Kristin Gemme: 0:00

peptides are really running the show with our physiology and how our bodies work. And as technology has moved throughout the decades here, we as a scientific community have really figured out how to harness them and utilize them synthetically, to kind of biohack our bodies and make it do the things that we want it to do.

Philip Pape: 0:24

Welcome to the Wits& Weights podcast. I'm your host, Philip pape, and this twice a week podcast is dedicated to helping you achieve physical self mastery by getting stronger. Optimizing your nutrition and upgrading your body composition will uncover science backed strategies for movement, metabolism, muscle and mindset with a skeptical eye on the fitness industry, so you can look and feel your absolute best. Let's dive right in. Wits& Weights community Welcome to another episode of the Wits & Weights Podcast. Today I'm joined by Kristin gem, a board certified physician assistant with over 10 years of experience as a PA and 16 years in the medical field. She's the owner and operator of ethos, medical aesthetics and wellness in nearby Avon, Connecticut. And we connected through my coach and recent podcast guests, Andrew Romeo, I had the pleasure of being on her podcast just to pinch to talk about nutrition and wanted to bring her on my show to discuss peptides, hormone therapy, medical weight loss and other ways to complement lifestyle interventions. Kristin has a passion for helping people achieve optimal health with personalized holistic interventions such as skincare, injectables, lasers, PDO, threads and wellness programs. And as I mentioned, she's also the host of the just a pinch podcast, where she discusses the good, the bad, and the ugly side of aesthetics, fitness, nutrition, and wellness. Kristen, welcome to the show.

Kristin Gemme: 1:49

Thank you so much for having me on. I'm excited to be here.

Philip Pape: 1:53

I'm excited as well, because it's been a while since we talked and I want to get a little bit into your backstory first and then dive into some of the specifics here people want to know everything about so you know what inspired you to get into this field to become a PA but also specifically pursue a career in aesthetic medicine.

Kristin Gemme: 2:10

I so my road to becoming a PA was a little bit complex, but I don't think outside the norm. I was in my undergraduate education over at Endicott College in Beverly, Massachusetts, and I was in the nursing program. And while I was going through so in my clinical rotations, I found myself being very much so drawn to what the doctors and the PAs and NPS were doing and drifting away from my nursing care plans and IV drip titration. So, I had a real kind of come to Jesus moment with myself and my advisors, and said, You know what, I think I want a little bit more than I think I want more of the science, I want to be the one making the decisions and making the calls, as opposed to implementing the plan, the way that nursing typically goes. So I jumped ship, I switched my major in the middle of my education into biotechnology with a biology concentration, and pre med. So I wasn't sure at that point if I was going to go through to medical school or what I was going to do. But I had some friends and family members that were going through the medical education and really recommended that I investigate physician assistant as as a career versus an MD, and I am so happy that I did. And from there, I went to Springfield College and did their graduate master's program to become a PA. And it was during that time that I really found a love for aesthetic medicine and skin. But I wanted to do a little bit more than just classic dermatology. I love skin. I love the science of it. But I like to do stuff, I'm a do stuff kind of girl. And I like to do procedures, I like to use my hands as well as my brain. So I found the aesthetic side of dermatology and skincare to really be where I would thrive. So all day I am using my hands I'm you know creating these treatment plans in my head and using the science and then implementing that with my hands, whether it's utilizing laser technology, doing a lot of injectables, placing IVs, all sorts of different things. So it was just kind of the perfect blend for me. Okay,

Philip Pape: 4:25

and I liked that combination of doing and coming up with a plan but also using your hands and brain aesthetic medicine. Tell us just a little bit more about that because we don't get into that on this show as you would imagine as much because I want to be able to tie it in a relevant way to you know the listeners thinking where does this fit into an overall nutrition or fitness plan? Absolutely.

Kristin Gemme: 4:46

And so I mean a lot of that comes from my my personal background so I did not enter the PA space directly into aesthetic medicine. I always knew it was something that I wanted to do. But it's not where I started because I know that it's I needed a good base, I needed a really strong medical base. And I love medicine, I love all of it. So I worked for several years in primary care, treating ages five to 100 plus. And from there, I worked in the surgical trauma critical care unit in Hartford and took care of critically ill patients, you know, going through some of the worst days of their life and their family's lives, I did some part time and full time work in urgent care. So I've kind of seen it and done a lot, I've had a lot of exposure to medicine, and especially to primary care, because I, I like the concept of being able to take care of somebody across the lifespan, but I was really, really disenfranchised, truly being directed by insurance companies. And I mean, that's a huge conversation to get into with just the current state of medicine in America. But it made it really difficult to take care of people the way that I wanted to take care of them, and to be able to give them the time that they deserved, and to investigate and utilize tools that aren't readily available in the primary care world. So from there, I was able to transition into aesthetic medicine where I got to do the stuff. And I got to learn the skincare even more. I studied under a facial plastic surgeon in Massachusetts and was able to see things from the inside out assisting in facial plastic surgery, which I think was really imperative in my knowledge today, of skin and anatomy. And what aesthetic medicine ultimately is, is we're utilizing medicine, technology, biotechnology, for elective interventions. Now a lot of what we do is truly taking care of the skin, but it's nothing that insurance companies are going to be covering. So this is all out of pocket costs for the patient, trying to improve the health of their skin. You know, you can, you can go I mean, the gamut of aesthetic medicine goes everywhere from purely aesthetic, you know, reduce my wrinkles, I want a brow lift, I want bigger lips, I want all of these things to make me feel and look more beautiful, all the way to treating burn scars, acne scars, surgical scars, helping erase trauma from people's skin and helping them on different levels. So there's a real wide range of aesthetic medicine. So aesthetic, dermatology, aesthetic medicine, it's all there's a bunch of different terms out there for it. But I do everything from you know, plumping the lips of 25 year olds to helping erase domestic violence scars off the bodies of women and everywhere in between. And when I opened up ethos, not only was aesthetic medicine important to me, but wellness was to where I kind of circled back to my primary care days, and even my critical care days. And I really wanted to integrate total body optimization. And that's kind of my tagline for ethos is total body optimization. Because it's not just how we look on the outside, it's truly we need to be healthy on the inside and feel good. And that's kind of how I define wellness too is it's you're not just not feeling bad. You're feeling good. And that is what we're looking for with wellness.

Philip Pape: 8:15

I love your answer I think a lot of people can relate to you call the disenfranchisement disillusionment, whatever of the GP and primary care industry as well as the lack of options or the even the gaslighting, whatever phrase you want to use when it comes to hormone issues, women's health. I mean, I've seen it all with my clients with my wife, you know, with so many people. Yeah, and the idea of pursuing wellness for its own sake for you, whatever that comes in whatever form is a positive thing. Like, it doesn't matter if it's everybody has different reasons, right? And there may be a physique or physical reason there may be a an underlying tie in between something that happened to you, like you said that domestic violence scar and, and trauma or how it makes you feel all that. So I'm fully on board with that. And the total body optimization approach is really cool. So why don't we get into some specifics? Because there's areas here that I may have talked about on the show once or twice, but you can really shine a light on it. The first one is peptides, right? Yes. They what are they? I know they're proteins. I talked to Dr. Ron Maclean a long time ago on the show about it. What are they? How do they work in the human body just so we can start the conversation there? Oh, I mean, we

Kristin Gemme: 9:24

are we're made up peptides. We function with peptides. peptides are nothing more than short chains of amino acids, which are the building blocks of proteins. And these peptides are doing, I mean countless different functions in our body. It's also part of a lot of medications such as like insulin, insulin was really truly I believe it was the first peptide based medication available. So peptides are oftentimes signaling they're mimicking something, they're turning something on, they're turning something off. You're going to work in our body and either mimicking Have a hormone, or a neurotransmitter, or they're just helping your body function better. There's certain peptides that get released by your body naturally to say, hey, release more more insulin release more glucose, release more of this neurotransmitter, release more of the serotonin, all of these things are signals. So peptides are really running the show with our physiology and how our bodies work. And as technology has moved throughout the decades here, we as a scientific community have really figured out how to harness them, and utilize them synthetically, to kind of biohack our bodies and make it do the things that we want it to do. And peptides, for the most part are extraordinarily safe as well. There's a lot of research behind them. They've been being used for decades across the world. And there's a wide range of them. Now, within peptide therapy for what I do, we're really focusing on the growth hormone releasing peptides or stimulating peptides. So these are products such as Sermorelin, ipamorelin, CJC, 12, nine, five, those are some of the more common ones, but there's a whole bunch of them out there. And what these are doing is you're injecting them into your body about five, three to five nights a week for cycles of anywhere between three to six months. And what you're doing is right before bed, you're injecting it so that your own natural growth hormone that's getting released by your brain at night, when you hit that deep sleep cycle is boosting up more. So growth hormone really peaks when you're about 20 years old. And after that time, all it's going to do is your natural production, is just going to slowly go down. Like with everything in our body, we just stopped producing as much. So we want to give it a little boost. So what's the alternative to it? HGH? Everybody's pretty familiar with that term? And is it an option? Yeah, it's an option, it's not an option that I offer. Because it's a little bit more dangerous, there's a lot more side effects that come with it, you're supplying an exogenous outside hormone. So when you do that, your body's going to stop making your own. So it becomes a lot more of a chronic thing that you need to stay on. Whereas peptides, all we're saying is, Hey, make a little bit more, but it's staying within your body's own natural feedback mechanism. So it's almost impossible. I never say impossible with anything with the body. But it is almost impossible to overshoot your target and to start cranking out so much growth hormone that now your heart's enlarging, your organs are enlarging. And we're creating, you know, situations that could even give you diabetes, that's those are things that we see more so with HGH that we don't see with peptides. So peptides are a safer alternative to helping boost your own natural HGH while staying within your body's own safety parameters. Okay,

Philip Pape: 12:55

so I want to explore that a little bit specifically, if someone want to understand which populations this is for, because it sounds like there's an aging component to it because of the loss of your natural production. But also, you know, I'm a big fan of understanding like the before, after, like, what kind of data what kind of tests do we get to actually see that it worked? And it's not, you know, some magical elixir that because people are going to be skeptical of this stuff, especially if it's newer on the market. How do they know that it actually made a difference other than that, and how they feel? So I want to, let's talk about that. Yeah, so

Kristin Gemme: 13:25

for me, the way that I practice medicine and utilizing peptides is safety always first, we always start out by doing some blood work and blood work, we can either have you go to a lab or my preference is I draw right from you right in my office in my chair during our consultation. So when we look at your blood work, we're really trying to look at a snapshot of your overall health. So we're looking at your metabolic health. We're looking at your thyroid function, we're looking at your hormones, especially with men. bloodwork tends to work best for hormones. So looking at testosterone, free and total sex hormone binding globulin, estrogen, ultra sensitive estrogen at that, we're looking at C peptide, we're looking at a fasting insulin level, your hemoglobin a one C, which is kind of your average blood sugar over the course of three months, I'm going to look at how your kidneys, liver, electrolytes, a complete blood count all of it. We may even dive deeper into some other things too. And one of the most important markers that I like to look at when looking at peptide therapy is an IGF one level, which is an insulin insulin like growth factor level. This is ultimately what we're trying to target when it comes to growth hormone. And with these peptides, so we want it within a certain range. We like to see high normal we can even see outside of high normal but only for short periods of time. If we were to have that level be too high too long. That's when we can look at some some studies that show that it can affect your cardiovascular health or your your your glucose metabolism and Things like that. But that's why we have all of these safety parameters set already with how we do peptides, there's really safe protocols. And if you follow the protocols and you're monitoring these things, they're extraordinarily safe. So we always start out with that bloodwork. When I draw it in my office, I get results back, typically within 48 hours, which is faster than any any lab that you're going to see around here. If you go to quest, we're waiting two weeks before we get results back. So love to see you in my office for this. So once we have your baseline health, we look at everything we say, all right, are you a candidate for peptide therapy? What is your IGF one level look like most adults that are over the age of 40, I'm seeing their IGF one levels, pretty low, either remarkably low or low normal. And these are people that are going to benefit honestly the most for peptide therapy, because they are deficient. And we know that they're not producing enough of their own natural growth hormone. Now even people that are completely normal within their IGF one levels, or even high normal, you're still a candidate. As long as you're not off the charts high at baseline, you're all of your organ functioning is good. You have no major chronic medical problems, like big things that are affecting your organ function, we can go ahead and get started. And with that, I always start slow and low. So we're going to start you off at an introductory dose, we're going to see how you feel, see how things are going for you see if you're having any side effects or not. If you're doing good, each month, we're gonna bump you up a little bit until you're going to really feel that difference. And so far, the results have truly been amazing. And by results, I mean subjective and objective. So subjectively, people feel great, you feel better and better every week with peptides, typically week one and two, you're just gonna be sleeping better, it can tend to make you a little bit sleepy, which is awesome, because that's what we want, you're injecting it right before bed. So you're gonna be sleeping deeper than you ever have. If you have any of the wearable biometrics, like I have an aura ring that I like to wear. This showed me after two doses that I was getting much, much deeper sleep and for longer periods of time. So my restorative sleep was better than it was by itself with just my own body here. And for for reference, I am, you know, 36 years old, so, okay, got much, much better with just that. As the weeks go on, I start noticing at the gym, it almost feels like when you first start taking creatine where you feel like oh, I've got a little bit more in the tank that I used to, you know, I can tap into that extra gear that I couldn't really get to last time. And I'm recovering better, I'm not as sore as I was. All of those things that make your your gym going experience better get better. As time goes on, aches and pains start to go down kind of that chronic, oh, I have that tendinitis that I just can't get rid of. All of a sudden you wake up one day and you realize that like, Oh, um, it doesn't, it's gone, it's fixed, it's better. And then from there, your energy levels get better, your energy levels get better. Also, because you're sleeping better, you're more restorative, you know, we all know top to bottom that sleep is the most important thing that you can focus on when it comes to your own wellness, wellness and well being and being able to get over illnesses, injuries, and get those gains in the gym to you have to sleep. You know, sleep is more important almost on your training session itself. From there, it's going to help improve your metabolic health. Everybody that I do repeat bloodwork on, which if you're on peptides, we're going to do repeat bloodwork at the end of your first three months cycle. And it's amazing people that didn't have metabolic issues, you know, their cholesterol was normal, their blood sugar's were normal, nothing that any doctor would ever look at and say there was a problem with still improved people's a onesies that were normal, or even better normal. Cholesterol was good. It's amazing now, so we're seeing real improvements in metabolic health. And as we're seeing those improvements in metabolic health, we're seeing changes in body composition as well. body composition with peptides does take a little bit longer to happen. That magic really happens between months three and six, just a longer, longer exposure to the medication. And you're going to support lean muscle growth. So it's going to be easier for you to put on lean muscle, you're not going to bulk, especially for women like you are not going to just get swell off this stuff and feel like you're getting bulky and big. It's not HGH and I can't repeat that enough.

Philip Pape: 19:35

And the women listening to this podcast by now should know that muscle is the best thing in the world.

Kristin Gemme: 19:39

It's good athlete. So and we also know here the more muscle that you have, the more fat you burn because we are increasing your basal metabolic rate. So we see weight loss, we see fat reduction because of all of these health metrics. It's not a magic pill for weight loss. It's not something that you take and all of a sudden you should All this body fat, it's a long term, long term thing, you know, and it's it's fixing you from the inside out. Now, the reason that we take you off of it at six months, is ultimately not because it's dangerous to stay on, but because we want you to be able to utilize it long term in cycles. And if you were to continue to use this without breaks, there's a chance that your body just gets used to it, and you're not going to get those benefits from it anymore. So we give your body a break, everything goes back to normal, there's no withdrawal, I just came off of a six month cycle myself, I am about a week off of it. I feel no different. I feel no different. There's no withdrawal whatsoever.

Philip Pape: 20:40

Yeah, I'm on board. So that's that sounds like, you know, a lot of the benefits people hope to get from testosterone or anabolics or other things. And it sounds a little bit safer than that. Well, how do you separate that from natural intervention? So for example, IGF one, you know, we've talked about here can also be increased by increasing in protein, you know, a lot of people are deficient, also by strength training itself. How do you divorce the two? Because, you know, we want to understand that that is giving you the impact independent of those factors, do you, you start somebody on lifestyle changes? Where does it come into play.

Kristin Gemme: 21:13

So I mean, I always promote lifestyle changes, if we are if we're doing an intervention, like peptide therapy that you are committing to, and you're investing in, I mean, sure, you can sit on the couch and change nothing about anything that you're doing and decide to not work out and not eat right and not do the things and you're still going to get some benefits, because you're still going to boost your own natural growth hormone. But it's a waste in my opinion. So anytime that we're starting these things, we're also discussing the need to do some weight training, to exercise to dial in your nutrition to make sure that your your lifestyles including good sleep, you know, I don't want you, you know, injecting yourself at 3am with this stuff, when you're getting into bed to get up at 630 for the day, like we're kind of defeating the purpose of it. Now, how do we differentiate between what's coming from the peptide versus what's coming from the other parts of your lifestyle, you cannot, you cannot unless you were to do a controlled study where you are doing nothing other than utilizing your peptide and not doing the other things. And ideally, I don't want you to do that. So it's all a cumulative effect. And one thing I didn't mention with peptides too, especially with men, if men are a little bit on the low side of their testosterone, because like I said, I like to look at that when we're looking at peptide therapy, too. If you're a little bit low, we don't necessarily need to reach for testosterone right away, either. I do you typically see testosterone levels boost, you know, mildly, it's not going to shoot up into a huge range. It's not testosterone replacement. But because we are dialing in your body and your metabolic system here, I do see nice modest boost in your testosterone level as well with peptide therapy.

Philip Pape: 23:00

And you mentioned the increase in lean mass and improvement in body composition, which which we know comes from both adding muscle and losing fat, usually through diet. Is this because of the additional performance you can gain in the gym? Or does it is it somehow directly making it easier to synthesize muscle? Right? Well, what's the mechanism there? All

Kristin Gemme: 23:17

of the above all of the above. So if you look at things like HGH and growth hormone, those are the benefits that you're getting from peptides, you're just getting it in a smaller pulse. So every thing that you are doing is augmented, you know, think of like every rep that you're doing every squat, every curl, everything that you're doing is augmented and almost on steroids, right? So you're getting more out of each of those things.

Philip Pape: 23:46

Yeah, I'm gonna have to come in and experiment with this. And to talk about it on the podcast in my next next cycle of my building phases. Let's talk. Yeah, because I'm curious about that to see the differences and get some blood work or whatever. How do you see this evolving over the coming years and decades is peptides? I know you said certain peptides like insulin is have been around for a while. But I've heard the term used more often in terms of these specific types. Yes, yeah. Tell me more about how the field is evolving.

Kristin Gemme: 24:14

So it's, there's a lot up in the air, honestly, with how it's going to evolve. Very recently, if you were to do a Google search right now on peptides, specifically ipamorelin, CJC, 12, nine, five, I butum. Morin, any of these, you're going to see a big pop up all over Google saying FDA shut it down. And these are illegal and we can't use them now. Yes, and no. peptides, the ones that I'm talking about have never been FDA approved. That's an all of my consent forms. That is what we talk about with patients. These are not FDA approved medications. They are not FDA approved, mainly because they are not as efficacious, as he Ah, and for something to get FDA approval, it has to prove its place, it doesn't matter that it's safer, it doesn't matter that it's doing very similar things in a safer manner. The end results of studies obviously, are not going to be as potent as HGH. So that is one of the main reasons why they're not FDA approved. Now, the memo that went out several weeks ago regarding taking these peptides off the market, it's not that they're illegal, it's not that you cannot use them, what they did was they made it so that compounding pharmacies, which is where we get them from, can no longer obtain the raw materials to synthesize them. And now what I'm about to say is going to be nothing more than my opinion. You know, nobody truly knows the nitty gritty, you know, backdoor deals going on here. But I've spoken to many providers that do similar things that I do here with peptide therapy. And we're all pretty much in agreement that the wrong people were making money off of peptides. And the powerful people were not so well, because they're not FDA approved, big pharma companies are not able to synthesize them, they are not able to put their price tag on them and a brand name and put them on the market. So they're not getting paid off of it. And unfortunately, a lot of those companies also have their hands on the FDA. A lot of high ups in the FDA, are old executives of these pharmaceutical companies. So there's a lot of conspiracy opinions about all of this, the memo that I read from the FDA that went out to the compounding pharmacies, it just shook my head. You know, they're saying, Oh, we saw safety issues with this medication when it was administered intravenously? Well, it's a good thing that we don't administer them intravenously. I mean, if you grind up carrots into a puree and inject it intravenously, you will die. Does that mean that carrots are unsafe and should be taken off the market? No. So there's a lot of drama around it. But in all of our opinion, for the providers that have been using these for years, and have seen incredible changes in their patient's health coming off of, you know, chronic medications, sometimes being able to come off of, you know, lifelong medications to treat metabolic conditions, or even anxiety, medication, depression, mental health, all of these things, people are taking less pills, because of peptides. And, you know, to not sound like a conspiracy theorist, I think that has something to do with all of a sudden the shutdown of those specific peptides. Now, there's just a couple of them on there. So not everything is on there. And we can still get them completely fine from all of the pharmacies that we've been getting them from, you know, ipamorelin, which is my personal favorite, it has a very low side effect profile, it's very safe, it's easy to dose, it's very reliable, that one, I'm no longer going to be able to get believe me, when I got that memo, I stockpiled it. So I have a hefty pile of it in my stock here. For all of my patients that are currently on it, they need to be able to continue their cycles. But Sermorelin was not taken off the market, which is crazy, it does the exact same thing as ipamorelin, the exact same thing. So that's just the one that I'm going to be transitioning patients on to. So there's a ton of research about a lot of different peptides out there right now. And some of the biggest players in the world of peptides in medicine, some of the physicians out there, I mean, they're using peptides that like we've never even heard of. So the technology is there, the advancements are there. So I think over the next decade, we're going to see kind of a whittling down of peptides into ones that are, you know, really tried and true, are safe, have a lot of data behind them. And that we can trust because that's the main thing, especially when we're working off label, you know, or non FDA approved procedures or products is you as the provider really need to feel confident with what you're offering patients what you're doing. Yeah,

Philip Pape: 29:14

a lot of what you said, makes a lot of sense. When you look at the health care industry as a whole and how, you know, the sick care versus health care paradigm the you know, the money is definitely made from keeping people in a certain state where they're gonna buy meds, I mean, we know it and I don't even call it conspiracy. It's just truth. You see it out there. Now

Kristin Gemme: 29:31

we're a Sikh culture. We're not a well culture, you know, no, makes money when people are healthy. Yeah,

Philip Pape: 29:37

and I think the same thing for hormones because this is a good segue hormone treatment. I've seen it with so many women in my life, that it is like pulling teeth to get I pretty much say don't talk to your primary care like your PCP anymore about hormones because they're not gonna help you like I just seen that 90% of the time. There could be a few good ones out there. But both access to treatment, the types of testing you know, Oftentimes the testing that's performed is inadequate, because it's, you know, maybe it's not the free version of the hormone. And maybe they need, I don't know, saliva or metabolite testing and all this. So let's get into hormones laid on me, you know, the testing side who benefits what kind of therapy men and women, you know, all of that

Kristin Gemme: 30:18

there's a wildly wildly diverse range of, of hormone therapy out there. And most of it is being done. Now, by these wellness centers, you basically, in order to truly take care of somebody's Hormonal Health, not just testosterone, not just estrogen, I mean, just about any hormone in your body. You can't involve insurance companies, insurance companies have these really bananas standards. And like just numbers that say, if you are this number, we will cover this medication. If you are this number, we will not they're not treating the patient. They're not insurance companies don't allow you to treat the patient, they're just treating a number. And they're not covering a lot of the testing and the testing is done incorrectly for men. Yep, we can pull blood, we can see some really good results easily with blood with women, bloodwork for hormones, depending on what we're looking at is relatively useless. You know, it will tell you if there is a massive problem with a hormone, but it's not going to give us the information that we need to know to be able to determine really your hormonal replacement levels, and saliva testing dried saliva is truly the best for that. And as we know, women's hormones are wildly complex, and are so different than men. Men are simple. They my men treatment in many ways. One equals two, here we go here, like here's our algorithm, this is great, easy to treat, you give me a female, and it's like, Let's put on our thinking caps. Let's stare at this for a while. Do a ton of physic physical history, we need to know exactly where you're at in your menstrual cycle, what day you're on. If you are Peri menopausal and irregular or you are postmenopausal. Yay. Now we get to figure that out too. So it just makes it a lot more difficult, but it can absolutely be done. Now there is a lot of weird distorted old studies when it comes to hormone replacement as well, specifically, the sex hormones. So estrogen, progesterone, testosterone. And if you look at some old studies, they were saying, oh my gosh, this gives you testicular cancer. This gives you all sorts of different types of cancer, it's going to give you blood clots, it's going to make you have a heart attack and die. And unfortunately, a lot of physicians and providers in the space, whether it be primary care or urology, OBGYN, they read those studies and then just said, Okay, we're not doing hormones, we're gonna wipe our feet of that we're not touching them, because it's not worth it. And it really comes down to those studies were flawed design. Testosterone will not give you testicular cancer, if you have testicular cancer, testosterone replacement can potentially expedite it, it can make it advance faster. However, recently, there was another study that just came out that showed that now some forms of testicular cancer are actually being treated with testosterone. So there is a lot of combative data out there. And when it comes to cardiovascular risk, with testosterone therapy, the thought was always it's bad, it's gonna give you a heart attack, it's not good for your heart. It's actually very false. If you have you are causing so much more damage to your cardiovascular system, being deficient in testosterone than being on it. So you're actually boosting your cardiovascular health when you are on replacement. Now from a medical legal standpoint, this is where it gets really kind of into uncomfortable territory for some providers and people and it really depends on your providers. Comfort level, some people will say, Listen, I don't care if you've had a cardiovascular event, you're really low and I think that you're going to benefit from going on therapy. Absolutely. And they're gonna go on it. Other providers are gonna say, Oh, you you have a personal history of a heart attack 10 years ago. I'm not taking that risk and

Philip Pape: 34:41

somebody else's same reason, right? Yeah. No, it's

Kristin Gemme: 34:45

It's tough. And it's it's really personal preference on that. Now, when it comes to female hormones and those studies, those ones are also a little bit complex to a lot of the poor data that was coming out of those was were based on synthetic hormones. Progesterone especially right? Yes, exactly coming from like the pregnant pregnant marier and the PMU, foals, all of that so coming from synthetically made hormones that data is not supported by bio identical hormones bio identical are exactly what they sound like bio identical, they are molecularly identical to the ones that your body makes on their own. So those kind of let

Philip Pape: 35:29

me stop you. So the synthetic progesterone, is that also in the pill, or at least one variant of the pill? Yes. And doctors have no problem prescribing that to women of all ages, for whatever reason, instantly. Okay, continue.

Kristin Gemme: 35:43

Welcome. Welcome to Oh man. No,

Philip Pape: 35:45

I've heard it. I can empathize against so many women I know after this.

Kristin Gemme: 35:50

Okay. Absolutely, absolutely. So now when it comes to replacing hormones, there are a ton of different ways to do so. And your local compounding pharmacy that is of high quality standards is going to be your best friend. Because going to your local CVS to pick up your prescription is likely going to be not covered by insurance and take your hat off when we go through compounding pharmacies to get either an injectable form of testosterone, which is my personal preference. Or you can get compounded creams or lozenges or pills there. I mean there are you name it. If you need a way to get a hormone or substance into your body, your compounding pharmacy is going to be the one to do it and to do it well. Now with that being said, not all compounding pharmacies are built the same. You really need to be careful about who you're going through making sure that they are third party tested and vetted and have a very good reputation for for standards of quality. I have a handful of them that I use. And I trust them and they're wonderful and they are affordable, which is the main important part here. So with testosterone, I really like it injectable form testosterone cypionate is one of my favorites. There are different ways that you can play with it. You can use different testosterone blends so that way they have different halflife. So you're, you're missing big peaks and valleys. If somebody's really sensitive to that, but testosterone cypionate is my favorite go to to get men on it and to get it just started and then we go from there. Start simple. I like to keep things as simple as possible for people.

Philip Pape: 37:25

Yeah, the minimum minimum minimum effective dose.

Unknown: 37:27

Yes. Hi, my name is Shawna and I want to give a big shout out to Philip Wits & Weights. I discovered his podcast just a few short months ago. But I quickly realized how valuable this content is. With all the many fitness and nutrition influencers out in the world today. I often suffer from information overload. But Phillip poses careful questions to his guests that get to the meat of the subject matter. While most everyone offers free guides to this in that what I found most unique about Phillip is his live training and weekly q&a sessions. If I can't make it live, I can always catch the replay. I am very grateful to find someone I feel is so passionate and genuine to His purpose. while also being hands on within the Wits & Weights online community he is truly only a click away. Thanks Phillip for all you do.

Philip Pape: 38:16

Let's talk let's assume for a second while we're testing men, because I've heard so many different so many different guidance on the ranges of values, right we have the population range that doctors use, yeah, then we have the symptom centered kind of approach of like, it almost doesn't matter if you have symptoms. And then we have kind of different ranges in between what what is what's your guidance.

Kristin Gemme: 38:39

So my personal philosophy on it is is a blend. So you need by law, you have to have a symptom. In order to go on testosterone, you have to have a documented symptom. The crazy thing is that it can be as simple as I have chronic fatigue. I am tired all the time. I don't feel like myself. I feel depressed. I'm not sleeping well. I am not getting morning erections anymore I'm having difficulty with with sexual activity, I have decreased desire, you know, my wife hates me right now because I'm not acting like myself, I just feel like a lump on a log. This is kind of the chronic condition that we see with men with low tea, at least on some level. So you need to have at least one symptom. From there. You don't need to be real low, but you need to be suboptimal. You know, if you have a testosterone level naturally when we pull it of, you know 900 You know, you're you're you're flying high you are a high tea king here as I like to call them. And, you know, you're just like, Yeah, I'm tired from a little depressed. We're not we're not going that route. You know, I don't think it's the most appropriate because for the most part once we start testosterone you're on it, you know, we're we're replacing it. We are Replacing a hormone. So your natural production of it is going to kind of come to a halt to some degree. So it's not something that I take lightly. So when somebody wants to start testosterone, you know, we have a real conversation about this being lifelong treatment the same way, if you need thyroid replacement, you know, I gotta take my thyroid pill every day, I gotta do my thing got to replace what's what I'm missing. This is that too. So my personal ideal ranges for testosterone when I'm replacing somebody, if they are symptomatic, and on the lower end, my goal, as long as they are tolerating a well is to get their testosterone level between 700 to 1100. You know, that is that is like optimal functioning. And as long as they're not having any sort of crazy side effects from it, you know, again, I'm not just cranking it into people trying to just like, you know, ramp up. Yeah, you know, we're not using it in that way we're doing it, we're titrating your dose based on your symptoms and your levels and your side effects.

Philip Pape: 41:01

If someone is like, let's say, a moderate case, like in their in the five hundreds, and symptoms are minimal, but again, like you said, you have to have at least one symptom is that is that still in the range? Because you said you currently have 711, but I've always thought of like four or 500, as probably enough at the low end. But yeah,

Kristin Gemme: 41:20

so we have it in, I would say, probably not just this country, but in the world right now we there is a I'm gonna call it a pandemic of low testosterone, and hormonal imbalances. You know, our world is just saturated with endocrine disruptors, between all of the chemicals and plastics and toxins that we are exposed to, across our entire lifespan. You know, being the age that I am, I grew up in the plastic world, everything that we touched as kids was plastic and artificial, you know, everything was just plastic, you know, I only imagine how much plastic is sitting in our bodies now. And it's been there since we were, you know, infants. So all of these things disrupt our hormones. And so there are far more men almost of all ages now that have lower testosterone levels than what they should have, you know, based historically, a lot of things can play into it, the endocrine disrupters, chronic stress, sometimes even people that work out a lot, you know, you can literally train your testosterone. So there's a lot of different things that can play into it. But post traumatic stress, a lot of military vets come back from overseas, and they will have chronically low testosterone and feel symptomatic from it all because of that PTSD and the trauma that they sustained over there. So there's a lot of different scenarios that cause that. So if somebody is, let's say, 35 years old, and otherwise healthy, you know, works out takes care of themselves, no real reason why they should have low tea, their tea should be higher than 500, then especially if they are feeling symptomatic at all, you know, and when you go through my questionnaire of symptoms, people are oftentimes alarmed of being like, I didn't even think that that could be a part of it. You know, a lot of people think, Oh, my, I'm just depressed, you know, and they reach for their SSRI take the Prozac take the Paxil. And it's not a primary depression issue. It's a low testosterone issue. So I do think that people with mental health issues do need to have some some endocrine and hormone testing done before just immediately reaching to some of these other drugs as well. Because it could be very easily fixed primarily from that. That reason there.

Philip Pape: 43:36

I'm with you. I'm with you there. Yeah. For folks listening for the men listening definitely just get it tested, at the very least have a number there have a baseline. It's so easy. It's done. Now, women Okay, so now we get open up Pandora's box of all the potential, you know, DHEA and testosterone and estrogen thyroid. And I have clients that are a lot of my clients are perimenopause, post menopause, on treatment or need it or in some cases, they you know, the dosage has been able to bring brought down once lifestyle interventions come into play, which is Yeah, I think yes. But inevitably, with age humans weren't, like you said they weren't designed necessarily live this long, but also the endocrine disruptors. So what does the profile for woman look like to somewhat simplify it? So it doesn't get too complicated? Oh,

Kristin Gemme: 44:19

my goodness, there's really unfortunately, no real simple way to simplify women's hormones.

Philip Pape: 44:26

Like what's step 123. For women, step one is

Kristin Gemme: 44:29

going to be let's get your let's get your testing done. So we're gonna draw some blood, we're gonna get a saliva sample, we're going to send it off to the lab, we're going to see where you stand. You know, ideally, you're going to come in and you're going to be able to tell me that like, this is where I'm at. This is my day cycle. This is where I'm at in my menstrual cycle. So we can kind of pair things in or Nope, I haven't had a period for a year. So now I'm technically postmenopausal. So we need to know some of that we need to know your medical background. So we need to know your medical history, what medications you take you You know all of it, it's all super important because this is all prescription medication. Now from there, I will say that most women are going to they find that they do have a deficiency in something a lot of it is estrogen creams these days are doing bioidentical creams. Most women will have vaginal symptoms, they will have vaginal dryness, pain, decreased sensation, decreased lubrication, just everything. And so now they don't want to have sex either. And that's now going to put a huge stress on things in their own life and with their partners. So estrogen creams can be very commonly used there to help improve vaginal health. Testosterone is oftentimes low too. And sometimes that is also a cause of decreased libido, poor mood depression, kind of overall, crankiness almost. And testosterone for women can be done with creams with pellets. Pellets is a super common way to treat. And that is a like to call it a set it and forget it procedure. So with that, there's really little to no titration with it. And pellets are literally tiny, tiny, tiny little pellets, little pearls of medication. And what you do is it's an in office procedure, we bring you in, we inject a little bit of lidocaine for numbing in the upper part of your of your butt, your butt cheek pick aside, and then from there, we take a little tiny scalpel blade, we poke a little hole. From there, a sterile trocar gets introduced into that you don't feel anything but pressure at this point. And then we put those pellets into it. So those pellets are gone now going and they're living in your tissue in the butt cheek ultimately. And then it's just closed with a little steri strip, and you're going to get a steady release of that testosterone, or sometimes even a blend of other hormones to it's not just t. And that's just going to be a slow release. And a lot of women really like that, because they don't have to do any maintenance with it. They'll come in, you know, once every six months to a year for a little top off. But again, app before you do any dosage changes with any of these medications, you're always doing bloodwork and saliva testing to see where people's levels are at. Right?

Philip Pape: 47:11

That actually simplified. Pretty well, pretty nicely. What about what about DHEA? Is that a precursor to testosterone? Was there any benefit.

Kristin Gemme: 47:18

So that is a precursor. I mean, you can it's not one that I personally reach for that often. Usually, if people are coming to see me, they're like ready to do something a little bit more aggressive about it. But DHEA is always a potential thing that you can look at, you know, also sometimes looking at cortisol to cortisol is, that one's a little bit trickier to do testing on because it's not just a one time thing, and it's not a blood test, you do a blood test for cortisol, we can tell if you have a gross disorder of it, we can tell if you are non existent, you know, with with your cortisol or if it's wildly high, but what we want to see is your your daytime curve, so we need to have you do a test, kind of within the first hour of waking, and then we need to see it again towards the end of the day. And there is a cortisol curve that we try to follow with that. And if your cortisol is off, it's, it's a little bit of a thief. And it can actually steal hormones from other parts of your bodies, because hormones are kind of transfer. They're not just all separate molecules, they will borrow from each other and transform into each other. So if one is low, it may steal from somewhere else too. So that's why it's important to look at all of your hormones, because they will steal from each other. If you have one problem somewhere, there's a chance you might have another problem.

Philip Pape: 48:40

Yeah, I did have a question about adaptogens and nootropics. Why don't we start there? I mean, what what do you what are your thoughts on those like Ashwagandha or holy basil, etc. So

Kristin Gemme: 48:51

there, I can kind of take them or leave them. You know, I don't think there's any problem with them. Ashwagandha I find is really just kind of good for mood. So if you feel like your mood is just a little bit miffed, then it's good to do you know, you're it's, I'm not gonna say you're not going to hurt yourself with adaptogens and herbs because medications come from adaptogens herbs and plants. So but I mean, it's if it's something that you want to play with and try out to see how you like it first, by all means you absolutely can even with testosterone, some men, they're just like, Okay, I got my testing done. I know where I'm at. I'm not ready yet to take the jump into actual testosterone replacement. What else can I do? So those are the cases where first and foremost you gotta sleep. If you're not sleeping, your testosterone is going to be in the toilet. So really dialing in lifestyle, so you need to work out but not overdo things you need to eat right? You know, you need to hit all those lifestyle markers first. And then you can look at some supplementation. There's like Tangata Li. There's a couple of different supplements out there that are kind of pro hormones or precursors to some of these things. And it's all anecdotal. Some people find that they work really well. Other people are like, didn't do a darn thing. So, okay, yeah.

Philip Pape: 50:08

Yeah. And real quick, the Dutch test. What do you think about that?

Kristin Gemme: 50:12

Honestly, I don't use it mainly just because it's wildly expensive. Okay,

Philip Pape: 50:16

got it. So you talked about lifestyle. This is a good segue into talking about medical weight loss. Super hot topic right now controversial. Yep. They just FDA approved yet another one the Manjaro I think, yeah, that gave

Kristin Gemme: 50:29

me Manjaro. Yeah, exactly. So they're now saying you can use it just for weight loss, and they're gonna slap another fancy new name on it. Make more money? Yeah.

Philip Pape: 50:38

So we have ozempic. We have that we have GLP one agonists agonist is some magnetite. There's a lot of strong opinions all over the place. And my opinion is still forming, because it really depends, right? And context. And these are peptides as well. And then peptides as well. Okay. Because they signal that hormone, right? We're talking about the appetite hormone or the suppresses appetite.

Kristin Gemme: 51:01

ones are glucagon like peptide. Yeah, exactly. Fair point.

Philip Pape: 51:05

Yeah, fair point. So, so where does this fit into a holistic approach? Then let's talk

Kristin Gemme: 51:10

about that. So I personally have a lot of feelings about them. Do I offer them? Technically yes. Do I have some patients on them that I am helping lose weight and monitor and doing their thing? Yes. Do I tell more people know than I tell people? Yes. Also, yes. I think that these drugs in general are being I don't want to say abused but overused. They're being used by people as a quick fix or a crutch. I think that there's a lot of providers out there especially in the med spa and wellness fronts that are using them as a money grab. And I don't agree with that. Anybody that walks in that says I want to lose 10 pounds, as long as there's nothing wrong with their their health history are getting put on these compounded versions of you know, semaglutide or chews up the tide.

Philip Pape: 52:16

I've even seen bodybuilders using them like Yeah, crazy. Like just to get that last shredded, you know, yeah.

Kristin Gemme: 52:22

And so from a business standpoint, this is my warning to all of these, you know, businesses that are like building themselves on these medical weight loss just cranking out you know, buying vials and vials of semaglutide interest appetite from these compounding pharmacies, because right now you can get them from there. You don't have to get brandname ozempic Are we go V or Manjaro. The only reason that you can obtain these medications right now from a compounding pharmacy is because they are on the FDA shortlist. So they are on shortage because they are unsure rootage these compounding pharmacies are legally able to compound them and offer them. So that's why they're able to be bought a lot more affordably from clinics like myself, I do get it from compounding pharmacies, ones that I actually think are good quality, because you can buy semaglutide almost anywhere. And that's terrifying because this is this is an endocrine medication. So once the FDA takes these medications off of the shortage list, now, poof, you are no longer going to be able to obtain them from compounding pharmacies. And if you want to utilize them for a patient, you are going to be sending a prescription to the local CVS or Walgreens. And the patient's going to go there and pick it up. Does their insurance cover it? Unlikely. So they're going to be paying out of pocket and they're going to pay out of pocket more than what they're paying your clinic right now for it. So the run of these things is going to be short lived and because of that, I don't base my business off of a medication that is on a temporary list of availability. Yeah,

Philip Pape: 54:07

that's fair enough. Yeah. And I know I would really like to do a podcast episode on this because the more I hear about it, if there are aspects of this we have to be careful of like the ability to maintain results long term. Yes. You know what it does for some level of dependency when you're not quite fixing your lifestyle or even when you do what happens when you come off of it? Or can't get it? Yep, absolutely.

Kristin Gemme: 54:29

Yeah. So I mean you you have to titrate on to it so you're not just popping in and you know, cranking in a 2.4 milligram doses semaglutide On day one, you are going to be hospitalized and ill if you do that, so it's a titrate up and it should be a titrate down. Once somebody has lost the weight that they are looking to lose they are now in a healthy BMI they're in a healthy you know, body fat percentage they've they've achieved their goal. Now what we do is we start to slowly back them down off of that dose. And I do it slowly, so that we can see how they feel. Because odds are, they're going to gain some weight back on average, people gain about 25% of the weight loss back. So if you've only lost 10 pounds, let's look at that, you know, so this isn't for the person looking to lose 10 pounds, this is for big weight loss. This is for meaningful weight loss. This is for people with metabolic risk factors that maybe have high cholesterol are pre diabetic or diabetic, you know, have all of these risk factors. This is kind of like who I'm saving this medication for. You know, I have somebody on turns appetite, right now, does he need to lose a little weight? Yeah, he does need to lose weight, his triglycerides were through the roof, his cholesterol was awful. And he was already taking prescribed cholesterol medication to his appetite works on two different pathways. It's the GLP one, and it's a gf gap. So what that's going to do is it's also going to help with a Dipa lysis. And it's going to help break down some of those fatty acids. So I put him on that primarily for his metabolic health, and not just to shed weight to aesthetically look better, you know, it was truly to get these metabolic markers down. So there was a time and a place for them, they have to be used judiciously, they have to be titrated down, I think that it can be used as a lifestyle modification tool, because it is decreasing your gastric emptying when you eat a meal, now that meal is going to sit in your gut for at least seven hours before it transits through, you're not going to be able to eat as much, you're not going to be able to eat trash food, if you eat a high fatty meal or ton of sugar or something that's really truly not good for you, you're gonna pay for it, you're gonna feel terrible, you know, you're gonna get that negative feedback. So in that sense for people that don't necessarily have a great relationship with food, and overeat, or make really poor choices, and like aren't doing the right things, that can be a good tool to help get them through that. And to help break some of those habits, while they're losing weight. Kind of just help reinforce some of those habits, teach them how to eat correctly, teach them how to eat smaller portions, all of that can be really beneficial. But it also has to come without warning that you're you're likely going to gain some weight back. Some people, especially if they have all those metabolic risk factors already, they may need to stay on it long term, it D this very well needs to be a lifelong medication. When used for diabetics, type two diabetics, it's a, it's not a short fix for them, you know, they're not using it for six months and coming off. It's a long term medication. So I mean, have have some people had life changing results with weight loss. And now they don't have to worry about those risk factors of type two diabetes. They've come off of cholesterol medication, they're awful blood pressure meds, everything else in their life got good because of this medication. Yes, there are tons of stories of that. And it's great for that. But my problem is more so with the providers that are prescribing it really irresponsibly, the bad apples out there. Yeah, yeah, it's a complex money, money grab, you know, and it's not without risk, you know, these medications all have risks. The main, the big, big one here is pancreatitis, and pancreatitis can kill you. So you have to really, you know, weigh your your risk factors out here, you know, looking at the, the thyroid cancer, you know, that was only in mouse studies that wasn't shown in human studies at all. I'm way more concerned about somebody's risk of pancreatitis than I am about thyroid cancer when it comes to these meds. It's

Philip Pape: 58:44

a complicated topic, because I know that even the marketing says, you know, you, on average, lose X amount of weight. Yeah, in combination with how, you know, lifestyle, positive lifestyle. And of course, what immediately comes to mind. Whether I'm being judgmental or not, is why don't we try that Heil healthy lifestyle on its own and see if I can make the change. And I understand that people, some people are, you know, have an excessive unhealthy amount of weight that they need to deal with right now. And there's a lot of emotional and environmental factors involved. So yes, all right, let's, let's move on. Okay, go ahead.

Kristin Gemme: 59:13

This is one important thing that I think a lot of people don't also know. You're seeing the scale go down. Unless you're doing in body scans or some sort of body composition scanner, you're not seeing what I'm seeing. And what I'm seeing is that most of the weight loss is coming from muscle breakdown. It's not coming from that. So we are taking you and we are turning you into skinny fat. So most of I've actually seen people gain body fat percentage and decrease their muscle mass. So they're like

Philip Pape: 59:45

I'm losing weight. That is a great point. Loss Yeah, at what cost

Kristin Gemme: 59:50

and so a lot of my older women will come to see me and they want to lose weight, but they're like by I need to healthy muscle mass because I'm starting to get to that age where I need to worry about osteoporosis and falling and breaking a hip, I'm not putting them on that that's not appropriate for them, you know, we're gonna go more of the route of peptides, let's help you with your lean muscle mass. So that's something to take into consideration with these GLP one medications is you need to be really, really careful about muscle wasting, because you're not taking in enough calories to support your muscle and you're just breaking that down.

Philip Pape: 1:00:23

It's true. Because even we know even when you exceed something like 1% of your body weight a week, you're gonna start losing muscle mass. This is an extreme crash diet version of that, just like any other even if you did a normal crash diet, you would see this a similar result. Yeah, and I wonder if this medication even accelerated further, right. So yeah, for sure. I know, we only have a few minutes left. Do you have a hard stop? Can we go a little bit past?

Kristin Gemme: 1:00:46

I'm good until about 320 or so.

Philip Pape: 1:00:50

Okay. Okay. Just Just a couple more questions, because I want to tie it back to the very beginning with with how you got into this field of aesthetic treatments. And the psychological impact of that, I guess what I'm curious about is how do you work with clients to make sure it's appropriate for them and that there are not, you know, negative aspects of body image and history there. And I know you've talked about this before. So I want to understand the nuances there.

Kristin Gemme: 1:01:15

Absolutely. So Body Dysmorphia is real. And it's a huge thing. I actually had a conversation about this exact thing with a patient of mine, I think it was last week. And the way that I look at body dysmorphia, it's not you have it or you don't it is a spectrum. And I think that we all fall onto that spectrum of body dysmorphia, we all see ourselves a little bit different than how other people do, we may see something that bothers us every day that nobody else sees. When Body Dysmorphia becomes pathogenic or becomes a problem is when it's interfering with your daily life. And it becomes an obsessive thought, it's now interfering, you're now doing things irrationally, or doing things outside of your norm to deal with it. Let's say for example, you know, you have this, we're going to go super simple, you see a wrinkle that nobody else sees. And you see it when you squint an eye and you turn your head to 75 degrees, and you're looking at it from upside down with a light just in the right angle. And in this one particular mirror. I'm not kidding when I say that, I hear that, you know, that's not me being crazy saying that as an example. Those are things that people do. That is disordered thinking. And those are patients that you should not be treating, and that you should be referring to mental health services, because they need some help, or you need to take them under your wing, not treat them do other things that are just basic healthy skin care. And you need to be able to counsel them and talk about it and have a real conversation about it. This is a medical problem. It's nothing to dance around, you're not going to offend somebody, maybe you will. But you know why? It's for their benefit. It's a medical condition, it is diagnoseable it has an ICD 910 code for it. Like it's something that needs to be addressed. It's like seeing a medical problem with a patient and just not addressing it because it's uncomfortable to talk about. So you need to be aware of where everybody falls on that spectrum. With esthetics people are coming in because they want to feel better about themselves. They want to boost their their, you know, personal image of themselves. They want their outsides to match how they feel on the inside, or they have something that they've been insecure about for a while that they want to fix. And that's okay, you know, there's nothing wrong with that. It's like saying, you know, I have really weakened small muscles, or you know, my glutes are really small. I'm going to go to the gym, and I'm going to really work on building up my glutes. And I'm going to do that because I want it to look the way I want it to look. And I'm going to be healthy about it too. There's nothing disordered with that. And that is a normal, healthy thing. We all want to be our best versions of ourself. And that also falls into aesthetic medicine. But hearing the way people talk about themselves, are the only things coming out of their mouth negative, can they not give themselves a compliment? Something that I started implementing this year during my consultations is before we talk about what the problems are, tell me what you like about yourself. Tell me what you love about your face. What's your favorite facial feature or your favorite body feature? You need to be kind to yourself, and you need to recognize that we're not all perfect, and it's okay. So listening to red flags. I've seen six providers this year, and nobody's been able to make me happy, but I know you're going to be able to make me happy, not touching you with a 10 foot pole. That is such a huge red flag. It's unbelievable. So it's really just having conversations and that's why you need to talk to your patients. You need to really get to know them. You need to understand the drive and force behind why they're asking for these things, why they want to have procedures or interventions done. And you need to, you know, be educated about body dysmorphia to know, is this appropriate, if I start treating this person, am I actually adding fuel to the fire? You know, if some people you don't know, some people definitely have have duped every provider that does what I do has been duped, where somebody you know, keeps it together until you start treating, and now all of a sudden, they're becoming angry, they're becoming combative. You know, they're they're pointing fingers blaming you that you didn't give them what they want, but theirs did. And they will never see it for what it is they can't see it for themselves. They think they are just ugly, and are never fixed. So mental health is huge. It's absolutely huge. And if you're not addressing it in, you know, your aesthetic practice, you are doing such a disservice to your patients.

Philip Pape: 1:05:59

Yeah, I like how you ask your patients what they like about themselves, right? Because kind of leaning into their strengths and making sure it's, it's a filter for that. And then also understanding why someone wants to do something, like I just came out with a mini episode called, it's okay to want to look better and improve your physique. And it was around that whole theme of like, there are many reasons we do things. I don't envy how, how different, how much more difficult, it might be in your type of practice, like, you know, nutrition coaching, it's, it's, it's a little bit easier. But even there, you see people who the red flag is they just want to lose weight at all costs, for example, right, and there's a red flag there. Are there any misconceptions people have? I'm sure there are but like, what are some of the big misconceptions people have about medical esthetics? And how do you work to educate them on those? Sure. So

Kristin Gemme: 1:06:43

I mean, a lot of misconceptions, you know, come from people that just genuinely have no idea what we do. And all they do is they see examples of celebrities with bad plastic surgery, and they just think it's Botox. It's always lips, Botox is always just the go to our bad Botox, you know, and it's, there are people out there with bad work. Yeah, There absolutely are. You know, unfortunately, there's there's very little regulation when it comes to aesthetic medicine, if you have a medical license, you can, you can do it, you know, there is no governing body for anybody other than dermatologists and plastic surgeons. And even then there's, there's little standards with it. So there are plenty of places out there that Roque will give you botched work and you know, give our industry a bad name. And they don't have ethics and they're just going for money grab somebody comes in and says make it bigger, I want my lips bigger. And now they're you know, out to here and just look distorted. You know, there's always going to be somebody out there that will do the thing that you ask them to do. And it's unfortunate, but I mean, that's just about in every industry, you know, and ultimately I look at it, it's skincare, it's your skin, it's your biggest organ, and we're taking care of it. When I speak to patients about you know, the reality of aesthetic medicine, doing in office interventions with lasers or injectables is hands down the least important thing that we're going to be focusing on first and foremost, we're looking at your lifestyle, we're looking at your sun exposure, we're looking at your skincare products, you know, not using good quality skincare products to take care of your skin on a daily basis. But coming in for you know, one or two lasers a year or your Botox is like going to your dentist for a cleaning and then not brushing your teeth at all at home, you know, it's that same thing, we're taking care of skin. And when you have healthy skin, you have beautiful skin, you know, you don't need to be augmented and have cosmetic interventions, it can be more restorative and I like to look at it in those two, two realms here. You know, restorative medicine, we're restoring you back to the way things should be you have volume loss from from, you know, fat atrophy and your cheeks, we're replacing it, we're not augmenting you and making you look deranged. We're just restoring it. It's like restorative dentistry, you know, they're not giving you you know, crazy looking teeth, they're restoring it back to a natural looking form. Whereas more cosmetic medicine, we're taking somebody that there's nothing wrong with them, they're young, their volume is perfect, and they want something a little bit more dramatic, a little bit more augmented for just an aesthetic cosmetic outcome. So those are the kind of two ways that I look at it, but the best injectables truly should be undetectable. You know, nobody walking down the street that doesn't know you should be able to point out what you've had done. Okay,

Philip Pape: 1:09:36

and there are gender differences for a fact and I am clueless about all this stuff. I don't use any creams. I don't use product and I'm probably like 95% of men, I'm guessing what what are what are some what's some interesting differences and I'm sure you work with men, but like, what are your thoughts on the matter?

Kristin Gemme: 1:09:52

So first off, it's easier to get a man in the door to do Botox than it is to get them to put any sort of cream on their face at home. Hands down, stop washing your face with shampoo, I'm speaking to all of you stop doing it. So I mean, basically, if there's one thing that you're going to put on your skin, and I tell this to all of my women who are trying to get their men to start taking better care of their skin is you need to wear sunscreen. I mean, you just do you need to wear sunscreen as the most important thing that you can do to help prevent poor aging and help improve skin health and also fight skin cancer. So the basics of wear sunscreen, you know, you don't need this crazy 12 Step skincare regimen to take good care of your skin. If we're giving you daily antioxidant protection, taking all those free radicals that you're exposed to, you know from from blue light, from pollution, from the sun from intrinsic factors inside of your body, all of it, you need to be fighting those with antioxidants, vitamin C's are really good one to utilize with that. We can even use topical peptides to help with that to helping support collagen. Collagen is what gives us our nice firm skin. It's what makes it elastic. That's why kids skin is so bouncy and tight and looks good. And as we get older, we get kind of saggy and thin and wrinkled. You know, that's from loss of collagen and elastin. So for using some peptides or growth factors to help stimulate that help keep your skin looking youthful, wear sunscreen to protect you from the sun. I mean, we're done there. And a lot of these skincare companies have really gotten smarter when it comes to men's skincare. Knowing that we'll be lucky if we can get you to put one thing on, they have made combination products to where you can grab one bottle, and it is your skin treatment. It is your skinny antioxidants, and it is your eight hour long sunscreen. My favorite one that's come out comes from a company called police. It was developed by a What was she she's a chemical engineer, either Harvard or MIT, I'm screwing that up. And basically, it's a sunscreen mineral based sunscreen that you put on your skin once a day stays on for eight hours, so you don't have to reapply. And it also contains anti aging elements and antioxidants to help take care of your skin. So I'm really pushing that for men to make it easy, it's not going to make you shiny, it's not going to make you you look literally and shimmery. It's going to make you look good. You know, it's going to make your skin look healthy. And really at the end of the day, for me, it all comes down to skin health, we want your skin to be healthy, like the rest of you.

Philip Pape: 1:12:28

I mean, even just the sunscreen alone is definitely important if you're concerned about skin cancer and things like that, but I these are some great tips that I didn't think we'd get to talking about, you know, skincare advice for men, but it's awesome. For so I'm gonna look up that previous myself, I take high dose vitamin C, but not really any of the other stuff, though. Yes, I used to I just use the touch up feature in zoom. And that does it. All right. So I like to ask this of all guests, Christina. And that is what questions did you wish I had asked? And what is your answer?

Kristin Gemme: 1:12:59

Oh, boy. What did I wish you asked to? One? I think you've asked really great questions. I think that we've really covered everything well, I don't have anything else burning inside of me that I didn't get to get out here. You know, I mean, I guess really my main takeaway point for listeners, especially in the wellness front is get your blood drawn, like don't stop being scared of what your bloodwork is going to show and get it done. The best thing that you can have is knowledge and to know where you're at. And if you get bloodwork done, bare bones minimum once a year, if you can get it done every six months, you are so ahead of the curve. And we can really identify early issues with you. You know, just recently I had a patient come in, she was interested in starting peptide therapy, and we pulled her bloodwork, I'm looking at things that your primary care is not I'm looking at fasting insulin, I'm looking at C peptide, those levels on her were triple what they should have been. So we may have identified an insulinoma in her which is a tumor that secretes insulin. And if she had just gone to her primary care for her basic yearly screenings, they would have looked at her a one C which was totally fine and been like, Oh, you're good to go. Your metabolic health looks great. While lying underneath is a potential huge problem. So we look at things that your primary care will not and does not. Because insurances either not going to cover it or they just don't have the time to look at it.

Philip Pape: 1:14:35

There you go. So if you're listening, get the blood work and the saliva test if that's indicated. Talk to Kristen, you can we're gonna I'm gonna ask her now where people can reach you but reach out to her even if you're not in Connecticut. I'm sure she can help you even with a discussion online and actually, why don't you let us know where people can find you and then for people who are remote versus people local to the area,

Kristin Gemme: 1:14:58

so you can find me first foremost ethos medical esthetics in Avon, Connecticut, we're located at 51 East Main Street. From here ethos, ethos, medical esthetics.com. From there, you can look at my full list of services. And there's even a book online function. So if you want to book a consultation or any services, you can do it right from there. On Instagram, most you're going to find me is injector Kristin, k, r i s t i n Scandanavian. I n on that one. So you'll find me on there everything is also over at ethos aesthetics, that's the best way to find me is truly on Instagram or make an appointment, I do have some virtual options as well. However, if you are interested in testosterone replacement, or hormone replacement therapy, those are controlled substances. I need to physically see you in the office once you need to come in and sit in my chair and face me and have a conversation so that we can do our examination. One time and after that, if you're a candidate for treatment, we can do everything virtual, we can do virtual follow ups, all of that medications can be sent right to your door. Depending on states, I don't have it right off the top of my head, some states, I cannot practice telemedicine and you can't have certain things shipped to. But for the most part, we cover most of the country. So peptide therapy, you know, ordering bloodwork, all of that we can do remotely. So there's a lot that we can do

Philip Pape: 1:16:22

there. That is great to know actually that distinction. You can find Kristen at ethos, and Avon, I'm gonna include all the information in the show notes, if those medical esthetics.com at injector, Kristen at ecosystemic. I know it's a lot. I'll have it in the show notes. And then also the podcast, which is going to start up again for another season. And just a pinch podcast. So go follow that. And what was a was one more thing I was gonna say. And I can't remember what it was. But it's been awesome. Oh, I know what it was. For folks listening. I definitely vouch for Kristen. I mean, I met her through another man a very high standards and ethics and Andrew and that's how we find people we trust. And again, Kristen mentioned this, this industry is rife with charlatans. And so you've got to be careful and find good people. And Kristen is one of them. So Kristen, thank you so much.

Kristin Gemme: 1:17:05

It was an open book and is more than happy to talk to anybody about his experience with both testosterone and peptide therapy, everything that we've been doing. I mean, if you go on to the Instagram, you'll see he's written out like how it changed his body, his body composition, his blood, work, all of that. So if you have any questions, you can also seek him out. He'd be more than happy to give anybody a personal testimonial for how his experiences been awesome.

Philip Pape: 1:17:31

And I'm declaring right now that I'm going to set something up with you and talk to you about it. And then hopefully I'll be able to talk about on the show of depending on what happens from there. So absolutely,

Kristin Gemme: 1:17:40

knowledge is power. You just got to know where you stand. All right.

Philip Pape: 1:17:43

Thanks so much for coming on.

Kristin Gemme: 1:17:44

Thanks so much.

Philip Pape: 1:17:47

Thank you for tuning in to another episode of Wits & Weights. If you found value in today's episode, and know someone else who's looking to level up their Wits & Weights, please take a moment to share this episode with them. And make sure to hit the Follow button in your podcast platform right now to catch the next episode. Until then, stay strong.