Exploring HRT: Controversies, Questions & Education
featuring Carrie Jones, ND
Audio Only:
Episode 83
Published December 3, 2024
In this conversation, Dr. Carrie Jones and Dr. Jaclyn discuss the challenges that providers face when learning about hormone replacement therapy (HRT) for menopause. They highlight the confusion and conflicting information surrounding HRT and the need for a comprehensive and evidence-based approach. They also introduce a new educational course from DUTCH, Introduction to Hormone Replacement Therapy, which aims to provide a clear and practical guide for providers looking to incorporate HRT into their practice.
Dr. Jaclyn and Dr. Carrie also discuss:
- The core hormones involved in HRT, including estradiol, progesterone, and DHEA
- Different forms and routes of administration
- The importance of understanding the evidence and guidelines for HRT
- The need for individualized patient assessment and testing
- Controversies and common questions surrounding HRT
Key Moments
00:00 Introduction and Overview of HRT
06:03 Understanding the Core Hormones: Estradiol, Progesterone, and DHEA
20:43 Forms and Routes of Administration for HRT
27:39 Addressing Controversies and Common Questions in HRT
32:39 Optimizing Patient Outcomes: Individualized Assessment and Testing
Jaclyn (00:01.134)
Well, Dr. Carrie, thanks for joining me today.
Dr Carrie Jones (00:04.412)
Well thanks for having me back, I always love talking with you.
Jaclyn (00:06.722)
I feel the same way. And I'm really excited today because you and I got to work together on a really exciting project. And that's what we're going to really chat about today. And it's around HRT. So I want to start, before we really share the details of this project, really just start by talking about HRT. We're really talking about menopausal hormone replacement therapy. And tell me a little bit about what you hear from providers around this topic. Because it's a really popular topic to talk about. And I know you talk with a lot of providers. So tell me a little bit about what comes up for them when they're trying to learn HRT and get started.
Dr Carrie Jones (00:43.004)
A lot of them feel super overwhelmed and they don't know where to start. And especially because hormones have such a mixed connotation given the history of things like estrogen. In fact, I was just talking with a doctor the other day who is a background in gastroenterology, moving into functional medicine and wanting to get into hormones. And they were like, wow, this is a whole other world, obviously. But the background and training they had had nothing to do with hormones. And for them, they just felt paralyzed. They're like, I don't know where to start. I don't know if I do like a patch, a cream, a pill. Do I test? Do I not test? And I kind of get that census over and over again, that when you start to dip your toe in, it just feels like the fire hose as opposed to a nice easy step into learn how to prescribe HRT.
Jaclyn (01:31.16)
Yeah, that's been my experience talking to providers too. And I think part of it, if I can add to that, that not only is the topic kind of scientifically complex, especially since publication of WHI and all the research done after that, and we can talk about that, but also what I've observed is that the way HRT is taught to functional medicine providers is so disparate and diverse and actually contradictory and conflicting. So.
Dr Carrie Jones (01:40.848)
Mm -hmm.
Dr Carrie Jones (01:52.101)
Yeah.
Jaclyn (01:58.98)
People want to do the best for their patients, and they literally hear one thought leader say, here's what you should do for HRT. And then they sit in another training, and they hear exactly the opposite recommendation. People say, don't do what that person said. Do it like this. And it's really hard to unravel and figure out, well, what is the evidence say, and what is the best approach for my patient?
Dr Carrie Jones (02:12.124)
Yeah.
Dr Carrie Jones (02:25.668)
It's even levels. was asked this question yesterday of like, what level, what level do I want to get them at? Let's say she's postmenopausal. What level protects the bone? What level is being studied for, you know, brain health? Is it being studied? it the levels depending on the route that you use? Is that information anywhere? And I can understand if somebody is brand new to this, how that might feel as opposed to somebody like yourself or me that's been in for a long, long while and really been piecing this apart for a long, long while where it comes more naturally. It's a little easier. know what to do. We've read the literature. And so I'm excited to really get into this more because again, just confusion. If I had to pick a word, it's hashtag confusion.
Jaclyn (03:12.02)
I love it. is HRT confusion. That's going to be the hashtag when we post this podcast out. And I mean, think it is. It's so common. And I hear from more providers with questions than I do, providers who feel clarity around hormone replacement therapy and menopause. So what we're here to talk about and really to launch and to share or to say this is coming is that Dutch has put together
Dr Carrie Jones (03:14.662)
Hahaha
Jaclyn (03:36.162)
a basic HRT course that really breaks down what a beginner should learn and should know and should master before they get into doing HRT in practice. This is not intended to be the place you go to learn everything that you'll ever need to know about HRT. It's the place that distills down the most important elements for you to master, to feel competent and confident and really be able to help patients. And that feels really...awesome to me to like clarify that for providers because I think when you talk about like you and I when we see new research or we see a new modality or route of administration or approach, there's context to compare it to, to say how is this different from what the evidence has to do and could this advance the practice or is this conflict with the evidence? And you can think a little bit more critically but you need to have that critical foundation in place.
Dr Carrie Jones (04:04.528)
Yeah.
Dr Carrie Jones (04:31.19)
Especially sometimes we hear more is not always better. And that's what I love about this course. And I think what the practice centers are going to love about this course is that they can watch it and immediately implement on Monday and not feel like I don't know what to do. I don't know what to pick. I'm not sure. I'm still not sure. I still feel like it was a fire hose. But if you're coming into it with a zero level, a clean slate, and you want that science-backed, where do you start? Feel confident.
Jaclyn (04:35.534)
Mm
Dr Carrie Jones (05:00.23)
help your patients, this is it. I mean, this is definitely the place to start.
Jaclyn (05:04.972)
I totally agree. And I would even say, even if you've been trained in some type of approach to BHRT, it's still worthwhile to watch this because this is, I mean, we really debated the evidence. This was built by a team of docs within Dutch. And we literally have read all the papers, debated all the research. Also, Mark Newman, our founder and CEO, got involved. And we had some pretty hot debates about different topics and how things should be stated.
Dr Carrie Jones (05:08.955)
Yeah.
Jaclyn (05:34.05)
or positioned or interpreted. And really we want this to be very evidence driven so that people who listen can feel really confident in those steps that they're taking. And we also debated what should be in and what should be out. And that was a really interesting conversation. So let's start by talking about this HRT course and what we included and why and where it came from. So let's talk about the general topics first. So at a high level,
Dr Carrie Jones (05:46.928)
Yeah.
Dr Carrie Jones (05:56.439)
Right.
Jaclyn (06:03.451)
When we're talking about getting started with HRT, what are the core hormones that are really important for providers to know about?
Dr Carrie Jones (06:10.0)
The big ones, especially of course in this course, the big ones everyone thinks about, estradiol, progesterone, of course, and then DHEA. And it does touch on testosterone, but doesn't go into testosterone as far as a review. But number one and number two, estradiol and progesterone for sure. Those are the hot topics, those are the ones everybody wants to know about. That's what everyone is coming to you for saying, I saw on social media, or my sister's taking, or my best friend started, or I heard it causes cancer.
It must be my estrogen, right? Or must be my progesterone, right? And so those are the biggies.
Jaclyn (06:45.102)
Definitely, and let's talk a bit about testosterone and DHEA because that was an area where we thought, we include testosterone or do we exclude testosterone? And tell me a little bit about the hurdles that come into play when you start to think about testosterone as part of a hormone therapy regimen.
Dr Carrie Jones (07:02.652)
One of the things that I, well first of all testosterone is a controlled hormone. It's a controlled medication. So you have to have a DEA number and not everybody has a DEA number. So it can be exclusive for certain practitioners when it comes to hormones. Second, when it comes to the hormone hierarchy, testosterone as a hormone, if you start with testosterone too soon, and especially if you haven't really evaluated estradiol or progesterone, then you can end up causing more side effects than you would want if everything was maybe started the other route. Started with progesterone, add estrogen, and then added in testosterone later. And I do say this in the videos and I'll say it again here, there's some really interesting research on the imbalance between testosterone and estradiol as women move through this transition as it relates to metabolic syndrome. So if she has, more testosterone relative to estradiol and you just put her on more testosterone, it could increase her risk for visceral adipose gain, which most women don't want. It can increase her risk for fatty liver. It can increase her risk for insulin resistance and inflammation. And if you don't know that little piece, if you don't understand that testosterone doesn't decline like progesterone and then like estradiol for most women, not all women, but most women, but you just jump in with testosterone, then you maybe might cause some unfortunate outcomes. Now the other thing is testosterone can aromatize into estrogens. And so you do have to be careful when you're using testosterone because we can't really control for that so well. The body, it's a very controlled system, so the body can choose or not choose. Depends what kind of mood it's in that day to convert it on over into estrogen. And if that's not what you're looking for, you're trying to just keep it as testosterone, you really can't choose that, not on its own. And so just listing off those things you can see like right away for a brand new practitioner into HRT or maybe it's been a while or you're still feeling like you're getting your feet wet. There are a lot of caveats with testosterone. And so it's probably best not to start there in this course.
Jaclyn (08:59.929)
Mm -hmm.
Jaclyn (09:19.8)
Now what percentage of patients do you think you could improve the symptom picture for with estrogen and progesterone alone?
Dr Carrie Jones (09:27.74)
Most of them. That's a huge person. I mean, I think right away when they come to you and they're reporting a lot of their symptoms, a lot of their concerns, their lack of quality of life. I love testosterone. Dr. Jacqueline loves testosterone. We are not against testosterone at all. But in this particular starter course, estradiol and progesterone are going to be your big winners right off the bat Monday morning.
Jaclyn (09:29.25)
Yeah, that's how I feel too.
Jaclyn (09:51.278)
Yeah, I couldn't agree more. And I think the other thing to think about is what's FDA approved? And what can you do that is in alignment with published literature? And most of the literature is around, well, estradiol or estrogen therapies plus a progestogen for uterine protection. So you've got to learn about that as well. we really, the course starts and kicks off with.
Dr Carrie Jones (09:55.75)
Yeah.
Dr Carrie Jones (10:03.536)
Yeah.
Jaclyn (10:13.43)
an overview of menopause and menopausal hormone replacement therapy. And this one, in particular, was really fun to build because our team went through all of the updated practice guidelines, both within the US and internationally, to look at how things differ and what types of medications are used, what studies have been published on risk of therapy, also different formats and delivery methods, so bioidentical versus synthetic estrogens and progestogens. So it was really interesting and I would say our team who are mostly naturopathic doctors, well we all were that were working on the course other than Mark with more of a chemistry background. We all had, we realized we had some biases that we had to check a little bit. Even in that first foundational piece when it came to risks. For example, one big piece that was kind of indoctrinated in us in our training was that oral estrogen was like not a good choice because of its high risk. As we looked, go ahead.
Dr Carrie Jones (11:14.65)
I think that's indoctrinated, and I was gonna say, I think that's been indoctrinated in everyone. I feel everyone that I see educating out there, no matter their designation, is also advocating against the use of oral estrogen. And then you read the literature and I'll let you keep going because it's, you know.
Jaclyn (11:33.498)
The literature shows it's a very safe option. And I would say transdermal is even safer, but oral estrogens are safe. And I think the literature really shows that. And that was a surprise to us, where we're like, wow, our community maligns oral estrogens. However, even CEE has a good safety profile. We want to use the best possible, the lowest risk possible. And so we do recommend bioidentical.
Dr Carrie Jones (11:55.632)
Yeah. Yeah.
Jaclyn (12:02.38)
Astrodial in this course however I think it would be unfair to be overly critical of even conjugated equine estrogens because overall for most women they're a safe choice and when we think about Patient preferences there might be patients where transdermal patches cause irritation or where Putting a cream on feels like a hassle and they won't take it consistently or whatever and so I think
That was one example of a surprise that was almost a myth buster in the course. We really want to be honest with not just our own biases, and we're not here to just restate the biases that the providers might have. We actually want to cut to the chase. And I think hopefully when people listen, they realize we are NDs who were raised the same way in that hormone culture. I graduated, the WHI was published my first year in med school. So I was raised with like, as little hormone for as short a time as possible. And it takes time to unravel all that, but it is important that we are constantly re -examining the data that's out there and changing our practices in alignment with that.
Dr Carrie Jones (13:11.708)
And for those who are listening, maybe,
Griffen Harris (13:13.299)
Quick jump in. sorry, Carrie, we think your headphone microphone is clipping your star necklace. And it's, I'm not sure, Jacqueline, if you're hearing that, but Joey and I both are, there's like a high pitched clicking and it sort of seems to coincide with your nodding. And so if you could just be aware of that, it's not a problem why it's happening while Jacqueline's speaking, because we can just mute you. But when you speak, we don't want that to.
Jaclyn (13:32.218)
Stop agreeing.
Dr Carrie Jones (13:32.54)
Okay, I know, I'm...
Dr Carrie Jones (13:41.788)
Okay, I will hold it further away from said necklace. No, that's good, I'm glad you said something.
Griffen Harris (13:44.949)
Sorry about that.
Jaclyn (13:46.234)
Thanks.
Griffen Harris (13:48.299)
Thanks, sorry.
Dr Carrie Jones (13:52.213)
I want to just clarify for those maybe who are new or don't know, oral estrogen can increase the risk of blood clots. And that's where people took it to mean it's an automatic. If you take oral estrogen, you swallow it, you're immediately going to develop a blood clot. And that's the issue. Therefore, don't do oral estrogens. Switch to transdermal. And as she was saying, the literature shows, sure, there's a slight increase of blood clot, but it's slight.
And if you have a family history or a personal history of a clotting disorder, that would have to be rolled out ahead of time. But for the large majority of women, large majority, it's not an automatic take oral estrogen, develop blood clot. It's not how it works, thankfully.
Jaclyn (14:36.462)
Definitely, and so that first module is really fun to go through, even if you know your hormones, which is what the future module's about, we'll talk about that. If you wanna get current with the literature that's published, particularly around controversies, like we do have a whole lesson just on controversies, these are all the questions that patients come in to ask you about, like breast cancer, or VTE risk, or bioidentical versus synthetic, we wanna make sure that you're really well prepared.
to answer those and to feel comfortable with them yourself before you start prescribing any of these. They're going to come in.
Dr Carrie Jones (15:09.116)
because you know they're gonna come in and ask you these questions. You know they're gonna come in and say, our patients have biases just as strongly as we do as practitioners. they're also probably that age again, I was the same, I was a first year medical student when the WHI came out. And now being in my late 40s, I'm prime hormone. So that means a lot of women who grew up with the WHI where hormones are bad and cause cancer.
Of course, if they're not in the medical field, how would they know anything has changed? And so if they're going to come in, they're going to comment on your social media posts about, my gosh, I've heard all these scary things. Just as she said, you want to be able to articulate what has changed, what we've learned since that time.
Jaclyn (15:55.428)
Definitely, and I did a podcast with Dr. LaKeisha, who is an OB -GYN. She's awesome, by the way. She's fabulous, but I asked her what's the sentiment and the knowledge base around this transition of hormone replacement therapy being dangerous and an option that should be minimized for patients versus one that maybe should be embraced just for pure prevention purposes.
Dr Carrie Jones (16:01.658)
I love her.
Jaclyn (16:22.986)
And she thought it was like, well, amongst her colleagues, conventionally trained colleagues, she thought many had not updated their understanding of menopausal hormone replacement since the WHI, which got such widespread media publicity that like you saw it on the Today Show and you saw it on Good Morning America. Everyone saw it while they drank coffee at the breakfast table. Whereas the updated information doesn't really get those headlines. You have to be seeking out publications to stay current with that.
Dr Carrie Jones (16:53.282)
Even pharmacies, if I go get my bioidentical prometrium, the package insert that comes in the bag still says causes cancer. I it's multiple pages long and it's incredibly scary. And I'm a doctor, so I couldn't even imagine somebody with no medical background, which is common, going to pick up their prescription and getting this whole handout about, well, you can take it, but the risks are pretty phenomenal, so good luck.
And I know patients come back, they call the office, they freak out and they're like, well, I'm not taking this. I'm not taking this because the insert, the first thing says cancer, what do I do? And so even our pharmacies haven't updated the education that's being provided with these prescriptions.
Jaclyn (17:38.626)
Yeah, so I mean, we try to be as honest as possible in this course with where does the evidence sit. One great example is cognitive health. There's data suggesting menopausal hormone replacement could benefit women, some women. But the data is not clear on that, and it's not an FDA approved indication, and we're just not there. It's promising, but we're not there. We want everyone to actually have clear understanding of where we're at so that you don't fall prey to like, putting bad information out on social media and getting slammed for being overly promoting or saying something like HRT is great for every woman, everyone to be on it. We really want you to be very well informed in a fair and balanced way. And we worked hard to really toe that line. Really just where does the evidence lie? Which is, it's fun, challenging, and like I said, it challenged a lot of our own beliefs as we built out the course.
Dr Carrie Jones (18:32.188)
I was going to say when it comes to the neurocognitive, this is where I'm hoping amazing researchers such as Dr. Lisa Moscone, get on it. We need you, get your funding because I know she's looking at estrogen, estradiol and the brain. I know she's one of the researchers doing that and we need it. So it doesn't mean it's not possible or it's not coming. It's just unfortunately women were left out of the research for a very long time.
Jaclyn (18:42.158)
Get on it, we need you.
Dr Carrie Jones (19:00.41)
And then at that, menopause was like the last of their concerns. They're more concerned about fertility things, or you see a lot of research on PCOS, thank goodness, but menopause was always like, eh, we don't need to study that. And so now that we're getting more updated, one, money, and therefore two, data, we're finally starting to get some of these outcomes. It takes time.
Jaclyn (19:21.208)
Yeah, it takes time, it's much needed. So that first module really preps people to like, here's everything you need to know to identify patients where HRT might be an appropriate option, to know what is it FDA approved for versus not, which I think is also really important, especially when you think about things like insurance coverage for some of these medications. And then what are some other commonly, how would you describe that, commonly claimed benefits that women report, like mood improvements or libido, know, the testosterone we've got for libido, those other quality of life things that don't meet the criteria of like bone protection or hot flash management. But then we start to get into each of the hormones. So I really think that this is where there's a ton of value. So we have a module on estrogen, a module on progesterone, and a module on androgens, which is primarily focused around DHEA.
Dr Carrie Jones (19:53.722)
Great, quality of life, yep.
Jaclyn (20:16.564)
And these are where the rubber hits the road. We teach you everything about the main routes of delivery and medication so that you can actually decide what's best for your patient. And you know what hormones are out there, what they're called, what the doses are that you should be thinking about, and really comparing and contrasting the different options available. So let's start by talking about estrogen therapy.
Dr Carrie Jones (20:43.866)
Yeah, that's a big one.
Jaclyn (20:44.388)
Tell me a little bit about what are the main forms that practitioners should know about when they're starting to think about prescribing estrogen therapy.
Dr Carrie Jones (20:53.826)
I'd say the main most popular form, again, thanks to social media, is probably the transdermal. The top of the patch is what I see at least over and over. It's available for women, and it's an amazing, fantastic option. But as she said, there's also, of course, the oral form. So there are the capsules. And then there are all sorts of vaginal forms. And so as we go through the video, we break down the basically the who, where, what, when, why, and how including the different doses and including, for example, like not all vaginal applications are created equal. Some are very local, some are very systemic. And if you don't know that, you're just trying to keep it local, but you accidentally prescribed the one that's very systemic, then now you have a systemic one. Or maybe you're trying to do the systemic option, but you accidentally prescribed just the local option and they come back to you and say, nothing got better. Maybe my vagina feels better, but nothing else feels better. What's going on, and so to have this information, to know where the different levels are, the milligram doses or microgram doses, even in the patches, some patches are once a week, some patches are twice a week, and so even knowing that information is so helpful to be able to prescribe confidently.
Jaclyn (22:08.416)
Mm -hmm. Yeah, so that the estrogen piece I think is it's critically important It is like the hormone that you need to know about because if a patient doesn't have a uterus Astrodial might be the only thing that you're prescribing For a patient, so we definitely want people to feel really comfortable one decision We made in the course is that we don't teach by us and try us
Now that might be controversial because a lot of providers want to know about bias and triest, but we really think it's a little bit more complicated and it has to be compounded. It's not as readily available. Was that the right decision for this course, you think?
Dr Carrie Jones (22:42.172)
I think for a 101 level and probably the majority aren't familiar with compounding pharmacies. And so if you're literally just dipping your toe in, then you are likely going to go through an insurance company with your patient direct to a typical expected pharmacy. And while I love, you love, we love compounding pharmacies. That's like the next level. Like, okay, you've got the basics of HRT done. What's the next level and compounding could fall into that. So I think it's a good idea that it was left out. It is explained. I do cover what does it mean to be biassed or triassed? What does it mean to be 80 -20 or 50 -50? Because obviously your patients may come in on that or ask you about it. But again, if you're brand new and then you're trying to navigate what are these hormones, who's a good candidate, what's contraindicated, and then how do I write a prescription at a compounding pharmacy, let alone I've never even written one at your basic everyday pharmacy could feel a little overwhelming and we're trying to avoid that.
Jaclyn (23:38.774)
Yeah, we want to keep it simple. And so the next module on progesterone therapy, we really do the same thing, covering what are the different forms of progesterone that are available. There's a couple really key drive home points that when I was recording based on the slides, I was like, how many times can I say this exact same phrase over and over and over again? Without feeling like I'm really repeating myself and people are going to get, they're going to drive them crazy. Can you guess what those were? There were really two of them.
Dr Carrie Jones (24:10.832)
You're the two, I don't know. Does it help us sleep and it's calming and help sleep? no, I bet it's about, I'm gonna guess. I'm gonna go ahead and guess for the sake of the podcast. I bet it's about one is whether or not they have a uterus and progesterone and two topical progesterone versus oral progesterone.
Jaclyn (24:12.654)
Okay, one of them.
Jaclyn (24:17.242)
Now one of them.
You can guess.
Jaclyn (24:25.988)
Ding ding ding! That's right.
Yes, topical progesterone does not in any circumstance, there's no evidence to suggest that it can protect the uterus when a patient's on estrogen therapy. You nailed them, good job. You didn't even teach that module, but girl, I know you know what's up. Yeah, I mean, there's some really important take home points around that of like, when do you need progesterone? When do you actually need it for like risk protection for a patient with uterus?
Dr Carrie Jones (24:40.508)
I was, yes, I listen to you.
Jaclyn (24:58.174)
As far as conventional medicine and NAMs are concerned, you really only need a progesterone when there is estrogen on board and the patient has uterus. If there's no uterus, it's not necessary. Now we do talk about the fact that there might be benefits to women and like every provider that does HRT has seen women that still benefit from progesterone therapy even when they don't have a uterus. There could be reasons you might still put it on board. Sleep is one example that people report all the time.
And yeah, we see a lot of providers using topical progesterone, which we think is a really great option in perimenopause. It's one of the first kind of hormone therapies that people put on board, but it cannot convert into mutual protection. That was something that was taught by a major thought leader in the space for like decades. And it actually, if providers are doing that, if you're doing that when you're listening, one of your listeners here, that puts you at a humongous liability because there's just no data suggesting that it's effective. So.
We really want to drive hold those points. But then other than that, talking about what forms are available, what's the difference between synthetic progestins and a bioidentical progesterone, there's a lot of data on different safety risks. We actually think that that synthetic progestin is responsible for a lot of the negative outcomes that happened in WHI. So anyway, there's a lot to talk about with progesterone therapy.
Dr Carrie Jones (26:20.43)
And with the topical, I always joke, there's no hormone law. There's no law abiding hormone society. But if there was a law abiding hormone society that set literal laws, it cannot be topical progesterone if you have a uterus and you're on estrogen and you're trying to prevent hyperplasia. And I bang that drum just like you do over and over and over again, especially because sometimes people buy topical progesterone at the store or they've gotten it compounded in their perimenopausal years and they like it and they just want to stay on it when they go on estrogen at the same time. Or they have followed thought leaders who said topical progesterone is fine and sadly the studies are not there, are not there. And hyperplasia is on up, hyperplasia on up to something like endometrial cancer we just don't want to mess with.
Jaclyn (27:03.022)
Yeah, they're not there.
Jaclyn (27:13.555)
Absolutely. So then our fourth module is on androgen therapy. You mentioned the real focus of this, the real prize winner when you're getting started is DHEA therapy. So if you had to sum up the benefit of DHEA, especially for providers where testosterone replacement is off the table, maybe they don't have a DEA license, they don't feel comfortable prescribing it, how is DHEA a helper in the menopausal hormone replacement therapy world?
Dr Carrie Jones (27:39.864)
my gosh, well, I'll give you a little sneak peek versus giving it all away. But the vaginal DHEA in particular has been shown to be really helpful. One, if somebody can't do estradiol at all, full stop period, or is averse to it. They absolutely just don't want to. But because DHEA has that androgenic part to it, it's really nice vaginally because it does all the wonderful things that estrogen can do in helping the lubrication and even helping with estrogen in the microbiome.
And then giving you some, little bit of strength so it could even help with the integrity of the entire pelvic floor. So that's one little sneak peek of, you know, vaginal DHEA as an option for somebody who says lubrication's an issue, orgasm's an issue, control is an issue. I feel like my muscles are really loose down there. Like it's just, it's dry. It's not what it used to be. And it could be, and you can use it in addition to vaginal estrogens if you want to.
But that is definitely an area and people forget about it. People forget about vaginal DHEA. They only think about the oral or other options of DHEA.
Jaclyn (28:45.422)
Hmm. So the course, think, really comes together in the fifth module, which is where we walk you through a step -by -step process to assess patients. We talk about what lab testing should be done in the menopausal period. Of course, if you look at NAMM's guidelines, you do not need to run labs or confirm or diagnose menopause to start women on hormone replacement therapy. But we at Dutch, of course, one of the reasons why we exist as a lab is we absolutely believe that having more information can influence the dosing that you use, could help you choose the right hormone therapy, and really help with optimization. That's controversial. I don't know. What do you say about that, Carrie? Because I know you've been in this space a long time. You've heard the detractors who say it's all hogwash to be doing this extra testing. But I really have seen cases where it has make or break implications.
Dr Carrie Jones (29:43.472)
And especially when we're looking at bone health, preventing osteoporosis is an example that probably has the most studies around it. If you have somebody on estrogen and you have them on enough that it stopped their hot flashes, but it's maybe not to the point where it's going to prevent or support bone growth, how would you know that without testing? Because just stopping hot flashes tells you nothing about bone. And so that's why I like to have the information in my menopausal, postmenopausal women to get an idea of where you fall. Again, you and I were raised in the era of lowest dose for shortest amount of time. And there are practitioners who still to this day feel that way. So they're starting out with really tiny doses of estrogen. And again, the minor symptoms go away, but it's those health span longevity that I'm looking for, that's those symptoms that I'm looking for. And so I do love testing in those women. And addition, of course, biased, but usually those women are stressed out. And usually those women might have some nutrient deficiencies. There are other things and it comes to testing that goes with this whole transition that you can pick up on the Dutch test and how nice to be able to address it. It's like a whole 360 approach to make
Jaclyn (31:07.566)
Yeah.
Dr Carrie Jones (31:08.25)
their whole longevity and health span that much better.
Jaclyn (31:11.162)
Yeah, I completely agree. mean, there's also studies showing, there was a really interesting study, we go through it in the course, where they give, it's about 25 women, they give them like the same doses of patch and gel. They don't use creams, because it's just patches and gels that are FDA approved. And they find it's actually like a pretty high percentage, I think it was about 15 % of the patients in this small study that had abnormal pharmacokinetic curves, like different from expected. They maybe had, high absorption on the patch and none on the gel. They were very variable, more than I would have expected. And so I think when you think about the impact of that, that's a lot of women actually that would be, if you extrapolate that to a larger population, you're gonna catch women who are not following the typical pharmacokinetic curve when you apply a patch or a gel. And like you said, you might be able to tell if their hot flashes aren't resolved. However, you can't measure bone protection. And we also know that
Dr Carrie Jones (31:48.144)
Yeah. Yeah.
Dr Carrie Jones (32:10.033)
Right.
Jaclyn (32:11.194)
Hot flashes have about a 50 % placebo rate. When you give placebo to treat hot flashes, about half of women report improvement. So in my eyes, it's not necessarily a reliable indicator that estrogen levels are high enough. So I mean, we really, in this module, walk you through step by step how to get started. In fact, we have one of those yes, no algorithms where it's like, ask these questions and then start on this dosing. And then if your patient does well, here's what you do. If they don't, here's how you modify it. We also talk about kind of other testing that you could consider for patients in the perimenopausal and menopausal time frame. It's a great time to check in on other wellness parameters like thyroid health and things like that. And yeah.
Dr Carrie Jones (32:57.422)
Even lipids, I think even having before and after lipids, because we know our lipid parameters go up substantially for a lot of women as they lose their estrogen, estradiol in particular. And so she maybe came to see you last year or five years ago and everything looked great. And now that she's that much further along in this transition, all of a sudden her trilaterides are high and her LDL is high and her apolipoprotein B is high. But here's the cool kicker. Now you put her on a plan you put her on hormones and you can follow up. So maybe you're not following up or you don't think or want to follow up right away with the hormone testing, although we advocate for that, but at least follow up with these other markers and you will see that the hormones do make an impact and you can track those markers as it relates to cardio metabolic. So even just a big picture on testing, like don't rule out testing. The message out there seems to be don't test, full stop. And I think we're missing the full forest through the trees.
Don't test anything. Come on. We really have to take care of our patients.
Jaclyn (34:01.198)
Yeah, I couldn't agree more. And even when it comes to testing to get the right prescription for your patients, we recommend, we are really direct in this. If you're starting with a patient, here's the delivery method and dose that we think you should start with for most women. Barring any contraindications or anything in their baseline testing that would make them not a good candidate for this. Generally, here's where you would start. If your patient got partial improvement,
That's another time where I think Dutch testing could be helpful because I think it could tell you, well, should we be increasing estradiol or should we be thinking about DHEA? Because sometimes it's a toss up around which of those you should think about or HPA axis function and addressing some of the symptoms that can come up like sleep disturbance or anxiety or things like that when there's HPA axis dysfunction. Really, you can see root cause there. So there's so many different elements that come into play, but we really walk you through step -by -step how to use Dutch test for this. Again, controversial. Some people are going to listen and we're going to get haters and trolls that are going to say you shouldn't be doing this. But one, this has been validated. We published in Metapause. It was in 2023. And we published creams, gels, and patches. Like we've published monitoring data aligning it with serum.
Dr Carrie Jones (35:16.529)
Yes.
Jaclyn (35:22.936)
We know the data is reliable. We know about where women should fall in the Dutch test in order, or what it would look like on the Dutch test if they were in the serum range to offer bone protection. We can help people identify that. We even give you this template dial to use that you can compare to your patient's results and really walk you through step by step. What do you look at? What order do you look at it? And then how do you make modifications and adjustments to optimize things for your patient on HRT? And I feel like that is so crystal clear.
Like the team did such a good job breaking it down and will even show you like, here's what your patient looks like. But let's say you turn up the dial on estradiol and you can see everything else adjust and the way that it might adjust if you added more estrogen into the system. it's really very, the team did such an eloquent job. And then we talk about troubleshooting, what to do if things go wrong, if your patient's not feeling better, you know, all of the different problems that your patients might bring to you and how to go from there.
That to me feels like such a missing piece for patients, I mean for providers. And I can't wait to get this into their hands.
Dr Carrie Jones (36:30.522)
Which will be when. When is the big launch for this?
Jaclyn (36:33.474)
It's coming out this year, so really soon. We are wrapping up post -production. Again, when we put this together, this is better than really any course we've ever made before. We really invested in making sure it's clear, it's engaging, interactive, and crystal, crystal clear. So it's taken a long time for us to go from draft recordings to finished product, and that's because we've really gone through it with a fine -tooth comb.
We validated every comment and we've cited everything that's in there. You'll find a ton of citations and references that you can take a look at and have for people who don't practice. And so it's coming really, really soon. In the next couple of months, we'll have it to you guys in your hot little hands by the end of the year. And I really can't wait to share it.
Dr Carrie Jones (37:22.3)
For everyone listening, then you better make sure that you are paying attention to all things Dutch through social media. You better get on their newsletter if you aren't already, because of course this will be a very large announcement.
Jaclyn (37:32.514)
Absolutely. And I would just say the last thing, we have one more module in there that's a quiz, a case -based quiz. So that's another piece is we want people after they go through the course to be able to test what they've learned and feel like, did I get this? Did I not get this? Should I rewatch a module? Or am I good to get going? So that is another really good confirmation that you are ready to go and you really captured all the understanding. So bottom line, I'm so grateful for your participation in the course because
Of course, we know you know your stuff and you also make it super fun to learn from. So hopefully all of our listeners, like if you like Dr. Carrie and I and our banter, hopefully you're going to enjoy moving through this course as well.
Dr Carrie Jones (38:07.283)
Hahaha
Dr Carrie Jones (38:17.488)
Well, I'm excited.
Jaclyn (38:19.074)
Me too. Well, thank you for spending some time with me today to talk about it. Like Dr. Kerry said, if you want to make sure you get information about this course as it launches, you can visit DutchTest .com. If you're a provider, make sure you click Become a Provider. Get on our email list. You guys will be the first ones to know about it. And like she said, follow our social as well, because we'll definitely be putting out lots of juicy announcements when this becomes available. So we can't wait to share it from you, share it with you, and hear what you think. Thanks so much again, Dr. Carrie. See you soon.
Subscribe to the DUTCH Podcast wherever you get your podcasts
About our speaker
Carrie Jones, ND, FABNE, MPH is an internationally recognized speaker, consultant, and educator on the topic of women's health and hormones with over 20 years in the industry. Dubbed the “Queen of Hormones,” Dr. Jones is a Naturopathic Physician who did her 2-year residency focused on women's health and endocrinology. She went on to get her Master of Public Health and was one of the first to become board certified through the American Board of Naturopathic Endocrinology. She was the first Medical Director for Precision Analytical (the DUTCH Test) and the first Head of Medical Education at Rupa Health. She co-hosts the highly popular show, the Root Cause Medicine Podcast, that has over 9 million downloads. She is the Clinical Expert for the Lifestyle Matrix Resource Center, was on Under Armour’s Human Performance Council, works with the new League One Volleyball (LOVB) organization and is an advisor to Metapause. Currently she is the Chief Medical Officer at NuEthix Formulations and Head of Medical Education at Metabolic Mentor University.
Show Notes
Sign up to get early access to the Introduction to Hormone Replacement Therapy course. This course is exclusively for registered DUTCH Providers – become a DUTCH Provider today!
Follow Dr. Carrie Jones on Instagram @dr.carriejones.
Please Note: The contents of this video are for educational and informational purposes only. The information is not to be interpreted as, or mistaken for, clinical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment.
Disclaimer: Special offer of 50% OFF first five kits is invalid 60 days after new provider registration.