I am here to attest that you do not have to deal with it unless you want to win the battle. That’s how you deal with it. So come on to Cassie Lane, that’s how it’s going to help you.